Catching up on the swine H1N1 situation -- the Big Picture
Scott McPherson
in Politics and government, influenza and infectious diseases
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1 Comment
OK, we have had a couple of days in which to charge our batteries, refresh and reflect on the events of the past ten days on swine flu, or H1N1, or PC FLU fluffy bunny slippers, or whatever you want to call it.
Here's the quick catchup, and where we will probably go from here:
The situation in Mexico appears to be abating. Fewer cases and much lower mortality.
Cases in the United States and elsewhere are increasing. This is technically true, but the reality is that cases are being confirmed that were first swabbed over a week ago. So it would be natural and not surprising that the number of cases would increase. These cases are days to a week old by now.
The real issue is this: Just how deep is this "widespread" flu epidemic?
Flu can best be described using the visual of that old classic shampoo commercial. You know: "And they tell two friends, and so on and so on..." as the screen continues to show little squares of faces, Brady Bunch-style. This increase of shampoo-happy faces carries on in the mind of the viewer.
So it is with influenza. To paraphrase the commercial: "You'll infect two friends, and they'll infect two friends, and so on and so on..."
The problem is, we are unsure if we are seeing that "and so on" infection from swine H1N1. We are seeing human-to-human, maybe even human-to-human-to-human. But are we seeing the type of sustained community infection patterns that would signify the true start of a pandemic? And are we seeing this on other continents?
So this is clearly a widespread infection. But how deep is it? How well can the virus sustain its ability to infect? Early indications are maybe not so well, but sustained testing -- and eliminating that testing backlog accurately but quickly -- will answer that question.
Even if we are not seeing sustained community outbreaks, we are not out of the woods by a long shot. And it is not just if this disease decides to take a victory lap around the world. I would remind everyone of the prime theory of the late Dr. R. Edgar Hope-Simpson; namely, that a pandemic candidate needs to seed the planet with asymptomatic cases prior to the seminal event that triggers a true pandemic.
With the Internet, rapid testing and other 21st century capabilities (including bloggers, of course!), something that would have never even been a blip on the radar -- not even in 1968 -- can be detected in a reasonable timeframe and dealt with before it is Too Late.
Despite these advances, it is surprising and alarming to listen to certain people in the media talk in one moment about "this response was SO overblown" then alternately asking "Why did it take so long for the Mexican government and the WHO to respond?"
One genetic change in the 1918 virus made it a killer of tens of millions of people. ONE CHANGE. That is why organizations and agencies are moving in the ways they are moving. And what a marvelous opportunity to go to school on this event; to test plans to see what works, what is workable and what clearly is not; and what to tweak and what to abandon.
We don't get these opportunities very often, and we should take advantage of them whenever possible.
Back to the woods: We're clearly not out of them yet. The virus has moved to some nations in the Southern Hemisphere, which is having its regularly-scheduled influenza season now. This means that swine H1N1 will have multiple opportunities to recombine with its seasonal counterpart H1N1, and also reassort with a multitude of oither flus, including seasonal H3N2 -- and H5N1. So vigilance must be exercised and the course of this situation will be measured not in news cycles. It will be measured in weeks or months.
Remember, this virus will do one of two things: It will either burn itself out, or it will go pandemic. And even if it appears to burn out, it could come back in the fall. That is one reason why public health authorities are making the decisions they are making.
So settle in, and don't get wrapped around the axle of expecting this to resolve itself on a 24-hour news cycle. Because we are weeks away from knowing the real scope and more importantly, the depth of this new virus.
We ain't gonna know anytime soon.
Reader Comments (1)
Well stated post. I agree completely that regardless of what happens, this is an excellent opportunity to test out preparedness procedures and learn how a virus develops and spreads in its early stages.
I also agree that it is too early to tell if there is an "...and so on..." and that evidence in cases outside of Mexico do not convey convincing evidence of sustained transferability at this time.
Vigilance is the correct action. However, overreaction can be counter-productive. I still don't see Phase 5 being justified, let alone the rumors that they want to rush to move to Phase 6. I do not see such action as prudence in the public eye - in fact I worry about a backlash against the kind of monitoring and vigilance that will be needed in the future if it appears the WHO is "crying wolf", even if they are only prematurely jumping the gun.
Some of the reports of certain school systems closing without even any confirmed cases in their districts are a bad sign of over-reaction as well, and here is why - if you close a school too early and for many days in a row based on little supporting reason, what are you going to do if the virus does emerge and spread in your area soon after you reopen? Now you probably just have to close again for legitimate reasons...and how much of those children's education has been sacrificied or delayed beyond what was truly necessary? Not to mention the impact on parent's schedules (and faculty as well). Imprudent overreaction acerbates the negative economic impact that comes along with an outbreak.