# 3244
The question I keep getting – from friends, family, and sometimes from strangers via email – is, why should we be concerned over this `mild’ H1N1 virus?
Admittedly, my level of concern with this virus isn’t anywhere near what it would be if this were the H5N1 virus, or some other – more virulent- pathogen.
But that doesn’t mean I’m ready to dismiss Swine flu as a non-event.
Here’s why.
Roughly a month after the H1N1 Swine Flu first gained the world’s attention, cases continue to escalate here in North America and around the world.
No one knows the actual number of infected, but the CDC acknowledges that the `real number’ in the US is probably at least 20 times higher than the `official number’.
A week from now, that number will probably have doubled again. The numbers being reported no longer represent reality.
This H1N1 virus, luckily, appears to produce `relatively mild’ illness in most victims.
Yet, a disturbing percentage of younger victims – higher than we normally see with seasonal influenza – are sick enough to be hospitalized.
Some with serious, even life threatening, symptoms.
So this virus, while not the fearsome killer that the H5N1 virus has proven itself to be, isn’t exactly benign. Particularly for children, and young adults.
Swine flu, like all influenzas, can kill you.
Even in its present `mild’ incarnation, we don’t know how big of an impact this virus will have around the world over the next few months, or even years.
Hundreds have already been hospitalized here in the United States, and while nearly all survive, they owe that good outcome to modern medical care, antibiotics, antivirals, and in some cases ventilators.
Advantages that simply won’t be available in many developing countries around the globe. A virus that might kill 1 in 1000 in a developed country could kill 1 in 50 (or more) in an undeveloped region.
Unknown, also, is how big of burden this virus will place on our own healthcare system next fall and winter.
During `heavy’ flu seasons in years past we’ve seen doctor’s offices, emergency rooms, ICUs, and hospital wards overflowed with patients.
This is not a trivial concern, as it impacts not only the ability of flu patients to receive care, it can interfere with other medical needs as well.
The wait to be seen by your doctor, or in the emergency room, or even to have elective surgery could certainly be adversely affected next fall.
We have very little surge capacity built into our medical system, far less than we did during the 1968 or 1957 pandemics. It simply isn’t cost efficient, we are told, to maintain (and pay for) resources that are only needed in an emergency.
Which is true up and until an emergency arises.
Since most people appear to have little or no immunity to this virus, there is a high likelihood that a greater percentage of the population will fall ill next winter with influenza.
HCWs (Health Care Workers) are likely to be particularly hard hit until an effective vaccine is made available, which could further degrade the ability of hospitals to deliver care.
Instead of 7% to 10% of the population sickened, as we see in a normal flu year, we could see 20% fall ill . . .or more.
Right there, that could double the impact of a `normal’ influenza year, even if the virus remains mild.
But of course, we don’t know if this virus will remain mild.
Viruses mutate constantly. Most of these mutations are insignificant, or are evolutionary dead ends, but every once in awhile a virus hits the jackpot and picks up virulence while retaining transmissibility.
Whether that happens with this virus is unknown. But it is a possibility.
The virus may also lose its sensitivity to oseltamivir (Tamiflu) over time, which could in turn increase its impact, even in developed countries.
A flu virus may also pick up temporary, localized virulence.
The virus that people see in Fresno or Chicago could produce a different severity of illness compared to the virus seen in London, or Shanghai.
Scientists will be watching the southern hemisphere, which is just now entering their flu season, to see how this virus evolves and impacts their societies. A bad flu season there could be a harbinger of things to come next fall north of the equator.
But viruses know not from clocks or calendars.
If a serious flu season fails to emerge in Australia, New Zealand, or South Africa over the next couple of months, that doesn’t mean we are in the clear for next fall.
The H1N1 virus will do, whatever it is going to do, on its own timetable and it its own way. It doesn’t care how we describe it, or what pandemic alert level we declare.
Which is why public health officials are concerned, and warn us not to turn our backs to this virus.
No one should be panicked over this virus.
But we all should respect its potential, and be preparing to deal with it.
