# 3320
Six week and nearly 300 essays ago - when the Swine Flu story was just hitting the news wires - I put together a primer on pandemics for first-time visitors to Flublogia (our little corner of the Internet that specializes in influenza) .
Today, with the declaration of a pandemic apparently imminent, I’ve updated that piece to include some of the information we’ve learned about the H1N1 swine flu virus over the past 6 weeks, and am running it again.
The HHS rates Pandemics like Hurricanes. Category 1-5
The 1918 Spanish Flu was a CAT 5 Pandemic.
While my regular readers are no doubt familiar with the basics of pandemics, it is probably a good time for a review.
Don’t worry, I’ll be gentle.
First, you need to know that scientists have been expecting another pandemic (global spread of a novel virus) to come around for years.
Influenza viruses, you see, are notorious for being unstable.
They mutate constantly, which is why we need a new flu shot every year. The changes from year to year are often minor, but even a tiny antigenic shift or drift in the virus can render your last flu shot useless.
Every once in awhile, we see a major change in an influenza virus. It can jump species to humans (as we believed happened in 1918), or it can acquire genetic material (reassortment) from another flu virus and create a new hybrid.
Fig. Birds, humans, and Pigs are all susceptible to Influenza
In either event, you can end up with a new (novel) virus to which humans have little or no immunity.
If the virus is also easily transmissible, and it produces illness in humans, you have the ingredients for a pandemic.
The term `pandemic’ describes the geographic spread of a novel virus, not the severity.
Roughly every 30 to 40 years for at least the past 3 centuries the world has seen an influenza pandemic. Usually these pandemics are mild or moderate, but on rare occasions they can be horrific.
The last true pandemic was in 1968, and the culprit was the H3N2 Hong Kong Flu.
As pandemics go, it was pretty mild. It probably only killed a million people or so, and perhaps 30,000 in the US.
Before that, you only had to go back 11 years, to 1957 and the H2N2 Asian Flu. A more lethal pandemic than 1968, the Asian Flu killed between 2 and 4 million people worldwide, and nearly 70,000 Americans.
The Granddaddy of flu pandemics occurred in 1918, and that was the H1N1 Spanish flu. Somewhere between 50 and 75 million people are estimated to have died over an 18 month period. The United States saw about 675,000 deaths from this flu.
We’ve also had `close calls’, such as the Swine Flu Scare of 1976, the Liverpool Flu of 1951, and the pseudo-pandemic of 1947.
In 1977, the H1N1 virus returned after an absence of 20 years, possibly due to an accidental release from a laboratory in the former Soviet Union.
It is also likely that we’ve been close to a pandemic other times, and simply were oblivious to the fact.
For the past 10 years we’ve been watching the H5N1 `Bird Flu Virus’ as it has moved out of Central China, to the Middle East, Indonesia, and parts of Europe.
The H5N1 virus has `pandemic potential’, but luckily hasn’t acquired the ability to spread from person to person easily.
You should know that despite the fact that the press has lost interest in it, the Bird Flu threat has not gone away, and the emergence of the H1N1 swine flu pandemic does not eliminate H5N1 as a threat.
The novel H1N1 `swine’ flu virus that has unexpectedly thrust us towards a pandemic is a distant relative of the seasonal H1N1 virus that has been in circulation – off and on – since at least 1918.
It has picked up genetic material from hosts (pigs) over the years (including some avian genes), that makes it unique enough that most humans have little or no immunity to it.
The good news (at least so far) is that this virus doesn’t appear to have the virulence (severity) that some pandemic strains have demonstrated in the past.
None of this is to suggest that this virus is benign. It isn’t. It is fully capable of producing serious, even fatal, illness in some small percentage of its victims.
For now, the WHO is calling this virus `moderate’ – not mild.
Early studies have suggested that it may be roughly equivalent to the 1957 `Asian Flu’ in virulence, but it is probably too soon to say with any certainty.
And the virulence of any influenza virus can change over time. The flu that we see this summer, or even this fall, may not be the same flu we see next winter or the following year.
And something else you should know; a pandemic is not a short-term event, like a hurricane or a flood. They can last for months – even a year or longer.
This is something we are likely to be dealing with in 2010 as well.
In late April, in response to the emergence of the novel H1N1 virus, the WHO began raising the pandemic alert level – from Phase 3 – where it has sat for several years, to Phase 4 and then to Phase 5.
It is anticipated that the WHO will declare a Level 6 Pandemic Phase later today. If that happens, it is simply official recognition of what has been going on for several weeks; the global spread of this novel virus.
We don’t know right now how seriously this pandemic will affect our society, our healthcare delivery system, and our economy. The impact could range from minor to severe – and since the virus could mutate, the effects could change over time.
It is unlikely that the vast majority of Americans will see a vaccine before 2010, meaning most of us will have to go through this winter without the protection of a H1N1 flu shot.
Certain high risk individuals, either due to their profession or due to falling into a medical high risk group, may see a vaccine late in the fall.
The HHS wants you, and your business, and your community to take this pandemic threat seriously. And that means being proactive, and taking steps now to prepare for this pandemic.
If you have not done so, go to Ready.gov. Get A Kit, Make A Plan, and Be Informed.
You should also visit pandemicflu.gov, and read and follow the advice provided on their Plan and Prepare page.
A pandemic may bring societal disruptions, such as prolonged school closures in the fall. You need to be figuring out now how you will handle it if your child is forced to stay home for weeks at a time.
You may also find that your regular employment is affected by a pandemic. There may be supply chain interruptions, personnel shortages, and possibly even some public health ordinances that interfere with your ability to work – at least temporarily.
And of course, during a pandemic there is a strong likelihood that you could contract the virus. For most people, this will simply mean spending a miserable week or two at home. The vast majority of people will recover without incident.
But some people, particularly those at higher risk, may experience serious, even life threatening illness.
You need to be prepared to care for yourself, and your loved ones, in your home. Dr. Grattan Woodson's Home Treatment of Influenza is as good a reference for the treatment of influenza as you are likely to find, and it’s free.
Hospitals and clinics are likely to be overrun with flu cases during a pandemic wave, and medical care will probably be difficult to obtain – even in developed countries.
Lastly, you need to be thinking about how you can help your neighborhood, and greater community, get through a crisis.
It can be something as simple as volunteering to be a `flu buddy’ for a neighbor or friend – being willing to fetch medicines, food, or render medical assistance in the event that they are unable to help themselves.
If you are able, you might consider volunteering with the Red Cross or, CERT, or the Medical Reserve Corps. There will also probably be opportunities to help with your local school, church, or hospital.
The important thing is that we react – not overreact – to this crisis.
If we retreat into our homes, refuse to work, or are afraid to help our neighbors and community we will only compound the effects of a pandemic.
And we risk putting a stake through the heart of an already staggering economy.
The pandemic of 2009 will make the third pandemic in my lifetime. It probably won’t be my last.
As Michael Leavitt, former Secretary of the HHS liked to say, “Pandemics happen.”
Now it’s our task to deal with it.
