# 3172
It’s a serious question.
Today we are getting another `cautionary’ report from Reuters regarding statements from the WHO that the A/H1N1 virus could `still mutate’, and spark a pandemic.
But even if the virus doesn’t mutate, we could be in for a rough flu season this fall.
First the article, then a little discussion.
Tuesday May 12, 2009
New virus could still mutate, spark pandemic – WHO
By Stephanie Nebehay
GENEVA (Reuters) - The new H1N1 flu virus could still mutate into a more virulent form and spark an influenza pandemic that could be expected to circle the globe up to three times, the World Health Organisation said on Tuesday.
The impact of any pandemic would vary, as a virus that causes only mild illness in countries with strong health systems can become "devastating" in those with weak health systems, shortages of drugs and poorly equipped hospitals, it said.
<snip>
But influenza viruses mutate frequently and unpredictably and "the emergence of an inherently more virulent virus during the course of a pandemic can never be ruled out," the WHO said.
CIRCLING THE GLOBE IN WAVES
"The overall severity of a pandemic is further influenced by the tendency of pandemics to encircle the globe in at least two, sometimes three, waves," the WHO said.
Yesterday the big news was that the A/H1N1 virus, as it exists right now, is believed to have about the same pathogenicity as the 1957 virus. In other words, it produces roughly the same level of illness and fatalities.
These assumptions are based on very scant preliminary data, and must be used with caution. It is, however, the best information we have on this virus right now.
Ask again tomorrow, and these assumptions may have changed.
Anyway . . . .
Estimates vary, but the 1957 H2N2 pandemic (which produced excess mortality for about 5 years), is generally blamed for between 2 million and 4 million deaths worldwide.
If you adjust for today’s increased population, a similar pandemic could kill between 6 and 10 million people.
And that is without having to have a mutation that increases its virulence.
In a normal influenza year, more than 200,000 Americans are hospitalized due to the flu, and estimates put the number of `flu-related’ deaths at over 36,000.
While most of the victims are elderly, and many succumb to pneumonia, we also see about 100 pediatric deaths each year as well.
And each winter, this increase in illness puts enormous stress on our healthcare system.
Hospitals are frequently filled to capacity, elective procedures get canceled, and sometimes emergency rooms are forced to divert ambulances to other facilities.
Seasonal influenza is not a trivial illness.
According to a recent study a normal influenza season in the United States costs the US economy almost $90bn a year :
Annual medical costs are in excess of $10bn, and the disease accounts for more than 40 000 deaths a year, as well as 31.4 million outpatient visits involving 10.6 million patients and 3.1 million days in hospital, says the report, published online in Vaccine (doi: 10.1016/j.vaccine.2007.03.046).
Since we have a novel virus, one that could pick up virulence over the summer, it makes sense to remind the public that `mild today doesn’t necessarily mean mild in the fall’.
But even if the virus gains no virulence, and remains as it is right now, it could still produce a very nasty flu season.
Novel viruses are new strains that most of the public has little or no immunity to, and therefore the number of people who get sick is much higher than from a seasonal flu strain.
Instead of 10% of the population catching the flu, as we see in a normal year, we would expect to see 20% or even 30%.
So even if the hospitalization and death rates run the same as seasonal flu, we could easily see a doubling or tripling of the number of deaths and hospitalizations.
With little or no surge capacity in our hospitals, a doubling of those needing hospitalization would be a disaster for the health care delivery system in this country.
And a failure of the hospital system to cope could end up costing even more lives. And not just from influenza.
Ambulances and emergency rooms deluged with flu cases would have difficulty responding to other emergency cases. Hospitals may have to turn away patients due to a lack of staffed beds.
Additionally, health care workers are not immune to a novel virus, and so staffing at some facilities may be compromised due to flu-related absenteeism.
And of course, all of this assumes that the virus remains no more pathogenic than `seasonal flu’.
Right now, we don’t know what the next flu season will bring.
This novel H1N1 virus may fizzle out completely, mutate itself into a less pathogenic strain, or simply become a 4th component to the seasonal flu mix.
But history tells us that when a novel virus appears in the spring, it often returns (sometimes stronger) in the Fall. And so health officials are appropriately concerned.
So what is the answer to: How Bad Does A Pandemic Have To Be?
Not all that bad to still have a major impact.
None of this should induce panic in the public, of course.
But it should make everyone take notice, and take prudent steps over this summer to prepare for what could be a rough flu season.
While it has been stressed here (and elsewhere) ad nauseum, washing your hands (or using alcohol gel) frequently, covering your coughs and sneezes, and STAYING HOME if you are ill are all important components to staying healthy and preventing the spread of the virus.
But there is more to do over the next few months.
If you own a business, you need to be planning on how to deal with employee absenteeism, social distancing, and other flu-related issues.
If you are an individual, you need to be planning on how you will cope if schools are closed and your children are home, or if you are ill and unable to take care of yourself or your children.
Good advice on personal and business planning for a pandemic, even a mild one, can be found at www.pandemicflu.gov.
For more information on how to prepare for emergencies, up to and including a pandemic, the following sites should be of assistance.
FEMA http://www.fema.gov/index.shtm
READY.GOV http://www.ready.gov/
AMERICAN RED CROSS http://www.redcross.org/
For Pandemic Preparedness Information:
For more in-depth emergency preparedness information I can think of no better resource than GetPandemicReady.Org.
