# 3403
It’s now been just over two months since the H1N1 virus first leapt into the headlines, and nearly 380 blogs later, I’m the first to admit that I don’t know where this H1N1 pandemic is going to lead us.
So far, this virus seems to be relatively `mild’ for the vast majority of people. But, for an unlucky small percentage of cases, it produces severe – sometimes, even fatal – illness.
Which is pretty much what you see with seasonal flu.
Except . . . with this flu, the age groups hardest hit are much younger than we normally see with influenza. A lot younger.
For weeks people have been trying to figure out if this flu is more, or less deadly than seasonal flu. I’m not sure we know the answer to that question yet.
I know that if you take the estimated number of cases around the country – or around the world – and divide it by the known number of deaths, you come up with a `comfortingly’ low CFR (Case Fatality Ratio).
And I am comforted by this number.
But I’m not convinced we have a good handle on either the number of infected or the number of deaths, and so I take these calculations with a very large grain of salt.
I think we would have noticed by now if this virus had a particularly high mortality rate, although there are some worrisome reports coming out of places like Manitoba and Argentina.
For now, it appears that that this virus has roughly the same virulence as seasonal flu, albeit with a disturbing predilection for younger victims.
That could change over time, of course, and may vary right now between different populations and societies.
So . . .assuming that this virus isn’t any deadlier than seasonal flu, why do we care?
First, we care because this is a novel virus, one that most humans have no immunity to, and that means that over the next year or two, a lot of people are going to catch it.
During a pandemic, 2 to 3 times more people are infected each year than normal. And so, even with a low mortality rate, the number of people that could die can double or even triple over that of a normal flu season.
That would also mean double or triple the number of people needing hospital care, and much higher rates of absenteeism from work and school.
With this virus hitting younger adults and children disproportionately hard, it will also have a greater psychological effect than we see with seasonal flu, which primarily kills the elderly.
All of these things can have a serious impact on our society, our economy, and our ability to deliver essential services. Particularly health care.
Since the last pandemic, 42 years ago, we’ve reduced the surge capacity of our hospital systems considerably, in order to streamline them and save money.
We’ve neither the beds, or the staff, to care for hundreds of thousands of additional flu patients each year.
To make matters worse, HCWs (Health Care Workers) are likely to suffer a high rate of infection and absenteeism, further degrading the system’s ability to cope with a surge of patients.
We may also find ourselves facing shortages of ventilators during the peak of the flu season, and having to make tough choices about who gets one, and who doesn’t.
And all that assumes this virus doesn’t pick up virulence.
Which brings us to our second big concern.
Influenza viruses are inherently unstable. They change over time. Sometimes they become milder, sometimes they pick up virulence, or resistance to antivirals.
Which is why we need to reformulate our flu vaccines every year or so, because influenza is always a moving target.
Over the past year, the seasonal H1N1 virus (a distant cousin of the pandemic H1N1), has become almost 100% resistant to oseltamivir (Tamiflu). There are serious concerns that this pandemic virus could, over time, acquire the same resistance.
That would seriously compromise our ability to treat people with severe influenza symptoms, and would probably drive the fatality rate higher.
And, as we saw in 1918, and to a lesser extent in other pandemics, the first wave can be deceptively mild. As this virus replicates in more and more hosts, the odds of producing a dangerous mutation (or a reassortment with another virus) goes up.
It is impossible to predict what `Swine Flu version 2.0’ will look like, or when it might be released. It might actually be less virulent than what we see today.
But it could also be much worse.
Even if we ignore the possibility of something worse coming down the pike next month, or next fall, or in 2010 . . . the pandemic we have right now will no doubt serve up plenty of grief.
And so it is prudent that we take this pandemic seriously. That we take reasonable steps to prepare our families, our businesses, and our communities to deal with it.
Even if it appears `mild’ or `moderate’ right now.
To learn how, visit the HHS’s pandemic website www.pandemicflu.gov.
There has never been a better time to volunteer to help with the American Red Cross, The Medical Reserve Corps, CERT, or your Neighborhood watch.
And if your pocketbook can stand it, there are organizations like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, and others that could use your financial support as well.
If, for most of us, this pandemic turns out to be a non-event, we can thank our lucky stars. But as we do, we need to remember that not everyone will be that fortunate.
There will be families all over the world impacted by this, with many enduring terrible losses. Regardless of the overall statistics, for them, this won’t be a `mild’ pandemic.
There will likely be economic, political, and probably even international diplomatic fallout from this pandemic, as well.
As I stated at the top of this essay, I don’t know where this pandemic will lead us.
But I do expect it to be a bumpy ride.
