# 4060
If you base your expectations on the latest media punditry and opinions du jour, you probably believe the H1N1 pandemic of 2009 is on the wane, and that `the worst is behind us.’.
In fact, that was the headline of Canada’s National Post yesterday.
Worst Of Flu Pandemic Behind Us, Experts Say
Shot Still Urged
Tom Blackwell, National Post Published: Saturday, November 21, 2009
At times in recent weeks, the number of suspected flu patients showing up at the B.C. Children's Hospital's emergency department soared to 50 or 60 a day above usual, prompting it to set up a separate influenza clinic.
In the last several days, however, the arrivals have fallen off so much that the special area was officially closed down on Wednesday.
Perhaps. And I hope its true.
But this is just November. Influenza is notoriously unpredictable, and short term trends don’t always tell us what next month or next spring may have in store for us.
But it does appear that we are seeing a bit of a welcome lull in new infections, at least in some parts of the US and Canada.
Whether that trend will last . . . well, stay tuned.
While the H1N1 virus has been a challenge – particularly for emergency departments and hospital ICUs – we’ve been lucky so far with this pandemic.
As we’ve discussed for months, Swine Flu has thus far been a high morbidity – low mortality event. Lots of illness, but relatively few deaths.
Not as few deaths as are being counted and reported, perhaps. But relatively few compared to previous pandemics.
The true impact of this pandemic will never be accurately tallied, of course (see When No Number Is Right), but we should have some decent estimates several years from now. Until then, `official’ death counts need to be viewed as merely the `tip of the iceberg.’
We’ll let the always-terrific Maggie Fox, Health and Science Editor for Reuters, pick up the story from here.
Follow the link to read the story in its entirety. Maggie reports on the Tamiflu resistant strains and Norwegian mutation story towards the end of this piece.
Swine flu may have hit one peak; more to come
Sun Nov 22, 2009 5:51am EST
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - The pandemic of swine flu may be hitting a peak in the Northern Hemisphere, global health officials said on Friday, but they cautioned it was far from over.
Officials also said they were investigating several troubling outbreaks of drug-resistant H1N1 but noted they were limited so far and that there were no indications yet the virus was mutating in a sustained way.
The World Health Organization said H1N1 flu was moving eastward across Europe and Asia after appearing to peak in parts of Western Europe and the United States.
At least 6,770 deaths have been recorded worldwide since the swine flu virus emerged in April -- but officials always stress the confirmed count represents only a fraction of the actual cases, as most patients never get tested.
There are "early signs of a peak in disease activity in some areas of the northern hemisphere," the WHO said in a statement.
With the Holiday traveling and shopping seasons ahead, colder weather in store, and mass gatherings such as the Olympic Games in Canada, Carnival in Rio, the Super bowl, and Asia’s yearly mass migration around the time of the Chinese New Year, there are ample opportunities for twists and turns in this story.
Flu season normally runs from November through April in the northern hemisphere.
We’ve another 5 months to go.
Plus, this virus has shown a propensity to circulate out-of-season, as well. And there is always the possibility the virus could mutate and return at a later date with a vengeance.
We’ve yet to hear from the seasonal strains (H1N1, H3N2, and B) this year. Are they temporarily brushed aside, or have they been completely supplanted by novel H1N1?
No one knows the answer to that one yet, either.
The daily barrage of predictions make for interesting filler for newspaper articles, but anyone who thinks they know how this flu season turns out is simply guessing.
Lest we forget, the 1957 pandemic produced 3 distinct waves over a 5 year period of time.
This graph comes from NEJM (The Signature Features of Influenza Pandemics ) and demonstrates just how variable pandemics can be.
No doubt, when November and December rolled around in 1958 and flu levels were normal, most scientists thought the pandemic was over.
It literally skipped the 1958-59 flu season before returning in 1960. It then went quiescent again until the 1962-63 flu season, when it flared back up again.
While it would be nice to believe the worst is behind us, the truth is, we won’t know if that’s true until this pandemic has been over for some time.
