# 4640
One year ago today the World Health Organization raised the pandemic alert phase to 6, the highest level on their scale.
While flu activity today remains low in the United States and most of Europe, there are signs that novel H1N1 may be on the rise again in some parts of the world.
Lisa Schnirring, writing for CIDRAP, penned this report last night:
Three countries report growing flu activity
Lisa Schnirring
Staff Writer
Jun 10, 2010 (CIDRAP News) – Some parts of India and Colombia are reporting increases in pandemic flu activity, along with some deaths, while New Zealand, which is beginning its regular flu season, is reporting a rise in flu-like illnesses, particularly in young children.
Yesterday India's health ministry said nine pandemic H1N1 flu fatalities have been reported so far in June, one from Karnataka state and four each from Maharashtra state and the city of Kerala, Indo-Asian News Service (IANS) reported. An official told the news service that the ministry saw a rise in pandemic flu cases following monsoon activity in the area at the end of May.
Whether this is simply the sputtering embers of a declining pandemic, or signs of another viral offensive, is impossible to tell. Influenza viruses – particularly pandemic influenzas – are notoriously unpredictable.
And novel H1N1 is no exception.
Over the past year this virus has deviated from the `pandemic script’ in dozens of surprising ways, never quite doing what scientists expected.
It sprang from the wrong strain (H1N1) and the wrong animal host (swine, not avian), it caused surprisingly severe symptoms in a very small subset of victims, and peaked in the fall and then failed to mount a third wave.
At almost every point, when we expected it to zig, it zagged.
Along the way, we’ve learned a good deal we didn’t know about influenza viruses, our ability (or lack, thereof) to deal with them, and the ways the public and the press react to an emerging disease threat.
Lessons that are only valuable if we take them to heart.
Although one could write volumes about the things we should take from this experience (and people, no doubt, are) – in the interest of brevity I’ve picked just a couple to highlight in today’s blog.
1. Pandemic H1N1, like most emerging infectious diseases, was a zoonotic pathogen.
It originated (like all influenzas) in a non-human species, and in this case, bounced around in swine for a decade before it picked up the right combination of genetic changes to allow it to jump to humans.
Although scientists were aware of its existence, few considered another H1N1 to be a pandemic threat, and surveillance and monitoring of swine herds for changes in the virus was limited at best.
In many parts of the world, no surveillance of farmed animals is done.
Even after the pandemic broke out, despite urging from the USDA to upgrade surveillance, swine herd owners in the US were avoiding the testing of their herds for the novel H1N1 (or any other swine flu virus), out of fears that another discovery might further depress pork sales (see Swine Flu: Don’t Test, Don’t Tell).
Fear over H1N1 detection brings down swine disease samples
Sep 25, 2009
DVM NEWSMAGAZINENational Report -- The U.S. Department of Agriculture (USDA), concerned about a perceived drop in swine disease samples from pork producers, is urging veterinarians to continue monitoring herds for a variety of diseases, including the H1N1 influenza virus.
Over the past three decades we’ve seen – on average – one new emerging zoonotic disease a year. HIV, Lyme, SARS, Strep suis, Q-Fever, Hendra, Nipah, Hantavirus, Chikungunya, H5N1 . . . . the list is long and likely to grow.
And farms, as we’ve seen, can breed more than just animals.
By placing thousands of animals in close proximity to one another (CAFOs), by shipping animals all over the country, shooting them full of non-therapeutic antibiotics, and by not following stringent biosecurity procedures, farms can breed new and deadlier classes of pathogens as well.
Maryn McKenna’s book Superbug: The Fatal Menace of MRSA goes into some depth into the problems of antibiotic use on farms, and Michael Greger’s video Flu Factories is an often damning indictment of factory farming practices.
Veterinary surveillance of wild and farmed animals remains under funded and under utilized around the world. History tells us that the next great global health crisis will likely spring from a non-human host.
While there are researchers out there looking for the next AIDS virus (see Nathan Wolfe: Virus Hunter), and organizations like the OIE and FAO are trying to combat animal diseases, it is a big planet and more resources are needed if they are to have any success in identifying – and hopefully preventing – the next pandemic.
2. All Flu Deaths Aren’t Created Equal
While it may be considered a bit `insensitive’, most people accept that the death of a child, or a young adult, is far more tragic and far more costly to society than the death of someone in the last years of their natural life.
During a normal flu year, the median age of death for a flu-related fatality in the United States is 76 years of age.
While all unnecessary deaths are regrettable, this is awfully close the average life expectancy in this country. Influenza usually takes the weakest, and frailest members of society.
And in a normal flu year, that means that 90% of all flu fatalities occur in those over the age of 60.
Most are over the age of 80.
When someone who is in their 80’s dies, they’ve lost but a few years off their life. But when a child or young adult dies, they’ve lost decades of productive life.
Much has been made of the lower fatality count from pandemic H1N1. In the United States, the number of deaths has been less than half of what is normally seen during an average flu year.
To some, this indicates that pandemic H1N1 was a bust.
But, the mean age of death from the novel H1N1 virus has been calculated to be half that of seasonal flu, or 37.4 years.
In terms of years of life lost (YLL), the average 2009 pandemic flu death has a many fold greater impact than the average seasonal flu fatality.
When you look at the number of years of life lost already from pandemic H1N1, the impact on society equals or exceeds the pandemic of 1968 and may eventually match 1957.
By Cecile Viboud, Mark Miller, Don Olson, Michael Osterholm et al (5 authors)
For more on this subject, you may wish to revisit my blog The Measure Of A Pan.
* * * * * * *
Where this pandemic virus goes from here is anyone’s guess, although most scientists expect it to eventually settle into being the dominate seasonal flu strain over the next few years.
The virus may shift antigenically enough to begin to seriously impact the elderly – who have been largely spared to date. If so, next winter could see higher fatalities than this past flu season.
The H1N1 virus could develop new virulence factors, or become resistant to Tamiflu. Constantly evolving, influenza viruses are a moving target, and difficult to pin down.
The only sure thing is that a year into this pandemic, we find our text books on influenza need to be rewritten. Things we thought we knew about pandemic flu must now be adjusted in light of newly collected evidence.
If we are smart, we’ll take the lessons of this pandemic to heart, and use them to begin working seriously to mitigate (or hopefully even prevent) the next pandemic.
My fear is that we will simply minimize this pandemic, marginalize those who worked to combat it, and move on with our lives pretending that pandemic preparedness is a fools errand.
That’s been our history. Once a crisis passes, we quickly forget about the danger, and move on to other diversions.
Until next time, that is.
And nature has a nasty habit of serving up `next times’.
