Why The Swine Flu Is A Big Deal

We tend to hear so many warnings from government and the media that there is a tendency towards skepticism among many people. In some cases this turns into outright denialism, such as with the number of conservatives who outright deny the scientific consensus on climate change. While comments here are hardly representative of the population at large, noting two different comments to the previous post (from different parts of the political spectrum) questioning the attention paid to swine flu I have decided to briefly explain why this story really is a big deal.

One commenter writes, “I remember the bird flu and the outbreaks of normal flu before and after, too. At certain times of the year, people get the flu. Is this really news anymore?” The potential of a pandemic is far more significant than a normal influenza outbreak. Infectious disease and pubic health experts have been concerned for years about the dangers of an influenza pandemic comparable to the 1918 pandemic which cost a tremendous number of lives worldwide. The current swine flu outbreak may or may not turn into a pandemic, but there is reasonable concern for the potential of this happening. The World Health Organization ranks the risk of pandemic on a scale of one to six, with six being a full-scale pandemic. Currently the swine flu outbreak is rated at four, but it looks like the WHO is getting close to moving this up to a five.

During a normal seasonal influenza outbreak there’s a tremendous number of people who are immunized against the expected influenza strains for that year. Even those who have not received the influenza vaccine are partially protected by herd immunity. Having less people in the community who are susceptible to the infection makes it harder to spread, reducing the risk for those who have not been vaccinated. In contrast to normal influenza outbreaks, we do not have large numbers of people immunized against the swine flu. (I have seen some speculation that those who have received influenza vaccines on a regular basis have received immunizations against a large number of influenza strains and might have some partial immunity, but we certainly cannot count on this).

One feature of this infection might also make it potentially more serious than other influenza epidemics. Many of the more serious cases have occurred among young adults, as opposed to among the higher risk individuals who often suffer the most in influenza outbreaks. There is speculation that the more serious consequences of this strain come not from the initial infection but from the response of one’s immune system. Paradoxically this might make young healthy people with strong immune systems the ones at greatest risk.

Another consequence of influenza is the development of secondary bacterial infections when people are weakened by the flu. Overuse of antibiotics has increased the risk of the selection of bacterial strains which are resistant to conventional antibiotics.

Our patterns of travel make it more difficult to control a potential pandemic. The ideal way to contain an epidemic is to identify the outbreak in its first location and contain it there. It is far too late for that. The amount of air traffic from Mexico and around the world has spread the virus around the world, with confirmed cases in seven countries, with this number expected to rise quickly. As of 11:00 a.m. today the Center for Disease Control reports ninety-one laboratory confirmed cases in the United States. These are in ten states (Arizona, California, Indiana, Kansas, Massachusetts, Michigan, Nevada, New York, Ohio, and Texas). The largest number of cases are in New York City (51). The first death has been reported in Texas.

There might be some tendency to see an increase to only ninety-one confirmed cases as trivial, but we have no idea how much this will increase. The incubation period is two to seven days, meaning that there can still be many people who will turn out to have the disease from contact which occurred even before news broke of this infection last Friday. The bigger question is how much it will spread in different communities.

At this point we do not know how severe an illness we will be seeing. Initial reports out of Mexico suggested that the virus might be more deadly than it now appears to be. Even when there were reports of over one hundred deaths it was difficult to interpret this as we had no accurate count of overall cases. It now appears that these reports were exaggerated, with the WHO officially reporting only seven deaths in Mexico.

The considerable amount of media attention might actually be helpful in reducing the risk of pandemic. Simple precautions such as washing hands (including use of products such as Purell when hand washing is not practical) can greatly reduce spread. Knowledge of the existence of the virus could increase the chances that those infected do remain at home and avoid contact with others. Besides taking prudent action to avoid infection, it would also be advisable to be prepared with supplies such as food in one’s home should there be a serious outbreak in one’s community. The more people avoid public places in case of such an outbreak, the more likely it will remain limited.

At this point we do not know how serious a problem there will be. It is important not to panic, but also not to write this off as a meaningless scare should this not turn out to be a serious problem this year. The same concerns which cause infections disease specialists to be concerned about the risk of a pandemic exist, and we can still face such problems in the future. It also must be kept in mind that we are at the end of the usual influenza season and we might stop seeing this strain as we stop seeing other types of flu this time of year. It remains possible that the swine flu will return during next year’s influenza season, but that would leave plenty of time to develop vaccinations.

Be Sociable, Share!

13 Comments

  1. 1
    Eclectic Radical says:

    I have a very hard time agreeing with either the piece or the arguments about flu immunization. Influenza is a mutating virus, which means that immunizations are of very limited use against the majority of strains… flu shots normally only help with one or two strains.

    Secondly, despite the popular claim otherwise, flu shots carry a small but significant risk of contracting the flu as a more acute case than normal contraction. The very people who are now being told to get flu shots (kids and seniors) are the very people who were told not to get flu shots a few years back. While I know there are more shots good against more strains now, I am not aware of the breakthrough that makes the assertive statement ‘you will not get the flu from a flu shot’ more than mostly true. It’s true you probably won’t get the flu from a flu shot, but if you do it will be a more acute case.

    Finally, the lack of exposure to the virus makes it difficult for the human immune system to adapt to the mutations. It is very possible that many of these dangerous outbreaks are directly linked to the lowered natural resistance level of immunized populations to mutated strains against which they think they have been immunized. Our sanitized civilized world has been absolutely wonderful for the natural selection of viruses, and mutations and evolution are happening every day.

    Every few years there is some ‘nightmare’ flu outbreak. I am not saying that we should not take disease seriously, which is one of the many reasons I am strongly in favor of national health care, but it is very important we not buy into the panic mentality of many in media and government during these periods.

  2. 2
    Ron Chusid says:

    Eclectic,

    Your comment is seriously in error. Influenza is a mutating virus, but the influenza vaccine is changed annually to account for this and is highly effective for the strains present every year. That is why the vaccine is given annually.

    The risk of getting the flu from the vaccine is very small. The perception that you can get the flu from the vaccine is greatly exaggerated due to people attributing problems which have nothing to do with influenza with the vaccines. Studies have shown that as many people who receive placebos believe they received the flu from the injection as those who received the actual vaccine.

    Those rare cases in which people do get the flu from the vaccine are much more mild compared to the actual infection, still making the vaccine worthwhile.

    The most dangerous outbreaks of flu occurred before we had vaccines so it makes no sense to attribute them to vaccinations.

    Influenza causes about 40,000 deaths per year. These are often preventable deaths which occur because of people failing to receive the vaccine–often due to believing misinformation such as in your comment.

  3. 3
    Fritz says:

    From what I remember, the annual flu vaccine is effective against the 3 or 4 strains it is designed to protect against.  The problem is that, because of the long production time, scientists have to predict in early spring what strains will be dominant in the next winter.  Sometimes they are right.  Sometimes not.

    There are research efforts to create a shorter development cycle.

  4. 4
    Ron Chusid says:

    They’ve been quite close the last several years, but a shorter development cycle would help improve this further. Fortunately the times in recent years when there has been concerned over a strain not included in vaccine for the year the outbreak of the strain not included didn’t turn out as bad as feared.

    The swine flu could be considered a case of them missing a strain as we would be in a better position if somehow it had been predicted and included in the 2008 vaccine, or at least in the planned 2009 vaccine. It sounds like it might already be too late to include it in the 2009 vaccine and we might wind up having to give separate injections for the swine flu this fall.

  5. 5
    Eclectic Radical says:

    “The risk of getting the flu from the vaccine is very small. The perception that you can get the flu from the vaccine is greatly exaggerated due to people attributing problems which have nothing to do with influenza with the vaccines. Studies have shown that as many people who receive placebos believe they received the flu from the injection as those who received the actual vaccine.”

    I am aware of the studies and I have never been totally convinced. I am aware that the odds of getting the flu from the flu shot is relatively small, but I am not convinced by claims it is more mild. The only person I know who died of the flu died after getting the vaccination, which has colored my perceptions ever since. I am aware of the death statistics, but when one considers the death rate compared to total population, the odds of dying of the flu are not significantly higher than the odds of getting the flu from the shot. That isn’t enough of a difference for me.

    One of the biggest reasons flu shots are being pushed so hard in recent years is economic… employers don’t like lost work hours. I can certainly understand that, but I think people need to make their own decisions irrespective of their bosses’ bottom lines.

    It is also worth noting that if the psychological stigma of flu shots is severe enough that many people suffer difficulties from placebos and the shots alike, then the value of the shot can be questioned. If there is a good chance I will mentally make myself sick because of my preconceptions, which are not necessarily easily banished (I am too innately skeptical), then it might not be worth the cost of the shot.

    I am extremely skeptical of the rapid reversal of medical opinion on flu shots with the lack of available information about the medical advances that have allegedly made them safer than they were before. Were doctors simply wrong before, are they wrong now, or has the vaccine been improved that much? And why wasn’t I informed between flu seasons?

  6. 6
    Ron Chusid says:

    “If there is a good chance I will mentally make myself sick because of my preconceptions, which are not necessarily easily banished (I am too innately skeptical), then it might not be worth the cost of the shot.”

    It is not necessarily that people make themselves mentally sick. They just happen to attribute every ailment they have after receiving the flu shot to the shot. They have the problems regardless of whether they have the shot. Plus none of these problems have the morbidity or mortality of influenza.

    There has not been a rapid reversal of medical opinion on flu shots. The primary changes have been to increase the strength of the recommendations for administering them due to years of proven safety and efficacy.

  7. 7
    Eclectic Radical says:

    There has been a reversal in that they used to strongly suggest children under twelve or thirteen and adults over 60 not get them and now they suggest the same groups do get them, as strongly. That’s a pretty serious change of opinion.

  8. 8
    Ron Chusid says:

    That is incorrect.  There has been no such reversal. Until recently the recommendations were to vaccinate children ages 6 months to 5 years. They extended this to all children under 19 (but there was never a recommendation not to vaccinate children 5-19, just that they weren’t in the priority group). The recommendation has also been to vaccinate everyone over 50, as well as high risk adults younger than this, for many years. (Previously this had been 65 with later lowering of this recommendation to 50). Many ID people agree that near universal vaccination would be best and we are gradually heading in that direction.

  9. 9
    Ron Chusid says:

    Incidentally, the annual recommendations for influenza vaccine have also included “Any person who wishes to reduce his/her risk of acquiring influenza infection” for many years.  

    The safety and efficacy of the vaccine for all age groups (over six months) has been agreed to for quite a while. The only question has been which groups are most strongly advised to have the vaccine, and there has been a steady expansion of such groups.

  10. 10
    DrJaz says:

    The extension of immunization recommendations to all under 19 is because research in Scandanavia showed that the best way to “protect” senior citizens from influenza, and consequent bacterial superinfections and death and morbidity was to immunize all school-aged children. 

    It is a fact that unimmunized school children are killing their grandparents from normal flu. The jury is still out on whether there is substantial immunity to the current swine flu from annual flu shots. I had a case of “real” flu about 20 years ago, three days of serious dog-sick fever chills muscle aches, followed by fiv e days of real sick hurting aches, pains mental clouding and cough. I have gotten flu immunizations since and have avoided that particular scenario.

    As a health care worker I now regard it as a duty to my patients to get myself immunized – like school children here and in Scandanavia. If you have a senior in the home, I would suggest the same, as well as an immunization for them – but theirs is not as effective as yours or your kids are. That’s my story and I’m stickin toit.

  11. 11
    Ron Chusid says:

    As I’m sure you won’t be at all surprised by, the same argument for universal immunization of children to reduce transmission to grandparents is also made in the US. Of course immunization is also recommended for health care workers and senior citizens.

    Your experience of twenty years ago is also why it makes sense for everyone, not only those in the high risk groups, to receive immunizations–with recommendations in the US including “Any person who wishes to reduce his/her risk of acquiring influenza infection.”

    Other for the very rare real contraindications (as opposed to the larger number of people who refuse flu shots because they came down with a Rhinovirus or diarrhea at any point after receiving an influenza vaccine and attribute it to the vaccine) there are very few people who shouldn’t receive the vaccine.

  12. 12
    Zach says:

    Normal Flu: 250,000–500,000 ..deaths annually
    Swine Flu: 10,074 ..deaths annually

    If i get the flu i hope its Swine Flu.

  13. 13
    Ron Chusid says:

    The point is to try to stop the spread of both. H1N1 has turned out to be far less deadly than initially feared but there is still a growing number of young otherwise healthy people who are dying from H1N1.

3 Trackbacks

Leave a comment