Tune in to any media channel and you will be bombarded by news of a new and deadly influenza virus. When this started about a week ago, I was underwhelmed. I’m less underwhelmed now as I do believe this is something newsworthy, I’m just not alarmed or frightened as I know what flu truly is.
The flu to most Americans is something that keeps them out of work or school for a few days. They get the sniffles, a cough, chest congestion and they call it the flu. That’s not the flu. That’s most likely a cold caused by one of several viruses. I’ve had colds, I usually get one each year, although this year it’s been about two or three times. I blame my air travel.
I’ve never had the flu. I have had terrible colds, but not the flu. A lot of people who call their colds flu also have never had the flu. People who have had the flu know the difference. They feel downright awful. One day they are fine, the next day they suddenly have body aches, headache, weakness, cough, sore throat, and fever. That’s the flu. If you are lucky, you will feel much better in seven days or so although the cough may linger for another couple weeks. If you are not so lucky, you may develop one of many complications such as pneumonia (caused by the flu virus itself or a bacteria such as Streptococcus pneumoniae or Staphylococcus aureus including MRSA) or death.
Who tends to be unlucky with the flu? Old people (> 64yo), babies/infants, people who are immunosuppressed for whatever reason (taking steroids, HIV, cancer), diabetics, renal failure/dialysis, or pregnant women in the 2nd and 3rd trimester, just for example.
But my point is that the flu has always had the potential to be deadly if it gets the “right” person. Worldwide, 250,000 – 500,000 people die from the flu every year. That’s a lot of people! It’s akin to the malaria issue which kills about a million people worldwide every year but which in countries at most risk people treat it like a minor nuisance.
In the US, about 50,000 people die from the flu every year. That’s not a small number either.
So what about this swine flu business.
First, some basic science. There are 3 types of influenza virus. Type A (humans, other mammals including swine, birds), type B (humans only), and type C (humans only). The outer membrane of a flu virus contains two glycoproteins – hemagglutinin (H) and neuraminidase (N) which are used in naming the strain of flu. As viruses multiply, mutations occur in the H and in the N causing new strains (antigenic drift). These are usually minor changes that keep flu alive year after year. But once in a while the mutations are so large that they actually change the entire H or N glycoprotein (antigenic shift) and these new strains can really cause problems as presumably no human would have been exposed so the entire human population is at risk (no prior immunity, partial or otherwise) and that can lead to a pandemic.
The 1918 influenza pandemic that killed about 50 million people worldwide (the last serious pandemic in the past century) was also caused by a swine flu virus transferring its H to a human flu virus. It was also H1N1. It also started in the spring rather than normal flu season (although in the tropics, flu season is year-round). It also targeted young and middle age adults rather than those on either end of the age spectrum. The 1918 H1N1 whimpered along during the spring and summer but when fall and eventually winter came, the virus reared it’s head with a vengeance.
That’s what the fear is. Right now we know H1N1 is here. It may have been here all winter for all we know. Mexico unfortunately is bearing the brunt, but that doesn’t necessarily mean it’s their fault. A week or two ago, I would only have been concerned for someone walking into my hospital with the swine flu if they had told me they had been to particular areas in Mexico or had been in direct contact with an ill person who had been in said area. But as I said, the virus is already here. We are all at risk as we would have been with any other flu virus.
So now, when someone walks into the hospital with an acute respiratory illness, I need to determine if it is the flu (versus a cold, or seasonal allergies, or pneumonia) and if it is the flu is it the regular flu that has been here all winter and should be peetering out, or is it this swine/H1N1 flu that is beginning to rear its head. Hence, the heightened awareness all around.
Right now, the H1N1 influenza appears not to be as virulent as the 1918 flu. But who knows whether it will surge during the regular flu season later this year or whether small mutations (antigenic drifts) might make it more virulent in a few months. Those are the the real questions. That’s my concern because the potential for damage then would be much greater.
So I’m not writing out a will just yet. Now if it was the avian flu (H5N1) which we already know to be very virulent that had managed to make the jump from birds to human (it has) AND spread effectively from human to human (not quite yet), then I might start putting my house in order with the Lord. That’s a whole another story.
Until then the best thing I, and you, can do to prevent spread of the flu is to WASH HANDS! That cannot be overstated. In addition to washing my hands like a person with OCD (obsessive-compulsive disorder),
- I will try to limit the times my hands drift towards my eyes, nose, and mouth aka entry portals for viruses. That’s much easier said then done.
- I’m going to try and stay in good health by getting my sleep, exercising, trying not to get stressed (I said trying not to get stressed), drinking plenty of water/fuids and eating nutritious foods.
- I will not unnecessarily touch public surfaces, such as doorknobs, if I can help it. I do think Purell and other hand sanitizers are often overused by the general public but if there’s ever a time to use them, now is it. I wouldn’t be surprised if there are none on the shelves anymore.
- I will try not to get too close to people with obvious respiratory symptoms but that’s a tall order for an infectious diseases fellow. Please, I’ll be front line. The ER will be calling me to examine people they haven’t even gone in to examine! So I guess, I should amend that to say I will wear my respiratory mask when I go in to see such patients and check over and over again that it is on properly.
Even with that, I could get influenza (the regular seasonal one or the new H1N1 one), especially since people are contagious in the 24 hours before they start to show symptoms. If that happens, I will do the world a favour and stay home until I’m better! If I’m really really sick, of course I’m going to have to go to the hospital, but I could still do the world a favour by not taking the bus, the train or other public transportation there breathing onto everyone else. That would be stupid.
Until then, happy increased awareness everyone! Bacteria and viruses are so much smarter than us humans, that’s true, but at least now as compared to 1918 we are also a tad smarter and have better testing methods, and anti-viral medications which we know so far work for this particular virus!
Leave a Reply