The Swine Flu Pandemic of 2009: Much Ado About Nothing?
The Swine Flu Pandemic of 2009: Much Ado About Nothing?
By on May 6, 2009The Swine Flu Pandemic of 2009: Much Ado About Nothing?
A quick perusal of the media coverage of the swine flu outbreak of 2009 would lead many to conclude that this outbreak has the potential to rival or surpass the 1918 flu pandemicwidely regarded as the worst influenza outbreak in history. While the emergence of a new H1N1 swine flu variant is significant note worthy and has possible public health implications the unrelenting, often scientifically-inaccurate media coverage did little to quell the fear and anxiety of many Americans. Once again, the mediarather than physicians, public health officials and influenza expertsgot out in front of the story and managed to create enough panic, fear and anxiety, the likes of which haven't been seen since the 2003 SARS pandemic. It wasn't until last Friday, when the Wall Street Journal published an interview with Dr. Peter Palesea leading scientific expert on influenza A infections did a clearer picture emerge about the severity and public health implications of the current swine flu pandemic.
According to Dr. Palese, there are several reasons why people and public health officials ought to be optimistic about the current pandemic:
In 1976 there was a an outbreak of an H1N1 swine virus in Fort Dix, New Jersey, which showed human to human transmission but did not go on to become a highly virulent pandemic strain
The presently circulating swine virus is most likely not more virulent than the other seasonal strains we have experienced over the last several years
The current swine virus lacks an important molecular signature (the protein PB1-F2) which was present in the 1918 virus and in the highly lethal H5N1 chicken viruses. If this virulence marker is necessary for an influenza virus to become highly pathogenic in humans or in chickens, then the current swine virus doesnt have what it takes to become a major killer
Since people have been exposed to H1N1 viruses over many decades, we likely have some cross-reactive immunity against the swine H1N1 virus. While it may not be sufficient to prevent becoming ill, it may very well dampen the impact of the virus on mortality. I would postulate that by virtue of this herd immunity even a 1918-like H1N1 virus could never have the horrific effect it had in the past. The most likely outcome is that the current swine virus will become another (fourth) strain of regular seasonal influenza.
The landscape of vaccines and anti-influenza drugs has dramatically improved over what it was just a few years ago. Based on what we know of the structure and sequence of the swine virus, these FDA-approved drugs and FDA-licensed vaccines (modified to include the swine strain) would be highly effective against this new virus. Also, present technologies as well as manufacturing capacities will allow us to make sufficient quantities of a swine virus vaccine for the winter 2009-10 influenza season in the US.
In other words, there is reason for concern but no need to panic beyond typical public health precautions that are taken during normal influenza outbreaks.
Vincent Racaniello, who writes the Virology Blog reported that as of Monday there have been laboratory confirmed cases of H1N1 infections in 30 US states with a total of 226 cases and one death in Texas. Globally, 20 countries had reported 985 cases of infection. The highest numbers are in Mexico, with 590 cases and 25 deaths. While there have been 26 deaths to date, the severity of the infection appears to be waning and person-to-person transmission appears to be low.
Unfortunately, there has been some fallout from the news medias oft times over the top coverage of the pandemic. Many US hospital emergency rooms (most notably in Texas and California) have been overwhelmed and overburdened by visits from people who think they may have swine flu. Also, while some schools and daycare center closures were warranted, others may not have been. Finally, and perhaps most important, it is becoming increasingly apparent that the lay public's understanding of infectious agents and the outbreaks that they cause is grossly deficient and must be improved.
We live in a world where viral pandemics, food poisoning outbreaks and infections caused by multiple-antibiotic resistant bacteria are becoming commonplace. While vaccines, antivirals and antibiotics can afford some protection against many viral and bacterial disease, the best way to fight infectious diseases is to understand what causes them, how they are spread and what public health measures can be implemented to prevent or control their transmission. Until the world becomes better educated about infectious diseases, we will continue to be overly-dependent on the news media during future outbreaks and epidemics.