I hadn’t really thought about swine flu since I (along with 40% of my classmates according to unofficial University Health Services estimates) was stricken with it during Harvard commencement last year. I remember hearing that the strain of the virus wasn’t nearly as bad as had been feared and most people ended up like my roommates and I – coughing, sleeping and drinking orange juice for a few days before making a full recovery.
Two things brought it back to my attention recently:
1) I’m reading The Great Influenza, an excellent book by John Barry published in 2004 about the 1918 so-called “Spanish Influenza.” It turns out that the strain of the flu in 1918 was also H1N1. So what does that mean? Influenza viruses are defined by their protuberances: hemagglutinin (the part of the virus that binds to the cell the virus takes over) and neuraminidase (the part that allows the virus to distribute from the cell once it has taken over) – H and N. The type of hemagglutinin and the type of neuraminidase are classified by numbers; both of these shift and change to make H3N2 (Hong Kong Flu), H5N1 (bird flu) and the many different types of flus that require a different shot every year. However, even though last year’s swine flu was in the same category as the 1918 flu, it was obviously a very different strain. Even within the 1918 flu itself, there was an original, much milder form of the virus that preceded the devastating one that killed between 50 and 100 million people. My point? Flu is a crazy, crazy virus, and I think I finally understand the paranoia of last year – as happened in 1918, the virus could very easily have shifted to something more deadly that retained the highly contagious qualities of our commencement swine flu. Another point: I highly recommend The Great Influenza – especially pgs 98-106 in which Barry explains the mechanism of infection and change of the flu virus.
2) This article in The Wall Street Journal last week: http://online.wsj.com/article/SB10001424052748703435104575421591518817872.html The WHO just declared the Swine Flu Pandemic over – I thought it had been over for a long time! Apparently the mere classification of last year’s incidence of H1N1 as a pandemic has been a major point of contention – WHO officials admitted that it would be helpful to have different vocabulary to describe the types of disease so that a relatively manageable issue like last year’s H1N1 would not fall into the same category of pandemic as a disease like HIV/AIDS. Given that H1N1 killed only 18,449 people last year, it is difficult to believe it needs to be given such a special classification when a normal seasonal influenza would often kill more than that and countless diseases around the world are comparable killers. Each of the top 10 most deadly infectious diseases kills >50,000 people annually. I believe the extra attention swine flu got was due in part to its concentration in the developed world and in part due to the fear that the disease would become a more deadly strain.
Both The Great Influenza and the case of last year’s swine flu are making me realize one of the great challenges of public health – striking a balance between ensuring all precautions are taken and keeping public fear to a minimum. In the 1918 flu, officials fell firmly on the side of doing too little, too late, while last year, officials quite possibly did too much.
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