The flu pandemic: the last time and the next time

We are now almost through the period considered to be the traditional flu season (to the end of March in the temperate northern hemisphere) and so far the amount of documented influenza infection is at a relatively low normal level and pneumonia and influenza deaths are about usual for this time of year. Said another way, there so far has been no big "third wave" of pandemic swine flu. Most flu experts didn't know what would happen but if they had to bet, probably would have bet on a resurgence. I suppose it could still happen, since the original transmission in the community occurred "out of season" (April to June of last year). But now the odds look to be against it. So what lesson do we draw from this? I hope it's not the wrong one:

Alberta's health minister is now calling for a review of the process.

"Specifically I asked the Health Quality Council if they would look into the issues of preparedness and response to the H1N1 epidemic and anything else they thing is important to be reviewed," said Health Minister Gene Zwozdesky.

Alberta Health Services CEO Dr. Stephen Duckett now admits he might have done things differently.

"It's easy in hindsight to say, 'well if I had more -- the same information now, I wouldn't have done it in the same way, but you've gotta look at what we knew at the time." (Canadian TV)

Examining response is a good idea. But the idea that because this one didn't turn out horribly -- if in fact that turns out to be the case -- next time we should not take it as seriously as we took this one, is terribly wrong headed. Our understanding of the dynamics of influenza is still primitive. A notoriously unpredictable disease is just that: notoriously unpredictable. Past experience is some guide but far from infallible. That's why we may have gotten the third wave wrong this time. There was a third wave in the otherwise similar 1957 pandemic.

That was based on hindsight, too. And it wasn't 20-20.

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One thing we in the west can learn about flu is that people in the east wearing face masks when they have symptoms of flu do it to prevent infecting others - rather than the the misconstrued view that people wear masks to avoid contracting flu - is a good idea.
Another is that economics has a large role to play - people who cannot afford not to work go to work, spreading flu even when they know they have it.
So yes by all means look back with what you now know but do it with open eyes, open mind and a view of all the factors... it's when rather than if it happens again.

As you know, I'm from Canada and yes, I've seen that. I hope Duckett doesn't act on these thoughts for the next pandemic. The pandemic response in Canada was already very disorganized and the "low mortality" led to major gains for the anti-vaccine movement. If the PHAC decides to tone down it's vaccination campaign, this is going to get even worse. Marc thinks the same.

Btw Revere, you know the ads that SB displays on the right of the screen? Just before the "Top Five Most Active"? One of the adds is called "Death by Medicine" and here's where it links to:

Null and the others are a bunch of fake doctors selling dangerous CAM treatments. Orac has talked about Null before in his posts if I remember well. Can you and Orac ask the SB ppl to remove this add? It's dangerous.

I am thinking that in this global village that with such frequent travel and high population densities, not to mention generally healthier people, that herd immunity can develop pretty quickly, perhaps before the virus has a chance to change and become too effective.

In 1918 you had the big war where most of Europe was in desperate conditions and immune systems suppressed, and in the large numbers of young US men were kept in barracks in large numbers and poverty was entrenched in the inner cities with their large immigrant population. Population densities were lower and international or long domestic trips were not as common.

In 1957 you had China suffering through Maos rule, and poverty was the rule in Asia relative to todays good times, and the inner city poverty in the US was much worse, today this is alleviated to some degree by welfare and the civil rights act. Travel was not as extensive as it is today, although it was much more so than in 1918.

I don't know if conditions are as ripe for a pandemic flu virus today. This one got it's start in Mexico and kind of fizzled outside Mexico (in terms of mortality rate). Most folks probably were exposed early on, like with SARS in Asia (SARS appeared to have an ethnic preference for Asians), and were asymptomatic or had mild disease, giving them partial immunity.

Doesn't mean that we are not at risk for a pandemic disease, HIV is proof of that, but the focus should be on being able to handle it (treatment and care), and not using unproven tactics like quarantines (which promote panic) and vaccines which take over 6 months to develop (not to mention safety concerns when such vaccines are produced in haste with complete immunity for the manufacturer).

The problem science has sometimes is pretending to a certainty that the understanding of the science, and the data, does not support. Of course, you don't make the news expressing uncertainty, or get funding for research grants, or gain support to increase your favourite programs funding.

Given how common influenza is, our ignorance of it seems quite strange. Of course, if we were to declare war on influenza, and actually win such a war (unlike the war on drugs, war on cancer, etc), the vaccine industry takes a big hit. Better to keep everyone ignorant and keep the demand for flu shots up. Ignorance breeds fear, and fear is profitable.

Not saying it's a conspiracy, but who approves the funding for research? Those with an interest in the vaccine industry might not approve funding for research on influenza that might help improve understanding and lead to solutions that compete with vaccination. I can't say this is happening since I know so little about those who review said applications. I know peer review is basically anonymous, maybe those who review grants are anonymous as well.

I think there really wasn't a third U.S. wave in 1957-58.

Obviously, that isn't meant to be an opinion for or against a third wave of pH1N1. Just an effort to prevent a false meme about 1957 patterns from taking hold.

Here is what says about the 1957-58 H2N2 pandemic in the U.S.:

The virus came to the U.S. quietly, with a series of small outbreaks over the summer of 1957. When U.S. children went back to school in the fall, they spread the disease in classrooms and brought it home to their families. Infection rates were highest among school children, young adults, and pregnant women in October 1957. Most influenza-and pneumonia-related deaths occurred between September 1957 and March 1958. The elderly had the highest rates of death.

By December 1957, the worst seemed to be over. However, during January and February 1958, there was another wave of illness among the elderly. This is an example of the potential "second wave" of infections that can develop during a pandemic. The disease infects one group of people first, infections appear to decrease and then infections increase in a different part of the population. Although the Asian flu pandemic was not as devastating as the 1918-1919 flu, about 69,800 people in the U.S. died.

By Jody Lanard M.D. (not verified) on 23 Mar 2010 #permalink

AB almost made a great contribution but instead made a mistake, IMO. They were ready to or did, pay doctors $500/hr to work during a pandemic, 5x higher than average. To me this encourages doctors to come in sick and shedding. The science suggests immunity may occur (almost certainly for flus) after 3 or more weeks of being sick...AB could've designed their system to call up previously infected reserves and demonstrated for the world how to track and verify sick and subsequently immune doctors. Be nice if their oil sands revenue that will exterminate our species were used for good.
Lining up for vaccines indoors before lighting innovations permit UV-B indoor pandemic lights is stupid if outdoor sunlight is facilitated by climate.
Whoever connected bees with shoddy handsanitizers should be shot.

By Phillip Huggan (not verified) on 24 Mar 2010 #permalink