Influenza A(H1N1)

A media firestorm has been unleashed over the last few weeks regarding the so-called “swine flu.” If you pay attention to CNN or any mainstream media outlet, you are bombarded with dire warnings and panic-inducing reports of swine flu deaths and the resulting mayhem. I want to write this post to put things into perspective. Keep in mind that the news outlets have one thing in mind: ratings. The more fear they can strike into you, the more likely you are to watch. This is not to say that there is no reason to be concerned. As with any influenza outbreak, the more you know, the better prepared you are to handle it. However, the media consistently compare the current outbreak with previous pandemics, particularly the 1918 pandemic. The chances of such a disastrous pandemic are rare. Here, I will explain why that is, as well as provide some insight into this disease and some resources that will help you prepare should you come into contact with anyone infected with influenza.

First of all, the nomenclature “swine flu” is inaccurate. I am not saying this because I have been paid by the pork lobby. The truth is, this virus is part swine, part avian, and part human. This description is, in and of itself, probably confusing for a lay-person. Influenza virus biology is too complicated to get into here in real detail. Basically, influenza virus has a segmented genome. These segments are similar to chromosomes in humans, in that they are nucleic acids (RNA in the case of flu) and each segment codes for a different viral protein. The process of segments from different strains of virus (eg. swine, avian and human) coming together to form a new strain of virus is called re-assortment. This occurs when multiple viruses infect the same cell, and a basic example is illustrated in the figure below. This process occurs frequently, particularly in animals such as pigs and birds, but rarely results in super-virulent strains of influenza.

Influenza Re-Assortment

Influenza viruses are further subdivided based on their surface proteins, hemagglutinin (HA) and neuraminidase (NA). To date, 16 unique HA subtypes (H1-16) and 9 unique NA subtypes (N1-9) have been identified. The virus in the current outbreak has subtypes H1 and N1, leading to the appropriate Influenza A(H1N1) designation.

When thinking about outbreaks of viruses such as influenza, which occur annually, it is important to maintain a level head and not fly into a frenzy, as it seems the mainstream media would like for you to do. When the Vice-President of the United States goes on television and essentially tells people to not go outside and to avoid crowded places, it not only demonstrates his ignorance on the subject, but spreads that ignorance to everyone who listens to his nonsense. This causes undue panic, and makes people think they may die just by getting on a bus, subway or airplane. The truth is, no one really knows how serious this outbreak will be. But to compare it to the 1918 influenza pandemic, largely because they both happen to be H1N1 strains, is ridiculous. By all estimations, the 2009 outbreak is already a pandemic, as cases have been reported around the world. A map of laboratory-confirmed cases is shown in the next figure.

However, a pandemic only means that cases have been reported in various countries around the world. It by no means suggests that this disease is going to be as severe as the 1918 virus. It is estimated that between 70 million and 100 million people died in the 1918 pandemic. So far, only 26 people have died worldwide as a result of this virus, 25 in Mexico and 1 in the United States. Compare these figures to the annual death toll caused by “regular” influenza: in the United States alone, more than 36,000 deaths occur annually as a result of influenza, and between 250,000 and 500,000 deaths occur worldwide. Clearly, the 2009 Influenza A(H1N1) virus has a long way to go to reach either of these statistics.

In my opinion, for what it is worth, it is unlikely that this virus reaches anywhere near the severity of the 1918 pandemic. First of all, the disease reporting is far better today than in 1918. When cases occur practically anywhere in the world, those cases are reported and everyone around the world knows about it quickly. A disease as severe as the 1918 influenza is not going to sneak up on us. This gives us time to prepare. One of the good things that has arisen from the media firestorm is that people are taking the outbreak seriously enough to go to the hospital as soon as symptoms arise. While there is no cure for influenza, early treatment is key to preventing the development of severe complications due to influenza infection. Furthermore, we actually know how to care for patients now, unlike in 1918. A virus would have to be extremely virulent to cause as many deaths as the 1918 flu, and this virus has thus far given no signs of being that virulent.

Finally, there are a number of things everyone can do to reduce your chances of becoming sick and to avoid spreading the infection to others. This may be boring, but it is important. First and foremost, wash your hands! This seems so basic, yet it seems that people must be constantly reminded. If you are in a crowded place, be it a bus, subway, etc, the first thing you should do when you reach your destination is wash your hands. Other people carry a variety of germs, not just influenza, and the primary means of contracting these germs is to touch a contaminated surface, then touch your face. So wash your hands! Secondly, get the annual flu vaccine. It will not protect you from this ongoing Influenza A(H1N1) outbreak, but it typically does a very good job of protecting against the very serious seasonal flu virus that kills over 36,000 people annually in the US.

Symptoms of influenza infection are:

fever (usually high)
headache
extreme tiredness
dry cough
sore throat
runny or stuffy nose
muscle aches
Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults.

If you experience these symptoms, seek medical treatment. If treated early, antiviral therapeutics may help reduce the severity of the disease. After seeking treatment, avoid crowded places so as not to spread the infection to other people. When you cough or sneeze, cover your mouth and nose with your arm, not your hands. If you sneeze in your hands then touch something, other people may come along and touch the same surface, thereby risking transmission of the virus.

The bottom line is, no one knows how severe this outbreak of influenza will be, but influenza is always serious! However, by thinking rationally and following some basic, common sense principles, we can aid in reducing the severity of this outbreak and others.

Tags: Influenza
| May 4th, 2009 by Daniel Gaddy | Posted in Life Sciences |

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