All You Need to Know About the Coming Pandemic

On my walk to Harbourfront yesterday, I saw the first of what I fear will be a familiar thing in the next number of months - a person walking around with a medical mask on. I guess this is a familiar sight in Mexico, but frankly, I did a double take, seeing it in Toronto.

As of 06:00 GMT, 18 May 2009, 40 countries have officially reported 8829 cases of influenza A(H1N1) infection, including 74 deaths. That is 450 more cases reported than yesterday.

I spent some time last night reading about pandemics in general, influenza pandemics in particular and some time researching the 3 influenza pandmeics we have had this century. I also listened to 3 TED talks which relate to Pandemics and Influenza and I would highly recommend at least listening to the first one, if not also the other two which provide related background information.

Laurrie Garrett on Lessons We Have Learned from the 1918 Flu

Larry Brilliant Wants to Stop Pandemics

Nathan Wolfe's Jungle Search for Viruses


So What?

I have drawn a few conclusions from my research, which I would like to share.

It is clear to me that it is extremely likely that we are facing a world wide pandemic which will personally touch each one of us in some way. Lets put that in perspective, though. A pandemic is simply a is an epidemic of infectious disease that spreads through populations across a large region. It is different than seasonal influenza in that it is a single influenza strain which affects populations over a 12-18 month period (usually making 2 or 3 waves through the population) and then is joins the seasonal flu virus group.

Seasonal flu occurs each winter and comprises many different strains, some of which the population has immunity from, so there is not nearly the level of infectiousness that the pandemic has. In addition, flu viruses tend to get less virulent over time, so seasonal flu is by definition less deadly. Less, but still deadly. 30,000-40,000 people in the US and 2,000 to 3,000 Canadians die of influenza each year. So even in a mild year, people die from the flu.

According to wiki, an Influenza pandemic has occurred every 10 to 30 years since first recorded in 1580. We have had 3 this century - The Spanish Flu in 1918, Asian Flu in 1957 and Hong Kong Flu in 1968. The impact of these 3 pandemics varied greatly as you probably know. The pile of rice in the Rice Exhibit representing those that died of Spanish Flu (see yesterday's blog) was several times larger than the very large pile of rice representing soldiers killed in WW1. There were no rice piles for the 1957 or 1968 pandemics. They were mild, but still many folks died. (1-4 million of Asian Flu, .75 to 1 million of Hong Kong Flu, as quoted by wiki)

So it is not unexpected that we might have a pandemic and from all accounts this is it. We could very well have a mildly impacting pandemic or we could have a vicious and nasty one. We aren't able to predict how virulent a strain will be in advance, or in the case of a new strain, even once it has arrived because influenza is notoriously susceptible to mutation. And therein lies the conundrum. Even if they develop a vaccine now, it may not protect against the next mutation, which could be more virulent than the one we see today. But lets not dwell on that. I prefer to worry about things I can do something about and more about that in a bit.

The real issue is that a lot of people are going to get this flu, even if it is mild (btw, mild just means not deadly) since it is a completely new strain and none of us have any antibodies to it. So it will touch each of us, even if only that we have to nurse our loved ones through a bout of it, or we have to work extra hard at work because a lot of folks are off with "a mild" flu this year. See here for a Toronto man's account of this "mild" flu! Occassionally we have a "bad flu" winter, and from my read, it will be much worse than that - and that will be the best case.

For an explanation of why H1N1 is considered mild see this You Tube explanation:


Right now the Swine flu does not seem particularly easily spread, nor particularly virulent outside Mexico. But is that a false sense of security? I think so and so does the WHO - see here for the official word. For a couple of reasons. If it is a pandemic (and I understand that it will be announced as such this week), we are in month 1 of perhaps 18 months of, at best, a bad influenza "season".

Worst case, it seems, is that the Swine flu infects someone (or some animal) who also has bird flu (and pigs seem to get both) and the resulting mutation combines with the virulence of bird flu (which is now not easily transmitted to humans) and we get a new virus which can hit both people and kills easily. See here more about that. Even if that mutation doesn't happen, apparently a flu virus can become more virulent with minor mutations over time and new strains are particularly "unstable" and subject to mutation. This is what happened with the Spanish Flu. It started in March of 1918 and the first wave was fairly mild and did not kill. By August, when the 2nd wave started it turned deadly. In the worst case, there are not enough doctors, hospital rooms, or medical supplies for the living due to their contracting the disease and dead bodies often lie unburied as few people are available to deal with them. So worst case is that the virulence of this flu pandemic increases over time and it turns more deadly than we have capacity to deal with.

Once the WHO raises the pandemic threat level to 6, which officially makes the call that we are dealing with a pandemic, then they also start reporting the category level (like Hurricanes but referring to expected deaths), with 1 being equivalent to seasonal flu, 3 Asian Flu and 5 being equivalent to the Spanish Flu. If the Who raises the category above a 1 is the time to sit up and take notice!

The Key is To Be Prepared

We have no idea how bad it will be so what can we do? I say don't panic, instead become prepared! There are several types of preparation, in my mind.
1. Develop habits which discourage transmission:
- wash hands well and often, or use the alcohol goo appropriately.
- stay home if you feel unwell
- sneeze or cough in a tissue/on your sleeve
- be aware that you touch surfaces all the time which harbor these viruses and develop a habit not to touch your face or eyes with your hands.

2. Lay in supplies and be prepared for sick days!
- Some of my reading suggests that we may have shortages of things because too many people will be sick to man the stores or even production might cease because of illness. I think it is wise to lay in some things simply because if everyone in town comes down with flu, it makes sense that the drugstore might run out of some things you need just when you need it - or even you might be too sick to go to the drug store.
- I have read sites which promote stockpiling a 30 day supply of needed items (see here.) I wouldn't go to this trouble quite yet, but I am going to lay in a supply of flu meds and a vapourizer, cuz I can see the local Shoppers Drug mart running out the very day I come down with flu.
- For those of us who are not entitled to sick days, I suggest we need to be serious about that emergency fund to supply enough money for a couple of unexpected weeks off work.

3. Think about who you will need to care for and who will be able to care for you and yours if you all are sick. Apparently, there will be limited facilities to handle all the sick and in fact there is concern that there will be fewer nurses willing to work with the sick during a pandemic. So going to the hospital may not be a given.

4. Stay informed and stay calm. While we all have IMHO something to be concerned about, it’s important to keep things in proportion, and go direct to the sources of news rather than spreading panic. Tap into good information sources and keep informed. I have identified several really good news sources which I have set up google news alerts for. If things get worse, and as they get worse, you may wish to change your approach to preparedness by watching what is happening elsewhere and judging how bad it is/will be by what you see happening there.
Some good sites I have found are:
- Live Transmission Map You can even go to your home town on this transmission map to see how many people in your town have it! Here I discovered that there are 75 confirmed cases in Toronto.
- Home Care of the Flu Be ready to look after yourself and others. Know when you should go to the hospital and when you should not
- World Health Organization For the latest update on official statistics
- Flu Trackers forum
- For a comprehensive list of credible sites go here.

The latest news (as of Mon May 18th) is that Novel influenza A (H1N1) activity is now being detected through CDC’s routine influenza surveillance systems and reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories. The fact that novel H1N1 activity is now detected through seasonal surveillance systems is an indication that there are higher levels of influenza-like illness in the United States than is normal for this time of year. About half of all influenza viruses being detected are novel H1N1 viruses.

So what if this peters out and no pandemic develops? Well, we know for certain that there will be another one, potentially rearing its head in the years ahead, so I will treat this as a dress rehersal and count myself lucky if that is the case!