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The real deal about swine flu: A shot across the bow

BY JOAN WHITLOW
NEWJERSEYNEWSROOM.COM

docdentistry_optSo far, the swine flu virus has not been behaving like the monster we all thought it would be. I've been trying to understand what that means, so I had a phone conversation and a few email exchanges with Dr. George T. DiFerdinando, Jr., a University of Medicine and Dentistry of New Jersey adjunct professor who is heavily involved in public health preparedness.

I asked him if this outbreak might not be a blessing in disguise: It  has come toward the end of the flu season. So, it's likely to peter out before it has time to do as much harm as it might have, had it kicked off in the fall, at the start of the flu season. Because this new virus reared its ugly head in the spring, the scientists get a chance to make a vaccine against the new bug. That should offer some protection, even if  a mutant version comes back next flu season, changed and ready to work viral vengeance.

First , DiFerdinando sternly warned me not to call this situation a "blessing." He's right. The regular-flu, any flu, is too dangerous to call it that. Influenza kills more than 30,000 people in this country in so-called mild flu seasons  and puts tens of thousands more in the hospital. If a disease came at us out of the blue and did that just once? People would be in a panic even greater than we've seen in the days since the phrase "swine flu confirmed" hit the headlines. It's because the flu strikes with such regularity, kills with such regularity that we don't get as alarmed by the carnage. Like highway deaths, the big numbers are part of the background noise. What if we all washed our hands and kept them away from our faces every flu season, or all the time? What if we never -played noble and dragged our contagious selves to work, never sent a queasy child off to school? What if we had  workplace policies and back up child care systems that made those healthy decisions possible?

In any case, DiFerdinando was right. No blessing. We have, however, had some warning,. We have a chance to prepare for the worst. Based on what happened during the  1918 swine flu pandemic that killed more than 600,000 in this country, more than 50 million worldwide, the worse could come.

In his  book "The Great Influenza," John M. Barry, who had an op-ed piece on the subject in the New York Times, April 27, noted that the great pandemic came in waves. The first wav e appeared in the late spring, like this one. It was mild, like this one.

The second wave, in the fall, was much more severe, and a third in the winter was also worse, DiFerdinando said. Right now, he added, we're seeing the effect of this flu in the late spring, in northern  cultures with advanced public health systems.

As the flu spreads in southern hemisphere countries, many with less developed public health systems, during their winter, we will likely get a better idea of what may be in store for us when both the seasonal flu and swine origin H1N1(that's the swine flu's official scientific name) come back to visit the north.

Our flu seasons is ending. There is nothing sanitizing about warmer weather, but human behavior changes – we aren't as cooped up together, the schools are closed and the most efficient lines of transmission are broken – here. But the flu keeps circulating elsewhere in the world. Each time it moves through a population, the virus has an opportunity to mutate, in ways that could make it milder  or in ways that could send a lethal wave of infection around the globe.

The flu can be deadly because of the sheer numbers that it infects. The more people who get it, the more likely someone too old, or already weak from other disease will get the flu and die.  From what I understand about the 1918 pandemic, however, that was a virus that  took the young and healthy along with the old and sick. Healthy immune systems went on the attack, hot and heavy, and young bodies burned themselves out in a  futile fight against that swine flu.

Some of the great medical centers and their heralded scientific techniques developed in response to the 1918 pandemic. Medicine is more advanced than it was back then. We can make vaccines based on our best guess of what is going to hit us next. We are still guessing  because despite the progress, science is still making vaccine in a slow, archaic way: sticking the ingredients in hen eggs and waiting and waiting for the potion to brew.

Scientists are already at work on a vaccine for the swine flu in circulation now. It will not be ready for months, at best. Such a vaccine should offer some protection, even if the virus changes some. But, because of the vaccine growing methods in use,  we cannot change our vaccine quickly enough to match viral mutations step-for-step. Better vaccine production should have been made a top priority long ago.

This outbreak is teaching important lessons not just about how the virus behaves, but how the humans might behave badly in the face of a true crisis. The worried well have been clogging up emergency rooms trying to find out if every sniffle and sneeze means doom. In a true crisis will the  public health system be distracted by  that crowd even as the system  struggles to treat the really sick? We have to prepare for that possibility.

There are reports that some pharmacies ran out of the antiviral agents that might be needed to fight a tough flu. People who didn't need those drugs were buying them up for personal stockpiles, just in case. That kind of hording could create acute shortages of precious drugs in time of real need.

But understand this: No one can buy those drugs, not legally anyway, without a prescription from a doctor. Some doctors may be too wimpy to tell patients they are not going to get a prescription for what they don't need.  Some doctors may be ill informed. In either case, getting the private part of the medical profession to do its duty in the face of a medical emergency  looks like another thing that society has to start working on now.

I have some sympathy for Vice President Joe Biden, who got hammered for saying people should beware of traveling in close quarters,  on an airplane for instance, because of this swine flu scare. Essentially he was saying what the average schmuck was thinking. Vice presidents, of course, aren't average schmucks.  In any case, by the time the final draft of what Biden really meant was released,  a big international jet made an unscheduled stop to get a passenger who had been feeling fluish off the plane. In the face of a public health emergency mixed messages do not instill confidence.

Finally, about those folks who are calling for truly stupid things like closing the U.S. border with Mexico. That's where  the current outbreak seems to have started, and Mexico has the most cases. Yep, Mexico is number one, but the U.S. is number two in the case count and no other country is close as of yet. It could be that we are doing a better job of looking for flu and testing and counting. The problem with that kind of efficiency and accuracy is that it makes a country look very germy compared to the slackers. In the face of our higher numbers, however, if  the U.S. closes its border with Mexico, how long will it be before Canadians decide that  cutting off U.S. trade and commerce and visits is a good idea, how long before international airports post "Yankee stay home," signs?

 

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