The threat of morbidity and mortality from swine flu has captured our attention because people have died and because we feel threatened by the unknown. None of us wants to die, and, when we hear from experts that this particular strain of pig-bird-people flu has been previously unknown, our instincts to protect ourselves and our loved ones engage. As we look for answers, we would do well to choose our sources wisely. We would benefit, as well, by developing some perspective on influenza.
This frightening history of the 1918 influenza outbreak comes to mind. My parents lived through it, but they were not within the population that most often succumbed — 20 to 40 year olds. The disease course was rapid. The symptoms were unusual, severe, and alarming. Sources describe coughing up blood, severe loss of bowel control, and pneumonia that led to a solidifying of the lungs. Mortality estimates range from 50 million to 100 million. The mortality rate is estimated at 2.5 – 5% of those infected.
The 1918 influenza pandemic is singularly horrifying in its truth and in its relative historic closeness. Many of us know or knew someone who remembered the outbreak. When the first flu shots were developed in the mid-1950′s for the Asian flu, those who remembered 1918 felt a sense of relief.
Since then we’ve dealt with any number of flu viruses including the infamous meeting with the last swine flu in the mid 1970′s. Stern warnings about the potential outbreak led to a massive inoculation effort. In fact, only one soldier died from swine flu– even though 500 of his fellow soldiers who fell ill recovered. Still a massive inoculation effort was undertaken with a hastily developed vaccine. For a number of people the preventive was worse than the disease. Some fell ill within days of taking the shot. Cases of Guillain-Barre syndrome with its paralytic results were attributed to the flu shot. Though the intent was noble, this was not public health’s finest hour.
In the years after 1976, we’ve become more aware of the cycle of influenza. We expect it during certain times of the year. We line up for flu shots. We know it tends to be more severe for the very young, very old, and for the immuno-compromised. This last group took on new meaning in the 1980s as AIDS came on the scene. With the exception of these groups, we’ve come to consider the flu as a cold weather annoyance that lays us low for 24 hours to two weeks, makes us achy, nauseous, and just generally messes with our systems for a while. We may hear about outbreaks, but we rarely hear the mortality rate.
In 2003, the Center for Disease Control released a figure of 36,000 deaths from influenza, but they qualified the number by enumerating possible sources of error. In their 2007-2008 discussion of influenza, they note that it is impossible to count deaths due to influenza. Still if the 2003 figures are at all close to reality, it means that in that year we were able to effectively ignore a flu, that right now was 36,000 times more deadly than the current swine flu. Since many of us use Google for our information — I googled 2003 flu pandemic — no results. The CDC called it an epidemic, but how many of us remember it?
Still, the World Health Organization is one level away from declaring a pandemic. A level 5 means a pandemic is imminent, but it’s difficult to find information on what the WHO bases its decisions to raise or lower levels. The likely spread of the disease, the reporting of cases in a particular number of countries seem to be part of it. The impact of their decision, though, is startling. Countries are posting estimates of drastic drops in gross domestic product. Others have decided to slaughter all pigs. Many countries are working through educational efforts.
In the U.S. we hear calls for calm, stories of school systems closing, nearly hour by hour accounts of suspected, but not confirmed cases, Purell dispensers popping up everywhere, and we wonder what to do. No one has an definitive answers, but a few common sense actions keeping cropping up.
Wash your hands — that doesn’t mean rinsing. It means soap, rubbing, for thirty seconds. Cover your mouth when you cough or sneeze — of course, then you have to wash your hands again. If you’ve not been in school lately, you may not know about the way kids are being taught to cover their mouths. They use their upper arms or the crooks of their elbows. That way, the germs don’t get on their hands, and they don’t spread them when they touch something.
Beyond these usual precautions, seek out good information. The Centers for Disease Control and Prevention website is your source for information on what they call H1N1 Flu and only parenthetically swine flu. In fact the CDC’s tagline is, “Your Online Source of Credible Health Information.” Good information is the first line of defense. Next, use that information wisely. Listen to your local officials and heed their advice. Oh, and yes, stay calm. You live in a place with outstanding public health conditions and some of the finest medical institutions in the country and the world within 15 minutes to an hour from Crownsville. Listen to your body. Listen to your children. If you or they do get sick, consult your health care provider for your own good and for the sake of tracking the truth about H1N1. You may have to stay home — you live in Crownsville: home is pretty nice!
To your health.