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There seems to be a lot of interest in Influenza A all of a sudden. Particularly in one of the sub-types called H1N1. Some scientists and public health officials may be totally excited but when a major news network goes to Mexico and comes back with a hot story, panic sets in. As things unfold, it seems plausible that the poor old pig is getting an undeserving rap, unlike the chickens of a few years ago, which actually did cause the last scare. What follows is a bit of a survival guide to help you get through this medical mystery.
Firstly, it should be noted that us docs have not locked our doors and fled the country, which tells you something. Secondly, I am not currently walking around in a space suit. I actually did have one issued to me a few years ago during the SARS scare.
When the CNN story broke (April 2009), we on the front-lines were prepared. I received a faded fax to tape to my door, a phone message from my lab asking me not to send sick people, and an email notice about the swine flu. That Monday, we had a hurried staff meeting and decided that more must be done. We pitched in and bought four bottles of hand-sanitizer, Kleenex, commondeared the waiting room TV to CNN, and decided to order some of those naso-pharyngeal swabs because the poor Public Health Doctor on TV was telling everyone that he had no confirmed cases. In our offices, we have been seeing returning travelers with flu symptoms for months. The least we could do is to help the cause by performing a few flu tests by swabbing the furthest nether regions of people's noses.
Influenza is that coughing lung disease that we talk about every fall, and then try to give everyone shots for. If you did roll up your sleeve for the cause, you probably are a little ahead of the game. Influenza is a group of closely related viruses, which produce sudden and severe respiratory illness. We loosely divide flu into Type A, B and C with the A group being more troublesome. Viruses are very small particles of genetic material within protein coats that are microbiological dwarfs compared to monsrous bacteria. They have no consciousness or brain, and their genetic programming promotes happy coexistence, not destruction. The influenza virus exists by attaching to and invading human lung cells. This is essential for reproduction and survival. The last thing a virus wants to do is kill its host, whose cellular machinery it depends on for reproduction.
Now for the big secret that you hear repeated in the press. The current erroneously named "swine flu" is just another sub-type within the Influenza A family, which has a strong presence in Canada very year. In this year's flu season, Canada has confirmed thousands of cases. A very miniscule amount is due to the H1N1 sub-strain. We expect influenza death rates in the 2000 to 4000 range. The Mexican strain has not really changed that yet.
What has people worried is the word PANDEMIC. It does not mean deadly! Pandemic is simply a scientific way of describing something that spreads quickly. Even in the 1919 influenza pandemic, the death rate was only about 2.5%. Think about it. The largest Pandemic in the last 100 years allowed over 97 percent of affected people to survive! And that was before the advent of shots, antivirals and antibiotics. The death toll was 19 million because a fast spreading agent was able to statistically affect more people. The H1N1 strain is not yet pandemic as of this writing.
Another similarity to the 1919 pandemic is that in both cases, the most susceptible people were young middle aged adults. Some feel it was the consequence of a rapid immune response and others feel it was their lack of experience with other viruses. The take home message for us is that generally if you get swine flu symptoms, they come on quick and hard. If you don't get really sick in the first 3 days, you will probably do fine. This should be a relief to the many mothers with children experiencing symptoms, who lay awake at night fearing that their children's influenza is getting worse week after week.
Here is another surprise. Influenza viruses are generally found in birds, not humans. They see their finest hours as viruses in birds. It is their natural host. In fact, we still use eggs to grow the viruses and make vaccines. But humans, horses, pigs and seals have become somewhat unwilling carriers over the eons. Influenza symptoms appear suddenly and quickly. Fevers, chills, muscle aches, stomach upset, cough, mild sore throat and fatigue are a few of the symptoms. It has been described like being beat up! This year's flu vaccine is not effective against the swine flu. The lucrative flu vaccine industry which is largely driven by Canadian tax dollars boils down to a "best guess" as to what might work in any given year. Some countries use a different approach of waiting for an outbreak with pandemic potential such as Mexico, then develop an effective vaccine and administer it in selected areas. It is a technique called "ring vaccination". It is much cheaper and has potential to be highly effective in third world countries.
I invite you to join me on Saturday, May 30, 2009, 3 p.m. at the Yee Hong Centre, 5510 Mavis Road, Mississauga, ON for a Healthy Living Expo Community Health Day. (Free Admission, Free Parking, Free Testing, Free Activities. 10 a.m. to 6 p.m.). I will be doing an update on the H1N1 as well as providing some of my own insight on Influenza in general. Knowledge is a good and empowering defence. Use your hanky, wash your hands and hope to see you there!
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