Swine Flu: Lessons From a Familiar Enemy
A shorter version of the following op-ed appeared in the Chicago Tribune on April 29, 2009. The author is Kenneth Alexander, MD, PhD, chief of pediatric infectious diseases.
"Pandemic" is a scary word. It summons images of the 1918 global influenza pandemic, which claimed perhaps 60 million lives and continues to shape our responses to influenza today.
But in light of the new swine flu reported in Mexico and in parts of this country, we should remember that a pandemic can take many different forms, some more dangerous than others. By the World Health Organization’s reckoning, the current situation has not yet progressed enough to be called a full-fledged pandemic. Even if it becomes one, it appears, at least at this early stage, to share many features with the seasonal flu we see every year.
The familiar seasonal flu is serious enough to kill up to 20,000 people in most flu seasons. But our lengthy experience with the common virus should render the current outbreak less mysterious and alarming than that imposing word "pandemic" might suggest.
The guidelines for when an outbreak can be called a pandemic are a bit arcane; the World Health Organization defines six separate phases of pandemic alert. The potential for a pandemic begins when a novel variant of flu spreads from animals to humans - something we know has happened with the current form of swine flu. Current indications are that the virus can spread from person to person. Efficient person-to-person spread is a requirement for widespread influenza.
This influenza strain is a new virus; a form of H1N1 influenza that is an assemblage of influenza viruses we have seen before. The swine flu is part bird, part pig and part human. This mixed lineage is common in flu viruses - such mixing of pig, bird and human viruses happens almost continuously around the globe. What is more unusual is that this virus made the jump to humans, has the ability to spread from person to person, and has affected people across a wide region.
At this early stage, the disease that this virus produces is generally indistinguishable from ordinary flu, with one important caveat. The severity of illness being seen in Mexico is drastically different from the severity of illness that health authorities have observed thus far in the United States. Mexican officials are reporting significant mortality, sand severe disease among patients with the infection. In contrast, the influenza in this country is behaving much more like the flu that you and I know from our annual late winter experiences.
Matters could change, but thus far, it is possible that swine flu could be no more serious than the influenza we’re used to dealing with each winter. We will know more over the next few days.
This said, influenza is not a trivial disease. One good case of flu, and you remember the cough, sore throat, headache, and fevers for the rest of your life. Sometimes, it even seems like your hair hurts. We must also remember that even regular old seasonal influenza kills people, especially the young, the elderly, and the chronically ill.
Inevitably, swine flu will kill, too. Time will tell whether the mortality due to swine flu will be greater than we see with seasonal influenza.
Given that the U.S. form of swine flu does not appear to be unusually lethal, were I treating a patient who might have swine flu, I would approach the patient much as I would a patient with seasonal influenza. In the vast majority of cases, it doesn’t matter which variety of flu a patient has, because the outcome will most likely be the same. They will be sick and miserable for a while, but eventually they're going to do just fine.
I say this because it means people with flu symptoms do not automatically need to visit an emergency room or doctor's office. These places will be crowded enough if we see swine flu in this area. Emergency rooms especially should be reserved for patients whose severe flu symptoms require immediate medical attention.
For the average person who gets influenza, even the new variety, the tried and true treatments will suffice: Drink plenty of fluids, and take pain and fever relievers such as Tylenol or Motrin, and go to bed. A bowl of Mom’s chicken soup will help you feel better. And by all means, follow the basic health tips your mother taught you. If you're sick, stay home and spare your work colleagues the risk of infection. Cover your mouth when you sneeze. Throw away your used Kleenex. Wash your hands and try to avoid touching them to your mouth, nose or eyes.
For patients at high risk of complications from flu, such as the elderly, those with lung disease, and people with immune deficiencies, one encouraging sign is that this swine flu appears susceptible to anti-viral drugs. Still, for most otherwise healthy people, such drugs are not necessary. People will get better on their own; the anti-flu drugs, which may be in limited supply, should be reserved for those at highest risk of becoming very ill. Likewise, most people have little reason to wear facemasks as a precaution against infection. Studies have yielded little evidence that such masks prevent infection in a community setting. Medical professionals use fitted respirators to avoid infection, but they also rely on gowns and gloves. Using a facemask without other means of protection is akin to locking just one car door; it won’t stop the bad guys from coming in the other side.
We do not yet know whether swine flu will become a noteworthy pandemic.
In the meantime, we should do the usual things to stop the spread of an infectious disease: Cover your mouth when you cough or sneeze, wash your hands, stay home from work or school when you’re sick, and stay abreast of what public health officials at the Illinois Department of Public Health and the Chicago Department of Public Health are recommending. A little TLC from someone you love helps a lot, too.
