Health News Digest

May 4, 2009

Swine Flu: Media Hype, Cause For Concern—Or Both?

wear your mask

By  Michael D. Shaw

Skeptics will remember the previous hysteria over Ebola virus, SARS, and avian flu. They will point to unfounded concerns over how widespread AIDS would be among heterosexuals, and how during a previous scare over the swine flu in 1976, only one person died from the disease, although hundreds appear to have died from the vaccine—promulgated in a massive drive to inoculate all Americans.

Some say that President Ford’s desire to push such draconian measures was based on his surprise loss to Ronald Reagan in the North Carolina Republican presidential primary. Certainly, politics was involved. As writer Paul Mickle, now city editor of The Trentonian, would put it…

The swine flu case of 1976 forever reduced confidence in public health pronouncements from the government and helped foster cynicism about federal policy makers that continues to this day.

Notably, confidence in official pronouncements is not helped by factual errors:

Many reports put the death toll so far at 152, with Mexican officials confirming 20 deaths. But, according to reports from the World Health Organization (WHO), as of 17:00 GMT, 30 April 2009, 11 countries have officially reported 257 cases of influenza A (H1N1) infection. The United States Government has reported 109 laboratory confirmed human cases, including one death. Mexico has reported 97 confirmed human cases of infection, including seven deaths.

It should be noted that the one death in the US was actually a Mexican who came to this country for treatment. Note also that the disease is now being officially referred to as influenza A(H1N1).

Despite reassurances that it cannot be contracted from eating pork products, sales of the meat are down in some stores, and trade negotiators for many countries are already taking advantage of the panic, to extract concessions in other areas.

In the US, during a typical flu season, 36,000 deaths will occur from around 50 million cases of infection. For the most part, these deaths are in individuals who are immunocompromised in some way, and the majority are from complications—often pneumonia.

However, the nature of flu viruses can render humans immuno-challenged based on their uncanny ability to mutate and occasionally jump between hosts. While we can develop immunity, and can have this enhanced by vaccination, the virus seems to undergo minor changes every few years, as well as major changes every decade or so that enable it to rapidly infect large populations.

But, even these norms of flu virus natural history can be broken. In the Spanish flu pandemic of 1918-1919, the first wave of the disease was far less virulent than the second wave—occurring only a year later—which was fatal in perhaps 10% of those infected.

The deadly nature of this flu has been attributed to a so-called cytokine storm. Cytokines are a group of small, short-lived proteins that are released by one cell to regulate the function of another cell, thereby serving as intercellular chemical messengers. Some of them signal T-cells and macrophages to travel to the site of infection. For unknown reasons, this process can sometimes be an overreaction, whereby too many immune cells are caught in an endless loop of calling more immune cells to fight the infection.

If this should occur in a lung infection, a prolonged cytokine storm will eventually shut down breathing altogether as a result of severe lung inflammation.

As an US Army doctor recorded at the time:

These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most vicious type of Pneumonia that has ever been seen…and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white. It is only a matter of a few hours then until death comes…It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies…We have been averaging about 100 deaths per day…

It is by no means lost on health officials that the Spanish flu was a variant of today’s H1N1 strain.

So, the possibilities for a horrible pandemic are there. Bear in mind that unlike 1918, we do have effective antivirals, and our public health practices are far superior to that time, as are living conditions and general sanitation—at least in first-world countries.

Concerned citizens are advised to visit the swine flu web pages of the CDC and Mayo

Don’t panic. Be informed and be safe.