Friday, May 01, 2009

Why the new H1N1 flu is important

This new flu is beginning to look like it is not the new "killer flu" like the 1918 flu was, but it has a real problem anyway. It is genetically novel, and humans have no immunity to it based on previous experience. Here is an explanation of the danger from an expert:
What's important about this virus is its genetic novelty. As far as we know, the human population doesn't have any natural immunity to it. But what people perceive about the virus is its lack of novelty. Clinically it seems a lot like what they are used to with seasonal influenza. It's not (so far) the monster of 1918 and doesn't have the virulence of H5N1. What they are forgetting is what the genetic novelty might mean.

Because there is no natural immunity to this virus, even though clinically it appears to be like garden variety flu to the individual, with respect to the population it has the potential to spread faster and many more people sick than seasonal flu. And remember, seasonal flu is not a walk in the park. It kills an estimated 30,000 people a year.

A bad flu season can fill hospital emergency rooms and in patient beds to the bursting point. We currently have fewer staffed hospital beds per capita than we did in the last pandemic, 1968 (the "Hong Kong flu"). There is no reserve capacity. We can't just add physical beds. Beds don't take care of patients. Nurses and doctors do.

Now take a bad flu season and double it. To each individual it's the same disease but now everybody is getting it at once, in every community and all over the world. In terms of virulence, it's a mild pandemic. It's not a lethal virus like 1918. But in terms of social disruption it could be very bad. If twice as many people get sick, the number of deaths could be 80,000 in the US instead of 40,000. Gurneys would line the hallways of hospitals and clinics. And absenteeism amongst health care workers would compound the problem. Infrastructure would probably survive intact. No need to have your own water supply or electricity generator. But it would be a very rough ride.

All of this could plausibly happen from this virus without it causing anything more than the usual case of influenza. We are pouring tens of billions into infrastructure. I'm a big fan of high speed rail. But the public health and social services infrastructure -- good, job producing infrastructure -- needs attention and needs it right away because of this virus.
We are not in any position to back off of preparations for this flu. We don't want our current health care system to be overwhelmed. How many other medical problems would go untreated if we back off of protective actions and this becomes a mild pandemic?

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