So it's here at last. After months of will-it-won't-it anticipation, H1N1 officially went pandemic on June 11.
Yet despite increasing numbers of cases in over 70 countries, many still think it a fuss over nothing: "What's the big deal? It's just ordinary flu." It is worrying that even Canadians are saying this, although they know from recent memory what it is to experience a big disease outbreak.
Many in Britain are saying the same thing. One high-profile commentator, Simon Jenkins in the Guardian newspaper, asserted that swine flu was a panic stoked in order "to posture and spend," saying that health scares such as this enable media-hungry doctors, public-health officials and drug companies to benefit by manipulating fright.
Those who dismiss H1N1 as a panic-fest are profoundly wrong. This "ordinary flu" might have real consequences to many Canadians.
Canada has an excellent flu vaccination program and good access to medical care. Nonetheless, 6,000 to 8,000 Canadians die of seasonal flu each year, mostly older people or those with other health problems. These are people's mothers and grandfathers, uncles and fathers. Ordinary flu causes a great many deaths, even in a country such as Canada.
Let's say that H1N1 continues to be mild and is no worse than seasonal flu. "Mild" means having up to five days feeling really unwell with fever, cough, sore throat and muscle aches, and then a further week before one feels able to return to work and normal life.
The old story about the difference between flu and a cold holds good: If a $50 bill is dropped outside your front door, if you've got a cold, you'll go pick it up; if you've got flu, not even $50 will get you out of bed.
This is a novel flu. While people over 50 seem to have some immunity, perhaps because of the Asian flu of 1957, those who are younger have not been exposed before and have no defences in place. Current H1N1 attack rates are about 20 per cent. That is, one in five people exposed to this new flu will come down with symptoms like the ones above; exposure can result from merely touching a surface where there are viruses, because someone else has touched it. Pretty much everyone who comes into contact with other people will be exposed to this flu, sooner or later.
4-PER-CENT IMPACT ON GDP
That means 20 per cent of the population becoming sick, with perhaps another 10 per cent of the working population home looking after them. Think about the effects on business, on transport, on day-to-day life, of so many people being off sick at the same time. Flu is estimated to have a 4-per-cent impact on a country's GDP.
And think about its effect on hospitals. Not on its effect on patients requiring intensive care, but its effect on staffing. A tanker drivers' strike in Britain bought our hospitals to a halt in less than a week. Why? Because schools didn't have fuel for heating and were closed, working mothers had to stay home to look after their children. Where are there are large proportion of working mothers? In nursing and allied health services.
There are 33 million people in Canada. At an attack rate of 20 per cent, six million people would develop flu. The death rate in Canada is currently tiny, at roughly 0.1 per cent (12 deaths, 4,905 cases). But 0.1 per cent of six million is 6,000. These 6,000 will not be just the old and the sick, whose deaths, extraordinarily, don't seem to greatly concern many commentators, but will include previously healthy twentysomethings (such as three of those admitted to intensive care units in Britain), pregnant women and a disproportionate number of those sections of the population that are genetically particularly susceptible. Such effects are already appearing in Canada with outbreaks of severe illness among previously healthy native people in Manitoba.
This is not scaremongering. This is reality.
Many people expect that all medical staff will turn up for work during a flu pandemic. Toronto's experience of SARS in 2003 shows that they won't, and cannot be made to do so. Many of them won't be able to, because they are looking after family at home, and some will fear catching flu and its effects. Normal hospital schedules will grind to a halt, meaning that far fewer elective procedures such as hip replacements and heart surgery can take place. It will inevitably cause deaths that should have been preventable. This is without the strain on services from many more people requiring respiratory support because of flu.
So why couldn't the hospital authorities make flu vaccines mandatory for health-care staff when they become available? Britain does not make this mandatory, and only 13 per cent of National Health Service Staff front-line staff voluntarily had seasonal flu vaccination in 2008-2009. Why? It's principally because staff think of flu as "ordinary," not something that causes severe illness. Recently, unvaccinated NHS staff were shown by Britain's Health Protection Agency to have been the cause of a major outbreak of flu among patients who were already critically ill in a hospital in Liverpool.
When people look upon the threat to themselves as "mild," they will not consider vaccination, which they feel has greater risks than the illness.
Playing in the background are current attitudes to vaccines, coloured by the long-running contention that the MMR vaccine is linked to autism, but also by the experience of swine flu in the United States in 1976.
THE FORT DIX PRECEDENT
In January, 1976, scores of army recruits at Fort Dix, N.J., complained of flu symptoms - not unusual at that time of year. But 18-year old Private David Lewis, with the bravado of youth, decided to ignore medical advice to go to bed; he went out on a strenuous all-night exercise in the bitter cold. At the end of the exercise, he collapsed. He died a few hours later. An autopsy revealed that his death was caused by a previously unknown variant of swine flu A/H1N1. But what really spooked the Centers for Disease Control was its similarity to the strain that had killed more than 40 million people across the world in 1918.
The CDC rightly decided to develop a swine-flu vaccine for use in the following flu season. But there were many production problems. It was on the point of being cancelled, when there was an outbreak of fatal pneumonia after the Pennsylvania convention of the American Legion. The media linked it with swine flu (although today it is known to have been what is called legionnaires' disease), and politicians joined in the clamour to push forward the swine-flu vaccination program.
The threat from swine flu was vastly exaggerated in the media, although it was already clear that the outbreak (which involved no more than 300 people) was over. President Gerald Ford took personal charge of a mass vaccination program, and it had deadly consequences.
With all manufacturing capacity devoted to swine flu, seasonal flu production stopped. That year, there was a particularly virulent strain of seasonal flu, and there were thousands more regular flu deaths than normal, largely in unvaccinated seniors. There was also the problem of vaccine side effects.
SIDE EFFECTS BECOME NUMEROUS
When millions of people are vaccinated, very rare side effects become numerous. About nine in every million of those vaccinated then developed Guillain-Barré syndrome, a paralytic disease. There were 500 cases and 25 deaths.
The batches may have been contaminated with a bacterium. In any case, the vaccination program was stopped, having only treated 24 per cent of the population.
This is not then. There are already thousands of cases, and vaccine technology is better than it was. But no vaccine is absolutely safe. There will be very rare side effects with new H1N1 vaccines too, and most have not yet been tested on children, who are one of the groups that are most likely to be vaccinated as a priority, because they seem to be especially affected. But people can only ever see risk from their own perspective.
It seems probable that, despite knowing that 6,000 or more Canadians might be prevented from dying and tens of thousands more prevented from having serious illness, people will concentrate on their own individual risks, with many choosing to remain unvaccinated. This places individuals at risk but also friends, family and loved ones and those who are unable to be vaccinated for one reason or another.
All this comes from a mild illness that many people think is not a risk and claim to be overhyped. Everyone should think again about the seriousness of pandemic flu.
Let us hope that the nightmare scenario of a new virus with the virulence of H5N1 (bird flu) and the transmissibility if H1N1 does not come to pass. That really would be scary.
British science writer and broadcaster Vivienne Parry sits on the independent committee advising the British government on vaccines.