The Globe and Mail talks to Colin Lee, an associate medical officer of health at the Simcoe Muskoka District Health Unit in Ontario, a graduate of the London School of Hygiene and Tropical Medicine in Britain, and a member of Ontario’s Provincial Infectious Diseases Advisory Committee. Dr. Lee is also the co-author, with physician and writer Vincent Lam, of the 2006 book The Flu Pandemic and You: A Canadian Guide.
Every year thousands die of flu. What makes this outbreak of swine flu different?
This particular swine flu is worrisome because it appears to be close to fulfilling the requirements for a pandemic flu strain. It is a new strain that we have never seen before in humans. We likely have little immunity to it and do not currently have an effective vaccine against it.
It seems to be virulent, meaning it causes serious illness, at least in Mexico, where there have been a number of hospitalizations and deaths, particularly in the young and healthy. This is reminiscent of the 1918 Spanish Flu. However, outside of Mexico, the cases appear milder, including those in Canada. Finally, it seems to be contagious from person-to-person, as those who are ill do not seem to have contracted it from pigs.
What are the most important questions epidemiologists are now trying to answer about this flu?
The most important questions are: How contagious it is from person-to-person; how virulent (its ability to cause serious illness); and, can we make a vaccine against it if this becomes a pandemic? The investment to make a vaccine is huge and to do it, you have to isolate the flu strain, which only happened four days ago. From the time you isolate it to producing a vaccine takes four to six months. Scientists have begun the process of making a vaccine, but whether or not it comes to fruition in time depends on many factors, including how the outbreak progresses.
Why do scientists think that, so far, only those sick in Mexico have died from this flu?
There are a number of hypotheses. Mexicans may be more susceptible because of genetic factors or medical conditions. There may be a lot more Mexicans who have a mild version of this flu but who are not been seen and therefore not officially counted. They may not have gone to a doctor or hospital. Or, if they did, may not have been tested, given Mexico’s limited testing capabilities. If this is the case, the percentage of those in Mexico who have serious illness is currently being overestimated. It is also possible we have not seen enough cases outside of Mexico to see serious illness. Or, the virus may have mutated in the past weeks and become less virulent outside of Mexico.
Why is this important to know?
If this flu can cause serious illness and death, this is more ominous, and makes it more likely it could become a pandemic strain.
In your book, you note that most governments were preparing for a pandemic of avian flu, and now we have so-called swine flu. What is the difference?
In terms of preparation for a pandemic, there is no difference. We have been preparing for a flu pandemic whose origin could be avian or swine. The difference has to do with genetic makeup. The current strain of H1N1 has most of its origins in swine, while H5N1 “bird flu” has most of its origins in birds.
In 1976, there was a small outbreak of swine flu in a U.S. military camp which infected about 230 soldiers. A dozen were seriously ill and one died. At that time, the U.S. government believed it was likely a pandemic strain and produced a swine flu vaccine and began vaccinating the population.
Any advice you can give people who are worried about a flu pandemic?
During the last two pandemics, in 1957 and 1968, the most vulnerable were those who were the least healthy – the elderly and people with medical conditions. The best way to prepare for a pandemic is to be as healthy as possible before one. Eat healthily, exercise, and get your recommended vaccinations. As well, have an emergency kit of supplies at home, including non-perishable food, batteries, a flashlight, candles and matches. If you are taking prescription medication, keep an extra month’s supply. Stock up on contraceptives, pain killers, multivitamins and oral re-hydration fluids. During the Spanish Flu of 1918, healthy young adults and pregnant women were more vulnerable than usual, though researchers aren’t sure why.
Why does the World Health Organization say travel advisories are of no use, and may make things worse?
Historically, travel advisories and quarantine measures do not seem to have prevented the spread of pandemics, even in times when air travel was less common than today. Travel advisories can cause anxiety and panic. During SARS, travel advisories did not seem to decrease its spread.