Copyright (c) 2009 Mark Farrell

H1N1 and H5N1 may co-mingle. Mutations are not the only concern. Scientists are worried about the possibility that the swine flu virus might co-mingle with the highly deadly bird flu A(H5N1) virus.

Looking at the Southern Hemisphere
Important clues about the likelihood of a lethal swine flu pandemic in the fall may come from the Southern Hemisphere, where the influenza season is just about to begin. Scientists and healthcare officials are actively monitoring the virus behavior in those countries, with particular attention to Colombia, Costa Rica, Guatemala and El Salvador. This would enable them to determine whether the swine flu out breaks actually becoming more severe. The hope is to use such information to develop more effective pandemic plans.

Pandemic Preparedness may help reduce mortality
One thing thats for sure: Putting in place systems that will quickly detect any sign of increasing severity or an upsurge in cases following the first wave is a priority, says McCaw. Pandemic planning, including antiviral distribution strategies and vaccination preparation efforts, need to work on the assumption that a second wave may occur. And that it may be more severe than the first.

Of particular relevance, in this regard, are the findings of a 2006 re-analysis of the Spanish pandemic influenza of 1918, led by professor John Oxford, of the Centre for Infectious Diseases, Bart’s and the London, Queen Mary’s School of Medicine and Dentistry, London, UK.

Oxfords team found that, contrary to common belief, most of the people infected with the swine flu A(H1N1) virus during the 1918 Spanish flu survived. This, despite the fact that vaccines and antiviral medications were not available at that time. If this tells us anything, its that judicious and careful planning… could help reduce mortality in a new pandemic to figure significantly less than 1918, says Oxford.

There is every reason as we face the first pandemic of the 21st century that we can be optimistic, turn again to history and return to Churchill for inspiration give us the tool and we will finish the job.

Major differences between then and now
Avaccine to protect us in the event of a deadlier swine flu outbreak in the fall is being prepared in countries across the globe. As mentioned above, together with the availability of antiviral medications, this is one major difference between now and the Spanish flu pandemic of 1918-19. However, there is no guarantee that the vaccine will be ready in time, or even effective, because the virus may change in the meantime. And, almost certainly, there will not be enough of it for everyone.

There is also the likelihood that, by fall, the swine flu A(H1N1) virus might become resistant to antiviral medications, hampering any effort of treatment when most needed, as millions of people will likely be infected.

Probably not better off than in 1918
What is the most likely scenario for the world in the eventuality of a second, more severe, wave of swine flu? Experts say this may be more similar than expected to what experienced during the 1918 Spanish flu pandemic. Of particular concern is hospitals’ supposedly inability to cope with increasingly large numbers of patients, at a time in which a severe shortage of healthcare professionals, due to sickness, and lack of adequate medical supplies and medications are highly likely. Fear may play a role, as well.

During the Spanish flu, fear of contagious kept caregivers from performing their duties, says Dr. Monica Schoch-Spana, of the Center for Civilian Bio defense Strategies at the Johns Hopkins University, in Baltimore. Hospitals were crippled by influenza’s hold on urban population shortage of linens, mattresses, bedpans, and gowns arose in some instances.

Despite 80 years of medical advances and expansive growth in the health care industry, there remains great uncertainty about our capacity to respond to an infectious disease emergency, says Schoch-Spana. In many respects, we may be at a disadvantage today compared with 1918. Then, most people were cared for by family members. Patients did not rely heavily on paid health professionals, nor did they expect today’s sophisticated standards of care.

Intentional exposure to the A(H1N1) virus should be avoided
Lastly, health officials warn that getting swine flu, now, does not necessarily give immunity to further, more severe infections. One reason for this is that the virus may not be the same in a few months, as a result of mutations.

Another, and most important, reason is that too little is known about how the swine flu A(H1N1)virus reacts in any one individual. It may cause severe disease and death. Consequently, intentionally mixing with people who have swine flu in the hope of being infected should be avoided.