Saturday, May 2, 2009

Influenza A(H1N1) / Swine Flu - Come On, How Bad Could it Be?

Pretty bad, actually.

The good news is that we've learned a great deal, since influenza killed around 40,000,000 people, back in 1918. That was the first pandemic of the 20th century.

PBS put together a timeline of the 1918 influenza event. Aside from historical interest, I think it's a good example of how a disease that's not all that unlike the influenza A(H1N1) we're dealing with waxed and waned over several months.

Stanford University's website includes a more detailed look at the 20th century's first pandemic:

"The Influenza Pandemic of 1918"
Molly Billings, June, 1997 modified RDS February, 2005, Stanford University website

"The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as 'Spanish Flu' or 'La Grippe' the influenza of 1918-1919 was a global disaster...."

The article says that about a fifth of the world's population was infected. About 28% of all Americans were infected: and around 675,000 Americans died.

"...In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children...." (Stanford)

Influenza A(H1N1) is No Ordinary Flu

The conventional wisdom is that diseases like the flu are particularly dangerous for the young, the elderly, and people with compromised immune systems. And, generally speaking, that's true.

Influenza A(H1N1), or the version of swine flu we're dealing with (a virus with DNA that combines avian, human, and swine flu coding), may not be as infectious as it could be. Unhappily, it seems to be particularly dangerous for relatively healthy adults.

"...'When you think about the flu, the seasonal flu, the flu that we're accustomed to, it typically tends to have the worse ramifications in people that don't have developed immune systems -- the elderly and the very young. They can't fight it off,' said Dr. Sanjay Gupta, CNN's chief medical correspondent.

" 'What's counterintuitive with this particular virus, it's in the people who have robust immune systems. As their body starts to respond, to try and fight off that virus, they produce tons of inflammatory cells. Those inflammatory cells can sort of flood the lungs.

" 'So, in essence, it's not the virus itself that's so problematic, but the body's reaction to it.' " (CNN) [emphasis mine]

Cytokine Storm - Cool Name for a Serious Issue

One overreaction of the immune system is hypercytokinemia - or "cytokine storm," which I'll admit is a cooler name. The University of Minnesota Academic Health Center published an article on H5N1 and hypercytokinemia back in 2006. The gist of it seems to be that, when the body gets infected with a new virus - one that the immune system can't handle at first - "...explosive viral growth and the resulting cytokine storm, or excessive immune response..." can be lethal. (CIDRAP) Looks like H1N1 may act the same way.

I don't think it makes any sense to get worked up emotionally about influenza A(H1N1), but I do think that making people aware of the situation - and (very probable) dangers - makes sense.

I certainly prefer the current situation to one in which we're kept ignorant - 'for our own good.'

More: List of posts relating to Swine flu 2009; and list of background resources:

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