Swine Flu: Confused About What to Do?

By TARA PARKER-POPE
Published: May 4, 2009
NY Times: Well Blog

Confused about swine flu? It’s no wonder, with all the seemingly mixed messages coming out of health agencies and news organizations.

Last week, the World Health Organization raised the alert level for the virus, whose formal name is H1N1, indicating that a “pandemic is imminent.” Now, health officials report that although the virus is widespread, most cases seem to be mild. People are being told not to panic, but schools in some communities remain closed.

It’s good news that the imminent threat appears to be abating, but questions remain about the virus and whether it will re-emerge in the Southern Hemisphere or back in North America next fall. Here are some answers.

Regular flu kills 150 people a day during flu season. Why is everyone so concerned about this one?

This is a new and unusual virus. Most flu viruses have two genetic elements, but H1N1 has four: two types of swine flu, a bird flu and some human flu genes, said Dr. Neil O. Fishman, an infectious-disease specialist at the University of Pennsylvania. The virus has also shown that it can quickly infect large numbers, as it did at a school in Queens.

But it is a historical precedent that fuels most of the present concern. In the 1918 pandemic, the virus was relatively mild when it first appeared in the spring, but it came back with a vengeance in the fall. “That’s what has a lot of the experts frightened,” Dr. Fishman said. “When it recurs, there’s the possibility it could be more virulent.”

Flu typically preys on the old and on those whose immune systems are compromised. This one seems to be infecting more young people. Why?

It may be related to spring-break travel patterns or the fact that older people have more natural immunity after years of exposure to a variety of flu viruses, according to officials from the Centers for Disease Control and Prevention. In the 1918 flu pandemic and in the SARS outbreak in Asia this decade, the viruses appeared most deadly to young, healthy adults. The reason may be that the immune system of a healthy person responds with too much force when it detects a new virus, filling the lungs with fluid. This overreaction is called a “cytokine storm.”

In 1918, there were reports of people dying within hours of developing symptoms. “That doesn’t happen because you have a virulent flu,” said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations and the author of “The Coming Plague: Newly Emerging Diseases in a World Out of Balance ” (Penguin, 1995). “That happens because the whole body went bananas.”

She added that even though many SARS patients were housed in the AIDS wards of hospitals, patients with H.I.V. and AIDS apparently did not contract the disease, suggesting that the real threat was a strong immune response rather than the symptoms of the virus itself.

I am coughing and feverish. Should I be tested for swine flu?

Most people who exhibit flu symptoms will not be tested for H1N1. There are a limited number of testing sites that can confirm a case, and whether you have swine flu or another type of flu, the medical advice is the same. Call your doctor to see if he or she considers you a candidate for an antiviral treatment like Tamiflu. In some cases, a doctor may order a rapid test.

“Are you getting better or are you getting worse?” said Dr. Michael R. Anderson, chief medical officer for the University Hospitals Case Medical Center in Cleveland. “If you’ve got a low-grade temp and a cough for a few days, wait it out. If you’re into that second day of symptoms and your fever is 103, you’re coughing every five minutes to the point of respiratory distress, shortness of breath and you can’t keep things down, I don’t care what the virus is. I would seek medical treatment.”

Don’t confuse flu with other respiratory illnesses. One characteristic of flu is that it does not creep up on you over a few days. “Give yourself the sledgehammer test,” Ms. Garrett said. “Are you vaguely off and then all of the sudden it feels like someone just whacked you over the head? That’s flu.”

Are there reasons to be less worried about swine flu now than a week ago?

Yes. In recent days, genetic sequencing analyses of this flu have suggested it is not as virulent as suspected. It lacks certain proteins and amino acids that would make it as deadly as other flus. And it appears similar enough to other common strains that most people may have some immunity. Researchers have even begun to speculate whether this year’s flu vaccine, which protected against a form of H1N1 flu, may have offered partial protection against the swine version.

Should I buy a face mask just in case?

The public health officials I interviewed are not stocking up on personal supplies of face masks for family members. “I haven’t brought any home,” Dr. Fishman said.

Face masks aren’t particularly effective against the spread of flu. The main effect may be “social distancing”: masks scare people away from one another.

If the flu does progress to a pandemic, the most effective response will be to limit public gatherings. In 1918, for example, the outbreak in St. Louis was mild, because the authorities closed schools, churches and theaters. Meanwhile, Philadelphia, which had one of the highest death rates, held a war bond parade at the start of the outbreak.

“That’s circumstantial, but it’s the type of thinking that’s behind the community mitigation strategies,” Dr. Fishman said.

Now that the swine flu scare seems to have died down, does this mean we all overreacted?

“It’s the classic problem in public health, trying to prove a negative,” Ms. Garrett said. “If, after an intervention, nothing happens, then everybody says, ‘What was the big deal?’ ”

But the course swine flu will take in the Southern Hemisphere — and, this coming fall, in the Northern Hemisphere — still isn’t clear. And it’s worth considering what might have happened if public health officials hadn’t sounded the alarm.

“I think the whole world should be saying, ‘Gracias, amigos,’ to the Mexicans for the tremendous sacrifice they have made,” Ms. Garrett said. “That may have stopped what otherwise would have been a serious pandemic.

“Some people will look back and say: ‘Wasn’t that ridiculous? Didn’t we overreact?’ But in New Orleans, wouldn’t we have preferred an overreaction that built too many levees too tall, than doing nothing and allowing the city to be flooded?”