H1N1 flu is here: winter worries

As published in MapleLine Magazine: Nov.4, 2009

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by Rebecca Brooke, B.Sc.

The H1N1 flu virus (also known as human swine influenza) is a new strain that emerged in April 2009 which is different from seasonal flu, and it's a hot topic.

Some years have a worse flu season than others, but this year is not automatically the year for a feared flu pandemic. Intensified concern about H1N1 has been media-amplified and politically driven.

Virulence, or the damaging nature of a virus, is a measure of how many infected persons experience symptoms and how many die. In Canada to date (Oct.15/09) there have been 80 deaths (seven of those in BC) due to H1N1. This tally differs little from the usual annual flu season, however over 50% of those who have died from H1N1 had underlying respiratory disease. Those with suppressed immune systems – the very young, the elderly, pregnant women, those undergoing chemotherapy, and those with HIV – are at a greater risk of complications from both annual flu strains and H1N1.

Usually viruses that jump the species barrier, or zoonoses, make people sicker because the viruses are not well adapted to the new host; a well-adapted virus doesn’t cause much or any harm. We carry thousands of viruses that scientists have yet to discover; many such viruses are so well adapted we don’t notice them. Some are essential to normal health as we’ve co-evolved with them for millennia. H1N1 fortunately doesn’t make people as sick as other zoonoses but random mutation can cause the virus to make people sicker. However, increased mutation is possible with all viruses. H1N1 has no greater likelihood to mutate than other viruses.

Could the two flu strains together make flu season worse? About 3,000 people in Canada die every year from influenza. This year that figure will likely jump by a few hundred people due to H1N1 flu. Individuals infected with both viruses might have a more difficult time fighting the viruses, but it will be the same people with suppressed immune systems who are at risk. This virus does not pose the threat that we think it does. New viruses are scary. Remembering the SARS outbreak certainly impacts how people react to new emerging viruses but when news coverage tips toward sensationalism it’s not helpful to public health management. Thankfully the media has been helpful in promoting frequent hand washing, sneezing away from others (and into a sleeve), and staying home from work or school if ill.

Public concern has caused governments to act yet the government’s delay in purchasing vaccines was criticized by the federal opposition (a trend seen in many countries). No government wants to be blamed for insufficient action on H1N1 influenza but the costs and benefits of preventing H1N1 flu are not clear. Vaccination protects those who receive the vaccine and prevents spread to others by producing immunity. Stopping transmission protects those who did not respond to the vaccine or did not receive the vaccine for health reasons. However, the possibility of spread through the general population is low compared to normal flu because the number of cases is so small, and may not warrant mass vaccination.

Better to be safe than sorry? It’s not that simple. Together the federal and provincial governments are planning to purchase 50 million vaccine doses (note: total Canadian population 33.5 million in Jan.2009) at a total cost of over $400 million dollars; the BC government allocated $80 million for this in its recent budget. This is money that is not going to other programs. In public health policy decisions of this nature there is always the need to examine where money is not being spent. For the sake of debate, H1N1 vaccine will save lives but health expenditures elsewhere might be more efficient at saving and improving lives. It’s clearly beneficial to purchase vaccines for those at risk, but vaccinating the entire population is a bad decision driven by politics and the media in response to a frightened public.

It’s less costly and far more effective to stay home when feeling ill, to maintain a strong immune system, and wash your hands. MM

Rebecca Brooke, B.Sc. (Microbiology) is now taking her Masters in Political Science at UBC.

See definition of immunocomprised, from the Vancouver Island Health Authority website.

This article was first published on page 18 in MapleLine Magazine (Holiday 2009 issue / No.09-Jan.10).

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