Swine Influenza: The Next Pandemic?

Although I am making a career out of security, there are many different kinds of security. Cyber security comes as a consequence of our growing technological world. There are military security concerns, food security concerns, drug trafficking and crime concerns...and then there is health security.

The Associated Press and the New York Times have been reporting on the new cases of Swine Influenza A (H1N1) that have been emerging in the United States. As of 4:30 pm on Saturday (April 25), the AP has reported 9 confirmed cases of Swine Flu in Texas and California, two cases in Kansas, and eight possible cases in New York (students who recently travelled to Mexico), which won't be confirmed until tomorrow. The Center for Disease Control in the US has only reported 8 confirmed cases, however [EDIT - CDC updated to reflect 11 cases around 10pm]. All the US cases reported have been mild, including the eight suspected cases, and nobody has died in the US so far. [EDIT - 200 students at the NYC school have reported feeling ill, although only 8 are suspected to have the H1N1 Swine flu]

Mexico, however, is having a much different story. The new strain identified has killed over 60 people so far and sickened more than 1,000 across the country. Mexico City has issued reports encouraging people feeling ill to stay home, and has cancelled all large gatherings and public events. Schools are closed as well in an attempt to contain the outbreak. The WHO has warned that the strain has "pandemic potential" and both WHO and CDC medical experts have said if this is the strain that will cause the next pandemic, it is now too late to contain the outbreak. Even still, both Mexico and the US say that the situation is under control and are not worried. The virus is so far treatable with antivirals Tamiflu and Relenza, but CDC reports it is resistant to amantadine and rimantadine.

The World Health Organization held an emergency committee today to discuss the situation, and reports "After reviewing available data on the current situation, Committee members identified a number of gaps in knowledge about the clinical features, epidemiology, and virology of reported cases and the appropriate responses. " In response, the WHO has discussed moving the alert level from 3 to 4, (meaning that sustained human-to-human transmission of a new virus has been detected), which is higher than any alerts given to date, even for the H5N1 Avian Bird Flu. So far, they have not and the alert remains at 3.

The main cause for concern is that this new strain contains "gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu," according to the CDC. What brings attention to this new influenza are the key concerns for the Avian Bird Flu. Scientists have been warning for years that the next pandemic will most likely occur with an influenza strain that is a mix of animal and human strains that then mutates to form an infection that is no longer animal-to-human, but human-to-human. In addition, pandemics often hit young, healthy individuals hardest, unlike normal seasonal flus that strike infants and the elderly. According to Dr. Moscona, "The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs." This does not mean that the elderly and infants are not at risk. In truth, they will still suffer the burden of the disease.

So what does all of this mean? Is there a pandemic? No, there is currently no pandemic. A pandemic flu occurs when a "virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person." That is not what is currently going on. The cases have been limited to Mexico and only a very small number of mild cases have been reported in the US. Even still, the situation bears watching. Because of the ease of mass migration and travel, illnesses spread rapidly and are not containable unless isolated in a small community.

If the situation does develop into a pandemic, judging from prior pandemics, 30% of the global population will likely be infected. In other words, roughly 2 billion people will be infected over the course of the disease, which is usually about six weeks. The WHO estimates conservatively that 2 million to 7.4 million people would likely die from a pandemic (globally), although this is mere speculation since an accurate estimate cannot be given until a strain is properly identified. The swine flu outbreak is currently treatable, which will likely ease the situation in the long term. This estimate is based primarily on the 1957 "Asian influenza" in which 2 million died (remember travel was not so easy in comparison to today), although the 1918 "Spanish influenza" killed an estimated 40 to 50 million people worldwide, which was 2% of the global population at the time (though this was definitely an exception). Given the ease of travel, however, it is likely all continents would be infected within three months. In addition, pandemics often occur in waves, so even once a country moves into recovery, there is a high chance it will become reinfected at least two or three times before the disease finally runs its course. For the US, it is estimated that 90 million will likely be infected (30%), with 200 thousand deaths (about .07% of the US population).

The biggest dilemma that occurs during any substantial illness is absenteeism, meaning that people do not show up for work. This has a huge impact economically, and also socially. At peak times, this number exceeds the amount of people infected, probably around 40%. In most cases, infected individuals are asked to remain home, and in other cases, healthy people have to stay home to care for ill family members. This only gets worse when schools and day care centers close, since now young, healthy parents have to stay home to care for children. The most at risk are health care workers, who are typically most likely to succumb to infection during peak times after lengthy exposure. In addition to health care systems being affected, infrastructure will be disrupted as well, meaning that production and supply chains will be broken or slowed, reducing the availability of goods and services. The drop in consumer consumption and investment activity will impact the global economy as well, and some banks estimate a 5% drop in overall real GDP. To offset the consequences of absenteeism and demand reduction, many businesses and governments have made continuity plans (BCPs) over the last eight years as the WHO began monitoring the H5N1 virus in anticipation of another pandemic. Countries that experienced the SARS outbreaks a couple years ago, and countries with complex financial systems, are by far the most prepared in terms of BCPs.

Overall, a pandemic is a scary scary thing. It is something we worry about in the back of our minds, but don't really think about. We assume that the worst case will be something like a cold, where we sneeze and cough and then get better. We don't think about the true effects, where people are afraid to shake someone's hand, where a sneeze on the metro makes everyone get off a stop early, and our lives become disrupted, such as when an event we've been looking forward to for months gets canceled. We don't think about the fact that we shouldn't eat in restaurants because our food might be prepared by someone sick, who might be too financially burdened to take a few days off work. We don't think about contaminated doorknobs, the burden of who will watch our children, and if our grocery store will be restocked in three days like it is supposed to be. Most importantly, we don't think about the people we may lose. There are true consequences to a large pandemic, the effects of which we can't even imagine in our global, transnationally connected world. Almost 3,000 people died in the September 11, 2001, terrorists attacks. Almost everyone in the US knows of somebody who was affected. Imagine now, 200 thousand people dead in the US alone, not to mention the deaths in the rest of the world.

Even if this new strain of influenza is not the beginning of the next pandemic, be mindful of the consequences it is already having. 68 people have paid the ultimate price in Mexico already, and an entire city is feeling the effects of what could be. Respect what they are going through, and put yourself in their place. In times of tragedy and suffering, the truly brave step forward. The worst of humanity comes out, but so does the best. If your neighbor is sick, don't be afraid to go to the store to buy them clean water, tissues, and canned soup just because you might get sick. The rules of pandemics are the same for any other illness. Be courteous and considerate, mindful that your friends might now be feeling well. Stay hydrated and eat fruits and vegtables. Wash your hands and cover your mouth when you sneeze. Take personal responsibility for your health. A pandemic might not be starting today, tomorrow or even for years to come, but be ready, and play nice if and when it does come.