In the spring of I collapsed at a college debating tournament dinner and soon found myself in quarantine in Guelph, Ontario. Collapsing with a cough and fever is worrisome at any time. It was particularly troubling to me and to the intake nurse who whisked me into an isolated room because at the time I was living in Toronto, which was then one of several cities internationally caught in the grip of a frightening new respiratory disease.
Other patients weren't so lucky.
Worldwide, SARS killed an estimated of the 8, people infected, a fatality rate of 9. The world, all things considered, was fortunate.
While those deaths were tragic, they were a fraction of what was feared. The signs in had been ominous for those familiar with medical history. SARS produced pneumonia in otherwise healthy adults, turning them blue before leaving them to drown in their own lung fluids. The threat of a pandemic felt very real. Although SARS is a different type of virus, such frightening symptoms brought to mind one of the greatest public health nightmares of the twentieth century: the influenza pandemic of , the most widespread and fatal in recorded history.
That pandemic of the influenza A virus killed anywhere from 50 to million people worldwide, many of whom were young and healthy before being stricken. It caused widespread social and economic upheaval, and SARS looked poised to potentially do the same. In the end, SARS was not contagious enough to cause such widespread devastation. Yet, since the SARS outbreak, the world has remained on high alert, watching nervously for a new pandemic, whether flu or some other respiratory disease.
The Influenza Epidemic of 1918
Beginning in , Asian "Bird Flu," H5N1, a deadly form of influenza, attracted much anxious attention. But, as we soon learned, the concern was misdirected. The next pandemic came not from birds but from swine and, for Americans, from much closer to home. In spring of , reports of a particularly deadly form of influenza A—H1N1—began appearing in Mexico and the American southwest.
By June, the World Health Organization announced that the disease had spread widely enough to be considered pandemic. The virus spread globally, peaking, it seems, in the later months of and causing over 14, deaths worldwide. What the world dodged in with SARS it could not in Pandemic influenza, a frequent visitor in the past, was back again.
As the threat of the H1N1 virus began to fade for this year at least , the world breathed a sigh of relief that we had avoided a repeat of Yet, people around the globe continue to worry and wonder how best to prepare for, perhaps even prevent, the next pandemic. The viruses that affect humans come in many types, and their impact on human communities varies considerably according to the qualities of a particular virus—how contagious and how virulent or fatal—and the ways that human societies act or structure themselves that facilitate or block a virus's spread.
SARS and influenza hold a special place in pandemic planning because, like any airborne virus, they can be caught from casual contact: from a sneeze on a bus, a dirty door handle, or a shared water fountain. Although viruses such as Ebola—which causes bleeding from the eyes, mouth, and organs—are deadlier, they require more direct contact to be transmitted and, with proper local quarantines, usually burn themselves out before they can spread.
HIV, however, is more difficult to transmit than airborne influenza or SARS, and requires different community-based initiatives for its treatment and prevention.
The stigma that has long been associated with HIV has also allowed many to ignore the disease at their peril as one that happens to other people. While diseases such as HIV and Ebola brought viruses back into the consciousness of the Western public, long accustomed to the safety afforded by antibiotics and vaccines, they represent a different public health danger than influenza and SARS.
Influenza is one of humanity's most persistent and constant foes—many will get sick each year with some form of flu, some of them will die—but only every so often does a pandemic occur. While it is impossible to prevent influenza, today we are working to reduce the chance of a pandemic and we are learning how to respond more efficiently to pandemics when they hit to avoid mass fatalities.
Influenza, unlike some epidemic diseases, has no magic bullet. As a virus, it is impervious to antibiotics. Anti-virals can help, but they do not cure. So influenza, like many viral illnesses, requires an array of strategies to deal with infection and containment. And it requires no small amount of luck. A century of advancing medical science has given humanity a variety of new weapons to fight the spread of influenza.
But each has its limitations.
Questions and answers on influenza pandemics
Going forward, to minimize or avoid the next pandemic, humans need to understand fully the patterns of human and viral behavior, and to look not only to cataclysmic pandemics like for lessons but also to the less spectacular flu pandemics that have dotted the landscape of the twentieth century. Influenza is a perpetual scourge. Even though its fatality rate is relatively low typically 0.
Once a vaccine becomes available, certain individuals and groups will be vaccinated first. If mass vaccination clinics become available in your community, be prepared to provide medical information about your family. In addition to vaccinations , you can take other prevention steps like these:. If human infection of swine flu is confirmed in a community and you develop flu symptoms :. It uses a ratio to estimate the number of expected deaths. Similar to preparing for a hurricane, this index helps communities with pandemic preparedness and planning.
If available, prescription antiviral drugs may help with both treatment and prevention of influenza. These may come in a pill, liquid, or inhaled form. Five influenza antiviral drugs are approved in the United States.
Pandemic Influenza (Flu)
The ones currently recommended are:. If you are already sick and it has been less than 48 hours since the onset of symptoms, an antiviral drug may help by:. A pandemic causes economic and social disruption due to high rates of illness and worker absenteeism. This is especially true if absenteeism affects key services such as transportation, communication, or power. For more information on influenza pandemic preparedness, go to the federal government's flu website.
What is the pandemic (H1N1) 2009 virus?
Epidemics, Pandemics, and Outbreaks When is a disease outbreak a concern? What is a disease outbreak? What is an epidemic? What is a pandemic? Spanish influenza killed million people in Asian influenza killed 2 million people in Hong Kong influenza killed 1 million people in An influenza pandemic occurs when: A new subtype of virus arises.
This means humans have little or no immunity to it. Everyone is at risk. The virus spreads easily from person to person, such as through sneezing or coughing.
The virus begins to cause serious illness worldwide. With past flu pandemics, the virus reached all parts of the globe within six to nine months.
Like all vaccines, rare events may occur in some rare cases for example, swelling, weakness , or shortness of breath. If any symptoms like these develop, see a physician immediately. Several antiviral agents have been reported to help prevent or reduce the effects of swine flu. The most used are zanamivir Relenza and oseltamivir Tamiflu , both of which are also used to prevent or reduce influenza A and B symptoms. These drugs should not be used indiscriminately, because viral resistance to them can and has occurred.
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Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the hour guideline. The CDC has suggested in their guidelines that pregnant females can be treated with the two antiviral agents.
Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection. Two other new antiviral drugs Rapivab and Xofluza may also be used under certain conditions. Some researchers suggest the data on Tamiflu and Relenza is not correct and suggest the antivirals are not effective. On Dec. It is approved for use in the following settings:. Another new drug, baloxavir marboxil Xofluza , is an oral antiviral approved in for use in children 12 years and older.
What is the history of swine flu in humans? In , there was an outbreak of swine flu at Fort Dix. This virus was not the same as the H1N1 outbreak, but it was similar insofar as it was an influenza A virus that had similarities to the swine flu virus. There was one death at Fort Dix.