H1N1 – the pandemic!...?
I am continually shocked at the general response of the public to the H1N1 virus. The World Health Organization is calling it a pandemic so everyone is in a flap. What no one really seems to know is why they are in a flap. A person can give you the five things they are doing to help prevent the flu – i.e. Hand-washing, anti-bacterial hand sanitizer, eschewing hand shaking, etc – and they are desperate to get the flu shot – but if you asked them what the difference was between H1N1 and the “seasonal flu” they would be hard pressed to tell you. Am I the only person who finds this a bit ridiculous? It is like being afraid of the bogeyman when you were five– you don't know what he was but you knew he would get you if the nightlight wasn't left on! The thing is we are not five anymore and surely we should be able to distinguish the difference between the real and the imagined. So why are we not doing our “due diligence” and discovering what the difference is and what it is we are actually afraid of.
The two key features that seem to be causing the most concern is that it is a pandemic and that the patients are not primarily among the elderly or ill. First, pandemic status. The H1N1 virus is a pandemic because it is found in a large number of countries – that is the World Health Organization's actual criteria – how many countries' have reported cases. Pandemic status does not necessarily reflect how severe nor how contagious the disease actually is. The WHO is classing the H1N1 flu as being of “moderate” severity which means that the majority of cases will resolve without medical intervention within a week. Yearly in British Columbia we see 400-800 deaths from the seasonal flu – mainly among the elderly – since April of 2009 we have only seen 12 deaths in BC from H1N1. In all but one case there have been underlying health issues.
Second, the unusual patient profile arises from the fact that a very similar strain of flu swept through the population in 1957 and has left those born before 1957 with a high degree of immunity to the H1N1. This type of radical change in the flu virus is a cyclical occurrence.
The issue of greater immunity is one that seems to be creating a great deal of consternation for a number of people. One, this means that the elderly, usually the highest risk population, are relatively safe. Two, it has created the differing profiles for the two flu shots we are seeing this year. As the elderly have protection from the H1N1 but not the other flu strains expected this year, they get first “shot” at the seasonal flu vaccine. The earlier vaccination for the elderly will also allow their generally slower immune response plenty of time to build up its defences from that seasonal flu. As the younger public are generally more healthy and less likely to get the flu period they are being given access to the H1N1 shot first, as that flu is expected to make significant impacts earlier in the year, and will have an opportunity to get the seasonal shot later on. The two shots are best done separately and the height of seasonal flu impact is not expected until later on so it is safer to delay that vaccination than the H1N1. The seasonal flu is also one that most of us have relatively high resistance to as it is very like last years seasonal flu, and the year before that, and the year before that, etc.
Some myth-busting – the reason everyone is getting the H1N1 diagnoses right now is that is what is out there. The seasonal flu isn't around yet so if you have the flu, you have H1N1. Why aren't they testing? Because it costs a lot to test every sniffle. You are better off staying home, assuming you have H1N1 than running around at the most contagious stage wait to hear results from a test to say you have it. The WHO actually recommends that areas with high incidence of the virus (which includes BC) stop testing in favour of concentrating resources on prevention and care for the very ill. Yes, children have died from H1N1 and that is tragic. There is also evidence that there have been underlying conditions that increased risk for those children. This is consistent with the information provided to the public by various health authorities and though extraordinarily sad is not a cause for huge concern unless your child has one of those underlying conditions. If you think you have and have had the H1N1 virus DO NOT GET THE H1N1 SHOT! You body is already producing the antibodies the vaccine is designed to provoke so leave that shot for someone else!
What everyone should be keeping in mind is that unless you have a cough and a high fever you do not have the flu. Aches and pains, headache and fatigue are other common symptoms. In the under five crowd fever may be reduced but the incidence of vomiting and diarrhoea is increased. Though a runny nose and sore throat may occur they are more common with colds and throat infections than flu. Unless you fall into one of the high risk categories – underlying health concerns, first nations ethnicity, second or third trimester of pregnancy or under five you have a very low risk of developing a severe case of H1N1. If you think you have H1N1 and fall into one of the high risk categories talk to your doctor about anti-viral medication for yourself and anyone in your household who may be at risk. Once you have the virus the vaccine is not useful! Do follow basic hygienic precautions, do get the H1N1 shot if you are in one of the at risk categories, do stay home if you think you are sick (save the rest of us!) and stay rested and well generally – but do not panic, no one is helped by that!
I have included a few links below to some sites I looked at and believe would be useful reading for those wishing to know more.
Health Canada's H1N1 information site
BC Ministry of Health Bulletin for October 27th, 2009
