by Rob Lamberts, MD
I’m Dr. Rob, and this is part two of my series on influenza. My previous podcast covered the basics about the infection; in this episode I’ll focus on the H1N1 (or swine flu) version of the virus.
And I think life wouldn’t be complete without my disclaimer. So here it is:
This podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of that weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor. He or she is the one you should always consult for your own medical conditions.
What is Swine Flu?
So let’s get back to swine flu, or swan flu as they say here in the Deep South. There is a lot of confusion and misinformation regarding this virus. Let me clear up some of these myths:
You don’t get this type of flu from eating pork (or swans, for that matter)
Your pet pig Fluffy is not in grave danger; and please don’t bring your pig to your doctor’s office. We don’t treat pigs.
To avoid this confusion, I will call it H1N1 and explain later why it is sometimes called swine flu.
Why is the H1N1 (Swine Flu) Virus So Dangerous?
So what’s the deal? Some folks are talking about H1N1 like it is the Black Death, while others think the dire predictions are a bunch of hooey. One of the main take-home messages of my last podcast was that the regular yearly flu is dangerous, killing 30,000 people in the US every year. The most recent estimates I have read have speculated that H1N1 in its current form could kill between 30 and 90 thousand Americans. Let me put these numbers into perspective: prostate cancer kills 27,000 men each year in the US, and breast cancer kills 41,000 women.
What is it that makes this virus so bad? In my last podcast, I talked about the two forms of influenza, A and B. H1N1 is in the influenza A family, which is the worse of the normal flu strains. A is worse because it can change more and fool the immune system better than B.
The A virus can also infect animals, which is a very important fact. While in animals, the virus can change outside of the watchful eye of the human immune system. When the animal-infecting variety then combines with a human strain (which viruses can do), it can form a virus that is very different from the usual A strains. Many of these new viruses from animals infect a person but still can’t be transmitted from one person to another. But occasionally an animal-associated virus not only infects people, but also is transmissible from one person to another. When that happens, it can cause a pandemic.
The current H1N1 strain came initially from pigs, so that is why it is called the swine flu.
Epidemic Vs. Pandemic
So what’s the difference between an epidemic and a pandemic? Let me roll-play and pretend I am Grammar Girl for a bit. The word epidemic comes from the Greek epi, which means “upon,” and demos, which means “the people.” So an epidemic is something that happens “upon the people.” The Greek prefix pan, on the other hand, means “all.” So a pandemic is something that happens to “all of the people.”
OK, now back to Dr. Rob.
Why is the Swine Flu Called the H1N1 Virus?
The reason pandemics are so bad is because the virus undergoes a radical shift to its antigens, and so is very unfamiliar to the immune system. Epidemic strains are similar enough to previous strains that our bodies usually recognize them sooner and prevent more serious illness. The two main antigens on the surface of influenza A are called hemagglutinin and neuraminidase, but since it’s impossible to say these words without spitting and so spread the virus, they are shortened to H and N. Both of these antigens are type 1 in the current outbreak, so it is called the H1N1 virus.
With such a big shift to the antigens, the virus not only causes more severe disease, it also infects a much bigger percent of the population. So an already dangerous virus is made more dangerous and infects more people. I have recently read estimates that half of the US population will be infected, with 1/3 of those having symptoms. That’s a lot of people infected with a potentially deadly virus. This has scientists nervous. The 1918 virus killed between 20 and 100 million people.
The Good News
The good news is that this is not 1918. So far, the virus hasn’t been all that bad, although there is still a chance it can mutate and get much worse. We also have much better ways to fight this possible threat, through the use of communication tools (like podcasts), drug treatments, and prevention via immunization.
Immunization basically shows your immune system what the virus looks like without causing you to get sick. Then when the body is exposed to the real virus, the antibodies and white blood cells subdue the virus and keep it from causing trouble.
Who Should Get the H1N1 Vaccine?
A vaccine against the H1N1 virus should be available around October of this year in the US and will be given separate from the normal influenza vaccine. As opposed to the yearly flu epidemic, the H1N1 hits younger people more than it does the elderly. So the following people should be the first get the H1N1 vaccine:
People between 6 months and 25 years of age (young children will get this in two separate shots about a month apart)
People caring for infants under 6 months of age.
Once these groups have been immunized, the rest of the public should be vaccinated. People 65 and older are at lower risk because they have lived long enough to already have antibodies against H1N1 in their system.
Additionally, high-risk people who aren’t immunized and come into immediate contact with the virus can be treated with preventive antiviral medication. This doesn’t however, replace the flu shot.
What Should You Do?
So, what should you be doing about the H1N1 threat?
My first advice is that contained on the front of The Hitchhiker’s Guide to the Galaxy: Don’t panic. Most people infected with the virus don’t end up on death’s door. Yes, the possible threat is big and the consequences bad, but the best way to save the most lives is for us to keep cool and work together.
The second thing I would recommend is to stay informed. Don’t get all your information from the TV morning shows or the evening news, as they tend to get medical facts wrong. Instead go to the CDC website-- specifically go to www.cdc.gov/h1n1flu for accurate and up-to-date information. Other reputable websites like WebMD and MedPage Today are also good places to find information.
Make sure others stay informed as well. Share this podcast and any other information sources with your friends and family. An educated and informed public is by far the best defense we have against this potential threat.
Quick and Dirty Tips for the H1N1 Virus
Here are my tips to keep you and your family healthy:
1. Get vaccinated if it is appropriate. People who are not at high risk should let others who are have first dibs on the vaccine.
2. During significant outbreaks, isolate from others as directed by the authorities. They may close schools and places of business if the virus is bad. Listen for direction from the proper authorities.
3. Observe good hygiene. Washing your hands with soap or using hand sanitizer reduces the spread of the virus. Covering your cough with your arm will keep the virus for going into the air to infect others and will keep your hands clean. But if you do that, don’t go around touching people with the inside of your elbows.
4. If you or a loved one starts having flu symptoms, specifically: high fever, body aches, headache, and cough, seek medical attention immediately. Many of the treatments are only effective if given in the first few days.
5. Follow the rules. If you are not in a high-risk group, don’t demand vaccine or antiviral treatment. We all need to work together, and someone who is lower-risk getting the vaccine or antiviral medicine may put someone else’s life in serious danger.
6. Look out for scams. Like any tragedy, unscrupulous people will try to capitalize on the fear. Get your information and advice from trusted sources only.
Yes, this sounds scary. Think of it as a large hurricane forming in the gulf. You prepare for the worst-case and hope for the best. The best-case scenario is that our preparation will be unnecessary and this H1N1 ends up being a dud virus. The CDC is kind of in a no-win situation, because a low death rate (which is what they want) will draw them criticism, while a high death rate (which is what they are trying to prevent), will justify their concern. I think they are doing their best in this difficult situation.
Don’t panic, prepare for the worst, keep informed, get educated, and work together. This podcast should only be the start of that process. And please take advantage of the wonderful CDC website: http://cdc.gov/h1n1flu.
If you have topics you want me to cover in future podcasts, email me at firstname.lastname@example.org or tweet me at @houscalldoc. You can also find me on Facebook.
Catch you next time. Stay healthy!