Guest Post: Swine flu has “pandemic potential”

By Suchita S, (cross-posted from University and State)

The recent outbreak of swine flu in Mexico and now California, Texas, and New York City (…!) is definitely an epidemic, though it is not yet that pandemic flu that public health officials have been fearing for years. But, like the World Health Organization has noted, it has the potential of becoming pandemic.

Unlike the “normal” flu which is particularly dangerous usually only to the elderly, children, and the immunocompromised, this strain of swine flu has been killing otherwise healthy people in their prime of life, in their 30s and 40s.

A quick intro to swine flu, courtesy KevinMD:

Symptoms of swine flu are similar to those of regular influenza, and can include fever, cough, sore throat, chills, fatigue and body aches. Gastrointestinal symptoms like vomiting and diarrhea can be present as well. The diagnosis is made by analyzing a respiratory specimen, which is generally collected within 4 to 5 days after the onset of illness.

And no, you cannot get swine flu from eating or preparing pork.

What has escalated fears in recent days is the fact that this virus, which is generally transmitted from swine to humans who have close contact with them, has now been found to spread via human-to-human interaction. (As of now, President Obama appears to be swine-flu-free after his recent trip to Mexico, where he greeted someone who has since died of the disease.) It echoes of Andrew Speaker with his MDR-TB; seal an infected individual into an airplane for an international flight and there’s your pandemic. And its a lot more difficult to quarantine exposed humans than it is to eradicate an infected herd of swine.

And therein lies the classic public health tradeoff: individual rights vs. the benefit of the community. Mexico has decided to play it safe and protect the community:

President Felipe Calderón published an order that would give his government emergency powers to address a deadly flu outbreak, including isolating those who have contracted the virus, inspecting the homes of affected people and ordering the cancellation of public events. …

The government encouraged people to stay at home by canceling concerts, closing museums and banning spectators from two big soccer matches on Sunday that will be played in front of television cameras, but no live crowd.

What level of severity would the pandemic threat need to be for measures like this to be enacted in the United States? Does President Obama have this power? Would Americans accept curfews or home inspections?

As I ponder this, I’m comforted by the quick response by the CDC and the WHO so far. The WHO had an emergency committee meeting today to coordinate international efforts to contain the virus. The CDC has been constantly updating its Morbidity and Mortality Weekly Report with detailed reports of the cases in California and Texas, and I’m betting something from the NYC - Queens cases will arrive in my Google Reader no later than Monday (yes, I do subscribe to the RSS feed…). The CDC is even Twittering its updates - talk about public health 2.0 (though I wonder who actually follows the CDC on Twitter).

Are the hospitals ready, though? Thankfully, this isn’t like SARS, where no one really knew what we were dealing with. Nationwide, there has been organization over the past decade or so in preparation for a major flu pandemic, what public health officials predict will be deadlier than the 1918 Spanish Flu outbreak. We discussed this in Prof. Judith Leavitt’s public health history course at UW-Madison; she indicated that, if (when?) a pandemic like that does occur, hospitals and clinics may not be able to handle the sudden influx of patients needing ventilators and isolation rooms with negative air pressure, etc. Hospitals today are not built for treating massive quantities of infectious diseases. They’re reflective of chronic sicknesses of current society, not the pre-immunization-era illnesses. It makes financial and operational sense, but it may come back to haunt us.

One thing that the government/CDC is doing towards immediate preparation is working with a pharmaceutical company to create, manufacture, and distribute a vaccine for this particular strain of swine flu. But that’s not going to happen overnight. It will definitely take months if not a couple years. However, the US has been stockpiling flu drugs since 2005, including Tamiflu, which appears to be effective (so far) against this new swine flu strain.

It might be a good idea to buy stock in Roche on Monday morning. And to wash your hands.
A special thanks to Suchita, a Columbia med. student and friend of the blog.