Swine flu: still waiting for the Big One

Hey there, time traveller!
This article was published 25/2/2011 (3252 days ago), so information in it may no longer be current.

Keep the kids home from school — better yet, close all the schools — avoid public places, wear a mask and rubber gloves, keep away from Mexicans, throw out the pork chops, try not to breathe.

Two springs ago, on the 100th day of Barack Obama's presidency, we cowered in the East Room of the White House as pandemic and panic spread around the world.

"Wash your hands and cover your cough," the president advised us, taking on the role of national mother. He scared the press corps, as we scared everyone else.

It was a nervous hour, now all but forgotten. Swine flu, glibly nicknamed but clever, mobile and deadly, already had claimed hundreds of lives by the time the president spoke in 2009. There was, health officials warned, a real risk H1N1 influenza — the scientific name sounded more like a chess move than a latter-day Black Death — would decimate the human race, harvesting millions of souls irrespective of country, continent, health, wealth, age, race, or class.

But it didn't.

Two years later, I am in the office of one of America's most honoured and decorated medical leaders — Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, holder of the Presidential Medal of Freedom and the National Medal of Science — to ask a simple question: Why didn't we all die?

"Bottom line, it was luck," Dr. Fauci says. "We were lucky."

Anthony Fauci is a bright-eyed, unquenchably energetic son of Brooklyn; his father and my mother went to the same high school. Welcoming a visitor, he sprints to his computer and punches up a slide show: The H1N1 Vaccine Challenge. In 2009, Dr, Fauci explains, the swine flu strain wasn't identified as a threat until April; it began to spread rapidly from its Mexican nexus at the end of August.

"The flu came right at Labour Day, right when the kids were going back to school," the scientist says. "Late virus recognition, early flu season, greatly reduced time to formulate and perform clinical trials on a vaccine. A perfect storm."

"Actually," he smiles, "the PERFECT storm would have been a really virulent one that killed everybody."

At the time, swine flu was perfect enough.

"It was the deaths among children that were the anomaly," Dr. Fauci says. "We average from seven to 40,000 deaths a year from influenza in this country. The total in 2009 was about 12,000, so not far from the median.

"But there were disproportionately more deaths in children. Not a cataclysm, but two or three times more kids died than usually die."

"I saw three unbelievably tragic cases and I can't tell you how scared I was," Dr. Trish Perl, senior health system epidemiologist at the Johns Hopkins Hospital in Baltimore, tells me. "How often in the year 2009 or '10 or '11 do you see a healthy 30-year-old die within 24 hours of hitting our unit? As clinicians, we weren't used to seeing that.

"We activated the emergency system several times. I remember telling my staff, 'We have to sit back and realize that we're living history here.' "

The key word was "living." Even the clinicians who treated the most deadly cases didn't keel over and die.

"That's what is so interesting about flu," Dr. Perl says. "It's highly communicable, but if you don't get it, you don't get it."

(This also happens to be the advertising slogan of the Washington Post.)

"But if you don't get it, you're still not immune to it. It's a smart enough virus that it can morph in a subtle way and come back and get you the next year."

There are other threats. Bird flu, in Dr. Fauci's words, "smoulders and continues to smoulder." We don't hear much these days about SARS, but that could change tomorrow.

"What about H1N1?" I ask him

"Yes, we will see H1N1," he replies. "Yes, we will see deaths."

"It is a national tragedy that only 30 per cent of Americans are vaccinated against a preventable disease," says Trish Perl. "Did we beat this? No. We walked into this flu season with probably 40 per cent of people already having had it, and 60 per cent at risk. We've learned how to use the antiviral drugs we have better. Maybe that's why it wasn't the Big One."

 

Allen Abel is a Brooklyn-born

 

 

Canadian journalist based

 

 

in Washington, D.C.