About: H1N1

The H1N1 Influenza: Pass on the caution, not the virus

In February 1918 several young men traveled from Haskell County, Kansas to begin their military training at Camp Funston, Kansas. At that time a “severe influenza” was raging in Haskell County and it is theorized that some of these young recruits may have already been infected with the causative virus. Within one week (which is the typical incubation period for the influenza virus) the hospital at Camp Funston began to receive its first few soldiers with influenza and within three weeks eleven hundred troops required hospitalization. During this period soldiers were freely moving between Camp Funston and other Army bases throughout the country and within a few more weeks two-thirds of the Army’s largest camps experienced influenza outbreaks which soon spread to adjacent cities. At first there was little concern about these outbreaks because the illness was generally mild and most troops and civilians eventually recovered. Many prominent physicians openly doubted that this illness was actually influenza as opposed to an influenza-like illness. The same illness had also broken out in military camps in Europe. Reassuringly, by August the illness was so effectively contained that a British medical journal reported that the influenza epidemic had “completely disappeared”. In the United States, the illness had also lessened and by late July a prominent medical bulletin had reported the “the epidemic is about to end”.

However, by mid-September the illness returned to US military installations with a vengeance. Sailors at naval yards in Boston and Philadelphia developed violent respiratory symptoms and they were dying horrible deaths. They bled from their nostrils as well as from their ears and they were coughing up blood. Unlike the traditional seasonal influenza which killed mainly the elderly and children while largely sparing healthy young adults, this respiratory illness showed no preferential favor upon the healthiest in society. Healthy young adults were succumbing to the illness in unprecedented numbers. The illness also had no respect for geographic borders and it soon spread worldwide despite much effort to contain it. The well renowned physician/scientist Paul Lewis was commissioned by the Navy to study this devastating illness. Approximately ten years earlier (i.e. at the turn of the 20th century), Dr. Lewis had proved that a virus was the cause of polio and he later developed a vaccine to protect against polio. Dr. Lewis knew that the pathogen now causing illness among the sailors was much more virulent and deadly than the polio virus. He was working against time and, in part, had to abandon the long, laborious process of scientific investigation. Instead, he largely went by his hunches and guessed that the causative pathogen was a virus. He, of course, turned out to be correct. The influenza pandemic of 1918 was caused by a subtype of the influenza A virus. By the time the influenza pandemic faded away in 1920 it had killed millions of people worldwide. The most respectable estimate is that there were between fifty million to one hundred million deaths. To date, this illness, which is believed to have originated in the United States, has remained the deadliest pandemic in human history.

Is history about to repeat itself? Fast forward 91 years from 1918. In April 2009 the world began to hear reports of a novel (new) influenza A virus. The virus is believed to have originated in Mexico and because the pig serves as a natural host for it, the resulting human respiratory illness was called the Swine Flu. The proper name however is the H1N1 Influenza A virus and the respiratory illness is therefore the H1N1 influenza. The virus soon surfaced in the United States and scientists immediately became concerned about the rapidity with which this virus simultaneously spread throughout the US and across international borders. The entire world had a front row seat as the geographic containment of the virus rapidly became nonexistent. We all watched as the spread of the virus went through various levels of alert until the influenza was finally declared to have spread worldwide and therefore, by definition, it had become a pandemic. Just as alarming as the rapid spread of the virus is the fact that it is killing healthy young adults who have very robust immune systems. These two alarming events are eerily similar to the nature of the 1918 pandemic. Thus far, the fatality rate is relatively low, but so too was the initial fatality rate of the 1918 pandemic. The scientific community, as well as the world at large, is nervously waiting to see if this 2009 H1N1 influenza pandemic would now come on with the same deadly vengeance as previously seen in 1918. Should this happen, it is estimated the virus would cause 200 thousand deaths in the United States and a total of 2 million deaths throughout the world.

What can we do to protect ourselves and others? Well, the guidelines are everywhere. For example you can find them on the internet @flu.gov or cdc.gov as well as at many other websites. Your local health department is also a resource you can access. The H1N1 influenza is spread primarily by respiratory droplets. Therefore the guidelines for protection boil down to the same common-sense practices we should all adhere to during the traditional flu season. We should all cover our coughs; sneeze into the bend of our elbows or into facial (Kleenex) tissue rather than into our hands; wash our hands frequently; use paper towels when turning the water on and off; use a facial tissue only once and then discard it; avoid rubbing our eyes, nostrils and mouth; get vaccinated against the seasonal influenza and against the H1N1 influenza unless there is a medical contradiction why you should not; wear a mask when appropriate; and avoid close, prolonged contact with those who have the flu. In addition to being aware of these preventive measures, we must also be able to recognize the signs and symptoms of the flu. They include the abrupt onset of fever, chills, headaches, sore throat, a dry cough, runny nose, muscle ache, eye pain and fatigue. When these symptoms occur it is important that you stay away from work and immediately contact your doctor’s office for further instructions. This immediate contact with your doctor’s office is important because if you are prescribed the appropriate medications at the very onset of your symptoms, then the duration and severity of your illness are both likely to be less than if treatment is delayed. If you should remain sick for more than 7 to 10 days, then you should be seen by your doctor to make sure you haven’t developed a pneumonia.

I hope this article has served to heighten your awareness of the possibility that the current H1N1 influenza A pandemic could soon turn much worse. Historically, mankind has been experiencing three influenza pandemics per century (or one approximately every 30 years). The last pandemic was the Hong Kong flu in 1968, so for the past several years experts have been predicting we were overdue. Well the pandemic is now here and it is incumbent upon all of us to take necessary preventive measures to help limit its spread and potentially deadly toll. The fact that America’s best known physician, Dr. Sanja Gupta of CNN, recently contracted the illness while on assignment in Afghanistan tells us that we are all very susceptible to infection with the H1N1 virus. We must therefore plan for the worse while hoping for a much lesser catastrophe than anticipated. Be cautious and share your knowledge of this threat with everyone in your circle of life. And please, pass on the caution and not the virus.

My source for the historical data in this article is a book entitled The Great Influenza by John M. Barry.

Author: Ian Johnson, M.D.
H.A.L.O. Medical Director