On May 2, 2009, the Wall Street Journal (WSJ) published an opinion piece by Peter Palese MD, Professor & Chair Microbiology and Professor Medicine, Infectious Diseases at Mount Sinai on why swine flu is not that scary. His opinion is likely to make many feel better about our current threat. He is highly respected is his field. Here is a summary.

Concerns About The New H1N1 Viruses

  1. The swine virus belongs to the same H1N1 family the 1918 pandemic virus.
  2. The swine virus is readily transmitted from human-to-human and has already been reported on four continents. Conversely the avian H5N1 virus has not adapted to readily transmit from human-to-human.
  3. The swine virus shows an unusual hardiness for occurring outside the normal seasonal period for the virus.
  4. Viral changes or gene mutations derived from other human or animal influenza viruses could make the swine virus into something much more virulent than it is now. This is a natural process for influenza viruses against which there are no human interventions and can’t be predicted.

Why We Should Be Optimistic

  1. 1. In 1976 the infamous outbreak of an H1N1 swine virus on Fort Dix, New Jersey, showed human-to-human transmission but did become a highly virulent pandemic strain.
  2. The presently circulating H1N1 is most likely not more virulent than the other seasonal strains we have experienced over the last several years.
  3. The H1N1 lacks an important molecular signature (the protein PB1-F2) which was present in the 1918 virus and in the highly lethal H5N1 chicken viruses. If this virulence marker is required for an influenza virus to become highly pathogenic in humans or in chickens, then the current swine virus doesn’t have what it takes currently to become a big killer.
  4. Since people have been exposed to H1N1 viruses over many decades, we likely have some cross-reactive immunity against the swine H1N1 virus. While it may not be sufficient to prevent becoming ill, it may very well dampen the impact of the virus on deaths. A possible outcome is that the current swine virus will become another strain of regular seasonal flu.
  5. Vaccines and anti-viral drugs has dramatically improved over what it was just a few years ago. Based on what we know of the swine virus, these drugs and vaccines (modified to include the swine strain) would be highly effective against this new virus.
  6. We have a vastly improved infrastructure to deal with novel emerging diseases including improved overall surveillance.
  7. Major advances have been initiated by our government to develop new and improved manufacturing processes and exciting new vaccine and antiviral approaches are in the pipeline.

He ends by saying that it is prudent to prepare against swine influenza, but equally important to keep a balanced outlook and an awareness of our current capabilities.

There is conflicting information on how to proceed…do everything, do less, do little, do nothing.   It is difficult to know what is the best course of action.  You will likely be judged harshly if you fail to adequately prepare.   Be reasonable in your approach and know that 85% of a good pandemic plan will help in any emergency.

Resource Wall Street Journal – May 2, 2009