| Health
Matters
H1N1—the
next great pandemic?
by Jill Fries
From an historical perspective, what occurred this spring and
into the summer is very similar to what occurred in Spring 1918,
although somewhat milder.
In late January and early February 1918, Loring Miner, physician
to the residents of Haskell County (Kansas) began seeing patient
after patient with influenza-like symptoms. However, in Miner’s
many years as a physician diagnosing influenza—this was different.
This influenza struck swiftly and the symptoms were violent. He
kept meticulous records and submitted warnings to the new National
Public Health System.
Then, in March 1918, Camp Funston, also located in Haskell County
(Kansas), a training ground for new recruits for World War I,
saw more than 1,100 soldiers needing hospitalization, thousands
more scattered across the base became ill in a three-week period.
“Only” thirty-eight deaths were recorded. From our perspective
today, this was considered the “index” cases or beginning
of the first mild wave of the Great 1918 Pandemic.
It continued to erupt at various Army camps and nearby cities
or towns as soldiers moved throughout the United States, Central
America, South America, Pacific Island Region and eventually Europe.
It seemed to disappear for a few months until September 1918,
when it erupted again at military bases on the East Coast of the
United States. Within a two-year period (1918-1920), at least
fifty million deaths were attributed to Pandemic Influenza; however,
given what epidemiologists know today, the total death rate more
likely was closer to 100 million.
What does H1N1 mean, several people have asked? The “H”
stands for “hemagglutinin,” which is like a spike protruding
on the outside of the virus cell that the virus cell uses to latch
onto a receptor cell when the virus collides with it. The “N”
stands for “neuraminidase,” which breaks up the sialic
acid remaining on the invaded cell’s surface.
This allows the new viruses that will burst from the invaded cell
to escape freely and invade another cell. Why do we not call H1N1
Swine Flu? So that people do not come under the mistaken impression
that they can contract this virus from eating pork or from contact
with pigs.
Science is advanced, our pharmaceuticals are better. There were
no antibiotics, antivirals or vaccines for influenza in 1918.
Our means of communication, the tools to track disease and research
laboratories are significantly more advanced than in 1918.
Will all these benefits help save us from disease and death when
the second, more deadly wave arrives in the Upper Peninsula? Is
it a given that a second more deadly wave will arrive? This is
when a crystal ball would be most helpful. In general, the influenza
virus, which is an RNA virus, is unpredictable.
The following passage from The Great Influenza by John M. Barry
sums up the influenza virus life cycle succinctly:
“DNA has a kind of built-in proofreading mechanism to cut
down on copying mistakes. RNA has no proofreading mechanism whatsoever,
no way to protect against mutation. So viruses that use RNA to
carry their genetic information mutate much faster—from 10,000
to one million times faster—than any DNA virus.
“A few mutate so rapidly that virologists consider them not
so much a population of copies of the same virus, as what they
call a ‘quasi species’ or a ‘mutant swarm.’
These mutant swarms contain trillions and trillions of closely
related—but different—viruses. Even the viruses produced
from a single cell will include many different versions of themselves,
and the swarm as a whole routinely will contain almost every possible
permutation of its genetic code.
“Most of these mutations interfere with the functioning of
the virus and will either destroy the virus outright or destroy
its ability to infect. But other mutations—sometimes in a
single base or a single letter in its genetic code—will allow
the virus to adapt rapidly to a new situation.
“It is this adaptability that explains why these quasi species,
these mutant swarms, can move rapidly back and forth between different
environments and develop extraordinarily rapid drug resistance.
As one investigator observed, the rapid mutation “confers
a certain randomness to the disease processes that accompany RNA
[viral] infections.
“Influenza is an RNA virus….Influenza can develop a
drug-resistant mutation within days. And the influenza virus reproduces
rapidly—therefore it adapts rapidly as well, often too rapidly
for the immune system to respond.”
Here are a few interesting facts regarding Pandemic Influenzas:
• People in the prime of their life with healthy immune
systems tend to have the highest mortality rate
• Thorough and regular hand washing still is one of
the best ways to prevent transmission
• Influenza virus can survive on hard surfaces from
two to eight hours
• Current H1N1 could reassert with seasonal flu or the
“bird flu” (H5N1), potentially making it more lethal
• People older than seventy generally have shown some
immunity to H1N1.
The following table, adapted from the August 17 issue of Time,
shows one of the particular differences between Seasonal Influenza
versus Pandemic Influenza—in this case H1N1. Below are the
percentages of hospitalizations of those infected with H1N1 as
reported to the Centers for Disease Control and Prevention from
April 15 through June 30, 2009.
My personal philosophy has been “Prepare for the worst, and
hope for the best.” I cannot predict the future, nor can
I control how H1N1 will mutate or progress. What I can do is prepare
my own household—which I have done. I have strongly encouraged
every person who has attended one of the many community seasonal
flu clinics in the last five years that the Marquette County Health
Department recommends stockpiling food and any prescribed maintenance
medication in the event the household needs to isolate.
This is what our community can do:
• Practice good personal hygiene and teach everyone
in your household the same.
• Stockpile enough nonperishable food for all household
members for a minimum of two weeks (longer is preferable).
• Prepare a household emergency plan.
• Learn how to care for ill household members and know
when it is necessary to seek hospital care.
• If you or a household member becomes ill, stay at
home.
• Get to know your neighbors:
Do you know if your neighbor has family that can care for them
if necessary?
What if you or your neighbor becomes too ill to care for themselves
or pets?
Find out who the emergency contacts are for your neighbors—in
the event they become too ill to make the contact themselves.
The Marquette County Health Department has tools to assist households
at www.mqthealth.org
If you have questions on how to prepare your household, call the
Emergency Preparedness Office at 475-5649.
To help encourage Marquette County Citizens in stock piling nonperishable
food items, the following grocery stores have agreed to hold weekly
or biweekly specials:
• Econo Foods, 1401 O’Dovero Drive, Marquette,
226-3500
• Farmer Q’s, 219 West Washington Street, Marquette,
228-2004
• Jim’s Jubilee Foods, 900 US-41 West, Ishpeming,
486-4900
• Marquette Food Co-op, 109 West Baraga Avenue, Marquette,
225-0671
Marquette County Health Department wants to encourage citizens
to patronize these locations and take advantage of the specials
they will be offering.
—Jill Fries
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