THIS CHANGES EVERYTHING

SAT MAY 2 - 7:00 AM. (Updated 5/3/09) Whether this virus produces a pandemic occurs or not, the genetic material of 2009 H1N1 will eventually join the flu cocktails that routinely traverse the globe during seasonal influenza. While it may be good news in the short term that this flu causes just "mild cases," some infectious disease experts such as Dr. Michael Osterholm from the University of Minnesota view that data in a different light. Consider listening to this 4/30/09 interiew with him conducted by Minnesota Public Radio.

The unnerving part of how this virus performs is very similar to what happened in the spring and summer of 1918. You might cry foul with that idea, claiming: "What about technology and advances in modern medicine, surely we can do better than relying on data almost a century old?" To that I would respond by echoing what epidemiologists have said for years: The key to to understanding the next influenza pandemic is to study every available aspect of past ones. The situation now closely resembles that of the Spanish Flu and the Hong Kong Flu of 1968: A "herald wave" of a highly transmissible virus with low lethality. This enabled those viruses to spread quickly, infect a high number of hosts, and provide astronomical opportunities for antigenic shift, or reassortment of the recombinant DNA into another new novel strain.

What disease researchers hope will not happen is H1N1 infects a host (whether human, pig or bird) which has or may catch a pre-existing virus such as season human influenza A, (H3N2) or avian influenza subtypes (H5N1, H6N1 or H9N2). Update: Canadian farmer infects swine flock with H1N1. (Source: UK Times Online article - 5/4/09). This is why every health agencies around the world are working around the clock to glean as much data from this virus. Now the CDC has begun that drumbeat of concern for what may come this fall. (Source: Bloomberg article - 5/3/09)

Why would that be a problem? A long-studied theory is the idea of reassortment. Let's say today's virus reaches a host in Southeast Asia who has just been exposed to the bird flu, a virus with a 50% case fatality rate (421 confirmed cases, over 200 deaths). Inside that person's cells, both viruses exchange RNA and reassort into a completely new pathogen which retains the worse elements of both parents: Easily transmissible, highly lethal to certain populations. That is a snapshot of what may have happened in 1918: an entirely new strain that was so unusual, it even "tricked" the host's immune system into turning against itself. This describes the much-theorized "cytokine storm." (Source: Dr. Osterholm in Washington Post, 11/9/2005)

The result was that healthy young adults ages 15-34 experienced the highest mortality rate in the U.S. In extreme cases, some victims started their day with no symptoms, and by nightfall had drowned in their own blood-choked mucus as their lungs filled with fluid. Too alarmist for you? Then ignore history at your own peril. Remember the saying: "those who fail to understand history are" .... (you finish the sentence.)

Since we're on the cusp of WHO declaring a full-blown pandemic, it's time you come face-to-face with what it means. No doubt the parents and school community of Milford Mill Academy in Baltimore County are quickly finding out what it means to "shelter-in-place" or implement "social distancing." The best part about a mild case of pandemic influenza is those individuals might have a better shot at overcoming the virus should it reassort prior to a second wave this fall. I am not making this up, it is based on volumes of research into what happened with the three previous major global epidemics. Nature and science have given us fair warning, because this changes everything.