Dr. Nathan Wolfe
Special to CNN
Last week I was stranded in London by Eyjafjallajokull. As I waded through the throngs at St. Pancras station in London hoping to catch one of the few seats available on the train bound for Paris, I thought back to the fear and disruption during the first days of the swine flu (A/H1N1) epidemic roughly a year ago.
Natural threats, whether they be eruptions or epidemics, have the potential to disrupt our lives, and as I watched the media report on the eruption and heard disgruntled passengers complain, it became clear that many saw these distinct natural events in a very similar light.
[cnn-photo-caption image=http://cnnpagingdrgupta.files.wordpress.com/2009/12/lagloria3.jpg caption="Dr. Sanjay Gupta and crew found patient zero tucked away in this small mountain village in La Gloria, Mexico"]
CNN Medical Producer
It was late April. I remember it being a somewhat quiet news day when I received the call. It was an editor on our international news desk alerting us that about 100 people had gotten very ill in Mexico City with severe flu-like symptoms. They had no clue what was causing it at the time. The only thing health officials were telling us was that the patients had contracted a highly contagious virus that hadn’t been seen in humans before. The hunt was on: Dr. Sanjay Gupta and I hopped on the next flight out to Mexico City to track down the mystery virus that was getting so many people so sick.
Within 24 hours of arriving, the dense city of about 8 million people had literally turned into a ghost town. The mayor was urging people to stay inside; the hospitals were overcrowded; schools, public transportation, and restaurants closed their doors. At one point, I remember walking down the unusually empty streets of Mexico City in awe. It was an eerie feeling, but also a defining moment for me as a journalist. I realized that people, not just in Mexico City, were scared of this unknown killer virus. What was it? Would they be infected? What should they do? We didn't know it at the time, but H1N1 influenza was about to become a global epidemic and the world was already looking to us for answers.
Centers for Disease Control and Prevention
– CDC estimates that between 14 million and 34 million cases of 2009 H1N1 occurred between April and October 17, 2009. The mid-level in this range is about 22 million people infected with 2009 H1N1.
– CDC estimates that between about 63,000 and 153,000 2009 H1N1-related hospitalizations occurred between April and October 17, 2009. The mid-level in this range is about 98,000 H1N1-related hospitalizations.
– CDC estimates that between about 2,500 and 6,000 2009 H1N1-related deaths occurred between April and October 17, 2009. The mid-level in this range is about 3,900 2009 H1N1-related deaths.
Aaron Bernstein, M.D.,
Children’s Hospital, Boston
Faculty, Center for Health and the Global Environment
Sometimes the best perspectives come from far away places and few places are farther from Boston than Singapore, a small yet highly developed island nation in southeast Asia where I spent much of October.
The distance between Boston and Singapore is more than geographic, however. While I was away, H1N1 reclaimed the national spotlight back home. Not a day went by without mention of it in the news. It became the topic of conversation among doctors and patients everywhere. Well, almost everywhere.
While everyone in Singapore knew of H1N1, it was hardly the hot topic it had become in the States. During my stay, the main paper in Singapore ran just one article on H1N1 informing its readership that the first vaccine doses wouldn’t arrive for several more weeks.
To my surprise, the Singaporeans I met took this news in stride. One reason for this is that many Singaporeans perceive (and rightly so) that H1N1 is, in many ways, no worse than the seasonal flu that comes every year. In addition, Singaporeans have endured two much more deadly epidemics in the past decade, making H1N1 pale in comparison. In 1998, the first known outbreak of Nipah virus occurred in Malaysia and Singapore infecting 276 people, 105 of whom died. In this and eight subsequent outbreaks in India and Bangladesh the virus has earned the grim reputation of being one of the deadliest viruses known, with a mortality rate between 40 and 80 percent. Nipah virus resides in bats (the “reservoir”, as bats do not get sick when infected). Bats infect pigs, and exposure to infected pigs causes disease in humans.
Wondering where, when , and how to get the H1N1 vaccine? Go here to get the latest information on where to get vaccinated.
[cnn-photo-caption image=http://i.cdn.turner.com/cnn/2009/HEALTH/11/10/h1n1.poll/t1larg.jpg caption="51 percent of Americans are confident in government's ability to prevent H1N1 epidemic." width=300 height=169]
CNN/Opinion Research Corp.
Americans are starting to lose confidence in the government's ability to prevent a nationwide epidemic of the H1N1 flu, according to a new national poll.
But the CNN/Opinion Research Corporation survey, released Tuesday morning, indicates a small majority continue to say that the government and private industry eventually will produce enough of the vaccine for the virus, also known as swine flu, to inoculate everyone who wants it.
According to the poll, 51 percent of those questioned are confident in the government's ability to prevent an H1N1 epidemic, with 49 percent not confident. The number of Americans who are confident is down 8 percentage points from August, while the number of those not confident is up 9 percentage points.
"Only one in 10 say they are 'very confident' that the government can ward off an epidemic," says CNN Polling Director Keating Holland. "But the growing doubts may not be directly related to the shortfall of vaccine so far."
CNN Senior Medical Correspondent
On a recent flight from San Francisco, California, to Atlanta, Georgia, Dr. Julie Gerberding was thrilled to get bumped up to first class. The thrill, however, quickly disappeared: As she did her victory walk to the front cabin, she noticed that the woman in the seat next to hers was hacking up a lung.
"She was on her cell phone, saying, 'I feel miserable. I just know I have swine flu,' " Gerberding remembered. "I thought to myself, 'Oh, great.' "
For the duration of her transcontinental flight, Gerberding played viral roulette as she sat shoulder-to-shoulder next to Ms. Sneezy in a confined space.
Gerberding, the former director of the Centers for Disease Control and Prevention, had a few strategies for avoiding this woman's germs, some of which you can use on planes, trains, automobiles and anywhere else if you get stuck next to Typhoid Mary - or, in this case, H1N1 Mary.
[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/HEALTH/08/20/h1n1.flu.kids.trial/art.h1n1.nathan.stein.jpg caption="Nathan Stein, 7, gets a H1N1 shots. "]
As the number of H1N1 cases continues to climb in the U.S., researchers are collecting more and more data on the spread of the pandemic flu and getting a clearer picture of its victims — who is most vulnerable to H1N1, how the most severe cases progress and which risk factors tend to contribute to life-threatening disease. That data is now helping public-health officials identify some critical H1N1 trends, which may enable them to treat patients more effectively and hopefully control the disease as it peaks in the coming months.
The latest study, published this week in the Journal of the American Medical Association, offers a snapshot of 1,088 H1N1 cases in California that were severe enough to require hospitalization — or resulted in death — between April 23 and Aug. 11 of this year. Experts at the California Department of Public Health, who led the study, say their findings are largely in line with the growing body of data on the worldwide pandemic flu, confirming, for instance, that the 2009 H1N1 flu disproportionately affects younger patients. The California research team found that the median age of hospitalized H1N1 patients was 27, much lower than the median age of seasonal-flu sufferers.
While H1N1 infection results in mild or moderate disease in most patients — indeed, the most severe cases account for a small proportion of overall infections — a subset of patients are harder hit, the data show. And in those patients, the disease can often quickly become life-threatening. "The major point of our findings is that there has been a lot of perception that this is a mild disease, and a lot of people may be ambivalent about vaccination," says Dr. Janice Louie, a public-health medical officer at the California Department of Public Health and the study's lead author. "But for those patients who were hospitalized, 30% required intensive care. This is something that clinicians should be aware of when patients walk into their clinic or office with signs of flu."