Sunday, June 28, 2009

Is "Mild" the right word for H1N1?

There's really no such thing as a "mild" pandemic. Even with a virus that causes mostly mild illness, roughly 30% of the world's population will become ill with the virus. That means increased deaths, even if the case fatality rates are low, and increased burden on health systems. That's most likely why WHO has characterized the pandemic as "moderate"

Yet we keep seeing the word mild pop up a lot and Helen Branswell, an imminently respected influenza reporter wrote about some of the inherent problems with using the word mild.

"Officialdom's mantra about swine flu - "it is overwhelmingly mild" - might seem incongruous if we knew the number of children, teens and young adults in ICU beds right now alive only because a breathing machine has taken over for their ravaged lungs.

The heavy reliance on the word "mild " could be creating a false impression of what is actually going on and what the world may face in coming months, some experts worry."


"When we're told that swine flu is mild, we don't think, 'It will infect a half to a third of the world population and kill a few million people, mostly young people, before it's over,"' says Sandman. "We think, 'It's like having a bad cold."'

Well, swine flu isn't over. And it's not like a bad cold sweeping the globe.

But officials and experts are having a hard time striking the balance in messages to the public, unclear what they are dealing with now and what it might become.

"I think the problem is we don't know how to paint this picture properly," says Dr. Allison McGeer, a flu expert at Toronto's Mount Sinai Hospital.

"Because it's perfectly true that most cases are mild. But it doesn't mean that you shouldn't worry about it."

Regular flu, as anyone who has had it know, is no walk in the park.

And with this new flu, a small subset of people gets very, very sick. Their lungs are overwhelmed by an aggressive viral pneumonia one doctor described as looking like a "white out" on an X-ray. A number of hospitals are struggling to keep these people alive.

Generally much younger than the typical hospitalized flu patient, many of these people have been on ventilators for weeks. And every day, officials in some part of the globe announce that a 15-year-old boy, a 24-year-old woman or an otherwise healthy pregnant woman in her third trimester has lost the battle.

"When you look at those things then you begin to say 'Well, is it really accurate, is it really fair to say that this is a mild phenomenon?"' says Dr. Keiji Fukuda, the World Health Organization's top flu expert.

Fukuda and his team have been warning for some time that the unusual age pattern of severe cases, the odd out-of-season spread and the fact that the virus is killing some previously healthy young adults makes the term moderate a more appropriate severity assessment.

That pattern, seen in previous pandemics, makes flu watchers sit up and take notice. "What it really leads you to conclude is that boy, we'd better watch this pretty carefully," Fukuda says.

There still isn't a good estimate of the percentage of total swine flu cases that becomes gravely ill, or the percentage that succumbs to the virus's onslaught. Currently the numbers may seem small; 25 deaths in Canada, 127 in the U.S., 263 worldwide. (Swine flu has already beat bird flu in terms of death tolls.)

But as a human pathogen this virus is still a baby, despite its rapid global spread. No one knows what it is going to be when it grows up.

Catch the whole article here at: news_channel_id=145&channel_id=145

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