Back When Swine Flew

I’m an epidemiologist, a word derived from “epidemic”, which means that I’m supposed to know something about diseases. This past week, several people have approached me for “expert” commentary on the emerging swine flu pandemic. The university has asked me if I’m comfortable enough with the topic to field inquiries from the media, and the Maytree Foundation has asked me to offer an official statement, also for media digestion. As well, concerned friends have been asking for advice on how to protect themselves.

I’m wary of misrepresenting my expertise. A few years ago, I wrote an article for The Toronto Star called “Are We Overdue For A Pandemic?” It garnered so much attention that CBC Newsworld invited me to go on-air to be interviewed by Evan Solomon. Uncharacteristically responsible, I told them that I am not a flu expert, but rather a global health generalist, and that I could only discuss the issue on those terms. They thanked me for my honesty and retracted the offer.

The same day, CanWest Global called with a similar offer. I told them the same thing. The producer then asked me, “Are you good looking?”

“Um,” I said, “My mother thinks so.”

“Can you be controversial?”

“Sure,” I said, thinking about all the penis jokes I could offer.

“Then come on down!”

So I went down to the Global “studios” in Ottawa to be interviewed remotely by Bruce Dowbiggin in Hamilton. It was quite a farce. I was on with Donald Low and a couple of other experts in what quickly devolved into a WHO-bashing session. The “studio” was me standing in the middle of the Global TV offices, alone with an unmanned camera and a wonky microphone and earpiece, with no local producer or technician to guide me, and no monitor to show me what was going on in the Hamilton studio, but with a buzz of unconcerned office drones scribbling away behind me in their cubicles.

My audio cut off early into the segment, and I spent the rest of the time looking like a mute doofus, tapping my ear in frustration. After 15 minutes of that, with no one telling me whether the segment had ended, I just took off my earpiece and went home.

I don’t think I’ll be doing Global TV again anytime soon.

Thus, with the current flu panic, I am loathe to stretch my expertise too thin, lest I find myself knee deep in another media travesty. Having said that, I thought I’d put up one token blog post to summarize what little I know about the current swine flu epidemic.

If you’re an old codger like me, you may remember the first big swine flu scare in 1976. Panicky public health officials convinced President Gerald Ford to push for a widespread vaccination programme across the USA, for fear that another 1918 pandemic was imminent. (The 1976 virus was believed to be closely related to the 1918 strain). Well, the side effects of the vaccine –predominantly Guillain-Barre Syndrome— ended up hurting more people than did the flu itself.

For history’s sake, here’s a PSA from 1976 advertising the swine flu vaccine:

The current strain of swine flu is a new strain that, I believe, is unrelated to the 1976 variety. Today we have reports of the first death in the USA, while Canada’s tally holds at 13 cases, but no fatalities.

These numbers are to be expected. They are the result of travelers returning from the endemic zone of Mexico. As far as I can tell from news reports, there have been no cases in Canada of someone contracting the disease from someone who has just returned from Mexico. This means that the system is working as it should: those returning from Mexico with the disease are being quarantined and treated… for the most part.

The fatality rate thus far is about 5-7% (which is actually higher than the 2.5% rate of the world-changing pandemic of 1918). Also, the cases in Canada have all been of the mild variety, which means there is a reasonable expectation of full recovery for each case. This is not the Bubonic Plague. In other words, if current controls are kept in place, there is every expectation that our very thorough and professional public health infrastructure will keep civilization quite safe from this disease.

Having said that, it is too late to fully contain the disease. It is already among the population. But its mildness suggests that most people contracting it will recover on their own. Flu viruses tend to mutate very quickly. If an individual is infected with several viruses simultaneously, those viruses may swap DNA and become something new. With more infections in the population, there is an increased chance of a virus mutating into something really lethal… or into something quite banal and barely noticeable.

Let’s not forget the killer bees scare of the 1970s. Back then, there was genuine panic that as the killer bees migrated north from Brazil, they would destroy scores of people, animals and infrastructure as they went. But as the interbred with tamer species, by the time they reached the northern climes, they were barely noticed. The same is always possible with varieties of influenza: with greater mutation and DNA exchange, there’s always the chance the predominant strain will be something quite manageable.

Every flu pandemic is compared to the 1918 Spanish Flu, which killed so many people in the prime of their lives that it is thought to have contributed to the stoppage of World War I. As the current swine flu is actually more fatal than the 1918 variety, there is cause for concern. But the world today is much different from that of 100 years ago. In terms of disease threats, we now have a great many more people, each of whom represents a possible vector for disease. We also have a lot more international travel and a lot faster travel. This means that a voyage from Mexico City to Toronto actually takes less time than the incubation period for most diseases –a far cry from the situation in 1918.

On the other hand, we also have a great many advantages today. We have a remarkable communications infrastructure, which allows us to know of outbreaks everywhere in the world, pretty much as it happens. Combined with our much more advanced public health system, we caqn then theoretically marshall resources rapidly in preparation for anticipated stressors on our health care system.

Lastly, today we have technologies for treating the flu which were not available in 1918. In Canada, our hygiene options are much greater than they were 100 years ago when many more people lived in agricultural environments with limited access to fresh water and indoor plumbing. We have hospitals with quarantine protocols and the experience of SARS to guide us. And we have superdrugs, like neuraminidase inhibitors (that I did some work on), which can serve as both prophylaxis and treatment for many varieties of influenza.

So it looks as if we are in a very good position to avoid a major influenza pandemic.

Frankly, though, I don’t know. No one knows. The next few days will tell the tale. Is the epidemic outside of Mexico dying off, or is it yet to fully manifest? I think it’s foolish to give an opinion one way or another.

As for what we can do to protect ourselves, just do what your mother told you: wash your hands, sneeze into your elbow pits, don’t touch your face or mucous membranes before washing first, avoid extremely crowded areas (like sporting events, theatres, etc) and keep yourself in good health to maintain a robust immune system. You can do the latter by practicing good daily health: eat fresh foods, particularly fruits and vegetables; enjoy moderate exercise regularly; get lots of sleep; drink lots of fluids; avoid stress; practice basic hygiene; and avoid unhealthy products like alcohol, tobacco and preservatives.

Oh, and don’t worry about pork products. That’s just ridiculous. The food chain is safe from this particular disease. I avoid pork for an entirely different reason: eating pig is just gross.