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Swine Flu (H1N1) – Part 1: What Is It and How Worried Should You Be?

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August 18, 2009
	Dr. Gary Huber : Head Medical Ego

(Part 1 in a 3 part series)

There is so much confusion and anxiety surrounding the topic of Swine Flu. I would like you to take a deep breath, relax, and just explore this topic as we uncover the truth and scare away the myth. I will say up front that I think every individual needs to make their own decision in this matter based on their own health and personal risk. I do not feel that there is a one size fits all solution. It would be easy if it were black and white, just go get a swine flu vaccine and be done with it. Maybe that’s the best decision for you but personally I feel there are some safety and efficacy issues that need consideration.

So what is this H1N1 or “Swine Flu”?  First of all it is nothing new. Influenza A is a virus that causes what we all refer to as the “flu.” Every year there are multiple new genetic mutations of the influnza A virus roaming around the world. H1N1 is just one of those variations. This is not some mysterious new alien life form from the planet Swinelia.

Influenza virus type A has been around longer than man has been able to identify it. Every year new influenza versions appear and are identified by scientists and given a name based on the surface antigens it carries. These are proteins attached to the surface of the virus that identify it just as your nose and eyes identify you. One antigen is called hemagglutinin and comes in 15 different varieties. Therefore it gets identified as “H” (hemagglutinin) followed by a number and in this case the number “1.”  The other protein on the surface is a “neuraminidase” and there are 9 varieties of this therefore it is noted as “N” and a number (1 thru 9) and this year it is “1.”  So you have an influenza A virus with a H1N1 subtype.

The worst pandemic of all time occurred in 1918 and all influenza virus types since then are descendants of this virus but we have never witnessed the same severity of illness. The world war played a part in the severity of the 1918 pandemic. The viral pandemic of 1918 was an H1N1 influenza A virus.  It can get confusing to the lay person but just understand that swine, bird and human influenza virus’ will commingle and continually mutate into new versions.  The swine H1N1 and the H3N2 lines uncommonly infect humans, and the human H1N1 and H3N2 lines have historically shown low rates of illness and death.  So don’t let the “H1N1” nomenclature alarm you. It’s just the name given and means little else. We could just as easily call it Sid or Walter.

Influenza A virus becomes active every year and the official flu season runs from October through May and usually peaks in January. The virus spreads by cough and sneezes, human contact, or contact with contaminated surfaces. You are familiar with the symptoms of cough, sneezing, fever, sore throat, headache, runny nose, muscle and joint ache and they can last for a week on average. The influenza virus has been shared between birds, pigs and man for years. So what is so different about this year’s “Swine Flu” or H1N1 that is creating all the buzz?

The first cases arose in Mexico and the alarming issue was that people in the 20 to 40 year age range died from complications of this flu, which is very unusual. Typically it is the very old, the very young, and chronically ill that die from flu so the deaths of people in their 20’s and 30’s was new and alarming. The other alarming issue was the rate at which this virus seemed to be spreading. But let’s take a closer look and reduce the panic. 

How do you diagnose influenza A, and how do you determine that influenza A was the cause of death?  Well that’s where the waters get muddy. The tests used to quickly diagnose influenza A are only 50 to 70% accurate. Getting a sputum specimen and attempting to grow the virus in a lab is a more reliable method for diagnosing influenza A but this method is not typically employed because of the labor and expense in doing so. The death toll in Mexico created panic but it appears that these initial reports were not accurate. Dr. Gregory Evans, a member of the Federal Pandemic Planning committee reported in April that the numbers coming out of Mexico are lower than first reported and that careful analysis showed that many of the deaths were not influenza related. This matches what has been witnessed worldwide which is that people are not dying at alarming rates and that thus far the flu has been mild to moderate in its effect.

In the US, we see an average of 36,000 deaths per year, year in and year out, due to influenza. This year alone, in the US, through the first part of 2009 we have incurred an average of 800 deaths per week as a result of complications to the typical influenza A and this is no different than 2008 or 2007, etc. The “Swine Flu,” this terrible killer, has netted only 263 deaths as of July 17, 2009.  There have only been 429 deaths worldwide.  Yet each week we lose 800 people to boring NON-swine flu. The media has driven us all nuts and created a storm that doesn’t appear to exist in my view. 

Related:
Swine Flu (H1N1) – Part 2: Should We be Rushing an H1N1 Vaccine?
Swine Flu (H1N1) – Part 3: How Should You Protect Yourself?
H1N1 Flu Update – How Are We Doing?
H1N1 Flu Update No. 2: Surprising Numbers