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What We Learned

April 14, 2010

A couple of days ago, this Op-Ed in the New York Times by Richard Wenzel made the rounds in the blogosphere and on Twitter. I found the article to be sober, competent and that it raised a number of good points.

First, and primarily, is the definition of “mild.” Experts have been saying for a while that H1N1 influenza was a mild pandemic. And in some ways, that’s correct. Amongst those who normally experience the greatest levels of mortality from influenza, H1N1 was no big deal. On top of that, for the overall number of people that caught the disease, only a comparative few experienced adverse outcomes. Sounds like the very definition of a mild flu. Dr. Wenzel, though, made sure to counter all of that “mild” talk by noting the disease’s predilection for young adults and children. I tend to believe that a disease that is MUCH more likely to take 16-year-old Johnny than 89-year-old Aunt Millie is not particularly mild.

The language we use in these situations is extremely important. A “mild swine flu” could very well end up being something else altogether.

Second, Dr. Wenzel describes what the disease taught us about influenza and about our ability to respond to large-scale infectious disease response. He notes that:

Whereas doctors associate fever and cough with outbreaks of influenza, one-third of patients admitted to hospitals and up to half of infected outpatients in this pandemic had no fever, yet they were infectious.

[H1N1 influenza] was found not only on hard surfaces in the environment, which is common to all influenza strains, but in the stool of patients, a feature of avian influenza.

As John Barry so famously says, “If you’ve seen one flu season (or pandemic), you’ve seen one flu season (or pandemic).”

And then there’s the things we did poorly and should aim to do better next time. Agreement on recommendations for infection control (like masking) and social distancing (like school closure) and isolation (like when to send kids back to school).

Dr. Wenzel’s recommendations read like everything else you’ve read about H1N1 (or any other fatal pandemic/epidemic): better surveillance, new vaccine technologies, better vector control (farming practices in this case), and sharing of resources and information across borders.

That last one, though, Dr. Wenzel points out actually happened:

Mexico has already set an excellent example. Only 10 days passed between Mexican health authorities’ recognition of a possible new epidemic and their announcement of it, a sharp contrast to the many months in 2003 between the outbreak of SARS in China and its public declaration.

If nothing else, that’s a small comfort — that there are government officials that place the safety of the world’s population above nationalistic worries. Perhaps there’s hope for us after all.

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