Governments and international agencies are taking a big risk by playing down the potentially lethal effects of the H1N1 flu pandemic, earlier called “swine flu”, because most information during the last 11 months has come from the world’s rich countries.
People affected are expected to double every three to four days for several months but in rich countries they are generally well nourished and access to medical care is easier. So they recover quickly and often suffer little more than symptoms similar to ordinary flu. This has created the impression that the impacts of H1N1 will not be as devastating as expected in late 2008.
The World Health Organization (WHO) raised red flags quite vigorously late last year but muted its warnings partly because of pressure from governments and airlines afraid of downturn in international travel and tourism.
Looking at numbers, it decided that the pandemic was spreading too quickly for it to monitor figures territory by territory. Instead, it turned to raising public awareness without causing too much alarm. That muting of alarm bells may soon give cause for regret to everyone, especially people in poor countries.
Worse, most poor countries do not have effective public health systems so tracking the H1N1 infection and its progression to severe illness will not be thorough. That makes it difficult to detect mutating strains quickly enough.
Rich countries are working hard to shield themselves by quickly stockpiling anti-viral drugs and injections ahead of the coming school season and winter, when older persons are weakened by colds and other ailments. But even they will have little protection if the virus returns in a second cycle after mutation in poor countries.
Poor countries have almost no protective drugs partly because little is left over from the rich nation stockpiling. But their key weakness is being unable to afford stockpiles “just in case” the infection turns into a major killer of their people. The richer world helps them only when a crisis has already struck. Paying for prevention is much harder.
Those with weak public health systems already stressed by HIV/AIDS, tuberculosis, and malaria, will have great difficulty managing the surge. Deaths are likely to occur through neglect and incapacity to do much more than wring hands. Deterioration in poor countries will worsen the situation worldwide making it harder to put a floor under the pandemic and energize a turn for the better.
The CDC thinks the H1N1 flu could impact 40 percent of Americans including care givers. But the real shocker is that worldwide, some 40% of severe cases are now in previously healthy children and adults, usually under the age of 50 years.
Until recently, the conventional wisdom was that those at high risk were children below five, malnourished women and adults over 65 weakened by other ailments. It now seems that the presence of underlying medical conditions will not reliably predict cases of severe illness. Many healthy patients experience a sudden and very rapid deterioration usually on the fifth or sixth day of the onset of symptoms.
Thankfully, so far most patients experience typical influenza symptoms and fully recover within a week often without medical treatment. But this is not a reliable indication of the future when the pandemic really begins to head for massive numbers. People hit for a second time may succumb or the strain may mutate. Almost everything about its progression is unpredictable.
Reports from all outbreak sites show that the H1N1 virus rapidly becomes the dominant strain of influenza. So WHO is asking doctors to not wait for laboratory confirmation of H1N1 infection before treating the symptoms with more vigilance. Despite the controversy about using strong drugs on young children, it recommends prompt antiviral treatment for children under five with deteriorating illness.
In severe attacks, primary viral pneumonia destroys the lung tissue and does not respond to antibiotics. Multiple organs start to fail, including the heart, kidneys, and liver sending patients into intensive care units. The fact that this is not yet happening on a huge scale should not lull us into thinking that most of the world’s poor will get through this pandemic as undamaged as the rich ones have so far.