Len's News, Notes, and Stuff

Has the H1N1 Pandemic been all hype?

With the movie 2012 playing in theatres, more mediocre disaster flicks than you can shake a stick at, movies like Outbreak with Dustin Hoffman, and dire comparisons with the 1918 Influenza Pandemic, it’s hard not to conclude that the current H1N1 pandemic has been something of a flop.

What happened to the hordes of sick and incapacitated that we were told to expect?  What happened to the dead and dying littering our streets?  What happened to the hysteria of people barricading themselves at home with their stashes of food and water, using grandpa’s trusty old shotgun to warn strangers to back away from the front door?  What happened to the collapse of civilization, with burning cars in the streets, looters pillaging every store in sight, and martial law imposed in a vain attempt to keep the end of the-world-as-we-know-it at bay?

Is that what it would take for us to really consider a pandemic to be serious?

Perhaps.  Surely we all admit that media and entertainment skew our perceptions – and surely the scale that we’re accustomed to seeing in disaster movies must skew our expectations somewhat.

Chances are, you never even got sick during these past few months.  And if you got sick, chances are it was pretty mild.  Just like a regular seasonal flu.   Chances are also that you don’t know anyone who got really sick from the H1N1 virus beyond the wallop that the regular flu might give.

But that’s looking at things at a very low level.  Yes, we all think we are the center of the universe, but we can’t all be right.  So let’s take it away from the individual level and look at things at the system level.

I’m going to use US numbers here just because I have them handy.  But they pretty much jive with the Ontario numbers that I’ve been seeing.

Over 9,800 people in the US have died due to H1N1, versus the 36,000 people who die every year from seasonal influenza.  No big deal, right?  One problem with that comparison is that the 36,000 figure includes deaths where the flu triggers or exacerbates other existing conditions.  Direct deaths due to seasonal influenza are about 9,000 per year in America.  In terms of pure, direct mortality, H1N1 is just as serious as seasonal flu, not less.

The other, more serious problem, is the age distribution amongst the fatalities.  90% of deaths from seasonal influenza (including those through aggravation of existing conditions) is in the elderly.  But what we find with H1N1 is that just over 10% of deaths occurred in children under 18 years of age, and over 75% of deaths were amongst those aged 18 to 64.  Less than 15% of those who died from H1N1 were seniors over the age of 65.

If you look at this in terms of “years of life lost”, H1N1 is clearly more serious than the regular, seasonal flu.

Now how about the load placed on the healthcare system?  In the US, and here in Canada and Ontario, H1N1 has led to many more serious cases requiring hospitalization in Intensive Care Units than seasonal flu.  The healthcare system, particularly at the acute care level, is being stressed to the seams handling the increased load due to serious H1N1 cases.

You know that driving is one of the most dangerous activities that any of us does on a regular basis.  So you take simple precautions like wearing your seatbelt.  The vast majority of us will never be in a serious collision where the seatbelt saves our lives.  But on a system-wide scale, auto collisions causing fatalities happen often enough that they need taken seriously.

Similarly with H1N1 influenza, most of us will not come anywhere near the Grim Reaper because of the virus.  But enough of us will that it is considered serious, and needs to be treated seriously.  Getting yourself vaccinated is like wearing a seatbelt in that regard.

If you’re not vaccinated, get yourself vaccinated.  The virus can come back for a third wave this flu season, and it might even mutate just a bit to make things even worse.  It takes about 10 days after inoculation for you to actually build immunity against the virus.  So if you think you can just get a shot when things start turning bad, that’s like trying to put on your seatbelt just before the collision.

It’s too late by that point.

For the vast majority of us, those of us who have not been working in the healthcare system that is operating at the red line, the H1N1 pandemic has been a flop.  It’s been a disappointment.

But that’s only because our perspectives are skewed not only by the fact that we generally don’t see things at the system level, but also because our perceptions have been warped by watching too many disaster movies.  At least mine has, and hey, my work deals very closely with the H1N1 response!