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Page #16

The 1957 pandemic, during an era with much less globalization, spread to the US within 4-5 months of its detection in China, and the 1968 pandemic spread to the US from Hong Kong within 2-3 months. Now we live in the era of “overnight” delivery – and that speed of travel might well come to do us harm.

I am sure you understand that we were able to stop the SARS outbreak by rigidly enforcing “barrier nursing techniques”. However, many of the public health interventions that successfully contained SARS will not be effective against a disease that is far more contagious, has a very short incubation period, and can be transmitted prior to the onset of symptoms.

We have a roughly 20-24% divergence of this novel 2009 H1 from the seasonal influenza H1 virus. This antigenic shift will play itself out with the novel virus replacing the seasonal influenza as the dominate strain. As that happens you should look for new risk groups to emerge and for the tracking of classical period doubling episodes in the infection rates.

In phase transitions there are three universal routes:

• Period doubling
• Intermittency
• Quasiperiodicity

But as an epidemic moves from its initial introduction into a population to mass infection - it is period doubling that best defines that route. At some point along that transition the health authorities will cease to count cases and use macro metrics to measure the disease penetration.

We are very near that phase.

Q: Do you believe that this virus (H1N1) will lead to the type of deaths and disruption that the 1918 flu caused?

MA: In the field of medicine anything is possible, but on balance I would have to say no. In fact, there is some evidence that this influenza A (H1N1) might even be less lethal than our seasonal flu.

That does not mean that there will not be problems. When you have a virus that targets the young, pregnant and those with asthma, respiratory illness and compromised immune systems- then there will be suffering.

But we have fought this battle many times.

However, because of the level of transmission in this pandemic we must be prepared for a huge spike in the fall.

We can’t completely prevent its spread, but we can minimize it through simple measures: frequent handwashing, covering our mouths with the crook of our elbows when we cough, and staying home from work or school when we’re sick.

For people who are exposed and at high risk from influenza, medications such as oseltamavir (TamiFlu) are still effective against H1N1, although there is always a risk that widespread resistance to these drugs could develop.

A vaccine for H1N1 influenza is under development, and people at high risk of illness from infection (such as the elderly) or at high risk to transmit the infection (such as schoolchildren) should be strongly recommended to receive it.