Volume 17, No. 3, Summer 2009
The recent swine flu/H1N1 pandemic that surfaced this spring was widespread, but not particularly virulent. But watch out for the sequel! When Son of Swine Flu/H1N1 opens at your local theater, school and public gathering place with the advent of the annual flu season this fall, it has the potential to be much scarier and more deadly.
With some conjuring images of the deadly worldwide 1918 flu epidemic, this was the ominous consensus of members of the Advisory Board of To Your Good Health, A Health Care Newsletter, at their quarterly meeting at Cape Cod Community College June 4.
Summing up, this was the reasoning behind their dire warnings. All flu viruses mutate over time. That is why a new vaccine must be developed every flu season. And you can’t create a vaccine until you know the nature of the mutated virus. Because the current flu outbreak was spread over so many different environments, the odds that some extremely dangerous versions could surface in the mix are greater. And this is why the world health organizations were so quick to label it a pandemic despite its relatively benign nature.
“Nobody really has a clue as to whether in the fall this version will mutate—as all of these flu viruses do eventually—like the 1918 flu virus did and,” explained Dr. Herbert Mathewson, VNA Medical Director and To Your Good Health medical adviser. “So there’s no degree of certainty what’s going to happen next and we will continue to chase our tail in terms of isolating the virus. The next flu peak is expected to be in October or later and the interesting thing is the federal government already has ordered $298 million worth of a vaccine that doesn’t even exist.”
Dr. Arthur Bickford, a co-founder of the Duffy Clinic, said he had heard from other medical sources that “the virus appears to be picking up elements to make it more lethal. The number of cases we have now is low because we’re not in flu season, which runs until April, but we’ve got to be prepared for everything.”
One clue as to how the new virus will develop could come from Southern Hemisphere regions, Africa and South America, where it already is flu season. “The virus mutates from South to North,” pointed out Dr. Jim Butterick, Cape Cod Hospital’s Chief Medical Officer. “But it’s in so many countries and, with the ease of transmission, the real fear is the virus will resurface in combination with one that is more virulent. And then , of course, you also have to worry about side effects from any new vaccine.”
Creating new vaccines on the fly is not easy, as Jim Lyons, a former pharmacist himself and retired president/CEO of Cape Cod Healthcare, pointed out, “Those new viruses haven’t been identified yet and the pharmaceutical industry has to wait until the mutated virus is ready to be worked on to produce the vaccine with very little time to do it. That’s the challenge on a national basis. Plus those people like to get paid up front even if the vaccine doesn’t appear on the shelf right away.”
The mechanics of testing for exotic versions of the flu also create problems in a major outbreak, Dr. Mathewson added. “Office tests only determine if a patient has the flu, not what kind,” he explained. “If that test is positive, then the sample must be sent to the state lab by courier to determine the type. During the recent H1N1 episode the state lab was quickly overwhelmed and crumbled because everyone wanted to be tested for swine flu. And if we tell the school the kid has some kind of flu, they panic and shut down. Plus, while you’re waiting for the state results, you don’t want to waste limited therapies on people who turn out not to have swine flu at all.”
Gary Sheehan, president of Cape Medical Supply, noted that even the recent relatively mild flu episode produced “a high level of public hysteria” on Cape and, over a two-week span, his company’s supply of surgical masks, gloves and other protective material was “pretty much exhausted.”
Another potential problem is what happens when caregivers are forced to miss work either because they’re ill themselves or because they must care for children who are sent home due to school closures. “If we have a serious attack, will we have the human resources to cope?” he asked.
“That could represent a critical challenge,” David Rehm, president of Hospice & Palliative Care of Cape Cod, agreed.
There is some positive news that came out of the recent swine flu scare.
“The surveillance and communications systems and response times proved adequate and the Internet has added a brand new element for reporting that allowed for much earlier identification of the epidemic,” Dr. Mathewson said.
Sue Miller, Dean of Health Sciences, Social Sciences and Human Services at Cape Cod Community College, said the school had used the Internet to keep its scattered student body aware of developments and also positioned antiseptic hand sanitizers throughout the campus “to stress the importance of good hygiene.”
Of course, the Internet can be a mixed blessing. As Kathleen Schatzberg, the Community College President, pointed out, “The capacity for misinformation and anxiety—if not panic or hysteria—is great. People get anxious and do dumb things.”
There was an ironic plus, however, according to Jeanette Perkins, infection control director at the Rehabilitation Hospital of the Cape and Islands. “The number of people who don’t take the vaccine for seasonal flu is quite large, particularly among the younger population, but there may be a little bit of irony in the fact that in the current absence of a vaccine we may learn something about how important a vaccine is.”
The recent outbreak also provided a dry run to help local caregivers prepare for a future crisis. Gigi Dash, Infection Control Director at Cape Cod Healthcare, said , “By state mandate, we’ve had an epidemic response plan for several years and this enabled us to put that plan into effect and see how it worked. If it comes (again) in the fall, we will be ready.”
The key, though, may be Capewide cooperation and coordination. “A marriage of all elements coming together,” said Mary Devlin, Public Health Team Leader for the VNA of Cape Cod, “That means the VNA, public health in the county and all the towns in planning and, of course, posting places for vaccines.”