I have participated in online forums related to pandemic influenza for years. Like many participants in “Flublogia”, I have tried to prepare for a worst case scenario, a highly lethal flu virus, like H5N1, that spreads readily human to human. Thus far, this has not happened. The current pandemic H1N1 is a nasty virus that is estimated by the CDC to have already killed over 1,000 American children. It may kill many more children, and adults, before it becomes a “normal” seasonal flu virus. I think that the CFR of this virus is much higher than seasonal flu, especially in people younger than 65. However, pandemic H1N1 does not have a CFR that exceeds 1 or 2%, even in countries with little access to Tamiflu or vaccine. In countries with anti-virals and vaccines, the CFR is likely to be less than 1%, assuming no change in the virus.
Is that a reasonable assumption?
No, in my opinion.
There is already evidence that Tamiflu-resistant strains are becoming more common. And evasion of vaccines due to antigenic drift is a specialty of flu viruses. That is, after all, why we need a new vaccine every year. As dangerous as a virus would be without effective antivirals or vaccines to combat it, there is a bigger danger – a hybrid with H5N1.
A number of public health authorities in Asia have recently expressed concern about this possibility, most recently in Vietnam.
From VNA, December 12, 2009 [hat-tip, treyfish for the machine translation]
Director Nguyen Huy Nga also make recommendations, winter weather makes progress Complicatedly influenza A/H1N1 and more dangerous. Especially with the recurrence of avian influenza H5N1, the risk of recombinant H1N1 influenza virus with the H5N1 strain variables have a pathogenic virus spread is strong and huge.
In my opinion, the odds that an H5N1 hybrid that can spread easily will be formed has never been higher. Yet, concern about such outcome among the general public has probably never been lower.
Most people get their information about the world from television. For many, TV is reality. If newscasters tell them the flu is dangerous, they will be concerned. However, if they are told that the current pandemic is mild or there are simply no English language stories at all about the increasing likelihood of a dangerous hybrid virus, few will seek out information on their own. Fewer still will prepare for a true worst case scenario.
The thing is, flu viruses don’t care whether anyone is watching what they do. It doesn’t matter to them if the MSM is tired of the pandemic story. Nor do they care if even veteran flu watchers are experiencing pandemic fatigue and don’t want to think about it anymore. Flu viruses will go about their business of mutating, spreading, and possibly exchanging genetic material.
Experiencing extreme anxiety every time there was an outbreak of H5N1 was not healthy, in my opinion. But nor is ignoring what is likely the greatest risk we have experienced to date.