Boston Globe
Officials temper stance on illness
By Stephen Smith
Globe Staff / May 5, 2009
When a novel flu virus emerged from a dusty Mexican village, disease investigators feared a global killer was on the loose: Two weekends ago, adults and children were falling ill by the hundreds in Mexico City, and reports of more than 100 deaths drew parallels to the lethal flu pandemic of 1918.
By yesterday, those worries had diminished somewhat. Swine flu, in a matter of days, had hopscotched the globe, racing in the era of jet travel from Mexico, through the United States, Europe, and all the way to China. But the virus has resulted in only a single death outside the outbreak's epicenter.
Instead, the strain known as H1N1 has spawned symptoms akin to the seasonal flu that strikes each winter. That was evident in new findings released last night by Governor Deval Patrick and his top health adminis trators at a State House press briefing.
They reported that the state now has 34 confirmed cases of the disease, up from six at the end of last week. People across the state have been stricken, but only three fell so ill that they needed to be hospitalized, and all have recovered.
"This is a cause for concern, but not for panic," Patrick said. "Flu always spreads." But, the governor quickly added, an ordinary flu season generates many more cases than the number of H1N1 illnesses reported so far.
And so, less than two weeks after disease detectives first identified the new virus, officials from Boston to Atlanta to Geneva began to ever so subtly modify their message about swine flu: Yes, it's something that needs to be watched closely. But the worst - at least right now - might not happen.
"While we're not out of the woods yet," said Dr. Richard Besser, acting director of the US Centers for Disease Control and Prevention, "we are seeing a lot of encouraging signs."
He counted among them the impending return of vibrancy to the streets of Mexico City, where the threat from the virus appears to have abated. Restaurants, bars, and churches will welcome revelers and worshipers once more later this week. And workers there are expected to return to their jobs in office towers and factories.
In the United States, federal health authorities are reconsidering their recommendation that schools stay shuttered for at least a week when a case of swine flu is confirmed. Mainly, it reflects what was apparent by yesterday: The virus has gained a foothold in most of the country and is being transmitted in the community, so closing schools does little to stem the spread.
But the reconsideration of the policy is also a tacit acknowledgement that the symptoms being caused by the germ - fever, coughing, headache, muscle pains - although miserable rarely result in life-threatening complications.
"Our approach, as I've said, has been very aggressive. You may only get one chance to get out in front of a new infectious disease, and so, that's what we've been doing all along," Besser said. "But as we've gathered more information, we're continually evaluating our guidance."
When disease trackers first spotted the virus, they knew this much: Most people's immune systems would not be able to put up much of a fight. That, and the deaths reported in Mexico, explained why they were so alarmed.
But even if the swine strain winds up being no more serious than an ordinary flu season - and there's still no guarantee of that - the consequences could still be substantial. The course of a flu outbreak is notoriously difficult to predict, and some specialists caution that swine flu could mutate and reemerge next winter in a more dangerous form.
"You have a virus that most people have no natural immunity to, it can spread to a lot of people quickly, and so the name of the game now is to slow transmission," said Dr. David Ozonoff, a Boston University School of Public Health disease specialist.
Much about the swine flu outbreak remains unexplained - and intriguing to the specialists tracking it. The tally of deaths attributed to swine flu in Mexico topped 150, for example, but has shrunk considerably as confirmatory testing has proceeded, to 25 now.
"The information simply came out very quickly and maybe they didn't have the opportunity to do the epidemiological studies that allow the best data to come out," said Dr. JudyAnn Bigby, the Massachusetts secretary of health and human services.
In the United States, the disease has disproportionately struck the young, with children and young adults accounting for 22 of the 36 cases reported in Massachusetts. That may shed light on why complications have been few: Flu generally proves most damaging to the old and to patients whose ability to fight diseases is impaired.
The large increase in Massachusetts cases reported yesterday in part reflects a backlog in testing that is being addressed now that the state lab in Jamaica Plain can perform the sophisticated analysis to identify the swine flu.
At least one of the new confirmed cases was a Harvard dental student. A cluster of as many as nine cases at the Longwood-area school led to the suspension of classes late last week at the adjacent dental and medical schools. Harvard announced medical school classes would resume today, but remain suspended at the dental school.
At last night's news conference, the state's chief epidemiologist, Dr. Alfred DeMaria, said there is reason to believe that the H1N1 virus may be spreading less aggressively than some seasonal flu strains. A reporter asked whether that made him less afraid.
"Influenza," he said, "always scares me."
Stephen Smith can be reached at stsmith@globe.com.
© Copyright 2009 Globe Newspaper Company.
We have better medicine and preventive measures here today than say back in 1918; however, the world is much more closely connected globally (air travel to just about anywhere is but a few hours) which makes a pandemic just as dangerous today as in 1918.
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