EMERGENCY RISK REDUCTION

This season’s influenza is front and center in the news, especially with reminders to “get your flu shot”. It is perhaps this year’s the most universal health risk. Like other affronts to our physical condition, flu is a real and present threat. The death toll is rising, but is this different from any other flu season? Yes and no. Yes, people do succumb from the flu and always have. The health costs are colossal. Related, it’s difficult to fully quantify the production cost from this ailment, but it’s literally billions.  What’s interesting is that this year’s flu is targeting a disproportionate number of young, working adults.

Let’s step back a bit. There are many variations of flu – three “types” of which “Type A” is most serious; “Type B” is nothing to sneeze at (ouch, the pun!); and most of us walk around with “C” and don’t feel it.  I will concentrate on Type A and its subtypes. The subtype is a combination of two proteins, with the difficult words, hemagglutinin (H) and neuraminidase (N).  There are 16 variations of H and 9 variations of N, resulting in a finite number of subtype variations, albeit hundreds.

I am sure you’ve heard of H1N1 for instance. It is the most common ‘strain’ this year and was also in the 2009 outbreak, originally called “swine flu”, which killed 18 million. Another common variation is H5N1, or ‘avian flu’. Others include H7N9, H3N2, etc. The hundreds of strains are one of the challenges with a vaccine. Researchers literally guess at next season’s strains, due to the time to produce even a broad vaccine. Another challenge is that the flu can rapidly change, also called ‘re-assortment’. A great concern is that the avian flu proteins that are endemic in wildfowl will ‘re-assort’, and become susceptible to humans. It is a real and present risk. Approximately 67% of animal pathogens are “zoonotic”, meaning they can transfer to humans. This is especially alarming if that human population, or a portion of it, has no resistance.

The deadly ‘Spanish flu’ of 1918 was a H1N1 that spread worldwide and killed 50 Million, far more than WWI fighting casualties. It was also ‘high pathogenic’ or “HP”, meaning it was especially virulent.  Fortunately our recent H1N1 outbreaks have been low path.  It is noteworthy that the 1918 virus attacked the young and healthy in disproportionate numbers, as happened in 2009 and also today. The virus was so virulent that it caused a ‘cytokine storm”, which is an over-reaction of the immune system by very healthy persons. The reaction is so strong that it attacks the flu but can’t shut down, and damages healthy cells. This results in rapid death for the normally healthy.

The seasonal flu has a tendency to lull the population into viewing this threat as a mere inconvenience. This is deceptive and naive.  The mechanics of ‘re-assortment’ are remarkably simple and could easily happen. Combined with our interaction with animals, wild and domestic, and our complete globalization (compared to 1918!), we have numerous risk factors for a deadly epidemic or pandemic (i.e. worldwide reach). The effects will be individual, social, cultural, and economic. Historians say that society could revert to the ‘Black Plague’ days of 15^th Century Europe, where people literally ran from each other – fearing this invisible killer.   Economists say that commerce could grind to a halt, since who would go shopping or into a bank with a threat of contracting the virus? Sociologist indicate that culture would change, without business and labor in an inter-dependent society, resulting in unrest and even anarchy caused by desperate people.

I don’t mean to paint a bleak picture here. Most of us live in relative comfort. I hope our lifestyle continues and is not in jeopardy from the many risks that high ahead — of which pandemic is only one. Our decision can only be personal – based upon examining personal and community risks, and making deliberate decisions to prudently prepare ourselves and our loved ones for an emergency that we hope and pray will never happen.

Thanks for reading.