The Peter Pandemic

Three days ago, I felt like crap. Sudden onset aches, chills, and nausea with a 100 degree plus fever. I didn't go home because I did not want to expose my family to Mexican pig flu. I had not been south of the border recently, but plenty of people around here have been, so I figured my exposure was not zero. I called my doc from the car and headed to the hospital. He called back and persuaded me to go home. Without respiratory symptoms, he wasn't worried about swine flu. I slept in a separate part of the house anyway, just to make sure. And felt better the next day.A flu scare is not a trivial thing. In sight of my office is one of the largest wards of the disastrous 1918 flu pandemic -- Oakland's Kaiser Convention Center. But 2009 is not looking like 1918. We do not know what course the H1N1 virus will take but it is hard to build a bad scenario out of the numbers we have seen so far. An unfortunate toddler hauled to Texas from Mexico is the only US casualty of this wimpy epidemic. Imagine if instead of one death this week, we had seen 1,400 people dead from flu -- 200 a day. The media would be in a panic -- and so, trust me, would everybody with a fever caused by dodgy seafood.But 1,400 deaths per week from flu is normal during flu season in the United States. Tragic and worth fighting -- but normal. Some 36,000 people die during the six cold months of each year that we call flu season. How big a threat is H1N1? It looks like an outbreak that refuses to grow up. Last Wednesday, as I recovered, there were about 85 confirmed swine flu cases in the US. On Thursday, there were 109. Today there are 141. Mexico, which last week thought several hundred people had died from swine flu now believes that the number is 15 -- and in many of those cases nobody figured out what the disease was until too late. In general, swine flu has caused very mild symptoms. Nobody should ever turn their back on a potential pandemic virus. I keep six weeks food and water for my family in my basement, along with an assortment of emergency supplies. We have disaster plans, go bags on our cars, back up phones, and rendezvous plans. I never miss a flu shot and have faithfully issued paranoid warnings about flu risk here, here, and here. I live on an earthquake fault, trained as a paramedic, and frankly bow to nobody in my disaster preparedness. When I came home sick Tuesday, I asked my wife to scrub with alcohol any surfaced I had recently touched. I may be a barking certifiable disaster crank (sue me, I sleep better), but as disasters go, H1N1 is not looking all that disastrous. Exponential growth of the sort that a truly contagious virus brings would have added a zero to the number of incidents every few days. Keep your fingers crossed, but if the US does not see 1,000 flu cases by this time next week, this thing is a goner. H1N1 will Peter out -- at least from the headlines. Even the CDC decided not to interrupt normal seasonal vaccine production to crank out emergency H1N1 vaccines -- the epidemiological case for doing so is way too weak, even if the political pressure is not. This turns out to be an odd virus -- so odd, that I wonder if the smart move is not to deliberately become infected. The disease is trivial at this stage -- less lethal than seasonal flu -- but the risk is that it mutates over the summer and comes back lethal in the fall. If exposure to the H1N1 now conferred immunity later in the year, I'd consider the risk carefully. By the way, one reason that H1N1 may not be so lethal is that the virus has been circulating, thanks perhaps to bugs that got out of a germ warfare lab. Even though health officials are calling this new virus H1N1, that's also the type of virus that's in wide circulation today. And it has an interesting history. It was the dominant flu virus through the 1920s, '30s and '40s. (John Oxford of the Royal London Hospital) says it disappeared in 1957, when it was displaced by another flu virus. But then a strain of H1N1 suddenly reappeared in 1977. "Now where could it have come from?" he asks. "We reckon now, in retrospect, it was probably released accidentally from a laboratory, probably in northern China or just across the border in Russia, because everyone was experimenting with those viruses at the time in the lab." It was nothing malicious, Oxford believes, just some flu vaccine research that broke out of containment. The descendents of this virus are still circulating. He notes that most people who have encountered the newly emerged H1N1 virus seem to have developed only mild disease, and he speculates that's because we have all been exposed to a distant cousin, the H1N1 virus that emerged in the 1970s. "That escaped virus perhaps will provide some benefit now in the face of this pig thing," Oxford says. If the virus dies off over the summer, many will bow and take credit. Applaud, but don't believe it. The 1917 flu died out and came back lethal a year later. So in spite of a really impressive national (CDC) and global (WHO) response to H1N1, if the virus turns out to be too weak to spread efficiently or fails to mutate to a more viral form, our day will have been saved not by heroic human efforts but by the force of nature that shields more people than vaccines ever will -- dumb luck.