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H1N1 precautions inconvenient but needed

Posted on September 23, 2009 in Uncategorized by Leslie Lawrence, Medical Director of the Student Health Center

I have received a lot of e-mails from students since my e-mail on September 18 asking me, “What’s the big deal? Isn’t this just the flu?” I can’t possibly answer all the e-mails personally, but I did answer a few, and felt it might make sense to write to The Polytechnic so I could reach all the students who have similar questions.

So what’s my argument to try to convince these individuals that they should care about H1N1? To start, let me give very specific statistics. This virus has killed three college students thus far this fall and has also caused over 70 hospitalizations. We probably had 25,000 cases across the United States on college campuses. So, thus far, this is statistically very similar to a seasonal flu as far as the severity (number of complications and deaths).

However, there are some differences between the H1N1 virus and most seasonal flu viruses. The fact that this virus preferentially affects the young (6–24 years old) is most unusual.

Most flu viruses infect and kill the extreme ages preferentially (under 6 months and over 65 years). Also, the deaths tend to be in the very ill subset of these individuals.

However, two of the three college students who died of H1N1 were thought to be previously healthy (no major medical problems). This is extremely unusual for any flu virus. The infectivity is very different as well. In a normal flu season, as much as 10–20 percent of the population will contract the virus. H1N1 seems to cause incident rates as high as 50 percent of certain populations (the highest incidence of 50 percent is almost exclusive to the 6 to 24 year old age range, probably because of the close living conditions and social behaviors). Because it infects a higher percentage of the population, that means that there will be more overall deaths, even though the percentage of people dying per total number of cases will not change. The President’s Council of Advisors on Science and Technology reported to President Barack Obama that they expect as many as 90,000 deaths (on the high end of the estimate) during the H1N1 outbreak, compared to a regular flu season, where an average of 36,000 people die.

So, to summarize the previous paragraph, we expect as much as 2.5 times the number of deaths this year, namely due to the increased incidence (not increased severity), and most of the deaths are going to occur in individuals between the ages of 6 and 49. As a society and as a campus community, we are not used to seeing healthy young people die; thus, we see some fear developing. We feel that a strong proactive plan is better than fear. Also, if followed correctly, we know from previous studies that preventive measure can reduce the number of people infected by as much as half, and therefore decrease the number of young people who die. I understand this is a big “if,” as I know asking college students to practice social distancing and wash their hands repeatedly after each interaction is a tough sell.

The last part of my argument: some history. I always ignored history when I was in high school and college … I never thought it was of any use. Anyway, in 1918, a novel flu virus caused some localized outbreaks in the spring of that year. The influenza virus was identified as an H1N1 type. It had a very low incidence of complications and deaths. That same virus returned in the fall of 1918 and initially seemed unchanged, so people and public health officials ignored it. About mid-November to December of 1918, the virus apparently mutated, as suddenly it began killing 20 percent people it infected. It also preferentially infected young, healthy people, so most of the people who died (tens of millions) in this particular pandemic were young. Does the first part of the 1918 pandemic sound familiar? Those of us in medicine think so. This does not mean that we think this year’s H1N1 virus will be like the 1918 pandemic, but it brings to mind the saying “better to be prepared than sorry.”

In closing, I hope at the end of this flu season those of you who doubt the necessity of all this planning can make fun of those of us at Rensselaer who spent time making plans and warning the student body. However, I am not willing to bet even one student life on that.