With New York reporting its first swine flu death this weekend, the nation’s attention is once again focused on the 2009-H1N1 influenza outbreak that began in April. The May 17 death of New York City public school assistant principal Mitchell Wiener of complications of H1N1 influenza occurred as Japan announced it is closing more than 1,000 schools and kindergartens in response to a rising number of cases there.
As of May 17, 39 countries have officially reported 8,480 cases of influenza A H1N1 infection, according to the World Health Organization. Case numbers dominate media reports about the influenza outbreak, but the CDC’s focus on patterns of transmission may be more germane to a global pandemic.
Speaking at the annual meeting of the Society of Hospital Medicine, Dr. James Pile noted that the mother of all influenza outbreaks – the 1918 Spanish influenza pandemic – had three distinct peaks with periods of relative inactivity in between. Samples have been retrieved from some victims of that pandemic, but it remains unknown if the virus changed or was the same throughout the three waves.
Yet Dr. Pile, a hospitalist and infectious diseases specialist with MetroHealth Medical Center in Cleveland, spoke to fewer than 30 attendees in a grand ballroom at a sold-out meeting of more than 2,000 physicians. The other competing sessions scheduled for the same time at the meeting were far better attended.
Has the 2009-H1N1 2009 flu become yesterday’s news? Are physicians burned out about a now quieting (at least for now) epidemic? Just two weeks earlier, an overflow crowd filled the same Hyatt Regency in Chicago for an influenza session at the American Geriatrics Society. At both meetings, drug companies handed out antibacterial gel in the exhibition hall, but the bottles of hand gel dotting the registration desk were now missing, as were the odd face masks present among the geriatricians.
The hospitalist panel said that this could be just the initial spike of the epidemic; if so, a second, third and fourth spike could overwhelm the health care system. Given this possible scenario, Dr. Jennifer Hanrahan, also with MetroHealth, advised hospitalists to get the H1N1 vaccine as soon as it becomes available. Healthcare workers are a vehicle for the virus and owe it to their patients to be healthy in the event of an outbreak. She acknowledged concerns about the risk of Guillain-Barre syndrome associated with the vaccine, but noted “influenza can cause Guillain-Barre as well.”