While there are no confirmed cases of the H1N1 virus in St. Louis, public health experts in the area continue to closely monitor progress of the flu outbreak in the U.S. and are working with the State health department to identify suspected illnesses.
“We only started testing for this last week,” said Pamela Rice Walker, acting director of the St. Louis Department of Health.
“There is really no way to go retro with it. You really have to get it when they have signs and symptoms.”
Cautious preparation rather than panic is the prevalent response to the new H1N1 virus, which has origins of two strains of swine, and one strain each of avian and human influenza.
“I think President Obama has handled it brilliantly, because he has kept away from panic but he has emphasized preparedness,” said Rachel Schwartz, a public health and disaster preparedness expert in the School of Public Health at Saint Louis University.
Schwartz, who worked on the State pandemic plan, said because the virus could mutate at any time, public health officials are anxious to see that preparedness extend to communities and households.
“Most organizations and most individuals did not do much to prepare. What’s paying off is at the State level and the public health level,” Schwartz said.
“We have an opportunity to pick up where we left off and develop those plans further so that they are more effective. Then whether that influenza turns worse or not, this fall we will be ready for it.”
Seasonal flu kills 36,000 people each year in the U.S., according to the Centers for Disease Control and Prevention (CDC). Although the H1N1 virus has presented milder in the U.S. than in Mexico, the virus could change over the summer months before the next flu season.
“It is possible that this influenza could come back in the fall in the regular flu season mutated. That’s what viruses do,” Schwartz said.
Drift vs. shift
A virus can undergo two types of mutation.
“One is called a drift. It’s a lesser change in the virus, and it’s basically still the same strain. Vaccines work –they may not be perfect for that virus, but they still work,” Walker explained.
“The other is called a shift. When it shifts, it’s an all new strain. It could get more mild or could get more virulent. These strains pass back and forth between humans and animals all the time.”
The current H1N1 virus represents a shift in the previous strain.
“It contains two strands of two different strands of swine virus, a strain of avian and a strain of human virus,” Schwartz said. “Our concern is what happened in 1918 will happen again here.”
In the 1918 pandemic, the initial outbreak of Spanish flu was mild, yet came back in a second wave with a deadly vengeance.
Walker said this is the reason health officials would want to wait as late as possible to develop a vaccine. If it is created too soon and the virus shifts into a new strain, a newly developed vaccine would be useless.
“When you have a shift, we don’t have vaccines prepared to deal with it,” Walker said.
As her first official trip outside of Washington, new Health and Human Services Secretary Kathleen Sebelius visited those working on H1N1 at the CDC in Atlanta. She told reporters that scientists from the CDC, National Institutes of Health and the FDA are working on a potential vaccine.
“There will be testing phases underway to get to the right dosage and to make sure that we are administering this in the safest possible fashion and to be ready should the decision be made to go into production phase,” Sebelius told reporters during a CDC briefing.
In addition, Sebelius said private partners are producing seasonal flu vaccine now to be available to produce the H1N1 vaccine should the scientific decision be made.
SIDEBAR
H1N1 do’s and don’ts
Health officials in St. Louis suggest the following measures to limit risk for H1N1 or other respiratory diseases:
• Thorough hand washing with soap and warm water or use of alcohol-based sanitizing gels
• Coughing or sneezing into your sleeve (rather than in your hands, in the air or toward others) and throwing away used tissue after use
• Avoiding people who are sick
• Seeking medical attention for flu-like symptoms and
• Keeping children and adults at home for seven days when they are sick.
At this point, no agency is advising people to wear masks as a public precaution.
“We don’t have the science base to show that’s an effective measure and we do have the science to support the measures that we’ve been actively promoting,” said Dr. Richard Besser, acting director of the CDC.
The World Health Organization is not recommending restricted travel to affected countries, stating the action would have little effect on stopping its spread. They are advising travelers who are sick to delay their travel and seek medical attention.
On Tuesday, the CDC eased guidance regarding school closures due to H1N1, recommending affected students stay home for seven days and schools remain open unless it is decided locally that flu-related absences disrupt the normal function of the school.
The latest information about H1N1 and taking care of someone with the flu at home can be found at www.redcrossstl.org and the CDC site www.cdc.gov/H1N1flu.