A(H1N1) Pandemic: Hoping for the best

First the good news. The swine flu which has swept the world in just a few months has so far proven to be mild. It has caused a few deaths, but nowhere approaching the scale of the calamitous 1918 “Spanish Flu" pandemic. Now the bad news: everything could change suddenly. And if it does, poor countries like the Philippines could suffer the most. The reason is that the virus, A(H1N1), has one main characteristic: it is unpredictable. When Dr. Margaret Chan, the World Health Organization's director general, announced on June 11 that “the world is now at the start of the 2009 influenza pandemic," she noted that “the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment." But she also warned that “this early, patchy picture can change very quickly." She pointed out that “The virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time."

Currently, the Philippines has the highest number of confirmed cases in Southeast Asia at 344 – a fact which Health Secretary Francisco Duque III attributed to the government's “aggressive contact tracing and surveillance and transparency in our reporting of data." Declining to declare a public emergency, the Department of Health has repeatedly stressed that the flu epidemic is “mild" and Filipinos are more at risk from dengue than Swine Flu. However, a virologist from a top Philippine medical school pointed out that type A influenza viruses mutate or change abruptly in what is called an “antigenic shift." The virologist, who declined to be identified, said that the A(H1N1) virus is itself believed to have been the product of four known influenza strains – two endemic to swine, one to birds and another to humans. WHO's representative to the Philippines, Dr. Soe Nyunt-U, said: “If you have two viruses at the same time, the two viruses can swap genes. If that happens we might have more severity trait going into it. But if it is less virulent, that is not a problem. The worry is you create a virus during this gene swapping that is more virulent. That is what we are more worried about." John Barry, author of “The Great Influenza", said that the 1918 pandemic which swept the world actually arrived in two waves: the first was a mild virus, the second a deadly strain which killed at least 50 million people worldwide within one year. For the Philippines, Dr. Nyunt-U said, the situation is made more complicated by the fact that it's already the flu season. What this means is that the country typically has more flu cases during the rainy season. However, this “seasonal flu" could provide a cover for the appearance of a deadly mutant strain, which might not be noticed early enough. “We're worried that during this rainy season, we might have seasonal flu and a novel virus circulating in our population. Symptom-wise there's not much difference." Mild though it might be, the A(H1N1) novel virus is already costly to deal with. Duque estimated that an infected person has to spend around P25,000 for examinations, doctors' fees and medications. Dr. Eric Tayag, head of the DOH's National Epidemiology Center, said that many of the Filipinos initially infected were people who were generally healthy and could afford to pay for the treatments. However, as the flu spreads nationally, not only will it affect the poor. “What if the disease spreads in poor communities, in areas that have no adequate public facilities? In a squatter area, for example, where many people are already suffering from chronic illness? This is what worries the WHO," said the virologist from the medical school. The nightmare scenario is that the virus will not only spread to poor communities; it might also find in those areas the ideal conditions for an antigenic shift into a deadlier strain. The virologist speculated that the government hasn't brought up this scenario because of fears it could cause public unease. In the Philippines, Dr. Nyunt-U said, “there'll be many people who'll have both seasonal flu and H1N1 – you just need to have a chance occurrence of gene swapping in one human body." He explained that “you just need one person that will create the virus. From that one person it will start spreading to others." He said, “I hope this remains mild. Sometimes an endemic virus starts mild, then later on severe. Sometimes it starts severe and becomes mild. This is a numbers game." Duque has constantly advised the public to practice good hygiene and strengthen the immune system through proper nutrition as a defense against flu viruses. In the teeming slums and congested neighborhoods, however, this is much easier said than done. - GMANews.TV