Panel Puts H1N1 Flu in Historical Perspective

A CDC microbiologist examines a reconstructed 1918 pandemic influenza virus.

As cases of Influenza Type A H1N1, or "swine flu," emerged around the globe and as the Harvard School of Dental Medicine managed a recent cluster of cases there, HSPH faculty and other experts convened a panel and discussion for the School community on May 6. The event was presented by the Center for Public Health Preparedness (HSPH-CPHP) and the Division of Public Health Practice.

A major flu outbreak has been in the cards for a long time, said Paul Biddinger, director of disaster medicine and director of operations in the emergency department at Massachusetts General Hospital, and assistant professor in the Department of Health Policy and Management. Usually occurring three times per century, a major outbreak has not spread since 1968. In 1918, a strain of H1N1 flu killed more than 500,000 people in the United States and at least 20 million worldwide.

Incidence of diseases like the new H1N1 flu strain are increasing and are likely here to stay, according to Jennifer Leaning, professor of the practice of global health and co-director of the Harvard Humanitarian Initiative. New viruses have emerged at a rate of one per year for the last three decades, she said. Many originate from animal sources, a fact she traces to humans' incursion into wild animal habitats and the proliferation of factory farms.

Regarding the current strain, Barry R. Bloom, Harvard University Distinguished Service Professor and Joan L. and Julius H. Jacobson Professor of Public Health, said that Type A flu is "fiendishly clever" about causing disease. An RNA virus made up of eight segments of RNA rather than DNA, its replication makes frequent mistakes, resulting in mutation. The current virus is a mongrel and contains gene segments from two types of swine sources, as well as avian and human flu viruses. Humans have no known prior immunity, Bloom said, which gives the strain the potential to be quite dangerous and the cause for the public health concern it evokes.

Keeping the public informed during these confusing times is a challenge, said K. "Vish" Viswanath, associate professor of society, human development, and health at HSPH. People look to a wide array of sources for information, from national broadcast news programs to small blogs. And given what Viswanath called a culture clash between scientists' deliberative approach and reporters' need for fast facts on deadline, it's difficult for public health officials to convey messages that provide context.

However, Viswanath said, "Considering these challenges, I think the communication has been pretty good about this virus. It's part of the preparedness lessons we have learned from SARS and 9/11."

Michael Stoto, an adjunct professor of biostatistics and co-principal investigator of HSPH-CPHP's "Linking Assessment and Measurement to Performance in Public Health Emergency Preparedness (PHEP) Systems," cautioned against "Monday-morning quarterbacking" the efforts to respond to public health crises. Instead, questions should be asked about what can be learned from the decision-making process behind crisis management.

Other speakers at the event included Gregory N. Connolly, interim director of the Division of Public Health Practice; David Rosenthal, director of Harvard University Health Services; and Elena Savoia, acting director of the HSPH-CPHP.

-- Amy Roeder. Photo by CDC/James Gathany.