N&Q1 Science Café
Science Café, Jan. 26th, 2010
Pandemics – Risks and Reactions to an Issue of Public Health
The topic of pandemic is especially pertinent at this time, as we are currently involved in the H1N1 flu pandemic. One of the important points made this evening was that we are not through with H1N1, even though it is no longer newsworthy, and there may be a third wave of the virus, as has been evidenced in the past with other pandemics.
The introductions were made by Dr. Paul Koobs, head of a new institute in Calgary, the Alberta Sepsis Network: Viral, Fungal, and Microbial. It’s housed in the new building on the grounds of the Foothills Hospital. He discussed how the major problem with the H1N1 virus was not the virus itself, but the body’s overreaction to the invasive phage. The hyperactive immune system condition, called sepsis, actually causes more damage than the virus does. This is how the great pandemic of the 20th century, the so-called Spanish Flu, killed its victims by proxy, when the white cells’ caustic chemicals used to kill phages turn against body tissues. Five hundred million people died, most of them young, fit, and healthy. Sepsis is so dangerous that the death rate today is 50%, while the death rate from a stroke is 20% by comparison. Twenty years ago, the sepsis death rate was closer to 100%. Some fascinating videos were shown on the PowerPoint presentation of white blood cells ‘searching and destroying’ invasive phages.
From Dr. Koob’s introduction on the microissue of what is happening in the body, Alberta’s Deputy Medical Officer of Health, Judy MacDonald, who made the case for Alberta’s preparedness, spoke about the macroissues of public health. Public health is a very big job, with timely and effective vaccine production and distribution one of the many responsibilities. The H5N1 virus was first detected in Hong Kong in 1997, later named the Bird or Avian Flu, as this was its animal vector, and resulted in an undetermined number of deaths before the Chinese government took the radical step of slaughtering 1.5 million fowl in the poultry markets. This was the first indication that an influenza phage, present in all migratory birds and most domestic ones, could be passed directly to people without the intermediary host of the pig, which serves as a ‘mixing vessel’ to incubate and transform the virus into one that can attack humans, due to the remarkable physiological similarities between humans and swine. Alerted to the possibility of a new, more dangerous flu, nations began cooperating on an unprecedented scale for pandemic contingency planning. In the midst of this, another shock as delivered in the form of SARS in 2002, which forced the issue of faster and better pandemic planning through the World Health Organization. Canada now has a dedicated manufacturer for antivirals as a result of this planning. The next virus arrived in mid-April of 2009, from Mexico, another version of swine flu, now called H1N1. Dr. MacDonald said that preparedness is expecting the unexpected from viruses because of their rapid mutation and today’s rapid travel, which can move a virus planet wide within days. By June 11, a pandemic was announced, with 28,774 confirmed cases in 74 countries, and 144 confirmed deaths. Canada’s antiviral manufacturing committed to producing a dose for all 36 million Canadians, with priority given to the ill and health care workers directly involved. A huge public messaging program for hand hygiene was developed, but the vaccine dosed didn’t arrive until October 26th, well after the initial surge of reported cases. So far, only 33% of Canadians have taken the dose, as the media have ignored the fact the pandemic is still on, and may produce a ‘third wave’ of renewed infections. One of the indicators are schoolchildren – the ‘canaries in the coal mine’. Once school absenteeism reaches 10%, school health officials are required to report that to Alberta’s Public Health as an outbreak. Winter is the high season for outbreaks of flu, but H1N1 chose summer of 2009, coming in at double the normal seasonal illness rate.
Dr. Chip Doig, AMA president for Canada and U of C intensive care specialist, discussed that H1N1 was more treatable with Alberta’s available 300 intensive care beds as it occurred through October, the ‘shoulder season’ when demand for intensive care was not as great. During the summer, ICU capacity hovers around 90% because of summer recreational injuries, and it was fortunate that October had the available space for those H1N1 victims. The white blood cells ‘overreact’ to the phage, and victims effectively drown in their own lung fluids. The process is not yet clearly understood, but the treatment is extremely intensive, long and very expensive. Heart attack victims use a cardio pulmonary bypass machine for perhaps 2 hours of surgery, while H1N1 victims need 14 days on the machine, in addition to a dialysis machine and ongoing, real time blood chemistry testing. The cost can exceed $10,000 a day for treatment, lasting over 2 weeks just for the victim to overcome the white cell overreaction and complications. Another 6 – 8 months of recuperative time is required before the victim is even close to the same fitness as before the attack. It’s a serious business. Dr. Doig assured the audience that Alberta’s health care is among the best in the world, despite media sensationalist reports to the contrary. In 20 years, we have moved from a non-survivable prognosis to survivable in most cases.
All in all, this Science Café was excellent, in both the content and presentation. If you’d like to learn more, Science Café is on the web as a co-production of the U of C and the Telus World of Science, and is presented the last Tuesday of each month, nine times a year, December and June and July excepted. Sign up for notifications via e-mail or Facebook. See you in February!
Jeff Pugh
