As a board member of the MIT Center for Engineering Systems Fundamentals, John Barry, influenza historian and author of The Great Influenza, discussed how the "mild" H1N1 influenza could be just the first wave of a pandemic at MIT in Cambridge, Massachusetts, on October 5, 2009.
It remains uncertain how to explain (or prevent) the human to human transmission of the virus. It's unclear if the virus binds directly to cells in the lung. The question remains if the virus spreads in the air during respiration, coughs, and sneezes. How long the virus survives outside the human body depends on temperature, humidity, and the kind of surface it's on. A virus that survives on a surface thirty minutes to a couple days can be spread through touch.
"If it's all aerosole, if it all comes from breathing it in, then washing your hands isn't going to help," said Barry. "If someone coughs, opens the door, you come by an hour later, open the door, then rub your eyes you've just transmitted the virus, if hand transmission is involved. So the extent that hand transmission is involved, then hand washing works."
Barry says he is "lukewarm" about hand washing as a preventive measure, at least hand washing does not hurt anyone.
Social distancing may cut down on the number. Quarantines are useless as prevention. A university dormitory reserved for sick students is "just a good place to provide care" but no quarantine can contain the spread.
"In terms of things like quarantine, I can give you data on quarantine that that's worthless. It's good data. In terms of things like school closings, that's trickier," said Barry.
The H1N1 influenza virus is currently so mild that "school closures work but are not justified."
"If the virus suddenly becomes much more virulent and dangerous then the use of school closing begins to make much more sense," said Barry.
This pandemic of the H1N1 influenza virus may have waves of mild and more extreme activity.
"You're going to be exposed to the virus pretty much no matter what you do," said Barry. "My attitude is the virus is going to find me. No. Fortunately right now the virus is mild. I would say that if I had symptoms I would take Tamiflu."
The seasonal H1N1 virus in the United States has developed resistance to Tamiflu but the one in Japan has not. As of right now the pandemic strain of the H1N1 virus "does not seem to be developing resistance to Tamiflu, although it probably can and probably will eventually," said Barry.
Barry said the World Health Organization should have called the H1N1 influenza virus a 'pandemic' earlier. The WHO response was "appropriate and belated" and the "messaging could have been clearer" said Barry. "The whole world had been so geared for one particular event and we got sideswiped but basically I think the WHO has done a very good job on this. Now I would criticize them, if anything, for not having declared it earlier."
Barry said that airports, although international hubs of activity, are not the only sites of influenza transmission. Air travel spreads the disease faster but not significantly in the case of a disease like influenza. Historically, viral pandemics occur regardless of the transportation. In 1918 influenza quickly spread in a world without airplanes even when it took months to cross the oceans on sail boats.
"The fact of the matter is influenza is not containable," said Barry. "So I think air travel is kind of overstated for this disease."
Attending emergency preparedness meetings, Barry asks questions about plans for the worst case scenario. Preparation for the most virulent, dangerous influenza pandemic does not necessarily prepare for a mild one.
"But what happens, if you get a mild first wave, to your planning?" Barry asked. "Just look and the historic pattern and plus it makes evolutionary sense that when a virus jumps species and suddenly in a new environment it's not going to be perfectly adapted in that new environment, and it's going to take awhile to learn where the bathroom is, in the kitchen, before it's fully efficient in infecting people."
Historical data on pandemics indicates that the first wave of a pandemic can be mild. The current pandemic strain of H1N1 influenza seems generally mild, depending on how one defines "mild" when there have been deaths. Emergency plans need to include responses to all waves of the seasonal and pandemic strains of the H1N1 flu.
"So if it makes evolutionary sense that it's going to take awhile plus you have historical data telling you so why it certainly should have been part of the message," said Barry. "People did think and do think that if they are prepared for the worst then automatically they're prepared for the best and that is not the case."
It remains uncertain how to explain (or prevent) the human to human transmission of the virus. It's unclear if the virus binds directly to cells in the lung. The question remains if the virus spreads in the air during respiration, coughs, and sneezes. How long the virus survives outside the human body depends on temperature, humidity, and the kind of surface it's on. A virus that survives on a surface thirty minutes to a couple days can be spread through touch.
"If it's all aerosole, if it all comes from breathing it in, then washing your hands isn't going to help," said Barry. "If someone coughs, opens the door, you come by an hour later, open the door, then rub your eyes you've just transmitted the virus, if hand transmission is involved. So the extent that hand transmission is involved, then hand washing works."
Barry says he is "lukewarm" about hand washing as a preventive measure, at least hand washing does not hurt anyone.
Social distancing may cut down on the number. Quarantines are useless as prevention. A university dormitory reserved for sick students is "just a good place to provide care" but no quarantine can contain the spread.
"In terms of things like quarantine, I can give you data on quarantine that that's worthless. It's good data. In terms of things like school closings, that's trickier," said Barry.
The H1N1 influenza virus is currently so mild that "school closures work but are not justified."
"If the virus suddenly becomes much more virulent and dangerous then the use of school closing begins to make much more sense," said Barry.
This pandemic of the H1N1 influenza virus may have waves of mild and more extreme activity.
"You're going to be exposed to the virus pretty much no matter what you do," said Barry. "My attitude is the virus is going to find me. No. Fortunately right now the virus is mild. I would say that if I had symptoms I would take Tamiflu."
The seasonal H1N1 virus in the United States has developed resistance to Tamiflu but the one in Japan has not. As of right now the pandemic strain of the H1N1 virus "does not seem to be developing resistance to Tamiflu, although it probably can and probably will eventually," said Barry.
Barry said the World Health Organization should have called the H1N1 influenza virus a 'pandemic' earlier. The WHO response was "appropriate and belated" and the "messaging could have been clearer" said Barry. "The whole world had been so geared for one particular event and we got sideswiped but basically I think the WHO has done a very good job on this. Now I would criticize them, if anything, for not having declared it earlier."
Barry said that airports, although international hubs of activity, are not the only sites of influenza transmission. Air travel spreads the disease faster but not significantly in the case of a disease like influenza. Historically, viral pandemics occur regardless of the transportation. In 1918 influenza quickly spread in a world without airplanes even when it took months to cross the oceans on sail boats.
"The fact of the matter is influenza is not containable," said Barry. "So I think air travel is kind of overstated for this disease."
Attending emergency preparedness meetings, Barry asks questions about plans for the worst case scenario. Preparation for the most virulent, dangerous influenza pandemic does not necessarily prepare for a mild one.
"But what happens, if you get a mild first wave, to your planning?" Barry asked. "Just look and the historic pattern and plus it makes evolutionary sense that when a virus jumps species and suddenly in a new environment it's not going to be perfectly adapted in that new environment, and it's going to take awhile to learn where the bathroom is, in the kitchen, before it's fully efficient in infecting people."
Historical data on pandemics indicates that the first wave of a pandemic can be mild. The current pandemic strain of H1N1 influenza seems generally mild, depending on how one defines "mild" when there have been deaths. Emergency plans need to include responses to all waves of the seasonal and pandemic strains of the H1N1 flu.
"So if it makes evolutionary sense that it's going to take awhile plus you have historical data telling you so why it certainly should have been part of the message," said Barry. "People did think and do think that if they are prepared for the worst then automatically they're prepared for the best and that is not the case."