Jay P. Greene's Blog

Just because the current influenza epidemic has been relatively mild doesn’t mean that it will continue to be so.  If you want to read something scary, check out this paper by noted flu researcher, John M. Barry.  Barry is a distinguished scholar at the Tulane University Center for Bioenvironmental Research and author of the award-winning book on the 1918 flu pandemic, The Great Influenza: The Epic Story of the Deadliest Plague in History .

In the new paper, Barry writes:

The novel H1N1 virus [the current swine flu] seems thus far to be following the pattern of the first three pandemics, and it seems highly likely that it will return in full flower. If the virus is fully adapted to and efficient at infecting humans, this would occur soon, possibly during the influenza season in the southern hemisphere or possibly a few months later in the northern hemisphere. The 1918 and 1957 viruses both exploded in September and October in the northern hemisphere, even though this is not the influenza season….

The most disturbing pieces of information are two:

First, unlike seasonal influenza viruses, novel H1N1 seems to have the ability to bind to cells deep in the lung, which H5N1 does and which the 1918 virus could do.

Second, molecular biology has provided is that, according to scientists at CDC and elsewhere, “genetic markers predictive of adaptation to humans are not currently present in the [H1N1] viruses, suggesting previously unrecognized determinants could be responsible for transmission.” This suggests two things: first, this virus may have other things to teach us; second, we do not know the whole story of how influenza becomes transmissible from human to human, so our monitoring of H5N1 for these markers is incomplete.

Novel H1N1 also lacks genetic markers for virulence identified in the 1918 virus and is expected to remain a mild virus, but this information about transmissibility has unsettling implications.

H5N1 continues to infect and kill people, and Robert Webster, one of the most respected virologists in the world, has expressed concern about a further reassortment of novel H1N1 with H5N1. This is not so far-fetched. A recent laboratory study in which ferrets (the usual animal model for influenza studies) were coinfected with H5N1 and the seasonal H3N2 virus found that a new reassortant virus with genes from both was produced 9 percent of the time.This reassortant was likely much milder than H5N1 itself. (H5N1 is virulent because it binds only to receptors deep inside the lung; other influenza viruses bind to receptors, usually in the upper respiratory tract; the reassortants all were found in the upper respiratory tract.) But given the lethality of H5N1, a reassortant that includes it is frightening. Assuming H1N1 matures to full pandemic status and begins to infect 20 to 40 percent of the population, reassortment with H5N1 is a threat.

Let me translate — the current swine flu, called novel H1N1, is easily transmitted but relatively mild.  The same was true in the first waves of past pandemics.  But if there is a reassortment, a mixing, of H1N1 with the more lethal but less transmissible avian flu, H5N1, we are in for big trouble.  Laboratory experiments with ferrets suggest that the two might mix to combine the transmissibility of one with the lethality of the other. 

Don’t be fooled by the mild first wave.  The mixing could take place in a second or third season, as it did in 1918.

If this does happen we will have all sorts of things to worry about, but one of them is what we do about education.  Despite headlines declaring Swine Flu Should Not Close Most Schools, Federal Officials Say, we may well have to close large numbers of schools.  If that happens do we have contingency plans prepared?  Do we have plans to provide education even if large numbers of students have to stay at home?  Will we have procedures for using phone and internet technologies to disseminate assignments and instruction?

I’m willing to bet that fewer than 10 of the 10,000 school districts in the country have workable emergency plans ready for a deadly flu pandemic.  Just look at the school districts around New Orleans.  It’s not as if school districts all along the Gulf of Mexico should be surprised that a hurricane might hit and close school for several weeks.  It’s likely to happen at least with some districts on a fairly regular basis.  And yet none of them had workable plans for how to educate students when the schools closed.  They just relied on sending many of those students to other cities outside of the impacted area or leaving them to wander the streets.

But what will happen when schools all over the country are closing because of a deadly flu pandemic?  We won’t just be able to send the kids to some other, unaffected city.  Let’s hope and pray that it won’t happen, but that doesn’t mean we shouldn’t be prepared in case it does.