Illustration by Paul Blow
Reports about the new swine flu went from mass hysteria to email jokes in less than two weeks. In one, Kermit’s shown as a sprawled green corpse—“and guess who gave it to him?”
Poor Miss Piggy. It’s not her fault that humans can catch the flu from pigs. Besides, the pigs caught this one from the birds. That’s why scientists despise the media shorthand of “swine flu”—by now, H1N1 is a mosaic of avian flu, swine flu, and human flu, recombined in a grim hommage to its serial hosts.
In June, the World Health Organization officially declared this flu a pandemic—the first in 41 years. By then, it had spread to 74 countries. Here in the United States, alarm had subsided. But experts were warning that if the new flu “drifted” in the hot summer months, while it was dormant, it could return in a more virulent form. Then even the vaccine that the WHO is rushing into production might not provide immunity.
Of course, that’s the kind of sensationalistic media warning that gets people all hysterical and fades just as suddenly. Dr. Gregory Evans has watched the cycle since 2000, when Saint Louis University opened what’s now the Institute for Biosecurity, funded by an earmark from a worried Sen. Kit Bond. SLU, which had the only School of Public Health in the region, began educating people about bioterrorism. And because there was little difference between responding to a vicious release of plague and fighting the new West Nile virus, the institute added emerging infectious diseases to its mandate.
Evans, the institute’s director, began by surveying public-health workers: Were they concerned about a bioterrorism attack in the United States within the next five years? Only one-fourth had any concern, and only about 3 percent thought it could happen in their own community.
After 9/11, the institute repeated the survey. Now, three-fourths were concerned about a bioterrorism attack on U.S. soil. But only 6 percent thought it could happen in their own community.
How do you teach people to prevent contagion if they don’t see a real danger?
Sure, there are tiny ripples of panic—Evans did multiple media interviews a day for weeks when H5N1 (avian flu) broke out. Then his phone stopped ringing, and he learned that the reporters had been called off because the public was sick of the story. First you have media saturation, then you have sated indifference: People stop thinking about preparation. They’re not ready for telecommuting or school closures (in children, flu remains contagious far longer than adults’ one-day-before-fever-and-seven-days-after). They forget to keep 6 feet apart (“social distancing”), wash their hands thoroughly, and stock up. “You should always have enough food, water, pet food, and medications to stay home for three weeks,” Evans says. “And my personal opinion—this is controversial—is that you should have masks.”
It’s true that masks don’t screen out small droplets carrying the virus, but in public places, transmission is by large droplets. It’s direct caregivers who need the more protective respirators; for everybody else, respirators are too uncomfortable to ensure compliance (never the general public’s strong suit).
To educate public-health, safety, and Homeland Security workers—and hopefully change public behavior—SLU began offering graduate degrees in biosecurity and disaster preparedness; this fall, it will add a Ph.D. and encourage desperately needed research. How do you change public behavior when so many of us either overreact, racing to the E.R. with a sneeze, or underreact, trudging in to work with a fever? How do you stop people from blowing off a flu vaccine as unnecessary or refusing for fear of contamination? (“Shoot virus into a healthy body? No way!”)
“But the vaccines work,” Evans repeats wearily. “And what people don’t realize is how many lives are lost every year to flu: even without a pandemic, about 36,000.”
In the lobby of SLU’s Doisy Research Center, a guard stops me, demands and Xeroxes my driver’s license, motions me toward a camera. Click, zzzssst, he prints out a photo name tag, adds my data, watches while I affix it to my bosom, and records my destination.
“The oversight for working with organisms is intense since 9/11,” explains Dr. Sharon Frey, clinical director for SLU’s Center for Vaccine Development. “I can’t get a cup of coffee if I forget my name tag.” She and her colleagues test new vaccines against everything from seasonal flu to smallpox, determining the best dosages and frequencies for various populations. By the time you read this, they’ll be hard at work testing a new vaccine for H1N1.
And praying it doesn’t mutate into something more lethal.
The 1918 “Spanish flu” pandemic was an early form of H1N1, and it killed more people than World War I. Not just the usual victims of flu—children, the elderly, pregnant women, anyone with a weak or compromised immune system—but also healthy adults who’d never been exposed to anything like it. Some researchers believe that strong immune systems went into overdrive to fight the new virus—and wound up destroying
bodily organs.
So far, this H1N1 isn’t anything like that, but it could change. “There are two ways viruses mutate,” Frey says, explaining that while one type, Virus B, stays more stable, the problematic Virus A has 25 different possible proteins. If one of those proteins changes slightly, that’s called a “drift”; it results in a different strain of the same flu, so anyone who’s already been exposed or vaccinated has a fighting chance.
The other kind of mutation is an outright “shift,” and it happens when the virus jumps species. Say a pig that’s already got swine flu comes into contact with a sick chicken. The avian and swine viruses recombine, inside the pig’s body, into a new virus. Then some unsuspecting swineherd shovels pig manure and wipes his hand across his mouth, contracting an avian-swine virus that, inside him, recombines with a human flu. The result? A new organism altogether.
This May, Frey was eagerly waiting for the new H1N1 to be cultured, grown in embryonated chicken eggs, harvested, purified, and made into a vaccine the center’s researchers could begin testing. By fall, it should be ready to inoculate the rest of us. That way, provided the virus hasn’t changed much, our bodies can start preparing their disaster response before the real thing hits.
If only society would do the same.
