By Susan Blumenthal, MD, Former US Assistant Surgeon General, Bowen Jiang and Yi-an Ko
The recent emergence of H1N1 "swine" flu is a powerful wake-up call to the health challenges ahead, reminding us of the important roles prevention and public health preparedness play in mitigating the spread of disease and in promoting good health. So far, 30 countries across five continents have reported cases of H1N1 infection. In the United States alone, as of May 12, more than 2,600 cases in 44 states (including the Washington D.C. metropolitan area) and three deaths have now been confirmed. The U.S. government has declared the H1N1 flu a "public health emergency" while the World Health Organization (WHO) echoed this assessment, raising its pandemic flu alert level to Phase 5 (its second-highest level), sending "a strong signal [to the world] that a pandemic is imminent."
A pandemic is a massive, prolonged, and widespread disease outbreak on the global level. More specifically, an influenza pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population, causing serious illness and then spreading easily from person-to-person.
Historically, disease outbreaks affect many sectors of society; in the case of the H1N1 flu, world leaders fear that a pandemic could derail global economic recovery. Within a few days of the outbreak, public speculation caused crude oil, industrial metals, and hog futures to drop and sent stock markets tumbling. The H1N1 flu has also negatively impacted education, transportation, commerce, and tourism, causing school closings and flight cancellations. The rapid spread of cases of this flu and its widespread impact on society underscores that in today's era of globalization, an infectious disease is not only a jet plane away but also capable of threatening the health of economies worldwide.
The ripple effects that infectious disease outbreaks have on societies are not new. These illnesses are major killers of humans and have been decisive shapers of history. For instance, one of the most catastrophic infectious disease outbreaks ever was the 1918-1919 Spanish influenza pandemic that infected one fifth of the world's population and killed an estimated 20-50 million people globally. Even the milder influenza pandemics of 1957 and 1968 collectively claimed over 100,000 lives. What is new, however, is the unprecedented disruptive potential that infectious diseases have in an ever more interconnected world. Since the 1960s, the WHO has documented 40 new or re-emerging infectious diseases including this H1N1 flu strain, AIDS, Lyme Disease, SARS, and the H5N1 avian flu. The world has not seen a disease explosion of this magnitude since the Industrial Revolution. These diseases usually originate where animals and humans live in close proximity and are exacerbated by rapid population growth, international travel and trade, urban crowding, poverty, climate changes, and lack of access to healthcare.
Stemming the spread of the H1N1 flu outbreak and effectively responding to emerging infectious diseases in the future hinges upon three essential pillars of public health: 1) prevention and preparation, 2) surveillance and detection, and 3) response and containment. These steps for flu outbreaks are detailed in the Pandemic Preparedness Plans developed by the WHO and the U.S. government in recent years. Fortunately, advances in the scientific understanding and detection of infectious illnesses, the establishment and effective deployment of stockpiles of medications and supplies, the development of a test kit to detect the presence of H1N1 that has been shipped to all 50 states and other countries, and the enhancement of global networks for surveillance have better equipped health professionals and policy makers to respond to emerging diseases. Likewise, improved and coordinated communication messages and technological innovations that allow instant communication through e-mail alerts, podcasts, news feeds, and even "tweets" from Twitter have expedited the rapid and wide dissemination of information.
As health experts prepare and respond to the current flu outbreak, the public also has a critical role to play. Individuals should practice good hygiene by washing their hands often, covering coughs and sneezes, staying home if they are sick, and marking their calendars to get vaccinated for seasonal flu this coming winter. People are often surprised to learn that seasonal flu every year causes approximately 36,000 deaths in the U.S. and 250,000-300,000 worldwide. While laboratory analysis indicates that the currently available seasonal flu vaccine does not appear likely to confer significant immunity against the 2009 H1N1 virus, annual flu immunizations will save a significant number of the 36,000 lives lost in our country to seasonal flu every year, prevent suffering, and boost productivity.
While nations are better prepared for infectious disease outbreaks than ever before as evidenced by the rapid global response to the H1N1 flu, much remains to be done. Many developing countries, where new diseases (including strains of influenza) often originate, have inadequate public health infrastructure and are limited in their ability to respond because they lack sufficient surveillance capabilities, early warning systems, laboratories, and a robust health workforce. Moreover, even in the U.S. today, vaccines are still being made using inefficient techniques from the 1960s. Based on current methods using eggs from chickens, and with many manufacturing facilities located overseas, it could take many months to create a safe, effective vaccine for the H1N1 flu and years to produce enough vaccine to meet global demand.
Other issues that can impede an effective response in the U.S. include separate federal and state authorities, lack of sufficient surge capacity in emergency rooms and hospitals, scarce preparedness resources at the state and local level, and inadequate investments in public health infrastructure. Furthermore, despite the documented power of public health interventions to prevent and control disease outbreaks, only 1-3 % of US health expenditures are spent on prevention, a percentage that is unchanged since the 1930s. Additionally, the 47 million Americans who lack health insurance experience difficulty accessing and receiving care. This results in missed opportunities for early diagnosis and treatment of infectious illnesses such as the flu, which can lead to poorer health outcomes and the inadvertent spread of disease.
Looking forward, it is critical to marry the public health lessons of the past with new advances from science and medicine. Vigilance against infectious diseases requires a commitment from all nations to invest a significant portion of their health budgets on disease prevention and preparedness, to strengthen both national and global public health infrastructure, and to develop coordinated strategies for disease response that crosses sectors, agencies, and countries. Additionally, every business and community should be prepared. Taking these steps will pay a dual dividend to prevent and protect against this flu outbreak as well as other disease threats that face us today and those that will invariably emerge in the future. One adage remains certain: complacency is the enemy of preparedness.
Listed below are some steps that individuals, businesses and communities can take to improve health:
- Practice good hygiene:
- Wash your hands often with soap and water, especially after you cough or sneeze. Using alcohol-based hand cleaners is also an effective alternative.
- Cover your nose and mouth with a tissue when you cough or sneeze and dispose of them afterwards. If tissues are not immediately available, use the crook of your arm.
- Avoid touching your eyes, nose or mouth. Germs spread this way.
- Try to avoid contact with sick people.
- If you get sick, stay at home and limit contact with others.
- Be alert to your symptoms and get help. H1N1 flu symptoms include fever, body aches, sore throat, cough, runny nose, lethargy and some cases, vomiting and diarrhea. If you exhibit any of these symptoms, seek medical attention immediately
- Develop an emergency plan for your family including having supplies at home such as food and medical supplies.
For Businesses and Communities:
- Develop preparedness plans as you would for other public health emergencies.
- Participate and promote public health efforts in your state and community.
- Talk with your local public health officials and health care providers; they can supply information about the signs and symptoms of a specific disease outbreak.
- Implement prevention and control actions recommended by your public health officials and health care providers.
- Adopt business/school practices that encourage sick employees/students to stay home.
- Anticipate how to function with a significant portion of the workforce/school population absent due to illness or caring for ill family members such as telecommuting.
- Provide current and updated health information for your employees.
Helpful information resources include:
Pandemic Flu - One-stop Access to U.S. Government Pandemic Flu Information
Latest Information on H1N1 Flu from the CDC
World Health Organization H1N1 Flu Information
Emergency Preparedness Information
Rear Admiral Susan Blumenthal, M.D. (ret.) is the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C. and is a Clinical Professor at Georgetown and Tufts University Schools of Medicine. She also serves as the Chair of the Global Health Program at the Meridian International Center and as Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research. For more than 20 years, Dr. Blumenthal served in health leadership positions in the Federal government, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Dr. Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. She was recently named the 2009 Health Leader of the Year by the Commissioned Officers Association. For more information, please visit www.susan-blumenthal.org.
Bowen Jiang, a graduate of Stanford University, will be attending Stanford University School of Medicine in the fall.
Yi-An Ko, a graduate of Harvard University, was a Health Policy Fellow at the Center for the Study of the Presidency and Congress in Washington D.C. and is currently a research and policy assistant.
This article was updated from an article published in the Washington Times on May 11, 2009.