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H1N1 Reality Far Lower than Expectations, says British Medical Journal

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Joe DeCapua

The British Medical Journal is taking a hard look at H1N1, examining why the flu strain did not become the huge epidemic that many feared it would.
   
The World Health Organization says the latest estimate indicates 13,000 people around the world have died from H1N1.  It says it expects that number to be much larger when the final estimate is released in the coming months.  In comparison, the seasonal flu kills about 36,000 people each year in the United States.
   
BMJ deputy editor Tony Delamothe says, “I think you’re right to say everybody was concerned about the potential for H1N1, but from the vantage point of early January 2010, at least in the U.K., it doesn’t look as if it’s any worse than an average bout of flu,’ he says.
   
He says after a spike of H1N1 cases in mid-2009 in Britain, reports of flu cases remained steady and then began to decline.
   
Over 360 deaths from the disease have been reported, but Delamothe says, “Really, flu kills people every year.  And it’s really hard to know whether that’s more than an average year for flu mortality.”
   
Did early warnings and preparedness help?

There were many warnings about the potential danger of H1N1.  And while vaccine was being manufactured, there were campaigns in many countries on how to reduce the spread of flu.  These included washing hands and making sure sneezes were covered.
   
Delamothe asks what steps were really taken to stop the flu.  He questions the effectiveness of the drug Tamiflu, which many people took to reduce flu symptoms.  And he says cases started to decline before a vaccine was fully available.
   
“In this country (Britain) it started about 10 weeks ago and really there’s not been much happening on the flu front since August.  So, I don’t think we can say everything’s panned out as well as it has because of vaccinations.  Certainly not in the U.K. anyway,” he says.
   
The situation appears similar in many other parts of the world, he says, “because vaccination stocks weren’t really available until relatively recently.”
   
Delamothe says data collected by the BMJ “suggest that week on week the number of flu cases is going down….  It was here and now it’s going.  And it’s going pretty fast.”
   
Lessons learned
   
Everything is easier with hindsight, says Delamothe.  But he adds, “I think we’d been primed for a catastrophic mutation of influenza….  The question is:  ‘Given the expectation that a big mutation’s on the way, what do we do when we get the next outbreak in any country in the world?’ “
   
The British Medical Journal deputy editor says, “I feel that we should have worked out much sooner that this wasn’t going to be absolutely catastrophic… . Other people whose business it is to interpret flu surveillance should have at least been a bit more skeptical than they were.”
   
The public, he says, certainly will be much more wary of any future warnings similar to the one about H1N1.
 

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