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H1N1 Influenza: A Cytokine Storm Conclusion, But Still More Questions Than Answers

The good news on H1N1 (commonly called Swine Flu) is that in current strains the death rate appears to be as low as 1 in 2,000 infections, at least in First World countries with modern hospital facilities. The bad news is that at least 60% of world's population is expect to contract the bug, and that further mutations are probable.

The Mutation Question

Mutations to less virulent strains are the historic norm for viruses but there is the risk of one that is very deadly. (To explain: in the grand scheme of things, a mutation with high lethality is is not good for a virus. Some, like Marburg and Ebola, have had strains that were so deadly that the hosts didn't live long enough to pass it along to a large number of new carriers. The most successful viruses are the ones that propagate well, but do not kill too many of their hosts.) We can surmise that the absolute "worst case" for H1N1 is that a much more lethal strain emerges, to be followed by a global infection, and a large-scale die-off. But again, that is the less likely outcome.

The Cytokine Storm Question

Up until recently, I agreed with SurvivalBlog reader "L. Jean" in England who in an e-mail last week noted that we were "still waiting to find out if it's a cytokine storm that kills or not." This is a determining factor whether young, healthy folks should try to boost their immune response, or whether that might make matters worse. Based on the latest literature, I believe that it is now safe to say that with H1N1 a cytokine over-reaction is indeed a substantial risk, and could be a bigger killer than the virus itself. So my updated advice is to continue to store immunity boosters, but not use them to treat H1N1 unless you are Imuno-suppressed. Otherwise healthy patients in ages between 18 and 50 should refrain from doing so. I have updated my article on influenza pandemics, accordingly.

The Immunization Question

There is a vaccine for H1N1 in development, but it has been put on a radically fast track for development and trials. This has raised concerns about contamination and efficacy. Since the strain chosen for the immunization is both a "snapshot" and a "best guess" about what strain will be circulating next winter in the northern hemisphere, and there will only be limited animal testing to rule out pathogenicity. So there are some critics that argue that the vaccine might pose more of risk than the flu itself. It is also noteworthy that the vaccination program will require multiple injections for each patient. In my opinion, it is not yet clear whether the risks will outweigh the benefits. For some of my readers this won't be a matter of choice. Both Canada and the UK have announced their intent to implement universal inoculation programs.

The Madagascar Question

In the well-known computer game Pandemic II, the president of the island nation of Madagascar is quick to isolate the country to prevent the advent of a pandemic. This has become a standing joke among gamers, and the term "Madagascar" has migrated into the epidemiology community. "Going Madagascar" is essentially slamming the doors shut, in the hopes of avoiding infection. (BTW, I know of at least two survival retreat groups that use "Madagascar" as their activation codeword, a-la the novel Alas, Babylon .) As I noted previously, the "worst case" for any virus is that a very lethal strain emerges, and rapidly spreads globally, as depicted in the novel (and television series) Survivors  by Terry Nation. The spread of H1N1 via modern jet air travel illustrated just how quickly this could happen. H1N1 has already spread throughout the United States. So I stand by my oft-quoted advice: In such an event you need to be ready and able to isolate your family for an extended period of time. Essentially, you would declare your homestead a mini-Madagascar and "button up" to wait for the virus to burn itself out. (BTW, I briefly describe the logistics of this in my article "Protecting Your Family From an Influenza Pandemic.") It is obviously too late and inappropriate to take extreme measures to isolate yourself from the current strain of H1N1, but we must remain vigilant for any new viral threats. The ability to "go Madagascar" is just one more reason to a have a deep larder!

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