FEATURE: Swine flu: Pandemic or Panic?

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The swine flu virus has all the ingredients of a frightening story: A virus which has jumped from pigs to humans; highly infectious, spreading quickly and, in a few cases, deadly.

After starting in Mexico, it’s spread steadily to more than 70 countries including the United States, Japan, India, China and Australia.

But debate continues over whether swine flu really is the next big lethal global pandemic.

“The cases we’re seeing continue to be mild, more mild than the seasonal flu,” said Victoria’s Premier John Brumby.

Dr Rachel David, from CSL laboratories in Melbourne, is preparing for the worst.

“There is the potential for this virus to mutate and become more serious as it circulates through the community, and we need to be extremely vigilant about that happening over the winter months,” she said.

CSL has won a contract worth $US180 million to supply swine flu vaccine to the United States, as well as Australia.

A key raw ingredient in vaccine manufacture is the plain old chicken egg.

Only living fertilised eggs will do. The eggs are ‘candled’ with a bright light to ensure the embryo’s heart is beating. Later, the fluid surrounding the embryo is injected with the live swine flu virus, where it will grow and be harvested for manufacture into a vaccine.

CSL is getting through 300,000 eggs every day to meet orders for 60 million doses of vaccine.

“It means we’ve had to order in more raw materials, in this case chicken eggs, to feed into the process,” Dr David said.

“We have probably about 120 additional staff who need to be employed through the winter months to work on the process, and our plant, which fortunately has a very large capacity, will have to work 6 days a week to produce the vaccine.”

Pandemic candidates

History has taught public health officials the need to be prepared.

In 1918, Spanish flu swept the across the globe. In the first instance, it was harmless. But when it resurfaced a few months later, it had mutated into something far more deadly.

It’s estimated a billion people became infected, half the world’s population at the time. Up to 50 million are believed to have died.

That virus jumped from birds to humans, and ever since, public health officials have feared a repeat.

The past decade has seen two other potential pandemic candidates: bird flu and SARS.

Bird flu, or H5N1, killed more than a hundred people in Indonesia and other south east Asian countries.

And by August 2003 Severe Acute Respiratory Syndrome (SARS) killed almost 1,000 people.

However, to put these figures into proportion, 26 people died of SARS in Singapore in 2003; in the same year, 246 Singaporeans committed suicide. Singaporeans were still 10 times more likely to kill themselves than be killed by SARS.

Doctor Glen Bates, a psychologist specialising in public anxiety, says when people are confronted with a heavily publicised risk to their safety, it’s easy to lose all sense of proportion.

“If you ask people what’s more likely to be a danger to them – being killed in a car accident or stomach cancer? You find that the majority of people answer that with car accidents, even though the facts would show they’re about four or five times more likely to die of stomach cancer than car accidents,” he said.

Even compared to previous pandemic scares, swine flu seems relatively tame. It’s currently less harmful than normal seasonal flu, a virus which gets almost no publicity, despite killing up to half a million people each year.

“Both SARS and the birdflu had a higher mortality than the circulating strain of swine flu and fortunately they did not spread more than to a limited number of people,” said Dr Rachel David.

“This type of flu, the swine flu spreads very quickly, but at the moment, the mortality and the illness is not great. That could change, which is why I believe that the heightened awareness of the issue is important.”

Heightened awareness has seen schools closed down in Melbourne, and the cruise ship ‘Dawn Princess’ forced to stay offshore for 10 days after some on board showed symptoms of swine flu.

When the ship was eventually allowed to dock, no-one tested positive.

Drawing the line

Professor Peter Collignon is an infectious diseases specialist at the clinical school of medicine at the Australian National University.

He says authorities are over-reacting.

“I guess it’s more than what i would put on if I was running the policy,” he said.

“We need to take measures to keep people who are sick away from those who aren’t – and that means don’t allow sick people to go to school and don’t allow sick people to go to work, but other than that, quarantining people who haven’t got any symptoms, is probably excessive.”

The next stage in any containment plan would be to ban mass public gathering like sports matches and shut down public transport. That’s not being considered, yet.

“The trouble is where do you draw the line,” Professor Collignon said.

“Because if we do this now, does that mean we have to do it every winter? And there’s an issue about how society can function, and at what level of risk you’re willing to take as a society.

“We will always have germs we will always have influenza. We have to accept that there is a risk with that. We can make the risk less by really stopping the spread, but it has these other costs, in that to some degree it can cripple how society functions both from a schooling point of view and business point of view.”

Vaccination lessons

This is not the first time the world has been gripped by swine flu fever.

In the United States in 1976 when an outbreak at the Fort Dix military base killed one soldier, the public awareness campaign went into over drive. Fourteen people died after receiving a hastily prepared vaccine, although a direct link was never established.

The lessons of 1976 are not lost on the World Health Organization.

“I think that probably was an example of an over-reaction,” Dr Ian Barr from the World Health Organization said. “That virus only infected a small number of people, only killed a single person, and yet you went and vaccinated 70 or 80 million people.

“I think that will temper the response to this swine influenza outbreak and I think countries will look very carefully at the safety of their vaccines, and also consider the cost benefit of introducing those vaccines.”

The WHO collaborating centre in Melbourne, one of four worldwide, receives samples from all over the Asia Pacific, and the recent swine flu scare has seen a big jump in business.

Samples from Australia have returned the greatest number of positive tests; over a thousand now have the disease, but there have been no fatalities.

Dr Anne Kelso from the WHO says most of the concern is being reserved for what might happen if the virus spreads to countries which aren’t quite as well equipped.

“In the developing world, there are many people of course who are malnourished, or who have other health conditions because of their poor living circumstances,” she said.

“So, it’s a bit difficult at the moment to predict what will happen, but I do have some concern.”

Simple measures

When dealing with the unknown and the unpredictable, much of the battle against swine flu takes place inside the mind – remaining calm, and doing simple things right.

“The evidence we’ve been getting recently is it’s not a virulent virus,” psychologist Dr Glen Bates said. “It’s nothing like the degree of danger even of the standard flu that we have.

“But I think people are often influenced in these sorts of things in the initial way in which they come to the issue. And our initial response was one which presented it as quite a substantial threat.”

Dr Rachel David says people need sensible information about protecting themselves from swine flu.

“There is a big variation in the quality of the way that these issues are reported, from alarmist types of reporting to dismissive types of reporting, and neither does the issue justice,” she said.

“We really need to look at providing people with sensible evidence based information about how to protect themselves. Simple measures like handwashing and staying away from people who are clearly infected are still the best measures while we wait for a vaccine to become available.”