Dated 10th November 2009

Since the outbreak of swine flu was first detected in Mexico in the spring of 2009, the media have reported on it extensively. Focus has ranged from the alarmist to the blasé; neither of which really helps. Also, officials from various countries seem to respond differently: Some impose quarantines and screening-measures, some do not; some close schools and distribute anti-viral drugs, some do not.

The virus is said to be as contagious as normal, seasonal influenza rather than more so as first stated. It mostly, but not always, seems to cause mild illness in people without underlying conditions. Why some individuals, who are otherwise healthy display severe symptoms is yet unknown, although this is also seen with normal seasonal influenza.

Indeed the risk of severe disease is now considered the same as seen in seasonal influenza, though, again it must be stressed that those of 50+ years face a much lower risk than they normally do.

It has been estimated that 20-30 % of the total population will get infected. Of these, some 17 % will have complications of some sort and 2 % will need hospitalization. However, by October 2009 these numbers are less certain. It seems possible that a significantly larger number of people than was first expected will be asymptomatic when infected, although how large this group will be remains unknown so far.

Fatality rate
The fatality rates vary. During late summer 2009, it was believed that fatality rates would be in the range 0.1%-0.3% of those infected, but by mid-September 2009 this was re-evaluated.

Indeed, fatalities among younger people are now believed to be the same as with normal influenza, and among the elderly it is believed to be much lower.

Travel advice
Travel, particularly air-travel means exposure to people from all across the world, sometimes in confined spaces like air planes, lobbies, terminals and transfer buses, which may increase the risk of infection. In these settings, you may wish to be extra vigilant when it comes to the general precautions. When arriving at your destination or back home, you should be wary of any symptoms you might develop in order to avoid infecting your family, friends or colleagues. If you have flu-like symptoms prior to travel you should consider postponing your travel plans, if only for practical reasons.

What is the local risk?
The disease is now a pandemic, i.e. it has spread world wide. While some regions are more affected than others, nowhere is “safe”. The exact numbers of people infected in each country is unknown, despite reporting: Even in countries with very diligent health care reporting systems, many cases will go unreported because symptoms are often mild or infected people are asymptomatic. Many countries have stopped testing in all symptomatic patients save those at added risk.

Even so there may be local “clusters” of infection, where rates are much higher than elsewhere in a given country. Somewhat surprisingly, the temperate regions of the Southern Hemisphere have reported slower rates of infection or even declining rates by mid-September, early October 2009. This is unexpected as these countries are in their seasonal flu-periods, and because the “first wave” of H1N1 may have peaked earlier than previously assumed.

Government and industry response
The level and type of response varies greatly from each country to the next due to historical and sociological factors. In countries with centralised, possibly undemocratic regimes, the response tends to be stronger, just as some cultures tend to value the interests of society more than the rights of the individual.

There have been quite a few closures of various institutions and transportation hubs already, including schools and universities, airports, shops, cinemas, restaurants and even whole communities. Such measures may be imposed by local authorities with little or no warning and may be very disruptive to travel and doing business in general. Some airlines have already imposed restrictions on carrying people with flu-like symptoms, which could become more common. Indeed, travellers may simply be denied entry to a country by local officials if they display symptoms.

Wider implications
As the disease spreads and more people become infected, there is some consideration that this may have wider effects on society as a whole. Various functions may become crippled or cease to work properly because staffers become incapacitated. The extent to which this may be expected depends mainly on the rate of disease transmission and the qualities of each country’s infrastructure.

Reporting by October 2009 seems to indicate that the disease continues to spread in North America, East Asia, India and parts of Europe with activity above expected seasonal levels. Tropical areas tend to report normal rates of influenza activity, although variations are considerable. The Southern Hemisphere is witnessing decline of influenza rates in some countries, notably Australia, while rates are within norms in others.