This week, an incredible revelation took the world by storm. The news was featured worldwide and sent millions into reactions of frustration, anger and even worry. Yet those who were in the know understood that there was no surprise; in fact it should have been known for some time.
Of course, this had nothing to do with cycling.
The 2012-2013 influenza virus season has shocked North America with its early start and high numbers of both cases as well as deaths. In the United States, the percentage of deaths attributed to flu and pneumonia has reached over the epidemic level of 7.1 per cent and continues to rise. Forty-eight of the 50 States are registering widespread activity and most of Canada has at least localized activity with the most populated regions suffering from one of the worst seasons in a decade.
Yet for microbiologists, this has been a rather "healthy" flu season, but not one that should instill any panic. Moreover, the surge of concern and panic is somewhat unwarranted, especially considering the world knew almost eight months ago that this was coming.
Influenzavirus has a traditionally seasonal profile that offers those of us in North America a distinct advantage. The virus first affects the Southern Hemisphere during their winter season, our summer. During that time, the rate of infections, the hospitalizations, the rate of spread and unfortunately, the number of deaths provide more than just a clue as to what we should expect in the subsequent winter season.
In the case of this year's flu season, data from Australia mimics exactly what we are experiencing now. The season started early and was aggressive. About two-thirds of the cases were due to an H3N2 virus, close to a third of cases were found to be influenza B and a handful of cases were the swine flu, also known as H1N1pdm. The season started early and showed an aggression not seen since the 2003-2004 season. The number of deaths also showed epidemic rates. The rate of vaccine uptake was just over half and there were some shortages in areas of the country.
What perhaps is even more unfortunate is that the warnings were actually sent out to the public, as early as September of 2012. Back then, the CDC was already warning the public that the upcoming flu season, based on the fact that what had happened "down under" was going to be significant and could lead to significant burden not only on health but also on life itself. Yet few heeded the warnings until well into December when the epidemic was in full swing.
Over the coming months, the flu will eventually decline and by the spring, the worry and concern will be gone for yet another year. Yet many will look back at this time and wonder why there was so little attention paid leading up to the start of the season and then why there was such a panic in the first few weeks of this month. Several excuses will be proffered, including a lack of interest on the part of the public and the "Crying Wolf" theory due to the disparity between the relatively benign impact of the 2009 pandemic flu and the perceived overzealous response; but perhaps the real reason stems from the fact that in the context of history, influenza has become less of a threat than ever before.
A simple exploration of the last century of influenza records in the United States reveal that the number of deaths attributed to this virus has dropped dramatically. Even at the height of the 1918 pandemic, one of the worst seen in history, the number of deaths were about 350 cases for every 100,000 people. That's less than one-tenth of one per cent of the population. During the next half-century, the numbers never reached higher than 100 deaths per 100,000. Today, those numbers are less than 1 per 100,000. That is one of the reasons mortality is now considered to be a measure of all deaths as opposed to a fraction of the current population.
But even if it's not a significant killer, influenza still represents a large burden in a different manner. In today's world of 24/7 connectivity and the necessities of work and home life, the concept of having to suffer between 10 days and three weeks with an illness is anathema. From an economic perspective, the loss of productivity equals close to $100 billion dollars in the US. These two points alone suggest that even though the life or death worry may be gone, there still exists good reason to be concerned and also to be prepared.
Perhaps this year's flu "shock" will prime us to be a little more vigilant in the future. Perhaps we'll pay more attention to hygiene, especially hand hygiene; seek out the flu shot in October, when there are no lines instead of January when the lines are long; and do our best to not panic should the numbers be a little higher than normal, and more importantly, not to ignore the flu should the season be mild.
SEE: The 10 things you need to know about norovirus:
The virus is spread through an infected person's feces or vomit, and often by unwashed hands. "It's not that it's in food, but more often than not, it's in the environment," says Dr. Gerald Evans, a professor of medicine, biomedical and molecular sciences at Queen's University, and the medical director for infection prevention and control at Kingston General Hospital. "You don't want to know how much stuff from people's intestinal tracts is all over the environment."
The most common places for norovirus to spread are residences where many people are living together — nursing homes, for example, or cruise ships.
The clinical syndrome is characterized by nausea, vomiting and diarrhea, though for some, it can also include a fever and abdominal pain. It comes on very suddenly — usually within 10 hours of transmission — and lasts one to three days. After three days, it's no longer contagious.
Anyone can get norovirus, but it can be a particularly bad illness for the very young, and the very old. "Healthy people who get it feel awful, but they recover quickly," says Dr. Evans. "The problem is when it combines with other ailments. For very old people who might have other health problems, it can have serious effects, while very young people can dehydrate much more quickly." Interestingly, the virus particularly likes people with the blood group O, which constitutes about 45 per cent of the population. This is thanks to the receptor the virus attaches itself to. If you have another blood type, you can still get norovirus, but the disease will likely not be as severe.
"Lay low and wait for yourself to get better," advises Dr. Evans. There's no treatment, and while medical professionals advise keeping fluids up, Dr. Evans acknowledges this can be difficult, given the nature of the illness. "We want people to try to hydrate themselves as best they can, but it can hard," he says. "Because it's usually just one day, the situation doesn't get too dire, but every so often, we see perfectly healthy adults coming into the emergency room for intravenous fluids to get hydrated again."
You'll want to practice good hygiene in order to reduce the possibility that you'll ingest the virus, recommends Dr. Evans, and of course, try to avoid being in a circumstance where you can get the virus. "We really encourage handwashing, but I won't tell you will absolutely not get sick if you wash your hands," he says. "Viruses are tiny little particles, and it doesn't always matter how fastidious you are at cleaning things — they get everywhere."
The biggest problem, notes Dr. Evans, is that the virus is very transmissible, and can easily pass from person to person. It's also quite the trial on your health. "It's very traumatic," says Dr. Evans. "It's amazing how fast it starts, and it's amazing how bad you feel for at least a day or two. Most people who get it would rather have anything else."
The flu is an entirely different illness than norovirus. As Dr. Evans explains, the flu takes place in the respiratory system, while norovirus is a gastroenterological illness. Besides the lack of cough and cold in norovirus, it also has a much short lifespan: Three days vs. the flu's five to seven-day stint.
Norwalk is an old term for norovirus, says Dr. Evans. "Viruses are always named geographically, and the first norovirus was discovered in Norwalk, Ohio, so it was given that name. It's been since changed to give the group of viruses the name 'norovirus.'"
"As far as we know, there are no long-term effects — it's a very self-limited illness," says Dr. Evans. "The biggest, scariest thing about noro is that you're never immune to it, because there are a bunch of different strains. Once you get it, you can pretty well guarantee you will get it again."
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