01/20/2013 11:04 EST | Updated 03/21/2013 05:12 EDT

Why This Flu Season Shouldn't Shock You

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.

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