One Year Later: 5 Lessons from the H1N1 Pandemic

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Luis Acosta / AFP / Getty

Mexicans protect themselves from the swine flu virus at the Mixcoac health center in Mexico City

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Not quite. Understanding why H1N1 was, and remains, a legitimate public threat and how health officials could have handled it better will help when the next new virus inevitably makes its way into our bloodstreams.

Here are five key lessons from the 2009 H1N1 flu pandemic.

1. H1N1 was more serious than the death toll suggested.

At the start of the H1N1 pandemic, officials could already see the virus was easily transmissible — cases were accumulating fast, and it took only a few weeks for the virus to reach nearly every corner of the world. But while researchers knew from past pandemics that a new flu virus like H1N1, against which humans have no immunity, could spread quickly, what they could not immediately gauge was whether it could also be deadly. Some past pandemics had been relatively mild, while others, such as the 1918 flu, which killed as many as 100 million people worldwide, had not. At the outset, there was no way to know which kind of virus H1N1 would turn out to be.

In hindsight, the 2009-10 pandemic looks relatively mild — certainly much milder than the initial media panic might have led us to expect. Still, a closer inspection of H1N1 shows that it was no trifle. Unlike seasonal flu, which tends to kill the elderly and those with underlying health conditions, H1N1 proved disproportionately dangerous to the young, the healthy and the pregnant.

A recent study published in the journal BMC Infectious Diseases found that more than 75% of H1N1 cases recorded in the early months of the pandemic occurred in people under age 30, with the highest proportion in those ages 10 to 19. And when researchers at the National Institutes of Health measured the impact of H1N1 in estimated American life-years lost — which gives more weight to deaths among the young — they found that it was at least as serious as a typical flu year; at its worst, it hit levels seen in the pandemics of 1957 and 1968. Its death toll may have been lower than feared, but H1N1, especially in the early months, stressed the U.S. health care system with large numbers of young, sick flu patients, and ventilators and antivirals were sometimes in short supply. "H1N1 was an enormous challenge," says CDC director Thomas Frieden.

2. The pandemic you prepare for may not be the one you get.

When H1N1 struck, the WHO and other health agencies had already been preparing for a new flu pandemic — just not the one that actually arrived. Rather than from the pork farms of Mexico, officials thought the next pandemic would emerge from the yards of Asian chicken farms. In the years since H5N1 avian flu began simmering in Southeast Asia in 2003, scientists and doctors had monitored the virus closely, waiting for it to mutate to the point that it could spread easily from person to person. The virus had already proved itself deadly — it has killed nearly 300 people to date — but the question was when it would become transmissible.

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