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One Year Later: What Have We Learned from H1N1?

Cheryl Clark, for HealthLeaders Media, March 10, 2010

It's been nearly a year since H1N1 arrived in the U.S. How has the healthcare system responded and is the nation any more prepared for a larger health crisis?

The good news from the Centers for Disease Control and Prevention is that "there's no evidence that the virus is mutating in such a way to cause a different spectrum of illness, or will cause more severe cases," says the CDC's Dr. Beth Bell, associate director of science for the National Center for Immunization and Respiratory Diseases. "And there's no evidence that the virus is resistant to antiviral medications and it's still a good match for the vaccine."

But, she says, there's no way to predict what will happen this year.

So far, she says, "it's been extremely unusual that we haven't seen any H3 or other influenza strains circulating, although usually we see more than one strain [by now]. Since we don't know what strains are circulating, it's too difficult to say much about what we expect in terms of morbidity or mortality. It's extremely unpredictable."

Key to preparation this year, Bell says, is ramping up vaccinations for healthcare workers, pregnant women, and people with underlying infections, who have a higher risk of becoming ill with H1N1 viral disease.

"I think we have lots of room for improvement with influenza vaccination," Bell says.

School vaccination programs are another important priority for the nation this year, and public health officials have learned lessons from last year on how to increase the number of children who receive the vaccine. "We can always do more."

Bell acknowledges that some providers may be concerned that the CDC and state public health agencies over-reacted last year in issuing warnings of a pandemic potentially as severe as that of 1918, which killed an estimated 50 million worldwide.

"There could be a lot of second-guessing," Bell acknowledges. "But we, at the CDC, base what we have to say on science. And when we don't have all the science, we provide the best advice on what might happen. We strove from the very beginning to tell people what we knew.

"And I would say that for the families of the 11,160 people in the U.S. who are estimated to have died last year, and the 245,000 who were hospitalized because of this infection—I would say they would not have considered this to be a false alarm."

Chris Van Gorder, president and CEO of Scripps Health in San Diego, where the first confirmed case in the U.S. was treated last March, also worries that dire warnings of pandemics, if issued too frequently and harshly, may harden some providers and the public to not take the necessary precautions.

"My fear is always the 'little boy who cried wolf' syndrome," Van Gorder says. "If we warn the public multiple times and the expected situation does not materialize, than eventually, the public will stop paying attention to the warnings. It's a 'catch-22' for public health officials and I don't envy them.

"If they don't warn and prepare, they will be criticized if something happens; and if they do warn and nothing happens, they will be criticized."

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