BERKELEY, California: Although the 2009 H1N1 swine flu pandemic appears to have peaked, Dr. Keiji Fukuda, the top flu expert of the World Health Organization (WHO) recently said a third wave could still be ahead. Third wave or not, there are sufficient data since April 2009 to show that this virus is less severe than normal seasonal flu and that efforts to prevent the spread of this pandemic were futile - especially hand-washing, still promoted by the WHO, the US Centers for Disease Control and other national agencies. According to WHO estimates, recent normal seasonal influenza viruses have killed between 250,000 to 500,000 people a year - about 0.005 percent of the world population. This can be used as a yardstick to compare the severity of past and current influenza pandemics. The initial fear was that the 2009 H1N1 flu virus might be as deadly as the 1918 "Spanish H1N1 influenza pandemic that killed an estimated 30 to 50 million people, or about 2.5 percent of the world population. The 1918 influenza pandemic was therefore 500 times as severe as recent seasonal outbreaks. In contrast, the death toll of the 1957 "Asian H2N2 influenza pandemic was about 14 times and the 1968 "Hong Kong H3N2 influenza pandemic about six times more than the death toll of current seasonal influenza viruses. As of late 2009, the new H1N1 virus has actually killed fewer people overall than recent seasonal influenza viruses, although it may be more severe for children. Global transmission of the new H1N1 virus has apparently peaked or is just beginning to peak and, while it is definitely not over, its overall death toll may well end up lower than the death toll of recent seasonal flu viruses, including Egypt's 24 victims so far. Initial fears of a repeat of the devastating 1918 influenza pandemic led to an unprecedented public health response, which included expanding the target groups to receive the H1N1 vaccine, travel bans from infected areas, isolating and quarantining suspected infected persons, school closures, canceling or limiting large public gatherings or events, and recommending universal hand-washing. Measures such as isolation or quarantine, school closures, and so on were not implemented uniformly but left to the discretion of national and often local health departments. At best, they may have slowed the spread of this virus in some areas. When I asked Ed Kilbourne, an Emeritus Professor at New York Medical College whom I consider to be the dean of influenza experts, about the effectiveness of hand-washing for preventing influenza transmission he replied that influenza is transmitted through inhalation, rather than by touching contaminated objects: "Hand-washing does nothing to curtail the spread of influenza but it may be a good substitute for hand-wringing. No one opposes the promotion of hand-washing as a good hygienic practice in general but it has been misleading for public health agencies to claim it is vital for preventing transmission of influenza viruses. Blind adherence to this scientifically unsupported measure threatens to erode the credibility of all public agencies that have aggressively implemented this recommendation. It is bizarre that many government health agencies, including the US Centers for Disease Control, continue to promote it, despite lack of evidence. It is now clear that the 2009 H1N1 virus is not as deadly as current seasonal influenza viruses and that public health efforts to contain the spread of this virus were largely wasted. The WHO's graded alert phases for influenza pandemics may imply but do not take into account the severity (as measured by deaths) of the pandemic. The WHO's alert for the 2009 H1N1 pandemic still stands at its top phase 6 which merely denotes "widespread human infections. Based on the global influenza surveillance data collected, the WHO influenza forecast and advisory for 2010 should say: "The severity of the 2009 H1N1 influenza pandemic virus has been reduced from a potential maximum severity virus to a baseline severity seasonal influenza virus that may cause scattered outbreaks during the 2010 respiratory disease season. All of the additional high-risk populations identified for the 2009 pandemic should receive the 2010 seasonal influenza vaccine and everyone should continue to wash their hands regularly, even though this practice does not prevent transmission of influenza viruses. James Chin MD MPH is Clinical Professor of Epidemiology at the School of Public Health, University of California, Berkeley, and former chairperson of the US national Advisory Committee for Immunization Practices (ACIP).
