Unsung professionals of the flu pandemic

In 1932 my mother stood on the platform of the railway station of Trenton, Ontario, the small city in southern Ontario where she grew up. She had just finished high school. With her was a small beige and brown striped suitcase. Toronto General Hospital had accepted her into its nursing programme.

From then until 1980, when she retired, except for about ten years when I was young, she worked in some capacity as a nurse. For the last twenty years of her career she was a public health nurse. You will forgive me, then, if I have a bias. Although I respect all health care professionals, I reserve my highest admiration for nurses. I don’t think that I have ever met one whom I did not respect.

Listening to my mother at the dinner table when I was young does not qualify me as a public health expert, but it did give me some insight into the problems of the public health world.

Ontario has had an exemplary public health policy with regard to flu inoculations, one of the best in the world. It has tried to inoculate everyone. Like smallpox or polio or any other infectious disease, the more people who are inoculated, the fewer places there are for the virus to hide and then spread again. Smallpox has been eradicated and Rotary International, in conjunction with the Bill and Melinda Gates Foundation, has reduced the prevalence of polio from 125 countries in the world in 1985 to four now. There are very few parents who would not get their children inoculated against mumps, or measles, or rubella.

Getting a flu shot as an individual dramatically decreases the chance that you will get the flu. Or, it is better to say, a flu, because there are many strains. It is not just one disease. Like the cold is not just one disease, but an unpleasant runny nose, coughing kind of thing we don’t much like to have that is caused by a number of related viruses.

The flu is like that too. The seasonal flu shot normally protects against three strains of the flu that public health officials forecast are likely to be prevalent. Flu viruses mutate in often-unpredictable ways, so they aren’t always right, but they are right more often than not.

This year they knew that there was a strain, H1N1, that was going the rounds. So they prepared a vaccine to inoculate against it. Although public health authorities originally feared that it might prove deadlier than the normal seasonal flu, they were relieved when they discovered that it was merely nastier (as my wife can testify). It also caused exceptional harm to an unusual group, the healthy young, and caused less harm to the elderly.

They called the group who were unusually susceptible to this particular strain high risk. That group includes small children, pregnant women and people with serious underlying healthy conditions. They reserved the first doses of the vaccine for these and also for people such as such as health care workers. They were the priority groups. Not everyone can be vaccinated at the same time.

Overall, morbidity rate (the percentage of people who get the illness who die) from H1N1 is probably no higher than for other flus, but it is still a flu. You should not be asking yourself: Am I high risk? Whether you are high risk or low risk of serious complications from the flu, your chances of getting the flu is the same s anyone else’s. You probably won’t die if you get the flu, but you will spend a miserable week in bed. Get inoculated and, after two weeks, there is a ninety percent chance that you won’t catch it.

Just as important, if you don’t get the flu, you cannot pass it on to your family, your friends, your co-workers, or people you cough on at Tim Horton’s.

Once vaccination becomes available to the general public, you have three good reasons for getting inoculated: to avoid unnecessary misery, to help maintain a healthy community, and to say thank you to all the dedicated health care professionals like my mother, who believe that an ounce of prevention is worth a pound of cure.