Among swine flu’s unknowns: Impact here

By Brendan Buhler

Tuesday, April 28, 2009 | 2 a.m.

It was as if we had made the cosmic mistake of asking what more could go wrong for tourism.

Ah, yes — swine flu.

Just what tourism needed.

On Monday, we awoke to the news that the European Union’s health commissioner was recommending that people avoid all unnecessary travel to Mexico, where the sometimes lethal outbreak started, and the United States, where it has spread. The World Health Organization raised its alert level to four. An alert level of six is a global pandemic. Cable news ran swine flu updates all day. You run into people who say they saw someone equipping himself for air travel with a sterile mask and taking Xanax to settle his nerves.

The Las Vegas Convention and Visitors Authority declined to comment.

Some countries have announced they will quarantine sick visitors, and others are banning pork, even though you can’t catch swine flu from cooked pig meat. A casual observer would be inclined to think one of the four horsemen of the apocalypse has escaped from the stables. One wonders what this will do to the Las Vegas economy and hotel occupancy.

(And later, guiltily, one wonders about planet occupancy.)

To figure out, we asked a couple of medical historians how bad this flu epidemic is likely to get, based on the history and the science. Is this the sniffles or the plague?

Their answer: Life is an adventure, epidemiology especially so.

Howard Markel, an M.D. and a Ph.D., is the director of the University of Michigan’s Center for the History of Medicine, the author of “When Germs Travel” and the lead author of a study of the Spanish influenza pandemic of 1918-20, which killed 50 million people worldwide. We asked him, Could that happen again?

Sure, but the real questions are which influenza strain will it be, when will it break out and will we recognize a killer when it comes. “Predicting influenza pandemics is virtually impossible. They fool us all the time,” Markel said.

The problem is ignorance.

Consider the last swine flu scare in the U.S. In 1976 at the Fort Dix army base in New Jersey, four soldiers came down with the flu and one died. Soon, several hundred soldiers were sick. The virus was identified as a strain of the H1N1 influenza subtype. (The current swine flu is also an H1N1 strain.) At the time, some believed the virus was the reincarnation of the lethal Spanish influenza. The public health apparatus shifted into overdrive. The government launched a national inoculation program.

A rare side effect of the vaccine killed 25 people. The vaccination program was halted, and the pandemic never came.

But was the inoculation program a mistake? It’s hard to say.

“The thing is, if you’re not overcautious, then you’re probably under-cautious, and you don’t really want to do that when you’re talking about people’s lives and a possible pandemic,” Markel says.

The problem is, when an outbreak starts, it’s almost impossible to know how bad it will get.

Here’s what little we know about the 2009 swine flu: It has been blamed for 2,000 infections and 149 deaths in Mexico (the World Health Organization can confirm 26 infections and 7 deaths). In the U.S., 45 cases of the flu had been confirmed by Monday evening, and one person had been hospitalized. The flu had been found in five U.S. states — California, Kansas, New York, Ohio and Texas — and abroad. There are six confirmed cases in Canada and one in Spain, which resulted in hospitalization. Scotland is claiming nine infections and two hospitalizations.

But there is so much we don’t know.

For instance, we don’t really know how many cases of swine flu there have been in Mexico. The government says 2,000, but what if 10,000 or 20,000 people got a mild fever and never went to the hospital? That changes the lethality of the strain. One hundred forty-nine deaths out of 2,000 is a mortality rate of more than 7 percent — as bad as the 1918 flu. On the other hand, if there were 20,000 cases, the rate is 0.7 percent, which is on par with a really bad seasonal flu. And the cases in the United States seem much more mild. Is the virus more lethal in Mexico because of some co-infection or a medication used — or is it that there are very few U.S. cases so far and we’ve been lucky?

These are just a few of the more important gaps in our knowledge.

That said, Markel believes the reaction of public health agencies has been just right (so far).

The Centers for Disease Control and Prevention is helping to investigate the outbreak in Mexico and has freed up emergency supplies of antiviral medication. It has also recommended that people take such common-sense measures as covering their mouths when they cough, washing their hands and staying home from work and school when they are sick. The World Health Organization has advised against international travel restrictions, saying the virus has spread widely enough that containment is a moot point. And, by the end of the day, the European Union appeared to backtrack from the advice of its health commissioner.

And the effect on tourism (so far)?

MGM Mirage spokesman Alan Feldman said he’s not aware of anyone canceling reservations in a swine flu panic.

But, he noted morosely, “CNN already has graphics and theme music.”