My Perspective on the 2009 H1N1 Influenza A Virus

Over the past several months, the federal government has thrown resources into tracking, studying and developing a vaccine for the 2009 H1N1 influenza A virus (H1N1/09). The media has reported a drumbeat of stories about the virus, its spread and deaths worldwide. Here in the U.S., the federal government had announced that a vaccine for this virus would be available en masse early in the flu season. Unfortunately, the development and deployment of the vaccine was delayed--a classic situation of overpromising and underdelivering. In the meantime, the steady stream of scary news about the impending H1N1/09 flu pandemic has filled most Americans with worry. Vaccine supplies remain scarce, implementation plans have been uneven, and now people are more scared than informed.

While it is understandable that people are concerned about the H1N1/09 flu virus, I think many Americans are overreacting based on media reports of illnesses and deaths, and not acting rationally on information. The seasonal flu (yeah, that's the flu we are all exposed to every year), infects between 15 million and 60 million, hospitalizes over 200,000 and kills almost 40,000 Americans every year. The H1N1/09 is forecast to infect up to 150 million, hospitalize up to 2 million and cause between 30,000 to 90,000 deaths in the U.S. Based on these numbers, it's reasonable to conclude that the H1N1 is more contagious but has a lower mortality rate than seasonal flu. It is almost a certainty that more people are going to suffer the flu this season, but even with the higher infection rate, it is also possible that same or even fewer people will die from the flu this season.

Yet, in talking with many friends and coworkers, the perception is that the H1N1/09 is like getting small pox or anthrax. Many people are deathly afraid of this pandemic. When told that my kids had it, they try to avoid me at all costs--in case I am a carrier! Most of these same folks however don't get the seasonal flu vaccine and seem to think that the "regular' flu is just like a bad cold.

From everything I've read, the two main differences with H1N1/09 are: (1) it's far more contagious and (2) it negatively affects primarily the young, pregnant women and people with chronic medical conditions. The seasonal flu more negatively affects seniors and people with chronic medical conditions. The H1N1/09 conversely saves its most serious side effects for the young, who have strong, but virgin (to the flu) immune systems.

Parents with children, pregnant women and other high risk people understandably have real concerns. With the flu season well underway already in the U.S., is the long delayed and still scant supply of the H1N1/09 vaccine too late to do much good? Children under 9 years of age, for example, need two doses of vaccine at least four weeks apart, so they wouldn't have immunity for about a month from the start of their vaccination. With many schools in this country already reporting 10%, 15% or higher absentee rates due to the growing H1N1/09 pandemic, is it already too little, too late to vaccinate many of our most at-risk population? In addition, what about safety concerns and other unknowns about a new and "rushed to market" vaccine?

My own kids had the H1N1/09 flu last week. To be quite frank, it wasn't a big deal at all in our case. Our daughter was lethargic with a fever for several days, and had a mild cough. Except for a short fever, small cough and a sore throat, most people wouldn't even know my son was sick by the way he still ran around the house.

Part of me is glad that our kids are already done with the H1N1/09. One of the biggest concerns with any influenza virus is that it can mutate and become potentially more virulent. This is the reason why scientists are constantly battling and reformulating flu vaccines. H1N1/09 could actually become more virulent and lethal as the season progresses.

The treatment for H1N1/09 is the same as for any other flu: rest, fluids and either acetaminophen or ibuprofen to reduce fever. Anti-virals may be leveraged for certain high-risk individuals. As with any flu, you need to be diligent about secondary infections and should seek emergency medical care if you experience respiratory and other complications.

So the H1N1/09 flu is really just another flu for which there is no need for undue concern or panic. For this season, I conclude:
(1) You are far likely to get the flu--most probably the H1N1/09
(2) For most, the symptoms will be milder than the seasonal flu
(3) More children and young people will die due to H1N1/09
(4) Parents with kids and young people must be extra diligent about secondary infections and respiratory complications
(5) It's probably better to get the flu earlier than later
(6) Get your season flu vaccine!

What you should know for your first cruise!

1. Tipping is complicated on cruise ships. Read the cruiseline's specific recommendations for your stateroom attendant, waiter and assistant waiter. Definitely take care of them if you feel they did a good job. Give them extra for going above and beyond. Tipping the head waiter and others is entirely at your discretion. And if you use the children's programs, I recommend a tip for the counselors even though it is optional.
2. Your room is usually ready and the luggage is delivered typically sometime between noon and 3 pm. But just in case you don't have access or your luggage is delayed, be sure to carry on anything you need for that afternoon such as medications, a swimsuit, etc.
3. Ship time may differ from local time so make sure you know the difference if you have excursions planned in port and so you don't miss the ship.
4. If you plan to use many AC-powered devices in your stateroom, bring a multiple outlet plug or power strip because there aren't many places to plug things in!
5. If you are large person and find it difficult to show in the microscopic showers in your stateroom, consider using the more spacious facilities in the spa or gym.
6. Staterooms don't have alarm clocks so bring one if you need it!
7. Your luggage will usually stow nicely under one or both beds
8. On some ships, the stateroom coffee table adjusts up and down!
9. Excursions, and specialty restaurant and spa reservations can usually be reserved on-line prior to boarding.
10. Private companies and tour operators in general offer tours and excursions that are better in quality, more flexible, just as reliable, and far cheaper than the ship tours!
11. On some lines like RCI, motion sickness medicines like meclizine (aka bonine) are complimentary at Guest Relations.
12. You pay for alcoholic beverages and sodas, but the coffee, tea, lemonade and milk are free. Carnival and RCI charge for espresso and cappuccinos but they are complimentary at dinner on HAL.
13. Order as much as you want in the main dining room--you're not limited to one appetizer or one entree!
14. In the main dining room, you can order or ask for things that aren't even on the menu!
15. You pay to eat at the specialty restaurants and there is no unlimited ordering there.
16. Room service is free but remember to tip!