Doctor: Pandemic leveling

The H1N1 (swine flu) pandemic appears to be leveling off and so far is no more deadly than seasonal flu and perhaps less so, according to Dr. James Wilde, director of the pediatric emergency department at the Medical College of Georgia.

"It's too early to tell, but it may be that we've reached the peak of this pandemic and we're on our way down right now," said Wilde, who is board-certified in emergency pediatric medicine and infectious disease. He cautioned that physicians and the general public should not drop their guard yet.

On Friday, Wilde gave the pediatrics department at the Medical University of South Carolina an updated overview of H1N1 -- including issues with the vaccine -- and offered advice on how to proceed into the flu season ahead.

Meanwhile, also at MUSC on Friday, officials with the S.C. Department of Health and Environmental Control were training dental school students on providing flu vaccines in the event of a massive outbreak later this season.

"We're training the students because they are a good, untapped resource for (providing) immunizations," said Dr. John Simkovich, public health director of DHEC's Region 7, which serves Charleston, Berkeley and Dorchester counties. "This is a contingency plan, not knowing how this virus will behave, if it will get worse."

Dr. Michael G. Schmidt, a microbiology and immunology professor at MUSC, called the volunteer enlistment of dental students "a pilot program" that will be extended to other medical and nursing students.

"This is extra (activity)," Schmidt said. "Everybody is trying to do more with less. This is a great opportunity for our students to see what they need to do at time of a national crisis."

As for the latest local information on H1N1, Simkovich said the health department continues to get vaccines, has extended its hours for taking appointments (call 953-0090, preferably between the hours of 5-8 p.m. every day but Sunday) and remains on target for H1N1 immunizations at local schools starting on Thursday in one elementary school in Dorchester County.

Simkovich recommends, however, that parents who want their children vaccinated should not wait for the school vaccinations.

"If you want your child immunized, don't sit and wait for us to come to the schools. Bring them to one of our clinics," he urged.

As for the vaccine delays and disorder this fall, Wilde said blame likely lies with the federal government and manufacturers.

Wilde said the federal government's insistence on giving thiomersal-free vaccines to certain risk groups over the years has created suspicion and misinformation on a preservative that is safe and needed for getting mass quantities of vaccines to the public. Meanwhile, he thinks manufacturers have failed to deliver vaccines, as previously promised, because of worries about losing money.

"My own suspicion is the vaccine manufacturers don't want to be left with 200 million doses of vaccine," Wilde said, noting that manufacturers have had to absorb the cost of leftover vaccine in the past when viruses fizzled out.

"If we are on the downslope of this outbreak, does it make sense for us to be giving vaccine? I think it still does because we still have swine (flu) circulating. But from the vaccine manufacturer's standpoint, does it make sense to put 250 millions doses" out by mid-fall?

After an overview of how the flu caught the attention of international, national and state health authorities last April, Wilde cited a Centers for Disease Control and Prevention study of swine flu in countries of comparable socio-economic class to the United States -- including Argentina, Australia, New Zealand and Uruguay -- in the Southern Hemisphere during their flu season last summer.

The study showed a spike and then leveling off -- much as it has been borne out this fall in North America.

"As of Nov. 5, we have a pandemic still continuing," Wilde said. "There was a rise in activity that coincided with (children) going back to school. There's variable activity around the country. Deaths remain low compared to seasonal flu, but there are still people dying. It's not a completely benign bug. Children and young adults are disproportionately affected."

The relatively high death rates for H1N1, he added, have been confined to Mexico -- a fact no one has yet to be able to explain.

He urged physicians, however, to continue paying attention on high-risk groups -- pregnant women, the elderly, people with underlying medical disorders and children younger than 2 -- because "swine flu seems to be going after the high-risk folks."

Wilde also recommended that diagnosis of swine flu based on clinical grounds, not on the basis of a test because of inaccuracies with it.

"If you have ILI (influenza-like illness) -- fever plus a cough or sour throat, and you don't have strep, and flu is circulating -- you probably have flu," Wilde said. "If you do the tests and it's negative and it's a high-risk person, are you willing to bet that it's an accurate negative? I'm not. So the recommendation is that if you have a high-risk patient and they have ILI, call it the flu and treat for flu."

He added, too, that most children five and older do not require antiviral therapy, and in fact, probably don't even need to see a doctor.

"When they come into the clinic or ED (emergency department), what are doing for them? ... We're telling them they have the flu. We're confirming their worst fears -- 'It's probably swine flu.' And the parents' eyes get this big. And we very quickly tell them that swine flu is no more deadly than seasonal flu, and probably less so."