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September 2nd, 2009 HENRY STERN | Q & A
 

Gary Oxman

Should this fall’s back-to-school checklist include freaking out over swine flu?

     
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A FEVERED PITCH: One of Portland’s top public-health officials warns swine flu is “not hype.”
IMAGE: Mike Perrault

If a doctor’s calm demeanor could halt swine flu’s spread, there would be no reason to fret when school resumes this month.

During an hourlong interview, Gary Oxman, the health officer for Multnomah, Washington and Clackamas counties, dispassionately dissected the facts about swine flu, a.k.a. the H1N1 virus.

Among the facts are these: 90 percent of the deaths for a typical seasonal flu are among people older than 65. But with H1N1, the vast majority of people at greatest risk are children to middle-age adults. Oxman and others theorize that’s because younger people haven’t built up the same immunities as older people to this virus, which is similar to viruses that spread through this country decades ago.

Officials expect there to be 45 million to 52 million swine flu vaccine doses by mid-October for those higher-risk groups, with another 20 million a week after that.

Those are the facts. Here’s whether you should be worried about them.

WW: Is swine flu a serious health concern, or is it being blown out of proportion?

Gary Oxman: I don’t think it’s being blown out of proportion. H1N1 virus itself is a mild to moderate virus. That means it’s not a horrible virus like we experienced in 1918. That virus among people who got sick then produced a death rate of 40 to 50 times what happens in a normal influenza season. We had a couple other pandemics in 1957 and 1968. And those had death rates about two to three times the average influenza season death rate. What we’re expecting is something between a regular influenza season and what we experienced in 1968 or 1957.

So why has swine flu drawn so much attention?

When you put together the fact it’s a new virus and the fact there’s a real switch in age distribution of this virus, that’s where the serious part comes up. The death rate would be .05 to .08 percent. The problem is that applies to an awful lot of people. And when you get a new virus, very few people have immunity. And as a result, we could see attack rates of 30 to 35 percent. So one-third of the population gets sick and you multiply that by the death rate…that is serious. [By comparison, the 1918 flu pandemic had a 2 percent to 2.5 percent death rate.]

Do you get called when a school is deciding whether it should close?

I do.

What’s the criteria you use when making a recommendation?

Back in the spring, there were a lot of preventive closures to prevent transmission. Those decisions were made selectively because we didn’t know what was going on. The reports first coming in from Mexico were scary.

And this fall?

We don’t anticipate a lot of preventive school closures. The reason to do a closure is if the virus is not circulating in the community, you can really suppress it with a school closure. The virus is here now, so we’ve lost the opportunity preventive school closures bring. We think any closures will be spotty.

What are some common misconceptions out there?

The trickiest part about this is, is it something serious or is it hype? It’s not hype. You’ve got a virus that’s mild as far as these viruses go. But you’re going to have a fair number of people who get sick and will have hospitalizations, intensive care and even death. If there are 200 deaths in the metro area, it’s a very different 200 deaths than we usually experience. Ninety percent are usually from elderly people. If you take that 200 and say it’s schoolkids, college-age kids and working-age people, it’s a very different result for the community.

Does the vaccine guarantee you won’t get the flu?

No. The vaccine is 60 to 90 percent effective depending on the population. It does two things: It decreases the influenza illness, but it also modifies the course so that even if you get sick, you are substantially less likely to have severe illness that results in hospitalization or death. You could argue the H1N1 vaccine may be a little more effective because the people who will get it are younger and tend to respond well to a vaccine.

Do you get a flu vaccine every year?

I do. I will admit I missed one year and I paid the price. Type A influenza is a miserable illness.

Is there anything unique about swine flu that will allow people to suspect they have something other than a common flu or cold?

There’s nothing unique to H1N1. But any influenza is very different from your average cold. [When I had the flu] my eyes were burning and I was feverish and achy within the course of a half-hour to an hour. There may be some vomiting and diarrhea, especially among younger kids.

Will you encourage colleges and universities to have a little more leeway on absences?

We’re urging some flexibility. You don’t want to be encouraging kids to skip class, but at the same time you do need some flexibility.


FACT: Among the Oregon school districts that temporarily closed some of their schools in the spring over swine flu were Eugene, Forest Grove, Willamina and the Central School District in Polk County. Western Oregon University also temporarily closed its campus.
 
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