What Do You Want To Know About Swine Flu?

A White House panel warns that the swine flu could kill 90,000 Americans and infect half the U.S. population. NPR health and science correspondent Richard Knox answers questions about what these numbers mean, and what you need to know as we head into flu season.

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This is TALK OF THE NATION. I'm Neal Conan in Washington.

There's some big numbers on swine flu in the news. Yesterday, the president's Council of Advisors on Science and Technology said it's possible that almost half the country could be infected by swine flu this fall, up to 120 million people could feel the symptoms, close to two million people could wind up in the hospital and the number of deaths could range between 30,000 and 90,000.

And that's all expected to start in the next few weeks as the weather cools and schools reopen. If you have questions about the virus, the government's response, the status of the vaccine, how hospitals, clinics, businesses and schools are set to respond, give us a call: 800-989-8255. Email us: talk@npr.org.

NPR health and science correspondent Richard Knox joins us now from a studio at the CDC, that's the Centers for Disease Control in Atlanta. Richard, always nice to have you on the program.

RICHARD KNOX: Thanks Neal, glad to be here.

CONAN: And those are some pretty scary numbers from the White House. Is that a worst case scenario?

KNOX: No, I don't think it's the worst case, although some people here at CDC thinks it might be an overstatement. They call it not a prediction, but a plausible scenario, which means it's something that we should plan for and hope it doesn't materialize. It's, you know, worst case I suppose would be a bullet we've already ducked. This doesn't seem to be a virus that's similar to the one 90 years ago that really spread disease and sickness around the globe very quickly, the swine flu - excuse me, not the swine flu, but the 1918 epidemic. They called it Spanish flu, by some.

CONAN: Mm-hmm.

KNOX: This one isn't like that. It's somewhere in between that and I guess an ordinary mild flu season.

CONAN: Well, last we saw of the swine flu in the spring. It was - it had a run here. Schools closed when kids got it or came back from Mexico with it. And then it went down to the Southern Hemisphere for our summer here, their winter there. And there was fears that it would, well, mutate and come back in a much more potentially dangerous form.

KNOX: Yeah, that's one good piece of news so far. They've been tracking the virus very closely, as it goes through its southern tour - Southern Hemisphere tour and looking at its genetics and looking at the kind of disease it causes. And it doesn't seem to be any noticeable change in this virus as it has gone down South. And that's good because people worried that it might become more virulent, that is to cause more serious disease.

CONAN: Now, you're attending a high-level meeting at the CDC about the swine flu. Who's there? What are they talking about?

KNOX: Well, it's not exactly high-level in the sense that they're bunch of ordinary reporters here. Maybe…

(Soundbite of laughter)

KNOX: …maybe 50 of us. I don't think that's high-level. But, you know, we're quite a diverse group of people from around the country who cover these things and, you know, interested enough to come here. We did have some nice access over the last couple of days to some of the leading flu specialists at the CDC. And we had the chance to pepper them with a lot of questions. And I got a few answers.

CONAN: Here's an email that we've from Eric(ph) in Auburn, Alabama: I'm the father of a six-year-old first grader. We know that H1N1 is in our school system. We've had confirmed cases last week. Last time, my daughter came home and told me that three children in her class went home with a fever. With a possibility of a vaccination not likely until the end of September or more likely mid-October at the earliest, how do we help protect our young school-aged children? We've had discussions of hand washing and not sharing food and drinks. But, these are young children and they just don't want to understand.

KNOX: Yeah, young children are a tough one because they are, I mean, in any ordinary flu season and for that matter for a lot of infectious diseases, they are super spreaders. They really amplify the spread of flu throughout a community. And because this flu virus, which materialized for the first time in this country in April, never did go away - very strikingly, they've never really seen, at the CDC, a summer that had as much flu around the country as this one did. So, that means that it's still there and it's waiting for an opportunity to take fire again once kids begin to congregate in large numbers. So, that's really a focus of a lot of the planning and concern.

Secretary Kathleen Sebelius was here yesterday and she said, you know, until we get a vaccine, until we get a lot of people vaccinated and until those people have a chance to make enough antibodies to be protective - and we can go back to that…

CONAN: Mm-hmm.

KNOX: …to that equation - then the only thing we're left is what she called hands and home. Hands means washing hands and covering your cough and all those things to basically prevent as much spread as you can, and, you know, you've got to do as well as you can with a 5- or 6-year-old. And we - and home, which means if a kid is sick, whatever it is, a respiratory illness, you know, it could be this new flu, maybe not. But, you know, stay home until the symptoms abate and the fever goes away. That's, you know, that's really the best thing to do.

CONAN: Interesting, you mentioned respiratory - there are a lot of respiratory diseases out there that are not swine flu. And do we expect another regular flu season in addition to the swine flu?

KNOX: Yes we do. I mean, there's no reason, really, not to think that the regular seasonal flu viruses won't continue to circulate. In the Southern Hemisphere, you had some countries where there were both regular, old flu that we're familiar with circulating around, and you had this new flu. In other Southern Hemisphere countries, the new flu kind of quickly took over and crowded out the old ones. But I think for planning purposes and for the moment, they think that we better expect a kind of a dual flu season.

CONAN: Let's get another caller on the line. This is Seth(ph). Seth calling from Minneapolis.

SETH (Caller): Hey, Neal, first-time caller. Thank you very much for taking my call. I am an adjunct college instructor here in Minnesota, and I'm starting class in the next week or so as are a lot of teachers and instructors. And I'm wondering if the CDC can offer a quick soundbite that I can include on - even on my attendance policy on what my students should look out for - and you just sort of mentioned this -how should my students know or how should I advise them to stay home, and please don't come in to class for, you know, this week or next week if you're experiencing these particular flu symptoms rather than, you know, just a mild cold, in which case I wouldn't want them to necessarily miss my class for two weeks?

KNOX: Although I am sitting in the basement of the CDC here - I am not speaking for the CDC, so I'm not going to give you government soundbites. But I think what I can say is that there's a pretty good Web site called flu.gov that will have a whole lot of information that make you sound a lot - you know, as knowledgeable as you want to be, really, about what they know.

And it'll have some specific guidance and advice about this. But in general, it's really very simple. I mean, you really should encourage students to - if they feel sick, don't come in. And maybe you should make it easy for them to, you know, to get what they need in terms of lesson plans or readings or, you know, just give them permission to stay at home if they're sick. I think that's probably the most important thing for their own sake and for everybody else.

CONAN: Good luck, Seth.

SETH: Great. Thanks.

CONAN: Appreciate it. And last spring, as you mentioned, there were a lot of schools that did close when the first kids got swine flu for fear of spreading it to the other kids. Is that going to be the response this fall?

KNOX: They're trying to minimize the disruption - some of the disruption we saw last spring, where, you know, tens of thousands of kids were out of class and some for pretty long periods of time. And different communities had different levels of knee-jerk, I suppose. In some cases, we saw especially early on when we really didn't know what we're dealing with, and when there were - you know, there was one teacher, for instance, in New York City, where of which it was an early focus because kids came back from Mexico with the virus…

CONAN: Mm-hmm.

KNOX: …where, you know, one of the staff members died. And that kind of freaked everybody out and thought, well, you know, we've got to act fast to prevent another one of these. This time around, the CDC has issued recently new guidance they call it, on when to close schools. And they're leaving it up to local school systems to decide what their threshold should be, but basically saying don't close the school at the first, you know, sign of flu. Wait until it, you know, there really is, you know, so much absenteeism not to - you know, if things aren't functioning well.

Encourage people to stay home, as we just were talking about, until 24 hours after the fever goes away. And that'll vary from one person to another. You know, the course of this disease, normally, is about seven days or so, seven to 10 days. And that's going to, you know, that's going to be a hardship for a lot of parents, you know, to have kids at home during that length of time. But that's, you know, that's the advice.

CONAN: Let's get Amanda(ph) on the line. Amanda with us from Boulder, Colorado.

AMANDA (Caller): Hi. I'm a mother of a 1-year-old infant, and I've had a lot of concerns about the safety of the virus, and that previous swine flu vaccine caught an inordinately high percentage of cases of the Guillain-Barre syndrome. And I'm wondering if the potential risks are being weighed, in that they're trying to push out millions of doses of this vaccine in a short period of time. And have there been enough clinical trials to find out if there's going to be many cases of Guillain-Barre syndrome, and if the potential risks outweigh the potential benefits of the vaccine?

CONAN: Of the vaccine. Amanda misspoke earlier. You said - concerned about the safety of the virus. She's concerned about the safety of the vaccine. Richard?

KNOX: Those are very good questions. In fact, we just got off a fairly long session involving some of the CDC's experts on how they're going to - on vaccine safety and how they're going to monitor for any signals of problem. One of the points that gets made over and over is that 1976, which is when the last time we had a swine flu as this one is - but this is a different one. And they - the decision was made by President Ford to vaccinate ultimately more than 43 million people. They got vaccinated before they stopped.

And there are number of things that need to be said about that. One of them is that vaccines were less purified then than they are now. They contained a whole killed virus, you know, a dead virus but the whole thing. And vaccines today only have pieces of the virus. And those things together thought to reduce the risk of another episode of some people getting Guillain-Barre syndrome. A few hundred people got this paralytic - frightening paralytic disease. Some of them recovered. Some of them didn't.

The other thing is that we have got a lot more experience over the last, you know, years with seasonal flu vaccines made with the same technology that this new vaccine is being made. And they've been watching closely for Guillain-Barre syndrome and have not seen over many years a spike in any of these cases. But the fact is the clinical trials that are being prosecuted right now - and we'll know the results of it in a few weeks -are not going to really tell us very much about the risk of Guillain-Barre.

In the general population in a current year, there are one to two cases of the Guillain-Barre per 100,000 people per year. Now, that's not from vaccine. That's what they call the background rate. I mean, there are a number of things that can cause these things, and so that hasn't changed over the years. And they'll be watching closely as they roll out this new vaccine in monitoring a number of different groups, such as soldiers who will all get it. Populations of 50 million people will be closely watched to see whether there's any suggestion that this is happening. And if they do, you know, they're going to reevaluate it pretty quickly.

So there's no guarantees in life. I think that not taking a vaccine exposes you and your children to the risk of this flu. And keep in mind that this flu seems to affect more young people including, tragically, some previously healthy young people who got very sick and some died. So, you know, you've got to balance risk, like anything else.

CONAN: Amanda, good luck.

AMANDA: Okay. Well, thanks for the information. Have a nice day.

CONAN: Bye-bye.

KNOX: You're welcome. Thanks for calling.

CONAN: Speaking with Richard Knox, NPR health and science correspondent, who's attending a session at the CDC offices in Atlanta, Georgia, about the prospect of a swine flu pandemic in a couple of weeks.

You're listening to TALK OF THE NATION from NPR News.

And here's an email question now from James in Howell, Michigan: On what scientific grounds is that 90,000 death number based, given that so few have died thus far - almost all with underlying health conditions? And the swine flu is regularly described as mild. It seems suspicious that drug companies tend to make so much out of such a mild illness with the government fear mongering the public into taking an untested and potentially dangerous vaccine.

KNOX: Well, I think that James is expressing an opinion I've heard quite a lot of in recent weeks and months. And, you know, I think it's a question that needs to be taken seriously. The - I think if I can understand the latest estimates of a range of 30,000 to 90,000 deaths -that's a big number. Normally, by the way, we should say that in a normal flu season, 30 to 40,000 people die, those people tend to be concentrated in a normal flu season among elders, people over 65.

One new thing about this virus is that the hospitalizations and deaths are much more likely to be among the people of, under 60 years old. And partly that's because - or maybe entirely - that's because people born after 1957 have been exposed to earlier forms of so-called, H1 virus -this is an H1N1 virus - so they have some residual immunity to viruses in this family. So everybody under the age of 57 or 52 or so, have no protection against this new virus. And that's one reason why they think that more people are likely to get sick and more people are likely to get hospitalized and die.

CONAN: And this is - I've heard it described as sort of a race between the disease, when it arrives and spreads rapidly, and the arrival of the vaccine which is, as you said, takes some time even after it arrives -what, we now expect October?

KNOX: Absolutely. Now, the virus have a head start, because it hasn't gone away, you know, it came up in April and is still circulating in humans in this country, and popped up in summer camps. You know, it's interesting. It seems to spread more easily person to person, in close quarters, people who live together or spend a lot of time together. It doesn't seem to spread quite as efficiently as regular seasonal flu through the air, through droplets, which isn't to say that it can't. And that's why you should cover your cough with your inner elbow and, you know, and sneeze into napkins…

CONAN: Mm-hmm.

KNOX: …and you know, all those personal hygiene things. But one of the patterns is that it seems to affect people in close quarters, which is why schools and colleges are ideal environments for it to come to the fore.

CONAN: Is this something you can contract twice?

KNOX: Once you've gotten this particular virus, then you have a pretty substantial immunity to it and probably for your life.

CONAN: Here's an email that we have from George(ph) - a radical idea -why not postpone all classes for a month until there's enough vaccine?

KNOX: That would be pretty disruptive.

(Soundbite of laughter)

KNOX: It would be a pretty radical step. I mean, I think, if we were dealing with a virus that looked like 1918 and, you know - or even worse, the bird flu virus that's been circulating in Asia for several years, called H5N1, that we worried might be the cause of the next pandemic - about 60 percent of people who've gotten this virus have died, much worst than the 1918 flu. If we were dealing with that kind of situation then we - then measures that disruptive might actually be on the table. But, you know, we're not. And I think that the best idea is to wait and, you know, but do what we can until the vaccine arrives.

CONAN: Richard Knox, thanks very much for your time. Appreciate it.

KNOX: You're welcome. Anytime.

CONAN: Richard Knox, NPR's health and science correspondent, with us today from the CDC offices in Atlanta.

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