Past Pandemics: Barack Obama and the 2009 Swine Flu
Barack Obama had just been inaugurated as President of the United States when the 2009 swine flu pandemic began. As if the President didn't have enough on his plate, what with a financial crisis, two ongoing wars and a proposed universal health care plan, now he had a pandemic too. The swine flu was an influenza pandemic that lasted from January 2009 to August 2010. It was the second of the two pandemics involving H1N1 influenza virus (the first being the 1918-1920 Spanish flu pandemic that had occurred on Woodrow Wilson's watch.)
According to an article in the New England Journal of Medicine, the first formal description of this virus was given in April 2009. It was described as appearing to be a new strain of H1N1, which had resulted from a triple reassortment of bird, swine, and human flu viruses further combined with a Eurasian pig flu virus. That's how they came up with the name "swine flu". If you're like me and have no idea what "reassortment" means in this context, it is the mixing of the genetic material of a species into new combinations in different individuals. Reassortment can result from a variety of causes, including assortment of chromosomes, and chromosomal crossover. The term us used when two similar viruses that are infecting the same cell exchange genetic material. Reassortment occurs among influenza viruses.
Some sources estimated that 11 to 21 percent of the global population at the time contracted the illness, (a total of between 700 million to 1.4 billion people out of a total world population at the time of 6.8 billion). This was more than the number of people infected by the Spanish flu pandemic. The 2009 pandemic resulted in between 150,000 to 575,000 fatalities. It was later discovered in a follow-up study completed in September 2010 that the risk of serious illness resulting from the 2009 H1N1 flu was no higher than that of the yearly seasonal flu. At the time, the World Health Organization estimated that 250,000 to 500,000 people die of seasonal flu annually.
Unlike most strains of influenza, the 2009 virus did not disproportionately infect adults older than 60 years, an unusual feature of that pandemic. The virus manifested itself with increased breathing difficulty that typically occurs three to six days after initial onset of flu symptoms. The pneumonia caused by flu can was either direct viral pneumonia or a secondary bacterial pneumonia. A November 2009 New England Journal of Medicine article recommended that flu patients receive both antivirals and antibiotics. In some cases, children would seem to be getting better and then relapses with high fever. The relapse was the result of bacterial pneumonia.
The 2001 H1N1 virus had begun spreading in Mexico. The first case in the United States was detected on April 15, 2009, in a 10-year-old patient in California. Two days later, Center for Disease Control laboratory testing confirmed a second infection in an 8-year-old also living in California. Within one week, the CDC had activated its Emergency Operations Center to respond to what it had identified as an emerging public health threat.
President Obama declared the H1N1 flu a national emergency. He issued a proclamation allowing public health agencies as well as doctors and hospitals to bypass certain Food and Drug Act requirements, in order to expedite work on a vaccine. The proclamation said, "given that the rapid increase in illness across the Nation may overburden healthcare resources and that the temporary waiver of certain standard Federal requirements may be warranted in order to enable U.S. healthcare facilities to implement emergency operations plans." For example, FDA permission to use the investigational antiviral peramivir to treat patients who are critically ill with H1N1 was announced.
The Department of Health and Human Services declared a public health emergency within days of the first reported cases. It started releasing medical supplies and drugs from the CDC’s Strategic National Stockpile. According to the CDC website, “the real-time PCR test developed by CDC was cleared for use by diagnostic laboratories by FDA under an Emergency Use Authorization (EUA) on April 28, 2009, less than two weeks after identification of the new pandemic virus.” Coincidentally, that was the same day that former Kansas Governor Kathleen Sebelius, was sworn in as President Obama's new HHS secretary.
The test developed by the CDC was created quickly and it turned out to accurately test for the virus. It was shared with governments around the world. According to Dr. Tom Frieden, who was CDC director under President Obama, testing for H1N1 and the United States’ willingness to share its test with other countries was a success. Friedan was quoted as saying, “I traveled all over the world and for years afterward even very hostile governments were saying thank you for sending it to us.”
Six days after the first case was identified in April 2009, the CDC began working to develop a candidate vaccine virus. Clinical trials began in July. On Sept. 15, the Food and Drug Administration approved four 2009 H1N1 influenza vaccines. The first doses of the vaccine were available in October, and by December, 100 million doses were available to be ordered. There was some controversy about the slow pace of vaccine production. In October of 2009, Friedan said at a press briefing: “We are now in a period where the vaccine availability is increasing steadily but far too slowly. It’s frustrating to all of us. We wish there were more vaccine available. Manufacturers are working hard to get as much vaccine out safely as possible. The vaccine strains of the virus grow and that’s how we develop vaccine. Even if you yell at them, they don’t grow faster.”
Once it was manufactured, the vaccine was distributed widely. CDC arranged for 126.9 million doses of the vaccine to be shipped to tens of thousands of medical providers. About 81 million U.S. residents were vaccinated, and the strain is now a regular part of annual flu shots. President Barack Obama was vaccinated against H1N1 by a White House nurse on Dec. 21, 2009.
According to Sebelius, President Obama deserves high marks for his leadership during the H1N1 pandemic. She later said of her President. “From Day 1, he said: ‘We will be led by the facts. We need to tell people what we know and what we don’t know.’” Sebelius and her team were directed to hold twice-daily press conferences to keep the media informed. In June 2009, Obama invited experts who helped respond to the 1976 swine flu outbreak to a private meeting at the White House. He asked them “what went right and what went wrong. What do we need to learn, how do we need to do this,” according to Sebelius.
The pandemic began to taper off in November 2009. By May 2010, the number of cases was in steep decline. On August 10, 2010, the Director-General of the WHO, Margaret Chan, announced the end of the H1N1 pandemic. She announced that the H1N1 influenza event had moved into the post-pandemic period.
COVID-19 has many significant differences from the H1N1 swine flu. The biggest difference appears to be the mortality rate. The death rate of H1N1 was just 0.02%, while data to date seems to indicate that the case fatality rate (the number of reported deaths divided by the reported cases) for the coronavirus is 3% to 4%, according to WHO, thouth that number is expected to fall over time. Coronavirus appears to spread more easily than H1N1. Each person who is infected will likely infect more people than a patient who had H1N1. So far deaths from COVID-19 have been concentrated in those over age 65. By comparison, H1N1 struck children and young and middle-aged adults the hardest.
According to an article in the New England Journal of Medicine, the first formal description of this virus was given in April 2009. It was described as appearing to be a new strain of H1N1, which had resulted from a triple reassortment of bird, swine, and human flu viruses further combined with a Eurasian pig flu virus. That's how they came up with the name "swine flu". If you're like me and have no idea what "reassortment" means in this context, it is the mixing of the genetic material of a species into new combinations in different individuals. Reassortment can result from a variety of causes, including assortment of chromosomes, and chromosomal crossover. The term us used when two similar viruses that are infecting the same cell exchange genetic material. Reassortment occurs among influenza viruses.
Some sources estimated that 11 to 21 percent of the global population at the time contracted the illness, (a total of between 700 million to 1.4 billion people out of a total world population at the time of 6.8 billion). This was more than the number of people infected by the Spanish flu pandemic. The 2009 pandemic resulted in between 150,000 to 575,000 fatalities. It was later discovered in a follow-up study completed in September 2010 that the risk of serious illness resulting from the 2009 H1N1 flu was no higher than that of the yearly seasonal flu. At the time, the World Health Organization estimated that 250,000 to 500,000 people die of seasonal flu annually.
Unlike most strains of influenza, the 2009 virus did not disproportionately infect adults older than 60 years, an unusual feature of that pandemic. The virus manifested itself with increased breathing difficulty that typically occurs three to six days after initial onset of flu symptoms. The pneumonia caused by flu can was either direct viral pneumonia or a secondary bacterial pneumonia. A November 2009 New England Journal of Medicine article recommended that flu patients receive both antivirals and antibiotics. In some cases, children would seem to be getting better and then relapses with high fever. The relapse was the result of bacterial pneumonia.
The 2001 H1N1 virus had begun spreading in Mexico. The first case in the United States was detected on April 15, 2009, in a 10-year-old patient in California. Two days later, Center for Disease Control laboratory testing confirmed a second infection in an 8-year-old also living in California. Within one week, the CDC had activated its Emergency Operations Center to respond to what it had identified as an emerging public health threat.
President Obama declared the H1N1 flu a national emergency. He issued a proclamation allowing public health agencies as well as doctors and hospitals to bypass certain Food and Drug Act requirements, in order to expedite work on a vaccine. The proclamation said, "given that the rapid increase in illness across the Nation may overburden healthcare resources and that the temporary waiver of certain standard Federal requirements may be warranted in order to enable U.S. healthcare facilities to implement emergency operations plans." For example, FDA permission to use the investigational antiviral peramivir to treat patients who are critically ill with H1N1 was announced.
The Department of Health and Human Services declared a public health emergency within days of the first reported cases. It started releasing medical supplies and drugs from the CDC’s Strategic National Stockpile. According to the CDC website, “the real-time PCR test developed by CDC was cleared for use by diagnostic laboratories by FDA under an Emergency Use Authorization (EUA) on April 28, 2009, less than two weeks after identification of the new pandemic virus.” Coincidentally, that was the same day that former Kansas Governor Kathleen Sebelius, was sworn in as President Obama's new HHS secretary.
The test developed by the CDC was created quickly and it turned out to accurately test for the virus. It was shared with governments around the world. According to Dr. Tom Frieden, who was CDC director under President Obama, testing for H1N1 and the United States’ willingness to share its test with other countries was a success. Friedan was quoted as saying, “I traveled all over the world and for years afterward even very hostile governments were saying thank you for sending it to us.”
Six days after the first case was identified in April 2009, the CDC began working to develop a candidate vaccine virus. Clinical trials began in July. On Sept. 15, the Food and Drug Administration approved four 2009 H1N1 influenza vaccines. The first doses of the vaccine were available in October, and by December, 100 million doses were available to be ordered. There was some controversy about the slow pace of vaccine production. In October of 2009, Friedan said at a press briefing: “We are now in a period where the vaccine availability is increasing steadily but far too slowly. It’s frustrating to all of us. We wish there were more vaccine available. Manufacturers are working hard to get as much vaccine out safely as possible. The vaccine strains of the virus grow and that’s how we develop vaccine. Even if you yell at them, they don’t grow faster.”
Once it was manufactured, the vaccine was distributed widely. CDC arranged for 126.9 million doses of the vaccine to be shipped to tens of thousands of medical providers. About 81 million U.S. residents were vaccinated, and the strain is now a regular part of annual flu shots. President Barack Obama was vaccinated against H1N1 by a White House nurse on Dec. 21, 2009.
According to Sebelius, President Obama deserves high marks for his leadership during the H1N1 pandemic. She later said of her President. “From Day 1, he said: ‘We will be led by the facts. We need to tell people what we know and what we don’t know.’” Sebelius and her team were directed to hold twice-daily press conferences to keep the media informed. In June 2009, Obama invited experts who helped respond to the 1976 swine flu outbreak to a private meeting at the White House. He asked them “what went right and what went wrong. What do we need to learn, how do we need to do this,” according to Sebelius.
The pandemic began to taper off in November 2009. By May 2010, the number of cases was in steep decline. On August 10, 2010, the Director-General of the WHO, Margaret Chan, announced the end of the H1N1 pandemic. She announced that the H1N1 influenza event had moved into the post-pandemic period.
COVID-19 has many significant differences from the H1N1 swine flu. The biggest difference appears to be the mortality rate. The death rate of H1N1 was just 0.02%, while data to date seems to indicate that the case fatality rate (the number of reported deaths divided by the reported cases) for the coronavirus is 3% to 4%, according to WHO, thouth that number is expected to fall over time. Coronavirus appears to spread more easily than H1N1. Each person who is infected will likely infect more people than a patient who had H1N1. So far deaths from COVID-19 have been concentrated in those over age 65. By comparison, H1N1 struck children and young and middle-aged adults the hardest.