As if the global financial meltdown weren’t enough, this spring introduced scary words like “novel virus” and “pandemic,” bumping the financial crisis off the headlines. The attention-grabbing RNA virus took the world by surprise and, thanks to air travel, spread rapidly from its origin in Mexico to every continent. The virus’ spread was a perfect storm of mutation (a combination of swine, human, and avian elements), little to no human immunity, and no available vaccine against it. To make matters worse, everyone was touting its similarity to the 1918 H1N1 virus that had wiped out 20 percent of the world population.
Fortunately, the ensuing months alleviated those fears. From the outset, many things went right. The internet allowed for sharing of public health information easily between countries. The World Health Organization and the Center for Disease Control tracked the virus internationally and nationally and communication flow regarding infection rates and recommended treatment was seamless. Harvard, like many other institutions, had developed a preparedness plan a few years ago in response to the potential threat of the avian flu (H5N1) virus. Consequently, a multidisciplinary team, drawn from University Health Services, University Hall, Harvard University Dining Services, and the University Operations Services’ Environmental Health and Safety department, was in place to respond immediately when the initial cases of H1N1 hit Harvard.
Even more reassuring was the fact that most patients who were getting ill in the spring had only mild to moderate symptoms. After a relatively quiescent period over the summer, we began to see a steady stream of cases of H1N1 beginning at the end of August.
Since August, we have seen over 400 cases of influenza-like illness, with nearly 300 undergraduates affected going to UHS. Our strategy has been three-pronged. First, we have been educating the Harvard community about flu prevention by advising good hand washing, covering one’s cough, and social distancing from sick individuals. Second, this fall we implemented a large-scale immunization program offering 17,000 vaccines against the seasonal flu. Through this effort, we were able to inoculate over a third of the undergraduate community. Finally, we have been advising self-isolation for individuals diagnosed with ILI. About 46 percent of students diagnosed with ILI were sent back to their single rooms with meals provided to their rooms by HUDS. Another 42 percent of students, who lived in shared rooms, were kept in Stillman Infirmary or other campus singles. About 11 percent of students were either sent home to convalesce if they lived within a 150-mile radius of Harvard, or moved to other off-campus locations.
Luckily, most of what we have seen of this illness has been reassuring. Most people have had relatively short and uneventful courses of illness, usually lasting about 4 to 7 days. New England has had a relatively low incidence of illness compared to the rest of the country—a finding that some are attributing to our higher incidence in the spring possibly inducing some low-level immunity in our community. Older people have been similarly less affected, possibly because of their immunological “memory” of earlier exposures.
Following CDC guidelines, we cultured the first few cases, and once we had confirmed that we had documented H1N1 in our community, we proceeded to make the diagnosis of subsequent cases based on clinical features (fever, cough, headache, muscle aches). Antiviral agents—such as Tamiflu—have been reserved only for those patients who are at higher risk for complications.
Now that the first shipment of H1N1 vaccine has arrived, we have started our second wave of vaccinations, prioritizing the highest risk patients first. In the meantime, people can protect themselves by continuing to wash their hands, maintaining social distancing from sick individuals, and checking the website for information about availability of the H1N1 vaccine. With any luck, our regional rates will continue to be low until we get our community vaccinated. We only wish we could be so fortunate with tackling the global financial crisis.
Soheyla D. Gharib is chief of medicine of Harvard University Health Services. David S. Rosenthal is director of Harvard University Health Services.