Dr. Bonnie Henry is a physician, preventative medicine specialist, and epidemiologist—or “virus hunter.” Before becoming the director of public health emergency management at the B.C. Centre for Disease Control, she fought outbreaks of SARS in Toronto and the Ebola virus in Uganda. Dr. Henry is leading emergency preparedness for the Vancouver 2010 Olympics. Her new book, Soap and Water & Common Sense, documents our constant battle against viruses, bacteria and other bugs, including the new pandemic strain of H1N1.
Q: What’s your message to parents who are worried about their kids getting swine flu, especially as school starts?
A: Most people recover at home without any need for health care. But parents need to be really careful for two things. One is if their children have underlying illnesses that make them have less ability to fight off the virus—bad asthma, diabetes—they should think now about making a plan, talking to their doctor. Because these kids would most likely benefit from antiviral treatment [such as Tamiflu]. If your child doesn’t have underlying illnesses, you still should be careful. So if they’re having a hard time breathing, turning bluish, a baby who is very lethargic, irritable, not drinking—those are indications that they should be assessed by a physician.
Q: I saw an online poll asking if people thought Canada is prepared for an H1N1 pandemic. Seventy-five per cent said no. Are we?
A: I think we’re as prepared as you can be, but there’s always more to do. One of the things that we learn every time there’s a crisis is that getting consistent and up-to-date information to everybody is always difficult. It’s important that we get messages to people that are relevant to them in a way that they can understand. We’re not always good at that.
Q: I get the impression that for years we’ve been bracing for the next big influenza pandemic. How much of our concern about swine flu is actually due to the virus’s unique profile, and how much is anticipatory anxiety, however justifiable?
A: In my world we’ve been planning for an influenza pandemic for a long time. And you’re right, we’ve been planning for a really bad one. And this wasn’t a really bad one. We didn’t know that at first. I think the reaction that we all had at first was a lot of concern and that probably engendered a fair amount of fear that’s now, we realize, unwarranted. We talk about H5N1, the avian influenza—it’s a very frightening disease. It has a case fatality rate of up to a third of people who get this—or more—die from it. We were very concerned about seeing something like that. But most people do not get very sick with this strain of H1N1. It’s a mild to moderate illness. Now that we understand a bit more of it we’ve been backing off.
Q: The Canadian Medical Association Journal recently reported that Canada is lagging in getting the vaccine to people who need it most—that waiting until mid-November is too late. The health minister and chief officer of public health replied that if we need it sooner, it will be available in October. Who’s right?
A: I think there are some factual errors in the CMAJ article. One is that they say that because we’re using—or Glaxosmith Kline is producing—a vaccine that’s an adjuvant [a chemical substance that assists another], that that’s taking longer. That’s not true. My understanding is that the vaccine development is progressing at the same rate as for [every other country]. Health Canada has a branch that licenses vaccines. They have an expedited process for influenza vaccines, including this one. So it can be done very quickly. But there need to be studies done to show that it actually works to protect people and we need to make sure that it’s safe. That’s what takes time. There is some leeway. If we start seeing a lot of people getting really sick and we need it without those studies being finished, then the public health officer has the ability to work with regulators to get it approved more quickly.
Q: You were at the H1N1 medical conference in Winnipeg last week. Since then, the federal government has said it plans to unveil “pan-Canadian” recommendations to help hospitals handle a potential surge in swine flu cases this fall. What might those include?
A: The issue that took us by surprise around the world is a higher proportion of young people are ending up needing intensive care because of this virus. That can really stretch our ICU system. So this meeting was to make sure we know what resources we have, looking at measures that can reduce the need for ICU beds, and that may be temporary suspension of some surgeries, and making sure that areas that don’t have a lot of ICU support can transport people rapidly to another facility. That’s what we saw a couple of months ago in northern Manitoba. We’re trying to pull together in a much more co-operative way than we have in the past.
Q: Every year many of us debate getting the flu shot or not. Who needs it this year?
A: We have two shots this year, the seasonal influenza vaccination, and the pandemic H1N1 one. We’re still recommending that the same risk groups get the seasonal influenza vaccine. And for the pandemic vaccine it may be offered to everybody because we know that most people in the population in Canada don’t have immunity. There are people with underlying health conditions that make them more at risk for H1N1. So we encourage them to get the vaccine first.
Q: Tell me about the title of your book.
A: It comes from Dr. William Osler, who was a Canadian, although he made his name in the U.S. in the late 1800s as the father of modern medicine. For many bacteria and viruses the last common pathway to us getting sick is us putting our hands in our mouth. So if we’re careful washing our hands, that goes a long way to protecting us from getting ill.
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