- The Washington Times - Sunday, May 10, 2009

The most pivotal moments in the swine-flu saga may be yet to come.

In the weeks since swine flu grabbed international attention, and even years before that, some important actions have helped shape the course of this outbreak and the ways the world will handle future epidemics.

It’s not clear if this new swine-flu strain is a brush fire, sparking up around the globe only to fizzle, or if it will worsen when the regular influenza season hits.

So far, the deaths attributed to swine flu total 45 in Mexico; two in the U.S., both in Texas; one in Canada and one in Costa Rica. One of those who died in the U.S. was a toddler from Mexico. Officials said the Canadian, U.S. and Costa Rican victims also had other underlying medical conditions.

Globally, there are thousands of confirmed cases of the flu in 29 countries, including more than 1,300 in Mexico, at least 2,254 in the United States and 247 in Canada.

No matter how this story ends, at the very least it has offered a real-world drill to find gaps in the playbook.

“We’ve been given an opportunity to take a look at this before it really got bad, and we need to,” said Dr. Michael Osterholm of the University of Minnesota, a prominent pandemic flu specialist. “We better damn well do it now, because one day we are going to really be in it for more than a week. If it’s not this virus, there will still be another one.”

For this virus, the coming months will bring a series of big decisions: Do manufacturers start brewing millions of swine flu vaccine doses? Will they be stockpiled unless the new flu worsens or given along with or soon after regular flu shots? Will rich countries share enough with the developing world? Who gets in line first - the younger people that this strain so far seems to target or the elderly who usually are flu’s most vulnerable?

“You may only have one chance to get out ahead of it,” said Dr. Richard Besser, acting chief of the Centers for Disease Control and Prevention. “It’s important for people to understand that all of these decisions will need to be made with incomplete science.”

A virus of a different sort was the world’s wake-up call. SARS (severe acute respiratory syndrome) started in China, and once it broke out of the mainland in early 2003, it took just weeks to infect more than 8,000 people from 37 countries. The virus killed more than 770 people before it disappeared.

Governments started scrambling to put together plans to handle the next global disease threat. Soon after, bird flu hit Asia, reinforcing the need.

Had the new swine flu hit sooner, before all that pandemic planning, it almost certainly would have spread faster. Even if it proves no more dangerous than garden-variety flu, that’s deadly enough - a pandemic is more about geography than super-lethality. By the World Health Organization’s tally, between 250,000 and 500,000 people worldwide die each year because of regular winter flu.

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