H1N1 Flu Q&A

Dr. Timothy Kelley is a professor in the Department of Health Education and Promotion in the College of Health and Human Performance. He is also the director of the environmental health program at ECU. Dr. Kelley is an expert in the field of infectious microbiology, including transmission of infectious disease agents through the environment. He sat down with us to shed some light on the H1N1 flu pandemic and how it might affect ECU.

About H1N1: The H1N1 flu was first diagnosed in the United States in April 2009. The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and death have occurred as a result of illness associated with this virus.

Can you explain how H1N1 flu became known as swine flu?
H1N1 has been referred to as swine flu because the virus that causes it appears to be a combination of different viruses that are typically found in animals. In many parts of the world, people live in close proximity to animals, and sometimes the viruses that infect animals spread to humans. In these typically agrarian societies, it is far more common for families to have a few pigs, chickens, goats, or what have you, than for the country to have the rather isolated, large-scale animal production facilities that we tend to have here in the United States. So viruses sort of move back and forth between humans and animals and there is a process called reassortment that occurs with viruses where they mutate and change over time. The H1N1 virus, as near as we can tell, is a combination of viruses that have been traditionally found in swine. This same thing happened with poultry in Asia a few years ago and caused the avian flu in humans. So the virus began with a swine virus, but it has mutated to the point where it is now primarily a human virus, although there was a suspected case this summer in Canada where officials think that perhaps the virus was spread from humans back to pigs. We really try to call it H1N1 rather than swine flu because there is no real threat of contracting H1N1 from a pig, and certainly not from eating pork.

What is the danger associated with H1N1?
There is always a danger associated with any form of influenza. People do die every year from seasonal flu, particularly the elderly and the very young. Part of the concern with H1N1 has been that up until now we didn’t have a vaccine for it. Because of reassortment, even the seasonal flu is different every year and requires a new vaccine to combat it. It’s part of the reason why influenza can be so difficult to control, and also why there is no cure for the common cold. Most people don’t know that once you have a specific cold or flu virus, you are immune to it from that point on. Your body produces antibodies to it and can react to it. But when the virus changes, even slightly, then you no longer have immunity and that’s why we have to vaccinated every year, and why it has been difficult to develop a vaccine specifically for H1N1.

At this point I don’t think the H1N1 virus is particularly dangerous in terms of its strength. The danger that surrounds H1N1 is the ease at which it is spread and the lack of a vaccine to prevent it, although ECU should be receiving the nasal spray version of the vaccine very soon. It’s not so much that people are going to be deathly ill, it’s that so many people might become sick that places like universities would shut down. That is unlikely however, thanks to the effectiveness of our public health system in this country.

Why are we hearing so much about H1N1 in the news? Couldn’t this all just be media hype?
I would not at all characterize the current situation as media hype at all. Yes, there is a lot of confusion out there and a lot of conflicting information and a huge amount of misinformation. In fact, I just saw on a Web site where someone was saying that H1N1 was created by the Centers for Disease Control in order to sell vaccines. That is just so absurd, but that’s what people see when they go online and don’t know which sites have the correct information.

As to why we are seeing and hearing so much coverage of H1N1 on the news, I think there are couple factors. One is that I think initially the public health community thought that this might be a much more serious strain of the flu, and that there might be a lot more associated mortality with it. Remember, there have been some very serious forms of the flu in the past, most notably the 1918 flu outbreak that killed more than 50 million people globally. The other factor is that there is just more information out there, and the public health community is doing a much better job of sharing that information with the public. It’s like any other emergency situation. Every year meteorologists get better at predicting where hurricanes are going to hit, and every year public health professionals are getting better at predicting outbreaks of disease. Some people are pointing to SARS and bird flu as examples of media hype, because neither of those ended up being very serious in the United States, and there was a lot of news coverage of both. But just because they didn’t happen doesn’t mean they weren’t real risks. Think about it like this. If a meteorologist comes on TV tomorrow and says that there is a possibility of a hurricane hitting the North Carolina coast, you’d want to know that, right? Now, if it doesn’t make landfall, then was that media hype? Of course not. Disease is sort of like that. There is a chance of it affecting certain populations, and there’s a chance of it affecting individuals within that population. So public health professionals do the best that they can to help you protect yourself, and reduce the chance that you become one of the groups that are affected.

ECU has been very proactive at distributing information about H1N1, and developing contingency plans should a severe outbreak occur on campus. Do you think ECU’s response has been appropriate?
Absolutely. I always think that a university should be a leader in this area. In fact, I think the community in general looks to universities to be leaders in this area and are sometimes disappointed when they don’t feel the universities are leading to the extent they perhaps should. So I’m very glad to see that ECU is stepping up and providing information and educating the public. I think that is a very important role for universities and other educational institutions.

What are some of the ways the university might deal with an outbreak?
Well, I think in many ways the university is already dealing with it by focusing on prevention. We are getting lots of information out there to the public. We are telling people to stay home if they are sick. We are reminding them to wash their hands. We will be offering the vaccine as soon as it is available. These things are very important. But should an outbreak still occur, one of the biggest ways ECU can continue to deliver on teaching students is by utilizing technology like Blackboard and email. Before fall semester, I, along with the rest of the rest of the university community was asked by the administration if I had a continuity of instruction plan for my courses. A continuity of instruction plan is just what it sounds like, a plan to ensure that courses are still taught regardless of what is happening on campus. It was an effort to get faculty thinking about what they might do if half of their students didn’t show up for class, or if they themselves were ill. With technology, we can communicate with students without being in direct physical contact with them or even in the same room. We, as faculty, here are fortunate to have such a robust distance education infrastructure that can allow us to temporarily convert any face-to-face class into an online one.

What can people do to protect themselves against the H1N1 flu?
It has been said that 20 percent of all infectious disease could be eliminated, practically overnight, if people would start washing their hands regularly. That’s a tremendous impact we can all make right now. I have started washing my hands more often, and I’ve also tried to avoid touching my face, which I tend to do. Covering your mouth when you cough or sneeze is also important. The best way to do that is by coughing into your sleeve at the crook of your arm at the elbow. That way you don’t deliver the virus directly to your hands where you can then spread it by touching things. You rarely ever touch anything with the inside of your arm.

If you do get sick, get lots of rest, take Tylenol/Ibuprofen for any fever you might have, and drink plenty of fluids. But most importantly, if you are sick, stay home and get better. Especially here at a university where on any given day you might come into contact with a couple hundred people. Stay home and get well. Communicate with your professors and ask about their continuity of instruction plan. The CDC recommends that you stay home for 24 hours after the last sign of a fever. The fewer people who are in a position to spread the flu, the slower an outbreak will occur, and the better the chances of containing it. I’m not in favor of more extreme measures like surgical masks, but if people want to wear them, it’s certainly their decision. Masks don’t actually work all that well unless you are wearing a full respirator that’s been fit tested, which means that when you breathe in and out, the air being filtered and not just going around the edges.

Some might be surprised to learn about H1N1 from an environmental health professor instead of a doctor. What would you say to them?
There is obviously a medical side of any potential H1N1 outbreak on campus, and I have tremendous respect for the medical community. But doctors become involved after a pandemic hits and people get sick. Public/environmental health professionals are really the ones who are involved right now. So when it comes to talking about what might happen, or how best to avoid anything from happening, a public health perspective can be helpful. We are what the CDC calls primary prevention, controlling the environment so that we reduce the chance of people getting sick.

One of my colleagues had a diagram that he’d show his first-year students that helped explain the roles of doctors and public health professionals in a crisis. The diagram showed a sink overflowing out onto the floor. There was one person mopping up the mess on the floor and there was another person going over and to turn off the faucet. He would ask his students which person they thought was the physician and which was the environmental health professional. The answer was that the physician had the mop and was cleaning up the mess. The environmental health professional was the one turning off the faucet. I think that even the medical profession recognizes that the most cost-effective, the most efficient way to deal with illness, particularly in the environment, is to prevent it in the first place. And that actually becomes a marketing issue for the field of environmental health because an environmental health professional is doing his or her job correctly when we’re not getting these outbreaks of diseases.

Is the world going to see more pandemic diseases in the future?
There’s a huge potential for future public-health emergencies. Obviously there are more people on the planet than there have ever been before. We are now approaching 7 billion people on the planet. That causes people to be in closer proximity, not only with other humans, but with animals as well. And it means that diseases are more easily transmitted from person to person, or from animals to people. Our environment has been degraded to some extent by human actions, and that’s going to cause problems in the future that we are going to have to address. There are some pretty dire predictions about some of the problems we are going to have in the future, as far as the environment and our health is concerned. I try to be positive about that and optimistic about it and that’s one reason why I ended up in the field of environmental health and why I think a lot of our students end up in environmental health, because it is a problem solving discipline and we want to contribute to finding the solutions. I think it’s very important to recognize that humans are not divorced from our environment. We are part of our environment. We are literally becoming part of our environment when we drink water, or breathe the air, and our environment is becoming part of us. So I think recognizing that and recognizing interactions that we have, both positive and negative with our environment are very important and can go a long way in determining if we have a healthy future, or a future with a major new pandemic every few years.

What role does our environmental health program here at ECU play in keeping us all healthy?
Believe it or not, we are doing quite a bit. We have an excellent online program here and we are currently seeing a lot of active public/environmental health professionals from all over the state enrolled in our courses. These are the people who are working at the federal, state, and local levels in the field as we speak. We offer a couple different certifications online and we also have the only accredited completely online master’s degree program in the United States. Besides our online master’s program, we currently have the only nationally accredited master’s program in environmental health in the state, and we are one of two nationally accredited environmental health sciences programs in the state of North Carolina. We prepare students to serve as professionals in public health, occupational health, institutional health, and environmental protection, and right now there is a tremendous job market in environmental health. In fact we almost have a crisis nationally that there’s not enough trained professionals in the field. There are only about 30, accredited programs in the United States and they don’t train anywhere near enough professionals to serve in these positions. So that means that people working in the field of environmental health right now may certainly be qualified, but may not have the specific training in environmental health that we are providing our students with. It is very important, and all our professional organizations agree, that it’s best to have environmental health professionals who are trained and educated in the field of environmental health because then they can hit the ground running. They know exactly what to do, and I think our program does a very good job in preparing them for that.

For further information visit H1N1 flu information, College of Health and Human Performance, Department of Health Education and Promotion, Environmental health sciences program.