With the news this week of the first swine flu death in San Diego, as well as the private school class from Carlsbad that was quarantined in China because of the virus, I decided it was time again to touch base with Robert Liddington.

Liddington is the director of Burnham Institute for Medical Research’s Infectious and Inflammatory Disease Center. I last spoke with Liddington about the flu in April. At that time he said he didn’t think the swine flu was “the big one” — as in a virus that could create a massive pandemic like the 1918 Spanish flu that killed between 50 and 100 million people worldwide.

Since our conversation, the hysteria surrounding the swine flu has subsided, but the virus keeps chugging along. Last week, with the number of cases worldwide estimated at more than 26,000, the World Health Organization declared a global pandemic.

What have you learned about this virus in the past couple months?

I think what we’ve learned that it is highly contagious from person to person, but that most people get mild symptoms. There is a subset of people who get severe symptoms and we don’t quite know the reason yet. It is clear there are other risk factors associated with getting a severe case.

And what are these other risk factors?

If you have an autoimmune disorder, asthma, cardiovascular disease, obesity, or if you are a pregnant women you have a higher risk of getting a severe case.

Well, certainly people with autoimmune disorders are more susceptible to viruses. But it seems especially true in this case. And the link between diabetes and obesity and severe cases of this flu, that was news to me.

And it has been true from the beginning in this flu that young, healthy people were susceptible, and we really don’t know why. We don’t know if it is a lifestyle issue. A young healthy person might not take a high fever seriously; they will just go to bed. From what I gather, the person who died in San Diego just showed up at the emergency room, and died before she was even hospitalized. And what we said before is if people are getting seriously sick and have a high fever, they really should call their doctor or clinic and find out what is going on. Swine flu continues to be totally treatable as long as the anti-virals are given early.

The start of the traditional flu season is now just a few months away. How does that complicate things?

We have to get ready for the next flu season — there is no room for complacency now. Just because [the flu] didn’t kill many people in the beginning, it doesn’t mean that it won’t come back with a vengeance. That was certainly the case in 1918, and with some of the other big pandemics. The virus can be mild to start with, but then it can mutate just a little bit and change characteristics quite significantly. It’s not surprising that this one is continuing.

We and many other groups are gearing up for the next season. And assuming the worst — that this will become a much nastier virus than it is now.

Are you worried that people are complacent because there was so much hype in the beginning but not much happened?

Yes, definitely. People should certainly not be complacent at all — in fact, quite the opposite. Health agencies erred by declaring this great emergency clearly too early. Then people say this is a case of crying wolf and it’s gone, and you know let’s forget about it.

I’m not saying panic, but don’t let down your guard. It’s going to stick around, and could get worse. I don’t think the agencies were explaining the situation well enough earlier. With influenza, the longer it hangs around the more dangerous it gets. The possibility of the virus mutating to become drug-resistant or crossing with a regular human virus becomes very high once it’s been transmitted around large populations. That is the special thing about influenza.

DAVID WASHBURN

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