H1N1: Most Dangerous To Young People
If you're confused about the 2009 H1N1 "swine flu" virus, no wonder. There's a lot of conflicting information. The Centers for Disease Control tells us that the way this virus is spreading is unprecedented.
The CDC opened its doors to give 60 Minutes and correspondent Scott Pelley a look at the extraordinary federal response. It turns out, in many respects, that the 2009 H1N1 virus is no worse than the everyday flu.
Ninety-nine percent of the people who get it suffer just a few miserable days at home. But it is also true that for something less than one percent, H1N1 can be fatal. And many of them are the last people you'd expect to see rushing to an emergency room.
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On Oct. 7, 15-year-old Luke Duvall landed at Arkansas Children's Hospital in Little Rock. His life was slipping away. Luke was on a ventilator, not breathing on his own.
Dr. Michele Moss suspected H1N1. She had already lost one patient to the virus. "He's extremely fragile right now. His blood pressure is very tenuous and could go down at any second. So he's a very, very sick young man," she explained.
Luke had been perfectly healthy before. He had broken a state record in weightlifting. After a football game on Friday, Luke got sick.
His parents Belinda, a school teacher and Chad, a pastor, worried about H1N1 so they called their doctor.
"We were not able to get into the doctor until Monday, Monday afternoon about 2:30," Luke's father remembers.
Asked why, Chad Duvall told Pelley, "There's just so much of the flu around that by the time we were able to get a hold of the doctor Monday morning and get an appointment, it was that late in the day before they could actually even just get us in."
The family says the doctor sent Luke home to take medicine to control a fever of 103 and he started to improve.
His father remembers that they thought Luke was getting better. "And he actually said, 'I feel better. I think I'm going to get a shower now.' In the five minutes it took for him to go from the shower he came out and said, 'Something's wrong. I can't breathe.' His color had gone from normal pink to just grey in that five minutes, he was panting like a dog, just really fighting for his breath. At that point, it was no longer 'Do we go to the ER or wait 'til tomorrow?' Now it's 'We have to call 911 and get an ambulance to get him right now,'" Chad Duvall remembers.
At the local hospital, doctors decided Luke needed to fly to Arkansas Children's Hospital, with one of the nation's newest pediatric intensive care centers. Before the helicopter got there, Luke's football coach Charlie Sorrels rushed to see him.
"And he stuck his head in just before they put him to sleep and he said, 'Luke I just want to you know that I'm here for you and I'm gonna stay 'til your gone.' And he looked over and he said, 'Coach I can't play Friday night,'" Luke's father remembered. "And the coach said 'That's alright boy. I got you covered.' So that was the last words he said - it's Luke you know, 'Coach I can't play Friday night.' And so, you know, he's a fighter."
Luke was tested for H1N1. It would be hours before they would know.
But reports of his case and others like it were pouring into the emergency operations center of the federal Centers for Disease Control and Prevention in Atlanta.
Rear Admiral Anne Schuchat is the CDC's chief health officer in the war on H1N1. When 60 Minutes first met her two weeks ago, she showed us the virus was widespread in 27 states. When we saw her again last Thursday, things had changed.
"We think the virus is virtually everywhere in the country. Quite a lot of illness, hospitalizations, and deaths," she explained.
Asked what that tells her, Rear Adm. Schuchat told Pelley, "It's only October and we're seeing really uncharted territory. Typically, in the month of October, we would not have seen so much influenza. We would not see the whole country with widespread disease. That's something that we often will see in February."
The numbers are remarkable: last year, in the second week of October, there were seven cases reported. The same week this year there were nearly 5,000. By this time last year there were 7 deaths; today there are 885.
You can trace the jump to two things: because the virus is new, more people lack immunity and H1N1 never went away in the summer as flu usually does.
Asked who is most at risk, Schuchat told Pelley, "Children and young adults, pregnant women, people with chronic health conditions like asthma, diabetes, heart disease and neurologic problems, immune-suppression."
One of the most unusual things is the higher number of kids who are ill: usually, an average of 66 children die in a flu season; this year, it is 86, so far, with seven months to go.
"Why is it that kids who have never had a medical problem in their lives are suddenly critically ill?" Pelley asked.
"This is one of the really tragic parts of this epidemic. That people who are in the prime of their life, totally healthy can suddenly become so sick. The virus is serious, it can cause overwhelming bacterial pneumonia in some people. The influenza followed by a bacterial pneumonia," she explained.
Asked why the bacteria is following the virus, Schuchat said, "Influenza can damage the respiratory tree's lining and make it easier for bacteria to invade and then the bacteria can cause a pretty overwhelming pneumonia in those circumstances."
H1N1 is a pandemic, meaning it is a global epidemic. It's the first flu pandemic in 41 years.
The federal response looks like a war room, but the officers are in the U.S. public health service, not the military. Their naval rank has been a tradition since the 1790s.
The CDC was first to map the new virus' genetic code. Pathologist Dr. Sherif Zaki showed 60 Minutes lung tissue from patients who died.
"The mortality of H1N1 is something under one percent?" Pelley asked.
"Yes, it's much lower than one percent. But what we're seeing here are those very, very unfortunate times where it is able to kill or cause life threatening disease," Schuchat said.
Dr. Zaki says the amount of virus in these patients is higher than anything he has ever seen in a flu season. "If you imagine all, everything in red here is virus," he explained. "You know, you can see it's lining all those air spaces. You know, we've never really seen this with seasonal influenza."
The rapid growth of the virus is why doctors are recommending many patients take anti-viral drugs at the very first sign of illness.
The 2009 H1N1 strain was discovered in April in California. It is a unique combination of virus genes from birds and humans, but most are virus genes from pigs. That's why some call it swine flu.
The first outbreak was in Mexico. Today, at least 75 percent of the world population lives in areas with the virus and millions have been infected. H1N1 has overwhelmed other viruses, so now it is the dominant flu in the U.S. and in the world.
Dr. Peter Palese at Mount Sinai Medical Center in Manhattan is one of the nation's top virologists. In animal studies, he has found the virus can travel at least 10 feet from person to person.
"So if the virus transmits readily across 10 feet, people in a carpool, people in an elevator, even people on an airplane?" Pelley asked.
"Correct," Palese replied. "I think all of these scenarios are very much likely to allow transmission of an influenza virus when humans are together."
Palese compared the new virus to viruses that he keeps frozen from decades ago. And he has found 2009 H1N1 is a relative of the 1918 virus that killed 50 million people worldwide.
The 1918 flu was in a class by itself; the 2009 version isn't nearly as lethal. But, Palese told 60 Minutes his research does show why older people, who usually get the sickest, seem to be immune to 2009 H1N1.
"There were similar viruses circulating in the 1930s and the 1940s. And therefore people who were born before 1950 have antibodies, have a protective immune response against such a virus, against the novel H1N1 virus," he explained. "And therefore the older people are better protected against the novel H1N1 virus than are young people."
"You lose that protection if you're born after what year?" Pelley asked.
"About 1950," Palese said.
In Little Rock, the flu tests came back on Luke Duvall: it is 2009 H1N1, but also something else - staph pneumonia on top of the flu virus.
Staphylococcal bacteria came in behind the virus, in that common co-infection seen in the sickest patients.
Asked what that means, Dr. Michele Moss told Pelley, "Well, it means that some of the injury in his lung is due to the virus and due to the flu, but on top of it he's got just a good old fashioned bacterial pneumonia with the toxins from the bacteria causing his blood pressure to be unstable."
After two days, Luke still couldn't breathe on his own. They wanted to keep him unconscious because the ventilator is too uncomfortable. But he came out of it from time to time.
Remember, Luke got sick after his football game. And sure enough, most of his teammates came down with flu-like symptoms, so did the cheerleaders and so did the players on the opposing team. But just like the pandemic throughout the country, everyone got well at home, most were back to play the next week, with one very serious exception.
"Just only about 20 seconds, just remember Luke, remember his family, remember what they're going through, ok?" Luke's coach said. "Father, who art in heaven, hallowed be thy name, thy kingdom come, thy will be done on earth as it is in heaven."
No one can predict how hard H1N1 will hit the country. The director of the CDC, Dr. Tom Frieden, has placed his faith in a $3 billion vaccine program.
"Vaccine is going to make the difference between whether we have lots and lots of cases or many fewer cases and lots and lots of deaths or fewer deaths," Dr. Frieden said.
"The vaccine saves the country from the worst case scenario," Pelley remarked.
"Absolutely," Frieden agreed,
Asked if he has that much confidence in the vaccine's ability and safety, Frieden told Pelley, "Absolutely. We're confident it will be effective we have every reason to believe that it will be safe."
The vaccine has been out only since Oct. 5. The CDC has not received any reports of side effects, so far.
Asked what makes her so certain that this vaccine is safe, Anne Schuchat told Pelley, "The vaccine against H1N1 influenza is made just like the seasonal flu vaccines. About 100 million people get seasonal flu vaccine each year and they have a very good safety track record."
"For the people watching this interview who say, 'Look I've got a 99 percent chance of staying out of the hospital, why should I be vaccinated?' What do you say?" Pelley asked.
"You know, I hope that you'll be lucky and not suffer hospitalization or complications from flu. But the best way to reduce your chances of one of those terrible outcomes is to be vaccinated," she replied.
No one would have thought Luke Duvall in Little Rock would end up so critically ill. It's been a marathon. His condition improved, then worsened and improved again. He's still in intensive care.
"There is a full expectation that he is going home with us. The question is just when," Luke's father Chad said.
"You weren't sure of that?" Pelley asked.
"That's a fact," Chad Duvall replied.
Produced by Michael Radutzky, David Gelber and Sam Hornblower