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Influenza and the anaesthesiologist

The advent of yet another influenza mutant, the ‘new influenza A (H1N1) virus’, has caused unprecedented concern among health authorities in industrialized countries. A high case-fatality rate associated with the initial outbreak in Mexico earlier this year seemed to compare with that of the influenza pandemics of the early 20th century, in particular, the ‘Spanish flu’ of 1918–1920, which claimed between 20 and 100 million lives (2–20% of those infected). WHO declared the new influenza A-H1N1 a pandemic in June after worldwide spread. The prospect of a deadly pandemic led to an increased demand for antivirals and a pressure on drug companies to speed up vaccine development. Similarly, medicine agencies in Europe and the United States have been advised to shortcut the approval process for both vaccines and antivirals, commodities that poor countries cannot even hope to afford. Late summer, a rapid spread in the early autumn was expected. But the initial scare was short-lived. The first phase of the pandemic has passed without affecting more than a fraction of the populations of countries with good influenza surveillance. Notwithstanding the real possibility of a second phase – or a ‘surge’ – coinciding with, or replacing, the seasonal influenza of the winter months, the mortality rates associated with the first phase also informs us that in all likelihood the plague-like proportions of the 1918–1920 pandemic will not be repeated. Numbers