Since April we have been hearing growing reports of a new strain of influenza virus, officially named 'H1N1' and, more commonly, 'swine flu'. Fergus Bescoby asks: What does it all mean to the insurance industry?
H1N1 has been called a ‘flu pandemic' and we are hearing daily of the number of people around the UK and world who are contracting this illness. The effect on the worldwide mortality rate is being watched very closely and is widely publicised. But what is a pandemic?
An epidemic is a widespread outbreak of an infectious disease with many people being infected at the same time. An influenza pandemic may occur when a new virus appears against which the human population has no immunity. With the increase in global transport, as well as urbanisation and overcrowded conditions in some areas, influenza epidemics are likely to take hold around the world, and become a pandemic faster than before. Pandemics can be either a mild or severe illness and in extreme cases can lead to death. The severity can change over the course of the pandemic.
Swine flu is thought to be a mutation of four known strains of the influenza A virus. Subtype H1N1 (the H and N numbers designate the proteins on the outside of the virus that bind to target cells in the victim). Experts assume the virus "most likely" emerged from pigs in Asia, and was carried to North America by infected people. There is also evidence that the new strain has been circulating among pigs in other continents for years before infecting humans, but transmission is now human-to-human.
The outbreak began in Mexico and evidence shows that they were already in the midst of an epidemic before the outbreak was recognised. Soon after, the government closed down most of Mexico City's public and private offices and facilities to help contain the spread. In early June, as the virus spread globally, the World Health Organization (WHO) declared the outbreak to be a pandemic, but also noted that most illnesses were of "moderate severity." The virus has since spread to the Southern Hemisphere which entered its winter flu season, and to many less developed countries with limited healthcare systems. Because the virus was spreading with "unprecedented speed", and many clinics were overwhelmed testing and treating patients, WHO stopped requiring countries to report all cases, but is still monitoring unusually large outbreaks.
The virus typically spreads from coughs and sneezes or by touching contaminated surfaces and then touching the nose or mouth. Symptoms, which can last up to a week, are similar to those of seasonal flu, and may include fever, sneezes, sore throat, coughs, headache, and muscle or joint pains. The Centers for Disease Control and Prevention notes that most cases worldwide have been mild so far and most hospitalisations and deaths have been of people that have also had underlying conditions such as asthma, diabetes, obesity, heart disease, or a weakened immune system.
Pandemics are not new. The 20th century saw three pandemics of influenza: The 1918 (Spanish) influenza pandemic spread to nearly every part of the world. It was caused by an unusually virulent and deadly influenza, a virus strain of subtype H1N1. Most of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. The pandemic lasted from March 1918 to June 1920, spreading even to the Arctic and remote Pacific islands. It is estimated that anywhere from 50 to 100 million people were killed worldwide. An estimated 500 million people, one third of the world's population (approximately 1.6 billion at the time), became infected.
The 1957 (Asian) influenza pandemic caused between 1-2 million deaths worldwide. It began in southern China, and the deadly genetic mixtures of human flu with bird or swine variants targeted vulnerable young or elderly victims. The Asian Flu was identified as a form of avian influenza, normally found in wild ducks, which had crossed with a human virus. It was named H2N2. The flu seemed to have burned itself out by December of 1957, but in January and February of 1958, a second wave struck. This rebound effect is not uncommon during influenza epidemics, as the virus finds a new pool of people to infect. It also remained in the wild duck population.
The 1968 (Hong Kong) influenza pandemic caused about 700,000 deaths worldwide. The first record of the outbreak in Hong Kong appeared in July 1968. By the end of July extensive outbreaks were reported in Vietnam and Singapore and by September the flu reached India, The Philippines, northern Australia and Europe. It would reach Japan, Africa and South America by 1969. By that time, public health warning and virus description were issued in the scientific and medical journals.
Each of these pandemics differed from the others with respect to causative agents, frequency, distribution, and severity. They did not occur at regular intervals and in the case of the latter two that occurred within the era of modern virology (1957 and 1968), the hemaglutinin (HA) antigen of the viruses showed major changes from the corresponding antigens of previous strains. The immediate antecedent to the virus of 1918 remains unknown, but that epidemic likely also reflected a major change in the virus.
Fewer people died during the 1968 pandemic, this was due to the following: some immunity against the N2 flu virus may have been retained in populations struck by the Asian flu strains which had been circulating since 1957; the pandemic did not gain momentum until near the winter school holidays, thus limiting the infection spreading; improved medical care gave vital support to the very ill; the availability of antibiotics that was more effective against secondary bacterial infections.
When a pandemic influenza virus emerges, its global spread is considered inevitable. Preparation should assume that the entire world population would be susceptible. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it.
Most people have little or no immunity to a pandemic virus. Infection and illness rates soar. A substantial percentage of the world's population will require some form of medical care. Nations are unlikely to have the staff, facilities, equipment and hospital beds needed to cope with large numbers of people who suddenly fall ill.
Death rates are high, largely determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations and the effectiveness of preventive measures. Past pandemics have spread globally in two and sometimes three waves.The need for vaccine is likely to outstrip supply, and the need for antiviral drugs is also likely to be inadequate early in a pandemic.
A pandemic can also create a shortage of hospital beds, ventilators and other supplies. Surge capacity at non-traditional sites such as schools may be created to cope with demand. Difficult decisions will need to be made regarding who gets antiviral drugs and vaccines.
Care for sick family members and fear of exposure can result in significant worker absenteeism.
In an attempt to slow the spread of the illness, a number of countries, especially in Asia, have quarantined airline passengers with flu symptoms, while some are also pre-screening passengers.
At the time of writing, more than 1,300 people have died with swine flu since the pandemic began. In the UK, the total number of deaths stands in the 30s, with approximately 800 people in hospital. The majority of deaths have been in adults and older children with underlying risk factors.
It can clearly be seen that we are far better prepared this century for a flu pandemic than last century. This can be put down to improved living conditions, advanced health care and better global communication.
Underwriting Implications
Regardless of all the above, swine flu should be viewed in the same light as normal flu, so as long as there are no other underlying problems the risk can be accepted at standard rates for life cover and other benefits.
Fergus Bescoby is underwriting manager at PruProtect
References:
WHO
New York Medical College, Valhalla, New York, USA
Wikipedia
NHS
