While public health officials are putting out calm messages about the global influenza A (H1N1, also known as swine flu) pandemic — that summer camps are safe, that most illness has been mild — behind the scenes they are preparing for the worst.

Pandemic planning requires that officialdom consider all scenarios. And while the best hope is that the H1N1 virus will continue to cause mostly mild illness, though infect many more, the worst fear is that it
could follow the same course as the 1918 Spanish flu, which hit with a mild form in the spring, but returned with a vengeance in the fall. It infected one-third of the world and contributed to the deaths of more than 50 million people.

September is the big question mark for public health officials. That’s the earliest that the second wave could hit. So public health officials and infection control experts have been changing summer vacation plans and are hunkering down in preparation for the fall. (Toronto is an anomaly because of the civic workers’ strike. Pandemic planning is continuing, but at a reduced capacity.)

The problem is no one knows what to expect. Dr. Allison McGeer, a microbiologist and director of infection control at Mount Sinai Hospital, uses the example of a hurricane to explain the conundrum:

“There are some pandemics where disease is mild, the equivalent of a hurricane that never quite makes it to force five, blows itself off the Atlantic Ocean and never bothers anybody. And there are some pandemics, like in 1918, that are like hurricane Katrina and do a huge amount of damage.”

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