Anatomy of a virus: A biological breakdown of H1N1

Strange mutations, odd biological behaviour and the potential to become more deadly have catapulted H1N1, better-known as swine flu, into the scientific limelight.

With the threat of a more deadly version of the virus on the horizon, scientists are trying to understand how this virus came to be, and what it will become.

A team of UBC researchers has made interesting discoveries about H1N1 by studying a different virus: the one that causes avian flu.

The team has been studying how avian flu causes inflammation, and compared it with similar viruses, including H1N1.

“Intrinsically, swine flu doesn’t have the ability to cause inflammation as strong as avian flu,” explained UBC microbiology professor Bob Hancock.
Hancock described H1N1 as “somewhat less harmful and lethal than even the normal seasonal influenzas usually are.”

However, the British Columbia Centre for Disease Control reports five deaths related to swine flu.

The cause of such deaths could be revealed by research Hancock’s team is doing into systemic inflammation.

“[The viruses] have on them… molecules that are recognized as ‘foreign’ by receptors inside cells, which turns on the inflammatory process,” said Hancock.

This process is a natural defense against these foreign objects, but the trouble comes when flu virus gets into the lungs. The inflammation that occurs can spell disaster if it continues for too long.

“Inflammation in the lungs… causes a lot of fluids to come into the lungs. People literally drown from their own fluids,” said Hancock.

In addition, the virus can worsen secondary infections and cause death, as shown by the 1918 Spanish Flu, which was also a form of H1N1. More than 20 million people died in that outbreak, according to the World Health Organization. Antibiotics had not yet been invented.

Seniors with age-related, health complications are vulnerable to flu-induced complications, but that may not be the case with H1N1.

“Elderly people have seen an H1N1 type virus before. I think the
last outbreak was in the ’70s,” said Hancock. “They tend to have some immunity to this virus…balanc[ing] off the sort of increased susceptibility.”

A young, healthy person’s lack of existing antibodies may put them at higher risk than someone who was exposed in the past.

However, past exposure and the resulting antibodies don’t necessarily rule out infection, as the swine flu of 1918 and 1970 was not exactly the same as the swine flu of today.

“Flu has the ability to undergo a variety of processes that can change it…so that our body no longer recognizes it,” explained Hancock.

These changes of form are the reason people must be re-immunized every year.
Scientists use the system of H1N1 to categorize various flu strains by the sequence of hemagglutinin (H), the molecule that binds the virus to cells, and neuraminidase (N), the molecule that cuts free freshly made virus cells.
Some strains have similar sequences (swine flu is H1N1, avian flu is H5N1), so they are grouped together although they are biologically different.

The viruses categorized as influenza A, of which swine flu is one, generally have a hard time infecting humans, but H1N1 found a way to adapt itself to allow easy human-tohuman transmission.

“What it looks like is a farm worker managed to acquire two strains of influenza from pigs, and they went through a process known as reassortment,” said Hancock.

The two viruses swapped bits of each other until a new one was eventually created.

The union produced a certain strain that is easily transmitted between human beings.

“It’s really new, and people don’t really have an existing immunity,” he said. “There’s substantial concern that it could mutate in a way that would allow it to become more deadly.”

Extreme measures to avoid extreme flu

How far would you go to avoid getting the H1N1 virus, more commonly known as swine flu?

Some countries have been taking extreme measures against the virus, but local health authorities say that’s not necessary.

• In April, Egypt ordered the slaughter of the country’s 300,000 pigs, believing it would calm people because pigs are seen as unclean, reported the Sydney Morning Herald.

• The majority of the Japanese public has worn masks since May to avoid the H1N1 virus, thousands of schools were closed and testing centres were flood with people, reported Foreign Policy magazine. Also, Japanese politicians have announced that they will not shake hands with anyone until the H1N1 scare has died down.

• The Big Gig Weekend festival at the Royal Bath and West Showground in Britain has taken out insurance of up to one million pounds for performers Katherine Jenkins, James Morrison, Boyzone and Diversity, in case they come down with the virus, reported the London Telegraph.

• According to l’Agence France-Presse (AFP), when a case of H1N1 was confirmed in a passenger coming from Mexico, Hong Kong quarantined the hotel where the traveller was staying, and tired to track down all the passengers who were on the plane with the man.

• China was prepared to close schools and convert a holiday camp into a quarantine centre when the virus hit the country, reported AFP.

• The Local (Sweden) reported that some Swedish churches have started serving fortified wine at communion, hoping that it will reduce the risk of the spread of H1N1, while others have advised Swedish faithful not to attend communion.

But all the action that needs to be taken is being prepared, said Roland Guasparini, the Chief Medical Officer at the Fraser Health Institute.

“I’ve heard of people avoiding air travel and keeping kids out of their activities, but there’s no need to do anything much more than that,” said Guasparini. “What you need to do is stay healthy, sleep, eat well, get some exercise and keep away from sickies.

“If you do have to look after someone, put a mask on them, so that they’re not coughing all over you, and then wash your hands thoroughly or use an alcohol-based hand sanitizer.”

Though it’s a bit of an odd idea, Guasparini said that the Japanese politicians may be on to something by not shaking anyone’s hand.

He said that if you shake hands with somone with the virus, and then eat something without washing your hands, you could get the virus. Guasparini thinks that the ru- mour of how H1N1 is contracted – humans getting it from pigs – has been put to rest because of media coverage. He said that it’s actually the other way around: humans give H1N1 to pigs or to other humans.

“[The disease] is passed on per- son-to-person through the eyes, nose and mouth, usually through hand-to-hand contact with objects and then touching your face, where the cells attach to the inside of your nose and/or mouth.”

Quarantined down under

When Charlotte Stokes boarded the plane to go from Vancouver to Australia in August, she was amused by the people who wore masks to protect themselves from catching the H1N1 virus. It hadn’t occurred to her at that time that they were protecting themselves from her.

“I walked into the plane and there were all these people wearing masks, and I thought to myself what stupid over-reacting people,” said Stokes.

Stokes was going to Sydney to be a bridesmaid at a friend’s wedding. Two days after she arrived, she was quarantined in her mother’s house because she was suspected of carrying the H1N1 virus.

When the plane landed, Stokes was fatigued and achy, but assumed it was just the effects of a 20-hour flight, so she went to meet the bridal party for a dress fitting.

Soon after, the symptoms started getting worse.

“I saw all the bridal party and then the next morning I felt really sick. It felt like I had taken an aspirin on an empty stomach,” said Stokes.

She went to a clinic and told them that she had just arrived back from North America and they automatically assumed she had the H1N1 virus. Because test results would take about a week to process, she was quarantined at her mother’s house.

“Immediately if they thought you had the swine flu you weren’t allowed to leave the house for five days,” said Stokes, “so I went all the way to Australia to sit at home for five days.”

At first she did not believe she had the H1N1 virus because she didn’t have all the usual symptoms. According to the World Health Organization (WHO) the symptoms of H1N1 are those of any other flu: fever, aches and pains, sore throat, coughing, diarrhoea and headaches.

Stokes said she did not experience the cold-like symptoms such as coughing and a sore throat, but certainly felt the other flu symptoms such as alternating chills and fever. She said she felt as if she was hungover from dehydration and had an intensely high fever.

To Stokes, who usually combated the flu by resting for a day and then heading back to work, the H1N1 virus was like the flu on steroids.

“I seriously have never felt so sick in my life,” she said. “I could not have left the house even if I wanted to. I couldn’t even get up to get a glass of water without a huge amount of effort.”

WHO makes clear that those with underlying health issues and weakened immune systems are the most vulnerable to H1N1 and will have more severe symptoms than a healthy person who catches the virus.

“I could see how if you already were really sick how this could put you over the edge,” Stokes said.

After the five days of quarantine, Stokes had another checkup and was given a clean bill of health. She found out a few days later that it was the H1N1 virus that had made her so ill.

None of the people in the wedding party contracted the virus and Stokes was able to be a part of the wedding, although she did have to deal with the stigma of being the “swine-flu girl.”

Travel costs drop as fear grows

Students looking for sun and sand on a budget may be in luck this winter, but they shouldn’t forget to wash their hands.

“Southern destinations are always popular over the holiday season. Even this year, with the H1N1 scare, ticket sales are still very strong,” said Kyko Purvis, a travel agent with Merlin Travel. “It has a lot to do with the great deals available.”

The Public Health Agency of Canada posted a level one advisory for travel globally because of the H1N1 flu, but has not specifically listed any country as an area of higher risk. The level one advisory is the lowest of three issued by the organization.

As a result of the H1N1 virus outbreak, most airlines, hotels and travel agents have sweetened their deals in an attempt to cash in on the lucrative holiday travel season. Room upgrades, seat upgrades, travel vouchers that cover the cost of your airfare when you book for a week-long stay at a resort, and transfers that will get you from the airport to your hotel for free are all perks being offered for those who are willing to ignore the travel advisories.

“People are weighing the risks to their health against the savings in their pocket-books,” said Purvis, “and booking their tickets, for most, is an easy choice.”

Dr. Sarah Thrasher, of the Travel Medicine and Vaccination Centre, has seen an increase in people inquiring about the safety of travel to many destinations.
“I’ve been advising people the risk of travelling this year is relatively
no different then that of previous years,” said Thrasher.

Regular hand washing, using hand sanitizers, avoiding people with signs of respiratory illness and being vaccinated – once the vaccine is available to Canadians – are all ways of protecting yourself against H1N1 infection, said Thrasher. Canada has just over 50 million doses of the vaccine on order, and they should be available in early to mid-November. That’s enough for everyone in Canada who wants one to be vaccinated.

“H1N1 causes relatively moderate symptoms in those infected, so people don’t need to feel afraid to travel,” said Thrasher.

Old news sparks new views

Avian flu and the West Nile virus may have dropped off the media radar with all the attention on H1N1, but they have not dropped off the map.

“Because [avian flu is] not spread effectively between bird and human, it’s not a huge concern for most people,” said Roy Wadia, director of communications for the British Columbia Centre for Disease Control. “If it were to become of pandemic size, it could cause a catastrophic pandemic on a scale that would epically dwarf the current H1N1 pandemic.”

“Everything is ultimately local,” said Wadia. “If it’s happening in your neck of the woods, it’s a big story,” said Wadia. “If it’s happening in another country thousands of miles away, or even two or three countries away from you, it’s not a concern.”

Wadia, who was working in China during the original outbreak of avian flu in 2003, recalled that although it was a big concern in that area, it was of minimal concern in the West.It was not until the virus resurfaced in 2008 on Western farms and began having a direct affect on farmers and citizens that it received widespread attention. Since then, media focus has shifted again, but Wadia still sees avian flu as a huge public-health issue.

According the World Health Organization, there have been 442 documented cases of avian flu infection among people, with 262 of those cases proving fatal. Direct contact with diseased birds is believed to be the cause of most of these infections, and transfer from human to human has been rare. However, the potential for the disease to mutate or evolve and become more efficient in transferring is the largest concern for public-health officials.

West Nile virus is another infection endemic to various parts of the world. The virus first appeared in North America in 1999, but how it came to New York remains a mystery. Until then, the virus was found in Africa, Eastern Europe, parts of the Northern Mediterranean, Egypt, Israel, Romania and the Czech Republic. Upon its arrival in North America, it became the most widely spread vector-borne disease (spread by the bite of an insect or animal) on the continent, according to the BCCDC. To date, seven Canadians have reportedly contract the virus, two in B.C., two in Alberta and one each in Saskatchewan, Manitoba and Ontario. None of those people died.

A senior environmental health specialist for the BCCDC, Ken Cooper, noted that the original North American form of West Nile, designated NY99, has mutated, is virtually extinct and has been replaced by WN02, a closely related variation.

According to the BCCDC, only one in 150 people infected with the disease will respond strongly to it; others can carry it without ever knowing they had it. The centre reports that there were 4,511 cases of WNV reported in Canada between 2002 to 2008.

“There are serious side effects for those who become ill with neurological symptoms,” said Cooper an email interview. “Even those who get milder symptoms can still be quite ill and have an impact on health care and on economics.”

The economic cost of responding to avian flu has been felt by farmers around the world, who have had to slaughter their birds, including geese, ducks and chicken, to stave possible spread of the infection. In 1997, Hong-Kong destroyed 1.4 million chickens when a portion tested positive for the infection, according to reports from CBC. In 2007, a commercial duck farm in Regina executed 50,000 birds after some of them tested positive for H7N1, a variation of avian flu that does not kill people.

“Avian flu has a strong economic impact on people who are poultry farmers and [who] work in the agriculture field,” said Wadia. “From Vancouver’s perspective it’s no big deal right now, but if you see it from the perspective of a farmer in China, or a very large poultry processor in Thailand, it’s a huge deal.”

Wadia added he is confident the Canadian health community is well-prepared for H1N1.

Fraser Health predicts and prepares for worst-case flu scenario

After months of monitoring the southern hemisphere’s H1N1 cases, Fraser Health has determined 40 per cent of the world’s population will catch H1N1 before next April.

The number is twice the yearly 20 per cent seasonal flue infection rate, according to Dr. Roland Guasparini, Fraser Health’s chief medical health officer.

“The vast majority are going to have a mild, self-limiting illness,” Guasparini said. “[But] the flu’s not really mild. You will feel like you get hit with a truck.”

Fraser Health based its estimate on the number of cases that have been reported in the southern hemisphere. As winter and the flu season comes to an end there, the infection rate offers a glimpse into what residents of the northern hemisphere should expect.

Guasparini said Fraser Health has been planning for a severe pandemic for many years, expecting it to surface at any time. The summer arrival of the H1N1 flu suggests that the virus will peak early, over the next eight to 12 weeks, and taper off by December.

The health unit has spent most of its time planning for a worst-case scenario including 200 intensive-care patients, more than Fraser Health facilities can currently house.

To prepare, it has planned alternative treatment sites, purchased additional ventilators and decided how to staff additional health care locations.

“But we’re not going to see that worst-case scenario,” said Guasparini. “We’re expecting, based on the southern hemisphere, that we’ll be able to manage the hospital cases as usual.”

H1N1 is a contagious disease, he explained, so “the attack rate will be the same regardless of the severity of the symptoms.” A mild disease could, however, allow H1N1 to spread more widely than expected if infected people don’t remain home until they recover.

Current concern is for the elderly, children, pregnant women and those with chronic respiratory and cardiac conditions. Those who fall into these categories are at a high risk for severe illness until they receive the H1N1 vaccination, which will not be available until November.

“We’re hoping . . . we just have a seasonal flu year, but the nice thing about all the media attention is that it’s just brought attention to safety conditions,” said Guasparini.

The message about hand-washing, coughing into a shirt sleeve and staying home when sick “has hit home in a big way.”

He said the media is doing a great job of accurately presenting H1N1 facts. Public-health workers are dealing with the additional strain of responding to patients’ concerns, but the attention devoted to understanding the threats and safety procedures is a new and welcome phenomena.

During previous pandemics, the methods of communication were far more limited.
Guasparini said the international attention and response is a testimony to the system health officials have for monitoring and responding to infectious diseases.

“People are not scared, they just kinda focused their attention.”

Don MacLachlan, former managing editor at the Province and former director of public relations for Fraser Health, agreed that media has “been doing a very responsible job.”

MacLachlan said the public perceives H1N1 as a problem, and its status as a pandemic means it is, so the media is rightly informing people about it.

A number of rumours have cropped up since H1N1 first appeared, leaving some people hesitant to trust media coverage. Bulletins have been issued debunking beliefs that H1N1 can be contracted by eating pork, that entire villages in Asia were being wiped out and that the coverage is only hype. But the myths aren’t from the mainstream media, said MacLachlan.

“People aren’t reading or listening to traditional media news. They get news from Facebook, Twitter or MySpace and they treat that as the definitive truth.”

The media attention has pushed some towards fear or skepticism about the reality of the threat. MacLachlan attributed any “exaggerated state of concern or panic” to individuals who are receiving the media’s messages. He added that “people are hearing and reacting responsibly to responsible messages.”

Flu virus spawns crop of conspiracy theories

We’ve heard it all: The moon landing was faked, 9/11 was an inside job, there are UFOs at Area 51. But have you heard that H1N1 flu was genetically engineered?

Dan Jason, a Saltspring Islandbased organic-seed farmer, thinks H1N1 was created. Jason, who studied seed growth for 20 years, knows a lot about genetically enhanced crops and is calling bullshit on the idea that H1N1 is a chance mutation.

But what does a lowly seed farmer know about all this?

“Genetic engineering creates things that wouldn’t normally happen in nature,” he said, recalling an experiment that introduced flounder genes into a strain of tomatoes. (Winter flounder, a species of fish which produces an antifreeze protein, have the ability to survive in subzero temperatures. Genes were taken from the fish and grafted onto tomatoes, in hopes of creating a crop that wouldn’t freeze.)

“It’s a very weird thing to take genes from a foreign species and bombard them onto a crop,” said Jason. “It doesn’t happen normally and it’s the same story with the flu.”

Jason, like many others, believes that H1N1 flu was engineered by combining viruses from birds, pigs and humans, a sort of grab bag of genes intended to create dependencies on pharmaceutical companies.

His explanation? Vaccines for the flu (which he believes will soon be mandatory) contain mercury, which some people believe causes autism in children and therefore creates a need for Ritalin and other medications used to treat behavioral problems.

Lee Moller argues a different point.

“If we really had the power to genetically modify, to create a flu, we’d create something much bigger than [H1N1],” he said.

Moller, the head of the B.C. Skeptics Society, runs a website that aims to debunk conspiracy theories, urban legends and folklore, ideas that Moller says are “based on faulty logic and paranoia.”

Moller’s website features links to articles that disprove or explain conspiracies , to a blog titled “Rational Enquirer,” and an organization called “skepticamp,” which hosts an annual conference that touches on paranormal claims, alternative medicine and cryptozoology.

“There’s conspiracy theories galore,” he said. “It’s almost human nature to assume a hidden cause.”

Kwantlen psychology professor Steve Charlton thinks there are two sides to conspiracy. “Often people aren’t skeptical enough,” he said, “but the other extreme of that is people who are overly critical without skepticism.”

Those would be the conspiracy theorists.

“There’s lots of conspiracy theories based on misunderstanding or [lack of ] probability,” Charlton said.

Alex Jones, head of InfoWars, hosts conspiracy-heavy radio broadcasts, which, despite perhaps farreaching and often exaggerated nature, has a substantial following. The InfoWars website (www.infowars. com) features an article that claims “[swine flu] originated at the army base at Fort Dix, New Jersey.”

“Coincidence becomes fact in people’s minds,” said Charlton.

Sidebar: Other myths about H1N1

Swine flu was a rumour created by the U.S. government to persuade people into buying sterilization products to stimulate the economy.

The U.S. made up swine flu because they hate Mexico and want to close the border.

Hand sanitzer can spread swine flu.

A new strain of H1N1 has emerged, specific to those who died from the influenza, called H1Z1 (or zombie swine flu). The new virus would be able to restart the heart and resurrect the victims as zombies.

Health community ready for outbreak, but virus’s unpredictable nature could ruin plans

Although he sounds fatigued, Dr. James Lu’s voice can only be described as confident when he speaks about the state of the H1N1 outbreak in B.C.

“I think the current concern is making sure the population has the correct information in terms of the level of risk or severity of the pandemic at this point in time, as we understand it,” Lu, the medical health officer for Vancouver Coastal Health in Richmond, said in an interview with the Kwantlen Chronicle.

In its Sept. 22 website bulletin, the Ministry of Health Services reported that 48 B.C. residents had contracted the virus so far. Among those, 21 had been sent to intensive care units and six people with preexisting medical conditions had died from the illness.

Lu said the provincial and federal governments, in conjunction with the B.C. Centre for Disease Control and Vancouver Coastal Health, have followed the guidelines set out by the Public Health Agency of Canada in the B.C Pandemic Influenza Pre-paredness Plan.

Developed in 2005 by the B.C. Ministry of Health and the B.C. Centre for Disease Control, the 200-page document outlines the steps officials are to follow before, during and after a flu-pandemic outbreak, and is consistent with national and international pandemic preparedness protocol, according to the introduction.

Lu said that because of the plan, provincial health authorities were able to quickly and effectively track and monitor the outbreak of the virus, as well as educate the public about how to avoid getting sick. The current rates of death and sickness due to H1N1 in the Lower Mainland are comparable to those for the common flu.

“It’s quite reasonable,” he said of the impact of the H1N1 on B.C residents.

“It’s not any different from what we would expect from seasonal influenza. The sense we have right now is that the health-impact severity is similar to the seasonal flu instead of the 1918 Spanish flu that people are recalling. The majority of the cases are mild.”

The Spanish flu was a pandemic that killed over 20 million worldwide in 1918 and 1919.

Historians believe that during that pandemic, Vancouver had one of the highest rates of death of any North American city, when 795 of an estimated 4,890 infected people died, according to a June 12, 2009 Vancouver Sun article.

The H1N1 virus has made headlines around the world for being an aggressive flu strain that has killed as many as 3,486 people as of Sept. 18, according to the World Health Organization weekly H1N1 update.

However, Lu insisted that the strain isn’t as aggressive as he and his colleagues had initially thought it was.

“You probably have about 50,000 hospitalizations or so each year from the flu and you would probably would have 4,000 to 5,000 deaths a year from the flu in Canada. I think we’re doing something to help keep H1N1 in that range, but the virus also isn’t as virulent as we feared initially,” he said.

Even so, Lu is advising those who are concerned about contracting H1N1 to make an effort to get the H1N1 vaccine from their local health authorities as it becomes available locally.

According to Lu, the vaccine will gradually become available within the next week, as it is being produced in batches, and is prioritized for vulnerable B.C. populations.

Irene Lanzinger, president of the B.C. Teachers Federation, said that strategies for preventing the spread of flu among students – such as hand washing and covering coughs or sneezes – are being implemented by teachers and schools as students settle into classes.

However, Lanzinger also said that she doesn’t know of any specific plans or strategies put in place by provincial health authorities to protect students.

“The ministry of health and the ministry of education need to make sure that school boards are prepared for what might happen,” she said.

“I don’t know whether they have given instructions to school boards. We really get the sense that there is a little bit of a wait-and-see attitude out there because nobody knows for sure how bad it’s going to be. Having said that, people need to put some plans in place in case something does happen.”

Lu is optimistic that the H1N1 outbreak in B.C. won’t evolve into a greater crisis, but he is also realistic about the unpredictability of the virus as the flu season hits.

“Because most of us don’t have any immunity to it, I wouldn’t be surprised if come the fall, we do have a large number of people who become ill,” he said.

“Most of it will not need hospitalization or need to be seen by a doctor, but more people may become sick with the flu,” he said. “It may turn out that yes, this virus may be causing a little more severe illness in a healthy person, but it’s hard to sort that out now.”

H1N1 vaccine might be free for students

If H1N1 injections became available to Kwantlen students, they might be covered under the existing student health plan.

The Kwantlen Student Association is looking into the possibility of including H1N1 vaccines in student health benefits. The KSA has contacted Gallivan & Associates, Kwantlen’s health and dental insurance company, and hopes to negotiate the vaccine’s inclusion, should it become widely available.

“We’ve taken steps to make a change to the plan so that that cost would be at least partially or wholly covered by the KSA,” said KSA general manager Desmond Rodenbour.

If the H1N1 vaccine is added to the benefits, Kwantlen will direct students to vaccination clinics for the shot. Rodenbour said he hopes all full-time students on the medical plan would be eligible to receive the immunization.
Currently, the vaccine is still being developed and the KSA doesn’t have a projected cost

for the shot, but it’s expected to be generally available later in the fall. The Public Health Agency of Canada reports that the government intends to purchase 50.4 million doses of the vaccine, enough to cover the population of Canada.

Linda McCannell, a program leader in communicable disease for the Richmond Health Department, said she doesn’t think people in good health should be as concerned about getting infected as those who are illness-prone.

“From what I’ve seen, the severity [of H1N1] tends to be very similar to regular flu,” she said. “It’s pregnant women, it’s children two years of age, it’s people with chronic health problems and those are who we normally immunize for flu [who might have a more severe reaction].”

Janine Hadfield, a coordinator of the Kwantlen Wellness Centre, said the regular seasonal flu shots will be given on campus near the end of October or early November.

Last year, about 180 staff and students got flu shots on-campus, according to Eddie Lee of the Student Health Improvement Program.

Lee said the number of people getting the shot might increase because of the awareness of the flu virus.

Lee estimated the flu shot will cost $15 to $20, adding that the KSA will subsidize some of the cost for students on the health plan.

Kwantlen is promoting good hygiene, such as washing your hands and covering your mouth when you cough, as defences against the flu in general and H1N1 in particular. Automated hand-sanitizer stations have been installed at main entrances and updates about influenza are available on the Kwantlen website (www. kwantlen.ca/hr/ohs/h1n1.html).

“The primary thing is education,” said Peter Chevrier, Kwantlen’s director of marketing and communications. “If we educate everybody on some of the really fundamental, basic processes, you start to cut down on the likelihood of infection.”

According to Kwantlen’s Influenza Exposure Control Plan, the Emergency Management Committee would issue a health notice in the event of a major flu epidemic.

Students should be concerned if they have a fever above 38 C and any other H1N1 symptom such as cough or shortness of breath. Suspected and confirmed cases should be reported immediately to Healthlink BC at 8-1-1 and the manager of Kwantlen’s Occupational Health & Safety Office at (604) 599-2924.

Much of the Influenza Exposure Control Plan is about precautions to stop the spread before it starts.

Local and regional health authorities would decide if school closures are needed. Kwantlen, however, is not restricted from implementing its own preventive measures, said Chevrier.

“We have a lot of freedom to do what we feel is the best in order to provide a level of commitment to the health and safety of our students,” he said.

He added that the janitorial crews have been trained for more thorough and frequent decontamination, such as sanitizing doorknobs and handrails.

The Public Health Agency of Canada has reported five cases of H1N1 in B.C. There are no reports of H1N1 affecting anyone at Kwantlen.