Over the last few weeks I’ve been glued to the television watching the NFL playoffs.  As with other years, this season featured a crop of emerging teams who have either gained a new prominence or have found the path to long gone days of glory.

The playoff matches for the most part were fun to watch and gave hope to many that a Cinderella team would arise and make it to the Big Game.  But this year, it was not to be. With each week, one by one, the teams of dreams faced an unyielding opposition that ended their hopes and their season. At the end of it all, two veterans with significant Super Bowl won out leading to cries of “Maybe next year…” from the upstarts and their fans.

As I sat watching the celebrations for the victorious teams, I wondered if I would even watch the Super Bowl two weeks from now or if I would forgo the game and find something else to watch.

I hear Contagion is on DVD now.

As the playoff games came to a close and the matchup for the Super Bowl was finalized, I started to realize that there was something familiar about my  emotional reaction. I had the feeling that another struggle, a playoff if you will, had engaged me in a similar way.  I had been rooting for an emergent team only to be flummoxed by a veteran.

Then it hit me what had gripped me so tightly only to leave me unsatisfied.  It was the determination of the strain of influenza that led to the 2009 pandemic.  Just like the realization that the Super Bowl was going to be the Patriots and the Giants, I was stunned to learn that the pandemic was being caused by the well known H1N1.

Let me just say that infection is no laughing matter and the cost of the pandemic in terms of lives affected and unfortunately lost, continues to haunt me primarily because the infectious disease world should have seen this coming.  But in the same vein as those who root for the underdog, I honestly had felt that the next big one would have been something novel.

You can’t really blame me. Look at the news headlines about the next pandemic prior to 2009.  All the research, the meetings, the prioritization mandates and the speculation of expert forecasters all pointed at a few suspects. Yet, when the pandemic hit back in 2009, everyone was shocked that the culprit wasn’t the odds on favorite, H5N1 (avian flu) or the up and coming H9N2 or even one of the offshoots that might have had a chance like the H7N7 that led to a mass slaughter in British Columbia in the early 2000s.

So what happened?

Much like an NFL team, viruses change their roster from year to year.  The difference is that the roster of an NFL team consists of a star quarterback, strong running backs, spectacular wide receivers and of course unstoppable defensive lines while the roster for a virus consists of genes and proteins that mutate on a regular basis.  When it comes to flu, each year results in a pathogen that looks different (the reason we need yearly flu shots!).  Also, much like an NFL team, the viruses that succeed the most are ones that have a propensity for success.  In the NFL, that counts as wins both during the regular season and the playoffs.  For viruses, it’s about virulence and transmissibility throughout the year.

From that logic, H1N1 should have been the one virus that everyone considered.  However, no one really expected the roster to be so strong.  The 2009 strain had the right combination of genes and proteins to cause high virulence and high transmission.  Add to that the fact that the virus moved faster than human’s ability to stamp it out (which is increasingly becoming harder thanks to the efforts of pandemic preparedness and response – sorry, Contagion) and you had what would be the perfect Super Bowl team – a pandemic strain.

I guess this shows that no matter how much we want to look at the new and upcoming stars, like H5N1 and H9N2, we can never forget that the old ‘graybeards’ like H1N1 can make a huge comeback.

So, as the world awaits the match between the Patriots and the Giants, I hope you take a moment to look back upon the past pandemics and the most recent one as well as the new strains.  I invite you to play armchair epidemiologist and determine what might be the best way to move forward.

I would bet that you come up with the same answer that I did.  Keep studying and believing in the upstarts but never ever forget to keep an eye on the usual suspect (and in terms of scientific research, that means continued evolutionary studies and monitoring of H1N1 mutations worldwide, not only in China).  After all, you never know when a team or a virus may end up having a banner year.

Hope to hear your thoughts…and of course your Super Bowl picks.

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