MILLVILLE, Cache County — Like millions of Americans, Rick Morgan was a bit skeptical of all the talk about the H1N1 virus — that is, until it almost killed him.
"I thought it was a bit overblown," he remembers.
It was October 2009, and Utahns were lining up to be vaccinated by the thousands. But Morgan wasn't part of the "eligible" group, and he certainly didn't consider himself "high risk."
A researcher in the Space Dynamics Lab at Utah State University, his mind was often more engaged on what was happening in the heavens, rather than here on planet Earth. But on Wednesday, Oct. 21, he woke up focused on how ill he felt.
"Rick doesn't stay home from work, ever," said his wife, Marie. "But he woke up so sick he couldn't get out of bed. I remember he had a fever of 103 and a cough."
He hunkered down in bed, frustrated to be missing work. He had no idea how bad things were about to get.
Now, more than a year later, the H1N1 scare has all but subsided. In fact, according to the Centers for Disease Control, flu numbers were below normal in February. What's more, thousands of vials of H1N1 vaccine are expiring every day across the country.
In Salt Lake County alone, 1,500 doses will be trashed this week. Nationally, an estimated 71.5 million doses will be discarded if they are not used before they expire.
The swine flu vaccine push, which cost the U.S. government $1.6 billion, was the most ambitious immunization campaign in American history. There are no estimates on how much money will be lost when the unused doses are discarded, but the BBC has reported that the UK government will lose as much as $150 million on its 34 million unused doses.
To some, the swine flu threat seems like the pandemic that never happened. Others have questioned why so much money was spent on a public health outbreak that never materialized.
But local officials see it differently, and the CDC warns that another outbreak could be coming.
For survivors of the H1N1 virus like Morgan, there's no question the public health system did the right thing. For him, the flu was as real and as deadly as the World Health Organization initially warned.
"Public education and vaccine programs mitigated the effect quite a bit, but it's hard to quantify," says Dr. David Sundwall, the director of the Utah Department of Health. "How do you measure what didn't happen?"
Sundwall still remembers where he was when word of the "swine flu" first started trickling out of Mexico in the last week of April 2009. At his office off North Temple in Salt Lake City, he began to pace as updates started coming in from the CDC and the WHO. He knew what the word "pandemic" could mean.
"I was very nervous," he says, looking back on the initial stages of the pandemic. "What we were anticipating was something much more severe. … The scenarios were based on what happened with the Spanish flu in 1918, and that was like Armageddon."
Word of the first American cases came within hours, and Sundwall immediately requested 87,000 doses of antiviral medications from the strategic national stockpile, bracing for indications that H1N1 had made its way into the Beehive State.
It didn't take long. The first "probable" cases appeared in Park City, where all eight schools in the district were closed on April 30 after three students showed symptoms. A resident believed to be carrying the virus had returned from Mexico after spring break, possibly setting off an outbreak.
Medical masks, gloves and hand sanitizer began popping up in public places and flying off store shelves. How did H1N1 spread? Who was at risk? What could be done to prevent it?
The questions became so intense so quickly that both Gov. Jon Huntsman Jr. and President Barack Obama called televised press conferences within 24 hours of each other, trying to prevent hysteria and assure the public that response at both the state and federal level would be swift and effective.
Yet at that point, there was no vaccine available and production was months away. So health officials shifted into high gear prevention mode, setting up hotline numbers and speaking through every available media about the importance of personal hygiene.
Turns out Sundwall had more reason to be concerned early on than many of his peers nationwide. "We had a severe impact with the first wave. … Utah and New York City had the highest prevalence of disease the way we monitor it."
Schools closed. Doctors' offices and emergency rooms saw a surge in patients. Tamiflu and Relenza — the two anti-viral drugs used to treat those with severe symptoms — were rationed by pharmacies and medical providers, who found themselves taking the drugs off state-owned liquor delivery trucks since the state had no dedicated distribution mechanism.
Distribution was only one concern for Dr. Andrew Pavia, chief of pediatric infectious disease at the University of Utah and a member of the National Vaccine Advisory Committee, who was huddling with national officials as they tried to "anticipate how a vaccine would be developed quickly."
Years of planning for what was anticipated to be a highly deadly avian pandemic was based on the theory that it would first appear in Asia and not migrate to the U.S. for a few months, he said. "What we got was a virus of average severity that showed up in North America with no lead time at all," said Pavia, who also leads the Infectious Diseases Society of America's pandemic flu task force.
"In the first two to three weeks, every day we were attempting to understand the severity, and it really took that long to get a good handle on whether this would be terribly deadly. The first reports out of Mexico indicated it might."
Since they didn't have enough data from U.S. cases, it became something of a waiting game as information evolved along with the illness. "That's one of lessons we learned: that we really need to understand the severity and who is at highest risk as early as we can so we can tailor our response."
Avian flu planning meant Tamiflu stockpiles were available and officials believed they had enough, but they needed guidelines for how to best use the finite supply — and worried about how to "get the supplies the last mile" to those who needed them most, Pavia said.
"We hadn't figured out the details of how that would be done in every community, how to track who had it and which areas were running out."
At Intermountain Medical Center, Dr. Russ Miller was anticipating "something like the seasonal flu with lots of critical lung disease. We didn't really anticipate that H1N1 might be all that different, as it turned out to be."
As medical director of IMC's respiratory intensive care unit, Miller was not only surprised at the young adult patients that began showing up, but at the multiple organ dysfunction they experienced. "We were seeing a fair amount of brain and cardiac dysfunction, low blood pressure, trouble with their kidneys."
Based on guidelines that health officials and doctors were providing, patients who had been exhibiting symptoms for three or four days would come to the emergency room "and got what we thought was a good test, but it ended up not to be very useful. It was almost always negative."
Those same patients would return in a day or two and be admitted directly into the ICU, often with multiple organ dysfunction, he said. "The viral flu doesn't usually do that."
Patient conditions were complicated, requiring more time and hospital resources that doctors were used to seeing with seasonal flu.
As spring turned to summer, the cases — and accompanying media attention — tapered off both locally and nationally. Yet health officials continued to warn that H1N1 was likely to return with a vengeance again in the fall.
Back in Cache County, Morgan was hoping his flu would blow over. But after a few days, despite prescribed medication from a doctor who thought he had pneumonia, Morgan was having a hard time breathing. He checked himself into Logan Regional Hospital, where he had a chest X-ray taken.
Several days into his visit, with no improvement, he nearly panicked as he watched his oxygen level falling on a monitor. Later that night, he was put on a ventilator and airlifted to LDS Hospital in Salt Lake City.
"The doctor said if he stayed in Logan he would die," remembers Morgan's wife, Marie.
In the meantime, public health officials were trying to get a grip on the second wave of H1N1 infections, which came on like an extreme version of the seasonal flu. As it began to sicken many and kill some, federal health officials kept promising the vaccine would be arriving "any day." The first shipment finally arrived Oct. 5. Utah's 12 local health departments at first struggled with, and then improved vaccination for the crowds of several thousand that turned out for weeks afterward.
The epidemic reached its peak locally by the end of October, and officials at all levels who had worried that the health care system would be overwhelmed expressed relief that it didn't happen.
"We never got to the point where we were unable to take any more patients," Miller said. "We feared it on a couple of occasions and got very close to running out of dialysis machines on a couple of days." Keeping staff healthy by containing transmission included the mandatory use of masks, gowns and gloves, along with stringent isolation precautions.
Back at the hospital, Morgan was experiencing the cascading symptoms of organ dysfunction that doctors found so common in H1N1 patients. Every morning when she returned to the hospital, Marie Morgan learned of a new medical problem. "It just seemed like 'are you kidding me?' "
Doctors drained Rick Morgan's lungs of fluid, then blood, dealt with what appeared to be a bowel obstruction and a hundred other things Marie Morgan has fading memory of.
"I think the scariest thing that happened was one day he just became completely unresponsive," she remembers. "For about 15 to 20 minutes, he didn't react to anything. They ran him downstairs because they thought he had a stroke, but I don't know if they ever figured out what that was.
"One nurse said some people, after so long they can't deal with it any more and just shut down. That was very frightening."
The organ dysfunction, one after another, was a signature mark of H1N1 for ICU doctors who had observed other patients long enough that they were learning better what to anticipate. Sometimes the multiple dysfunctions simply become too much to deal with all at once.
By the time he was released on Dec. 11, Rick Morgan had spent five weeks at LDS Hospital and one at Logan Regional. He lost 35 pounds, "mostly muscle mass from just lying in bed all that time," his wife said.
He recuperated at home for two months before returning to work for a few days beginning in February. His work colleagues were "great in accommodating me to let me do what I could." He continued a part time schedule for a month before returning full-time in March.
"To a certain degree I'm still on oxygen, but I don't need to carry it around. But if I exert myself too much, I can still feel it." His doctors say he should return to full strength and vigor within the next year, but both Morgans have learned not to push the timing.
"I've been healthy all my life. This was the first time I'd been in the hospital since the ninth grade."
Looking back on a national scale, Pavia said many have mischaracterized the severity of the virus, noting that "had it been much more severe we would have had many problems staffing hospitals and running out of ICU beds." Some days in June, the "adult ICUs were really feeling the strain and staff was exhausted. It never got to a stage beyond that, but we were on the edge."
Based on preparation for a severe pandemic, Pavia rates the severity of H1N1 as "average," though it was "quite a bit more severe in young people and pregnant women."
"The term 'mild' has been used over and over, but that's just not accurate," he said. With more than 1,200 hospitalizations and 46 deaths in Utah alone, "it would be hard to call that mild." There were only 61 influenza-related hospitalizations statewide in 2008-09 before H1N1 appeared in Utah.
As for Rick Morgan, his skepticism about the severity of H1N1 is gone, and "I'm grateful to be alive." He's always mindful that technology and "the amazing crew" at LDS Hospital saved his life.
"I think they did some unique things there many places don't. They had me up walking with every tube and all these carts going alongside to get me moving again. Apparently that has a big impact on how quickly you can recover."
Now he's back to designing and building electronic instruments that will fly in the heavens, his feet firmly planted on Earth for what he and Marie hope will be a good long time.
e-mail: carrie@desnews.com