I remember the moment when I first heard about the H1N1 pandemic flu, formerly known as Swine Flu. It was a quiet Saturday morning near the near the end of April when news began to break about cases of people dying of a new infection in Mexico. This infection had all the hallmarks of a serious public health crisis: a new "bug," young people dying, and an infection spreading quickly through the population. After working on the public health response to SARS in 2003 and for a potential avian influenza or bird flu pandemic in 2005, I had a feeling we were in for a wild ride.

Within days, shelves in stores were wiped clean of hand sanitizers, gloves, and face masks. Tamiflu, an anti-viral medication which can decrease the severity of infection, was becoming hard to find. The media began reporting on cases of H1N1 infection in the United States. The Centers for Disease Control and Prevention (CDC) started holding news conferences and teleconferences with doctors around the nation. We knew that we were in the midst of a potential pandemic, and the severity and impact was hard to predict.

With each new case, the level of fear began to grow. Talk about the 1918 “Spanish flu” increased. The first wave from that flu was mild and then it came back with a vengeance. Millions of people died around the world. Stories of how healthy people dropped dead within hours with blood oozing from their eyes and mouth just escalated our anxiety of what could be around the corner for all of us today.

The funny or perhaps odd thing was that I never placed the nation's pandemic plan in my bookcase in my office at NASA; instead I kept the giant binder next to my desk. Perhaps it gave me a sense of confidence that we were ready for anything. The interesting thing was that the plan was designed for an infection that occurred overseas such as in Asia-we were expecting bird flu not a home grown variety from our own continent. The Vice President took a bit of flak for suggesting that it may not be a good thing to take public transportation and to fly. He was actually correct according to our pandemic plan but the challenge was that the bug had originated over here. Social distancing which is what the Vice President was suggesting would have potentially worked if the virus had not yet spread widely-it would have helped to slow down the infection.

Over the past few weeks, I have been giving briefings on the H1N1 flu to NASA and its occupational health clinics. NASA has always done an outstanding job tackling health emergencies which impact their employees -- from the devastation of Katrina in 2005 to the anthrax scare. I recently attended the White House Summit on Flu which was held at the National Institutes of Health (NIH). Leaders from the Department of Health and Human Services, Department of Homeland Security, and the Department of Education, as well several governors and public health officials from every state, were in attendance. Even the President participated from his meetings in Italy. Discussion about a new vaccine and who would get top priority was discussed -- namely health care workers, children, pregnant women, and adults with underlying conditions. We hope to have a vaccine ready for mid-October. There are concerns that folks will need two shots to be effectively immunized since our immune systems have not been exposed to this virus before.

I have been concerned that women, especially pregnant women, are at high risk for complications. Animal studies have shown that females may be more resistant to H1N1 infection compared to males, but once they are infected, they mount a very vigorous inflammatory response which can cause more secretions, leading to pneumonia in the lungs. Pregnant women may lose that resistance because their immune systems have changed so that they do not reject the fetus, yet they still have a strong inflammatory response. It may also be harder to ventilate a woman who is pregnant because of the increased resistance and pressure on the lungs from her pregnancy. The positive side to this may be that women may only require one shot or a smaller dosage to be immunized. Studies are now underway to assess what is needed. We know that women can have more side effects to vaccinations and that women are more likely to develop auto-immune diseases compared to men in general. So this is an important area to investigate.

I am concerned that the fall will be a difficult time. Kids are coming back to school and, if summer camp infections are any indication, schools may be another hot bed for infections. We will just have to see what happens and be ready. Closing schools can slow down infection rates, but it is also challenging for families, as parents need to work and some children get many meals at schools. In the meantime, schools are preparing for distance learning just in case.

We will also have the seasonal flu vaccine available, probably starting in September. Keep in mind that this will not protect you from pandemic flu. Pandemic vaccines will be given through public health departments. Surveillance or checking for side effects will be closely followed, especially since this is a new vaccine. We learned some important lessons from the 1976 swine flu vaccine program. More people died from the vaccine than they did from the swine flu in 1976.

I have found that with information and with honest communication, we can keep the fear level down. Fear can cause bad decisions and keep people from living their best life possible. We will learn a great deal as we move forward. There may be times of confusion, but this is understandable. As long as we keep an open mind and ask good questions, we will get through this new pandemic -- the first one of this century.