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Though lessons can be learned from the past, the 2009 H1N1 flu in some ways is strikingly different from the 1976 swine flu, just as the 1976 swine flu turned out to be strikingly different than the 1918 pandemic, says Harvey Fineberg, president of the Institute of Medicine and co-author in 1978 of The Swine Flu Affair: Decision-making on a Slippery Disease.

Unlike the 1976 swine flu, H1N1 cases continue to rise around the world, but today there are effective antiviral drugs. Barry Bloom, Fineberg's successor as dean of the Harvard School of Public Health, says, "My biggest worry in this crisis is that people will overuse Tamiflu and Relenza," leading to flu strains resistant to the antivirals.

Although person-to-person spread of swine flu never reappeared in the 1976-77 flu season, the 1918 Spanish flu laid low during the summer but came back with a vengeance in the fall.

H1N1 would be expected to wane as summer approaches, Fineberg says. "It does not really tell you what will happen in the fall. Could it fizzle? Yes. Could it explode? Yes." Monitoring the situation in the Southern Hemisphere's winter, the Northern Hemisphere's summer, he says, "is going...
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