Re: Prominent Ottawa chemistry professor latest suspected H1N1 victim
H1N1 death shrouded in mystery
Chemistry professor's rapid decline exemplifies swine flu's complexity
By Pauline Tam, With files from Tom Spears, Joanne Laucius and Scott Nowoselski, The Ottawa Citizen November 14, 2009 5:02 AM
The death of a 38-year-old University of Ottawa professor, who had no known underlying medical condition when he succumbed to the H1N1 flu this week, highlights a medical mystery that continues to dog researchers: Why does a tiny minority of otherwise healthy young Canadians become gravely ill or die from swine flu?
Why does the novel virus seem to behave differently from seasonal flu strains, which are typically more fatal to the old and ailing?
While experts have theories, they have so far not produced hard scientific evidence that points to clear answers.
Even so, the death of Keith Fagnou, a doting father and budding chemistry star, underscores what scientists know about the pandemic virus' worst cases to date -- that H1N1 disproportionately hits the young.
Fagnou died Wednesday in the The Ottawa Hospital's intensive care unit three days after he was admitted. The first sign of illness his colleagues noticed was last Friday, when he sounded hoarse and said he was losing his voice. If that's the case, Fagnou's condition appears to have deteriorated at alarming speed.
"He complained that he had a sore throat," said Deryn Fogg, one of Fagnou's chemistry colleagues. "I had a meeting with him that morning, and think he might have gone home afterward. But he was working on, I think, a research proposal over the weekend."
According to case reports from intensive care units across Canada and around the world, half of patients who have become critically ill have been under the age of 40, with the other half being older.
Even more significant, doctors say, is that the virus can cause serious disease in previously healthy people, which does not fit the typical patterns of flu.
"That's novel," Dr. Robert Fowler, a University of Toronto medical professor said in a recent interview. "It makes it difficult, therefore, to define a segment of the population that is so-called high risk."
Experts suspect people over 65 have some immunity to the pandemic virus, because they were likely exposed to a distant cousin of H1N1 that circulated in the 1950s.
Other researchers have speculated that during the 1918 flu pandemic, young, healthy people became very ill because they have strong immune systems, and their immune response to infection kicked into overdrive, leading to more inflammation and severe disease.
While scientists are still trying to learn more about what predicts severe illness in people with H1N1, how the virus attacks and kills is better known. Seasonal flu viruses tend to infect the upper respiratory tract, particularly the cells lining the main airway and nasal tract. What makes H1N1 different is that while it also infects the upper airways, in some people, it penetrates deeper down, infecting the lungs with frightening speed and effectively drowning them. "There's an overwhelming amount of fluid that goes into the lungs," said Dr. Isra Levy, Ottawa's medical officer of health.
In other people, said Levy, the virus inflames of the cardiac muscle, which can cause sudden heart failure. Still others are so weakened by the virus that they develop secondary bacterial infections, which can lead to fatal pneumonia, said Levy.
Meanwhile, family and colleagues paid tribute to Fagnou, praising him for his modest temperament and extraordinary abilities as a teacher and researcher. "He was one of the stars of his generation," Fogg said.
As such, Fagnou had an unusually large group of students in his lab -- 19, of whom 14 were grad students. On Friday, university officials were meeting with the students, to ensure that they won't be abandoned. Grad students, in particular, depend on a close relationship with a professor who guides their work.
Fogg said Fagnou's most high-impact research lay in his invention of "a powerful, very imaginative new way to assemble the carbon frameworks of molecules important in a whole range of contexts."
"What he was doing was changing how chemists think about carbon-carbon bonds," she said.
"That is the carbon skeleton of most of the molecules that you think about," she said -- anything from drugs to "fine" chemicals used in products like perfumes and other substances made in small amounts.
Work he published two years ago in the prominent research journal Science "was an astonishing advance," and has been cited by hundreds of later researchers, she said.
"Keith's work overturned prior ideas of what is possible," she said, and "this work received tremendous attention from both academic and industrial groups."
"He was also interested in understanding how and why this chemistry occurs: he put forward a completely new idea for the mechanism of this reaction, which has important implications" in broader fields. But while Fagnou won awards for his research, he kept his successes as a scientist to himself, said father-in-law Bob Gervais. "We never heard about the awards. And we're family," he said. "He stays under the radar, but he accomplishes things."
Fourth-year biology student Liane Leclair had Fagnou in first year, and described the professor as a "great prof" whose notes were among the best in the department.
"I was devastated," she said. "I found out Wednesday and I was really sad. He was just an amazing prof, and he seemed like the future of organic chemistry."
Leclair added that the death was especially troubling because Fagnou displayed no signs of being sick.
"There was absolutely nothing wrong with him, and he still passed away," she said. "It's really scary."
Chemistry professor Andr? Beauchemin works in the office two doors down from Fagnou, and said it was startling to see his colleague fine one day and gone the next.
"There's some structures on this board that were drawn by him either Thursday or Friday," he said, gesturing at the blackboard in his office.
"There is a lot of disbelief in the department. He was a great colleague, great friend."
Fagnou is survived by his wife, Danielle Gervais-Fagnou, a family doctor with the University of Ottawa's health services clinic. The couple have three children, Zachary, Clara and Samuel.
The family is to receive friends at McEvoy-Shields Funeral Home on Hunt Club Road on Sunday at noon, followed by a memorial service in the chapel at 2 pm.
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