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Tuesday, April 28, 2009

Proper Ways to Handle Swine Flu

“Panic is quite rare. What's quite common is denial; denial is why panic is rare. We are organized such that, when we're about to panic, we trip a circuit breaker instead and go into denial.” - Peter Sandman, Risk Communication Specialist

My column yesterday could be viewed as a form of denial. I suggested ignoring the media-hype and twitter panic on swine flu and calming preparing for a possible pandemic that was unlikely to happen. Since then I’ve done more reading from the opposing view point of “don’t risk your life, respond now.”

The NYT Health section this week includes a well-written article on Assessing the Danger of New Flu. It discusses the complications in judging how dangerous flu might be and then looks at Hong Kong as a model for proper government response.

Contagion and virulence
Two measurements describe flu or any disease. Contagion = how easily does the disease spread from person to person? Virulence = how deadly is it? (i.e. what percentage of people die from catching the disease?)
- The Spanish influenza of 1918 had a mortality rate of ONLY 2.5% but was very contagious and killed tens of millions.
- Bird Flu (global/current) kills 61% of those afflicted but so far infects mostly birds, rarely people. The total number of fatalities is 257.
- SARS (Hong Kong 2003) was virulent (17%) and spreadable. But it killed only 299.
It is not easy to figure out which flu bugs will be pandemics and which ones won’t before it is too late.

Lessons Learned
Hong Kong (HK) learned much from SARS about how to respond to an epidemic:
- By weeks end, HK will have six laboratories studying the genetic markers for Swine Flu to allow for rapid detection and diagnosis of new cases
- HK has tens of thousands of doctors and nurses, including retirees, on standby and ready to be mobilized. (The US has a similar program called the Medical Reserve Corps created under President Bush.)
- HK has contingency plans to keep public transport, electricity, food supplies, telecommunications and other vital services running if large numbers of people fall ill.
- Since SARS Hong Kong has added 1,400 respiratory isolation unit beds to hospitals.
- HK with a population of seven million people has stockpiled 20 million treatment courses of Tamiflu. The US with 300 million people has 50 million courses of Tamiflu.
- HK is quickly passing a law to require all health professionals to notify authorities of any suspected cases of Swine Flu. This allows the disease to be accurately tracked.
- HK has broad and detailed legal powers to quarantine possible cases. The US (after six years) is still debating how to handle legal issues during a possible pandemic.

Bottom Line
Several articles today have suggested that a little panic is good for public health. As discussed above it is very hard to know which flu bugs will fade quickly and which ones will be deadly killers. By the time authorities do know, the bug may have already spread widely making quarantines useless. The safest course for individuals and the public is to follow the example set in Mexico at the first hint of a new flu virus. Order the public to stay home and close the schools, non-essential business and all public events. If you must go out, wear a facemask.

Staying home and sitting out the flu will save lives but at terrible economic cost in lost business, lost jobs, etc. While you and I may value our life over money, not so for governments which feed on tax revenues. Since governments exist to prevent panic and to promote business, they will placate, lie, under report illnesses & deaths, over promote actions & cures, etc, to keep the peace. So Mexico deserves credit for putting the people first by declaring a National Emergency and quarantine.

Updates
WHO Raises Swine Flu Alert Level but stopped short of declaring a global emergency.
The suspected number of deaths rose to 149 in Mexico, the epicenter of the outbreak with nearly 2,000 people believed to be infected. The number of U.S. cases rose to 48, the result of further testing at a New York City school, although none was fatal.


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