Tuesday, April 28, 2009

Various Thoughts on The Flu

The "Swine Flu" situation is so rapidly moving that to provide commentary on the technical aspects of the disease (such as: is this year's vaccine protective against it? why do the cases in the US appear to be not as severe? when should i take Tamiflu? etc.) would be possibly outdated within hours of this post. Moreover, I assume that the limited readership of this blog is familiar with the excellent sources of information whose job it is to keep the public informed, among them the CDC and WHO websites, and in particular the NY Times site has a great page devoted to the outbreak. Thus, what follows is a scattering of thoughts about the portrayal of the outbreak, and my own reaction to what's happening.

a. I first heard about the outbreak Friday morning April 24 at my division's weekly infectious diseases conference. At the end of the meeting one of the senior clinicians informed us that there was a flu outbreak in Mexico City with an apparent new strain, and that up to 60 people were believed dead. That got me to sit up straight. True, Mexico City is (I believe) the most populous city in the world, with a population somewhere in the vicinity of 30 million people, so normally 60 deaths of any cause save Ebola in a city of that size would not seem to be such a big deal. Yet 60 deaths from flu in a short span of time anywhere is at least concerning.

Following the conference I went to my computer and sought info from The Paper Of Record, and was surprised--indeed, stunned--to see a quote from Dr. Anne Schuchat, the head of the respiratory disease division of the CDC, in the first NYT article on the outbreak. "We don't yet know the extent of the problem," she said, "but we don't think this is a time for major concern." [my emphasis] Now it is possible that Schuchat was misquoted, or quoted out of context; I certainly hope so, because this statement seemed to me wildly at odds with my gut impression of the early information coming out of Mexico: hey, this is scary! I am not the world's foremost authority on flu, but I am an infectious diseases doc, and I couldn't fathom how an outbreak of apparently lethal influenza wasn't a cause for "major concern" in a country that borders the outbreak. Within less than 24 hours, the CDC had a much different take on the events in Mexico, and within 48 hours had declared a public health emergency. Which, make no mistake, this is, even if the total number of US cases doesn't rise above 100 and nobody dies. You don't mess with the flu. (Doc Schuchat, it may be time to spruce up that résumé!)

b. There is a fine line between engendering appropriate concern and contributing to hysteria, and while the statements that I have heard from US public health officials have (except for Dr. Schuchat's initial whopper) seemed on the mark, the media sometimes--okay, often--do such a poor job of putting things into context that, when coupled with a largely scientifically illiterate public, you can't help but induce a panic. For the interested reader with 13 bucks I highly recommend Marc Siegel's book "False Alarm," which delves deeply into the mainstream media's dependence on fear-mongering as a means to keep huge segments of the public titillated, distracted, frightened and whatnot.

So far, though, the coverage has seemed reasonably good. I grant that my sources are skewed as I prefer the Times and NPR to Newsweek and "Good Morning America," but the stories have generally put the facts out, supplied the let's-not-go-overboard-but-still-let's-stay-alert quote from public health officials, and then discussed the situation either in Mexico or on the home front with requisite fretting about how this will affect the economy. There's a little obsessing as NPR, for instance, took 10 full minutes this morning to lead with the story, which may have been a bit much, but make no mistake, this is the Number One news story of the week. People do need to know it's out there and that, under worst-case scenario, they may need to be prepared to take the steps that are already well underway in Mexico (see below). Panic isn't useful; concern, however, is, and we should all be concerned about this bug right now.

c. I don't claim to know anything about the machinations of the Mexican government but thus far it appears that their public health officials know what they are doing, and President Calderón has been admirable in his swift response to the events. Given that, it hardly needs pointing out about our own government's failings during Hurricane Katrina. Mexico is experiencing the biological version of Hurricane Katrina right now, and as of now the ferocity and competence of their response has, alas, put our own national emergency response to shame (at least based on recent history, not the current situation, where it's still too early to tell).

d. To expect politicians to be political without being partisan may be expecting too much, but I saw at least one instance this week where a pol was being goofily partisan, and I saw another situation where the pols should have been vociferously partisan but appear to have left the battlefield. In the former instance, one of the Dems (I think Homeland Security Sec'y Janet Napolitano, but please don't quote me) said that the Republican holdup of HHS Sec'y nominee Kathleen Sibelius was putting the country at risk given the situation with the flu. That's just pure overstatement, especially as Napolitano herself appears to have assumed the lead role in terms of crafting a federal government response. I'm not saying that I want the Sibelius nomination held up, only that you don't want to use a real crisis for a political cheap-shot.

On the other hand, President Obama himself should have called a press conference saying that Texas Governor Rick Perry could help himself to all the Tamiflu he wants--per his request that portions of the federal Tamiflu stockpile be dispensed to Texas--if and only if he would stop braying like an ass about seceding from the Union. You wanna secede, Rick? Well, here's your first act as guv of the New Republic Of Texas: find some Tamiflu! Wishing you luck on that front.

e. One other point on the media coverage is that the media has appeared to need to give a moniker to this bug, and thus it is the "Swine Flu" outbreak. And while there is a ring of honesty in the name, it's a touch misleading. Flu biology is quite complicated but one critical point is that the virus's natural habitat is mostly humans, water fowl, and pigs--so nearly all influenza viruses are to greater or lesser degrees "swine flu." The type of virus causing all the fuss is known as H1N1, which is a strain that is "native" to humans; one of the components of the flu vaccine is an H1N1 strain. (Without going too much into detail, there are multiple types of "H" proteins, which combine with multiple types of "N" proteins, and consequently make up dozens of types of influenza, each with strain variants. The vaccine for flu is actually a combination of two of these types, the H1N1 and H3N2 types, and includes a third component of a related virus, Influenza B.)

Those are my thoughts for the moment. I would love to hear anyone else's take in the comments.

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