Swine Flu: Get a Grip

I'm not sick with swine flu. I'm sick of swine flu.

We've had a week of dire warnings and declarations of health emergencies and school closings and surgical masks and, in some cases, borderline hysteria.

It's time to get a grip.

From the New York Times:

On Saturday the W.H.O reported that there were 658 confirmed cases of the illness, officially known as Influenza A(H1N1) , in 16 countries. [Dr. Michael J. Ryan, the director of the World Health Organization global alert and response team,] said that the health organization was sending 2.4 million doses of antiviral drugs to 72 countries, including many poor countries that do not have supplies of their own.

In the United States, the Centers for Disease Control and Prevention reported Saturday that there were 160 cases confirmed by laboratory tests in 21 states. (The agency posts the case count once a day; states sometimes report new cases later the same day, but they are not added to the official total until the next day.) Thirteen people have been hospitalized.

“It’s important to remember that with seasonal flu, we get 200,000 hospitalizations each year, mostly the very old or very young or those with other problems that put them at high risk,” Dr. Anne Schuchat, head of respiratory disease at the disease centers, said at a news conference.

In the U.S., there have been thirteen swine flu hospitalizations compared with 200,000 hospitalizations with seasonal flu.

Of course, it's early in this outbreak and the situation is still unfolding. But at this stage, panic is an inappropriate response.

...As of Saturday morning, Mexico had confirmed 473 cases of H1N1, out of the 1,303 suspected cases that had been tested, indicating that the outbreak may be much smaller than it initially seemed. The death toll was raised Saturday night to 19.

Mexico had 159 deaths thought to be caused by swine flu. But many had other causes: 66 have now been attributed to other illnesses. Other cases have yet to be tested.

Dr. [Anne] Schuchat of the C.D.C. took a cautious view of the optimistic reports from Mexico.

“I’m encouraged by what I’ve heard out of Mexico, but it’s important that we remain vigilant,” she said.

Yes, it's important to monitor this virus closely.

However, it doesn't seem that this will be the global catastrophe that officials, and subsequently the public, were fearing.

The swine flu may still be declared a pandemic, but a pandemic is not necessarily disastrous.

“At the present time, I would still propose that a pandemic is imminent because we are seeing transmission to other countries,” Dr. Michael J. Ryan, the director of the World Health Organization global alert and response team, said in a teleconference from Geneva. “We have to expect that Phase 6 will be reached. We have to hope that it is not.”

Phase 6, the highest level in the organization’s alert system, is a pandemic. But Dr. Ryan emphasized that the term describes the geographic spread of a disease, not its severity. There can be a pandemic of a mild disease. The current level, Phase 5, means that the disease is spreading in communities — not just within households or in returning travelers — in two countries in one of the World Health Organization’s six regions, in this case the United States and Mexico.

Phase 5 also means a pandemic is imminent. To move up to Phase 6, community spread would have to occur in at least one other country in another region.

Phase 5, Phase 6, whatever.

What matters is that by far most people with the disease experience relatively mild flu symptoms and recover.

The media should stop referring to swine flu as the "deadly virus." They don't refer to the seasonal flu in that manner.

The fearmongering and hype is irresponsible.

Swine flu appears to be no more deadly than seasonal flu.

It might be time to act like it.
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Parents should make plans in case swine flu closes more schools

Authorities plan to announce Sunday whether more Milwaukee Public Schools campuses will close because of concern about the spread of swine flu. Officials are recommending that parents start making arrangements now in case their children cannot attend school Monday.

...Geof Swain, the city's medical director and chief medical officer, said data indicates people generally show symptoms around four days after they are exposed. He said people remain infectious for seven days after they first show symptoms, or one day after they stop - whichever is longer.

Swain said the city was taking the extraordinary step of closing schools because so little is known about this new virus.

The city does not close schools for seasonal flu, which kills between 30,000 and 40,000 people in the United States every year.

"As we learn more about this virus, we will re-evaluate and respond accordingly," he said. But for now, they are being cautious and prudent in the face of a disease they know little about.

"There is no vaccine for it," added Baker. "Therefore, we have to use other methods to mitigate this."

Health officials said seasonal influenza is also still floating around. That may explain why so many tests are coming up negative for swine flu.

The state Department of Health Services tallied 25 probable swine flu cases in Wisconsin on Saturday, including five in Milwaukee. The new information from the city brings the state total to more than 50.

It's not terribly unusual for there to be strains of seasonal flu in the community that aren't covered by the yearly vaccine.

That happened last year.

It also happened about ten years ago when the Sydney flu showed up. People who were vaccinated were not protected from the predominant strain of flu that was circulating.

At present there isn't a vaccine for swine flu. Time to create one.
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In terms of a public health emergency and finding some perspective on widespread illness, let's recall what happened in 1993 in Milwaukee.

The United States has a reputation for high standards in its water systems; it wasn't until a parasite slipped through the cracks in Milwaukee and killed more than 100 people that water systems managers started to take a closer look at how they monitored their product.

...And the Centers for Disease Control and Prevention find that as many as half the water utilities in the country sometimes fail to remove the same microbe that caused half the people in Milwaukee to get sick three years ago.

That parasite, cryptosporidium, made 400,000 people sick and killed more than 100. Since then, expensive overhauls have begun at the aging water treatment plants of Milwaukee.

...The CDC estimates that each year, infectious drinking water sickens a million Americans and kills a thousand. But most cases are isolated.

In Milwaukee, it took a massive outbreak and public outrage to bring about overdue improvements and safeguards.

400,000 people in Milwaukee became sick and there were more than 100 deaths in 1993 because of cryptosporidium.

Here's an eye-opener: "Cost of Illness in the 1993 Waterborne Cryptosporidium Outbreak, Milwaukee, Wisconsin."