Ignore the swine flu scaremongers and just get on with your life
How does it feel? Somewhere between mild and severe, I guess. I’ve a headache, a sore throat and am feeling a bit listless. Let’s say I’m moderately ill.
Moderate is, however, very far from how you would describe the reaction to a flu strain that continues to dominate the headlines. The Department of Health’s chief medical officer, Dr Tony Holohan, calls it “a national public health emergency”. Are you scared yet? And, if not, why not? If you haven’t been panicked, is it because this “emergency”, this plague, has, so far, killed precisely 10 people in the Republic and fewer still in Northern Ireland? And most of those who do die are already suffering some other health-related condition.
No one has any interest in diminishing the tragic deaths of 10 people but these are the bald facts about swine flu’s impact. Nevertheless, the chief medical officer told us in an article on Monday that he is working on the “assumption” that “the first wave could lead to infection of 25% of the population”. What evidence this assumption is based on, he didn’t say.
Dr Holohan then went on to cover his back with a statement of the bleeding obvious: “While this figure may not turn out to be this high, there will certainly be further increases in hospitalisations and deaths in the coming weeks and months.”
How many deaths? Again, he didn’t say.
The main point of Dr Holohan’s article was to encourage health professionals and people in high-risk groups to get themselves vaccinated which is, I’m sure, eminently sensible. Swine flu is not very nice. Nor is Dr Holohan alone in using alarmist language. For instance, Margaret Chan, the head of the World Health Organisation, after raising the pandemic alert from level four to level five, warned “all of humanity is under threat”.
But over the past six months, the steady drip-drip of anxiety-inducing statements from epidemiologists, accompanied by ‘but-don’t-panic’ caveats, seem intent on doing the very opposite given their frequency. The narrative of swine flu has sounded a consistently ominous tone, with each fatality seemingly providing yet further proof of the catastrophe to come.
We have been here before. Ever since an editorial for the New Scientist in February 2004 warned that a bird flu outbreak in which the virus was transmitted between people could kill 1.5 billion people worldwide, it has become quite normal to confuse worst-case flu scenarios with normal flu outbreaks. In such circumstances, even attempts to reassure the public are undermined by officialdom’s own worst-case mindset.
Best to be prepared, comes the doomsayers’ chorus. No doubt, the H1N1 virus could mutate to become the most virulent strain since the 1918 flu pandemic that killed 20 million people. It could be even worse than the Black Death of 1348 that reduced the population of Europe by a third.
But it probably won’t. The pity is that public health authorities nationally and internationally appear to have become incapable of distinguishing between sensible contingency planning and scaremongering propaganda.
Instead of quietly admitting at the outset that very little was known about swine flu and discreetly getting on with the job of preparing a vaccine and testing drugs, they reached for the megaphone. Better, according to the official mantra of 21st century risk aversion, to prepare for the worst and hope for the best. One suspects that if the disease did not exist the authorities would have to invent it.
Though leading public health authorities cling to the belief that proclaiming nightmare scenarios is useful in raising public awareness of disease; in reality it provokes anxiety out of all proportion to the benefit.
Have we forgotten that malaria kills a million people in the world annually? Closer to home, the average mortality rate from common flu in Ireland is about 50-300 deaths per year in a non-epidemic year and around 1,000-2,000 in an epidemic year. So while swine flu is, in rare cases, fatal, the key point is that so are the other strains of flu which we cope with year in and year out.
We also know that treatment with anti-viral drugs is effective and, where there are complications, that intensive care treatment is far more sophisticated than it was in 1968, during the last global pandemic of flu which killed an estimated one million people worldwide.
The other danger of scaring people is the disruptive of primary healthcare — an upsurge in surgery consultations, mostly by people with minor symptoms but high levels of anxiety. But the most damaging aspect is likely to be the further corrosion of trust in medical authority. And in relation to the swine flu vaccine, which no doubt will result in an unprecedented wave of adverse reactions (enthusiastically anticipated by the lawyer class), the outcome may well be a wider loss of confidence in vaccination, with negative consequences for the various immunisation programmes.
Yes, any novel influenza virus should be a cause for concern, particularly in medical circles. If lots of people were infected, even a low mortality rate could lead to many deaths. But for most people, especially in the developed world, the likelihood of being made seriously ill or dying from swine flu would appear to remain very low. The bigger threat is a widespread overreaction.
The unfolding swine flu fiasco raises an interesting hypothetical question. What if the World Health Organisation, the Department of Health and all the rest had declared an embargo on press conferences and public statements? What if they had encouraged the virologists to concentrate their energies in the laboratories (where their achievements have been impressive) and stay away from the TV studios (where their pronouncements have often been alarmist)?
What if family doctors had been allowed to respond in the familiar way to cases of flu apparently occurring in an unfamiliar season? Given the relative mildness of the vast majority of swine flu cases, it is difficult to believe that this approach would have resulted in any higher morbidity. It would certainly have led to less anxiety, to a much lower number of diagnosed cases and to a vastly lower consumption of anti-viral drugs with unpleasant side-effects. It would also have prevented much distress to patients and much disruption to schools and workplaces, not to mention to doctors’ surgeries.
After the bird flu, ebola and SARS pandemics that weren’t, shouldn’t health officials in future stick to providing scientifically grounded information and avoid the temptation to speculate? People are quite capable of making sensible judgment calls about the risks they face. Indeed, when swine flu was “over there” in Mexico and not over here, it was the potential subject of far greater trepidation. Now it is here, it is the subject of jokes.
Learning from our engagement with uncertainty is part of life. Day by day, year by year, we convert uncertainties into insights about how to cope and what makes us human. Ignore the swine flu scaremongers and get on with your life.
