Monday, August 3, 2009

H1N1: Sound the Alarm! Or not . . .

(Note:  This is the latest in a series of posts about H1N1.  You might be interested in the previous ones.)

This weekend the New York Times ran a series of four op-ed pieces about Influenza A H1N1 "swine" flu.  They asked four people with expertise in four different areas to comment on what needs to be done to get ready for what the Times calls "Swine Flu, Round 2."  The articles covered schools, airlines, emergency rooms, and vaccine safety. (A big Quarterback shout out to my mother, hereinafter referred to as the "Quarterback Mum," who drew these articles to my attention)

Now, far be it from me to criticize others for sticking their nose into H1N1 preparedness issues.  People who live in glass houses shouldn't throw stones.  But at the same time I would be remiss if I didn't give their Monday morning crisis quarterbacking some MMCQuarterbacking of its own.

I would say the Times commentaries are two for two.  Let's start with the good ones:

Arthur Allen's piece, "Prepare for a Vaccine Controversy," does quite a good job at looking at the other side of the coin that I talked about last week with regards to H1N1 vaccination.  While I looked at the controversy that was likely to occur because people who wanted vaccine couldn't get it, Allen points out that there are likely to be those who the government thinks should get it but don't want to, and those who do get it who then get sick or die, either from the vaccine itself or by coincidence.  He urges the government to get out in front of this and talk about vaccine safety, the importance of vaccination, and how to tell a dangerous vaccine from the random chance that something bad will happen to you whether you get the vaccine or not.  All good points, well stated, and, if his advice is followed, likely not only to get people vaccinated but also to keep their panic level down.

Eric Toner wrote, "E.R.'s May be the First Victims" about the overload on emergency rooms that occurred during the initial outbreak and what could be done about it if there's another big one.  He suggests such steps as educating people better about when to stay home vs. when to go to the ER, setting up flu clinics and adding staff at Emergency Rooms.  Frankly, he sounds a lot like what I had to say on the subject so it's hard to find fault.

Then we come to two articles that made me scratch my head:

The first is entitled "Fly the Germ-Free Skies" by an emergency physician named Marc Gendreau.  Gendreau's basic argument is that airlines should do more to stop the spread of disease on airplanes.  I don't actually disagree with that, but his breathless and alarmist tone is really counterproductive. As one example of many, Dr. Gendreau notes that
on a recent full flight from Boston to Orlando, Fla., I was horrified to see that most of my fellow passengers failed to periodically wash or sanitize their hands.
Really?  Horrified? On what planet does Dr. Gendreau live where people are constantly sanitizing their hands in the course of daily life?  This wasn't in a hospital, it was on a plane.  And there's a big difference between saying, "people should probably wash their hands" and being "horrified" that they don't.

Keep in mind, thus far what is atypical about this virus is that it is new and it infected people in the spring and summer.  Yes, it could come back around in a particularly virulent form during flu season.  But we don't know that it will.  What is causing everyone to worry is some combination of that possibility and the fact that initial reports out of Mexico City suggested that this virus was much more deadly than it appears to be now.  Would Gendreau be "horrified" that people aren't sanitizing their hands on the way to Disney World during a typical flu season?  I have no problem with a general campaign by airlines and airports to get people washing and sanitizing more often, but a little reminder to panic at the same time is not what we need.

Which brings us around to Dr. James C. King, Jr., a pediatrician who wrote "The ABC's of H1N1."  King has a lengthy litany of things he believes schools and health departments should be doing, or preparing to do, during the coming flu season.  He suggests that schools tell people to keep their kids home for 7 days if they are sick.  He proposes schools have hand sanitizer dispensers installed.  He thinks schools and health departments should work together to monitor flu activity and make sure preventative steps are taken.  All of these things are good ideas.  In fact, they are so good that schools started doing them in April at the latest -- some of them have been standard practice in many jurisdictions for years.

While there's no harm in making sure we school folk are doing what we're supposed to do, by putting these out as novel ideas it reinforces the notion among parents and the rest of the public that school don't know what they're doing.  If April and May are any indication, the more measured and scientifically informed the steps that schools take, the more parents seem to believe we are not doing anything.  What is needed is a unified message that schools are taking their lead from public health, period.  King's article implies that cooperating with health departments is at best the exception, not the rule.

The kicker, to me, is that in the middle of his article, King throws out this gem:
In cases of a widespread outbreak — if, for instance, there are confirmed cases of H1N1 flu in half the regions of a state — it may be wise to close schools for a few weeks until most of the children have recovered.
The problem is that this is not the current recommendation from the CDC, which now encourages schools to treat H1N1 the same as it would ordinary seasonal flu.  Can you imagine if schools shut down anytime half the regions in the state have confirmed cases of seasonal flu?  We might as well just plan to close for the winter.  And again, the last thing we need is panicked parents saying, "Why aren't you closed?  The New York Times thinks  you should be."

My bottom line is this.  Recommendations for what to do about flu when it happens should be based on what we know to be true.  Preparations for worst case scenarios can take into account what might be.  And responsible commentary needs to look at what is already being done.  Words, particularly words in the newspaper of record, have power.  I am very much opposed to covering up what needs to be shared with the public.  But we need to anticipate the reactions people will have to what we say.  While "don't panic" is insufficient, "go ahead and panic, we are unprepared" is irresponsible.


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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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