Saturday, October 24, 2009

The Sound and the Fury of the H1N1 Emergency

President Barack Obama declared a national emergency for H1N1 today. Technically speaking, this allows the Health and Human Services Secretary to waive some bureaucratic requirements in an attempt to help states cope with the spread of the virus. This sort of declaration, along with declarations of states of emergency of various kinds, stems from regulations that say that the government can do certain thing if certain people determine that an emergency exists. This is the President saying, "Yep, sure looks like an emergency to me. Go forth."

These declarations always strike me as somewhat odd. They are always reported breathlessly on the news, but in fact, they are not a change in the state of affairs, they are a recognition of what already exists. The President's declaration of a national H1N1 emergency did not change the number of people who have the disease, the number of people who have died, the number of people who will get the disease, or the number of people who will die. It did not even represent the outcome of some set of information that he has and we don't. It literally is him looking at the same statistics we all have access to and deciding, as many of us have, that it looks bad.

Meanwhile, we have some jurisdictions and federal officials throwing around the word "peak" to describe what is happening in flu cases. That feels like just the opposite of an emergency. The peak means it's all downhill from here, at least to most people. Only that isn't what it means. When they talk about the "peak" in this instance, they are referring to previous seasonal flu seasons, when widespread flu activity in most states (right now it's in 46) represented the full force of flu season arriving. If you look at graphs of flu activity from previous years, sometimes the "peak" looks like a peak and sometimes it looks more like a rolling hill -- in other words, the peak can last for a pretty long time.

It's also impossible to know whether the shape of the graph for this year will look like other years, because we haven't had pandemic flu in a while and this one came at an odd time of year. Right now, flu activity is well past what was the peak of the 2007-2008 flu season (which was pretty bad) but not to the point of the peak of the 2002-2003 flu season. Yes, it's bad, but it could get worse. It could get better. We just don't know.

So, is this an emergency? Depends on what you mean. I'd say that if your child has secondary pneumonia right now and is in the hospital, this feels like an emergency. And if no one you know has been sick, or they have but not very sick, then it probably doesn't. For the first person, the emergency declaration is too little too late, and for the second it's likely to make them more nervous than they might need to be. It's easy for those "in the know" to forget that what they mean when they use words that are so emotionally charged is not necessarily what people understand when they hear them. Maybe it's time to reexamine how those words are used, at least in public.


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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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