*sigh* Influenza pandemic not guaranteed? Gee, no kidding...

Skeptics warn bird flu fears are overblown

Doomsday predictions about bird flu seem to be spreading faster than the virus itself. But a small group of skeptics say the bird flu hype is overblown and ultimately harmful to the public's health.

There's no guarantee bird flu will become a pandemic, and if it does there's no guarantee it will kill millions of people. The real trouble, these skeptics say, is that bird flu hysteria is sapping money and attention away from more important health threats.

While I agree with some points the so-called "skeptics" make (we don't know if H5N1 will become pandemic, some people's concern about "bird flu" is disproportionate to the threat, etc.), what I don't agree with are their strawman characterizations of the public health response, discussed below.

First, a note on the skeptics interviewed for the article. One is Mark Siegel, who has two books to sell you: one on "bird flu" that I've not read, but have my doubts based on his interviews about it. The second is on the epidemic of fear perpetuated by the government. (Revere has a piece on him here).

The other is Wendy Orent, an author and anthropologist. (Revere's discussed her a time or two--the combination of them both in an article must be making his head spin). Her schtick seems to be that public health officials keep "exaggerating" the potential effects of a pandemic, even though, as Revere has detailed, her grasp of the science behind an influenza pandemic is a bit sketchy. Her contribution to the article:

"Ridiculous," scoffed Wendy Orent, an anthropologist and author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease."

She said public health officials have vastly exaggerated the potential danger of bird flu.

(An aside: This was in response to Robert Webster's comment that half the population could die from an influenza pandemic, which I've not seen Webster clarify.)

Anyhoo, onto Siegel's contribution:

He said he'd like to see more efforts at general pandemic preparation -- such as developing better methods for making vaccines -- rather than a laser-like focus on H5N1.

It takes a "skeptic" to say this? This is exactly what most of us have been emphasizing all along--general preparedness. Better surveillance for emerging diseases, no matter what they are. Money for response. Money for better vaccination development techniques. All-hazards approach, yada yada yada. Emphasis on H5N1 is obviously in the headlines because we're watching the virus spread in real-time, but I've not heard anyone suggest that H5N1 is our only concern. That's a strawman.

The problem with getting the message out about low-probability, high-impact events is, as I mentioned previously, is two-footed driving: raise awareness without scaring. A quote in the article by consultant Peter Sandman emphasizes that:

"It's unfair and dishonest to make it sound like we're sure H5N1 is coming soon and it's going to kill half the population," Sandman said. "It's equally irresponsible to say, because only a hundred people have died, it's not a biggie. It's potentially very scary, but potentially is only potentially."

This is just about exactly what Health and Human Service Secretary Mike Leavitt said recently:

Leavitt said pandemic diseases are difficult to discuss because anything said prior to an outbreak can be considered "alarmist" and anything said after "seems inadequate," so his job is to find a balance between the two.

See, here's the thing about preparedness and information. The general public, largely, isn't stupid. Even when faced with terrible events, panic is fairly rare. People frequently pull together and do what needs to be done. And I'm not just pulling this out of my ass here--as someone who's had a longstanding interest in bioterrorism, I've studied these issues. One paper of interest is this one:

Bioterrorism policy discussions and response planning efforts have tended to discount the capacity of the public to participate in the response to an act of bioterrorism, or they have assumed that local populations would impede an effective response. Fears of mass panic and social disorder underlie this bias. Although it is not known how the population will react to an unprecedented act of bioterrorism, experience with natural and technological disasters and disease outbreaks indicates a pattern of generally effective and adaptive collective action. Failure to involve the public as a key partner in the medical and public-health response could hamper effective management of an epidemic and increase the likelihood of social disruption. Ultimately, actions taken by nonprofessional individuals and groups could have the greatest influence on the outcome of a bioterrorism event. Five guidelines for integrating the public into bioterrorism response planning are proposed: (1) treat the public as a capable ally in the response to an epidemic, (2) enlist civic organizations in practical public health activities, (3) anticipate the need for home-based patient care and infection control, (4) invest in public outreach and communication strategies, and (5) ensure that planning reflects the values and priorities of affected populations. (emphasis mine)

Obviously, this is geared toward a response to bioterrorism, but it's also applicable in the event of a pandemic influenza. I think it's wrong to condescend to the public--to treat y'all like delicate little flowers who "can't handle" all the information being given to you, so that you become incapacitated by fear. I can understand people getting burned out on all the influenza updates. For those of you who feel that way, tune out. It's easy enough to do. Don't read the articles. Don't listen to the interviews. We can't make you be informed about influenza, or any other public health issue. But I'm glad there are a lot of laypeople out there who are listening, and getting involved. In my opinion, that shows that there's a lot more to the news coverage than just "fear-mongering." Again, from the article I linked by Glass and Schoch-Spana:

As demonstrated by community reactions to the terrorist attacks in New York and Washington, D.C., the power of the public to respond effectively to disasters should not be underestimated. In New York, individual volunteers and organized groups converged on the epicenter of destruction to offer aid and support, despite hazardous conditions and uncertainty about the risks of further attack or structural collapse of the World Trade Center towers. Volunteers responded rapidly and in large numbers to help in search and rescue efforts while professional operations were yet to be put in place. Since the attacks, affected communities have been organizing through local government, relief groups, and civic organizations, such as churches, neighborhood associations, and labor organizations.

And therein demonstrates the potential of education. The 9/11 attacks were largely out of the blue as far as the public was concerned, but people put themselves in danger and pitched in. An influenza pandemic, should one occur, shouldn't be a surprise attack--but the response can be much the same: government entities and local groups working together to ameliorate suffering as much as possible. IMO, the more information that's put out there prior to such an outbreak in order to allow the public to educate themselves on the matter, the better, no matter how much the "skeptics" scoff at "fear-mongering." Knowledge is power.

[A post-script: I just received this via email, regarding the recent tornadoes here in town:

Unfortunately, it is very early in the storm season and we could possibly see more violent weather come our way. It is imperative that we all educate ourselves and take the necessary precautions to enhance not only our own safety, but also that of others.

Odds are that the town won't get hit by another serious tornado for awhile, but is it "fear-mongering" to suggest that people educate themselves and take precautions? Why is it different, and scientists called "Chicken Littles" when we advise the same about influenza or other public health threats?]