It was a year ago today we put up our first post about swine flu: “The California swine flu cases.” I think we were the first blog to notice it, and it began this way:
Late yesterday afternoon a Morbidity and Mortality Weekly Report (MMWR) Dispatch appeared on CDC’s website that is unique in my experience. MMWR is usually heavily vetted and edited and nothing gets out of there fast. Indeed, in recent years, nothing at all got out of CDC very fast. And yet here is this Dispatch, with text referring to the same day of issue (April 21), reporting on two young patients with febrile respiratory illnesses, one of whose cases CDC only learned about on April 13, 8 days earlier. April 17 CDC determined that the two children, both from the San Diego, California area, were infected with a swine flu virus of a novel kind. (Effect Measure, April 22, 2009)
It was not at all clear what was happening, but the speed with which these cases were published was a warning flag that it wasn’t business as usual. The next day we were back:
This afternoon CDC held a “media availability” on the evolving swine flu cases. Evolving is an understatement. There are now more recognized cases, although not all cases are “new,” with some cases retrospectively recognized now that more intense investigation is occurring. The total is now seven cases. Two occurred in San Antonio, Texas, two sixteen year old boys in the same school. Three more were found in California (in addition to the initial two cases), including a father – daughter pair. All California cases are in San Diego and neighboring Imperial counties, the location of the initial cases. Those counties are also where there has been the most intense looking. CDC expects more cases to be recognized with the ramped up index of suspicion. They promise to update the situation daily at 3 pm on its website. None of the cases gives a history of contact with pigs, so together with the two “doubles” (the schoolmates and family pair), this strongly suggests active person to person spread. Moreover, the initial two viruses have been completely sequenced and are very similar. Partial information on some of the additional viruses from California are also similar, which reinforces the idea that the virus is in active circulation. How widely we don’t yet know. But this isn’t all the news. (Effect Measure, April 23, 2009)
We went on to present the first details of the “quadruple reassortment.” Then news of the Mexican cases blew things wide open:
Late yesterday we summarized a CDC media briefing about the developing investigation of cases of influenza in California and Texas with a previously unknown flu virus with genetic components from pigs (“swine flu”, humans and birds). At the same time reports were surfacing of an especially virulent respiratory disease outbreak in central and southern Mexico that had resulted in 20 deaths and hospitalizations with acute respiratory failure. 137 cases have been reported, including health care workers. When asked yesterday, CDC said they were in close touch with their Mexican counterparts but at that point had no evidence of a connection.
Whatever is going on in Mexico, however, it seems to be pretty serious. Mexico’s Health Minister has ordered schools closed in Mexico City and recommended people not congregate in public places (Effect Measure, April 24, 2009)
Thus began a wild ride, with multiple posts every day as we tried to make sense out of the volcanic eruption of information, sometimes illuminating, sometimes obscuring, although we didn’t know which was which. A year later it’s easy to forget how confusing and alarming those first few days were, especially if, like most people, you weren’t paying attention initially. If you were, what was appearing before our surprised eyes was pregnant with dire possibilities. It’s also easy to declare in hindsight that those who knew the most about flu overreacted. If you say it that way it is clearer that the alarmed reaction wasn’t because public health authorities didn’t know what they were doing but was because they knew more about flu than everyone else. Pandemic flu is always pregnant with possibilities and the ones that deserve the most attention are the ones that are dire. Would you have it any way?
Some people would, but I wouldn’t want them to be in charge of public health, which is about prevention. Let them join their local volunteer fire department. As far as I’m concerned, public health didn’t overreact. More accurately, we all dodged a bullet.