Swine flu: cruise to nowhere

by revere, cross-posted from Effect Measure

As flu season ramps up in the southern hemisphere, the US, Europe and Asia are keeping an eye on it to see what will happen as swine flu finds new pieces of meat to sate its appetite for human flesh. Sorry about the overheated image. I’ve been reading what’s going on in Australia. Because another lesson the southern hemisphere can teach us is how not to react to a pandemic virus.

Consider the Carnival Cruise Line ship, Pacific Dawn. It docked three days ago in Sydney onroute to the Great Barrier Reef to take on new passengers and let off others. But then, according to news reports (but see this version from the ship’s onboard blog; h/t crof), 2 children came down with swine flu, followed shortly thereafter by additional passengers:

Carnival Corp.’s luxury cruise ship Pacific Dawn was asked not to stop at ports in north Queensland after 38 people caught swine flu while on a South Pacific voyage, Australian health officials said.Passengers and crew tested positive for the H1N1 virus after nine days at sea on the 11-deck vessel. Most patients had a “mild illness” and were diagnosed after the ship docked in Sydney on May 25. Pacific Dawn will now reach Brisbane, Quensland’s capital, tomorrow after three new cases were reported, the state’s health department said yesterday.

“All passengers will be screened before disembarking and any passengers with symptoms will be swabbed and provided with masks and a course of Tamiflu,” Jeanette Young, Queensland’s chief health officer, said in a statement, referring to Roche Holding AG’s anti-flu medicine.

Australia’s health ministry said cases among people on board the ship have been found in Adelaide, Brisbane, Canberra, the Gold Coast, Melbourne and Sydney, contributing to a more than twofold increase in the nation’s swine flu case tally to 147 in 12 hours. Southeastern Victoria state said 43 additional cases were confirmed late yesterday, bringing its total to 96. (Jason Gale, Bloomberg)

 OK, fine. Doesn’t sound too unreasonable, although the cat’s out of the bag for sure. But the rhetoric and actions around a futile government attempt to contain the virus are not so fine and they led to predictable results:

Swine flu victims are being kicked out of their Sydney hotels by nervous proprietors who fear bad publicity might drive other customers away.The Daily Telegraph understands that two hotels are evicting 14 people who were on the swine flu-contaminated cruise ship Pacific Dawn.

It is understood 12 people will be evicted from Meriton Serviced Apartments in Parramatta and two from a Holiday Inn, either in Darling Harbour or Kings Cross, The Daily Telegraph reports.

One of the first confirmed swine flu victims, Nicholas D’Arcy, is staying with his family at the World Tower residential apartments in the CBD [Central Business District]. It is understood the D’Arcy family will be given a reprieve and will not be evicted this morning. (Joe Hildebrand and Holly Byrnes, The Daily Telegraph [Sydney])

 Ouch. If you make flu cases sound like lepers they’ll be treated like lepers. And the result will be further spread of the disease rather than containment. It’s not as if Australia is blazing a trail, here. When this virus was first recognized in California at the end of April there was substantial uncertainty about what to do. But that phase is over. There is now a month’s worth of experience in Mexico, the US, Canada and Europe (of course the UK is also behaving irrationally, so it’s not just Australia). Australia is geographically isolated and may have thought it could escape this. That was a pipe dream. The world is now too tightly connected to think a major developed country could be epidemiologically unlinked from the rest of the world.

The doubling of swine flu cases in 12 hours makes it obvious that the virus is starting to circulate in the community. There is no hope of bottling this up any more (if there ever was). Australia should be bending all its efforts (and its public education) to managing the consequences of a new flu virus. This means being straightforward with the public about three things. The first is that so far the virus is clinically like seasonal flu. It is reasonable to tell people this, not to allay fear but because it is true. It may change, but that’s what we see at the moment. But the second thing to be straightforward about is that seasonal flu is something to respect. It’s a “seasonal flu” teachable moment. Flu of any kind can make you very sick and even kill you. The third thing is that even though the impact on the individual is not so very different than the flu people are used to, the effect on the community could be very different because of the potential speed of spread and the age groups and number of those affected. So people need to get ready for that.

We’ll be watching what happens there for clues about the epidemiology. In our view, CDC did a fairly creditable job in its messaging. Perhaps Australia should have watched what happened here first.