Wednesday, April 29, 2009

Swine Flu and (the E) You

It’s hard to recall a time when there wasn’t some impending doom that was going to kill us all. The ubiquitous stories about the dangers of common household items are enough to send some people into nervous breakdowns. Pandemic disease has always been a common fear but in the past few years it seems that we have stepped up our anticipation to claim that any outbreak of the flu might be “the big one.”

The panic du jour is of course swine influenza. The trouble is, we have been down this road before with SARS, monkey pox and avian flu in the last few years and none of them has come close to the killer pandemic that was predicted. It is impossible to deny that a pandemic won’t happen for the simple fact that there have been three in less than 100 years. According to the World Health Organization, the 1918 outbreak of Spanish influenza somewhere between 20 and 40 million people worldwide. The subsequent 1957 Asian and 1968 Hong Kong influenzas are believed to have killed about an order of magnitude less. So is swine flu going to kill us all? The answer is: probably not.

As of two hours ago, the WHO reported that there have been 148 laboratory confirmed cases of A/H1N1 in Mexico, the US, Canada, the UK, Israel, Spain, Austria, Germany and New Zealand. That’s up from 105 confirmed cases yesterday. Of the 26 cases in Mexico, seven have been fatal and of the 91 cases in the US, only one has resulted in death. Despite reports of hundreds of people sick with swine flu in Mexico City, there have been only 26 laboratory confirmed cases. The hundreds of other cases being reported are unconfirmed by tests calling into question the severity of this entire panic. The fact of the matter is that seasonal influenza kills more people in the US annually that swine flu will probably kill worldwide. The CDC estimates that 36,000 Americans die every year from the flu. That translates to almost 100 per day. Again, currently only seven people have died in Mexico from swine flu despite reports to the contrary while the sole US death was of a 23-month old boy from Mexico City that was transported to Houston for treatment.

So why aren’t people dying in the other countries with confirmed cases? Again despite what has been written in some places, swine flu responds to treatment. Like it or not, Mexico is essentially a third world country where medical care leaves a lot to be desired. It is rather unsurprising that there would be deaths from this flu considering that potable drinking water is hard to find in large parts of the country. As far the lone US casualty, the Mexico City native was reportedly sick for several weeks in which time he had been transported from city-to-city in Mexico and south Texas before ultimately reaching Texas Children’s Hospital in Houston. Vigilance and common sense are obviously important in cases of communicable diseases, but the facts of these cases are not yet cause for undue panic.

Here in the Netherlands swine flu mostly appears to be a non-story. We received an email from the US consulate in Amsterdam yesterday assuring us that there have been no confirmed cases in the country and that antivirus medications are available if the need arises. We don’t have much access to English language television so I really can’t say if this story is being covered on a moment-to-moment basis on Dutch news, as I’m sure it is in the States, but it is a big story on the BBC and CNN International. That all being said, on Monday the health commissioner for the European Union recommended that citizens postpone non-essential travel to the US and Mexico which is not necessarily an overreaction to the situation but I’m sure it doesn’t help to mitigate fears in North America.

Elsewhere in the European Union, France has asked the EU to officially suspend travel to Mexico although they apparently have no authority do so. An Air France flight crew has reportedly refused to board flights bound for Mexico since Saturday. Tomorrow the EU will be holding a meeting of health ministers in Luxembourg to coordinate the continent's response to the outbreak.

The simple fact is that pandemics have happened before and will happen again. Most people had never heard of swine flu before last week, but there’s nothing new under the sun as is evidenced by these swine flu public service announcements from 1976:

The 1976 outbreak of swine flu in the US resulted in one fatality. That was not the end of the world and neither is this.

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