Public health officials faced a tough choice in May and June, said Robert Field, a professor of health management and policy at the Drexel University School of Public Health. Had they done little and an epidemic occurred, they would have been blamed for doing nothing. If they did a lot and there had been no major outbreak -- or even if their efforts stopped a potential outbreak -- they would have been blamed for wasting money.
"The attitude of public health is better to be safe than sorry, and to some extent, we may be seeing a milder epidemic than we feared because of the vaccine and other measures people are taking," Field said. "It's so easy to be a victim of your own success -- no one ever sees the disease that's being prevented, you just see the one that appeared and then got cured. It's a consequence of any disease that you develop a vaccine for and more broadly, of any disease that you're able to prevent."
It is not clear how H1N1 will act in the coming months. While swine flu cases have hit their peak, public health officials are saying they expect another peak of influenza in winter, around the time when flu season typically peaks.
On the East Coast, the winter cold has just settled in, so it is unclear what effect that will have on swine flu numbers.
"I am concerned that as more H1N1 vaccine arrives, people won't be as motivated to spend the time and energy to get it," said Schaffner. "We'll begin to see the vaccine left in the refrigerator while the virus continues to get people sick. H1N1 seems to persist because so many people are susceptible."
Such a phenomenon is typical for flu season, where vaccination peaks before Thanksgiving, but the majority of cases come in January and February.
"We're now beginning to enter the period of time of the regular seasonal influenza viruses," said Schaffner, explaining that he expects a mix of seasonal flu and H1N1, but is not sure of the proportions.
"I'm a little unsure of the relative proportions."
Schaffner does not believe that current responses will hurt the credibility of public health officials in the future.
"I would not think so," he said. "This has been an illness that has been pretty widespread throughout the country. Almost everyone knows someone who has been affected."
But Alcabes said while he does not know how people will respond to the directives of public health officials in the future, he thinks it is a concern.
"This was mild, and that's no relief to the families of people who died from it," he said."One feels terrible for them, but people do die of flu. People die from flu every year."
Because we do not yet know what will happen as flu season continues, Field noted, it is probably too early for Monday-morning quarterbacking.
"The game isn't over yet, it seems to be waning, but we don't know for sure," he said. "You could say it's not over till it's over."