Swine Flu Snafu: Ernst & Young Episode Reveals Pandemic Panic

Lessons of SARS, Mad Cow show public panic around disease is unpredictable.

April 27, 2009, 4:32 PM

April 28, 2009— -- As the swirling national media coverage of swine flu nears the end of its first full week, signs are emerging that a certain degree of panic may be gripping the public.

While the official case tally in the United States hovers at 64, according to data presented by the U.S. Centers for Disease Control and Prevention today, even suspected cases are edging their way into the public eye. A spokesperson for the accounting firm Ernst & Young announced that a female employee in their Manhattan office was confirmed to have swine flu. A few hours later, the announcement was rescinded.

"Based on new information, we can no longer confirm that an Ernst & Young employee who works in the Five Times Square building has a verified case of swine flu," spokesman Charles Perkins said. "Out of an abundance of caution, we have taken appropriate steps to protect the health of our employees."

But when does an "abundance of caution" become an overabundance?

Primary care physicians across the country report that they are receiving a deluge of calls from patients worried that they, too, have swine flu.

"I saw one patient this morning who asked whether he could have the swine flu, but really has a viral gastroenteritis," Curt Hawkinson, a Salem, Ore.-based physician assistant told ABC News on Monday. "That patient didn't have a fever, cough, sore throat, et cetera, and he hadn't traveled recently."

Hawkinson said that another patient that same day came to him "absolutely convinced" that he had the swine flu.

"We'll test him and see if he does, but my index of suspicion is pretty low," Hawkinson said. "That's one of the issues with this--it can look just every other respiratory illness.

In Texas, a state where swine flu's presence has already been confirmed, the fear of swine flu is perhaps even more pronounced.

Dr. Ari Brown, an Austin, Tex.-based pediatrician and author of Baby 411, said that his office has received "tons of phone calls" from worried parents who are "wondering what to look for, wanting their child tested -- patients who don't even have flu like symptoms."

"One parent asked for Tamiflu for all his family," Brown added. "I'm sure that won't be the last person that asks."

Meanwhile, pharmacists report that demand for the anti-flu drugs Tamiflu and Relenza has skyrocketed.

"We purchased a large quantity of Tamiflu and Relenza over the weekend in anticipation of a run on both drugs," said Des Moines, Iowa-based pharmacist John Forbes. "I am seeing the major drug wholesalers are running out of product... I did receive an email from McKesson Drug Company and they are now limiting quantities that pharmacies can purchase."

Other pharmacists report that facial masks, too, are flying from the shelves.

Panic Over Swine Flu Pandemic Threat

Psychological experts have long known that public hysteria is a natural reaction to news that is surprising, frightening and unpredictable -- like swine flu.

As the news coverage ratchets up, so does a sense of fear about how big and how dangerous this new swine flu virus will be.

While the Centers for Disease Control and Prevention, have declared the new resistant strain a "public health emergency," comparing it to the 1918 flu pandemic that killed 50 million worldwide, some are warning that although panic is natural, it's not necessarily healthy.

"In general, people are risk averse, they want to protect themselves," said Dr. Robert Klitzman, a Columbia University Medical Center psychiatrist who has researched the AIDS and mad cow epidemics.

"You don't want to overreact or underreact, and knowing what to do is extremely hard," he told ABCNews.com. "We tend to go one way or the other. We want to avoid either one."

Today, travelers have been cancelling airline tickets, while others have been sporting face masks at airports like JFK in New York.

Nielsen Online has just released new data that shows the Internet has been buzzing furiously about risks, symptoms and other updates for information. Even people who never leave their homes are worried about swine flu.

Right now, according to Klitzman, "there's a lot of hype and fear." Next week, when the CDC gets a grasp of its spread, "things go back to normal and people relax."

Public panic is a primal reaction, according to Klitzman.

"It's an evolutionary need to respond quickly as group to a real threat," he said. "When someone says there's a hurricane or a flood coming, you need to act quickly and do something, or you are in trouble. It's in our genes."

"But sometimes, it's switched on when it's not needed," he said. "We think, better to be safe than sorry. Better to run for cover when it's not going to rain than to be laissez-faire and be flooded."

Fear can also be useful in mobilizing resources -- emotional and otherwise. The CDC noted it issued its alert to free up funding for swift detection and response.

Swine Flu Cases Growing

So far, the World Health Organization suspects more than 1,600 cases and 16 deaths, as 900 remain hospitalized. In the U.S., no deaths have been reported, but the number of confirmed cases is incrementally growing to about 40, most of them mild.

Not to diminish the danger of flu -- typically it kills about 36,000 American deaths each year, according to CDC statistics -- but the 1918 pandemic struck before the advent of antibiotics, anti-virus drugs and sophisticated breathing machines.

"Million died, but we live in a different world now," said Klitzman. "We have thermometers now."

And some would say -- credit to Franklin D. Roosevelt -- "We have nothing to fear, but fear itself."

But even though fear is an "important motivator," until danger plays out, even public health experts can be confused about how the disease will take its course.

History shows that Americans have often overreacted to public safety threats -- from buying fall-out shelters in the 1950s to protect against nuclear Armageddon to preparing for "Y2K" at the turn of the 21st century.

In the year 2000, many predicted planes would fall from the sky, cash machines wouldn't work and medical equipment will break down. But at the stroke of midnight, no computer systems crashed.

In the jittery aftermath of the Sept. 11, 2001 terrorist attacks, Americans panicked over a series of anthrax-laced letters, haplessly sterilizing mail in their microwaves.

And when the Bush administration decided to go to war in Iraq and urged Americans to buy duct tape and sheets of plastic to protect against a retaliatory chemical attack, home improvement stores ran out of supplies in the rush.

Some medical threats caused many Americans to fear their own backyards: tick-born Lyme disease was the nadir of the 1980s and mosquito-carried West Nile disease was a scare of the 1990s.

Diseases are also unpredictable and even the experts are often wrong.

In 2003, Severe Acute Respiratory Syndrome (SARS) spread to 29 countries and caused nearly 800 deaths and many predicted a pandemic. That global scourge and the bird flu epidemic never materialized.

On the other hand, so-called mad cow (Creutzfeldt-Jakob) disease was under-played. With a long incubation period and spread through infected beef, the disease killed 165 people in Britain and six elsewhere before the public saw it as a real public health threat.

Mad Cow Underestimated

In a British pub with friends in 1993 while researching his book, Klitzman noticed 11 people at his table ordered the roast beef and Yorkshire pudding.

"I asked, 'Aren't you afraid?'" he asked. "They told me, 'No, the government says it's fine.' It had only killed a million cattle and house pets had died. But there was no sense that anyone wanted to talk about. I ordered chicken and they laughed at me."

"People don't want to worry about it until there is a law," he said. "We don't worry about seat belts until the cop pulls us over and gives us a ticket."

And public fear can fade as quickly as it swells. At the height of the HIV/AIDS epidemic of the 1980s, some refused to touch patients and shunned them like those with leprosy.

The late conservative columnist William F. Buckley once suggested that those who are HIV positive be tattooed.

But today, a recent Kaiser Family Foundation study found that Americans are least concerned about that disease than at any time in the last decade, even as the number of new cases rises.

As folklore suggests, public health can be as threatened by malaise as by panic when experts "cry wolf" too many times.

"When you see the wolf coming in to town, you want to have an instantaneous reaction," said Klitzman. "It used to be when the wolf came, you saw a wolf. Now you don't know how to react."

As for calculating an individual risk, he suggests dying of swine flu is an unlikely event. He advises periodic hand washing, getting enough sleep and drinking lots of fluids.

If flu symptoms emerge, "catch it early," he said, and get a prescription for Tamiflu.

"You have to put your risks in perspective," said Klitzman. "The family in Queens whose kids are sick, I hope they are being very careful. But at the moment, to say you shouldn't take an airplane because there might be someone next to you and you'll get sick is an overreaction."

"You are more likely to die today in a car or from smoking," he said. "You have to make decisions intelligently."

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