Flu Fighters Not Content with Calm

Aug. 25, 2009— -- Why are health agencies peddling more and increasingly specific advice on flu preparedness, when the public is feeling pretty chill about it?

The latest Washington Post-ABC News poll shows the American public is not very worried about flu. Most people feel confident that health agencies will be able to handle a flu outbreak. But health officials don't seem content with that sort of tranquility.

Perhaps these officials are more clever and more subtle than we give them credit for. Maybe they know that if they keep escalating the barrage of flu "guidance," if the tabloids run a scary flu headline every few days and the airwaves are alive with tweets on flu, many people will dismiss it all as overblown advertisement about a mild threat -- and therefore stay calm.

But calm isn't what officials are after. "No need to panic" is so '80s.

Now, officials' aim is to fight what they claim is public complacency. We're not fearful enough. And, behind that, their goal is to keep the taps open on the flow of dollars to their own agency or project.

That's why last week you heard the World Health Organization warning government to be ready for what it calls an "explosion" of new flu cases. And why, here in the United States, the Centers for Disease Control and Prevention gave recommendations to businesses about planning for employee absenteeism.

It's why it isn't enough for the CDC to offer straightforward contagion-control advice, like telling people with influenza-like illnesses to stay away from others for at least 24 hours after fever subsides. They also offer guidance to schools and colleges, including last week's suggestions about using shirt sleeves to cover sneezes and wearing masks to kiss -- reaching, it seems, new heights of irrelevancy. But these efforts are important to the organizations' crusade to keep the fear alive.

Each health agency feels it must make an announcement about flu at least twice a week. Does that mean something new has happened with flu? Not so far: H1N1 flu has been consistently mild since the outbreak began, in April.

'Preparation' Gone Wild?

It's true that the number of H1N1 flu deaths keeps increasing -- to about 2,400 now, according to the European Center for Disease Prevention and Control (an outlier among agencies, by the way, content to handle data and avoid hype).

It's sad when people die. But, as the CDC, WHO and the other public health agencies well know, people die from infectious diseases every day. In fact, the worldwide toll of confirmed deaths from H1N1 flu these past four months is roughly equal to the number of kids who die of malaria every single day or the number of children who die of diarrheal diseases in any 10-hour period, and it's less than the number of Americans who typically die of influenza and its complications in any given week each January.

That's no comfort to the bereaved families of H1N1 flu victims, but it should give some perspective -- perspective that's easily lost amid the epidemic hoopla on swine flu.

Sound public health preparation makes as much sense as ever and will work (as the American public seems to sense) for controlling flu. But pandemic preparedness -- those high-voltage, low-content announcements about flu explosions and the superfluous advice on safe kissing and the like -- is basically a jobs program for public health workers. It isn't real public policy.

While some preparedness funding goes for standard health programs of the sort that inspire the public's confidence in our health agencies, other money goes into allowing officials to posture, to keep reassuring the public that they're not asleep at the switch -- even when the public isn't asking. Preparedness is what officials do in order to make sure the funds don't wander away and that nobody claims they're being soft on flu. That's why you're hearing about flu buddy schemes, and why you hear a different story about school closings every few weeks.

Nobody knows what part H1N1 flu will play in the seasonal flu scene to come. But in the end, the difference between a mild flu outbreak and one in which a lot of people die is going to rest on two things. One is the virus, and it's impossible to predict right now what strains, with what virulence, will be circulating. The other is garden-variety disease control. Public health measures to deal with flu already exist, and require no crystal-ball gazing to make ready.

Facing Realities About Flu

We're going to have flu this winter, no matter what. Thousands will die. That's what happens every year. That it's only thousands, and not hundreds of thousands, is a triumph of public health planning (That it's still thousands, after a century of flu outbreaks, is evidence of a failure of public health imagination, not a failure of preparedness. But that's a story for another day).

The difference between a serious outbreak, with more deaths, and a mild one, with fewer, is certainly not going to depend on flu buddy schemes.

Philip Alcabes, PhD, is associate professor of Urban Public Health at Hunter College and the Graduate Schools, the City University of N.Y. He is the author of "Dread: How Fear and Fantasy Have Fueled Epidemics From the Black Death to Avian Flu (PublicAffairs 2009).