A few weeks back, I had an interesting conversation with David diSalvo, who’s interested in health, the environment, and how we think. He’s written it up and posted it at his thought-provoking blog, Neuronarrative.
Philip Alcabes discusses myths of health, disease and risk.
Disease Cycles: The Rebirth of Flu
Flu has taken on the resonance of other big diseases in the culture – autism, AIDS, breast cancer, and the like. We don’t have a ribbon yet, or run/walk fundraisers, but what was once an everyday affliction has become an epidemic of interest.
Based on the evidence of the last few weeks, officials are going to be expected to generate substantial plans to curtail a pandemic whenever something out of the ordinary happens with flu – whenever they say that an outbreak can “no longer be contained.” And they’ll be applauded – as Margaret Chan is in a paean in yesterday’s NY Times – for (as Chan herself puts it) “managing a high pressure crisis … with a sense of urgency.” Pharmaceutical companies will be urged (and paid, of course) to produce extra-large lots of vaccine and antivirals.
In other words, flu will have followed the pattern set by many other illnesses, both real and imagined. We live with them for a time; we figure them as being among the countless travails of normal life; they’re unremarkable, even if lamentable. At some point, they seem to resonate with specific anxieties, and we become more attuned to their occurrence. They become epidemic threats (or, with flu, a “pandemic threat”).
Tuberculosis had a trajectory like this – an unremarkable cause of suffering and death for centuries, until it came to be associated with ethereal spirituality. Later on, TB took on a new resonance because of its association with poverty, which by the 20th century had started to carry an ideological flavor (or several flavors).
Syphilis had many meanings heaped on it, but it only came to be seen as a public health problem when the Progressive movement shaped it into a rationale for combining moralism with medicine, ca. 1900. And syphilis became a social crisis after the Progressives’ approach called for epidemiologists to make sense of it (statistical findings always help craft the narrative of rising threat), and the new data helped to further the narrative of social failing and personal misbehavior.
The flu scene is thick with epidemiologists now, fogged with rumors about what went wrong, and filled with theories about causes. This is exactly what it takes to create an epidemic. Some people think that’s good, because more attention will be paid, and more funding appropriated, and we’ll be better able to “fight” flu. That remains to be seen. In any case, you have to wonder who is going to benefit, and what the price will be.
Palese on H1N1: Not a Global Threat
Peter Palese, an accomplished and highly respected virologist at Mt. Sinai Medical Center, has written a piece for the Wall Street Journal explaining “Why Flu Isn’t So Scary.” The full op-ed article is viewable only by subscription, but a distillation by Vincent Racaniello appeared May 2nd at Virology Blog.
In essence, Palese explains why the current outbreak strain has little chance of posing a global health problem. The virus lacks virulence determinants found in strains known to be highly pathogenic and it is from an ancient (in flu chronology) strain and therefore many people probably have some cross-reactive antibody protection — “I would postulate that by virtue of this ‘herd immunity’ even a 1918-like H1N1 virus could never have the horrific effect it had in the past,” Palese writes. He also sees promise in immunization, which would further damp the threat. And see “H5N1″ for a May 6th post about widescale production of H1N1 vaccine.
Palese’s argument is not only reassuring; it reminds us that preparation serves us and “pandemic preparedness” is beside the point.
Pandemic Fantasies and the News Cycle
As of today (2 May), it seems that the Mexican outbreak of flu was neither as extensive or as deadly as early reports claimed. The overstating of the situation is testament to our anxiety about epidemics in general and our particular hypersensitivity to any sign that remotely suggests a flu disaster.
Perhaps it shouldn’t be surprising that we, and especially our health agencies, overreacted to the early news from Mexico. As Gardiner Harris points out in today’s NYT, the furor seems to have started in mid April when a CDC operative saw a connection between two reports: One was of two cases of flu in San Diego that represented infection with a virus that contained genetic sequences from flu viruses previously seen only in swine. The other was of an unusual burst of pneumonia cases in Mexico. It turned out that the latter came from scans of media reports, which detected news articles reporting on a cluster of severe respiratory illness among adults in La Gloria, Mexico, where pork processing is an important industry.
On 24 April, in its first article to make the link between a flu outbreak in Mexico and isolated cases in the U.S., the NYT led with two facts that would turn out to shape the narrative: the new flu virus contained genetic sequences from pig, bird, and human viruses, and many of the flu deaths in Mexico were young adults (later it would turn out that many of those Mexican deaths were not actually caused by this flu virus – but of course pausing for all the facts would have interfered with the creation of the desired pandemic story). By featuring these two facts, the news story pointed to the 1918 outbreak – the Times article allowed an infectious-disease doc to make the case explicitly, but for readers who know about the 1918 flu the connection would seem obvious.
From there, the horses were out of the gate. Health agencies, media, and lots of intelligent people began to imagine a coming pandemic. Who can blame them? Having been prepped by the W.H.O. pandemic preparedness campaign and the U.S. one over the past few years, they were primed to seize on any little piece of news and turn it into the fantasized reprise of 1918.
W.H.O. was probably trying to help when it cranked up its threat barometer from 3 to 4 to 5 (on a 6-point scale). By issuing warnings, the agency could give leverage to health authorities in poor countries who had to plead with their governments for more funding, and it might have helped shake loose some foreign-aid change from the pockets of the rich countries (at least, this is what I hope the W.H.O. was thinking). But all the talk about “possible pandemic” just played into visualizing the horror scenario. Officials haven’t learned that when they say “pandemic” they merely mean “the same flu strain produces human illness in multiple countries,” but when most people hear “pandemic” they hear “tens of millions of people are going to die.”
