In his weekly radio/YouTube address President Obama struck much the right note on swine flu:
This H1N1 flu has had its biggest impact in Mexico, where it has claimed a number of lives and infected hundreds more.
Thus far, the strain in this country that has infected people in at least 19 states has not been as potent or as deadly. We cannot know for certain why that is, which is why we are taking all necessary precautions in the event that the virus does turn into something worse.
This is also why the Centers for Disease Control has recommended that schools and child care facilities with confirmed cases of the virus close for up to fourteen days.
It is why we urge employers to allow infected employees to take as many sick days as necessary.
If more schools are forced to close, we’ve also recommended that both parents and businesses think about contingency plans if children do have to stay home.
We have asked every American to take the same steps you would take to prevent any other flu: keep your hands washed; cover your mouth when you cough; stay home from work if you’re sick; and keep your children home from school if they’re sick.
Unfortunately, his administration hasn’t spoken with a single voice on this subject. Chronic loose cannon Vice President Joe Biden did his level best to raise the panic level:
Appearing on NBC’s “Today Show,†Biden said he has already advised his family to avoid traveling in small spaces. “I would tell members of my family, and I have, I wouldn’t go anywhere in confined places right now,†he said. “It’s not that its going to Mexico, its that you are in a confined aircraft when one person sneezes, it goes everywhere through the aircraft. That’s me.â€
“I would not be at this point, if they had another way of transportation, suggesting they ride the subway,†the vice president went on. “From my perspective, it relates to is mitigation. If you’re out in the middle of a field and someone sneezes that’s one thing. If you’re in a closed aircraft, a closed container, closed car, a closed classroom, it’s a different thing.â€
How concerned should we be? After all the World Health Organization has raised their pandemic warning phase level to 5. That’s just short of the maximum 6, indicating that a pandemic is in progress.
Yesterday the BBC quoted a WHO official:
Dr Michael Ryan, WHO Director of Global Alert and Response, praised European nations’ handling of cases and said events did not seem out of control.
Mexico has cut its suspected death toll by 75 to 101, indicating the outbreak may not be as bad as initially feared.
The country has ordered a five-day shutdown in a bid to contain the virus.
Mexican Health Minister Jose Angel Cordova told the BBC that, based on samples tested, the mortality rate was comparable with that of seasonal flu.
Dr Ryan, meanwhile, said that there was “no evidence of sustained community spread outside of North America”.
“I think it would be, at this stage, unwise to suggest that, in any way, those events are out of control or spreading in an uncontrolled fashion,” he said. “I think the next few days will tell as this develops.”
Note also this from later in the article:
Mr Cordova appeared to agree, saying that the Mexican authorities may, on reflection, have overestimated the danger.
He said 43.7% of samples from suspected cases so far tested had come back positive, a total of 397. Sixteen in this group had died.
“That means that apparently, the rate of attack is not as wide as was thought,” he said.
That 43.7% roughly means that for every four cases submitted for testing that are, indeed, found to be swine flu six weren’t swine flu. And the mortality rate among the positive cases was roughly 4%. In Mexico. The mortality rate has been much, much lower everywhere else.
Is there sustained community spread within North America? Indeed, is there sustained community spread in Mexico? Consider the Associated Press recap.
Pablo Kuri, a Mexican epidemiologist, said three of the dead were children: a 9-year-old girl, a 12-year-old girl and a 13-year-old boy. Four were older than 60. The other nine were between 21 and 39 — unusual ages for people to die from flu because they tend to have stronger immune systems.
Although most of the dead were from Mexico City, they came from different neighborhoods in the metropolis of 20 million, and there were no similarities linking their medical backgrounds.
One theory for the deaths is that perhaps they sought treatment too late — falling sick an average of seven days before seeing a doctor.Many of the sick around the world were people who had visited Mexico, including 13 of Britain’s 15 cases.
That doesn’t sound like it satisfies the criteria for sustained community spread to me. Perhaps someone with more knowledge can enlighten me.
What other explanations are there for the WHO’s action? Pundita has been doing yeoman’s service in tracking the handling of the disease through multiple bureaucracies see here, here, and here. Pundita notes:
Events have moved swiftly since Washington Post reports on April 26 and April 30 reports detailed the slowness of U.S. public health officials to respond to important information about the new virus.(4)(5)
And already the Mexican government’s chief epidemiologist is calling for an investigation of the World Health Organization’s slowness to inform public health agencies and the general public about the threat from the influenza outbreaks in North America.(1)
This aspect of the H1N1 story is about the interface between bureaucratic protocols, politics, medical science, and public health, and has many moving parts. I began sorting through the parts in the last two Pundita posts, but there are still blanks in the story and much fog emanating from as far away as Geneva, the site of WHO headquarters.(6)(7)
Pundita and I differ, however, in our interpretations of what has happened. I don’t believe I’m misrepresenting her views to say that she believes that the WHO succumbed to political pressure, violated their own protocols, and reclassified the spread of the disease in the light of better information and techniques than they were able to produce themselves and we’re the better for it. My view is that the WHO succumbed to political pressure and violated their own protocols because they were afraid of being wrong and it’s provoked an excessive response. Prematurely, as it may turn out.
Well, what’s the harm in reacting prematurely or overreacting? The answer is that acting wrongly has costs and may even result in the loss of human life. Millions of face masks are being sported all over the world—face masks which will have little if any effect on the spread of disease. I’d bet that people are, improperly, taking antivirals assuming they’re preventative (they aren’t) rather than curative. They’re only worthwhile when you’ve already contracted the disease and, as the statistics above suggest, that’s very, very uncommon.
There have been calls for quarantines, closing of borders, travel bans, avoiding air travel, avoiding subway travel. Six countries including Russia and China have put bans on the importation of pork from the United States. Choirophobia seems to be sweeping the Middle East with Egypt and Iraq both killing pigs in an irrational attempt to prevent the spread of the disease. Not a single case of swine flu in humans anywhere has been determined to have been caused by an Egyptian pig.
There are definitely costs and IMO these costs are being borne because of hasty actions and statements by the WHO and the U. S. and Mexican governments.
I don’t think the situation should be ignored. It makes sense for state and local public health departments to be prepared. But let’s take our cue from President Obama’s statement, quoted above: take normal, commonsense preventive measures just like any other flu.
