An epidemic of overreaction
THIS PAST WEEK, my patients seemed more nervous than usual. In addition to concerns about chest pain, coughs and fevers, there were also the sudden, uneasy questions about bird flu.
“Should I be taking Tamiflu?” several asked. “Can you prescribe it so I have a supply on hand just in case?”
My answer was always the same. “No. Tamiflu is an antiviral drug that has not yet been proved effective against bird flu. And even if it worked, there’s still no bird flu to treat.”
The difficulty with informing the public about a potential pandemic is that the uncertainty about when or if it could occur breeds fear. Scared people over-personalize the news, and their worries increase. Fear is a warning system intended to alert us to impending danger. The bird flu, though a potential large-scale danger, is not impending.
The facts are these: The current H5N1 avian influenza virus has not mutated into a form that can easily infect humans, and the 60 people in the world who have died of this bird flu have done so not because this bug is on the road to mutation but because millions of birds throughout Asia have been infected, and the more birds that have it, the more likely that an occasional human bird handler will be infected.
Most human influenzas begin as bird flus, but many bird flus never change to a form that can harm us. Though flu pandemics occur on the average of three times per century, and we are clearly overdue (the last was in 1968), there is absolutely no indication that the transformation to mass human killer is about to happen. The threat is theoretical. Unfortunately, the attention it has received makes it feel like something terrible is inevitable.
Why the overreaction? For one thing, direct comparisons to the Spanish flu of 1918, a scourge that killed more than 50 million people worldwide, has alarmed the public unnecessarily. In fact, there are many scenarios in which the current bird flu won’t mutate into a form as deadly as the 1918 virus.
And even if we accept the Spanish flu scenario, health conditions in 1918 were far worse in most of the world than they are now. Many people lived in squalor; 17 million influenza deaths occurred in India, versus about half a million deaths in the U.S. There were no flu vaccinations, no antiviral drugs, and containment by isolating infected individuals wasn’t effective, largely because of poor information and poor compliance. Today’s media reach could be a useful tool to aid compliance. Of course, the concern that air travel can spread viral infections faster may be valid, but infected migratory birds were sufficient in 1918.
Unfortunately, public health alarms are sounded too often and too soon. SARS was broadcast as a new global killer to which we had zero immunity, and yet it petered out long before it killed a single person in the United States. SARS was something to be taken seriously, but the real lessons of SARS, smallpox, West Nile virus, anthrax and mad cow disease weren’t learned by our leaders -- that potential health threats are more effectively examined in the laboratory than at a news conference.
With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the last six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further. It is reasonable to try to control the bird flu while it remains in the bird population. There is great value in improving our emergency health response system and upgrading our vaccine-making capacity. Government subsidies in these areas could make the public safer.
But, right now, there is no value in scaring the public with Hitchcockian bird flu scenarios. The public must be kept in the loop, but potential threats should be put into context. The worst case is not the only case.
