Swine Flu: Trying to Think Correctly

Three years ago, at the height of the bird flu scare, I wrote an article for WebMD called "Bird Flu Over the Cuckoo's Nest." It began, "After several years of trying to educate myself in order to answer questions from my anxious patients about nerve gas, anthrax, swine flu, mad cow disease, West Nile virus, SARS, and now bird flu, I find myself thinking wistfully back to 1963 when, as a 10-year-old, all I had to worry about was total nuclear annihilation."

Swine flu is the latest in a series of problems that have kept us in a heightened state of alert for years now. This cannot be good for anybody's sanity. We are wired evolutionarily for brief surges of adrenaline, "fight or flight" responses that temporarily put us in overdrive. But what engine can remain in overdrive for years at a time without becoming seriously fried?

Nobody wants to overreact, but nobody wants to be caught unprepared. Responsible members of the media are faced with the difficult task of properly informing without needlessly alarming the public.

It's a constant challenge to try to serve the news not too hot and not too cold. "Just right" is easier said than done. Clearly the current outbreak of swine flu is of global concern. As chief medical correspondent for the CBS Evening News with Katie Couric, I have a responsibility to try to put it all in perspective -- not to hype the story but not to sugarcoat it either. On tonight's Evening News broadcast, we reported that nearly 2,000 cases of swine flu have occurred in Mexico and at least 149 deaths; today US health officials advised Americans not to travel there. Here in the United States, there have been at least 40 cases, and the number is growing. But for some reason, the cases in the US have been relatively mild; there have been no deaths. Today I interviewed Dr. Bruce Farber, Chief of Infectious Diseases at North Shore University Hospital, one of the physicians who has taken care of the students at St. Francis Preparatory School in Queens who have come down with swine flu. He told me he was surprised at how "unsick" the kids appeared compared to some of the very ill patients in Mexico. There are various theories but nobody is sure why this is the case.

The truth is that we are in a fluid situation and we don't know exactly what will happen. My goal as a doctor and as a journalist is to try to think correctly -- to do my homework, read as much as I can, listen carefully, ask lots of questions, and then try to translate it all for my patients and for our CBS audience. And not be afraid to admit uncertainty.

The past flu pandemics (e.g., 1918, 1957, 1968) may have little predictive value for a pandemic today. On the one hand, airplanes will help spread the virus more quickly than in the past. On the other hand, we have far more sophisticated tools for early detection and treatment than we've ever had. Meanwhile, what can you do for yourself and your family?

Skip stockpiling antivirals. We all love to have control, and if not actual control then at least the illusion of control. Enter Tamiflu and Relenza, the anti-viral drugs that can lessen the severity of flu if taken within 48 hours of the onset of symptoms. Why not hoard them now? Shouldn't you have some "just in case"? For most healthy people, the answer is an emphatic "no," something I confirmed today with both the CDC and the New York City Department of Health. Yet I called several New York City pharmacies this afternoon and was told there's been a run on Tamiflu. As a physician, I know how tough it can be to "just say no" to an insistent, worried patient. And I haven't totally gone over to the dark side of not remembering what it's like to be a patient; believe me, there's an insistent, worried patient hiding inside many physicians, myself included. But inappropriate use of Tamiflu and Relenza can lead to the swine flu becoming resistant to these medications -- the same thing that's happened with overuse of antibiotics. The virus is sensitive to these drugs now but that could change with overuse.

In addition, shortages created by hoarding would hamper our ability to treat patients with regular flu, which affects millions of people and kills about 36,000 annually in the U.S. And shortages during an outbreak of swine flu might contribute to a more rapid spread of the virus. So, ironically, the unused Tamiflu in your medicine cabinet could increase the likelihood of the disease infecting you and your loved ones.

Practice good hygiene. Because swine flu is likely spread in a similar way as regular flu, i.e. by respiratory droplets, you should follow the same advice you would for avoiding regular flu (hand washing, covering your mouth with a tissue when you sneeze and then throwing the tissue away, staying home when ill, avoiding touching your eyes, nose or mouth, and so on). Bottom line: When your cab driver licks his fingers to help him peel off a few singles from his wad of bills, tell him to keep the change. Information on the effectiveness of masks is limited but the latest CDC recommendations can be found here.

Stay informed. For specific advice on swine flu from the CDC, go to www.cdc.gov/swineflu. For general advice on how to stay prepared, check out the "Pandemic Flu" website at www.pandemicflu.gov (look under "Plan and Prepare").

Personally, I am amazed and heartened by how many competent and brilliant people all over the world are working on the problem. It does make me feel better to know, for example, that officials at the New York City Department of Health and Mental Hygiene, who were extremely valuable sources of information for me and many other New York City doctors during the 2001 anthrax crisis and 2006 bird flu scare, have been all over the current swine flu situation. Most of us have been thinking about swine flu for several days; they've been thinking about it -- and preparing for it -- for years.

How can we recalibrate our anxiety to an appropriate level? Communication. Whether the problem is swine flu or some other health threat, I have found that patients are comforted by an honest, clear explanation -- even if the answer is "I just don't know." And patients are relieved when I remind them that they don't have to solve the problem themselves because there are very smart, dedicated people whose job it is to come up with an answer.

Finally, doctors have a special responsibility to stay informed. Many of us are used to practicing on our own, following our own clinical judgment. But during a health crisis such as the current swine flu epidemic, we must also follow the advice of public health officials. The right thing to do is not always intuitively obvious. For example, yesterday the New York City Department of Health issued an email update that suggested that most patients with mild flu-like symptoms not come into the office for flu testing unless they have an underlying illness that puts them at increased risk. Had I not received the update, I might well have advised patients incorrectly. Doctors should contact their local department of health for instructions on how to get on their email list.

Since I'm preaching about communication, tonight I tried to practice it with something brand new. For the first time, the CBS Evening News with Katie Couric was followed by a live webcast about health. To discuss the current swine flu crisis and to answer questions emailed and tweeted by our audience, I was joined by Dr. Jennifer Ashton, the medical correspondent for The Early Show on CBS, and by Dr. Peter Gross, a Yale-trained expert in infectious diseases who is currently the Chief Medical Officer of Hackensack University Medical Center. I look forward to hearing your comments and to continuing the conversation online.

Comments

[TazoWolf]

Decent Q&A about Swine flu here, backing up words with scientific explanations people can understand to dispel some fears and explain where the real concerns lie. http://www.youtube.com/watch?v=ma7IeWRH7y0

[AngieMom57]

An ounce of prevention is worth a pound of the cure.

Let food be thy medicine.

You are what you eat.

Health is our only wealth.

Prepare for the worst, hope for the best.

[financialfreedom2]

Eating healthy and private Ins. is the best system . Universal Health care is equal to rationed health care or no healthcare. Govt. Heath care gives government control over the most basic of human rights do you want George Bush deciding if you are worth the expense of health care?

[research]

Private health insurance in the USA "is equal to rationed health care or no healthcare"

You just "projected". Look it up.

[Kenta]

Universal health care is better than NO health care. And what would Bush have to do with it?

Single-payer is the only way to go.

[PVHurt420]

I'm scared of getting sick, but there's no way we could afford to go to a doctor. My husband and I both work min. wage jobs & we thank god our 2 yr old has medicaid, otherwise we'd be freaking out right about now. At least if our son gets sick, they'll see him for free, but if we do, I don't know what will happen. Scared down here in TX because we both work in a mall setting . . . .

I want to know what happened to the idea of Universal Health Care??? Preventative medicine is the best way to go . . .

[financialfreedom2]

I feel your pain and the Government is not listening to you. They are more concerned with giving you what they want you to have then giving you what you need. That happens to be extremely expensive and will never happen. If we simply pay cash for actual healthcare expenses and pass a law that says no Ins. for routine Health care office visits, ER, and prescriptions . This would cause family practice Doctors to charge affordable fees for the clients they serve. Sell Health Ins. only for all the really bad catostrophic stuff The monthly Catastophic health Ins. premium would be affordable., and could be paid for on a sliding Income scale. This makes DRs accountable to patients and compete for patients by charging what patients can afford.

[JustMyWords]

That's a nice fantasy world that you live in.

[HidingintheDeepSouth]

I thought that I would take this opportunity to remind Ya'll that our lack of health care could make you and yours' ill.
I am a contractor for our state social services agency. I have no benefits, including any health coverage. My clients are almost all poor and have none either. NONE of us are going to a doctor if we end up ill. It is just too difficult and too far away to get to the sliding scale clinic. (For me, it is over 60 miles away and not very good to boot.) Very few of us are going to go to the ER. I know that I will probably die first, because I can't let my credit get ruined again from medical bills. My clients feel the same way. Also know that they will continue going to work at their min. wage jobs when they get sick. They will check you out at the grocery, fix your burger and make your change at the gas station. They don't want to lose their jobs or their hours.
YOU AND YOUR CHILDREN are at greater health risk because I and my clients don't have health coverage. Please know that universal health care IS the best Public Health policy.

[PVHurt420]

Wow - I would think with your job, they would at least have a discounted plan available for you and your family. Makes me not want to even consider a social services job!!

And I agree, Universal Health Care for all!!

[financialfreedom2]

Univrsal Health Care means Rationed Care or no Care.

[sodisenchanted]

Hidinginth­eDeepSouth­, Thank you for your post. That is exactly what the rich right wingers who complain about having to pay for health care for the poor need to hear.

We are all connected.

[billw8017]

Merely sensible behavior may suffice. Diseases increase severity at the moment when they begin to spread the most. The "bug" that spreads has less interest in maintaining the life of any one host, and more interest in evolving the utmost vigor. If the disease is restrained, if people who are sickened stay at home or are isolated somewhat, a relatively "friendly bug" evolves and preempts the more virulent disease under circumstances where the body can fight it with its natural defenses.

All of which is to say, a disease with the potential of epidemic flue should be regarded seriously but intelligently. Remember, every cure is based in our natural defenses. Treatments that attack the disease mostly slow it down while natural defenses get a handle on it.

That there is only one factory in the US to cultivate vaccines is deplorible. How many companies have competing treatments for male sexual enhancement or baldness? Life and death seem too banal for real money making.

[billw8017]

A classic model is the public health procedure when the Tennessee Valley Authority caused a rise in American malaria back in the 1930s. The feds provided free screening for homes. Then the flies to spread the disease were confined, and the disease stopped spreading, It mostly disappeared and did not become the endemic curse it has remained in nations with an inferior public health sector.

[Justwonderingy]

Money that was set aside in the stimulus bill for research for swine flu was stripped as pork by the GOP

[financialfreedom2]

Because it is Pork that goes to the WHO the agenda of which is power, control and a 1 world central Govt.
The oldest socialist trick on record create a percieved problem IE: SWINE FLU bring a solution and get all involved to buy in now you get control by running an end around so the average joe can't see it comming

[breakingnews]

WHO just raised the pandemic threat level to 5 - meaning pandemic is imminent.

[dsws]

""After several years of trying to educate myself in order to answer questions from my anxious patients about nerve gas, anthrax, swine flu, mad cow disease, West Nile virus, SARS, and now bird flu, I find myself thinking wistfully back to 1963 when, as a 10-year-old, all I had to worry about was total nuclear annihilation.""

Don't forget asteroid impacts, electromagnetic pulse weapons, dirty bombs, earthquakes, peak oil, and climate change. There's an anxiety for every taste -- even if you restrict yourself to the ones that have some basis in reality, which of course not everyone does.

[billw8017]

I don't really like the nihilism that says we all die regardless and shouldn't worry about it. Disease is discomfort, and fighting disease is but a simple respect for people's happiness, doomed as we are.

[dsws]

There's a lot of middle ground between nihilism and the kind of anxietainment we get in the media over West Nile and such. Fund the CDC, yes. Stockpile canned goods every time a new strain of flu emerges, no.

[financialfreedom2]

Good point what ever will be will be just limit yourself on your NEWS intake to 10 mins. a day you will be just as informed and 10 times less anxious

[ICanHasDemocracy]

"We don't want to freak people out"...but tens of millions could die"...is not responsible reporting. Please advise and admonish the on-air "talent" of the irony of their statements. 6 cases in Canada is not an outbreak. 600 or 6000 yes- because those numbers increase geometrically.

More have died in the drug wars due to "bullet flu" in Mexico than H1N1. More have died in Iraq from bad water sources then H1N1.

[patianneb]

So long as people demand cheap food, most especially meat, the smithfields, tysons etc will provide it in ever increasing quantity. swine fle, salmonella in vegetables, etc., etc., is the way of the future along with the other results of greed and environmental poisoning.
but of course, nothing signficant will change until the consumer does, and until a milliion or so are wiped out in short order, much closer to home, who will really care other than the families of those unfortunate enough to be affected.
we, as a species, deserve all the calamity we harvest.

[bonum]

have you noticed that our American culture feeds off of fear, the predator-prey syndrome has many faces in this country .... it seems that our country always needs an enemy to fight

[Kenta]

Good observation. More than 35,000 die from complications of the flu every year in the US alone. Why the panic now? This happened in 1976 and a lot of people died from the vaccine, but in the end there was no flu because it never existed. Just like Sars, Avian Flu .... you decide.

[JustMyWords]

The flu did exist in 1976, just like it does now - it just did not spread in the way that had been feared/anticipated.

I think the hype over this strain of flu is overblown, but that doesn't mean that there's never a reason to worry.

[Hollypop]

Fear, Fear, Fear ...... why do we always have to live in fear ? ...fear of terrorists, fear of recession, bird flu, swine, flu, people with different skin color, different culture, religion etc: etc: etc:
Possibly because it's become a habit constantly fueled by the hungry for news media.
Chill out ... it most likely won't happen to you .... but if it does and you die ... so what ? we all have to die one day and from something ... but we have to live everyday and it's better for our health to live above fear.
If the media cares about the health of the nation it should stop fueling our fight and flight reactions... report acurately and with out sensation.

[ICanHasDemocracy]

Fear keeps the sheep in line.

[Kaves]

"Dream as if you'll live forever, live as if you'll die today"
-James Dean quote from a Barnes & Noble add on the NYC subway

[cyberbian]

http://www.idemc.org/


This site shows two dead in the U.S. Potentially from the Swine Flu.

The data is not completely in yet. But lets keep it honest.

[LemonMeringue]

Greatly exaggerated threat.

Ask yourselves: who is driving this news cycle?

[pshowisitto]

To all those talking about closing the borders... it is quite apparent Americans visiting Mexico brought this into the country so what would have closing the borders do? The outbreak is not near the border cities.

We live in a world of panic these days. I was amazed reading some posts on a story about how bad this could be on another website. People were saying they would stay holed up in their houses as long as possible. I guess anything to not have to face the real world. In what world they live in where they do not have to work I would like to know. I personally think this is being blown way out of proportion.

[StringOfLights]

While I agree that this is something to be concerned about, air pollution kills way more people every year in Mexico City than swine flu. Children from Mexico City color pictures with a brown sky because they've never seen a blue one. Why is that not a pandemic? Because the effects aren't immediate? I'm sure years of inhaling ozone, sulfur dioxide, carbon monoxide, and particulate matter isn't doing anything to help people's resistance in fighting off infections, in addition to the adverse cardiopulmonary effects.

[speakingout]

The town is downwind from a pig factory, compliments of a US pig farming operation. The feces create airborne bacteria and who knows what else that gets washed into their water supply. Maybe we should be questioning the big corps that want to control the food supply, aka Monsanto, etc.. They didn't think too much of the agent orange they manufactured that killed and infected thousands from Vietnam. Or the tons of PCB that they dumped in our rivers. They are now claiming patents on plants and pig farming. They also own most of the seed stock worldwide - a chemical manufacturer? Wake up America! Go to Wikipedia for their dreadful history. Bush gave the drug manufacturers $1 billion to come up with a bird flu drug. When has a drug cured anyone? They just casue more damage than they help; It's all about the money. Who's stock went up? We have more people dying every MONTH from diabetes (25,ooo) and cancer. Why isn't that considered a pandemic? Because the drug companies make more money keeping us sick than finding a cure. The cure - eat healthy non-pesticide food and drink purified (not bottled) water. Start growing your own garden, before Monsanto confiscates all the seeds and bioengineers them so we all end up mutants.

[patianneb]

Sometimes I feel I spend a lot of my life spitting into the wind -- I am so with you on everything you've said.
Excellent post.

[wolfdogNM]

The air pollution, or smog, thing is a very good point. One reason people have been hit harder in the Mexico City area may well have to do with their lungs not being able to deal with the virus as well as people in other countries where it has now spread. Of course, this particular strain of flu's epicenter still does seem to be the Mexico City area.