Swine Flu update: April 29, 2009

Part One of the Swine Flu epidemic here.

By the end of the day, panic over swine flu had reached pandemic proportions, with more than 117,607 news stories appearing on Google News. As media professor, Robert Thompson, at Syracuse University in New York, told Reuters this morning: “If as many people had swine flu as those [in media] that are covering swine flu, then it would be a pandemic to reckon with.”

He was more right than readers realize. As of tonight, the World Health Organization’s Swine Influenza Update reports 91 confirmed cases of the swine flu in the United States and one death; while Mexico has 26 confirmed cases, including seven deaths.

117 cases

117,607 news stories

That’s 1,005 news stories for each case of the flu.

It’s been heartbreaking to realize how many people have become truly frightened by the news stories. For consumers trying to find balanced information in the news, they’re encountering similarly overwhelming odds. But there have been tiny droplets of science and sense coming from experts that you can find — if you have time to wade through a thousand panic stories to find each one.

Death has come to the U.S.

The first U.S. death to swine flu instantly became all the proof needed to raise the panic bar about the threat of swine flu for our children and lead to schools being closed across the country.

What hasn’t been widely reported is that the 23-month old boy who became the first U.S. death to swine flu was from Mexico and had undisclosed “underlying medical problems.” He had been airlifted to Texas Children’s Hospital in Houston in critical condition. “While tragic and alarming, the case does not prove that the recently emergent virus has established a foothold in Southeast Texas,” health officials cautioned in the Houston Chronicle. “The boy was isolated in a hospital environment that made transmission of the virus unlikely, and no one in his family has exhibited symptoms.” As Dr. David Persse, Houston’s emergency medical services director said, this death doesn’t change the situation here.

Never before seen mutant virus

Media continues to describe the virus as an unexplained combination of swine, bird and human strains, lending to endless conspiracy theories and scares of mutant viruses. The core of beliefs that this strain of influenza could hold unique dangers to humans compared to ordinary seasonal influenzas originated from misinterpretations of CDC reports that the virus is a combination of bird, pig and human viruses, said Dr. Steven Salzberg, Ph.D., professor at the University of Maryland and Director of the Center for Bioinformatics and Computational Biology. The simplistic explanation reaching the public is incorrect. As we know, viruses naturally reshuffle their genetic material as they replicate. Dr. Salzberg explained that the current swine flu virus is actually a combination of two “already-circulating pig strains.”

The reason for the "triple reassortant" story is a bit complex, but (to simplify a bit): the history of one of the two parental swine flu strains indicates that part of that strain originated in birds — well over a decade ago. That strain is sometimes called "avian-like" as a result, but it's not an avian flu strain now. Second, the history of the other strain includes a small piece (one gene) that appears to have originated in humans — over 15 years ago. Again, it's a swine flu virus now, but there's a piece of it that might have come from humans. The event that created today's swine flu — the one we're worried about — is a combination (called a reassortment) between two pig strains, pure and simple.

There is no reason to suspect that this combination of flu viruses is any more deadly than any other recent swine influenza virus has been.

Pandemic around the corner

The most over-the-top rhetoric has come from the World Health Organization director general, Margaret Chan, when she raised the level of alert of an impending pandemic. “It is all of humanity that is under threat during a pandemic,” she said at a news conference in Geneva. “The biggest question right now is this: How severe will the pandemic be? All countries should immediately now activate their pandemic plans.”

The World Health Organization’s own data fails to support the scary proclamations of its director. WHO reports 91 confirmed human cases in the U.S., with one death, and Mexico has 26 confirmed cases, including seven deaths. Scattered cases have also been confirmed abroad, with no deaths. And, no different from earlier this week: “WHO advises no restriction of regular travel or closure of borders.”

The Department of Homeland Security instructed healthcare providers of the procedures they must follow should the government decide quarantines are necessary. Its notice said: “The Department of Justice has established legal federal authorities pertaining to the implementation of a quarantine and enforcement. Under approval from HHS, the Surgeon General has the authority to issue quarantines.” Under federal law, a quarantine order can be enforced by U.S. law enforcement agencies, including Federal Marshals, the FBI, U.S. Customs and Coast Guard Officers and the Bureau of Alcohol, Tobacco, Firearms and Explosives. Anyone violating a quarantine order can be punished by a $250,000 fine and one year prison term. As CBS News reports, a Defense Department planning document summarizing the military's contingency plan says the Pentagon is prepared to assist in “quarantining groups of people in order to minimize the spread of disease during an influenza pandemic” and aiding in “efforts to restore and maintain order.” Congress enacted the first federal quarantine law in 1796 during the yellow fever epidemic.

The CDC’s own influenza data fails to support any parallels of this swine flu outbreak as being as threatening as a yellow fever epidemic from two centuries ago or Spanish flu from nearly a century ago! The actual number of people sickened by any viral infection is naturally considered to be higher than confirmed cases, but today’s active surveillance by health departments enable reasoned estimates of disease prevalence. The actual numbers aren’t remotely close to tens of millions of deaths. But we don’t hear much about just how few cases there have really been — facts that offer a sense of perspective and balance.

While increasing number of cases of swine flu are being confirmed as testing increases, the number of cases and deaths continue to pale to those seen even with the typical seasonal influenza. As we’ve seen, government health statistics report 30,000 to 50,000 deaths each year in the U.S. attributed to typical seasonal influenzas, and the number of cases is considerably higher. Every week, the CDC reports the number of confirmed cases and this month, in just one week (April 12-18, 2009), for example, the CDC confirmed 25,925 cases of influenza in the United States and 55 child deaths.

Imagine what the media could do with those numbers to scare us. At the same rate of news coverage, that would be more than 25 million stories every week about the deadliness of the flu.

Mexico harboring a deadly form of the virus

Speculations abound as to why there have been more deaths in Mexico than here or any other developed country in the world. Scares are circulating that viruses from south of our border are somehow more deadly and dangerous and that we must keep “those people out.” As we’ve examined, the general health of people in poverty stricken countries such as Mexico is poorer, as is most people’s access to the quality and advanced medical care that we currently enjoy in our country — medical care that makes the difference for surviving the complications of viral infections. There’s a reason our healthcare is seen as the best in the world and our neighbors from Mexico come here for care.

But the “swine flu virus” (influenza A/H1N1) in Mexico is no different than here. Dr. Salzberg and colleagues and several other research groups around the country gained access to GISAID, where the genetic sequencing of flu viruses have been deposited. They found that the genetic sequencing of the virus from Mexico is virtually identical to those from the United States. “It would appear that any differences in virulence are due to differences in the people being infected, not to the virus itself,” he wrote. People living in situations of poverty are at higher risk of dying from all sorts of things that those in more developed countries no longer fear.

Health scams abound

The Better Business Bureau is already warning consumers about scams capitalizing on swine flu fears. McAfee, a computer monitoring company, has been tracking swine flu scams and reports there’s been a huge jump of sites selling supposed swine flu treatments and products, offering everything from face masks to phony vaccines, many websites masquerading as offering medical information. Face masks sales are booming, even though the CDC is not recommending that people wear masks because of limited evidence that they effectively prevent the spread of the disease. As Peter Palese, a microbiologist and infectious-diseases expert at Mount Sinai Medical Center, told the Washington Post, face masks don’t do much good:

Face masks do one thing — they protect people in terms of preventing other people from getting close to them. So you get a sphere of privacy from wearing a mask, but it's largely psychological. The masks do help if someone sneezes right at you. However, the pore size of these masks lets viruses go through. Again it is not a clear-cut yes or no; there is some benefit, but there is not as much benefit as we would like.

Yet, nearly every news story about swine flu is accompanied by scary images of people wearing masks.

What’s really playing on our fears?

Frank Furedi, sociology professor at the University of Kent and author of Culture of Fear, explained that what we are seeing is a moral drama. His thought-provoking article in Spiked-online began:

Recent events show that, while society has the scientific know-how to cope with outbreaks of flu, it still sees disease as a harbinger of apocalypse. The explosion of global fear about the outbreak of a deathly flu virus in Mexico is more a response to the dramatisation of influenza than to the actual threat it poses. There is nothing unusual about the outbreak of flu. Every year, thousands of people die from the flu, and, in normal conditions, society has learned to cope with the flu threat. From time to time, an outbreak of flu turns into a global pandemic, leading to a catastrophic loss of life. However, there is no evidence that the so-called swine flu, which has so far claimed a relatively small number of lives, will turn into a pandemic. Rather, what we are faced with is a health crisis that has been transformed into a moral drama.

As he explains, actual health risks are being inflated today far beyond any real danger. The World Health Organization’s escalation of the pandemic threat of swine flu, he said, “is acting on a script that was cobbled together in the early years of the twenty-first century.”

Since the turn of the new millennium, the term ‘pandemic’ has become normalised and is increasingly used to frame global anxieties and fears. ‘Health alerts’ have been transformed into rituals, through which fear entrepreneurs remind us, in a quasi-religious fashion, that human extinction is a very real possibility. Terms like ‘epidemic’ and ‘pandemic’ appear with increasing frequency in newspapers, and are now used in everyday conversation, too. This tendency to inflate the dangers that we face leads to a situation where fearmongers now speculate about hundreds of thousands, millions or even billions of casualties occurring as a result of some crisis or disaster. Even highly prestigious journals and media outlets seem incapable of resisting the temptation to spread alarmist high-casualty scenarios.

Increasingly, public health officials sound as if they are rehearsing their roles for a disaster movie. They frequently argue that, since we had deathly flu pandemics in the past, it is inevitable that we will face another one very soon…The fatalistic view of an inevitable global flu catastrophe is made more ominous still by linking it with our anxieties about terrorism. Leading British scientist Hugh Pennington also made this link, when he stated in 2005 that avian flu ‘is the biggest threat to the human race’ and it ‘far outweighs bioterrorism; this is natural terrorism’. Inevitably, the dramatisation of the flu has spawned various apocalyptic stories about how viruses can be ‘weaponised’ and used to threaten human survival… In line with Hollywood fantasy plotlines, the report invited us to imagine the possibility of a terrorist purchasing ‘genes for use in the engineering of an existing and dangerous pathogen into a more virulent strain’. Alongside fears about the ‘weaponisation’ of viruses, the internet is awash with rumours about the conspiracy responsible for the current outbreak of swine flu…

As he concluded: “It seems the swine flu outbreak has infected our imaginations, giving shape and tangibility to our anxieties about everyday life. We should give the pigs a rest, and get on with living.”

Not everyone’s imaginations are running overtime, though. The internet has also been the source of some comical perspectives, none better than xkcd.com: