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What to do about swine flu?

For those planning for the worst, it's always a tough call.

A Costa Rican immigration official wearing a surgical mask checks passengers at Juan Santamaria international airport, Apr. 28, 2009. Costa Rica had found a "highly suspect case of influenza" Costa Rica's Health Minister Maria Luisa Avila said Tuesday. It would be the first reported case of the virus in Central America. (Juan Carlos Ulate/Reuters)

NEW YORK — The swine flu mantra is: “rapidly evolving situation.” That’s what public health officials are saying and it means that no one knows what’s going to happen.

No one knows if it will be a gentle romp or a killer pandemic. You might as well consult a palm-reader. And that makes life neither easy nor enviable for those on the decision-making front lines.

If the experts are overly alarmist and close every public center and school, they’ll wreak havoc on day-to-day life unnecessarily, spark panic, and lose all credibility when the next epidemic strikes. If they are overly lax, the flu could spread and possibly kill — and they’ll lose all credibility when the next epidemic strikes.

“Our decision making is influenced by two things and that is 1918 and 1976 — 1918 is the worst case and 1976 is the worst overreaction,” said Dr. Stephen F. Morse, professor of clinical epidemiology at Columbia University. He was referring first to the flu epidemic of 1918 that killed upwards of 40 million people worldwide. And secondly, he was talking about the swine flu epidemic of 1976 that some feared would be a repeat global killer prompting a mass vaccination. The epidemic never amounted to much and the vaccine was linked to several cases of Gillian-Barre syndrome, that causes temporary paralysis. Didn’t help credibility.

This week, Janet Napolitano, the U.S. secretary of the Department of Homeland Security, declared swine flu a public health emergency. That allows funds to be released to support public health efforts. The U.S. Centers for Disease Control released about a quarter of its stockpile of anti-viral drugs, personal equipment and respiratory protective devices. Both Tamiflu (oseltamivir) and Relenza (zanamivir) kill the virus. Experts warn that overusing the drugs could trigger resistant strains.

On Monday, The World Health Organization raised the public health alert to level four of six levels. That means the flu is transmitted from person to person and can cause sustained “community-level outbreaks ” with a possibility of a pandemic. Again, they cannot say for sure. A pandemic — which means its gone global not that it’s a particularly virulent — is a level 5 alert and some say the WHO is on the verge of calling it a 5.

“It’s all about wording so people will take precautions without feeling coerced,” said Dr. Howard Markel, an expert on pandemics and professor of pediatrics and history of medicine at University of Michigan.

According to the latest WHO report, there have been 79 confirmed cases and seven deaths worldwide. While Mexican authorities said the strain killed 149 people, the WHO is still investigating those deaths. The U.S. Centers for Disease Control reported 64 confirmed cases in the U.S. with no deaths. There are reports but not confirmed cases in Spain, Costa Rica, and Israel.

While predictions are no more than guess work, experts do know a lot about the flu virus. For most people, the flu causes a high fever, muscle aches and extreme fatigue. The illness is bothersome but not dangerous. It can kill those who have weak immune system — every year the flu kills about 250,000 to half a million people worldwide.