What to do about swine flu?

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.

The flu spreads from person-to-person. A person can catch the virus by inhaling the germs spewed when someone sneezes or coughs, or by touching an infected person and then touching their own mouth or nose. That’s why doctors say hand-washing is a good idea. Masks can help but only if worn properly.

The new virus, called influenza A/H1N1 is called a swine flu because it shares similar genes to previous viruses that came from pigs. Though Morse explained it also shares genes with strains of bird and human flu and “we haven’t found the guilty pig yet.” People are scared to eat pork but cooking meat kills any potential lurking germ.

Markel explained that H1N1“is not as novel as 1918 and that’s good. We hope that means a lower case fatality because some people will have circulating antibodies,” meaning they could mount an immune response.

Unlike prior epidemics, the news of this 21st-century germ scare spread with a speed never experienced before, thanks to the Internet. Anyone can tap into the Centers for Disease Control website and the website of the World Health Organization for up-to-date information. Public health experts, while congratulating the CDC and the WHO for getting information out in a reasonable and rationale fashion (meaning: not panicking the public) worry that the flood of accessible information is confusing.

They also worry about the scare stories and the reliability of all the information out there. “I’m trying to decide if this is a good thing or a bad thing,” Morse said. “One of the things we are trying to do within the university is figure out the message strategy. We need to get across that they should be paying attention to what’s going on but not be overly concerned. The reality is that for most of us, it’s not something worth staying up all night.”

Could it reach that stage? Evolving situation. No one knows.

Randi Hutter Epstein MD is a medical journalist who has written for The New York Times, The Washington Post, The Daily Telegraph and several national magazines. She is currently working on a book to be published by W.W. Norton about the medical and cultural history of childbirth.

More Dispatches on the swine flu epidemic:

Mexico flu deaths at 149 and rising

Swine flu virus spreads

Tracking the swine flu epidemic