Lessons from Swine Flu, Year One

By Matthew Harwood

On the first anniversary of the first fatality from swine flu, an infectious disease specialist discusses lessons learned from a still mysterious virus on today's The New York Times op-ed page.

The first thing to note, argues Richard P. Wenzel, a professor of internal medicine at Virginia Commonwealth University, is that how one looks at the H1N1 flu virus depends on where they live.

"Those who describe the pandemic as mild base their conclusion primarily on what, at first, seems like a mortality rate in the United States similar to those seen after seasonal influenza," he writes. "But my colleagues in developing countries would strongly object."

Wenzel then goes on to list the lessons governments and the public health community should take away from swine flu's first year.

Resources matter. Developing countries, such as Mexico, suffered more than developed ones, like the United States. Although not enough Americans received the swine flu vaccine, U.S. vaccination rates dwarfed those of the developing world. Wenzel notes that only 26 of 94 poor countries in need of the H1N1 vaccine have received it so far. (Even though the United States received a good portion of the world's vaccine supply, anecdotal reports showed great anger and fear over the shortage.)

Optimistic infection rates. Swine flu infection rates were worse than documented, writes Wenzel. "Whereas doctors associate fever and cough with outbreaks of influenza, one-third of patients admitted to hospitals and up to half of infected outpatients in this pandemic had no fever, yet they were infectious." This means that the number of infected were much higher than previously thought. A British study last month found that one in three children surveyed had swine flu antibodies in their system—an infection rate 10 times higher than what clinical surveillance estimated. 

Ill-Informed, Contradictory Recommendations. Sometimes public health organizations issued bad recommendations due to a false understanding of the virus. The Centers for Disease Control and Prevention (CDC) told parents it was okay to send their children back to school a day after their fever went away. Infected children, however, are contagious for up to 3 weeks while adults remain contagious for 5 to 7 days.

In another example, Wenzel points to the contradictory recommendations for protective gear. While the World Health Organizations and the Society for Health Care Epidemiologists of America said surgical masks adequately protect against the H1N1 virus, the CDC said the N-95 respirator mask was the best protection.

♦ Public Health Over Profit. Public health officials and experts need to have the public's best interest at heart. Wenzel applauds Mexico for announcing a public health emergency, regardless of its economic impact. "Mexico's transparency was a policy decision made with full recognition of the unfavorable economic consequences from H1N1, now estimated to have cost almost 1 percent of the gross domestic product."

Wenzel's argument is simple: public health experts and officials need more modesty when publicly discussing disease and issuing recommendations. "It is not an easy task, but our public health authorities need to become clearer about the lexicon of uncertainty—what they know and don't know about a pandemic."

 ♦ Photo by Ben Chau/Flickr


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