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The Problem with a Pandemic

March 15, 2009

bullhorn I’ve been thinking about pandemic influenza a lot lately. Between the GAO report (pdf) on state panflu plans and the flu-bie folks on Twitter, it seems like the subject keeps popping up.

As we do so often in our culture, I’ve been trying to figure out what it’d be like, both to help me plan and because we like to think of terrible things and watch car crashes and the like. One of the prime candidates for a pandemic these days is, as I’m sure all of my readers know, the strain circulating in southeast Asia, north Africa, and some of Europe–H5N1 highly pathogenic avian flu. If you’ll allow me, please follow along on a little trip inside my mind, into the future.

Please understand that this is total supposition, not medical advice, and fraught with assumptions. I don’t know what’s going to happen, I don’t have any special insight, I’m just watching the car crash in my head.

Let’s say that a family in some southeast Asian country gets catches H5N1. All of them. It’s bad, and they go to the hospital. Then their neighbors come down with the flu and a couple of them die. Then a couple of the hospital workers get sick, too. The CDC and WHO determine that the cases are epi-linked and we’re in go time, we’ve got a real person-to-person H5N1 cluster–and it’s growing. Contact tracing and ring prophylaxis are instituted too slowly and the disease is spreading in the community. CDC and WHO dump oodles of antiviral medications into the country and the world sits up and takes notice. I mean all over the news–folks in Peoria and Harpers Ferry and La Jolla learn the names  of the hospital workers who were infected and know exactly who they are when the 11 o’clock news says they died.

And this is why I’m bad at this whole “walk through the disaster and make a plan for it” exercise. See, I get caught right here. The flu’s not even in America yet and I see a huge problem. My problem is that even though it’s still in some ramshackle little town in southeast Asia, but to the American (and maybe all developed countries, I don’t know) public, it’s already here.

Spurred on by near constant reporting and repetition and dire warnings from world authorities, the federal, state and local governments, people will start acting like it’s here. And that’s a good thing and a bad thing. As health authorities (if you’re reading this, you’ve been deputized), it gives us a great teachable moment. We can start some of the less stringent non-pharmaceutical interventions immediately so that when the flu does get here, it’s not a radical change to ask folks to cover their cough, or stay home when they’re sick, or wash their hands, or for businesses to set up tele-commuting policies (as an aside, I think we’re–yes, you, too–doing a terrible job at starting this process now). The bad thing? Over-reaction, then weariness.

The vast majority of folks will do great and will totally buy into this and will be our partners. People would stock up on food and medication and meet their neighbors and learn about infection control and generally be great. Some folks would go totally overboard, of course, but it’ll basically be a huge turn-out for the flu. The problem is that, well, we’ve seen folks get tired of hearing certain messages and start tuning them out. As communicators, we’ve got to understand that the first cluster does not mean the end of the world. Think back to your health theories class in college, not everyone is at that fevered pitch yet, but I’m sure we’d start spitting out material that assumes everyone’s there. Then, we’d wait two months or so for the flu to start showing up in US cities, and everyone would yawn and gripe about public health blowing things out of proportion again. Of course, then everyone would get sick, and we’d be caught on our heels again.

So, how to we avoid this? As a smart and savvy health communicators, how do we plan to bring people up to speed without making them think the world is ending? How do we make the public into partners? I’d argue that we should start today with broad-based and constant social marketing campaigns that talk about how folks can stop the annual flu–and the pandemic one–all at once! Then bring them into the planning process and have them be part of the response.

But, that’s just my take. Anyone else have any ideas?

Great photo by aisipos.

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6 Comments leave one →
  1. March 16, 2009 6:33 am

    The better plan is to start people stockpiling food and supplies now. If we wait until the “announcement”, the Just in Time delivery system will collapse under the weight of millions of Americans rushing to buy. Shelves will empty in a heartbeat and then we will first see panic… before the virus is even here. Well, in all likelihood, by the time we get the warnings, it will be here already.

    • March 16, 2009 12:32 pm

      I have no problem with folks stocking up, in fact there’s some great groups doing yeoman’s work on that front (see ReadyMoms Alliance, for example). The problem is that, especially in today economy, not everyone can have months worth of food sitting on their basement–if they even have a basement!

      From a preparedness planners perspective, that’s a message that should be included in a raft of messages that’s focused on disease mitigation (we are, after all, public health).

      Thanks for stopping by!

  2. aurora permalink
    March 17, 2009 12:51 am

    We may very well not have any advance notice.

    There are a lot of significant things that have happened or are happening in Indonesia – things that are not showing up in our media. There are human-to-human cases, clusters that include health care workers, a Tamiflu blanket over an entire island.

    Someone could easily travel during the time when they are infected but not yet showing symptoms which means that we could wake up one morning to cases in New York, Los Angles, etc.

    • March 20, 2009 5:13 pm

      Oh definitely. To be completely frank, the next pandemic could be circulating in a herd of swine in South Carolina right now! In which case, all of our worry about H5N1 high path is moot.

      This post was really little more than a thought experiment. A “suppose if,” if you will. I agree wholeheartedly, and would be utterly surprised if the real event unfolded like this.

      Thanks for stopping by!
      -Jimmy

  3. April 14, 2009 6:53 pm

    Greetings! Thank you for your kind words regarding the work that we are doing via our ReadyMoms organization.

    We all need to be aware of the impact a potential pandemic will have on the lives of our children. The best thing that every family can do is to begin preparing their households NOW. Waiting for news of a pandemic’s start will be too late. Times are difficult for many, given our current financial climate, but utilizing sales, coupons and small additional purchases during your shopping trip will all add up to help increase your pantry stock. Unfortunately the financial leisure that many have had the past several years may no longer be available, but that should NOT deter folks from starting to build their pantry stocks.

    There are many things that can be done to begin home preparation and the ‘Get Pandemic Ready’ website is highly recommended to get this process started ( http://www.GetPandemicReady.org ).

    For anyone who is willing to share pandemic home preparation information within their community we encourage you to go to our ReadyMoms Alliance website and download any of our FREE materials to use in building your own community display (www.ReadyMoms.org ). There is a ‘donate’ button on our site if you would like to help us keep promoting pandemic awareness & preparation [wink].

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  1. Communicating in a Pandemic « In Case of Emergency

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