Swine Flu, Where Art Thou
There’s a really interesting article on the front page (right now) of the New York Times about flu incidence rates across the country. For anyone who knows that flu incidence differs from state to state, county to county, city to city, and even neighborhood to neighborhood, this article will only surprise in how well it bears this maxim out. For everyone else, though, it’s a telling introduction into what flu planners, public health workers and PIOs have to deal with this season.
Flu is not like other public health preparedness topics. It does not plume and modelling its spread is notoriously difficult. An inefficient mode of transmission, combined with inconsistent replication does not make for a very linear progression of disease spread. Now add to that equation the idea that disease severity differs from person to person, ranging from hospitalized to any of a range of symptom presentations to essentially asymptomatic presentation, and you begin to get an idea of how hard it is to track flu. (That’s one reason why I’m so excited about Google Flu Trends – it allows people to self-identify flu symptomatology without forcing them to “commit to sickness” by going to the doctor’s office.
So, why is this important? Because with variability comes problems. In an athrax situation, everyone exposed has to take the same precautions; over time, while the danger to those exposed increases, the potential pool of exposed people decreases as the epidemiology of the situation improves. Same thing with a conventional attack: the number of exposed is finite, and the number of potentially exposed goes down over time. Flu situations are different, (especially mild flu situations), because too aggressive response seems out of place for a flu that, in the eyes of the public, isn’t that big a deal. Too timid a response, and you run into the same problem. (Not all infectious diseases are like this, a smallpox case could never be “under-responded to”
In a situation like ours, how do PIOs reconcile a national media that is pushing a “deadly flu” scenario, but there’s no flu in your city (like NYC, according to today’s article), and most of the country this past spring? How do you take years of pre-positioned message templates that spell out gloom and doom (mostly because of H5N1), and whip something together real quick, for a disease whose epidemiology changes daily, and for which CDC keeps changing their recommendations?