Thursday 30 April 2009
Deborah Orr: We need to be inoculated against outbreaks of panic
There is no reason to imagine that this flu is any more dangerous than any other flu
The pork industry is not keen on the name "swine flu" because it fears that it will be bad for its image. Its fears are not groundless. Ten countries, including China and Russia, have now banned the import of pork products, even though the World Health Organisation advises that you can't get H1N1 from eating bacon. Egypt has even ordered a cull of all the country's pigs. Presumably, in a Muslim state, there aren't so very many pigs, and people aren't going to be that upset about them dying in a rhetorical gesture.
Mexican flu, the obvious alternative, is disliked by Mexicans, because it is felt that this stigmatises the whole country. Some Mexican politicians argue anyway that H1N1 originated in Asia, then spread into Mexico via the US. The US-owned, Mexican-based pig-farm at the centre of the story insists that neither any of its staff nor any of its livestock has tested positive.
The plausible theory that H1Ni originated in Mexico is still just a plausible theory. One expert sympathetic to Mexico's worries about blame has suggested that the new strain should be called novel flu. No one involved in the production of literary fiction has baulked at the title, which is a good sign, although it doesn't solve the problem of what to call the next new flu. Meta-novel flu, perhaps.
No, that won't do. This flu, after all, has achieved the quality of a meta-novel already, one that is being written and re-written in all its possible permutations before anyone even knows how the real story will unfold. The absurdity of such an approach was summed up on Tuesday night, on Newsnight. If swine flu "cannot be contained", an authoritative-sounding voice asked, "how can we stop it spreading?" By re-phrasing the question, let's hope.
"We", of course can't "stop it spreading", not at an individual level, until we catch swine flu ourselves. Then we can stay home till the ambulance comes, hoping that our own experience of the illness will be mild, and that we are not responsible for passing the virus on to somebody who is more vulnerable. (This probably isn't the time to remind people that their babies should be immunised against such things as measles, mumps and rubella for similar reasons, but I'm going to anyway.) As yet, barely anyone on the planet has a personal interest in this story.
It is still a prurient global spectacle centred on a small number of individual and far-off tragedies. Even the panic-stricken media coverage has driven only a small number of people to seek medical attention. Weirdly, even some of those with good reason to be worried (like a recent trip to Mexico) were advised to go to their GP, trailing their possible infection with them.
One GP, in Clapham, South London, has told the press that he is in no position to deal with such patients, even though he has had one and is waiting for her test results. He has been given no anti-virals to take himself, is in contact with other patients all day, and none of the local pharmacies have any Tamiflu to supply to patients with prescriptions anyway.
Amid the huge effort to get every detail of this narrative out to the public, there seems to be a gap. No one is telling doctors what to do. Governments are concentrating on talking to the public, via the media. In Britain the government may not be slaughtering pigs. But the huge fuss they are making about "reassuring the public" is a sophisticated version of the same sort of thing.
In part, the great gush of information about this barely nascent new take on an old illness is an impressive consequence of the match-fitness of the international structures that exist to control disease, and also yet another reminder of how astonishingly quickly information can be disseminated around the world.
Mostly, however, it's yet another dreary confirmation of how media organisations love to turn concern into panic into audiences into profit, and how governments, when they see a big running story, want to position themselves flatteringly and busily at the heart of it, when the people at the heart of it really ought to be health professionals.
You wouldn't know it from the already feverish speculation, but there is no reason to imagine that this flu – and 36,000 people a year die of flu on average – is any more dangerous than any other flu. For Britons, in the short-to-medium term, this means a different winter flu shot to the one that vulnerable people already get, and a few other simple precautions. As Michael O'Leary of Ryanair so robustly put it, "the slum-dwellers" are the people at real risk.
Nevertheless, I am interested to note how fears of "beggar-my-neighbour protectionism" melt away when that scary consequence of "globalisation", the pandemic, kicks its way into the global bar-room. Despite warnings from more authoritative figures than Mr O'Leary that it is the poorer countries that will really suffer if this strain of flu turns out to be notably virulent, governments of the developed world are making strenuous efforts to protect their own citizens first.
Those with the money are ensuring that they have enough vaccine, that they have enough effective masks, or that they have, in Britain's case, a comprehensive leafleting campaign and lots of television advertisements. Brown might not be able to save the world on this occasion. But he can save Britain, whether it turns out to need saving, or not.
Yet shouldn't "we", at present, be trying to work out how best to distribute as many of our stocks of vaccine as we can reasonably spare to Mexico, Brazil, Peru and Guatemala, the nations that already are looking most susceptible, instead of working hard at getting our mitts on more? The global effort to stop a pandemic seems political more than practical.
There are as yet unconfirmed reports in Mexico of three doctors dying after treating infected patients. In La Gloria, Mexico, where the outbreak is believed to have started, residents say they have been fighting the disease for months. It's horrible, the sight of ordinary Mexicans trying to "keep calm and carry on" in face-masks that we have already been told in Britain are useless. It certainly puts California's state of emergency, now that it has 13 cases, into some perspective.
As I write the World Health Organisation has not yet decided whether it agrees with California's Governor Arnold Schwarzenegger that 13 cases comprises "sustained community-level transmission", which will notch the alert system up to "five".
When the WHO's emergency committee earlier this week graded the risk of a pandemic at an "unprecedented four", it also had to explain that its system only went up to six. Five indicates community-level transmission in more than one country, while six implies a global pandemic in more than one continent.
More puzzling is phase one of the alert-level scale which signals that "no animal influenza viruses circulating among animals have been reported to cause infection in humans". The WHO advises that in a phase one situation, as well as in a phase two or three, countries should "prepare the health system to scale up". In other words, official advice is to live constantly in fear.
I don't think this is official advice that "we' should take. In the developed world the hard work of gifted scientists will bring a new flu pandemic under reasonable control, as long as government lets it. The hype, like a package trip to Mexico, is just a cheap holiday in other people's misery, but without the much needed benefit to the local economy. As a spectacle it is not at all edifying.
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