Philip Alcabes: My own advice is to stop worrying

Remember that even in the worst outbreaks most people do survive

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Sometimes worry seems to be integral to modern life. It's not hard to know why we worry about getting stuck in an airport when a flight is cancelled, acquiring a computer virus, or missing a bus. They're common enough eventualities, and they cost us. (We lose out on work time; precious files get corrupted; we're late for an appointment or school.) But how to explain worrying about flu?

It isn't that the current outbreak of swine flu is devastating. The 160-odd deaths to date in Mexico and Texas are sad, but we are accustomed to death in this dosage, especially if it's distant – we're unmoved by the 160 deaths that diarrhoeal illnesses cause among the world's poor children every 15 or 20 minutes. We're concerned about the two dozen deaths each week on Britain's roads, but not especially anxious that vehicle fatality will go out of control.

In part, we're no doubt influenced by epidemiologists' concern that, because many of the Mexican deaths were among young adults, the new flu strain might have pathogenic properties similar to the strain that ravaged the world in the infamous 1918 outbreak. But if we were influenced much by epidemiologists' findings, we would derive reassurance from the comparatively low rates of serious illness and death.

Only a small handful of the 160 cases of the new flu outside Mexico have been hospitalised, and almost all of the hospitalised cases in Mexico have been released. And, the flu death rate Mexico in the past couple of weeks, fewer than one death per million people per week, is several times lower than the death rate the US typically sees from flu and its complications every year. Furthermore, those deaths following garden-variety flu – 36,000 every year, by the Centers for Disease Control and Prevention's estimates – generally go unremarked in the public conversation.

The worry here comes from a few sources. One is the notion that this virus comes from pigs. Even people who aren't averse to eating pork sometimes find swine revolting – the very name "swine" has been a pejorative term since at least the Middle Ages; we often associate pigs with filth.

But the more powerful engines of anxiety have to do with how we think about disease in general today, and how we think about flu. We've become accustomed to linking all sorts of health problems with personal misdeeds. You will avoid contracting the Aids virus if you don't engage in "risky behaviour"; your kids won't get Lyme disease if you dress them in long trousers when they play on the grass and inspect them for ticks afterward; you won't get heart disease if you slim down and stop smoking, and you'll be less likely to pick up any intestinal bugs when you travel if you carry your own water.

These claims aren't frivolous – the point is that they serve to make us hyperaware of how we act when we hear about a disease threat. We think: am I doing everything I can to avoid it?

With flu, there's a particular anxiety. Since the 1970s, we've been trained by the medical and public health establishments to believe that a pandemic is inevitable. And however the speaker defines the word "pandemic", it is always loaded. It alludes to the great flu disaster of 1918, when tens of millions of people died worldwide, including more than 200,000 in Britain and half a million Americans.

It became more anxiety-provoking in the context of the previous US administration's "biopreparedness" campaign – which began in response to newly emerging infections and was preoccupied with the possibility of "bioterrorism" in 2002, 2003 and 2004. By 2006 or so, helped along by concerns over avian flu, the preparedness campaign had turned its attention to flu and the supposedly inevitable pandemic. Similar pandemic plans were prepared in the UK and Europe, largely out of the fears over avian flu three years ago.

Much planning and capacity building went on in those years, from which the public will likely reap a benefit in terms of reduced rates of illness (including flu, if this outbreak expands). But separate from its public health planning function, the preparedness campaign also served to sensitise us to the possibility that a terrible flu outbreak would one day harm everyone.

In a sense, our worrying nature was ready for this outbreak, all set to pounce on it once it was announced. It became easy to see the outbreak as evidence that all those dire fantasies prompted by years of official-agency-induced anxiety about foreign-looking terrorists with microbe bombs weren't fantastical at all. There was the "swine" name; there was its debut in a foreign land (and one with which US foreign and domestic policy has been concerned for some time), and there was its resemblance to the 1918 virus. Our anxieties were awakened, and charged up.

What should we do now? Stop worrying, for a start. There's not much you can do about this outbreak as a private citizen. Wash your hands thoroughly; stay home if you're sick – the sort of thing your mother probably told you to do when you were in school anyway. Trust in the public health establishment, which has been very good about identifying and controlling outbreaks and has long experience with flu. And remember that even in the worst outbreaks, most people survive. Yes, the 1918 flu killed 200.000 Britons. That means that 99.4 per cent of the population survived.



Philip Alcabes is the author of Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu (PublicAffairs, 2009). He is associate professor of urban public health at Hunter College, City University of New York

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