It Isn't a Mild Pandemic Anymore

[indigo girl]

Constant use of 'mild' to describe swine flu misleading people about threat

Written by: Helen Branswell, THE CANADIAN PRESS

http://chealth.canoe.ca/channel_health_news_details.asp?news_id=28382&news_channel_id=145&channel_id=145

Officialdom's mantra about swine flu - "it is overwhelmingly mild" - might seem incongruous if we knew the number of children, teens and young adults in ICU beds right now alive only because a breathing machine has taken over for their ravaged lungs.

The heavy reliance on the word "mild " could be creating a false impression of what is actually going on and what the world may face in coming months, some experts worry.

Peter Sandman, a risk communications guru from Princeton, N.J., suggests if authorities are trying to ensure people don't panic about the new H1N1 outbreak, they are concerned about the wrong thing."In North America, swine flu panic is much rarer than swine flu deaths," Sandman says."The problem isn't panic or even excessive anxiety. The problem is complacency, both about what's going to happen and about what might happen."

In many places, public health officials have bent over backwards to tamp down anticipated panic. The results? Within a few weeks, most people appear to be convinced the pandemic was (past tense) a non-event, a blip of flu activity over-hyped by the sensationalist media hoard. "When we're told that swine flu is mild, we don't think, 'It will infect a half to a third of the world population and kill a few million people, mostly young people, before it's over,"' says Sandman. "We think, 'It's like having a bad cold."'

And with this new flu, a small subset of people gets very, very sick. Their lungs are overwhelmed by an aggressive viral pneumonia one doctor described as looking like a "white out" on an X-ray. A number of hospitals are struggling to keep these people alive.Generally much younger than the typical hospitalized flu patient, many of these people have been on ventilators for weeks. And every day, officials in some part of the globe announce that a 15-year-old boy, a 24-year-old woman or an otherwise healthy pregnant woman in her third trimester has lost the battle.

"When you look at those things then you begin to say 'Well, is it really accurate, is it really fair to say that this is a mild phenomenon?"' says Dr. Keiji Fukuda, the World Health Organization's top flu expert. Fukuda and his team have been warning for some time that the unusual age pattern of severe cases, the odd out-of-season spread and the fact that the virus is killing some previously healthy young adults makes the term moderate a more appropriate severity assessment.

There still isn't a good estimate of the percentage of total swine flu cases that becomes gravely ill, or the percentage that succumbs to the virus's onslaught. Currently the numbers may seem small; 25 deaths in Canada, 127 in the U.S., 263 worldwide. (Swine flu has already beat bird flu in terms of death tolls.)

Some things are clear, though. Since most people seem to have no immunity to the virus - some people over 60 may have some - huge numbers will probably catch this flu over the next couple of years. In a relatively tight time frame, lots of people will come down with the flu - far more than would be seen during a regular flu year.

To understand that impact, think back to elementary school arithmetic. If the denominator (the total number of cases) gets substantially bigger, the total number of people falling gravely ill or dying (the numerator) will rise sharply, even if the proportion of severe cases (the percentage) doesn't change. And sheer numbers could make the outbreak get nasty, fast.

Several centres in North America are already struggling under the load of critically ill patients - and this is summer, the season when flu viruses don't transmit as efficiently as they do during the cold winter months.

"But if in fact we're stretching medical resources, particularly in the pediatric community now in many communities, people will start to die with higher frequency with the same disease spectrum if care is compromised and we can't get every kid on a pediatric vent(ilator)," Osterholm warns.

"Even if the disease severity doesn't change but this fall we see more people get sick at the same time, we're in trouble. Now, add in the potential for this virus to obviously change and cause more severe illness - I mean none of this is good. I don't know how we can sit here and say 'Oh, this is mild."'

(hat tip Avian Flu Diary)

[mama_d, BSN, RN]

A big thank you, indigo girl, for doing so much to keep us all updated!

I've been getting increasingly frustrated with the attitude of "it's all over and it didn't even start" that seems to be prevalent, even among the nurses where I work...where, as I've mentioned previously, we had a patient with no PMH die from swine flu.

I keep trying to tell people that we need to wait and see what happens in the fall, that we should be seeing the numbers drop, not increase, given that it's almost July...and no one seems to care. It's a big joke. Seems like the only people not laughing are the ID and pulmonary docs. At least my family is taking me somewhat seriously, and spreading the word to their families as well, especially those with young kids and immunosuppressed conditions.

Honestly, I hope it doesn't end up being a big deal in the fall, that I'll be able to look back on my fears and giggle about it. But until then I'm waiting for the other shoe to drop, and for the vaccine to be available.

[Girl Scout]

I met a career nurse who believes the pandemic is largely a propaganda machine.

[Katnip, RN]

I'm seeing the same laid-back attitude in a lot of people. "Well I don't know anybody who got sick" syndrome. A few people who are not in the business-internationally, as well-are listening to me. But my own family? Nope. Ah well. We're just going to have to fasten our seatbelts and be prepared.