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Robert Lamberts, MD  
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Influenza, Terrorism, and Pediatrics

May 17, 2009 - 4 comments
Tags:

swine flu

,

pandemic flu

,

Influenza

,

Flu

,

H1N1



Before you get too “conspiracy theory” on me, let me assure you that I am not going to talk about how the influenza virus pandemic is the work of terrorists (unless the Napoleon and Snowball are trying to take over our farm).   I am also not suggesting that children are terrorists (although some do raise my suspicion).

The virus that brought such worry and even panic seems now to be “fizzling out” and people are now questioning if the authorities and the press overreacted to the threat.  Will this be a replay of the “boy who cried wolf” and have us complacent when a real threat comes?  One writer questioned if the flu “overreaction” was “more costly than the virus itself.“  Another article cites an Australian professor (of what, the article did not say) who stated that “the country would be better off declaring a pandemic of some of the real health problems it has, like diabetes and obesity.”

The real din, however is in the countless letters to the editor and calls to radio talk-show hosts mocking the “alarmism” put forth by the WHO and others about this flu.  This does appear to be in the minority, as one poll said that 83% of Americans were satisfied with the management of the outbreak by public authorities.  Still, I suspect the volume of the dissent and sniping at the non-serious nature of the pandemic so far will only increase over time.  The number of people who know better than public health officials will multiply.

This pandemic is a catch-22 for public health officials, as an excellent article on the subject states:

    "The irony is that the overreaction backlash will be more severe the more successful the public health measures are. If, for example, the virus peters out this spring because transmission was interrupted long enough for environmental conditions (whatever they are) to tip the balance against viral spread, CDC and local health officials will be accused of over reacting."

Which brings me to the connection to terrorism.  If public authorities somehow thought there was a 10% chance that New York City would be hit with another major terrorist attack, how big should their reaction be?  If they suspected that there was a reasonable probability, say 5%, that the subways would be flooded with sarin gas, should they shut them down?  I would certainly hope they wouldn’t leave that many people open to the chance of death.

And what is the best outcome?  The best outcome is that this is an overreaction.  The best outcome is that the terrorists, in fact, have reformed and are instead joining the Professional Bowling tour.  I would welcome this outcome (not to mention the exciting infusion of young talent to the tour).  The problem is, the officials have no idea how it will play itself out.  Truth be told, since 9/11, there have not been any major terrorist attacks in the US.  Does this mean that the money spent on the department of homeland security has been wasted?

As a pediatrician, I am very accustomed to overreaction.  If you bring in your 20 day-old child to my office with a fever of 102, I will do the following:

   1. Admit them immediately to the hospital
   2. Draw blood tests looking for serious infection
   3. Check a urinalysis to make sure there isn’t an infection (using a catheter to get the sample)
   4. Start IV antibiotics as soon as possible
   5. Perform a spinal tap to rule out meningitis.

This seems a little over-the-top, doesn’t it?  The child just has a fever!  The problem is that children this age with a fever caused by a virus look identical to those who have meningitis.  By the time their appearance differentiates, it is too late.  This forces me to do the full work-up on every infant with fever and treat each one as if they have meningitis or some other serious infection.  I do this despite the fact that the cases of meningitis are far outnumbered by that of less serious problems.

If this is your child, don’t you want me to do that?

Knowing what we know about pandemics, the same caution was, in my opinion, absolutely the right thing to do.  If the virus turns out to be nothing serious, hallelujah.  I don’t want my patients (or family members) dying at the rate that some of the previous H1N1 viruses caused.  I want this to be a lot of worry for “nothing.”  Please let it be so.

But I still don’t think it is time to relax.  As one commenter on an earlier post I wrote about this pandemic stated:

    "It’s still a bit early to relax. The 1918 flu went around first in the spring and was very mild - kinda like this. Then it came back in the fall after incubating and mutating and was a killer.

    I think the CDC and WHO probably will be concerned about this until next year, at least. Just to be on the safe side."

Remember that that flu, which was mild in the spring, went on to kill 20-100 million people.

For this reason, I hope the voices of reason win out over the armchair quarterbacks that don’t have to make these decisions that could mean the life or death of millions.  Will you tell me that evacuating the NY subways wouldn’t be a good thing on the threat of Sarin gas?  Would you criticize me for “overreacting” if your infant with a fever turned out to just have an upper respiratory infection?  I hope not.

If you would, then that gives us ample reason to ignore your opinions on how this flu was handled.

*This blog post was originally published at Musings of a Distractible Mind*

Comments
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by margypops, May 18, 2009
Great post Doctor Lamberts,,I agree with you it was not over reaction we need to always be aware  ,our borders wrent shut ,I live 70 miles from one and all the sick folks wre coming in to the hospitals ,clinics, stores I would have preferred our Leader to have shut down the border for a short time to protect us, and these folks all got free care the rest of us if we got the Flu are still paying..

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by teko, May 18, 2009
I think it was handled exactly as it should have bee, but like Margy, would have felt better if the borders had been closed. Just in case. Some people liken it to the animals are already out of the barn so why close the door. My response would be to keep the rest of them in. lol

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by BaronMunchausen, May 18, 2009
What people don't understand is that a seasonal flu.. most people have a natural immunity. Only 1 in 5 will catch the illness. A Pandemic, no one has any natural immunity. Should it mutate into a much more lethal form it would be deadly.

My only concern is that America is incredibly unprepared for a serious outbreak of any pandemic.

Compare the budget for say, America's CDC to England's equivalent and you see a huge disparity in the budget we (America) has assigned, considering population and country size.

Also, we lack a "socialized" public health care system.

In the case of a Pandemic, a National Health Care System would be the optimal way to see that the needs of the populace are met. Under our current HCS, the losses in American civilian Lives would be tremendous due to the lack of available easily accessible services.

As a rough guess I'd say we'd lose civilians at a rate of double or triple that the U.K. would (lose, as in death).

Lets face it; we got lucky.

So far.



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by jps1964, May 18, 2009
I want to commend the CDC and public health officials -- they actually made every effort to put RELIABLE information out there. I work for a health care quality improvement organization, and we were asked by CMS to post links to the CDC's information and not to speculate or dispense our own "theories." We did exactly as asked, and the information provided seemed to be balanced and commonsensical. Most of the measures that can protect us from a pandemic are a good idea in the absence of one, as well.

However, I do have a problem with the way the media handles these threats, and with the fact that many organizations saw this potentially serious threat to public health as a chance to "get some ink" and establish themselves as the self-proclaimed experts. That is NOT the CDC's fault. They did their job. But for two or three days, CNN became the swine flu network. That truly was sensationalistic and unnecessary -- and, in my opinion, self-defeating. People were running to the pharmacy here in Arkansas and demanding Tamiflu from the doctors -- before we even had one case of swine flu! (We've now had six reported.) Anyone who demands an anti-viral drug when they're not sick, "just in case" -- and any doctor who writes that prescription -- ought to be prosecuted. Those drugs will be needed to slow or prevent spread if this virus or some other bug does get completely out of hand before we have a vaccine.

And, for the record, ignore my opinion if you must, but no one can take away my right to have one, even if all I have is a puny little bachelor's degree in journalism. I'm no MD, but I know irresponsible journalism when I see it.

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