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The Swine Flu Pan(dem)ic

Posted by kostub on August 18, 2009

It has been almost two weeks since the first casualty from of the swine flu was reported in India [1]. Ever since, Pune (the city which reported the first casualty) has been gripped in extreme panic. Many public places like schools, gyms, theaters and markets were closed for extended periods of time. The amount of traffic on the streets decreased significantly and every person was wearing masks [2]. Was this kind of panic warranted [3] ? What caused it and what is the outcome that we could expect from this?

Swine flu or H1N1 flu was first detected in Mexico in mid-April [4]. Initially a wide number of cases and casualties were reported and there was a general cause for concern amongst visitors to Mexico. I was in Seattle at that time and one of my colleagues was in Mexico on vacation. When he came back we even quarantined him for a week from work to prevent any of us from getting infected. In less than a week the infection had however spread to the US. Many reports indicated that the flu affected healthy adults and humans did not have natural immunity to it [5]. However, within a couple of weeks it was realized that the fear was not as grave as what a was expected. Most of the symptoms were mild and most people recovered without any treatment. The number of deaths in Mexico were retracted and slashed by more than half [6].

The one thing I observed during this whole episode was that the typical American I interacted with was not too concerned about swine flu. Note that the demographic I interact with is a urban, highly-educated, working professional – so I cannot say what the reaction from a average American would be. There were definitely school closures in Seattle, and doctors and teachers were worried, but nothing amounted to outright panic. The general perception from the Indian American community was that Americans as a species, get scared very easily and the media coverage is causing an unnecessary concern. Most people were of the opinion that you would never see such kind of panic in India as Indians have seen all sorts of diseases and a simple sneeze or flu is not going to faze them. How wrong they were.

I arrived in Pune on Aug 7th. This was just a few days after India’s first death from swine flu. Since then to the time of writing the toll in Pune has climbed to be in the teens. The panic seen amongst the populace of Pune completely shocked and surprised me and it has far outstripped its counterpart in the US. If you just look at the whole episode statistically this panic doesn’t seem justified . There are far more infectious diseases in India than swine flu. Malaria and tuberculosis kill more than 1000 people in India per day [7].  On an average one person dies per day in a fatal road accident just within the city limits of Pune [8]. Yet far more people on the streets will wear H1N1 masks than helmets. When you question the same demographic that I questioned in the US (urban, highly-educated, working professionals) you can see that they are far more concerned than their US counterparts and when you ask them why, the typical response has been “oh so many people have died”.

In my experience, people in India have a callous attitudes towards safety. Many people ignore safety warnings and regularly flout seat-belt or helmet regulation. How did a society which did not care about safety suddenly become all to concerned with a disease that is typically mild and no worse than seasonal flu at best.  There are various factors which seem to have led to this – not the least of which is media hype [9]. Mass media has seen an enormous explosion in India the last decade. If you switch on the TV at any time you will find dozens of “news” channels which are broadcasting various sensational stories. This media took the swine flu hype to an unprecedented level – every single death was glamorized and multiple pages in the newspapers were devoted to articles describing these individuals and their deaths. Compare that with the first casualty in the US – I could not find any articles about the baby which died in Texas – except for mentioning that this was the first casualty. The media never dissected that case as throughly as has been done in India.

Another cause of the panic was the poor government response. Instead of trying to maintain calm and disseminating accurate information about the disease to educate people on prevention, the public officials were more interested in closing down the city [10]. And where did this whole mask meme come from anyway? The CDC advisory recommends masks for sick people to prevent the spread of the infection [11]. Whatever happened to maintaining basic hygiene and wash your hands with soap regularly – which was the advice given everywhere else [12]. And why were family doctors and private practitioners not involved in tackling the disease right from the start? All of the care was concentrated in 1-2 public hospitals. This caused tons of people to flock to these hospitals, generally overwhelmed the system and resulted in more panic. [13]. Of course the even political response in the US was not without its failings. After all, who can forget Joe Biden’s famous remark to stop traveling in planes [14]. The difference was in how people reacted. Biden was severely criticized by the media for inciting panic and resulted in an apology from the Whitehouse [15], whilst in India the officials were chastised for not containing the epidemic further by bringing the whole city to a halt.

After two weeks the panic in Pune seems to be abating – partly because of the newspapers having a holiday on Aug 15 and a few other headlines dominating the news, and partly because the there is only a small period of time in which the people can sustain this kind of panic. There is also some effect of many organizations calling for calm [16]. The media has also wizened to the effect it has had. Consequently, Bangalore which has the second highest number of swine flu cases in India is not gripped in such a panic [17]. Some cooler heads also seem to be prevailing on how how swine flu needs to be combated [18]. But this is definitely not the end of the story, there will be a lot more deaths as the number of people infected with swine flu grows and it spreads into more rural areas with limited medical facilities, and will India be prepared to handle it?

What can we glean from this panic [19], and what are the potential outcomes –

  1. India is definitely ensnared by mass media and has not developed a resistance to it like elsewhere in the world. Can this be harnessed for social good? If the media similarly concentrates on road accidents will we be able to make people wear helmets, make them aware of the dangers of drunk driving, discipline more bus drivers for rash driving and most importantly make the roads a safer place for everyone with a lot fewer casualties. You already see some media quoting these statistics [20].
  2. Would there be improved tracking and handling for other infectious diseases like TB and malaria? Can a government body like a CDC for India be set up. Experience has shown that simply tracking and measuring cases have led to efforts to reduce their causes. This would result in better health for everyone in India.
  3. Would there be an increase in public hygiene? If the government and media gave enough advice on how to maintain hygiene to reduce the incidence of swine flu this will have a substantially beneficial effect on other infectious diseases.
  4. Would the amount of government spending on public-health increase? India has very low spending on public health as a percent of GDP [21] as compared to other countries and most of this comes from private sources. Would the effort to tackle swine flu cause the government to up this spending and be able to incorporate private institutions in improving health of the general population in India?

All of the above happening it is clearly the optimistic scenario. The pessimistic scenario would be something like: People in India get jaded by the media response and the next time there is severe infectious disease will not respond adequately as required. Or even worse, the increased panic causes people hoard up on Tamiflu supplies, resulting in a rise in cost and shortage for people who actually need the medicine. Or the worst case, due to the large incidence of people taking Tamiflu because of the panic, the H1N1 virus mutates into a highly infectious strain which is resistant to Tamiflu and causes widespread deaths.

What will actually happen? Probably something in between the two extremes. But it is really hard to predict and one can only hope for the best.

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3 Responses to “The Swine Flu Pan(dem)ic”

  1. Nick Valen said

    I am in agreement that media and blogs like yours have played a vital role in awareness of H1N1 virus. Found an article which helped me in being prepared for the Swine Flu epidemic in a better way

    http://www.indierealm.com/2009/home-remedies/swine-flu-the-fad-about-n95-masks-and-respirators-vs-free-precautions/

  2. rocknroli said

    Actually, I think the reason the media attention has reduced is not because of August 15th but because Shah Rukh Khan was detained for questioning when entering US 🙂

    Nice article Kostub!

  3. Oliver said

    What will happen? More and more patients will start attacking the doctors, actually the WHO-swines with their lab-made virus and their deadly therapy! http://www.spkpfh.de/Criminal_charges_against_WHO_henchmen.htm
    http://www.spkpfh.de/Pathopractic_of_confrontation_against_vaccination_doctatorship.htm

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