Despite a few missteps, reaction to potential pandemic was on target

Just when you thought the swine flu epidemic was going to be the story of the decade, the saga appears to be coming to an end.

Sure, there are still new cases being reported around the world. And the focus of monitoring for any nasty mutations in the swine flu virus is shifting to the southern hemisphere, where winter — flu’s favorite season — is about to begin.

Still, it seems fairly certain that the spread of the H1N1 virus is not nearly as fast, pervasive or lethal as had been feared. The time for Monday-morning quarterbacking has arrived: Was the swine flu pandemic just a lot of hype or did the world mount a credible response to a very real threat and tamp it down?

There certainly were elements of hype in the media tsunami that accompanied the first reports of deaths in Mexico from a mysterious new flu. Few in the media clearly stated that the World Health Organization’s six-stage pandemic flu scale alerts have much more to do with the spread than the intensity of the epidemic.

And, sadly, the outbreak was used as excuse for racism, including calls to arrest all Mexicans living illegally in the United States and China’s detention and quarantine of persons with Mexican passports — many of whom had not been anywhere near Mexico in years.

But overall, the resources, attention and response to the H1N1 swine flu outbreak have been absolutely appropriate.

Mexico was slow in responding to the new virus. Once it got its act going, the Mexican government did an impressive job of communicating to the public, encouraging flu-killing behavior like hand-washing and banning large public gatherings. We all owe a debt of gratitude to Mexico for slowing the epidemic down enough to let the rest of the world respond.

The U.S. government, Canada, New Zealand, the European Union, WHO and many other governments and institutions did a good, hype-free job on a number of fronts.

They got the word out about hand-washing and coughing into your sleeve, staying home if sick and keeping an eye on people who might be ill at school or on a plane.

Stored supplies of antiviral drugs were moved quickly and showed some impact against the virus. Gene hunters nailed down the makeup of the new virus rapidly. Cases from around the world were reported to CDC and WHO, permitting reasonable tracking of the disease location, those affected and the impact of treatment on those who did catch the virus.

The media — print, Internet, television, radio — all pounded home the proper messages: Wash your hands, stay away from sick people, don’t panic. They never did figure out what to say about masks but, that flub aside, they really did a credible job educating the public about a fairly complex story.

What are the take-home lessons from the great swine flu scare of 2009?

First, there will be other viruses. This strain has not shown the lethal power that public health officials feared. Another strain might. And more are coming. Viruses don’t lollygag.

Second, we need better worldwide surveillance of deaths and outbreaks. The virus got started in Mexico because few expected an outbreak there, the local authorities were distracted by a ferocious drug war and it’s likely unsanitary practices were allowed to flourish at large pig farms.

There are still places in the world where viruses can get a foothold without anyone knowing until it is too late. That number must be reduced to zero.

Third, we don’t have enough capacity to make flu vaccine. This is in part because we don’t take plain old, seasonal flu seriously despite the fact that it kills a half million people worldwide every year.

Most of those deaths are preventable with flu shots. Too many people — including doctors, nurses and nursing home aides — don’t get them. If everyone were vaccinated, we would have to make more ordinary flu vaccine. Then, when a really nasty new virus showed up, we would have enough capacity to make a lot more swine or avian flu vaccine because the same factories produce both seasonal and targeted vaccines.

Finally, we need to be ready to coordinate our pandemic plans. A few plans were trotted out by various companies, counties, provinces, states, governments, agencies, institutions, hospitals, professional associations and schools. The problem? They’re not all on the same page. In the event of a widespread, deadly outbreak, they must be in sync.

It is easy to yell “hype” when this pandemic seems to be a bit of a fizzle. Think again. A fairly good worldwide response in terms of action and communication should make us all feel a bit less worried when the next viral mutant appears.  And important lessons were learned — we can do even better next time.

Amid swine flu outbreak, racism goes viral

“No contact anywhere with an illegal alien!” conservative talk show host Michael Savage advised his U.S. listeners this week on how to avoid the swine flu. “And that starts in the restaurants” where he said, you “don’t know if they wipe their behinds with their hands!”

And Thursday, Boston talk radio host Jay Severin was suspended after calling Mexican immigrants “criminalians” during a discussion of swine flu and saying that emergency rooms had become “essentially condos for Mexicans.”

That’s tepid compared to some of the xenophobic reactions spreading like an emerging virus across the Internet. “This disgusting blight is because MEXICANS ARE PIGS!” an anonymous poster ranted on the “prison planet” forum, part of radio host and columnist Alex Jones’ Web site.

There is even talk of conspiracy. Savage speculated that terrorists are using Mexican immigrants as walking germ warfare weapons. “It would be easy,” he said, “to bring an altered virus into Mexico, put it in the general population, and have them march across the border.”

As more than 140 cases of H1N1 virus, known as swine flu, have been confirmed across the United States — from San Diego to New York City — the growing public health concern has also exposed fear and hate.

Fear and blame are counterproductive and even dangerous in any disease outbreak because the more stigmatized any group feels, the more reluctant people in that group may be to seek medical care. That only helps propagate the disease.

The attempt to scapegoat Mexicans, immigrants and Hispanic Americans is no surprise to Latino rights groups, who are now mobilizing a countereffort.

‘Ignorant beyond the pale’
Angelica Salas, executive director of the Coalition for Humane Immigrant Rights of Los Angeles, called such comments “racist and ignorant beyond the pale … these so-called commentators shame themselves turning public health concerns into an immigrant bashing fest.”

“What we have seen is that the anti-immigrant groups are using this to shamelessly to promote their agenda,” said Liany Arroyo, director of the Institute for Hispanic Health at the National Council of La Raza.

While the war of words is mainly between the conservative commentariat and Latino advocacy groups, individual Mexican-Americas are beginning to worry.

“Our people are calling us and they are concerned,” said Florencia Velasco Fortner, chief executive officer of Dallas Consilio of Hispanic Organizations, an umbrella of affiliated service groups. “Even our staff members are starting to get a little discouraged. There was anti-immigrant sentiment prior to this and this adds fuel to the fire.”

The Consilio has mounted its own education campaign to teach Dallas-area Hispanic audiences proper disease prevention and hygiene techniques. Because many are uninsured and may avoid seeking medical care, the Consilio is also helping them find non-profit clinics and encouraging them to visit these immediately if they develop symptoms rather than waiting until they are severely ill.

As swine flu fears have spread, the backlash has also affected some Mexican restaurants’ business, possibly fueled by disparaging comments like those of Savage questioning the hygiene of workers.

Jennifer Pesqueira, whose family has owned and operated El Indio Mexican restaurants in San Diego since 1940, said her business has seen a 20 percent drop in business since the outbreak began.

Activist groups have advised their communities to be aware and on guard. “Board members put an alert out,” said Jan Hanvik, executive director of Clemente Soto Velez Cultural and Educational Center in New York. “It was a heads up, saying ‘pay attention.’ ”

Blaming ‘the other’
Fearmongering and blame are almost a natural part of infectious disease epidemics, experts say.

“This is a pattern we see again and again,” said Amy Fairchild, chair of sociomedical sciences at Columbia University’s Mailman School of Public Health in New York City. “It’s ‘the other,’ the group not seen as part of the nation, the one who threatens it in some way that gets blamed for the disease.”

Often, a disease outbreak is an excuse to vent pre-existing prejudices. “It’s fear of people we do not know or who look different,” said Dr. Howard Markel, a medical historian at the University of Michigan and author of “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed.” “You take the fear of the unknown that already exists and then combine that with a real or perceived threat that is contagious disease and it’s explosive.”

During the medieval Black Plague, Europeans blamed Jews, saying they poisoned the wells. In an 1892 cholera pandemic, the U.S. blamed immigrant European Jews. In the flu of 1918, Markel said, “Italians blamed the Spanish. The Spanish blamed the Italians. For HIV it was gay men and Haitians.”

Americans “have a history of trying to keep ourselves ‘pure,’ ” Fairchild explained. “You saw it after the Civil War when slaves were denied citizenship, in the late 19th and early 20th centuries when we were alarmed over southern and eastern European immigrants. There were fears that they would pollute America’s germ plasm, make us a weak nation of imbeciles.”

Americans have time and again responded to emergencies by clamoring to shut the borders and pull up the bridges.

“I’ve blogged for years about the spread of contagious diseases from around the world into the U.S. as a result of uncontrolled immigration,” conservative columnist Michelle Malkin wrote on her Web site. “9/11 didn’t convince the open-borders zealots to put down their race cards and confront reality. Maybe the threat of their sons or daughters contracting a deadly virus spread from south of the border to their Manhattan prep schools will.” (The cluster of New York school students who first contracted H1N1 brought the virus back from Mexico. The school is in Queens.)

“People who do not really know anything are creating ideas that don’t really exist,” said Sergio Ornelas, owner of a bi-national publishing and advertising business in El Paso. “I am worried these kinds of articles and comments might create panic.”

Fighting racism with information
Blame-the-victim reactions can be fought with clear, accurate information about the disease and about how it is spreading, said Dr. Larry Kline, a San Diego physician and member of the United States-Mexico Border Health Commission. “People get snippets of information here and there, and unfortunately much of it is inaccurate. That makes things ripe for blame and blame and fear never helped anybody.”

Tamping down blame and fear isn’t just the right thing to do morally, experts agree, it’s also the right thing to do medically. Germs, Markel stressed, don’t care about skin color or national origins or borders.

“These are naturally occurring events,” he said. “We expect flu pandemics every 30 to 40 years. It’s the cost of living in a world of emerging infectious diseases. That’s the folly of prejudice. They are wherever humans are.”

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