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H1N1 Just Isn't That Scary: Why There's No Reason to Go Overboard with Swine Flu Hysteria

Just a few years ago, we wouldn't have known there was a "swine flu."

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Global deaths from malaria are estimated at 1.5 million to 3 million -- 2,500 times the projected toll from swine flu -- but you’ll never see breaking news about someone dying of malaria splashed across the bottom of the screen of a cable newscast.

Perhaps the most exaggerated fear is that humanity might face a repeat of the 1918 flu pandemic, which may have led to the deaths of as many as 100 million people worldwide. That is partly due to the genetic similarity of swine flu to the virus that caused the 1918 pandemic, and also because the 1918 "Spanish flu" emerged at the end of the (Northern hemisphere’s) normal flu season, and then re-emerged with deadly effect the following year.

But the comparison is nothing short of ludicrous -- the "Spanish flu" pandemic predated the advent of antibiotics and vaccines. What’s more, most of the deaths in 1918 are believed to have been not a direct result of the flu but rather of secondary infections -- primarily pneumonia. In the era of modern medicine, even a similarly virulent strain of influenza would lead to a small fraction of the Spanish flu's mortality, if it were to hit today.

None of this is to suggest that swine flu doesn’t pose any threat -- or that it’s 100 percent certain that it won’t mutate into something more dangerous. And any pandemic that causes people to change their behaviors can certainly cause huge disruptions to travel, trade and other activities that we take for granted.

But fear of a deadly pandemic is far more likely to cause real problems than the underlying disease.

In fact, that is exactly what has happened since the swine flu was first identified in 2008. Writing in the New England Journal of Medicine ( subscription required), Lawrence Gostin, a Georgetown law professor who specializes in public health issues, notes: "epidemics often bring out irrational fears and discriminatory behaviors among individuals and governments."

Citing Gostin, Bart Laws, a medical sociologist at Tufts University, listed just a few of the excessive reactions that followed the emergence of the flu last year:

  • China and Hong Kong quarantined travelers from North America, including 22 Canadian students with no symptoms, 300 guests and employees who happened to be in a hotel where a Mexican man was isolated, and everybody in Singapore who happened to have visited Mexico ...
  • "Social distancing" measures included closure of 700 schools in the U.S., disrupting the education of 245,000 children …
  • Numerous countries restricted travel to and from Mexico and banned meat from North America, causing economic damage. In fact, Mexico's GNP declined by up to 0.5 percent in a few weeks.
  • Egypt culled 400,000 pigs, an act of irrational discrimination against the country's Christian minority

On a somewhat lighter note, Reuters reported in May that "Afghanistan's only known pig has been locked in a room, away from visitors to Kabul zoo where it normally grazes beside deer and goats, because people are worried it could infect them with the virus popularly known as swine flu."


Fear Itself

Public-health experts have long understood that what differentiates a minor outbreak of disease from what they call a "catastrophic infectious disease outbreak" has as much to do with how society reacts to the illness as it does to the ease with which a pathogen is spread, its lethality or the existence of a cure.

Avoiding unnecessary and destructive panic depends on the quality of public-health officials' statements, the media getting the story right and the degree to which solid information is disseminated to health providers. 

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