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.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.