Vice President Joe Biden has been roundly criticized for remarks he made on NBC’s Today Show concerning his level of concern over the burgeoning type A H1N1 influenza situation.
He is quoted as saying, “I wouldn’t go anywhere in confined spaces now,” in response to a question about what advice he would give a family member who was contemplating traveling to Mexico.
Good for Joe Biden. Neither would we.
Critical care physicians the world over who will be charged with caring for the sick and dying of this disease are feeling moistness around the collar when thinking about what possibly lies ahead.
The cold, hard fact of this newly emerging disease pattern is that no one knows the likely course of this pathogen. Scientists are mystified over several characteristics of this near pandemic, including why the infections in Mexico seem to be more lethal than anywhere else.
In an attempt to develop an understanding on the possible future events, scientists, government officials, and healthcare professionals are looking backwards in history – especially to the flu pandemic of 1918.
What is clear from a study of history of influenza is that non pharmaceutical interventions such as voluntary quarantine and social isolation were helpful in places they were deployed, both in lowering the number of infections and the number of deaths.
Histories of the 1918 pandemic such as John Barry’s The Great Influenzadetail the astonishing speed of the virus as it tore through the overcrowded barracks and troop transports of American soldiers being readied for WWI
Modern day epidemiological computer programs also provide rationale to avoid overcrowding whenever possible to lower the influenza infection rate.
What is also clear from a study of 1918 is that sound public health decisions were obscured by short term political and commerical agendas. Tens of thousands of Philadelphians died needlessly because public health and government officials ignored the public health catastrophe before their eyes so as to not disrupt commercial activity in the city.
From a financial and commercial viewpoint, Biden’s suggestion is inconvenient and, if followed, would no doubt cause damage to local economies, something that the federal, state, and local governments wish to avoid.
However, from a viewpoint of personal safety and health, they seem prudent. What is the reason not to avoid being in overcrowded spaces? Because people shed the virus and are infective for several days before showing symptoms, simply avoiding people that are obviously ill does not assure that a person will not contract influenza.
From the not so veiled criticism and backtracking of the federal government, it is clear the Obama administration felt that Biden’s obviously sincere worry was too strongly focused on preventing individual cases of influenza infection.
Correcting, balancing economic health and the safety and well being of the public will depend on the competency of the federal, state, and local governments in prioritizing these competing interests. The governments do not want to needlessly alarm its citizens but when is the policy of reasurance worth the risk of preventable illness and possibly death?
The question for the public will be how much trust it has in the government to get it right and effectively manage this crisis?
What is known now is that the global health alert network was slow to activate, with private companies whose business it is to monitor for global disturbances repeatedly contacting the World Health Organization and the Centers for Disease Control and Prevention to spur them to action and public notification.
The “health authorities” were asleep at the switch it appears. Although efforts have appeared to be more coordinated in the last several days, there exists a possibility that the scope of the likely pandemic may overwhelm government efforts of even the richest of countries.
Experts are unanimous in stating that the solution of this possible pandemic and future ones is the widespread administration of an effective vaccine.
However, there is no vaccine for this strain of H1N1 and in a best case scenario there will not be for months. The earliest doses available will be given to “essential personnel” – government officials, law enforcement officers, the military, and health professionals.
The majority of the public will be on their own to manage as best as possible. The best strategy for surviving an influenza pandemic is to not get it at all. Avoiding crowded places, starting today, is one thing people can do to improve the odds of that happening.
One thing is for certain – in the days ahead, there will not be many intensive care physicians riding the subways of New York city.