Monday, April 27, 2009

Ain't This New Flu Something!

At first the Geek was, well, not quite overjoyed, but certainly pleased when the Flu Alarm buzzed loudly over the weekend. It is not that the Geek feels a thrill of happiness at the prospect of disease, suffering, fear and death in a country which already has too many thoroughly unpleasant matters confronting it. The Geek is something of a cold dude, but not this far over the edge.

Rather his pleasure came from the opportunity to observe how governments--including that of the US--would respond to an excellent simulacrum of a major member of the counterterrorist's closet of anxiety--biowar. The H1N1 virus at work in Mexico and, to a much lesser extent, in other countries ranging from the US and Canada to New Zealand and Europe is a fine representative of an infectious agent having the characteristics of a anti-personnel biological weapon.

The somewhat misnamed "swine flue" (this particular H1N1 has genetic components from swine, avian and human flu variants) appears to have good human-to-human transmission, reasonably high lethality among the young adult population (at least in Mexico,) low, but not too low latency period and some difficulty in accurate diagnosis. These are all characteristics of a desirable biological agent.

Already we have witnessed the primary impact of any biological weapon directed against the civilian population. The "swine flue" has engendered a fear response from governments, extra-governmental agencies such as the World Health Organisation and private citizens. The last has been best illustrated by the impact on the handful of deaths and not much larger number of suspicious infections in Mexico on the stock and commodity exchanges of the world. (Big Pharma shares went up. The broader markets from Asia to New York slumped as did oil futures as investors shook in their pants over the prospect of economic dislocation.)

In Mexico the straws of public opinion blowing in the gale of fear point in the direction of rapidly blooming distrust in the government. Contradictory views ranging from the notion that the government is overreacting to the belief that the government is still not telling the entire truth converge only on the point of expressing a negative relation between government and citizen.

In the US various and sundry calming official voices including that of President Obama have sought to assure the public that there was no reason to panic. Calming mood music has accompanied the declaration of a public health emergency. This declaration is said to be a mere precaution so that first responders can be properly briefed, hospitals put on alert as to the necessity of having bed availability contingency plans up dated and good-to-go. Further, We the People are told this declaration is a prerequisite for the release of anti-flue vaccines and medications from the strategic stockpile.

Other governments ranging from Hong Kong (which is using its unfortunate experience with Severe Acute Respiratory Syndrome (SARS) a couple of years back to prepare for the new flu) to the EU members are taking measures and playing soothing tunes resembling those heard in the US. China has gone so far as to ban pork imports from portions of North America despite the scientific fact that the disease cannot be contracted from pork products, particularly after cooking. (One must be forgiven for hearing echoes of the theme music from The Empire Strikes Back in this, the home of food contamination.)

It is important to note that the current state of incipient(?) panic around the world as well as the awesome media coverage of the outbreak (currently over 25,000 hits on Google News) are predicated upon a very, very small number of deaths confirmed to have been caused by H1N1. Even this small number has not been parsed as to such contributory factors as an initially incorrect diagnosis, or unavailability of health care.

On the one hand the rapid publication of the news of the new flue can be considered praiseworthy. An axiom of public health is that rapidity of identifying a potential epidemic assures the most rapid and complete countering of the disease. On the other hand, a very high profile exposure of a disease outbreak assures an emotionally driven overreaction on the part of people who can identify with the victims. Fear of public fear drives public policy on the part of governments. And, fear driven policy may very well not be good or effective policy.

The goal of a terrorist is to provoke widespread fear by undertaking an action of such a high profile nature that people at a great distance from the action identify themselves as potential victims. This self-selection of victim status gives rise to fear. ("I'm scared because it might have been me." or "I'm scared because the next time it might be me.")

As soon as fear rises and spreads in a foul tide driven to even higher levels by the ministrations of the media, the terrorist has accomplished his primary goal. When governments respond to the tide of fear in diverting resources to meet a threat that may well not exist or undertaking actions which introduce frictions and inefficiencies into the social and economic activities of a country, the terrorist has accomplished his secondary goal. He has influenced both public and government in a way which is inimical to the best long-term interests of the target nation and state.

Because of its unseen nature and possibly quite lethal effects, the biological agent is a terrorist's wet dream. Disease is always frightening. Infectious disease breeds particular fear. This is more true in countries such as the US or those of the EU where infectious disease is no longer a routine hazard of life.

Influenza is not a minor matter. As the global pandemic of 1918-19 demonstrates, it can be an extremely lethal enemy. What is most intriguing about the impact of the "Spanish Flu" of 1918-19 in the US is not its morbidity (just over one in four Americans was infected.) Nor is it the lethality of the disease which killed more than a half-million here during the four months the epidemic raged.

The most singular aspect of the American experience with the "Spanish Flu" was what didn't happen. Despite the high loss of life and the disproportionate concentration of cases and deaths in crowded urban centers, there was no panic. There was no panic in the country generally. There was none in the most heavily hit areas.

Americans wore masks. Avoided theaters and sports events. They got sick. They died--and buried their dead. They went on with life. They sucked it up and pressed on. There were no recriminations. No accusations of government laxness. No demands that the government do more the next time. Press, pulpit and politics alike may have mourned the deaths, but they went no further.

We were not terrorised.

Neither were We the People shaking in our socks when the "Asian Flu" pandemic of 1957 fetched up on our shores. Globally this outbreak killed around two million, seventy thousand in the US. Unlike 1918 vaccinations were available and employed, but their efficacy was and is a matter of some debate. The important characteristic of the 1957 experience was the same as that of forty years earlier. There was no panic. No set of recriminations. No demands that the government "Do something!" No need for Ike to go on TV and ask the public to be calm in the face of the storm.

The stoic acceptance of disease and death which marked the 1918-19 pandemic or the similar lack of fear presented in 1957 is not possible today. It will not be possible tomorrow should bioterror emerge from some shadowy far away place.

This is not because Americans are lacking the character and backbone of their ancestors. Rather it is the necessary result of infectious disease having been controlled. Sure, there are still exceptions, the sexually transmitted diseases, hepatitis, new tuberculosis strains all come to mind. But, the control of infectious disease has been thorough enough for a long enough time that the mere thought of a lethal disease transmitted in the air around us has a power to scare which it lacked in past decades.

We have been living for some years now where good health is believed to be a basic right of Americans. We are proud of living in a Germicidal Age. With anti-bacterial, anti-viral wipes in our hands and germ slaughtering soap in our dishwashers and showers, we are confident that no mere germ will discommode us, let alone kill us.

We have been set up by our own success, by our own fear and loathing of the world of the microbe, to be scared out of our collective suck by the thought of an epidemic in our midst, of the air in our lungs right now being the possible agent of our death. Now, with the reflexes built in by our experiences with routine potential or actual disasters, we expect the government, the federal government to take action, to reassure us.

The "swine flu" of Mexico and elsewhere is providing not only governments (and those who watch governments for fun and profit,) but We the People and our institutions generally with an excellent opportunity to see just how well we can cope with both the actualities of disease and the penumbra of fear which surrounds disease. It is a laboratory experiment so to speak for how well we and our government could deal with the so-far only hypothetical danger of biological terrorism.

It is a lab test which we best not fail. Not only for the usual reasons such as preventing illness and death or social and political disorganisation which might well accompany a genuine pandemic. There is another reason, a sort of T. rex in the bathroom reason.

The bad guys of the world, the men of the black turbans and death wish are watching as well. And, learning.

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