Swine flu scareTo claim that swine flu has been "contained" is premature

You may recall that back in December 2008, Zimbabwe’s sclerotic and corrupt despot, Robert Mugabe, announced that the cholera epidemics in his poor country — a country which twenty-five years ago was the bread basked of southern Africa, but which he and his goons have destroyed — has been “contained.” Two months later, the World Health Organization issued a call for urgent action to tackle the cholera epidemic in Zimbabwe, reporting the number of cholera cases in Zimbabwe had exceeded the nightmare scenario of 60,000.

Why bring up the brutal and cynical Mugabe government? Because even democratic governments may be tempted to use the language of PR when it comes to epidemics. We note this: On 2 July the U.K. government announced that Britain has moved from the “containment” to the “treatment” phase of the rapidly growing swine flu outbreak. Why is this significant? Debora MacKenzie writes that the two things we know about pandemics are that they are global, and they do what ordinary flu does not: they strike in summer. As the first officially out-of-control summertime flu outside the virus’s native Americas, Britain’s announcement is proof that swine flu is doing exactly what scientists expect.

What, then, is this “phase of containment” Britain is ending? In theory, MacKenzie writes, containment means stopping a new infection from entering your country by catching every case that comes in, and treating everyone they contacted, so they won’t spread the virus. In practice, we have known all along that this was already impossible for swine flu by the time Mexico sounded the alarm in April.

Every epidemic modeler agrees that you can not contain a flu virus that has reached more than a handful of people. Back in April the World Health Organization (WHO) stated that containment of swine flu was “no longer feasible.” In a report on the subject, released 6 June, the European Center for Disease Control (ECDC) and Prevention remarked that “the term ‘containment’ is not recommended in this context as it raises expectations that a pandemic virus can be contained once it has got beyond the initial outbreak, as is the case with the 2009 virus.”

If European countries still insisted on tracking and treating cases — as most have, and as Britain did until the other day — the ECDC preferred to call it “delaying,” as it might conceivably slow swine flu’s spread. It said there was no scientific evidence this would happen. At best, it said, “it may seem to work, and represents actions that the public might expect and shows that action is being taken.” McKenzie says: “There is a term for this: PR.”

Until recently, for example, Britain refused to test people with flu caught locally, who did not fit the model of a disease from abroad. That policy elicited protests when cases caught in Britain turned up elsewhere. While it did not delay spread of the virus, it did delay the day when Britain had to admit swine flu was spreading freely.

Yet, says MacKenzie, officials knew it was. In a little-noticed move exactly a week previously, officials ended the “containment phase” in the three hardest-hit cities, London, Birmingham, and Glasgow — but not elsewhere. How, asks MacKenzie, can a virus like flu be spreading freely in three large cities, but not elsewhere on a relatively small island with a highly mobile population?

This would all be fair enough if nothing would have been done differently if Britain had acknowledged earlier that swine flu was spreading widely. The mirage of “containment,” though, meant administering prophylactic half-doses of antiviral drugs to contacts of the few known cases to stop them spreading the virus. Such a policy only makes sense if the virus is not already spreading widely, and it risks creating drug-resistant viruses — as happened last week in Denmark and also in Japan.

“At least that will now stop,” writes MacKenzie. “And I hope the temptation to put PR and public reassurance above truth will stop too.” It is worth recalling the British inquiry into the mad cow saga in 2000. As New Scientist reported, it concluded that officials did not make public fears about the potential danger BSE posed to human health — concerns of an economically damaging public overreaction took precedence. The report concludes: “this campaign of reassurance was a mistake”. When the government did announce a likely link between illness in cattle and human in 1996, “the public felt they had been betrayed.”

MacKenzie concludes:

We can’t risk that now — swine flu has already killed more people than BSE. When public health is involved, people need to be told the truth and to believe it. They need that now, especially if swine flu does that other thing we know pandemics do: gets worse.