Financial Times Editorial Comment: Plan for pandemic but avoid panic/New York Times Editorial: The New Swine Flu

Financial Times Editorial Comment: Plan for pandemic but avoid panic
Copyright The Financial Times Limited 2009
Published: April 27 2009 20:16 | Last updated: April 27 2009 20:16
http://www.ft.com/cms/s/0/d115adfe-335e-11de-8f1b-00144feabdc0.html


Authorities around the world have to perform a delicate balancing act in their response to the latest pandemic threat from the swine flu outbreak originating in Mexico. The flu virus is so unpredictable and scientific knowledge about the latest strain so scarce that no one can say yet with any confidence whether a pandemic is imminent – and if so how lethal it will be. A real sense of urgency is needed to prepare health systems for the worst; yet it is essential to avoid public panic and overreaction, which could do more harm than the disease itself.

Big falls in travel and leisure companies’ shares on Monday gave a glimpse of the potential economic damage that fear can inflict. The 2003 Sars outbreak, which never escalated into a pandemic, cost an estimated $50bn – at a time of worldwide growth. We are more vulnerable to the fear factor now, with economic morale much lower.

Some proposed responses to swine flu would be excessive. Screening travellers from infected regions and advising against non-essential travel may be sensible but outright bans on movement are not; epidemiologists say travel bans are ineffective in limiting the further spread of such a contagious virus once it has moved beyond its birthplace. Trade embargoes, such as stopping the import of Mexican meat, are pointless too.

The best responses at this stage combine intensive surveillance and research into the new flu virus with clear public information campaigns. It is essential, for example, that people with mild flu symptoms stay at home rather than spreading the virus and swamping health services by making unnecessary visits to their family doctors.

The threat has come from an unexpected direction, a porcine H1N1 virus from the Americas rather than the H5N1 bird flu in Asia on which the world had focused. But almost all the preparatory work carried out for H5N1 will come in useful now – we are far better prepared than we were five years ago to confront any pandemic.

In particular we have large stocks of two antiviral drugs, Tamiflu and Relenza, which can be mobilised immediately. A crash programme to produce a vaccine against the new flu strain will probably take six months but is worth undertaking.

History suggests that, if there is a pandemic, the first wave this summer may be relatively mild – possibly leading to a false sense of relief. A more severe second wave may follow during the autumn and winter. By then an effective vaccine against the new strain would be really welcome.




New York Times Editorial: The New Swine Flu
Copyright by The New York Times
Published: April 27, 2009
http://www.nytimes.com/2009/04/28/opinion/28tue1.html?ref=global


Is the new swine flu virus that has killed many people in Mexico and has spread to the United States and other countries the start of a much feared pandemic? Or is this yet another false alarm — the latest in a long history of worrying that some day a hugely lethal flu strain might sweep through the world and kill tens of millions of people, much as it did in 1918-1919?

The answer at this point is that nobody knows for sure. There are some disquieting elements about the severity of the symptoms appearing in Mexico, offset by the apparently far milder behavior of the virus in the United States. Experts clearly need to learn more about the origins, transmissibility and lethality of the new virus in coming weeks.

President Obama hit the right note on Monday when he said there is reason for concern and for a heightened state of alert but no cause for alarm. Although the new strain of influenza is suspected of killing 149 people and sickening some 1,600 others in Mexico, the toll, so far, in this country appears slight. There have been 40 confirmed swine flu cases, the majority — 28 — associated with a single preparatory school in Queens, some of whose students visited Mexico recently.

Only four states other than New York have confirmed cases: seven in California and one or two in Texas, Ohio and Kansas. The illnesses have all been mild; only one patient was hospitalized and no one has died. Four or five days after seeing the first signs of swine flu in New York City, there is still no evidence that it has spread further.

This situation does call for careful surveillance and preparations for the worst. American health officials have taken reasonable steps. They have made preparations to distribute up to a quarter of the anti-flu medicines from the government’s strategic stockpile to states and localities should they be swamped with a wave of swine flu cases. They also have taken preliminary steps toward possible formulation of a vaccine to combat the new strain. Although it would take months to produce such a vaccine, it could be ready should another wave of swine flu emerge in the next influenza season.

Individuals who feel sick are advised to stay home so as not to infect others. They should cover their noses and mouths when sneezing. Healthy people are advised to avoid those who are sick, wash their hands often and thoroughly, and try to stay in good general health. Face masks are of unproven value.

Officials also have recommended that Americans forgo “nonessential travel” to Mexico while criticizing a similar warning from a European Union health official against travel to the United States. The American complaint is less self-serving than it might seem, given that the disease is more widespread and more severe in Mexico. The World Health Organization raised its alert level for the swine flu on Monday but recommended against closing borders or restricting international travel.

While health officials scramble to keep up with the fast-moving virus, it is deeply disquieting that the Obama administration has few of its top health officials in place. The Senate, delayed by Republican objections, is finally scheduled to debate the confirmation of Kathleen Sebelius on Tuesday to be secretary of health and human services. And the White House has yet to announce a nominee for director of the Centers for Disease Control and Prevention. Those are two of the most important positions for dealing with an infectious disease epidemic.

The acting official in charge of the C.D.C. insists that the absence of top leadership has not affected how the health agencies have responded, and he may well be right. But if the Obama administration is to be judged, as it should be, on how well it responds to this potential crisis, it would be best to have the full team in place.