Pandemic Pandemonium

Victoria, Australia – where I write these words – is apparently right now in the grip of an epidemic of swine flu – an epidemic significant enough to play an important role in the World Health Organisation’s decision to declare a pandemic. ‘Pandemic’ sounds pretty serious, but in fact it is very difficult to get a sense of just how worried we should be. The World Health Organisation has warned Australia to prepare for deaths, but deaths from flu are perfectly normal occurrences at this time of the year. WHO says it is “concerned about current patterns of serious cases and deaths that are occurring primarily among young persons, including the previously healthy and those with pre-existing medical conditions or pregnancy”, but in Australia there have been no deaths. Indeed, outside of Mexico the death rate has been in line with what one might expect from a normal seasonal flu. Given this fact, it is probable that the death rate in Mexico is not a reflection of high virulence, but of high infection rate. Most people who come down with the flu in Mexico probably don’t routinely go to a doctor; thus, it is only the serious cases that are being counted.

Part of the reason that it is so difficult for a layperson to get a sense of how worried we ought to be is that the World Health Organisation’s message is implicitly being contradicted by governments. Nowhere is this more true than in Victoria. Up to 12 days ago, Victoria was officially trying to ‘contain’ the virus. This involved (voluntary) quarantine not only for sufferers, but also for those who had been in contact with sufferers. It also involved keeping a tally of sufferers. But once it is was clear that the virus couldn’t be contained, the government simply stopped counting sufferers. If you look at WHO’s own tally, you will see that their figures for Australia reflect only the increase in other states, not in Victoria. Some other states have decided to quarantine children who have visited Victoria; the Victorian government’s response has been to accuse them of attempting to steal our tourism. Prior to the failure to contain the flu, it was a serious problem; now, apparently, it is not even worth keeping count of sufferers.

We are to hope that if the flu outbreak turns serious – if, for instance, the virulence of swine flu increases dramatically – that governments and agencies will speak with one voice, and that voice will communicate a clear and consistent message. But the way both have handled the current outbreak doesn’t instill a great deal of confidence in either. WHO may have undermined its own authority by not making clear enough that referring to an outbreak as a ‘pandemic’ is a marker of the rapidity and extent of an illness’s spread, not of its severity, and the various Australian state governments have seemed more interested in tourism than in health. As a test of our pandemic warning system, swine flu might have indicated a real sickness.

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