Howard Markel: Swine Flu ... Better to Over-Prepare than Under-Prepare





[Howard Markel is a physician and historian at the University of Michigan, where he directs the Center for the History of Medicine. He has written for the New England Journal of Medicine and New York Times, among other publications, and is the author of When Germs Travel, a 2004 history of epidemics in America published by Pantheon. He currently serves as as a consultant to the Division of Global Migration and Quarantine for the U.S. Centers for Disease Control and Prevention (CDC). The views he expresses below are his and his alone. --Jonathan Cohn]

In Mexico, the swine flu is thought to have infected 1600 people and killed at least 149. Here in the U.S., the swine flu has apparently infected at least 40 people. But the number is growing fast--and spreading from border states to places like Michigan and Ohio.

Is it time to panic? In a word, no. But it is time to prepare.

The disease in question appears to be a novel strain of the Swine H1N1 virus. Flu viruses constantly co-mingle with each other, sharing different components. This swine flu virus contains antigenic elements of other human, swine and avian flu viruses that have been circulating in the community over the last few months and possiby years. (That's why you hear experts saying it contains "circulating elements" of avian, human, and swine flu.

Predicting flu pandemics is fraught with problems, given the ease with which the flu spreads and its inherent biological unpredictability. There is just no way to be certain, right now, whether this variant will turn out to be relatively mild.

As a result, government authorities--at the local, state, and national level--need to be monitoring the situation, communicating with each other, and making sure they are ready to intervene immediately if evidence of a pandemic emerges. And this is precisely what’s been happening. For example, officials at the CDC have been in constant contact with Mexican health authorities, the health agencies of other affected nations, the World Health Organization, and--most recently--local authories in communities affected by the flu. These open lines of communications also serve as sounding boards and brain storming sessions for all these experts.

It’s entirely possible--perhaps even likely--that the government's reaction will ultimately prove "unnecessary." This outbreak could prove to be nothing more than a scare. But, if so, Americans need to realize that the government has still acted properly by taking the precautions it has.

Hitting the sweet spot in epidemic control, one that protects the most people from disease and minimizes disruptions to the economy and society, is even tougher than hitting a fast ball thrown by a major league pitcher. In reality, the alternative to over-preparing is under-preparing. And, as a physician, I prefer to over-prepare for potentially dangerous events than to under-prepare. (I think my patients prefer that, too.)

So, no, you don’t lock yourself in your house and start storing up on provisions.

And don’t get mad at the government if, a few months from now, we’re all talking about that crazy flu scare from the spring of 2009.

Rest assured, it’s a good thing public authorities are taking the precautions that they are. With human life, it really is better to be safe than sorry.


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