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Sick Thinking

August 13, 2009

As usual, Phil Palin at Homeland Security Watch has some interesting thoughts on pandemic influenza planning and response, particularly at the federal level.  Getting the message right, as he suggests, is a matter that calls for public health and emergency management professionals to strike an appropriate balance between confidence and concern.

Efforts to achieve the appropriate balance may be confounded, though, by some sick thinking about where we are in the course of dealing with this threat.  Emergency managers think about the world in terms of a continuous cycle of prevention/mitigation, preparedness, response, and recovery, and efforts to address the threat from pandemic influenza are no different in this respect from other hazards.

But this new strain of H1N1 raises some interesting questions for us about prevention and preparedness.  I fear too many people see prevention/mitigation efforts primarily in terms of avoiding transmission among humans when, in fact, the opportunity to apply prevention techniques was more or less lost as soon as the virus jumped the species barrier from pigs to humans.

Preparedness too, it seems, has come to imply a readiness to manage those infected to prevent them from spreading the virus among others rather than seeing to their care and the continuity of operations disrupted by their illness.  This not only highlights the futility of such conceptions, but also illustrates some of the confused thinking around the important differences between prevention and preparedness.

One of the things about this threat that scares people in the know is the fact that such a small percentage of people now living have acquired immunity to all or part of the virus now circulating.  As such, until a suitable vaccine becomes available in sufficient quantities to immunize very large proportions of the vulnerable population, allowing the virus to spread but minimizing its impact on human populations and activities is our best defense against this and future outbreaks.

It wasn’t so many years ago that a mother would willingly and knowingly expose her children to others in the neighborhood with chicken pox or other virulent diseases against which no vaccine was available.  Sure the child would become sick, but she would be there to manage the illness and nurse the child back to health (in most albeit not all cases).  She did this with full knowledge that the illness presented certain risks, but the risks of acquiring the disease in later life without such acquired immunity was potentially much greater.

Today, we might consider such behavior abusive even to the point of applying criminal sanctions.  I have to ask, is this wise?

Taking steps to ensure quality care for those who become ill, while preparing to pick up the slack caused by their absence from work to recover or care for others who become ill makes more sense than trying to contain or suppress the spread of disease.  It’s certainly a more humane course of action, and probably a lot more practical to boot.  If nothing else, it’s a less complicated approach and will help us communicate clearly the steps people should take.

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