The UK is having quite a swine flu outbreak, although the authorities aren't owning up to it. As for the public, they are being whipsawed between the usual poles of "it's all hype" and "we're all going to die," with the latter fading in parallel with the fading of effectiveness in selling tabloids. So, yes, there's a lot of dreadful stuff in the news about swine flu, but there's some pretty astute stuff, too. Here's something I ran across in TimesOnline [UK] by Melanie Reid:
When we heard that the only deaths were a few Mexican peasants, we gave a collective shrug: this is not our problem. Nobody has died apart from a few foreigners. Why, even those Brits who brought it home just had mild symptoms. Why make a fuss? Just overexcited health staff keen to test emergency planning procedures, we thought; just another scare whipped up by the media. I bet most of us chucked our government swine flu leaflet away as junk mail.But influenza H1N1 isn't last season's Gucci handbag. It hasn't gone away. Two otherwise healthy people in the UK have fallen gravely ill and are in intensive care. Two other people, suffering from other underlying health issues, are also rated as critically ill in hospital in Scotland. In New York the first person not suffering from any other condition has died. None of these individuals has travelled from Mexico, or had contact with each other, or with other known cases.
[snip]
Up to now, we've treated the disease as a form of entertainment; a Hollywood plot. We've reacted, in other words, like thoughtless, cynical consumers. Arrogant to a fault, we really believe we are untouchable masters of the biological universe. Of course there will be medicines to keep us safe! Party on!
But wouldn't it be ironic if swine flu kills in part because it is that most old-fashioned, unfamilar enemy: a slow-motion event, one that terminally confuses a society addicted to constant change and bored by anything that hangs around for longer than 24 hours? (Melanie Reid, TimesOnline)
I'm not as critical of either the media or the public, but Ms. Reid's points are well taken. Swine flu is just one of many claims on our attention and our anxieties. The media don't help us sort out which are more important because the media are just another part of the public, distractable, not well informed and mainly interested in paying the bills. That's just the way it is, and hand wringing won't make any difference.
What will make a difference is a concerted, steady and systematic effort by public health and social service authorities to get ready for what might be a very difficult flu season ahead. There is no requirement that this be done in a noisy and highly visible way. Much can be done quietly and methodically.
But it will require political leadership. Some places have it. Some don't. The ones that have it will do better should things go as they well might. If they don't -- if swine flu is a temporary but unrealized threat -- generic efforts to make a community more resilient to flu will still pay off handsomely, and those places will also do better. Either way the win.
And either way, places with weak and gutless leadership will lose.
- Log in to post comments
I am concerned that in North America, in many locations without any significant local outbreaks, governments are now "standing down" from a communications standpoint so as to not seem alarmist, while waiting to see how things unfold.
My concern is that "standing down" is the kind of behaviour one would expect from authorities who had over-reacted to the threat, and who wanted to cool things down. If anything, however, the potential seriousness of the situation has been underplayed by most authorities.
When the authorities, through their behaviour and their non-communications, implicitly (and inadvertently) confirm accusations of fear-mongering leveled by skeptics, then they make it even more difficult down the road -- when it may matter a lot -- to convince people to do what needs doing.
Risk: There is lots of room for varying opinions, here, but my view now is that the public and public health authorities have such a huge amount on their plates that it is unrealistic to want them to keep flu at the top of the public list. I just want them to get ready for a bad flu season and since the demands on them are so significant this will require strong political leadership. In the absence of things "happening" this will disappear from the news and the communications of health dept., but as long as they are working away at it, I'm not that bothered. If they forget it, that's another thing.
Revere. Thanks for your comments. Indeed there is much room for varying opinions here, though I'm not sure we're that far apart.
From a communications standpoint, I would not advocate or want the story at the top of the public list, or atop the media agenda for that matter for weeks/months on end. Having said that, I worry about the long-term effect of going quiet while we go about, behind the curtain, doing what needs to be done.
The problem with that is that people, and media, may deduce from this that the situation has been over-hyped to begin with, which could well diminish their trust in the information they will receive if/when the flu does start to take off.
My preference would be, in appropriate doses, to keep the public informed about what is going on the background by being transparent about it, and by communicating, steadily and calmly, that the smart thing to do is to plan for worst case scenarios, while hoping and working towards a less severe outcome.
Within that context, people may then be more receptive to thinking about what people, communities, employers, institutions, etc. may need to do if things get bad. Ideally, if this happened, awareness/understanding/critical reasoning/action would not have to happen all at once, in a confused, mad rush, if/when the disease spikes.
I guess my point isn't that complicated, it's just that we need to find the right balance between going silent, and trying to generate banner headlines. I think the middle path here is the smart one, but I'm not sure we're really on that path at present.
And while I'm at it, I would urge my colleagues in the risk comms side not to start thinking in terms of what a great communications job we've done so far.
Here in North America, we've had a fairly easy communications job so far, what with the lack of spread and low severity of the disease. We've also been able to focus so far on simple behavioural messages (wash your hands, etc.)
If/when the disease becomes more contagious and/or severe, if/when we have to start communicating about truly contentious matters such as antiviral rationing, social isolation policies, school and workplace closures, etc. etc., that will be the real test for communicators.
My best regards to all.
Revere, you said: "What will make a difference is a concerted, steady and systematic effort by public health and social service authorities to get ready for what might be a very difficult flu season ahead." And that "it will require political leadership." The way you're stating this implies you think PanFlu prep can be amply handled by public health and social service authorities. However, I'm certain you also fully believe in the critical importance of prep by individual households and businesses. Both are required.
I agree with Risk_comms_guy's concerns that governments continue to fail to proactively engage in risk communications with their publics - at least, they're failing to do so on a large enough scale. (In this important regard, they lack "political leadership.") I live in a U.S. metropolitan area of 250,000 population. But around here you can't find a PanFlu public service announcement on billboard, newspaper, radio or TV; no informative posters or flyers in hospital and clinic waiting rooms; no useful info on local government Web sites; no luncheon speeches to civic groups; nothing. NOTHING.
We will not do well during any significant pandemic without individual understanding, prep, and cooperation. Government entities can't carry the load for everyone. (Why would they want to try? Why would they not want to get the public to share the load?) But, individuals won't prepare if they don't understand. And the window of opportunity to educate people and let them go through their adjustment reaction and begin preparing materially and mentally is passing by (may be almost closed already).
Sadly, the WHO and its member states have been hand-wringing over whether to call this Phase 6 (an official pandemic) - engaging in "panic panic" - in part because they're afraid of how the public will misread "Phase 6" in the context of "mild" novel H1N1 flu. They would have much less to worry about if they had been doing a good job all along of informing the public at teachable moments. The public would better understand possible/unfolding scenarios ... and would better trust their public authorities about this.
I know, I know - and fully agree - that the public and the authorities have a lot on their plate. And that people only have a capacity to worry about a finite number of things - it's just a question of which things get top-of-mind, front-burner attention. I'm afraid over the next year we'll see the results of our public leaders' tentative communications. As much as anything, we may witness a disaster resulting from absent/poor communications. (I fault the local news media, as well, for not proactively pursuing this topic and accurately reporting it.)
And the authorities can't say they didn't know how to handle it. If nothing else, they could have tapped the world-class advice from Peter Sandman and Jody Lanard (and Risk_comms_guy and others) - a lot of it freely posted on the Web on government sites, forums and personal expert sites. For example, authorities should, TODAY, be implementing "What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five." Yet how many have been doing it? And here we are probably days away from Phase Six.
Chirp
Risk: No, we aren't far apart. I am basically in the same place you are, I guess.
Chirp: We don't do individual prep here (not because I'm opposed to it, but it's not what we are interested in talking about). Having said that, the question is what to tell people to prep for. If we tell them to prep for a collapse of critical infrastructure, we may wind up in the same place we are now: prepping for the wrong thing. A really, really bad flu season because of a pandemic strain will be a really, really bad problem for the community, but one that is best handled at the community level IMHO, anyway). For me that means getting structures ready that allow us to help each other, either through required gov. services like public health and social services, or through voluntary community organization, like neighborhood groups that keep tabs on each other and run errands or go shopping. So to say we should prep as individuals doesn't answer the question, "prep for what", exactly.
The BBC are maintaining a global swine flu tracking map, which I'm finding is a useful way to keep abreast of the development of the disease as the media loses interest in it. It shows dramatic increases in some countries, such as Australia, in recent days.
http://news.bbc.co.uk/1/hi/world/americas/8021547.stm
Thomas, ta muchley for the BBC link.
Australia... As Revere writes, "places with weak and gutless leadership will lose." Basically, the primary problem confronting Australia at the moment is what afflicted the US prior to the last federal election -- totally uneducated loudmouth idiots behind the steering wheels of power.
The federal health minister, Nicola Roxon, has appeared to have given up on "containment" and is taking a bizarre laissez faire national approach to the community spread of H1N1/2009. The Victorian Premier and health minister both appear to be on drugs -- I mean, they seem "disconnected" from rational science and epidemiology if you analyze their statements in The Age excerpts below.
The most sensible and scientific course of action Oz authorites can enact is the "contain" model -- keeping the overall community numbers of H1N1/2009 infected low. Unlike the "sustain" model, this strategy assists in minimizing "evolutionary incidents" (eg. antiviral resistance mutations) and buys time for vaccine development, production and community uptake.
Several Australian state authorities are definitely on track eg. NSW Premier Nathan Rees. But others, like John Brumby, have lost the plot (his delusions regarding state tourism)...
The Age -- Victorian swine flu tally jumps to 752 (June 4, 2009)
http://news.theage.com.au/breaking-news-national/victorian-swine-flu-ta…
Poignant Excerpt: An interstate stoush has broken out over NSW's decision to impose a seven-day quarantine period on children returning from Melbourne, as Victoria's swine flu toll hit 752.
The figure includes the latest spike of 231 cases - far higher than any other state. NSW is coming a distant second with 74 cases.
While other states, including South Australia, Queensland and Tasmania, have made similar quarantine decisions, it's NSW that has received a lashing from Victorian Premier John Brumby.
He suggested a decision by NSW Health, to ban returning children from attending school for a week, could be an act of retaliation for Victoria's successful tourism push in NSW.
"Swine flu is an international and national phenomenon and that's the fact of the matter ... and frankly I thought the statements made by particularly the NSW government were just silly and extreme," Mr Brumby told reporters. "I don't know what's driving this from a NSW point of view...
But NSW Premier Nathan Rees defended his government's decision. "What we do have is cases of community transmission in Victoria that we don't have in NSW," he told reporters in Sydney.
"NSW, like Queensland, will take all necessary precautions to minimise the spread of swine flu. "We take advice from medical experts on this, no one else."
Victorian Health Minister Daniel Andrews denied Victoria had been blacklisted.
"At the end of the day, I think that decision will be rendered unworkable very, very soon as we see numbers grow in other states and I would not say that decision was proportionate with the risks posed by the H1N1 virus," Mr Andrews told reporters...
Risk_comms_guy
I think the situation, on the Ground, invite us to Swiftly share the Pertinent Information we have, we used to call that a technological transfert. We need to Communicate the 'Know-How' to the Leaders or Communities.
Knowing warning signs, knowing what can be done with an infected one, aware of the need to enshrine a preventive behavior to not catch the virus.
Locally when a majority behave thus, it release morbidity and reduce mortality.
Snowy Owl
"the public and the authorities have a lot on their plate. And that people only have a capacity to worry about a finite number of things - it's just a question of which things get top-of-mind, front-burner attention."
I still think the whole thrust of preparation is being approached the wrong way.
Everyone is concentrating on the danger de jour, whether it's a terror attack, a hurricane, banking collapse, or a novel flu strain. Then scads of money get spent to prevent the ONE THING getting the most attention, with nothing left over in case that ONE THING requires a different approach, or doesn't happen and something different does.
Some things have been problems in almost ALL crises. Communication of first responders. Availability of hospital beds/supplies/medical personnel. Food/shelter for citizens in need. Etc. These kinds of things CAN be prepared for. Some supplies are multi-purpose and CAN be stockpiled. Just-in-time delivery for emergencies is planning to fail.
And some things should have been built a LONG time ago! Any given anti-viral, vaccine, etc. may or may not be useful, but ground should have been broken on new vaccine PRODUCTION facilities back when SARS first showed up. Everybody said "There isn't enough time" but if building had started then, they'd be up and running now.
I wonder how many vaccine plants the banking bailout would have purchased?
The priorities in this country drive me NUTS!
ipmat: I couldn't agree more. Long time readers of this blog know that we are a broken record on this subject. Our mantra has been that preparation means strengthening the public health and social service infrastructures so that we are ready for whatever comes along and we also benefit in the short, medium and long term for everyday needs. That's the way to prepare for a pandemic and it is what we are suggesting here.
Revere wrote: So to say we should prep as individuals doesn't answer the question, "prep for what", exactly.
I think the best prep message right now is this:
- that this outbreak may spike with sufficient seriousness down the road such that people may have to change their behaviour/lives/routines/etc. in different and possibly inconvenient ways to avoid illness and/or contain the disease; and
- that some of the things people may have to do could include x, y. and z, so people should think about it now so they are ready if and when the time comes (which we hope it won't).
Actually, Dr. Anne Schuchat of the CDC was delivering that exact message calmly, repeatedly, and I thought quite effectively in the early days following the WHO announcement of Alert Level 5. But once transmission seemed to abate, and the flu appeared to be mild, communications from the authorities kind of went quiet, other than case count announcements.
(And on the matter of building the public health and social service infrastructure needed to respond to a pandemic, I am in total agreement.)
In Victoria, Australia, we have seen our confirmed swine flue case numbers increasing exponentially by 40% a day. Doctors (two relatives) believe that most cases have not had contacts with other known cases, so it seems likely to them that the majority of cases have been mild and not diagnosed. That means the numbers actually infected are presumably much higher than the confirmed numbers.
I think that is why we have moved from a "contain" model to a sustained infection model.