Philip Alcabes, Business Times 18 Mar 09;
THE northern winter is almost over, and it appears that the world is going to make it through another flu season without a global disaster. That may seem like a miracle after the hysteria generated in recent years by Sars, avian flu and the World Health Organization's (WHO) standing warning that it's 'a matter of time' before the next influenza pandemic strikes.
But the truth is that the threat is being hyped.
# Infectious diseases are spreading faster than ever.
The WHO made this claim in a 2007 report. But even before the advent of commercial air travel, diseases had no trouble moving from place to place. In the 1490s, syphilis rode Spanish ships across the Atlantic (whether from the New World to the Old or vice versa is subject to debate) in a matter of weeks, then made its way through Europe and Asia. In the 1820s, military and merchant ships carried cholera from India to the Middle East, Africa and Europe. At the end of World War I, the 'Spanish flu' virus crossed the ocean on troop ships, ravaged the forces fighting in Europe and then spread around the world to produce the 1918 pandemic. The death toll topped 40 million.
In 2003, Sars showed that although air travel can introduce a disease to a new location, it won't necessarily cause the illness to spiral out of control. Because public officials quickly contained the few Sars outbreaks caused by infected people on planes, the 774 deaths were concentrated in China, Taiwan, Hong Kong, Singapore and Canada.
Tuberculosis is another airborne illness that can be controlled.
Studies show that it's extremely unlikely for the disease to be transmitted in aeroplane cabins. (Remember the passenger with drug-resistant TB who travelled from Atlanta to Paris in 2007? No one else came down with it.) So germs do fly, but outbreaks don't go global that much more readily than they did before. And we can handle most of them by monitoring infectious people and distributing medicine quickly - precautions that have been in place for years and even centuries.
# To learn how to prevent a pandemic, look to the past.
We always seem to be preparing for the last war. But the worst calamities erupt precisely because they are unprecedented and unimaginable. When the Black Death arrived in Europe in the 1340s, wiping out at least a quarter of the population, the region had been plague-free for six centuries. In the 1830s and 1840s, cholera, never before seen in the West, killed up to one per cent of the populations of several British and American cities in a few weeks. The influenza of 1918 was unlike any before or since (see Myth No. 3). Then came yet another unheard-of illness: Aids. Like those before it, the next killer will be one that we've never imagined - or prepared for.
# We should brace ourselves for another Spanish flu.
Fortunately, we'll never see another flu outbreak of that sort.
During World War I, the movement of troops and refugees - many of whom were too young to have acquired flu immunities during the epidemics of the 19th century - created a unique breeding ground for the virus and probably allowed more virulent strains to develop. New research also suggests that most of the deaths in 1918 and 1919 were caused by bacterial infections that roared through weakened respiratory systems.
So if the disease came back today, antibiotics would save many of the infected. More probable than a reprise of the 1918 scenario are further outbreaks such as today's avian flu - which is far less dangerous because the virus spreads from animals to humans, not from person to person. Avian flu has killed millions of birds but has sickened only 411 people since 2003. Public health officials should spend more time preparing for the possible fallout from a widespread outbreak among animals rather than stoking panic about a new Spanish flu.
# The annual flu season is nothing compared to a pandemic.
Preparedness warriors try to frighten people by using the word 'pandemic'. But such strains of the influenza virus - new ones to which humans have not developed resistance - aren't necessarily more virulent than the ordinary ones we see each winter. Only two flu pandemics have occurred since 1918, one in 1957 and the other in 1968.
In both cases, global mortality was a fraction of what it was in 1918.
And in the United States, as a recent study showed, the number of deaths directly attributable to influenza during the two pandemics was no higher than during typical flu seasons.
# There's no such thing as being too prepared.
Actually, we run the risk of doing more harm than good by overreacting to the threat of a pandemic. In 1976, swine flu, a strain of influenza similar to the one from 1918, was diagnosed in a small number of soldiers at Fort Dix in New Jersey one of whom died. That prompted medical experts to warn that the US faced a crisis reminiscent of the Spanish flu. President Gerald Ford authorised a mass inoculation programme, and 45 million Americans - more than 20 per cent of the population - were vaccinated.
But the plan crashed. A disorder called Guillain-Barre syndrome, which causes the immune system to attack the body's nerves, began appearing in patients who had received the flu shots. About 500 cases were linked to the vaccine; 32 of those people died. The federal government ended up settling wrongful death and damage claims for millions of dollars. But there was no swine flu epidemic, just a handful of cases.
Philip Alcabes is a professor of urban public health at Hunter College of the City University of New York and the author of the forthcoming book, 'Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu'
