Swine flu lessons learned: Was all this really necessary?

Now that the worst may be over in Mexico and the swine (H1N1) flu virus doesn't seem to be much more contagious than seasonal flu, some folks—such as Jack Cafferty on CNN—are wondering if all the hoopla was warranted. Did they really need to shut down schools, distribute masks, and tell everyone to zealously wash their hands? The short answer: Yes. In fact, those and other measures may well have nipped the crisis in the bud.

Yes, there were some examples of people and governments going a step—or two—too far. There’s little reason, for example, for the Chinese government to have quarantined Mexican tourists in their hotel rooms, or for the Egyptian government to have ordered the slaughter all of the country’s hogs. But overall, our medical consultants say that the public-health response seems to be have been on target.

“The last two weeks should be seen as a public-health success story, not an example of fear mongering,” says John Santa, M.D., M.P.H., director of the Consumer Reports Health Treatment Ratings Center.

Indeed, many of the measures recommended over the past two weeks by the Centers for Disease Control and Prevention were backed up by considerable scientific research—and should be kept in mind when the next new flu bug emerges and starts to make the global rounds. For example, a review published by the nonprofit Cochrane Collaboration on October 17, 2007 concluded that the single most effective step against the spread of flu is “hygienic measures around younger children.” In other words, washing your hands when you’re around kids. That’s because kids tend to have longer-lived infections and to interact with a lot of people over the course of the day—and to be pretty bad at washing their own hands.

When the flu becomes widespread in a well-defined community—such as a school, nursing home, hospital, or, as in the case with Mexico, an entire country—other more aggressive measures may also be necessary. For example, a study published in the Nov. 27, 2007, issue of the British Medical Journal said that in such circumstances “isolation of potentially infected patients” makes sense, hence the recommendation to close schools or businesses in communities where the infection is widespread. The same study also ranked the effectiveness of several other measures, as shown in the table below.

Flu-prevention strategy	Number of people needed to adopt the practice to prevent one case of the flu
Wearing a mask rated N95	3
Washing hands more than 10 times a day	4
Wearing a gown	5
Wearing any mask	6
Wearing gloves	7

“In general, when the number needed to treat is four or under, the intervention is worthwhile for general use,” says Dr. Santa. “And while wearing the right kind of mask scored highest, the simplicity and affordability of hand washing makes it the preventive measure of choice.”

—Joel Keehn, senior editor

Image: shane o mac

Comments

[Bev]

While the steps taken to prevent the wide spread distribution of the H1N1 virus was good practice for the eventual possibility of a H5N1 virus epidemic, the steps taken were not compatible with the type of virus that we were being exposed to. Early on it was evident that this was not going to be a 'major epidemic virus'. This H1N1 was the result of a drift in the DNA. We (as humanity) were already exposed to the H1N1 in 1918 and again in 1976. Reported cases were also of a mild type. The deaths that occurred, though tragic, were in people with underlying conditions. The result of all the school closings and hype by the media may be akin to 'crying wolf' and may desensitize people to the real threat of H5N1.
One of the stories in the media mentioned that a flu virus that presents itself in the spring tends to be mild and then comes back in the fall with more virulence. If the H1N1 virus were left to follow a natural course, more people would be exposed in the mild season and then have immunity for when the flu season hits in the fall. Therefore, less people would then be at risk for the more virulent return of the flu. For protection of the immunocompromised, it would make more sense to quarantine them to protect them from exposure. By quarantining the people that present with the infection, less people will get sick but a more virulent form will present during the flu season.
I am glad that the CDC lifted it's directive to close the schools in this case. In the future, I hope that they act when there is a sign of a shift in the DNA and the threat of a potent infection.

Bev Carrigan, Medical Technologist

[Kally]

Kids tend to have longer lived infections and to interact with a lot of people over the course of the day and to be pretty bad at washing their own hands.