(Count yourself lucky, most of my paranoid ramblings on this subject have been self-censored. As these ones probably should have been as well. This really isn’t my best structured post, but it’s been ages, and I figured I ought to post something, and this is pretty much all I’m capable of thinking about at the moment.)
I don’t get why ‘the authorities’ are still so worried about swine flu. When we first heard about it, it was rather scary (and I was terrified, but that’s my problem…). Lots of people seemed to be dying in Mexico, no-one had any idea how many people had been exposed, and so it was impossible to say how deadly the virus was. Now we know that – exactly as normally happens with a new strain of H1N1 – it’s got pretty much identical attributes to ordinary ‘seasonal’ flu. In other words, if you get it, you spend a couple of days feeling rotten with a sore throat, an uncomfortable cough, and a high temperature that causes things like aching joints and a headache.
And then, unless you are very, very unlucky, you get better. A few people will need to go to hospital, and a few of those will, sadly, die. Most of these people will actually die of complications rather than the flu itself, and most of them will have a range of health problems besides flu. It’s against this backdrop that the ongoing barely-suppressed near-panic in official pronouncements just doesn’t make sense to me.
I do understand some of the difficulties.
Flu is one of the most wildly misused terms there is. The need to not be seen taking time off work for something trivial has caused a kind of inflation with regard to common illnesses, and people will now routinely call a slight case of the winter sniffles ‘the flu’. This means if official spokespeople talk about swine flu as a ‘mild’ form of flu a goodly proportion of the public will think it’s less serious than a mild dose of the common cold, and won’t take sensible precautions to prevent its spread. They’ll also think, if they get actual flu symptoms, that they have a desperately acute version of the virus, and will demand instant hospitalisation and bedside visits from their favourite celebrities, or, failing that, Robson Greene.
Ordinary flu is a nasty illness. It kills people. It killed a semi-distant relative of mine back in whichever year it was in the 90s when there was a big spike in flu cases. She wasn’t in the first flush of youth, and she suffered very badly with breathing difficulties before she got the flu, but it was still the flu that killed her. People don’t understand this, and so they start to panic and assume that, because this new virus has killed some people, it must be terrifyingly more serious than anything they have ever encountered before.
And so this is presumably why the authorities react in the way they do. It’s why everyone who is contracting the disease, and people who’ve come into contact with, are receiving antivirals, even though no-one would ever suggest dishing out Tamiflu in the same way during an outbreak of ordinary flu, because it’s spectacularly unnecessary and a colossal waste of money. It’s why talking heads on rolling news channels are talking in terms of vaccinating the entire population against swine flu, once the vaccine is available, and not just people in high-risk groups and health workers. It’s why schools are being closed if a kid so much as sneezes, even though they would cheerfully stay open throughout the ordinary flu season, even though many of the kids will pick up the illness, and some will pass it on to vulnerable elderly relatives who will go on to die. It’s why there’s talk of closing down public events like concerts and sports matches.
But all of this reaction is just ludicrous. It’s a massive overreaction. I understand there are concerns with this new strain, because there is no vaccine as yet, and so no way of protecting the vulnerable against it. But this situation isn’t unusual, either. Mass-vaccinations against flu are a relatively recent innovation, and anyway are not 100% effective, because the WHO basically have to guess which strains will be doing the rounds, and hope they include the right ones in each year’s vaccine. Before the vaccine was made widely available, or if a strain not included in the vaccine were to start circulating, no-one would even consider taking these ‘precautions’. So why are we doing it with this ‘swine’ flu, which to all intents and purposes is no better and no worse than ordinary seasonal flu?
These kind of responses I can just about understand. They’re ludicrous overreactions, but it’s possible to see what motivates them. What is much harder to understand are the doom-mongering predictions of people who are supposed to be experts in flu. Now, of course, I’m largely basing what I say here on the way these things are reported in the media, and it is entirely possible that a measured, serious, calm interview lasting 40 minutes is misleadingly edited down to a 30 second “we’re doomed!” soundbite. Given the way the media functions, it wouldn’t remotely surprise me. But the same kinds of things are being said on science blogs (though more often in the comments than the main posts, to be fair), where people are (presumably) able to say exactly what they want.
So, for example, there are lots of warnings about the possibility of the virus mutating into a more deadly form. This is a genuine fear, of course. All disease-causing agents have the capacity to mutate – this is why the problem of antibiotic-resistant strains of bacteria has arisen. Viruses, too, are more prone to mutating than bacteria, because they reproduce more rapidly, and more generations equals more scope for mutation. There’s also more cause for vigilance with a novel strain of a virus, because one of the ways it may be different is in its tendency to mutate. Like I say, it’s a legitimate fear, but that doesn’t mean it’s a particularly likely outcome.
In the course of learning to cope (barely…) with my mentalism, one of the things I’ve become better at is recognising dysfunctional patterns of thinking. One of the ways of thinking I’m most guilty of is catastrophising – that is, assuming that the worst-case scenario is the most likely scenario, or is even the only scenario, and that it therefore has as good as already happened. It can be a very damaging way of thinking, but it seems to me that there’s been a certain amount of catastrophising in the way even very knowledgeable people have reacted to this virus. Let’s look at the issue of mutation.
First of all, every strain of flu is prone to mutation (in fact it’s why there are so many strains of flu in the first place). Despite this, most of the time, flu doesn’t mutate in a way that is of any significance. Secondly, every mutation has the potential to result in a much more deadly strain. Despite this, most of the time, mutated strains that are different enough to warrant paying attention to are still similar enough to cause similar levels of illness. This is really a key thing – the overwhelming likelihood is that the new virus won’t mutate in a significant way. Even if it does mutate sufficiently to become a new strain, the overwhelming likelihood is that the new strain will be no worse than the existing one. A mutated strain substantially more deadly than the original strain isn’t just a worst-case scenario, it’s a worst-case scenario twice over.
That’s not to say, of course, that scientists and others are wrong to look and plan for the double worst-case outcome. In fact, it would be irresponsible of them not to do so. Every public building in the country has elaborate fire-evacuation procedures that are regularly rehearsed, even though most will never catch fire. The precautions are still appropriate, partly because a fire will break out in a public building somewhere at some point, and also because the consequences of not having taken precautions are so serious. In the same way, it’s vitally important to plan and prepare for the possibility of a deadly new strain of flu, because the odds are that it will happen eventually, and the consequences of such a strain developing are so serious.
But that is not the same thing as saying that this occasion (in fact, any individual occasion) is going to be the time when it happens. This is why I think it’s not too strong to call the way a lot of apparently quite expert people have reacted catastrophising. They seem to have completely set aside considerations of probability. They seem to have, more-or-less collectively, thought ‘This could happen sometime, therefore it must be happening now.” Like I say, preparing for the worst-case scenario is of crucial importance, but experts in the field ought to be able to recognise that the likelihood of the deadly mutation happening with this strain isn’t massively greater than it happening with any strain. In other words, they shouldn’t be any more fearful now than they are the rest of the time.
I don’t know, maybe I’m misreading this. Perhaps, because the thought of a seriously deadly strain of flu is one that scares the willies out of me, I’ve misinterpreted sober statements of potential danger as fear-induced near-panic. I don’t think I have, but it’s a possibility. I certainly think there’s been a widespread reaction against the panic lots of people (me more than most) were feeling a little while ago. It’s probably more than likely that the feeling of relief is leading to a feeling of complacency, and it may well be that which is making me think that people are overreacting. (Though I have to add that I’m not, personally, relieved, so much as I am still trying to persuade myself that things aren’t as bad as they could be.)
One thing that makes me more confident that I may not be misreading this is the frequency with which the 1918 pandemic has been raised as a comparison. That virus flared up, seemed to be relatively mild and to be dieing away, and then came rocketing back in a more deadly form a few months later. This is quite often wheeled out as the basis on which to fear that the same may happen with the present virus. Another way the 1918 outbreak is cited as precedent is when people are talking about mortality rates – that particular strain of the virus was very deadly.
I’m not surprised that 1918 is used as a comparison point by the media and people more generally, because it is massively the most famous flu pandemic. What does surprise me is the frequency with which experts also make reference to it. They must be aware that there are several other, more recent, pandemics that the present one could be compared to, and so their reasons for referring to it can’t simply be that it’s the only one they’ve heard of. It seems to me that this makes it more likely that they are referring to it because it was, by miles, the worst pandemic in modern times. I guess there are two reasons they might be doing that. Firstly, and quite legitimately, the 1918 pandemic is an example of a worst-case (or, at least, very bad) scenario, and so it’s entirely appropriate to keep it in mind, although with the proviso that it’s not likely that 2009 will be another 1918. Secondly, though, I think it could be another example of catastrophising – other less serious outbreaks are discounted because the jump to assuming that the worst that can happen is what will inevitably happen has already been taken.
Very possibly I’m wrong to be surprised by this. No matter how expert we become, or how rationally we try to behave, human beings are always fundamentally human beings, and that means that we get scared, and when we’re scared we’re bad at assessing risk, and tend to swing from massively over-estimating it to massively under-estimating it. As I’ve already said, it’s perfectly possible that the experts are staying calm and rational, and my perceptions that they’re behaving otherwise are all in my head, and because of my inability to accurately assess risk. Actually, putting it like that, I guess I’d be forced to say that it’s rather more likely to be me who’s getting it wrong – not just because I’m a non-expert, but also because we already know that my perceptions and emotions are less reliable than other people’s –
But enough of this self-analysis which can go on for days (years…?) and doesn’t actually get anywhere. The fact remains I don’t understand why the authorities still seem so scared of swine flu. I don’t understand why we’re closing schools. I don’t understand why we’re talking about shutting down concerts and sports events and other mass gatherings. I don’t understand why we’re dishing out Tamiflu to people who won’t experience anything worse than seasonal flu, and wouldn’t get given it for seasonal flu. I don’t understand why we’re doing any of this for a disease that is so patently non-threatening. Swine flu just isn’t serious enough. Is it?
(On second thoughts, I probably shouldn’t have asked that question…)