People, Panic, and Pandemics

by Danielle Ofri

Yesterday was a typically busy day in my medical clinic, plenty of killers on the loose – diabetes, hypertension, coronary disease. But every patient wanted to talk about swine flu. The news that swine flu had come to New York City sent my patients into a panic and they peppered me with questions: Is it the same as that bird flu from China? Is it like smallpox?  Can I get the vaccine?

These are the same patients who routinely refuse the flu shot every year because they’re sure it makes them sick.  There are tens of thousands of deaths every year from influenza – the one for which we have a vaccine – but it’s the handful of cases of swine flu that really grips their attention. They may have diabetes curdling their kidneys, cholesterol clogging their coronary arteries, blood pressure strangling the blood supply to their brain, yet their most pressing question is whether they should be wearing a mask when they ride the F train.

I, of course, am no different.  I’ve pored over every word of the articles about swine flu, while my medical journals discussing the latest cancer screening recommendations gather in a pile under my desk.

Why are we intrigued by these exotic, but far rarer, illnesses? There’s the newness, obviously, as well as the sense that we can’t control it. We’re not doing such a hot job controlling diabetes either, but that’s not very exciting news.

Priscilla Wald, an English professor at Duke University offers a different reason. In her intriguing book Contagious: Cultures, Carriers, and the Outbreak Narrative, she recognizes that the outbreaks that society tends to find compelling are the ones that follow a particular dramatic arc. These outbreaks usually arise in a dark and foreboding setting (HIV from the African jungle, avian flu from teeming Asian slums) and then infect the “civilized” world.

Outbreaks that stay confined to the developing world rarely make news. The fact that a half-a-million people die each year from filariasis, Guinea worm, and onchocerciasis elicits little more than a yawn because these infections stay huddled far from sight.

But Ebola virus had us riveted: a horrific pathogen emerged from the primordial African muck and could migrate via modern trans-Atlantic travel to infect the innocent Western world. Sounds like a thriller movie. Which it was. Outbreak, in 1995, grossed more money than the budget for most health departments.

Swine flu fits into this narrative paradigm: arising from teeming, foreign city, sneaking into the United States via easy air travel. This holds our attention and stokes our instinctive fears because we see ourselves as potential actors in this drama.

The fact that more than 1000 Americans died yesterday from cigarette smoking doesn’t agitate us. The fact that all my patients yesterday were facing actual death threats from their vascular and metabolic diseases didn’t cause a single one to jump up and proclaim, “Now I’m going to take my insulin! Today is the day to quit smoking! It’s urgent that I lose those 20 pounds!”

Of course, swine flu might very well turn into a pandemic.  The last major flu outbreak we saw was the Hong Kong flu in 1968– 69. But our medical system has changed vastly since then. We have many fewer hospital beds, many fewer primary care doctors, and many fewer resources devoted to public health.

Our national priorities – like me and my patients – have a toddler-like attention span.  We are gripped only by the crisis du jour.  It is not very dramatic to fund basic public-health campaigns, invest in everyday primary care, or focus on preventive medicine. None of these offers the engrossing dramatic narrative to engage us – whether by intelligent thought or by instinctive panic – in the necessary hard work to create a medical system prepared for such outbreaks.

And so I try to help my patients place their fears in perspective. I tell them that wearing masks on the subway is not necessary at this point. I remind them that basic hand-washing is the single most effective tool for preventing spread of disease. I point out that uncontrolled diabetes and hypertension pose much graver risks to their health than swine flu does. And then I mention the flu shots and the pneumonia vaccine and the tetanus booster.   They roll their eyes and shake their heads.  “No,” they say. “ Those vaccines always make you sick.  I don’t want any shots.”

I sigh. I write out their prescriptions. I shake their hands. I wish them well. And then I wash my hands.