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THE NOV. 3 ARTICLE in The Free
The story contributed to the anxiety that many people feel when confronted with infectious diseases without providing any concrete help or hope. Even human interest stories should strive to encourage us to do what's right, not build on fear and create mistrust between neighbors.
In reality, the "bird flu" that the Noonans are so prepared for is not now and may never become a pandemic. Should a pandemic strain of influenza emerge, it is impossible to predict its severity or the effect it will have on various elements in society.
The most likely disruption everyday citizens might face is disruption in health services. News of a pandemic could drive individuals to seek medical attention for minor illnesses, such as colds, possibly overwhelming private physicians and hospitals also treating the seriously ill. These same health workers will feel responsible for caring for any sick individuals in their own families and will face the possibility of infection with the new strain themselves.
This does not, however, mean that medical care will come to a grinding halt, or that the average citizen should learn how to set up and run a field clinic--only that in times of emergency, common sense and community bonds will be your greatest allies.
Stories encouraging a survivalist approach to a pandemic serve only to make the jobs of those tasked with planning for one more difficult. For instance, physicians in the area are concerned with the number of patients requesting prescriptions for Tamiflu,
Is a Tamiflu stockpile your best defense against bird flu? Probably not. Stocks of Tamiflu are limited throughout the world, and the best use of the medication initially is to limit the spread of a pandemic strain, hoping that it never reaches U.S. soil. If a strain does reach the U.S., the next best use of Tamiflu is to help those at highest risk of contracting or having serious complications from disease, including health care workers and persons with immune deficiencies.
There are also complications to the use of Tamiflu by private individuals without a doctor's guidance. Tamiflu has a limited shelf life, so stockpiles could expire before they are ever needed for a pandemic. Tamiflu can be used to both treat and prevent the flu; however, studies of treatment indicate that it reduces the length of illness only by a single day.
Use of Tamiflu to prevent the flu is complicated, since the drug must be used every day, possibly for months, while a flu strain is present in the community. How would you know it was time to start taking Tamiflu? How would you know when to stop? What about proper dosing for everyone in your family?
At nearly $5 per dose, Tamiflu is an expensive and uncertain prevention measure. And if Tamiflu is used incorrectly, the flu virus may develop resistance to its effects, eliminating one weapon in our health arsenal.
The ideal prevention against a pandemic strain of flu is a vaccine. The World Health Organization is leading the effort to develop a vaccine for humans against the bird flu in Asia, in the event that it begins to spread. This vaccine will be available in limited supply, and probably won't offer the highest protection, but
One of the criticisms in the article, that the U.S. vaccine industry was crippled by fear of uncapped liability lawsuits, has some truth. The vaccine manufacturing infrastructure in the U.S. could use some work. There is fear in the industry that a new vaccine, administered to millions of patients, could cause harm to some small fraction and lead to large settlements payable by the company. However, the reality of our lack of vaccine capacity is much more complex than a single issue. Change won't happen without the commitment of citizens to a lengthy improvement process, and without that commitment translating into pressure for companies and government to improve our nation's vaccine manufacturing capabilities.
In order to prepare in the community, leaders in healthcare, public health, emergency response, and local government need to come together to seriously address the issue of pandemic preparedness. Clear plans outlining the duties and responsibilities of local agencies, how to coordinate with state and federal officials, and how to provide medical care
Public education messages need to be widely distributed in such a way that people will see, hear, and respond to them. Knowledge will be our best defense against panic and fear. When we understand why difficult things are being asked of us, such as restricting travel plans, not visiting sick relatives, or quarantining ourselves at home after exposure to an illness, we are much more likely to cooperate.
One of the best defenses we will have against any infectious disease is cultivating our sense of community. When we care for our neighbor as much as ourselves, we will respect that minor illnesses do not require a trip to the emergency room, though they do require that we stay home and not spread it to others.
We will practice good hygiene, understanding the value it has for saving our neighbors from potentially life-threatening illnesses. We will trust physicians and public health officials to determine where medications are most needed and by whom. We will be prepared with a reasonable supply of food, water, and batteries, and we will be ready to share
ELIZABETH LOWERY is the epidemiologist for the Rappahannock Area Health District.
