Did public health experts overstate the threat posed by H1N1?

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One-size-fits-all might work for tube socks and trucker caps. But it’s no good when it comes to preparing for pandemic flu, according to an article published in Friday’s edition of the British Medical Journal.

Since the outbreak this spring of the novel H1N1, public health officials have treated the new so-called swine flu as if it were a replay of the devastating 1918 Spanish flu, which claimed tens of millions of victims and was particularly devastating to people who were otherwise young and healthy. But no virus since then has emerged with the same combination of high transmissibility and high lethality, writes Peter Doshi, an MIT graduate student in MIT’s program in history, anthropology, and science, technology and society.

The 1957 and 1968 flu pandemics were widespread but not unusually lethal compared to regular seasonal influenza. On the other hand, the outbreak of Severe Acute Respiratory Syndrome, or SARS, in 2003 had a 10% lethality rate, but only 8,096 people were infected worldwide. The much-feared H5N1 bird flu has likewise done little damage due to its poor transmissibility.

What’s wrong with preparing for the worst-case scenario? Plenty, Doshi writes. The SARS panic prompted involuntary quarantines, travel restrictions, and led to at least $18 billion in economic losses. In the end, the number of people affected by the response to the virus was much greater than the number of people infected by it.

Something similar is likely to be happening with H1N1, he writes. The U.S. Department of Health and Human Services declared a “nationwide public health emergency” on April 26, when there were only 20 confirmed cases and no deaths. The declaration prompted a huge spike in lab testing for H1N1, which in turn produced what Doshi calls a “concern bias, in which concern and anxiety may drive events more than the disease itself.”

Fears about H1N1 have been costly to the pork and travel industries, caused healthy people to endure mandatory isolation, and prompted massive government outlays for lab testing, antiviral medication purchases and expedited vaccine development. Unless things suddenly take an unexpected turn for the worse, all of that activity is probably out of proportion to the actual threat, he writes.

The costs are not just financial.

“Public health responses not calibrated to the threat may be perceived as alarmist, eroding the public trust and resulting in people ignoring important warnings when serious epidemics do occur,” Doshi writes. Pandemic responses that are based solely on the worst-case scenario “carry the risk of doing more harm than they prevent.”

-- Karen Kaplan