My morning routine is always the same: I survey the influenza news alerts that came in while I was sleeping as my morning coffee brews. It’s never a good sign when the first article that grabs my attention makes me angry.
This morning’s offering from Canwest News Service made me angry.
By Andrew Mayeda, Canwest News Service [Excerpted]
OTTAWA – For those who have followed the swine-flu outbreak, it has almost become a daily ritual, as routine as the morning weather forecast.
Each day, at roughly 11 a.m. eastern time, a senior official from the World Health Organization, often speaking in a dry, matter-of-fact tone, has appeared on TV screens to update the world on the outbreak.
But as fears of a catastrophic pandemic wane, some medical experts are questioning the apocalyptic statements that have occasionally emerged from WHO’s otherwise subdued press conferences.
“Sometimes some of us think WHO stands for the `World Hysteria Organization, ”’ said Dr. Richard Schabas, who was Ontario’s chief medical officer of health from 1987 to 1997. “There seems to be a culture at WHO where they’ve convinced themselves that a pandemic is such an imminent danger that they overreact.”
The problem with the way the above is phrased is one of knowledge and specificity. If you look at the issue of pandemics and 2009 H1N1 WHO acted exactly properly. But, I admit, one would actually have to be informed on influenza and pandemics to know. If, however, one only viewed pandemics through a lens of death, and how many of same, then the framing would be “correct”.
Perhaps the most sensational statement by WHO came on April 29, the day the UN agency raised its six-point pandemic alert to phase five, meaning it believes a global pandemic is “imminent.” Calling on all countries to “immediately activate their pandemic preparedness plans,” WHO director- general Margaret Chan reminded the world: “it really is all of humanity that is under threat during a pandemic.”
A loaded statement that attempts to spoon feed the readership with the concept of “sensational” when in fact, the statement by Dr. Chan was entirely correct when viewed through a lens of knowledge of pandemic influenza.
“Threat”, as used by Dr. Chan, if I may be forgiven for presuming to explain the statement of someone I’ve never met, means nothing more – and nothing less – than an uncertain outcome and uncertain path to that outcome when the world is faced with a novel pathogen.
Chan qualified her remarks by noting the world is better prepared than ever before to fight a pandemic, and the agency was still gathering data to determine the potential severity of a swine-flu pandemic.
Nevertheless, her “threat-to-humanity” quote hit the 24-hour news cycle with all the subtlety of a neutron bomb – triggering ominous headlines in newspapers and newscasts around the world.
In law enforcement actions taken by an officer are not usually judged strictly by what is viewed as “right” or “wrong” with the benefit of time to contemplate all choices that might have existed if given all that time to contemplate. Instead, fair judgment is based on something a bit more nebulous: was the action reasonable given what should have been reasonably apparent at the moment the action/reaction was initiated?
One of the things that protects the officer from is not knowing that a firearm was unloaded, or the person pointing that firearm had never fired a gun before and likely would have missed the officer even if fired upon, and almost an infinite number of “other” potentials. But, it is reasonable to not want to stand there and wait to find out whether the firearm is unloaded or whether the shooter will miss.
Using the analogy of a police officer facing a person pointing a firearm in their direction is directly translatable to Dr. Chan’s statement and WHO’s actions in general. Had she/they waited until they knew that H1N1’s “gun” was unloaded, or likely to miss “hitting” humanity, it would have been too late to be proactive. The failure to be proactive in the face of a potential threat can – and sometimes does – cost lives, or preventable misery and grief.
The WHO’s actions and statements were reasonable based on the then currently available information, logically assumed possibilities, and global responsibility.
[snip]
Chan has defended her statements, saying it’s her job to cautious.
“I’m not predicting the pandemic will blow up, but if I miss it and we don’t prepare, I fail. I’d rather over-prepare than not prepare,” she told the Financial Times.
And, had WHO done nothing until all was certain and 2009 H1N1 proved to be even slightly more virulent than seasonal influenza, we would be reading a slew of recriminations over that.
There is a term for this sort of thing: Monday Morning Quarterbacking. People engage in this to make themselves feel smarter, blessed with superior intellect, skills of logical analysis, and reason. My reaction to this sort of behavior is always a spare me – please – you pompous ass.
[snip]
But skeptics such as Schabas dismiss such warnings as speculation.
Schabas argues WHO should have a much more complete picture of a disease’s origins and severity before raising its alert level. “Their credibility is suffering. How many more times do they have to ring the alarm before people stop paying attention?”
Well, it’s not exactly like they were paying attention before WHO started raising the alert levels, and by raising them, hordes of folk “disengaged” from the issue of pandemic influenza. No, most were not “engaged” to begin with. Nothing has changed. The public, for the most part, could not care less.
Part of the problem might lie in the apparent gulf between the public’s perception of a pandemic and WHO’s technical definition.
I, for one, would not wish “public perception” to drive much of anything above the trivial. In other words, public perception is fine for some things, but anything beyond the trivial and meaningless – please – allow facts, logic, reason, and some modicum of prudence to guide actions. I could trot out a very long list of things “the public” got it wrong, but since the examples are so well known I won’t bother.
WHO’s original version of its alert scale, developed in 1999, said a pandemic involves “serious morbidity and mortality.” But its current system makes no explicit reference to the deadliness of an outbreak.
In other words, it’s possible WHO could declare a pandemic that would be no more lethal than the seasonal flu, which kills 250,000 to 500,000 people globally every year.
Using this logic, we should not declare an influenza pandemic until 500,001 people have died, or we are damned sure that at least that number will die. Again, using such criteria leaves us reacting to a health emergency, not taking proactive steps to guard health and life, and mitigate community level effects.
“Virulence should figure into the definition,” said Schabas, now medical health officer for Hastings and Prince Edward counties in Ontario. “What if we declared a pandemic and no one got sick?”
This last statement is the one that made an article I disagreed with into an article that made me angry.
The arrogant ignorance just drips from that statement in swollen pendulous blobs splattering all who have even the tiniest bit of reasoning skills tucked away in their brains.
Disease is intrinsic in the definition of a pandemic. After all, if a virus or bacteria does not cause disease who cares about them? I can put a pretty good estimated number to that question – zero – zilch – nada. And, make no mistake, 2009 H1N1 is causing disease, and it has contributed to the deaths of somewhere around 45 officially confirmed infections. As the infections rise, so too will the deaths.
The goal of the WHO’s actions is to keep both the infections and the deaths to a minimum, heavily weighted to the deaths bit. What is not a health threat to the average healthy person between the ages of 5 and 69 (statistically) is not so benign for all the many others who fall outside those parameters.
One of the hallmarks of an enlightened society is the protection of the most vulnerable among its members, not just the majority. When it comes to pandemic infectious disease, the whole world is our “society” and everyone is “our neighbor”.
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