Facing a wave of questions on swine flu

Last week, the Swine Influenza A(H1N1) pandemic swept through the media at a speed unparalleled by the global speed of the actual disease. But just as rapid was the response from the public health community, which showed itself up to the challenge.

Start with April 23, when ill students lined up to see the nurse at St. Francis Prep School in Queens, N.Y. Several of those students' cultures revealed a non-typeable strain of influenza A, quickly confirmed to be the H1N1 variant consistent with swine flu. The information crept from a call to the New York City Health Department to local media coverage.

Public health officials were quickly led to Mexico, where the infected students had recently traveled to the beaches of Cancun. There, we discovered significant illness, and the images of everyday people wearing surgical masks on the streets of Mexico City appeared in print and electronic media.

On April 24, the World Health Organization mentioned influenzalike illness in the United States and Mexico on its "disease outbreaks by year" section.

Five days later, with 148 documented swine-flu infections in nine countries, WHO raised its pandemic alert phase to 5, indicating widespread, sustained human infection. At that time, with the U.S. public now fully focused on swine flu, the Centers for Disease Control and Prevention noted 91 cases in 10 states, with more than half among the original group of New York students.

Stories have focused on viral transmission, treatment, prevention, preparedness, and panic. Questions from the public and the media have been dizzying, ranging from the intensely scientific to the seemingly obvious.

Can you get this from eating cooked pork? No.

Can my pets get this? No.

Should I hold my wedding in Cancun in September as planned? It's too soon to know; follow travel-advisory information from the CDC closer to the event.

Will there be a vaccine? Work is under way to make a safe and effective vaccine that hopefully will be available by next flu season.

Is there enough medication? For those who may truly need it, yes, but most infected persons in the United States have not required intensive medical intervention.

What should I do to protect myself and my family? Make sure you wash your hands, cover your cough, and stay home if you are sick.

Is the nation/state/city prepared for a pandemic? Public health authorities are more prepared than ever before, supported with some (more is needed) government funding and shaped over time by events, including the 1918 flu disaster, 2001 anthrax attack, the ongoing threat of avian flu, and Hurricane Katrina. The global community, however, is far from ready.

Is it time to panic? It is never time to panic. While it's no surprise that a circulating, airborne, invisible virus causes anxiety for many, panic serves no useful role in public health.

Keep in mind that about 36,000 Americans die each year during a typical flu season, most from disease complications. Many of those deaths may have been prevented with seasonal flu vaccination and everyday measures such as hand washing, covering coughs, and staying home from school or work when stricken by a respiratory illness.

Our nation's response to the swine-flu epidemic thus far has been sensible and swift. Coordinated actions of federal, state, and local health departments have been data-driven. Official health communications from the CDC and WHO have been timely and accessible to an array of audiences.

Understandably, it seems that everyone is talking about swine flu. Every cough and sneeze carries new meaning. We pay closer attention to each new documented case that moves closer to our home and family. At such times, a bright light shines on the public health infrastructure. The public wants to know if the nation is prepared, if they are safe.

When the epidemic response is rapid and effective, public health has done its job. But a job well done can soon be accompanied by a dubious public, which wonders if the media and the message have overplayed the situation.

Such no-win situations are built into public health. The daily business of preventing disease and promoting health is usually a quiet affair. When disease arises unexpectedly from the consumption of tainted peanuts or a breath on the subway, both the public and Congress demand an explanation, as well as a safer world. But when there are predictably low levels of illness each year from a known array of pathogens, the public goes about its business and Congress needs convincing that the public health infrastructure requires significant, ongoing financial support.

Thus far, the U.S. public health response to the influenza A(H1N1) epidemic has been entirely appropriate. There is an understanding of the threat and measures to interrupt disease spread have been widely employed. Swine flu and our response to it, illustrates the public's role in public health. The trick is to stay engaged long after the flu season has ended.