By Marc Siegel
October 19, 2005
A 50-year-old asthmatic patient who came to my office recently asked for Tamiflu as a protection against bird flu.
"Bird flu may get us all this year," he wheezed anxiously.
"There is no bird flu here," I said.
The greatest problem among my patients right now isn't bird flu; it is fear of bird flu. The greatest risk of an epidemic is of a fear epidemic.
The hyperventilating has reached well beyond my practice. The U.S. Centers for Disease Control and Prevention has been deluged with phone calls and questions. Among them: "Is it safe to keep a bird feeder in the yard?" The answer: Yes!
Bird flu scares us because it is a mindless microbe that has choked off the breathing of millions of birds. But a species barrier protects us from this virus unless there are several more mutations to the viral DNA.
So why are people scared out of proportion to the risk, which is currently close to zero for anyone except bird handlers?
All eyes on 1918
For one thing, comparisons to the terrible scourge of 1918 - when another bird flu mutated and passed human to human - have dilated the sense of danger. But there are many differences between 1918 and now. Many of the 1918 flu victims died of pneumonia because of a lack of antibiotics, which we now have in ample supply. There were also no flu vaccines or antiviral drugs back then, and people lived (and died) in wartime conditions of deprivation and sometimes squalor.
If Americans are afraid of avian flu now, imagine what will happen if a single scrawny, flu-ridden migratory bird somehow manages to reach our shores.
This is how fear works, how the fear epidemic - as opposed to a flu pandemic - spreads. Fear is supposed to be our warning system against imminent dangers, but as a deep-rooted emotion, it interferes with our ability to make sound judgments. And if anything is contagious right now, it's judgment clouded by fear.
Immediate government overreaction creates this cycle of fear: The public reacts and calls for action. Health officials, hearing the public and media cries, look to quiet these generated fears with knee-jerk health policy (such as stockpiling a product with a relatively short shelf life: Both Tamiflu and bird flu vaccines are perishable and will have to be discarded if not used in three years).
Right and wrong approach
So what's the right approach?
Modern-day scientists are tracking the current bird flu and comparing its structure with influenzas of the past. This should comfort us. Laboratory science and careful epidemiological study are the best kind of preparation.
But PR is inevitably part of the game. That's where calls for vaccine stockpiles and "fact-finding" missions come in. U.S. Health and Human Services Secretary Mike Leavitt just wrapped up such a trip to Asia over the weekend. His fear-provoking conclusion: Preventing the start of a global pandemic is just about impossible.
We've heard this all before.
First it was anthrax, then smallpox, followed by West Nile virus and SARS, then human influenza, and now the animal variety. The public-health batting average has been quite low.
It is true that AIDS taught us that we need to look seriously at emerging threats before they spread. But AIDS still kills nearly 3 million people every year in the world, tuberculosis nearly 2 million and malaria about 1 million. We would be far better off using our personal fear radar against these diseases than against a bird disease that's still off in the distance.
Marc Siegel is an associate professor of medicine at NYU School of Medicine. His new book is False Alarm: The Truth About the Epidemic of Fear
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