The flu. It's like a dog.

If I read one more time, 'dude, it's just the flu! We get flu all the time! Chill!', it's possible my head will explode.

Yes, it's the flu. But flu is like dogs - it comes in a variety of types and some are more dangerous than others. "Dude, it's just a dog!" makes sense when you're talking about a small tail-wagging puppy. It might not make as much sense when you're faced with a 100 lb snarling, teeth-bared, full hackles up specimen.

And in this case, we don't know yet which type it is.

What we do know is that it's new, which means that people don't have any immunity to it (although there are some reports that people born before 1957 may have some immunity) and that it's been spreading (although there's still uncertainty about sustained person to person transmission). BTW, epidemiologists sometimes talk about populations being "immunologically naive" when they don't have immunity to a certain organism. I love that phrase. Because naive is something I'm seeing a lot, along with just downright stupid.

We also know that previous pandemics came in waves. The 1918 pandemic started in the spring with a relatively mild respiratory infection, disappeared for a few months and came back with a vengeance with a second wave in August.

So maybe this is just a cuddly puppy now (thought it's too soon to tell), but it might grow into something quite different in the months to come.

Public health policy is designed to mitigate risk to the population.

And here's the meme for this time: when public health works, nothing happens. If this fizzles out, GREAT! Mitigating the spread of infection is public health's job. If they're successful at what they do, this may well fizzle and we should celebrate.

The school closures etc are analagous to the fire department evacuating buildings when the fire alarm goes off. Especially if there are reports of smoke.

It might turn out to be nothing. It might be easily put out. Then again, it might be moments away from an inferno. There are professionals whose job it is to assess the risks and to take reasonable precautions; the second-guessing and moaning of 'what's the big deal' is a sign of blase stupidity.

On a personal level, be sensible, be responsible.

The US government official pandemic flu preparedness program calls for individuals to be self sufficient for two weeks.

Can you do that?

The Get Pandemic Ready site, endorsed by several counties of Idaho, recommends twelve weeks of supplies.

Can you do that?

Yes, you can.

Natural disasters, serious pandemics, or the entire family succumbing to a really bad ordinary cold, or mom having a broken leg while hubby is out town - all are alleviated by careful planning and preparation. I live in an earthquake zone. Vancouver is also a major transportation hub and a significant point of entry for people and products from Asia, where the bird flu is still churning and mutating. And just to round things out, we're about 200 km away from a nuclear submarine base.

This isn't panicking or being hysterical or melodramatic. This is being prepared, like good scouts. It's no different than buying insurance. People who prepare and stock up aren't (necessarily LOL) paranoid survivalists - they're just getting some insurance.

Some interesting things:

1. Most of the numbers reported are of the 'confirmed' cases. Those are slow to come as they are determined either by RT-PCR testing or if the sample yields the virus in a cell culture. These methods are time consuming and expensive. Which means that the 'confirmed' numbers reported are the tip of the breakout pyramid. Beneath that tip of the pyramid you have the bulk of cases in the probable and the suspected. There are also increased reports that many areas are no longer doing full testing so the # of confirmed cases will by definition not reflect the true caseloads. See for ex this report: which says:

"Illinois has switched to a less aggressive testing standard as the number of swine flu cases continues to grow. The state now recommends testing on hospitalized patients with severe symptoms in order to use resources more cautiously."

2. In 2006 there was a pandemic simulation (pdf report) conducted in collaboration with the World Economic Forum. One of the conclusions drawn by Dr. David Nabarro, U.N. System Coordinator for Avian and Human Influenza: "Quite likely by Day 28 all systems will have fallen apart—we need a plan to improve infrastructure to support the response."

3. Large stores now do not carry extra inventory. When the supply chain is disturbed and people 'panic shop', this is the result. If there's a big official call to stock up, the store shelves will be bare in hours. Don't wait.

Further reading:
For really good, reasoned, intelligent discussion of the flu and public health as a whole, check out the Effect Measure blog which is written by epidemiologists: public health scientists and practitioners. Good discussion of what is happening now. Lots of interesting questions are raised and answered in the comments.

For more general and historical reading:


And finally, for pre-order, as it won't be available till November 2009:

Written by a Washington Post reporter who has been following H5N1 infections in the Far East.

And remember: when public health works, nothing happens.

And: be prepared.