health is bedeviled by the public's lack of understanding of
uncertainty. Public health policy deals with potential future events.
Decisions about policy have to be made with often inadequate data. If,
as often happens, bad scenarios don't unfold, policy-makers may well
make decisions that turn out to be wrong in the sense that the
preventive efforts were taken that proved to be unneeded.
We see this in the case of the current H1N1 swine flu pandemic. Skeptics are using the initial concerns about worst case scenarios , which turned out to be wrong when more data was available, to encourage skepticism about current plans to cope with a looming pandemic. We see this reasoning in a recent Alternet article by Joshua Holland -- H1N1 Just Isn't That Scary: Why There's No Reason to Go Overboard with Swine Flu Hysteria -- which claims that swine flu fears are more dangerous than the swine flu itself. [Holland's article received a furious rebuttal -- More crappy flu journalism, this time Alternet -- from a blogger named "revere" at Effect Measure with which I strongly concur. My comments complement revere's.]
Holland refers to comments last spring abut the potential danger:
"In April, Homeland Security Chief Janet Napolitano called a press conference and declared a public-health emergency. In August, officials for the Centers for Disease Control warned that H1N1 could infect half of the U.S. population and kill 90,000 Americans by year's end. CDC officials estimated that 1 in 10 New Yorkers had contracted the virus this spring."
To not take action, issue warnings, consider school closings, and start a vaccine development program would have been highly negligent. Had the pandemic developed differently, as could well have occurred, likely many of the same people now criticizing the "hysteria" would soon be screaming at the incompetence or corruption of a public health policy establishment that failed to respond to a looming crisis.
In any case, Holland and similar writers fail to understand that, even with the relatively low severity of the swine flu at this point, the overall risk is greater because of the lack of immunity in the population. Thus, a much larger percentage of the population is likely to become infected. If even a small proportion of the infected become very ill and require hospitalization, our emergency medical system, already operating under great continuous strain, will face much greater strain. Large numbers of severely ill people may be turned away from ERs, to take their chances at home. revere explains the problem:
"Our big city emergency rooms periodically and routinely go "on diversion," meaning that they divert the ambulance that's on its way [to] their hospital to another hospital. The main reason is not the already ludicrous long waits in the ER but the shortage of critical care beds, the ones with the ventilators and skilled nursing that Holland thinks will now save people seriously ill with flu. It's a common mistake. But it's a mistake."
Holland, however, recommends that the non-health professionals among us just ignore swine flu: