Gordon Campbell on the swine flu epidemic

swine flu meets bird flu - scoop image lyndon hood

Interesting that John Key began his press conference on Monday by covering off the politics of the swine flu epidemic first. No false modesty from him. New Zealand’s response, he claimed, had been swift, thorough and appropriate.

With the nation thus assured of his government’s performance, Key moved onto the matter of the public’s safety, should things from this fine, fine start, get a lot worse. Not an easy call to make. So far, the swine flu story has unfolded globally in such a fuzz of inadequate information that the panic! and don’t panic! buttons seem to be being pushed virtually at random.

One core question has been why, so far , the death toll in Mexico is higher than anywhere else. A death toll of 150 has so far been cited in some reports, though the confirmed figure of swine flu deaths is far lower. On Sunday, Mexican President Felipe Calderon made the case for the flu’s effects being not very severe – by claiming that of the 1,324 patients who had been identified with flu-like symptoms up until the day before, some 929 had been treated and released from hospital. Even if those figures have not simply been plucked out of the air (and they may well have been) the fact remains that so far, it is only in Mexico that swine flu victims have died.

How come? As Slate magazine has pointed out, part of the explanation is that Mexico has fewer resources to tell the difference between deaths from swine flu and deaths caused by other influenza strains, given that Mexico is in middle of its flu season (it is worth remembering that globally, some 500,000 to a million people die from ordinary strains of flu each year). Plus of course, Mexico has fewer resources to cope with the secondary effects of influenza.

Beyond that point, the likely explanation for the different mortality rate in Mexico is that the disease has been present in the Mexican population for far longer than the fortnight or so that the rest of the world has been told about. Since February perhaps, according to this report.

If so, as Slate also points out, this has a good news /bad news consequence. Either the true mortality rate per patient is relatively low in both Mexico and everywhere else. Alternatively, if the death rate is high, per patient – as high say, as it was with avian flu – then swine flu must not be easily transmitted between humans.

Which is more likely? Clearly, the former. Because on the evidence, swine flu is indeed highly contagious, and able to be picked up by tourists and kids on school trips. Since it seems to be so contagious, the likely explanation is that Mexico has had far more cases for longer than we think, and the mortality rate is quite low. As many observers have pointed out, this means that avian flu remains the nightmare. It has a high kill rate, but – as yet anyway – cannot easily and sustainably move from one human host to another. If avian flu ever solves that little problem – or ever re-assorts itself into a viral form that can be easily transmitted, then watch out. In the meantime, do try and keep the birds away from the pigs.

There is still one caveat about this optimistic attitude about the likely (non) severity of swine flu. It would help a lot if the Mexicans could gather and release reliable information on the victims’ age. gender and medical status. To date, we have only anecdotal reports that many victims are concentrated in the 20-50 age group – which if true, would be a bad sign. Earlier flu pandemics (including the 1918 Spanish flu and the Hong Kong virus of the late 1960s) have also wreaked havoc among the young and robust – by causing their healthy immune systems to over-react and flood the respiratory system in what is called a ‘cytokine storm.’

Has our own Health Department response been all that flash? As mentioned, a new variant was detected in a four year boy in a flu outbreak by Mexican laboratories in February, though Mexican officials now say they first detected this particular swine flu virus on March 18. As reporters asked Health Minister Tony Ryall at Key’s Monday press conference, hadn’t the Centre for Disease Control in Atlanta been issuing warnings of the swine flu outbreak in Mexico since at least April 21?

Had the bureaucratic cull left anyone in the Health Department able to read such alarms, and initiate an airport screening programme before Saturday, April 25, and the arrival back home from Mexico of those flu- bearing schoolkids? The response gap left the health authorities in the position of having to play ‘trace and catch up’ with other passengers on the flights involved.

Then there is the matter that having detected a likely outbreak of a viral epidemic on Saturday, health officials took until Sunday to notify Ryall, and until late Monday to get swabs onto a plane to Australia for testing, some 48 hours after first gathering them. “Swift” is not exactly the first word that comes to mind when considering the response pattern.

On the other hand, the swine flu saga does suggest there is a place for some of those backroom bureaucrats in the public service, after all. Perhaps some of the health spending the National Party slagged on the campaign trail – yes, your tax money does seem to have been lavished on stock-piles of Tamiflu, and on response plans for a flu pandemic – was not quite so wasteful after all. In the US, the Republicans are now having to eat humble pie on this very point.

Back in February, just as the swine flu storm was gathering in Mexico, the Republicans were gaily attacking the Obama stimulus package for containing items they were happy to depict as laughable and wasteful. Louisiana Governor Bobby Jindal for instance, lambasted the stimulus package spending on early detection systems for volcano eruptions. Karl Rove, the former White House spinmeister wrote a Wall Street Journal article in February that ridiculed the spending allocation for funding…a US preparedness plan for a global flu pandemic. Talk about laugh.

As Rove argued, hadn’t there already been extra spending last year on jobs in the health sector ? Big Government had gone mad yet again !

Well, lets take Rove’s central point – why should such an allocation be contained in an economic stimulus package ? Simple. Because the global recession has always seemed likely to last long enough that any subsequent economic gains would risk being wiped out should a flu pandemic happen to arrive right in the middle of an economic recovery. It arrived far sooner than expected. Even so, enough ‘moderate’ Democrats caved in to the criticism and gutted the emergency spending for a pandemic plan from the Senate version of the Bill.

The overall lesson being ? When it suits any government to do so, it portrays its officials as heroes, not zeroes. If the Key government truly believes the response by public service bureaucrats to this crisis has been swift, thorough and appropriate… it should act accordingly, and spare the axe. Let’s see how many of the hard working public servants that Tony Ryall so admires today, still have a job in a year or two.


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