PUBLIC HEALTH REPORTER
It has been just more than six years since the advent of severe acute respiratory syndrome, an outbreak whose trajectory is eerily similar to Mexican swine flu.
Swine flu stories have come to dominate the news, just as in the early days of SARS. Politicians and public-health officials have done non-stop briefings. Mexico City looks strangely like Toronto circa spring 2003, a city of mask-wearing residents living in fear.
But should we be more alarmed by the pandemic potential of swine flu than we were by SARS?
Almost all of the cases of swine flu we have seen in Canada are in travellers returning from Mexico. The virus is spreading human-to-human, which is worrisome, but there is no evidence of this occurring on a sustained or widespread basis outside of Mexico.
Unless the swine flu virus begins spreading in the community - in schools, shopping malls, etc. - we should keep the fear-o-meter on low. (That's exactly what level 4 of the WHO pandemic alert scale represents. We are a long way from level 6, a pandemic.)
There are valuable lessons to be learned from the SARS outbreak that can help us keep the threat of swine flu in perspective.
Yet, the media seems to have lost sight of one of the key lessons of SARS: Beware the numbers game.
During SARS, journalists tracked the number of cases, suspected and confirmed - not to mention the body count - obsessively.
Yesterday, the swine flu numbers game kicked into high gear, with hour-by-hour updates. This is misleading and unhelpful, neglecting the basic science of epidemics: Infections rise according to a predictable pattern, following an increasingly rapid curve until they hit a peak, then tail off. This is precisely what is happening with swine flu. There is no question that in the days - and likely weeks - to come, the number of confirmed infections and deaths will increase. This is not, in itself, a cause for panic. It is entirely predictable.
SARS was essentially a hospital-acquired infection. Virtually everyone who contracted the disease, after a traveller brought the pathogen from Hong Kong to Toronto, did so in a hospital, or was infected by a close relative who worked or was treated in a health-care facility.
There was never a threat in the general community. And, in the end, there were only 44 SARS deaths in Canada. (This is not to minimize these deaths, but to provide context: There are about 12,000 deaths annually in the country caused by other hospital-acquired infections.)
To reiterate, swine flu remains a travel-related infection that has affected relatively few people.
So far, the outbreak of swine flu news coverage has been far more severe than the outbreak of the disease itself. The good news is that there are stark differences in the response of politicians and public-health officials to swine flu, compared with SARS.
When SARS came along in 2003, Canada's public-health infrastructure was in disarray, relations between provincial and federal health officials were poisonous, and Canada spent more time bickering with the World Health Organization than working in tandem. This time, there is a co-ordinated response and it is led by people with expertise in infectious disease.
David Butler-Jones, Canada's chief public-health officer - a position created in direct response to the SARS debacle - and his provincial and territorial counterparts are singing from the same hymn book. Similarly, the response of politicians has been impressive. Federal Health Minister Leona Aglukkaq has shown quiet leadership, demonstrating enough smarts to defer to public-health experts.
The change has been even more spectacular in Ontario. The final report of the SARS inquiry described Ontario's public-health system as "broken, neglected, inadequate and dysfunctional," but today the Ontario Agency for Health Protection and Promotion is not only functional, but on the leading edge. The agency sent out an alert about a worrisome disease outbreak in Mexico on April 21, before the swine flu was identified as a new pathogen. It is hard to imagine how it could have done more.
Public-health officials have communicated well, delivering the message that we need to be concerned about the possibility of a pandemic flu, but not alarmed by what has occurred. The message has, unfortunately, sometimes been lost in the media frenzy.
Candace Gibson, an associate professor of journalism at the University of Western Ontario, noted there is an unofficial rule in medical literature (where multi-author papers are common) that there should never be more authors than subjects.
Similarly, Prof. Gibson says, there should never be more stories about a health threat than actual sick people.
With swine flu, hopefully, that balance will be achieved not with more death, but with a little more restraint.
How the virus works
Swine flu is a respiratory disease that infects pigs but also people,
typically those who have been in contact with pigs.
SYMPTOMS IN HUMANS:
THAT CAN END
People-to-people transmission is
through coughing, sneezing
Influenza A subtypes:
H1N1, H1N2, H3N1, H3N2, H2N3
New 'reassortant' virus
Forms when genes from different viruses begin to mix.
When flu spreads
Person-to-person, rather than from animals to humans, it can continue to mutate, making it harder to treat or fight off.
There are no vaccines that contain current swine flu virus causing illness in humans
GRAPHIC NEWS/THE GLOBE AND MAIL
SOURCE: MCT, WORLD HEALTH ORGANIZATION