Put “Pandemic” Back in Pandora’s Box—Until We Really Need It

Remember swine flu? I don’t blame you if you don’t. Think about what’s happened since late-April/early-May, when we all mentioned it (jokingly or worriedly) after every innocent cough and sneeze: Manny Ramirez earned an asterisk on his batting stats. Supreme Court Justice David Souter announced his imminent departure from the Court — and President Obama introduced his presumptive replacement, Sonia Sotomayor. Conan O’Brien succeeded Jay Leno as host of “The Tonight Show.” And the next so-called “iPhone killer,” the Palm Pre debuted…just in time for the announcement of a new iPhone.

A quick update: Since Joe Biden warned us not fly or take public transportation, the Centers for Disease Control increased its estimate of H1N1′s impact in the U.S. to nearly 18,000 cases and 45 deaths — extremely mild compared to a normal flu season. Nevertheless, because of the illness’ appearance in more than 70 countries, the World Health Organization raised its pandemic alert level to its highest point (6 out of 6), meaning “there are now ongoing community level outbreaks in multiple parts of world.”

Outside of the public health community, the use of the word “pandemic” has felt like an overstatement in light of the facts-and the faded memory of school closings and horror stories crossing the border from Mexico. Two recent articles comment on the reassessment of the one-time public health scare.

The New Yorker ran an historical allegory about psittacosis, or parrot fever, an illness that befell exotic bird owners in late-1929/early-1930 (and, interestingly, led to the creation of the National Institutes of Health). To the population at-large, it ended up being much ado about nothing; in fact, today, it still exists, infecting fewer than 200 people per year. Author Jill Lepore examined the media coverage in response to the outbreak, which initially portrayed scientists as superheroes pitted against a formidable, infectious villain. She writes:

Psittacosis incited, if briefly, a sizable panic among people who, by any reasonable measure, had nothing to fear. That was dangerous. Even as the story unfolded, what to make of parrot fever and just how much responsibility the press or the scientific community bore for the panic proved matters of dispute. But what happened next seems nearly as dangerous as the panic itself: people suddenly started insisting that parrot fever didn’t exist.

Is that happening again? Isn’t all this talk of swine flu as a “pandemic” combined with the lack of human-culling power that the label promises conditioning us to be flippant in the face of future public health concerns — possibly to our own detriment?

Lawrence K. Altman, M.D. examines this very topic in “The Doctor’s World” column in this week’s Science Times. Apparently, part of the problem is that pandemic isn’t officially defined within the medical community. There’s no agreed upon standard for what causes one, how an illness affects a particular country that it spreads to or when one ends.

United States and W.H.O. officials say their preparedness plans are intended for governments, not people in the street,” Dr. Altman writes. “Officials bristle at criticism that their messages and plans have led the public to equate the word pandemic with the Spanish influenza of 1918-19, the worst recorded pandemic in history, killing 20 million to 100 million people. (The double use of pandemic in that sentence could lead to further confusion about how to interpret the word.)

The editor of the “Control of Communicable Diseases Manual” assures Altman that the next edition of the reference book will contain an official definition for pandemic. But will that be too late for this generation? When the next pandemic comes around-and is actually a pandemic worthy of the word as we now interpret it — will we puff out our collective chest, go about our business and say, ‘I’ll worry about that…when pigs fly.”

Maybe we should shelve pandemic until the time when we actually need it–and hopefully that’s not sometime in the near future.

Art Credit: Photo by Ben Chau.