January 2006 | Back to Table of Contents

Avian Flu

A Pandemic of Fear

By Charles R. Meyer, M.D.

From Newsweek to the New York Times, media have fanned the flames of flu fear.

An epidemic hit doctors’ offices this fall. The symptoms struck quickly—phone calls, faxes, e-mails. The disease spread over a few days, taxing the clinical acumen of medical practitioners. Yet no patient needed hospitalization. No one died. And actually, no patient got sick. The epidemic was the feverish public reaction to the possibility of an epidemic, the H5N1 avian flu.

In October, just in time for Halloween, front pages across America warned of the coming plague. An Oct. 31 Newsweek article ominously proclaimed that “the world is on edge, stalked by a virus that travels the great migratory flyways and kills where it lands,” and explained that “the H5N1 variant of avian flu suddenly and mysteriously expanded its range this year.” Richard Falkenrath, Ph.D., former deputy Homeland Security adviser, opined in the same article that “a flu pandemic is the most dangerous threat the United States faces today.” Minnesota’s Michael Osterholm, Ph.D., M.P.H., stated that a global pandemic is the “single greatest risk to our world today.” An accompanying opinion piece by Newsweek editor Fareed Zakaria called for a redirection of national funds for a biological Manhattan Project targeting influenza viruses rather than ballistic missiles. The hype didn’t stop there. A Washington Post headline reprinted in the Minneapolis Star Tribune read: “Americans Stockpile Drug in Fear of Bird Flu Pandemic.” Pictures of hooded researchers advertised a National Geographic Channel television special on the “killer flu.” Even the normally sedate New York Times on Oct. 21 ran the ominous headline “When a Bug Becomes a Monster.”

Citing “this threat to our homeland,” President Bush on Nov. 2 asked Congress to approve $7.1 billion to help the country prepare for a global pandemic of influenza.

Although the Newsweek articles included accurate information about the current state of avian flu (110 total human cases worldwide at that time, mostly in Southeast Asia, with 68 fatalities, all but one caused by animal-to-human transmission after close contact with birds) and urged perspective, many people read this and other media coverage and saw imminent danger rather than precautionary readiness.

The early phone calls from patients requested the “bird flu vaccine,” some of them quite insistent that it was available. Next came the questions about quarantine. And finally, and seemingly forever, came the requests for Tamiflu. The Newsweek article included strong condemnation of Tamiflu stockpiling, quoting Centers for Disease Control and Prevention director Julie Gerberding, M.D., M.P.H., that “it’s a complete misdirection of energy to be so focused on the issue of stockpiling” and labeling personal stockpiling a “really bad idea.”

Yet many patients claimed they had heard that Tamiflu was “their only defense” and were adamant that they needed a prescription. Nationally, prescriptions for Tamiflu during the first eight months of 2005 were three times the volume of the previous year. One patient of mine who was traveling to Thailand demanded Tamiflu. I asked him what he would do with it. He said he would take it if he got sick. I asked him what symptoms would prompt him to take Tamiflu, and he wasn’t sure. I suggested that any infectious illness he might get would likely not be avian flu, that I couldn’t give him any parameters for how to decide what his symptoms might mean or when to start taking Tamiflu, and that by giving him a week’s worth of Tamiflu I would be reducing the supply for elderly patients and others who got influenza this winter. He still insisted that he would feel more comfortable having it.

Tempering the Tone
This is not our first epidemic of scared patients. Similar fright has been provoked by AIDS, SARS, West Nile virus, Lyme disease, anthrax, and even Ebola virus. The demands for Tamiflu echo the demands for Cipro during the post-9/11 anthrax scares. Despite the technology and pharmacology of 2005 American medicine, infectious diseases provoke fears the way TB, polio, and cholera did in past centuries. For media and physicians alike, the question is How do we tell people what they need to know about their health without scaring them?

Involuntarily, physicians become arms of the media, filling in the blanks, explaining, correcting, and disputing. Our job is really the same as that of the media, to put perspective on health threats. Newsweek’s coverage of the avian flu omitted the crucial fact that nobody knows when and if a pandemic will occur. Osterholm recently predicted “within 10 years.” Language like “the world is on edge stalked by a virus” may prompt congressional or presidential action, but it also triggers the collateral damage of a populace quaking whenever they cough.

A recent cover cartoon in The New Yorker showed a chicken with a flushed face, a hot water bottle on its head, and a thermometer in its mouth standing on the curb of a street, preparing to walk across. All the people in the cartoon were on the other side of the road. The caption of the cartoon was “Crossing over.”

Public health officials would be negligent to ignore the possibility that avian flu will “cross over” and mutate to a virus that can be passed between humans. But as medicine prepares for the worst case, a pandemic on the scale of the 1918 flu, we need to battle an epidemic of fear with large doses of perspective. MM

Charles Meyer is editor in chief of Minnesota Medicine.