Swine Flu is a Threat: Under-funded Public Health is a Disaster

MCT

   The following editorial appeared in the St. Louis Post-Dispatch on Wednesday, April 29:

   The three most alarming words in medicine are these: "We don't know." They've been invoked frequently in connection with an outbreak of swine flu over the last few days.

   It began in Mexico, where thousands of people have been sickened and reportedly more than 150 people are dead. The virus spread with alarming speed to the United States, Canada, New Zealand, the United Kingdom, Israel and Spain.

   Still, there is no reason to panic. Public health officials already have activated emergency plans. Doctors report the virus responds to anti-flu drugs that are available widely.

   Still, many questions remain about the new influenza strain, which is a combination of swine, bird and human viruses. The combination makes for interesting science. Perhaps one day what we learn about this flu will offer strategies to prevent future outbreaks of even more deadly diseases.

   The challenge for public health officials is to avoid both over-reaction and complacency.

   Swine flu is famous in the annals of public health. A small outbreak on an Army base in 1976 led to a national vaccination campaign, but the feared epidemic never materialized. For years afterward, swine flu was synonymous with a threat that was more theoretical than real.

   It's still unclear how great a threat the 2009 version poses. But in the United States, at least, it occurs against an ominous backdrop of budget cuts and soaring numbers of uninsured people.

   The public health network we rely on to protect us from disease outbreaks is a fraying fabric of more than 3,000 federal, state and local health departments. Falling tax revenues from the recession have caused many governments to cut funding.

   Ironically, one area that has been hit particularly hard is pandemic influenza preparedness. Federal funding for those state programs ended last August. The Association of State and Territorial Health Officials reports the loss of federal funding caused layoffs and program reductions at public health agencies. Those agencies are, quite literally, the first line of defense.

   At the same time, millions of Americans have lost their jobs and the health insurance coverage that came with them. Uninsured people are less likely to seek medical care right away, especially for things like the flu. Without treatment, they can spread the disease.

   When they do get care, they're more likely to seek it in an emergency department where they easily can become infected — or spread infection among the most vulnerable people, those hospitalized in ill health.

   In Mexico, which has a limited ability to detect and track community disease outbreaks, most swine flu cases have been reported among patients hospitalized for pneumonia. Infectious disease experts have suggested that explains why the death rate in Mexico appears to be much higher than in the rest of North America.

   It also may be, however, the virus has mutated to become less lethal. Or it could be that future waves of infection among more vulnerable patients will push up death rates here and around the world. We don't know.

   It will take time to answer those questions. A vigorous public health response doesn't have to wait, but unless the nation invests in its public health agencies, our ability to respond to emerging infectious disease outbreaks is as fanciful as pigs that fly.

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©The Voice 2009