What the BMJ survey confirms most clearly is that the main pandemic flu public perception problem is the risk of complacency, not the risk of panic. This is as true in the U.K. as in the U.S.
Of course scary new developments produce brief periods of widespread alarm, sometimes even excessive alarm. A good label for this inevitable and appropriate short-term reaction is “adjustment reaction.” The recent surge in anxiety after two people in the U.K. died of pandemic flu even though they had no previous medical problems is a typical adjustment reaction. Some journalists inaccurately described calling a government help line as panic; it is, in fact, prudence.
Risk communication experts have long known how difficult it is to persuade people to adopt a new precaution. Whether it’s seat belts or smoke alarms – or coughing into your sleeve – it typically takes a generation to inculcate a new precaution. And that’s when the communication campaign is well-designed and well-funded, and the risk is obviously serious. Of course a catastrophic and terrifying situation sometimes does the job virtually overnight. But getting people to prepare while the seriousness of the threat is still uncertain is very, very difficult.
Ideally, we should want the people of the U.K. (and other developed countries) to understand three things:
- This flu pandemic will almost certainly be pervasive. If it’s typical of other flu pandemics, it will infect one-quarter to one-half of the population before it’s over. It has already infected far more people in the U.K. and elsewhere than the official numbers suggest – because only a small fraction of people with the disease are tested and then added to the tally of confirmed cases.
- This flu pandemic is so far very mild. Based on pretty good data about how many have died and estimates (grounded in surveillance and modeling) about how many have had the disease, the case fatality rate so far is lower than the rate for the seasonal flu. But even a mild flu that infects 15-30 million people in the U.K. (as this one probably will) will inevitably kill thousands, many of them young and previously healthy.
- This flu pandemic may not stay as mild as it is. Flu is famously unpredictable, and some past pandemics (e.g. 1918) have had mild first waves and severe second waves. So we need to prepare – as a society and as individuals – not just for the pervasive-but-mild scenario (which is where we’re headed so far), but also for the pervasive-and-severe scenario. Good hygiene practices like covering your cough and washing your hands help only a little. There is much more to be done, once we get serious … but a severe pandemic will be a very major threat to health no matter how prepared we are.
Copyright © 2009 by Peter M. Sandman