Why H1N1 panic is not the answer

By André Picard
The Globe and Mail

People sit in a waiting area for turn to be injected with the H1N1 flu vaccine at a clinic in Ottawa. Fred Chartrand/The Canadian Press.
People sit in a waiting area for turn to be injected with the H1N1 flu vaccine at a clinic in Ottawa. Fred Chartrand/The Canadian Press.

The deaths of two young, previously healthy children are bound to terrify families, and to ramp up the fear related to H1N1 influenza several notches. Many parents are now wondering: Should they keep their kids home from school, should they keep them away from hockey practice and gymnastics and should they — horror of horrors — put the kibosh on Halloween? The answer to those questions is no — an equivocal no.

That doesn't mean that there is no risk, of course. The chances of contracting H1N1 are relatively high, and it is estimated that, by the time all is said and done, as many as one in three Canadians could be afflicted by the disease. Still, that is only slightly higher than seasonal flu.

While H1N1 flu is unpleasant, only a fraction of the infected will get so sick that they require hospitalization, and fewer still will die. But because the denominator is so large, a lot of severely ill people will be in intensive care in the coming weeks, and the deaths will be counted in the hundreds, perhaps thousands.

Statistics, of course, are abstract. The deaths of those two children — their stories and photos splashed across the front page of newspapers and on TV newscasts — are painfully and frighteningly real.

What is difficult is putting this risk in context so that it is meaningful.

In 21st century Canada, risk is a largely unfamiliar concept. In a country of 34 million people that has nearly 400,000 births annually, fewer than 800 children aged 1-14 die each year. (Another 1,200 or so under the age of 1 die, most of congenital abnormalities.) In Canada, the greatest danger to children is falls and motor vehicle collisions. Deaths from infectious disease are remarkably few, in large part due to vaccination.

Yet the H1N1 vaccine is hard to come by, even for high priority groups such as children. And while mass immunization campaigns are rolling out across the nation, the lines are frustratingly long.

So, what should parents do?

First and foremost, they should bite the bullet and get their children vaccinated. Pack a book, a GameBoy, and an iPod and get in line.

Stand in line and relish the thought that we live in a country where one of the greatest threats to our children is a bug with a relatively small risk. And don't forget that the risks of the vaccine itself are vanishingly small.

Paradoxically, the lineups for the vaccine are creating huge gatherings, something that should be avoided during an outbreak of disease.

But this risk too has to be kept in context.

The best and most reasoned information on the matter comes from the U.S. Centers for Disease Control, which has published a document entitled "Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza."

The guidelines say, essentially, that there is no point closing schools, except in circumstances where there are huge numbers of infected students and staff. (Similar reasoning applies to other community activities such as sports and trick-or-treating.) What the CDC says is that individual children (and adults) should stay home if they are sick to avoid infecting others. But closing schools only creates alternate gathering places, such as malls and makeshift daycares.

The CDC also says that when children (and adults) are out and about, they should practise hand hygiene and etiquette to minimize the spread of germs. Only in rare instances should activities be cancelled.

In other words, life can and should go on during flu season.

Isolation and quarantine are not very effective public health measures on a large scale. They don't substantially reduce the risk of the spread of disease and they greatly increase panic and fear.

After all, what is risk?

The dictionary definition is: "The possibility of suffering harm or loss: danger."

A more modern and timely definition comes from Peter Sandman, a professor at Rutgers University and the guru of risk management, and the creator of the formula "Risk = Hazard + Outrage."

We know, in a mathematical way, the risk of H1N1 influenza: low but still significant. What is more difficult to measure is outrage, or fear.

When children die, fear rises in an exponential manner.

If nothing else, the tragic deaths of Evan Frustaglio, 13, of Toronto, and Vanetia Warner, 10, of Cornwall, Ont., should shake Canadians out of their complacency. But the largely-indifferent-until-now masses should not hurtle to the other extreme, panic. Between complacency and panic is a vast territory — one we should occupy actively, by working, by going to school and, yes, by trick-or-treating.

October 28, 2009 — Return to cover.