Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2651 (Published 02 July 2009) Cite this as: BMJ 2009;339:b2651
All rapid responses
Handshake is commonly used on daily basis to greet other people in different circumstances and appears to convey trust, balance and equality. At times, a soft embrace or hug is used to greet people, especially women. In both circumstances, in addition to the physical contact the two individuals greeting each other are in close proximity. However, in the current era of emerging pathogens at risk for causing epidemics, it is time to re-think this form of greeting or salutation to avoid unnecessary physical contact and proximity among people. This is in addition to following general principles of meticulous washing and drying of hands to prevent the spread of infection.
In order to avoid unnecessary physical contact and close proximity it is time to consider other forms of salutation when greeting individuals without creating awkward or negative feelings between two people who are greeting each other. Namaste or Namaskar is used in Indian subcontinent for centuries to greet people, where the individuals (meeting or departing) while staying at a distance from each other, in addition to saying “Namaste” makes a slight bow made with hands pressed together, palms touching and fingers pointed upwards in front of the chest. It expresses respect for the other individual(s) and as all parties are doing the same brings equality. This is one example but other forms of greetings where close physical contact is avoided without causing insult or negative feelings among the parties involved, should be considered, as an additional measure to prevent the spread of infection.
Competing interests:
None declared
Competing interests: No competing interests
It would appear the swine flu "parties" that the press have been in a
lather about recently exist only in their fevered imaginations. It is
clear that some elements of the media, desperate for a unique slant on the
problem to make them stand out among the wall-to-wall reporting on swine
flu, have gullibly swallowed and promoted the idea that these are taking
place.
The idea of "pig flu parties" was first floated over two months ago
(1,2), only to rear its snout once more at the end of June (3). The BBC
was responding (over-reacting?) to information from Justine Roberts, from
the Internet forum Mumsnet. However, rather than having evidence of any
parties having taken place or being organised, it was clear that the
parties were just a "proof of concept" idea floated for debate on the
Mumsnet forum. The BBC itself even tried to drum up discussion, with Helen
Sorell, BBC researcher, saying the BBC would love to hear from anyone
thinking about a party so they could contribute to a Radio5 phone-in (4).
There was no evidence these parties were happening or even that
anyone thought them to be a good idea, as the posts to the forum clearly
indicate. Yet on the strength of these Mumsnet (non)discussions, Ms
Roberts was able to talk about swine flu parties on the BBC Today
programme, which generated warnings from Dr Richard Jarvis of the BMA.
This was then picked up by the rest of the media, spreading faster than
the flu itself, as reported by among others the Independent, Telegraph,
Mail, Express, Mirror, Times, Sky (and of course the BBC itself) giving
everyone the impression that parties must be taking place. By the next day
the certainty that the UK population was revelling in swine flu parties
became known across the globe, with Australian Broadcasting news reporting
"Parents in the UK are taking their children to swine flu parties" (5).
So were a lot of people taliking about swine flu parties? You bet.
Next thing you know they might even think of arranging some.
There are arguments in favour of allowing exposure to swine flu, but
they are faily weak in my opinion. One can understand the fatalistic view
of those who accept inevitable exposure, saying they might as well get it
over with now rather than later. But so far there is absolutely no
evidence that parties are being organised to deliberately expose children.
Once again, our nation's "science" journalists have spectacularly misfired
with their "incisive" and "accurate" reporting.
(1) http://news.bbc.co.uk/1/hi/magazine/8045896.stm
(2) http://www.nytimes.com/2009/05/07/health/07party.html
(3) http://news.bbc.co.uk/1/hi/health/8125191.stm
(4) http://www.mumsnet.com/Talk/media_nonmember_requests/782096-Swine
-Flu-Parties?addwatch=1
(5) http://www.abc.net.au/news/stories/2009/07/02/2614331.htm
Competing interests:
None declared
Competing interests: No competing interests
Sir,
The research by Rubin et al highlights some interesting trends with regard
to public reactions to the Swine Flu pandemic.
They report that one of the limitations of their studies is the
selection bias with regard the small numbers of ethnic minorities included
in their study. The ethnically diverse city, Birmingham, is a hotspot of
the pandemic. Are the public health messages reaching these groups? could
the spread of the infection have been limited by targeted interventions in
these communities? Unfortunately, the very low response rate (7%) further
limits the generalisability of their results1.
There appears to be some contradiction in the responses, with the
results suggesting that the authorities are to be trusted in handling
swine flu (mean scores (sd) number 3.9 (0.8), 997) while there is over all
agreement that the outbreak has been over-exaggerated (3.6 (0.9) 997).
This suggests that the public has not fully in understood the nature of
the problem. The difficulty in assessing the virulence of the influenza A
H1N1 is an important constraint that must be acknowledged.
Of key importance are the recent reports that parents are organising
'swine flu parties' across the country2. This portends a worrying trend
and suggests a failing in the Public Health response to the pandemic. The
mixed messages that the media frenzy has generated has not helped the
public health efforts in ensuring that the general public get the right
information. Therefore, the public might not respond by adopting the
suggested behaviour changes and avoidance behaviour advocated. There are
ancedotal reports that such parties have been held across the West
Midlands as well. Does this qualify as a child protection issue?
With the ever growing threat of more virulent pathogens with pandemic
capability emerging, there is a need for sustained joint up action that is
cohesive and credible which will be believable and taken seriously by the
public.
References
Public perceptions, anxiety, and behaviour change in relation to the
swine flu outbreak: cross sectional telephone survey
G James Rubin, Richard Amlôt, Lisa Page, Simon Wessely
BMJ 2009;339:b2651, doi: 10.1136/bmj.b2651 (Published 2 July 2009)
Swine Flu in Britain: Nothing to Party About. Timesonline. Friday,
Jul. 03, 2009
http://www.time.com/time/health/article/0,8599,1908407,00.html
Competing interests:
None declared
Competing interests: No competing interests
This little piggy could be something else
The Swine Flu epidemic is giving Harry Potter books or Lord of the
rings series a run for their money in terms of drama and Carry on films in
terms of farce and comedy. The latest headlines shout that the death toll
has jumped from 17 to 29, Cherie Blair is “fighting the illness” and
between 3,000 and 60,000 could die (a rather large range in any body’s
book?). Having attended an emergency meeting to discuss the plan of attack
for Swine flu I am more confused than ever. I was taught at medical school
to assess patients, take a thorough history and correlate this with
clinical signs. I was then in a situation to form an appropriate
differential diagnosis as well as gain a feel for the severity of the
illness. Now it seems that every differential includes Swine flu – not
that dissimilar to the normal shout of “It could be Lupus” that occurs on
House. My main worry is that the country is heading for hysteria central.
Headlines are often inaccurate, policies change on a daily and often had hoc
basis and one department does not know what the other is doing. England is
about to have a special Swine Line for advice but Wales and Scotland are
deemed not to warrant the same scheme due to lack of demand? Patients are
also finding it difficult to access GP’s for appointments regarding other
illnesses as they are closed for the duration. Some are aksing why ar we
giving out treatment for the flu- we have always preached that you don’t
prescribe for viruses – only bacteria?
While all this is going on, other patients are suffering from other
illnesses. Other patients are dying from serious illnesses. How long is it
going to take for a case of meningitis to be missed, for Cancers to be
overlooked for a time or for tonsillitis in children be missed and then
develop into complications? One criteria for diagnosis is a fever above 38
and in these cases you should give Tamiflu and send patients on teir way.
The major problem with this is fever in children is often the only
presenting complaint of a serious infection. I infants this could be the
sign of a UTI. In others could it herald meningitis? Could it be measles –
especially now with the drop in MMR vaccination rates. These patients need
admission for assessment and monitoring but to do this risks possible
infection control breakdown and spread of the Swine flu.
Yes, Swine flu has the potential to be deadly and serious but let’s
get back to basics. Assess each patient on their merit and remember all
the other killers when forming your differential diagnosis!
Competing interests:
None declared
Competing interests: No competing interests