Predicting and preparing for pandemic flu
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2988 (Published 23 July 2009) Cite this as: BMJ 2009;339:b2988
All rapid responses
This week’s edition of BMJ (2009;339:b2988) is a testament to the
challenge that the H1N1 virus represents to healthcare systems all over
the world. Estimations of its severity will differ globally
(doi:10.1136/bmj.b2840), but there is consensus that this year’s flu
season will be especially fierce. The top antiviral available, oseltamivir
(Tamiflu) will help, but it cannot be considered a panacea
(doi:10.1136/bmj.b2977).
The World Bank and the International Monetary Fund echo the concerns
of the healthcare sector, estimating that the H1N1 could provoke up to a
5% contraction of the world economy, crippling economic recovery in
addition to threatening our health.
Thus, the magnitude of the H1N1 virus calls for the participation of
the population as a whole, including the private sector. Private
enterprise should work to incorporate traditional public health actions
into the workplace and prepare for the worst, even while hoping for the
best. Knowledge is power, and establishing explicit plans and protocols
will help in maintaining calm as well as in controlling the spread of the
virus.
Measures should include the creation of special coordinating groups
to prepare ad hoc contingency plans for individual businesses; assess risk
based on the company’s activities (direct contact with clients, etc.); and
identify essential workers, services and logistical and distribution
needs. Parallel actions could focus on worker awareness and hygiene,
including the facilitation of flexible leave for ill workers or tele-
working for those who have been exposed. General hygiene in the
workplace, including frequent handwashing, cleaning of the facilities, and
covering the mouth and nose while coughing or sneezing, are also simple
measures which could be promoted during the flu season.
Although technologically and logistically we are more prepared than
ever for a serious pandemia, we must not underestimate the benefits of
traditional public health actions together with community participation,
moving away from paternalism and towards personal and pro-active
responsibility.
Competing interests:
None declared
Competing interests: No competing interests
Dear Fiona Godlee,
This editorial is very interesting. There seems to be a Tsunami in the
medical field vis-a-vis the new Swine Flu, an insult to that
poor animal! Every article and blog tells us about it but does not answer
many questions. I think this is an opportunity to ask those questions. I
am looking for answers, not knowing the answers myself.
I had trepidation in writing this response until I read about
educere, which Socrates used to practise, there was no "authority"
defined as we read in Theaetetus: (written by Plato in 360 BC translated
by Benjamin Jowett) "Well, my art of midwifery is in most respects like
theirs; but differs, in that I attend men and not women; and look after
their souls when they are in labour, and not after their bodies: and the
triumph of my art is in thoroughly examining whether the thought which the
mind of the young man brings forth is a false idol or a noble and true
birth. And like the mid-wives, I am barren, and the reproach which is
often made against me, that I ask questions of others and have not the wit
to answer them myself, is very just-the reason is, that the god compels-me
to be a midwife, but does not allow me to bring forth. And therefore I am
not myself at all wise, nor have I anything to show which is the invention
or birth of my own soul, but those who converse with me profit."
Every
medical student (and scientist) would do well to read this advice of
Socrates.
*Why was the WHO in such a great hurry to raise this to pandemic
level?
*Multiple drug resistant tuberculosis has been spreading to all
countries like wild fire; could kill millions if left unchecked reminding
us of the great white death epidemic. Why is that not a pandemic?
*Where is the controlled study to show the effect of Tamiflu against
the new Swine Flu virus, in our evidence based medical system?
*Has the new vaccine been tested against the virus in a large study?
How are we certain that it will be effective? Is this vaccine safe to give
to all age groups, especially when we are ignorant of its true validity?
Primum Non Nocere.
*What happened to the millions of dollars worth of Tamiflu stockpiled
for the imaginary pandemic of bird flu? The manufacturers must have had
the last laugh last time.
*Will the linear projection of large deaths due to the imaginary dread
of the new virus materialise? Do the non-linear universe and the human
body follow the linear laws?
*If this whole fear mongering fails to materialise who do we hold
accountable at the end of the day?
*Do we not know that fear, especially of millions in the world, might
weaken their immune system?
*Does the host resistance play any role in the final outcome of the
fight between the virus and man? If so, why are we not doing something to
build good resistance against the virus?
*Why do we not accept similar untested, but inexpensive, remedies
available in many other systems like the Chinese, Indian Ayurvedic and
homeopathic systems? Russian scientists have demonstrated viral (and other
germs) destruction using particular frequency of subtle energy non-
invasively! Our positive sciences understand only 5% of the total energy
in this universe while the large 95% needs to be explored for common good.
Why are all those efforts classified as pseudo science? What is the
definition of science, anyway? To me the present scenario looks like
science is what accepted scientists think it is! Wetenschap is wat
wetenschappers doen!
All these, and many more questions, beg more questions but answers!
Let not our untested expensive interventions be worse than the patient's
disease. Educational system was changed by the Romans from educere of
Socrates to educare of today, where the authority prescribes what the
students should learn from outside! That is the bane of medical, nay, all
sciences. Let us go back to educere from educare.
Yours ever,
bmhegde
Competing interests:
None declared
Competing interests: No competing interests
Time to lay predictions about the future to rest
Casey Stengel may have warned especially against predictions about
the future,
but then so did Niels Bohr, Albert Einstein, Woody Allen, Mark Twain and,
it
seems:
http://www.larry.denenberg.com/predictions.html
a large number of other people. As this list includes Winston
Churchill, it is a
shame that, in the British Medical Journal, he failed to get the
attribution.
Competing interests:
None declared
Competing interests: No competing interests