I don’t want to be picky, but I have to admit that as a fear expert I was more affected by President Obama’s statement a few weeks ago in response to the emerging swine flu threat that we should all wash our hands, then I was to Vice President Biden’s blatant misstatement about not flying on planes. Let me explain: clearly, we carry many bacteria and viruses on our hands, and in fact most of our stomach viruses as well as cold viruses are passed back and forth this way. It is hard to fault anyone for recommending hand washing, but consider that Obama’s statement carried the subliminal message that we might be carrying this virus, despite the fact that the statistical chances of that then and now remain extremely low.

The president followed that up by asking Congress for $1.5 billion to prepare us for this flu, an amount that seems totally reasonable until you consider what other health care needs it might be taken away from. Stockpiles of the anti-flu drug Tamiflu will have to be discarded if they aren’t used in 5 years, and we still have no idea what the extent of spread or severity of this swine flu virus will be. Preparing a vaccine seems wise, taking needed resources away from current pandemics like TB, HIV, or even the yearly flu does not.   It is paramount that at a time when our government is considering expanding the system for health coverage, that issues of allocation and proper use of resources be at the top of the list.

The Centers for Disease Control and Prevention has been front and center during the initial stages of the swine flu outbreak, and they have been very effective at identifying and tracking the virus, somewhat less effective at explaining it in context during press conferences (this may have something to do with the nature of the beast – press conferences themselves immediately become amplified).

I have more of a bone to pick with the World Health Organization in terms of their poor conveyance of contextual information. The WHO all too often seems like “fright night” though they too have been tremendous when it comes to “boots on the ground.”

Check out my article in today’s Slate magazine about how the WHO has dealt with swine flu.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

As we watch swine flu through the rear view mirror, and our concerns begin to fade, it is easier to see it in a more proper context. I tried to do just that in my oped in USA Today.

Even as we turn our attention to the southern hemisphere, and watch via the World Health Organization FluNet tracking system for the extent of the virus over the winter, I can’t help but comment on the WHO handling of the Pandemic Alert System as it applies to the swine flu outbreak.

The problem is that the current alert system was put in place in 2005 in reaction to the Avian Flu scare. Of course a tracking system in response to a scare has a built in tendency for overreaction. I don’t have a problem with the notion that level 5 involves sustained transmission of a new flu strain from person to person in 2 countries in the same region. Nor do I have a problem with the idea that a full pandemic (a scare term which is too vague to be descriptive) involves a sustained outbreak in different regions of the world. What I do have a problem with is the lack of statistics —number of cases and number of deaths don’t factor in. So it is possible to have a pandemic with only a few thousand cases. Where would the Bubonic Plague or the Spanish Flu, diseases which killed many millions of people, fit on a pandemic alert scale where a relatively small outbreak of Swine Flu is already listed near the worst possible ranking?

Not only that, but these pandemic alerts are used by the U.S. and other countries as a justification to divert needed health resources from other essential medical problems to the fear of pandemics. Sometimes that is justified, but often it isn’t. Keep in mind that Tamiflu and vaccines (which are stockpiled and then mobilized in anticipation of a pandemic), are perishable. We have already discarded hundreds of thousands of doses of unused smallpox and anthrax vaccines. How much excess expensive Tamiflu will we also discard when it expires?

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

The following statements are where I think we are currently on the new swine flu H1N1 influenza A strain. I’ve also communicated with Drs. Ann Schuchat and Nancy Cox at the CDC, who responded that they agree with these comments.

• The H1N1 influenza A is a new strain — a swine flu strain — with some genetic components that are characteristic of human and bird flu viruses. It bears watching and tracking, as any new influenza does.
• It is spreading human to human, and may have the attack rate of a typical yearly influenza A, but this is particularly difficult to determine because of both the overreporting (everyone thinks they have it), and under reporting (we are not really tracking the full spectrum of disease as we are not testing those with mild symptoms). It is also too early to really determine transmissability, because there are too few cases.
• Virulence appears to be low and if this continues, it will be a mild pandemic at worst. It currently appears to be very transmissible, but the outbreak could wane further if transmissability decreases. A severe pandemic will likely result only if it mutates into a more virulent strain. But assessment of the strain’s virulence is also based on a limited number of cases.
• It is worthwhile to begin preparing a vaccine, but we don’t yet have the upgraded technology (mammalian cell culture, reverse genetics) in regular use for flu, so we may have to rely on the older technologies (using hen eggs to provide a medium for growing the dead virus). This has yet to be determined.
• It is likely to wane soon due to summer weather, but bears watching carefully over our summer in the southern hemisphere, and mapping carefully for resurgence in the fall.
• Since the WHO designations for pandemic alert don’t include severity of illness or even true extent of illness, raising the pandemic alert levels have led to the public misperception that massive deaths are about to occur, which is part of the reason why the fear level is so high. It is best to provide calm accurate contexted information to avoid this, as I point out in “False Alarm; the Truth About the Epidemic of Fear.”

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com