By David DiSalvo
It’s a huge understatement to say that panic is part of human nature. We’re all wired to anticipate threats and experience nervous system overdrive when they arrive – our species wouldn’t have made it this far if we didn’t. But what happens when the anticipation itself is enough to trigger heart pounding panic? And stranger still, why do threats as rare as they are vague cause more panic than threats that surround us every day?
Those are a couple of the questions that infectious-disease epidemiologist Philip Alcabes set out to investigate in his newly released book, Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Plague to Avian Flu. What he couldn’t have known, however, is that his book would begin hitting bookstore shelves just as swine flu began consuming the public consciousness – providing a more than timely example of a dread-catalyzing threat with mass-panic potential.
Dr. Alcabes spent some time talking with me about epidemics real and imagined, how we respond to threat inspiring messages in the media, and why our attention is riveted by remote threats while tangible ones close to home are not hard to find.
We’re right in the middle of what appears to be a full-blown epidemic just as your book is hitting the shelves. What’s your take on what we’re seeing in the news?
All epidemics are stories. They often have a widespread disease at their core (often but not always, as the epidemics of “cyber-stalking” and school shootings attest). But the numbers of the sick, dying, and deceased aren’t the main aspect of the story. There have been 50-odd deaths associated with the new flu strain as we speak. Does 50 deaths make for an epidemic? That’s less than the death toll on American highways and roads on the average day. It’s less than the toll taken by malaria in Africa in any one-hour period of any day. It’s sad, and it’s a frightening reminder of the randomness of nature’s deadly bite. But 50 deaths from accident, incident, or infection doesn’t always constitute an epidemic for us.
In fact, the numbers of cases of swine flu and the flu death rate are both quite low in comparison to the normal situation with seasonal flu, the “bug” that comes around every winter. If this were January, we might not even have noticed this outbreak, as it would have been hidden by the far larger and more lethal outbreak of plain-vanilla flu. In fact, if in any given winter the death rate from flu were as low as it’s been in this springtime outbreak, we’d be relieved and call it a mild flu season.
But would you agree that it’s truly an epidemic – the “real thing”?
Yet, I would agree that this is an epidemic — simply because that’s what people say. In fact, as we speak, the W.H.O. has raised the “pandemic alert” to 5 on a scale of 6. Our officials are leading the way in making sure that this small outbreak (it has affected a handful of countries, with about 2500 cases in Mexico so far, 90-odd in the U.S., and scattered clusters elsewhere) is indeed defined as an epidemic. Possibly a pandemic.
The question I ask myself is, why is it so important to us to see this small, thus-far mild outbreak of flu as a scary situation? Why should W.H.O. feel the need to act?
In part, it’s because we’ve been primed for this. Our health agencies (the W.H.O. most notably) have been telling us for years that a flu pandemic is “inevitable.” All those agencies needed a case-in-point to justify their dire warnings, otherwise the “pandemic preparedness” campaign might have gone the way of the prior “bioterrorism preparedness” campaign (2002-2004): simply withered away from lack of interest.
But more deeply, the preparedness rhetoric influenced our thinking. Repeatedly gesturing toward the terrible 1918 flu outbreak, in which tens of millions of people died worldwide, authorities and flu researchers reminded us to think of 1918 when we think of flu. The result, as we see now, is that the few facts available about the new flu serve as the basis for projections of our horror fantasies. People (again, including W.H.O. officials) talk about the inevitability of a “pandemic,” about the likelihood that there will be more cases and more deaths.
So, if by “real thing” you mean, is this a public health problem, I’d say yes. People are sick with a contagious disease. More might fall ill. It demands attention from public health authorities.
But if you mean, is this the disaster that is being depicted, I would say not yet, and probably not ever. The problem is that once the fantasy scenarios start being painted, the facts become scenery on the stage. It’s the fear that drives the drama. We’ll undoubtedly see more fear-driven pronouncements. I hope we’ll also see good public health.
We’re hearing some health officials say that this flu is a harbinger of diseases to come — an evolved mutant virus combining multiple strains.
This is, simply, influenza. What flu does is switch back and forth between species, recombining genetic elements, mutating here and there, “reinventing itself,” to use the term of art. I suspect that calling it “swine” flu gives it a certain pernicious cachet, “swine” being associated with filth in the language. But it seems important to us to label this virus with its own name, not just as flu but “swine flu,” as if it had some special status. I think the naming helps us to be frightened.
Is it a harbinger of the future? Well, I don’t have that particular crystal ball. A lot of people who call themselves flu researchers and whom the media refers to as “experts” are fond of making predictions about pandemics, as if they could see the future. This has gotten us into trouble at least once, in the swine flu immunization fiasco of 1976 (when hundreds of Americans were sickened by a flu vaccine and over 30 died, yet there was no serious outbreak). And it gets us into trouble when, as with “bioterrorism,” we spend a fortune protecting ourselves from a chimeric threat.
But how do we plan to protect public health unless we make some predictions about possible outcomes?
I think we have to draw a distinction between sensible planning for sound public health programs based on observable facts, and so-called predictions that are really just projections of horror fantasies. We have to be careful with this flu outbreak, because, as I said earlier, there are a lot of fantasies afoot, and because many of them hark back to 1918. We have to remember that the world is a very different place than it was in 1918. We have to do good public health to ease suffering and control disease — but we don’t want to get into the business of divining the future. We should stick to what we know, and can see, and what we know how to do about what we can see.