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Last modified: Wednesday, May 27, 2009

Lessons to be learned from the H1N1 Flu (Swine Flu) outbreak

This essay first appeared in the Indianapolis Star on May 19, 2009, and it reappears here with the permission of its author, Stephen Wintermeyer, MD, MPH. Wintermeyer is an associate professor of clinical medicine in the IU School of Medicine Division of Pulmonary, Allergy, Critical Care and Occupational Medicine. He is also an adjunct associate professor in the Department of Public Health.

Stephen Wintermeyer

Stephen Wintermeyer

Wash your hands.

Cough into your sleeve.

Stay home if you have flu symptoms.

These messages were appropriately front and center in the public health approach to the present H1N1 outbreak. Public health professionals were trying to remind us all of these simple, effective, ways to decrease flu transmission.

As we approach the one month mark since the World Health Organization raised its world-wide pandemic alert level to Phase 5, it is appropriate to consider what lessons the greater Indianapolis community has learned, or should have learned from the last month. All groups that dealt with this outbreak, including the public, company and school leaders, media, government officials, physicians and public health experts, should all have learned plenty.

There are many things the average citizen should have learned. One is that simple things, like hand washing, really do help control disease transmission. Another lesson is to have a back-up plan in place. If you, or your child, have symptoms that indicate you should stay home, then stay home. Have alternatives in place for child care, such as coordinating coverage with a neighbor.

Another important lesson for the average citizen to learn is that even though it may seem that science will provide all the answers, it won't. Our scientific tools are impressive and over the last month we have had daily, almost real time, reports on the H1N1 virus, but we still have not had all the answers we wanted. It is unlikely that we ever will. The public cannot expect perfect information from public health officials, but should demand up-to-date information and clear explanations.

What should company and school leaders have learned about a possible pandemic? They need to have knowledgeable persons available to advise them on how to protect their staff and students and to provide appropriate information that they can get out promptly to staff, students and parents.

The media should relearn what it should already knows: let the story be the story and don't get in the way. Interviewing the leaders involved in this epidemic, such as Richard Besser, CDC director, and getting the facts right is what the media should strive to do.

Major government leaders should have readily learned to let public health leaders do their job. Joe Biden is the vice president of the United States, but he should not be the government official providing public health recommendations.

Private physicians should realize that they will likely have a busy flu season next winter. They should educate their patients as to when it is appropriate to see their physician about the flu and when it is okay to stay home (and not risk infecting other patients in the physician's office). This would be a good time to for physicians to develop a Web site or e-mail contact with their patients, if they do not have such a system now.

Finally, what should public health officials have learned from this outbreak? One obvious lesson is to get the facts and to accurately inform the people. This outbreak seemed more real, but less frightening, when specific numbers of confirmed cases and deaths in the U.S. were reported daily. Explaining the facts and the logic behind decisions based on those facts is critical. Two schools in Marion County were closed for one week because of H1N1. They then reopened open two days early without incident, because the logic of why they were reopened early was explained.

The biggest lesson for the public health community to learn is how to appropriately communicate the fact that H1N1 will not be going away. There are many key questions regarding H1N1: How will it change during the southern hemisphere flu season this summer? How widespread will it be during our flu season next winter? Will it become more virulent? Will there be a vaccine? Public health experts will need to accurately explain the situation to the public as new information comes out. At the same time, the public health experts should keep reminding us to:

  • Wash your hands.
  • Cough into your sleeve.
  • Stay home if you have flu symptoms.