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Topic A: Should You Be Worried About the Swine Flu?

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Tuesday, May 5, 2009; 12:00 AM

The Post asked public health experts and transportation officials to sound off on the threat of swine flu -- and on what America should be doing about it. Below are contributions from Vicki Bier, Richard Wenzel, John Catoe, Irwin Redlener, Jody Heymann, Edwin D. Kilbourne and Georges C. Benjamin.

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VICKI BIER

Professor of industrial and systems engineering at the University of Wisconsin-Madison

At this point, there is little or no reason for people to avoid public transportation or air travel within the United States, unless they are sick with flu-like symptoms such as high fever or body aches. The chance of contracting swine flu by traveling within the country is extremely small right now, because the number of infected or exposed people appears to be quite low. Moreover, the swine flu does not appear to be highly lethal. Things could change. But, for now, simple precautions such as frequent and thorough hand washing should be adequate to reduce any low risk of contagion to even lower levels.

RICHARD WENZEL

Former president of the International Society for Infectious Diseases and chairman of the Department of Internal Medicine at Virginia Commonwealth University

We're lucky there have not been more deaths from H1N1 to date. Each year America sees 36,000 deaths from the "regular" flu alone. The reason no one talks about closing schools or not riding on planes or trains in January during our usual visitation is that the flu is familiar then.

In another month, after some deep analysis, we'll know if this is just another flu strain or if it's something else. For now, I think it's better to be cautious.

I do, however, agree with President Obama's decision not to close the border. Many of our medical supplies come from Mexico, so closing the border would close off our supply. And as neighbors and allies, we need to help each other out as much as possible.

JOHN CATOE

General manager, Washington Metropolitan Area Transit Authority

Recently, I've been asked if it's okay to ride Metro, given what we know about the H1N1 flu virus. The best answer I have is in my own actions: I ride and will continue to ride.

Here's what Metro is doing: Every flu season we disinfect our trains and buses with a hospital-grade disinfectant, and we will continue that during this flu episode. We will also do the same for MetroAccess vehicles. In stations, we disinfect the touch surfaces (fare machines, fare gates, etc.) regularly, and we've activated a Metro task force to deal with flu-related issues. We've also launched information campaigns, in English and Spanish, for our customers and employees so they know how to reduce their risk of getting the flu. Some folks may wish to cover their nose and mouth for added assurance.

Regardless, you'll see me on Metro.

IRWIN REDLENER

Director of the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health

President Obama exudes calm, concern and honesty without the pandering or fear-mongering we have seen during past biological scares. However, the emergence and spread of a virus that still has the potential to create a dangerous pandemic brings with it a rapidly changing rush of information. Sometimes the data is reliable -- and sometimes not.

The public -- and public health officials -- must make decisions about how to curtail the spread and impact of a new biological threat in a fog of uncertainty. Much as we might wish for definitive information and advice, we simply cannot reliably predict whether the new H1N1 virus will prove to be less worrisome than our annual flu bug -- or will evolve into a form that kills millions across the globe.

JODY HEYMANN

Founding director of McGill University's Institute for Health and Social Policy

The threat of pandemic H1N1 flu is great enough that Americans should stay home from work when they are sick and keep sick children at home to slow transmission. There's only one problem: Working Americans won't stay home when they're sick. They can't afford to because they don't have paid sick leave.

While more than 160 countries ensure that their citizens receive paid sick leave, and more than 110 countries provide paid leave from the first day of illness, America does neither. Sixty million Americans lack paid sick leave. A poll in Florida and Ohio found that half of employed men and women go to work when they are sick. And working Americans won't keep their children home when they're sick because only a small minority have sick leave they can take when their children are ill.

This problem can be solved by passing legislation to ensure that Americans have seven paid sick days. This would cover the infectious period for most cases of influenza. Is it affordable? All of the most competitive economies in the world, except the United States, guarantee paid sick leave. What we can't afford is to wait any longer. Even if we are fortunate and swine flu does not take off this spring, without national paid sick leave we will remain utterly unprepared for the next pandemic, as well as the thousands of deaths in the next normal flu season.

EDWIN D. KILBOURNE

Leading infectious disease specialist during the 1976 swine flu scare

In February 1976 an epidemic caused by two different influenza viruses afflicted Army recruits at Fort Dix in New Jersey. One virus was the H3N2 virus then prevalent in civilians, but the other was the virus of swine influenza -- the putative agent of the notorious 1918 pandemic.

After the pandemics of 1957 and 1968, it appeared that in 1976 we might be entering a period in which they hit about every 10 years. And this seemed to be the first chance in history to abort a pandemic at its outset. Before the end of summer more than 50 million doses of vaccine had been produced and distributed, and before the end of the year 43 million people had been immunized. This National Immunization Program was abruptly discontinued when no cases of swine influenza had been found beyond Fort Dix and some vaccine recipients developed a neurological autoimmune disease known as Guillain-Barre syndrome.

Because the present variant of the H1N1 virus bears swine antigens cross-reactive with those of the 1976 virus, we already have in hand a vaccine of proved immunogenicity to be produced and used -- but only if the spread of the new virus continues.

GEORGES C. BENJAMIN

Executive director of the American Public Health Association

From anthrax and West Nile to monkeypox and SARS, we've had numerous infection scares over the last several years that have convinced the government to begin aggressively building capacity to respond to health threats. We funneled several billion dollars into our response system and allowed the public health sector to invest in people, training, equipment, surveillance and tracking, and communication tools. Based on the performance of the public health system to date, coupled with some good luck, the public should feel comfortable that the system to mitigate infectious threats such as H1N1 has been improved.

However, despite our early success on this flu outbreak, we still have a ways to go. If H1N1 ends up being just the trial run for the next devastating infectious pandemic, the best hope for our nation and the world is that we do not now become complacent. We must increase our investment in a public health infrastructure that ensures that we have the capacity to deliver an optimal response to keep us safe and healthy.


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