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Viral Threat Emerged in a Ready World
Network of Preparedness Plans in Place Before the News of Swine Flu Broke

By Rob Stein
Washington Post Staff Writer
Friday, May 8, 2009

So, is the great swine flu scare of 2009 just a big overreaction?

The answer, according to public health and infectious disease experts, is no.

But the world has been riding what might feel like a roller coaster, set in motion, they say, by the emergence of a menacing pathogen at a time when humanity has never been more primed to fight back.

"We've been getting ready for something like this for years," said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "And then this comes along, and all of a sudden the alarm goes off that says: 'Oh, my God, it's here.' "

That alarm activated a network of disaster plans put in place after seemingly disparate crises and threats including Sept. 11, the anthrax letters, SARS, Hurricane Katrina and the ominous avian flu virus, which has been skulking around Asia and other parts of the world for several years.

"What we've seen is a combination of lessons that we've learned from these events and the alarming news we were getting out of Mexico," said Thomas V. Inglesby, deputy director of the Center for Biosecurity at the University of Pittsburgh. "All these things put together really set things off."

Some reactions, such as the slaughter of thousands of pigs in Egypt, have been unnecessary. But many experts say the response has been calibrated to aggressively protect lives without causing damaging disruptions.

"What's remarkable is how orderly this has unfolded," said Howard Markel, a medical historian at the University of Michigan.

Experts stressed that it remains far from clear that the danger from the H1N1 virus, as it is formally known, has passed, and they are concerned that the sharp shifts could leave the public jaded and complacent.

"I'm afraid that a kind of epidemic fatigue or the-boy-who-cried-wolf syndrome could set in," said Stephen Morse, founding director of the Center for Public Health Preparedness at Columbia University's Mailman School of Public Health. "But what's the alternative? Not to talk about it? Not to respond? It's a real Catch-22."

Kelly Troy, who sends her second- and fourth-grade children to the Folger McKinsey Elementary School in Severna Park, was dismayed by the back-and-forth about local school closings. She fretted when the school remained open for two days after probable cases were reported, then went to Rehoboth Beach when it announced plans to close -- only to quickly reopen.

"Hopefully, they can be a little more decisive," Troy said. "They need to sound like they know what they're doing. . . . How are we parents to trust them?"

The backdrop to the roller coaster is decades of concern about influenza viruses. The microbes mutate easily and have morphed into dangerous strains. The most devastating pandemic began in 1918 and is estimated to have killed as many as 100 million people worldwide.

At the same time, the emergence of new microbial threats such as Ebola and AIDS, and the reemergence of old foes in more dangerous forms, such as drug-resistant strains of tuberculosis, have highlighted the potential threats.

The Sept. 11, 2001, terrorist attacks and subsequent letters laced with anthrax spores triggered emergency planning to guard against biological threats.

The Bush administration also implemented an $8 billion pandemic flu planning program that created a detailed national blueprint and funneled millions of dollars to state and local governments to create and rehearse their own plans.

After the 2003 outbreak of severe acute respiratory syndrome (SARS), the World Health Organization instituted measures that heightened the world's ability to identify and respond swiftly to outbreaks. They included international regulations that call for countries to report worrisome outbreaks quickly and a revised pandemic threat alert system, which was ratcheted up quickly last week.

So when reports emerged from Mexico of a new virus that most people might have no immunity against, and that appeared to be spreading easily from person to person and -- in an eerie echo of 1918 -- was killing healthy young adults, the world went on high alert.

"If what was being reported in Mexico played out in the United States and elsewhere, this was a potentially serious epidemic that was getting underway," Inglesby said. "We had to respond quickly."

The reaction has also been influenced by political missteps in previous emergencies, including the mixed messages and poor communication about the 2001 anthrax letters and the slow reaction to Hurricane Katrina in 2005.

But just as fast as the alarm bells rang, officials began to dial back when new information suggested that this flu might not be as lethal as initially thought.

Just as they are haunted by the 1918 "Spanish" flu, health authorities are guided by the swine flu of 1976, which has become a cautionary tale. The government launched a massive vaccination program for an epidemic that never happened, unnecessarily exposing millions to the vaccine's side effects.

Even if the virus is no more severe than a typical flu, it could still take a heavy toll. One-third of the world's 6 billion people could become infected, said Keiji Fukuda of the WHO, which may yet declare a full-scale pandemic if the virus takes hold in Europe or another part of the globe.

With the virus in the Southern Hemisphere, experts will be watching what happens as winter sets in.

The virus could mutate at any moment to become more lethal.

"We're dancing with this virus right now, and no one knows what will be the next step that the virus will take," Osterholm said. "All of us have to understand that we are not done with this dance yet -- not by a long shot."

Staff writer Ashley Halsey III contributed to this report.

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