Sunday, May 3, 2009

This little piggy went across the border.

The H1N1 virus has escaped the pages of serious medical journals and left is cloven hooves all over the nation’s psyche. Swine flue has become a porcine Rorschach test for all our national obsessions.

For the Nativists amongst us it is just one more example of the brown menace streaming across the Southern border. Michel Malkin, who life’s theme is “no more anchor babies after me,” of course was totally without irony banging away at the threat of the brown masses that do not happen to come from the Philippines like dear old mum and dad. Jay Severin chimed in with an even more over-the-top anti-Mexican rant on WTTK radio. Jay did not jump the shark he jumped a blue whale using the possible H1N1 pandemic to strike out at “millions of leaches” and “primitives” that are bringing down the USA. We have not heard this kind of vituperative rant about our neighbors to the south since, well, the 1930's and the depths of the Great Depression. Thus a nation of almost one hundred and ten million people and with a culture that predates Columbus by a millennium gets reduced to so many typhoid Marys; or is that typhoid Marias?

Not that H1N1 could care about the citizenship of its victims or their political affiliations or the national borders they may draw, it is just looking for some warm bodies to infect. Once H1N1 escaped its factory-farm breading ground it used our interconnected transportation and economic system to spread itself around. It was not Mexico or Mexicans that was the cause of the spread; it was the fact that our entire globe has become so interconnected. H1N1 could have originated from a pig farm in China or from some other point of the globe. The arteries of commerce help to infect the arteries of humans. Case in point the first infections in the USA were not linked to undocumented workers crossing the border surreptitiously but from school children from New York City who had all their papers in order. The school children had the bad luck to be in Cancun, Mexico when the virus first broke out.

But the fear of the Brown terror was not the only bit of over-the-top fear mongering that was aided by H1N1. The danger of the virus has been hyped into the stratosphere by our good friends at the corporate media. Granted this virus' great-great-great grandfather the “Spanish Influenza” of 1918 was ruthless killer of multiple millions. Still its more recent scion, the swine flu of 1975, was an underachiever. Poor Gerald Ford’s snake-bitten presidency had to deal with that strain. The response, some would say over reaction, is still hotly debated by public health policy wonks to this day. At least back in 1975 no one took agriculture lobbyist concerns as seriously as they do today. Today we are forced to talk about H1N1 lest the pork producers become upset. Granted some ill-informed people are avoiding “the other white meat” lest they somehow get the contagion of "swine flu" but that is more a reflection of our pitiful general knowledge about how biology works. More than that, it is a reflection of the ignorance of or failure to retain the simple home economics courses we took in high school. Is our children learning? Apparently not.

So back to the biology course we slept through in High School. Viruses are odd little pathogens. They have been around for several billion years or so the men in the lab coats surmise. Unlike the oldest form of life (blue-green algae or cyanobacteria) they have left behind no fossil evidence. Still the men in lab coats think that viruses are almost as old, around three and a half billion years old give or take a few hundred million years. This gives viruses an intimidating head start against modern humans who only go back some two hundred thousand years. This makes them incredibly difficult beasts to corral or kill. They are highly adaptable and readily mutate. This is why every year the medical profession is forced to come up with a new inoculation to combat the flu.

Influenza is a moving target. It is in constant flux. A strain may start up as mild irritant but then evolve, yes dear reader the bug evolves over time, in to a fearsome killer. A virulent killer can adapt to a less potent form over the same amount of time. Yet another possibility is that an outbreak will be typical, killing its “normal” yearly allotment. Influenza is Mother Nature’s way of informing mankind of what little we really know. Still the hairless apes are not totally bereft of responses.

President Obama’s actual responses have been both typical and little disjointed. His overarching response, that of calm and measured response has been spot on. The world medical community still has not gotten the true measure of this particular greased pig. It is worried that H1N1 could be a fearsome threat, that is why they have placed their worry meter up to a five on a scale of six. Is WHO over-reacting like it may have back in 1975 or is this bug the real deal? Prudence would dictate that the federal government treats the threat seriously. While there is a thing as too much caution it is usually better than not enough. One can always scale back too vigorous a response, one can not take back an oops-aw-shucks. If there was one administration official who failed to set the appropriate note it was Mr. foot-in-mouth disease himself Joe Biden.

Anyone who has observed Joe Biden will know that the man has a tendency to play fast and loose with his messaging. Sometimes it is endearing, he talks from the heart, other times it is embarrassing. The president himself was spot on with his don’t panic messaging. Critics fail to mention that Obama stepped into this issue not with just one shoe on but in his stocking feet. Republicans had blocked his HHS nominee to pointlessly posture with their base. Shocking that a Democrat would nominate both a woman and a pro-choicer for HHS when that is exactly what he promised to do if elected. So the Republicans pandered to the pro-life portion of their base and left the nation without leadership at HHS when a possible global pandemic broke out. The other shoe Obama was missing was that of the Surgeon General. As the head of the public health infrastructure of the USA the Surgeon General would be the point man for the preventive health measures and messaging of the federal government. Note to troglodyte Republicans trying to score cheep political points: obstructionism can have serious consequences; it can leave the nation exposed to real threats from the most unlikely places.

While we are talking about the serious unforeseen consequences of playing politics with our public health infrastructure, a few words about the stimulus bill. Please note that the stim had funding in it for such a public health emergency. Please note that the original tab for bulking up the public health system was around nine hundred million. Please note that the cost of delay, the new tab for responding to H1N1, is now one point two billion dollars. Because “moderates” like Olympia Snow and Charles Schumer thought that they could score cheap and easy political points by cutting “wasteful pork spending” the tax payers got dinged an extra three hundred million dollars and the nation was needlessly under prepared for the present outbreak. That is the problem with playing the percentages. It is easy to mock science, to portray the men in lab coats as ivory-tower nerds wasting time and tax payers money on pie-in-the-sky projects. It is far too easy with our ill-informed and sometimes willfully ignorant electorate. It takes real leadership to explain to the tax payers that spending on preventive medicine is almost always a superior investment. In the end it almost always cost the nation much more to pay for curative medicine than it does for the up-front cost of preventive medicine. It’s a clichĂ© but an ounce of prevention still beats a pound of cure.

Because of the vagaries of the mechanics of viruses especially those of the myriad of influenza viruses out in the wild it is anybodies guess how this pathogen will play out. Obama’s responses to the virus are by their very nature limited. Other than issuing the common sense directives that come with the territory we are very much at the mercy of this particular virus’ make up. Some are flogging the benefits of Tamiflu, but that drug may not be as efficacious as it was in the past. Viruses do evolve and some viruses have shown a possible resistance to Tamiflu. It would be a very good idea to find out if Tamiflu actually works against this strain of H1N1 before deploying it. Again the president’s natural caution, his insistence of gathering all the facts before making a decision is pitch perfect for the present situation. In the short time that H1N1 has been part of the news cycle it has gone from killer plague to overhyped threat and that is in just one week.

Obama on the other hand will at least come up with a sensible policy that is most likely to be in the dead center of our medical art. The proposal will have the stamp of approval of just about every public health expert worth the name. That unfortunately is no guarantee that it will be a success or in hindsight will be judged an appropriate response. This little piggy may be the runt of the litter or he could be one mean tusker, it is hard to say. It depends much more on imponderable and uncontrollable aspects of this particular outbreak than what the government does. The late arrival of this particular outbreak may have limited its propensity for harm more than anything the government does. The bug may law low until the arrival of winter and then strike or it may totally fizzle as the 1975 outbreak did or it may just be as big and bad as the WHO thinks it is. Only time will tell. So for now we wait for the CDC to come up with a better idea of what we are up against and we act like Lady Macbeth and keep those hands spotless with washings of 20 seconds or more. Hand washing is a good thing. Finally if you are a lover of the “other white meat” by all means indulge in your passion. Cook it until it is at least pink through and through and has no sign of red, meat thermometers are your friend. Be safe, and be happy.
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