Cautious commuters in Mexico (Image: Eneas, Creative Commons)

To help answer some of the many questions about the swine flu, “The World’s” Lisa Mullins spoke with Peter Sandman, a risk communication consultant based in Princeton, New Jersey, and Christine Gorman, a long time health and medical journalist.

Sandman is an expert on how to communicate with the public about emergencies. He thinks the U.S. response to the outbreak is successful in some respects and failing in others. "I'm very impressed with how candid the CDC and others in the US government are being about how dangerous the situation might be. I'm impressed with how candid they're being about how uncertain the situation is.

"Here's what they're doing badly: they are not making any effort to involve the American public. It's as if, you know, they're telling us this is very serious, we are responding aggressively, you don't have to. You know, watch while we protect you. And that's bad in a bunch of ways. It's bad logistically because we need people to be taking precautions: to stockpile food, to stockpile medications, to get a full tank of gas. Get some more cash in your wallet so if the ATMs stop working you're still okay. These are things that would make people tune in who have so far tuned out."

Sandman says although it's uncertain how serious the situation will get, it's still good to be prepared: "It all depends what's going to happen over the next couple of days and weeks. I mean, it now looks like a pandemic is likely. It's not clear that it's imminent but it could very well be imminent. And we haven't a clue whether it's going to be serious or how serious it's going to be. If there are, you know, millions of people dying obviously that is cataclysmic.

"But suppose there aren't millions of people dying. Suppose there are only millions of people feeling crappy; you know, not going to work and not going about their normal business because they're not well. You know, it's not a cataclysm. But it's still true that if there's a pandemic and it sickens large numbers of people at the same time the supply lines are going to be disrupted, markets may or may not be open, that's not catastrophic but it is disruptive. Being ready for that doesn't mean it's going to happen. It means if it does you're not up a creek without a paddle."

Christine Gorman is a long time health and medical journalist. She wrote for "Time" magazine and blogs about global health. She compares the United States government reaction to that of Mexico. "Well, Mexico has told people not to eat out in restaurants. They're clearly trying to get social distancing so that there aren't large groups of people. They are at a more advanced stage than we are with the exception of Vice President Biden saying that he wouldn't get on a plane and he's told his family members not to get on a plane or train."

Gorman believes the Vice President was overreacting. "... I mean, I wish he had said, you know; if you're sick don't get on a plane. As opposed to telling all healthy people not to get on a plane.

"The incubation period is about 24 hours as far as we know asymptomatic, without symptoms, and then maybe another seven days if you have symptoms. Most people know when they have flu, and so if you're sick stay home, that's the first message that we're getting from US government and health officials. In some respects it's actually not what's happening in the US and Mexico that is concerning, it's what's happening in Britain and Europe. There seems to be much more of a very funny kind of wanting to downplay even when you hear Margret Chan talking about going to pandemic level five.

"Right, so when Director General Margret Chan, Director General of the WHO talks about going to level five she both is telling everybody to, you know, come together and yet at the same time she's sort of downplaying it. And it's this funny kind of message that in England and in some other places people are definitely not taking the threats seriously enough because there haven't been a lot of deaths outside of Mexico."

Sandman doesn’t believe that closing the border with Mexico would stop the virus from getting into the United States. "The danger is not coming from across the border anymore, it's coming from across the street. It's the wrong focus. It's very, very tempting to want to close the border. It's very tempting to want to close airports. In pandemic drills routinely politicians close borders and close airports in order to try to keep it from getting from where it is to where they are. The experts invariably say that's foolish.

"You're gonna do more harm to your supply chain by stopping the trucks and freight than you are gonna do good by trying to stop the virus. The experts say it's foolish. The politicians say, alright maybe it's foolish but if I don't do it my constituents will crucify me and they close the airports and the close the boarder. Do I think it makes sense biologically? No. Does it make sense psychologically? Yeah, it's very hard not to want to do it."

In Mexico, it appears that aggressive measures have helped stabilize the outbreak. But would similar measures be effective in the United States?

Gorman says that the recent outbreak in New York City didn't show evidence of sustained transmission of the virus: "We have to really think about virology and viruses work very different from what we think how they should work, and actually researchers don't even understand completely how the flu virus works. Meaning, in many ways, I'm really paying attention to what's happening in New York City where we had an outbreak. Some kids came back from spring break in a school in Queens. Hundreds of people became sick. It wasn't just the kids who were in Mexico so it's the people who travel to Mexico, gave it to their families and to their friends, and we haven't seen continued sustained spread throughout Queens, and that's really what you're looking for is that sustained transmission.

"It's the same virus; in fact virologists were saying it's kind of remarkable given how sloppy a virus flu is, how closely related the genetic sequences are from the ones isolated in California and Texas and Mexico. So you don't have to say, okay, well, as bad as it sounds we should block the border, that it's not gonna work. You know, are you gonna block New York from the rest of the country? I don't think so. We have to be adult about this and take information that is unclear at the moment that will become more clear as we go on and take appropriate steps."

Both Sandman and Gorman have taken their own precautions. They’re stocking up on food and supplies. Sandman says the government needs to tell the public to do the same. "I am aghast that the government thinks this is serious enough that they have sent millions of doses of Tamiflu out to the states so they'll be ready to give to millions of Americans who might get sick. But they haven't told those millions of Americans who might get sick that now while they're healthy they should stock up on tuna."

PRI's "The World" is a one-hour, weekday radio news magazine offering a mix of news, features, interviews, and music from around the globe. "The World" is a co-production of the BBC World Service, PRI and WGBH Boston.

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