After the great SARS terror of 2002 which was predicted to cause more devastation than AIDS, and the bird flu panic of 2006 when we were warned that a quarter of Britons might die, we now have the great swine flu crisis of 2009. But just as SARS and bird flu failed to deliver on their predicted devastation (together, they were responsible for an estimated 1031 deaths globally), so will the great swine flu disaster also fade away into the annals of health scares that never were?

The truth is, it is simply too early to tell. While the number of swine flu cases greatly exceeded initial predictions and early attempts at containing the virus were soon abandoned, the summer outbreak has already peaked in the US and Mexico and is predicted to peak very soon in the UK. Furthermore, although there have been a number of tragic deaths, the severity of swine flu in most cases has been relatively mild, even milder than ‘normal’ seasonal flu for many people. On the face of it, it looks as though our worst fears have not been realized. The great flu epidemic of 2009 failed to materialize. Once again, a health scare has failed to live up to its hype.

However, this is not over this yet. Flu viruses are notoriously unstable. The H1N1 virus could still mutate at any time and without warning. The antiviral treatments that seem to be having some effect at the moment could be rendered useless against an evolved version of the virus. And, although the summer outbreak in the Northern hemisphere looks to have peaked, the cooler weather of the autumn and winter may bring the virus back with a vengeance; perhaps just as we let down our guard. Furthermore, the shadow of bird flu still threatens; just because we have had swine flu, does not mean we will not have bird flu. This is not an ‘either, or’ situation.

So, real threat or phantom menace? Who knows? Only one thing is certain; nobody responsible for public health is likely to come out of this well. If governments and health authorities underplay the threat, they stand accused of negligent complacency, and if they talk-up the threat, they are accused of scaremongering. They simply cannot win.

Ultimately, if we emerge through this scare relatively unscathed, there will be the predictable backlash against the authorities for causing unnecessary panic and squandering public resources. What we will never know, however, is how much all the preemptive action was responsible for mitigating the effects of the disease. As with the millennium bug scare (and, who knows, with SARS?), those in authority may be condemned by the very success of their actions.

In practice, global health authorities have no option but to plan for the worst case scenario, and advise the public accordingly. However, as they consider ongoing and future precautions, policy-makers must know they are in that familiar territory — damned if they do and damned if they don’t.

References

Editorial (2009). Between a virus and a hard place Nature, 459 (7243), 9-9 DOI: 10.1038/459009a