I spent the last week on the ocean liner The Queen Mary 2. I flew to England and boarded the ship because I wanted to recreate my father's voyage to America. It was amazing on Sunday to see the Statue of Liberty with the early morning sun on her. It was not without sadness as my 10-year-old uncle died shortly after coming to the United States. He passed the medical exam on Ellis Island, but he had caught some illness and left his twin behind to grow up without him in the new country.
Today, ships have antibiotics and a young staffer dispensing disinfectant to every passenger as they pick up a tray or silverware.
So, it is not surprising that the big topic toward the end of the trip was the fear of swine influenza. It rated way above any topic that the passengers discussed. I was asked why the United States was not more prepared, why people were dying across the border, was it going to spread and, if so, how quickly?
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The good news is that the Obama administration is taking this very seriously and even had an all-star briefing at the White House Sunday afternoon. Secretary of Homeland Security Janet Napolitano along with John Brennen who is the assistant to the president for Homeland Security and the acting director of the Center of Disease Control, Dr. Richard Besser. The other good news is that they are working with the Mexican government, and they are using the best surveillance so that they have early identification of any outbreaks of the swine flu.
What is scariest about this swine flu in the United States is that it is the same strain that they have found in Mexico and of the 20 confirmed cases, there have been eight in New York City, which is a long way from Mexico and even Texas. Our government is taking immediate action by declaring a health emergency, and it has 50 million treatment courses of antiviral drugs on hand. Better planning since previous scares in the past have paid off.
However, no one knows yet if the two antivirals they have on hand in large quantities are really effective with this virus, so they are working on containment strategies. Japan and South Korea said they are going to test passengers coming from the United States, but we are not testing people coming from Mexico except by using "passive surveillance" (asking about illness and seeing someone looks unhealthy). This is where our intervention is confusing. Is this a real health emergency? Or is this overreaction? The administration says it is going to re-evaluate over the next 24, 48 and 72 hours.
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Asked why they hadn't banned travel to Mexico, Dr. Bresser said they were watching carefully, and if warranted "we would make a change in that regard." The bottom line here is that this has been going on for a while (weeks to months), and the government has been silent about this. As soon as I landed, I spoke with several physicians about the outbreak. Their concern is the same I saw on the ship, that we are not hearing the whole story. Either the government is concerned and needs to take more rapid action, or this is not something to be overly worried about.
All of the doctors I spoke to were concerned about the "health emergency" that is being declared and the lack of public health information they are receiving.
Having information, or lack thereof, in a vacuum scares people. There needs to be active discussion on television, radio and on the Internet.
Otherwise fear and rumor will take its place. Already the tabloid newspapers are increasing fear on the front pages. Americans are intelligent and respond to good and solid information. A great first step was the Sunday White House Briefing but the Obama administration needs to go a step further and ask for prime-time television to help Americans understand the symptoms and what they can do about stopping a possible epidemic. Anything less will fill the American public with fear.