The swine flu rethink begins

With caseloads and death rates both declining, the debriefings have begun regarding H1N1 "swine" flu.

It seems clear that this flu was worse than regular flu, that it hit younger people and sent more to the hospital. The load seems lighter now in part because there is less seasonal flu than normal.

This close up from a recent CDC chart tells the story. The low peak on the left represents early 2009, a typical flu season. The high peak on the right is H1N1, striking earlier, peaking at a very high level, then rapidly dropping off.

The pandemic did not happen, but the panic's effect is lasting.

The biggest problem lies with the vaccine process. By requiring vaccine to be cultured in eggs, you have a long lead time in the face of uncertain demand.

The second problem lies with uncertainty, which was rampant in the early stages of the disease.

Any appearance of uncertainty can lead to panic. There was a huge demand for vaccine before vaccine was available. Once it was, and the flu peaked, demand dropped off, leaving unsold vaccine.

Now experts fear another rise may be in the offing, but public attitudes have been driven back-and-forth so much that any warnings sound like the boy crying wolf. Even if a reason to panic appears now, people may not respond.

Hindsight is a great thing. In hindsight too much attention was paid to the transmission of the virus, not enough to measuring its severity, or how severe it might be as more people were exposed.

Another problem was that hospitals were highly stressed when the virus was at its most virulent. More planning is needed in case the next pandemic is worse, just as we need more planning in advance of earthquakes and hurricanes.

Compare this flu to Hurricane Katrina. The lessons are really the same.

The problem in Katrina was not the situation in August, 2005. It was the deterioration at FEMA that went on for years beforehand. In politics the best defense may be a good offense, but in an emergency the best offense is a good defense. Before the next flu season we need more preparation.

So what do you think we learned from this flu, and what do you think we should do about it?

This post was originally published on Smartplanet.com