The Rockaway Irregular
Stuart W. Mirsky is a Belle Harbor based writer and former city official who last served as Assistant Commissioner for Operations at the New York City Health Department. He's the author of an historical novel, THE KING OF VINLAND'S SAGA, about Vikings in North America, and A RAFT ON THE RIVER, the true story of a young girl's survival in Nazi-occupied Poland during World War II. rockirreg@ aol.com.
Writing in the May 5 edition of the Wall Street Journal, columnist Brett Stephens points out that the recent government and media hysteria about swine flu now looks overblown, awarding "first prize" for the "dumbest response" to Egypt for deciding to kill all its pigs even though the disease is "mainly transmitted human-tohuman." Of course the Egyptian government has ulterior motives since Egypt, a Muslim country, is disinclined toward the pigs raised by the country's Coptic Christian minority. As the Obama administration's Rahm Emanuel has said in connection with other matters, a crisis is a terrible thing to waste and Egypt's government seems to heartily agree.
But Stephens reminds us that swine flu, despite extensive media coverage, is so far rather insignificant compared to epidemics of the recent past. The avian flu panic of 2005, he notes, produced 257 fatalities to date (according to the World Health Organization) and the SARS panic (2002-2003) 774. The current incarnation of swine flu hasn't approached anything like these numbers while, Stephens notes, "garden variety flus typically kill upwards of 30,000 Americans a year." The "mad cow" panic of the 1990s, he adds, was projected to "kill as many as 500,000 people a year in Britain alone," but the "total confirmed cases world-wide," he points out, actually "run to around 150." It's not that unnecessary deaths are ever acceptable but that some deaths are simply unavoidable. The level of response such risks trigger has to be moderated by the size of the threat posed.
Not all threats, of course, are false alarms. Stephens also reminds us of the infamous Spanish flu pandemic of 1918-1920 when fatalities were actually somewhere between 20 and 50 million worldwide - surely a legitimate reason to be concerned. But, as Stephens further notes, contemporary medical science has changed radically since those days, as have social and public health conditions. A big part of the development and rapid spread of the deadly strain of Spanish influenza in the early years of the last century reflected the overcrowded and unsanitary conditions that accompanied the movement of large numbers of soldiers in the aftermath of World War I and the living conditions of urban dwellers in crowded tenements and unclean public places, exposed food supplies, etc. Public health authorities back then were less vigilant and knowledgeable about what to look for or how to address the problems of their day.
Things are different now - for both good and bad. In New York City between 1998 and 2000 our Health Department got its first reports of the appearance of a new pathogen in Queens: the West Nile Virus, which could lead, in some cases, to brain inflammation and death. Apparently imported from somewhere in the Middle East (possibly Israel or Egypt), the virus infected wild birds and was transmissible to humans by mosquitoes. Although the disease had relatively mild symptoms in most cases, it was new to our shores and hence few antibodies had been built up in our population. It posed special risk to those who were very young, very old or had a compromised immune system. Of course, that's true for almost any infectious disease, but the fact that West Nile had been unknown here until that time kicked New York City's health officials into overdrive.
In those days I was running the department's logistical operations and thus had a part in the agency response. Management and staff medical experts realized the problem needed to be tracked and a surveillance system was put in place to capture data on patients presenting at hospitals, clinics and private health providers. A dead bird monitoring system was also set up, since birds were the first place the disease could be expected to appear, and reports of dead birds were taken from around the city, their carcasses picked up and taken to the city's Public Health Lab to test for presence of the virus.
The department soon realized it needed to control mosquitoes, too, and a system of mosquito remediation was put in place which included collecting and testing mosquito samples, monitoring and eliminating stagnant water (naturally occurring and manmade) where mosquitoes breed and, where necessary, larviciding and spraying to reduce mosquito populations. Of course, there were downsides to some of these efforts including the risk of contaminating the public via the chemicals used in the spraying and larviciding.
On the positive side the Health Department which, until then, had been ignoring mosquito problems throughout the city despite frequent complaints from communities in places like the Jamaica Bay area where mosquito activity was substantial, suddenly awoke and began to pay attention to the problem. Where such complaints had once been blithely dismissed, agency personnel could no longer afford to be so cavalier and communities that had suffered yearly from mosquito infestation suddenly got the attention they had long been denied.
There were very few fatalities from the new West Nile pathogen, in actuality, but plenty of concern about risk potential and the Health Department used that public concern to parlay a substantial increase in its operating budget under the fiscally tight Giuliani administration. Funding poured into a vast new system of surveillance and remediation and no small amount of it was redirected by management to other, unrelated parts of the Health Department's operations as the newly fattened bureaucracy took the opportunity to expand in the heyday of the "crisis."
But the relatively mild Middle Eastern pathogen eventually spread across the rest of the nation, despite the city's best efforts to contain it — there was never much chance it could actually be contained given that it mainly affected birds flying unfettered between jurisdictions — and Americans built up immunity to the illness as the populations in the original host areas had already done.
After a while, of course, the West Nile "threat" simply faded away and the media moved on, as it always does, to other crises and concerns.
The Spanish influenza of 1918-1920 amply demonstrates the need to be vigilant and proactive about matters of public health, of course, but instances like West Nile and this recent swine flu episode hold another message, too.
Public officials are often lax when they should be forward thinking - as New York City's health officials were when they arbitrarily let mosquito surveillance lapse in the years prior to West Nile's appearance - but are wasteful and greedy when they need to be efficient, as those same officials speedily demonstrated once they realized the dead birds they were so busy collecting, for testing and surveillance, included a taxpayer supported golden goose or two.