Dr Olarn's Blog

Swine ‘flu, my letter to the Bangkok Post. July 14, 2009

Your editorial column rightly stated that the public anxiety over swine flu is partly exacerbated by a lack of authoritative information and advice from from the nation’s health authority. Comments like “there are over 3000 confirmed cases but probably 200000 actual cases” are hardly reassuring and gives the impression that the government does not know what is going on. Government spokesmen appearing on TV seemed more concerned about appearing to be doing everything possible than about giving accurate and useful information. The media is also partly to blame for the panic and confusion. The Thai language press particularly are focused on the number of deaths and the rapidly rising number of sufferers, giving little if any emphasis on the now well established fact that the vast majority of swine flu sufferers recover uneventfully. In countries where the number of cases run from hundreds of thousands to well over a million, as is the case the USA, statistics have shown that swine flu is no more virulent than seasonal flu. Another truth that has emerged is that despite the very best efforts of health authorities in countries with more experience and more resources in dealing with disease epidemic than Thailand, the spread of swine flu can at best only be slowed down a little. No country has been successful in preventing or containing the outbreak. The government is accused by the media, the public, and the opposition of not doing enough and this may be true but it is hard to see what effective measures can the government really take. Short of shutting the country down, the virus is going to continue its march, until enough people are infected and consequently become immune, then the outbreak will peter out, and this is an inevitable fact. It will happen just as surely as the sun will rise tomorrow. Shutting schools and workplaces down for prolonged periods, urging the entire nation to wear masks, it has all been tried without discernible benefit. One thing our government has not mentioned to the public as far as I know, is that the capacity for testing for swine flu has been hopelessly overwhelmed weeks ago. The number of people who have had obvious symptoms of flu but have not been tested for swine flu literally cannot be counted. The estimate of 100000 to 200000 is an absolute shot in the dark and verges on the meaningless. Without the ability to test for swine flu, the government simply has no meaningful data on how many cases there has been. Without knowing the number of cases, the number of fatalities become useless other than to cause more panic. We know it is not 1%, but is it 1 in 1000? 1 in 10000? very much less than this? In all likelihood the number of preventable deaths in this country caused by road traffic accidents probably outnumber the number of swine flu deaths by several orders of magnitude. If there has been 17 deaths from swine flu in the past month, how many more have died from RTA’s? Surely not less than 100, but nobody is panicking over RTA deaths because it is not even old news, it’s not news at all. The sad fact is that if the government wants to save lives, it is more likely to achieve a degree of success trying to prevent RTA’s that to prevent swine flu spread, and for much less cost. But the government has to address the public’s concern over a disease outbreak, and as little as it can effectively do, it must be seen to be doing something. So we can expect more government spokesmen repeating the same vague useless information and advice. No person of authority is ever going to come out and say that the outbreak cannot be contained because frankly the government has no idea how to contain it. The public might try seeking reassurance by looking at what has happened in other countries where the epidemic started before ours. The number of cases will rise, it will reach a peak, and then it will fall. A few people will die. And then the next year as has happened every other years, there will be a different flu epidemic, with a different predominant flu virus, only it will no longer be hot news, and people will find something else to panic over. Dr. S (Olarn Seriniyom)