Blogging Under the Influenza

This is the post I alluded to last week. It might be a little bit overdue, but it's still something important, or at least interesting, to me

If you are a student at the U of A, you're probably aware that our Public Health Response Committee has sent out a massive electronic survey regarding the possibility of an avian influenza in hopes of devising a plan of action should such a pandemic erupt. And, of course, the whole topic of the survey made the cover of our beloved campus paper last, last Thursday. If you are not a student at the U of A, or have not yet seen the survey, here is a link.

Considering my university career focuses on things such as this feared pandemic, this survey was of particular interest to me. It's epidemiology in action, not just figures and statistics I have been learning about. Naturally, I took the survey, and was initially quite perplexed with the nature of some of the questions. Why are they asking me if I think I'm going to get food poisoning? Or cancer? What does sauerkraut have to do with anything? Was this survey really trying to collect information for a pandemic plan, or was that an ulterior motive? Thursday's issue of The Gateway also featured an opinion article concerning this survey, and it was relieving to see my suspicious sentiments echoed.... at first.

After reading this article a few times over, its ignorance dawned on me. My ignorance dawned on me. It just so happens that a few months ago I chanced upon a blog whose author talked on avian influenza and it got me all riled up. I cared about the fear and ignorance surrounding avian flu, its portrayal in the media, the fact that this thing could potentially kill half the people it infects. And after taking that survey I had thrown all that out the window for what I thought was critical thinking. In fact, I was thinking cynically.

Cynical thinking is, after all, not critical thinking, but the opinion article's author, one Miss Robin Palmer, seems to have the two confused. Her article centres around the seeming uselessness of some questions; she implies a lack of intelligence put into the questionnaire reflected in these questions, and flaunts a wishy-washy "I'm-actually-all-for-a-plan-and-maybe-I'm-just-taking-it-too-personally-but...." to cover her behind. So, does the survey really lack intelligence, or was it a lack of simple logic and reasoning that led Palmer to conclude such?

Her first attack is on question 17. She writes:

The “General Information” section was fairly bland until question 17, which asked “How likely do you think you may be affected by the following disease or injuries in the next year?” The person being surveyed was then asked to rank several diseases or injuries based on their likelihood of occurring. These diseases or injuries span the distance of “cold” and “annual flu” right through to “heart attack” and “traffic injury.” Now, I don’t know about everyone else, but I can’t exactly predict when I’m going to be struck by a bus.

Firstly, this question does not appear under the "General Information" section, nor does a section entitled "General Information" exist. It appears under the "Risk Perception" section. Presumably, figures exist for the average citizen's risk of contracting a cold, flu, cancer, having a heart attack, etc., but no such figures exist for avian influenza. Obviously. There are lists of confirmed cases, but those tell us little about our chances of getting it, at least while the cases are few and isolated. Thus, this question is guaging the public's perception of the risk of the pandemic happening, as the section's title suggests, in relation to conditions of known risk. It is not, as Palmer purports, a demand of prophecy, a prediction of one's own demise. Results of this question will give planners an idea of how much people know about and/or fear this potential threat, and will elicit a response of appropriate education and information about the real (though approximated) threat. In her conclusion, Palmer expresses that she doesn't "generally plan ahead for heart attacks," likening the ludicrousness of such a notion with that of developing a vaccine for avian flu. While I will talk on the idea of a vaccine later, I claim that planning for heart attacks is not so ludicrous. After all, a prevention plan is still a plan. People do what they can to reduce their risk of having a heart attack by keeping fit, eating healthy, yadda yadda. You must know your risk before you can reduce it. So, is developing a plan for avian flu that may encompass means of prevention really that crazy?

I can't vouch for Palmer's credentials and how she knows what a vaccine is. She describes them as such: "Vaccinations work by injecting a person with weakened or dead pathogens so that their immune system can produce antibodies to fight off an actual invasion of those pathogens." I cannot disagree with that statement as that is exactly the mechanism by which some vaccines work. She continues, "The fun thing about pathogens is they’re unique to each strain of infectious agent. How exactly does the Public Health Response Committee plan on producing these pathogens without knowing the strain of influenza?" This is also true (though the semantics of her first statement are not cohesive), and especially pertinent to avain influenza since the major targets for attack my our immune system are the hemagglutinin and neuraminidase proteins on the virus' envelope. It is these two molecules that determine the strain (i.e., H5N1 refers to a hemagglutinin of type 5 and a neuraminidase of type 1), though classifying something as a certain strain doesn't account for the entire molecular complexity seen by our immune systems.

Anyway, I'm being a little longwinded here. My point is that, yes, it is nearly impossible to develop an effective vaccine without acutally knowing, in great molecular detail, the strain that will emerge in a pandemic. However, I doubt the Public Health Response Committee plans on trying to develop a vaccine itself, as Palmer suggests. In fact, development of a true vaccine would take at least six months after a pandemic erupted. The whole point of the questionnaire was, again, to guage the public's knowledge on avian influenza in general. I will hazard a guess and say that not all people know how a vaccine works. In fact, recent portrayals of vaccines in the media, such as in the most recent X-Men movie and the television show Lost, are a little skewed. In both cases, I will assume that the vaccines they feature are passive vaccines, which work by giving infected or potentially infect people antibodies from another source as a means of protection or combat. It's not as effective nor as permanent as the aforementioned attenuated, active vaccine. So the public might be getting the idea that a vaccine for avian flu is a cure, a treatment, which is really not what it is. Again, the point of this question is to give the planners an idea of what they have to tell people in order for a plan to work smoothly. People have to know that there is no vaccine, so reducing our risk will have to come by some other means.

Perhaps the most touchy section of the questionnaire is the one entitled "Willingness to Volunteer During a Pandemic." It brings up the issues of volunteerism in such a crisis, forced volunteerism, and the possibilty of penalties to those who refuse to help. Palmer doesn't exactly develop her stance on this section fully, but from what she has written, I will imply that she thinks it goes a little too far. Yes, conscription (in Canada) may seem like a relic of the past, a violation of personal freedom, yadda yadda. But that's in context of nations versus nations, ideas versus ideas. An avain flu pandemic, if it emerges as deadly as predicted and feared, is life versus death, man versus virus. Desperate times call for desperate measures, as they say. Did conscription sound like a good idea during the World Wars? Yep. Might it sound like a good idea if a pandemic hit? Why not? Plus, maybe this is just me, but I would rather answers these questions now and know that a plan might involve this so-called conscription than to have the whole idea forced upon me when this pandemic is in full flight.

I started writing this a week ago, so I have lost my train of thought. I don't know what I wanted to say from here, but perhaps this would be a good time to stop anyway. Like I said, I was unsure about this survey when I first read it, but time and thought, logic and reason have brought a bit of clarity. Being proactive for something as devastating as this pandemic might be is perhaps of utmost importance. Understanding that planning calls for unusual and touchy questions will only help the cause. So, I really would rather take a "cuckoo test" over one flu that will liquify lungs, leaving me to drown to death in my own blood.