In Indonesia, emergency workers are having a very hard time getting into several remote villages devastated by last Wednesday’s 7.6-magnitude earthquake. As we’ve seen in every major disaster in history, regular people matter more than anyone else in the darkness of these voids. During the golden hours when rescue is possible, civilians do much of the lifesaving--and they are capable of remarkable creativity. It is wrenching and inspiring at once.
A few examples out of Indonesia:
“Every day on the road to Pariaman, a hard-hit district in the north, four or five women gather to make heaping plates of food for a village of 200, while their husbands collect donations from cars driving by."--Christian Science Monitor, Oct. 5, 2009
“On one block in the city’s Chinese quarter, workers at a coal concern and a truck rental company set up a base from which they dispatched much-needed earth-moving vehicles across the city."--New York Times, Oct. 4, 2009
“In a district north of the hard-hit city of Padang, stricken residents said they’d seen no rescue workers. Most structures there had been leveled, and people were using shovels and their bare hands to clear landslides and dig out bodies."--CBS News, Oct. 2, 2009
I highlight these stories not just because they are poignant but because they are evidence for what we need to do differently. In every country, we can do more to appreciate regular people--and invest in their training and knowledge--before we need them most.
Check out a story from Mercy Corps about how small investments in regular people helped a village survive last week.
At the moment, the bigger problem with the vaccine is that nobody knows when or where they can get it. The first doses just came out this week, and the feds are leaving it up to the states and locals to distribute them. Just like in most emergencies, your experience will depend almost entirely on how competent (and well-funded) your local officials are. Or, as Health and Human Services Secretary Kathleen Sebelius recently explained:
“We’ll never, from the mother ship, give one national picture. It’s going to be many, many local decisions.”
Welcome to the theme for this fall. Local, local, local. While it may make sense for the federal government to provide clear and specific direction, it ain’t gonna happen. Federalism makes hard things harder…
For now, confusion--and demand--seem to be swamping conspiracy and condemnation. As the New York Times reports today, pediatricians’ offices are currently being overwhelmed with calls from concerned parents who just want to know when, where and whether to vaccinate their kids. The problem is, nobody at the doctors’ offices knows the answers yet… And anyone who has been to a pediatrician’s office knows that it is the last place to expect agile customer service. So what we have now is a lot of irritated receptionists and frustrated parents.
There is a powerful anti-vaccine movement that may jeopardize this unprecedented public-health quest, but I don’t see it happening just yet. However, there’s still lots of time!
I did a swine flu interview the other day on Public Radio International’s To the Point. Most valuable moment: Dr. Georges Benjamin of the American Public Health Association does a really nice job of explaining how the flu virus works--and why it can change so dramatically (or, as he puts it, “makes a mistake") as it reproduces. (He starts talking around minute 24, for those of you in the mood for a short biology lesson.)
The single biggest challenge (so far) about swine flu is that the two questions your brain most badly wants answered are technically unanswerable: 1. What are my chances of getting it? 2. What are my chances of dying?
Our brains are wired to ask those questions. They are damn good questions. But no one really knows the answer (more on why that is coming soon). In the meantime, the trick is to make an educated guess. And that we can do pretty easily.
A bunch of people have emailed me lately to ask for help with the educated guess. I’m no doctor, but I’ve been fairly well immersed in studying swine flu (formally known as pandemic H1N1 of 2009) for a couple months now, as those of you following me on Twitter know a little too well. And I know a bit about how the brain processes risk--and the mistakes we tend to make. So here’s what I think:
1. Should I get the regular seasonal flu shot?
I would. It will be available earlier than usual this year, and even though it offers no protection against swine flu, it is a good way to hedge your bets. Why? Well, swine flu (the other flu) is extremely infectious--so your chances of getting it may be relatively high. If you get it, you will almost certainly recover. It is milder than regular seasonal flu so far. But it will kind of suck to be sick as a dog for a week to 10 days. If you get the seasonal flu shot, you at least reduce your chances of being sick as a dog twice this year. Plus, the truth is, too many people die or get hospitalized from seasonal flu in an ordinary year. So might as well not be one of them.
And let’s be clear: there’s no evidence that you can get the flu from the flu shot. The shot contains a killed, inactive version of the virus. The flu mist nasal spray contains a live version, but it is very weak. You may get a low-grade fever for a day or two, if you’re unlucky, but nothing like the actual flu. This thing is pretty well studied at this point, and it is very safe. I plan to get it, as I usually do. I figure my life is frantic enough without getting knocked flat by an optional virus.
2. Should I get the H1N1 (swine flu) vaccine when it comes out later this fall?
I will be getting it. I am not a health care worker or pregnant, under age 25, diabetic, asthmatic or dealing with any of the other chronic conditions that put people at higher risk. So I don’t want to take someone else’s dose. But once it’s widely available, which will probably be in November or so, I plan to get it.
It’s being manufactured the same way the regular seasonal flu vaccine is manufactured. Every year, the flu vaccine is altered to address different strains. So this is the same deal: same vaccine shell for a different strain. Also, it is being tested all summer by regular (if weirdly generous) people, and that includes pregnant women, small children and the elderly.
3. What about my kids? Should I get the vaccines for them, too?
This one is the easiest question, actually. Children are at higher risk when it comes to both kinds of flu (swine and seasonal). So as long as they are over 6 mos old and don’t have a severe allergy to chicken eggs, it makes sense to get them vaccinated for both. If they have any underlying issues--like diabetes or asthma--it is even more urgent.
OK, take a deep breath: For some kids, this may mean getting 4 different doses in all… Kids need two shots of regular flu vaccine the first year they get the shot (and only one seasonal flu shot after that)--and may need two shots of the new, H1N1 vaccine, too. This sounds unreasonable, I know. But it will probably be easier than ever to get these shots this year. Lots of schools, stores, pharmacies and doctor’s offices will be offering them. Also, the feds are paying for the H1N1 vaccine, so you should only have to pay a small administrative fee (or nothing, if your insurance covers it).
Lots of people are worried about thimerosal (a preservative) in vaccines. I’m not going to get in the weeds here on this very passionate debate, but I will say that both vaccines will be offered to children in thimerosal-free versions. So hopefully this won’t be a big issue. If you want to know more about the thimerosal debate, I recommend How Safe are Vaccines? by my Time colleague Alice Park.
For anyone trying to convince someone else (say a spouse or a grandparent) that the flu shot is a good idea for a child, you could always have them watch this CDC video. Once you’ve seen it, it’s hard to forget… And I know it’s kind of a cheap shot, because stories are always more compelling than stats (and the fact is that the number of kids who die from flu each year is pretty small--compared to, say, the four kids who die every day in car crashes in the U.S.). But still. There is a time and a place for manipulative storytelling, and this may not be a bad time and place:
4. What if I’m pregnant? Or thinking about getting pregnant?
So far, pregnant women have represented 6% of the people who have died from pandemic H1N1, according to the CDC. Pregnant women have also represented 6% of those hospitalized with the virus. But pregnant women only actually represent 1% of the population. So you can see that they are at higher risk of having serious issues from this otherwise moderate bug.
That said, if you are pregnant, your chances of having problems are still pretty small. If I were pregnant, I would get the vaccine as soon as it becomes available (likely mid-October). As I mentioned, it is being tested on pregnant women right now. And it is almost identical to the regular seasonal flu vaccine, which pregnant women are also supposed to get.
It’s hard to say if there’s enough risk to delay getting pregnant until the vaccine comes out… But since it’s coming out in a month, maybe it’s not such a hard question. Still, keep in mind that it will take 3 weeks for you to develop immunity--starting from the day you get your shot. Why? Because it takes a few weeks for your body to develop immunity.
5. So what’s the big deal?
Flu viruses are crafty bastards. They can change at any time. So the best defense is wisdom. You don’t need to worry about it as long as you check in with a few different, reliable sources of information every so often. What is a reliable source when it comes to swine flu? I can tell you that it’s generally not TV news. This thing is too nuanced for segments that last 52 seconds. But pick a couple sources--ideally ones that don’t all link to each other. My own favorites:
FLU.GOV (the federal government’s site)
FLUWIKI (a collaborative problem-solving wiki site)
THE PETER M. SANDMAN RISK COMMUNICATION SITE (a great site by an expert in risk communication--who has been following H1N1 closer than 99% of the population. Also, he’s funny, honest and blunt.)
A British PSA illustrating the ramifications of texting while driving has been making waves not in Wales where it was produced, but in the US via YouTube and major news outlets. This isn’t your average “this-is-your-brain-on-drugs” PSA. Instead it’s a long (over four minutes) and graphic dramatization of what happens when a teenage girl decides to text message while driving.
We know that people respond much better to stories than they do to statistics. This particular story revolves around a group of happy-go-lucky teenage girls unaware that their actions are about to destroy many lives. Between the blood, disturbing images of screaming passengers, and a possibly dead baby, there’s enough to make anyone squeamish. Since the PSA is too graphic for the US censors, you won’t be seeing anything like it on our TV screens (even YouTube insists viewers verify their age before viewing the video), but you have to wonder how effective it would be.
Personally the PSA doesn’t seem all that shocking. Perhaps I’m desensitized to violence on TV or maybe it’s no different than the totaled car parked in front of my high school before the prom —a good-in-theory, bad execution kind of thing. Both the totaled car and this PSA seem too hypothetical and cheesy. According to a recent poll, however, I might be alone— the majority of Americans feel the PSA is both effective and necessary viewing for US audiences.
See it for yourself here (remember, it’s 18 and over only!).
A while back, the Obama administration asked people to submit video PSAs about Swine Flu. The finalists have been chosen. Now it’s up to the rest of us to pick the winner. You can vote one time for (or against) each video every day--until Sept. 16. The winner gets $2,500 and boundless fame. My own personal favorite is the one pictured here.
