More than a month has passed since swine flu was considered widespread anywhere in Florida. The H1N1 vaccine is widely available, but demand has fallen off along with the threat from the virus.
Although they warn that H1N1 is still circulating and flu season is far from over, officials are starting to step back and reflect on the most extensive public health campaign in years.
From the school closings in the early days of the outbreak to the frustrating vaccine shortages at its peak, no one will soon forget the swine flu virus that sickened tens of millions nationally but proved less dangerous than feared.
"It wasn't severe to where we were seeing hundreds of thousands of deaths," said Sharlene Edwards, public health preparedness manager for the Pinellas County Health Department. Nor, she noted, was it mild. "It was making people sick, so we had to respond."
Last week, a 52-year-old Pinellas woman became the 188th person confirmed to have died from the virus in Florida, after three weeks in which the state reported no deaths. The Centers for Disease Control and Prevention estimated 7,900 to 16,500 people died of swine flu from April to mid-December 2009, acknowledging the challenge of such estimates because many people who catch the flu don't seek medical attention or get tested. Regular seasonal flu kills on average 36,000 people in the United States every year.
In planning for pandemic influenza in the past, however, experts often anticipated many more people becoming critically sick and dying than they saw with the swine flu virus.
"We always prepared for the worst," Edwards said. "A lot of us are now going to go back and take a different approach to future pandemic planning."
Pandemic is a term rooted in how widely a virus spreads, not the severity of the illness it causes. The public's fear of a pandemic was greater than the reality of the swine flu, said Mark Walters, an associate professor at the University of South Florida St. Petersburg and the author of Six Modern Plagues and How We Are Causing Them.
He worries that disconnect could spell future troubles.
"People may fear that we cried wolf on this one, and then the next one comes around and it is more dangerous," said Walters, a veterinarian who writes about the interaction between human health and the environment. "When anything is unpredictable, it carries a level of danger."
When the media hyped the scare factor, national leaders fell short in explaining the threat in everyday terms, said Ryan Pedigo, director of public health preparedness for the Hillsborough County Health Department.
"What I saw at the national level was a scientist trying to explain to someone like me, who is not a scientist, or my wife or my daughter, what's going on in terms we couldn't understand," he said.
The CDC acknowledges that people got frustrated, particularly over the vaccine shortages when swine flu peaked in late October and early November.
"Here we were telling them to go out and get vaccinated — and they couldn't find it," said Tom Skinner, a CDC spokesman. "In the future, we have to be careful about overpromising."
But Skinner said the greatest challenge is the need for faster vaccine production technologies. It takes about six months to develop flu vaccines, which have to be changed every year to match the influenza strains that are expected to circulate.
The timing of swine flu's emergence last spring — when it was too late to be added to this year's seasonal flu shot — flummoxed production.
Now vaccine is sitting on pharmacy shelves, and it's hard to know how much will get used during the remaining weeks of the flu season. Some may be donated to other countries, Skinner said. Leftovers will be thrown away, as scientists prepare an updated flu vaccine to administer next flu season.
But in the United States, public health officials say their response to the outbreak had some positive results, including expanded surveillance to monitor the spread of flu.
And the H1N1 outbreak may have finally gotten people to follow health officials' long-standing advice to take the seasonal flu seriously. Walgreens, for example, saw unprecedented demand for seasonal vaccine.
With children among the most vulnerable to swine flu, health officials took immunization clinics directly to local schools once the H1N1 vaccine became available. Hillsborough health officials administered more than 50,000 doses of the H1N1 vaccine in schools, reaching about 25 percent of the target audience, a figure that officials say they are pleased with. Pinellas provided about 35,000 vaccine doses in schools.
Pinellas health officials also point to their creative marketing, such as flying a plane over the Clearwater Jazz Holiday with a banner reminding people to get the H1N1 vaccine.
A third wave of swine flu could be on the horizon, officials say. For now, it remains the main influenza virus circulating around the Tampa Bay region.
But even as he promotes it, Hillsborough's Pedigo understands why people aren't lining up to receive the vaccine.
"As the incidence of the disease dropped," he said, "the community lost interest."
Letitia Stein can be reached at firstname.lastname@example.org or (813) 226-3322.