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From swine flu to bubonic plague, epidemics have always stirred fear and terror

So far, swine flu has infected fewer than 200 people, scattered across the United States. Most haven't needed hospitalization.

But the signs of fear are everywhere.

In the surgical masks worn at airports, bus depots and cruise ship terminals. In the words of the vice president, who said he would advise his family to avoid airplanes, subways and other confined spaces. In the closure of schools and cancellation of events in states with no confirmed virus cases. And in the media, with constant TV and Web updates and dire headlines.

Caution is good. But fear is unfounded and even unhealthy, say experts who have written extensively on the subject.

"Right now, if you poll people, they'd say this thing is going to kill us all. And the scientific reality is far different than that," said Dr. Marc Siegel, an associate professor of medicine at New York University who has written books on epidemics and fear.

"Fear is a worse virus than the flu,'' Siegel said. "If you define a virus as something that spreads, infects people, goes person to person, fear does that."

• • •

Why are people so scared?

History is one culprit. Every new disease outbreak brings back memories of previous ones. If you sang "Ring Around the Rosy'' as a child, you were singing about the Black Death, or bubonic plague, of the 1300s. The Spanish flu of 1918 killed tens of millions of people around the world and is still spawning bestselling books and TV shows. More recently, we have the mid century polio epidemic and the ongoing AIDS epidemic, not to mention SARS and bird flu.

"People have a tendency to envision scenarios of disaster. Those scenarios are based on fears that the 1918 flu is going to happen again," said Dr. Paul Alcabes, an epidemiologist, author and associate professor of urban public health at Hunter College in New York.

Epidemics, he said, are stories we tell ourselves. "It may have a disease outbreak at its core, but the way we tell the story isn't just driven by facts. It's layered with expectations, hopes, fears, fantasies and anxieties," said Alcabes, author of Dread: How Fear and Fantasy Have Fueled Epidemics From the Black Death to the Avian Flu."

Alcabes said government and health officials have done a good job of communicating the facts of the current outbreak without being alarming. He noted U.S. Homeland Security Secretary Janet Napolitano's decision this week not to close the border with Mexico, and President Barack Obama's strongly expressed support of the public health system.

Alcabes said it would be great if people would just stick to the facts. "But we don't seem to do that," he said.

• • •

Heart disease kills 650,000 Americans each year; cancer claims more than 500,000, according to the Centers for Disease Control and Prevention. And about 36,000 Americans die each year from seasonal flus.

So far, there are 160 suspected deaths worldwide from swine flu.

"It's an interesting phenomenon that we witness in public health, because if you look at the things that really harm people's life and detract from their quality of life, it's not things like these kind of disease outbreaks," said Donna Petersen, dean of the College of Public Health at the University of South Florida.

People are more frightened of swine flu than risk factors that are far more likely to kill them, like obesity, smoking, drinking and lack of exercise. That's because we perceive differently the risks that we can control, versus those we cannot.

"If I choose to smoke and ride a motorcycle without a helmet and eat poorly, that doesn't bother me as much as some unknown dreadful disease that I don't feel like I can control in my life," she said.

• • •

Alcabes sees no point in panicking. He and other scientists say it's false reasoning to imagine a reprise of the 1918 Spanish flu because there are now public health systems and agencies that make it their business to track the flu and educate the public on appropriate prevention measures.

In a paper titled "Panic In Place of Public Health," Alcabes cited the two flu pandemics that have occurred since 1918 — in 1957 and 1968 — that resulted in far fewer deaths. And he added that if the Spanish flu had happened today instead of 1918, the number of deaths would have been limited by medical advances such as the timely use of antibiotics to treat secondary infections.

Siegel agreed, pointing to the ability to discover viruses just as they're emerging. That's a new tool, he said. But with that comes a lot of responsibility.

"One thing that hasn't occurred is learning a new language to describe risk so that we don't scare everybody," he said.

Times staff writer Letitia Stein contributed to this report. Richard Martin can be reached at (727) 893-8330 or

From swine flu to bubonic plague, epidemics have always stirred fear and terror 05/01/09 [Last modified: Monday, May 4, 2009 6:12pm]
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