Great Moments in Public Health

Killing Egypt's pigs

When swine flu first hit, Egypt killed its pigs. All of them. Now this senseless decision has left Cairo with a major public health problem on its hands.

The pigs used to eat tons of organic waste. Now the pigs are gone and the rotting food piles up on the streets of middle-class neighborhoods like Heliopolis and in the poor streets of communities like Imbaba.

Ramadan Hediya, 35, who makes deliveries for a supermarket, lives in Madinat el Salam, a low-income community on the outskirts of Cairo.

“The whole area is trash,” Mr. Hediya said. “All the pathways are full of trash. When you open up your window to breathe, you find garbage heaps on the ground.”

The pigs belonged to the city’s traditional waste collectors, Christians who lost their animals and their livelihoods. “They killed the pigs, let them clean the city,” says one. “Everything used to go to the pigs, now there are no pigs, so it goes to the administration.”

Update: It doesn’t make me feel any better about this story to see that the pigs seem to have been buried alive.

[youtube]http://www.youtube.com/watch?v=jwMIlw7rCSc[/youtube]

I’m also reminded of the 4 million or so cows the UK ended up slaughtering and burning during the BSE crisis, because we couldn’t be bothered to maintain basic standards of animal husbandry.

Pandemic flu – what are we missing?

For governments, managing risk is a pretty thankless task. Today, the House of Lords Science and Technology committee published its report on pandemic flu. Here’s the finding you won’t see widely reported:

We know from the evidence we received prior to the outbreak of swine flu that there has been a significant amount of work undertaken to ensure UK pandemic preparedness. According to Ms Merron, the WHO recognised the UK “as one of the best-prepared countries in the world”. Professor Lindsey Davies, National Director of Pandemic Influenza Preparedness at the DoH, told us that “No other country in the world has done more than we have to ensure that we protect the population and that we minimise the pandemic’s impact”-other countries are now coming to the United Kingdom for advice.

Instead, the spotlight will be firmly on where the government has got it wrong:

Guardian: “Committee concerned over delays, failures and preparedness for expected ‘second wave’ of virus in autumn.”

Telegraph: “Committee says Government has failed to offer reassurance that NHS services can deal with a “second wave” of swine flu.”

Sun: “NHS can’t cope with swine flu.”

Independent: “The spy who blew the whistle on his former colleagues is now living in a squat, dressing as a woman, and railing against the ‘Zionist empire’.” [Sorry – seem to have got my wires crossed here.]

Of course, none of these stories is a surprise. The Committee made sure the bad news got out over the weekend, leaking the bad bits to the BBC. Ministers have been on the defensive ever since.

Three reasons why this matters. First, it feeds cynicism about the public sector, helping convince ordinary punters that civil servants are such morons that they haven’t done anything useful to prepare for the pandemic.

Second, it creates a cartoonish view of the nature, and limitations, of any response to a serious pandemic. With an attack rate of 30%, our social, economic and health systems are certain to degrade to a degree (though hopefully, in a controlled way). Resilience relies on individuals, families, communities and networks of all kinds to pull together.  Expecting the government to ride around dolling out magic bullets is both a self-indulgent and ultimately self-defeating strategy.

The final point, though, is perhaps the most serious one. The Lords’ criticisms are aimed mostly at patchy implementation of a good strategy. But what if the strategy itself is faulty – not just the detail of its execution? That would be a much more serious matter.

(more…)

Please someone save me! (updated)

India Knight, writing in the Sunday Times, wishes a state-employed magician could come along and make her feel better about swine flu. As that’s not possible, she’s putting her faith in larceny and homeopathy.

We’re not supposed to take our swiney selves or our swiney children into doctors’ surgeries, and doctors are far too busy for house calls, so, as far as I can see, we’re all in the dark. Also, I don’t like the sound of Tamiflu, with its side effects and lack of long-term trials. But then I don’t like the sound of death, either.

No wonder every parent I spoke to last week was in a state of controlled panic — except for the ones who’ve had swine flu, who were all cheerful and said, “Pah, it’s not so bad; you just go to bed for a few days” — although they all said there was absolutely zero support or advice available to them other than: “Don’t go to work.”

This — “it’s not so bad” — had been my take on it until healthy people started dying. Now I’m hovering between, “Yes, but healthy people still die of normal flu — not many, but some, just as some women still die in childbirth and nobody gets pregnant and then starts running around wailing about death,” and, “Oh my God, oh my God, what are we going to do?”

So far I have failed to come up with a plan. I used my low journalistic cunning to sweet-talk two chemists into telling me where the stocks of Tamiflu for my area of London were held, so now I know where to break into if we suddenly find ourselves burning up in the middle of the night. And I’ve ordered some homeopathic remedies.

Update: In the comments, Eleanor suggests a dose of homeopathic A&E.

[youtube]http://www.youtube.com/watch?v=HMGIbOGu8q0[/youtube]

Swine flu – far from over

A worrying factoid from CNN (courtesy of Chris Blattman):

In each of the four major pandemics since 1889, a spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease. This was true in 1889, 1957, 1968 and in the catastrophic flu outbreak of 1918, which sickened an estimated third of the world’s population and killed, conservatively, 50 million people.

As the small print in stockbrokers and pension funds’ ads always tells us (if only we’d listened), the past is not always a guide to the future, but if the swine flu scare wanes over the summer, it would be dangerous to get complacent.