Kevin Lamb, Bird flu fears may produce unwise actions, 12/6/05 Dayton Daily News E3  

EXCERPT "Overemphasizing quarantines also misses some more important points, says former nurse Vernellia Randall, the University of Dayton's expert in healthcare law. What about the homeless and poor, who can't stockpile food and have no obvious quarantine location? Or the working poor without sick pay, Randall says, who "need those jobs to take care of their families?"  

ARTICLE Kevin Lamb, Bird flu fears may produce unwise actions, 12/6/05 Dayton Daily News E3 The national discussion of bird flu is generating fear without much serious urgency, a rare parlay along the lines of making frozen pizza less healthy without adding taste. The result is chronic stress that's a bigger health threat now than bird flu, but without well-conceived preparations for a pandemic. Fear might be a good motivator, but it's a terrible mobilizer. It's as likely to motivate us to do foolish things as to protect us from whatever scares us. People avoid flying after 9/11, even though car crashes are almost 400 times more likely to kill us than terrorism, as the British Medical Journal reported last week. Here's what you need to know about bird flu: * History tells us we'll probably have another serious flu pandemic that starts with a mutated bird-flu virus. * That virus may or may not be H5N1, which has killed almost 70 people in East Asia over two years but is not yet contagious from person to person. * The cabinet secretary for U.S. health says we're not prepared for a pandemic, primarily because of long-term neglect of vaccines and antiviral drug production and public health resources. * Bird flu seems scarier to many people than the seasonal flu, which kills more than 30,000 a year. Fears have been fanned by the breathless cable-news impression that H5N1 is just a sneeze away. Fear causes stress, which helps us avoid dangers we can run from. But chronic, uncontrollable stressors lead to health problems through overeating, smoking and drugs, and directly to poor health through biochemistry. The body reacts to stress by releasing hormones that prepare us for action by diverting blood flow to our large muscles. The process strains the heart and takes resources from the digestive, immune and endocrine systems, which is fine in the short run but not for long. That's how chronic stress increases risks of heart disease, muscle and digestive pain, infections and depression. Ohio State University researchers added to the evidence behind these risks with Monday's report that stress from merely a half-hour marital argument slows the healing of wounds by a day. The stress response wants to convert fear into constructive action. For flu, that would mean developing habits of good nutrition and hygiene. Those customs "may save more lives than a Tamiflu (antiviral) stockpile," writes Tyler Cowen, a flexibly libertarian economist at George Mason University with a bird flu blog at avianflu.typepad.com/avianflu/. Cowen calls "well-prepared health-care systems" the "single most important thing we can do" for any pandemic. But fewer and fewer emergency rooms are handling more and more patients, largely the fast-growing uninsured. So what? A Toronto patient waiting in the ER infected 78 others with SARS. Yet national planning has centered on billions for well-connected drug companies to develop vaccines and antivirals, and military enforcement of quarantines. We do need better incentives to develop these drugs and more plants to manufacture them. But antivirals are no silver bullet, as Cowen says, because flu viruses change so quickly. Good distribution systems and even face masks could be more important than stockpiles. He also says the military would be more likely to spread a virus than contain it, considering soldiers' close living quarters. Overemphasizing quarantines also misses some more important points, says former nurse Vernellia Randall, the University of Dayton's expert in healthcare law. What about the homeless and poor, who can't stockpile food and have no obvious quarantine location? Or the working poor without sick pay, Randall says, who "need those jobs to take care of their families?" Early in my previous life covering pro football, I asked a player if it bothered him that his coach's calm sideline demeanor might indicate lack of passion. Not at all, he said. It told him the coach had a plan to overcome the latest misfortune and confidence in the players to execute it. "If he reacted by throwing down his clipboard and stomped on it, I'd figure we didn't have a chance." We have some time to prepare for a flu pandemic, but not if clipboards go flying.