This is the weekend for retrospectives on the year and the decade, so here are five points I think I've learned since April.
First, the blogosphere is a fairly good medium for disseminating flu information; unfortunately, much of that information is either wrong or incomplete or distorted. It takes effort and reflection to identify the reliable sources, especially when everyone is keenly aware of the political aspects of a pandemic.
Second, we were all surprised by H1N1 last spring because it didn't fit the narrative that Flublogia (and apparently the experts) had constructed between 2003 and April 2009: Bird flu coming out of muddy little villages in Vietnam or Indonesia with just the right mutation to spread easily from the villages to the airports to the industrial nations. Instead it was North America that launched the threat on the muddy little villages--and the big cities of Asia.
This plot switch clearly baffled everyone from Margaret Chan on down, and so did the low case fatality ratio. The narrative had been overturned and the risk-communication message was now clearly overblown.
(It reminds me of a classic Charles Addams cartoon in the New Yorker long ago: a patent official is standing at his office window with a futuristic-looking weapon, looking scornfully at the weapon's inventor: "Death ray, fiddlesticks! It doesn't even slow them down.")
Third, the media have done a fairly good job of covering the pandemic--on the local level. The Latin American media, and those of India and China, have actually tried to report on H1N1 around the world, while the North American and other English-speaking media have clearly not cared how many people were dying (or even slowed down) by H1N1 in Mexico or Brazil or Egypt.
No doubt the epidemiologists in London and Chicago have been well aware of events in Sao Paulo and Pune, but the general public has learned little beyond the local community's attitude toward school closures and getting the H1N1 vaccine when it became available.
Fourth, the gap between well-informed experts and ill-informed public could cause real problems in the next outbreak of any disease, not just flu. People will remember the scare stories of spring 2009, and shrug off the next round of warnings. Maintaining the public-health system's preparedness will be hard, even though the system itself seems to have been grateful for a full-scale dress rehearsal.
So the onus will be on the experts to make the case for ongoing preparedness, without seeming to be demanding cushy tax-funded jobs. This will be especially hard when the North American experts have done such a good job of concealing the human face of the pandemic, and when some governments (like Brazil and Turkey) have followed Indonesia's example of simply falling silent about H1N1.
Fifth, H1N1 and H5N1 continue to teach me about healthcare politics and new media, and I intend to keeping covering them as well as I can with my limited technical skills. Flublogia is (until the third wave or the mutation of H5N1) a smaller community than it was a few months ago, but it is a well-informed community of public-health experts, journalists, and laypersons whose knowledge and wisdom I value.
