History teaches us so many lessons, most of which we quickly forget until the next history-making crisis. Nothing in history is a more predictable crisis producer than “fear.” Fear sows panic, panic sows irrational behavior, and irrational behavior sows wars, economic disasters, bigotry, and protectionism.

When the dust settles, we analyze our missteps and, often, recognize most of the fallout could have been avoided had we learned from history.

The Great Depression was a real economic crisis rooted in overinvestment and the crash of 1929, but fear and lack of confidence added many more years of pain as armchair economists around the country fled the markets and froze consumption in fear of what could happen. “Better safe than sorry” turned into a crisis of confidence that further brutalized the markets.

And then, Franklin D. Roosevelt would famously say, “The only thing we have to fear is fear itself.” One sentence, saying absolutely nothing concrete, changed the way we perceived the crisis, and led to a slow, but steady, rise in confidence that ultimately led us out of a perpetual economic doom. Every economic depression since, regardless of cause (oil scares, savings and loan failures, dot com busts, real estate busts) follows a similar pattern of recovery. Public confidence, ultimately, determines when the depression ends.

So what does all this have to do with swine flu (now known as the far less threatening-sounding H1N1)? Only six short years ago, SARS taught us several lessons in public health, most of which we quickly forgot. Perhaps the most notable: The fear of the disease often has a far greater impact than the disease itself.

Though 1,000 people died from SARS worldwide, we all know this pales in comparison to the deaths from seasonal flu every year. Yet, people canceled flights, donned the familiar surgical masks, and created an economic impact far greater than the reality of the outbreak. Much of this was fueled by the same “fear of what could happen”, and the “better safe than sorry” approach that prolongs most economic depressions.

In the end, the surgical mask was deemed of little value, and in the end, the public health message was honed down to “wash your hands” and “stay home if you’re sick.”

So, here we go again, with swine flu – doomed from the start by its name alone. Panic, dear, protectionism, face masks, and an economic impact far greater than the reality of the public health threat. The CDC stumbled in the first week of the scare, changing their recommendations sometimes twice daily and often out of step with local health departments. This, despite the fact that the plan of test-and-treat should have been for the sickest patients and those at risk for complication from the very beginning.

Closing schools turned out not to be the answer, and the face masks, once again, proved of little worth. All lessons we should have learned from SARS. Businesses suffered at a time they could ill afford to. An entire country (Mexico) and all its citizens were hung out to dry, leaving an already precautious neighbor on the brink.
Don’t get me wrong, a real pandemic is nothing to sniff at, and is still possible with H1N1. Even if it remains a mild illness, a pandemic could sicken a full one-third of the world’s population and lead to thousands of deaths. But you are still more likely to die of the seasonal flu in your lifetime, and you don’t shutter the doors every winter, or cancel your trip to Mexico.

The lessons are simple, and have not changed:

  • Wash your hands frequently.
  • If you do get sick, stay at home, and stay away from those most vulnerable.
  • Seek treatment if you are at high risk for complication or are very ill.
  • Do not seek treatment “just in case.”

And one more thing. Nothing turns a “scare” into a “crisis” more quickly than when someone yells, “The sky is falling! The sky is falling!”
Lee A. Resnick, MD
Editor-in-Chief
JUCM, The Journal of Urgent Care Medicine

Of Swine Flu, ‘Chicken Little,’ and the Great Depression

Lee A. Resnick, MD, FAAFP

Chief Medical and Operating Officer at WellStreet Urgent Care, Assistant Clinical Professor at Case Western Reserve University, Editor-In-Chief for The Journal of Urgent Care Medicine
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