So far the swine flu has frightened far more people than it has infected, but fear of a disease can be just as potent as the sickness itself. Outbreaks of plague in medieval Europe led to the murder or exile of Jews who had nothing to do with its spread. In the 20th century, the specter of contagion was used to turn impoverished immigrants away from Ellis Island, demonize gay men and discourage women from getting jobs and even wearing shorter skirts. “So often epidemics end up as campaigns to capitalize on people’s fears or spread prejudice or encourage one or another kind of injustice,” says Philip Alcabes, a public health professor at Hunter College of the City University of New York and the author of a new book, “Dread: How Fear and Fantasy Have Fueled Epidemics From the Black Death to Avian Flu.”
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To understand the history of epidemics as cultural forces, Alcabes, an epidemiologist by training and an AIDS expert, delved into both scientific literature and works of fiction ranging from Albert Camus’s “The Plague” to Michael Crichton’s “The Andromeda Strain.” The story that a society tells itself about a disease, he discovered, is just as important as the disease’s actual mechanism. Often these narratives reveal a cultural unease that looms larger than the sickness – sexual anxiety, for instance, or suspicion of foreigners.
Though in recent years America has largely been spared from killer epidemics, the terminology has spread to cover a variety of non-contagious phenomena. The obesity epidemic. The autism epidemic. The drunk driving epidemic. Alcabes shared his thoughts on the swine flu “epidemic,” and on the history and psychology of that fearsome word:
What is an epidemic? And how is it different from a plain old disease?
If you’re an epidemiologist there’s a very simple answer – an epidemic is more than the expected number of cases of a particular disease in a given place and time. That’s easy. But that doesn’t describe what epidemics mean to people. A little more expansive definition is that an epidemic is a disaster of some kind, or, to get still more expansive, an epidemic is a perceived disaster. I write at the end of the book about autism, and autism as an epidemic. There is much more autism among children today than there was a generation or a couple of generations ago. On the other hand, the preponderance of evidence does not suggest that there’s something happening that’s making more kids be born with autism. The increase in autism seems to happen as a combination of expanding diagnosis and changing diagnostic patterns, plus better awareness of the problem and more awareness of what can be done for autistic kids. So there you could say what’s going on is perceptual.
Is swine flu an epidemic?
Yes, sure. Why? Because people are talking about it as an epidemic. And an epidemiologist would say that, since we have never seen cases of this strain before, as soon as we have seen some cases it’s an epidemic.
Can we learn anything about what’s going on now from the swine flu “epidemic” of 1976?
I believe there is much to be learned from what happened in 1976. Health officials were too quick to assume that we were going to see a repeat of 1918, the so-called Spanish flu epidemic (which killed millions). In 1976, officials pulled the switch too soon and called for mass vaccinations against this particular flu strain. And they did it because they had been convinced by some bad history that there was a great likelihood of a very severe and widespread flu epidemic at that time. As a result of this mass vaccination program, some people died. They died from Guillian-Barre Syndrome (an immune system disorder) and no flu was prevented because there was no outbreak. There was the usual outbreak of garden-variety seasonal influenza but not of the new strain. For me there’s a lesson there. I think responding to flu requires balancing sound public health measures against the need to have some foresight. What happened there was the sound measures were outstripped by the desire to predict in advance of the facts.
People used to see epidemics as the work of God?