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Swine flu: why we are party poopers

Posted on: May 7, 2009 5:49 PM, by revere

It seems a conversation on one of the comment threads about "swine flu parties" at Effect Measure has made the New York Times:

One of the first open debates of the idea of intentional self-infection was on Effect Measure, a public health blog with many posts by thoughtful people who say they are clinicians, epidemiologists, veterinarians and other professionals, sometimes in government, but who post under pseudonyms to speak freely.

On April 28, a user calling herself OmegaMom posted: “Just a quick note — I just got a Tweet from a mom suggesting ‘swine flu parties’ because the U.S. version seems to be a mild version. Can you speak to the utter insanity of doing this, please?”

Several posters weighed in to say it would be foolish given the number of deaths in Mexico, the lack of information on the virus and the unpredictability of flu. (Donald McNeil, New York Times)

The report is accurate regarding the question and answers in the comments. I was going to post on this topic anyway, but now Mr. MacNeil has given me a good excuse to do it sooner rather than later (my grant proposal deadlines took no notice of this outbreak, alas).

Like other scientists quoted in the article, I also think deliberately self-infecting yourself or your family is a very bad idea, something I also expressed strongly in the aforementioned comment thread. I understand completely why this would be an attractive idea, and I have been asked about it by reporters and at least two colleagues, both of them smart and well informed. Given how this is being portrayed in the media and occasionally by public health officials the logic seems ironclad: the virus might return with a vengeance next flu season in a more severe form, it currently is a mild disease, and there is no protective vaccine for it at the moment and uncertainty as to when there might be or its availability. So why not take advantage of a naturally circulating "live virus vaccine"?

I can think of a number of reasons:

• While clinically the virus seems to be resulting in a "mild" flu, even a mild flu is not most people's idea of a mild illness. Even mild cases of the flu can be very uncomfortable: high fever, wracking muscles aches and pains and a hacking cough that goes on for weeks after other symptoms subside, not to mention easy fatigue and tiredness. This version also has an unusual prevalence of nausea, vomiting and diarrhea
• Of course you could get a milder or even asymptomatic case, too. On the other hand, you could get seriously ill. Last I looked there were 35 people hospitalized in the US and as the disease spreads there will be more. The hospitalization rate is somewhat higher than for seasonal flu, especially the relative number of healthy young adults and children. The hospitalized cases seem to have roughly the same age distribution as the cases in general, that is, half of them are 15 years old and younger. Few parents would consider something that sent their child to the hospital a mild illness
• All this is predicated on the virus continuing to act as it does now -- or as we think it is acting now. As we pointed out in this post, we still are not confident we know how severe it is
• It may not continue to act as it does now. Flu viruses are notoriously unpredictable. It could just disappear, it could become more severe or it could change in ways that make a subsequent infection possible, as with the changes we see from year to year in seasonal flu
• Given all this, you may still choose to voluntarily and knowlingly infect yourself or your family. But unless you and all your fellow party-goers are also willing to isolate yourselves for 14 days, you also may infect others. You could be spreading the disease in your community to others who have not consented to take the risks you have

At the moment this is likely moot, as confirmed cases are being isolated. But as the disease spreads more widely, some people may decide to do this with friends or family.

So let me be crystal clear. We think it would be a very foolish and irresponsible thing to do.