Dr. Harley Rotbart’s GERMBlog™

New York has been hit hard by the current swine flu outbreak, and many schools in NY have been forced to close. A story in the New York Times today (As Schools Close Because of Flu, No Guidance on How to Rein It In, NYT 5/19/09) adds to the confusion regarding halting the spread of influenza. The article minimizes the potential importance of school disinfecting – the use of germ-killing solutions on inanimate surfaces.

Schools are well known as amplifiers of influenza and other community-wide infections, explaining why school closures are included in pandemic planning by the CDC and the WHO. While it is never absolutely clear in any particular outbreak what percentage of influenza cases in a school are spread directly person-to-person rather than by indirect contact with contaminated surfaces, both routes likely have a role. The ability of flu viruses, as well as other viral and bacterial contagions, to persist in infectious form on inanimate objects has been proven repeatedly. To state, as the article did, that “disinfecting closed schools is pointless” ignores the scientific reality that viruses persist on surfaces and that the greater the quantity of viruses, and the greater the number of contaminated surfaces, the greater the risk of acquiring an infection from an inanimate object.

Disinfecting reduces the surface viral “load”, and reduces the number of infected surfaces. Until evidence shows that spread of influenza from surfaces to people doesn’t occur, surfaces in highly trafficked sites in schools should be disinfected. This does not mean that schools must be closed to disinfect, nor does it mean that hand washing and alcohol hand sanitizers aren’t necessary. We should use all the weapons available to us when influenza enters our schools to prevent its further spread to those in the school building and those outside in the community; disinfecting is not “just for show”, as one of the experts says in the article.  

Remember Mad Cow Disease? That was the brain-rotting mystery disease that crossed over to humans from cows when humans ate parts of the cow’s brain or nervous system. The disease caused mass culling of infected bovine herds around the world, bans and boycotts of beef, and widespread panic throughout much of Europe. Some of the panic spread to the U.S.

Remember SARS (Severe Acute Respiratory Syndrome)? The respiratory infection that arose in Asia, with a few cases spreading to North America and Europe. The cover pictures on both Time and Newsweek magazines showed frightened women wearing masks, hoping to avoid certain death.

Each of these outbreaks were projected to infect millions and kill 100s of thousands. Each infected thousands and killed hundreds. Hundreds of deaths should not be minimized, but 100s of thousands of deaths, as occurred in the U.S. during the 1918 influenza pandemic, would have been unimaginable.

Where did Mad Cow Disease and SARS go? A combination of 2 factors made them disappear long before they reached their potential devastation: brisk responses by public health authorities; and, infections that were not nearly as severe as initially feared. That is, our response was effective and the germ was not.

Will today’s Swine Flu outbreak become the feared worldwide pandemic or will it go the way of Mad Cow Disease and SARS? Indications so far are for the latter path, and for the same reasons that made the other 2 infections disappear: effective public health response and a wimpier than expected germ. There’s a cautionary note here – this current outbreak, if it indeed fades away relatively harmlessly, can be seen as a call to readiness for the next, possibly more severe outbreak. Or, people may choose to say “they’re just crying ‘wolf’ again, next time we’ll be smarter and not react so quickly.”

I hope that all of you, and certainly my colleagues at the CDC and WHO, see this as a cautionary note and a reason to redouble our efforts to be ready for the next one. It would be a mistake to say that because we got lucky with this epidemic, we don’t have to react as briskly and as effectively the next time. On the other hand, the culling of millions of pigs, as is being done in some countries, and the statements by some elected officials (you know who they are) urging avoidance of planes and subways, are uninformed overreactions.