[ Sekai : July 2009 / Tatsuhito Tonooka / unlicensed and abridged translation/summary ]
Initial alerts by WHO were ambiguous : a level 3 alert was called at first, but this is supposed to indicate the spread of a disease among animal populations with insufficient evidence to suggest human-human contagion; perhaps the WHO were afraid of causing panic? It seems that a version of pig influenza had been documented in America for some years prior to this new-type being identified – but it had not shown a capacity for jumping the animal-human barrier. That original type was a combination of pig, chicken and human influenza viri; the new-type pig influenza that has been making the headlines since early May this year has been influenced by the Eurasian pig influenza virus. Although highly contagious between animals and humans as well as between humans, the new, Eurasian-pig-influenza-influenced virus is not particularly virulent and the majority of patients have only mild symptoms. This obviously made it more difficult for the WHO – on whom most countries depend entirely for such disease/health/sanitation advice – to issue suitable warnings. The level 3 alert was raised a few days later to level 4, and then 2 days later was raised again to level 5; at the same time, the verbal warnings given by the WHO were that countries need not take stringent measures against the spread of the disease due to its weak virulence. This advice led to confusion in many countries, not least Japan.
When the WHO issued its Level 5 alert on 30th April 2009, the Japanese Labour Ministry was ready to put into action its previously-prepared ‘Plan for Conduct of Measures to Counter New-Type Influenza’, which had been prepared in November 2007. That plan was based on the Ministry’s appraisal of the health advice for measures to counter the H5N1 virus and was therefore fairly extreme in its stipulations – even a single case of human infection in Japan would lead to the closing of all schools and subsequent steps to be taken on a national level. The problem here is that words ‘new-type influenza’ were used – incorrectly – to label a range of different viri and this is why the Japanese response to the new pig influenza soon found its wheels spinning in the air. Japanese media, as of course the government, also swallowed and regurgitated this inaccurate use of the phrase ‘new-type influenza’. In no time the Labour Ministry’s 2007 plan to counter the H5N1 virus, labelled as a set of counter-measures against ‘new-type influenza’ was in execution and the effects were immediately clear throughout the country. In health centres throughout the country ‘fever’ consultation centres were set up and screening centres where anxious patients could find out if they were in fact infected with this ‘new-type’ influenza. Of course, many of the more unresponsive health centres (no doubt innured by some ‘cry wolf’ syndrome to such warnings from central government bodies) refused to take any action at all. All the advice from central government was based on the 2007 plan, which was brought out of its cupboard with inadequate consideration as to its applicability to the new situation. Every time the TV news broadcast images of the freshly-empowered quarantine inspectors boarding airplanes and standing importantly in airport lobbies, people were led to believe that there had been a further spread of ‘that’ new-type influenza; this misunderstanding, propagated by the government and spread by the media, ballooned into a nationwide panic.
TV and newspaper companies broadcast detailed reports about the make-up of the new virus, but there was a conspicuous absence of balanced reporting on the relative mildness of the disease – that its effects are no worse, and usually milder, than normal seasonal influenza. Experts in government bodies were heard to comment that the influenza currently spreading around the world was considerably different in its genetic form and symptoms to the ‘new-type’ influenza which the 2007 plan was drawn up to address and that, therefore, there was no need for on overly-dramatic response from the government. The author of this article also received mail from experts in other countries expressing surprise at the heavy-handed media reporting of the disease in Japan and stating that the Japanese government reaction was over the top. It seems there was not as much fuss in their countries over the disease. Mass media hysteria reached a peak when reports were made, on 9th May, of the first person in Japan to catch the new influenza. The Health and Labour Minister’s ridiculous comments were broadcast on every TV channel as he solemnly called on the nation for calm, and in the next breath gesturing at a seating plan of the plane explaining that anyone who had been on the plane with the sick individual had been exposed to risk of infection. But it seems that there were very few journalists who felt uneasy at the content of the Minister’s announcement.
The next day, the author posted the following on his web-site : “We are seeing a media frenzy of the type we have not seen for some time. From bureaucratic government meetings to newspaper editorial committees, heads were put together to work out a ‘presentation’ policy. It could be argued that the aim, rather than to disseminate information in such a way that social calm and order could be maintained, was to produce reports with higher-impact content than any other company or office.” (cont. below)
“What kind of business continuity plan (BCP) – that all companies and government authorities in modern society should have in place – was this action based on? To simply battle with other companies to produce articles that will sell more issues than any other company? Or to actually think carefully about their role in times of potential crisis?” (cont below)
“The author feels that the role of the mass media in the case of a ‘new-type’ influenza propagating itself around the world is principally the dissemination of correct information and to act as the source of an energy that will work to to direct society in a more moderate direction. But the current mass media were on this topic like ‘flies to cow dung’ and their behaviour was surely little different to a company making money out of ‘new-type’ influenza merchandise.” (cont below)
“Among the careless reporting unscientific articles and articles seeming to have been written for no other purpose than to make waves particularly struck the eye. The mass media can become a source of the kind of energy that creates social hysteria and this writer feels that the Japanese media have not yet escaped from this zone.” (end quote)
When high school students were quarantined with the new-type influenza at Narita airport, the media companies were falling over each other to publish influenza special editions. They did not disseminate correct information – and that may have been because they did not know what the correct information was. The state had not at this stage yet communicated to the media, or indeed to society at large, the principal characteristics of the H1N1 new-type influenza virus that was being identified around the world. All anyone knew was that a new-type of influenza was out there, and that it had arrived at Narita airport through infected high-school students. Considering how little information they had, it is remarkable how much ink the media used to cover the story at this stage.
And yet, at exactly the same point in time, the detailed characteristics of the new virus were known in America and at the WHO – the latter organization had also been tirelessly disseminating this information : even without a flu jab, the disease will cure naturally; the majority of infected people display only mild symptoms. In the US, the government revised an earlier advisory that schools should close for two weeks if a student contracted the disease, stating that there was no need for such action.
Experts already thought it likely that the H1N1 virus was already present in Japan. The virus spread from Mexico to the southern US between March and April; it would require a greater exercise of the imagination to suppose that no Japanese carrying the virus had returned home from that region during that time period. Even after being infected, the virus cannot be detected during its incubation stage; and when symptoms do break out, they are very mild. Influenza was already going round in the provinces and the new-type could well have blended in with that, so to speak, as it spread. Heavy quarantine measures were judged by local authorities in those areas (Mexico and southern US) to be unnecessary – and medical authorities also disseminated the same opinion. The purpose of such heavy quarantine measures can only have been to create an illusion for the general public of a strong and uncompromising response by the government in a moment of crisis. But the medical basis for such action was doubtful.
Isolated like criminals, criticized as if it were their fault for coming home infected with the virus, the high school students were used in this media feeding frenzy; even their school’s headmaster’s apology was widely reported.
Obviously, something is not quite right in Japan – for such a typhoon of panic to build up with nothing more than ignorance in the eye of the storm. The author cannot say for sure whether this is the fault of the government or of the media, or whether it is just down to the introverted tendency common among the Japanese population. What he feels he can say for sure is that this is evidence that a healthy civil society has not yet been built in Japan.
On 16th May matters took a turn for the worse – at least, as far as the government were concerned. A high school student in Kobe was confirmed as having new-type influenza. The student had not been abroad, but had become infected without leaving the city; meaning that there were already people carrrying the virus inside the city. This led, in the end, to a change in the government policy with regard to quarantining the infected. The government had always known that some people would catch the virus; yet, public statements gave the impression that it was only thanks to the strict quarantine systems put in place by the government that the virus had been kept outside Japanese borders until then.
The infection spread through high school students and more broadly among the population of Kobe. Allowing for an incubation period, the first victims must have been infected during the Golden Week holiday period. One can conclude that the peak time for the spread of the virus was between 15th and 18th May, and thereafter the spread began to slow down. Over 80% of people infected were teenagers; the number of infected adults was extremely low.
Curiously though, it was the adult population that started wearing masks – one might call this phenomenon ‘new-type flu-mask syndrome’. There was no scientific basis for people to believe that wearing a mask would prevent the spread of the new influenza virus. The US government and the WHO advised people to wash their hands frequently but did not recognize or promote the use of masks as an effective preventative step. The Labour Ministry was particularly conspicuous in its lack of clear advice on this matter. Long queues formed outside drug stores, which soon sold out, and masks were traded at auctions at inflated prices. All this based on a panic reaction – and still the media shows picture after picture of businesspeople wearing masks on their way to work and students doing the same on their way to school.
Tamiflu and Rilenza were doled out like candy to anyone who feared infection, while the WHO appealed for medical services not to prescribe such medication except in extreme cases. The WHO wisely feared that the virus may further evolve in response to broad use of medication, and also that, in case of the pandemic ballooning towards the winter, over-prescription at this stage may result in sufficient reserves not being maintained.
In the Kansai region, a few hundred high school students were infected but their symptoms were, for the most part, milder than seasonal winter influenza cases and easily treated.
On 20th May, a Tokyo high school student returned from the US and was soon confirmed to be infected. Of course, the symptoms were mild and the individual soon recovered. For about three weeks, the new-type pig unfluenza was treated like the harbinger of Armageddon. It wasn’t until the 21st May that a more measured response began to be considered.
There is a chance that as Summer progresses, the new-type influenza will subside. But the WHO and US Committee for Disease Control have their minds focussed on the possibility of the virus increasing in virulence towards the winter. To prevent this, the main work is to produce a vaccine in sufficient quantities that can block its symptoms and limit its spread. There are a number of other key tasks that should be listed :
- Japan needs to make clear with whom in which departments responsibility for measures to tackle the new-type influenza lies and to take action based on the advice of suitably qualified experts and specialists – for example, an office of the kind of the US CDC may be necessary.
- Vaccines will need to be mass-produced for both the new-type H1N1 virus and the usual winter influenza virus. The key points are the volume of vaccine to be produced and how soon it should be ready. Japan is relying on domestic pharmaceutical manufacturers, but most American and European countries are turning to multinational pharmaceutical companies to produce suitable quantities of the required vaccines. The WHO estimates that vaccines for 5 billion people would be the maximum that could be prepared world-wide; the WHO is thinking about having multinational manufacturers supply the vaccine to the populations of developing countries. The UK’s Glaxo Smithkline has already promised to provide 50 million vaccines.
- While developed countries may have little to fear from the new virus, developing countries are more likely to see large numbers of victims and it is now a matter of urgency to send vaccines in sufficient quantities to where they are needed – international cooperation centring on the WHO is going to be essential.
- It is possible that the coming of winter may see a new mutation of the virus, with greater virulence, arrive in Japan. The new-type influenza may mutate in contact with other influenza strains within one individual leading to a more virulent form of the disease. The ‘New-Type Influenza Counter-Measures Plan’ needs to be strengthened and its content revised; relevant bodies (local government or doctor’s groups, etc) need to be organized in such a way that they can respond cooperatively to situations like this.
- At present, what is of greatest concern on the international scale is the direction the virus will take from now on. The author is praying that it will not spread as a major pandemic, but sees no scientific evidence for being sure it will not.
1 Comment
June 19, 2009 at 12:08 pm
[...] Original post by bbt [...]