Epidemiile emotionale- despre H1N1

N-as fi scris despre H1N1 daca nu avea legatura cu influenta.

Luni in sir secretarul de stat din Ministerul Sanatatii, Dr. Streinu-Cercel a avertizat populatia sa se vaccineze. Si nimeni nu l-a bagat in seama. De ce? In primul rand pentru ca (sa ma ierte Dumnezeu, dar asta e adevarul) a vorbit cum se spune in Ardeal, “mult, prost si fara rost”.

A trebuit sa moara Toni Tecuceanu (Dumnezeu sa-l ierte!)  pentru ca oamenii sa constientizeze pericolul. De ce?

Raspunsul ni-l da un articol aparut recent in The New England Journal of Medicine, din care citez:

“The irony was painful. No matter how often I trotted out the statistics of 30,000 to 40,000 annual deaths from influenza, the patients would not be moved. So when they demanded the H1N1 vaccine last spring, I reminded them of their reluctance over the seasonal flu shot. “Oh, that’s different,” they said.

Six months have passed. Flu season is now here. After repeated delays, H1N1 vaccine finally arrived in our clinic earlier this month to the uniform relief of the medical staff. But my formerly desperate patients were now leery. “It’s not tested,” they said. “Everyone knows there are problems with the vaccine.” “I’m not putting that in my body.”

(..) Just as there are patterns of infection, there seem to be patterns of emotional reaction (“emotional epidemiology”) associated with new illnesses.

(…) When the inoculum of dramatic illness is first introduced into society, the public psyche rapidly becomes infected. Almost like an IgE-mediated histamine release, there is an immediate flooding of fear, even if the illness — like Ebola — is infinitely less likely to cause death than, say, a run-in with the Second Avenue bus. This immediate fear of the unknown was what had all my patients demanding the as-yet-unproduced H1N1 vaccine last spring.

As the novel disease establishes itself within society, a certain amount of emotional tolerance is created. H1N1 infection waxed and waned over the summer, and my patients grew less anxious. There was, of course, no medical basis for this decreased vigilance. Unusual risk groups and atypical seasonality should, in fact, have raised concern. By late summer, the perceived mysteriousness of H1N1 had receded, and the number of messages on my clinic phone followed suit.

But emotional epidemiology does not remain static. As autumn rolled around, I sensed a peeved expectation from my patients that this swine flu problem should have been solved already. The fact that it wasn’t “solved,” that the medical profession seemed somehow to be dithering, created an uneasy void. Not knowing whether to succumb to panic or to indifference, patients instead grew suspicious.

No amount of rational explanation — about the natural variety of influenza strains, about the simple issue of outbreak timing that necessitated a separate H1N1 vaccine — could allay this wariness.

(…) There is no doubt that we are far behind the curve in terms of public relations. Our science has not been dithering at all, but our articulation of that science has often seemed that way, from the unfortunate initial appellation of swine flu to our inability to clarify distinctions between vaccine-production issues and clinical-risk issues. Suspicion has its own contagion, and we have not been aggressive enough in countering it.

Every practicing clinician is, to some degree, an armchair epidemiologist. We register patterns of disease as they play out among our patients. We are also keen detectives of emotional epidemiology, though we often aren’t aware of this as such. Keeping tabs on the emotional epidemiology as well as the disease epidemiology, and treating both with equal urgency, are the essential clinical tools for this influenza season.