Swine flu: lessons from the 1994 plague

Swine flu has killed over 20 Indians so far, and may soon claim hundreds, even thousands. That is a tragedy. Even so, swine flu remains a very minor cause of death, far behind other diseases that kill millions. The panic generated by the media is unwarranted, and is worsening health outcomes.

In 2001-03, the Registrar General conducted a survey to gauge the main causes of deaths in India. Heart disease came first (19%), followed by respiratory diseases like asthma (9%), diarrhea (8%), respiratory infections like pneumonia (6.2%), tuberculosis (6%), and cancer (5.7%).

Applying these percentages to India’s annual deaths of around 9 million, we find that 1.37 million people die annually of respiratory diseases and infections, 720,000 of diarrhea, and 540,000 of TB. These are staggering numbers. They imply that on an average day, 3,753 people die of respiratory diseases and infections, 1,973 of diarrhea, and 1,479 of tuberculosis.

Seen in this light, 20-odd swine flu deaths are almost laughably trivial. I do not laugh, because every death is a tragedy. But I am infinitely sadder for the millions whose plight has been swept out of public view, and is actually being worsened by upper-class panic.

Make no mistake, swine flu panic is substantially an upper class worry. Why do the media overflow with news of swine flu while ignoring other diseases that kill thousands every day? Because those everyday diseases are the problems of the poorer half of India, and the media target the upper half. Some upper class folk do get asthma or TB, but they are quickly treated and rarely die of these diseases. The millions who die come from the bottom half, lacking access to doctors and medicines. They die so regularly in millions that their deaths are no longer considered news.

Then along comes swine flu. It is a new disease, and that itself commands media attention. The richer half is terrified that not even its money and access to doctors provides safety. As a disease carried by air travelers, swine flu is a quintessential elite concern. Elite panic soon spreads to lower rungs of society, as the media project a new apocalypse. This is true across the world. Globally, swine flu has infected 177,000 people and killed 1,126. The numbers are trivial compared with deaths from malaria, respiratory disease or diarrhea. Yet the global media focus on swine flu.

Panic over a new disease of limited impact is hardly new. The 2002-03 epidemic of SARS (severe acute respiratory syndrome) hogged global headlines for almost a year. Yet WHO data between November 2002 and July 2003 listed only 8,096 infections and 774 SARS deaths globally.

India had a plague panic starting in Surat in 1994. Half a million people fled Surat, and more fled Mumbai and other cities in Gujarat and Maharashtra. Schools and businesses closed down across India. Business losses in Surat alone were $ 260 million. Foreign countries stopped buying Indian agricultural exports, causing losses of $ 420 million. Foreign investors pulled out of stock markets, 45,000 foreign tourists cancelled their trips to India, and some international airlines stopped flying to India.

The media duly reported these economic costs. Yet arguably the greatest costs were borne, unseen, by the poor. Tetracycline, a cheap antibiotic popular with the poor, disappeared from chemists shops because of panic buying by plague suspects. Hospitals everywhere were inundated with lakhs of citizens wanting to be checked for plague. Only a handful of these were found infected. Indeed, only 53 deaths were ultimately attributed to plague, and some experts cast doubt on whether even these were plague cases. But doctors and hospitals across India were overwhelmed by plague suspects, and so had no space, time or medicine for those dying of other everyday diseases. This suffering, mainly of the bottom half of society, attracted no media attention whatsoever.

In dealing with swine flu, we must remember lessons from the plague panic of 1994. The media must put swine flu deaths in perspective by also reporting how many people are dying of other diseases. Politicians and the media must repeatedly highlight lessons to be learned from the plague panic: how it hugely inflated fears and death estimates, how it crowded out medical attention to sufferers of other killer diseases, and how it imposed huge financial and psychological costs unnecessarily. The Prime Minister has appealed to the media not to spread panic. Yet panic is inevitable when the Health Minister says in a Times of India interview that one-third of all Indians could ultimately be infected. We need cool heads and discreet tongues.

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