Swine flu poses broader questions for society

As swine flu spreads, hitting dozens of Victorian schools and communities, questions emerge whatever our response to the epidemic – from concern to unreasoned fear, from mild caution to unhindered business as usual.

In Northcote, close to the epicentre of reported cases, it’s easy to give in to fears that fragment families and communities, to look at others not as people but as potential carriers of the disease, as threats.

Differences can arise within families, and have in my own. I’m uneasy about what I see as needless visits to crowded places, choosing to do the big weekly shop early on a Sunday morning, when few people visit the supermarket. Even then, of course, coughs are echoing across the aisles, perhaps more loudly in the emptiness, amplifying my fears of the contagion they might carry.

A week or so ago, a high school friend of my daughter’s told me a case had been reported in her class. Self-consciously, but quite deliberately, I stepped back and asked my daughter to do the same. We were standing in the yard of the primary school attended by siblings of the girls, and I spoke with the other father about self-quarantine, feeling terrible as I raised the subject, with its suggestion of uncleanliness and contamination.

Though there are many kids with flu symptoms at the girls’ high school, and the arrival of swine flu there is probably inevitable, the case that caused my fears was a false alarm.

And what of the little primary school kids, with their beautiful camaraderie, their customary hugs of greeting and departure? One can see why schools are such a hotbed of transmission, but there’s a price in keeping them apart, of turning their gaze on each other as potential causes of illness.

Perhaps that’s why my wife is more mindful of the unnecessary anxiety children might suffer from an overly cautious approach. Café visits, play centres and weekend shopping are still on the cards, to some extent justified, it must be said, by the mildness of symptoms in the cases recorded to-date.

Yet, as recently reported in The Age (‘Infection a riskier prospect for some’, 2/6/09), a range of conditions, such as asthma and cystic fibrosis, threaten more severe outcomes for those who contract swine flu. So, while our sometimes unfounded fears may be amplified by fevered visions of pandemic, the consequences of thoughtless actions can be multiplied for those among us already ill with chronic conditions.

When it comes to individuals, thoughtful actions align fairly clearly with the kinds of public health messages being issued by the government – hand-washing, taking care to protect others from your coughs and sneezes, and staying away from people when you know or suspect you’re ill, or they are.

Unfortunately, while some of those Sunday morning supermarket coughs were no doubt from people who had no other choice in getting their weekly necessaries, in other cases it was quite possibly a failure to consider other people when they had no idea if they simply had a cold or something worse.

For some of us, downplaying swine flu is not so much driven by the impulse to avoid unnecessary anxiety and social division, as it is by the rejection of any constraint on our behaviour for the sake of others.

To these questions – of an appropriate balance between legitimate concern and groundless fears, between personal freedom and restraint – we must add consideration of the broader social and economic factors that seem geared to the spread of disease.

It is one thing, for example, to ask people to keep their sick children away from school, but another for employers to accept the absence of parents when they need to do this. Those without children are likely to encounter employers even less willing to accept absence for the sake of preventing the spread of illness through the workforce.

While a sick workforce is not a productive one, this simple truth is not reflected by the number of people who press on at work despite contagious illness. For whose sake? We need to ask ourselves whether the default position in our workplaces puts a greater premium on the continuity of business than on the broader public health.

We ride to work on crowded trains, increase the chances of catching or spreading illness at work, send our sick children to school for want of practical alternatives, and then seek help when we do fall ill from an over-stretched public health system.

For reassurance we can repeat the mantra, ‘The symptoms are mild’. But what if they weren’t? What if this highly transmissible flu does mutate into a more virulent form? While there is little current evidence that this will happen, there are historical precedents such as the 1918 Spanish Flu Pandemic, and it’s a possibility that would seriously raise the stakes on the questions asked here.

How well are we prepared as a society for this eventuality? How might swine flu, hopefully continuing in its current mild form, help us devise better public health strategies, and how might these be complemented by a rethink of some of our social and economic assumptions?

For my part, I’m selling the noticeable increase in hand-washing to the kids as a good way to stop not just the swine flu, but the usual round of winter bugs. And maybe a family walk in the park is a better choice than those snazzy shoes at the crowded factory outlet.