My husband and I have three boys under the age of five, which is another way of saying we’re sick a lot. School-age kids average between eight and twelve colds a year, as do the siblings with whom our kindergartner competes in twice-a-day long-distance spitting contests known around our house as “brushing your teeth.” Adults, who tend to be more particular about toothbrush ownership, average between two and four colds annually.
If you figure it takes about a week to work through the effects of the average rhinovirus, this means that forty-four weeks out of the year, or almost ten months out of twelve, someone in my family is sick. That’s in a bad year. In a good year—well, we’ve never had a good year. Given our highly infectious history, it’s easy to imagine the viruses likely to visit us in the near future, hitching a ride home from preschool or lurking on the sticky fish tank at the pediatrician’s office that my two-year-old can’t resist licking.
Two years ago, when public health officials convened in St. Paul for a pandemic influenza summit, I read every newspaper report, studied the state’s published emergency plan, followed the movement of birds infected with avian flu from Turkey to Ukraine, quizzed my pediatrician about the effectiveness of Tamiflu, and even stocked up on canned tuna fish after someone in the federal government said I should. In the midst of this activity, one of our kids complained that his eyelids were stuck together. By the time he passed his pink eye to every member of the family, the buds were back on the trees and I forgot all about the flu—until the following year’s flu season, when my fretfulness resumed.
This is not the most productive approach to the flu—or to any health threat—but public health experts say it’s typical. According to Buddy Ferguson, the Minnesota Department of Health’s risk communications specialist, most of us have a short attention span when it comes to what he calls the “disease du jour” that dominates the day’s headlines. Whether it’s seasonal flu or the pandemic influenza that health officials have been warning us about during the past few years, our risk is often more enduring than our interest in doing anything about it. “That’s why when there’s a window open—an educable moment when the public will listen to our message—we try to make the most of it,” Ferguson says.
That window opened wide in 2005, when a shortage of seasonal flu vaccine forced people waiting for a shot to stand in long lines (the line I stood in reached into a frozen parking lot). Reports of human deaths caused by the H5N1 avian flu virus had made headlines and President Bush announced plans to use the National Guard to enforce quarantines in the event of a pandemic. Then Minnesota epidemiologist Michael Osterholm, now director of the state’s Center for Infectious Disease Research and Policy, sent chills up the public’s back when he was asked what would happen if a pandemic were to strike that year and he answered, “We’re screwed.”
In response to the pandemic concern, the legislature appropriated $500,000 for the health department to begin an awareness campaign to help Minnesotans prevent and prepare for such an event. But by the time the session concluded and the check was cut, says Ferguson, “it was already clear that people were turning their attention elsewhere. The educable moment had passed.”
The moment passed, but the threat did not. “Influenza experts assume a pandemic is in our future—it’s part of the natural history of the influenza virus,” says Elizabeth McClure, medical director of the Academic Health Center Office of Emergency Response at the University of Minnesota and an associate at CIDRAP. What experts can’t predict is whether the next pandemic will be as widespread as the one was in 1918, when influenza killed an estimated 40 million men, women, and children worldwide, or whether it will be less severe, more like the pandemics of 1957 and 1968.
An influenza pandemic remains the worst-case scenario, but each year seasonal influenza takes a toll of its own. Though flu-related deaths among adults aren’t reported to the U.S. Centers for Disease Control, pediatric deaths reported nationally paint a grim picture of seasonal influenza. Across the country, 153 children died of flu-associated deaths during the 2003-04 flu season. During last year’s season, which the CDC described as “generally mild,” sixty-eight children died.
“Influenza is one of the leading causes of death, year in and year out,” says Ferguson. But getting that message out can be a challenge, even in a media-saturated culture such as ours. Go too far while telling the public the human toll a severe flu season—or, worse, a full-scale pandemic—could take and you “scare people into denial,” Ferguson continues. Beat the drum too often and the public becomes bored, an effect dubbed “flu fatigue.” Tell the public how quickly our world would change in the event of a pandemic (businesses closed, flights grounded, students and workers sent home in an effort to break the chain of exposure) and you face ridicule and resistance in a post-9/11 world grown weary of alerts and official advice to stock up on duct tape and plastic sheeting.
McClure says the idea of planning for emergencies is a foreign concept to most of us, who have never even had to stock up for a winter storm. “It’s very counterintuitive for us to think we have to put anything aside because we can go anywhere and get anything we want, at any time,” she says. “We don’t even have seasonal vegetables anymore. But I try to remind people that all of that stuff in front of us is supported by a very thin supply chain that can be interrupted.
“If you haven’t experienced [a public health emergency],” McClure says, “it’s very difficult to believe it can happen.” But it will happen, she insists. “It isn’t a matter of if, it’s a matter of when.”
When a pandemic does happen, I’m going to need a lot of dog food.
That was one of the discoveries I made recently, after creating an emergency-planning kit as prescribed by codeready.org, the emergency preparedness website created by the state departments of public health and public safety. The goal of the codeReady campaign, which the state rolled out last spring, is to get Minnesotans to plan for a pandemic or other emergency that would require them to stay home for extended periods of time or otherwise strain the official emergency response. So far, more than 57,000 individual visitors have gone to the site, and nearly 11,000 say they’ve created an emergency kit as I did, starting with a comprehensive shopping list of items a family would need in a worst-case situation.
When I went to the site to figure out what a one-week preparedness plan would look like, I expected instructions for turning my basement into a bunker. But the suggestions seemed surprisingly reasonable. For instance, my family of five would need 137 servings of protein, which seemed excessive until I learned I could cover that with a few pounds of dry beans, two jars of peanut butter, and the tuna fish I had left over from last year’s flu season. The thirty-five gallons of water the site says we’d need seemed more daunting.
“I say do what you can do,” Elizabeth McClure says. “If it gets you off zero, that’s a start.”
The checklist that accompanies the codeReady planning kit helped me determine the specific needs of my family. A few boxes of diapers, for example, are a must-have for my brood, while extra supplies of blood-pressure medication might be a concern for older neighbors down the street. Because my kids are fever-prone and a quick trip to Walgreen’s may not be an option in an emergency, I need to make sure I’ve got a fresh supply of Advil. The pet store may be as inaccessible as the pharmacy, which is why I need to stock a week’s worth—fourteen cups—of kibble for our dog. Yes, calculating our needs like that makes me feel as though I’m playing a cameo role in one of those depressing post-apocalyptic disaster movies.
“People think,‘Oh, no, I don’t want to be one of those basement people,’ ” says McClure. But, she adds, taking stock—and stocking up—could prove an enormous help during an emergency. Instead of my usual “just-in-time” fretting, a clear-headed plan and well-supplied cupboards could help cut down on the anxiety of caring for my family in a bad situation. It might even allow me to help friends and neighbors who are harder hit, by simply keeping out of the way.
“Our hope is that disaster preparedness becomes a kind of social norm, if you will,” McClure says. “That it means we’re ready to help each other in our communities if something unexpected happens.”
Thinking proactively about the dark side may have another bright side. “I believe [the threat of] pandemic flu has made people more aware of seasonal flu and that will only serve to help us,” McClure explains, noting that when we’re alert to the dangers we’re more likely to cover our mouth when we cough, get flu shots, and practice other infection-control measures. “I know that when someone in our family got sick, I used to think, ‘Oh, great, now we’re all going to get it,’ ” she says. “Now I say, ‘No. Let’s try washing our hands, let’s not share towels and glasses, let’s see if we can’t avoid everyone getting sick.’ ”
She’s definitely onto something. I notice that the more I think about what’s beyond my control, the more committed I become to what’s within it. I can’t do anything about the respirator shortage that made headlines two years ago, but I can keep my kids home from school when they’re sick. I can’t predict what the federal response to a pandemic will be, but I can wash my hands more often. In fact, a recent review in the British Medical Journal of more than fifty studies concluded that hand-washing and using germ barriers such as face masks may be more useful than drugs in preventing the spread of respiratory viruses such as influenza and SARS.
My family is making other changes that don’t feel like emergency prevention, but probably are. My husband and I take turns supervising our boys’ tooth-brushing ritual and insist they use separate cups. On Dr. McClure’s recommendation, I bought my first bottle of alcohol-based hand sanitizer.
Forty-four colds a year may have been the norm at our house, but with this new plan in place we might end up breathing a little easier.
Laura Billings is a St. Paul–based journalist and regular contributor to Mpls.St.Paul Magazine.