Love in the Time of Swine Flu: A Story in Three Acts

by Larry Brilliant, M.D. Larry Brilliant is an M.D. and M.P.H., board-certified in preventive medicine, epidemiology and public health.

He is President of the newly created Skoll Urgent Threats Fund and Advisor to Jeff Skoll, the founder of Participant Media, the Skoll Foundation and, now, the Skoll Urgent Threats Fund. The Skoll Urgent Threats Fund helps to solve some of the most urgent threats of our time: climate change, nuclear weapons, water scarcity, emerging potential pandemics, and conflicts in the Middle East.

Larry was one of a four person international team that led the successful World Health Organization smallpox eradication program in India and South Asia where he lived for more than 10 years working on polio and blindness after smallpox was eradicated. He later founded The Seva Foundation of Berkeley, California, which works in dozens of countries around the world to eliminate preventable and curable blindness. Seva's projects have given
back sight to nearly 3 million people. In 2008, Time magazine named Brilliant one of the 20 most influential scientists and thinkers and one of the 100 most influential people in the world. He served a three-year stint as the first Executive Director of, the company’s philanthropic arm before becoming Chief Philanthropy Evangelist for Google.

Brilliant co-founded The Well, a pioneering virtual community, with Stewart Brand in 1985. He also holds a telecom systems patent and has served as CEO of multiple public and venture-backed technology companies.

Earlier in his career, he was a professor of global health and epidemiology at the University of Michigan. He has authored two books, and dozens of scientific articles on smallpox, infectious diseases, pandemics, early warning systems, blindness, and international health policy and is currently writing a book for Harper-Collins on the world's most urgent threats and how to fight them.

He has received numerous awards including the Global Leadership Award by the United Nations Organization in 2008. In 2006, he received the TED Prize. He was named "International Public Health Hero" by the University of California in 2004. Larry worked in India for WHO for more than 10 years, on smallpox, blindness and polio. His polio work for WHO led him to the idea for a documentary, The Final Inch, which won an Oscar nomination
in 2009.

After the September 11 attacks, and the anthrax bio-terror attacks which followed, Larry left corporate jobs to volunteer as a “first responder” for CDC’s smallpox bio-terrorism response effort. After the Christmas 2004 Tsunami, Larry volunteered to work in refugee camps and personally collected and carried financial contributions to refugee organizations in Sri Lanka and Indonesia. He currently chairs a task force created by Presidential directive, the National Biosurveillance Advisory Subcommittee.

He was elected to membership in the Council on Foreign Relations in 2009. He sits on the boards of The Skoll Foundation, Health Metrics Network, and Omidyar Networks Humanity United. He is an actively sought after speaker, and has received numerous other awards, prizes and honorary doctorates.

Act One: The Story of Swine Flu and What It Feels Like to Be Sick With It

I want you.
I shall seek & find you.
I shall take u 2 bed & have my way with you.
I will make u ache, shake & sweat till u moan & groan.
I will make u beg 4 mercy.
I will exhaust u 2 the point that u will be relieved when I'm finished with you & you will be weak for days.

All my love, Swine Flu

--Anonymous Internet humor

Some worry nonstop about it. Others are in denial. Many simply don't know what to think. Even more joke about it and don't give it the respect it deserves. Swine flu is the Rodney Dangerfield of pandemics.

There is something diminutive about the swine flu "meme" or "brand" which leads otherwise sane people to consider dismissing it, resisting vaccination whenever it becomes available. My colleagues call it a "mild pandemic" -- an ironic oxymoron like "jumbo shrimp." In ten years as a professor of epidemiology, I never saw the word "mild" and "pandemic" in the same paragraph, let alone used in the way the adjective "mild" seems to take the fearsome edge off of the show-stopping noun "pandemic."

We don't even agree on its name. Pork industry lobbyists pressured the mighty U.S. Government to cease calling it "swine flu" so now government agencies call it by the more readily dismissed "Novel H1N1 Influenza." Bird flu is still bird flu. Mad cow is still mad cow. Monkeypox is still monkeypox. I guess the monkey, bird, and cow lobbies weren't as effective as pork, because they are still named after their primary animal hosts, while swine flu has been unceremoniously dismounted off its first ride like a neophyte equestrian. And those in the media who have not caved in to the pork lobby can't decide whether to hyphenate it (swine-flu), capitalize it (Swine Flu), or concatenate it (swineflu).

Medically, swine flu is, like monkeypox, bird flu and mad cow disease, something we call a "zoonosis" -- a disease, like rabies, which has an animal (swine, birds, cows, monkeys, bats, etc.) as its primary host and humans become accidental or secondary victims at least before the virus begins to spread human to human.

And swine flu is a virus, like other influenza diseases, or like measles, mumps, polio or smallpox. Can you imagine a faux love letter like the one above being written about smallpox? Compare Lord Macaulay's classic literary description of smallpox:

The smallpox was always present, filling the churchyards with
corpses, tormenting with constant fears all whom it had stricken,
leaving on those whose lives it spared the hideous traces of its
power, turning the babe into a changeling at which the mother
shuddered, and making the eyes and cheeks of the bighearted
maiden objects of horror to the lover.

-T.B. Macaulay
The History of England from the Accession of James II, Vol IV

Somehow "swine flu" lacks a muse like Macaulay to conjure vivid images of its casualties -- and no Gabriel García Márquez has arisen to write a poignant homage the time of Swine Flu. Why? Probably because this pandemic is less a danger to the health of any specific individual than it is to the public health of the nation and the world; it is less a threat to any one person's individual well-being, and more to society as a whole. It has a low case-fatality rate, but it is the fastest spreading disease and will ultimately infect the greatest number of people in recorded history. So make no mistake, this pandemic has the potential -- although clearly not the certainty -- to wreck havoc on our community, our society, our hospitals, and our economy and even, only a bit farther fetched, our national security. Just think about this: if the "normal, seasonal, yearly" flu kills 35,000 Americans and between a quarter and half million people globally each year, how many may die if the "case-fatality rate" were the same, but the number of people who catch this disease increases by ten fold? Best estimates today: we should expect that 2 to 3 billion worldwide will contract swine flu; and about 100 million Americans will be sick from it, depending on when vaccine is available. These 100 million Americans will be sick for about a week each, losing half-billion days of work or school. And those half billion days won't be much fun at all, not at all.

Let me tell you about my own "dance" with swine flu, and then I will do an epidemiologist's primer on what makes a pandemic "mild," "moderate" or "severe" and third and lastly, let me address the pros and cons of getting yourself and your family vaccinated and what other steps you can take to stay healthy and safe.

Swine Bites Doc

"Epidemiologist gets swine flu" is not as catchy a news headline as "man bites dog" but it is cut from the same ironic cloth. And if the pandemic peaks before sufficient vaccine is available, it won't be news anymore: just based on random probability one third to one half of doctors, epidemiologists, senators, congressmen, Heads of State, football players and Fortune 500 CEOs, cops and robbers, plumbers and celebrities will also get swine flu. And while few will die, some will, and even more will go to the ER, or their doctor, and overwhelm a health care system which is broken and does not have sufficient "surge capacity" to handle a load like this. And this pattern, plus or minus a few months, plus or minus hospital capacity, respirators, and good clinical care, will occur all over the world.

I got sick a couple of days after I had agreed to write this post for Huffington Post, about two weeks ago. I do hope those two events were unrelated, needless to say.

You should not read too much into my own personal experience with the swine; yours will be different. But my swine flu was not a lovable affair, it was not a joke, and it was not "mild." I spent three nights of aches and pains, and chills and fever. My sheets were soaked with sweat and the sound of my teeth chattering kept me awake. I tried a hot bath in the middle of the night and was so weak I could hardly get out of tub unassisted. Although my temperature stayed below 102 degrees F, the teeth-chattering chills felt more like the two cases of malaria I had years ago in Asia than ordinary flu. I self-quarantined at home, drank lots of teas and sugar-free sports drinks to rehydrate, took ibuprofen for aches and fever and treated myself with the anti-viral drug oseltamivir phosphate (Tamiflu) and watched many, er, ah.... therapeutic movies and was still out of work for a week, and weak for days afterward. But while I was never sick enough to consider going to see my doctor or going to an ER, I would not wish this disease on anyone and I certainly would have preferred a vaccination to this teeth-rattling bug. Most poignantly, even though I tried to stay isolated, I infected one of my children who also spent a lousy sweat soaked teeth chattering week dancing with the swine. No loving parent would ever want to spread this disease to his or her kids. If the sole reason to get vaccinated were to prevent my spreading this disease to my family and community, that alone would make getting vaccinated an easy choice for me.

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