Influenza A: A Medical and Political Battle

Influenza A: A Medical and Political Battle
United Daily News editorial (Taipei, Taiwan, ROC)
A Translation
August 27, 2009

Coverage of the Influenza A virus subtype H1N1 has replaced coverage of the 8/8 Flood. Kuo Hsu-sung, current Director of the Center for Disease Control, estimates that when the epidemic peaks, 7 million people on Taiwan will be infected. Former CDC chief Su Ih-jen estimates that 5,000 to 10,000 people will die. Such information stretches peoples' nerves to the limit, and makes their skin crawl.
At this point the government's responsibility is twofold: First, preventing and treating disease. Second, easing public anxiety. Looking only at the social crisis, the government's primary responsibility is undoubtedly easing public anxiety. Increasing public trust in the government's ability to prevent and treat the disease is essential to easing public anxiety.

From this perspective, convening a National Security Council conference on Influenza A prevention and control, and invoking the National Security Act is not merely an administrative issue. It is also an issue of social psychology. Some say that invoking the National Security Act would increase public anxiety. But others believe the opposite, that failure to convene a National Security Council meeting would increase public anxiety. As we can see, regardless of the pros and cons of invoking the National Security Act, the issue has an impact of social psychology. The presidential office and the cabinet believe "the epidemic has not reached that level." They are in no hurry to invoke the National Security Act. But experts point out that the new school term begins on Monday. By then the epidemic may be at its peak. The number of infected could double every four days. In which case the epidemic could reach "that level" in a matter of days.

We warn the Ma administration: Do not waffle over whether to declare a state of emergency. Public anxiety over epidemics is probably even more intense than public anxiety over earthquakes and floods. An earthquake is over in seconds. The damage caused by floods is visible to the naked eye. But viruses are invisible and odorless. Anyone could be infected. Once it spreads, there is no distinction between victims and non-victims. There is no distinction between disaster areas and non-disaster areas. Everyone feels insecure. Everyone feels troubled. Under such circumstances, would the advance convening of a National Security Council meeting increase public anxiety? Or would the tardy convening of a National Security Council meeting increase public anxiety? The authorities should have no trouble making that call.

From a public communications perspective, an influenza epidemic would test the Ma administration's public communication skills. The goal of the government's public communications campaign must be to ease public anxiety over the epidemic and increase public trust in the government.

The epidemic is spreading, but information remains confused. Will the year-end elections be postponed? Which strategy is better? An "accelerated spread" or an "obstructed and prolonged spread?" Schools are measuring students' ear temperatures. But how about offices, factories, and military bases? When will vaccines be made available? How safe are they? Can patients with liver and kidney ailments be vaccinated? Can they take Tamiflu? When is the right time to administer Tamiflu? What is the right dosage? Do we risk creating drug-resistant strains? How can we raise patient awareness? How should the medical treatment pipeline be configured? Is the supply of ICUs adequate? Should hospitals recommend the wearing of masks, or demand the wearing of masks? Should those who come in contact with high society, such as chauffeurs and store clerks wear surgical masks? These are matters of detail. But they are also matters of public concern. The authorities must show concern. They must communicate to the public in terms they can understand, and do so as soon as possible, They must make information available through a variety of channels. They must ensure that the relevant information is effectively communicated to the public. Experts predict that the epidemic could last as short as six months, or as long as three years. During its public communications campaign, the government must take full advantage of the hardware, software, and content creation capabilities at its disposal. It must not make light of the matter. Only by establishing an information network embodying both quality and quantity, can it ease public anxiety. Only then can health institutions remain focused on disease prevention and treatment. Conversely, if information is confused, if the situation is chaotic, the public will become anxious, and controversy will escalate. The public is already facing the threat of an epidemic. The government must not increase public suffering by increasing fear and confusion.

The prevention and treatment of epidemics is a public health issue. It is a political test as well. The government's responsibility is not limited to fulfilling the needs of health professionals. It must also maintain social stability. Among its most basic responsibilities is to establish a transparent and effective system for the timely dissemination of information.

The government must demonstrate both political and administrative effectiveness. It must help public health professionals. It must not increase public anxiety. It must not add fuel to the fire by making bad decisions. It must not pour salt in the wound by being poor communicators.

對抗新流感：是專業戰爭也是政治戰役
【聯合報╱社論】
2009.08.27 04:00 am

新流感的新聞取代了水災新聞的篇幅。現任疾管局長郭旭崧估計，在流行高峰期，台灣將有七百萬人感染；前疾管局長蘇益仁則估計，死亡人數將達五千至一萬人之間。這類訊息皆令國人神經緊繃，頭皮發麻。

值此關頭，政府的責任有二：一、防疫治病；二、平撫社會心理的緊張焦慮。唯若從處理社會危機的角度來看，則「平撫社會心理的緊張焦慮」無疑尤是政府的主要職責；因為，增強國人對政府「防疫治病」能力的信任，本身亦是安定社會心理的重要手段。

從這個角度來看，現在是否要為防治新流感召開國安會議，及啟動國安機制；就不只是一個行政手段，而也是一個社會心理事件。有人說，現在發動國安機制，會製造社會緊張；但也有人認為，現在不舉行國安會議，反而會令社會焦慮。可見，不論正反意見，皆知「發動國安機制」其實也是一個心理標誌。何況，據稱府閣方面認為「疫情還沒升高到那個程度」，所以不必急著啟動國安機制；不過，所有的專家都指出，下周一學校開學，即可能進入感染流行高峰期，且每四天感染者即增加一倍，然則所謂的「那個程度」，豈非僅在數日之遙而已？

我們要嚴正警告馬政府：不要再陷於「發不發布緊急命令」那類困境之中。疾疫造成的社會心理緊張恐怕尚逾於震災水災，震災幾秒鐘就過去，水災造成的損害也可目睹；但病毒看不見、聞不到，任何人皆有被感染的可能，流行起來即無「災民／非災民」的區別，亦無「災區／非災區」的區隔。人人自危，家家煩慮。在這種情勢下，是及早召開國安會議會製造社會緊張？或推遲召開國安會議反而增加社會焦慮？當局難道不能作出明智的裁斷。

從「傳播溝通」的角度來看，面對可能即將爆發大流行的新流感，又是一次對馬政府「傳播溝通」能力的嚴峻考驗。政府在這場傳播溝通大戰的目標，就是要提高人民對政府的信任，及安定社會心理。

疫情升高，資訊卻相對紊亂。年底選舉要不要延期？「加速」流行或「阻滯延長」流行，何種策略為佳？學校實行量耳溫，但辦公處所及工廠及軍隊要不要量？國光疫苗能否即時推出？安全性如何？對於肝腎等各類慢性病患，能否接種疫苗？可否服用克流感？克流感的適當投藥時機究竟如何？抗藥性的風險對策何在？患者染病的自覺如何提高？就醫的管道與動線如何？加護病房的縱深備量夠不夠？醫院是「建議」戴口罩或「規定」戴？高社群接觸者如司機、店員要不要戴？這類問題雖皆細瑣，卻是民間的重大疑慮；當局應當以最高的關切來面對此一情勢，用民間看（聽）得懂、看得到，且能及早看到、及時看到，並在不同傳播管道上都能看到的方法，將相關資訊有效地傳達給國人。專家估計這場疫病流行，短則半年，長則二、三年；政府在這場溝通大戰中，於硬體、軟體，及內容製作上的投入皆不可輕估；亦唯有把資訊網絡的品質與數量皆建立起來，始有可能平撫及安定緊張、焦慮的民心，醫衛機構也才能專心投入防疫治疾。反之，倘若資訊錯亂、情勢渾沌、民心焦慮、輿論譁然；社會大眾除了面臨疾疫的威脅，還要生活在疑惑恐懼之中，那就不啻是水深火熱了。

防治疾疫是一個醫衛專業問題，但也是一個政治考驗。政府的責任非但在必須充分支應醫衛專業的需求，更應盡可能地維持一個相對安定的社會心理情境；其重要的基礎職責就是要架構一個透明、有效、及時的溝通傳播體系。

政府的政治及行政效能，必須要成為醫衛專業的助力；反之，倘若政府在疫疾流行期中，因溝通不良、決策失當而使人民加重痛苦，那就是火上澆油、雪上加霜了。