Saturday, July 25, 2009

The Flu Virus: We Have No Idea

I have the factory farm flu, commonly known as H1N1 swine flu. Most likely I was exposed to the virus at a festival, July 5. By the end of that week I was unaccountably tired, and for most of the next week I had the unmistakable symptoms of flu. To reduce the risk of spreading the virus, I kept myself at home for eight days in a row. My symptoms are starting to fade now, just as you would hope.

But I won’t be showing up in the flu statistics. They only count cases in which an actual virus test has been done. Technically, I am only guessing that I have the flu. But the guess is almost certainly correct. There is a story that goes with flu symptoms, and my case matches it. It is also safe to say that the flu I am experiencing is the factory farm flu, because that is what the vast majority of flu cases are this summer in North America. And most cases are even milder than mine, especially in people who are more than 27 years old. According to estimates, more than one million people in the United States have already had the factory farm flu, with most not even noticing that they had it. That is typical for summertime flu.

Fall, winter, and spring are another matter. There is no telling how much damage factory farm flu might do in those seasons, according to the World Health Organization (WHO), which keeps track of such things. It might be useful if we could keep track of the cases, but the United States is not doing that very effectively. We are testing and recording only about 1 case out of 50.

A funny thing has happened on the flu tracker map. The United Kingdom has jumped ahead of the United States in reported factory farm flu cases, 63,179 compared to 46,157. Has the United Kingdom suddenly become the epicenter of the pandemic? Hardly. Nothing suggests that the United Kingdom has had one million cases, or anything close to that. Perhaps it has had about 150,000 cases, but it has managed to report nearly half of them.

How can the United Kingdom be doing so much better than the United States at this? It’s easy to see if you look at my case. My symptoms weren’t serious enough to get me out to see a doctor, but if I had wanted to see a doctor, it is far from certain that I could have gotten in to see one while I still had the illness — it might have taken the doctor’s office two or three weeks to schedule me. That’s a striking contrast to the United Kingdom, where telephone hotlines can direct people to flu treatment offices that provide basic flu treatment to thousands of people. If I had seen a doctor, it is highly unlikely that the doctor would have recommended any tests at all. My story already indicates a flu diagnosis. The test would be somewhat useful, but there is no particular reason for me to pay for a test to confirm a diagnosis that would have me applying the treatment that I am applying anyway.

The test would have little value to me, but would have significant value for the Centers for Disease Control as they attempt to track the spread of the H1N1 virus. The obvious question, then, is why our system assumes that I would want to pay for a test that is mainly for the good of the public. Shouldn’t the government be somewhat eager to pay for these tests so it can have better data to look at?

It is really a political problem. The fear of “socialized medicine” prevents the government from getting deeply involved in tests on flu patients. You can see that this is the issue when you see how much the government’s approach changes when people die. Health officials routinely bear the entire cost of flu virus tests when anyone dies with flu-like symptoms. There is no fear of “socialized medicine” in that situation, because there is no possibility of medical treatment — the patient has already died. But how does it really make sense to wait until people die before we are willing to test them for flu? We would learn about the spread of the H1N1 virus much more quickly if we collected more data, which we could do at rather modest expense to the government. At the same time, more people would recover sooner and fewer would be exposed to the illness. The way it is now, we have no idea where the virus is headed next. We aren’t out there looking for it, so we don’t give ourselves a chance to do anything to contain it.

Economically, it would make good sense for the United States to go to the other extreme and adopt some kind of single-payer health care system when it comes to infectious diseases. These costs are a tiny fraction of all health care treatment costs, and they are a natural extension of existing efforts to track these diseases, a task made more difficult by the scarcity of hard data.

There is no reason to hope that something like this could be included in this year’s health care reform, but eventually, it will have to come to this. The current you’re-on-your-own approach to health care, in which the government is little more than a disinterested observer when people fall ill, encourages epidemics. It ensures that when there is anything contagious, the maximum number of people get sick. The cost of treating the illness and the lost productivity from it are also maximized. A more active approach would stand a better chance of limiting the spread of a disease, thus reducing all the costs associated with the disease.

No one can say that flu, or any other disease that spreads readily from person to person, is someone else’s problem. If other people have the flu, it creates the risk that you will catch it too. But the U.S. health care system treats it this way — and that approach, ultimately, doesn’t make sense.