Unintended Consequences of Swine Flu Panic

 by Mario Rizzo  

Recently the Obama Administration declared the H1N1 pandemic a “state of emergency.” While there is a largely technical meaning to this, some people have understandably gotten nervous. All this adds to the extraordinary public concern about a flu that, so far, as proven milder than the seasonal flu – albeit with a different profile of people getting ill.  

The problem is and is going to be the stress on emergency room facilities with people who are alarmed but not really in need of ER services. There will be a cost to the swine flu precautionary activities. By increasing the waiting time and confusion in ERs some people with life-threatening problems will die who otherwise would not have.  

While I am not aware of any systematic analyses of this problem, the following data is cause for concern.   

“For someone in a life-threatening situation, the recommended wait time before receiving medical attention in an ER is less than one minute; in 2006, 1 in 1.35 (74%) of those patients waited longer, sometimes far longer. The average wait was 28 minutes. At the next level of urgency, patients needing emergent care, the recommended time is 1 to 14 minutes, and 1 in 1.98(51%) waited longer. The average wait for these patients was 37 minutes, up from 23 minutes just three years before.

The consequences of this slowdown can be deadly. A 2009 study showed that patients arriving at the ER with chest pain are significantly more likely to suffer cardiac arrests and heart attacks when the emergency room is crowded. And the prospect of flu victims flocking to already stretched ERs this flu season has many physicians and public health officials across the country concerned. ‘Our emergency healthcare system suffers from severe crowding on a daily basis,’ says Dr. Kristi Koenig, director of public health preparedness for UC Irvine Healthcare. Handling an additional onslaught of flu victims would be ‘very challenging.’”

Compare this with the very small swine-flu mortality rate in the US of 0.75%. (This is the best estimate I have been able to find.) It is true that this is the overall rate and one might expect that those cases which go to the ER would be worse than the average. However, the greater the public panic the more the ER rate will approach the average rate. And, just as important, not all the ER cases will be swine flu – some will be simple colds.

The data we really want is a comparison between the mortality rate of those in the ER with swine flu (or imagined swine flu) and the increase in mortality (from say cardiac problems) due to greater waiting time induced by the ER overload. As far as I know (inform me if I am wrong!), we do not have this data.

Nevertheless, there is a significant likelihood, it seems to me,  that the swine flu panic induced by the government will cost more lives on balance than are saved. It will be very informative to come up with some answers once the data is in.

(Of course, I understand the difference between ex ante and ex post and that there was (is?) a risk that the H1N1 pandemic could have been more lethal. Yet what was the evidence that this was likely? More importantly, who is looking at the bigger picture given the obvious constraints on medical services?  To what extent is the government more worried about the costs easily seen rather than those that are unseen?)

7 thoughts on “Unintended Consequences of Swine Flu Panic

  1. Of course I agree with all the Public Choice explanations for why the government is raising the alarm on this. However, just to throw out a theoretical justification: I was on a plane next to a woman who was something like the disaster coordinator for a major CA hospital system. She wasn’t a complete tool or anything; before I even brought it up, she complained about the stupid regulations the government was making them do regarding swine flu. (E.g. they had to spend a lot of money getting masks for the ER workers every time they dealt with a new swine flu case. I don’t remember the specifics, but she was saying that not only was it expensive, but in practice it wouldn’t even accomplish the ostensible objective.)

    Anyway, she said the reason actual health officials (i.e. not dumb politicians) are so concerned, and why they want everyone to get vaccinated even though H1N1 isn’t all that lethal, is that the more people who catch it, the greater the likelihood that it will mutate into something worse.

    Please don’t ask me, “Why isn’t that true for seasonal flu?” because I don’t know. I’m just reporting what she told me, when I was gently pressing her on why everyone is freaking out when so few people had actually died by that point.

  2. When writing the post I was trying to figure out a way of distinguishing between simply inducing people to get the vaccine and scaring them so that they clog up emergency rooms. Perhaps there is no way to do the former without doing the latter — in which case the possible problem I mention here must be considered one of the costs.

    Another possibility is for the ERs to triage the cases in such a way that suspected swine flu gets a low priority. (But then the politicians would have to refrain from screaming when someone dies of swine flu.) Perhaps the triage nurses are doing this now.

    I await the studies.

  3. Panicing the public is now the approved method for the government to line the public up behind a policy. We saw it at its most extreme when Paulson and Bernanke tried to panic Congress and the public in order to get Tarp approved. John Taylor argues that it was that performance, and not Lehman’s failure, that generated the credit crisis last year. Now Obama is doing it with swine flu. The question is to what end?

  4. There is even a theory behind this. Behavioral economists say people are naturally subject to optimism bias (“It won’t happen to me”).

    So to offset this bias we must introduce another bias — availability bias. This is the bias that causes us to exaggerate the probability of danger as when a plane crashes with much publicity.

    If the government-media scare people about swine flu (or the dangers of cigarette smoking) with vivid stories of people dying then perhaps the biases will offset each other. Voila rationality!

  5. “When writing the post I was trying to figure out a way of distinguishing between simply inducing people to get the vaccine and scaring them so that they clog up emergency rooms.”

    I have read about waiting lines of several thousands of people to get less than one thousand available flu shots. In many cases those in line were healthy middle age adults not in a high risk group. And in some case those high risk groups such as pregnant women were unable to get a flu shot because they were in the back of the line.

    The flu shots given out were of course free.
    If they had charged $20 per shot many of the healthy low risk adults would have dropped out of line and the high risk adult probably would have felt that the benefit of a shot would have exceeded the $20 cost. If the only very high risk groups received the limited supply of vacinations through a pricing mechanism then those needing emergency room treatment might be reduced.

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