Public health and "unintended consequences?"

Social distancing. Community resiliency.

These are two phrases that are used a lot by experts who analyze the potential impacts of a pandemic - an unfamiliar disease that is causing serious illness around the world.

A commentary in the February 6 issue of JAMA, the Journal of the American Medical Association, brings the conflicts to the surface again (JAMA, vol. 299, no. 5, pp 566-568, subscription required).

The state epidemiologist from Florida writes of the American respect for diversity, based on shared goals and aspirations. But, he says, recommendations for "social distancing" are "based on limited current scientific evidence and could have serious adverse unintended consequences for the social fabric of society..."

Dr. John Middaugh is concerned. This public health leader believes that public health is changing its longstanding, science-based recommendations for flu that focus on protecting the most vulnerable people with either vaccinations or antiviral medications.

The new messages from public health, he says, tell us that we each have the power and responsibility to prevent exposure to a pandemic flu virus and it will be up to us to take action to reduce the effects of a pandemic on everyone.

Hmmm, I can see what Dr. Middaugh is saying.

When the U.S. secretary of Health and Human Services visited Colorado, his main point seemed to be, "Don't count on us [the feds] for help."

Is that what all of public health is saying now?

That would really be a shame. It kind of takes the "public" out of "public health," doesn't it?

What do you think?

• If we encourage social distancing, do we risk weakening our commitment to community? Does social distancing = social disorder during a crisis?

• Will social distancing mean that we abandon those who would not survive a pandemic without the support of others -- the ill, the young, the old, the disabled?

Here's another take on the JAMA commentary:

http://scienceblogs.com/effectmeasure/2008/02/toughening_a_community_for_a_p.php

Oh, and P.S.
Dr. Middaugh also talks about fear-mongering around seasonal flu and flu vaccination campaigns. Is he right that flu shot campaigns are really our government's approach to increasing the demand for vaccine so vaccine manufacturers will expand production? And, he says, "The campaign to increase use of influenza vaccination for seasonal influenza adds to the fear of this disease and fuels separation and isolation." Yikes. What does this mean for public health?