Saturday, September 24, 2005

Heading for the Hills

In plagues of yore, the privileged got out of town. Shakespeare is thought to have written his sonnets and other poetry while the London theater was closed due plague in 1592-94. The conceit of Bocaccio's Decameron, as is well known, is that some aristocrats are entertaining each other with stories while escapaing the Black Death in a rural villa. In Poe's Masque of the Red Death, aristocrats are taking refuge in a rural castle to escape a fictional plague -- as it turns out, they can run, but . . .

In the event of a new epidemic, it is certain that people will have the same impulse to flee. As the conversion of the highways around Houston to parking lots demonstrates, that may not be a very pretty picture.

In the event of an epidemic, I presume -- and others more expert may correct me -- that the authorities will want people to stay put, not to travel; to wash their hands frequently; to stay home if they feel any symptoms; and to go to the hospital (not by public transportation) if and only if the symptoms become severe. It is a certainty that people will not obey these instructions.

The precise dynamic of panic will depend on how the mass media present the case. Since they have noticed the threat of a flu pandemic in the past week or two, I would say that they have been reasonably responsible and restrained, but that is unlikely to continue if the real thing comes. Here in the Hub of the Universe, two cases of West Nile virus were enough to cause mass hysteria followed by aerial spraying of high school playing fields. The SARS scare, which was only that and never resulted in an actual epidemic in North America, turned Chinatown figuratively radioactive. There was nearly an epidemic of restaurant bankruptcies. A report of a kitchen worker with Hepatits A became the lead item on the TV news for two days and had people lining up for blocks to be vaccinated against a minor, transient illness -- most of whom had never eaten at the restaurant in question.

A report of bird flu anywhere on the eastern seabord will have Muffy and Thurston packing up the Escalade and heading to the Berkshires before you can say "Every yuppie for himself!" Unless of course Thurston sneezes, in which case they'll head straight for a Major Teaching Hospital of Harvard University. Less privileged people may have more difficulty finding a destination but this isn't the Middle Ages. More people have automobiles today than had mules back then. It wouldn't surprise me if a fair proportion of the population decides their chances will be better in the countryside. Meanwhile the hospitals will be overwhelmed, but not with people who are actually sick. Any attempt to restrict travel or quarantine an area is just going to have people doing everything in their power to get out of the hot zone.

Note that all this happens just because people think the epidemic may have arrived. It doesn't have to actually get here. So how can we manage the flow of public information to tell people what they have a right to know, honestly and ethically, while avoiding panic and counterproductive behavior? The flip side of this problem is getting information to people who are harder to reach -- those who don't speak English well, the socially marginalized, the alienated; and making it possible for people who do need to access health care to get it, even if they don't have transportation, or are afraid of being turned away for lack of health insurance, or are afraid of deportation.

Is my vision of the hypothetical accurate? What are some solutions to these problems? Are responsible people even working on them?

Note: This question has nothing to do with constitutional law.