What has happened to your views of the H1N1 pandemic since it first started?

Have they changed? How?

Have you known anyone who has contracted it?

Whatever your answers, this article is about the “emotional epidemiology” of patients—-how patients feel about the pandemic.

This is from a free full text published in the New England Journal of Medicine online, November 25, 2009.

The physician-author, Danielle Ofri, M.D., Ph.D., describes her patients’ shifting attitudes about H1N1 influenza, her study of her patients’ ”emotional epidemiology.”

Read about one practice’s experience with H1N1.

New England Journal of Medicine

…”Just as there are patterns of infection, there seem to be patterns of emotional reaction (”emotional epidemiology”) associated with new illnesses. When 2009 H1N1 influenza was first detected, it fit a classic pattern that Priscilla Wald recently outlined in her book Contagious¹: It was novel and mysterious; it emerged from a teeming third-world city, and it was now making its insidious — and seemingly unstoppable — way toward the “civilized” world.”

…”When the inoculum of dramatic illness is first introduced into society, the public psyche rapidly becomes infected. Almost like an IgE-mediated histamine release, there is an immediate flooding of fear, even if the illness — like Ebola — is infinitely less likely to cause death than, say, a run-in with the Second Avenue bus. This immediate fear of the unknown was what had all my patients demanding the as-yet-unproduced H1N1 vaccine last spring. ^{(Emphasis added)}

“As the novel disease establishes itself within society, a certain amount of emotional tolerance is created. H1N1 infection waxed and waned over the summer, and my patients grew less anxious. There was, of course, no medical basis for this decreased vigilance. Unusual risk groups and atypical seasonality should, in fact, have raised concern. By late summer, the perceived mysteriousness of H1N1 had receded, and the number of messages on my clinic phone followed suit. ^{(Emphasis added(}

“But emotional epidemiology does not remain static. As autumn rolled around, I sensed a peeved expectation from my patients that this swine flu problem should have been solved already. The fact that it wasn’t “solved,” that the medical profession seemed somehow to be dithering, created an uneasy void. Not knowing whether to succumb to panic or to indifference, patients instead grew suspicious. ^{(Emphasis added)}

“No amount of rational explanation — about the natural variety of influenza strains, about the simple issue of outbreak timing that necessitated a separate H1N1 vaccine — could allay this wariness. ^{” (Emphasis added)}

Citation: (10.1056/NEJMp0911047)