|When a Disease Loses Its Most Potent Ally, Fear|
STORM BEFORE THE CALM A quarantined medical worker wears a protective mask against SARS in Beijing in 2004, and mad cow testing in western France in 2000. Both diseases are now seen as less of a threat.
By DONALD G. McNEIL Jr.
Published: March 26, 2006
THE obituary for mad cow disease was written earlier this month. Maybe you didn't notice.
The disease isn't really dead. But its power to terrify seems to be.
On March 13, the government said that a cow in Alabama was the third in the country to have the disease. The New York Times ran its article on Page 25, and other papers did roughly the same.
There was no clamor of "press cover-up!" But neither had the disease, formally called spongiform encephalopathy, which turns the brain into a grainy lump of Swiss cheese, become any less horrific since the first mad cow in the United States, discovered in December 2003, led to nervous "Is Beef Safe?" headlines across the country.
Instead, it had finally become clear that any threat to people is very, very remote.
Over the last two years, bending to pressure from consumer groups and its own inspector general, the Agriculture Department had finally tested 650,000 animals instead of a token handful. It had also adopted rapid tests and banned "downer" cattle from the food supply so that the most disgusting aspect of the first case would not be repeated: that the old dairy cow that tested positive had been in a truckload of animals so broken by age, disease and injury that some had to be winched out to the slaughter, and that all had been ground into hamburger and sold before the test results were in.
Mad cow isn't the only disease in recent years to soar into high-flying panic and then collapse into the "I wonder whatever happened to ... ?" category.
One could argue that the obituary for resurgent smallpox was written on June 18, 2003, and that SARS died on Feb. 19, 2005.
The first date is the one on which the Centers for Disease Control admitted that the smallpox vaccination drive ordered by the Bush administration in the lead-up to invading Iraq had ground to a halt. The administration had wanted 500,000 health workers to be vaccinated because Saddam Hussein or others might unleash weaponized smallpox. But barely 38,000 volunteered.
The latter date is the one on which a microbiologist from the University of Colorado, after a review of worldwide scientific literature, announced that the virus that causes SARS, a respiratory illness that had killed about 10 percent of 8,000 victims two years earlier, was no longer found in humans. (Later, scientists found that it thrives in bats, ending hope of total eradication.)
Why, in each of these cases, was a public frenzy whipped up, only to fade again? And what does that say about today's mounting frenzy over avian flu? In the past, "we cried wolf too fast, revving up the emotions and there was nothing to show for it," said Judith Walzer Leavitt, professor of medical history at the University of Wisconsin.
An obvious scapegoat is the media, which is often accused of being alarmist about medical news. But a more important factor was simpler: fear waxed or waned according to whether the public thought government was being honest.
In the case of mad cow disease, there were early accusations that the government was playing down the threat to protect the beef industry. The secretary of agriculture when the first case was found, Ann M. Veneman, was a former food industry lobbyist, her critics noted, and her chief spokeswoman's last job had been press representative for the National Cattlemen's Beef Association.
In the case of smallpox, there was suspicion that the government was exaggerating the threat to whip up support for its drive to war. As skeptics then pointed out, smallpox had been eradicated worldwide in 1977, and if Mr. Hussein had a cache, he presumably would have vaccinated his troops against it, which he had not.
In the case of SARS, it was not the American government, but the Chinese one, whose motives were questioned. It was concealing cases and refusing entry to international disease detectives.
"If you want the public's cooperation, honesty and frankness is much better," Professor Leavitt said.
In 1894, she noted, smallpox sparked a month of rioting in Milwaukee. The cause wasn't the disease itself, but the city's policy of seizing sick children in immigrant Polish and German neighborhoods and taking them to isolation hospitals, while leaving wealthy families alone, saying their larger houses and abundant servants would isolate them. With rioters flinging hot water and pepper in the eyes of the police and their horses, a vaccination drive collapsed and the epidemic spread.
Now the public is nervous about another potential pandemic.
Virologists disagree about whether the A(H5N1) virus that is killing chickens by the millions has the genetic power to do the same to humans, as the flus of 1918, 1957 and 1968 did. It could be a plague of medieval proportions — or it could fade as the swine flu threat of 1976 did.
Right now, the situation is reminiscent of SARS. Like that disease, avian flu originated in China, and some crucial questions have never been answered — like how much Chinese poultry vaccines were to blame for the disease festering in birds for nine years, and whether the virus infected thousands of Chinese who never got sick.
But no one is speculating about an American government cover-up. Its most respected health officials, like Dr. Anthony Fauci and Dr. Julie Gerberding, have admitted that the country is utterly vulnerable.
Nor is any powerful industry, like drugmakers or poultry raisers, accused of having a thumb on the scale of public policy, as the beef industry was during mad cow.
Predicting what a virus will do is impossible. But humans are predictable. John M. Barry, author of "The Great Influenza," a history of the 1918 pandemic argued that even if A(H5N1) becomes a killer, the panic it creates will fade faster than might be expected now, when a sense of mystery still enshrouds a threat that normally would sound silly — a "killer bird flu."
"What people are afraid of is the unknown," he said. "Not eating meat because you're worried about mad cow is like not going in the water because you saw 'Jaws.' But once the threat arrives, even if there's an undercurrent of terror in the whole society, people see the consequences and they get accustomed to it, just as they got accustomed to plague in the Middle Ages."