The "Panic" factor: How Best Handled?

[4-ABBA]

I would like to start this thread regarding the best way for local / regional / national governments to approach the aspect of "public panic."

If a pandemic is coming, it appears "panic" on the part of the public at large is unavoidable: Either panicking as it is approaching, and/or panic as it is unfolding.

In other words, an "either/or" choice may be unavoidable.

In attempting to minimize the public's panic before the plague hits, there is "management" of the news cycle on a very large scale by various government and healthcare agencies. The rationale is, the worse the news is, the more the public may panic...so to minimize it, medical facts are "scrubbed" to make it less threatening to the public.

However, this effort may very well add in an exponential manner to the public panic after avian flu is upon us: The less prepared we are as a population, the more the population will have to fear as the pandemic comes upon us.

Comments?

[sharon sanders]

Re: The "Panic" factor: How Best Handled?

Excellent topic.

[Thornton]

Re: The "Panic" factor: How Best Handled?

The Yerkes-Dodson curve is a basic graphic in psychology to show the relationship between anxiety and performance. http://www.merck.com/mmhe/print/sec07/ch100/ch100a.html





Misguided efforts to minimize anxiety also minimize preparedness and increase the probability of panic and disorganized behavior. Paradoxically, excessive efforts to create anxiety in the absence of perceived danger leads to habituation and less anxiety response to realistic dangers.

We observe some conflicting efforts among responsible officials on how to instruct the population to prepare for what circumstance (as evidenced by the State Department advisory to US citizens in Hong Kong.). I am encouraged by ambivalence because it is so far advanced relative to denial. At least now we have some type of foothold to gain a conversation on the topic of pandemic.

The November issues of the Journal of Infectious Disease is dedicated to the
Topic of SEASONAL AND PANDEMIC INFLUENZA: AT THE CROSSROADS, A GLOBAL OPPORTUNITY(http://www.journals.uchicago.edu/JID...093179245Guest) The information here makes it easy to educate ourselves and our friends about seasonal influenza. Once we understand the importance of preventing seasonal influenza it becomes more apparent what skills are necessary to deal with the pandemic. Once your group starts watching how rapidly flu spreads through school districts as in Yancey County then you have audiences that are prepared to listen.

All of the above I write in my professional voice.

I offer my opinion on why most government officials have such a hard time including the public in on information and even less on decision making. I believe it is a matter of control. The more people read and think about the published plans the more they are going to question, disagree or outright challenge the officials. Somehow we need to find a way to convince officials at all levels it is better to go through that scrutiny now rather than in the midst of crisis. I have not found the formula for that goal yet.

There are threads on flutrackers.com that address risk communications (excellent resources from Lanard and Sandman). There are also threads to address more specifically the psychological aspects. I still favor trying here and now scenarios such as response to Phase 4 as a way to engage folks. http://www.flutrackers.com/forum/showthread.php?t=9837 post #7.

Joe Thornton, M.D.

[AlaskaDenise]

Re: The "Panic" factor: How Best Handled?

Somehow we need to find a way to convince officials at all levels it is better to go through that scrutiny now rather than in the midst of crisis.

As long as they're only looking at CFRs equal to or less than 1918, which popular opinion believes can be mitigated by "modern medicine", they may consider it "manageable." When there is some convincing evidence of a higher-than-1918 CFR, then they will realize this will not be effectively managed with plans that involve any sort of "business-as-usual."

How can you minimize panic? Restricting movement may be a start.

.

[Laidback Al]

Re: The "Panic" factor: How Best Handled?

Thanks, Thorton.

It is a delicate balance--

excessive efforts to create anxiety in the absence of perceived danger leads to habituation and less anxiety response to realistic dangers.

What do you think the likelihood is that "panic" will set in among the decision makers (i.e. TPTB, government officials, boards of directors, corporate officers, etc.)? Perhaps, the first line of defense against widespread panic is the education of the decision makers that things could be a lot worse than 1918 scenario as AlaskaDenise points out.

It would be important to keep the ratio of anxiety to performance at the "optimal level" for the people that will be the actual decision makers once a pandemic starts.

[Snowy Owl]

Re: The "Panic" factor: How Best Handled?

Thank you 4 Abba for this thread, and I hope Mods will agree that it has to not be close, tjat is indeed the subject of this thread.

As some of you know I now have been 4 years pro-active on raising awareness, prompting preparedness, colligeate informations on how to cope, etc...

Four years ago my aim was to raise awareness and slowly but surely it slept towards developping independence towards energy, food and medicine. If I would have been conscious of the easiness of talking about developping independance towards the system, the economical savings of such a behavior, the lack of resistance, etc,, I would have hold such a language 4 years ago.

Being inform, rising our independance day by day, fells good, granths a sense of security and avoid the level of anxiety that Joe Thornton showed has having a paralysing effect.

Simply said it works.

[AlaskaDenise]

Re: The "Panic" factor: How Best Handled?

There may be some minimum preparedness level that would cause the average person to feel reasonably able to cope. If a large enough segment of the population were in that category, that may minimize panic.

I thought about as I've gone through COSTCO - they have 5-gallon buckets filled with XXX servings of food for $109.99....peace of mind, but it may also reduce panic.

Legitimate panic might come from: lack of baby formula, lack of life-sustaining meds, etc. ... many of which could be handled with a promised emergency delivery system.

.

[4-ABBA]

Re: The "Panic" factor: How Best Handled?

At the seminar I went to here in Seattle last weekend, co-sponsored by the CDC, they were "bipolar" in their presentation. They were eliciting participants feedback on how best to deal with sheltering in place for an extended time, and even the power grid being down. But they said absolutely nothing about laying in food / water supplies.

It was most interesting.

As long as they're only looking at CFRs equal to or less than 1918, which popular opinion believes can be mitigated by "modern medicine", they may consider it "manageable." .

[AlaskaDenise]

Re: The "Panic" factor: How Best Handled?

Was that presentation targeted to those responsible for maintaining the infrastructure? Maybe they're not familiar with the JIT system in food distribution.

If they're associated with the folks who handled the food distribution system for Mt. St. Helens eruption - I can personally vouch that they did a good job. But here there will be no "outside help". They may have confidence that WA produces enough food, that they could provide something for people to eat. Those apple warehouses are pretty big and have you counted the feed lots in E. WA lately? Then there are the very large silos filled with grain products.

.

[4-ABBA]

Re: The "Panic" factor: How Best Handled?

I used to live in Los Angeles. For residents in big cities, I would add a few elements to the legitimate panic list:

No running water, power; no foodstuffs on store shelves; no gasolene; no internet / phone; no CNN....

And I don't mean to be morbid--but one problem I keep hitting the wall over: DEAD BODIES. What in the world can be done--in large metro areas, if there is no transporation system--and there is nowhere to put corpses?

Perhaps this is one of the subconscious reasons that "authorities" have a difficult time bringing themselves to come "out of the closet": Eventually, one has to inform the public about dealing with the bodies....and all the vomiting....diarrhea....horrible suffering....etc.

Our culture has a loooong history of removing the sick / elderly / deceased from our midst. We cannot stand to even look at it.

Youth and vitality and beauty are virtually worshipped. Avian flu...will rip this facade to shreds. We cant deal with it.

Legitimate panic might come from: lack of baby formula, lack of life-sustaining meds, etc. ... many of which could be handled with a promised emergency delivery system.

.

[Snowy Owl]

Re: The "Panic" factor: How Best Handled?

I used to live in Los Angeles. For residents in big cities, I would add a few elements to the legitimate panic list:

No running water, power; no foodstuffs on store shelves; no gasolene; no internet / phone; no CNN....

And I don't mean to be morbid--but one problem I keep hitting the wall over: DEAD BODIES. What in the world can be done--in large metro areas, if there is no transporation system--and there is nowhere to put corpses?

Perhaps this is one of the subconscious reasons that "authorities" have a difficult time bringing themselves to come "out of the closet": Eventually, one has to inform the public about dealing with the bodies....and all the vomiting....diarrhea....horrible suffering....etc.

Our culture has a loooong history of removing the sick / elderly / deceased from our midst. We cannot stand to even look at it.

Youth and vitality and beauty are virtually worshipped. Avian flu...will rip this facade to shreds.

3 years ago the problems of dead corpses has been adress and some pragmatic solutions have been identified but form ost of it not made public. It will be at the proper time it has been decided.

We cant deal with it.

This is a dead end thinking. We cannot deal and cope with this majistral event with such statements or toughts.

We have region with resources and capacity, we have a new inerventions forces called Northcomm that is highly efficient. No it will not be the cavalery of all big cities, but it will indeed be appreciated.

The region will not be able to cope with all "extra-muros' needs, but it will help.

Please avoid stating that there is no way to cope with this. There are now about a couple of tens of thousands of people dealing with this.

Four uears ago we ahere probably under 3 000.

So yes there is concrete hope, yes people will have to preps, to learn, to cope and to help.

It is not because the Future will not be a Rose Garden that it means it will only be a vast cemetery.

No that I can assure you from knowledge of Human History, from Ancestral Wisdom, from Popular Wisdom, from Modern Wisdom and Knowledge Wisdom.

And do not forget, Grace, Luck, Hazard or Coincidence, whatever you call it.

There is hope and as a specy more than expect will survive, as usual.

Snowy Owl

[gsgs]

Re: The "Panic" factor: How Best Handled?

seems to me, that the politicians want us to prepare but
without asking why. And often, since they know, we would ask why,
they prefer not to tell us at all.
Once you take this serious you would be doing all sorts of things,
which just aren't good for the economy.
And I don't even mean, those who are directly "panicing".
Just thinking about it -like we do here- diverts attention from
increasing the GDP, which they want us to do in the first place.

[4-ABBA]

Re: The "Panic" factor: How Best Handled?

Please avoid stating that there is no way to cope with this. There are now about a couple of tens of thousands of people dealing with this.Four uears ago we ahere probably under 3 000. Snowy Owl

Snowy--is this in large cities that you are talking about?

Also, I think you took my meaning wroing when I said "people cant deal with it." I was saying that we are not used to it, we avoid it, we have not wanted to deal with things like this. Up to this point in time--we do not and can not deal with it.

[AlaskaDenise]

Re: The "Panic" factor: How Best Handled?

4-ABBA:

With a little prepping and assistance, most of those items can be dealth with - no running water doesn't mean there won't be water to drink, people can live without power (candles, camp stove, etc.), no food on store shelves is why people should stock at least 2 weeks of food, no gasoline - their legs should work fine, & people did live without the internet and phone not very long ago.

Not having everything they want doesn't mean they can't live, it means they'll adjust - really fast.

What we need most is available for the taking - a sense of community, caring, and most of all - hope.

Nobody is saying solutions will work 100% everywhere, but that not to say nothing will work anywhere.

.

[Thornton]

Re: The "Panic" factor: How Best Handled?

What do you think the likelihood is that "panic" will set in among the decision makers (i.e. TPTB, government officials, boards of directors, corporate officers, etc.)?

Most of us have confronted the challenge of prepping our household when 3 or more other people in the home don?t understand why. Imagine yourself as a Emergency Manager for a small county of 500,000 people. You have no budget, few if any local allies, minimal to no support from the State, and you are 2 years away from retirement. I interpret some of the behaviors among officials as a form of ?all or nothing? thinking typical of crisis or stress. If we focus only on the worst case scenario and apply current plans and resources then the prospects can appear so overwhelming to lead to inaction. The way we encourage movement for preparation is by looking at tasks that are doable, useful in themselves now and lead to better preparedness for worse situations. We can apply the term Dual Use to supplies and training.

Efforts now to prevent seasonal influenza can provide great impetus to preparing a community for pandemic flu. I am very impressed with the program in our area where the health department is providing FluMist to the entire elementary and middle school population free of charge to the individuals. It provides a direct service, educates on influenza, draws in community volunteers and exposes glitches in a non-threatening environment. For communities that have not planned ahead to acquire vaccine, it is still feasible to conduct a campaign to educate on hygiene, surveillance for flu in the community and social distancing once seasonal influenza is in the area.

I am also encouraged that I see more employers and local governments accepting the engagement of pandemic planning as a natural responsibility to their organization?s survival and not simply some exercise to satisfy externally imposed standards. The more our community participates in season flu and pandemic thinking the more we can free the key officials from all or nothing thinking.

Although written to address the impact of bioterrorism I quote from a key article that applies to pandemic preparations ?

Bioterrorism and the People: How to Vaccinate a City against Panic
Thomas A. Glass1 and Monica Schoch-Spana2
Clinical Infectious Diseases 2002;34:217-223

http://www.journals.uchicago.edu/CID/journal/issues/v34n2/011333/011333.html?erFrom=-4443838660566795816Guest

Ultimately, actions taken by nonprofessional individuals and groups could have the greatest influence on the outcome of a bioterrorism event. Five guidelines for integrating the public into bioterrorism response planning are proposed: (1) treat the public as a capable ally in the response to an epidemic, (2) enlist civic organizations in practical public health activities, (3) anticipate the need for home-based patient care and infection control, (4) invest in public outreach and communication strategies, and (5) ensure that planning reflects the values and priorities of affected populations.

Joe Thornton MD