Communicating the Swine influenza A (H1N1) crisis

Informed or misinformed?

With the emergence of Swine influenza A (H1N1), a phenomenal amount of news is available via the internet. There are numerous webpages, blogs (and their rss feeds), facebook walls, notes and pages and these days, tweets as well.

The chatter is welcome instead of silence, but with any communication medium, the undiscerning reader runs the chance of being misinformed almost as easily. This ability of people to be misinformed and pass on incorrect news was discussed last week regarding Twitter. Agencies are doing their best to fight back. e.g. CDC Emergency's latest tweet when I was writing this said, "CDC reminds you that you can NOT get swine flu from eating pork...." and follows with a link to their FAQ.

The chance of being misinformed increases when a reader engages in multi-tasking activities or lays claim to "reading" hundreds of sources - in a crisis I am reluctant to rely on rss-skimming friends for specific facts, but rather, use their pointers as potential sources of information pending investigation before further forwards. And beware that one time you relax your guard - it will be the occasion in which you contribute to the problem of misinformation!


Be a source of reliable information

Avid web-readers can be a resource to friends and family in such trying times by being a source of reliable and updated information. In addition to television news from international and local news sites, I find reading just a few reliable sources on the net thoroughly and reviewing the information for specific lessons helpful - I find it useful in responding with practical applications including communication and myth-busting in daily conversation!

During the SARS outbreak in 2003, I found the face to face conversations with like-minded friends (they happen to helpfully also be biology grads) to be extremely helpful. These conversations were supplemented by email discussions, and all of it helped me in decision making and preparations for a large meeting of about 300 people at the university (Biodiversity of Singapore Symposium). This pattern was employed during the 2004 Indian Ocean Tsunami - the information completely transformed my approach about how to help.

The need to communicate

Will large, global agencies tell it like it is? I was quite surprised by the aggressive updates of the the World Health Organisation (WHO) during the SARS outbreak - I felt information was served up as soon as it was acquired, and this was later expressed as a critical strategy in the WHO Outbreak Communcation Guidelines [pdf], which advocate "Trust, Early warning, Transparency, An understanding of the public, suggesting mitigation measures and an aggressive Communications plan."

For the H1N1, I find these same (as in SARS) international and local sources useful:

• WHO Disease Outbreak News


• Center for Disease Control and Prevention: Swine Influenza (Flu): cdc.gov/swineflu/


• CDC has a twitter account, @CDCemergency! Hat tip - Kevin


• Ministry of Health, Singapore: Update on Global Human Swine Influenza - helpfully this URL: moh.gov.sg, brings you right there.

New sites I refer to include:

• Channel News Asia special on the Swine Flu Outbreak - note the useful, simple URL: channelnewsasia.com/swineflu/


• CNN Health: Swine Flu


• BBC: Swine Flu Special Report
• News aggregators (search term = "swine flu"): Google and Yahoo

Besides the very helpful graphics and background pieces, archive stories and supplemental news on social, economic and other aspects, the mainstream media is important for its opinion pieces, especially by experienced medical journalists. And alternative views of seasoned writers help keep a perspective at times, e.g. see Simon Jenkins' "Swine flu? A panic stoked in order to posture and spend." The Guardian, 29 April 2009.

Singapore - see the Ministry of Health's webpage

In Singapore, where the WHO Outbreak Communcation Guidelines meeting was held, the reliable source of updated information about status and core health issues is available at the Ministry of Health. The "Highlights page" now carries the "Update on Global Human Swine Influenza" - there is text and video of the minister's media update which is useful. The site could profit from a dedicated section, a useful rss feeds for this developing situation and perhaps, twitter as nudged by @acroamatic.

Too much information - a summary?

All this reliable information poses another problem - it is A LOT of information. A summary would be helpful but run the risk of sacrificing accuracy. Also with news updates and changes almost every day during such incidents, these would need to be regularly updated.

Well information dissemination is critical to limiting the further spread of infections and a "lack of information and knowledge about a global outbreak ... makes all affected people vulnerable, especially health professionals who need accurate and up-to-date information to care for patients and undertake crucial research."

However "... health information can [now] be rapidly accumulated and disseminated through the internet to the global medical community. .. Just-in-time (JIT) lectures, which target educators, can help to improve the dissemination of information in a health crisis." (Chotania, R. A., R. E. LaPorte, F. Linkov, S. Dodanic, D. Ahmed & K. M Ibrahim, 2003. Just-in-time lectures: SARS. The Lancet, 361 (9373): 1996. [7 June 2003: doi:10.1016/S0140-6736(03)13586-6])

Their paper recounts this approach during SARS which apparently borrowed a term from a manufacturing concept: just-in-time lectures (JIT) - these were rapidly assembled presentations that informed users could adopt, incorporated the brevity of a slideshow, distributed rapidly electronically, updated frequently and from what I see properly labelled to reflect the specific version.

The Just-in-time Swine influenza lecture

As a result, here it is: "Just-in-Time Lecture: Swine influenza A (H1N1) Outbreak in US & Mexico: Potential for a Pandemic," by Rashid A. Chotani. Uniformed Services University of the Health Sciences (USUHS). Updated daily. The html and powerpoint versions are available at the Supercourse site at the WHO Collaborating Center, University of Pittsburgh.

Pointing to the latest update

In response to an email query, he said, "Please use, post and circulate as widely as possible. .. I update the presentation everyday (some time twice)."

In light of his statement and the awareness of the potential of rapidly changing information, I abandoned any thought of using a slideshare embed of Version 3 (28 Apr 2009), but simply point back directly to the Supercourse site, for the reader to obtain the most updated version.

The slideshow is simple and clear for clinicians and biology teachers to use directly for briefings. The explanation of terms that are broached before diving in further is critical in clarifying the use of specific terms and the different sections are clearly spelled out.

Likewise in Singapore, despite the web2.0 shortcomings, the MOH webpage page includes a pdf slideshow which teachers and organisation communication teams will find useful for briefing or disseminating to students and staff. THe MOH slideshow reviews details of the local status with a breakdown of cases and types and sort of control measures that are being adopted and enforced.

Teachers like Cheng Puay who are primary communicators, are using such information to educate and prepare students. They are certainly armed with more effective tools these days!