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Experts worry mild disease outside of Mexico hampers bid to get people to prepare

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TORONTO - The mild nature of swine flu infections that have been reported to date outside of Mexico may be undermining efforts to get the public to prepare for a range of pandemic scenarios, some experts in public health say.

Some officials are already facing accusations that they are exaggerating the threat of the swine flu situation.

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"Some people are alleging that we're hyping the threat. That's not the case," said Dick Thompson, a spokesperson for the World Health Organization.

"What we're trying to do is to provide the best information possible. To gather that information and to provide it to the public. Because that's the best defence, is to have information."

The WHO said Wednesday it had been informed of 114 laboratory confirmed human cases in seven countries. But even as he revealed the number, Dr. Keiji Fukuda, the acting assistant director-general for health security and environment, acknowledged that official counts are likely to be behind what is actually happening in affected countries.

Fukuda said there had been eight laboratory confirmed deaths - seven in Mexico and one announced Wednesday in the United States, a child from Mexico who was being treated in a Texas hospital. But Mexican authorities say swine flu is now suspected in 159 deaths.

For several years, flu experts and the WHO have been warning of the possibility of a pandemic with the dangerous H5N1 avian flu virus, which has killed roughly 60 per cent of the people it has been known to infect.

With the H1N1 swine flu virus, the world appears - at least for now - to face a much less fearsome foe. That fact leads to some relief and some concern. The concern is that people may not be taking the threat of a pandemic seriously enough.

"I think that people misunderstand the word pandemic," Thompson said from Geneva. "Pandemic speaks to the geographical distribution of disease. That it's widespread, that it's global."

"Then there's the question of severity. How severe is that disease? And we can have very mild pandemics. But we can also have pandemics that can come in waves."

"And a first wave might be mild. And that might lull people into complacency thinking - 'we've seen this, it's not so difficult to deal with, it's not so scary.' And then another wave comes along. That has been a pattern. And that's something we have to keep thinking about."

Officials have started to point to the example of the 1918 Spanish Flu, the worst infectious disease outbreak in known history. It's estimated upwards of 50 million people around the globe succumbed in that pandemic, which was caused by an H1N1 virus believed to be of avian origin.

A leading risk communications expert, who consults for an A-list of government agencies and corporations, said he believes authorities need to alter their messages to give people more of a notion of the unpredictability of the current situation.

Peter Sandman, who is based in Princeton, N.J., said officials may be torn between wanting people to start preparing - those messages are being voiced - and not wanting to alarm them.

"I think they're much more worried about frightening people than they need to be," Sandman said in a telephone interview.

"They're walking a fine line. So they very calmly, almost reassuringly, are saying: 'This could get much worse.' And they're saying it almost as if they want it on the record but they don't want you to do anything about it."

He is puzzled that after years of work at the U.S. Department of Health and Human Services on plans to tell people how to stockpile food and water and to secure extra supplies of needed prescription drugs, those ideas aren't being raised.

Sandman, who believes people should prepare for a more dire situation than is currently being seen, said the messages ought to be aimed to get people to understand the importance of hoping for the best while preparing for the worst.

"The thing I wish officials would say more often ... is the following two sentences," he said.

"This is the way a devastating pandemic could well look at this early stage. That's the first sentence. And the second sentence is: 'This is the way a false alarm could well look at this early stage."

"Reading the tea leaves now to see which of those is happening simply can't be done," Sandman said.

"Congress wants us to do it. The world wants us to do it. Politicians want us to do it. The public wants us to do it. We can't."

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