Illustration by HealthCanada

If you want to talk about mixed signals, just step back a bit and look at the messages being sent and received on the care and treatment of the Swine Flu pandemic.

The Seattle Times ran a front-page story about the largest outbreak of H1N1 in the country, so far. Washington State University and community health officials on the southeastern edge of the state said that 2,000 people, or about 10 percent of the student body, had H1N1.

The diagnosis came from laboratory analysis of swabs from the first few dozen students to show up at the school infirmary.  It was enough to convince the docs that they probably all had Swine Flu.

About 2,500 miles away at Atlanta’s Emory University, 200 hundred students were diagnosed with the disease.

Now here’s where the differences begin.

At Emory, which is in the very shadow of the Centers for Disease Control ­ – Mecca for information on infectious diseases – the university told students with the flu to go home if nearby, or some other place off-campus, away from other students.

For those that had no place to go to wait for the infectious period to pass (24 hours with no fever) the university opened an unused dorm – quickly dubbed “Club Swine’’ – and, as of yesterday, school workers were providing meals to more than 120 students. It is not called quarantine, but rather “self-isolation” and it appears to be working.

At other southeast campuses, Stillman College in Tuscaloosa, Ala., canceled its season-opening football game on Saturday because players and some students had the flu.  At New Orleans’ Tulane University, medical officials cancelled “Fan Day” for the football team, and the volleyball team scrubbed its first game.

Back at WSU in Pullman, officials said those with the flu should “limit contact with others to keep from infecting them and don’t go to class or work.”

But apparently infectious disease control doesn’t spread to sports. With thousands sick, a sell-out crowd packed the stadium for the game against Stanford, which went on anyway.

University officials said there was “little danger of exposure to the flu in the outdoor” setting, where the rabid football fans were crammed cheek to jowl.

But unless things at the Pullman campus are dramatically different than the rest of the collegiate world, big football weekends also mean packed bars and restaurants and lots of parties.

The university website did helpfully caution that “kissing and sharing eating or drinking utensils should be avoided.”

It is an intricate dance that public health professionals must do when it comes to keeping the public aware of emerging health threats.

Too little information and they’re accused a coverup; too much and they’re fear mongers. Everyone knows that influenza is generally a self-limiting disease, and most people make a full recovery without medical treatment. But with so many groups considered “high risk” for hospitalization or death, the hazard must be acknowledged and planned for.

For example, Dr. Thomas Frieden, CDC’s boss, was asked again today whether he believes the study by the President’s Council of Advisors on Science and Technology, which said half of those in America will contract H1N1 and as many as 90,000 will die.

He said it is one of many possibilities that is being planned for, and to do any less would be wrong.

That’s solid public health logic.

But it doesn’t seem to be logic that’s uniformly embraced.

Just 60 miles north of the WSU football stadium in Spokane, Wash., the public view is that the CDC should chill out and not over react.

Spokane is one of 10 U.S. cities where the CDC convened a citizen’s group to guide the agency in how best address the pandemic.  According to the city’s Spokesman-Review newspaper, which covered a CDC meeting last week, 89 percent of those polled said there was no need for a full-scale vaccination programs, including mass vaccinations at local schools.

I’m left with questioning whether athletic department and their boosters should be the ones weighing public health threats,

If H1N1 truly poses the health risk that government experts say it does, isn’t it time that the CDC and the public health community stop sending mixed messages and articulate a coherent, consistent policy for controlling the spread of the disease?

Note: If I were a public health policy grad student at Stanford looking for subject for my dissertation, I would closely watch this week for reported cases of H1N1 on the San Francisco-area campus and then see how many went to the WSU game or kissed someone who did.

Here is a link to the Seattle Times story and another link to the Spokesman Review report on the CDC meeting.