Anxiety related to swine flu may have hit a new high this week when an episode of coughing incited a brawl on a New York City subway. One woman on the train coughed without covering her mouth, inciting another woman to respond: “you need to cover your mouth — I don’t want swine flu.” A second woman started to yell at the coughing woman, admonishing the cougher until she started to curse back. The argument escalated from there until the cougher was violently yanked to the floor while trying to exit the train.

As the shouter was restrained and the cougher escorted out of the train, a male witness commented: “I could have decked her too. That swine flu is treacherous.”(For more of the story, read: http://www.businessinsider.com/fight-on-nyc-subway-over-swine-flu-2009-11)

While this story is extreme—an almost vigilante-like response to a public display of illness—it speaks to a larger issue this flu season. While in prior years it would be considered prying or rude to publically comment on a person’s health status, it is not uncommon to see individuals publically policing the health behaviors of others in the era of H1N1. Not only is this behavior condoned, it is considered acceptable—an act of social responsibility even. Individuals with flu-like symptoms (or incidentally symptoms of other respiratory illnesses, asthma, long-term smoking) are vilified, berated for their public appearances; their diagnosis is assumed and their purpose presumed malevolent.

And yet, do our pointed glares, insults, or condescending comments –motivated by fear of contracting the flu virus—result in positive behavior changes among our recipients? Should we congratulate ourselves for taking an active role in protecting our health and the health of others? Or are we alienating individuals –creating a new kind of stigma that punishes people for being sick? That criticizes them for poor hygiene instead of instructing them how to better prevent the spread of germs? Or that admonishes them for having jobs without sick leave?

Particularly as public health professionals, what is our role in publically policing the prevention of H1N1?