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Earlier this year saw an outbreak of a frightening new strain of the flu. The resulting panic created a lot of sound and fury…but what did it signify?
Just when the A(H1N1) flu (“the flu formerly known as swine”) was losing its headline luster for being too mild and ordinary a bug, the World Health Organization (WHO) declared the first global influenza epidemic in 41 years. On June 11, 2009, the WHO raised the pandemic warning to level 6, the highest possible alert.
Officials point out that this classification refers only to the geographic spread of the new flu over the globe, and tells nothing of its virulence or deadliness. Nevertheless, the heightened alert will likely rekindle the flames of “pandemania” in the United States, sending multitudes of panicky parents to already overcrowded emergency rooms with feverish, sniffling children.
Hysteria in the realm of public health is highly disruptive to normal health services, not to mention unnecessary and costly. Intentionally or not, health leaders the world over create panic with their pronouncements. What about educating the public rather than raising a ruckus? Wouldn’t that help us all maintain our health (and sanity) and prepare us to respond rationally to future epidemics of flu—and fear?
Scary predictions tossed about by health leaders and incessantly repeated by the media are responsible for the public’s perception of health risks. The avian flu (remember the avian flu?) was predicted to become the next global pandemic. As panic spread in 2004, the prevailing sentiment was grim: “It’s not a question of if the avian flu pandemic is coming, but when.” Such dire predictions were based, in part, on a high rate of death of those who became infected with avian flu, particularly in Vietnam. The death rate in Asia was reported to be as high as 70 percent.
As scary as it sounds a death rate is simply a ratio: a comparison of the number of people who are infected to the number who actually die from the infection. But a couple of years after the 2004 outbreak, a report was published in the January 2006 edition of the medical journal Archives of Internal Medicine, suggesting that the death rate attributed to avian flu was severely overblown.
In the midst of the avian flu scare a group of Swedish researchers traveled to Vietnam to conduct a study and were surprised with what they found. The scientists concluded that hundreds of thousands—perhaps millions—of people in Asia are infected with avian flu each year… not just the few hundred individuals sick enough to wind up in a hospital. The vast majority of the population infected with avian flu seems to experience only a mild, self-limiting illness, indistinguishable from the symptoms of seasonal flu. (Sound familiar? It’s not unlike the experience most infected U.S. citizens had with the new pig/bird/ human flu.)
Public health officials at the WHO and elsewhere have yet to acknowledge the likelihood that enormous numbers of people become infected with avian flu every year and recover without incident. The scary death rate from avian flu would likely plummet spectacularly if health leaders would examine and confirm the evidence suggesting that avian flu is widespread and ordinary.
As of this writing, the WHO has reported 429 deaths worldwide associated with the so-called swine flu, officially renamed A(H1N1). To an American public accustomed to annual flu shot campaigns howling about the deaths of 36,000 Americans each year from seasonal flu, the swine flu sounds entirely flimsy and feeble.
If we do the math, a death toll of 36,000 per year from run-ofthe- mill seasonal flu means an average of 690 deaths per week. In the six weeks preceding the WHO’s high pandemic alert, a total of 45 deaths were attributed to the A(H1N1) flu in the U.S., or about 8 deaths per week. That means the ordinary flu is about 86.5 times more deadly than the new flu, based on official numbers. So why all the fuss and feathers?
Part of the confusion stems from comparing confirmed numbers to estimated numbers. In the current outbreak, the WHO has been releasing only laboratory confirmed numbers of A(H1N1) flu cases. Meanwhile, in the U.S., the Centers for Disease Control (CDC) estimates numbers of seasonal flu cases and deaths based on statistical modeling—a process that provides projected figures based on data, rather than relying on the hard data itself.
Confusing matters even more, the CDC stubbornly persists in lumping together statistics for influenza-related illness and death with that of pneumonia-related illness and death. Note to the CDC: Pneumonia and flu are not the same thing, nor do they always occur together.
In the initial stages of reporting on A(H1N1) flu, the CDC released numbers of confirmed cases only, but the limited capacity of laboratories in the U.S. to test for the new virus was quickly overwhelmed by hordes of Americans fearful they were infected. Eventually it was announced by officials that laboratory confirmation was no longer necessary for the new flu and we returned to estimates: “Right now, we are estimating over 1 million cases in the U.S.,” reported CDC researcher Lyn Finelli, DrPH. Probably, maybe, we think so, nobody knows for certain.
The official response in the U.S. to the novel A(H1N1) strain of influenza has been threefold: First, scare the bejeebers out of the public; second, distribute government stockpiles of “antiviral” drugs; and third, make a new vaccine. How has this been working so far?
Public health officials started off by pushing the panic button with chilling predictions and worst-case scenarios that were amplified and echoed by the media, always happy to hype the latest sensation. But suppose the A(H1N1) virus had turned out to be a deadly pathogen. Is the creation of a state of fearful hysteria about new and unknown health risks helpful to anyone at all?
Officials were also quick to begin distributing expensive government stockpiles of so-called antiviral drugs as the best defense against the new flu. What do we know about how well these drugs fight viruses? First, most viruses become resistant to drugs in a very short time. Second, when these antivirals do “work,” it means slightly diminished symptoms of flu, or the shaving of less than 24 hours off the length of time symptoms are suffered.