Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, May 01, 2009

The Obligatory Flu Post

Many other people have posted all kinds of useful information about this little Spring hiccup of a swine flu pandemic we seem to be experiencing on our planet this year. But I've still been getting I'm-not-really-worried-but-should-I-be? emails and calls from assorted patients, friends and others, so I suppose the most efficient way to address the topic is by posting on it.

Actually, most of this is re-posting. Good information is available here and here. Here is my bottom line answer to the question, "Is this whole swine flu thing a just lot of hype?"


Here's why. I heard Governor Corzine of New Jersey put it rather well on TV the other night. To paraphrase, we have to keep in mind that "pandemic" refers to geography, not to severity. Its anomalous timing is also part of what's keeping it in the news. Flu is usually a winter thing. Did anyone bother monitoring the spread of flu 24/7 online over the winter? (Actually, yes, some people did. They were widely felt to have had no life.) As far as news coverage, flu in winter is too "Dog bites man" to warrant much excitement. Flu in spring is so much sexier.

I think the main reason the word "pandemic" engenders so much visceral fear is that it is (INCORRECTLY) used as a shorthand reference to the 1918 Spanish flu pandemic that was, in fact, unusually virulent and lethal to populations who do not ordinarily succumb to the flu, ie, healthy young adults aged 20-40. The very old, the very young, and the already-sick are always susceptible to complications from any kind of flu, be it human, bird or pig. There is no evidence that the current swine flu strain is especially virulent. Most cases have been mild; few hospitalizations have been required; the single US death was a toddler with a pre-existing illness.

So yes, closing schools and canceling events is definitely overkill. The real question we should be asking is why wasn't everyone worried over the winter, when the "regular" seasonal flu killed 36,000 people in this country alone? As of today, there have been a whopping 141 cases and 1 death. This is not something rational people should be losing sleep over.

Of course, "rational" and "American" do seem to be mutually exclusive much of the time.


At Fri May 01, 03:07:00 PM, Anonymous aliby said...

Even the definition of pandemic as affecting a wide geographical area now seems rather a problem. I mean, diseases are hoping around the globe by plane rather than spreading across the globe from person to person. If it was more than normally contagious wouldn't we have seen all the isolated cases in different countries turning into clusters?

Seems to me that whether something has pandemic potential these days depends on whether it originates in a popular travel destination.

At Fri May 01, 03:21:00 PM, Anonymous Anonymous said...

Actually I think it's too soon to determine whether it's all hype. We really don't know how this is going to play out over the next month or so.

And it seems to me you're missing the point. The point is not that this is - gasp! - an unusual time of year to have influenza. It's that there's no effective vaccine, and a lot of people are going to be vulnerable who might otherwise have been protected with a flu shot.

The media and the public health community can't win. If they go into a state of high alert over a novel flu outbreak and the disease fizzles out after a week or so, they'll be blamed for hyping it. If they downplay it and don't take it seriously and the outbreak turns out to be severe and widespread, they'll be flogged in the town square.

But hey, everyone's vision is 20-20 through the retrospectoscope.

At Fri May 01, 07:17:00 PM, Anonymous Anonymous said...

I agree with the previous poster. We don't know how this is going to play out. We do know that it is not outrageously virulent at the present time, but this could change as it infects more people and accumulates mutations.

The point is that we don't have a vaccine and quite a few people, young and old, are at risk for severe complications. True, they were at risk during the winter flu, but we had a vaccine. We don't have any immunity to this strain.

At Sat May 02, 02:25:00 AM, Anonymous Anonymous said...

I thought the vaccine for the 'winter flu' was actually a combination of the more popular flu(s) for the year... So, technically, every year we could be caught without immunity, because they don't vaccinate us for every flu they can make vaccine for... (Am I completely off base with this thought?)

Personally, I'm just glad people are taking their hygiene more seriously... Very few filthy hands at work today... Though the store is completly out of alcohol gel...

At Sat May 02, 08:46:00 AM, Anonymous Anonymous said...

Like the above said, you never know what is going to happen when flu virus mutates. We know it does, and sometimes quickly--that's a given. What the product therof will look like no one can know at this point. Freaking out? No. Just vigilant is all.

At Sat May 02, 12:48:00 PM, Blogger jmb said...

I have been absolutely stunned by the reaction to this. Once again the media leading the charge with their scaremongering and forcing even those who know better to do things they otherwise would not.

They even closed a school here when one child was diagnosed and I saw in the UK they were giving all children in a school antiviral drugs because one had been discovered to have it.

At Sat May 02, 12:55:00 PM, Blogger Dr. K said...

I agree with Dino. I cannot believe how much media attention has been devoted to this. As Dino points out: we need to put this into perspective with the "regular" flu.

The only thing notable about H1N1 is that it is a new virus. I'll bet the virologists are having a lot of fun with that.

At Sat May 02, 10:03:00 PM, Anonymous 3rd year vet student said...

It's all great practice for when high-path H5N1 makes the shift to being highly human to human transmissible.

At Sun May 03, 12:13:00 PM, Anonymous Anonymous said...

I fall into the "I'm-not-really-worried-but-should-I-be?" category. It's hard to ignore the media hype, but it seems to behave like the "regular" flu. I think I'm more worried about whether this is going to cause a huge shortage in Armour...will I still be able to get my Armour!?

At Sun May 03, 06:27:00 PM, Anonymous Anonymous said...

I like what Prof. Manfred Green, dean of the University of Haifa's School of Public Health (and formerly the director of the National Center for Disease Control in Israel), said about H1N1:

"The damage from media exaggeration may be larger than the damage from the disease itself"

At Sun May 03, 10:20:00 PM, Anonymous Anonymous said...

When this flu first surfaced in Mexico, it was of great concern because the majority of people who died were healthy adults between the age of 25 and 50 - just like with the spanish flu of 1918/1919. As further cases have emerged throughout the world, it does not seem to be as virulent/dangerous. it IS good practice to start taking hygeine seriously. but to close schools? nah. As Dr. Dino points out, 36 THOUSAND people died from complications of the 'seasonal' flu in the States alone this year. (but they are the old and weak - does this matter? ).
One thing to keep in mind, however, is that in previous 'pandemics', the flu started in the spring, then went away, only to resurface as a much more virulent version later. But really. wash your hands, stay home when you're sick and quit picking on the Mexicans!

At Mon May 04, 10:35:00 AM, Anonymous Anonymous said...

"Once again the media leading the charge with their scaremongering and forcing even those who know better to do things they otherwise would not."

What a bizarre statement. Since when does the media "force" people to do anything? Have people lost all responsibility for making their own decisions? Are we to let everyone off the hook because "the media made them do it"?

Instead of calling it swine flu, maybe we should just call it sheep flu.

At Wed May 06, 12:35:00 AM, Blogger The Hatchling said...

We had a "swine flu" clinic on Friday at the medical center. It was followed by a student organization pig roast. I shit you not.


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