It’s a Swine of the Times

Well, the President may be dithering over Afghanistan, but he is not dithering over the H1N1 pandemic. From RealClearPolitics:

President Barack Obama declared the swine flu outbreak a national emergency, giving his health chief the power to let hospitals move emergency rooms offsite to speed treatment and protect noninfected patients.

No doubt the fringe elements among the President's critics will see this as another step in the establishment of a police state. As for me, the extension of the government's powers to pay hospitals for tents more than three hundred yards away from the hospital doors is very low on my list of concerns. I am more concerned that the distance from the hospital doors makes a difference.

It's hard to blame the President for wanting to get out in front of this one, and he pretty much has to take the most authoritative medical advice he can get. But when you step back and look at this thing, it's hard to see why the World Health Organization and the Center for Disease Control are treating it as a global emergency.

Health authorities say more than 1,000 people in the United States, including almost 100 children, have died from the strain of flu known as H1N1, and 46 states have widespread flu activity.

Well, that sounds pretty serious, doesn't it? But then there is this bit:

"Many millions" of Americans have had swine flu so far, according to an estimate that CDC Director Dr. Thomas Frieden gave Friday. The government doesn't test everyone to confirm swine flu so it doesn't have an exact count. He also said there have been more than 20,000 hospitalizations.

Well, they don't really know how many hospitalizations and deaths are from swine flu and how many are from non-swine flu, do they? Meanwhile, how do these numbers compare to the garden variety types of flu that sweep the nation every year? The CDC has this:

CDC estimated that about 36,000 people died of seasonal flu-related causes each year, on average, during the 1990s in the United States. This figure includes people dying from complications of seasonal flu. This estimate came from a 2003 study published in the Journal of the American Medication Association (JAMA), which looked at the 1990-91 through the 1998-99 flu seasons [10]. Statistical modeling was used to estimate how many flu-related deaths occurred among people whose underlying cause of death on their death certificate was listed as a respiratory or circulatory disease. During these years, the number of estimated deaths ranged from 17,000 to 52,000.

Michael Fumento points out that WHO did a very strange thing when it declared an H1N1 pandemic:

When the sacrosanct World Health Organization (WHO) made its official declaration in June, we were 11 weeks into the outbreak, and swine flu had only killed 144 people worldwide — the same number who die of seasonal flu worldwide every few hours. The mildest pandemics of the 20th century killed at least a million people worldwide. And even after six months, swine flu has killed about as many people as the seasonal flu does every six days.

In order to justify the pandemic label, WHO eliminated severity (large numbers of deaths and illnesses) as a criterion.

That's also how we can have a "pandemic" when six months of epidemiological data show swine flu to be far milder than the seasonal variety. New York City statistics show it to be perhaps a 10th as lethal.

In Australia and New Zealand, flu season has ended, and almost all cases have been swine flu. Yet even without a vaccine, these countries are reporting fewer flu deaths than normal. (In New Zealand, that's just 18 confirmed deaths compared with 400 normally.) Swine flu is causing negative deaths! The best explanation is that infection with the milder strain (swine flu) is inoculating against the more severe strain (seasonal flu) it has displaced.

If Fumento's account is accurate, the reaction of public health agencies is altogether disproportionate to the threat. That matters, because we all have to trust these people to get it about right, most of the time. Crying wolf when all you are faced with one of the lesser pigs will make it all the harder to mobilize the public when and if the wolf actually shows up.

I don't know what's going on here, but I know this: the ability to rationally evaluate a health threat, which means above all to put it in context, is fundamental to an effective public health regime. Just right now it is hard to see that the CDC and WHO have such an ability.

Comments

[Erik]

KB:
Some good points here. Nice to see Fumento's work referenced; he is an interesting and good writer. If we are seeing an overreaction; I think it is due to the incompetence of the reaction to Katrina. Even the press release mentions that this is the equivalent of declaring a national emergency in times of disaster like a Hurricane...

[sarah]

great info...you might also want to highlight that in all years past - the CDC only tallied laboratory confirmed cases of flu pediatric deaths, and only laboratory confirmed flu hospitalizations of all ages. This year, for some unexplained reasons, the CDC isn't requiring lab confirmation for these two columns. The doc suspects flu as the culprit - the CDC counts it as an 'official' case without any testing confirmation. So, we won't even be able to compare last year's pediatric deaths with this years - different reporting requirements. its all there on the CDC website, different rules for this year - charts with 'confirmed and syndronic-cases' which are all being lumped together now. IF other countries are reporting less deaths, we will have less death too no doubt, but thanks to the CDC loosening of tally rules - the US will look like it had the worst flu season ever.

[ariel]

The U.S. president, Barack Obama, has signed a decree establishing a national emergency in light of the swine flu.
The question is if it is a ploy to push through the health care reform through a federalization of the health care centers or if its all just a question of too little too late. Heres a look into it in more depth.
http://ketiva.com/Health/is_the_h1n1_state_of_emergency_a_health_care_reform_ploy1.html

[gandolph]

Thanks for a nice, well researched article. For a look at how many cases of swine flu have been recorded/estimated by the CDC & WHO in the US/world, check out:
http://www.peterdolph.com/2009/10/how-many-swine-flu-cases-are-there.html

[Cliff Hadley]

Swine flu must be caused by climate change, because everything else is.