As the recent collapse on Wall Street shows, we are often ill-equipped to deal with uncertainty and risk. Yet every day we base our personal and business plans on uncertainties, whether they be next month’s sales, next year’s costs, or tomorrow’s stock price. In The Flaw of Averages, Sam Savageknown for his creative exposition of difficult subjects describes common avoidable mistakes in assessing risk in the face of uncertainty. Along the way, he shows why plans based on average assumptions are wrong, on average, in areas as diverse as healthcare, accounting, the War on Terror, and climate change.
The first article is from the New York Times:
A Nation Battling Flu, and Short Vaccine Supplies
[excerpts]
By ANDREW POLLACK and DONALD G. McNEIL Jr.
Dr. Anthony S. Fauci was talking with fellow federal officials in September, a month before swine flu vaccinations were to begin, when it became clear they had a bigger problem than they feared with supplies.
“As we got closer and closer, they said, ‘Oh, my God, we’re not going to make it,’ ”
Many of the projections originated from the Biomedical Advanced Research and Development Authority, or Barda, a part of Health and Human Services, which is responsible for vaccine contracting for emergencies. In April, an official with the agency predicted that as many as 600 million doses could be available by January, if all went well. From May through September, Barda signed contracts worth $1.5 billion for about 250 million doses of vaccine with five companies. The contract volumes were based basically on what each company said it could provide.Dr. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said in an interview.Earlier this month, the government was forced to announce that only about 28 million doses would be available by the end of this month, about 30 percent below the 40 million it had previously predicted. That is not enough to satisfy panicky people who are lining up for vaccine around the country or desperately phoning their doctors and public health departments.
But the October shortfall was not the first. Indeed, since the outbreak of the H1N1 swine flu occurred in April, federal projections have been consistently and wildly overoptimistic and have had to be ratcheted down several times. As recently as late July, the government was predicting having 160 million doses by this month.
[snip]
But, these experts say, the government’s accomplishments, and its credibility, are being undermined by overly rosy projections that did not take account of the vagaries of vaccine production, making it look as if the vaccine effort is failing.“To my mind, it was over-promising what there would be based on our historic experience with flu vaccines,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“When you plant corn in May in Iowa, you have no idea what your harvest is going to be in October,” Dr. Osterholm said. “You have to factor in hailstorms, floods and whatever. They put out a very high yield estimate early on. Every time they had to back off, they lost credibility.”
An introductory scenario from Sam Savage’s book gives us an easily grasped glimpse into the likely flawed thinking that fed those estimates..
Imagine that you and your spouse have an invitation to a ritzy reception with a bunch of VIPs. You must leave home by 6 p.m. or risk being late. Although you work in different parts of town, each of your average commute times is 30 minutes. So if you both depart work at 5:30, then you should have at least a 50/50 chance of leaving home together for the reception by 6 o’clock.
This thinking sounds right. But your instinct warns that you will probably be late. Which is correct: your brain or your gut?
Your gut is correct, but not being particularly good with words, it may have difficulty winning the argument intellectually. So here, in terms that even a brain can understand, is why you’ll probably be late.
Suppose there really is a 50/50 chance that each of you will make it home by 6:00. Then the trip is like a coin toss in which heads is equivalent to arriving by 6:00 and tails to arriving after 6:00. Four things can happen:
- Heads/tails: You are home by 6:00 but your spouse isn’t.
- Tales/heads: Your spouse is home by 6:00 by you aren’t.
- Tails/tails: Neither of you is home by 6:00.
- Heads/heads: Both of you are home by 6:00.
The only way you can leave by 6:00 is if you flip two heads, for which there is only one chance in four.
Now imagine that your brother, who also works 30 minutes away, is going to join you. The chance of your all leaving on time now drops to one in eight.
Back to the New York Times article..
Federal officials say they factored such difficulties into their projections. They say they were pressed to make the projections by state and local health officials and by the news media.
I have it a lot lately, we botched our response to this pandemic — thankfully providence was kind and handed us one that was mild. Though I sort of chuckled when I read that last line from the NYT. “Don’t blame us — it’s YOUR fault!” Ah, the Blame Game, it’s only human nature I suppose.
Still, they said, they relied on assurances from the vaccine manufacturers, some of whom might have been overconfident of their ability to resolve production problems.
“I think it’s fair to say that some were overly optimistic, thinking the fix was just around the corner,” said Dr. Nicole Lurie, the assistant secretary for preparedness and response at the Department of Health and Human Services.
Given how badly we botched the vaccine issue, and I must say – due to long known potential issues, though not specific to H1N1-2009,rather novel influenza strains in general, it is only natural to question other official assumptions. When I started down that road I suddenly found myself asking exactly how much trust do we invest in our government and public officials anyway? Not much was the answer I came up with, which explains why I also laughed when I read this bit…
But, these experts say, the government’s accomplishments, and its credibility, are being undermined by overly rosy projections that did not take account of the vagaries of vaccine production, making it look as if the vaccine effort is failing.
Two things: A) The vaccine effort IS failing, and B) We are learning as we go. Mistakes will be made. That too is only human nature. As much as we would wish our public officials to be perfect – they are not – they are fallible human beings dealing with other fallible human beings, sometimes in the course of their duties a lot of fallible human beings in the course of the performance of their duties.
Let’s not get twisted up in the “Blame Game”, instead, let’s deal with the realities, and yes, the vagaries, of the situation we find ourselves in.
But more importantly, let’s learn from our mistakes so that next time — and there will be a next time at some point in the future — we will do better. Doing better means less human misery [even if only temporary misery] and fewer very preventable deaths. Preventable, that is, if one has access to a vaccine.
The stakes may be high but the learning curve is not all that steep.
]]>The 2009 recipient of the Richard Dawkins Award (a.k.a Bill Maher): Antivaccine lunatic and quackery supporter
Here we go again. The 2009 recipient of the Richard Dawkins Award, anti-vaccine wingnut and lover of cancer quackery Bill Maher, decided to use the occasion of the season finale of Real Time with Bill Maher to answer some of the criticisms that have been leveled against him. All I can say is this: I’m incredibly grateful that this is the season finale of Maher’s show. I don’t think I can take much more of his moronic anti-science stances being proudly trumpeted
It was painful to watch and showed very much that Bill Maher still doesn’t get it. In fact, if anything, he escalated his quack arguments to a whole new level. True, he states up front that he isn’t a germ theory denialist, lamely claiming that maybe he was a “bit too cocky” when he said that diet and healthy living (plus avoiding the ubiquitous “toxins”) would protect him from the flu, but that’s a load of steaming, stinking, toxin-laden bullshit, …
Please do hop on over to Orac’s blog and invest a few minutes to read his post. And in case you are just now waking up from a coma or some other incommunicado condition, he also has that infamous YouTube clip posted.
A bit of a snarky aside: My only hesitation in recommending this Brilliant Rant is that “Orac” hides behind a pseudonym. Perhaps I’m in the minority, but if one is going to attack someone, and do it with such caustic alacrity, one should “own” their statements and positions. Even as WRONG as Bill Maher is at least he “owns” his stupidity and ignorance.
]]>This week we also had a vaccination campaign at work. Our seasonal vaccine was paid for by the corporation that employs me and the pandemic vaccine [FluMist] was paid for by the government. I am pleased to say that our vaccine uptake at work was impressive. Those that were eligible [no contraindications] to receive the FluMist vaccine opted to get it as well if they were getting their seasonal vaccine.
The vaccines can be difficult to come by, depending on which version one wants or needs:
Swine flu vaccines delayed, CDC says
Fri Oct 16, 2009 9:54pm EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) – Delivery of some swine flu vaccines has been delayed because companies cannot make it as fast as they had hoped, just as the virus has really started to spread, the U.S. Centers for Disease Control and Prevention said on Friday.
The CDC’s Dr. Anne Schuchat said that while 40 million doses had been anticipated for the end of October, only about 28 to 30 million doses would be available.
“Yields for vaccine are lower than would be hoped,” Schuchat said in a telephone briefing. “We unfortunately won’t have as much at the end of this month as we had hoped to.”
We have over 300 million people in the US. That’s a considerable shortage of vaccines.
She also said deaths from H1N1 swine flu were above the epidemic threshold in some U.S. cities and states. H1N1 flu activity was widespread in 41 states, she said.
“It is unprecedented for this time of year to have the whole country having such high levels of activity,” Schuchat said.
An interesting “lesson” from this thankfully mild pandemic is that official assumptions have generally been that infections would “roll” across the country.
CDC : US Influenza 2009 Week 40
We now know that the “official assumption” is not supported by the reality of a highly infectious, even if mild, disease.
“There are now a total of 86 children under 18 who have died from the 2009 H1N1 influenza virus,” she added. Many had died in recent weeks and the number was now higher than the usual number of child deaths in an entire flu season.
“These are very sobering statistics … 43 deaths in one month is a lot,” Schuchat said. “Some of these children have been totally healthy.”
Older children were hardest hit, she said, with 16 deaths among 5- to 11-year-olds and 19 deaths in 12- to 17-year-olds.
That would leave 8 deaths for children under 5.
I cannot help but remember the furor – and efforts expended – and costs incurred – when salmonella showed up in peanut butter. Every peanut butter product was cleared from store shelves irrespective of whether they used the contaminated institutional product in their manufacture. People cleared their pantries and cupboards of everything “peanut butter” in order to protect themselves [and their children] from the salmonella threat.
Not for the first time I find myself wondering why we can be outraged and driven to action [sometimes over reaction] when the perceived threat is caused by “the hand of man” yet many of us blithely ignore the potential assaults on our health from infectious disease – influenza specifically in this case. Perception being “it’s only the flu” for many. For most salmonella is no worse than a genuine case of influenza – yet look what we did in the face of that threat. Mother nature just doesn’t inspire the same factor of outrage as human malfeasance. Odd but true.
BUMPY DELIVERY
Schuchat said 15 percent to 20 percent of patients with H1N1 who needed to be hospitalized were requiring intensive care. “Influenza is widespread in the country and illnesses, hospitalizations and deaths continue to increase,” she said.
The U.S. government has opted to roll out seasonal flu vaccine and H1N1 vaccines as they become available, which the CDC has said could make for a bumpy vaccination plan.
People need both vaccines to be protected from all the circulating viruses, although Schuchat says virtually all cases of influenza are due to the new H1N1 virus.
I received my seasonal influenza vaccine on Thursday, paid for by my employer. The doctor’s office that was administering the seasonal vaccine was also administering the FluMist version of the pandemic strain vaccine, free of charge thanks to the government.
I turned 50 years old in April of this year and so I am a few months outside the official “2-49″ age range for FluMist. I attempted to ask the nurse to administer the FluMist vaccine anyway, given I was only a few months outside the official guidance. She very angrily responded that “It wasn’t safe!” to do so. My counter was that if it would have been “safe” for me in March it was “safe” for me in October.
Needless to say, I was roundly denied the vaccine irrespective of “me as an individual”. Not only was I flatly denied, the nurse reacted as if I had asked her to administer poison. I very much wanted to tell the nurse that I was quite confident that I probably knew a great deal more about the vaccine than she but decided there really are times in life when fact and reality have no meaning outside an arbitrarily drawn line of demarcation.
Yes, the height of irony: I have spent two years expounding on the superiority of FluMist to the traditional injected vaccine, I have spent months exhorting the prudence of vaccination in the face of a pandemic, I… me… denied a vaccine because I am a few months too old.
Although I was angered by the arbitrariness of the “line of demarcation” and angered by someone obviously informed by nothing more than “orders”, I have no anger about being unvaccinated. With only so many to go around some of us will just have to do without. At least for the time being.
“This is how influenza vaccine production often goes,” Schuchat said. She said there should be widespread availability by November and advised people who wanted a vaccine but were having trouble finding one to keep trying.
Good advice. Advice I will surely follow. But as sound as the advice is, there will be an awful lot of us who will either become infected before we find a vaccine or this active phase of infection will pass and then we will lose the sense of urgency. Influenza ain’t peanut butter.
]]>Judge Halts Flu Vaccine Mandate For Health Workers
[ Excerpt]
New York Health Care Employees Won’t Be Forced To Get H1N1 Vaccine…For Now
Health care workers in New York will no longer be forced to get the H1N1 swine flu vaccine, CBS 2 has learned.A state Supreme Court judge issued a restraining order Friday against the state from enforcing the controversial mandatory vaccination.
The order came as the Public Employees Federation sued to reverse a policy requiring vaccination against the seasonal and swine flu viruses, arguing that state Health Commissioner Richard Daines overstepped his authority.
Three parties – the Public Employees Federaion, New York State United Teachers, and an attorney representing four Albany nurses – challenged the order and for now the vaccination for nurses, doctors, aides, and non-medical staff members who might be in a patient’s room will remain voluntary.
I can only hope that this is not only a temporary victory, but also very short lived. I can hardly imagine being so selfish and self-centered, to say nothing of short-sighted.
]]>Study Explains Immunity to H1N1 in Older People
[Excerpted]
By Julie Steenhuysen
Reuters
Older people who have been infected with or vaccinated against seasonal flu may have a type of immunity produced by cells that protects them from the swine flu virus, U.S. researchers said on Wednesday.
They said the pandemic H1N1 virus has parts found in earlier flu strains, and some people past age 60, who may have been exposed to similar viruses in their youth, may have some latent immune cells that protect them.
“These findings indicate that human populations may have some level of existing immunity to the pandemic H1N1 influenza and may explain why the 2009 H1N1-related symptoms have been generally mild,” said Carol Cardona of the University of California Davis School of Veterinary Medicine. Her study appears in the journal Emerging Infectious Diseases.
Cardona said cell-based immunity may be serving to weaken the effects of swine flu.
“The meaning clinically is you are going to get sick but it may not be as severe if you had no immunity whatsoever,” Cardona said in a telephone interview.
There may be quite a few people who have had an infection of the genetically related seasonal A/H1N1. I have very little doubt that I have, but I do not know for a fact, and it can be quite murky when we attempt to guess. Since 1978 there have been two strains of seasonal influenza A virus circulating, A/H1N1 and A/H3N2.
Each “flu season” one strain will represent the majority of infections, referred to as “the predominate strain”. And, now that we have A/H1N1-2009 we have actually had three strains of influenza A virus circulating, however, the predominate strain quickly became our pandemic virus – A/H1N1-2009, which now officially accounts for roughly 90% of cases typed. Only a small number of infections are typed so the exact percentage is not known, but extrapolating the ones that are tested we arrive at the 90% of the infections being from our pandemic strain.
The important take away from all of that is even if you had a case of “the flu” last year and think you might be one of the lucky ones who is walking around with a fresh load of these antibodies, you may have had a case of H3N2 and not the seasonal H1N1. Unless infections were tested and typed there is just no way of knowing beyond a guess.
If one wishes to arrive at a slightly informed guess: look up the predominate strain circulating during the time you remember being ill with a case of “the flu”. Chances are, the predominate strain is what you had. Of course, that brings up the question of whether or not you actually had a case of “the flu” in reality, or one of the other hundred odd pathogens that people often confuse with influenza.
We can guess – or we can err on the side of caution and get our pandemic vaccine. I’m going to play it safe even though I’m fairly certain I had seasonal H1N1 back in the late 70’s. For me, it’s just not worth being sick, possibly quite sick, when something so simple as a vaccine will protect me.
The Emerging Infectious Diseases paper can be found here: Ahead of Print PDF.
At “my day job” we have been offered the opportunity to receive our vaccines, seasonal and pandemic [if one can take the FluMist pandemic vaccine], I am pleased to be able to report the uptake rate has been impressive. I assume part of the success has been because our corporate HR department sent around a wonderfully informative memo explaining issues and concerns. Of course, I would like to think that a small part of the uptake numbers has been because I have answered a few questions here and there. However, it may only be coincidental that we’ve had our first cases strike within family and an employee. Whatever the threat is, it “feels” close by — that can be quite motivating, far more so than some “hypothetical – in the future – potential of becoming sick.”
Regardless of the reason[s], I am pleased and proud of the demonstration of my coworkers taking personal responsibility for their health. I could make a strong argument that those of us who are stepping up and getting our vaccines are also doing something concrete to help protect the “health” of our “community” – our fellow coworkers – the ones who do not have the foresight to protect themselves and the ones who cannot take the FluMist vaccine and are waiting for their turn at the injectable version. That wait will be several months long for some, months during which the virus will be actively circulating.
]]>Because of America’s Grand Tradition, we have all manner of people spouting off about all manner of things, and yes, I am included in that category. The “consumers” of the products of America’s Grand Tradition are not always well served, and on occasion even harmed, by “consuming” the “product” of some other person’s free speech. Someone who listens is invested with the presumption of reason to independently ferret out the helpful, the benign, and the harmful when such “ferreting” is prudent — such as in matters of health and physical safety.
With Global Warming, believing one side’s “experts” over the other side’s “experts” has no ramifications to one’s health or life [despite what one side likes to say occasionally]. As in: we have only ‘X’ years to fix the issue or we’re all going to fry under the parching sun, our cities will drown, and our crops will fail, causing death and destruction on a “Biblical Scale” [my phrase].
Although the issue of Global Warming may chafe and bruise my sense of logic and reason, what I choose to believe and disbelieve will have no effect on whether I, or a minor child in my care and custody, will become ill, possibly severely – possibly even fatally so. The same cannot be said for what I believe about the efficacy and safety of the pandemic A/H1N1-2009 vaccine.
Since I tend to lean rather heavily on “the science”, even if I wind up investing that science with a great deal of “personal emotion”, I do restrict that investment to scientifically credible issues. In other words: an emotional plea is just not enough for me, it has to be backed by science – credible science.
There is little doubt that the issue of pandemic influenza vaccination is driven by a great deal of emotion, on both sides of the issue, but “the science” speaks for itself… assuming one actually bothers to look at the science — even the dumbed-down layperson’s “science” on the issue.
The A/H1N1-2009 vaccine is no different than the seasonal influenza vaccine we have been manufacturing for decades. It is made precisely the same way.
The only material difference is the new HA and NA [the two genes that code for influenza's two outer proteins]. These two genes are swapped in our seasonal vaccine with a certain cyclical regularity, anytime the virus changes enough that the [then] current vaccine is no longer a “good match” to the strain [then] circulating. We’ve had enough of these swaps in recent years that it should not be difficult to remember the news about “pooly matched” vaccines.
The American A/H1N1-2009 vaccine does not contain an adjuvant. Period. The British and Canadian versions will contain an adjuvant, but the US vaccine DOES NOT.
The veracity of the Thimerasol controversy aside: The single dose vaccine for children under six years of age does not contain the preservative, nor does the inhaled vaccine known as FluMist. FluMist can be given to children two and older. The single dose Thimerasol-free vaccine is also being made available to pregnant women. So, if one happens to believe the debunked Thimerasol/Autism link: Please know and understand there are Thimerasol free options available for your children.
Those three very simple – basic – FACTS are easily – and understandably – documented with a simple search of the internet or trip to the local library. Knowing how easy the FACTS are found, FACTS backed up BY SCIENCE and not just “he said” or “she said” or even the very authoritative sounding “Doctor so-and-so said…” I was stunned to find out about – and view – a recent tirade by Rush Limbaugh [video below].
Say what you will about Rush Limbaugh, he is usually much more thorough about checking his facts.
Mr. Limbaugh has fallen victim to the same “infectious disease” as many on the vaccine issue: letting emotions decide a scientifically based medical issue.
Mr. Limbaugh states his doctors have never suggested he receive an influenza vaccine previously, and there is good reason for such: he has always been outside the recommended age brackets, traditionally those over 65, and recently, those under 5, and very recently those under 18 as well. As you can see, Mr. Limbaugh never met the age criteria when the criteria were operative, so he never warranted a doctor’s recommendation to get a seasonal influenza vaccine.
Healthy adults under age 65 have not been viewed as needing a vaccine because with seasonal influenza healthy adults are not usually at risk of severe illness and/or death. That doesn’t mean the occasion severe/fatal outcome didn’t happen, but when it did it was a truly freak happenstance of some really bad luck.
With A/H1N1-2009 the only folk who seem to be getting any sort of “influenza free pass” are the folk older than 65, the very same folks who are at greater risk from traditional seasonal influenza.
That may seem “weird”, or counter intuitive at first, but with pandemic influenza no one has existing immunity. Since A/H1N1-2009 is a “genetic cousin” [so to speak] of the influenza virus A/H1N1 circulating prior to 1957 [when H2N2 replaced it] and after 1978 [when a version was accidentally reintroduced into the human population] some of us are presumed to have at least some pre-existing immunity, those over 65 seem to have drawn the lucky straw on this one and appear to have the most pre-existing immunity.
Those who have never had an infection of seasonal A/H1N1, and there are a goodly many who have not, will not “enjoy” any of the benefits of that pre-existing immunity – at whatever level it may [or may not] exist in reality for each of us as individuals.
There is a blood test that can be done to determine if someone has ever had an infection of A/H1N1, and at what level circulating antibodies specific to A/H1N1 exist. That takes laboratory analysis, a technician’s time, and a lot more money than a vaccine would cost, to say nothing of not being covered by any health care plan one might have.
Or, one can do as Mr. Limbaugh seems to have decided to do: Not be vaccinated and risk being infected.
Mr. Limbaugh is probably almost 100% safe in his gamble – almost a “sure bet” if you will. His age is right to be at little risk, though somewhat more than those over 65, still, not very high. He’s also quite well off financially so if he does suffer a severe infection and lands in the hospital he can afford all those medical bills. And, if he is really – really – unlucky and ends up one of the statistically rare fatalities for his age bracket and general health then he won’t be around to care – or even know – that he was dead wrong.
Mr. Limbaugh is making the decision for himself. He’s a grown adult in possession of all his mental faculties, even if some would question the veracity of that statement, he is. As such, his decision is of no concern to me.
What is of concern to me is that he allowed the propagation of falsehoods on his show for what may have only been a political point. That is the only explanation I can assume given how easily the FACTS – “the science” if you will – could have been ascertained. FACTS that are EASILY ascertained by just about ANYONE, let alone someone with the staff and resources Mr. Limbaugh has at his disposal.
For the record: I haven’t listened to Rush Limbaugh since “Bush Senior” was our president. I do not dislike Mr. Limbaugh in any form or fashion, but neither am I a “fan”. I know him to be a man of intelligence and sharp whit, even if occasionally “flawed” – in the same respect that I myself am flawed [imperfect] – and you are – and you are – and all are.
I am not writing this to score any sort of “point” at Mr. Limbaugh’s expense, whatever he believes and chooses to do is his business [there are no minor children in his "decision tree"], but the same cannot be said for those that tune into his show and heard his emotionally and politically driven tirade propagating and reinforcing the lies and disinformation campaign of the anti-vaccine lobby.
And so I raise my tiny voice to the Godfather of Talk Radio: “Check your Freakin’ Facts man! ‘Cos that is so NOT like you — to get it sssoooooo WRONG!“
]]>I may die tomorrow in a car accident or some freak random act of violence, but I know I will not die next week from smallpox, a threat my parents faced for the first thirty years of their lives.
Philly.com has a wonderful piece this morning by Rachel Sobel [a medical professional of unclear type].
Scrubbing In: It’s swine flu we should fear, not the vaccine that saves us [Excerpts]
Rachel Sobel
[snip] I’m talking about what’s become a culture of fear around getting the shots. More than a third of parents don’t want their kids vaccinated for swine flu, according to a recent Associated Press-GfK poll. Many fear that vaccines do more harm than good. This comes up a lot with the scientifically discredited link between vaccines and autism-related developmental disorders. There’s also the conventional wisdom that a flu shot can “make you sick.”
The vaccine-autism controversy has mostly run its course. Celebrities such as playmate Jenny McCarthy and actress Amanda Peet argued about whether to vaccinate kids. Peet called McCarthy and the other vaccine-phobic parents “parasites” for relying on the immunity of others to hold off measles, small pox, polio, and other now-rare diseases.
I am not that rabid, but the science at least is clear. “If you decide not to vaccinate your child, you put your child at risk. Your child could catch a disease that is dangerous or deadly,” says the American Academy of Pediatrics.
It has been a long time since the hospital wards were filled with kids on iron-lung machines suffering from polio. And it’s been almost a century since a worldwide flu killed more than 20 million people. That’s probably why some people have not been getting the message about the importance of vaccines.
Last year, the Centers for Disease Control and Prevention counted 131 cases of measles in the first half of the year, more than double what it had been for the preceding year. More than 90 percent of those cases were in unvaccinated children or those with unknown vaccination status. And half of those did not get vaccines because of “philosophical or religious beliefs.”
[snip] Sometimes concerns about vaccines are just plain irrational, even among doctors. Last year one of our residents, who is a particularly astute clinician, opted not to get the flu shot. He boasted that he had never gotten the flu shot and had never gotten sick. Why would he get it now?
We all joked about his overconfidence. Then the next week he got really sick and had to miss work, though he claims it wasn’t the flu. I asked him whether he will get the seasonal flu shot this year. “Probably.” And the H1N1 vaccine? “Potentially,” he said. “We’ll see.”
Vaccines are modern miracles. The last naturally occurring case of small pox was in 1977 in Somalia. Polio is still out there, with several public health groups working toward eradication.
Some time ago I came to believe that having so many people unaware of what it really means to live with the threat of deadly infectious diseases as part of the very fabric of day-to-day life leaves them bereft of a “healthy respect” for that threat – pardon the clumsy pun. It has been over thirty years since our last influenza pandemic, and that one was also mild.
Additionally, a portion of our population has “never had the flu”, real influenza, the kind that puts you abed for several days wishing you would just ahead and die already. These people have no conception of what “a case of the flu” feels like – if they did I don’t think they would be quite so cavalier about becoming infected. I’ve had “the flu”. I had a pretty nasty bout of influenza in 1978. I have all the respect one could have for “the flu” because of that infection.
The Wall Street Journal offers us this today:
Swine Flu Is Severe for Some, Studies Show
[Excerpts]
A girl receives the H1N1 nasal mist vaccine at Wake County Human Services in Raleigh, N.C., on Friday.
Only a small portion of those who develop swine flu become severely ill. As of Aug. 22, 278 people had been admitted to ICUs in Canada, about 3.9% of total reported cases for that period, according to the Canadian study.
Swine flu is mild for most people, but some become so gravely ill that they require sophisticated techniques, equipment, and aggressive treatment in intensive-care units to survive, according to three new studies.
“This is the most severely ill that we’ve ever seen people,” said Anand Kumar, lead author of one of the studies and ICU attending physician for the Winnipeg Regional Health Authority in Canada. “There’s almost two diseases. Patients are either mildly ill or critically ill and require aggressive ICU care. There isn’t that much of a middle ground.”
Some of the patients Dr. Kumar and his colleagues saw were so sick they had to be saved with a technology similar to one used for patients undergoing heart bypass.
The studies of critically ill patients in Canada, Mexico, Australia and New Zealand, published online Monday in the Journal of the American Medical Association, suggest that intensive-care units could be stretched as a second wave of H1N1 swine flu builds in Northern Hemisphere countries such as the U.S.
American public-health and hospital officials have expressed concern that the country’s intensive-care facilities may not be up to accommodating the swell of patients they could potentially end up with in large-scale outbreaks.
[snip] In Canada, Australia and New Zealand, doctors turned to an advanced technology similar to one used for cardiovascular surgery when prolonged mechanical ventilation and other therapies proved not to be enough for some H1N1 patients. “Extracorporeal membrane oxygenation,” or ECMO, acts as a lung machine, circulating a patient’s blood through a system that adds oxygen. The severely ill patients’ lungs were so filled with fluid they couldn’t get oxygen to their blood.
[snip] Only a small portion of those who develop swine flu become severely ill. As of Aug. 22, 278 people had been admitted to ICUs in Canada, about 3.9% of total reported cases for that period, according to the Canadian study.
How does one communicate risk when many do not have an existing frame of reference within which to “internalize” that risk? There’s an entire specialty devoted to the psychology of it: Risk Communications. I’m not expert in it, I’m not even good at it most of the time, but I’ve been doing this long enough to have been continually frustrated by the difficulty of the task.
An excerpt from the New York Times today is yet another attempt to debunk the misinformation campaign of the anit-vaccine lobby. Please follow the link for the entire offering,
Nothing to Fear but the Flu Itself
By PAUL A. OFFIT
Philadelphia
[excerpts]
PUBLIC health officials are now battling not only a fast-spreading influenza virus but also unfounded fears about the vaccine that can prevent it.
Since April, more than a million Americans have caught H1N1 flu, more than 10,000 have been hospitalized, and about 1,000 have died, including 76 children. And it’s only the beginning of October. Yet, in a new survey, 41 percent of adults said they will not get vaccinated.
The good news is that for the first time in more than 50 years we’ve made a vaccine against a pandemic strain of influenza before the onset of winter, when lower temperatures and humidity allow the virus to spread more easily. Distributing this vaccine to those who need it most — pregnant women, health care workers, children older than six months and people with compromised immunity — will be difficult enough. But the task is made harder by the various myths, spread on TV talk shows and Web sites, suggesting that Americans have more to fear from the vaccine than from the deadly disease it prevents. Here are some of those myths, and why they’re wrong….
[snip]
New myths will inevitably arise as some of the millions of people who are inoculated against H1N1 flu suffer unrelated illnesses. Health officials will keep a close eye out for any real problems. One can only hope that the American public will understand that subsequence isn’t necessarily consequence, and not be scared away from a vaccine that can save lives.
Paul A. Offit, the chief of the infectious diseases division of the Children’s Hospital of Philadelphia, is the author of “Autism’s False Prophets: Bad Science, Risky Medicine and the Search for a Cure.”
I left out Dr. Offit’s debunking because this post is already too long and those who have a genuine interest in seeking the truth will follow the link to read the entire piece. Those who are not interested in learning the truth would not benefit even if I copied Dr. Offit’s OpEd in its entirety.
It is extremely difficult to dissuade people from what they believe, even when what they believe is wrong. We are “emotionally invested” in those things we believe. For the most part, what we believe has a limited impact on our lives, and an even smaller likely impact on those around us. If we are parents of minor children what we believe about influenza in general, pandemic influenza while one is occurring, and vaccines [generally and the pandemic vaccine] has impact on our children.
I would also posit that when it comes to pandemic influenza and its protective vaccine it has an impact on our wallets, or at least some wallets. Importantly to me: My wallet is one of those wallets impacted.
The health insurance premiums I pay and my husband pays [separately insured with two different health insurance companies] are based on what “plan costs” were the previous year. The more plan participants use their health insurance the greater our premiums. The higher the cost of those services the greater the overall plan expenses are.
The company I work for has a statistically probable likelihood of having several plan participants [whether primary or dependent] suffering an H1N1-2009 infection severe enough to require in hospital intensive care. Even one of these cases [above and beyond the plan's normal experiences with intensive care incidents] will affect my health care premium when we renew our policies next fall. If the plan suffers ten infections requiring ICU care my premium will be severely impacted. That’s real money out of my wallet.
Those on publicly funded healthcare plans, Medicare and Medicade, impact the tax dollars the federal government helps itself to out of my pay check. That’s real money out of my wallet.
Those who receive no cost [to them] health care at the local public hospital because they have no health insurance impact my local taxes, my state taxes, and my federal taxes. That’s real money out of my wallet.
So, in the end, what people believe about the threat of pandemic influenza, the statistical likely severe cases, small though the percentage is, and all those who are going to refuse to be protected by the pandemic vaccine does impact me — personally– because it impacts my wallet.
Some people have no choice, or no choice right now. I can’t yet receive the H1N1-2009 vaccine because I’m pretty far back in the line of who gets it when. If I become severely ill and require ICU care the impact I have on my health care plan’s costs will be at no fault of mine, up until the time I am allowed to receive my vaccine. Once I am able to receive and choose not to be vaccinated, then I am willfully telling all of my fellow plan participants that I don’t give a spit about how my actions impact their wallets.
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This weekend found me embroiled in a particularly personal forum dust-up on this issue. It is not unusual for me to be involved in “internet dust-ups”, but it is unusual for me to become so personally outraged. As I said in one of the conversations – up front and plainly:
“I have *extreme* difficulty keeping my *contempt* for the anti-vaccine gang from showing. I have *extreme* difficulty in remaining patient in the face of self-inflicted ignorance. I have *extreme* difficulty in quietly accepting the willful endangerment of dependents, be they our children or our elderly, or those otherwise vulnerable populations-segments-cohorts.”
We are supposed to understand and respect a parent’s “right” to refuse to have their children vaccinated, and since only about 40% of parents are willing to have their children receive the pandemic influenza vaccine, their position and opinion is the loudest one heard. Never mind that the opinion and decision is stupid, ill-informed, ignorant, and potentially reckless.
The anti-vaccine crowd has done such a thorough job with their disinformation rhetoric that roughly 60% of parents believe the vaccine is the danger their children face, not the novel influenza virus H1N1-2009 [Swine Flu].
Most people believe that the pandemic influenza vaccine is an “experimental” vaccine.
It is not.
The pandemic vaccine is the exact same vaccine we have been producing for influenza for over forty years – more than 4 decades. The only thing different about the pandemic strain vaccine and the seasonal influenza vaccine is the swapping of the two genes that code for influenza’s outer proteins, the NA and HA.
Those genes are swapped out with a certain cyclical regularity as our seasonal influenza changes [drifting or shifting] and the HA and NA used is no longer a “good match” to the circulating strain.
No one indulged in histrionics when the seasonal vaccine received the genes pertinent to the latest dominate strains of seasonal influenza, the Brisbane strains, yet for the pandemic version we are “rushing untested vaccine”, interpreted as “unsafe”, and “making our kids guinea pigs”.
The pandemic vaccine is manufactured in exactly the same way, using the same outdated, inefficient, and expensive process we have used to manufacture our seasonal vaccine for those more than 4 DECADES. It is grown in chicken eggs. It may be outdated, inefficient, and expensive, but at least we have a decades long track record for safety and efficacy to look to.
Most people believe the vaccine is adjuvanted. The US pandemic influenza vaccine is not.
There really isn’t much to explain. It’s a “Yes – No” kinda thing. It is not, so that would be “no”.
Many parents believe the hysteria about Thimerasol causing autism irrespective of having no science to back up that belief. Regardless, the children’s vaccine does not contain Thimerasol, nor does the inhaled version: FluMist. Thimerasol free. How much plainer does that need to be made? It is either in the vaccine or it is not. In the case of the injectable children’s vaccine and FluMist: It is not.
I could go on with the more “wing nut” beliefs circulating among people, but I will spare the reader – and myself.
But back to my weekend dust-up:
A mother on the flu forum I participate on posed the question of whether or not she should get her asthmatic son vaccinated with the pandemic and/or seasonal influenza vaccine. A child with asthma. I found the question being posed by someone who was a member of Flublogia itself to be as painful as it was shocking. Flublogia is the umbrella name for the social media sites [forums & establish/credible blogs] devoted either entirely, or in large part, the issue of novel influenza viruses and pandemics from same. One would think that those who occupy Flublogia would be a bit more well informed of very simple FACTS. Alas, they are not.
One would also expect medical professionals to be more informed than the average ill-informed citizen. Alas, they are not. Two trained nurses chimed into the conversation about the vaccine for H1N1-2009 being “experimental” and “untested” and of “unknown safety and efficacy”. Further, because I am not a trained medical professional I couldn’t possibly know WTF I’m talking about [paraphrased]. ’Tis a fact, I am NOT a trained medical professional. But I am also not ignorant, and they, at least on this issue, clearly are, their professional training aside.
Nurses and doctors are victims of the very same lies and misinformation as the general public. Thankfully, not quite to the extent as the average [non-medical professional], but still, shockingly frequent.
Many people have not enjoyed the plethora of factual information to be found sprinkled all around Flublogia and they have very little chance of over coming the anti-vaccine rhetoric so thoroughly propagated throughout every media outlet. I may worry for them and even pity them in some ways, but I do not blame or necessarily fault them. Hearing and reading the truth for the vast majority of people would be nearly impossible for all the noise produced by the anti-vaccine campaign. They surely would have come across the information but it is hardly “noisy” enough to ‘break through” and register.
As is my habit, I offered my opinion on this mother’s perceived dilemma. If you don’t wish to risk your [asthmatic] child DYING get him vaccinated. Being quite “blunt” in my exhortations I was viewed as attacking this “conscientious, loving, well-intentioned mother, just trying to do the best she can” by those who agreed with her on not “risking” having her child vaccinated [and by default, disagreed with me]. Not a single one of them expressed concern over the asthmatic child should he just happen to be so unlucky as to come down the H1N1-2009. I guess he is an “acceptable loss” [see below] as long as everyone can smugly exercise their free will and “rights” [for their children; they don't get a say in all of this].
Congratulations were roundly extended to this thoughtful and well-meaning mother for her steadfastness in the face of my “ranting”. I’m quite sure she, and they, feel vindicated wrapped in their shared mutually-affirming ignorance.
Meanwhile….
CDC: Seventy-Six U.S. Children Have Died From H1N1 Flu
By JENNIFER CORBETT DOOREN
WASHINGTON
– Federal health officials said 76 children have died from the H1N1
flu since the virus was discovered in April, which appears to be a
higher rate than pediatric deaths caused by the seasonal flu.Anne Schuchat, the director of that National Center for Immunization and
Respiratory Diseases at the Centers for Disease Control and Prevention
said that, by comparison, 46 to 88 children died each year during the
past three influenza seasons.
She said she expected additional pediatric deaths from the H1N1 flu.
While most of the children had underlying medical conditions, Dr.
Schuchat said 20% to 30% of them didn’t.The H1N1 virus has hit children and young adults at higher rates
than older people, who are believed to have some sort of immunity from
exposure to viruses linked to past influenza pandemics. So far most
influenza illnesses are being caused by the novel H1N1 virus.
How do you tell a well-intentioned mother she is dead wrong?
As plainly as you can.
Then, you accept defeat and move on… and hope that she is one of the lucky ones if her son contracts H1N1-2009. If she isn’t she will not only be dead wrong but her son might just be plain, irreversibly, dead.
In my black & white, simplistic, world view a parent has a moral obligation to protect their children from harm when and where possible — and within reason. We cannot wrap them in bubble wrap until their 18th birthday [no matter how much we might want to].
Coincidentally, to say nothing of tragically, this story hit the wires this weekend:
Faith-healing parents charged in death of infant son
On the last day of Kent Schaible’s life, his parents and pastor intensely prayed over his 32-pound body, which, unbeknown to them, was ravaged by bacterial pneumonia.
When the 2-year-old boy finally died at 9:30 p.m. Jan. 24 inside the family’s Northeast Philadelphia home, the pastor called a funeral director to take the boy’s remains to the Philadelphia Medical Examiner’s Office.
At no time that day, nor in the week-and-a-half prior, did Herbert and Catherine Schaible seek medical treatment for their son despite his sore throat, congestion, liquid bowel movements, sleeplessness and trouble swallowing, Assistant District Attorney Joanne Pescatore said in court yesterday.
“All it would have taken is a simple visit to a doctor for antibiotics or Tylenol, maybe, to keep this child alive,” she said during the couple’s preliminary hearing.
The Schaibles were no doubt loving and well-intentioned parents… right up until their son loosed his tenuous grip on life and died.
Parents have extensive, free of interference, control of how they raise their children. Over all, and in general, that is the way it should be. Over all, and in general, it is the most evolutionarily intelligent way for humans to raise their children given we no longer live as small bands of hunter-gatherers. But our system means we have parents, no matter how loving and well intentioned they may be, occasionally making that stupid — and fatal — decision in the exercising of their rights to raise their children as they see fit… and make medical decisions for their children. Irrespective of how ignorant or well informed they may be — it’s their right — usually.
A “right” is not always Right, however. After all, in the United States one person used to have the right to own another. A husband had the right to beat his wife — and/or children — with whatever severity he deemed “appropriate”. I believe a parent doesn’t have the moral Right to deny a minor child a vaccine that might save their life. Yes, even though statistically most children will recover. What about the statistically unlucky ones? Have we no obligation to them? Do their parents have no moral obligation?
Or, are they just the acceptable losses in our pandemic? What’s a few fewer children in our over populated world anyway? And, could it be reasoned that removing the children of ignorant parents is evolutionarily advantageous to our species as a whole? I could make the case that it is. Unvaccinated children are risks to the larger community, and if parents aren’t willing to vaccinate for a pandemic event what else are they refusing to have their children vaccinated against?
The continent of Africa is having a resurgence of polio because parents fear the vaccine and are refusing to have their children receive one. I don’t know about anyone else, but I’ve enjoyed living a life free of the threat of contracting polio, a threat that may one day soon suddenly appear again, as suddenly as H1N1-2009 burst onto the world unawares in April of this year.
No, I do not believe any child’s death is “an acceptable loss”. That’s kinda the point behind my week long rant… every child deserves the best possible chance to survive to live their full compliment of naturally allotted years. A child’s death is a horrific loss, to those who love and cherish them and to the wider community denied what contributions that child might give in the fullness of their lives.
For those who would prefer a more measured and reasoned posting on this issue, one can be found at EffectMeasure:
Why the epidemiology of swine flu matters
[Excerpt]
Posted on: October 11, 2009 2:00 PM, by revere
If you are hesitating to be vaccinated for swine flu this year, perhaps this post will help you make up your mind. If it does, I hope it pushes you to get vaccinated, but whatever persuasion we attempt here will only be from a recital of what we know of the epidemiology of this pandemic. Because it is the different epidemiology that is the main feature, not the clinical characteristics or the virulence of the virus. So far this looks pretty much like a standard influenza A virus – except for the epidemiology. Since I’m an epidemiologist, you might expect me to think this is important, and I do. Epidemiology is the public health science that studies the patterns of illness in populations. One kind of pattern we study is who is getting sick. And it is a change in this pattern that is one of the big differences between a pandemic strain and a seasonal strain. Pandemic strains have a greater tendency to infect and make sicker much younger victims. In seasonal influenza it is the over 65 age group that contributes most of the serious illness and deaths, but with pandemic strains (not just the current one), lack of immunity in the population makes those under age 65 a bigger target and they sicken and die proportionately more than in a non-pandemic season. And that’s exactly what we are seeing this year. The story that made the headlines on Friday was that 19 more pediatric deaths were added to the pediatric death toll in week 39, although not all of these children died in that week.
The dates of death for the 19 stretched between July 19 and October 3 because of the way the tally is done. Starting in the 2003 – 2004 flu season deaths from influenza in people below the age of 18 became a nationally notifiable disease, reported to CDC through state epidemiologists. Each state has its own way of ascertaining the number.
Some states are more complete and more timely than others, so notifications that come in a particular week can, and do, represent deaths that occurred over varying time periods, as in the instance of the 19 added this week. Still, it is clear that the young population is being hit particularly hard in comparison to the last three years for which we have data. 76 have died from swine flu since it made its first appearance in April, and 29 of those deaths have come since August 30, i.e., 29 in 5 weeks and those 5 weeks are extremely early in the flu season. In fact they occurred before the official administrative flu season even started (week 40).The pattern of pediatric deaths and its difference from previous years is dramatically shown in this graph from CDC’s weekly flu report:
[snip]
You once again see the altered age pattern, this time very dramatic when comparing the youngest age group with the oldest. For those of us in the over 65 age group, the seasonal has barely begun. We are just inching our way up from typical summer levels. There’s a long way to go before we get to where we would usually be by the end of flu season. My age group looks pretty normal for this time of year. But if you look at the other panels you see that several have already exceeded, in the first week of the official flu season, the level of season risk we would have expected by the end of the season. Babies and toddlers are two thirds of the way there already (remember the scale is different for them so the same height is a higher risk than compared to the 2 to 4 year olds). The 2 to 4 year olds are already there and everyone between 5 and 49 years old has already exceeded their year end risk at a time when the season is usually just starting. The 50-44 year old group is already at seasonal average and then there’s the over 65 age group, the exception that proves the rule: this is a pandemic strain.
[snip]
The seasonal and swine flu vaccines are not intrinsically different except for the flu strains they contain. We change flu strains every couple of years routinely and these vaccines are made in the same way as we have been making them for many years. The only difference is a strain change, which is routine. This means that we have had extensive experience with the swine flu vaccine already, extending over years and hundreds of millions of delivered doses. It is not untested. Far from it.
The most rational thing to do at this moment, given what we know and don’t know, is to get vaccinated with both seasonal flu and swine flu vaccines. That’s what I’m going to do. I already got my seasonal flu shot and I’ll wait in line for my turn for the swine flu vaccine and get it as soon as I can. You not only protect yourself but you help prevent spread of flu to others.
It should be required reading for all parents who have yet to make up their minds on whether or not to allow their children to receive the pandemic vaccine.
Finally, for those who think I’ve totally slipped my last remaining tenuous grip on sanity, I will leave you with this snippet from Abbott’s Flatland: A Romance of Many Dimensions since the conversations over this past weekend so strongly brought it to mind…
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How I then tried to diffuse the Theory of Three Dimensions by other means, and of the result
[snip]
And yet at times my spirit was too strong for me, and I gave vent to dangerous utterances. Already I was considered heterodox if not treasonable, and I was keenly alive to the danger of my position; nevertheless I could not at times refrain from bursting out into suspicious or half-seditious utterances, even among the highest Polygonal and Circular society. When, for example, the question arose about the treatment of those lunatics who said that they had received the power of seeing the insides of things, I would quote the saying of an ancient Circle, who declared that prophets and inspired people are always considered by the majority to be mad; and I could not help occasionally dropping such expressions as “the eye that discerns the interiors of things”, and “the all-seeing land”; once or twice I even let fall the forbidden terms “the Third and Fourth Dimensions”. At last, to complete a series of minor indiscretions, at a meeting of our Local Speculative Society held at the palace of the Prefect himself, — some extremely silly person having read an elaborate paper exhibiting the precise reasons why Providence has limited the number of Dimensions to Two, and why the attribute of omnividence is assigned to the Supreme alone — I so far forgot myself as to give an exact account of the whole of my voyage with the Sphere into Space, and to the Assembly Hall in our Metropolis, and then to Space again, and of my return home, and of everything that I had seen and heard in fact or vision. At first, indeed, I pretended that I was describing the imaginary experiences of a fictitious person; but my enthusiasm soon forced me to throw off all disguise, and finally, in a fervent peroration, I exhorted all my hearers to divest themselves of prejudice and to become believers in the Third Dimension.
Need I say that I was at once arrested and taken before the Council?
However, after reading the actual news item I take acceptation to the headline. This is not a legal requirement, this is a requirement of continued employment – they are two different things. New York health care workers are completely free to not get vaccinated and their employers are completely free to fire them if they do not.
Via Newsday.com
Mandatory flu vaccination splits workers
Despite a planned rally in Albany Tuesday to protest a state regulation requiring health care workers be vaccinated against influenza — both seasonal and swine flu — New York’s top public health official predicts dissenters will ultimately extinguish their anger and roll up their sleeves.
The regulation, which was approved in August, comes with a stinging addendum: Get vaccinated or get fired.
But some nurses and many other health care providers say the regulation violates their personal freedom and leaves them vulnerable to vaccine injury. And they cite deaths associated with the last federal government swine-flu vaccination program in 1976.
Refusing to be immunized against H1N1 because of the vaccine debacle in 1976 “is like saying a plane crashed 33 years ago so I’ll never fly again,” said Dr. Richard Daines, New York State health commissioner.
New York is the only state in the nation to require that health care workers be vaccinated, though other states are considering such measures. Health workers, including doctors, must be immunized by Nov. 30. Opponents say it’s simply unnecessary.
I am a staunch and vocal proponent of immunizations, the influenza immunization included. I am also in absolute full agreement with this employment requirement. Medical professionals come into physical contact with the patients they serve. Setting aside proactively protecting one’s own health, becoming infecting and passing the infection on to others, some of whom may develop life threatening complications – and some of those might be fatal is something to be guarded against with the means we have at our disposal, in this case that is a vaccine, along with standard hospital infectious disease protocols. When someone’s health and life are at risk extra burdens are placed on those who introduce the element of risk.
It is technically no different than the requirements I had to meet yearly to remain a certified police officer; without certification a person cannot be a law enforcement officer in the state of South Carolina. Those requirements were to protect the public I was out protecting. Some professions carry extra burdens for those who are in them, it’s just the way of it – accept it or move on.
Several registered nurses said they will neither contract nor transmit the flu because they’re constantly washing their hands.
The ignorance of that belief is astounding. I can’t help but wonder if these nurses have read or heard anything about Canadian nurses and the SARS outbreak in that country. Canada was not the only country that had nurses become infected with SARS, some of which were fatal.
SARS was not as transmissible as the influenza virus and SARS was also not infectious until after obvious symptoms presented. With influenza a person can be infectious prior to physical symptoms, in other words, a person can infect someone else [potentially] before they even know they are infected themselves. The exact threat or how much virus is shed prior to symptoms has not been quantified.
[snip]
“We cannot force employees to be vaccinated; however we do not have an infinite number of non-patient care positions available to reassign those who simply refuse the vaccine,” said hospital spokeswoman Lauren Sheprow.
To restate my earlier point: Accept it or move on. If the choice is to not receive a vaccine that would be a choice freely exercised. A choice freely exercised does not a victim make.
I applaud New York’s decision. It protects the most people in the best manner we have at our disposal. Sometimes, the best we can do is imperfect, but – it’s the best we can do.
]]>This from Hong Kong’s RTHK.org
HK warned of second wave of swine flu
28-09-2009
The head of the Centre for Health Protection, Dr Thomas Tsang, has warned that a second wave of swine flu might hit Hong Kong early next year, but a vaccine should be ready by that time. Starting from today, the number of new infections will no longer be reported daily, except for critical cases and fatalities. Dr Tsang says the virus is now so widespread that the daily figure has become meaningless. But he says the government is still closely monitoring developments. Meanwhile, another swine flu related death has been reported. The victim, a 66-year-old man, who was also suffering from diabetes and a heart condition, died on Sunday at Yan Chai Hospital. So far more than 26,500 cases of human swine flu have been recorded in Hong Kong.
It’s probably bad form to say abnormal influenza seasons are going to be the New Normal, but they will be for a few years. Novel influenza viruses, once attaining sustained transmission between humans have never just gone away, as SARS fortunately did. We have dealt with strains until a new one comes along that “uses up” all the susceptible hosts, the older strain becoming extinct in humans.
As such, I wonder if the use of the term “wave” is not entirely helpful to our understanding of what we will be dealing with for the next several years. No doubt a rhetorical question since, like “Swine Flu”, it has entered the popular vernacular irrespective of its correctness.
If we could wean ourselves from terms that support the concept that H1N1-2009 is strange and alien and instead accepted that it is now our flu de jour, perhaps we could get about the business of readying ourselves to deal with it. By dealing with it I mean get our immunizations and prepare to see excessive demands on our medical infrastructure.
Since we will be dealing with H1N1-2009 for the foreseeable future we need to think of the needed investments, whether financial, medical, or immunological, as investments that will pay out long term dividends instead of “unbudgeted one-off” expenditures for a “wave” or two.
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