5.03.2009

so much for pandemic: h1n1 flu already declining in mexico

This past week, we've witnessed the mainstream media at its typically irresponsible worst. When I saw the word "pandemic," I thought, you've got to be kidding me.

Sure enough, cases of so-called "swine flu" are already declining in Mexico. A total of 19 people have died from the disease in Mexico to date.

The World Health Organization quoted in this CBC story cautions that viral outbreaks can decline before increasing again. But they also increase before declining, and they can decline and continue declining.

We're supposed to be "vigilant". But this supposed vigilance is just the ordinary precautions we should always take. Avoid close contact with sick people. If you're sick, avoid contact with other people. Wash your hands.

When WHO raised its pandemic alert level from 4 to 5, that only meant human-to-human spread of the virus had been confirmed in at least two countries. Given that flus spread like this all the time, it's hardly a cause for panic. But media loves panic, and media consumers love a change of story after being beaten senseless with economic gloom and doom.

This column by Andre Picard, health columnist for the Globe and Mail warns against panic. Sadly, Picard's own employers have been among the worst offenders, using the word "pandemic" immediately and generally fear-mongering at every opportunity.
Yet, the media seems to have lost sight of one of the key lessons of SARS: Beware the numbers game.

During SARS, journalists tracked the number of cases, suspected and confirmed - not to mention the body count - obsessively.

Yesterday, the swine flu numbers game kicked into high gear, with hour-by-hour updates. This is misleading and unhelpful, neglecting the basic science of epidemics: Infections rise according to a predictable pattern, following an increasingly rapid curve until they hit a peak, then tail off. This is precisely what is happening with swine flu. There is no question that in the days - and likely weeks - to come, the number of confirmed infections and deaths will increase. This is not, in itself, a cause for panic. It is entirely predictable.

SARS was essentially a hospital-acquired infection. Virtually everyone who contracted the disease, after a traveller brought the pathogen from Hong Kong to Toronto, did so in a hospital, or was infected by a close relative who worked or was treated in a health-care facility.

There was never a threat in the general community. And, in the end, there were only 44 SARS deaths in Canada. (This is not to minimize these deaths, but to provide context: There are about 12,000 deaths annually in the country caused by other hospital-acquired infections.)

To reiterate, swine flu remains a travel-related infection that has affected relatively few people.

So far, the outbreak of swine flu news coverage has been far more severe than the outbreak of the disease itself. The good news is that there are stark differences in the response of politicians and public-health officials to swine flu, compared with SARS.

When SARS came along in 2003, Canada's public-health infrastructure was in disarray, relations between provincial and federal health officials were poisonous, and Canada spent more time bickering with the World Health Organization than working in tandem. This time, there is a co-ordinated response and it is led by people with expertise in infectious disease.

David Butler-Jones, Canada's chief public-health officer - a position created in direct response to the SARS debacle - and his provincial and territorial counterparts are singing from the same hymn book. Similarly, the response of politicians has been impressive. Federal Health Minister Leona Aglukkaq has shown quiet leadership, demonstrating enough smarts to defer to public-health experts.

The change has been even more spectacular in Ontario. The final report of the SARS inquiry described Ontario's public-health system as "broken, neglected, inadequate and dysfunctional," but today the Ontario Agency for Health Protection and Promotion is not only functional, but on the leading edge. The agency sent out an alert about a worrisome disease outbreak in Mexico on April 21, before the swine flu was identified as a new pathogen. It is hard to imagine how it could have done more.

Public-health officials have communicated well, delivering the message that we need to be concerned about the possibility of a pandemic flu, but not alarmed by what has occurred. The message has, unfortunately, sometimes been lost in the media frenzy.

Candace Gibson, an associate professor of journalism at the University of Western Ontario, noted there is an unofficial rule in medical literature (where multi-author papers are common) that there should never be more authors than subjects.

Similarly, Prof. Gibson says, there should never be more stories about a health threat than actual sick people.

With swine flu, hopefully, that balance will be achieved not with more death, but with a little more restraint.

Update. I wrote this off the top of my head, without much thought to context. Fortunately, wmtc readers are less lazy. Please read the first comment for more.

21 comments:

redsock said...

In 2003, CBS reported that an average of 36,000 people now die each year because of flu. That's nearly 100 each day. And there was/is no media coverage.

Last month, the UN reported that a child dies of malnutrition somewhere in the world every 6 seconds. That's 14,000 children every single day. That report was released on April 8. According to the blog Left I, "not a single 'western' news source has carried the story".

L-girl said...

Thanks for that. I edited the post to draw attention to this excellent comment.

John F said...

My favourite bit of irresponsible "journalism" came from the Fox News coverage (as reported on the Daily Show). They put together a little intro graphic (as all the cable news outlets do) featuring foreboding music, a black skull and crossbones, and the title "The New Black Death?"

redsock said...

Now that is funny. I have to believe some people at Fox thought it was funny and over the top, like a Weekly World News story. If they were entirely serious, then I don't know what to say.

How many people would have to die for a plague to actually earn the title of Black Death Jr.? One billion? More?

deang said...

Thanks for making us aware of the Left I blog. That looks like a good one. I'd heard figures like that talked about elsewhere in recent days in the context of this supposed pandemic and it strengthened preexisting suspicions. My initial thought when I learned that the "pandemic" was only affecting a a couple dozen people was that it was being emphasized in the news to whip up anti-immigrant hysteria in the US, which indeed it has.

L-girl said...

"How many people would have to die for a plague to actually earn the title of Black Death Jr.? One billion? More?"

Well, here are the numbers (according to Wikipedia) on the 1918 influenza pandemic.

"The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of those who were infected died. Note this does not mean that 2.5-5% of the human population died; with 20% or more of the world population suffering from the disease to some extent, a case-fatality ratio this high would mean that about 0.5-1% ( ≈50 million) of the whole population died.[11] Influenza may have killed as many as 25 million in its first 25 weeks. Older estimates say it killed 40–50 million people[3] while current estimates say 50 million to 100 million people worldwide were killed.[12] This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the Black Death.[13]"

* * * *

Btw, I was amazed to hear media outlets referring to the 1918 disease as "Spanish flu". Why not call mononeucleosis "kissing disease" and AIDS "gay cancer", while you're at it.

redsock said...

Wiki on Black Death:
75 million deaths worldwide (estimated, of course); 25–50 million deaths in Europe (or 30%-60% of Europe's population); may have reduced the world's population from 450 million to between 350-375 million.

75 million is 16.7% of 450 million.
100 million is 22.2%.

Current world population is 6,777,000,000.

16.7%: 1,131,759,000
22.2%: 1,504,494,000

So somewhere between 1.1 and 1.5 billion people.

Fox would shit bricks if 500 Americans (not total people, just Americans) died.

L-girl said...

"My initial thought when I learned that the "pandemic" was only affecting a a couple dozen people was that it was being emphasized in the news to whip up anti-immigrant hysteria in the US, which indeed it has."

Oh of course! I hadn't even thought of that.

In Canada, it's used to feed into the "fear travel to Mexico" theme. A few Canadians were robbed or assaulted while taking resort-style holidays in Mexico, plus two people were murdered last year (was it last year? maybe longer ago), and now Mexico is supposed to be this big scary place for Canadians.

It seems to dovetail very nicely with many Canadians' disinclination to travel.

redsock said...

deang: it is good, very strong on israel's crimes, the us's support for them, and on cuban issues too.

for some reason, when I put my cursor over his blue links, nothing happens. it acts like regular text. so i can't cut and paste anything from there.

redsock said...

The flu also seems to have pushed any discussion over the release of the Bush torture documents well out of the spotlight.

impudent strumpet said...

"Gay cancer"??? Seriously? Come on, get your slander right, at least pick something contagious.

L-girl said...

Seriously. AIDS was called that in the early 80s, before much was known about it. And virulent US right-wingers have been known to continue to refer to it that way.

richard said...

Malaria kills about 2000 people a day but that's happening far away from us and the CNNs of this world are not interested. But when WE are threatened no irresponsible metaphor is too strong.

RevDave said...

The trouble, it seems to me, is that the media is capitalizing on a new definition of "pandemic" from the WHO which isn't really what we would consider a pandemic.

The new "technical" definition of pandemic simply means that there's a new flu that is spreading regularly in at least two countries in one geographic region (level 5), and another country in a second geographic region (level 6). It doesn't say anything about how deadly or the flu is, or about whether it's in any other countries. It certainly doesn't mean that everybody is about to get it.

Cornelia said...

Thanks so much, Laura. I don't like this kind of journalism either. Ugh, it's awful!!! AIDS is pandemic and abstinence-only-education makes it worse but...

Cornelia said...

Once some friends of mine over here and a friend of mine across pond freaked out at the same time.
It was tough...My comment was: "What sort of pandemic could that actually be? If I was not an enlightened, well-informed person, I might think bird flue...or what?"

Cornelia said...

The last comment was just on a lighter note, in order to make a point about hysteria about pandemics.

Cornelia said...

Thanks so much for the info, Rev Dave.

Cornelia said...

It's really good to know.

Cornelia said...

Trust the Republicans to try to take advantage of it by instigating racism and prejudice. Scapegoating bunch!!!

Cornelia said...

Once again, thanks so much for all the info. I had to reassure two friends of mine this week so it was very helpful and came in handy!