The Swine Flu Boogeyman

Posted: Nov 09, 2009 12:00 PM

"The boogeyman will get you!" parents sometimes tell misbehaving children. With about 40% of parents saying "no!" to vaccinating their kids for swine flu, apparently health officials think turnabout is fair play. And the media seem happy to help.

You see it in such headlines as "CDC Shocker: Swine Flu Killing Young People at Record Rate!" And in lines of panicked parents queued outside vaccine clinics like fans trying to score tickets to a Paul McCartney concert. And in schools closing willy-nilly, which could cost the nation tens of billions, according to a recent Brookings Institute study.

Which is so sad, because this boogeyman is not much more substantial than the legendary one. And adding the proverbial insult to injury, parents are told they must get their children vaccines that--because of the shortage and despite Obama administration promises--they can't get.

As told, the tale does sound scary. Almost a quarter of deaths from swine flu since Sept. 1 have occurred "in young people under the age of 25," Centers for Disease Control and Prevention (CDC) official Anne Schuchat declared at a press conference. Among cases of seasonal flu, those over 65 account for about 90% of deaths.

What Schuchat didn't say is that, as tragic as any child's death always is, in this case they merely represent a disproportionately larger slice of a very small pie. Very few people are dying of swine flu in any age category. Put another way, it's not that younger people are being slammed but that older ones are catching a break.

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Hence among 65,000 college students afflicted with CDC-defined "flu-like illness" seriously enough to seek medical help, according to an American College Health Association running survey, there have been only 123 hospitalizations and zero deaths. That in turn reflects swine flu as a whole, which in the seven months since the outbreak began has apparently killed fewer Americans than normally die every two weeks from "ordinary" flu during the season.

But the CDC claims to have scary numbers as well as percentages, with 85 attributed swine flu fatalities under age 18 in the last two months, as of Oct. 30. By comparison, in the 2006-07 and 2007-08 seasons there were 78 and 88 such deaths reported, respectively. Although it appears the epidemic has peaked, attributed child swine flu fatalities this season will eclipse them. But it probably won't mean much according to James Chin, a professor at the University of California, Berkeley, and former World Health Organization epidemiologist.

That's because, he says, the deaths attributed to swine flu both now and in the future will reflect the rule that "the more you look, the more you find."

Understand first that neither the seasonal nor the swine flu death figures are supposed to represent total numbers, but rather what the CDC surveillance system nets. Causes of death are determined not by computers but by human beings who are sensitive to what Chin calls "media hype."

True, to be labeled a swine flu fatality you have to have the virus. But after that it gets tricky. According to the CDC, "Many millions" of Americans have been symptomatic with swine flu and, therefore, says Chin, many people "will be dying of any number of things but just happen to be infected."

The CDC says about 30% of the cases classified as swine flu fatalities had chronic medical conditions such as asthma, cerebral palsy, and muscular dystrophy. These could be contributing causes, but they can also kill on their own. The more swine flu is in the news, the more likely it will be listed as the primary cause of death.

Such a phenomenon, Chin says, occurred during the early 1980s media blitz over the tampon-related "toxic shock syndrome epidemic." According to Chin, "Every time there was a headline, toxic shock cases shot up. It turns out it was occurring in small numbers. It was blown out of proportion." A later CDC analysis showed that through 1986 fewer than 200 women died, including those who never used tampons.

Chin says a bonafide apples-to-apples comparison might still show swine flu claiming more children's lives than does seasonal flu typically, but based on his observations "It still can't be that much more severe."

It's also necessary to view childhood flu deaths in perspective to all childhood deaths.

Annually, about 50,000 Americans perish before their 18th year. Unintentional injuries alone kill about 5,000 children below age 15, according to the National Safety Council. Of these, 1,100 are drownings and an additional 600 are from suffocation. These occur each year and yet could be prevented without quarantining Johnny or Jane at the South Pole.

Specifically regarding infectious diseases, there are probably few Americans who fear methicillin-resistant staphylococcus aureus, or MRSA – indeed many probably haven't heard of it. Yet each year it kills about 19,000 Americans, including an estimated 150 below the age of 18.

It's sad that public health officials seem to believe that getting people to do "the right thing" requires presenting a modern version of the Slaughter of the Innocents. It's also ironic in that surely some vaccination antipathy reflects the constant cries of "Wolf!" since the swine flu outbreak began.

There was the first declaration of a public health emergency in late April, with almost no U.S. deaths at the time. Then came the President's Council of Advisors on Science and Technology "plausible scenario" of 30,000 to 90,000 deaths with a "mid-October" peak. It came up rather short--though the latest CDC weekly FluView report may indeed indicate the peak of hospitalizations and deaths came in mid-October.

For that matter, consider five years of scary promulgations and headlines about avian flu such as "Flu Pandemic Could Kill 150 Million, U.N. Warns." Remember avian flu?

It's folly to think you can solve a problem caused partly by crying wolf simply by crying wolf even louder. That just squanders the credibility among public health officials--credibility which should be their most precious asset.

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