Hyping the flu hype!
Now the hype is being hyped.
I have to say that it’s hard not to chuckle at the big media outlets, making news out of their own desperate need to make news. After encouraging the panic, and seeing it die down, big media is looking for another story besides the deadliness of H1N1. The new story: media coverage (and public attitude) regarding the current flu pandemic is overblown.
Tragedies have occurred, but it’s time for a reality check, according to most MDs. I recall a recent CBC broadcast indicating that the chances of dying from H1N1 are equivalent to the chances of dying in a car crash. The CBC asks its audience, do you think H1N1 has been over-hyped?
People are looking to unusual sources for their information. The National Post asked some Canadian celebrities about their viewpoints on the vaccine. I’m no expert, but I do get the official government bulletins and live and breath medicalese.
Whenever I spoke to my patients about H1N1, especially when expressly asked “so, why is this a big deal? should I be concerned?” my ‘short’ answer was as follows:
Lots of people are sick right now with sore throat, cough, fever, and sore muscles. These people probably have the flu. And if they have the flu, it’s probably H1N1. Most people are miserable for a while, but are able to recover in less than 2 weeks from this flu, which really is just that – a flu. There’s no point swabbing and testing since it doesn’t change our management. If we catch you in the first 48 hrs of having symptoms, we can start Tamiflu.
The reason that we are a bit scared about this H1N1 thing is that people who are generally healthy – and who often do well with the seasonal flu – can (but won’t necessarily!) get very sick. Being young, female, pregnant, and aboriginal are just some of the risk factors. Really, anyone can get it. And if you get it, chances are you’ll be A-OK after a crappy time in bed.
There is some data out there about rates of admission and deaths, but because we are treating most people presumptively and NOT testing them, the numbers are probably way off.
From UpToDate: “2 to 5 percent of confirmed cases in the United States and Canada have required hospitalization . . . however, since the number of cases of mild illness is almost certainly under-reported, [the actual rate is much lower]. . . Of 272 patients requiring hospitalization in the United States for pandemic H1N1 influenza A between April and mid-June 2009, 25 percent were admitted to the intensive care unit (ICU) and 7 percent died”
I hate giving patients prognostic numbers, statistics, etc. because they really aren’t meaningful or accurate, but if I do, I try and frame things so that it makes real sense. When talking about statins, I love to mention “Number Needed to Treat” for my low-risk patients because it makes a huge difference in how they see the cholesterol-lowering therapies risk/benefits balance.
(NB: I’m making up the following numbers for illustrative purposes) For example, if a person has a 0.005% overall risk of being in the ICU as a result of H1N1, I can tell them as such. But I’ll say, when it’s you – it’s 100%. So, protect yourself and others. Wash your hands, get your vaccine, stay home if you are sick and cough into your sleeve. Your risk of dying of this is very very very low, but why not do everything you can to minimize it?
Alan Cassels, a drug-policy critic, has an important viewpoint. While I recommend the vaccine to most of my patients, it is not necessary for everyone. He does have a point in that a large body of data is lacking with respect to vaccine efficacy and safety. Also, drug-companies do stand to benefit from fear-mongering and mass-immunization campaigns so we must be careful. Still, the vaccine has passed the standards set by Health Canada and preliminary data is reassuring and points to efficacy. When you work on the front lines, and see people dead or dying from this, it’s hard to say “ehhhh, let’s wait for more data before we do something.”
Special circumstances require special treatment. In aggressive cancers and AIDS, experimental medications are often tried. These are radical situations demanding radical therapy. Does a pandemic flu count? We’ll never know what would happen if we didn’t vaccinate.
The ideal study would be to vaccinate one population and not vaccinate another population and to introduce the H1N1 strain into all of the subject’s mucous membranes. Then when more people in the non-vaccine group died, we could say “oh look, the vaccine is beneficial.” The design and composition of the vaccine have enough parallels to the available seasonal flu vaccines that we can reasonably assume that the H1N1 vaccine may have a similar safety and efficacy profile.
In One Flu Over the Cuckoo’s Nest, John Mazerolle concludes that the epidemic of stupidity is worse that the pandemic flu; “So, in short, get your flu shot, but don’t panic about it, and remember the government is not out to get you. They just do it by accident sometimes.”
So, I’m about to roll up my sleeve, since I’m working the perinatal unit and it’s a given that I don’t want to be passing my viral passengers to any lovely, glowing preggers ladies.
Just because I was probably one of the last people to see this cartoon: