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Hyping the flu hype!

November 7, 2009

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:

12 Comments leave one →
  1. Nico permalink
    November 7, 2009 4:23 pm

    my gripe is that people aren’t thinking this way with it, they’re using the whole “it’s a government plot to implant us with chips for the lizard people’s takeover”, or simply refusing because they don’t do what “the MAN’ tells em, or that they prefer natural immunity over a vaccine, or any of the erroneously attributed side effects that have been debunked.

    What we figure is that these people have never been well and truly whomped by a flu, and attribute all manner of mild sniffle to a “flu”. True flu usually smacks you down hard. ( the overwhelming refrain I’ve heard is “it’s hell!”)

    and like you, rather than be a carrier for the bug, I’d rather get the shot because I don’t know that everyone I meet is able to fight it, they could be immunocompromised, their kid could and because I don’t want people spreading a bug to me, in turn, I should strive to not spread it to them.

    More so, I’m aghast at the ever dropping vaccination rates, and having seen how fast the disease rate dropped with the advent of the meningitis vax, and such, I fail to see how anyone wants to risk some of the current bugs going around, if they don’t have to.

    If 5000 people a year die of flu ( I’ve seen that number about), and that’s acceptable, but a 1 in a million risk of death/side effect of the vaccine, that’s 33 people. 4467 people who wouldn’t die, theoretically, if we all got vaccinated.

    No where in my mind is 5000 a season an acceptable loss rate for something largely preventable.

    And being half way through a science degree it just chaps my ass that people are so willing to toss science and medicine, and declare that we’re just part of the conspiracy. I missed those lectures!

    To me, the vax issue goes beyond h1n1. Way beyond.

    • November 8, 2009 12:05 am

      fair points, all!

      The flu vaccine may NOT prevent a person from contracting the flu. It may. It also may lessen the severity if infected. It is still possible to die of the flu if you have the vaccine, though the chances are probably infinitesimal.

      There are a lot of unknowns. And it might turn out that the thing doesn’t work or that there are long-term side effects that aren’t so hot. Those things aren’t likely, and even if they happen, to call it “conspiracy” is not right. I do believe our government is acting in our best interests or at least trying to.

  2. November 7, 2009 4:53 pm

    Two weeks where I’m not feverish and hallucinating and wishing for sweet death or a bit of an achey arm?

    I went for the H1N1 shot, and I’ll be going for the seasonal shot when it comes up next month here, for 90% selfish reasons; I HATE having the flu. Sure yeah, herd immunity, blah blah, but this is ME we’re talking about 🙂

    I’ve had two that I can remember in my adult life, and I can live a long time without ever having it again. 40+ degree fever, wondering at what point I should seek medical attention before I suffer brain damage, etc. The things you worry about when you’re sick…

    Love the cartoon.

    • November 8, 2009 12:08 am

      I got both my H1N1 and seasonal vaccines today, thanks to working in ther perinatal unit. I don’t want the flu, but I REALLY don’t want to make someone else very sick from it. Knowing that I’ve done my best to protect those around me – even if my arm is gonna hurt like a MOTHA’ tomorrow – is my selfish reason.

      Nothing would feel worse than to not do everything I can to keep my self and my patients safe.

      Fingers crossed none of us have to endure the owch/frown/zzzz flu fest, let alone get put in the ICU. Though, I’ve worked in the ICU and generally the nurses are some of the brightest and kindest I’ve met. Still.

  3. November 7, 2009 11:02 pm

    Flu pandemic is one of the ways to scare the sh!t out of the poor citizens of a country. There are so many other ways to do such, so the flu is just a temporary addition to the fear the ordinary people already have.

    I am a doc, and I read articles, and I do flu shots every year, but I am not quite convince how much that helps me to survive another year of misinformation. Anyways, the world goes totally crazy now, there is no evidence whatsoever what works and what not works. In the H1N1 case nobody has a slight idea of the side effects and consequences, and how well the vaccine works. To take or not take the vaccine is kind of question even the super experts don’t wanna try to answer. Of course the government people will say that they got the shot, and didn’t have any side effects besides feeling sick for 3 days after the magic vaccine. The biggy infectionists people enjoy their great time being popular and exposing their tiny deltoids to show where the life saving shot was. BS, give me a break. The truth is somewhere nowhere.

    Just a quick example. Our baby was diagnosed with ITP at 13 months of age. A week ago they told us, “We are going to put on hold all the vaccines”, because of the some evidences that the vaccine can trigger a new ITP bout. Well, yesterday after the last H1N1 conference they told us, “The baby has to take the H1N1 vaccine”. Why? They don’t know, but this is the new recommendation. Really? Based on what? I am kind of guy who wants to see percentage, evidence, something that can convince me that this is the wright thing to do. Well, with the H1N1 shot I am very confused. Any ideas, links, articles for the compatibility of ITP and H1N1 vaccine are very well appreciated.

  4. Gary Day permalink
    November 27, 2009 4:07 pm

    Sorry but the vaccine was not tested enough and quite frankly your body is much better off with a constant flow of medical chemicals..this whole H1N1 fiasco is just a lot of crap…the numbers are way down but the media is telling a different story….I very seldom get anything and it’s because I stay as far away from doctors and hospitals as possible.

    • November 28, 2009 4:13 pm

      Handwashing, coughing into one’s sleeve, and staying home from work or school are all good preventative strategies. The ‘hamdemic’ maybe have not been as large as projected, but we will never know (accurately) how much larger it would have been without the vaccine.

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