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Did public health experts overstate the threat posed by H1N1?

September 3, 2009 |  4:01 pm

One-size-fits-all might work for tube socks and trucker caps. But it’s no good when it comes to preparing for pandemic flu, according to an article published in Friday’s edition of the British Medical Journal.

Chan Since the outbreak this spring of the novel H1N1, public health officials have treated the new so-called swine flu as if it were a replay of the devastating 1918 Spanish flu, which claimed tens of millions of victims and was particularly devastating to people who were otherwise young and healthy. But no virus since then has emerged with the same combination of high transmissibility and high lethality, writes Peter Doshi, an MIT graduate student in MIT’s program in history, anthropology, and science, technology and society.

The 1957 and 1968 flu pandemics were widespread but not unusually lethal compared to regular seasonal influenza. On the other hand, the outbreak of Severe Acute Respiratory Syndrome, or SARS, in 2003 had a 10% lethality rate, but only 8,096 people were infected worldwide. The much-feared H5N1 bird flu has likewise done little damage due to its poor transmissibility.

What’s wrong with preparing for the worst-case scenario? Plenty, Doshi writes. The SARS panic prompted involuntary quarantines, travel restrictions, and led to at least $18 billion in economic losses. In the end, the number of people affected by the response to the virus was much greater than the number of people infected by it.

Something similar is likely to be happening with H1N1, he writes. The U.S. Department of Health and Human Services declared a “nationwide public health emergency” on April 26, when there were only 20 confirmed cases and no deaths.  The declaration prompted a huge spike in lab testing for H1N1, which in turn produced what Doshi calls a “concern bias, in which concern and anxiety may drive events more than the disease itself.”

Fears about H1N1 have been costly to the pork and travel industries, caused healthy people to endure mandatory isolation, and prompted massive government outlays for lab testing, antiviral medication purchases and expedited vaccine development. Unless things suddenly take an unexpected turn for the worse, all of that activity is probably out of proportion to the actual threat, he writes.

The costs are not just financial.

 “Public health responses not calibrated to the threat may be perceived as alarmist, eroding the public trust and resulting in people ignoring important warnings when serious epidemics do occur,” Doshi writes. Pandemic responses that are based solely on the worst-case scenario “carry the risk of doing more harm than they prevent.”

-- Karen Kaplan

Photo: World Health Organization Executive Director Margaret Chan. Credit: Frederic J. Brown/AFP/Getty Images

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Comments (8)

Personally, i think the authorities have over-reacted. H1n1 is just like an ordinary flu with a twist, and because it was a new strain, and the medical society didn't and still doesn't know what to do, people over-reacted to it especially the , authorities.

On the other hand it is difficult to fault them, they are just doing their job to best inform the public and prevent further spread as they know how.

I could not disagree more with the view that we are overdoing it in terms of preparations. Looking at the models, either by our group (see link) or by the President's scientific advisers, the potential numbers of people getting critically ill and dying are quite concerning. Even in the absence of mutations to make it more deadly, by virtue of its transmissibility the virus is poised to cause a lot of disease. Sitting by and hoping that the likely scenarios will not happen even without active intervention is ostrich-like, particularly given our level of unpreparedness at the ICU level.

All they want is to scare people off into getting a swine flu shot.

1st of all it would mean a lot of money
2nd I don't think it's a healthy vaccine
3rd swine flu is the reason for population control.

Think. All you see on TV is "you are so not independent, we have to kick in and help you". No. Swine flu is not "pandemic"
And if it will ever get, it's not caused by nature.

Good luck

Something else that this article fails to note is the media attention given to the swine flu that exaggerates it's spread and severity. Television, newspaper and internet sources all have to sell advertising and they do this in part by maximizing readership. What better way to get people watching or reading than to get the public riled up over a relatively minor health threat? The aviary flu was exactly the same phenomenon. It reminds me of the media's overhyping of "killer" bees that were supposed to attack from Central America and the panic over shark attacks from some years ago.

It has been said before, but it can't be said enough:

The 1918 flu was pre-antibiotics!!! The m a j o r i t y of deaths was due to pulmonary infections, and not due to some evil flu virus.

Spread the word (pun seriously intended)

Last week alone, 700 more people died from swine flu. Bringing the total to more that 2800 (WHO website).

The previous week’s total number since the flu was discovered was only 2100.

Yup, it’s nothing to worry about. Only that is, if you can’t count.

-The Peasant Philosopher

It has been a scare in our country too. Even a small child was so scared to acquire the h1n1. I think media has overreacted on disseminating about the disease. Classes were even suspended because of H1n1. Thank God It has subsided now.

I agree fully. I share similar concerns as a health provider.
1. The typical flu kills over 36,000 per year, or the streptococcus bacteria that causes "Strep throat" kills over 1000 per year, etc, etc.
2. In a time of economic crisis, we are causing undue anxiety. Consider also the financial and emotional cost of stressing out millions of people, especially our most vulnerable people, then strongly suggesting they pay out of pocket for a "treatment" / non generic Tamflu medication that doesn't cure, but only "shortens the course of fever and symptoms by one day" but will cost you over $100 plus your lab testing $200 and then office visit $75. For the 50 million uninsured, what does this mean or the millions of unemployed that are so stressed about this flu virus that they feel obligated to spend this money? Unncessesary.
3. Not thoroughly tested vaccine, or tested without the adjuvant. Concerning. Would I want to risk my child with such a vaccine for a disease that is very unlikely to hurt them? I would rather employ building the child's immune system with probiotics throughout the flu season (for $2 per month for chewable acidophillus (shown to reduce the incidence of contracting the flu).

I could go on an on. I smell money behind some of this push for vaccines and "anti-flu" medical treatment, and not a genuine concern for our American people.


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