April 30, 2009

A couple of points about this reassuring L.A. Times article on the swine flu:

As the World Health Organization raised its infectious disease alert level Wednesday and health officials confirmed the first death linked to swine flu inside U.S. borders, scientists studying the virus are coming to the consensus that this hybrid strain of influenza -- at least in its current form -- isn't shaping up to be as fatal as the strains that caused some previous pandemics.

In fact, the current outbreak of the H1N1 virus, which emerged in San Diego and southern Mexico late last month, may not even do as much damage as the run-of-the-mill flu outbreaks that occur each winter without much fanfare.

"Let's not lose track of the fact that the normal seasonal influenza is a huge public health problem that kills tens of thousands of people in the U.S. alone and hundreds of thousands around the world," said Dr. Christopher Olsen, a molecular virologist who studies swine flu at the University of Wisconsin School of Veterinary Medicine in Madison.

Science and public health areas are now so specialized, experts are sometimes misleading because they just don't know what the people on the next floor are doing. (Just because you know about viruses doesn't mean you understand epidemiology, and most reporters don't know, either.) So let's address that "36,000 people a year die from the regular flu" mime that's making the rounds.

First of all, the bulk of those numbers are made up of victims aged 70 and older, people who are already high-risk because they have heart or lung diseases. That's because (despite scientists who've called for more precise methodology) our public health system counts any deaths from natural causes among the elderly during the winter as flu-related. The fact is, we just don't know. It's a guesstimate.

The difference with swine flu is, it's killing people in the 20 to 40 age group. That's unusual. That's why we're so concerned.

So don't feel reassured just yet. Don't panic, but please don't ignore the potential threat of this new flu strain. As I keep saying, there's a middle ground between panic and denial. That's where you should be.

Flu viruses are known to be notoriously unpredictable, and this strain could mutate at any point -- becoming either more benign or dangerously severe. But mounting preliminary evidence from genetics labs, epidemiology models and simple mathematics suggests that the worst-case scenarios are likely to be avoided in the current outbreak.

"This virus doesn't have anywhere near the capacity to kill like the 1918 virus," which claimed an estimated 50 million victims worldwide, said Richard Webby, a leading influenza virologist at St. Jude Children's Research Hospital in Memphis, Tenn.

What he says is factually correct - right this minute. (Actually, by the time you read this, that may no longer apply.) As the Reveres like to say at the public health blog Effect Measure, "You've seen one flu pandemic... you've seen one flu pandemic."

No one knows why or when a virus will suddenly become more virulent. Everyone hopes it doesn't, but the fact is, once it becomes widespread here, it will mutate and anything can happen. So pay attention. Go on with your life, but prepare yourself. (As my favorite saying goes, "Allah will provide, but first tie your camel.")

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