Swine Flu Update 21
Just in case you thought that we might have learned something from the 1975 Swine Flu debacle, where the vaccine killed more people than the flu itself, comes the news that Europe is “fast-tracking” the Swine Flu vaccine. “Fast-tracking” means that, when we give the vaccine, we won’t know the proper dose, any of the less common side effects or whether it actually works or not in the general population. Not to worry, though. That is almost the exact same set of problems they had with the MeNZB vaccine and that didn’t stop our gung-ho vaccinators from involving 1 million kiwi kids in a giant, phase 3 trial. New Zealand has, of course, enthusiastically signed up for hundreds of thousands of doses of the untested, european vaccine. The World Health Organisation has, at least, issued a caution on the matter, though they are careful not to criticise the practice:
“Dr Keiji Fukuda, the World Health Organisation’s flu chief, warned about the potential dangers of untested vaccines, although he stopped short of criticising Europe’s approach outright.
““One of the things which cannot be compromised is the safety of vaccines.
““There are certain areas where you can make economies, perhaps, but certain areas where you simply do not try to make any economies.””
Talking about side effects, there has been an entirely predictable rise in the number of nasty reported side effects of Tamiflu in Britain. There is nothing like a spike in usage to really bring out the worst in a drug. As far as I am aware, Britain is still pursuing a policy of offering Tamiflu to everyone with the symptoms, rather than New Zealand’s policy of offering it to those who are most at risk of complications.
- Pregnant women
- Severe heart failure
- Severe emphysema
- Severe Asthma
- Immunocompromised
- Dialysis patients
- Nursing home residents and workers
Where severe means bad enough to curtail normal daily activities or requiring frequent hospitalisations. Nursing home workers are, of course, not really at risk by need treatment to reduce their infectivity to residents.
The latest Lancet contains a study on pregnant women and Swine Flu, suggesting that pregnant women are more susceptible to complications. I note that this study is based on a number of epidemiological assumptions and may not be true. Certainly the conclusion of the authors is by no means definite.
“Pregnant women might be at increased risk for complications from pandemic H1N1 virus infection. These data lend support to the present recommendation to promptly treat pregnant women with H1N1 influenza virus infection with anti-influenza drugs.”
Hardly a ringing endorsement. Pregnant mums should consider that we have no idea if Tamiflu is dangerous to your baby and that most mums have mild, benign symptoms and no complications.
Finally just to illustrate exactly how difficult it is to interpret epidemiological data, here are a couple of graphs on Swine Flu in Auckland I have lifted from a Swine Flu presentation given to the Auckland DHBs
This one is the number of calls to Healthline about flu:
And this one is the consultation rate for flu-like illness:
Now, bearing in mind that these graphs measure calls and consultation rates, not disease directly, the epidemiology question of the day is do they represent a massive spike in flu due to the H1N1 virus, or do the represent the result of the concerted media campaign to make Swine Flu a terrifying disease? Are there more consultations and calls because people are genuinely sick, or simply concerned? As a GP, I can tell you that consultations represent both, but I couldn’t tell you what the percentages are. Should we count someone with flu symptoms as concerned or sick? Beats me.
Remember, Statistics are misleading (MacDoctor rules of statistics interpretation #1)
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Jul 31 09 2:10 am
We know why there is a spike in doctor’s visits for flu-like illnesses- I thought you would know since you were also sick recently.
Since the symptoms of swine flu and ordinary flu are the same, by making swine flu notifiable (and thus serious in the eyes of the general public) the MOH has made ALL FLU notifiable in our eyes, as we (and by we I mean joe blogs’s like me) can’t tell the difference between the two.
I had exactly this problem when I recently got sick. If I had exhibited flu-like symptoms, everyone in the family would have avoided me in case I had the swine flu, or marched me down for a blood test. Everyone who has flu must be treated like they have swine flu- the symptoms are the same (a head cold).
This over-reaction of the MOH has caused a widespread change in attitudes towards public illness among society- all flu is considered to be of a serious nature now, when it is not.
You’re a church-goer like myself- despite the small additional threat posed by swine flu, priests are getting rid of all physical contact between parishioners, and getting those who are sick with the flu to stay home, when people have been coming to church with colds since the start of the church in NZ! They will probably continue to limit contact every flu season now. I reckon the damage has been done for the long-term in this department. Paranoia has become a public duty- if you cough, you’re outta here.
I agree over-reaction is a big part of this spike, but there is also a much larger number of people with flu, because swine flu is considerably more infectious than ordinary flu.
Jul 31 09 3:30 am
MediaCurves.com just conducted a study exploring physicians’ perceptions regarding the H1N1 swine flu. Results showed that doctors’ level of concern has steadily increased over the past month. More in-depth results can be seen at http://www.mediacurves.com/HealthCare/J7472-H1N1/Index.cfm. Thanks.
Ben
Thanks, Ben. Most of that would be explained by the natural inclination to be concerned about the thing you see the most. And we are seeing a great deal of flu at the moment. Much more than usual.
Jul 31 09 11:31 am
Look, that is a cop out. It is obvious that govt action has resulted in long-term change in attitudes in the general public that has been overwhelmingly negative. Just ask someone you know who is not in the medical field about what they would do if they had flu-like symptoms, and you’ll confirm what I’m saying! No-one can rule out the possibility that their ordinary flu is a notifiable disease! It is not a matter of just a simple overreaction by some, (which you believe is partially justified by the increase in flu cases) as everyone is faced with this dilemma when they get sick.
Your profession has a lot to answer for for not stepping in to make it as plain as daylight that this is just another flu strain, and that is deserves no more attention than any other strain of flu. The doctors who do are like lone voices in the wilderness.
This is exactly the case that Dr William Beech (hope I got the name right) made as guest speaker at the recent Bioceuticals conference in Wellington (promoting their product line & the new research behind it), that swine flu is just another of the 300 or so common strains of flu that have existed since time eternal- none of which have EVER shown any evidence of mutating into new strains. He also said that that is why no swine flu cases have been seen in adults over about 40- because we have had this exact strain in NZ before, and NZers around then have natural immunity- they will never get swine flu again.
In supporting the MOH’s decision to make swine flu notifiable, you guys are culpable for spreading unwarranted paranoia among NZers with regard to how serious they perceive the ordinary flu to be, with negative flow-on effects for social interactions with people who are sick IN THE LONG TERM. As a result, we shut down businesses, can’t worship in church until we are well, and can’t earn a working wage- all because of the common cold.
To be afraid of not being able to earn a living because of a common cold I think is an appalling state of affairs in our country, and shows a blanket disregard from the medical profession as to your role in society, and the role of illness in society- flu viruses should not be feared by the masses as they are a normal part of life. They even have an upside by testing our immune systems of the healthy so as to make them more capable of fighting SERIOUS diseases.
Jul 31 09 2:44 pm
Correction, Dr William Barnes, BSc, MB ChB
Jul 31 09 8:31 pm
Johnnieboy:
I think your judgement on this issue is too harsh. Swine flu was originally a concern because of poor data from Mexico. Initially, it sounded like this flu might be as dangerous as the 1918 pandemic variety. It was perfectly reasonable at the time to sound a warning.
As usual, the medical profession was then promptly waylaid by the media and the story was utterly overhyped. It has subsequently been next to impossible to play this down, despite every single announcement from the department of public health containing the words “this is a very mild disease in most people” or some variation.
Although mutation is not a serious worry, your statement none of which have EVER shown any evidence of mutating into new strains. is not correct. Viral geneticists have shown conclusively that influenza viruses have swapped genetic material with each other in the past. That there has not been a new strain of the virus since we have been tracking flu viruses is merely fortunate, rather than definitive proof that this is not going to happen at all.
Dr. Barnes is correct in saying that the previous swine flu in 1975 is providing immunity (and is virtually identical with the current version). This is why I find the recommendations concerning nursing homes to be a bit puzzling, but then, I never claimed to be able to understand the public health guys.
In supporting the MOH’s decision to make swine flu notifiable, you guys are culpable for spreading unwarranted paranoia among NZers…
Do you know any doctor beside the public health ones who supported this? I don’t. As you point out (which was obvious to all of us “normal” doctors) this makes all influenza effectively notifiable. The public health docs tell us that this is so they can get accurate stats on the prevalence of flu. As I have pointed out above, this is not really telling them anything useful or easily interpretable.
Jul 31 09 10:38 pm
Well, it is useful to know that there are more doctors out there than Dr Barnes who disagree with the approach from on high or who are looking at things more critically. Maybe I am being too harsh in that point.
Frustrating though. In the period of a year people have lost all perspective on the issue and the reality is that- where is the voice of a level-headed doctor to point out the real risks from flu season, which has never bothered anyone before, and yet now if I obviously have a cold I can’t reach out to give someone a handshake without them looking at me like I bear the plague. Perhaps this is happening because not enough of you guys who disagree with public health policy are speaking up- does that argument have some merit? We should not be living in a society where most of us are paranoid about the flu.