False precision and the state of health and science reporting

As a follow up to my question on the last post, as it is even more relevant here: If there are labs doing random sample testing of the entire population, where are those numbers? They would seem to be the sensible numbers for the media to be reporting.

Robert: I don't know anyone doing truly random sampling, but the national surveillance systems (e.g., NREVSS at CDC) uses a representative sample of hospital labs to keep track of the what is happening virologically. See our post here.

So, it seems reasonable to presume that the .45% fatality rate isn't particularly that useful. It is the likelihood of death following testing, not following infection Presumably those are quite biased toward the more severe cases.

Are there any estimates of other rates: % needing ventilation, % needing hospitalization, % missing 1 day work, % missing 10 days work, % likely to be infected.

Yes, I understand it's difficult to make these estimates; but that excuse is getting a little worn. The press has plenty of flaws, but in this case I blame officialdom for failing to provide the press, and the rest of us, with a more comprehensible story line.

Ben: We've covered various summaries of some of those indices here, but these are estimates of specific populations. A current paper over at Eurosurveillance (free online) tries to get another handle on case fatality and comes up with figures that differ by orders of magnitude. The difficulty of making the estimates is real and the failure to do so is not unexpected. I have more difficulty with very uncertain estimates presented with more certainty than they deserve. I fault both official sources and scientists for that. They cannot presume that the media has the expertise to sort through this (although some of the best reporters are able to do it using journalistic methods -- triangulating between trusted sources). This is an extremely unusual historical event: watching a pandemic evolve in real time. As a result we don't know exactly what we are seeing. Maybe next time we'll be better able to interpret things.

Revere,

While I understand your frustration, I think you may be giving reporters short shrift. All but the highest tier of science/medical reporters cover hundreds of issues in a year. Monday it may be A/H1N1, Tuesday, e. coli contaminated pistachios, Wednesday, a local outbreak of meningitis, Thursday, the shortage of hospital beds in the region, Friday, White Nose disease in bats...

Very few reporters have the luxury of becoming experts on the issues they cover so they do the next best thing: they gather as much information as possible from as many reputable sources as possible, (and most editors demand official sources be included, if not emphasized). They contact an average of three experts for analysis and commentary (five if they're really good). And then they compile and deliver a +/- three minute/500 word story with the most accurate, comprehensive information available to them -- all while under deadline and often after having started from scratch.

That's no small feat. It's like not only trying to run a marathon every day, but being expected to win it each and every time.

Revere, you might tilt your head forward and stop looking down your nose at these hardworking, dedicated professionals. While some may not measure up to your standards or serve the public as well as they might, like you and others dedicated to public service, the vast majority of reporters are trying to do the very best job they can with the resources available in the time allowed.

Quite laudable, really.

River the former Reporter

River: I hope my respect and admiration for good science reporters has been evident here over the years. We have consistently praised the goods ones, and, on occasion I(but not that often) knocked a few terrible ones. I understand it's a hard job, harder than almost any general reporter can do. I think that's part of the point. But there was another point, too. As the news business disintegrates, we are hearing a lot of unjustified praise of the bulk of reporting that goes on in the MSM and has been going on for many decades. Most of it is just regurgitating official sources, or in the case of a lot of reporting about science, regurgitating press releases written by university media relations offices and journals. In the political realm this gave us the war in Vietnam and Iraq, to name a few recent examples not related to science. And if you read the post again, you will see I am as much blaming WHO and scientists for not making information available in a form that doesn't require specialized expertise on the part of reporters.

I think bloggers have a much better record of recognizing the virtues of reporters than the other way around, BTW, although this is a separate point not related to this post. If you want examples of looking down the nose behavior, MSM attitudes towards bloggers is a much better one. I don't much care about it, but mention it since you brought the subject up. I don't compare myself or any non-journalist science blogger to the real pros like Helen Branswell. To say we can't expect most science reporting to reach that level is true, but that doesn't mean we shouldn't observe it routinely reaches a level barely beyond taking dictation or reprinting press releases. It is not the multiply checked-editor-scrutinized ideal that is portrayed. I read a great deal of press releases and the MSM science stories they produce very day. I confess I never knew it was true before, but I do now. I knew it was true in politics and policy but now I find it is the same in science reporting. Science isn't practiced the way it says in the textbooks, either, so I'm not picking on journalists any more than anyone else (and I've criticized scientists plenty, here). We have our constraints and pressures, too, and we talk about them a lot here.

The article in eurosurveilance uses the assumption that the reported death figures (WHO) are close to the total death figures for three of its estimates.

This is an assumption that does not hold for seasonal influenza where the number of death certificates listing influenza underestimates influenza deaths by more than an order of magnitude.

Personal communication:

I contacted the correspondence author and he said that because this new variant H1N1 is infecting mainly under 65s (where he thinks clinicians pay more attention to the precise cause of death) and because there is a lot of attention being paid to the strain that this error would not be as signficant for estimates of swine flu CFR. However, he provided no more than annecdotal support for this assertion. Clearly the magnitude of this death reporting bias remains unknown for new variant H1N1.

The fourth method employed assumes the CFR by age is the same as for seasonal influenza in the population of people below 65.

I am not objective about the following issue; I am the mother of a 21 year old university student who is leaving in mid-August to study abroad (in Italy) this coming semester through her universityâs international study abroad program.

Ultimately (and soon) I hope the CDC will specifically and formally address the unique issues that a global pandemic presents for our nationâs Study Abroad programs as they relate specifically and uniquely to the Fall semester of 2009. Students studying abroad are not typical tourists or business people who can change their plans at the last minute--they are overgrown American children who have committed to living abroad for the remainder of 2009. They are at risk of being held hostage by a virus in a foreign land--I hope we have a solid contingency plan for them.

The Fall 2009 semester is unique, indeed. We are in the beginning phase of a global pandemic, a second--perhaps more virulent-- wave of virus is predicted for the late summer/early fall, the first round of vaccines will not be available until late October, and swine flu preys on this age group. To make matters worse, this is a population that tends not to exercise the best judgment when it comes to transmissible illnesses--particularly when housed in close quarters. Those students who do get sick with the flu, will not be able to go home for a few a days to recuperate--they will stay in the dorms with their flu and share it!

More than half of all American college and university students who choose to study abroad do so in Europe. Generally speaking, those studying in Europe do not tend to âstay putâ on the weekends--they travel to other European countries--and may end up sick hundreds of miles from their host country and from the staff that is charged with their care.

According to one of the Institute of International Education websites, nearly a quarter of a million American students studied abroad in the 2006-2007 academic year. Even if a very small fraction of such students contracted the swine flu over the next 4-5 months, it could present a logistical nightmare. Parents of sick students would clamor for emergency passports; parents of âasymptomatic but exposedâ students would insist that the sick be quarantined, or that the âasymptomatic but exposedâ students be allowed to travel home with immediacy. There would be language barriers, unfamiliar medical systems, and issues relating to rationing. (Did Italy order enough Tamiflu and swine flu vaccine for my kid?)

The Study Abroad programs are revenue-friendly for colleges and universities; I do not see them voluntarily scrutinizing the wisdom of studying abroad this Fall. At the very least, I would like to see the CDC publicly advise such programs as to the increased level of preparedness that will be necessary in these (highly unusual) pre-vaccine, pre-second wave, pre-mutation, pre-antiviral resistance, next several months. We know so much less today than we will most-likely know at the end of this year; the Fall 2009 semester for Study Abroad programs is highly exceptional, and I believe it should be addressed as such.

Barnaby: I've read the Eurosurveillance paper (just once and quickly) and am still digesting it. There is very scant data for us all to be using. New Zealand is now experiencing the leading edge so there was extra pressure on these folks to come up with something, but I take it with a grain of salt at this point. Their high estimate is about the same as the seasonal flu average for the US (multiply by 30 for the US population) but the difference in age distribution is a wild card here. The same number of hospitalizations but in a much younger age group makes a difference to the health system.

melbren: I think CDC;s H1N1 site has guidance or links to guidance for int'l programs. Poke around a little. The good news is that Italy has a very good health system (better than the US in outcome and access), maybe the best in Europe. Also the US embassy has lists of docs. Your daughter will at least be in a good place should she need medical care.

and if you don't know who they are, you can start your list with the first names "Helen" and "Declan"...

The A(H1N1) virus has now spread to 136 countries and territories,
...

Looks like it will eventually hit everywhere.

I've been wondering how the third world will fare with a pandemic. Especially China and India with over 2 billion people. General nutrition and health can make a big difference in infectious disease outcomes. And the "medical systems" in many third world countries are rudimentary at best.

A recent article stated that Argentina has the third highest death toll so far in the world. The southern hemisphere is just starting their winter.

We will find out one day at a time.

The calming voices of Effect Measureâ¦taking on one hysterical mom at a time. Thank you!

So, in Italian, how do you say, âExcuse me sir, but I feel like I have been hit by a Mack Truck, please call Declan and Helen at Nature Publications. And have them bring some Tamiflu.â

It pays to know peopleâ¦.

melbren: . . . and you can visit her in Italy. It is a wonderful country. Every year I attend a regular scientific meeting near Bologna. Wonderful food, wonderful people. They know how to live.

As a science journalist, I'm with River, except I write usually longer than 500 words and for magazines with a slower turnover than newspapers/websites/breaking news outlets. I'd like to add a couple of things that in my experience inhibit clear and accurate reporting:

First, for at least the last 10 years and probably longer, federal agencies have been quite hostile to the press. They have made media and public access to information almost impossible, removing large swaths of material from the Web, refusing FOIA requests, and keeping all kinds of things "classified." In addition, they discriminate severely between the so-called "MSM" (mainstream media) and the rest of the journalism world. For example, I am a freelancer on the west coast - practically a career death sentence, even though I have an advanced degree in journalism, about 15 years of experience, and membership in two professional societies. I have a piece coming out next month about the health threat from iodine-129, which is produced in nuclear fuel reprocessing plants. Over a period of months I made numerous attempts to get information from both the DOE and the EPA, both by contacting the media offices and going directly to officials and scientists, but with zero substantive response.

A second consideration is that even in a longer explanatory piece, the reader and the editor want some kind of conclusion - even if the topic is interesting per se and important for people to know about, such as the H1N1 pandemic. People expect some sort of "take home message." They want certainty and resent spending tax dollars on inconclusive science (they don't realize almost all science is incremental and usually inconclusive). If we all became Buddhists, perhaps this problem would be alleviated, but I don't see that happening any time soon. :)

Valerie: I'm not beating up particularly on reporters, and especially not health and science reporters (the ones that are left). I'm making an observation. I know many reporters and ex-reporters and respect their journalism and have heard their (appropriate) tale of woe. But few want to face the facts that for a very long time we've had lousy reporting of all kinds in the MSM. I'm not talking about what you do (science writing, which has many marvelous practitioners). I'm talking about daily reporting. It's not just science reporting. Big name political reporters writing for the NYT and WaPo have done a terrible job of actually questioning what they are being fed. They just repeat it and have shown themselves easily manipulated. And the extent to which press releases are just regurgitated and put out as science reporting, often without any editing at all, is quite shocking for those of us who hadn't realized it was standard practice. If I hadn't seen it over and over again in the last 5 years of doing this I wouldn't have believed it. And much of the rest is at the level of this AFP story that just reprints numbers. That's not to say there isn't some really superb reporting and we've highlighted it here pretty often. We almost always include a reporter's byline in our links and have gone out of our way dozens of times to highlight good reporting and call attention to it. We'll continue to do so. But we don't buy the myth that health and science reporting is carrying the load and everyone else is parasitizing off it. On the contrary, bloggers rarely get recognition from MSM, even when it's due. I don't care particularly. I don't make a living doing this (which is good thing for my family). I've got a day job. I do it to make a contribution. So I have luxuries a working reporter doesn't have (although fewer rewards). One of them is being able to call attention to things when I think it is useful.

Even when you look at major news outlets like the washington Post, for example, science reporting is abysmal. There is alack of appreciation of basic concepts of statistics and methodology, let alone confusion about the simplest aspects of studies. For example, the major HIV reporter for the Englsih language Thai press consistently confused therepeutic and prevntive vaccines over a period of many years.

There have been excellent reporters for even mid-level papers. David Dietz, who wrote for the Cleveland Press for decades had a matsre's degree in a hard science area and peripheral involvement in the space program. he was great. Jon Cohen who has been following HIV (and now other diseases) for Science is excellent and he doesn't let scientists ' vanity and self-serving nonsense get in the way of a story. the majority, though, are awful and can't get beyond limitations that usually get addressed in lower division science courses in college.

This is a current picture of how things are panning out in NZ at the moment. Health services struggling to cope with swine flu on top of normal winter patterns. Plus local estimates from reserachers.

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10583121&…

Revere: I couldn't agree more! There are a lot of journalists outside the Beltway & NYC who are disgusted by the self-serving opportunism of the MSM, especially science journalists who are tired of seeing Washington political reporters make a hash of things like H1N1 and global warming. - Valerie

Reminds me of how we were taught to confess our sins with specific numbers for how many times we had cursed or been rude to our parents (or touched ourselves improperly, which was apparently whenever we weren't urinating, according to the nuns). A bunch of seven-year-olds sitting in pews, scribbling sin numbers before we confessed....
Maybe AFP's staffers went through that process, too.

Here is an interesting thing that was pointed out today. There have been 734 cases of flu in Oz. 1 death. So lets call it 1 death per 700. If you take the population of the US and divide it by 700 you get 435,714 deaths. All things being equal and they arent and put the same numbers in all states, then this means that 8714 deaths in all 50 will occur using these numbers. I also assume that they will all come on quickly and there will be the slight, mild and severe cases and the dying ones all mixed in together.

So somewhere between mild to severe the healthcare system at 5600 active hospitalized cases whether it was UHC or private would start to fall apart at something like a 10% surge for either entity like a two dollar watch.

This surge if correct would overwhelm the existing capacity in under one week if the surge was sudden... (56,000 beds and everyone who can be thrown out that could be) with only a 5600 bed nationwide surplus or so at any given time. This means that 5600 beds would be taken up in just over one week if this comes in like a bat out of hell? The remainder of that would be that 390,000 and change would be left out in the cold or at home or in something like a warehouse. Likely many more as the severe cases would be included in that but could make it at home. So what does this mean? The dead might get to see the hospital from a distance.

I have looked at the total number of tents suggested in the entire military inventory and if they were all working, available and here we might be able to just house another 45,000 in air conditioned and heated tents. That brings it down to about 345,000. After that...stadiums, malls, etc. with nothing but a place to die in. No treatment. Food would be terribly scarce if that many people had to be fed by the US govt. Total number of meals that FEMA/DHS could provide in a week is estimated at 225,000 with no sustainability after that week. Resupply required from...Where?

Its not totally scientific of course. It does point out a really interesting problem. We add in the fact that the vax may not work if things continue on the mutation front and it just looks like a damned stinking mess.

Revere when the research money is all gone you might find yourself to be one very busy guy anyway. This guy and I piss and moan at each other all the time but if I was lying on a cot with my butt half in the casket from swine flu I would want him treating me. I know he would do his dead level best to keep me from heading out. Foaming at the mouth about winning in the name of healthcare.

But old friend I think this one I think we are not going to win any way we look at it. Vax will not be available..Hear me now. Its going to be only lightly tested and GB lies in wait for one out of at least 100,000. Maybe more and it might be the same as drinking Dr. Williams Coal Tar remedy.

I think that using OZ, Argentina, Chile numbers and what we have seen even in the last few days is frightening. I have people in Argentina and Oz and the situation is grim. New Zealand is starting to head down the path too. Even with their higher numbers of availability of beds and services it doesnt seem to be working out. The GP's in the UK are from what I can tell from their news are about to revolt themselves. I know it scares the hell out of me. I posted on this before. At what point do they quit reporting the real numbers because they dont equate to anyone, anymore. The numbers become meaningless because there is nothing to strive for? We got it, we are screwed.

We are sampling and not testing now here in the US. They found another strain in the last 48 hours and didnt believe their own data initially. I see a strain in Argentina moving north, I see one in Canada that could move south and because of location and temps it may already be into the UK. The people are there are becoming shocked.

Saying 100,000 cases a day in August might not be off the mark in the UK. Sure report it. Scared is prepared. Calm is a balm. Okay, sure. But the real numbers that we need to know about are in the countries that have it the worst and now they have quit testing ....Sampling now. What will they do when there are high numbers of deaths? Sample those too? At what point will it be useless to do that? What idiot told states that only the CDC could confirm cases?

Its 95 degrees here in Memphis today and we got people that are out and big time already. I was told today that if one of my people dont turn by the weekend that they wont be here after Monday. Is this being reported here either? Shit no.

If this is the strain that beats up on people now then I really fear what is coming. The media is the watchdog and they are doing a shit sucking bad job of informing the people. Its like a script and some would say its the "All good in the Obamahood" scenario. I disagree. They are grown people, in positions and its up to them to report. They could break the mold and start telling people and save a bunch. They will if it gets ugly, they will and it will be too late. If there is an Obama blanket over the media then there is going to be a "Network" moment and thats when its going to unravel. 435,000 is just under .14% of the population here. What will they do at even 3%?

This news thing? I get more info out of OZ and Canada about the US than I do in the US. Why?

Revere is a put up or shut up type and that is you suit up, roll up your sleeves as he knows that I will be when this comes. In fact, its already here. Biz is going to be good for both and likely off the scale. Maybe we will scrape by on this with only that 435,000 and .14% and change but I seriously doubt it. I am seeing that which I posted on about years ago and that is the remain calm, we are doing everything possible, everything is good people are in charge.

Its going to be a slow motion 9/11 lasting months I think. A full on disaster is looming w/wo this administration in charge. It wouldnt have been any better if Bush was still there either.