I’m afraid I have to complain about crappy journalism again. AlterNet is an online newsmagazine I quite like. We’ve been linked by them numerous times and know their influence. Sometimes, though, some very smart writers write some very dumb things, even if they do it in a smart way. Alas, Joshua Holland has done it today on the front page of Alternet.org with a supremely wrongheaded story about why you don’t have to be scared shitless about swine flu. We agree with that bottom line, but how he got there is the problem (that and the fact that he doesn’t understand much about influenza).
Let’s take our points of agreement first. Holland says that in years past we wouldn’t have known about swine flu at all. Indeed this is a historic event in the long history of influenza infections, the very first time we have the ability to watch a pandemic with this virus unfold in real time. One of the reasons is the same as why we can read Joshua Holland’s writing: the internet and its speed and reach. That doesn’t mean that because we wouldn’t have known about ten years ago that it could have happened without our knowledge. The global spread of a novel influenza virus happens only occasionally, and when it does it is an event of some significance for public health. We found out about it but after we can do anything.
But we do know it is happening, and since I’m an epidemiologist, it’s a Big Deal for me and my colleagues. It will also be a big deal for your doctor or other health care provider (assuming you have access to health care; thank you Chuck Grassley and Max Baucus for putting some uncertainty into that assumption). But does that mean it should be a Big Deal for you? Joshua Holland thinks not, on the grounds that it is the business of me and my colleagues but not the average citizen based on his version of what makes something important: the media and how he interprets the “statistics.” Presumably the rationale is the same for climate change. Take it up with climate scientists. Don’t bother the public about it. No one has died from it yet and there isn’t that much they can do about it. If you read AlterNet, you know that’s not exactly their position. Nor should it be.
It’s true from the clinical point of view this isn’t a particularly unusual influenza virus. Every flu season is different and the various types and subtypes are different, not just from year to year but from month to month and season to season. Flu is an unpredictable disease, and Holland acknowledges this one could take a turn for the worse, because “viruses mutate.” True enough, but not the point. It’s also true that the media has run many stories about it. For example, there are plenty of “it’s all hype” versions (of which Holland’s is an example), there is the “deadly virus” version, which are absolutely predictable. MRSA is a big problem. So we get stories about flesh eating bacteria. Hey, pal. It’s your profession, not mine. Mine has malpractice and Medicare fraud. But before blaming the media for everything (something the media itself likes to do) we should note that there are also many more stories that are purely factual and accurate than terrible. This is partly because Holland’s colleagues in the media are so lazy or so overworked that they just take official press releases and rewrite them, the same kind of stenography that brought us the Wars in Iraq and Afghanistan and so much else we know and love. But it’s also because there are some superb science journalists out there who understand the science; Holland isn’t among them. Holland is just another example of inaccurate media reporting contributing to public confusion. But that’s the system. The system that Holland is an integral part of and his article is just another example.
Even the premise that media reporting is causing widespread public panic is pretty stupid. I’d like to see the evidence. Are there scary stories? Sure. Alternet itself is full of scary stories. Journalists make their living writing scary stories. We all know that. They also earn their living writing stories that allegedly debunk scary stories. As members of the public we have a zillion things vying for our attention, of which swine flu is one but not the biggest. Losing our jobs or paying our rent or getting sick and bankrupted come way, way ahead of swine flu. It doesn’t happen to most of us, statistically speaking. So why write about it? It’s news. So is swine flu. Swine flu is more than news. It’s news that can and probably will affect everyone. Do I wish every story written about it was exactly accurate? Of course. I wish Joshua Holland’s article were exactly accurate.
I won’t go through his misunderstandings point by point. It’s a long article and much of its wrongheadedness is related to how he strings together facts and his emphases. While there is nothing to say that this virus will be comparable to what happened in 1918 (possible but this looks much more like 1957 than 1918), comparisons and suggestions to the contrary are inevitable, especially in the media. Duh. Straw man argument. The trouble is, Holland doesn’t understand that influenza — not this influenza particularly, but all influenza — is a serious public health problem. And he doesn’t understand that this is a pandemic strain and isn’t the same as seasonal influenza. That’s not because of the “statistics” he cites about how many people have died of it; or how it compares to lightning strike risks (a fatuous technique beloved of wingnuts trying to trivialize whatever their paymasters find inconvenient); or that more people die of seasonal influenza (we don’t even know how many people that is, but if this isn’t any different than seasonal influenza and it’s the only flu A strain out there, then presumably hardly anyone will die of flu this year according to Holland’s “statistical context”); or that more people die of malaria (so we shouldn’t worry about the ones that get polio?).
The problem is not the virulence of this virus (all influenza viruses are potentially virulent for certain people) but its epidemiology. It’s a pandemic strain, which means it is infecting a much different population (the very young, and adults through middle age), making more of them sicker, continuing to circulate at unprecedentedly high levels during times of year when flu is almost absent, and confronting an extremely brittle and unprepared medical care system especially vulnerable to just this kind of virus.
Holland makes much — as did the bird flu deniers of a few years ago, who, if we’d have listened to them, would have left us much less prepared to deal with this pandemic virus — of the fact that conditions in 1918 were far different than now. For one thing there was the historic event of World War I. He forgets to mention this old chestnut of the flu deniers, but does claim that we now have medical tools we didn’t have then, namely antibiotics. Even though he doesn’t mention it, let’s talk about World War I. We’re at war now, but compared to WWI, it’s nothing. So that’s certainly a big difference. But in 1918 we didn’t have factory farms, either, those exquisite hothouses of virulent viruses. What are the biggest factory farms? Hogs and poultry. It doesn’t much matter if this virus came from one originally or not. Their very existence means that if an influenza virus gets into that population (as it has for avian influenza) it will become enzootic and constitute a continuing experimental laboratory for the virus to find the right recipe to wreak havoc. I don’t say this to scare you. I say it because it’s true and we can do something about it. The response to this bad possibility is to regulate factory farms and do continuous and adequate surveillance of animals for zoonotic disease. Does Holland think I shouldn’t write this? I wonder.
Now to our vaunted medical capabilities. Joshua Holland has never cared for a critically ill person with Acute Respiratory Distress Syndrome (ARDS), which is often the terminal event for flu patients. So I’ll tell him. It doesn’t matter if it’s caused by bacteria (many are). Half of them die no matter what you do and no matter what intensive care unit you have available to you or what antibiotic or what computer controlled respirator. We still can’t do much. But we don’t even have the beds to give it a try to begin with. Our big city emergency rooms periodically and routinely go “on diversion,” meaning that they divert the ambulance that’s on its way their hospital to another hospital. The main reason is not the already ludicrous long waits in the ER but the shortage of critical care beds, the ones with the ventilators and skilled nursing that Holland thinks will now save people seriously ill with flu. It’s a common mistake. But it’s a mistake. Even a bad regular flu season can break the system. And because the people who are winding up on ventilators are in their 20s and 30s and not in their 70s, this is a different kettle of fish. As for Holland’s recital of the “official” statistics on flu deaths and cases, no one knows the true numbers. Everyone stopped counting long ago, for reasons Holland doesn’t understand. We don’t even know how many people die each year of seasonal flu. But we’ve covered this ad nauseam on this site, so we won’t repeat it.
If we didn’t know this was happening, would we, as Holland avers, just go on about our business? Likely, until the ER and ICUs filled up. Same with global warming. We certainly do it with malaria, which is happening far away to people of color and which he thinks deserves more attention than it gets (it does, but so do a lot of other things). So what? As for comparing it to cigarette smoking, as my friend Bart Laws at Tufts does (quoted by Holland), I don’t get the relevance. Bart is a friend and very smart. He and I disagree about flu. He thinks too much attention is being paid to it and I’m one of the people that pays attention to it. It’s an interest of mine. Do I think the danger of a pandemic is worse than the danger from climate change? No, I don’t. I think overall climate change is a bigger threat to public health. But neither Bart nor I write much about climate change although we both write about it to some extent. So? Bart has his reasons for objecting to what he feels is a misplaced attention to flu. I respect him and our differences. But Holland, unlike Bart Laws, doesn’t know what he’s talking about, and he has no good reasons.
He’s just another journalist mining swine flu for readership.