Effect Measure

I don’t know what happened in the Ukraine regarding swine flu (or some other illness) and without any hard facts we refrained from speculating on it (we did post once on the lack of clarity and WHO’s reponse). We still don’t know what to say about what did or didn’t happen, although it appears others are now talking:

The global swine flu outbreak has become something of a political football in every country where the pandemic has spread, but Ukraine’s response to the virus has achieved a new level of blatant politicization. According to a campaign advisor to Yulia Tymoshenko, the Ukrainian prime minister and presidential candidate purposely inflated fears of an ongoing swine-flu epidemic to aid her presidential run.

“We had to create a phantom and then have a white knight riding in to save the day,” Taras Berezovets, a senior campaign advisor for Tymoshenko’s BYuT bloc, told me in a Kiev restaurant, confirming widespread suspicions among Ukrainian journalists.

Since October, Ukraine has been in the grips of a full-blown panic over swine flu, complete with quarantines, school closures, runs on pharmacies. The Ukrainian health system, already badly dilapidated, was caught off guard and almost 400 people died of the flu in just three weeks. (Foreign Policy via NPR)

The long NPR story (from their content partner, Foreign Policy) details the electoral ups and downs of the two contending presidential candidates and how Yulia Tymoshenko effectively used (some say manufactured) the panic — and its antidote — to her advantage. It is quite likely that the Ukraine had a bad outbreak of swine flu and that their medical care system and government were unprepared. It is also quite likely that the opposition candidate used whatever was available to aid her campaign (or see this damning description in WaPo). It’s done everywhere. These kind of shenanigans go on in the US all the time. Now that the political effects have worked their way through the system the Ukrainians are saying whatever it was has peaked and the panic is over.

For us this once again confirms the utility of pausing when trying to evaluate “breaking” public health news. It’s not an accident that the first step in working up a disease outbreak is to “confirm the diagnosis.” That’s because in the early phases of any outbreak there is always a considerable amount of confusion and misinformation. Whether it’s the Ukraine or Argentina or swine flu in California in April, a “wait and see” attitude works best for those of us not on the ground and charged with stabilizing the situation.

It’s not always — in fact it’s not usually — easy to separate the wheat from the chaff during the opening days, or even weeks, of a disease outbreak. That’s no one’s fault. It is just the case that reliable information takes time to emerge from the noise and there is almost never any harm to waiting a bit for the dust to settle when you are observing and reporting. That’s one of the main reasons we don’t dwell on stories like the Ukraine outbreak here. Events that are a genuine cause for concern give a signal within a relatively short time (usually a week or two). Before that information isn’t reliable enough to weigh how much cause for concern there is.

That’s our advice, anyway. It’s not directed at anyone in particular. I’m not blaming the internet or the MSM or even the tabloids. By this time we all should be familiar with how this works. And since we are familiar with it, we shouldn’t forget all about it each time a new alarm is sounded.


  1. #1 cpg
    December 1, 2009


    This is old news. Do you have any new reliable news. This site is getting like the WHO. Too little too late. Sorry.

  2. #2 Don S
    December 1, 2009

    It’s all well and good to say to just wait for the dust to settle, except that the conspiracy theorists, and more so the alarmists, don’t. Those who know enough to even know that we do not yet know enough to know have an obligation to not let the voices of alarm be the only voices heard, to provide enough context to help the rest of us regulate our concern-o-meter to an appropriate level somewhere above “Meh” and below “ARRRGH! We all gonna die!!!”

    Funny enough, as we learn why we don’t yet really know enough we usually learn other useful information too.

    Please comment on controversies in real time.

  3. #3 JJackson
    December 1, 2009

    Is it old news cpg? And anyway isn’t it rather the point.
    The internet flu sites have been flu of stories about D225G changes in Ukrainian, and other, sequences with speculation regarding increased virulence. The NYTimes published an article on Friday saying “One isolate from Ukraine with the mutation had changed so that swine flu vaccine probably would not protect against it well, Britain’s national medical laboratory” internet pundits misinterpreted this as coming form the Mill Hill WHO reference lab who, today, denied the quote was from them and that there is any evidence of vaccine evasion. A ‘low reactor’ annotation on A/Lviv/N6 does not necessarily mean antigenic variance although antigenic variance would cause a sample to be a low reactor – they do not commute. All of which rather points to this story being both current and unresolved – the fog of war prevails and it is only likely to lift with the benefit of hindsight.

  4. #4 revere
    December 1, 2009

    Don: The Ukraine seems to be “old news” to some because it is receding in significance. But we still don’t know and at the outset it could have been anything. We didn’t comment in real time because we had no basis in terms of the info that was available and we didn’t have any more information than available to all the other sites, who were covering it. So there was no value added. Our only comment on it was in regard to WHO’s communique, which we thought was ridiculous given the obvious failure of the Ukrainian authorities and their health system. We don’t mind debunking bunkum if it is obvious it is bunkum, but except for tin foil hat country (which we don’t like to feed), it is rarely obvious at the outset. So if we have nothing of value to add, we usually don’t add anything.

    JJ: cpg’s comment merely says, “You aren’t worth reading anymore, even though I am reading you and commenting.” I don’t remember forcing cpg to waste his/her/its/their time reading us, so this is just internet troll behavior. Common, unfortunately, although we’ve had less of it here than the average site. At any rate, your observation is on the money.

  5. #5 Don S
    December 1, 2009

    But … when you, somewhat reluctantly, did tread into the “contentious” waters you indeed did add much value. By way of explaining the background you cited articles that presented what I personally see as major concepts – that individual hosts are NOT typically infected with a strain of influenza, but with a virtual ecology of strains, the diversity of which are lost in the process of consensus sequencing – explained the nature of the ongoing controversy regarding the means by which influenza viral diversity arises and opened up my mind at least to a wider appreciation of how influenza evolution may occur and on what raw materials. That background is without question “value added” even if it does not establish the significance or lack of significance of a particular news item making the blog rounds.

  6. #6 cpg
    December 1, 2009

    Defensive, arent we today

    I was referring the fact that we have been discussing the Ukraine situation in amazing detail for over a month. Then suddenly EM pops up with a article saying they dont comment without facts and hard evidence yet you provide nothing new.

    I think you are feeling a little left out.

  7. #7 debtfreerevolution
    December 1, 2009

    Gotta agree with Don S on that one, revere … the comments in your “I don’t want to speculate” post on the Ukraine were VERY enlightening to me as well, as a student who wants to specialize in clinical micro 🙂

    The links you posted also confirmed what I had suspected about the “consensus strain per patient” idea. Value added in my book as well!

  8. #8 Paula
    December 1, 2009

    Yeah, Revere, in areas still uncertain or controversial, the sanity and knowledgeability of your discussions and those of many commenters here are particularly valuable.

  9. #9 hjmler
    December 1, 2009

    for all that they might still’ve been better off than Moldova


    Moldovan soldiers given onions to fight swine flu

    (AP) – Nov 19, 2009

    CHISINAU, Moldova — Moldova’s army is feeding its soldiers onions and garlic to help them ward off swine flu.

    Defense Ministry chief doctor Col. Sergiu Vasislita says about 0.9 ounces (25 grams) of onions and 0.5 ounces (15 grams) of garlic will be added to each soldier’s daily diet. That roughly corresponds to a small onion and a couple of garlic cloves.

  10. #10 kdervin
    December 1, 2009

    Hi Reveres–was just in Boston visiting 2 kids in college there and visited Paul Revere plaza in North End, and walked by the North End community health clinic which was advertising H1N1 vaccinations for priority groups that night.

    All that made me think of your blog and just wanted to thank you for all of your blog posts on flu and progressive public health issues (including David Michael’s nomination to OSHA director).

    –a local public health worker in california.

  11. #11 slovenia
    December 2, 2009

    Folks, the collocation “the Ukraine” is a relic from the time when Ukraine was part of the USSR. It is mildly offensive to the Ukrainians in my circle of friends. The country is now known simply as “Ukraine”.

  12. #12 revere
    December 3, 2009

    slovenia: Thanks. It turns out my father and his family were from there (whatever it’s called) but as someone who tries not to think in terms of nationalist identity I don’t follow the nuances. For me it’s a designation of a geographic area, but I’ll try to remember to designate it properly.

  13. #13 Don S
    December 3, 2009

    Interesting which countries get “The” in front of the name. THE United States, THE United Kingdom, THE Federal Republic of Germany .. but not THE Germany or THE Great Britain or THE America. Is there a rule here?

  14. #14 Don S
    December 3, 2009

    Of course revere I believe that your father was Jewish, and likely wasn’t really accepted as Ukranian by others in that country. The only thing that mattered then when the borders changed was who was on the horses burning your town down… Ed Koch’s parents came from an area that was sometimes Poland and sometimes Ukraine I believe and allegedly he was in a Ukrainian day parade walking arm around the President of the organization down the street when he told the president “Hey just like for our grandparents in the old country! Only then my grandfather was a hundred yards ahead and your grandfather was on a horse with a pitchfork behind!” The story doesn’t say how the comment went over ….

  15. #15 revere
    December 3, 2009

    Don: Yes, correct. One of my father’s brothers went into Kiev which was forbidden (beyond the pale, literally) and everyone skedaddled. This was in Czarist days (my father was 15 and almost draft age, too). Later during the civil war following the downfall of the Czars the little town they had left just a few years before was ravaged by General Denikin and the White Army and saved by the Red Army (this is mentioned in Rosa Luxembourg’s autobiography). So the fact that Jews didn’t (or weren’t allowed to) identify with nation states may be some of the source of my own attitude. The other, I would claim, is that this accident of my personal history coincides with how it should be. Our biologies and our humanity doesn’t know about national borders. The same is true of religious identities. They are destroyed by them.

    “The” tends to be used it appears when the area is part of a larger collection (The United Kingdom, The US, The Soviet Union) and not so much for its constituent parts (not The Illinois), so how Ukraine became The Ukraine isn’t clear. But language isn’t always consistent, except for grammarians.

  16. #16 Ukraine
    December 20, 2009

    yes, it was swine flu

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