Effect Measure

Swine flu: (unfinished) story of the year

It’s the end of the calendar year and the traditional time the media looks back on “the biggest stories of the year.” There are websites about almost any subject (even one on a particular model of running shoe, I am told), but those of us who write specialized blogs (as opposed to ones about politics or current events) rarely expect our subject matter to show up on one of those lists. We’ve been writing about flu for over five years, here, and while re recognized the possibility our subject would come into vogue — that’s indeed why we were writing about it — it still took us and everyone else by surprise.

Now, just about everyone’s choice as one of the top flu reporters in the world, Helen Branswell of Canadian Press, confirms that for Canada, and likely for the US and much of Europe as well, the swine flu pandemic was the newsroom choice for biggest story:

The H1N1 virus was chosen by 70 per cent of the newspaper editors and broadcast news directors in the annual year-end survey of newsrooms conducted by The Canadian Press.

“There isn’t a Canadian out there who isn’t affected by or interested in the virus and how it may affect their families,” said Sandy Heimlich-Hall, assistant news director at CFJC-TV in Kamloops, B.C.

“It was a coast-to-coast story that people followed with interest no matter where they lived in Canada,” agreed Lesley Sheppard, managing editor of the Moose Jaw Times-Herald, in Moose Jaw, Sask. (Helen Branswell, Canadian Press)

Even Branswell’s news story about news stories is full of information. She quotes the naysayers to good effect . . .

“The H1N1 flu scare is almost more famous for the way it was handled by the media than how it spread wildly across the country,” said Victor Krasowski, news director of radio station CJUK in Thunder Bay, Ont.

Rocco Frangione, Krasowski’s counterpart at CFXN Radio in North Bay, Ont., agreed H1N1 was more hype than threat.

“The way health organizations spun this issue, I expected people to be falling dead in the street,” Frangione said. “It didn’t happen and once again the so-called experts got it wrong when it comes to a new virus hitting people.”

. . . going on to point out that as the story was unfolding it was impossible for anyone to know where it was heading. Maybe the most frightening part of the flu story is that there really are news directors like Krasowski and Frangione who have control over what the public hears. Their kind of understanding of the year’s biggest news story is so unsophisticated one only expects to hear it discussed this way casually around the water cooler by people whose lives are taken up with the daily struggle of trying to get by and who don’t pay attention to the news at all — not by people whose job it is to understand the news as part of their own daily struggle to get by.

I have a vivid recollection of the opening days of this pandemic and the sense of uncertainty — indeed the knowledge from past experience that with the given set of facts before us, just about anything could happen. Branswell quotes Nancy Cox, CDC’s flu chief, as saying, “I think this is one of those situations where everyone will want to stay tuned.”

And stay tuned we did. Like the opening engagements in a war, it was unclear what was happening. The media were confused and that made the public confused and all for a good reason: the scientists were also confused. With new tools of analysis and information being communicated at a speed unprecedented in any previous influenza pandemic (the last was 41 years earlier and there was no internet), we were watching a pandemic unfold in real time but still not clear what we were seeing. It was clear from the outset the epidemiology was quite unlike seasonal influenza, but we still didn’t know how the virus was going to behave clinically. Was it about as virulent as “regular” flu? Much more virulent, like a 1918 flu? More benign? We didn’t even have a good way to count the cases or estimate the virulence. Some of this was inherent in the disease and some of it was the result of systematic disinvestment in public health. Either way, the uncertainty of a breaking pandemic was every bit as confusing as the classical “fog of war.”

The current narrative, visible in Branswell’s story, is that modern medicine has mitigated what could have been a much worse experience. I’m not so sure and we won’t know for at least a year or two when we can assemble the available data in a form that allows us to make more sense of it. And the story isn’t over, only the 2009 calendar year part of it. What will early 2010 bring? We’ll let Branswell’s reporting of the views of WHO’s top flu scientist, Keiji Fukuda, have the last word:

“I can’t count the number of times that I have said, ‘We cannot predict what’s going to happen in the future. It could go this way, it could go that way,”‘ said Dr. Keiji Fukuda, the global health agency’s special adviser on pandemic influenza.

“But our job is to try to make sure that whatever direction events take place, the fewest people are harmed. That’s our business. That’s what we try to do.”

Fukuda suggested armchair quarterbacks who now insist that it was clear months ago that H1N1 wasn’t a real threat don’t know influenza.

“It is not true. And in fact, it’s still not true,” he insisted.

“One of the questions which one can pose is, in February or March or January, is the continent of North America likely to see another wave? And the answer is: Nobody knows.”

Fukuda continued: “And in that time period, is it possible that the virus would make some kind of change and things would get more severe? The answer is: It is possible. Would it happen? Nobody knows. And that remains as true now as it was in April when things were first starting.”

I doubt they are reading Helen Branswell in those two [small town radio] news rooms in Ottawa Ontario. It might make them too informed.

Comments

  1. #1 Crof
    December 28, 2009

    Thanks for this commentary, Revere. One point: the editors Branswell quotes are working in small-town radio stations, not in Ottawa. When I saw the original story, I thought it was interesting that Branswell had had to go so far afield to find an opposing view.

  2. #2 anon
    December 28, 2009

    I can’t count the number of times that I have said,
    ignore those statements like :
    ‘We cannot predict whether you are going to win
    the lottery. It could go this way, it could go
    that way ‘

    just this way is much more likely.

  3. #3 revere
    December 28, 2009

    Crof: My face is red. It is the second time I’ve confused Ontario and Ottawa. Typical yankee ignorance about our neighbor. But I also suspect the sentiments weren’t that unusual in news rooms. It certainly is common amongst the public and the news is one place that idea comes from.

    anon: Not sure what you are saying. That a bad pandemic is the same odds as winning the lottery? What exactly does “much more likely” mean?

  4. #4 anon
    December 28, 2009

    interesting that the PCAST survey
    from August wasn’t mentioned here.
    Not important enough in this context ?
    Or just not supportive to the agenda
    of the authors

  5. #5 revere
    December 28, 2009

    anon: Where is “here” and who are “the authors” and what are you talking about?

  6. #6 Jan Stradowski
    December 28, 2009

    Sad but true – mass media tend to behave like this, also in Europe. Probably the “body count” was too low for them :-/ and they don’t understand that flu is still really unpredictable (maybe they don’t like the word…). And this applies not only to journalists. One molecular biologist told me last summer that “everybody knew” H1N1 was going to be benign and it couldn’t be a pandemic strain. So how did it happen that it took so many lives?

  7. #7 Sam Dawes
    December 28, 2009

    One recollection I have from April is being at the CDC in Atlanta and sitting in on an “all hands” meeting where acting Director Rich Besser was addressing the employees about the unfolding H1N1 epidemic. I distinctly remember him saying how proud he was of the effort everyone was putting in to get a handle on the thing. He said it was the “Agency at its best.” Then the employee health service director addressed everyone and said, “get your sleep, it doesn’t do anyone any good to be pulling all-nighters.”
    For us public health types, we can all recognize this as an example of why we do what we do. It’s reassuring to know that our nation’s premier infectious disease agency was totally zoned in on H1N1 and doing all they could to protect the public health. May it ever be so.

  8. #8 elephantman
    December 28, 2009

    those who may still believe this pandemic was a “non-event” should read the new NEJM article on H1N1 mortality in Argentina, which contains the following notable quotes

    – Pandemic 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza in previous years.

    – Rates of hospitalization [from 2009 H1N1] were double those for seasonal influenza in 2008.

    http://content.nejm.org/cgi/content/full/NEJMoa0907673

  9. #9 Paula
    December 28, 2009

    Since I’ve done journalism off and on for most my adult life, I feel called on to defend these poor smalltown newspeople, though I really don’t want to as their reportage is often simply careless, callous, or ignorant. But they are also under a civic gun more closely pointed to their heads than, even, are reporers in the metro or national “press” (do we still call it that?–such a holdover from archaic print). When Johnny Jones or Priscilla Moneymoll or whoever owns the local garbage wrap says (perhaps so urged by the local cortege of self-important civic fathers–and they tend to be males) that it is time to calm down vox populi, time to get back to pictures of the cows a-grazin’ on the cornflowers (or wherever), there is no countervailing force, no opposition paper, nowhere to turn for alternate media employment; they can obey or quit. And this affects the coverage of health news, certainly of a pandemic, as much as any other story.
    Oh, but this sounds like reportage anywhere in recent years, doesn’t it?

  10. #10 revere
    December 28, 2009

    Sam: Indeed.

    Elephantman: Yes. Quite right. We mentioned the other day.

    Paula: But there is the new media and that makes a difference. This is a (painful) period of transition. But remember one meaning of “the power of the press.” It is the power of the person who owns the printing press. With the new media, many of us are now publishers and distributors. It’s a revolution just like 1450.

  11. #11 Jody Lanard
    December 28, 2009

    Revere, as you summarized: “the current narrative, visible in Branswell’s story, is that modern medicine has mitigated what could have been a much worse experience.”

    That is, of course, what developed country officials would tend to say if things go well. If things go badly, then it would be the virus’ fault…

    I look forward, with trepidation and anticipatory sadness, to eventual reports of the pandemic’s toll in places with poor baseline nutrition, and virtually no access to antivirals and ICU’s for panflu-afflicted children and adults.

  12. #12 Paula
    December 29, 2009

    Agreed, and I keep meaning to get my own act/blog together. Still, I wanted here to run just a bit of interference for the sometimes far overpressured smalltown (print) reporters out there.

  13. #13 Doug
    December 29, 2009

    One of the things I found interesting in the response to H1N1 was how the limited vaccine was allocated. I’ve always thought of vaccine as a population based prevention method, but it seems that recently many vaccines, including H1N1, are being used as a personal prevention method.

  14. #14 revere
    December 29, 2009

    Doug: Since vaccines are administered to individuals, they are both individual and population interventions. Even when targeting “high risk” groups like children, we are not only protecting individual high risk children but the population of chiidren, and those in contact with children. So the line between the two is indistinct and when “marketing” a vaccination capaign it is natural to do it in terms of individuals (who, with voluntary vaccination, make the decision). On the other hand, I agree with you that even those involved in public health don’t always keep the two perspectives separate and often talk and think in individual terms. That’s probably inevitable and at some levels the blurring even makes sense while the sharp distinction doesn’t.

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