I was going to try to sleep in this morning but my kid couldn’t find her femur—long story. So I figured I might as well brew up a pot of Pal’s Special, put up some Irish steel cut oatmeal, and review this weeks insanity.
This has been a rough week for the public’s health education. The flu pandemic is still on the rise, and if trends continue, we will hit a record number of cases quite soon. Currently the best primer on influenza is Joe Albietz’s, which I encourage you to read. But rumors about the flu are spreading nearly as fast as the virus, and we need a nearly real-time response to keep up. I’ve been doing quite a bit of tweeting and facebooking, responding to specific questions and concerns, and here I’ll summarize a bit of that.
This year’s flu is much like any year’s flu—there’s just a lot more of it, and rather than knocking off the old and infirm, it’s hitting young people particularly hard. Few people who get the flu will get a bad case, but a certain number will. Each year, tens of thousands of people die because of the yearly flu epidemic, and this year, since more people are getting the flu, more will die. Since we don’t test every case, we make sophisticated estimates which have worked well. One of the enduring rumors is that these estimates are either not very good, or are intentionally inflated for some nefarious purpose. These rumors are always started and spread by people without the expertise or knowledge to understand them in the first place. A very good, but difficult, summary of how we get these numbers is at the best public health blog on the web, Effect Measure. Many of the scary websites out there call flu death statistics “the big lie” based either on paranoia or ignorance. They make several immoral and dangerous arguments.
- “Because flu deaths are counted as “flu + pneumonia” deaths, people aren’t really dying of the flu”: this is wrong. We don’t test every single case of flu, and many people who die from flu are killed by a pneumonia that attacks their weakened lungs. If not for the flu, they would not have gotten the pneumonia and died. If they had gotten their flu shot, they would have been much less likely to get the flu, the pneumonia, and died.
- “Flu only kills the old and sick, so stop saying it’s so bad”: during non-pandemic years, the flu kills mainly the old and sick. I happen to like many old and sick people and do not wish them to die of the flu. In pandemic years, like this one, many of those killed are in fact not the elderly. This one like to hit younger people, as is typical of previous pandemics.
The flu vaccine has been made the same way for nearly half a century. Epidemiologists chase the virus around the globe, trying to see which strains are most likely to hit us during flu season. These strains are then grown in chicken eggs, killed, refined into a vaccine, and injected. The only difference between each year’s vaccine is which strains are in it. Some years we do better than others. Two years ago, a new strain came roaring out of Australia after the shots were made, and while the shots provided some protection against it, more people got the flu than usual. The shot still protected very well against the other strains that year. This explains why several other rumors are not true:
- “The vaccine is too ‘new’”: No, it’s not. It’s the same vaccine we use every year. If the swine flu had been identified a bit earlier, we could have wrapped it into the usual seasonal flu shot, but we didn’t have the chance, so we’re stuck with two shots.
- “The swine flu shot is untested”: False. It has been tested, more extensively than most flu shots. But this type of testing only detects common reactions because more serious reactions are very rare. The only way to find more serious reactions is to “test” many, many people. This has been done. Every year, millions are vaccinated and we have yet to see any significant complications. It may well be that a few people every year are seriously injured by the flu shot, but it is so rare that it is nearly impossible to tease out of the background of serious disease. It is also a much lower number than the number of people severely sickened or killed by the flu each year.
- “This vaccine contains squalene/adjuvants/mercury/other scary sounding name and we shouldn’t take it”: once again, false. This vaccine contains nothing that we haven’t used before. Some doses may in fact contain small amounts of scary-sounding things, but as we’ve seen, most of these rumors are either false or idiotic. When people complain about sodium chloride in vaccines (you know, salt) you realize you’re dealing with someone who is trying to scare people with big words. The water in the vaccine must be the same concentration as the water in your body, which is basically salt water, so what we inject is basically salt water as well. The only ingredient in the vaccine that is biologically active—that is, causes the body to do something—is the flu antigen itself. Everything else is either inert, or present in such a small amount as to make it essentially “not there.”
The most frustrating thing about all of this is that we are dealing with the worst flu pandemic in my lifetime and people are being, well, people. This is serious. I’ve been caring for an inordinate number of flu patients since this hit us in April, and it’s not just “a cold”. Many more people are dying than in a normal season, and this can be prevented by a simple vaccine. There is no other real way to prevent the flu. It is frustrating that people who have spent their entire careers studying, learning, and fighting infectious diseases are having their work discounted and tossed aside, while any idiot on facebook can convince an acquaintance that flu shots are made in dirty factories in Thailand from aborted babies force-fed deadly poisons and injected into poor innocent people in America to sap us of our precious bodily fluids. Really, to a professional, that’s what this stuff sounds like—deranged, psychotic. Please try to remember that we aren’t making this stuff up—we’ve been studying the flu for over a century and we’re getting pretty good at it—except for the public education part.