The winter flu hysteria Separating fact from fiction
By Dr. Michel Cohen
FluMist $80 with a $30 manufacturers rebate.
This enticing sign still hangs in a doctors office window in Tribeca. It is one of the remnants of the big flu scare two months ago. After all the hoopla, it looks like the 2004 flu is no more than a run-of-the-mill winter flu epidemic, albeit one driven by an unexpected viral strain that struck earlier than expected. Now that the panic is over, we can take a breath, look at the facts, and see what the hysteria was all about.
The flu is a viral illness that causes an average of three to five days of fever, headaches, nasal congestion, and muscle pain. It usually resolves without any complication, but it sometimes charts a rougher course. Some young children develop subsequent ear infections, while others may come down with pneumonia.
In very rare cases, the flu leads to an overwhelming infection which can cause death. Such complications are likelier in older people and in children with underlying conditions, and to a much lesser degree, in kids younger than two. So far, we have found no effective treatment for this annual epidemic. Medications such as Tamiflu supposedly reduce its severity and length if administered early, but none are approved for young children.
Prevention of the flu relies on a vaccine devised with an inexact science of predictions and extrapolations, based largely on past flu activity. Once formulated, the vaccine takes about four months to manufacture, so the flu virus has plenty of time to morph in the world at large.
A good vintage can protect about 85% of those exposed to the virus if the match is appropriate, but that number can be as low as 30% if the strain differs significantly. The fact is, if you and your kids get the flu vaccine, you still stand a good chance of catching the flu (though its course is supposedly milder in vaccinated people). This season, four out of five reported cases were caused by a drift variant of the virus, only slightly related to one of the three strains in the vaccines viral cocktail.
Every winter, especially when facing a news lull, the media runs rampant with images of emergency rooms packed with flu victims. This year it helped the nation whip itself into a state of near panic. It started with an early onset of flu in the southwest, which was still reeling from the West Nile Virus. Compounding matters is the SARS hangover, last years overblown health hysteria. Add a couple of Orange Alerts to the mix, and we had a recipe for mass panic.
At the height of the flu frenzy we were anxiously watching the flu map darken on the nightly news, state by state. Yet the statistics that suggested a more virulent strain of this new flu may have been distorted by the news itself. The omnipresent coverage led people, who in normal circumstances would have rode out their fever at home, to seek treatment, thus inflating the statistics.
The panic increased further due to an unexpected high childrens death report. Looking back closely at the numbers, it seems that this toll may have appeared higher because these tragic, but yet statistically expected childrens flu-related deaths, were reported more accurately this year in the bright light of media overexposure. (Doctors are not required to specifically report childrens flu-related deaths).
In our Tribeca office, where we care for about 4,000 children, the flu looks no different this year than it has in previous years. If anything, we have even fewer cases many of them in kids who had actually been vaccinated. The flus course has also been fairly standard, with the usual three-to-five days of fever and few complications.
The CDC has recently recommended that kids from 6-months to 2-years-of-age be immunized, as well as people older than 50. It also recommends immunizing people in contact with this high-risk group and anyone who wants to reduce her risk of having the flu. This pretty much means everyone.
I have a few concerns about this policy. First, the money it would take to widely administer this imperfect immunization could be used for more efficient preventative measures in other areas. Second, its possible that widespread immunization would make the virus mutate faster, thus rendering immunization even less effective as well as promoting more virulent mutant flu strains. Finally, I question the long-term effects of repetitive immunization: Will it make humans less resistant to the flu for want of having fought it off over the years with our natural immunity?
In the midst of all that influenza frenzy, we doctors had very little guidance from the Centers for Disease Control and Prevention (CDC) and had to scramble to assess the real risk. The CDC itself contributed to the panic by reversing its usual stand and recommending widespread vaccination. Vaccines, however, were not readily available and their effectiveness was more than doubtful.
Doctors offices phone lines were swamped with calls from panicked people seeking guidance on whether and where to be inoculated. In response, the government, in an effort to reassure a frightened populace, bought doses of vaccine from abroad. But instead of reassuring people they further alarmed them. If the promised pandemic materialized there would not have been enough of the augmented supply to go around.
One of the big beneficiaries of this frenzy was the pharmaceutical company Wyeth, maker of FluMist, which had recently introduced this new high-margin product. Who could have planned for a better marketing opportunity? Wyeth sold millions of doses. In June 2003, the FDA approved FluMist, the first weakened, live-influenza vaccine delivered via nasal spray. The efficacy is supposedly the same as its intramuscular cousin but this assumption is still based on relatively small clinical trials.
Now that the flu scare has passed, we must ask ourselves how we the media, the government, and citizens would react to a major outbreak of natural (or terrorism-driven) illness.
Based on this recent flu frenzy, we can easily see how the media would fan the flames of panic and leave people without sound information. When facing a new public health concern, we need government organizations like the CDC to stand apart from the frenzy and use their tax-driven resources to provide calm-headed, reliable information and realistic risk assessments.