Rhiza Labs FluTracker Forum

Disease mongering and the fear of pandemic influenza.

Vance MA.

Butler University, College of Pharmacy and Health Sciences, Indianapolis, IN 46208, USA. mvance@butler.edu

Abstract

The catastrophic H1N1 pandemic of 1918, which killed tens of millions, is now legendary, and influenza policy has centered on preventing another such disaster. There is reason for concern about influenza A. It can rapidly alter its genetic makeup to increase virulence and can jump from other species to humans. Nonetheless, ignorance about influenza in 1918, the lack of effective vaccines or antibacterial and antiviral drugs, and the social disruption caused by World War I also contributed heavily to the lethality, and it is unlikely that influenza of similar destructiveness will recur. The stupefying publicity over the threat of influenza has been generated partly by those, such as the pharmaceutical industry and influenza researchers, who benefit from the increased expenditures the publicity provokes. It is, in effect, disease mongering, the promotion of disease or dread of disease for one's own gain. Huge expenditures on influenza preparedness have produced little demonstrable benefit and some harm, independent of the wasted resources. Disease mongering, including spreading fear of influenza, is widespread and unhealthy and should be vigorously opposed.

PMID: 21319723 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/21319723

I do not agree at all.

First of all, the social disruption from WW1 didn't directly affect every country in the world. Second, we have plenty of social disruption all the time - right now, in fact. Thirdly, the current vax is mismatched, and vaxes, antivirals (and the flu can easily become, as have other flus, anti-viral resistant) and antibacterial drugs are certainly not available in sufficient quantities all over the world. Who is this guy, anyway?

The tricky thing about swine flu is the patchy geographical nature of its effects.

In 2009 Ukraine got really hammered. More recently the UK and now possibly the USA. But last winter in Australia was really quiet.

From what I have read (and I've read obsessively about flu pandemic stuff since I first heard about H5N1 quite a few years ago, and I admit I am a layman just trying to learn) a couple of years before the flu pandemic in 1918 there were increased severity of respiratory illnesses here and there.

I was thinking that last year was like 1917, but now I think maybe this year is. I don't think the full severity of swine H1N1 has been reached. If I am wrong, great. I had it once or most likely twice and it is a hellish flu, not at all like regular flus.

ANother point is that the CDC and the WHO are political entities and as trustworthy as any other national or international entity - that is to say, very, very untrustworthy. They have their own agendas which is not the wellbeing of the general population, nor the dissemination of facts and truth.

Icouldn't disagree more. These pieces are generally put up by those with no background in infectious diseases and no clue about virology or sequences. The piece fails on all levels and is really a political piece with a lot of handwaving. The argument that 1918 can't be duplicated because of unique conditions present in 1918 was silly before the latest pandemic emerged, and utter nonsense after.

In 1918 waves were facilitated by public gatherings like parades, and such gatherings exist today. Moreover, today's population is much more mobile, so spread can be quicker and more extensive. In addition to spread in humans, there are more opportunities for spread in animals.

pH1N1, like 1918 is swine origin and attacks previously health young adults. A small genetic change can have a major effect. D225G was present in 2/5 sequences from 1918/1919 and it is in a few percent of current case. A jump to 40% would have a catestrophic effect. As seen in the UK, the current version can tax health care delivery. Although more advance procedures are in place today, these alternatives, like ECMO machines or mechanical ventilation are limited, both in the number of devicesd as well as trained personal. A 20 fold spike in severe cases would compromise delivery by train medical personal. Increased activity would lower personal levels directly or indirectly.

Similarly, there are issues with vaccine development and delivery, which also apply to antivirals. Even antibiotics have issues, including resistance.

Thus, there are major issues and pieces like the one above should be called out for what they are - polical nonsense, no science required.

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www.twitter.com/hniman

I agree with the fact that a 1918-like scenario is very unlikely and yes it might repeat again (the article doesn't discard it) but, considering that we do not have a exact number of that event we cannot verify the true magnitude of what really happened in those years. So, we should extrapolate the data very carefully.

The public doesn't need to hear only catatrophic projects because after all the most plausible scenario is a moderate one, although pandemics are impredictable events. People must know that there are many possibilities before a catastrophic scenario many times showed in papers, articles, forums, blogs and influenza researchers websites. We are better prepared than ever before, this is very important for the people who could read us. We shouldn't forget that we have very aggresive disease surveillance systems around the world monitoring 24/7.

Health authorities around the world are preparing very efficiently for a catastrophic pandemic event although it is not likely to occur. Just prevention and better preparation for a mild- moderate scenario like H1N1 2009.


For example;
When the U.K was hit by H1N1 I asked Dr. Henry Niman for moderating his commentaries and giving an entire picture of what was really happening there as he had a very good sight of what was going on in the entire U.K. But, Henry Niman continued to write with an alarming tone and some data was exagerated in some cases.

Henry I do appreciate the work you do most of the time that is just excellent, but it's essential to improve what we're transmitting in the middle of a crisis. I know that you have a very good background on this subject.

Thank you!

The situation in the UK was quite severe, as indicated in commentaries, and the papers such as the one used to start this thread are absurd.

As far as 1918 is concerned, there may be some debate on whether the death toll was 20 or 50 million, but to claim that knowledge of the magnitude of 1918 is unknown is false.

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www.twitter.com/hniman

Yes, the H1N1wave this year in the U.K was significant in mortality in some areas, but overall most of the people had a mild course as seen in 2009 (This was avoided in your commentaries among other info that was as important as the 'negative' data)

Data indicates that the U.K has lived worse flu seasons than the 2010/2011 in recent years. Although the affected age group was largely displaced by those in their 20s and otherwise healthy young adults. As we see the health care system in the U.K did cope extremely well with this wave after all. The U.K has a very low rate of beds per population.

First of all, in 1918 they didn't even know what was killing them and the living conditions were very poor, also there weren't communication systems as we know them today. I don't need to remember that they didn't have antivirals and ICUs like in 2011. Important studies indicate that most of the deaths happened in India. This country is not reliable today and was much less by that time. The WWI disruption could caused a illusion number together with the above and the 1918 scenario might be reduced to something much more moderate. I do not doubt that the 1918 pandemic was catastrophic for some communities and we have to work to prevent this from happening again as we are doing everyday.

Yes, it is false to say that we know the magnitude of 1918. (From 20M to 100M deaths is estimated but not affirmed as it's not possible.)

There's still much to say about 1918 and the numbers.

In 1918 the H1N1 swine recombinant was causing the deaths (directly or via secondary bacterial infections), just like 2009 H1N1. This was not due to social disruption. There was a high number of deaths in the 1919/1920 season also. Most estimates are 20-100 million deaths worldwide for 1918-1920.

The 2009 H1N1 is just a few key changes away from similar numbers. WHO and CDC claim that the disruptions caused in the UK were by an antigenically indistinguishable H1N1. A few small genetic changes can have a VERY large effect, as indicated for D225G (which was in 2 of 5 HA sequences from 1918 and 1919). These changes would seriously disrupt health care delivery.

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www.twitter.com/hniman