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 Last week, the Boston Public Health Department declared a "public health emergency" because 18 Massachusetts residents have died of the flu and there have been 700 confirmed cases of the flu since December. Massachusetts has around 6.5 million residents. Basic division reveals that 0.00027% of Massachusetts residents died of the flu and 0.011% of residents have been confirmed to have the flu. Apparently, that's a public health emergency these days.
Boston hospitals have reported 1,500 cases of "influenza-like illness" in their emergency rooms since September. The city of Boston houses 650,000 residents. Even if we assume that only those who live in the city of Boston go to Boston hospitals then 0.23% (less than 1/4 of 1%) of Boston residents have sought treatment in a Boston emergency room for the vague term "influenza-like illness." The number would shrink to absurdity if the 4.5 million people who live in the Greater Boston area are used as the denominator.
The message being sent by media and public health agencies is that the flu is ravaging the population. Elementary school math reveals that simply isn't so. I think a wide variety of factors lead to the annual hyping of influenza into a plague. Some of it is genuine concern for public health. Stories of the Spanish Flu from 1918 still instill fear, but the world was very different in 1918.
The world was at war. Troops were clustered together with poor sanitation. Malnutrition, which remains the world's leading cause of immune deficiency, was common. Patients were treated with doses of aspirin much higher than would be used to today, leading some to postulate that perhaps salicylate poisoning played a role in the excess mortality. Some of the symptoms attributed to the 1918 flu are similar to those of Reye's Syndrome, a condition known to be associated with the combination of a viral illness and aspirin use in children. Reye's Syndrome has virtually disappeared since routine aspirin use in children was discouraged in 1982, which is strong evidence of a causal relationship. Regardless, the image of a killer virus storming through the country is enough to terrify the public. Infectious hysteria is a positive feedback loop that multiplies exponentially so a tiny little stimulus can set off a huge, dizzying sequence of events.
I was working in outpatient pediatrics during the completely fabricated "swine flu epidemic" in 2009 that followed years of false predictions by the World Health Organization (WHO) of an "avian flu pandemic" killing 150 million people. No such pandemic occurred, and swine flu turned out to be more benign than seasonal flu. James Chin, MD, MPH, now retired Professor of Epidemiology at UC Berkeley and highly-regarded epidemiologist for both the Center for Disease Control (CDC) and WHO, documents the invented "pandemic" in this powerpoint.
Parents called me absolutely terrified that their child was going to die of the swine flu. A mother took her two children to a local emergency room to get a prescription for Tamiflu because one of her children had a cough with no fever. Both children received prescriptions for Tamiflu. Their televisions had crafted a reality that didn't exist (it happens all the time). Healthcare providers similarly just followed the recommendations of the CDC. I had to wear a gown, gloves, mask, and goggles when collecting a nasal swab specimen. The fear was palpable. And all this for what was a new strain of flu.
It just goes to show that history repeats itself. The exact same thing happened in 1976. Playing on fears of the Spanish Flu of 1918 and the 1957 flu season, Gerald Ford went on television and told the American Public that every man, woman, and child should get the influenza vaccine because of a new, dangerous "swine flu," so named because pigs were postulated to be the reservoir. The rush-to-be produced vaccine caused high fevers in 1-5% of patients, but the vaccine was pushed through anyway. Soon hundreds of cases of paralysis following immunization began to develop. The program was abruptly halted. When it was no longer possible to deny that the vaccine caused 600 cases of Guillain-Barré syndrome and 74 deaths, the scandal ultimately led to the replacement of David Spencer as the chief of the CDC. The killer swine flu never came. The tab for the fiasco was $135 million dollars. There was one confirmed death from the swine flu . . . the one that set of the hysteria to begin with.
The story of seasonal flu is increasingly becoming the story of the boy who cried wolf with dire predictions justified by an "excess of caution" being falsified by reality year after year. Many factors lead to this systemic overhyping. The media loves a good plague. There's nothing sexy about "0.00027% of Massachusetts residents (mostly old or sick people) have died of the flu." Public health officials love having something to obsess over to justify their existence and budget. Healthcare providers see an influx of flu-related illnesses which can make the scope of the disease appear greater than it really is.
The pharmaceutical industry obviously loves the fear because a public health emergency makes it easier to scare people into accepting a flu shot even though it is only about 56% effective, and that is only in healthy adults, and remember that's a relative risk reduction. A 90% efficacy has long been considered the standard for vaccines, but flu vaccine proponents remain undeterred in their recommendations despite the facts that the flu shot contains formaldehyde, that the kind used in children and adults over age 3 still contains mercury, that it has never been proven to prevent the flu in children 2-17 or adults over 65, that it has never been proven to offer a statistically-significant mortality benefit, that it only decreases a healthy adult's actual risk of flu 1.5%, and that it has never been proven superior to oral Vitamin D supplementation.
Fear of the flu also leads many patients to request the prescription drug Tamiflu (oseltamivir phosphate), a drug that has never been proven to have saved a single life. Indeed, Tamiflu's own website (in the "Healthcare Providers only" section of course) reveals that Tamiflu has never been shown to decrease mortality; it has only been shown to decrease the duration of self-reported flu symptoms by about a day, and that benefit is only seen in healthy patients who started the drug within 48 hours of the onset of symptoms. Can chicken noodle soup match its efficacy?
The trade off for such a small benefit is a greatly increased risk of vomiting and a small risk of a potentially fatal condition called Stevens-Johnson's Syndrome where the patients skin sloughs off as if they'd been burned. I don't know the actual risk because the website only reports adverse events that affect more than 1% of subjects so the rates of rare, but potentially fatal side effects, go unreported. Tamiflu suffers from the same weaknesses as the flu shot. Just as the flu shot is least effective in those most susceptible to flu because those with weak immune systems don't mount a good immune response to it, Tamiflu isn't helpful to those who might actually need it. Tamiflu's own package insert states:
Efficacy of TAMIFLU in the treatment of influenza in patients with chronic cardiac disease and/or respiratory disease has not been established. No difference in the incidence of complications was observed between the
treatment and placebo groups in this population. No information is available regarding treatment of influenza in patients with any medical condition sufficiently severe or unstable to be considered at imminent risk ofrequiring hospitalization.
Efficacy of TAMIFLU for treatment or prophylaxis of influenza has not been established in immunocompromised patients.
Further absurdity can be found in the form of using Tamiflu for prophylaxis, meaning giving Tamiflu to patients who don't have the flu as a means of prevention. Tamiflu's own data reveals that 25 healthy adults would need to be treated with 75MG of Tamiflu for 42 days to prevent one case of influenza in the community during an outbreak. Similarly, it takes treating 25 senior citizens in a nursing home with Tamiflu for 42 days to prevent one case of influenza. I am far from wowed by those results.
I am left to conclude that seasonal flu is not a public health emergency. Current methods for treating and preventing the flu have such poor efficacy that their risks may outweigh their benefits, and the annual public health campaign against the flu is an immense waste of funds and resources that could be better spent in an innumerable number of ways. The poor efficacy of current methods of flu treatment and prevention highlights the needs for randomized controlled studies comparing the flu shot to oral Vitamin D supplementation at doses sufficient to raise 25-hydroxy Vitamin D levels to around 50 ng/ml. Tamiflu should have to prove itself superior to chicken noodle soup and oral Vitamin D supplementation prior to being considered as a viable treatment.
My television is telling me to be terrified of the flu that is running amock in Boston. Math is telling me that 99.99% of Massachusetts residents have not been confirmed to have influenza, 99.77% of Boston residents have not sought treatment in a Boston ER for "influenza-like illness," and 99.9997% of Massachusetts' residents have survived the flu season to date. The flu stinks, it makes people feel terrible, it can make some people very ill, and sadly a small number of Americans will die of the flu this season. However, current public health measures are ineffective, the flu is overhyped and flu prevention is overfunded, and even if this is a particularly yucky flu season (as it appears it will be), I can confidently predict that there will still be more than 99.99% of us here when it's over.
The best advice I can give to avoid the flu is to steer clear of sick people. The flu can spread up to 6 feet through the air in droplets. Other ways to prevent the flu are simply to bolster host defenses through diet, exercise, and Vitamin D supplementation. Aside from that, que sera sera. I am not going to drive myself crazy worrying about the flu. Plenty of people do that already.
Best Wishes,
Dan
Daniel A. Clinton, RN, BSN
Professional Nursing Tutor
617-312-3799
dan@awesomenursingtutor.com
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