Tuesday, August 25, 2009

Is 90,000 a Lot?

The President's Council of Advisors on Science and Technology came out with a new report on H1N1 yesterday. If you only read the headlines, what you will learn is that 90,000 people could die and 2 million be hospitalized this fall in the United States. I hope by now you know better than to only read the headlines. What the report actually does is posit a "plausible scenario" in which 30-50% of the population becomes infected, 20-40% of the population has symptoms and 10-20% of the population seeks medical care. This could lead to 1.8 million hospital admissions, 300,000 ICU beds used (which could be 50-100% of ICU beds at any one time), and 30,000-90,000 deaths.

The point of the report was to make some particular recommendations to the President about preparedness, and they all sound pretty good to me. I also appreciate the level of context they placed around the numbers they quote, something the press seems to be completely omitting in their coverage. This is in clear violation of Qarterback H1N1 Crisis Communication Commandment #5, "Thou shalt put thy information in appropriate context ." Obviously I lack the level of clout of some other commandment issuers.

The thing that I find most troubling about even the low end of the mortality estimate is the fact that the majority of those deaths will be in people under 50 years old. Children are going to die. And while we may be accepting of deaths among the elderly from influenza, we really aren't accepting of deaths among children from any cause, let alone from the flu. And, of course, the 90,000 number seems really high. But is it? Here are some things to compare it to:
  • 30,000-40,000 people die every year from seasonal flu. The predicted number for H1N1 in this scenario is higher almost entirely because a greater percentage of the population is expected to get sick. That's because few if anyone currently has immunity, and the vaccine isn't ready yet.
  • Over 121,000 people die in various kinds of accidents every year in this country (car accidents, falls, construction accidents, etc.)
  • The top number of deaths in this scenario represents 3 out of every 100,000 people in the United States.
  • If the current ratios of different age groups hold up, about 18% of these deaths will be people under 24, or 14,400 at most. That would represent 1.3 children and young adults out of every 100,000. There would still be more people under 24 killed by accidental injury than by H1N1.
The problem is not that 90,000 is a lot. The problem is that 90,000 is more than we're used to, and certainly more than we're used to for young people. It's as though we suddenly discovered that thousands of children were going to die of Alzheimer's Disease. We know that people die of Alzheimer's, but it shoudln't be these people.

I again find myself imploring the press not to pick naked numbers out of thin air and publish them as headlines. Unfortunately, few in the press corps appear to be listening to their Quarterback.


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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at www.SchoolCrisisConsultant.com
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