Friday, October 30, 2009

Pediatric H1N1 Deaths: Compared to What?

Deaths of children due to Novel Influenza A H1N1 rose 20% in just the last week.  So far 114 children have died.  That's what Bloomberg is reporting this afternoon, following the weekly update on the CDC website.  Bloomberg's coverage then continues with this penetrating commentary from Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University:
This is very unsettling news for parents, particularly when coupled with the shortage of the vaccine. The situation is much more fluid and uncertain than the government expected and than the public is comfortable with.

So, let's face it.  A lot of us very naturally look to the news to tell us how scared we should be.  If something makes the news, we figure we should pay attention to it.  If it's bad, we figure we should worry about it.  In the case of something like a pandemic, the news is our major source of information.  So a 20% rise in pediatric deaths in one week scares us, and now we have an expert telling us that this is unsettling news, so we feel, well, unsettled.

Bloomberg, as the press often does, is violating the Quarterback's 5th commandment of H1N1 communication:
Thou shalt put thy information in appropriate context so that thy public may understand the dangers they face with relation to other dangers, and not overreact to thy numbers.
The fact of the matter is that nowhere do we have a sense of comparison between the number of pediatric deaths from H1N1 and other causes of death for children.  We don't know how many children have H1N1 in the first place, so we don't know what the chances of any given sick child dying might be.  We don't know how many children tend to die from seasonal flu, nor how many of these children were medically fragile and likely to die from something else if they hadn't contracted the flu.

The death of any child is a tragedy.  The highly publicized death of a child is scary to parents.  But the naked number "114" has no meaning whatsoever.  And the statistic "20% in one week" is unbelievably misleading -- I certainly didn't think the number was going to be in the low three digits when I saw that.

Which brings me around to Professor Redlener, who really ought to know better.  Not only does he tell us to be scared without any context at all (although, to be fair, he might have given context that was edited out), but he then goes on to tell us that this is much "more fluid and uncertain" than predicted.  That is patently false.  Back in August, the President's Council of Advisors predicted between 30,000 and 90,000 deaths from H1N1, which translates to between 5,400 and 16,200 pediatrict deaths.  We've had 114.  I would say that if we are more uncertain than we thought we would be, it's because the big shoes have yet to drop, not because there have been so many deaths.

Reporters are trying to sell newspapers, and fear sells papers.  An honest headline this week like, "Yep, Still Lots of Swine Flu" would not sell papers, so that's not what Bloomberg picked up.  They need to remember that hysteria is a lot more contagious than any flu can ever be.


Matt said...

An average of four children die a day due to preventable accidental drownings in the US. This number, of course, spikes in the summer. Non-existent Headline: "120 Children Die in Backyard Pool Accidents this Month".

On average, seven children die in auto accidents every day in this country. This also peaks seasonally with the driving season. Another non-existent headline: "Over 200 children dead this month in car accidents."

Public health coverage in this country maddens me almost as much as people's inability to assess risk. Of course, flu has this invisible trail, so it seems like it's striking out of nowhere. And it's not like there aren't plenty of accidental deaths that come out of nowhere. But as a group we're not good at figuring out context, and especially not when there's risk assessment in play. And the understanding of the basic science and biology of viruses, and disease in general, is abysmal in this country.

I won't get off on another tangent, which is the increasing problem of parents believing vaccines are evil, which is even more maddening (and selfish, and stupid.) (No, I do not honor parents who refuse to vaccine as making 'different choices' anymore than I honor people who play the lottery for having an equally valid concept as me about the laws of probability.)

With respect to H1N1, this is clearly something unusual but not, at least at this point, anything that anyone can do anything about short of vaccinating and hand washing and that sort of thing. But there was even more panicky coverage last spring when there weren't ANY fatalities verified in this country (and remember how Mexico was more or less shut down?)

When would be the appropriate time to have some public interest? I dunno, when we decided not to invest in a national health care infrastructure? After 9/11 when there was at least panic about biological attacks and maybe we could have had some political momentum to have a national vaccination plan? Or maybe when we ran short of regular flu vaccine a few winters ago? Oh yeah, then we couldn't intervene in the private sector and have an anti-competitive government vaccine manufacturing program.

I'm sorry to rant but this is insane. I am ticked off I had to call around incessantly to even find a flu shot for my kids, even a regular flu shot, and I couldn't find one or get one scheduled before Nov. 11th. It's not like I'm panicky about the flu, but we get our kids shots every year. Why is it still so goddamned hard to get basic health care in this country even when you're insured, prophylactic, and reasonably informed and proactive?

I hate to be so cynical, but going after the media meme on H1N1 is a losing cause as long as the public is obstinately ignorant. If this goes to 1000 fatalities a month, coverage will spike. But I bet it'd fall off it it rose, or stayed there, as the usual complacency about preventable death in this country inevitably takes over...

Matt said...

On second thought, maybe panic is what it takes to get anything accomplished in this culture. Bring on the hysteria! Maybe we'll finally get a real public health service and single payer health care with some teeth.

Colleen said...

In a single google search on child deaths stats, I found some for 2003. If my quick math (done by the method of saying, "hey, Abe, what is 75000 divided by 52, which he then does in his head) is right, about which I make no promises, I come up with it being 14 times more likely that your child will die by poisoning itself on purpose than die of swine flu.

So far, it's about 2 kids per state. For each of those families it's a tragedy. I don't want to think of what they are going through....but we, as a society, shouldn't be panicking.

But I think it's sort of like that old Baby Blues cartoon...the parents are racing around with a sick child...Dad says, "Don't panic, we shouldn't panic" Wanda says, "why not? Go with our strengths!"

Meet the Quarterback

My Photo
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
View my complete profile

Subscribe via email

Enter your email address:

Delivered by FeedBurner

Quarterback for Kindle

Blog Archive