"Scientists sound warning after first death from new H10N8 bird flu reported," blurted the latest flu alarm. A 73-year old Jiangxi Province woman died last December from a new strain of bird flu called H10N8. Following last year's H7N9 scare, ChineseCenter for Disease Control (CDC) researchers admonished that “the pandemic potential of this virus (H10N8) should not be underestimated." Rest assured, US CDC officials will not miscalculate the pandemic potential of any strain of flu. The possibility of an outbreak — even seasonal flu — is an opportunity to shine as our influenza experts and saviors.
But, in terms of what is of interest to the average citizen and what should be of paramount interest to all health officials, surprisingly little — nothing with any accuracy — is known about the flu. Who are its victims? How many of them are there? What is the toll (deaths, hospitalizations, days of lost work, etc.)? What is the ability of the CDC to predict next season's flu strains, let alone epidemics and pandemics? Who should be vaccinated, and against what? How effective (and safe) are the vaccines? And so on.
The CDC answers all these questions, to its own satisfaction, but leaves the layman confused and more than a little suspicious that almost anything it says about the flu is designed to scare, very much more than inform. For example, we have been told for many years that the flu kills 36,000 Americans annually. That number has recently been reduced to about 24,000, and expressed as a range (3,349 to 48,614) to provide "a better way to represent the variability and unpredictability" of seasonal flu-related deaths. Thanks for the clarity, but now we have to worry about the possibility of 49,000 deaths.
In terms of what is of interest to the average citizen and what should be of paramount interest to all health officials, surprisingly little — nothing with any accuracy — is known about the flu.
And what is meant by flu-related? The CDC report Estimates of Deaths Associated with Seasonal Influenza provides the answer in Table 2: Estimated number of annual influenza-associated deaths with underlying respiratory and circulatory causes. But there is a footnote; the numbers include deaths from influenza and pneumonia. Pneumonia! How is my flu shot going to protect me from pneumonia?
And what are underlying respiratory and circulatory causes? These are not defined, but Table 1, which excludes them, provides an estimate of the influenza and pneumonia only death toll. It has a mean of only 14,715 (down from 24,000) and a range of only 684 to 16,347. While this precipitous drop, from 36,000 deaths to less than 15,000, alleviates many flu season worries, where is the estimate for the flu-only scourge? It's not in any CDC influenza reports.
For such a breakdown, the tenacious investigator must consult the latest National Vital Statistics Report (the May 2013 edition). There, hidden in the bowels of Table 10, the decomposition is found for the year 2010 — apparently taking three full years to count up all the carnage: a measly 500 deaths from influenza; 50,097 from pneumonia. That's ripe: 500 flu deaths, 50,097 pneumonia deaths (100 times more), and the CDC sticks 50,597 into its flu report. Is the flu vaccine lobby that powerful? And where's the pneumonia lobby? I want a pneumonia shot.
To some of us, grossly exaggerating influenza threats to expand public vaccination is a despicable approach to conducting a national influenza control and prevention program. But what's a little disease-mongering when you’re saving lives? And there is nothing like an occasional threat of an epidemic, better yet a pandemic, to win over anyone left undaunted by the flagrantly massaged mortality and morbidity statistics of mundane seasonal flu.
An incipient pandemic (or epidemic) unfolds with the discovery of one or more individuals infected by a new flu strain. Next is the one-two punch of scientific mumbo-jumbo uttered over suspicious genetic material, followed by perfunctorily ominous warnings. Scientists studying the H10N8 virus determined that it had acquired genetic characteristics that may allow it to replicate efficiently in humans. In the throes of that Eureka moment, one researcher speculated that "the H10 and H8 gene segments might have derived from different wild bird influenza viruses reassorted to give rise to a hypothetical H10N8 virus in wild birds, which infected poultry and then reassorted with H9N2 viruses in poultry to give rise to the novel reassortant JX346 (H10N8) virus." Yikes (to whatever that means)!
It sounds like we are just a few random mutations away from a more lethal variant with human-to-human transmissibility — aka, a pandemic. But plausibility does not a pandemic make. Last October, a leading Netherlands virologist, who had been tracking the H7N9 virus, hastily announced, "We're bracing for what's going to happen next." What happened next? After claiming 69 Chinese lives to date (from a population of 1.35 billion), H7N9 has shown no evidence of human-to-human transmission, and concerns of an H7N9 pandemic have fizzled. With only one death to its credit, it's a little early, therefore, for panic over an H10N8 pandemic.
The vast majority of the time, the "flu" is an influenza-like illness, not influenza.
On the other hand, it's a little early for disappointment, on the part of CDC officials, healthcare journalists, drug company executives, and others, who may have been rooting for an H7N9 or H10N8 pandemic. Recall that after years of warnings of a bird flu pandemic (following the Avian Flu scare of 2005), the Swine Flu (H1N1) pandemic struck; by August of 2009, the President’s Council of Advisers on Science and Technology exclaimed a winter death toll of up to 90,000. Hope springs eternal.
For the time being, we are left with the less shrill, but more dependable, cries of seasonal flu: those of our health officials, hustling every American over six months old to the vaccination lines. Flu shots, we are told, could save over 22,000 lives annually; modern vaccines are safe, and 62% effective. Moreover, according to a computer model, the CDC estimates that its vaccination program has reduced flu-related hospitalizations by 79,000 and has "prevented approximately 6.6 million influenza illnesses and 3.2 million medically attended illnesses."
A computer model to estimate lives saved and infections prevented? Why not simply count them? CBS News found the answer in 2009, when it asked the CDC for a state-by-state count of laboratory-confirmed instances of flu. After waiting more than two months for its Freedom of Information request (the CDC balked at the initial request) to finally be honored, CBS discovered that "the vast majority of cases were negative for H1N1 as well as seasonal flu, despite the fact that many states were specifically testing patients deemed to be most likely to have H1N1 flu." In California, for example, 86% of the 13,704 specimens tested negative for the flu; only 2% tested positive for H1N1 flu.
CBS should not have been surprised. The vast majority of the time, the "flu" is an influenza-like illness (ILI), not influenza. According to CDC data, of the hundreds of thousands of respiratory specimens lab tested in the US annually, only 15% are found to be true influenza. The remaining 85% includes the 200 or so non-flu viruses (rhinoviruses, coronaviruses, adenoviruses, etc.) that, while producing flu-like symptoms, or ILI, are impervious to flu vaccines. These specimens are obtained from patients already inflicted by an ILI. Virological testing of specimens from the general population tells a much different, and very small, flu season story: the incidence of ILI is only 7%, with true influenza playing a bit part of 1%.
The larger story is the disparity between influenza policy and influenza evidence. That and the inexplicable failure of the CDC to accurately characterize the epidemiology of seasonal flu. What else are we not being told? The final tally for the Swine Flu pandemic was 11,000 deaths. Even this much lower number (down from the 90,000, initially predicted) may be smaller still — perhaps 1,650 (15% of 11,000) or 110 (1% of 11,000) pandemic embarrassments, when the average seasonal flu allegedly kills 24,000.
What are we to make of the CDC's urgent pleas for vaccination and its wild claims of success? To the average person, 62% effectiveness means that only 38 of every 100 people vaccinated would become infected. What if only 1 out every 100 people would become infected by the flu, even if they were not vaccinated? Further, assume a perfect vaccine (one that matches the strains of wild flu in circulation during flu season, and wins every encounter with these strains). Such a vaccine would prevent 1% of the vaccinated population from getting influenza. Period. That's it, 1% effectiveness. It would have no effect on those who acquire non-flu viruses and those who escaped infection by true influenza and ILI — i.e., the other 99%. While my naive, aggregated estimate is in stark disagreement with the 62% effectiveness calculated by a CDC computer model, it is, oddly enough, about 62 times closer to actual vaccine effectiveness.
Statistically speaking, seasonal flu is a rare, relatively benign disease. Vaccination provides little or no protection for the very young and very old — those who may need it most.
A 2012 Scientific American article addressed the paucity of evidence behind pretentious CDC vaccination claims. According to Cochrane Collaboration research referenced in the exposé, vaccines approved for children under the age of 2 “are not significantly more efficacious than placebo.” For older children, "the shot reduces the absolute risk that a child will catch the flu by about 3.6 percent, whereas the live (inhaled) vaccine reduces the absolute risk by about 17 percent." Adults under 65 "have about a four percent chance of catching the flu if they don’t get the vaccine and about a one percent chance if they do." For adults over 65, there is only one vaccine that has been shown to protect against infection or death, "an inhalable vaccine that contains a live, modified version of the virus [wait for it . . .] which is not approved in the U.S. for adults over age 50." Regarding claims that vaccination slows the spread of flu virus, "there are no data showing that this is true."
None of this is vaccination denial. God bless the Jonas Salks of the world. They are saints; their vaccines are miracles. But in the world of seasonal flu, the state of the art for vaccines is pathetic, CDC hubris to the contrary. Statistically speaking, seasonal flu is a rare, relatively benign disease. Vaccination provides little or no protection for the very young and very old — those who may need it most. At best, it provides marginal protection for older children and adults under 65 — those who need it least.
As for the world of pandemic flu, the verdict is still out, waiting anxiously along with hypochondriacs, the obsessively risk averse, and an immense global flu ecosystem (the WHO, the CDCs, influenza researchers, public health officials, the media, and, of course, pharmaceutical companies), for more H10N8 victims. But the poor old woman from China, the only death to date, "also had several chronic conditions, including coronary heart disease." Alas, she might not even have been the first victim.