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Monday, 14 January 2013

Influenza – the public health credibility killer.

Its hitting hard right across the country, and if you did not get your influenza shot, no sympathy from here.  Nearly one-third of Canadians partake in the annual ritual, and they do sacrifice themselves to the shoulder pinch not just to protect themselves, but to contribute to cocoon and herd immunity. 

Since the pandemic year, we have been fortunate with milder than average years – it leads to complacency.  Time for a kick in the ass to remember what this bug has the potential to do.  So baton down the hatches and prepare for the ride over the upcoming weeks as Influenza A/H3N2 Victoria 2011 makes its rounds. M. Picard at the Globe and Mail has a very nice realistic overview of influenza G & M influenza article

We trust you have learned the classic triad of influenza’s fever, myalgias and cough as the hallmarks of the illness.   In schools, it is even more typical with students arriving in the morning fine, and then literally dropping like flies during the day.  It is the school administrative assistant who is the first to know as the students drag into the office needing to go home. 

Emergency rooms get backed up, hospitals get overcrowded and there will be the inevitable yells that there are insufficient hospital beds and surgeries have to be cancelled – when the intelligent health administrators will have scheduled the influenza surge into their booking schedules and not let the surgeons dictate hospital utilization.   The hospital bulging will continue for weeks after students have returned to school.  The bed utilization gripping will persist for months and scarcely a word will be said that it was predictable, partially preventable and most importantly manageable through queuing theory and not the traditional seat of the pants reactivity.

Many will die in the upcoming weeks, succumbing to the complications of influenza.  It is a predictable tragedy and one that collective real efforts are made to reduce.   So why do we continue to use mortality statistics that are based on severe years and poor vaccine matches?  After many years of saying there were 4000 influenza deaths per year in Canada, the number is finally coming under appropriate scrutiny.    CBC story on influenza death numbers . Driven in part by the body counting of pandemic influenza that filled a documented 428 graves when it was supposedly a really bad illness. Of course the actual numbers are based on mathematical modelling of excess deaths, not on body counts.   PHAC lists 2000-6000 deaths, CMA 4000-8000, and none provide really good basis for their numbers.   Some of the mathematical models predate current influenza and other prevention efforts. 

The time has come clean on using influenza mortality statistics, if for no other reason than in public health we must be truthful and transparent, and when exaggerations are used, credibility drops. Some sites are already decreasing their estimates to 500-1500 deaths per year, perhaps more believable and still far too many tragedies.

Add to the flippity approach to reporting mortality, here we are mid-season with an MMWR article announcing 62% vaccine efficacy.  The media reporting a poor match, but if you read the CDC statement this is in keeping with good match years. Moreover, the MMWR statement is more about the need to use oseltamivir in vaccinated patients with ILI (is there a conflict of interest here?), than concerns about the vaccine.  Credibility hit number 2 MMWR vaccine efficacy

The third credibility whammy taken by BC’s public health folks is over the mishandled implementation of mandatory influenza vaccination policies for health care workers.   There have been prior attempts elsewhere, Ontario coroner's recommendations, court and labour board rulings supporting such efforts – but when policy abuts labour unions, and the perceptions spill over into the political arena – the groundwork was insufficiently laid for what is likely the right thing to do.   And, public health professionals are the ones with the embarrassed look on their faces.

There are many reasons for getting the influenza immunization, washing hands, coughing into your sleeve, and avoiding worksites when you are ill.  There is no need to exaggerate or to use a sledgehammer to achieve the objective of reducing influenza’s annual contribution to the graveyards of the country. 

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