Re: CBS NEWS: Swine Flu Cases Overestimated...Whodathunk?
A few words about the Reveres since I am posting their commentary with their permission:
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
http://scienceblogs.com/effectmeasur...lu_testing.php
Most importantly what the CBS article pointed out was that unless you were confirmed positive by testing, you don't know for sure if you have immunity to this novel virus. Because of your lack of assurance, you have a decision to make to vaccinate or not. It's a very big decision if you have kids to protect.
Does it actually matter how many cases of influenza are occurring? Not a whole lot.
What matters most to me, at least is that
we are seeing an unusual number of deaths in groups that don't normally die of flu i.e. healthy pregnant women, school age kids, teens, and young adults. And, we saw this in the spring
and the summer as well. The fact that there were no prior exisiting conditions for at least a third of these cases is very troubling. And, the fact that they are dead means that they were indeed confirmed cases.
The CBS interpretation of events about the testing is misleading. Read the Reveres full commentary for a better explanation but here is bit of it.
Originally Posted by scienceblogs.com It is clear that CDC is saying to the state epidemiologists they are sorry they did not run the Q&As about stopping testing by them , not the decision to stop testing. Contrary to this article, I heard throughout this period that the pressure on CDC to stop the testing was coming from the states, not the other way around. It's no secret that state health departments are hard pressed to keep their heads above water financially and are short staffed all around. Expensive swine flu testing was something they couldn't afford. The burden to do the testing was on the states, not CDC, but as long as CDC recommended it, states couldn't easily stop on their own, especially if neighboring states were still testing. The reason for stopping was confusing (and CBS News shows themselves confused) and bound to be controversial. In effect, CDC decided to take the bullet for state health departments. And CBS News obligingly pulled the trigger.
Is it flu or is it something else? The likelihood increases with the circumtances:
Originally Posted by scienceblogs.com CBS's own investigation found that in all 50 states, prior to stopping testing in July, lab-confirmed cases showed that most specimens were not influenza. As I noted, since other viruses cause ILI during non-flu season this isn't too surprising. What was surprising was the amount of influenza there was at a time when we expect to see very little. Now that flu season is here, the chances that an ILI is truly influenza (causally defined) is much greater. And frankly, there is no possibility of testing all ILI cases for swine flu. There will be millions of cases of ILI and they can't all be tested and most won't even be seen by anyone. Moreover, during the period of the CBS "study" many people were having specimens taken that would not ordinarily have seen a doctor. The data they looked at were from all 50 states (and we don't know what data it was or what they counted or whether they even calculated things correctly) and were mostly cases that were not epidemiologically linked.
This last is important. CBS News cites an outbreak of 250 cases at Georgetown University as an example where no testing was done so it isn't certain this was a flu outbreak. Admittedly, it could have been adenovirus or respiratory syncytial virus or a bunch of other things. But when something like this happens in the setting of a pandemic, the odds are that it was influenza. More importantly, data on the number of positive specimens for all the people of Georgia over a several month period three months prior is not the same as 250 cases among students who were in contact with each other and that occurred over a few weeks. And think about the alternative? Nothing prevented Georgetown University from testing all those cases. Nothing except that it would have been infeasible and the resources weren't available, that's all. And it wouldn't have changed how they were treated, except perhaps to delay treatment.
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