Philip Alcabes discusses myths of health, disease and risk.

How to Cover a Health Crisis – or Make One

A post by revere at Effect Measure reminded us that the pandemic preparedness initiative had an intrinsic ineptitude to it.  “CDC had been training state labs to make the differentiation between the two seasonal flu subtypes, H1N1 and H3N2, and bird flu, H5N1, so the capability to do seasonal subtyping already existed outside of CDC. But neither the reagents nor the proficiency for the new swine virus did.”

In other words, everyone had their guard up – but not for the right thing.

How was the public health apparatus so beguiled by the possibility of disaster that, when a relatively mild outbreak of flu took shape, the entire public health industry responded as if disaster were truly at hand?

To investigate, we tracked mentions of flu in news articles (letters and op-ed pieces were not included) published in the NY Times.  The pattern turned out to be revealing about how a pandemic is made.

From 1981 through 1996, inclusive, there were between 5 and 16 stories on flu each year – with the exception of 21 articles in 1986 (when a very mild flu season was predicted and a rather severe flu season surprised people).  On average, the Times ran 8.7 stories per year in that period.

Flu fever at the Times spiked in 1997, when the first cases of avian flu were announced and there was interest in how the W.H.O. would handle it.  Through 1999, there were 20-25 stories per year, an average of 22 – about two articles per month.

But in 2003, which was both the year of SARS and the peak of the bioterrorism-preparedness psychosis, coverage exploded:  the Times ran 50 stories on flu.

In 2004, the failure of any bioterrorists to take the field forced the Bush administration to claim that it wasn’t bioterrorism it had been worried about, it was pandemic flu.  As that administration was always a fountain of unassailable truth, it will be recalled, Secretary Tommy Thompson’s August ’04 Pandemic Preparedness plan convinced many people that flu is our real security problem.  The Times complied, running 130 articles on flu in 2004, with a slight fall-off thereafter.

If you were a dedicated Times reader, you had encountered an article on flu roughly every six weeks back in the early ‘90s.  But by 2006 you read about flu twice a week, on average.  And that was often in the context of pandemic preparedness.

The Washington Post’s pattern was similar (differences in the Post’s search engine and archive arrangement required a slightly different analysis), but its coverage was even more flu-prone.  A dedicated Post reader saw five articles on flu in the A section each week, by 2006.

Does this mean that media created a flu crisis singlehandedly?  Of course not – media make stories, or deliver other people’s, but they alone can’t make crises.  Much of the coverage followed leads provided by scientists – who, let’s face it, have to make sure the grant money keeps flowing in their particular direction (that was the origin of the 1976 fiasco over swine flu vaccine).  And much of the crisis was driven by business, especially the growing market for flu remedies.

But the media analysis sheds some light on why the preparedness rhetoric was so powerful in shaping American public health around security – and therefore juicing up the current flu outbreak into a global crisis.

H1N1 flu is a health problem, sure.  As DemFromCT has been explaining, it’s a problem that can and should be dealt with through standard public health channels, and with a circumspect eye on what we know and what we don’t.

But if it weren’t for weak government, overeager scientists, and compliant media infusing flu with a global-crisis flavor, would it register as such a grand problem?  We feel sad about the 332 swine flu deaths, but we also recognize that that total equals just a few hours worth of mortality from TB or malaria in the poor parts of the world.

As for media, the number of flu deaths registered in the U.S. is almost exactly equal to the mortality on American highways on any given Saturday.  (At Effect Measure today, revere notices the similarity between seasonal flu mortality and vehicle-related mortality.  Alas, revere misses the larger point:  this similarity demonstrates that flu can be called a “crisis” when it causes far lower mortality than usual, whereas highway accidents are never called a crisis.)

Any preventable death is lamentable, of course.  But you don’t read much about an epidemic of vehicle crashes in the papers.

n.b.  This is a slightly amended version of the original post, which because of faulty hyperlinking, improperly implied ineptitude where there wasn’t any.

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This entry was posted on Saturday, July 4th, 2009 at 6:51 am and is filed under Disease, epidemics, Health Professions, Narratives, News, Outbreaks, public health. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

2 Responses to “How to Cover a Health Crisis – or Make One”

revere says:

A couple of things. The reason flu popped up in 2003 was that was when avian flu popped its head above water after being absent since 1997. We don’t know what makes flu transmissible or virulent, but H5N1 is extremely virulent and if it becomes transmissible and keeps even a fraction of its virulence, it is a catastrophe. Preparing for that made, and makes, sense. I won’t argue it with you, further. I understand it is not your field of expertise.

As for the scientific establishment generating interest, it did this because it was of genuine scientific interest. It involves a virus that is a major public health problem. Not the only public health problem. But a major one, nonetheless, with significant morbidity, mortality and cost. But very few scientists are engaged in it and they don’t drive the agenda. It was then, and remains, a very small field. As for Big Pharma driving interest, they had no interest in flu vaccines at the outset. They followed the interest, they didn’t generate it. If you had been following events as they evolved isntead of construcdting your own narrative, you’d realize that.

As for whether we missed “the larger point” in our post today, we don’t want to trade point-missing accusations. There’s too much for all of us to do. But we had a point to make. It just wasn’t the point you wanted to make, although I have no idea what point you were making, other than everyone has missed the boat but you.

We’ve written thousands of posts (literally) in the last four and half years. We write about many things, but we have been very consistent. As we have stated repeatedly, we chose to write about flu as a lens through which to look at public health. We won’t go over the reasoning why we thought it appropriate except to say we could have chosen other lens, too. We chose this one. We are cancer epidemiologists. We are not flu practitioners, we have no grants about flu, nor do we make any money from discussing it, except whatever the blog brings in (which is very little).

Just so you understand the point we have pushed from the outset — years and thousands of posts — it is that the way to prepare for a pandemic is to strengthen and public health and social service infrastructure. We have consistently refused to engage in discussions of personal prepping (how much water should you stockpile, for example) in favor of talking about how neighbors can help neighbors and how together we get through difficulties as a community, not hiding under our beds. That is part of using flu as a lens to discuss public health from a progressive perspective. Although we are licensed physicians we do not have our own stash of Tamiflu and we do not intend to jump the queue for vaccines. Nor do we have a stockpile. We have a message: getting ready for a pandemic means having a robust community that is resilient and where its members care about and help each other.

I do not know what your bigger political point is, assuming you have one. You sometimes come across sounding like a denier or crank. The idea that fear of pandemics is a bigger problem than a pandemic is not only bizarre but smacks of conspiracy theory thinking. Each of our point of view has others we’d just as soon not be associated with (I give you Michael Fumento on your side). But that’s not relevant. Emergency rooms will fill up in even a moderately bad flu season, not because people are afraid of flu but because they are sick and have nowhere to turn, a dramatic example of the brittleness of our health care system. We could be talking about this, instead of hyping fear of fear.

    Philip Alcabes says:

    Really glad to see you here, revere; your perspective has been invaluable. We agree on nearly everything, especially that disease outbreaks can be a lot worse than what people fear. Flu is a serious threat to the public’s health, and needs more insightful – and more global – thinking than it has received thus far.