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Cases of swine flu seem to be vastly overstated

Via CBS:

If you've been diagnosed "probable" or "presumed" 2009 H1N1 or "swine flu" in recent months, you may be surprised to know this: odds are you didn’t have H1N1 flu.

In fact, you probably didn’t have flu at all. That's according to state-by-state test results obtained in a three-month-long CBS News investigation.

[...]The results reveal a pattern that surprised a number of health care professionals we consulted. 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, based on symptoms and risk factors, such as travel to Mexico.

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Submitted by hipparchia on

the scandal they SHOULD be digging into and reporting on is just how much the right wingers have been destroying all the agencies and programs that work to help and protect the rest of us: cdc, epa, fda, fema, medicare, social security...

among the federal agencies that have been woefully underfunded for decades is the cdc, meaning that among other concerns, they cannot afford to test everybody who shows up with 'flu-like symptoms' for every type of possible flu. as early as APRIL they had already given out 1/4 of their stockpiled flu supplies, we're late getting the regular flu vaccine this year, we'll probably need a swine flu vaccine too, we can probably expect a noticeably worse flu season than usual this winter...

not to mention the fact that doctors and nurses seem to think that requiring them to get flu shots is evil, and that a significant percentage of them plan to show up for work even if they're contagious.

that cbs article doesn't say very clearly [or perhaps i didn't read as carefully as i should have] exactly when those test results were obtained. it's entirely possible that the results reflect a tailing off of seasonal flu cases from last winter and at the same time an increase in swine flu cases as we moved into the summer.

if this is the case, then given limited funds, it makes sense for the cdc to stop testing flu-like illnesses, keep that money available for other needs [like replenishing the stockpile of flu vaccines and flu medicines], and treat even small outbreaks aggressively to keep them from spreading, because our health care system is woefully unprepared for a huge outbreak.

also, since they are NOT testing to find out which flu germs people have, they are very prudently recommending that people NOT assume they have acquired immunity to the swine flu just because they have been given treatment for flu-like illness. yes, it would have been nice to be able to test everyone who gets sick, but you have to pay taxes if you want government services.

we desperately need to start taxing the living daylights out of both the corporations and the rich people, and we need to start doing it soon.

Sarah's picture
Submitted by Sarah on

very limited numbers of flu test kits available. We sent out letters asking our providers to request flu test kits when they started seeing the fall 'surge' of flu-like illness.

I'll never forget the pediatrics clinic (three MDs and two FNPs) who told me in February that they'd been seeing scads of flu (schools were closing!) in kids, but hadn't reported it because "we didn't know it's reportable in patients under 18."

Some days, it's not worth chewing through the restraints ...

Submitted by hipparchia on

Some days, it's not worth chewing through the restraints ...

that made me smile, in a if i don't laugh, i'll cry kind of way. but yeah, i know what you mean.

Submitted by [Please enter a... (not verified) on

Well, I don't know if the CDC has the budget to do the job. (It does have a $8.8 billion budget, but I suppose it's possible that isn't enough.) I also get the impression that this testing service doesn't come out of the CDC's budget, but out of the states' and the states in fact already had this information. The CDC just chose not to collect it. The director of the CDC says in this video that they work in "conjunction" with the states, and the reason the CDC didn't release it was the needed to make sure that the data the states reported was "accurate" and "actually reports what they intended to report."

Well, what is the accuracy of the states?: "'What we are doing is much more detailed and expensive than what CDC wants,' said Dr. Bela Matyas, California's Acting Chief of Emergency Preparedness and Response." I'll assume she's telling the truth. Plus, there's the fact that the CDC was presumably relying on this data before, but then for some reason chose not to rely on it. The CBS article mentions the rationale given for the CDC's stop: "[W]hy waste resources testing for H1N1 flu when the government [me: the CDC] has already confirmed there's an epidemic?" Also, in the CDC's letter to the states as to why they have stopped collecting the data, they don't mention inaccurate (how would they even know that?) results, or lack of money, they mention lack of time:

"Attached are the Q&As that will be posted on the CDC website tomorrow explaining why CDC is no longer reporting case counts for novel H1N1. CDC would have liked to have run these by you for input but unfortunately there was not enough time before these needed to be posted."

Hmmm, how interesting. It looks like the CDC made its mind up about what was and wasn't an epidemic before they had all the information, or actually after they had all the information, but just chose not to release it to the public. According to this, Dr. Thomas Frieden, director of the CDC, said at a press conference just two days ago that "many millions" had been infected." So, he's comfortable giving figures on just how many Americans have been infected across the country, but he's also not comfortable taking in or "releasing" figures from the states that would let him know that. Again, how very interesting.

The swine flu has been pumped up and used to scare people for months. Hopefully, this can shed a bit of light on the reality situation.

Submitted by hipparchia on

here. the blogger is an epidemiologist, so it's worth reading.

apparently the 'precipitous decision' was about putting up a Q&A that hadn't been carefully looked at. the decision about TESTING was NOT precipitous.

also, it appears that the states are the ones that asked to be allowed to stop testing for swine flu.

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.

The kind of testing asked for here -- determining the subtype of an influenza isolate -- is not a piece of cake. It requires specialized equipment and specialized expertise. Both the equipment and expertise exist in state health departments thanks to money and training CDC did in anticipation of a bird flu pandemic, but it wasn't designed for high throughput. There was no way states could handle tens of thousands of specimens. If taxpayers don't want to pay taxes, they shouldn't complain when the infrastructure isn't there, but in fact they might legitimately have complained about a laboratory capacity that goes unused except during an influenza pandemic. Since pandemics are unpredictable, that capacity would mostly lie fallow.

Submitted by [Please enter a... (not verified) on

With all due respect to that poster who's the epidemiologist, I think he ignores two important points.

He ignores the fact that the overwhelming majority of cases when tested did not show swine flu. That's what this whole thing is about. Secondly, he ignores that the states, despite the cost to them, continued with the testing in the same manner as before, yet the CDC simply chose not to release those numbers. So, it's not a matter of cost at that point. It's a matter of interest.

Submitted by hipparchia on

the overwhelming majority of cases when tested did not show swine flu

true. the testing was done when swine flu was just beginning to appear in the population, so this is a logical result.

the cdc does have in place a program for following the spread of flu, including swine flu, even without testing every single case of possible flu-like illness. it's imperfect, but it's a compromise from the fact that we don't have the tax dollars, particularly at the state level, to have labs sitting around idle waiting for the odd pandemic to happen along.

the important question from a public health perspective then becomes: given that testing resources are limited and that the results aren't available until it's too late to start treatment, what's the best thing to do?

the limited resources problem isn't just a money thing. if you're going to hand out test kits, the manufacturer[s] have to make more of them. if you're going to analyze those test kits, you have to buy, build, or rent lab space, buy or rent lab equipment, buy lab supplies, and hire [or train] lab techs.

the states, despite the cost to them, continued with the testing in the same manner as before

actually, it sounds like california continued with the testing, and that most other states were overwhelmed and wanted the cdc to stop requiring them to do so much testing. apparently the cdc agreed to that. nor does the cdc seem to have required states to STOP testing if they want to keep on.

the CDC simply chose not to release those numbers.

ok, i watched the video of the press conference that's posted at the cbs site. the cbs reporter says that all 50 states have released their numbers to cbs, but that the cdc won't release their copy of the same numbers to cbs. the first question that pops into my head is: why, if you already have all the numbers, are you badgering the cdc?

the cdc person goes on to explain that the numbers they got from the states are in many cases incomplete or preliminary, and that they'll release the data when it's complete. he could be lying through his teeth of course, but one alternative explanation is that the states released their incomplete and/or preliminary numbers to the press. there's some reason to believe this, since cbs only lists results for 4 states in their graphic that you posted. if they've got numbers from all 50 states, why didn't they make up a map, or a list, showing the results of the other 46 states?

That's what this whole thing is about.

the blogging epidemiologist apparently thinks that cbs has their hearts in the right place, and are just mistaken in their emphasis. my own opinion of cbs is much more cynical, but i'm willing to leave it at that.

Submitted by [Please enter a... (not verified) on

Your opinion of CBS might be cynical, but my opinion of the CDC is cynical. If I'm right, and there has been fear mongering from the government about the swine flu, the CDC has much more to gain, much more at stake than CBS.

You also say that it's a logical result that most of these tests don't come out positive for swine flu, but these were not random tests. It says, "many states were specifically testing patients deemed to be most likely to have H1N1 flu, based on symptoms and risk factors, such as travel to Mexico."

I'm also not sure that these figures are from when swine flu was "just starting to appear," meaning I don't think that the figures are from: March, April, May. I think that the figures are more likely from late July/early August, September, October. That was when the CDC stopped releasing these numbers publicly, and the article says the investigation went for three months.

Submitted by hipparchia on

from cdc:

When the novel H1N1 flu outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the novel H1N1 outbreak. On July 24, 2009 official reporting of individual cases of confirmed and probable novel H1N1 infection was discontinued. Below is a summary of information gathered during the first weeks of the outbreak. These key disease characteristics are thought to remain an accurate representation of novel H1N1 flu.

so the tests that cbs wants to see the results from would have to be from april through july, wouldn't they? mid-april to late july is close enough to three months.

ordinary flu season in the us

gqmartinez's picture
Submitted by gqmartinez on

It seems like the CDC, was trying to track the extent of the swine flue during the peak flu seasons. They stopped when the peak seasons ended.

The CDC and the states aren't exactly loaded with extra cash as far as I know. It makes little sense that they would throw money away on tests they didn't think would provide valuable epidemiological data. Given the danger of novel viral and bacterial infections that jump from animal to human, I think I would probably be more distraught had the CDC not bothered to study this.

Submitted by hipparchia on

it makes sense to test at first, whether or not resources are limited, because it's worth knowing whether something is an isolated outbreak or widespread.

the cdc seems to have concluded that it's just widespread enough that less testing is needed and just dangerous enough that fairly aggressive actions [prescribe anti-flu medicines, get vaccinated, close schools] should be taken.

this looks like one of those damned if you do, damned if you don't situations where if they take aggressive [read: expensive] action, they'll be pilloried for scare-mongering and if they wait [read: risk letting people die] before declaring an emergency, they'll be pilloried for not taking action sooner.

there's probably a legitimate debate about just exactly where to draw the line, and cbs could have taken the lead in covering all aspects of this. both the science blogger and josh fulton ascribe fairly benign motives to cbs, but to me this article makes them appear to be on a witch hunt.

Submitted by [Please enter a... (not verified) on

I don't think CBS is talking about getting data from the states from April to July, because as far as I know the CDC already made that data public. They'd have to get the data from the states from the period that the CDC wasn't making public, which seems like it would have to be from the post July period.

Submitted by hipparchia on

the article says that the freedom of information act request was filed 'more than two months ago', which would make it some time in early-to-mid august, which would have been shortly after the decision to stop testing. i suppose you can file a foia request asking to be provided in the future with data that hasn't been produced yet, but i don't actually know.

the paragraph in the article that describes the graphic you posted says that the data used to produce those pie charts was from the april-july period, which would have been the beginning of the swine flu outbreak.

the article is poorly written, which just underscores the fact that the reporters involved don't seem to understand science or epidemiology and have not taken any great pains to educate themselves about it either, beyond collecting a few scattered opinions from some public health officials.