Posted: December 15, 2009
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Article SummaryOn December 2, I posted a long “Swine Flu Pandemic Communication Update” entitled “It’s Official (sort of): The Swine Flu Pandemic Is Mild So Far.” I explored the implications of November 12 CDC data on the first six months of the pandemic, and criticized the CDC for failing to discuss those implications publicly. On December 10, the CDC released new data, and I wrote a new (and shorter) update. This “Update on the Update” covers four topics related to the earlier update: (a) The uncomfortable reaction of many public health professionals to the update; (b) Flaws they pointed out in the update; (c) Increased media attention to the pandemic’s mildness; and (d) Continuing CDC interpretations – misinterpretations, in my view – of its own pandemic severity data.

Update on the December 2 Update

Reactions, Reflections, and Developments
Since My December 2
Swine Flu Pandemic Communication Update

The CDC released estimates of U.S. pandemic cases, hospitalizations, and deaths on November 12, then released updated estimates on December 10.

My December 2 update discusses the CDC’s November 12 estimates, focusing on their implications and how those implications were (or weren’t) communicated.

My December 15 update discusses the CDC’s December 10 estimates from the same perspective.

This “Update on the Update” addresses reactions to the December 2 update, and some developments with regard to communication of the CDC’s November 12 estimates that happened after that update was posted.

My December 2 “Swine Flu Pandemic Communication Update” was entitled “It’s Official (sort of): The Swine Flu Pandemic Is Mild So Far.” It explored the implications of CDC data on the first six months of the pandemic. It also criticized the CDC for failing to discuss those implications publicly in its news briefing announcing the new data, and it criticized the media for failing to notice.

I focused especially on the CDC’s reluctance to acknowledge that its own data showed the pandemic to be much less deadly (so far) than the average seasonal flu. I also contended that, contrary to most people’s impression, the CDC’s data showed the pandemic has been deadlier for American seniors (people 65 and over) than for children 0–18. The difference is far smaller than the difference for the seasonal flu (which is much deadlier for seniors than for children), but in the same direction.

(The first contention is based chiefly on an overall case fatality rate calculation using the total number of cases and deaths from the CDC’s November 12 estimates. The second contention is based chiefly on age-specific population mortality rate calculations using the CDC’s November 12 age-specific estimates along with U.S. census data. You can see the basis for all the calculations in my December 2 update, or you can calculate them yourself, using the CDC’s estimates and U.S. census data.)

I have received a lot of feedback on the December 2 Swine Flu Pandemic Communication Update, some of which I want to share. I also want to take note of some aspects of media coverage and CDC communications between my December 2 update and a later update regarding new estimates released by the CDC on December 10.

Reactions to the Update

The best word to describe the reactions of people I have heard from in the U.S. public health and medical journalism professions is “uncomfortable.”

Of course, risk communication commentary is at most a sideshow. Only a fraction of public health and medical journalism professionals follow such commentary. But of those who both are interested in risk communication and usually like my writing on pandemic communication, most were reluctant to say much about the December 2 update.

I am grateful to the people who talked or wrote to me about their discomfort, and tried to explain why they found the update troubling – even though they weren’t always sure why.

Nobody suggested that I got the numbers wrong. Nobody said that the implications I saw in the CDC’s November 12 data weren’t there, or that the CDC was discussing those implications in its public messaging.

A few reporters did direct me to earlier stories in which the media covered various experts’ and commentators’ claims that the pandemic was mild. And everyone noted that a study published on December 8, showing the pandemic was mild so far, got extensive coverage. (I will discuss this later.) But the reporters agreed that media coverage of the CDC’s messaging went along with that messaging, rather than pointing out the evidence that the messaging conflicted with the agency’s own November 12 estimates.

Several reporters defended the coverage by arguing that it’s not their job to second-guess the CDC, and that it would be a failure of objectivity to do their own arithmetic on the data in the November 12 report. Others said that they had no stomach for numbers and no trust in their meaning, and neither did their editors or their audience.

It’s the discomfort of public health professionals that was most striking. They didn’t seem to feel I was wrong so much as wrongheaded. I think they were saying that the truths I was emphasizing ought not to be emphasized.

Health professionals seemed to be feeling four main things:

  • Most feel that it is important to vaccinate as many people as possible against swine flu, especially people in the prioritized groups, including all children. Information (however accurate) that undermines this goal by suggesting that the pandemic is mild overall and that children aren’t really more at risk than adults and seniors is a disservice to public health.
  • Some feel that the credibility of the CDC and of health officials at all levels is an important and sometimes fragile resource that shouldn’t be undermined. Debates among experts about what officials should and should not say about the pandemic are appropriate and can be useful, but any such debate should be kept among experts, and should be conveyed to officials privately. Valid claims that officials are being less than candid about some aspects of the pandemic (e.g. overall severity and who is most at risk) can damage their credibility about other aspects of the pandemic (e.g. vaccine safety), and therefore shouldn’t be made public.
  • Many feel that state and local health officials are far too tightly stretched to spare any time to second-guess the CDC – and certainly too stretched to read my over-long “monograph” (as one journalist called it) even if they stumbled across it. Officials are exhausted, sleep-deprived, short-staffed, and highly dedicated – and they are desperately trying to get vaccine into as many bodies as possible as quickly as possible. They need the CDC to be right; they have no practical choice but to follow its messaging lead. A suggestion that the CDC might be off-course and they might want to chart their own course simply isn’t helpful.
  • Many feel that everybody in the know already realizes that virtually all flu numbers are highly unreliable – both seasonal flu numbers and pandemic flu numbers. We don’t actually know that 36,000 Americans a year on average die of a flu-related illness, nor that 90% of them are 65 and over. The swine flu numbers are more tentative still. Doing arithmetic on these estimates treats them with more respect than they deserve, a textbook case of “garbage in, garbage out.”

I am calling these responses “feelings” rather than “opinions” because that’s the sense I got. For the most part, the public health professionals I talked or corresponded with didn’t actually argue that public health matters more than truth, or that instances of misleading CDC communications should be covered up, or that local health officials have to follow the federal lead even if it’s mistaken, or that our influenza statistics are close to worthless. (Well, several flu experts did actually tell me they think that last “feeling” is true.)

But feelings along these four lines seemed to underlie people’s discomfort with the update. Perhaps people also experienced some ambivalence about those feelings – and thus all the more discomfort with the update for arousing them.

I am still absorbing these four reactions – especially the first two: that public health matters more than candor and that public criticism of public health leaders does more harm than good.

Several people asked me this very pointed question: Other than not hacking into anybody’s computer or invading anybody’s privacy, how am I different from the people who launched the “Climategate” controversy? The hackers found and published evidence that some global warming scientists are also global warming activists, and are sometimes underhanded in how they try to convince the world to take action. If you think the hacked scientists whose underhandedness was exposed are basically right about global warming, was it a service or a disservice to the world to expose them? Everyone assumes the hackers are climate change deniers or at least skeptics, not supporters trying to hold their own side to a high ethical standard. If I am not an opponent of public health, why am I acting like one?

I believe that public health leadership is sustainable only if it’s credible, and that it is sustainably credible only if it’s candid. And sometimes doing a public analysis of publicly available information is the only way to drive the lesson home. (Here is one previous example of such an analysis.)

That’s my argument, and it has been my argument throughout my career as a risk communication professional. But it clearly sounds hollow to many public health professionals. I continue to revisit their uncomfortable (and discomfiting) responses – wondering if they could be right; concluding that they are wrong; and then wondering again.

Flaws in the Update

These conversations and exchanges of emails also revealed three serious flaws in the update.

Emotional insensitivity about the word “mild”

The December 2 update was thoroughly insensitive to the emotional impact of the word “mild” on someone who has suffered as a result of this pandemic – someone who lost a loved one, or was severely ill, or even just worked 90-hour week after 90-hour week trying to cope. I was using the word epidemiologically, the way the CDC used to summarize certain flu seasons as “mild to moderate,” and the way many states still refer to some flu seasons as “of mild severitylink is to a PDF file or “notably mild.” link is to a PDF file   But that isn’t how “mild” came across in the update.

For the hundreds of thousands of people on whom the pandemic has inflicted severe suffering, hearing someone casually say it’s a “mild” pandemic has got to be infuriating.

Maybe we can find ways to explain that “mild” doesn’t mean that those who suffer suffer less, only that fewer people suffer. A mild flu pandemic is a pandemic with relatively few tragically severe cases, compared with other flu pandemics.

Or maybe we can find a better term than “mild.” It’s probably less offensive to say that the swine flu pandemic is “a Category 1 pandemic” than to call it mild. The problem there is that the U.S. Pandemic Severity Index says: “A category 1 pandemic is as harmful as a severe seasonal influenza season, while a pandemic with the same intensity of the 1918 flu pandemic, or worse, would be classified as category 5.” There’s no category for a pandemic less deadly than the average seasonal flu.

At the very least, a risk communication expert who goes on endlessly about empathy ought to have been more empathic about the implications of “mild.”

It’s not just the word. Nowhere in my update was I appropriately empathic about the reality that the pandemic has already killed several times as many children as a typical flu season. That’s a fact that has many parents understandably and justifiably worried. It’s a good reason for getting kids vaccinated. And it’s a devastating tragedy for more than a thousand families around the country so far.

A related problem with “mild” is that the term means something different to infectious disease professionals than to normal people. For normal people, the salient question is how many friends and colleagues have gotten really sick – not whether 99.98% of them get better or only 99.88%. (That’s the difference between the pandemic’s estimated case fatality rate of 0.02% so far and the seasonal flu’s average estimated case fatality rate of about 0.12%.) It’s not the pandemic’s overall case fatality rate that is affecting most people’s lives but its case attack rate, especially its case attack rate in their own community – plus their knowledge that an unusually high number of children have died as a result.

I have a daughter who teaches at a university in Virginia. She says more of her students have been out sick with the flu this semester than any semester in her memory. As far as she knows, none of them died. Nevertheless, she, her colleagues, and her students have experienced this fall as a severe flu season. They’ll laugh at anyone who tries to tell them it was mild.

Comparing apples and oranges

One statistical linchpin of the December 2 update was comparing the CDC’s estimates of seasonal flu case numbers and fatalities with the CDC’s estimates of swine flu case numbers and fatalities, in an effort to understand which kind of flu the CDC (implicitly) considered more deadly, both overall and separately for different age groups. That seasonal-versus-pandemic comparison wasn’t needed to figure out which age groups are most vulnerable to the pandemic so far. But it was essential to my argument that the pandemic so far is less deadly overall than the seasonal flu average.

Several flu experts have generously spent time explaining to me the ways in which the two sets of CDC estimates – seasonal and pandemic – are not strictly comparable.

The types of data the CDC has about the pandemic are different from the types of data it has about past flu seasons. In each case, experts collect the best data they can, and then use modeling to extrapolate from their data estimates of the actual numbers of cases, hospitalizations, and deaths. But the methodologies for collecting and modeling data for the ongoing pandemic differ in many ways from the methodologies for assessing non-pandemic flu seasons.

I still think the CDC’s best estimates of seasonal flu parameters and its best estimates of swine flu parameters (to date) are worth comparing. The day before the November 12 estimates were released, CDC communication expert Glen Nowak told Donald G. McNeil of The New York Times that the new estimates “will be a more accurate comparison to the 36,000 deaths from seasonal flu each year” than previous counts of laboratory-confirmed cases and deaths. (The quote is McNeil’s paraphrase of Nowak, not Nowak’s direct quote.)

My critics are certainly right that comparing estimates based on different methodologies has an “apples and oranges” problem. It’s not just that both estimates are only approximate and likely to be wrong; they’re approximate in different ways, and likely to be wrong in different ways.

In the uncertain world of an ongoing disease outbreak of a novel virus, that’s the only kind of comparison available. I think it’s a comparison worth making. But I should try harder not to overvalue it.

Experts rightly told me I should have stressed the unreliability of this comparison in my December 2 update. Instead, I never even mentioned it.

Finer distinctions I didn’t make

The CDC’s November 12 estimates included just 12 numbers (with a range around each number): the estimated number of cases, hospitalizations, and deaths for Americans 0–17, 18–64, 65+, and overall – all for the first six months of the pandemic. Those are the numbers I analyzed, focusing especially on cases and deaths.

But there are finer distinctions experts say should be made, especially with regard to age. Because I relied exclusively on the three broad age group categories in the CDC’s estimates, some of my calculations could well have been epidemiologically misleading even though they were mathematically correct.

For example, the age band 18–64 is very broad, encompassing 63% of the U.S. population. Such a broad category could easily obscure important distinctions. The seasonal flu kills mostly people 65 and over; within the 18–64 range, people 50 to 64 are believed to be at higher risk than people 18–49, which is why the most recent seasonal flu vaccine target groups include all people 50 and older, but only specified risk groups within the age band 18–49. But there were indications early on that the pandemic might be tougher on younger adults (18–49) than on older adults (50–64). So the 18–49 group may be even harder hit by the swine flu pandemic (compared with the seasonal flu) than the CDC’s estimates already suggest for the 18–64 cohort as a whole. Although I didn’t (and still don’t) have the data to analyze such possibilities properly, I should have mentioned them.

The hypothesis that adults 18–49 may be at higher risk than adults 50–64 was raised again by CDC Director Thomas Frieden in his December 10 press briefing. The updated estimates released by the CDC on that date don’t address the question. A different CDC webpage, however, reports some data based on confirmed and probable cases (rather than statistical extrapolations) for the first three months of the pandemic. These data showed a case attack rate for adults 25–49 almost twice as high as the case attack rate for adults 50–64. But the two groups’ hospitalization rates were about the same, which seems to suggest that the older group had more severe cases.

On November 30, about 43 minutes into a webinar [requires Microsoft Windows Media Player], CDC expert Martin Cetron presented very preliminary and tentative data about population mortality rates for various age groups, covering the period from April through November 14, 2009. The data showed that children are dying at a lower rate than seniors, and seniors at a lower rate than adults. The difference between the 0–4 and 5–24 age cohorts looks small. But the difference between 25–49 and 50–64 is huge. According to the preliminary data presented at this Webinar, older adults are much likelier to have died from a pandemic flu-related illness than younger adults, who are likelier to have died than seniors, who are likelier to have died than children.

I haven’t found any data to support the hypothesis that the pandemic is harder on children and young adults than on older adults 50–64. But there may be some. Certainly my December 2 update should have addressed the possibility that subdividing the “adult” group into smaller subgroups could greatly affect the meaning of the CDC's estimates.

Similarly, in focusing on cases and deaths, I neglected to explore the implications of the CDC’s November 12 data on hospitalizations – other than noting that the CDC estimated 98,000 swine flu hospitalizations so far compared to 200,000 estimated seasonal flu hospitalizations in an average year. Thanks to the feedback, I have paid more attention to the hospitalization data in my update on the CDC’s December 10 estimates.

Finer distinctions in hospitalization data might shed additional light. I could have tried to include seasonal flu hospitalization breakdowns by age to compare with the pandemic flu breakdowns. I could have tried to include information about the hospitalization of very young children versus older children, and of adults 18–49 versus adults 50–64. I could have tried to include age-related data on median length of hospital stays and on use of intensive care units, to see if one age cohort is taking longer to recover than others or is being admitted in more dire need.

And if I couldn’t find the data to assess these finer distinctions, then I should have stressed more than I did that the finer distinctions exist – and might possibly change the picture that emerged from my examination of the CDC’s November 12 pandemic flu estimates (and roughly comparable seasonal flu estimates) alone.

Readers interested in pursuing these finer distinctions should look at Dr. Cetron’s presentation on the webinar I mentioned earlier.

Have the Media Memes Changed?

I am going to switch gears now, from reactions to the December 2 update itself to developments since that update was published.

The December 2 update focused on two memes that I argued were dominant in media pandemic coverage.

The first, and the one I stressed, was the meme that the pandemic is “like the seasonal flu” – as opposed to CDC estimates suggesting that it is actually significantly less deadly (overall) than the seasonal flu.

The second, less emphasized, was the meme that the pandemic is deadliest to children and least deadly to seniors, with adults in the middle – as opposed to CDC estimates suggesting that it is actually deadliest to adults and least deadly to children, with seniors in the middle (but closer to adults).

How have these two memes fared in the weeks since the CDC released its November 12 estimates?

There has been no perceptible change in the second meme. The media still keep telling us that the pandemic is toughest on children and easiest on seniors.

But the media meme that the swine flu pandemic is “like the seasonal flu” has broken.

What broke it was the December 8 publication in the Public Library of Science (PLoS) of an article entitled “The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis.” Written by Harvard Professor Marc Lipsitch and a long list of coauthors (including one from the CDC), the article was based on an entirely different data set and methodology than the CDC’s November 12 analysis. But it led to similar conclusions:

  • It estimated the swine flu case fatality rate at 0.048% – much higher than the 0.018% CFR estimate derivable from the CDC’s November 12 numbers (and cited by the CDC’s Martin Cetron in his November 30 webinar presentation), but still much lower than the average flu season’s CFR (which my December 2 update argued was 0.12%). It concluded that “an autumn–winter pandemic wave … with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher.”
  • It estimated that the swine flu case fatality rate was higher in people 18 and older (that is, adults and seniors) than in children under 18 – but higher in children 0–4 than children 5–17. It found that the pandemic was killing larger percentages of non-elderly adults and children (especially children 0–4) than the seasonal flu, which kills mostly the elderly – but it was nonetheless killing smaller percentages of children than of older Americans.

The media didn’t pick up on the second finding (that the pandemic has been deadlier so far to adults and seniors than to children) – but there was a lot of attention to the first: that the swine flu pandemic so far is surprisingly mild, probably milder (that is, less deadly overall) than the seasonal flu.

Among the media headlines:

The media are no longer overstating the severity of the pandemic thus far in its course. In fact, the last few days of coverage could support a complaint that the media are understating – even more than before the December 8 PLoS article was published – the possibility that the pandemic could get more severe. Some hyperbolic segments of the media have even declared the pandemic over, which is certainly premature! See for example: “Swine flu: the pandemic that ended with a whimper.”

Media coverage and public opinion about risks (especially new risks) sometimes tend to lurch from one extreme to another – from “Oh My God We’re All Gonna Die!” to “How Dare the Government Hype This Trivial Risk?” and “Remember When They Told Us We Were All Gonna Die?” (when officials never said any such thing). There has been some of that with regard to the swine flu pandemic.

But pandemic coverage in the mainstream media has had a different problem (except at the very start): adhering to a “middle ground” that consistently fails to distinguish current risk from possible future risk.

Public health officials and the media were right to warn us in the early days that the pandemic looked serious. As new data emerged that the pandemic so far was less deadly than close flu observers expected (and much less deadly than we feared), they needed to find a way to change the warning – to let us know that although the news was better than expected so far, it could still take a turn for the worse in the months ahead.

Failing to acknowledge that the pandemic is mild so far is one error. Failing to stress that it could get a lot more severe is a different error. The “about like the seasonal flu” meme commits both errors: It overstates the pandemic’s current severity and understates its possible future severity.

The trick is to balance an accurately reassuring message about current overall severity (it’s milder than the seasonal flu so far) with an accurately alarming message about possible future severity (there are some very frightening worst case scenarios still on the table) – plus an accurately alarming message about the current increased risk to children under 18.

Hurricane forecasters frequently face the same need for balance, and routinely handle it well. “The hurricane is losing intensity and we’re downgrading it to a tropical storm. But there is still likely to be flash flooding in the following areas…. And don’t let down your guard. The storm could still regain its intensity and become a dangerous hurricane again.”

Until very recently, the CDC and the media weren’t acknowledging sufficiently that the pandemic is – overall – mild so far. Now the media are doing that. But in their desire to avoid further charges of fear-mongering or sensationalizing, they’re still not warning sufficiently that the pandemic won’t necessarily stay as mild as it is.

Have the CDC’s Interpretations Changed?

An accurate translation of the CDC’s data into words would be:

So far, the H1N1 influenza pandemic is less severe than past pandemics, and less severe than the average seasonal flu. While it is several times more dangerous to children than the seasonal flu is to children, it is still several times more dangerous to adults and seniors than to children.

But the CDC has not moved off its prior positioning. It explicitly says the pandemic is not mild (because it is killing more children than the seasonal flu), and declines to address the evidence (its own evidence) that the pandemic’s overall case fatality rate so far is lower than the average CFR for the seasonal flu. And it continues to assert that pandemic H1N1 is especially dangerous to children (which it is, compared with the seasonal flu), while declining to address the evidence (its own evidence) that the pandemic is actually killing children at a lower rate than adults and seniors, whether measured in terms of case fatality rates or population mortality rates.

It’s worth memorializing two examples of the CDC’s consistency on these matters.

On December 4, CDC Director Thomas Frieden conducted a news briefing. Only one question touched directly on the two issues we are considering. It came from Bob Roos of the University of Minnesota’s Center for Infectious Disease Research & Policy (CIDRAP). Here are Roos’s question and Frieden’s answer:

Bob Roos: Thanks for taking my question. I had a question about the kind of the overall severity of the pandemic and case mortality rate. The CDC recently estimated the case fatality rate at 0.018%. This is much lower than the seasonal flu epidemic. I wonder if you can comment on that.

Tom Frieden: The key point is really age specific case fatality rates. We’ve reported that H1N1 has not affected the elderly significantly. So while some elderly have gotten it and those who are infected sometimes become severely ill and that’s why we have emphasized the importance of prompt antiviral treatment of the elderly and others with underlying conditions who are severely ill. What we’re finding really is this virus is a much worse virus for younger people. The number of people, not just children, but young adults under the age 50, who will get severely ill or die from this virus is much higher than from seasonal flu. The fact is that with 210 laboratory confirmed H1N1 deaths, we are really before the beginning of flu season, we don’t know whether there will be much more H1N1 or not. Already three times the number of deaths among children than we would [see] in a usual flu season.

Dr. Frieden’s answer starts by stating that “the key point is the age-specific case fatality rates.” That bridges away from Roos’s question about whether the CDC will stand by the 0.018% CFR estimate that Martin Cetron (and I) had calculated from the CDC’s November 12 estimates. Essentially, it bridges from the first issue (is the pandemic mild) to the second (is it worse for kids than for adults and seniors).

But Dr. Frieden didn’t actually provide the age-specific case fatality rates that he said were the key point … and no reporters pressed him to provide them. Here they are, based once again on the CDC’s November 12 estimates:

Children 0–17: CDC estimates 8 million cases and 540 deaths
540 deaths out of 8 million cases = 0.007% CFR
      (70 dead children out of every million sick children)
Adults 18–64: CDC estimates 12 million cases and 2,920 deaths
2,920 deaths out of 12 million cases = 0.024% CFR
     (240 dead adults out of every million sick adults)
Seniors 65+: CDC estimates 2 million cases and 440 deaths
440 deaths out of 2 million cases = 0.022% CFR
     (220 dead seniors out of every million sick seniors)

Rather than assess the implications of these numbers – that the pandemic case fatality rate is three times as high for Americans 18-64 and for Americans 65 and over as for Americans under 18 – Dr. Frieden states instead that “H1N1 has not affected the elderly significantly” and “this virus is a much worse virus for younger people.”

Note that this is not borne out by the age-specific population mortality rates, calculated from the CDC’s November 12 estimates:

  • 7.49 dead children out of every million children in the U.S.
  • 14.88 dead adults out of every million adults in the U.S.
  • 11.44 dead seniors out of every million seniors in the U.S.

(Of course all the numbers are higher when recalculated based on the CDC’s December 10 estimates, but the order is unchanged.)

Then Dr. Frieden bridges again, this time to the key fact that supports his two propositions that the pandemic isn’t mild and that it is especially horrible for children:  The pandemic has already caused “three times the number of deaths among children than we would [see] in a usual flu season.” This is true. The pandemic is (a) killing more children than the seasonal flu kills, though it is (b) killing fewer children (as a percentage of the total number of children or the number of children with swine flu) than adults and seniors.

Dr. Frieden’s response showcases the first fact (a), which supports the CDC’s vaccine prioritization groups, and avoids the second fact (b), which doesn’t.

The second example is very similar. On December 8, National Public Radio broadcast a story by Richard Knox based on interviews with Marc Lipsitch, Thomas Frieden, and me. Here’s the relevant portion. (I’ll quote from the version Knox wrote for the NPR website rather than the radio version; they cover the same ground.)

“And what you find is that the pandemic is making more kids sick. But it’s killing a smaller percentage of the kids it makes sick than it is of the adults and seniors it makes sick,” says Peter Sandman, an expert in risk communication.

He says the CDC has been reluctant to acknowledge that swine flu has been much milder than expected.

“The CDC may be thinking, you know, ‘There are already millions of people who plan not to get vaccinated because they think the pandemic is mild, and if we announce as the official health agency of the U.S. government that the pandemic is mild, than even fewer people will get vaccinated and some of those people will die,’” he says.

Not so, says the head of the CDC, Dr. Thomas Frieden.

“I think we’ve been completely transparent with what we think is happening. I think we have a difference of opinion on whether that is mild or severe,” he says. He points out that the CDC has counted more than 250 deaths among children.

“Any flu season that kills at least three times more children than a usual flu season – I think it would be very misleading to describe that as mild,” he says.

Far from being “completely transparent” about the two awkward implications of its November 12 estimates – that so far the pandemic is less deadly overall than the seasonal flu and less deadly to children than to adults and seniors – the CDC has yet to acknowledge these implications. Dr. Frieden emphasizes instead the fact that the pandemic kills more children than the seasonal flu kills. That fact is true, important, and genuinely upsetting. But in isolation, it is misleading with regard to the overall severity of the pandemic, and more important, misleading about the pandemic risk to adults and seniors.

Copyright © 2009 by Peter M. Sandman

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