The New England Journal of Medicine (NEJM) should be the pinnacle of good sense and sensibility related to health issues but the article in the current issue (June 18, 2009) The signature Features of Influenza Pandemics – Implications for Policy on the current flu pandemic certainly fails. That article sheds little new light on what public policies should be supported and sheds considerable darkness on how to understand what little is known.
A simple illustration of their confusion is easily seen in the chart below which they used to support their claims. I challenge you to try and wade through this attractive looking mess just to see how bad it is. Click here for a window with a bigger chart.
A chart of four flu pandemics, 1890, 1918, 1957, 1968
There are four panels which are intended to show the relationships of data from different flu events. However, in every panel there is a different time base along the bottom. Panel A appears to have 2 months between labeled tick marks. 2 months between January 1890 and March 1890 but 3 months between equally spaced tick marks from March 1890 to June 1890 and this panel covers 1 year 2½ months. Panel B is different, it has 1 month between tick marks but the linear spacing is different from A’s and covers 20½ months. Panel C is totally different in linear spacing from the first two and appears to have 3 months between ticks and covers 6 years one month. In Panel D the tick spacing is yet again different and it covers 18½ months. Every panel is different on the horizontal scale and each one has a different time spacing. But wait there’s more. It gets worse.
In every panel the vertical scale is variable and is not marked and for very good reason: it doesn’t make sense. Notice that the highest blue peaks are adjusted to the same general height in each of the panels. However, in panel A the peak is 45%, in B it is 60%, in C it is 28% and in D it is 85%. There is no explanation for the various measurement scales for these displays of similar data. The variable width blue vertical lines are never defined. They appear to represent weeks but they are never labeled as such. The pink vertical areas are never defined and I have no idea what they were intended to represent. Everything about this chart was confusing.
The article itself is a little better than the graphic but it was written in such a bland bureaucratic style that it is difficult to know what new information was being presented and it is difficult to know what the new recommendations to the policy makers are. They seemed to recommend the vaccinating the children in preference to old people because the old people are projected to be more immune to the flu. This was a particularly strange suggestion because young adults, not children or old people, were at most risk in previous flu epidemics. They blandly mention social distancing as a possible method which could be useful in slowing the transmission but offer nothing as to how to even minimally accomplish that strategy. They discuss briefly the shortage of vaccine and antivirals but quickly cover it over with the possibility of creating more of these in the hoped for periods between waves of flu fatalities. They ignore the fact that it takes months to manufacture these products even with a crash program. Their recommendations dampen any enthusiasm for immediate action by the policy makers.
They conclude their “policy recommendations” article with, “The documented relevant signature features can help health authorities prioritize national strategies and aid international collaborators in addressing the initial and successive waves of illnesses and deaths.” That sounds like an ample load of undeserved self praise because when one looks at the documentation it is little more than the chart discussed above which is so confused and confusing as to be more hindrance than help.
Another obvious way to slow flu transmission
I have proposed several ways for coping with the flu, see below, and would here propose yet another obvious and easy method of lowering transmission rate between countries. It is on airlines. Have everyone on the airplane wearing a good quality face mask. That way if anyone had the flu, even if they were asymptomatic, it would slow their transmission rate and if healthy people were all wearing masks it would slow their rate of acquiring the infection. These two functions of the masks should drop the transmission rate quite substantially. A second procedure, when the flu was more prevalent, would be to have all intercontinental air flight passengers take an antiviral pill like Tamiflu on entry into the airplane and another one several hours later on departure from the airplane. These pills are most effective at the very onset of a flu and would dampen down the transmission of flu even if only these two pills were taken. Also, it could be required for international travelers to phone in once a day for several days to report on their health. That way it would be known if that particular airplane flight was at risk and if those passengers should be monitored more carefully and given more Tamiflu and isolated if necessary.
Some of my previous blogs on flu:
Probaway - Life Hacks 
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