Friday, 17 July 2009

Swine Flu - Another Pig In A Poke

Our government, having so many expensive and catastrophic bungles on its CV in recent years, now has another in the making. One of the earliest signs that it is really worried and headed for a major crash is that on 14 July it wheeled out Hugh “Shampoo” Pennington, its tame oil based scientist from Aberdeen to reassure the nation that all will be well, and there is not really much of a problem.

Pennington, appearing in the Governments propaganda sheet, “The Guardian” treated us all to an exercise in basic statistics as they appear to relate to Swine Flu. His cut and shuffle was very expert, reminding me vividly of the dealer in a poker school I once sat in on, whose performance was wonderfully convincing, but marred by the fact that only he seemed to draw a decent hand. With any ordinary flu, it seems, we can expect 41,000 deaths, so if only around that is recorded for Swine Flu, then hey guys what are we all worried about? But within hours, the Chief Medical Officer, Sir Liam Donaldson, is suggesting an estimate of 69,000.

As anyone who has trawled the Bills of Mortality of the past could tell you, it all depends on how the death is recorded, who is doing the recording, and the definitions of cause. Senile Debility, Apoplexy, Fever, Dropsy, etc. all describe but do not inform. The detail and reality can take a good deal of time and trouble, and post mortems have been cut (sic) and access to many forms of testing discouraged. Now to reduce the work on doctors, we are told that there is to be a new procedure for “fast tracking” documentation on deaths. So where did they go to work this one out? The legal records on the Harold Shipman case perhaps?

What guidance is to be given? Already it seems that if anyone is ill, or has an issue and then swine flu comes along to finish them off, then it is not the flu that is the medical reason, it is the other complaint. But in recording in the past, if it was the flu that was listed, and not necessarily in all cases, then the figures now will not be comparable with the past. But there are more expert views than mine.

The Flu Mortality Formula is potentially misleading is a lead in Science Daily. A standard calculation used in forecasting potential numbers of deaths during the swine flu pandemic risks misleading healthcare planners by being open to both over- and under-estimation of the true figures, say the authors of new research published in the British Medical Journal.

The proportion of people who die due to infection during an influenza outbreak - known as the case fatality ratio - is calculated by dividing the number of deaths by the total number of cases in the same time period. Early data from the current swine flu pandemic suggested that the new influenza A (H1N1) virus causes mild disease, with case fatality ratios of around 0.5%, or 5 deaths per 1000 people infected.

However, the researchers from the MRC Centre for Outbreak Analysis & Modelling at Imperial College London, say this ratio may not be accurate. They highlight three reasons for the inaccuracy. Firstly, that the total number of deaths during this pandemic is being underestimated because the cause of death is not correctly attributed to swine flu (e.g. influenza can temporarily increase the risk of vascular events, such as heart attacks).

Secondly that as the pandemic progresses, the total number of cases tends towards underestimation, as people presenting with milder symptoms may not be tested or visit a doctor at all, leaving only the most severe to be reported.

Thirdly, that the 'snapshot' calculation does not take account of the time delay between infection and death, thus leading to the false impression that the infection is actually becoming more severe as the pandemic progresses.

Dr Tini Garske, lead author of the study from the MRC Centre for Outbreak Analysis & Modelling at Imperial College London, said that: "Accurately predicting the severity of this swine flu pandemic is a very tricky business, and our research shows that this can only be achieved if data is collected according to well designed study protocols and analysed in a more sophisticated way than is frequently being performed at present.”

"If we fail to get an accurate prediction of severity, we will not be providing healthcare planners, doctors and nurses, with the information that they need to ensure they are best prepared to fight the pandemic as we head into the flu season this autumn.” The research was funded by a Medical Research Council UK Centre grant.

So Pennington declares for the Government, ignoring basic research that has been done the road a few minutes down the road from Whitehall. This is not the only problem they may have to face. The major epidemics of the past did not take place in economies where much is done on a “just in time” basis, or both medical and community facilities were tightly staffed and bound to particular targets. Also, there is now a far higher number and proportion of the aged and infirm subject to “community in care” dependent on carers who rush from one to another, and with no spare capacity in hospitals or what remains of care homes. And for other reasons much of the population may have respiratory systems in far worse shape than in even the recent past. Even if there is not death, there could be serious damage.

Whatever the calculations, large numbers will be affected to one degree or another, so the disruption may well be immense, and given the way things are organized these days, and the typical way of working, very damaging. There is to be a vaccine, but when and where is still open to question. So where will Parliament be for three months? Playing the property market in repossessions? Where will the government be? Electioneering? What lengths will the government go to in order to spin the figures and the shambles that could happen?

It is almost enough to give one apoplexy.

1 comment:

  1. Well said sir, and very funny too. I do recall that Shipman was adept at "fast tracking" the death documentation.

    The issue, for the government, is not about reality: they're goal is to avoid an unhappy public and appear to be "doing" something. That, in fact, the something is fixing the numbers has a long and storied tradition.