Trust for America's Health Flu Warnings

Go to the Trust for America's Health webpage on a possible flu pandemic.

A few days ago there was a large add in the Washington Post with the headline:

How Bad will the pandemic flu be? As bad as 500 Katrinas.

The add is apparently based on a report published on the Trust for America's Health website titled A Killer Flu?. That report contains numbers describing the potential impact on the United States of a flu pandemic;

Number of deaths: 541,433 (low death rate: 180,478; high death rate 1,082,866)
Number of hospitalizations: 2,358,089 (low severity/hospitalizations 786,032; high severity/hospitalizations: 4,716,192)
Number of cases: 66,914,573

500,000 deaths would indeed be 500 times the death toll of Katrina!

The figures are based on a guess by the World Health Organization "that an avian flu epidemic could impact 25 percent of countriesÂ? populations." Data from the Hong Kong flu epidemic of 1968-69 was apparently available describing the percentage of the persons thought to be infected who were hospitalized for flu and who died of flu. The Hong Kong flu epidemic hospitalization and death rates were then multiplied by three to get the "estimates" given above.

The important point is that these are guesses. Their epidemiological backing is more apparent than real. The portion of the population that will get sick with a future flu is of course not known, although -- as we all know -- a lot of people do get the flu each year. However, the U.S. Government pandemic flu website reports:

# 1957 influenza pandemic caused at least 70,000 U.S. deaths and 1-2 million deaths worldwide
# 1968 influenza pandemic caused about 34,000 U.S. deaths and 700,000 deaths worldwide

Thus the numbers of U.S. deaths of the 1957 and 1968 pandemics are far below even the lower value included in A Killer Flu?.

Perhaps some deconstruction is required. The add was posted by the Working Group on Pandemic Influenza Preparedness. It consists of:

# American College of Occupational and Environmental Medicine
# American Lung Association
# American Public Health Association
# Association for Professionals in Infection Control and Epidemiology
# Association of Public Health Laboratories
# Campaign for Public Health
# Center for Biosecurity of the University of Pittsburgh Medical Center
# Foundation for Environmental Security and Sustainability
# Infectious Diseases Society of America
# Service Employees International Union
# The Federation of American Scientists
# Trust for America's Health

The websites given for the add were those of the Trust for America's Health and The Association of Professionals in Infection Control and Epidemiology (APIC).

The Trust website lists a very distinguished Board of Directors and Advisory Council including former high ranking political officials and leaders of schools of public health. Its budget tops US$2 million per year, mostly from foundation grants,

APIC is a professional society serving infection control professionals, including physicians, nurses, and epidemiologists. Its efforts seem most focused on the control of infections occurring in health care facilities.

I have no doubt that all the organizations forming the Working Group are vitally concerned with improving health. They are all oriented toward the domestic health issues in the United States. And they would all seem to share an interest in increased government funding to prepare to ameliorate the effect of a global flu pandemic on the population of the United States. Note the following from a statement of purpose by the Working Group:

It is clear that that the revised pandemic flu preparedness plan issued by DHHS reflects the professional judgment of leading health and scientific experts. Our concern is that that AdministrationÂ?s budget request does not provide sufficient resources to assure nationwide implementation of all aspects of the plan, including state and local public health preparedness efforts, hospital surge capacity and related priorities, and the U.S. obligation to support international efforts to identify and contain a flu pandemic overseas.

While I do not doubt the sincerity of the opinion expressed, it seems likely that the organizations in the Working Group (and their members) would benefit from an increase in government funding of flu prevention efforts.

We don't know whether there will be a flu pandemic. If there is one, we don't know how many people will get sick from the flu, nor how severly ill they will be. In the last century, only the Spanish flu pandemic of 1918 killed as many as 500,000 people in (the much less populated) United States. The damage done by the 1957 and 1968 pandemics was terrible, but their damage was much less than that of 1918. The numbers published by the Working Group seem well tailored to getting the government to increase funding for flu preparedness. Soo too does their publication in a large add taken out in the nation's capital's most prominentnt newspaper. But those numbers must be understood as guesses, not conservative estimates based on strong scientific evidence.

We simply don't know if there is one chance in a hundred that 500,000 people will die in this country of a flu pandemic in the next few years, or one chance in a thousand, or even one in ten thousand! The decision of how much to spend on pandemic flu prevention is clearly a political one, and one that will be made under conditions of uncertainty.