Undue Influenza
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

On November 28, 2003 a series of articles on the subject of influenza began appearing in national media outlets. The following is a sampling of typical news releases.

MSNBC (11/28/03): Four youngsters have died of the flu in Colorado since last week in what U.S. health officials say could foretell a severe flu season for the country.

CNN (11/28/03): Thousands of people have been sickened across the country with what health officials say is a severe strain of influenza in a season that started earlier than expected. Colorado is one of the hardest-hit states. Four children there have died from the highly contagious respiratory virus.

USA Today (11/28/03): Flu is tearing across the country, sending people to hospitals or their sickbeds in at least 39 states and killing three children in Colorado, where nearly 4,000 cases have been confirmed.

CBS (12/4/03): An early strong start to the flu season and the deaths of at least five children in Colorado from the flu highlight the importance of getting a flu shot for at-risk children. (emphasis added throughout)

Hundreds of similar stories would appear in newspapers, and on television, radio, and the Internet over the ensuing weeks. Almost without exception, these reports would lead with a mention of children in Colorado who died of influenza. At about the same time, the Centers for Disease Control and Prevention (CDC) recommended that all eligible people, children and adults, should get a flu vaccine.

What followed can be described fairly as a wave of collective panic.

Some pediatrics practices began receiving phone inquiries about flu vaccine at a rate of 60 per hour. In my own practice, calls came so thick and fast my nurse and I could not write down the messages fast enough to collect them all. It is probably not an exaggeration to state that all the parents in my practice, or nearly all of them, called or emailed me about flu vaccine at least once during the four weeks following November 28. In early December we began receiving calls from other pediatricians’ patients, all asking whether we had any vaccine left over. The tone of some of these calls suggested that the parents calling were sincerely worried that their own children might die of influenza.

Wait, It Gets Worse
In mid-December 2003, the Associated Press distributed a "news release" which included an interview with a Dr. Greg Poland of the Mayo Clinic. The subject of the piece was influenza pandemics. A pandemic differs from an epidemic in terms of scale and lethality. The "Spanish Flu" pandemic of 1918, for example, killed 500,000 people in the United States. In a normal year, influenza kills about 36,000 Americans. Dr. Poland predicted that the next influenza pandemic "is going to happen. For the American public in particular, I think it will be horrific. (emphasis added)"

"…I think it will be horrific". News outlets across the country ran Dr. Poland’s ominous warning during the height of an influenza outbreak. These included Fox News, CBS, and MSNBC. The question is not whether Dr. Poland’s prediction is correct – the question is why did news organizations publish this interview during a flu outbreak? To be sure, the response to this interview was not a collective sigh of relief from the American public! On the contrary, the panic only intensified. Healthy Americans began lining up outside clinics and emergency departments, hoping to get one of the last doses in the dwindling supply of vaccine.

It Gets Better (sort of)
By mid-January, 2004, the number of cases of influenza dropped off sharply in Massachusetts. The public began to sense that the worst was over. Though providers had worked hard to search for remaining doses of vaccine, and many offices purchased FluMist, patients began canceling vaccination appointments. Some parents failed to bring their children for the second dose of the two-dose vaccination (required for young children who have never had the vaccine). By the end of February, the Massachusetts Department of Public Health and many private offices were left with doses of vaccine but no patients to vaccinate. In four weeks the Commonwealth’s vaccine deficit became a vaccine surplus.

Five Children From Colorado
By early March it was clear that the 2003-2004 flu season was not particularly unusual compared to previous seasons. Though a larger than expected number of Americans died this year from influenza and complications, this year’s flu outbreak was less severe than the one we endured in 2000-2001. It is probably the case that the number of children who died from influenza was not unusually large. The problem is that we don’t know how many children die of influenza in a "normal" year! The 2003-2004 season was the first in which the CDC gathered information on influenza deaths. As of April 9, 2004, there were 143 recorded influenza deaths among children in the United States, or about 3 children per state.

If you were to watch the 5 o’clock news on a local television station, you will notice that the first 1/2 hour will include at least one story about a child who has been harmed or threatened with harm. Regardless of where in the United States the story occurred, it will run in your local media outlet. Such stories leave the public with the impression that the world is a more dangerous place than it really is.

With the benefit of hindsight, this year’s media-generated influenza panic was triggered by the catastrophic deaths of five children in Colorado in late November 2003. It is our natural response to identify with these families and to worry that our children will become the next victims. But childhood deaths from influenza truly are newsworthy precisely because they are rare. It is a short step, however, from newsworthiness to sensationalism. This year, unfortunately for the rest of us, the media took that step.

This year, in addition to scaring millions of people, the media were directly responsible for causing a significant strain on the health care delivery system. Emergency rooms became dangerously crowded with patients hoping to receive vaccine or fearful they had contracted influenza. Doctors’ offices that were inundated with inquires about influenza vaccine had difficulty delivering routine care to patients. Worst of all, many "at-risk" patients did not receive influenza vaccine because healthy patients who did not need the vaccine had exhausted the supply.

Next Flu Season
Before the next flu season starts I encourage parents to discuss influenza vaccination their child’s pediatrician. If the supply of flu vaccine were unlimited, everyone could get it. But the supply is limited, and we must prioritize vaccinations according to the risk of something bad happening if your child gets influenza.

If your child belongs to a "high-risk group", he or she should be vaccinated. These groups include infants 6-23 months old, children with severe lung and heart problems, and some children with certain chronic medical conditions. If your child is healthy, influenza vaccine is not necessary. Remember: the dose of vaccine your healthy child receives may be the dose that a high-risk child does not receive! If you nevertheless wish to vaccinate your healthy child, I recommend that you purchase the vaccine through your health care provider, and have the vaccine administered in the doctor’s office.

For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.

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Medical Office Building
MetroWest Medical Center
Leonard Morse Campus
67 Union Street, Suite 305
South Natick, MA 01760

(508) 655-9699
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Posted: April 21, 2004

©2004. Robert P. Lindeman, Natick Pediatrics. All rights reserved.