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Editor, Senior Moderator
Source: http://www.nytimes.com/2009/08/26/health/26flu.html?_r=2
Agency Urges Caution on Estimates of Swine Flu
By DONALD G. McNEIL Jr.
Published: August 25, 2009
ATLANTA ? Up to 90,000 deaths from swine flu flu in the United States, mostly among children and young people?
Up to 1.8 million people hospitalized, with 50 percent to 100 percent of the intensive-care beds in some cities filled with swine flu patients?
Up to half the population infected by this winter?
On Monday, a White House advisory panel issued a report with these estimates, calling them ?a plausible scenario? for a second wave of infections by the new H1N1 flu. The grim numbers by the panel, the President?s Council of Advisers on Science and Technology, got considerable play in the news media.
On Tuesday, however, officials at the Centers for Disease Control and Prevention, the agency with the most expertise on influenza pandemics, suggested that the projections should be regarded with caution.
?We don?t necessarily see this as a likely scenario,? said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases.
A press officer for the disease centers, speaking carefully to avoid a feud with the White House press office, said, ?Look, if the virus keeps behaving the way it is now, I don?t think anyone here expects anything like 90,000 deaths.?
Even one of the experts who helped prepare the report said Tuesday that the numbers were probably on the high side, given that some weeks had passed since the calculations were finished in early August.
?As more data has come out of the Southern Hemisphere, where it seems to be fading, it looks as if it?s going to be somewhat milder,? said the expert, Marc Lipsitch, an epidemiologist at the Harvard School of Public Health. ?If we were betting on the most likely number, I?d say it?s not 90,000 deaths; it?s lower.?
Dr. Harold Varmus, president of the Memorial Sloan-Kettering Cancer Center and one of the panel?s chairmen, defended the report.
?A lot of people think the flu is over,? Dr. Varmus said. ?We think it?s important that there be a dose of reality. It?s certainly not an outlandish proposal. A lot of people are going to be infected.?
For a report with such striking figures, it was released with little fanfare and less coordination than might have been expected among public health officials.
The report was posted on the White House Web site on Monday, two weeks late, since it was dated Aug. 7. With President Obama on vacation in Martha?s Vineyard, no news conference with the White House or with the report?s authors was scheduled.
Kathleen Sebelius, secretary of health and human services, was at the disease centers? headquarters in Atlanta, addressing a special symposium on swine flu.
A summary of the report was handed out by the centers? press staff to medical reporters as she spoke, but Ms. Sebelius did not dwell on it or mention its forecast of 30,000 to 90,000 deaths, more than twice the 36,000 deaths usually caused by seasonal flu.
With the centers? director, Dr. Thomas Frieden, by her side, she said fall would be a challenge when flu returned, and acknowledged a recent Washington Post poll showing that few Americans were worried. She even joked that it might bring handkerchiefs back into fashion.
Both she and Dr. Frieden acknowledged that ?some people? would die, but neither gave an estimate.
Dr. Varmus said he was not happy with the way the report had been released ?but that?s above my pay grade.?
A debate over alarming predictions for flu would recall September 2005, when Dr. David Nabarro, then in charge of the United Nations response to H5N1 avian flu, estimated that a human outbreak could kill 5 million to 150 million people.
Headlines focused on the larger number, and arguments over the wisdom of such estimates went on for months. But the flu never mutated to transmit easily between people and thus far only 262 deaths have been attributed to it by the World Health Organization.
Since the epidemic began, the centers have been reluctant to issue projections about probable swine flu cases, and the agency has even stopped estimating how many Americans have already had the flu. The official estimate has been stuck at ?more than one million? for months.
At the Atlanta symposium, Lyn Finelli, head of surveillance for the influenza division, was asked when that would be updated. ?Sometime in the next few weeks,? Dr. Finelli said. ?We?re working on the model.?
Officials at the centers said they had known that the panel?s report was in the works, but had focused on the recommendations it would make.
They included these:
?Releasing some vaccine for high-risk people in September, even before clinical trials are finished.
?Speeding plans for intravenous flu drugs and clarifying guidelines for using drugs like Tamiflu.
?Using social media that appeal to youth to urge them to get shots.
?Changing federal rules and programs that discourage school closings.
Agency officials said they had already adopted some measures. For example, vaccine makers have been asked to prepare early batches of vaccine, and the disease control centers are already on Facebook and Twitter.
Even while distancing themselves from the grim forecasts presented in the White House advisers? report, officials at the centers saw a possible benefit.
?Anything that breaks the complacency is a useful tool,? said Glen Nowak, the director of media relations at the centers.
Agency Urges Caution on Estimates of Swine Flu
By DONALD G. McNEIL Jr.
Published: August 25, 2009
ATLANTA ? Up to 90,000 deaths from swine flu flu in the United States, mostly among children and young people?
Up to 1.8 million people hospitalized, with 50 percent to 100 percent of the intensive-care beds in some cities filled with swine flu patients?
Up to half the population infected by this winter?
On Monday, a White House advisory panel issued a report with these estimates, calling them ?a plausible scenario? for a second wave of infections by the new H1N1 flu. The grim numbers by the panel, the President?s Council of Advisers on Science and Technology, got considerable play in the news media.
On Tuesday, however, officials at the Centers for Disease Control and Prevention, the agency with the most expertise on influenza pandemics, suggested that the projections should be regarded with caution.
?We don?t necessarily see this as a likely scenario,? said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases.
A press officer for the disease centers, speaking carefully to avoid a feud with the White House press office, said, ?Look, if the virus keeps behaving the way it is now, I don?t think anyone here expects anything like 90,000 deaths.?
Even one of the experts who helped prepare the report said Tuesday that the numbers were probably on the high side, given that some weeks had passed since the calculations were finished in early August.
?As more data has come out of the Southern Hemisphere, where it seems to be fading, it looks as if it?s going to be somewhat milder,? said the expert, Marc Lipsitch, an epidemiologist at the Harvard School of Public Health. ?If we were betting on the most likely number, I?d say it?s not 90,000 deaths; it?s lower.?
Dr. Harold Varmus, president of the Memorial Sloan-Kettering Cancer Center and one of the panel?s chairmen, defended the report.
?A lot of people think the flu is over,? Dr. Varmus said. ?We think it?s important that there be a dose of reality. It?s certainly not an outlandish proposal. A lot of people are going to be infected.?
For a report with such striking figures, it was released with little fanfare and less coordination than might have been expected among public health officials.
The report was posted on the White House Web site on Monday, two weeks late, since it was dated Aug. 7. With President Obama on vacation in Martha?s Vineyard, no news conference with the White House or with the report?s authors was scheduled.
Kathleen Sebelius, secretary of health and human services, was at the disease centers? headquarters in Atlanta, addressing a special symposium on swine flu.
A summary of the report was handed out by the centers? press staff to medical reporters as she spoke, but Ms. Sebelius did not dwell on it or mention its forecast of 30,000 to 90,000 deaths, more than twice the 36,000 deaths usually caused by seasonal flu.
With the centers? director, Dr. Thomas Frieden, by her side, she said fall would be a challenge when flu returned, and acknowledged a recent Washington Post poll showing that few Americans were worried. She even joked that it might bring handkerchiefs back into fashion.
Both she and Dr. Frieden acknowledged that ?some people? would die, but neither gave an estimate.
Dr. Varmus said he was not happy with the way the report had been released ?but that?s above my pay grade.?
A debate over alarming predictions for flu would recall September 2005, when Dr. David Nabarro, then in charge of the United Nations response to H5N1 avian flu, estimated that a human outbreak could kill 5 million to 150 million people.
Headlines focused on the larger number, and arguments over the wisdom of such estimates went on for months. But the flu never mutated to transmit easily between people and thus far only 262 deaths have been attributed to it by the World Health Organization.
Since the epidemic began, the centers have been reluctant to issue projections about probable swine flu cases, and the agency has even stopped estimating how many Americans have already had the flu. The official estimate has been stuck at ?more than one million? for months.
At the Atlanta symposium, Lyn Finelli, head of surveillance for the influenza division, was asked when that would be updated. ?Sometime in the next few weeks,? Dr. Finelli said. ?We?re working on the model.?
Officials at the centers said they had known that the panel?s report was in the works, but had focused on the recommendations it would make.
They included these:
?Releasing some vaccine for high-risk people in September, even before clinical trials are finished.
?Speeding plans for intravenous flu drugs and clarifying guidelines for using drugs like Tamiflu.
?Using social media that appeal to youth to urge them to get shots.
?Changing federal rules and programs that discourage school closings.
Agency officials said they had already adopted some measures. For example, vaccine makers have been asked to prepare early batches of vaccine, and the disease control centers are already on Facebook and Twitter.
Even while distancing themselves from the grim forecasts presented in the White House advisers? report, officials at the centers saw a possible benefit.
?Anything that breaks the complacency is a useful tool,? said Glen Nowak, the director of media relations at the centers.
