The H1N1 muddle

Just received, in the mail, John Muir Health’s advice to get vaccinated against the seasonal flu and H1N1.

This advice about the H1N1 vaccine might be useful—if the vaccine were readily available. And it sounds like it’s not. I haven't been looking, though, for reasons I'll explain below.

An older woman was at my gym the other day, telling how she had gone to her doctor, insisting she get the H1N1 shot, because she looks after her young grandchildren. “They didn’t want to give it to me!” Someone at my job sent out a company-wide email, asking co-workers if any of us knew any doctors who were dispensing the vaccine.

Yesterday, the New York Times describes the “willy-nilly” distribution of the swine flu vaccine and, in an editorial, says that the availability of the vaccine “is running way behind the original expectations."

In any event, the Times says it is not time to panic--that President Obama’s declaration of a national emergency is a procedural maneuver to make it easier for hospitals to transfer any sudden crowds of sick people to alternate sites for triage and treatment.

Am I panicking?

No.

Maybe I should be?

Back to the Times editorial, which says that, yes, H1N1 so far has killed more than 1,000 Americans and sent more than 20,000 to the hospital. Most recently, the recent death of a first-grade student in Vacaville prompted the closure of two schools in that town. As of October 23, eight people have died of possible swine flu deaths in Contra Costa County, and 196 have been hospitalized with possible H1N1-related illnesses. Such numbers can be "frightening," the Times editorial acknowledges. But the season's "final tally is still likely to be less than in a normal flu season, when the circulating strains typically cause around 36,000 deaths and 200,000 hospitalizations.”

H1N1 is indeed spreading rapidly, but, so far, appears to be no more virulent or deadly than regular, seasonal flu, the editorial says.

The backlash against the vaccine urgency also continues with an excellent article in the Atlantic this month. “Does the Vaccine Matter” asks whether the swine flu vaccine really works, whether it prevents infections or will reduce the number of people who will die.

This article suggests what I have long suspected: that flu vaccines don’t really work that well, or as well as we'd like to believe, and for a whole host of reasons. The thing is, the authors say, placebo-controlled studies of flu vaccine and those flu medications prescribed by doctors every year, to test their efficacy, have never been conducted.

This is the curious state of debate about the government's two main weapons in the fight against pandemic flu. At first, government officials declare that both vaccines and drugs are effective. When faced with contrary evidence, the adherents acknowledge that the science is not as crisp as they might wish. Then, in response to calls for placebo-controlled trials, which would provide clear results one way or the other, the proponents say such studies would deprive patients of vaccines and drugs that have already been deemed effective.

Students of U.S. medical history will find this circular logic familiar: it is a long-recurring theme in American medicine, and one that has, on occasion, had deadly consequences.

The article asserts that vaccines and flu treatments give the U.S. population a false sense of security. “Little discussion has appeared in the press to help people understand the measures they can take to best protect themselves during a flu outbreak—other than vaccination and antivirals.”

Well, I don’t think our public health officials have been remiss in reminding us again and again about the importance of washing our hands frequently or of staying away from work, schools, and other public places if we’re experiencing flu-like symptoms. Still they have been beating the “get the vaccine” message pretty hard.

I’m not saying people shouldn’t get either the seasonal flu or H1N1 vaccine. My husband always gets the seasonal flu vaccine because he’s in one of the vulnerable populations: he has asthma and is prone to upper respiratory illnesses during the winter months. Another co-worker, who gets hit with the flu every season, believes it keeps her from being hit as hard as she normally would.

On the other hand, I don’t get the seasonal flu vaccine. Knock on wood, but so far, I seem to be one of those lucky people who is not prone to getting achy, feverish flu-like illness. At most, I suffer one or two bouts of the common cold every season.

As for my son? He is 11, and the Centers for Disease Control and Prevention recommends that children from six months to 18 years receive the vaccination. However, he is not in one of the "priority populations," mentioned by the Contra Costa Public Health Department. This would include kids his age, but with chronic health conditions.

He seems to have inherited my immune system. Of course, it's one thing to take a chance with my own health, but it's another to do the same with his. But then, I believe it's possible--based on reports from parents in the Walnut Creek schools, and which I reported on a few weeks back--that the swine flu has already swept through at least one elementary school and his middle school campus.

Knock on wood, he was spared in this round.

Actually, what is disturbing is that my cross-my-fingers approach to this pandemic may be as reasonable or scientifically sound as the CDC's statement that vaccines are the best way to prevent influenza.