Ho-hum killer creates real risk
By Marc Siegel

We live in an era when fear affects us far more than risk. Anthrax, West Nile virus and SARS have driven people wild with worry while actually killing fewer than a thousand people combined in the Western Hemisphere. Panic over possible infection has cost the world billions of dollars in economic losses, not to mention the extra medical costs in sedatives and doctor visits needed to treat worry, not actual disease.

Meanwhile, influenza, a proven killer of about 36,000 people a year in the U.S. alone, is met with complacency and inattention, in large part because it isn't mysterious or new to our reckoning. But a greater fear of the flu could help public health systems contain it better, reducing economic costs and possibly saving thousands of lives each year.

Influenza affects up to 20% of the U.S. population in a given year, with 114,000 people hospitalized on average. While roughly 70 million Americans receive the flu vaccine every year, another 70 million should get it but don't. Health care workers, older people, those with respiratory or chronic illnesses, pregnant women and anyone who may come in close contact with the flu all should be vaccinated. In fact, it may not be long before the vaccine is recommended for everyone.

The Centers for Disease Control and Prevention reports that more than 85 million vaccine doses are available, so there should be a dose for anyone who wants it. The fact that there is an effective vaccine is one reason the flu doesn't scare us; people know it's there, should they choose to take it.

Effective prevention

The World Health Organization's global influenza-surveillance system studies flu patterns so that an effective vaccine can be developed each year. By the time the flu takes hold here in December or January, millions have received a vaccine that we know works — a sound, reassuring public health practice.

WHO also has done a good job of not spreading panic by connecting the flu to the media megaphone the way SARS was. During the past century, three influenza pandemics — diseases spreading over a large region — caused millions of deaths worldwide, social disruption and profound economic losses. The scourge of 1918 wiped out 33,000 people just in New York City. Luckily, no one is hyping this history.

Influenza experts, however, agree that another pandemic is likely some day. Epidemiological models project that in industrialized countries alone, the next such scourge is likely to result in 57 million to 132 million outpatient visits, 1 million to 2.3 million hospitalizations and 280,000 to 650,000 deaths in less than two years. The impact is likely to be even greater in developing countries, where health care resources are strained and the general populations are weakened by poor health and nutrition.

Preparation trumps predictions

This year has been a bad flu season in Australia and Chile, which might be a harbinger for a bad flu season here. In addition, since we have just experienced two mild flu seasons, some experts say that a severe one is due. But such speculation is about as sure as predicting the stock market. We are better off preparing, not predicting.

And dire predictions from infectious-disease experts risk causing further complacency: If they keep issuing warnings during what turn out to be off years, they will be viewed as the "boy who cried wolf."

This year's new inhaled vaccine has brought more attention to the flu, which is a good thing. But because this new vaccine does not use a killed virus, as the injected form does, it cannot be used in the elderly, the infirm or the immune-compromised.

Influenza is an underappreciated, boring killer that is especially problematic in the very young and the very old, in people with breathing problems or chronic illnesses. To contain it, we need more vaccinations, more isolation of those who are sick, more hand washing — and even, for once, a little more fear.

Marc Siegel, M.D., is a clinical associate professor of medicine at New York University.

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Copyright © 1990-2007 Marc K. Siegel, M.D.