Important points about U.S. flu surveillance, with examples from the 2009 H1N1 "pandemic"
Astute and sobering analysis.
I was part of the leadership team for H1N1 in 2009-2011. Ran the clinical trials testing vax in pregnant women and also in AIDS patients, at NIAID under Fauci. Oct 2009 we distributed the vax and then "positive tests dropped dramatically over Thanksgiving". Of course, we attributed it to our 'great efforts'.
Seen much differently now, in retrospect. Sigh.
Laura Kragie MD. biomedworks.substack.com
"WHO/CDC Swine Flu Venture was successful in what it demonstrated about testing. Specifically, that testing could be leveraged to a) get the public’s attention, b) justify the pandemic preparedness industry, c) expand global disease surveillance programs, and d) pin more P&I deaths on influenza. " Describes my several years of experience as a sentinel provider, then as an objector to the H1N1 HCW mandate in NYC - threatened with termination in 2009 and ultimately terminated in 2016. Finally, as an active primary and urgent care physician in NYC during the panic-demic of 2020, i will attest that everything you have observed in your research for this article reflects very accurately what I experienced in my day to day practice.
The CDC introduced its Weekly Flu Surveillance Reports 20 years ago during 1999/2000 season. Going over those original reports you'll see in those early years reports just a few pages and a scant amount of detailed information.
Going back to the 1980's you might get 14-18 million doses per year in the US. Compare that to today's 175 million doses per year.
This all changed significantly in the 2007/2008 season.
In the 2007/08 season the CDC reports doubled in length and offered up significantly more detail in their national flu surveillance data. What was once a mom and pop operation turned into a big box store with weekly reports that were once three pages long now expanding into ten plus page reports complete with colorful graphs and regional information.
With this expanded focus on flu data came much more specificity in each report.
Not coincidentally in 2008 ACIP began with recommendations that people ages 6 months to 18 years old get an annual flu vaccine.
By 2010 ACIP recommended that everyone age 6 months and older get an annual flu vaccine.
All of this at the behest of Pharma- they created a market.
In North America alone the flu vaccine market stands at around $3.7 billion per year as of 2021- globally around $7 billion.
"The flu" is not a medical condition it is a business model.
So when I was working as a GP I used to get loads of people with headcolds and the like coming to tell me they had the flu and I used to send them away telling them it was a cold virus or whatever. And that if they really had influenza they wouldn’t be in front of me they would be flat out in bed at home. My idea then was that influenza made you quite Sick with myalgia headaches rigours etc but no particular respiratory symptoms. When I think back I can barely think of any who fitted in with my idea of what the flu was. But it didn’t really matter to me because most of what I was seeing was fairly trivial illness anyway.
More to follow…….
I know this is boring - but important nevertheless. I’m now very sceptical about the whole story of influenza mortality. The flu is generally lumped together with lots of other pathology and called Influenza like illnesses ILI’s. I’ve read a lot about the Spanish flu pandemic of 1918 and I’m of the opinion that the data is very dubious. We really don’t have any idea of exactly how many died and from what. I suspect much of it was from the effects of ww1 on nutrition and immunity and other things besides. The statistics in the uk on flu and flu incidence are based on reported episodes by selected practices. These reports will be based on some arbitrary idea of what the flu is. This will depend on the ideology of the individuals reporting it.
So in those winters of alleged high incidence of flu and flu mortality I believe what we were seeing was bacterial pneumonia resulting from any number of respiratory viruses.
I don’t believe any of the statistics on flu were confirmed by reliable laboratory testing. Although I’m sure there was sample testing by fluorescent antibody or PCR or cell culture but this is a whole debate in itself.
More to follow……..
Brilliant stuff Jessica.
I had worked out that H1N1 was a test-run, but I didn't realise just how much there was to be not learned from it at all!
From your post: “This is not to say that physicians are simply following a formula; to be sure, each doctor exercises professional judgment and assesses individual patients or situations, but clearly there is a kind of conditioning steered by smaller groups of professionals”
A phenomenon that has occurred over the past 25 years and accelerated in spade’s following Obamacare is hospital ownership of physicians. In my community, it is clear that “institutional “ medicine follows (and hides behind) CDC recommendations. This provides leverage for behaviors (testing decisions) to be affected, providing support to your claims.
I look forward to your follow up on this issue.
Side notes I wish to share:
The point of care testing now available does significantly enhance diagnostic clarity for etiology during ILI. The last review on confirmed causes of pneumonia was a few years ago. What we learned is the majority of clinically admitted pneumonia remains undiagnosed. Further of confirmed (through PCR assays) were due to Rhinoenterovirus !
What saddens me as a physician is that despite these facts, there remains no targeted anti viral medications. The public health leaders appear fixated w vaccination as the solution.
Trouble is ……there is no (IMO that is) satisfactory way of clinically diagnosing Influenza or Covid-19. I have spent all of my career in medicine and I can honestly say I do not know what Influenza is. I’m not even convinced that influenza viruses are necessarily pathogenic among the whole gamut of viruses found in the upper respiratory tract. Until we really go into this we are just scrabbling about among the garbage
This debate about what the “flu” is needs to be disseminated more widely. So many of our presuppositions need to be challenged. Because what we thought we knew about the flu corresponds to what we think we know about coronaviruses.
The reason I keep banging on about flu.....what it is and whether it is what it is supposed to be....is that constantly we compare IFR’s using that of flu as the yardstick. I believe these waves of winter mortality due to pneumonia are bacterial. The issue distracts us from focussing on what is really going on with mortality. That’s all.
Chris (retired GP)
So what I’m leading up to - is - has there ever been a major epidemic - or pandemic - due to a virus - that has resulted in major mortality? Is it not the case that there is a tendency for there to be a seasonal wave of death from pneumonia in frail and vulnerable individuals in winter months . And that if a search for the putative virus is carried out we will find a culprit?
Amazing that you Jessica figured this all out in no time and generations of Drs around the world never thought about it
So it really is a case of …….what you think you know that ain’t so.
A conversation I recently had with a colleague
Have just read your tweet re Spanish flu plague etc and like you have been thinking some things over. Having talked to my erstwhile partner in the practice we got to the the subject of “the flu”.
So I’ll send you my thoughts in a series of bulletins so as not to bore you.
First - what the hell is the flu?? Medical textbooks describe the symptoms as temp myalgia poss sore throat cough etc etc. These are exactly the same as any old upper respiratory infection. Due we believe to any number of viruses.…..more to follow
Great! So we’re on the same page metaphorically speaking.
I’ll send you a copy of a recent conversation I had with a colleague. It may come in instalments ….
First - what the hell is the flu?? Medical textbooks describe the symptoms as temp myalgia poss sore throat cough etc etc. These are exactly the same as any old upper respiratory infection. Due we believe to any number of viruses.
I have some views on influenza based on my lifetime experience as a GP in England.
I think you may find them useful.
Would you have time to consider them?
Don't trust the CDC's Flu/ILI reports - Dang straight!
I make the same point in this piece, which documents all the school closings in America before "official" Covid. I do admit I use CDC data ... but lots of other sources as well.
Thanks Jessica, great work. I want to synthesis your series into an article, so wondering how many more on the subject you are planning on writing?