Tuesday, October 28, 2014

Ebola Represents A Trivial Threat To Americans' Health

NPR: Do 35,000 Americans Really Die From Flu Each Year?

"Don't Believe Everything You Read About Flu Deaths"

Alan: When Americans older than 15 die, there is no legal obligation to cite "flu" as "cause of death" even when it is. 

Against this "lax" backdrop, it is clear that thousands of American seniors (and other citizens who suffer a wide range of compromising health conditions) are killed by flu -- with no subsequent reference to the fact -- and that these same citizens would NOT have died except for the flu that actually killed them.

A person with emphysema who would not have died except for supervening flu infection will almost certainly be issued a death certificate that lists emphysema as cause of death, not influenza.

Or consider the under-reported mortality of Alzheimer's Disease, an analogous illustration of how actual "cause of death" is ignored.

"Alzheimer's Disease: A Much Larger Cause Of Death Than Reported"

Regardless the confounding complexity of determining the "mortality of flu," it is indisputable that just one Ebola patient has died on American soil, a Liberian man.

Compared to the lethal complications of flu -- particularly in an epidemiological milieu where nearly half the citizenry chooses to forego protectivce vaccination -- Ebola is a trivial health threat to American citizens. 

By far the most dangerous activity healthy Americans undertake -- and we do it every day! -- is getting behind the wheel of a car. Nothing else comes close.

Currently, West African hospitals and clinics are employing ever more Ebola survivors, all of them immune to the disease and thus requiring NO protective gear. 

In Africa, these immune workers perform all routine medically-supportive functions, from hydrating Ebola patients to cleaning their waste.

Couple this huge (and growing) pool of immune health workers with soaring production of useful medicines, exceptionally effective "convalescent serum," and already-developed vaccines that have proven to be 100% prophylactic, and the real contagious threat to Americans remains influenza, not Ebola. (Notably, a large number of American conservatives - along with many liberals - shun the vaccination that would protect them from this deadly disease.)

Remember When Ebola Was The Harbinger Of Apocalypse? The Guinean Epicenter Is Now Ebola-Free

New Ebola Vaccine Provides 100% Protection

WHO Calls The Use Of Convalescent Blood To Treat Ebola "A Matter Of Priority" 

The other public health threat caused by Ebola is collective hysteria.

Since 9/11, self-terrorization has been our National Pastime, to such an extent that America -- formerly "The Land of The Brave" -- has devoted itself to international terrorism's primary goal of spreading broad-spectrum fear in whose shadow Ebola is a particularly hysterical manifestation.

"Self-Terrorization Is The National Pastime"

Although hysteria is the cornerstone of America's current crisis, paranoia and xenophobic scapegoating are also foundational.

Conservatives And Serial Hysteria

(And How Conservatives Never Admit That Their "Most Recent Freakout" Was Baseless)

In light of morbidity and mortality statistics it makes more sense to quarantine people suspected of flu infection than non-symptomatic travelers who have resided in West Africa.

However, any such proposal - even as a heuristic device - makes no impression on American conservatives except to provoke their next apocalyptic tirade.

Conservative opposition to "epidemiological sense" distills to nonsensical aversion to science. 
"The Danger Of Science Denial"
TED Talk by Michael Specter

Open the door to science-and-intellectual-rigor and most American conservatives are revealed as lunatics.


And mad women, resurrecting yesteryear's caricature of female hormones compelling harpy hysteria.

Quem Deus vult perdere, prius dementat. 

"The Psychiatric Diagnosis Of American Conservatives: 
Folie √† Plusieurs"

"The Death Of Epistemology: Anti-Vaccine Epert (And Playboy Model) Jenny McCarthy"

"Study: Fear Of Ebola Highest Among People Who Did Not Pay Attention In Science Class"

"12 Percent Of Americans Think It Likely That A Relative Will Contract Ebola In The Next Year"

"Ebola Will Make Americans More Conservative"

"Shark Attacks Rise Worldwide: Risk Assessment and Aquinas' Criteria For Sin"

"National Insecurity" 
Brilliant Diane Rehm Interview

Estimating Seasonal Influenza-Associated Deaths in the United States: CDC Study Confirms Variability of Flu

Questions and Answers

What are seasonal influenza-related deaths?

Seasonal influenza-related deaths are deaths that occur in people for whom seasonal influenza infection was likely a contributor to the cause of death, but not necessarily the primary cause of death.

Does CDC know the exact number of people who die from seasonal flu each year?

CDC does not know exactly how many people die from seasonal flu each year. There are several reasons for this. First, states are not required to report individual seasonal flu cases or deaths of people older than 18 years of age to CDC. Second, seasonal influenza is infrequently listed on death certificates of people who die from flu-related complications. Third, many seasonal flu-related deaths occur one or two weeks after a person’s initial infection, either because the person may develop a secondary bacterial co-infection (such as bacterial pneumonia) or because seasonal influenza can aggravate an existing chronic illness (such as congestive heart failure or chronic obstructive pulmonary disease). Also, most people who die from seasonal flu-related complications are not tested for flu, or they seek medical care later in their illness when seasonal influenza can no longer be detected from respiratory samples. Sensitive influenza tests are only likely to detect influenza if performed within a week after onset of illness. In addition, some commonly used tests to diagnose influenza in clinical settings are not highly sensitive and can provide false negative results (i.e. they misdiagnose flu illness as not being flu.) For these reasons, many flu-related deaths may not be recorded on death certificates. These are some of the reasons that CDC and other public health agencies in the United States and other countries use statistical models to estimate the annual number of seasonal flu-related deaths. Flu deaths in children were made a nationally notifiable condition in 2004, and since then, states have reported flu-related child deaths in the United States through the Influenza Associated Pediatric Mortality Surveillance System.

Why does CDC estimate deaths associated with seasonal flu?

CDC feels it is important to convey the full burden of seasonal flu to the public. Seasonal flu is a serious disease that causes illness, hospitalizations, and deaths every year in the United States. CDC estimates of annual influenza-associated deaths in the United States are made using well-established scientific methods that have been reviewed by scientists outside of CDC. Top of Page

What categories does CDC use to estimate flu-associated deaths?

CDC uses two categories of underlying cause of death information listed on death certificates: pneumonia and influenza (P&I) causes and respiratory and circulatory (R&C) causes. CDC uses statistical models with records from these two categories to make estimates of influenza-associated mortality. CDC uses underlying R&C deaths (which include P&I deaths) as the primary outcome in its mortality modeling because R&C deaths provide an estimate of deaths that include secondary respiratory or cardiac complications that follow influenza. R&C causes of death are more sensitive than underlying P&I deaths and more specific than deaths from all causes.

How many people die from seasonal flu each year in the United States?

The number of seasonal influenza-associated (i.e., seasonal flu-related) deaths varies from year to year because flu seasons are unpredictable and often fluctuate in length and severity. Therefore, a single estimate cannot be used to summarize influenza-associated deaths. Instead, a range of estimated deaths is a better way to represent the variability and unpredictability of flu. An August 27, 2010 MMWR report entitled “Thompson MG et al. Updated Estimates of Mortality Associated with Seasonal Influenza through the 2006-2007 Influenza Season. MMWR 2010; 59(33): 1057-1062.," provides updated estimates of the range of flu-associated deaths that occurred in the United States during the three decades prior to 2007. CDC estimates that from the 1976-1977 season to the 2006-2007 flu season, flu-associated deaths ranged from a low of about 3,000 to a high of about 49,000 people. Death certificate data and weekly influenza virus surveillance information was used to estimate how many flu-related deaths occurred among people whose underlying cause of death was listed as respiratory or circulatory disease on their death certificate. Top of Page

What else does this study tell us?

The MMWR study also found that during seasons when influenza A (H3N2) viruses were prominent death rates were more than double what they were during seasons when influenza A (H1N1) or influenza B viruses predominated. In addition, the study confirmed previous findings that about 90% of influenza associated deaths occur among adults 65 years and older.

Why doesn’t CDC base its seasonal flu mortality estimates only on death certificates that specifically list influenza?

Seasonal influenza may lead to death from other causes, such as pneumonia, congestive heart failure, or chronic obstructive pulmonary disease. It has been recognized for many years that influenza is infrequently listed on death certificates and testing for seasonal influenza infections is usually not done, particularly among the elderly who are at greatest risk of seasonal influenza complications and death. Some deaths — particularly in the elderly — are associated with secondary complications of seasonal influenza (including bacterial pneumonias). Influenza virus infection may not be identified in many instances because influenza virus is only detectable for a short period of time and/or many people don’t seek medical care until after the first few days of acute illness. For these and other reasons, statistical modeling strategies have been used to estimate seasonal flu-related deaths for many decades, both in the United States and the United Kingdom. Only counting deaths where influenza was included on a death certificate would be a gross underestimation of seasonal influenza’s true impact.

Does CDC think that influenza causes most P&I deaths?

No, only a small proportion of deaths in either of these two categories are estimated to be influenza-related. CDC estimated that only 8.5% of all pneumonia and influenza deaths and only 2.1% of all respiratory and circulatory deaths were influenza-related.


Alan: The following document served as cover letter to a version of "Trivial Threat" sent to friend Fred Owens.

Dear Fred,

It bears mention that Ebola has infected but two Americans in the United States, both of them healthcare workers who deliberately 
put themselves in harm's way.

It is also noteworthy that Americans' outsized fear of Ebola is an outgrowth of The National Lunacy unleashed by the events of 9/11.

The nation formerly known as "The Land of The Brave" has actively allied itself with the agents of Global Terrorism via abject 
submission to the consuming fear that Osama bin Laden promoted as centerpiece of his agenda.

Al Qaeda (and its derivative organizations) have won The War on Terror because a critical mass of Americans are craven sheep.

Although Americans' ardent alliance with Global Terrorism is not de jure, it could not be more complete as a de facto reality.

Pogo was right. "We have met the enemy and he is us."

Psychological Projection

I have long lamented Mencken's use the word "all" rather than "most" or "almost all."

That said, Hermann Goering expressed Mencken's truth with flawless precision.

All the people whose company I keep -- including a retired Air Force general -- knew that Bush's rush to war was sheer trumpery 
(reinforced by Evangelical hubris) and would involve the United States in a nightmarish waste of blood, talent and treasure.

Anyone with a folded cortex, an internet connection and the ability to question putative authority should have discerned this same truth.


But let's return to the denunciation of those who "expose the country to danger" and "lack the patriotism" to provide adequate protection.


Related Links:

  • Dushoff J et al. Mortality due to Influenza in the United States--An Annualized Regression Approach Using Multiple-Cause Mortality Data. Am J Epidemiol 2006.
  • Eickhoff TC et al. Observations on excess mortality associated with epidemic influenza. JAMA 1961; 176:776-782.
  • Falsey AR et al. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med 2005; 352(17):1749-1759.
  • Nicholson KG. Impact of influenza and respiratory syncytial virus on mortality in England and Wales from January 1975 to December 1990. Epidemiol Infect 1996; 116(1):51-63.
  • Serfling RE. Methods for Current Statistical Analysis of Excess Pneumonia-Influenza Deaths. Public Health Rep 1963 June; 78(6):494-506.
  • Simonsen L et al. The impact of influenza epidemics on mortality: introducing a severity index. Am J Public Health. 1997; 87(12):1944-1950.
  • Simonsen L et al. Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population. Arch Intern Med 2005; 165(3):265-272.
  • Thompson MG et al. Updated Estimates of Mortality Associated with Seasonal Influenza through the 2006-2007 Influenza Season. MMWR 2010; 59(33): 1057-1062.
  • Thompson WW et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003; 289(2):179-186.
  • Tillett HE et al. Excess morbidity and mortality associated with influenza in England and Wales. Lancet 1980 April 12; 1(8172):793-795.
  • Wiselka M. Influenza: diagnosis, management, and prophylaxis. BMJ 1994; 308:1341-1345.

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