Was the Flu Fracas a Flop?

In Aesop's fable about the shepherd boy, the youngster yelled wolf just to amuse himself and have the villagers come running. After he did this a couple of times when there was no wolf, they got fed up with him. When the wolf really appeared and started eating his sheep, nobody came to his rescue.

This fall the media cried flu. People freaked out about the possibility of the H1N1 influenza pandemic killing millions around the world.

It's hardly any wonder. Some experts compared swine flu to the Spanish flu of 1918 and 1919. During that pandemic, 50 to 100 million people died, more than were killed during World War I.

The media stoked fears with graphic images of young people dying. The vaccine was slow to arrive and people lined up for hours to get immunized. Churches canceled communion and some people started wearing face masks to work.

Was all this fuss an overreaction? By this time of year, flu is usually at its peak. In a normal season, schools are reporting widespread absences and hospitals are swamped with sick people in February and March.

This year, though, the pandemic petered out. It peaked in October and now doctor visits for flu are way below normal. Unless there is a sudden resurgence, this is likely to go down in health history as the flu that fizzled.

Seasonal flu (non H1N1) has been surprisingly scarce this winter. Although the weather was awful and people were cooped up inside more than usual, there was an amazing lack of ordinary influenza circulating.

Public health authorities advised people on how to avoid spreading the flu: wash your hands, cover your mouth when you cough and get a flu shot. Although there were 155 million doses of swine flu vaccine available, fewer than 90 million people were vaccinated. We still don't know how effective the vaccine will prove to be.

Even in a normal year, however, serious questions have been raised about the effectiveness of flu shots. This is especially true for the elderly, who are presumably the most vulnerable. A recent analysis concluded that: "the 'effectiveness' of the vaccine is in great part due to the selection of healthier individuals for vaccination, rather than due to true effectiveness of the vaccine" (Journal of Infectious Diseases, Jan. 15, 2010).

Even healthy younger people don't have fewer sick days, shorter hospital stays or fewer deaths from influenza if they get vaccinated (British Medical Journal, Oct. 28, 2006).

Questions also persist about the benefits of flu shots for babies and toddlers under two. Although they are more vulnerable to influenza complications, the data suggest that most flu vaccines are not terribly effective for these young ones (Cochrane Database Systematic Reviews, April 16, 2008).

Public health officials are faced with a difficult task. They need to warn people when there is a true threat so they can take action. But they also need to be careful not to cry wolf.

If the public becomes too accustomed to scary stories about flu pandemics that don't pan out, it might let down its guard. Were a truly dangerous flu virus to emerge, people might not follow the precautions needed to protect themselves