Swine flu and statistics - again!

I'm glad to report a website I've discovered called Straight Statistics. Its mission statement says: "We are a campaign established by journalists and statisticians to improve the understanding and use of statistics by government, politicians, companies, advertisers and the mass media. By exposing bad practice and rewarding good, we aim to restore public confidence in statistics." Amen to that! A campaign that's is long overdue and most definitely needed here in the UK.

There are some worrying reports about numbers of swine flu cases in American schools that have already returned from their summer holidays. Most UK schools will be starting to return in the first few days of September.

Swine flu and obesity

Finallly, we have news about what 'underlying health problems' are. UHPs are usually blamed for spokesman for the reason why someone has died from swine flu - but they never say what the UHPs are. Now news comes from the French Institute for Public Health Surveillance that there are two main factors: pregnancy and obesity. The Guardian reports that "Where an underlying disease was found to be present after someone had died of swine flu, in more than one in four cases the deceased had a metabolic condition – diabetes and/or obesity". Diabetes has been mentioned before. So too has asthma but that doesn't seem to be a factor according to the latest report. Interestingly, the idea that children are most at risk also seems to be changing. The average age of those who have died to date is 37. The confirmation of pregnancy as a factor will reignite the debate as to whether women might decide not to get pregnant at the moment.

Did you know? Of the 104 deaths throughout Europe from swine flu, 65 of them are from the UK.

Black Death: Hopefully nothing like swine flu

My interest in swine flu has rekindled my interest in other plagues, including the Black Death of the mid-14th Century. So rather timely as been the publication in paperback of Prof John Hatcher's "The Black Death - An Intimate Story of a Village in Crisis", published by Phoenix. Prof Hatcher gives the already saturated Black Death literary market a personal twist by providing a fictional narrative of what it must have been like to live in the village of Walsham during these years. But - fortunately - Prof Hatcher can't keep the academic in him down and we are showered with wonderful historical detail about those times. Frightening but totally absorbing.

Latest swine flu figures (end of August)

The latest swine flu figures have been released by the UK government. They show "Pandemic influenza activity continues to decrease across most regions of the UK and in all age groups, though remains at levels higher than expected for this time of year." The total number to have died so far this year in the UK is 65. But as the figures were being issued Scotland suffered its seventh death from swine flu. The 52-year-old not only had Underlying Health Problems but "significant" underlying health problems. As usual, no information is given on what these UHPs are or how many of the rest of the population have them.

Is your firm ready for the return of swine flu?

So how is your company preparing for the return of swine flu in the autumn? Think you've got it all sorted? Then follow this simple mathematics...

Just how are you still going to run a company if 10, 20, 30 per cent or more of your workforce is absent.It's no good thinking, 'oh almost no one is going to get swine flu here' as once you start to do the maths you see how big the problem gets.

• First, there are those who will have swine flu and will be off work for two weeks. Let's be optimistic and say it's only five percent of your 200 work force (10 people).
• Then there's the mums (strange how it's rarely the dads) who phone in because their child is sick and they need to stay at home. Let's say an optimistic 10 per cent (20 people).
• Then there are those who are feeling 'under the weather' but have been rightly advised not to go into work in case it is swine flu. That's another 10 per cent (20 people).
• There are a few more, say five percent (10 people) who have to stay at home because the school has shut and they have to care for their healthy child at home.
• Then there are a few more who are so freaked out by the news that they decide to stay away from work as a precaution, and a few more who have had a bad reaction to the swine flu vaccine (say another 10 people).

We're already up to nearly half your 200 workforce. And now consider that the van delivering your vital supplies doesn't turn up because the small family firm is all off work with swine flu.You can't ring up for freelancers or extra help because everyone has the same problem and suddenly freelancers are as rare as hen's teeth.

Still think you're prepared for swine flu's return?

Another Scottish death

Another swine flu death, another glib reference to the person having 'underlying health problems' (UHPs).

This time it's a 59-year-old woman from Islay, in Argyll - the sixth person to die in Scotland. No other details are released and yet we are reliably informed by Scottish health secretary Nicola Sturgeon that "As we have seen in previous cases, this patient was suffering from underlying health conditions and her death should not cause alarm among the general population".

But what are these UHPs? Mild asthma (like what I've got), epilepsy (as at least one report suggests was a contributory cause in a swine flu death) or is it just a phrase churned out each time to reassure the public.

In my quest to pin down when to panic and when not to, I have found this advice on the World Health Organisation website. It says medical attention should be sought when any of the following danger signs appear in someone with confirmed or suspected H1N1 infection:

• Shortness of breath, either during physical activity or while resting
• Difficulty breathing
• Turning blue
• Bloody or coloured sputum
• Chest pain
• Altered mental state, including drowsiness and confusion
• High fever that persists beyond three days
• Low blood pressure
• In children, warning signs include fast or laboured breathing, lack of alertness, difficulty in waking up, and little or no desire to play.

Incidentally a Leicestershire doctor said at the start of August there had been five deaths to date (in England? or the UK?) where there were no UHPs. It's worth looking at this report just for the delightful picture of Dr Brian Brown that accompanies it!

Back to school

It will soon be time to return to school and while the swine flu scare has largely died down in the UK at the moment, it won't be long before a child goes home with 'flu-like symptoms'. What then? Well the government advice is quite clear: keep the school open. For a start, it's likely the child will just have flu (not swine flu). Secondly, there's as much chance of your children catching bugs while walking around town or playing with their mates as in school. The official advice is online but one wonders how parents will react if several children in the same school go ill - will they keep their child away. And what if there is a death in a school - does that school then close, do parents unilaterally decide to keep their children away or do all schools in the area shut down for a while? For what it's worth, here's my prediction: Despite all the good advice coming out from the government, individual head teachers will decide what to do and that will be based on their own 'feeling' about what is best and will reflect what parents want to do. Watch this space.

An unscientific poll

The Whitehaven News website is running a completely unscientific poll at the moment asking the question: Are you convinced enough of the safety of swine flu vaccine to give it your children? With just 50 votes in, the results so far are: Yes 14%, No 66%, Not sure 20% I think someone in government should be worried.

Swine flu poetry

I've been searching the web for a few days for a decent swine flu poem - to continue my theme of the arts and swine flu. But this was the best I could come up, posted by one Kevin Johnson. If you can do better, do let me know...

Celebrity and star of great fame
Kermit the frog found dead what a shame
Not found green instead blue
He had died of swine flu
Any guesses of whom we should blame?

"Underlying health problems" - a cliche exposed

My concerns over the trite phrase "underlying health problems" (UHPs) being trotted out every time someone dies from swine flu have been borne out. It has become an almost journalistic cliche - no one simply dies of swine flu, they all have "underlying health problems". My suspicion is that people in authority are using this as a way of reassuring the public that swine flu is not dangerous; people can relax - they weren't 'ordinary' people who died from swine flu, they were deeply ill in the first place. Alarm bells rang in particular when the Northern Ireland soldier Lee Porter died from swine flu and it was said he had UHPs. The Belfast Newsletter have interviewed his family who strenuously denied he had UHPs.The 30-year-old had, say his family, no UHPs. The Belfast Newsletter adds that Lee was: "Employed full time for the Northern Ireland Fire Service, he had been involved with the Territorial Army since the age of 18 and had also progressed to the rank of Company Sergeant in the Army Cadet Force." So in fact he was incredibly fit and strong - surely a more important news story that someone of his ilk can be brought down by swine flu than someone with UHPs. Why did/do journalists accept the glib phrase "underlying health problems" so easily. Journalists should be asking what UHPs. For the record, here's the MoD apology. Well done Belefast Telegraph for digging a bit deeper and finding out what the real facts were.

Tamiflu humour

An old joke revamped for the swine flu era... Doctor: "Take this Tamiflu and your swine flu symptoms will be gone in a week. If you don't take the Tamiflu your symptoms could take seven days to disappear."

Latest swine flu figures

The latest swine flu figures continue to show a drop in the number of new cases (but there are still new cases). In the last week there have been 11,000 confirmed new cases in England (it was 25,000 the previous week). There have been 1,793 cases confirmed in Scotland - the full report is online. Curiously the BBC news on Radio 2 talked about 54 deaths in England to date - poor old Scotland being left out again. In fact it is 59 deaths so far for the UK. The map shows the cases across Europe - it is explained fully on the website of the European Centre for Disease Prevention and Control but shows the UK suffering worse than any of our European neighbours. Why? There have been 73 deaths across Europe - 59 of those in the UK. The USA has reported 477 swine flu deaths. Australia has reported 128 deaths.

Anyone for Tamiflu?

Tamiflu gives children nightmares, Tamiflu is next to useless, Tamiflu could kill people at risk from a stroke... the bad headlines just keep coming for Tamiflu. Fortunately in the UK the swine flu scare has gone away as people set off on holiday and forget all about the nasty bug. With the first phase of the flu come and gone we can now only wait for the second phase in the autumn. By then Tamiflu will be forgotten and all the talk will be about the vaccine and how safe that is.

Shop sign in Keswick

This sign is on the door of a pharmacy in Keswick.

Causes of swine flu?

I found this in The Whitehaven News for 28th April 1870. It is a letter from 'Carbolic Acid' attributing an outbreak of typhoid to:
1. Overcrowding
2. Partial or total want of ventilation
3. Want of sufficient light
4. Want of cleanliness in apartments
5. Living and sleeping in the same room.
6. Almost total disuse of water-closets where placed outside the house
7. The keeping of foul utensils within doors for weeks together without emptying
8. The keeping of poultry in the house, often in bedrooms
9. Sleeping on the floors of bedrooms
10. Almost total disregard for the presence of bad smells
11. The want of changes in clothing, unfrequency of washing the clothes and skin, and its consequences
12. The use and abuse of certain kinds of drink
13. The use of bad and low-priced ood
14. The Want of sufficient food
15. Irrregular habits of body, of times of eating, and of living generally
16. Recklessness in warding off first attacks of illness
17. General and almost total ignorance of the laws of health, and superstitious and erroneous ideas respecting the origin and treatment of diseases.
18. Total disgreard for almost anything and everything but a carouse* weekly or fortnightly, oftener when convenient.

Sounds remarkably good advice for avoiding swine flu and similar in 2009.

* = drinking session

Count me out

Journalists, by and large, don't do maths. Ask them what 40 per cent of 40 is and they won't have a clue. Ask them what the difference is between a median average and a mode average and they'll just look blankfaced. It's only when they come to fill out their expenses that they suddenly become boy geniuses about tax and compound interest. And I count myself as among those who are statistics-blind. However, I hopefully can at least ask questions and spot when some table or graph looks or smells a bit dodgy. So I'm going to start an occasional series of swine flu stats presented by journalists. And here's the first, courtesy of the BBC website...

It purports to show swine flu increases in the last week but (and it may be just me being thick) surely without any figures it's meaningless. If eight people died in China one week and 12 the next, that's a 50 per cent increase - worrying but 'only' four more people. But if 600 died one week and 900 the next, that's still a 50 per increase but now it's 300 who died in one week. So the BBC table tells us almost nothing. Or is it me?

State of the art

Like any major event, swine flu has inspired artists to come up with some creative work. Here are just a few of the posters from zazzle.com.

Only the NHS can save us now

We're all waiting in trepidation in the UK for the winter version of swine flu- particularly as we will only have the NHS to protect us. The Americans are discussing our NHS at the moment as they discuss whether to switch over to that type of health system (have they never watched the film Sicko?!). It's a tough call unless you're one of the millions of Americans too poor to get health insurance. The NHS has many problems but it's still good to know that if I fell ill as I typed this blog I could walk into a hospital and get sorted for 'free'.

Anyway, back to swine flu and the latest figures show a continuing fall in the summer swine flu outbreak. Yesterday's statement by the Health Protection Agency (never going to win a Plain English award) says that 49 people have now died from H1N1 in the UK and "gives an estimate of 25,000 (range 15,000 – 60, 000) new cases in England in week 32 compared to an estimated 30,000 cases in the previous week. The estimated number of new cases has decreased in all regions and age groups."

On TV last night was reassuring footage of the new vaccine being tested on patients in the Midlands. It didn't make it clear whether people would be forced to have the vaccine. However, the BBC website is voicing the concern of some experts about the rushing through of the vaccine. Generally though, the assumption of the TV news is that of course people will rush to get the vaccine - why wouldn't they? I think they might get a bit of a shock!

Jane Burgermeister

There have been some half-hearted attempts at swine flu conspiracies (it was spread by Al Quaeda, the manufacturers of face masks etc) but for the genuine article you need to Google Jane Burgermeister. She's a journalist who has filed criminal charges with the FBI against the World Health Organization, the UN and others for deliberately spreading swine flu in an attempt to commit mass genocide against the people of the United States. But it's not the swine flu she believes will kill everyone, it's the 'vaccine' being prepared to fight the swine flu.

Who's behind the conspiracy? President Obama, bankers David Rockefeller and George Soros and numerous other world figures.

Why would they want to kill much of the population of America (and the western world)? She claims to gain access to the natural resources of North America and reclaim the houses, property etc of the dead.

How is the plan being carried out? By deliberately spreading swine flu (a man-made virus, she claims, that was unleashed in Mexico during a trip there by President Obama). Then forcefully injecting everyone with the 'vaccine' that is in fact designed to kill them. The blame will then be put on swine flu being much stronger than first thought.

It's all nonsense of course but I would say that because, according to Jane Burgermeister, the media is also involved in this conspiracy. And if you think this can be quickly dismissed as bonkers, just bear in mind her Facebook group has more than 6,000 followers already.

• You can read her complete lawsuit filed with the FBI online.
• She has her blog online.
• And her Facebook group.

Where there's muck...

Swine flu may be pretty frightening but it's not going to stop some people making a quick buck. How about swine flu T-shirts, the swine flu fridge magnet, or even the swine flu hat! Let me know if you've found a swine flu tacky novelty.

The ghost of MMR returns

Oh dear. Here we go again. The nightmare of the MMR scandal has returned and one suspects the only losers are going to be the poor members of the public who are now confused and concerned about giving their children Tamiflu (children remember are those most likely to get swine flu).

It all started with a piece of research in the British Medical Journal. I've linked to the research article but in brief: "The analysis was based on a systematic review of seven clinical studies looking at use of Tamiflu and Relenza in seasonal flu outbreaks in 2,629 children aged 1 to 12 years... The authors conclude that it is difficult to know the extent to which their findings can be generalised to children in the current swine flu pandemic but, based on current evidence, the effects of antivirals on reducing the course of illness or preventing complications might be limited."

Fairly reasonable and the first news headlines simply stated "Benefits of swine flu drug questioned", "Flu drugs unhelpful in children" or "Drug use discouraged". But it wasn't too long before they darkened into headlines like "Don't give children swine flu drugs - says doctors", "Swine flu drug Tamiflu 'does children more harm than good'" and "Swine flu cure a danger to kids, says docs".

I think you will be hard-pressed to find any parent rushing to give their children Tamiflu at the moment. So what is the real story? Unfortunately science appears not to be an exact science. So journalists will start playing off one against the other. Oh for the days when a man in a white coat would come on the evening news and tell you exactly what was what. There's good discussion on The Guardian story and of course Bad Science will no doubt be discussing this issue.

Once again it seems that journalists aren't prepared to give readers enough precise information for them to make up their own mind - perhaps they don't think readers will understand it, or perhaps journalists can't convert science-speak into plain English. Shameful really - that's supposed to be a journalist's job. One wonders just how long it will be before a child dies unnecessarily because the parents wouldn't give them Tamiflu.

Nothing changes

This statement by Dr R Lumb, onetime medical officer of health to Whitehaven, was found during a trawl of our archives in the January 20 1870 edition of The Whitehaven News. But it will ring bells with many town centre residents today.

"I wish to call attention to an evil of a very dangerous nature, viz, the emptying of refuse matter into the streets, and allowing it to remain there till the town's carts are ready to remove it. This exists to a great extent in the high parts of the town, many people having complained to me of this abominable evil."

People today living in the town centre where the streets and alleyways are almost continually littered with rotting food, soiled nappies and other detritous pecked out of thin plastic bags by seagulls will wonder why, 139 years on, little has changed.
At the time Dr Lumb made this statement, the town was in the grip of a typhus epidemic that became so bad a Government Inspector visited the town and was, of course, suitably horrified, describing it as having "a stagnant foulness of atmosphere hardly to be surpassed in any English town". Things are not quite so bad today but we still don't seem to have made the link between disease and our streets being covered in the ripped-open contents of bin bags, urine from late-night revellers realising there are no public toilets in this town, dog dirt from lazy or ignorant dog owners and spit.

How do you illustrate swine flu?

I've been keeping an eye on the logos used by newspapers and websites to illustrate swine flu. Many of them use a pig even though there's very little pig in swine flu. And many go for the dark, dramatic and slightly scary look! See what you think..

Welsh whisky

There appears to be a story doing the rounds in foreign newspapers and websites that Welsh whisky is a miracle cure for swine flu. Now, even the Welsh would admit that it takes brave person to drink Welsh whisky and it may be responsible for many things but miracle cures aint one of them. It seems this story got started when a Russian sports team was visiting Wales and they were advised to drink whisky as a way of avoiding getting swine flu (you may recall that Wales at one time looked immune to swine flu but has now rapidly caught up). And from this small beginning the internet rumour began. Welsh whisky may not cure you but its taste will almost certainly take your mind off the flu.

It comes back

Should we be happy/relieved/cautious over the latest swine flu figures that show only 30,000 new cases were reported last week (compared with 110,000 the previous week). I keep hearing the catchphrase from BBC4's docudrama, The Forgotten Fallen, in my head: "It comes back". Which is of course what Sir Liam Donaldson and others keep saying.

But I still have concerns over the figures being banded about. Leaving aside for a moment the questions of how that '30,000' is calculated, the BBC news story suddenly said: "The total of swine flu-related deaths in England and Scotland stands at 40". Er, just a minute - only yesterday it was 31 dead - so we've had a 30 per cent rise in the number of deaths?!

Still, may hay while the sunshines and if you want to know what's likely to happen in Europe over the winter, just see what's happening in the southern hemisphere at the moment. Argentina is a sobering place to start.

Mass of Separation

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I am grateful to Channel Four blogger, Dr Peter Stott, for bringing this to my attention. It is the Mass of Separation from the 13th Century and was a series of instructions to sufferers from leprosy. Strangely, the instructions are equally valid today for avoiding the spread of swine flu! Just shows how little our understanding of viruses has grown in 700 years!

MASS OF SEPARATION

"I forbid you to ever enter a church, a monastery, a fair, a mill, a market or an assembly of people.

"I forbid you to leave your house unless dressed in your recognisable garb and also shod.

"I forbid you to wash your hands or to launder anything or to drink at any stream or fountain, unless using your own barrel or dipper.

"I forbid you to touch anything you buy or barter for, until it becomes your own.

"I forbid you to enter any tavern; and if you wish for wine, whether you buy it or it is given to you, have it funnelled into your keg.

"I forbid you to share house with any woman but your wife. I command you, if accosted by anyone while travelling on a road, to set yourself down-wind of them before you answer.

"I forbid you to enter any narrow passage, lest a passerby bump into you.

"I forbid you, wherever you go, to touch the rim or the rope of a well without donning your gloves.

"I forbid you to touch any child or give them anything. I forbid you to drink or eat from any vessel but your own."

Northern Ireland's first swine flu fatality

How sad to learn of Northern Ireland's first swine flu death - Lee Porter was only 30 years old. Once again journalists are unquestioningly throwing in the line that he had "underlying health problems" as some sort of reassurance to the public. He was 30 years old, a bombardier in the Royal Artillery and also worked in the fire service. It's hard to see what underlying health problems someone that young and fit could have that would weaken him to the effects of swine flu. The BBC says he is the 28th person in England (surely United Kingdom?) to have died, plus three in Scotland.

On BBC4 tonight (Wednesday, August 5th) at 9pm there is a docu-drama on the Spanish flu of 1918 and that's followed by a documentary on how the world tries to cope with pandemics. Should be interesting if morbid viewing.

Men in Black

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Those who watched the webchat with Dr Nigel Calvert yesterday (and those who didn't can replay it online) will no doubt know more about swine flu than most other experts! He was superb - giving quick, concise answers to a myriad of questions. There was some very interesting stuff, not least a first figure on swine flu in Cumbria for some weeks. He estimated - and emphasised it could only be an estimate - that there are currently 600 swine flu cases in Cumbria. I also found interesting the comment from 'Brian' who said his mate had swine flu and the boss sent somebody round to take a swab. 'What's the point of that' asked Brian. What's the point indeed. Are employers going to then prescribe tamiflu or offer a course of treatment - or turn round and say "I don't care what your doctor says, you haven't got swine flu so get yourself back to work". Bizarre. It also had a flavour of Men in Black nipping round to swine flu cases echoing tales and legends in plague times past of strangers wandering the land. Dr Calvert, NHS Cumbria’s associate director of Public Health, said: "We have been asking a sample of people to take a swab so we can see what proportion of people getting tamiflu actually have the flu. I have heard of some employers who are doing swab tests. Many people with suspected swine flu will actually have some other infections like bad colds." I can understand doctors taking swabs - but company bosses?!

Patient Zero

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Who was the first person in the world to get swine flu? Experts are divided between a six-month-old child in Mexico and five-year-old Edgar Hernandez. But Edgar is the one who has caught the attention of the world media (well babies are more difficult to interview) and Edgar even has a statue of himself. The sculptor was Bernardo Luis Artasanchez who seemed to share the net's belief that there is something significant in being the first. The statue is called Nino Cero – Little Boy Zero and it stands in Edgar's home town of La Gloria, Mexico. It may be doing some good. It's starting to attract tourists to the small town, no doubt giving a welcome boost to the economy. But others are unhappy at their town becoming infamous as the place where swine flu started.

It's not just me

I was encouraged to see the Royal Statistical Society questioning the lack of detail in the government swine flu statistics - though I fear this is one press release that is going to pass most journalists by. President David Hand had written to Sir Liam Donaldson with a few questions. You will find his letter online but the key points are:
The dangers of producing weekly reports on swine flu instead of daily ones

• Some vagueness on statistical standards
• Lack of demography in the data
• Lack of other data relating to sex and age of patients

And interestingly a concern that those who die from H1N1 away from hospital might be missed out of the statistics. This line from David Hand's letter particularly interested me:

"Readers of the UK’s weekly H1N1v updates need to know numerators and denominators, not just percentages, and the empirical basis for multipliers used in inferring from GP-consultations for influenza-like-illness (ILI) to headline figures on the estimated number of H1N1v cases. Moreover, the provenance for intervals of uncertainty should be properly explained."

I think that's what I've been saying - but the RSS puts it in their own jargon. It seems to be saying there's a basic lack of statistical data missing. If so, journalists should be highlighting the government's failure to understand the necessity of such information.

But I fear not much is going to come of this. Journalists and maths/statistics just do not mix. Very, very few journalists have the understanding to look at a graph or table of stats and ask pertinent questions. And there's another problem. The Royal Statistical Society can't talk in plain English. They need a press officer who can explain in layman's term precisely what their concerns are with H1N1 statistics. It's no good hiding behind "oh it's all very complicated and can't be simplified". It's the job of press officers and journalists to make sure the public can understand such information.

One bright light on the horizon: The RSS does hand out awards on statistical excellence in journalism which hopefully encourages the hacks to improve their act.

Thin on the ground

One member of staff has gone down with 'swine flu' - as much as anyone knows if they really have swine flu or not. Dr Google tells you that you have some of the symptoms and prescribes you Tamiflu but no one ever gets really tested for the virus. However, one member of staff off ill during this holiday period and post-redundancy era is already having a big effect on how the paper operates and even gets out. The public keep phoning in with news but there's simply not enough people to process them all properly. My in-tray is getting bigger but the public are going to just have to understand that we're in strange and difficult times.

I did manage to get to Keswick Theatre last night for Midsummer Night's Dream (excellent show by the way). It was nice to see so many young kids in the audience - well, not the teenage girls rustling plastic sweet bags all through the first half. But one poor lad (probably about seven years old) was coughing like a good un. A few weeks ago he would have been in quarantine with parents gravely muttering 'swine flu' to family and friends. But, hey, this is the summer holidays so he was out at the theatre. And I overheard his dad in the pouring rain after the show telling the taxi driver to take them back to the campsite. That's the Bulldog spirit we've been missing!