What does Risk Communication Look Like?

Last month, I wrote about the severity of the H1N1 pandemic, commenting that while it is noted as "mild", it is a very serious public health issue.

Let's talk about one important characteristic in which this pandemic is different from the seasonal flu. Most hospitalizations and deaths from seasonal flu are in people who are 50 or older while 90% of the hospitalizations and deaths from H1N1 have been in those younger than 50. The World Health Organization measures this in disability-adjusted life year (DALY) to understand the number of years of potential life lost and the loss due to disability. In this measure, the H1N1 pandemic will look very different from the seasonal flu.

Researchers Amos Tversky and Daniel Kahneman in 1981 conducted a study about how a situation or risk is framed or described and the effect that has on decision-making. They concluded that the psychological principles that govern the perception of decision problems and the evaluation of probabilities and outcomes produce predictable shifts of preference when the same problem is framed in different ways.

So how do we frame the H1N1 pandemic? Understand that it is a very serious disease that requires an informed and practical response from each one of us. Know the risk then take action that makes sense an effectively reduces the risk. While flu virus is unpredictable, current activity suggests:

• May infect 30% of Americans
• Generally mild with some suddenly serious (13,000 hospitalizations and 1,200 deaths)
• Differs from seasonal flu in important ways:
• 90% of cases between 5-65 years
• Average age – 20 years
• Cases rising rapidly (4x normal) since start of school
• Peak now expected in October-November
• Vaccine and antivirals will be effective, but vaccine timing may come after peak
• The U.S. government has ordered more than 200 million H1N1 vaccine doses
• The first available doses of the H1N1 vaccine are becoming available now
• Vaccine will be available in varying amounts and targeted to high risk groups including, pregnant women, children and those with underlying medical conditions that may worsen flu

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What will the 2009 pandemic be like? It depends on your definition of “mild”.

Will the fall flu season, and the second wave of the 2009 flu pandemic be mild or severe? Experts agree on the bottom line answer: no one really knows. Flu viruses are constantly mutating. This is why we get a new flu shot each year. The virus changes enough from year to year that the immunity you have this year you will not have the next.

Fortunately, H1N1 (Novel H1N1, 2009 pandemic flu or Swine Flu) has been mild so far. In fact, a Google search of the terms “H1N1” and “mild” has 2.5 million results.

But what is “mild”? The health risk from H1N1 is often compared to that of the seasonal flu. In terms of risk communication, this translates for most of us to “no big deal”.

To put this in perspective, if the number of deaths from the pandemic flu equals the typical flu season, 35,000 Americans will die as a result of this mild infection this year. This is more than the total deaths from 9/11, Hurricane Katrina, the sinking of the Titanic, Pearl Harbor, 1906 San Francisco earthquake, the 50 worst tornadoes in the US and all terrorism worldwide since 2001 combined.

So what does this mean. We hear news headlines that vacilate between "we are all going to die!" and "no big deal". I posted about both extremes on Twitter. The H1N1 pandemic of 2009 is neither. It is a very serious disease that requires an informed and practical response from each one of us. Follow our response and connect to experts throughout the pandemic on the Minnesota InfraGard site and sign up for more posts on this blog. For medical information and tools to respond, go to flu.gov.