FluPortal.org

[Disclaimer: We're featuring the following study and estimate as interesting food for thought. We can't vouch for their accuracy; you would need to do your own reporting to evaluate that.]

Two different assessments of U.S. immunity to H1N1 have emerged recently. The first suggests the number of Americans infected by swine flu in 2009 (roughly 63 million). The second estimates the number of Americans who currently have immunity to H1N1 (somewhere roughly between 150 and 165 million).

Ted Ross [U. of Pittsburgh]

Assessment #1: A new study published in PLoS Currents: Influenza estimates the number of Americans who were infected with H1N1 in 2009. (Read our post about PLoS — the Public Library of Science — here.) The lead author is Ted Ross, an associate professor of microbiology and molecular genetics at the University of Pittsburgh.

The study looks at levels of antibodies to 2009 H1N1 in Pittsburgh-area residents. (Infection with a virus stimulates antibody production, which then confers immunity.) It examines blood from “846 persons that ranged in age from 1 month to 90 years of age.” The samples were taken from “hospital and clinic patients in mid-November and early December 2009.”

It’s possible that some people with antibodies to 2009 H1N1 got them from the vaccine rather than infection with the virus — but “the timing of the sampling relative to vaccine availability in Pittsburgh suggests that these samples are likely from a largely unvaccinated population during the peak of the second pandemic wave.” In other words: the data probably approximate the number of people actually infected by H1N1 in 2009.

Here’s the study conclusion in a nutshell:

21% of persons in the Pittsburgh area had become infected and developed immunity. Extrapolating to the entire US population, we estimate that at least 63 million persons became infected in 2009. As was observed among clinical cases, this sero-epidemiological study revealed highest infection rates among school-age children.

Ian York [Michigan State University]

Assessment #2: Ian York, an assistant professor of microbiology and molecular genetics at Michigan State University, recently offered his best educated guess of the number of Americans now immune to H1N1 (on his blog Mystery Rays from Outer Space). As he puts it, there are three ways in which someone could have acquired immunity:

They could have been exposed to a related virus, some time in the past, and have developed a long-term immunity. They could have been infected with [H1N1], somewhere in the first or second wave. Or, of course, they could have been vaccinated.

He collects the available data for each of those categories — emphasizing that “[t]hey’re more or less approximate” — and concludes that:

• Over half the US population as a whole is now immune to the new [H1N1].
• As many as three-quarters of the elderly and two-thirds of the children — the most important populations as far as flu is concerned — may be immune.
• Between a third and about half of this immunity was due to vaccination.

To find York’s full table of high and low estimates — broken down by age group — click here.

Why is it useful to know what percentage of the population may have immunity to H1N1? As the PLoS study puts it, it “provides valuable information about the likelihood of a possible third wave and may be useful in decision-making about immunization strategies.” Or as York writes, the “level of immunity” that he calculated “is probably enough to impact virus transmission drastically.”

FluPortal will be winding up as an active project at the end of March. So we’ve recently been trying to evaluate what the site has done well and what its shortcomings are — with the idea that FluPortal might be a model for future “crisis portals.” (You could imagine a generic CrisisPortal or something more specific like EarthquakePortal.)

A few days ago, I spoke with Katie Donnelly, Associate Research Director at American University’s Center for Social Media. Donnelly focuses specifically on the intersection of social and public media. She featured FluPortal a couple of weeks ago in a blog post and told me she feels it’s a “really good solid model” for helping pubmedia to report on crises. So I pushed her on what she really thinks — on what constructive criticism she might have.

Donnelly had two main recommendations.

First: She suggested encouraging more direct interaction among stations. This could happen in a forum on the site, for example, or in something like a webinar or an online chat. The idea here, she said, would be to “improve ways for stations to connect with each other” to share ideas about crisis coverage.

FluPortal did experiment early on with a Google Group for just this reason, but very few people signed up. Perhaps it was the wrong technology for convening pubmedia people — or perhaps it indicated that station staff are simply too busy for this sort of thing.

I also mentioned to Donnelly that the FluPortal blog was a possible place for stations to interact (in the comments section). She observed that for some reason pubmedia people very rarely seem to comment on blogs — that blogs probably aren’t the right place to persuade stations to talk to each other.

Second: Donnelly felt that FluPortal is “lacking first-person accounts” about H1N1. She suggested soliciting crowdsourced information and encouraging the general public to tell their swine-flu stories on the site. Donnelly understood that FluPortal is aimed at public media — and not at a general audience — but felt it could be a good place for reporters to make contacts with regular people who are part of the H1N1 story. She acknowledged, however, that any public forum on swine flu would require active moderation to avoid “propagating inaccurate information.”

During the FluPortal project, we’ve searched the blogosphere for good H1N1 stories but haven’t found much that stood out. (Most posts and tweets were of the “I’m on my couch and I feel terrible” variety.) For other types of crises, however — earthquakes or storms, for example — personal narratives offered up online might indeed be more provocative.

What would you add to Donnelly’s critique of FluPortal? And what improvements could you recommend for future crisis-reporting sites modelled on FluPortal? (If you prefer not to comment directly on this post, you can email us!)

The Harvard School of Public Health (HSPH) recently hosted a talk evaluating how well journalists and health officials communicated H1N1 information to the public.

Dr. K “Vish” Viswanath
[Viswanath Lab]

One of the speakers, Dr. K “Vish” Viswanath, runs a lab at HSPH dedicated to researching health communication. Viswanath highlighted some particularly difficult aspects of transmitting the H1N1 story:

• Health journalists have to straddle two cultures: the world of medical complexities and uncertainties; and the world of deadlines and commercial pressures.
• “More information does not necessarily mean more communication”: even if scientists and journalists do an exemplary job during a health crisis, the internet makes it impossible to control the spread of misunderstandings and misinformation.

One interesting positive lesson: Viswanath noted that whether or not the subtleties of the H1N1 story were getting through to the public, people seemed to be following recommended behaviour — if it was easy to follow. He tracked sales of hand sanitizer during the pandemic, for example, and saw that they went up significantly:

[Dr. Viswanath, screenshot from lecture on H1N1 communication]

Finally, Viswanath made one more very important point: different social groups — whether based on “class, race, ethnicity, or language” — differ widely in their access to information and where they go to look for it. This “communication inequality” is hugely significant during a public-health crisis.

Not everyone, for example, has equal access to online information — or the skills to learn from it or act on it. As he put it, while “it’s exciting to see social media being exploited [...] not everybody uses the internet.” If media and public-health departments rely too much on the web, he says, this can actually widen disparities in access to reliable information. In a survey done in April 2009, only 19% of people reported getting “the most information” about H1N1 online. The lesson here: local and ethnic news sources in traditional media — whether broadcast or paper — remain critical; it’s not just all about Twitter and Facebook.

I asked Viswanath whether he feels there’s a dearth of experienced health reporters (see this post). He said yes, that because of cuts in journalism, reporters are covering multiple beats and not necessarily able to stay on the health beat over the course of their careers. He hasn’t had a chance, however, to study this in relation to the H1N1 story specifically.

You can learn lots more from Dr. Viswanath in this video of the talk.

Food aid distribution in Haiti (David Schaper/NPR)

As a reporter for NPR, David Schaper has done his fair share of crisis coverage. He was in Mississippi during Katrina, covered Midwest floods, and reported from towns leveled by tornados. But nothing prepared him for the scenes he witnessed during two weeks in Haiti. I spoke to Schaper earlier this week about his experiences reporting on the earthquake recovery efforts and what lessons can be gleaned for public media crisis planning.

Based out of NPR’s Chicago bureau, Schaper was part of a second wave of reporters, arriving in Haiti two weeks after the earthquake struck to relieve staff that had been in place since the first days. He had been following the news from Haiti, but had not expected to cover the story. With just a few days to get ready for the assignment, Schaper did his best to prepare himself — emotionally and professionally — for the conditions in and around the Haitian capital. “I knew I would be faced with immense human suffering, but you have to be able to separate what’s sad and what’s really a story for the news.”

Schaper hit the ground running and was filing news spots from Haiti the day of his arrival. The challenge of getting his work done in a disaster zone was made easier by the NPR production and operations staff.  “The reporters and producers who were there before me and ops staff back in Washington did a fantastic job in dealing with the complex logistics that made the NPR coverage possible.” A makeshift production office had been set up in hotel that had suffered minor quake damage. Schaper described it as “the best you could expect under the difficult circumstances.” The NPR team had shelter, power (with intermittent interruptions), and fairly reliable internet connectivity via satellite phones.

Haiti is a poor nation to begin with and Schaper pointed to the difficulty of discerning which of the conditions he witnessed were a direct result of the earthquake and which ones were merely the local standard. Schaper informed me that Port-au-Prince is one of the largest cities in the world without a sewer system, and sanitation issues that arose after the quake have to be traced further back than January 12^th.

Schaper says his time in Haiti reinforced his belief that public broadcasters can be a lifeline for local communities during crisis situations and he urges local stations to review their emergency response plans. “What public radio does best — provide depth and context to a story — becomes even more important during a crisis.” Schaper urges reporters to remember that emergencies often mean dealing with the unexpected and less-than-ideal conditions. “Who are your emergency contacts in local and state governments? What are your contingency plans if the power goes out or the transmitter goes down? That kind of preparation creates opportunities to make a difference during a crisis.”

You can listen to David Schaper’s reports from Haiti on the NPR website.

Today WHO recommended that next winter’s seasonal-flu vaccine include H1N1. Keiji Fukuda, WHO’s resident pandemic-flu expert, apparently cautioned in a press conference, however, that “[t]he inclusion of the H1N1 pandemic virus in the influenza vaccine does not signal that the pandemic is over.” WHO will meet next week to determine whether the pandemic is waning.

Here are the three viruses WHO recommended for the 2010/11 vaccine:

– an A/California/7/2009 (H1N1)-like virus;
– an A/Perth/16/2009 (H3N2)-like virus;*
– a B/Brisbane/60/2008-like virus.

* A/Wisconsin/15/2009 is an A/Perth/16/2009 (H3N2)-like virus and is a 2010 southern hemisphere vaccine virus.

Click here for a link to a PDF of the full report.

HHS Secretary Kathleen Sebelius
[HHS / (usable on your site)]

Yesterday, at the 2010 Public Health Preparedness Summit, Health and Human Services Secretary Kathleen Sebelius assessed the federal response to H1N1. (The summit was spearheaded by National Association of County and City Health Officials.)

Sebelius’s overall tone was positive. She felt the government’s preparation for “all hazards” allowed it to “hit the ground running.”

One of the first steps we took after identifying the flu was to release 11 million antiviral doses, 13.5 million surgical masks, and more than 25 million respirators from our Strategic National Stockpile. Having these countermeasures on hand allowed us to ensure that commercial shortages didn’t slow our response.

She also cited the effectiveness of the Hospital Preparedness Program, which she said guided hospitals “when their emergency rooms and ICU beds started filling up.”

Sebelius highlighted, too, HHS’s “unprecedented multimedia communications campaign,” which “taught an entire generation of kids how to sneeze” and rebuilt flu.gov.

Sebelius pointed to “partnership with state, local, tribal and territorial public health officials” as another critical pillar of the federal response.

But what were the lessons learned? HHS, Sebelius said, is currently conducting a full review. One of the obvious lessons that has already emerged: partnerships outside the public-health community are vital (e.g., with schools, which provided vaccine clinics for many children).

The other standout lesson is that vaccine production needs to be improved. Sebelius praised the speed with which vaccine development began but conceded that “outdated” manufacturing processes caused frustrating delays. As she put it, “there was nothing we could do to make the vaccine grow faster in eggs.” The US needs to make “long-term investments,” she said, in “faster and more reliabl[e]” vaccine technology.

Finally, Sebelius recognized the fragility of the budget-strapped state and local public-health infrastructure.

Ultimately, Sebelius said, HHS needs to aim for this:

[A] modernized countermeasure production process where we have more promising discoveries, more advanced development, more robust manufacturing, better stockpiling, and more advanced distribution practices.

Some local public-health officials — like those in Seattle and King County in Washington — are starting assessments of their own. And some appear less upbeat than Sebelius. The chief of communicable-disease control for King County, for example, feels “‘we need to be much more prepared. [...] This should be a wake-up call.’”

How are your state and local public-health departments evaluating their H1N1 response? And do residents and health-care workers in your town or state see the same successes and failures?

Vincent Racaniello
[Virology Blog]

The CDC’s new H1N1 data re-emphasize that, compared to seasonal flu, swine flu has disproportionately affected people under 65. Vincent Racaniello, a professor of microbiology at Columbia University, recently summarized a study done in mice that suggests one possible reason for this. The study appears to confirm initial hunches that many older people have immunity to swine flu because of previous H1N1 vaccines or bouts of flu.

The mice, Racaniello says, were inoculated with various past strains of H1N1 — and it turns out that several of those strains offered significant protection:

In other words, if you lived before 1943, or received the 1976 swine flu vaccine, you may be protected against infection with 2009 H1N1 virus. After the 1976 swine H1N1 outbreak at Fort Dix, NJ, approximately 40 million people in the United States were immunized with an NJ/76 vaccine. The NJ/76 swine virus never spread in the general population, but the vaccine against it has finally proven useful.

If you are less than 35 years old, you are more likely to be infected with the 2009 H1N1 virus because you did not receive the NJ/76 vaccine, nor were you infected with viruses that circulated from 1918-1943.

Racaniello blogs regularly at Virology Blog. You can find his previous posts exploring the same topic here, here, and here. The mouse study that Racaniello cites is here.

The CDC put out some new H1N1 numbers on Friday: on cases, hospitalizations, and deaths. The data span the period from April 2009 to 16 January 2010. The CDC emphasizes that its numbers are estimates based on a “nationwide surveillance system” and “statistical modeling.” It’s impossible to generate exact numbers for several reasons:

[M]any people with flu don’t seek medical care and only a small number of those that do seek care are tested. More people who are hospitalized or die of flu-related causes are tested and reported, but under-reporting of hospitalizations and deaths occurs as well.”

With those caveats, here are the estimated numbers:

CDC estimates that between 41 million and 84 million cases of 2009 H1N1 occurred between April 2009 and January 16, 2010. The mid-level in this range is about 57 million people infected with 2009 H1N1.

CDC estimates that between about 183,000 and 378,000 H1N1-related hospitalizations occurred between April 2009 and January 16, 2010. The mid-level in this range is about 257,000 2009 H1N1-related hospitalizations.

CDC estimates that between about 8,330 and 17,160 2009 H1N1-related deaths occurred between April 2009 and January 16, 2010. The mid-level in this range is about 11,690 2009 H1N1-related deaths.

To find a more detailed chart showing the numbers for three different age ranges (0-17 years, 18-64 years, 65 years and older), click here. This chart is especially interesting because it illustrates how strongly h1n1 has affected young people. The same page also explains the methodology CDC uses to generate its H1N1 data.

Two links caught our attention this week that could be of interest to stations covering H1N1. While these examples are not directly related to swine flu, they may inspire you to try new approaches in your coverage.  

WNYC’s audience submitted economic indicators

The first is Crowdsourcing: A Field Guide from WNYC. Crowdsourcing entails soliciting your audience to help collect, curate, and vet information around a specific topic or issue. WNYC has been experimenting with crowdsourcing for the last few years, most notably on the Brian Lehrer Show (recently, the program asked the audience to contribute examples of the recession’s impact for their Uncommon Economic Indicators project). The guide provides case studies on how to implement crowdsourcing at your station, along with tips on where it fits in your existing editorial process and standards. There’s a useful 10 point quick-guide that rounds up the big takeaways from the field guide.

While the recent snowstorms in the Washington DC area don’t reach the crisis threshold, it’s fair to say they had a major impact on the region. The Washington Post is using the Ushahidi platform (which we mentioned in our round-up of responses to the earthquake in Haiti) to map the impact of the storm. The map provides an online tool that allows the audience to highlight locations still buried from the storm — impassable streets and sidewalks, cars buried, and power outages. But they also encourage folks to map opportunities to help in the dig out — snow blowers available or a shovel to share.

Getting to know emerging tools and techniques during more routine scenarios will allow public media outlets to respond more effectively when and if a crisis hits.

The International Center for Journalists (ICFJ), which aims to “raise the standards of journalism,” has just published a comprehensive guide for journalists called “Disaster and Crisis Coverage.” It offers detailed advice that you could apply to H1N1 or any other crisis.

The guide starts off with a reminder of journalism’s importance during a disaster:

Veteran journalist and consultant Michael Marcotte says a news organization plays four key roles during a crisis. It’s a vital information resource, telling what is happening where, who is affected, how things are changing, and why. It’s a communication lifeline, saving lives by relaying critical information to and from affected parties. It’s an early warning beacon, transmitting timely, reliable information that prevents harm. And it’s a community forum, giving citizens a way to come together, share concerns and support one another during difficult times.

It then explains step-by-step how to prepare your newsroom for reporting on disasters. It outlines backup plans in case your newsroom itself is compromised by the crisis. It covers ways to maximize the security of your staff. And it offers editorial advice on tone and story angles.

The guide devotes its entire second half to trauma. It explores “[h]ow journalists interact with victims, survivors and eyewitnesses of tragedy” and “[h]ow they cope with the emotional impact of trauma on their own psyches.” This, it feels, is critical to improving disaster reporting.

One of the toughest decisions for journalists is how to cover victims, survivors, and eyewitnesses to catastrophic events. [...] How do we balance truth telling with minimizing harm to vulnerable people?

In one powerful example, the guide describes a photojournalist’s dilemma during Hurricane Katrina of whether to photograph some victims before trying to help them.

In addition to providing its own advice, the guide links to a variety of other online tips about crisis reporting. If you’re a reporter or in charge of a newsroom, it’s a valuable resource.