Is "bird flu" the same as "bird flu?" Poor communications does its damage.
July 12, 2006
Many people have been misled about bird flu - all because of the confusing way a certain two-word phrase has been used.
The phrase?
"Bird flu."
To illustrate, here's an excerpt from a July 3, 2006 article in the Patriot-News, the daily newspaper of Harrisburg, Pennsylvania (the state capital):
According to the federal Centers for Disease Control and Prevention, a strain of avian influenza, also known as H5N1, could potentially infect 1.6 million Pennsylvanians and kill up to 9,800 in a few months. An estimated 37,000 could be hospitalized in a worst-case scenario, according to the agency.The flu has not been reported in the United States, but health officials have warned that it inevitably will, likely this year.
Do you realize those two paragraphs are talking about two very different things - a disease in humans and a disease in birds? More to the point, are you given any reason to think it's talking about two different things?
The first paragraph is describing a pandemic which could happen the next time a new human influenza virus emerges (maybe derived from the avian influenza A H5N1 virus). In contrast, although it doesn't indicate the change in topic, the second paragraph is talking about a currently-existing disease among birds (influenza A H5N1) - a disease not yet seen in birds in the United States.
Here's the problem: Although this article discusses both diseases, it fails to clearly distinguish between the two. In the excerpt above, for example, it gives no indication the subject changed from "potential human disease" to "current bird disease." We assume "The flu..." in the second paragraph is the "avian influenza" in the first paragraph. But it isn't.
Instead, it sounds like this: A flu with the potential to infect 1.6 million Pennsylvanians inevitably will be in the United States, likely this year.
Two different flus, rolled into one. This is very bad communications.
Regardless of cause, the result is misinformation
Treating two topics as one may have been an oversight by someone hurrying to meet a deadline. That's bad, but it's a problem of one sort - a one-time mistake by someone in a hurry.
On the other hand, the mix-up may have happened because the reporter didn't know the difference between "bird flu in birds" and "pandemic flu in humans." If so, that's very bad. Because this uninformed reporter will continue to make the same mistake in future articles, spreading misinformation wherever he/she goes. (Not just in articles, either, but in conversations with co-workers, neighbors, etc. A trusted, "knowledgeable" source - spreading misinformation everywhere.)
Why misinformation is a problem
You may be thinking, "So? What's the big deal? Why is this such a problem? H5N1 in birds. H5N1 in people. What's the difference?" That's the point: they are different. A strain of H5N1 in birds is not the same as a strain of H5N1 in people. I'll discuss the difference - and the ramifications - in my next post. For now, let's just say this blurring of two diseases into one is a problem because it leaves people in the dark and, as a consequence, unprepared.
- If people are misinformed, they won't understand the risk of a human flu pandemic.
- If they don't understand the risk, they'll see no need to prepare. (In fact, they may think people who are preparing "aren't thinking straight.")
We need people who understand and are preparing. We need people who aren't misinformed.
How did this confusion come about?
We shouldn't just blame journalists for this confusion. It's also the fault of people interviewed by journalists - medical experts, government officials, and others - who have used "bird flu" in mixed ways. I've probably made the same mistake. It's easy to do.
But we need to become more conscious of the problem and catch ourselves before we make the mistake again. Because every time it happens, it creates or reinforces misunderstandings. And it's happening a lot.
As in the July 11, 2006 Stamford Advocate, where an article headlined "Health officials look to fight unlikely bird flu outbreak" leads off with this:
STAMFORD -- Despite facing only a one in a million chance of contracting avian flu, people should still be prepared for an outbreak, state Department of Public Health officials said yesterday.[snip]
Despite those slim odds, state public health officials want to ensure that hospitals and local health departments are prepared in case the flu hits here.
Why all the hubbub over a "one in a million chance?" Well, the hubbub isn't over the "one in a million chance" - i.e., catching bird flu from a bird (that's what they're talking about). The hubbub is over the possibility of a human flu pandemic developing. If that happens, everyone will have about a one in three chance of getting sick. That's a little different. That's worth a little hubbub.
The article also leaves people wondering, "How can you even have an 'outbreak' of a disease that only infects one in a million? That's just 300 cases in the entire United States." Logical question.
Amazingly, the lead sentence switched from bird flu to pandemic flu - within the same sentence - with no indication there were two topics.
How should it have read? Something like this:
STAMFORD -- Despite only a one in a million chance of catching avian flu from sick birds, people should prepare for the possibility that the bird disease could develop into a new human flu. Such a flu could cause a pandemic, sickening perhaps 30 percent of the population, state Department of Public Health officials said yesterday. Hospitals and health departments are preparing for that possibility.
In cases like this, I'll wager the reporter simply didn't understand what he/she was writing about.
Unfortunately, thousands of people read what he/she wrote.
We have to do better than this.
What to remember
There are two points to glean:
- The whole discussion about "bird flu" and "pandemic flu" isn't talking about just one disease, but two - one in birds, one in humans - caused by two strains of a flu virus. They're related, but not the same. Their ramifications are vastly different.
- A lot of misunderstanding has occurred because (a) those two diseases are often talked about as one or (b) the traits of one are wrongly assigned to the other.
To solve this problem, we need to understand the difference between the two ... and use different terms to identify each. It's harmful to call them both "bird flu."
Risk communication experts Peter Sandman and Jody Lanard say this communications mix-up is a "monumental mistake."
In my next post, I'll give you some of their specific observations.
Footnote: I know what you're thinking. "Chirp, you're inconsistent. You use the term 'bird flu' - instead of 'human flu' or 'pandemic flu' - when talking about a possible pandemic." That's true. But I do so accommodatively because "bird flu" already is so ingrained as the catch-all descriptor. The discussion above is only partly about terminology. Its main purpose is to highlight two important points which are not well understood:
It so happens that indiscriminately calling both diseases "bird flu" has blurred the differences and contributed mightily to this misunderstanding.
Going forward, I'm trying to use "bird flu," "human flu," and "pandemic flu" more precisely. But, more than worrying about the particular choice of terms, I'm first worrying about making sure people understand what I'm talking about. That will require descriptions, definitions, and discussions, not just a choice between saying "bird flu" or "human flu."
Incidentally, Sandman and Lanard talk about the quandry we've put ourselves in and the possible need to invent more descriptive terms:
We may need to introduce awkward workarounds like "bird bird flu" and "human bird flu"; "pandemic in humans" and "pandemic in birds."
This post is part of a series: