Tag Archives: #flu

Your Team Made the Super Bowl? Better Get a Flu Shot

As an emergency medicine physician, popular spectator events such as the Super Bowl usually mean little more than a temporary slowing in the rate of patient arrivals, especially among males, a phenomenon described in several countries in addition to the U.S.

A recent Upshot post shows that the impact of widely popular spectator events extends beyond decreased visits. The post cites a study published in the American Journal of Health Economics showing that the death rate from influenza is higher among those whose home team makes it to the Super Bowl. Across all ages, 5.6 people per million die from the flu, a rate that increases to about 6.6 in Super Bowl-contending areas. Although it is too early to tell if this is relevant this year, the mortality impact is about seven times larger when the peak of the flu season occurs closer to the Super Bowl than when it is held about three weeks or more before or after the peak.

The flu virus can spread whenever a person with it sneezes, coughs or even talks (or yells loudly at a televised referee), releasing droplets of saliva within six feet flumainof someone without it. At a Super Bowl party, people are mingling closely. Because influenza becomes contagious beginning 1 day before symptoms develop; in fact, some evidence exists that people become even more sociable than usual during that contagious, pre-symptomatic period.

Super Bowl parties are not unique in providing large numbers of people the chance to be within 6 feet of someone with influenza.  Other large gatherings have been shown to increase influenza spread, including the Salt Lake City Winter Olympics in 2002, large music festivals in Hungary and Belgium, and the Hajj pilgrimage.

As a resident of one of the towns sending a team to the Super Bowl this year, I again remind my readers it is not too late to vaccinate against influenza
. Other prevention measures recommended by the Centers for Disease Control and Prevention include

  • frequent hand washing
  • avoid touching your eyes, nose and mouth
  • clean surfaces frequently touched in your home or workplace
  • use hand sanitizer

One scourge not shown to be associated with Super Bowl Sunday is domestic violence.  The claim of a rise in domestic violence on Super Bowl Sunday was propagated by the media starting right before the 1993 Super Bowl. Myth-busting website Snopes.com traces the momentum of the myth here. For example, the AP labelled Super Bowl Sunday the “Day of Dread”, and the myth has been propagated more recently. However, the association between football and intimate partner violence (IPV) is not as unfounded as suggested by Snopes.  A study found that football game upset losses led to a 10% increase in IPV, whereas non-upset outcomes of football games led to no change from baseline rates of IPV. Of note, the study found IPV associated with other days of the year and with the weather:

The resulting estimates show large and precisely estimated effects of major holidays on the rate of IPV: for example, Christmas day +18%, Thanksgiving +20%, Memorial Day +30%, New Year’s Day +31%, New Year’s Eve +22%, and July 4th +29%. They also show a significant positive effect of hotter weather: relative to a day with a maximum temperature less than 80 degrees, IPV is 8% higher when the maximum temperature is over 80. Thus, an upset loss is comparable to the effect of a hot day, or about one-third of the effect of a holiday like Memorial Day or the Fourth of July.



The WSJ as purveyor of evidence on echinacea and flu

An article in this week’s Wall Street Journal‘s Health column–Can Echinacea Melt Winter’s Colds and Flu? –is illustrative of some limitations of the media’s role as a purveyor of scientific information.  Specifically, the writer opted to highlight two scientifically flawed trials, without mention of a  2014 Cochrane Database Systematic Review on the topic, a review that encompassed 24 double-blind trials with 4631 Echinacea purpurea plantparticipants, and that found no benefit for echinacea over placebo. The role of echinacea in the common cold has been evaluated previously as an example of the inconsistencies in how media translate scientific studies–and, in this case, three systematic reviews of the topic–to construct advice to their readers about echinacea.

The Wall Street Journal‘s Health writer leads with her summary of the findings of 2 studies on the benefits of echinacea in viral respiratory infections:

The Verdict: A study in 2015 found a hot drink containing echinacea to be as good as prescription Tamiflu for treating influenza, and a large 2012 study found the
remedy cut down on the number of days suffered with colds.

Neither component of her verdict is a precise summary of the referenced study. Both studies are funded by the echinacea’s manufacturer, Bioforce. Most concerning is the initial claim, that Bioforce’s echinacea preparation is “as good as prescription Tamiflu for treating influenza.” The 2015 study (in Current Therapeutic Research) cited randomized patients with “clinically diagnosed influenza illness”–those with symptoms typical of influenza–to receive either Bioforce’s Echinaforce Hotdrink or oseltamivir (Tamiflu).  Of course, oseltamivir is only effective in influenza; the study group likely included many patients who had non-influenza viral infections and thus would not be expected to improve at all with oseltamivir.  Of the 473 study subjects, 41 had test-confirmed influenza. Despite this flaw, the study authors, all funded by Bioforcechinacea_3e, conclude “treatment of influenza with Echinaforce Hotdrink overall outperformed treatment with oseltamivir in the studied patient cohort”.  The WSJ quotes the author of a New England Journal of Medicine study showing no benefit from echinacea, who notes that the absence of confirmed influenza in much of the Bioforce study’s patient population undermines the Bioforce study’s validity.bn-ma414_0111ac_hd_20160108150704

The 2012 study (in Evidence-Based Complementary and Alternative Medicine) of Echinacea-vs.-placebo states “Echinacea reduced the total number of cold episodes”; however, the comparison between total number of episodes was not significant.  Although the study did find a statistically significant difference in the number of days of cold symptoms, the authors eagerness to draw unfounded conclusions from their analyses are a threat to the study’s validity.

Although media bias in coverage of medical research is neither new nor limited to herbal remedies such as echinacea, if nothing else, this topic provided an excuse to behold lovely flower photos mid-January. It also provides a chance to remind readers it is still not too late to get your flu vaccine!

Times Square and Influenza

On this New Year’s Eve, I wanted to share this factoid from the CDC on the benefits of influenza vaccination in the 2014-15 flu season.  As you see the nearly one million people counting down to 2016 in Times Square, remember that the flu vaccine prevents that many people from needing medical visits in one season. If you want to track this season’s influenza numbers, there is a great interactive feature at the CDC’s website, featuring mapping of influenza activity, as well as hospitalizations and deaths.

Children’s Sinusitis Guideline in Iambic Pentameter

The American Academy of Pediatrics acute sinusitis guideline was too complex for limerickification, and even resisted sonnet format, so here it is in iambic pentameter.

Nasal discharge’s mostly allergic or viral

And thus needs only symptomatic care

With no need for an antimicrobial trial

Unless high-risk and flu virus is there.


Only think sinusitis as a cause

In three scenarios based on the patient’s tale

Note none involve a mucus color clause

So green snot counts not–neither dark nor pale.


First, symptoms exceed 10 days and don’t improve

Or second, improve but then thereafter worsen

(‘Tho this usually means that in has moved

A second virus attacking the same poor person).


Third is when the onset is severe

With fever 39 degrees or higher

And nasal discharge purulent not clear

Both unrelenting for three days required.


For children meeting persistent criteria

Consider observing three days more

And, weighing risks such as diarrhea,

Start antibiotics only if symptoms endure.