Don't worry - the ABS is ready for a bird flu pandemic!

They initiated regular reporting of flu and RSV at the end of April

Photo by Todd Trapani: https://www.pexels.com/photo/selective-focus-photography-of-white-hen-1405930/

The Austalian Bureau of Statistics (ABS) has a reporting system ready and waiting for an influenza pandemic and it is also primed to deal with an uptick in respiratory syncytial virus (RSV).

The most recent edition of the Provisional Mortality Statistics (31st May 2024) announced that these two respiratory infections were going to be monitored along with covid in a section entitled “Deaths due to Acute Respiratory Infections in Australia 2022 - March 2024”.

There are three things about the report that concern me:

1. WHO rules favour flu as an underlying cause of death

Unfortunately, just as for covid, according to World Health Organisation guidance, if influenza appears anywhere in the chain of causal events on a death certificate it is put as the underlying cause of death.

This means that a person with stage 4 cancer, or advanced heart failure who dies when they catch the influenza virus, will be reported as having an underlying cause of death of influenza.

Of course, the ABS is unlikely to go against WHO guidelines. It would be nice, though, to see debate and discussion among scientists, health professionals and the public about whether that is the best way to classify such deaths.

One thing is sure, this approach will increase the number of deaths reported from flu, just as it does for deaths from covid.

2. Deaths ‘with’ flu and ‘with’ RSV are being reported

I’m also concerned that deaths ‘with flu’ and deaths ‘with RSV’ are going to be reported. At least, though, the sum of deaths ‘with and from’ influenza is not being tabulated. This approach, were it to happen, could lead to talk about ‘influenza-associated deaths’ and that should be resolutely opposed from the outset, I believe. This is because the death could be perceived incorrectly as a death from influenza when in fact it is a death from a different underlying cause.

Furthermore including deaths ‘with’ a condition runs counter to WHO guidance that states that “the cause of death for primary tabulation should be designated the underlying cause of death”. In other words, the WHO says every death has a single underlying cause, and that’s what matters when counting and comparing deaths from different causes.

This practice - of including covid-associated deaths in government statistics (giving total deaths ‘with and from’ covid, or ‘deaths with reported covid’) - was common;ly used during the declared covid pandemic. This measure is still being used by the ABS in an influential graph in its official excess mortality reports.

3. No meaningful baseline comparator

When the ABS first started the Provisional Mortality Statistics in June 2020, it provided a useful comparator (the average of the preceding five years) so we could see whether deaths were higher than ‘normal’. Sadly, they no longer compare to a baseline average of several years in this way.

The only comparators in the new report are the numbers for flu and RSV in 2022 and 2023. Many of the numbers for flu in those years are so small (under five) that they have been deemed ‘not publishable (np)’ presumably because of privacy concerns.

Where is the monthly data on deaths from these two conditions for the years going back to 2015 so we can see the numbers in context?

Let’s hope, if there is a bird-flu-spreading-to-humans scare, that fear does not turn us into headless chickens (as happened to many of us - including me - during covid), and that we keep our heads firmly attached this time!

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