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Deaths from the flu – do not seek and ye shall not find


THE flu vanished from the UK in the winter of 2020/21 and did not return for another year, as I wrote in TCW here. The official reason is that the novel and deadly SARS-CoV-2 virus ‘outcompeted’ flu and replaced it as a primary cause of death during that time. However there appears to have been a collective and systemic failure in flu surveillance and flu death reporting systems in the UK during 2020 and into 2021. Thus, it is possible that the failure to detect and report flu (and deaths recorded as due to it) may better explain the mystery of vanishing flu rather than viral interference from SARS-Cov-2.

A mix of surveillance systems consistently reported on flu before 2020 and continued to have some role to play post-spring 2020 until flu returned at the end of 2021. In the UK, flu surveillance is performed via clinical surveillance by primary care (based on networks of GPs), the FluDetector and the FluSurvey systems.

Credence has been given to the idea of tracking pandemics using machine learning via Google Trends data, the UK’s FluDetector system being one such system. FluDetector reported that flu disappeared in 2020/21, yet this is totally at odds with Google’s own data and UKHSA reports, both of which report a clear signal for flu in the UK in 2020/21. What the Google data does show is that people were concerned enough about flu that they searched for flu on the internet in significant numbers, even when apparently in the middle of a deadly pandemic caused by SARS-CoV-2, a virus they were told was more novel and more deadly than the flu. It is also notable that the number of searches for flu in 2020 were not significantly different from those conducted in previous years in the UK.

The UK FluSurvey system was originally conceived to survey a panel of self-selecting participants for signs and symptoms of influenza-like illnesses (ILIs). In March 2020 it was repurposed to cover both Covid-19 and flu symptoms, and the routine questionnaire was adapted to capture Covid-19 specific information. The FluSurvey system tracked ILI incidence only until week 20 of 2020, and never updated this data. It was decided no longer to track both flu and Covid from November 2020 but report this change in policy only in January 2021. The FluSurvey then stated it (presciently) knew in January 2021 that the flu season had now begun and did so after (supposedly) witnessing the near eradication of flu from March 2020 to May 2020. Fever and cough symptoms were still tracked and peaked in the same way as in previous years and this continued, but tracking ILI incidence was abandoned, thus reducing the strength of the flu signal.

The Office for National Statistics (ONS) have a legal duty to report mortality statistics for each year. The 2020 statistics for England and Wales exclude any report on influenza and pneumonia deaths, and instead are wholly focused on deaths ‘involving’ Covid-19. In contrast, their 2021 statistics report on influenza and pneumonia deaths, starting on January 8. So, for 2020 any reporting of flu deaths was completely abandoned in favour of Covid-19 reports, and flu is included only in surveillance reports from 2021, thus giving the impression flu had disappeared in the intervening period.

In response to a freedom of information request about flu in 2020 the ONS obfuscated its answer by using a different death code, ‘respiratory disease’ rather than flu, for the period up to May 2020, and may have done so to hide the deaths that should have been attributed to flu. This FoI request shows that there were 2,287 flu deaths in March 2020, which is not greatly different from the 3,324 Covid-19 deaths that same month; yet SARS-CoV-2 was considered to be a significantly greater threat to public health. Furthermore, in January 2021 the ONS reported that there were almost as many deaths involving flu (5,719) as there were involving Ccovid-19 (7,610), yet for only 5.2 per cent of these flu deaths was flu recorded as the underlying cause of death.

Evidence for the presence of flu is available from other data sources. Data for pneumonia and flu deaths can be extracted from the UK NOMIS (official census and labour market statistics) system. When we queried this system, we were quite shocked to find that it returns 20,130 influenza and pneumonia deaths for 2020, at a rate consistent with previous years (eg 26,342 in 2019). The presence of flu deaths in 2020 in the UK is repeated elsewhere. In the US, influenza and pneumonia numbers are similar in 2020 to previous years, as reported by the CDC, with 53,544 deaths in 2020 compared with between approximately 50-60k deaths in each year from 2015 to 2019.

Despite these facts, the WHO’s international flu surveillance system, FluNet, shows no significant flu for 2020/21 in either the UK or US.

The fact that these failures cut across all parts which comprise the UK flu surveillance and reporting system suggests that this failure is not coincidental, as do the observed inconsistencies in changing patterns of flu surveillance and reporting across different branches of UK public health.

In a previous article we pointed out the dearth of virological evidence for viral interference causing SARS-CoV-2 to ‘outcompete’ flu. These new findings relating to reporting systems also strongly suggest that viral interference between SARS-CoV-2 and the flu is a myth. Flu was present in 2020 and some of the respiratory deaths attributed solely to SAR-CoV-2 may have also involved flu in some significant way.

This is based on an original article co-authored with Professor Norman Fenton, Nick Hudson and Jonathan Engler. The extended version is available from the substack Where are the Numbers?

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Professor Martin Neil
Professor Martin Neil
Martin Neil is Professor of computer science and statistics at Queen Mary, University of London

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