A new analysis, using H1N1 deaths in the United States in the spring and projecting likely outcomes for this fall, shows that a typical -- or possibly even a milder flu season than average -- should have been expected.
The finding begs the question: Has swine flu been oversold?
The new study, done by researchers at Harvard University and the Medical Research Council Biostatistics Unit in the U.K., says swine flu cases in the spring indicated a flu season that might be, at worst, slightly worse than normal.
"It would have been great to have that back in June," said Philip Alcabes, an associate professor in the program in urban public health at Hunter College's School of Health Sciences. "There would have been one more bit of evidence behind my assertion six months ago" that people were overreacting to H1N1.
He added, "I'm not saying they could have done that [analysis] even faster."
Around the time that swine flu first started making headlines, Alcabes' book, "Dread: How Fear and Fantasy Have Fueled Epidemics From the Black Death to Avian Flu," was published, and he said the circumstances surrounding H1N1 provide an apt case study.
"I think that it was, from the very beginning, created as a crisis and overstated as a real threat," he said, adding that he did not want to understate the seriousness of influenza.
"Flu is a serious illness, it kills people," he said. But, he added, "It does a disservice to public health when, in the name of a preparedness crusade, people create a narrative of crisis or catastrophe before we have enough data that this is happening."
Alcabes said that while public officials, in the early going, admitted to having little data on the virus and resisted calls to close the borders. But as time went on, he said, officials took many steps he feels were unnecessary, including mass, rather than targeted vaccination.
While the new paper suggests swine flu was unlikely to create a severe epidemic, the researchers, disagreeing with Alcabes, say they do not think public health officials overreacted.
"In the early on, we would not have been able to estimate severity. We were going with what was known at the time," said Anne Presanis, a statistician with the Medical Research Council Biostatistics Unit.
"I don't think it's been oversold," he said. "I think you have to prepare for the worst and then be gratified that it wasn't as bad as it was."
While H1N1 affected different age groups from a typical flu, the intensity of that difference was not yet known in the spring.
"When it first hit, nobody knew how severe it could be or that population aged 60 and over would be relatively spared," said Schaffner. "Had this virus had an impact in the age 60 or over, it would have been vastly more injurious than seasonal influenza. We were fortunate in that regard, but we didn't know that at the time."