HAI Controversies at 10 years

It’s been a decade since we started this infection prevention blog. So I was planning to write a reflective post on whether it was still relevant, why I'm blogging less frequently, perhaps expand upon Eli’s post about why he stopped blogging, and maybe even add my voice to all those proclaiming that “blogs are dead”. 

So I went to our blogger stats page to get some data, and found a few interesting tidbits: this blog has had over 3 million page views since its inception, and is still getting over 10,000 page views monthly! Is this accurate? I have no idea, but it persuades me to hold off, at least for a while, on predicting the demise of the blog. 

A few other fun observations from the stats page: see the huge spike of page views in late 2013? That resulted from an almost 2-year old post being picked up in a Reddit thread (a post by Mike about neckties). The next four most-viewed posts in the blog’s history are about toilet lids for infection prevention, contact lenses, sinks and Fusarium, the inability to eradicate M. chimaera from heater-cooler devices, and the epic Skullcap Feud still raging between surgeons and AORN. With topics like these, who needs cat videos?

We started the blog to have a forum for freewheeling, even hyperbolic, discussions of controversial infection prevention topics. I think much of that back-and-forth has moved to Twitter. I’ve now come to believe that the blog is at its best during the early stages of outbreaks/crises that impact hospital infection prevention programs—to provide updates, opinions, suggestions for colleagues struggling with the same issues. The best recent example is the global M. chimaera outbreak, posting our thoughts as we navigated our own hospital response. For these complex situations--especially in the early, evidence-free phase--a blog post may allow for more nuanced discussions of the pros or cons of different approaches. Though I've been pretty impressed with some of the amazing twitter threads I find on med Twitter, a great example being this discussion of the Merino Trial.

I guess we should definitely have a larger discussion about the relevance of medical blogging.  Maybe on Twitter....

Did Google Flu Trends Miss the Mark This Year?

There is a nice review of how various influenza-like illness surveillance systems performed during the 2012-2013 influenza season by Declan Butler at Nature.com. There is some good news and some bad news. The good news is that the timing of the start and peak of the epidemic appear pretty well-aligned between the three methods. However, it appears that the "Google Flu Trends" peak was much higher than the CDC and "Flu Near You" peaks. Reasons for the possible divergence include timing of non-influenza ILIs in the community, a bad norovirus season and excess media coverage including CDC's alert of a bad/early season in early December 2012.

I think these reasons and others given in the article have a lot of face validity and certainly follow what many were feeling as the epidemic progressed. One thing I haven't seen in the coverage is whether the "peak" count of ILI is all that important. I'm more interested in the timing of the epidemic's beginning and the peak and not so interested in an absolute count. I suspect that the absolute number of infections helps in future years, but the timing is more important in the current year. I hope someone will comment or covertly tell me why the peak amount matters so much. It's not like ILI is the greatest definition anyway.

Another assumption I haven't seen discussed is whether Google Flu Trends actually got it wrong or was it the other methods which missed the mark. When you have an imperfect definition, it's hard to call any of these three methods a gold standard. Any attempt to pick a winner seems a bit arbitrary. If the intent is to match the CDC so rates can be compared from year-to-year, that's one thing. But what if we are burdening ourselves with a suboptimal gold standard. A lot of sunk costs go into any legacy system, but it's at least worth wondering occasionally if the legacy is worth continuing.

Image source: http://www.nature.com/news/when-google-got-flu-wrong-1.12413