5 ms·

> Computer modelling suggests that if the 1918 H1N1 virus were to break out of the facility in Atlanta it would cause around thirty million deaths. Considering

> Computer modelling suggests that if the 1918 H1N1 virus were to break out of the facility in Atlanta it would cause around thirty million deaths. Considering the original death toll of 50-100M deaths, and today's increased population and rapid communication (air flight), that's actually a very impressive number in how low it is. Edit: I wonder how much of the improvement is due to the surviving population's natural immunity?

rm_-rf_slash 9y ago
It’s only a model. The housing market crash and the 2016 election show how wrong models can be, even if all the inputs and the formula make sense. They could be off by a factor of ten. In the wrong direction. We won’t know until it’s time.
- ggg9990 9y ago
  The housing market formulas did not make sense. They assumed that default probabilities were uncorrelated.
dpatrick86 9y ago
Can they... get rid of it? I'm feeling nervous just reading that.
h1n111111111 9y ago
I'd guess the biggest lever in the model is an assumption about using Tamiflu for prevention/treatment. Perhaps also faster detection and coordination between public health entities. AFAIK, immunity to a particular flu strain is acquired through exposure (via infection or vaccine) rather than passed genetically.
- maxerickson 9y ago
  Immune response to the flu does vary across populations. The CDC considers American Indians/Alaska Natives to be at higher risk of complications than the population at large.
tzs 9y ago
I would expect that a significant factor is that we both have better treatments nowadays and treatment is much more accessible. In 1918 a lot of people, especially in rural areas, probably died before they even had a chance to see a doctor. A rural person could easily be a day's travel or more by horse drawn wagon away from a doctor. It might take two people to take the sick person. One to handle the horse and wagon, and one to tend to the sick person. Having two healthy people away from work for several days, and having the wagon unavailable for that time, could be a serious hardship. I'd thus expect such people to tend to wait until it was clear that what they had was more serious than any normal flu they had had before. News traveled much slower in 1918, especially in rural areas, so they might not know that there is an unusually deadly flu pandemic in progress. So by the time they realize that they are going to need help, it might be logistically too late. Even if our medical treatment was no better today than in 1918, we'd probably save a lot more just because news spreads faster and more widely, we have faster transportation, and we have faster communication.
- chakalakasp 9y ago
  That feels wrong to me. I don’t know how the rest of the world operates, but here in America I suspect the health system would struggle to even begin to cope with seeing a 50fold increase in patients across the board across the country. Just the strain on hospitals and respiratory support systems like ventilators alone would quickly make modern healthcare seem more or less like it was in 1918. Additionally, unlike in 1918, few households today have spare capacity to homecare gravely ill family members as in most middle class families both partners must work to provide a living wage.
- rsync 9y ago
  "I would expect that a significant factor is that we both have better treatments nowadays and treatment is much more accessible." If, by "treatment", you mean access to clean water, sanitary conditions and decent rest, then I would agree: we're certainly better off than rural populations circa 1918. I suppose access to IV fluids could be helpful if you're elderly, or otherwise immune-compromised. Beyond that, not much has changed since 1918. The flu is a virus and is not affected by antibiotics. Further, the two antivirals associated with influenza either do nothing[1] or almost nothing[2]. Very much like there is no such thing as "cold medicine" (contrary to what TV says) there is also no such thing as a broadly useful flu treatment. What you're most likely to receive from a doctor is relief of superficial symptoms. Going to a hospital for the cold or the flu will potentially expose you to much more serious bacterial infection. [1] "Overall the benefits of neuraminidase inhibitors in those who are otherwise healthy do not appear to be greater than the risks." (https://en.wikipedia.org/wiki/Influenza#Treatment https://en.wikipedia.org/wiki/Influenza#Treatment) [2] "These drugs (M2 inhibitors) are sometimes effective against influenza A if given early in the infection but are ineffective against influenza B viruses" (https://en.wikipedia.org/wiki/Influenza#Treatment https://en.wikipedia.org/wiki/Influenza#Treatment)

rm_-rf_slash 9y ago

It’s only a model. The housing market crash and the 2016 election show how wrong models can be, even if all the inputs and the formula make sense. They could be off by a factor of ten. In the wrong direction. We won’t know until it’s time.

ggg9990 9y ago
The housing market formulas did not make sense. They assumed that default probabilities were uncorrelated.

dpatrick86 9y ago

Can they... get rid of it? I'm feeling nervous just reading that.

h1n111111111 9y ago

I'd guess the biggest lever in the model is an assumption about using Tamiflu for prevention/treatment. Perhaps also faster detection and coordination between public health entities. AFAIK, immunity to a particular flu strain is acquired through exposure (via infection or vaccine) rather than passed genetically.

maxerickson 9y ago
Immune response to the flu does vary across populations. The CDC considers American Indians/Alaska Natives to be at higher risk of complications than the population at large.

tzs 9y ago

I would expect that a significant factor is that we both have better treatments nowadays and treatment is much more accessible. In 1918 a lot of people, especially in rural areas, probably died before they even had a chance to see a doctor. A rural person could easily be a day's travel or more by horse drawn wagon away from a doctor. It might take two people to take the sick person. One to handle the horse and wagon, and one to tend to the sick person. Having two healthy people away from work for several days, and having the wagon unavailable for that time, could be a serious hardship. I'd thus expect such people to tend to wait until it was clear that what they had was more serious than any normal flu they had had before. News traveled much slower in 1918, especially in rural areas, so they might not know that there is an unusually deadly flu pandemic in progress. So by the time they realize that they are going to need help, it might be logistically too late. Even if our medical treatment was no better today than in 1918, we'd probably save a lot more just because news spreads faster and more widely, we have faster transportation, and we have faster communication.

chakalakasp 9y ago
That feels wrong to me. I don’t know how the rest of the world operates, but here in America I suspect the health system would struggle to even begin to cope with seeing a 50fold increase in patients across the board across the country. Just the strain on hospitals and respiratory support systems like ventilators alone would quickly make modern healthcare seem more or less like it was in 1918. Additionally, unlike in 1918, few households today have spare capacity to homecare gravely ill family members as in most middle class families both partners must work to provide a living wage.
rsync 9y ago
"I would expect that a significant factor is that we both have better treatments nowadays and treatment is much more accessible." If, by "treatment", you mean access to clean water, sanitary conditions and decent rest, then I would agree: we're certainly better off than rural populations circa 1918. I suppose access to IV fluids could be helpful if you're elderly, or otherwise immune-compromised. Beyond that, not much has changed since 1918. The flu is a virus and is not affected by antibiotics. Further, the two antivirals associated with influenza either do nothing[1] or almost nothing[2]. Very much like there is no such thing as "cold medicine" (contrary to what TV says) there is also no such thing as a broadly useful flu treatment. What you're most likely to receive from a doctor is relief of superficial symptoms. Going to a hospital for the cold or the flu will potentially expose you to much more serious bacterial infection. [1] "Overall the benefits of neuraminidase inhibitors in those who are otherwise healthy do not appear to be greater than the risks." (https://en.wikipedia.org/wiki/Influenza#Treatment https://en.wikipedia.org/wiki/Influenza#Treatment) [2] "These drugs (M2 inhibitors) are sometimes effective against influenza A if given early in the infection but are ineffective against influenza B viruses" (https://en.wikipedia.org/wiki/Influenza#Treatment https://en.wikipedia.org/wiki/Influenza#Treatment)