6 ms·

On the Epidemiology of Influenza (2008)

63 points by AndrewBissell 6y ago

Vecr 6y ago
Current flu vaccines don't work very well in old people, due to their weakening immune systems. There is now a high dose inactivated flu vaccine available in the US that also contains adjuvent to partially address this issue[0], but an mRNA flu vaccine would probably help even more. In theory, I think it would be preferable if each person over 55 would receive one dose of the current high dose vaccine in October of each year and be given a silicone P100 respirator, and then be given a booster in December. [0]: https://web.archive.org/web/20130508081643/http://www.sciencebasedmedicine.org/index.php/high-dose-flu-vaccine-for-the-elderly/ https://web.archive.org/web/20130508081643/http://www.scienc...
- saurik 6y ago
  So your plan is that everyone over 55 be forced to wear a super serious level of mask for... is it at least three months of the year, or do you just mean "for the rest of their lives"?
  - Vecr 6y ago
    No, just provide it to them. I don't expect lots of them to wear it, but I think it would be better to do so than not.
- SketchySeaBeast 6y ago
  Or we could just normalize wearing a mask when you're sick along with good hand and face hygiene. The outstanding success of the last flu season let's us know that if we take it seriously it should be relatively easy to markedly reduce the misery caused by the flu to a fraction of what it was before COVID.
  - Mediterraneo10 6y ago
    A fringe of the scientific advisors to various Western governments for the COVID epidemic have given interviews where they advocate for mask-wearing and social distancing to continue in perpetuity even after COVID because of influenza, but they seem to assume it would only make sense if everyone wore a mask all the time. Influenza spreaders often spread the virus before they start to feel ill and think to put a mask on.
    - SketchySeaBeast 6y ago
      Given how much less dangerous influenza is I would expect even half measures to have a marked effect. We don't need to stamp it out entirely, we just need to curb it. The shot helps, but so would wearing masks when you're obviously sick. In 2019-2020 Alberta had 1,595 hospitalized and 41 deaths. This year Alberta had 0 cases of lab tested influenza. That's how much of an effect the current COVID restrictions and renewed awareness of the flu vaccine had on the virus. I'm sure just wearing a mask when you're obviously sick would help close that gap.
      - noughtme 6y ago
        I'm curious if that's just because zero flu cultures were ordered this year. People may have had the flu and covid, but they weren't testing for the flu.
        SketchySeaBeast 6y ago
        Not the case at all. I don't have an exact number, but Alberta completed 300% more flu tests than the previous year. https://globalnews.ca/news/7606557/alberta-2020-2021-flu-season-no-cases-increased-testing/ https://globalnews.ca/news/7606557/alberta-2020-2021-flu-sea...
        Pyramus 6y ago
        My feeling from speaking to doctors (including an ENT specialist) is that while in our perception Covid eclipses everything else, for them it's just another infection on top of everything else. So I would be very surprised (and see no indication) that doctors suddenly stopped doing standard diagnostics.
  - FearlessNebula 6y ago
    Why do I suspect that most people are too lazy and apathetic to wear a mask when they are sick post COVID...
    - SketchySeaBeast 6y ago
      Because many people are too lazy, apathetic, or misinformed to wear mask mid-COVID?
    - whatshisface 6y ago
      Another motivation for not wearing a mask is the weird looks you get in "normal times" for doing that. People think you have some horrible disease or something.
  - qiqing 6y ago
    Some cultures have normalized this (good hygiene and mask wearing when sick) since the 1917 pandemic. I'm cautiously optimistic that it can take hold in the West this time around.
    - SketchySeaBeast 6y ago
      At least in part, yeah. I know I will. And every bit helps.
    - throwaway8581 6y ago
      Is there any evidence that respiratory viruses spread less readily in those countries in a regular year?
  - jMyles 6y ago
    > The outstanding success of the last flu season let's us know that if we take it seriously This analysis reads to me as so out-of-touch as to be other-worldly. Have we already forgotten that there was an incredibly widespread respiratory pathogen through virtually every corner of the world last year? How can you point to horizontal interdiction as a likely (hell, plausible) explanation when the most obvious is a simple incident of viral interference? How does the horizontal interdiction theory explain that influenza was similarly suppressed even in places that had no such measures? What about the apparent suppression of the other four endemic coronaviruses? And the rhinoviruses? How did every respiratory pathogen except one succumb to interdiction (even in places where there was no interdiction), while that one other flourished?
    - Pyramus 6y ago
      Let me give you the straight-forward answer from an epidemiological point of view (not an expert). Assume you have two pathogens A and B that are transmissible. A with a reproductive number of 3 and B with an R of 1.5. Now the pool of susceptibles behaves in such a way that only, say, half of transmissions occur. Then pathogen A will die out while B grows exponentially. > What about the apparent suppression of the other four endemic coronaviruses? And the rhinoviruses? How did every respiratory pathogen except one succumb to interdiction (even in places where there was no interdiction), while that one other flourished? From speaking to an ENT doctor there were indeed very little respiratory infections (apart from Covid of course). > How did every respiratory pathogen except one succumb to interdiction (even in places where there was no interdiction) Not sure what you mean by interdiction - lockdowns are only a proxy for human behaviour. If you have data that indeed influenza was suppressed with no behaviour change and/or seasonality that would be appreciated.
      - jMyles 6y ago
        > Assume you have two pathogens A and B that are transmissible. A with a reproductive number of 3 and B with an R of 1.5. Now the pool of susceptibles behaves in such a way that only, say, half of transmissions occur. Then pathogen A will die out while B grows exponentially. Indeed this is a good scenario for consideration. Next, to advance the theory in places where horizontal measures were taken, we'd need evidence that R of SARS-CoV-2 is sufficiently higher than other respiratory pathogens. Even if this is true for influenza (and sure, it might be), it seems unlikely to be true for the other four endemic coronaviruses. > From speaking to an ENT doctor there were indeed very little respiratory infections (apart from Covid of course). Right. And you don't need the anecdote; we know this from ILInet. > Not sure what you mean by interdiction - lockdowns are only a proxy for human behaviour. If you have data that indeed influenza was suppressed with no behaviour change and/or seasonality that would be appreciated. How do you explain the similar suppression in Sweden, Florida, Haiti, etc.? Places that had: 1) No serious interdiction to speak of, and 2) Fairly rapid achievement of endemic equilibrium in SARS-CoV-2 ...also experienced suppression not only of influenza but of the other four endemic coronaviruses and both rhinoviruses. The unambiguous Occam's Razor - and the explanation most established by historical study on these matters - is that we're seeing a case of viral interference.
- ArkanExplorer 6y ago
  Do we really have to be so averse to death that we have to shut down life? These sort of measures and proposals read as if you are talking about livestock, not humans.
Friesen36 6y ago
Works like a charm! The solution worked for me thanks to the community and the members for the solution. https://www.myccpay.vip/ https://www.myccpay.vip/
penteract 6y ago
This is very interesting and has helped me understand something I hadn't realised before - if a disease is primarily spread by a small subset of the population(superspreaders), but you assume otherwise, it gets very hard to do statistics. For example, if you're trying to measure the R number, then you're sampling from a very fat tailed distribution, so it's easy to underestimate. It also means that if an intervention (such as vitamin D) prevents transmission but not illness, it could be hard to detect/measure the impact. (This comment is not a summary of the paper)
- Pyramus 6y ago
  Just to clarify that both the fat-tailed distribution of R (most people don't infect anybody) and the low secondary attack rate (low infection in house holds) are also shared by Covid, and were one of the surprises early on.
manwe150 6y ago
This was a very intriguing and plausible-sounding hypothesis to read. Since this was 2008, are there good follow-up papers yet (or rebuttals)?
- rossdavidh 6y ago
  My thoughts exactly; we have had 13 years since this paper, what responses has it had?
Pyramus 6y ago
As a non-expert I found it very interesting to see these parallels between influenza (even though partly conjectured) and SARS-Cov-2: The surprisingly low secondary attack rate of 20-30% and the fat-tailed distribution of R (this correlate of course to some extent), and a potentially mediating effect of Vitamin D.
Mai914 6y ago
Interesting hypothesis, and can be quite relevant today too!
anonymous49298 6y ago
To those concerned about the ineffectiveness of flu shots or other vaccines in the elderly, Greg Fahy (eminent cryobiologist) developed a protocol for thymic rejuvenation that is in registered clinical trials now. And from the before/after scans, it does look like he's managed to replace much of the worthless fat in the aged thymus with functional tissue: youtube.com/watch?v=D3IteYQ7xhc It's crazy how little attention this is getting. We're living through a global pandemic of a respiratory virus that predominantly affects the elderly (with weakened immune systems) and the immune-compromised, and almost no one is interested in this.

63 points by AndrewBissell 6y ago

Vecr 6y ago

Current flu vaccines don't work very well in old people, due to their weakening immune systems. There is now a high dose inactivated flu vaccine available in the US that also contains adjuvent to partially address this issue[0], but an mRNA flu vaccine would probably help even more. In theory, I think it would be preferable if each person over 55 would receive one dose of the current high dose vaccine in October of each year and be given a silicone P100 respirator, and then be given a booster in December. [0]: https://web.archive.org/web/20130508081643/http://www.sciencebasedmedicine.org/index.php/high-dose-flu-vaccine-for-the-elderly/ https://web.archive.org/web/20130508081643/http://www.scienc...

saurik 6y ago
So your plan is that everyone over 55 be forced to wear a super serious level of mask for... is it at least three months of the year, or do you just mean "for the rest of their lives"?
- Vecr 6y ago
  No, just provide it to them. I don't expect lots of them to wear it, but I think it would be better to do so than not.
SketchySeaBeast 6y ago
Or we could just normalize wearing a mask when you're sick along with good hand and face hygiene. The outstanding success of the last flu season let's us know that if we take it seriously it should be relatively easy to markedly reduce the misery caused by the flu to a fraction of what it was before COVID.
- Mediterraneo10 6y ago
  A fringe of the scientific advisors to various Western governments for the COVID epidemic have given interviews where they advocate for mask-wearing and social distancing to continue in perpetuity even after COVID because of influenza, but they seem to assume it would only make sense if everyone wore a mask all the time. Influenza spreaders often spread the virus before they start to feel ill and think to put a mask on.
  - SketchySeaBeast 6y ago
    Given how much less dangerous influenza is I would expect even half measures to have a marked effect. We don't need to stamp it out entirely, we just need to curb it. The shot helps, but so would wearing masks when you're obviously sick. In 2019-2020 Alberta had 1,595 hospitalized and 41 deaths. This year Alberta had 0 cases of lab tested influenza. That's how much of an effect the current COVID restrictions and renewed awareness of the flu vaccine had on the virus. I'm sure just wearing a mask when you're obviously sick would help close that gap.
    - noughtme 6y ago
      I'm curious if that's just because zero flu cultures were ordered this year. People may have had the flu and covid, but they weren't testing for the flu.
      - SketchySeaBeast 6y ago
        Not the case at all. I don't have an exact number, but Alberta completed 300% more flu tests than the previous year. https://globalnews.ca/news/7606557/alberta-2020-2021-flu-season-no-cases-increased-testing/ https://globalnews.ca/news/7606557/alberta-2020-2021-flu-sea...
      - Pyramus 6y ago
        My feeling from speaking to doctors (including an ENT specialist) is that while in our perception Covid eclipses everything else, for them it's just another infection on top of everything else. So I would be very surprised (and see no indication) that doctors suddenly stopped doing standard diagnostics.
- FearlessNebula 6y ago
  Why do I suspect that most people are too lazy and apathetic to wear a mask when they are sick post COVID...
  - SketchySeaBeast 6y ago
    Because many people are too lazy, apathetic, or misinformed to wear mask mid-COVID?
  - whatshisface 6y ago
    Another motivation for not wearing a mask is the weird looks you get in "normal times" for doing that. People think you have some horrible disease or something.
- qiqing 6y ago
  Some cultures have normalized this (good hygiene and mask wearing when sick) since the 1917 pandemic. I'm cautiously optimistic that it can take hold in the West this time around.
  - SketchySeaBeast 6y ago
    At least in part, yeah. I know I will. And every bit helps.
  - throwaway8581 6y ago
    Is there any evidence that respiratory viruses spread less readily in those countries in a regular year?
- jMyles 6y ago
  > The outstanding success of the last flu season let's us know that if we take it seriously This analysis reads to me as so out-of-touch as to be other-worldly. Have we already forgotten that there was an incredibly widespread respiratory pathogen through virtually every corner of the world last year? How can you point to horizontal interdiction as a likely (hell, plausible) explanation when the most obvious is a simple incident of viral interference? How does the horizontal interdiction theory explain that influenza was similarly suppressed even in places that had no such measures? What about the apparent suppression of the other four endemic coronaviruses? And the rhinoviruses? How did every respiratory pathogen except one succumb to interdiction (even in places where there was no interdiction), while that one other flourished?
  - Pyramus 6y ago
    Let me give you the straight-forward answer from an epidemiological point of view (not an expert). Assume you have two pathogens A and B that are transmissible. A with a reproductive number of 3 and B with an R of 1.5. Now the pool of susceptibles behaves in such a way that only, say, half of transmissions occur. Then pathogen A will die out while B grows exponentially. > What about the apparent suppression of the other four endemic coronaviruses? And the rhinoviruses? How did every respiratory pathogen except one succumb to interdiction (even in places where there was no interdiction), while that one other flourished? From speaking to an ENT doctor there were indeed very little respiratory infections (apart from Covid of course). > How did every respiratory pathogen except one succumb to interdiction (even in places where there was no interdiction) Not sure what you mean by interdiction - lockdowns are only a proxy for human behaviour. If you have data that indeed influenza was suppressed with no behaviour change and/or seasonality that would be appreciated.
    - jMyles 6y ago
      > Assume you have two pathogens A and B that are transmissible. A with a reproductive number of 3 and B with an R of 1.5. Now the pool of susceptibles behaves in such a way that only, say, half of transmissions occur. Then pathogen A will die out while B grows exponentially. Indeed this is a good scenario for consideration. Next, to advance the theory in places where horizontal measures were taken, we'd need evidence that R of SARS-CoV-2 is sufficiently higher than other respiratory pathogens. Even if this is true for influenza (and sure, it might be), it seems unlikely to be true for the other four endemic coronaviruses. > From speaking to an ENT doctor there were indeed very little respiratory infections (apart from Covid of course). Right. And you don't need the anecdote; we know this from ILInet. > Not sure what you mean by interdiction - lockdowns are only a proxy for human behaviour. If you have data that indeed influenza was suppressed with no behaviour change and/or seasonality that would be appreciated. How do you explain the similar suppression in Sweden, Florida, Haiti, etc.? Places that had: 1) No serious interdiction to speak of, and 2) Fairly rapid achievement of endemic equilibrium in SARS-CoV-2 ...also experienced suppression not only of influenza but of the other four endemic coronaviruses and both rhinoviruses. The unambiguous Occam's Razor - and the explanation most established by historical study on these matters - is that we're seeing a case of viral interference.
ArkanExplorer 6y ago
Do we really have to be so averse to death that we have to shut down life? These sort of measures and proposals read as if you are talking about livestock, not humans.

Friesen36 6y ago

Works like a charm! The solution worked for me thanks to the community and the members for the solution. https://www.myccpay.vip/ https://www.myccpay.vip/

penteract 6y ago

This is very interesting and has helped me understand something I hadn't realised before - if a disease is primarily spread by a small subset of the population(superspreaders), but you assume otherwise, it gets very hard to do statistics. For example, if you're trying to measure the R number, then you're sampling from a very fat tailed distribution, so it's easy to underestimate. It also means that if an intervention (such as vitamin D) prevents transmission but not illness, it could be hard to detect/measure the impact. (This comment is not a summary of the paper)

Pyramus 6y ago
Just to clarify that both the fat-tailed distribution of R (most people don't infect anybody) and the low secondary attack rate (low infection in house holds) are also shared by Covid, and were one of the surprises early on.

manwe150 6y ago

This was a very intriguing and plausible-sounding hypothesis to read. Since this was 2008, are there good follow-up papers yet (or rebuttals)?

rossdavidh 6y ago
My thoughts exactly; we have had 13 years since this paper, what responses has it had?

Pyramus 6y ago

As a non-expert I found it very interesting to see these parallels between influenza (even though partly conjectured) and SARS-Cov-2: The surprisingly low secondary attack rate of 20-30% and the fat-tailed distribution of R (this correlate of course to some extent), and a potentially mediating effect of Vitamin D.

Mai914 6y ago

Interesting hypothesis, and can be quite relevant today too!

anonymous49298 6y ago

To those concerned about the ineffectiveness of flu shots or other vaccines in the elderly, Greg Fahy (eminent cryobiologist) developed a protocol for thymic rejuvenation that is in registered clinical trials now. And from the before/after scans, it does look like he's managed to replace much of the worthless fat in the aged thymus with functional tissue: youtube.com/watch?v=D3IteYQ7xhc It's crazy how little attention this is getting. We're living through a global pandemic of a respiratory virus that predominantly affects the elderly (with weakened immune systems) and the immune-compromised, and almost no one is interested in this.