6 ms·
The Next Pandemic: Not if, but When
- keyle 14y agoIt boggles me that nobody find this article disturbing. Also written as some sort of warning for the future, yet classified in OPINIONS... Furthermore, click on the author's name and get taken to his personal website... Where you can admire his book being promoted. And it's about scary diseases in the world that will kill us all. Please.
- f055 14y agoPandemics are overhyped. In the recent years we had 2 "pandemic" strains of flu, both of which as it turned out, were greatly exaggerated for the benefit of the pharma companies. The truth is, thousands more people die of know diseases every year (even from seasonal flu) than from any other unknown "pandemic" viruses. But this is not "exciting" at all.
- hga 14y agoReally? Here are the last three big ones, and there was a bad one in 1889–1890 about which we don't know much except that "About 1 million people died": Hong Kong Flu (1968–1969), "killed an estimated one million people worldwide." http://en.wikipedia.org/wiki/Influenza_pandemic#Hong_Kong_Flu_.281968.E2.80.931969.29 http://en.wikipedia.org/wiki/Influenza_pandemic#Hong_Kong_Fl... Asian Flu (1957–1958), "Estimates of worldwide deaths vary widely depending on source, ranging from 1 million to 4 million." http://en.wikipedia.org/wiki/Influenza_pandemic#Asian_Flu_.281957.E2.80.931958.29 http://en.wikipedia.org/wiki/Influenza_pandemic#Asian_Flu_.2... Spanish Flu (1918–1920), "It infected 500 million people across the world, including remote Pacific islands and the Arctic, and killed 50 to 100 million of them—3 to 5 percent of the world's population at the time—making it one of the deadliest natural disasters in human history." "Most influenza outbreaks disproportionately kill juvenile, elderly, or already weakened patients; in contrast the 1918 pandemic killed predominantly previously healthy young adults." http://en.wikipedia.org/wiki/1918_flu_pandemic http://en.wikipedia.org/wiki/1918_flu_pandemic That was the big one, and if you talk to your elders they'll remember the first hand stories they heard about it. Few families escaped unscathed, I lost a great-uncle. A repeat would be catastrophic, and efforts to avoid it are not "overhyped", except by the always excitable media. To dismiss such a well documented, in living history threat as being "for the benefit of pharma companies" is beyond blind.
- bwooce 14y agoAgreed. This is why the scientists playing with creating influenza variants freak me out. I suspect they have the 1918 variant on hand, combine that with something a bit slower to present and we'd have a winner.
- mtts 14y agoHowever, the Spanish Flu had some things going for it that were rather unique and unlikely to ever occur again: vast displacements of vast numbers of people, vast numbers of people in poor health due to years of deprivation as a result of food shortages and young adults being in especially poor health (Normally men of fighting age are the healthiest members of a population. After four years in the trenches, not so much). The Spanish Flu clouds the issue somewhat, as it's always the first thing people think of when they hear the words "flu epidemic" but it's also the most unusual of all such epidemics.
- hga 14y agoFrom the limited accounts I've read this doesn't explain well the US homeland experience, except of course by the late '50s the population was likely quite a bit healthier. The research on the recovered strain that reproduces in monkeys the "classic symptoms of the 1918 pandemic, and [dying] from a cytokine storm" is of concern (http://en.wikipedia.org/wiki/1918_flu_pandemic#Spanish_flu_research http://en.wikipedia.org/wiki/1918_flu_pandemic#Spanish_flu_r...), as are the intensely lethal strains that keep popping up, but fortunately with little to no human to human transmision.
- cantos 14y agoMany people would have been displaced in 1918-19 (though I can't find a good number). I think mostly they would have been soldiers since it was largely fought outside of cities. In any case in 2013 there are more than 1 billion people [1] who travel internationally each year so that condition isn't unique to the spanish flu. [1] Wikipedia - tourism
- mtts 14y agoYeah, I meant soldiers. They travelled far, came into close contact with large numbers of other soldiers and then brought back the flu with them to their home communities when they were repatriated. Modern mass tourism is pretty bad as well, but it's a far cry from having all of the young men in your town getting shipped out and back in again.
- mixmax 14y agoNo they are not - and a lot of people misunderstand why. It's true that in any normal year more people die from known diseases, and that pandemics are a rare occurrence. But when they happen they kill a lot of people. The 1918 flu pandemic killed 100 million people. 1 out of 20 inhabitants on the planet. And remember that this was back when we didn't fly around the planet giving a virus the possibility of spreading to the entire globe within a few days. That's why pandemics are so scary - when they kill they kill a sizable portion of the earths population.
- JunkDNA 14y agoWhile I'm in agreement that one can't dismiss them out of hand, I wonder how likely a 1918 Style pandemic really is. I don't believe we have had a pandemic on the scale of the 1918 flu in modern times. 1918 was a long time ago. The outbreak of HIV comes closest. It's easy to forget how much modern practices cut down on disease: wash hands, don't drink water people (or animals) poop in, sterilize (or dispose of) medical devices, store your food properly, don't live in a house also occupied by rodents, etc... That is all a great start, and we haven't even talked about antibiotics and other modern medical tech. Granted, access to all of this is far from uniform around the world. However, the situation has been steadily improving. Epidemiology and monitoring are also vastly better than years ago. I was working in pharma during the SARS outbreak and saw firsthand how fast research can move when people perceive something as an existential threat. Government and corporate red tape that normally gums things up immediately falls by the wayside (as does the usual academic quarreling over turf and recognition). Not wanting to see mass death has a way of focusing the minds of even the most recalcitrant beaurocrats in any organization.
- graeme 14y agoAs Nassim Taleb points out, you can't assess the likelihood of a high impact event merely from the fact that one hasn't happened for a while. We can identify reasons that disease transmission rates may be lower. We can also identify reasons a pandemic would travel more easily, such as air travel and more open borders in Europe. There are surely many factors that would only be identified as impactful after the fact. Likewise, we can't predict the virulence or transmissibility of any future virus. Pandemics belong in that class of rare events where it's impossible to predict the likelihood, the impact, or the timeframe. All this to say, you're correct that a 1918 pandemic is unlikely. But I don't think that's meaningful.
- FoeNyx 14y agoAround 250k to 500k people die from influenza epidemics each year (according to WHO, and the Doctor). The second wave of 1918 flu pandemic killed around 30M to 100M people from the 500M people infected. There's two factors to flu virus : spread and severity. The last influenza pandemic may have been "overhyped" and exploited by pharma companies, but we were also lucky that it had high spread but relative low mortality rate. The NCoV seems to have a high mortality rate. "Prevention is preferable to cure" (moreover when there isn't any cure ready yet).
- graeme 14y agoWhy is this answer downvoted so heavily? Edit: my upvote seems to have moved it out of grey.
- nodata 14y agoIf it hadn't been hyped, it would have killed loads of people. Preventing pandemics is expensive.
- FollowSteph3 14y agoBecause nothing happened people thing it was over hyped. But in fact it's because people reacted that nothing happened. The following articles I wrote explains a lot more of the details of what influenza is and why people wrongly think it was over hyped http://www.followsteph.com/2009/10/29/its-only-the-flu/ http://www.followsteph.com/2009/10/29/its-only-the-flu/
- MortenK 14y agoThing is the two strains that caused widespread panic, avian flu and swine flu, had a mortality rate equal to the standard flu. I.e it wasn't any more dangerous than what we deal with every winter season, yet people all over the globe got scared like cattle in a thunderstorm, with a lot of money changing hands as a result. While of course we shouldn't dismiss potential pandemic's, I think we'd all do well to exhibit at least a modicum of skepticism when faced with doomsday alarms, pandemic related or otherwise.
- FollowSteph3 14y agoH1n1 is the same strain as the 1918 epidemic that killed hundreds of millions
- Lost_BiomedE 14y agoI agree that they are a bit overhyped. The exclusion to that is places that do not have access to antibiotics. Even though the 1918 Flu had cytokine-storm-like effects, a large majority of people died of secondary infection, preventable with antibiotics. There is also a relatively small window of time going forward before we have decent universal vaccines. That said, a lot of the work done to get us to where we are is a big part of why they are not as scary as the hype.
- hga 14y agoAre you sure about magnitude of the secondary infection role in the 1918 flu (which I'll note doesn't match the previous pandemic's death toll of "only" about a million)? It sounds plausible, except I distinctly remember reading about common mortality paths in the "young" population that were just too fast. Heck, I just read that the first useful genetic sample came from Brevig Mission, Alaska, where "it killed 72 out of 80 residents in a 5 day period." Pneumonic plague is that fast, I Am Not A Doctor but I'm unaware of any bacteria that's similarly fast and lethal. I'm not sure we can predict when we'll have universal vaccines, as I understand it we've only recently gotten some serious traction on them ... we hope. But it is possible we'll get them fairly soon.
- deleted 14y ago[deleted]
- Lost_BiomedE 14y agoYeah. I just finished a 50 page research paper on it, so it is pretty fresh in my mind. I was surprised to find that it wasn't a greater killer. Yes, it is fast and lethal, but it did not account for most of the deaths. The pipeline on flu vaccines look very promising, and IMO, we will have an effective universal vaccine within ten years. The next generation of vaccines can be made by bacteria or other methods that do not require 1 egg for 1 vaccine. This makes them cheaper, much faster to produce, and easier to distribute. One test that amazed me was Inovio used a unmatched vaccine on the 1918 Flu with lethal dose in mice. All the controls died but none of the vaccinated.
- josh-j 14y agoThey weren't overhyped. Your point is a common and old canard. The worry wasn't that avian flu or the swine flu would kill a lot of people in their current states, but that they would mutate into something considerably more dangerous. The swine flu, for example, was known to spread easily but wasn't _yet_ very lethal. The avian flu (H5N1) didn't _yet_ spread easily, but was very lethal. If the swine flu mutated into something more lethal or if the avian flu mutated into something more communicable, then everyone would probably know someone that died from either virus. And that's exactly the worry with these new crop of viruses, and why it's important to react with extraordinarily measures -- to prevent them from becoming something much worse.
- knowtheory 14y agoThe frame of this OpEd is insane. Anyone who understands what the word "Pandemic" means should also understand that pandemic disease is an inevitability. The question is what can we do as a society (or societies) to reduce transmission, mitigate the severity and treat the afflicted if possible. It's why Public Health is so important. (And to be fair to the author, the piece doesn't seem to pick the super weird frame that the title of the piece does. As Mitt Romney pointed out during the election regarding his GM bailout piece, the authors don't write the article titles)
- azakai 14y agoThe problem is that mortality rates are always exaggerated, because the people that contract the virus and get very sick are the ones that come to medical attention. If 10x more people contracted the virus and fought it off, and never went to a hospital or contacted a doctor, no one would be able to factor them in and reduce the mortality by a factor of 10. That's why mortality rates tend to decrease in newly-discovered diseases, we start to look harder for people infected but not killed by them. Of course this isn't a reason to be complacent.
- kaolinite 14y agoIf you enjoyed this article, I strongly recommend the author's book (mentioned at the end - Spillover, by David Quammen). I am about half way through and finding it very interesting.
- tokenadult 14y agoI'm surprised that there is so much mention of antibiotics in this thread, as the author's book excerpt submitted here mentions a viral disease, and thus far we have very few "antibiotics" that have any effect on viruses. (Usual usage in English is to use "antibiotic" as a term for a broad-spectrum antibacterial medicine. Effective antiviral medicines have only existed since I became an adult, with the treatments for AIDS being the outstanding examples of antiviral medicines.) I get a lot of my pandemic prevention information from the Center for Infectious Disease Research & Policy, http://www.cidrap.umn.edu/cidrap/index.html http://www.cidrap.umn.edu/cidrap/index.html which, to be sure, has an institutional reason to raise awareness of risks of pandemics, but which also links to a lot of current, sound science reporting on infectious diseases. Novel strains of the influenza viruses or novel strains of coronaviruses are scary to thoughtful epidemiologists because they can be spread by the everyday activity of breathing. If a new coronavirus infection has a high case mortality rate, high virulence, and long latency period, it could kill many people before any of us have a chance to practice the isolation that eventually shut down the spread of SARS back in 2003. Every year, a lot of people get the flu, and a more virulent and more lethal strain of flu--especially one for which current seasonal flu vaccines provide no immunity--could kill a lot of our friends and neighbors.
- Lost_BiomedE 14y agoI mentioned this below. A lot of the high death rate from flu is due to secondary bacterial infection, which antibiotic can treat. Antibiotics would have reduced the mortality of the 1918 flu, which was novel at the time, drastically as bacterial infection counted for the majority of deaths. We are likely to have a decent universal vaccine within the decade. Example, one test by Inovio used a unmatched vaccine on the 1918 Flu with lethal dose in mice. All the controls died but none of the vaccinated. This type of vaccine would reduce the chance greatly that something like a bat flu would emerge without us being prepared. These universal vaccines are made by bacteria or other very fast to produce and cheap methods, compared to the popular egg method today. The biggest issue which the WHO has been working on is to make sure poorer countries have the know-how and distribution networks to ensure they can make and deliver current and next gen vaccines. This is especially important if access to antibiotics is not common and easy.
- 14y ago
- vxNsr 14y agoAs always the best offense is a good defense which in this case means keeping well informed of the spread of these diseases and staying away from people/places that have higher rates of infection.
- austengary 14y agoThe Next ______________: Not if, but When
- sn0v 14y agoI'll just leave this here :D - http://pandemic3.com/ http://pandemic3.com/
- rdl 14y agoI wonder what the second/third order effects of eradicating bats would be. I remember the consequences of eradicating mosquitoes being pretty minor, but presumably no bats would mean more insects, which would raise the incidence of various insect diseases, but also might increase birds and other insectivores. I have no great love of bats themselves, particularly due to rabies.