4 ms·

No 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 o

by mixmax 13y ago

No 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 13y ago
While 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 13y ago
  As 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.
- brazzy 13y ago
  > 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. With the exception of washing hands (which we don't do nearly enough) and the vague "modern medical tech", none of this would help against a flu pandemic at all...
  - JunkDNA 13y ago
    I disagree. If your immune system is already run down by low grade infection and you've got a persistent case of diaorreah from poorly sourced drinking water, it's pretty easy for a flu virus to knock you out. No anibiotics means there's no way to keep you from getting pneumonia or other secondary lung infections. The healthier you are to start, the more likely you are to make it. The one exception to this is the paradoxical case where people's immune response goes crazy from battling all the virus particles. This can happen in really healthy young people. My reference to medical tech is the whole system of diagnostic testing and patient monitoring. It allows for early identification, quarantine, etc... We also know a heck of a lot about proper bio safety procedures in medical centers to lessen the spread of disease through health care workers. Again, not arguing that a pandemic like 1918 can't happen at all. I'm just saying that we're not showing up completely clueless and unarmed to a gun fight. We're bringing a knife this time :)
gojomo 13y ago
...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... We have more people, and more rapid air travel, and denser cities than ever before... and yet no pandemics on the scale of the 1918 flu. Maybe, having more people, more rapid air travel, and denser cities is actually helping herd immunity? Any nasty virus has milder cousins. Milder cousin viruses spread faster, because those infected keep going to work and traveling, and show/suffer fewer symptoms. And these milder cousins serve as a natural inoculation against the nastier versions.
- graeme 13y ago
  I've written elsewhere on this thread that pandemics are not predictable. They are rare, non-linear events. We simply can't conclude anything from the statement 'no pandemics on 1918 scale since 1918'. 3,000 years from now, looking back, people might say that 1918 was the start of the end of pandemics, or that 1918-2013 was an unusually quiet period that preceded a major pandemic. With such a limited timescale, how can we possibly tell?
digikata 13y ago
A big problem is that the last two "pandemics" were declared early on to be so, but did not end up being pandemics. That seems to indicate that the trigger criteria or observable data for declaring a pandemic virus were inadequate for at least those two cases. On the other hand, I'm sympathetic towards public health agencies, because to effectively head off a pandemic you have to detect it and take action early. However, if you're going to err on the side of caution, there are going to be a lot of false alarms, which in turn is going to lead to public relations fatigue about the whole issue. Then you're going to have a problem mustering a response if a pandemic actually comes up. It's a difficult problem. One suspicion I have that leads to this problem is that we've never before had the tools to so easily & rapidly track the progress of a particular strains of flu virus - I suspect that really we just don't know about what the range of characteristics about the transmission rates really are to this level of detail, so really we don't precisely know how to accurately forecast if a virus at early stages will lead to a pandemic.

by mixmax 13y ago

JunkDNA 13y ago

While 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 13y ago
As 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.
brazzy 13y ago
> 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. With the exception of washing hands (which we don't do nearly enough) and the vague "modern medical tech", none of this would help against a flu pandemic at all...
- JunkDNA 13y ago
  I disagree. If your immune system is already run down by low grade infection and you've got a persistent case of diaorreah from poorly sourced drinking water, it's pretty easy for a flu virus to knock you out. No anibiotics means there's no way to keep you from getting pneumonia or other secondary lung infections. The healthier you are to start, the more likely you are to make it. The one exception to this is the paradoxical case where people's immune response goes crazy from battling all the virus particles. This can happen in really healthy young people. My reference to medical tech is the whole system of diagnostic testing and patient monitoring. It allows for early identification, quarantine, etc... We also know a heck of a lot about proper bio safety procedures in medical centers to lessen the spread of disease through health care workers. Again, not arguing that a pandemic like 1918 can't happen at all. I'm just saying that we're not showing up completely clueless and unarmed to a gun fight. We're bringing a knife this time :)

gojomo 13y ago

...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... We have more people, and more rapid air travel, and denser cities than ever before... and yet no pandemics on the scale of the 1918 flu. Maybe, having more people, more rapid air travel, and denser cities is actually helping herd immunity? Any nasty virus has milder cousins. Milder cousin viruses spread faster, because those infected keep going to work and traveling, and show/suffer fewer symptoms. And these milder cousins serve as a natural inoculation against the nastier versions.

graeme 13y ago
I've written elsewhere on this thread that pandemics are not predictable. They are rare, non-linear events. We simply can't conclude anything from the statement 'no pandemics on 1918 scale since 1918'. 3,000 years from now, looking back, people might say that 1918 was the start of the end of pandemics, or that 1918-2013 was an unusually quiet period that preceded a major pandemic. With such a limited timescale, how can we possibly tell?

digikata 13y ago

A big problem is that the last two "pandemics" were declared early on to be so, but did not end up being pandemics. That seems to indicate that the trigger criteria or observable data for declaring a pandemic virus were inadequate for at least those two cases. On the other hand, I'm sympathetic towards public health agencies, because to effectively head off a pandemic you have to detect it and take action early. However, if you're going to err on the side of caution, there are going to be a lot of false alarms, which in turn is going to lead to public relations fatigue about the whole issue. Then you're going to have a problem mustering a response if a pandemic actually comes up. It's a difficult problem. One suspicion I have that leads to this problem is that we've never before had the tools to so easily & rapidly track the progress of a particular strains of flu virus - I suspect that really we just don't know about what the range of characteristics about the transmission rates really are to this level of detail, so really we don't precisely know how to accurately forecast if a virus at early stages will lead to a pandemic.