5 ms·

A few comments on pandemic influenza

70 points by ivankirigin 18y ago

ivankirigin 18y ago
Quite literally a hacker talking about news. This was a good read.
sachinag 18y ago
As I said in the other thread, the only certainty in a pandemic is that the public will react in bizarre and strange ways. The general feeling is that the reaction will almost certainly be an order of magnitude over the threat, given our knowledge and expertise with pandemics, and that most deaths will be from human response as opposed to the pandemic itself (as would be the case with a dirty nuclear bomb).
- smanek 18y ago
  How? I'm not disagreeing, I just don't see any obvious ways that the human response would cause a lot of deaths - so I'm curious.
  - gojomo 18y ago
    A crash nationwide vaccination program in response to a swine flu scare in 1976 appears to have triggered hundreds of cases of Guillain-Barré syndrome, and "at least 25 deaths": http://www.semp.us/publications/biot_reader.php?BiotID=177 http://www.semp.us/publications/biot_reader.php?BiotID=177
    - smanek 18y ago
      Your link said that they vaccinated 40 Million people, and accidentally caused 25 deaths. If that's the downside, I'm willing to risk it ... To be ultra conservative, assume there's a 0.1% chance that this becomes 10% as bad as the 1918 flu. The 1918 flu killed ~3% of the world population - if swine flu is one tenth as bad it means ~300K deaths in America. Therefore the expected number of (American) deaths is 300. As long as the vaccine is expected to cause less than a 300 deaths, we should do it, right?
      - gojomo 18y ago
        Of course, if the net lives saved outnumber the net lives lost, and other costs are similarly weighed, you take the chance (or at least give people the option). But in the 1976 case: there was only 1 death from the feared strain... and 25+ deaths from the vaccination program, which was halted early. Overreaction can be out of proportion to the danger. And there are all sorts of other harder-to-measure costs, including excess deaths, from overreaction. If a collapse of commerce driven by fear retards economic growth, more people die of other causes. If funds are diverted from other health interventions, more people die of other causes. Even in trying to vaccinate the whole nation: some small but nonzero number of people will die in the extra road travel to the vaccination sites. Your 'ultra conservative' numbers are still way on the alarmist side, as far as I'm concerned. We may never have another natural pandemic even 1/10th as bad as the Spanish Flu. People are healthier; medicine and public health is far more advanced; the same WW1 disease-breeding-overcrowding is unlikely to recur; we have antibiotics (and many of the Spanish Flu deaths may have actually been from coincident bacterial infections). There was a good article at The New Republic during the bird flu mini-panic that emphasized how unique the Spanish Flu was to its time. It appears to have disappeared from their archives, but fortunately I quoted it in its entirety to another forum at the time. See here: http://www.xent.com/pipermail/fork/Week-of-Mon-20051003/038059.html http://www.xent.com/pipermail/fork/Week-of-Mon-20051003/0380...
    - forkqueue 18y ago
      Given that the geographically concentrated swine-flu related death toll is already over 81, this doesn't provide compelling evidence that 'most deaths will be from human response as opposed to the pandemic itself'. TV news stations will of course hype this thing beyond all proportion, as they always do, but that doesn't mean the threat isn't real and that, as the article suggests, the death toll from Swine 'flu itself won't run into tens if not hundreds of millions.
      - gojomo 18y ago
        I wouldn't suggest that overreaction necessarily kills more than the disease itself. (Your quote is from another poster.) But I did want to share one example where it clearly did, to show it's not impossible.
rms 18y ago
Anyone know an online pharmacy stocking Tamiflu? The one I know only has Symmetrel.
- m_eiman 18y ago
  According to what I've read Tamiflu won't do you any good. There's no vaccine for this strain yet.
  - arrrg 18y ago
    Tamiflu is no vaccine but a antiviral drug. It doesn’t help with the current seasonal flu but it seems to help with the swine flu. Vaccines won’t be ready for months.
Herring 18y ago
The virus is an influenza A virus, carrying the designation H1N1. It contains DNA from avian, swine and human viruses, including elements from European and Asian swine viruses, said the CDC, which is already working on a vaccine. - http://www.reuters.com/article/domesticNews/idUSTRE53N22820090424 http://www.reuters.com/article/domesticNews/idUSTRE53N228200...
gojomo 18y ago
Oh, great. A disease panic, now accelerated by online social media and Twitter. This could be worse than the bird flu (panic) of 2004-2005! Despite the opening claim to being "fairly sober -- neither alarmist, nor dismissive", I thought the choice of emphasis here is somewhat in the alarmist direction, mostly making sure to mention how bad it could be. Examples: I expect it will go global in the next couple of days, maximum. The social breakdown in a pandemic is extraordinary. No-one knows how bad another pandemic might be in terms of mortality... single digit millions... 100M might be possible. ...you should probably not believe anything any politician says about pandemic influenza. So let me offer as a small counterweight the at-least-as-likely alternative scenario: flu deaths worldwide in 2009 will be about the same as previous years, around 40K in the US and up to 500K worldwide. At this point: eat well, sleep well, and discourage sick people from coming to offices or socializing. Same as always.
- henryw 18y ago
  the 1918 flu pandemic was worse than the black plague and it's not even airborne like this one. http://www.puertorico-herald.org/issues/2003/vol7n30/KillerVirus-en.html http://www.puertorico-herald.org/issues/2003/vol7n30/KillerV...
  - gojomo 18y ago
    Neither of your claims check out. The black plague killed a higher proportion of the world's population, and the 1918 Spanish Flu was airborne, like other flus.
  - tomjen 18y ago
    There are properly more people living in Washington DC than in Europe during the time of the plague.
    - gojomo 18y ago
      Not at all. According to Wikipedia, the population of Europe before the plague peaked at 70-100 million, while the plague killed 25-50 million, still leaving the population over 20 million, possibly over 50 million. The population of Washington DC is 592,000; if you include the metro area, 5.3 million.
jraines 18y ago
I always thought the W-shaped spike in deaths-by-age from the 1918 pandemic was due to it spreading rapidly in infirmaries and barracks full of already sick and/or stressed out soldiers.
- Zaak 18y ago
  Another possibility is cytokine storms:http://en.wikipedia.org/wiki/Cytokine_storm http://en.wikipedia.org/wiki/Cytokine_storm
pfaux 18y ago
"In conclusion, I’d say that the thing is largely out of our hands" But remember your mother's best advice : wash your hands and don't touch your face. http://www.cdc.gov/flu/protect/stopgerms.htm http://www.cdc.gov/flu/protect/stopgerms.htm
- tjpick 18y ago
  My mother's best advice was drink more water and get an early night. But yeah, both are good.
xel02 18y ago
This is actually a pretty interesting case as the virus is such an odd mix. For those who aren't aware Influenza has a multipartite genome (separated segments), I think we're pretty lucky this didn't show up during flu season in which case there would have been a very high chance of it mixing with another strain that easily transferred among humans but still resistant to antivirals.
ashot 18y ago
if the virus spreads as well in the real world as it does in the virtual one we're screwed
- silentOpen 18y ago
  Population variability and imperfect interfaces make that unlikely.
tlrobinson 18y ago
"Don't eat pork from Mexico!!" Sigh Surely this sort totally false information and rumors has spread verbally before Twitter was around, now we just have a permanent record of stupid things people say.
DanielBMarkham 18y ago
This is going to sound strange, but I love watching how people act on incomplete information. Some will fall back to observe-hypothesize-test. Some will ignore/dismiss all observations unless someone in authority tells them to pay attention. Some will make the most outlandish claims. Some will make false statements, like the "don't eat swine" claim, just to add momentum to the story. Of course there's no right answer in a situation that could be fast-moving yet requires immediate decisions based on incomplete information. It's just cool to watch all the different modes of thinking critically. I hope this story turns out to be bogus -- I have a job where I deal with hundreds or thousands of people in small meeting rooms. But I've read up many years before today, and I understand that the pandemic IS coming. It's just a matter of time. Just not this year, I hope.

70 points by ivankirigin 18y ago

Quite literally a hacker talking about news. This was a good read.

As I said in the other thread, the only certainty in a pandemic is that the public will react in bizarre and strange ways. The general feeling is that the reaction will almost certainly be an order of magnitude over the threat, given our knowledge and expertise with pandemics, and that most deaths will be from human response as opposed to the pandemic itself (as would be the case with a dirty nuclear bomb).

smanek 18y ago
How? I'm not disagreeing, I just don't see any obvious ways that the human response would cause a lot of deaths - so I'm curious.
- gojomo 18y ago
  A crash nationwide vaccination program in response to a swine flu scare in 1976 appears to have triggered hundreds of cases of Guillain-Barré syndrome, and "at least 25 deaths": http://www.semp.us/publications/biot_reader.php?BiotID=177 http://www.semp.us/publications/biot_reader.php?BiotID=177
  - smanek 18y ago
    Your link said that they vaccinated 40 Million people, and accidentally caused 25 deaths. If that's the downside, I'm willing to risk it ... To be ultra conservative, assume there's a 0.1% chance that this becomes 10% as bad as the 1918 flu. The 1918 flu killed ~3% of the world population - if swine flu is one tenth as bad it means ~300K deaths in America. Therefore the expected number of (American) deaths is 300. As long as the vaccine is expected to cause less than a 300 deaths, we should do it, right?
    - gojomo 18y ago
      Of course, if the net lives saved outnumber the net lives lost, and other costs are similarly weighed, you take the chance (or at least give people the option). But in the 1976 case: there was only 1 death from the feared strain... and 25+ deaths from the vaccination program, which was halted early. Overreaction can be out of proportion to the danger. And there are all sorts of other harder-to-measure costs, including excess deaths, from overreaction. If a collapse of commerce driven by fear retards economic growth, more people die of other causes. If funds are diverted from other health interventions, more people die of other causes. Even in trying to vaccinate the whole nation: some small but nonzero number of people will die in the extra road travel to the vaccination sites. Your 'ultra conservative' numbers are still way on the alarmist side, as far as I'm concerned. We may never have another natural pandemic even 1/10th as bad as the Spanish Flu. People are healthier; medicine and public health is far more advanced; the same WW1 disease-breeding-overcrowding is unlikely to recur; we have antibiotics (and many of the Spanish Flu deaths may have actually been from coincident bacterial infections). There was a good article at The New Republic during the bird flu mini-panic that emphasized how unique the Spanish Flu was to its time. It appears to have disappeared from their archives, but fortunately I quoted it in its entirety to another forum at the time. See here: http://www.xent.com/pipermail/fork/Week-of-Mon-20051003/038059.html http://www.xent.com/pipermail/fork/Week-of-Mon-20051003/0380...
  - forkqueue 18y ago
    Given that the geographically concentrated swine-flu related death toll is already over 81, this doesn't provide compelling evidence that 'most deaths will be from human response as opposed to the pandemic itself'. TV news stations will of course hype this thing beyond all proportion, as they always do, but that doesn't mean the threat isn't real and that, as the article suggests, the death toll from Swine 'flu itself won't run into tens if not hundreds of millions.
    - gojomo 18y ago
      I wouldn't suggest that overreaction necessarily kills more than the disease itself. (Your quote is from another poster.) But I did want to share one example where it clearly did, to show it's not impossible.

rms 18y ago

Anyone know an online pharmacy stocking Tamiflu? The one I know only has Symmetrel.

m_eiman 18y ago
According to what I've read Tamiflu won't do you any good. There's no vaccine for this strain yet.
- arrrg 18y ago
  Tamiflu is no vaccine but a antiviral drug. It doesn’t help with the current seasonal flu but it seems to help with the swine flu. Vaccines won’t be ready for months.

Herring 18y ago

The virus is an influenza A virus, carrying the designation H1N1. It contains DNA from avian, swine and human viruses, including elements from European and Asian swine viruses, said the CDC, which is already working on a vaccine. - http://www.reuters.com/article/domesticNews/idUSTRE53N22820090424 http://www.reuters.com/article/domesticNews/idUSTRE53N228200...

gojomo 18y ago

Oh, great. A disease panic, now accelerated by online social media and Twitter. This could be worse than the bird flu (panic) of 2004-2005! Despite the opening claim to being "fairly sober -- neither alarmist, nor dismissive", I thought the choice of emphasis here is somewhat in the alarmist direction, mostly making sure to mention how bad it could be. Examples: I expect it will go global in the next couple of days, maximum. The social breakdown in a pandemic is extraordinary. No-one knows how bad another pandemic might be in terms of mortality... single digit millions... 100M might be possible. ...you should probably not believe anything any politician says about pandemic influenza. So let me offer as a small counterweight the at-least-as-likely alternative scenario: flu deaths worldwide in 2009 will be about the same as previous years, around 40K in the US and up to 500K worldwide. At this point: eat well, sleep well, and discourage sick people from coming to offices or socializing. Same as always.

henryw 18y ago
the 1918 flu pandemic was worse than the black plague and it's not even airborne like this one. http://www.puertorico-herald.org/issues/2003/vol7n30/KillerVirus-en.html http://www.puertorico-herald.org/issues/2003/vol7n30/KillerV...
- gojomo 18y ago
  Neither of your claims check out. The black plague killed a higher proportion of the world's population, and the 1918 Spanish Flu was airborne, like other flus.
- tomjen 18y ago
  There are properly more people living in Washington DC than in Europe during the time of the plague.
  - gojomo 18y ago
    Not at all. According to Wikipedia, the population of Europe before the plague peaked at 70-100 million, while the plague killed 25-50 million, still leaving the population over 20 million, possibly over 50 million. The population of Washington DC is 592,000; if you include the metro area, 5.3 million.

jraines 18y ago

I always thought the W-shaped spike in deaths-by-age from the 1918 pandemic was due to it spreading rapidly in infirmaries and barracks full of already sick and/or stressed out soldiers.

Zaak 18y ago
Another possibility is cytokine storms:http://en.wikipedia.org/wiki/Cytokine_storm http://en.wikipedia.org/wiki/Cytokine_storm

pfaux 18y ago

"In conclusion, I’d say that the thing is largely out of our hands" But remember your mother's best advice : wash your hands and don't touch your face. http://www.cdc.gov/flu/protect/stopgerms.htm http://www.cdc.gov/flu/protect/stopgerms.htm

tjpick 18y ago
My mother's best advice was drink more water and get an early night. But yeah, both are good.

xel02 18y ago

This is actually a pretty interesting case as the virus is such an odd mix. For those who aren't aware Influenza has a multipartite genome (separated segments), I think we're pretty lucky this didn't show up during flu season in which case there would have been a very high chance of it mixing with another strain that easily transferred among humans but still resistant to antivirals.

ashot 18y ago

if the virus spreads as well in the real world as it does in the virtual one we're screwed

silentOpen 18y ago
Population variability and imperfect interfaces make that unlikely.

tlrobinson 18y ago

"Don't eat pork from Mexico!!" Sigh Surely this sort totally false information and rumors has spread verbally before Twitter was around, now we just have a permanent record of stupid things people say.

DanielBMarkham 18y ago

This is going to sound strange, but I love watching how people act on incomplete information. Some will fall back to observe-hypothesize-test. Some will ignore/dismiss all observations unless someone in authority tells them to pay attention. Some will make the most outlandish claims. Some will make false statements, like the "don't eat swine" claim, just to add momentum to the story. Of course there's no right answer in a situation that could be fast-moving yet requires immediate decisions based on incomplete information. It's just cool to watch all the different modes of thinking critically. I hope this story turns out to be bogus -- I have a job where I deal with hundreds or thousands of people in small meeting rooms. But I've read up many years before today, and I understand that the pandemic IS coming. It's just a matter of time. Just not this year, I hope.