Okay, I hate to be the snarling curmudgeon (okay, maybe I like it a little) but I’m going to be stubbornly skeptical of the latest infectious disease scare: the new strain of Swine Flu that has so many people I like and respect (including normally level-headed Instapundit) just a bit too serious, at least to my eyes. Having seen wave after wave of hugely exaggerated concerns over new infectious microbes that turned out to be pretty much insignificant to the vast majority of people in the United States–and most of the rest of the developed world–including West Nile, SARS, Ebola, Mad Cow, Avian Flu, and now the latest strain of Swine Flu (Swine Flu, which hasn’t killed a substantial number of people in about 90 years), I hereby propose Esmay’s Rule of Thumb:
If a newly trumpeted malicious microbial agent is announced as a potential threat, no one but scientific specialists should fret much about it unless it has killed more people within in the space of one year than lightning strikes.
Can we measure this? Why yes. here’s a handy bunch of data compiled by the National Oceanic and Atmospheric Administration for the United States. It uses the years 1959 to 1996, which is probably an adequate sample, and since this isn’t an official research paper let’s just go ahead and hazard a guess that these numbers will be pretty close to what Americans will see in 2009.
So. Let’s put this immediately to the test:
If we assume 2009 to be a fairly typical year, then we should see 5-6 Americans dead by Zeus’s mighty throwing arm by the end of April. By the end of July we should have seen a cumulative total of roughly 60-70 Americans bug-zapped, and by the end of December we should see a total of 80-100 Americans taken out by Thor’s Hammer.
Now, I am willing to put a macabre bet out there: I’m quite poor and underemployed at the moment, but I’ll wager any one person exactly one dollar that Swine Flu will not have killed more than 6 Americans by the end of April, will not have killed as many as 60 Americans by the middle of summer, and that by January 1, 2010, Swine Flu will not have killed more than 100 persons nationwide.
In other words, based purely on my observation of previously trumpeted dangerous new infectious agents over the last couple of decades (Avian Flu, Swine Flu, SARS, Mad Cow, West Nile, Ebola, etc.), Swine Flu will not manage to kill even as many people as lightning–and that both lightning and Swine Flu combined will be an infinitesimally small number compared to everyday, run-of-the-mill flu and pneumonia, and other much more common and much more frequently lethal pathogens.
I do propose, however, that if I win my dollar, someone besides me in the blogosphere will start a serious discussion as to whether we are spending our dollars, and our attention, in a proportionate, sensible, responsible way on infectious disease prevention and research. Both in this country and outside of it.
One important caveat: no ginning the data by conflating third-world regions with what goes on in the United States or other parts of the developed world. If you want to bring in other regions, you have to bring in THEIR rate of deaths for rare things like lightning as well–and then, hopefully, compare them to things that are actually killing lots and lots of people there, like diarrhea.
The truth is, people in desperate poverty die in horrendous numbers of things like malaria and cholera and dysentery and malnutrition and a whole lot of other things that have been all but eradicated in the developed world. Trumpeting that there are 200 people dead in “Asia”–a continent that covers hundreds of millions living in desperate poverty–means nothing until you compare it to the MILLIONS who die there every year of common infectious agents, or mundane things like floods or being run over by trucks. If you’re going to bring in other regions, you need similar measures of other common and uncommon problems in those areas before you convince us that your brand new pathogen needs immediate worldwide attention and rapid response.
Furthermore, we should not be surprised that people living in areas with poor sanitation, poor access to medicines to fight secondary infections, poor access to clean water, poor access to doctors or even decent nursing care, and living most of the year with inadequate nutrition, actually tend to get sick easier!
Do we seriously need to sit around scratching our heads wondering why extremely poor people–such as, just to pick a random example, most people in Mexico–have lower lifespans and pick up new infections more quickly than your average American?
(And, will someone please suggest this to David Dobbs and Professor Reynolds? I need to get to bed.)
Anyway, to get back to my bet about exotic microbes such as the latest super-scary version of Swine Flu (which hasn’t killed much of anyone yet): If we’re talking about the United States, you have to play by my rules. Put up your new pathogen that’s more dangerous than lightning strikes, or shut up, keep your nose in your microscopes and your epidemiology charts, and come to the rest of us when you’ve got solid data justifying real mass fear and immediate global response. Is that an unfair request? I don’t think it is.
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I agree with you, Dean. There’s far too much speculating being done on far too little evidence.
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We have no baseline for Mexico. There have been something between 20 and 40 confirmed deaths due swine flu there with 150 or so reported deaths, the majority of which have not been confirmed with tests.
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Mexico is a country of 110 million or so people. 150 deaths and 1,500 reported cases doth not an epidemic make.
well said, Dean. I’ve put in my own two cents worgth (with some linkage here) over at COB.
I have to say, Dean, I was pretty amused yesterday when reading one article about this that stated that officials were confounded as to why the same strain of swine flu was more deadly in Mexico than the US.
Really ? I’m pretty sure that the average Mexican citizen, when actually seeking medical attention, is MUCH closer to death than when the average American goes to the doctor.
I don’t have any idea whether this particular virus is going to turn out to be a really big threat. Most true experts are still withholding judgement until more numbers come in.
I will note, though, that public officials are in a pretty big bind when it comes to potential threats, be it epidemics, hurricanes, terrorism, what have you. They’re pretty much obligated to act BEFORE it can be definitively known whether or not a given threat is going to be a big problem. Evacuations have to be implemented before hurricanes hit, leaving open the possibility that a hurricane will spin harmlessly out to sea, leaving hundreds of thousands of people inconvenienced for what turned out to be nothing. If we wait until the terrorists are definitely a threat, they’ve, well, flown aircraft into giant buildings; if we catch them ahead of time, we’ll never know if we’ve wasted money that could have been better used in conventional law enforcement. To effectively contain an epidemic, the WHO has to act before the potentially dangerous virus is widespread in the general population, and yeah, it may turn out to be no big deal – but we’ll only know that later. At which point, if it IS a big deal, it would have been way too late to react.
Sometimes it seems to me we blame public officials for not being omniscient, or at least precognitively clairvoyant. If they take measures before a threat that turns out to be nothing, we’re mad because they’ve wasted our time and money and energy, both physical and emotional. If they take a wait-and-see approach and it results in deaths, we accuse them of being criminally negligent for having waited so long. Unless we expect them to guess correctly every single time, we’re going to have to deal with the possibility that sometimes we mobilize for threats that don’t warrant it. Most fire calls aren’t five-alarm blazes, but that doesn’t mean I want the firemen to wait until we’re absolutely sure that the building is entirely ablaze before they show up.
In this case, there’s reason for concern, and the health authorities are reacting to that concern. Is it going to turn out that this was the second coming of the Black Death? Probably not. But if you wait until you’re absolutely sure that a illness is deadly and spreading, there’s fuck-all you can do about it, so I’d rather they react, in a measured way, now.
Deadrody: Good lord, I was literally STUNNED when I read that Slate piece by David Dobbs. He’s obviously not a stupid man, but seriously? Not a single thought about the differences in sanitation, adequate nutrition, and decent medical facilities between the two countries?
It’s not just Dobbs though. Look at all the talk about the 1918 epidemic: it’s like no one ever contemplates what conditions were like in 1918. This was the height of the largest war the world had ever seen. At a time when most of Europe and the United States was very, very poor by modern standards. The state of sanitation, nutrition, drinking water, and just plain decent nursing care were exceedingly primitive by modern standards.
Hint: In 1918, most people did not have electricity or flush toilets. Just for starters.
Little things like clean water, decent food, a warm bed, sanitation, even Lysol and laundry service, go an awful long way toward helping you fight off a nasty bug. And those are all things most people didn’t have in 1918.
I have to dial back my agreement with you , Dean, upon reflection. I agree with Elizabeth – theres a valid reason for a government and WHO response right now. Its analogous to the old saw about the guy with a banana in his ear.. “because it keeps the alligators away”. There aree no alligators, you point out, to which he responds “see it works.” the logic is irrefutable, but at least with global pandemics we do have precedent. The 1918 pandemic was some Serious. F^cking. S4it.
That’s fine Aziz. For the record, I don’t have a problem with the current response I’ve seen so far from the authorities. To a large extent, they’re just doing their jobs.
However, does that mean you’d like to take me up on my wager? Or you, Elizabeth? I’m on record predicting this, and I’m pretty sure I’m not putting my neck out: this latest Swine Flu will not kill even 100 Americans.
And I believe we have two real problems: first is too much press hysteria, yes. But this also points to a bigger question: of all the human and other resources we put into researching new and exotic viruses, or new versions of existing viruses, could we be devoting more of those resources to things which might actually save more lives? New exotic beasties are exciting, but are we really devoting our limited resources to them in a sensible way? Yes they deserve some of our resources, of course, but I really don’t think we are focusing our attention where it matters most, for now OR the future.
And, I’ll repeat what I’ve said about 1918: it was serious. It happened in the middle of the biggest war in world history (at that time), with massive damage to what little infrastructure there was, and huge population dislocations. Even in the United States, where millions of young (and not even all that young) men were being shipped across country packed into railway cars and in the back of horse-drawn wagons, then packed like sardines into primitive boats and shipped overseas. At a time when Europe and the United States were not electrified, when horses were still a primary form of transportatation (and horse feces and urine were an everyday pollutant on the streets), when sanitation and medicine and nutrition were ALL at what today would be considered third-world standards.
You would expect infections to spread like wildfire under such circumstances, and even young adults to frequently have compromised immune systems.
I would also point out that STILL, TODAY, if you just look at what malaria does, we’ve had an ongoing epidemic of that that makes the 1918 plague look tiny. We just don’t have the malaria plague HERE, although we used to. Malaria used to kill massive numbers of Americans. Just not anymore. Because we have such excellent sanitation, medicine, nutrition, etc.
It’s foolish to look at 1918 as if it were nothing but a superbug that swept through and all by itself killed tens of millions. It had help. Lots and lots of help. And the tools to fight it were pathetic by today’s standards–amounting to little more than “get under a blanket and hope for the best.”
We should stop putting all our concentration on just the specific microbe. We really should.
I mean, why aren’t we scared of a “Super-Malaria” sweeping through the United States like Regular Malaria used to in the good old days? Is it just because malaria isn’t caused by a virus?
Press reports have said something like 1600 infections in Mexico and ~100 deaths. That is a high rate of deaths. If this were true, it would be a pretty lethal strain. However, I doubt that it is true. There almost certainly are far more than the 1600 infections reported. Could easily be 10x or more the number of infections, so the death rate is probably lower.
Flue normally kills very young children and the elderly. In Mexico many of the deaths have been young, otherwise health people. That would indicate a more lethal strain than common flue.
So I think this is something to be concerned about, but not time to panic.
Well, I don’t mind risking the buck, but I’m not sure it will mean what you seem to think it means if you win the bet.
For one thing, a lot of those other health crises that “came to nothing” also had substantial efforts put into them by the health organizations of many nations. I don’t think you can logically conclude that -> -> means that the outcome of ‘few casualties’ was preordained and the effort was unnecessary. To use my fire example again, that’s like saying that you called the fire department when you saw smoke and they doused your house with water, but it was all wasted effort because, look, your house didn’t burn down anyway so the fire couldn’t have been a big deal.
Take, for instance, your example of malaria in the US, which is deeply ironic. Did malaria just softly and silently vanish away as we all learned to wash our sheets and stop eating nothing but cornpone? Nope. During the late forties and early fifties there was a massive effort to spray mosquitoes, put screening on structures, and take other efforts to control mosquito habitat and malaria transmission. The CDC was actually formed out of an organization that had malaria control as its primary purpose. It worked (primarily because of DDT and windows with screens on them), which is great, but it’s not exactly a great example of how diseases pose no threat to us healthy modern people and there’s no need for us to make any effort to fight them. When a healthy modern person nourished on Whole Foods organic fodder travels to an area where malaria is endemic, they’re not protected by their intrinsic healthiness or endangered by their sudden proximity to horse manure or primitive boats (seriously, WTF?), they’re endangered by their proximity to malaria-bearing mosquitoes. And, not surprisingly, they get it.
It’s true that we don’t have the massive troop movements of 1918, but people are packed equally sardine-like into commercial airline flights daily in the modern Western world. The whole point of the current effort to contain the swine flu is to identify people who have it, limit the transmission of the disease to others as much as possible, and treat those who do have it with modern drugs. If thousands don’t die in the US of this flu variant, is it a testament to our general modern healthiness and lack of horse poop in our streets, or is going to be due to the specific facets of our modern approach to disease and lessons learned from historic epidemics (quick identification, quarantine, treatment, rapid vaccine development) applied properly and promptly? In other words, from devoting our resources to taking the threat seriously.
This is almost off-topic, but because this particular strain has a 1-3 day incubation rate, I’m thinking it’s close to becoming a non-story. Had the guy in Kansas paused to attend a mixer for his local Chamber of Commerce or something, on his return from Mexico a lot more people might be sick. Instead, he went straight home. Good guy!
We’re also beginning to think that many of us here in SW Arizona have possibly already had it. There was a just awful flu circulating around the Marine base and in town, right before and after Xmas and the New Year. My husband and I were sick for the expected 7-10 days, and my husband never seems to get any of this stuff. Lots of Marines and spouses were also sick, but very few children.
I had several infections to complicate issues, so that’s what my doc focused on. My husband relied on liquids, etc., and getting as much sleep as possible. He did not see his doc. The upshot is we never had a flu diagnosed. But now we wonder…
To condense my point, because upon re-reading I see I was a little, um, wordy…
How can we tell the difference between public safety measures working versus public safety measures being unnecessary?
Mikeca: thank you very much for directly addressing the data and the conclusions I have drawn from same.
Seriously. That is not a joke. No sarcasm. Thank you. I appreciate you: full stop.
Now, I challenge you respectfully: we ahve approximately 1,600 infections and approximately 100 deaths in Mexico. Which yields us about a 16:1 infection-to-death ratio. There are two questions that spring from this:
1) What is the normal infection-to-death ratio of the average Mexican who shows up for medical care for any infection? This is not a joke, it’s a serious question.
2) How does this compare to the normal range of flu mortality IN MEXICO?
These are, I think, fair questions, yes? Have I planted some sleight-of-hand trickery into these questions?
I’m not being sarcastic. At all.
Elizabeth: Well I’m still waiting for someone to take my bet, but your conditional response basically means you aren’t accepting. Which is fine. A responsible scientist would not take the bet. And by the way, just so you know: I love you. I really do. No, not in some sloppy stupid Internet way, but because you’ve got a mind like a steel trap and you have low tolerance for bullshit. I love that. Just so you know.
Anyway, I read your last very carefully, and if I’ve distilled its essence properly, I think this is a fair response (and let me know if I’ve missed anything):
You (and Aziz and a few others) are asking me (and the peanut gallery) to accept the hypothesis that the lack of a recent 1918-like result (millions dead from the Flu) is due PRIMARILY to the brave action of public officials trumpeting that they’ve recently found a new strain of a mundane pathogen and whatever the fallout is from those results. As opposed to the result of great institutional work over the last half-century-plus in making sure that we all have clean water, decent sanitation, ample information on what kills babies and old people, safe and nourishing food, and all know to bathe regularly and wash our clothes regularly.
Seriously, that’s what I see. I mean, NONE of what I just noted was normal advice in 1918.
And also, by the way? Comparing the way men were packed like sardines into freight trains and the back of horse-driven wagons in 1918 to what you see in an airliner? Seriously? Dude, the way men were freighted across the U.S. in 1918 was more akin to what the Jews underwent on their way to Auschwitz. Except they were actually fed and allowed water and bathroom breaks. Also, in that era, that was the FIRST TIME most of those guys had travelled more than a few miles from home. Again, we’re talking massive population dislocation here, for people who’d never travelled more than 10 miles from home before. Nothing like it had happened in the U.S. since the Civil War at least.
And by the way, taking a population that has never travelled more than 5 miles from home before, and suddenly shoving millions of them together at once? What do you think THAT would like like, in terms of infection vectors?
These aren’t flip questions I’m asking. I hope you respect that much.
Trudy: I love you too by the way. ;-)
But just to respond to what you said: bully for you for tracking what these government officials are saying. In fact, I’ll say it now: if you were to raise these impertinent questions I’m raising, I’m quite certain they’d never invite you to attend another conference call ever. :-)
They’re paid to be Very Serious about The Latest Virus. And that’s no slam on them, it’s just what they’re paid to do. Just like if you attend a conference with a Fire Marshall, this Fire Marshall will want to talk to you about all the latest Fire Safety issues that his Firemen have noted lately. Which is damn well what he should do, otherwise what’s a Fire Marshall for?
But, the Flu kills tens of thousands every year. Telling us you’ve got a new strain of it that’s killed almost 80 people in Mexico is–and I’m not being sarcastic–like telling us that there was a recent hotel fire in Mexico that killed 80 people. And that hotel has certain features that look sort of like certain buildings in Arizona.
It’s not that he’s doing anything wrong. It’s not that he’s an idiot. There is no conspiracy. The question is, is my house, or the local Holiday Inn, likely to suffer the same result?
I’m not being rude. Influenza kills tens of thousands in the U.S. every year. We should all work to minimize this. The question is: how is this latest strain of “a particularly nasty flu virus” different from all the other flu viruses that we all see every year?
Again I’m gonna say, they’ll probably just get pissed. It’s almost unfair to them to even ask, because they’re paid to be Very Serious about This Latest Development. It’s like asking a cop “How Is This Latest Murder Different From The Last Murder You Investigated?”
They don’t deserve that. They really don’t. The real questions have to be asked at a much higher level. Although if you pose it to them that way, they often have really smart things to say that no one pays attention to.
Well, you know what, I’m actually beginning to wonder how much of this disease reporting is a smokescreen for something else. Obviously, I’m no epidemiologist, but shouldn’t there be hundreds or thousands of people sick by now?
This is not flu season anymore, tho it is, I think, big for allergies. So people are jamming the ERs all over AZ b/c they don’t know what they’ve got. I’ll wager it’s the same in other states. I don’t know how it is elsewhere, but even though I have a regular doc, I can’t see her when I’m sick and am usually referred to urgent care or our 1 local ER.
Actually, those conference calls are pretty much open to any press. I can’t claim any special status, just paying attention on Twitter. What I’ve observed is that the person being interviewed has rather limited knowledge of the issue at hand. One rep of a scientific publication (I didn’t catch the name) had a really detailed question regarding specifics of the disease that the doc in charge apparently could not answer. I wish I’d written it down, b/c I understood what she was talking about and was surprised at the lack of an answer. (I was thinking it was more related to info docs would need)
So as far I’m concerned, it’s becoming a real puzzlement. ;>)
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