I wonder if someone can explain why it is assumed this pandemic will happen in waves. I’ve done my reading on the 1918 pandemic, and a little bit of others, so I’m familiar with the history of that. Have communicable disease outbreaks always come in waves?
I ask this because medicine, and communication, and technology, have never been what they are today. In 1918 some were still using leeches, and the internet wasn’t even a dial-up bbs. Another big factor is air travel. So, can we count on the same human/social factors that would make a pandemic happen in waves? If pandemic waves happen solely because of human interaction, we ought to throw the 1918 model out the window. But are there other reasons, such as antigen shift, that would make the virus’ spread wax and wane?
Overall, I feel we’re so far away from what the world was in 1918, I think it’s a mistake to lean too heavily on that as our example of what will happen.
I’ve got to go read some bedtime stories now and then do some work, so I won’t be back tonight. Looking forward to reading anyone’s ideas about this in the morning…
Viruses mutate so quickly, that by the time a certain ammount of time/people have gone by, the virus is different enough that the first survivors’ bodies can’t recognize it, and can get sick from that new “wave” or “strain mutation”.
That’s why seasonal influenza shots have to be made each year from the recent strains in the previous hemisphere’s “flu season”. Pandemic doesn’t need a “season” but seems able to mutate and travel at any time.
Viruses haven’t changed how they live, and the fact humans now are travelling in webs all over the world every hour may only serve to help a strain lap itself, or, shorten time between waves, or, if two different continents on the globe spontaneously go pandemic, they may both be circulating at once; who knows what may happen? (In 1918, some places just happened to have waves run into each other; one place had influenza deaths for 6 months.)
Modern things like internet have nothing to do with preventing virus mutations, people will still transmit it. (And, even leeches still have their uses in modern medical practice now, how odd!)
I don’t see anything in 2006, nor human nature, nor “preparedness” that would prevent pandemic waves. There isn’t enough monitoring, nor medicine, nor boots on the ground to contain an outbreak at the wrong time in the wrong nation.
The world isn’t so “modern” sadly; ignorance about science still has places murdering scapegoated people when community members up and die because “someone must have hexed them”. Developed countries can’t even get all their citizens to wash their hands.
:-/
So, do you think our advances in medcine, organization, and communication, as well as maybe the first pre-emptive concerted effort to monitor the virus, will have no to little effect on it’s course?
Satago – at 18:54 1918 “some were still using leeches”
“Maggots and leeches make a comeback” http://tinyurl.com/zg98h
Maybe they were on to something??
Whatever advantages our “advances” give us will be more than counterbalanced by their “just-in-time/full utilization” limitations. And then when you add in the vulnerability of vast populations being supported in highly dense urban areas by a very brittle technological pyramid. Well, that is a recipe for disaster.
We have so much further to fall than all of the preceding generations who have ever experienced a pandemic.
More specific to your question, we are better at knowing of the problem than we are at solving it or containing it. If we have another four or five years, I think we have some kind of chance.
Indeed, it seems we’re just enough behind to be almost as helpless as the medical establishment was in the face of the 1918 pandemic. And, as MM says, with more fragile systems. And a potentially nastier virus.
If you are going to compare 1918 to now you also have to look at the fact that people are much more densely populated and a lot less self sufficient when it comes to food and water than they were then. In some ways we are worse off than they were.
My assumption (which may be way off base) was that say an area has an outbreak. People in that area isolate/cocoon for awhile. Anyone who might have gotten ill does, passes it on to those close by. The virus kind of runs its course within an area. Then, things improve and they start to venture out more. Somebody from another area could come into the first area and infect someone who didn’t have it the first time (say a guy delivering milk from Vermont to NY brings it in). That person reinfects the first area again.
Faulting thinking on waves? Any experts out there? I think that while the 1918 flu is a great teaching tool, there are important differences. We are more closely quartered, etc. and have air travel, commuting, etc. to contend with that we didn’t before. But, we also have better meds (Advil to reduce fevers) and the situation is so closely monitored now. Back then they didn’t relaly know what hit them until it was almost too late. And they didn’t know what they were dealing with. Let’s hope for a better outcome this time.
“So, do you think our advances in medcine,” [we have no vaccine for the public, and no way to make a pandemic strain vax quickly in large quantities, we have 3x the population we had in 1918, still can’t save all ARDS cases, and, medical systems are so full they are almost at collaspe now. Hospitals have not stockpiled enough personal protective equipment, nor any of the other things they’d need if deliveries stopped or if 1/3 the populace suddenly fell ill.]
“organization”, [I don’t see us so organized! and 1/3 those people may up and fall ill, too. Not the sort of emergency their plans are usually for, either. Contagious? Entire nation affected? Nothing like their normal disaster/emergency plans/drills. Whole populace would have to be in the know and preparing, which they aren’t.]
“and communication,” [still, even after 9/11 and Katrina, places do not have their communication problems sorted out]
“as well as maybe the first pre-emptive concerted effort to monitor the virus,” [watching it will have no effect on what it does, and they can’t even monitor it; countries like China and Myanmar, N.Korea, India, Indonesia; either the gov won’t disclose any info, or, no virus samples, no communication lines to know about outlying villages who need help, or, handles it themselves without “inviting” the WHO in to take charge of containment and monitoring…Now it is in Africa, where many nations have multiple problems and conflicts, and, no vets or doctors for the animal and people now; people die every day of AIDS and other problems and are buried the same day - their government may never have never known they were born and never knew they died. People can’t even destroy sick chickens where so many are starving that they will eat them.]
“will have no to little effect on it’s course?” [Afraid not. Wish I could be more optimistic, but, influenza is so contagious, and people so slow to change habits or take in new info; if the strain has a high attack rate, and it if stays virulent, in many ways we are less prepared than the more rural, more self-reliant, less populous, slower travelling people of 1918.]
What Medical Maven said, “we are better at knowing of the problem than we are at solving it or containing it” -the world is too populous and people too imperfect, to stop something like an influenza pandemic. Just the smugglers and other criminal travellers could undo an otherwise “perfect” response, and we already have H5N1 on whatever continent it wants; too many copies of the virus around able to work on a pandemic mutation if that’s what it is going to do. I don’t see such close monitoring even now, just attempts, that only work in the right places.
crfullmoon, well I guess we just disagree, which is no problem really, a healthy debate. We could go back and forth all day on the things that have changed for better and worse since the last pandemic. Ultimately they’ll probably balance it out - i.e. “overpopulation” negates “mass produced masks instead of sewn together rags”. I agree with you about things like “people are slow to change habits or take in new info” (unless it’s about thier fave movie star), but I’ll balance your example of the poor communication about Hurricane Katrina with the Flu Wiki itself. As far as I understand it, one of the reasons this Flu Wiki exists is to help us all prepare ourselves and others. Where you had one person who may have succumbed to the flu because they didn’t know about it, now that person may survive the pandemic because of some information they got here (even from you or me!). So, I think that’s a good example of how communication can affect the course of this virus.
Your first paragraph about why we would experience a pandemic in waves was spot on enough reason for me, by the way.
And I’ll also use Medical Mavens words about “we are better at knowing of the problem than we are at solving it or containing it”, and say that it’s corny but true, knowing is half the battle.
Please don’t misunderstand, I’m not expecting deus ex machina.
NW -
Okay. So how do we know when the first wave is passed, and it is safe to go out and restock? Given this is probably a local question that we can figure out for ourselves, will just calling around and checking on neighbors be enough..assuming we can call around, and that our cell phones still work. Remember, a fully charged cell phone will work to call 911 even if it’s not in service.
I think, a wave is over because everyone has already been exposed. So, when you had isolated and come out weeks after the wave died, you can still get it.
theres a cheery thought :(
I just finished Barry’s book and one thing that struck me was the extreem speed at which the 1918 flu spread. “Wildfire” Amazing how it leveled cities in a matter of days. Yes, gov’ts were trying to cover up what was going on so people didn’t really understand their exposure until it was too late. And I knew influenza was highly contagious but I didn’t realize hom much so until reading the book.
But, back to waves. I could be remembering this wrong from the book, but I beleive that cities that were hit the hardest in the first round fared well in subsequent rounds because most people either had it or were exposed to it so they had immunities. Other places that managed okay the first round were hit harder in other rounds because not enough epeople had immunities (San Francisco was praised as one of the cities that was open with its citizens but had many deaths in subsequent waves). It is also possible that mutations played a factor in subseuqent rounds but we don’t have the mdical data to back that up.
No matter what the cause of waves the reality is they will happen. Even if more people being preppeing they likely will only prep for a few weeks and will have to go out once the first wave subsides, only to risk being exposed later.
I would still like to know about examples of other pandemic or even epidemic waves in more recent times. I seem to always hear about the waves of a pandemic in conjunction with “the 1918 pandemic”. I realize that there is the physical factor of the virus itself mutating that contributes to some degree to the wave phenomenon, but I also suspect that social and technical factors play as great a role and may offset the wave phenomenon in places. Individual communities are not as individual as they were in 1918, anyone from anywhere could get there in less than a day. Quarantining and releasing out of step with the surrounding communities could affect it, couldn’t it? And you can’t base your asumptions on how people are behaving today, you have to factor in how they will be behaving during a pandemic, right? Sorry, I’m just not satisfied with the reasons that I’ve heard that explain the phenomenon of waves. They are always tied to what happened in 1918. Are waves caused mainly by the virus itself, or the behaviour of the host?
http://www.andypryke.com/pub/InfluenzaPandemic
1729 −33 Pandemic. Reported as originating in Russia in April 1729, it lay low over the summer and re-emerged in Sweden in September, Vienna in October. In November it spread across Europe, not reaching the Americas till 1732. Deaths were “most numerous amongst the elderly and pregnant women”, and later waves were more severe [2][1] “Relatively low Mortality”
1781–2 Pandemic. The first wave started in North Africa and North America in 1781. A pandemic wave started China the next year, and swept across Europe and the Americas during the summer. Two thirds of the population of Rome became ill (7). 10′s of millions were infected [2]
1830–33 Pandemic. Spreading out from China, waves hit in 1830–31 and re-occur in 1832–33. The infection rate is high(20–25%), but mortality low
1889–1890 Pandemic. Originating in central Asia, it followed a familiar path through Russia and Europe. The first wave was relatively mild, with low mortality, the subsequent three waves were more severe. Reports from Iran identifies high mortality amongst children, and infection rates of up to 50% [1][5] ~1m H2N2
1918–1920: Pandemic. The “Spanish flu” kills 50 to 100 million people, equivalent to 175–350m given today’s population[4]. As noted in the Momus quote above, it kills more people than World War I. Movements of US and other troops help spread the virus. It is thought to have originated in the United States in Feb 1918[8], or perhaps a year earlier in France. The second wave (Autumn 1918) was much more lethal, with unusually high mortality rates especially among young, otherwise healthy adults (see graph). This may have been due to an over enthusiastic immune response damaging the lungs[3]. Symptoms include “the most vicious type of pneumonia”. Within a few hours Cyanosis has appeared, and after another few, death. 50m - 100m [4] 2.5% + H1N1
1957–58: Pandemic. “The Asian Flu” originated in China in February 1957, it spread across the globe in 6 months. A second wave emerged across multiple countries in early 1958, with differing severity by region. About 40–50% of people were infected, and 25% to 30% experienced symptoms. [7] > 1m H2N2 [3]
Also, I just think of this year and my kids’ school as an example. Before February break there a nasty stomach bug going around. Kids and teachers were dropping like flies. During the week long break, when kids were only exposing their families to it vs their class or the entire school, the school disinfected everything (or so the school nurse tells me). As soon as school started back up again kids start puking (inclduing all three of mine who never got it the first time). Granted one week is not very long, but it shows that those who escape the first round can still get it later if the virus is still present around.
Excellent! Thank you I’ve been looking for something just like this. I’m still going to have to be skeptical about the wave phenonomenon (although I secretely believe there will be waves, because nature is for the most part reliable), I still haven’t seen a reason other than *past occurances* for a pandemic happening in waves. If I flip a coin ten times and it comes up heads every time, what’s to say it will be heads on the eleventh toss? And what about 1968 flu (Hong Kong Flu?)? That would be a more accurate reflection of todays society. But still even then there weren’t the same aspects to that as there will be to this. Travel and social interaction has changed greatly in the past 30some years. The basic question is still What is the greatest cause of the wave phenomenon in pandemics, the virus itself or the host reaction?
lauraB, I’m also the parent of a preschooler, and know what you’re talking about. I think you give a great example of the social factor of waves, that the second wave was caused by school starting up again, not necessarily the virus itself.
BTW, we all had that puking stomach thing too. Awful!
Good finds, gs.
Satago, I guess I still would say the same things I did in my previous posts. We don’t hear anything clever from the powers that be, either, about any technical nor social factors in place to control transmission by effective quarantine. Don’t think they can; too many of the public to keep in line. Medicine will be overrun by sheer numbers and lack of supplies and reliance on electricity continuity, and Communication sounds good, but we still muck it up in disasters; we see plenty of examples of that. The public is not prepared to be Quarantined either (let alone “released in any helpfully coordinated way); you can bet they’ll be out looking for tobacco and drugs and food by the end of a week, at this rate.
Viruses mutate quickly enough to have different waves with different effects. (Especially with so many new hosts to mutate in during a pandemic.) Now we have so many mammals, as well as an over-abundant supply of humans, H5N1 can effect; no one knows what may happen, but I don’t see containment going to be successful -that old, Humans would have to do everything right in every instance, and the virus would only have to be right once.
crfullmoon, I agree that there’s no way the gov is going to be able to control it and oddly they seem to be able to admit that themselves for once). It isn’t the “control” of the virus that I’m looking at, if I believed that were possible we could do better at setting up a scnario where we could judge the waves. Instead, our inability to control it *combined with modern advances and strange missteps using those advances* that could throw off the whole idea of a pandemic happening in waves. We are more aware of this pending disaster than we have ever been, that in itself -not our ability to succesfully use the knowledge- makes this different than other instances. I know we’re all not prepared for it, or well equipped mentally to handle it, but “things” have changed more in the past 30 years than ever before, and that has got to skew things.
Still, the biological aspects of mutation and infection among different species does a lot to help me see why waves would happen.
Laura, I don’t feel confident that our medical treatment today will put us at a significantly greater advantage than in 1918. Even seasonal flu is not “curable” once it is contracted. We give palliative treatment such as aspirin, tylenol & ibuprofen primarily for patient comfort. These drugs reduce fever but we still are not certain that reducing fever is an appropriate goal, since fever is the body’s mechanism for fighting infection. Excellent nursing care as well as IV fluids for dehydration could improve survival rates if we could devise a way to treat the large numbers of patients at home. Unfortunately there will be large numbers of people who need ventilators who will be unable to access them because there simply are not enough ventilators available. Anti-virals are available today and they may prove to be a life saver for many but I personally am not counting on it. They must be given at an appropriate time and in doses that we still are not sure of. In my experience thay are not always effective even with seasonal flu. I think, like in 1918, it will be sheer luck whether one becomes a survivor or victim. As individuals, the best we can do is prepare ourselves and familes to at least be ready to weather the disruptions in everyday life that are bound to occur so that we can focus our energies at that time on those who are ill rather than the frightened and ill-prepared healthy individuals.
I agree DeLucca. There certainly won’t be any ways to “control” this if it goes H2H - that is one thing that really struck me in Barry’s book was just how quickly it spread. Without the ability to intibate thousands and thousands of patients on ventilators, we are ony somewhat better off than 1918 (althought if antibiotics are accessible that will help with baterial 2ndary infections). I put no stock in antivirals - I can’t get them, it’s not clear if they will help, and many people who do have them may take them inapporpriately/at the wrong time. I too am doing the best I can to prepare and after that it is more or less out of my hands.
The basic question here is how do we know when its safe to go out again. I dont know if we can come up with any hard and fast answers. But my opinion is once we are well past the seasonal flu season Ill venture out to restock. Watching this virus and comparing it with the regular flu it does seem to follow the flu season model. Viruses dont seem to spread as well in the summer months, for various reasons.
You assume that there will only be 2 or 3 waves. This stuff infects everything including fish. There are at least 4 human strains now. What if this just keeps going and going. We need a backup strategy to live on an alien planet.
Is it possible to change our DNA to be not vulnerable to influenza. Change the lock on the door. How about a blocking drug that plugs the lock. Lets have a blue sky discussion.
Would it then be likely that the more primitive (or self-sufficient) a society, the more likely they are to successfully survive H2H waves?
It makes you (almost) want to run out when the first wave hits and get ill, with the hope that you might develop an immunity to the next waves. Providing you survive the first hit.
I am assuming that nearly everyone was exposed in 1918 and was in 1 of 3 categories; never came down with if for some reason, developed an immunity because of contracting the flu, or died from it.
Today, the concept seems to be th hole-up until you are somehow notified that a cure has been found. But might not that be a forlorn hope if you do run out of supplies and exit just in time to get smacked down by wave 2, or the still present wave 1?
3L120, yourlast paragraph might explain why “waves” might not actually happen or be less than some anticipate. The fact that people are now (granted not many but certainly some, like you and I) going to “hole up” and then come out at a certain point. That is going to affect the characteristics of a wave.
Waves can be landing on a shore pretty much the same way for thousands of years. One day someone or something decides to build a reef, maybe to prevent erosion that is threatening thier beach house. The waves will change at that point. They won’t go away necessarily, but they will suddenly be much different than they had been. Surfers who had been coming there year after year will now have to change thier plans. Can you see the analogy?
I still hear everyone talking about pandemic waves as if they are a foregone conclusion. And I wonder how many individuals and communities, of those that are planning, are planning figuring “Ok, the first wave will probably last X weeks, the second wil be maybe stronger/weaker and last Y weeks, etc.”, and basing that mostly on what happpened nearly a hundred years ago during a world war and before air travel or Flu Wikie.
As a Landingcraft Coxswain in the US Navy many years ago, and being blessed with never having to beach my craft on a hostil shore, Let me say that the words of one of my Instructors at Assualt Craft School ring true in this situation. “If you’re in the first wave, and you can get your boat off the beach….. Ya got it made. the rest will be a piece of cake”. I believed that. I lived by that. Until I saw Saving Private Ryan, and watched the first wave of assualt craft decimated by the German MG-42′s. If you survive the first wave, BELIEVE me,you’ve got it made.
In a report on the Los Alamos pandemic simulations, there was some difference remarked on, in the pattern of waves due to current air travel. The statement was “the infection would be reseeded frequently”. Interpret that for yourself. There may be less defined waves.
Influenza, at least eventually goes to a ‘typical’ level of virulency, as the most successful spreading strategy, since the selective pressures are about spreading, not killing. Only in close quarters does fast replicating speed succeed over longer infectious and hence spreading, period. Tho speed is only one factor in overcoming the immune defense system, virulence comes from different effects. Maybe when it mutates it will trade off some of it’s deadly talents. Two/thirds of pandemics may be in the ‘not too bad’ category. So when it’s safe to come out may depend on what you hear the death rate is on the news. (If you’re not receiving any news, that could be a bad sign) By the time vaccines are available for the common folk, the worst will probably over.
It’s interesting that each new pandemic flu replaces the previous strain that was in common circulation. After 1918, H1N1 became the dominate strain, then after ‘57, H2N2 became the common flu, then after ‘68, H3N2 became the common flu strain. So whatever new strain emerges, it will not be going away, so much as just normalizing.
Influenzas in the wild bird population also don’t just go away. For the 60 years they have been looked at, the same avian viruses have been around in a stable relationship with waterfowl. Ducks have a 50% population replacement rate yearly, so there’s always a new generation of hosts. The HPAI H5N1 strain is very rare to find in wild birds right now compared to the usual influenzas in birds, so it still has room to grow in the population.
Older thread, closing for speed purposes.
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