Continued from here
Tom DVM – at 23:54
Bronco Bill Thanks.
anon22. I have looked at all three references that you cited at 19:23 but they are only abstracts…so I can only give very general impressions and not an indepth analysis of their data.
1) Strategies for mitigating an influenza pandemic.
2) Strategies fo mitigating an influenza pandemic.
With all due respect…he’s joking…right?
Did these people not study the history of H1N1 beforehand or are they talking about a 1968 type pandemic only. If they would like to model the outlier on the mild side (1968) and ignore the outlier on the virulent side(1918)…more power to them but the study is then rendered pretty much useless.
They have been trying to contain this monster (H5N1) for ten years…how has it been going so far?
3)Influenza in Seattle families 1975–59.
Last time I checked, I do not believe there was a pandemic in the years 1975–79.
No matter which strain or subtype of flu during those years, there was inherent immunity to all of them…so attack rates etc. are prejudiced by the background immunity…some individuals would not get the disease because they were immune or partially immune to that strain…
…Now fast forward to 2006. There are no asymptomatic infections, there is a very high CFR which is an indication of the uniqueness of the virus…in respect to immunity…
…The bottom line is the 1975 study has no relation to a pandemic strain (by definition…no inherent immunity) and shouldn’t be used by regulatory agencies and governments to cloud or downplay the issue.
If H5N1 becomes pandemic capable…which now seems only a matter of time…the best we can expect is between 5–15% avoidance rate. Those who avoid it during a time period will be infected by the virus at some point later…leaving at best probably 5% unaffected.
Tom DVM – at 23:56 \\ Sorry, 1) should have been Strategies for containing an influenza pandemic.
01 September 2006
Monotreme – at 00:05
Tom DVM – at 23:02
I would be afraid that the Monotreme, a little furry critter is the one spreading the virus in Indonesia rather than humans…and that furry critter is a mammal like us.
Hey Tom DVM, don’t blame us Monotremes!
No reports of H5N1 in Monotremes yet ;-)
Tom,
“With all due respect…he’s joking…right?”
Well, he is a modeller, so he’s got a right to play around with his models. A lot worse papers have been published than his.
But the ethics behind what he tells policymakers is a different story. The limitations of modelling are all in his papers and especially in the even thicker supplementary material (I believe 17 pages for one of the papers, took me a long time to read them), but he does not translate those limitations into English.
I’ve listened to the guy and he manages to make everything very believable. Therein lies the problem. It’s a very esoteric science, and not many people are capable of seriously rebutting his ideas.
The biggest problem with Ferguson is not Ferguson himself, but the fact that his containment modelling is being waved around in substitution for real pandemic mitigation policies, especially in the UK.
As you read from my ‘Social Distancing’ Thread, I’m not against strategies such as reducing social contact, but I’m against the word ‘containment’ because that makes people believe erroneously that it is possible to contain a flu virus.
Having said that, his modelling of how a pandemic virus might break out and then spread is extremely useful to read and learn, not necessarily to believe in his numbers, but it’s highly educational to think through the many considerations.
“They have been trying to contain this monster (H5N1) for ten years…how has it been going so far?”
To be fair, that is not what they are talking about. The prior efforts have had to do with avian outbreaks, now we are talking about what can be done at the beginning of a human pandemic. Even though I don’t believe his model works, I do think one mustn’t be too skeptical and should stay willing to explore everything that is presented. So we shouldn’t judge mitigation measures for a human pandemic in the West based on the success or failure of controlling avian outbreaks in Asia.
I quoted the paper on “Influenza in Seattle families 1975–59.” to answer your question of where they get the 50% symptomatic idea. I have read other references which I don’t remember now where they do similar surveys of family groups or closed groups in institutions and find that the number of seropositive cases is about twice the number of symptomatic cases in most instances. So there is some basis for using 50%.
Of course, none of this means that H5N1 will behave in the same way. But prior data, however inaccurate, still gives us some idea of at least the range of possibilities and likelihoods.
As I said, one mustn’t be too skeptical. Everything involves hours of trawling through data. :-) You never know where real solutions might come from.
This was my response to Monotreme last night. I thought I would add it here…thanks.
Monotreme. I am only following tradition…
…In the olden days, they would name the disease or syndrome after the discoverer…that makes the furry mammal a Monotreme.
annon 22.
I thought I would add a few additional comments to the discussion.
With respect to Dr. Ferguson…his two papers appear to be very similar…’containing an influenza pandemic’ and ‘mitigating an influenza pandemic’ which indicates to me, without reading the full documentation of both papers…that someone may have had a quota to fill in respect to publish articles. What is the next title going to be contain..mitigate…control the pandemic?
The romantic attraction of these titles for regulators and governments and in some senses researchers, is an old problem for humans…once again we are going to control nature…we are going to contain or mitigate (whatever that means) H5N1.
I don’t know how you model a disease you know so little about but given the occurence in 1997–2004, it would seem that one would first determine if it was more like 1918 or 1968 pandemic viruses. Having determined it was more like 1918 then I don’t think we would model on 1968 and MITIGATE…CONTROL THE PANDEMIC…
…I am reading John Barry’s book and although I am finding it difficult to read, there is some overwhelming anecdotal or circumstancial and direct evidence to indicate that they couldn’t control it and we won’t either.
One could also read the 1968 data to compare the effects of these two in a sense outliers.
One comment I noticed in the Fergusons’s abstract was ‘School closure during the peak of a pandemic can reduce peak attack rates but has little impact on overall attack rates’…so I guess than we keep the schools open at the ‘peak of the pandemic’…that is the type of information we get from modeling?
from your post at 1:18
Well, he is a modeller, so he’s got a right to play around with his models. A lot worse papers have been published than his.
But the ethics behind what he tells policymakers is a different story. The limitations of modelling are all in his papers and especially in the even thicker supplementary material (I believe 17 pages for one of the papers, took me a long time to read them), but he does not translate those limitations into English.
I’ve listened to the guy and he manages to make everything very believable. Therein lies the problem. It’s a very esoteric science, and not many people are capable of seriously rebutting his ideas.
I think in this description of modelling in general, without myself making any disparaging comments on Dr. Ferguson himself, these comments could be made about witchcraft or religion or several other ‘snake oil’ type products where they sound really good without really saying anything of substance.
to be continued
Something I forgot to add above was that when the supplementary explanations or limitations to a paper are longer than the paper…it means ‘Houston…we have a problem’.
You can model til’ cows come home (did it in a former life) but there are so many unknown variables in this one that can make the situation either semi-manageable or competely impossible. Those things would include infrastructure, HCW showing up for work, supplies (food, meds), power, financial markets, etc. Also, how the media reacts and covers the crisis as well as how the public reacts to the crisis could have a devistating impact. If the media does its usual stellar job (note sarcasm in my typing) there will be panic in the streets. It won’t matter if the CFR is low or high. There will be initial panic that could get really ugly. And if the CFR is high and/or this goes on for long periods of time, there is no telling how what’s left of society will react.
I agree with a previous post that what happens on local levels will make the difference. If a community, even a decent sized city (let’s Kansas City as an example), has it’s act together and it’s citizens are at least semi-prepared (eg. had two weeks worth of food and water, which is better than the current two days of supplies people have right now, at best), and it’s citizens knew it was coming (upfront awareness can help mitigate the reactions people will have), then that city has a shot. Or at least, a better shot than than most do right now.
So, I’ll continue to prod local officials and do what I can nearby(micro-level). On a macro-level too much is out of my control.
“There are no asymptomatic infections” And we know this how? If there are it would change the CFR significantly.
Okay, so what’s the bottom line for this type of modeling most often funded by governments or regulators? Is this a harmless esoteric excercise…kind of fun exercise?
Then the regulator (my friend Dick Thompson) jumps in with both feet and no brain and starts foaming at the mouth while distributing the World Health Organizations new Mantra to everyone who will listen including my dog Clover, the Norwegian Elkhound.
Well, the MSM are going to report on the issue and their headlines will read…
…World Health Organization will Mitigate…Contain the coming pandemic…and since people scanning the print will skip most of the article, they will miss the small 7 word disclaimer at the bottom which more often than not doesn’t exist anyway.
Sovereign regulatory agencies (for example the Public Health Agency of Canada)look at each other, have thirty top level meetings and telephone conferences across the country, and determine that why should they worry if the World Health Organization isn’t concerned. The Public Health Agency of Canada then goes to the Government of Canada and states that…
…there is nothing to worry about…the World Health Organization has done the modelling and they are going to contain or mitigate the pandemic.
Therefore, this is subtle but perniscous ‘brain washing’ to create a false sense of security that slithers down from the World Health Organization AND BECOMES AN EXCUSE FOR INACTION…
…and by the way, I have describes exactly what has actually happened in the past ten years…
…so annon 22, I will have to disagree with your premis that a nice guy who is distributing flawed modeling results is harmless. I could draw analogies to the harmless men distributing propoganda in past times but I won’t…I don’t need to.
Thanks for the information…it was an eye opener as usual.
anonymous You are right…we like you…please pick a name!!
LauraB. “You can model til’ cows come home (did it in a former life)”
Okay…Excellent…I look forward to the benefit of your field experience with respect to further comments on this and related issues…Thanks.
Tom: is that sarcasm I detect or genunine interest? I am more than happy to help out if needed. My main point was simply that in my previous experience, with far more known variables than what we are talking about here, sh++ happens that you can’t model for. Many assumptions have to be made in the absence of data and one small change can throw the whole forecast out the window. And in the end, there is so much we can not control. Even if we knew for sure that the CFR was going to be high, would that change what you are doing? Yes, it might get others to prep more. But I suspect that given the lack of interest in AF by the majority of people, gov’ts and media, no one will pay much attention to it until bodies start piling up.
Sorry to be so negative - the kids are still not back in school and are really getting on my nerves today. The thought of a long-term SIP with them is REALLY unappealing right now!
LauraB. No, I meant that I sincerely would appreciate your comments and your expertise in these matters…and yes, I was being sarcastic about the World Health Organization because I believe, based on the evidence, that they are bunglers and fools…maybe I didn’t get that hat off quick enough before I made my comment to you.
I appreciate your past contributions and I hope for many more in the future…after your kids are back in school. /:0)
Tom DVM – at 11:20 “With respect to Dr. Ferguson…his two papers appear to be very similar…’containing an influenza pandemic’ and ‘mitigating an influenza pandemic’ which indicates to me, without reading the full documentation of both papers…that someone may have had a quota to fill in respect to publish articles. What is the next title going to be contain..mitigate…control the pandemic?”
No, one is containing a pandemic at the source, eg in Asia, the other one is mitigating it for the US and UK.
Tom DVM – at 11:23 “Something I forgot to add above was that when the supplementary explanations or limitations to a paper are longer than the paper…it means ‘Houston…we have a problem’.”
:-)
I didn’t want to read them to start with, but then I had so many questions which were answered in the supplementary.
Here’s my key revelation, and you can say you arrived at the same thing without reading those damned papers, but for what it’s worth:
When you model something that involves multiple variables, and every variable gives you a range of possibility (ie confidence limit), as the number of variables increase, the range of possibilities also increase. If there is a ± 2% error on any item, and you have 25 variables, you will get ± 50% error, which renders whatever final number you get rather meaningless.
But, as I said, it was useful for my own understanding of the dynamics of how flu is spread.
Tom DVM – at 11:35
“Okay, so what’s the bottom line for this type of modeling most often funded by governments or regulators? Is this a harmless esoteric excercise…kind of fun exercise?”
No, it’s not. Its a model for not doing anything else.
Having said that, I’m willing to play their game. So my question is, based on these models that said social distancing works, what is the justification for UK amd other governments’ not telling people to stockpile? Do they expect people to stay home and starve?
A few days ago I asked if we suspected there may be another (intermediate perhaps) vector in the observed cases in Indo. Although I know we just can’t tell, my q is: is anyone looking for that other vector? Based on the raw epidemiological data coming out of there, something’s just not adding up. My 0.02c is that ether there is very efficient b2h (as in, look at a chicken and you will get sick), h2h2h is present but under very limited circumstances, or there is another vector that is very efficiently trransmitting the virus to birds, human and others like itself.
RE: plans, I have revised all to reccommend 3 months. I just can’t in good conscience do otherwise.
enza - Dr Niman says the recent sequences released in Indon do not show the ‘novel cleavage site’ that birds dying of H5N1 have in that geographical area - i.e. it appears that the recent outbreaks are NOT caused by infection directly from infected chickens - there is DEFINITELY some other vector!! WHO is not pushing hard enough for testing of other mammals or insects! Perhaps they already know that the ‘other vector’ is human and that this is already h2h2h??
The problem with Indonesia is that we have way to few bird samples to conclude anything, IMHO.
Anon_22-
The problem with Indonesia is that we have far too little knowledge about real conditions of any kind and far too little DATA of any sort.
true
we have just about enough data to be somewhat worried, right? :-/
SOMEwhat worried? Well, I am expecting a really bad pandemic to come out of Indonesia any day now. It’s sort of like looking at a semitrailer truck coming at you in really slow motion; You know it’s going to be bad, you just don’t know how bad till it happens.
But I’m really not worried; I’ve made my preparations, my friends are ready, and we’ll see what happens
LMWatBullRun – at 12:30 Basically that is where my wife and I are at also, and I agree with you, if one has the preps in place, and their head is straight, all one can do is watch as the train comes thru the tunnel. The light is getting brighter and you know that it will be right at your feet soon, but I and my wife have stepped back, being prepped and will watch as that train by passes us,,,,and we pass the word every chance we get to friends and relatives. I do feel the time is fairly short (in geometric timeline), and this train will be here WITHIN 2 years, and most likely this winter or next.
bump
I was reading up on the NC pandemic plan, and at the beginning of the section on mass fatalities, it’s got this info…
‘’Approximately 75,000 deaths occurred in North Carolina in 2004.
During a six to eight week wave of pandemic influenza, North Carolina could experience approximately 5600 deaths due to influenza.’‘
In 2005 1,534 people died from car crashes in the state. So when you compare the estimate of panflu deaths for a 2 month period to fatal car wrecks for the year, then that sounds kind of bad. But it seems like a low-ball figure to me and I’m not sure why they want to low-ball the estimate.
My research shows that the population of NC in 2005 was 8,683,242.
Dennis in Colorado – at 11:27 was quoting Dr. Bob Gleeson… In a town of 1,000,000 people then: 250,000 will become ill, 75,000 will seek medical attention, 7,500 will go the hospital, and 1,875 will die.
At that rate, if the population of NC is 8.7 times the population in the example, would that mean that we could estimate using his formula that 16,312 people would die? It seems that Dr. Gleeson is very optimistic while the state of NC is simply delusional.
This calculation of 5600 out of 8,683,242 seems to mean that they calculate that way less than a tenth of 1% of the population would die as a result of the pandemic. Anyone know how they could possibly come up with this formula?
Are other states estimating similar numbers? It’s no wonder people figure it’s no big deal.
A lot depends on how long you think the panflu will keep hitting and if it will come in waves or stay at the same (high) level. Estimates of the share of those likely to be infected run from 1/4 (low) to 3/4 or even more and the case fatality rates from a few per cent to 50% or even more. All of this is speculative and depends on both the characteristics of the virus and the characteristics of the response, including how well medical care holds up and if social distancing and staying home reduces the infection rate or stretches it out. If we take a 50% infection rate and a 10% direct fatality rate, we get 4.3 million sick and 430,000 dead from the flu in one year. But the actual number could be quite different in either direction.
Where am I wrong? 300,000,000 US citizens ±, x 50% infection rate = 150,000,000 infected. x 10% CFR = 15,000,000 dead. A 30% infection rate and 5% = 4,500,000 dead.
Please tell me where this is wrong?
I have seen multiple states running with figures along these lines:
30% attack rate (portion of the population that gets sick)
0.44% (that’s 0.0044)case fatality rate (those who get sick and die)- less than 1 in 200.
I still can’t fathom where they get these numbers, and why they are basing emergency preparedness decisions on them. IMHO it’s for two reasons - any higher than that and TPTB can’t even conceive of handling it and, it helps them sleep at night. I call BS!
Conservative and accepted estimates of the 1918 pandemic were more along the lines of a 2.5% CFR (although many here will dispute that as being too low - I know, I know - just let it go for the sake of arguement, please). The attack rate is unknown, because of the near impossibility in arriving at an accurate diagnosis in 1918, but were somewhere between about 25 and 40%.
So, if we were planning for a “worst-case” scenario, modeled on the 1918 outbreak, the fair state of North Carolina would look something like this (based on Anonymous’ figure at 14:52, above).
2.6 million sick (30% attack rate)
260,000 hospitalized (1 in ten of those who get sick) Or, maybe more accurately, NEEDING hospitalization, since there isn’t anywhere near that many hospital beds or skilled people to take care of the patients - 90%+ of these folks won’t see the inside of a hospital.
65,000 dead (2.5% CFR)
And I think that’s being rather generous.
NJ You are not wrong.
It all really depends whether the first wave is virulent or mild. If it is mild, there will be at least partial immunity when the virulent wave hits…
If the first wave is the virulent wave, then all bets are off, in my opinion.
Sorry, If the first wave is virulent, then we will probably experience a short, sharp pandemic…one wave…very bad.
Tom DVM -
I respectfully beg to differ -
It appears that there was a ‘mild’ wave in the 1918 pandemic that preceeded the disastrous October-November wave, and there was still a great impact. Of course, this is open to a lot of interpretation since so much of our information is retrospective and has had to be reconstructed through the works of folks like J.K. Taubenberger and so on.
Sarge. I respectfully agree with you. That was my point!! Because the first wave or maybe two in 1918 was mild…we got off easy.
Sorry, I shouldn’t have said we got off easy in 1918…I should have said we got off a lot easier than if the first wave in 1918 had been the virulent one.
Tom DVM -
If our present situation turns out worse than 1918… shudder…
It’s sort of understandable, but not excusable, that TPTB prefer to work with the low-ball figures.
It would be a shame for us to think we got off easy, if we had a 1918 type pandemic. But based on the current 60% CFR, I would take the 1918 result, at least there is hope there and the vast majority of people survived.
Need HELP! Is Indo. going through a second wave or is rhis what the stewing pot looks like since the H2H is still low? My old brain is doing some unusal things with the possible CFR outcome. gina
Try as I might, I just cannot get my mind around a first really bad wave with a high CFR.
I think that there are some rather interesting psychological mechanisms at work - see the previous threads regarding adjustment reactions. Few can come to grips with the potential for a disease that wipes out a significant part of the population. Some learned folks will argue here that it can’t happen - that killing off the host species is a ‘bad strategy’ for a bug - as if a virus had a long-term planning horizon.
I’m not so sanguine - I need only look at Dutch Elm disease - it’s pretty much made Dutch Elm trees in the US extinct - but that didn’t stop it, did it? American honey bees are steadily being wiped out by a combination of two parasites. Killing off the hosts doesn’t seem to slowing them down either.
We are different only in our capacity to respond and counter-attack, not that we have some magical innate immunity to a bug behaving badly.
Hillbilly Bill. I agree completely…but we must know our enemy and by knowing it maybe we can get some ‘purchase’ on the problem.
gina. What is going on in Indonesia at the moment is preamble…the virus is still messing around trying to get an edge on the transmissibility problem and only being successful a little at a time. It is making steady progress, however.
Now, if that million pigs in China turns out to be H5N1…I am going to the grocery store in the morning to start prepping…if you know what I mean. They are definitely hiding something or many things…I am not sure at the moment.
Tom DVM – at 16:05
I think you should start prepping anyway!
Hillbilly Bill. Thanks I know you are right…I have done a lot of thinking about it and other then tempting fate and being a procrastinator…I think you answered it in your post at 15:57. As long as I don’t start prepping, I don’t have to get my head around it…I don’t have to believe it is real…funny eh!!
NJ Jeeper at 15:29: Your math is fine, but you are leaving out the impact, if any, of a breakdown in food supplies, utilities, medical care [even for non-panflu problems] and perhaps law and order. If ten million or so died directly in the US from the panflu, it is likely that some additional number would also die from the secondary impact. The secondary impact is likely to be non-linear - if many millions more die directly, the impact on secondary mortality is likely to go up exponentially. This “breakdown” scenario is what is really scary and I think it keeps many people from thinking seriously or acting on the glimpses of chaos they see. One relative said, “You know, sometimes it is just easier to die.”
INFOMASS – at 16:31 I agree with you 100%. Just hard to imagine it would be that bad, but I have to prep as best I can and hope for the best. We can not control and prepare for every possiblitly. In the end, I will be able to say I did the best I could and if it was enough great and if not then I will be ok with it.
Tom, Do you think China will tell anyone if they have pigs that are h5n1? My eight ball says, “Not likely”. Now about you’re lack of prepping… The only thing I want you to wrap around this thing is pure logic. We are talking simple math here. Now get up off your ass and move. Procrastination period is now over. Disconnect your Umbilical Cord from the computer! If I can do it, so can you! See, I have faith in you. Please don’t break our collective hearts. Dieing from the flu may not be avoidable, but dieing from starvation(?)… gina
Gina /:0)
…and by the way, China isn’t going to tell us anything because…simply…they don’t have to thanks entirely to us!!
But I know them pretty well by now and I think Monotreme and maybe some others do to…so hopefully, flu wiki will know what they are up to before anyone else figures it out.
I’m a man…I can change…if I have to…I guess…
…(Man’s prayer from the Red Green Tv Show.)
Tom DVM: I tried googling news on all sorts of derivations of “China Pigs Dying” but nothing comes up. PLEASE do share what this is about the chinese pigs!
Mystery Swine Deaths in Eastern China Recombinomics Commentary September 4, 2006 link
The collateral damage numbers of unhealthy people dying from their meds having run out and/or lack of available medical care because all the facilities are overwhelmed by flu patients will be really astounding, IMHO. Triage in ER’s will be a nightmare.
bttt
Does anyone know off-hand what percentage of unvaccinated people come down with regular seasonal flu in any given year? I know this is a problem because of the fact that most of the time doctors don’t test for flu, pediatricians can’t diagnose flu in children, and a lot of sick people try to recuperate at home without seeing a doctor. Still, is there anyone who has studied the flu statistically and they think they have a realiable guestimate about what percentage of the unvaccinated population in the US gets the flu during any given flu season?
anon at 06:50: If you go to General Vaccination Discussion II thread and click to get back to the part #I, and go to Sept. 1st, anon_22 at 18:55 quotes one study that finds high effectiveness of flu shots. I (INFOMASS) quote a metastudy (study of many studies) in Lancet at 21:52 that day that finds about 50% effectiveness and Tom DVM at 22:01 quotes a study that finds no effectiveness. Obviously, the scientific findings are all over the map, but it is fair to say that on balance the shots seem to work variably and do some good in many cases. (Side-effects is another issue.) I do not know the prevalence of flu during the flu season, but Racter may have mentioned that about 10% of the whole US population gets sick to some degree from it, but you would have to get that confirmed.
Closed to maintain Forum speed.