Forum: How Many Kids Will Die in 1918 Scenario

I am prompted to start this thread from one of the presentations at the IOM workshop, in which it was pointed out that a 1918-like pandemic would kill the same no of kids aged 19 and below as would normally die in 2 decades from all causes.

Not wanting to completely take those numbers for granted, I went and did my own research. I used aged 24 instead of 19 cos that’s the age category that I could find death statistics for.

• According to Ferguson and others, a flu virus with an R0=2, which is within the range of what one would expect in a full-blown pandemic, would have a clinical attack rate of 40% within the first wave of a pandemic.
• A 40% AR and a 2% CFR would mean a death rate of 0.8% of whatever age group we are talking about.
• From the death by age group figures, deaths in 2002 from all causes aged 0–24 was 38,614.
• Based on US Census Bureau figures, there was a total of 101,306,000 people aged 0–24 resident in the US in 2002.
• 101,306,000 x 0.8% = 810,448
• 810,448 / 38614 = 21.

So the numbers are correct then.

The number of kids and young adults who will die in a 1918 scenario in the first wave would equal the total from all deaths in 20 years.

How does any society deal with that?

Anon 22:

Can’t be dealt with. Staggering really when you project them inside sports stadiums that hold thousands of seats. I have at least five nieces and nephews in that age group.

We’ll be just like any other species on this planet. We will adapt and repopulate, or we will not survive. We have overcome worse before even if we will feel like we have left part of our hearts behind forever.

Just in the first wave,

and we know pandemics can go on for some time…

So if we knew the say, student population for an area, we’d use the .8% ?

At least it would be a starting point to get people’s attention (some of whom still think the govt started making enough vaccine for eveyone back when the pres had that 6-month speech…) especially when talking about when to close schools.

If one were to ignore age groups and just do a calculation based on all ages, the US population in 2005 was 296.4M.

0.08% overall mortality in one wave would give 2.37M deaths.

To capture what those numbers mean, the tallest tower of the World Trade Center was 1368ft tall. The area of the floors was approx 208ft x 208ft.

If we were to put all these bodies in caskets of 6.5ft x 2.5ft x 2ft dimension, and stack them into the same area of the World Trade Center tower block, the stack would rise to approximately 1784 ft.

Which is 400ft more than the tallest tower of the World Trade Center.

Let’s say the first wave is not the most serious wave, but the second wave is, the numbers would still apply then.

Even if we spread those numbers within one year, or the whole of the pandemic ie about 18 months, those numbers are still staggering.

Leo7 – at 17:25 Anon 22:

Can’t be dealt with. Staggering really when you project them inside sports stadiums that hold thousands of seats. I have at least five nieces and nephews in that age group.

I have 2 kids and 23 nephews and nieces in that age group. That I know of.

The numbers are certainly staggering to those of us living in Western, “developed” nations where modern medicine has made lethal epidemics ancient history. It’s less unimaginable in parts of the world that deal with high mortality rates due to AIDS, malaria, malnutrition, etc. In Western countries I think we have a “failure of imagination” that keeps us from grasping the implications of panflu.

(My brain hurts) MA Population, 2005 estimate = 6,398,743

Persons under 18 years old, percent, 2004 = 22.8% of MA pop.

(Now, recently, isn’t the US thought to be at 300,000,000 ? )

crfullmoon – at 17:44 (My brain hurts)

Mine too.

We need to take that hurt and turn it into strength, and go out there and convince anybody we can convince.

The two most important things IMHO that might make a difference are:

- very early school closure, maintained till a cumulative attack rate of 25%−30% of the population is achieved, which is theoretically the threshold for herd immunity. It may sound weird to aim at 25–30% attack rate, but what this will translate into is a much more slowly rising epidemic curve, so that society is more able to deal with it, and possibly over time some attenuation of the virulence, which probably won’t happen till after the peak of the outbreak.

- widespread use of statins from the very first sign of symptoms in any age group.

anon 22. You won’t have to worry about regulators closing schools…

…parents will close them probably before the pandemic even gets going…they will just keep their kids at home.

Shocking stats!

Perhaps the Harvard questionaire about how long people would/could stay at home should have also asked at what level of risk to their kids/themselves would people ignore financial peril?

Shocking though the figures are, I’m not sure it would cause long term panic.

But I suspect that many of the more vital employees are those more likely to be swayed by these kinds of stats, have more financial leaway and SIP for longer.

That’s why I keep on prepping - I have three of my own to protect. And I have approached so many parents on the topic trying to get them to do the same. Nobody really understands how bad it migh be.

Tom - I totally agree. If kids, even if just a small number, start dying, parents will pull their kids so fast administrators’ heads will spin. It won’t matter if they are “open” or not - no one will be there.

Or, there’s the recent Australian 35%, or, how about a 50% attack rate and 70% cfr… (if no vents, meds, ect…)

My town, ( 6 years ago figures) said, about 43% of households had children.

How many kids will die if the power is out and unprepared households are using unfamiliar heating or cooking or lighting methods? And there is no emergency response/hospital care possible, and public doesn’t know basic safety, nursing, or first aid?

There’s many ounces of prevention possible now, where options will be severely narrowed, later…

Any advice on getting statins for home medicine stash? Are there any “pet medicine statins” or any suggestions for internet ordering - I recently have not had good luck with the internet pharmacies. Thanks

The death toll for children will be much, much higher, if you include causes other than the flu itself. The factor most important is much higher rate of single parent housholds, and the greatly reduced “extended family” care network. These factors will increase the death rate with similar virulence, but what will be seen is: 1. Poor or no care for sick children sick beacuse there is only 1 adult trying to deal with the situation. 2. Very poor or no care for sick children because the lone adult is sick. 3. NO care for chidren sick or well when the adult is sick. This means a huge majority of ALL children of a sick parent(s), unless taken in by another, will die.

The severity of the illness makes it hard for me to imagine ANY children of an adult caregiver surviving AT ALL if the adult becomes sick, unless those children are of an age and maturity to care for themselves in post pandemic conditions.

I just recently taught a 15 year old how to scramble eggs in a pan (she knew nothing except microwave heating). At that age in the 60′s, I could bake a cake from scratch, knew how to can produce and could butcher animals to eat (and I am male).

Few people will allow a child into their family homes to possibly expose their own family or be a burden (this is from direct statements on flu-prepping sites).

I could see arguments for the rate child deaths to be increased by a level of magnitude or more.

Fiddlerdave – at 18:16 just recently taught a 15 year old how to scramble eggs

With my daughters I had them each plan, shop, and cook one meal a week (the entire family did the grocery shopping together). That was from about 12 years or so of age. It mostly was mac and cheese or pasta but they did have to fix a hot meal a week. The idea is that I wanted to make sure they could “functions” when they left the nest. One of them got very good at it. (2 daughters). I currently have an exchange student from the EU. She has no idea how to cook. I have her enrolled in the culinary class at school.

Avoiding getting too much into religion- you might want to talk with those in your “house of faith” about helping each other with your children if TSHTF. Here we even have a way to “trade” baby sitting for each other in normal times and have “agreements” to help if TSHTF or there is a forest fire, and so on.

Sunny – at 18:08

Any advice on getting statins for home medicine stash? Are there any “pet medicine statins” or any suggestions for internet ordering - I recently have not had good luck with the internet pharmacies. Thanks

Perhaps I need to expand a bit on my statement. At the moment, there is no evidence that statins will be effective. There is enough preliminary data from epidemiological examination of statins in other similar conditions to think they may be effective.

We are working vigorously on getting research started, but its an uphill battle.

You should read everything you can get your hands on on statins, starting with this thread

Tom DVM – at 17:56

anon 22. You won’t have to worry about regulators closing schools… …parents will close them probably before the pandemic even gets going…they will just keep their kids at home.

THAT will be the worst of both worlds. To reduce mortality, schools need to close before or at least as soon as cases start arriving in a community. Given the time lag to diagnosis and confirmation, it will be very challenging to catch that window of opportunity when school closure will make the biggest difference.

Closing schools after outbreaks have already started will have no effect on AR in children, while the adverse consequence of increased AR for adults would still occur.

Plus there will be widespread loss of trust of governments, and no co-ordination of alternative childcare arrangements or when schools should re-open, all the issues that can be worked through ahead of time if planned early school closure is on the policy menu.

anon 22. I think the point I trying to make was that mothers have a six sense…the kids will be home from school, long before the pandemic arrives…the regulators will be hemming and hawing over closing schools with no kids in them…

…one should never mess with a mother’s intuition.

Tom DVM at 20:05

I mentioned once before that I read your posts everyday. And this is one of the few times that I respectfully disagree with you. We have mentioned so many times that panflu could erupt and spread across the globe at an alarming rate. I don’t think the public is going to have any clue about CAR and CFR, and they certainly aren’t educated enough at this point to make a quick and accurate response. A friend who is a mother and a teacher said her school has officially stated in their staff meetings that they would not close schools in the district until kids are dying. I know this is only a rumor and cannot be substantiated, but this is what she has been told. They do not want to risk their state funding over a false alarm or a pandemic that turns out to be mild.

I agree with you anon_22 at 19:20. I think the window of opportunity for school closures can and possibly may be missed and hindsight will be 20/20. The children may pay the tragic price.

/:0)

Too many parents use school as their only day care. Many single parents and working parents will want their children in school as long as they are open because there is no one at home to take care of them.

Parents send their sick kids to school every day and hope that no one will notice. They don’t want to miss a day of work to stay at home with a sick child. That is a big part of why diseases spread so quickly through a school.

MO Molly – at 21:26

Yes, but if there is widespread public education about the consequences of a pandemic, there will be far fewer parents like that. The time to do that is now, and the people to do that? All of us, in addition to officials.

I was self employed for many years when my kids were little, I didnt work I didnt get paid. I didn’t care. I stayed home with them and often did without. Their safety is all that mattered. Maybe it takes a big loss to comprehend what matters most, but I wouldn’t hesitate to tell the school or my office to go take a flying leap. Home, cars…things can be replace—children, loved ones can’t.

People and I don’t mean us on fluwikie, have to start putting people first and not money.

By the time the word gets out to the masses, No, by the time that the masses understand the situation, the virus will be endemic. No one wants to believe it will happen here.

KimT- at 21:46. You are a good mother and are willing to make sacrifices for your children. You are in the minority.

When I feel that we are certain that this monster is on the loose, I will be taking myself and my child out of the school system. I love my job and I love my kids but there is no way I am sacrificing my family in that situation. I asked about our schools plans for pandemic and was told that they are working on it. Ridiculous! They don’t even have a plan yet? I was floored.

Teacher-at21:56 Your school administrators don’t have a plan, and I would guess that 75% of the parents at any school don’t know what the word pandemic means. All the posters and lurkers here are so well informed that they forget how much the rest of the world has no clue there is any problem at all.

Teacher – at 21:56

When I feel that we are certain that this monster is on the loose, I will be taking myself and my child out of the school system. I love my job and I love my kids but there is no way I am sacrificing my family in that situation. I asked about our schools plans for pandemic and was told that they are working on it. Ridiculous! They don’t even have a plan yet? I was floored.

They don’t have a plan yet cos they don’t know how to make a plan without the right information. The IOM meeting that I just attended was in my view the first time that ‘real’ information was fed into mainstream policymaking forums. And it really is not anybody’s fault.

This science is not something that is easy to understand. I am an MD, have already spent a lot of time reading up the very difficult virology and even more so the modeling research, which is the necessary piece to inform policymaking, and still I found that I had to stay extra alert to keep pace with the data that was being presented.

I’m not defending anyone, just explaining the situation as I see it. At least in the US I’m seeing a genuine attempt by many officials at different levels to come to grips with this problem. I can’t say the same about other countries.

You will find lots of officals who are clueless, and some of that will not be because of incompetence, but because of lack of access to information that is understandable.

That’s the reason why I write stuff here on this forum, trying to translate science into layman language and explore the implication. We need to help them. If you meet people like that, you could perhaps suggest FluWiki as a resource for them.

If there are questions that they can’t find answers to, i would certainly be willing to help them.

Getting a little time to do some math, I wanted to expand on Anon_22 initial numbers. This is to take into account the significant number of children of sick parents who will die, regardless of whether the children are sick or well, based on the, to me, fairly obvious idea that a parent as sick as people get with H5N1, their children will not survive without outside care.

Let’s assume a child/children under 12 won’t make it alone under these adverse conditions. That’s 50 million (using half of Anon’s figure). Some will, but some older children won’t be able to from shock, deprssion or immaturity. Drop the 40% adult AR to 20% to allow for some to be pretty sick but still able to keep the kids going. An 1998 figure for percentage of children living with a single adult in the household of 31%, so 15.5 million have one adult in the household . I am guessing 10% of both parents will be sick at the same time (allowing for being away at work, war etc. and can’t come home, and a significant rate of running away - a major issue in 1918).

1. of children under 12 in single adult households = 31% x 50 million = 15.5 million
2. of children under 12 in two parent households = 69% x 50 million = 34.5 million

AR - 40%, seriously ill of those = 50% so serious illness rate = 20% for 1 parent, 10% for 2 so:

1. of children under 12 whose parents will be seriously ill = 20% of 15.5 and 10% of 34.5 = 6.55 million

What plans are there to take care of 6.5 million children under 12 while their caregivers are sick or dead? This does not count the children abandoned by parents. How may households will accept a child who has been exposed from their sick parents?

These children will be pariahs in the most literal sense! And 130,000 of these will be permanent orphans with a 2% fatality rate.

anon_22:

“You will find lots of officals who are clueless, and some of that will not be because of incompetence, but because of lack of access to information that is understandable.”

Was there any sentiment in the meeting that we could get these officials educated in time to make a difference? Once the officials are up to speed how would they educate the public? With PSA’s, letters from the school board….? What sort of time frame?

And thank you for all you have done here.

I want to ask everyone a question. This is not meant as a challenge to or criticism to anyone, as I know some of you won’t find this comfortable. But it might be a good self-examination exercise, which will tell you how you will likely react in a mass casualty situation.

When you read the horrible numbers posted here, or my 17:37 post, what was your first instinct? Did you want to take your family and hide? Did you want to switch off and do something else? Or did you feel a renewed or increased urge to go out and do something about this?

Just an extremely casual ‘poll’, for want of a better word.

anon_22, I am going to talk to my principal on Monday to see how far along they are at the county office. I may email you next week if that’s okay.

So intent on my math I forgot to put in my conclusion.

I believe the fatality rate for the enormous numbers of young children under 12 without care in a pandemic society will dwarf the CFR rates of 2%. How will any survive? There will be people who take some in no matter what, but I can’t see that for 6.5 million. I couldn’t even ask or expect a family with their own children to take that risk (I have no children so its not a problem to do so), and truly these families shouldn’t take it. But what do we do?????

Made me want to finish my preps up and lock my kids up. and the single parent/kid fatalitys scare me big time.

Lurker Mom – at 22:42

Well, the IOM committee itself is not ‘official’ in the sense that they are responsible for examining the information and giving recommendations to the government. We will have to wait for their formal report to see what they come up with but certainly their attitude and extent of knowledge was commendable.

There were representatives from school boards and other local authorities. They were pretty direct in asking for guidance. The 2 representing local health officials were most honest and desperate, and they were saying ‘give us the guidance, tell us what to do’ and also saying that it was their impression that the public can accept ambiguity if you are honest with them. That if you say ‘we don’t know but this is what we are doing to find out, and this is what we may not be able to find out’, that most people will be willing to go along.

Which is pretty similar to my experience on this forum. That the public is not as unreasonable and hostile as some officials or (worse) media want to make out, but the hostility comes from dishonesty and lack of communication.

Thanks anon_22 at 22:56, I found your response reassuring. In regards to your “poll” I believe I am having an adjustment reaction. It’s going to take me a few days to grasp this thread.

Just to clarify. I didn’t actually get what the representative from the National School Boards Assn was trying to say. She was reading very fast from a very long prepared speech, much of it appeared to be a laundry list of all the difficulties they would encounter if they were asked to close.

Fiddlerdave – at 22:50 But what do we do??

I have mentioned this before, but those that can do so should consider going through their state system for foster/adoptive care system and obtain a license. The “system” will want a safe place for the “orphans”. The bottom line is there will need to be individual homes for the “orphans” since they would be at risk of the virus if we tried to “warehouse” them in large groups.

anon_22,

You asked what some of us plan to do, knowing what we know. Wife and I plan to lock the door and SIP. NO one allowed in the house. We’re prepared to do this for an extended period and the world will have to take care of itself while the pandemic rages. We hope to be around to help pick up the pieces once it’s all over.

Anon 22: For your informal pole.

My mouth dropped open. I had been to a football game that was full 90,000 people and in my mind I saw the stadium replicated over and over to meet your numbers. Really, for at least twenty seconds, I don’t think I breathed.

Sorry informal poll not pole.

LEo7..you sure have put a powerful visualization on it all. 9 football stadiums die. 72 football stadiums of children under 12 who will have no caretakers, over the course of a few months. Takes the breath away. I have been thinking of the outlines of a plan of action for people to have for commandeering office buildings or schools and the various possible salvage supplies (office dividers, blankets from cloth at cloth stores) needed to make a place to go, even if there is no food or water, rather than these kids wandering alone outside or sitting with a dead family for those areas that have no where to go. A place if someone comes up with some supplies, at least we’d be in one place in an area for them to drop it off, or those who are in isolation to leave anything they can contribute nearby without breaking isolation. But so many.

I was researching another topic when I found this from the 1918 New Haven Annual Resport of the Health Department:

“The year 1918 will go into the annals of history on account of the toll of human life that Providence has seen fit to exact by violence and disease throughout the whole civilized world. Our own country and city have been called upon to pay their portion. Many of our young men have given their lives in the world’s war and the effect of this upon the lives, health, and happiness of many of our citizens has been far reaching and will endure for many years to come. Terrible as has been the war, the cost of life and distress brought to us as a community by it has been infinitesimal compared to the havoc caused by the late epidemic of influenza.

Pages have been written and much can and will be written, but the direfulness of the situation is too fresh in our minds to demand reiteration by going into a detailed account which differs in no material respect from what has happened in practically every town and city throughout the length and breadth of our country. From October first to December thirty-first inclusive, there were in the City of New Haven seven hundred seventy-seven deaths from influenza and its complications. This great number of deaths, about one-third as large as the total from all causes for a whole year under normal conditions, is by itself startling, but the calamity is appalling when we realize that over sixty per cent of the deaths were of persons between the ages of twenty and forty, the most useful and valuable ages of life and the period when both males and females have the greatest number of dependents. To dwell upon this subject as one is impressed by the results of the epidemic would be but a repetition of what has already been said by many and is useless, and we will pass it with the assertion that we have recently, by reason of influenza, gone through the most trying and serious calamity this country has ever experienced, either from sickness or war.”

link:http://tinyurl.com/y8l4yt

I am not sure this will format correctly but here goes. these are the estimates I have for various age groups. basically a “mild 0.2 overall death rate”, a 2% 1918 type death rate, and a 10.2% death rate (estimated on 34% infection rate, 30% CFR). I used the 2005 census for numbers and the 1918 deaths in age brackets for the US. (rounded to thousands in places)

Age 0.2% 2% 10% Under 5 years 45360 453600 2520000

5 to 9 years 51408 514080 2856000

10 to 14 years 69984 699840 3888000

15 to 19 years 51408 514080 2856000

20 to 24 years 47034 470340 2613000

25 to 29 years 43416 434160 2412000

30 to 34 years 40392 403920 2244000

35 to 39 years 38340 383400 2130000

40 to 44 years 33696 336960 1872000

45 to 49 years 29106 291060 1617000

50 to 54 years 22356 223560 1242000

55 to 59 years 19116 191160 1062000

60 to 64 years 12150 121500 675000

65 to 69 years 9450 94500 525000

70 to 74 years 9396 93960 522000

75 to 79 years 9450 94500 525000

80 to 84 years 9720 97200 540000

85 years and over 8424 84240 468000

you can take these and modify for various estimates of CFR. I just used the 30% since it was about half way between what we see now and what was seen before.

My estimate on the number of “orphans” we can expect is:

6500 at ”mild” 0.2% death rates 65000 at 1918 2.0 death rates and 362,000 at the 10.2% death rates.

Dennis. If you have time, could you work the overall numbers for an attack rate of 50% and a CFR of 7%. Thanks.

GraceRN - at 4:08:

Thanks so much for finding that piece from New Haven, CT, circa 1918. Our state’s new pandemic flu website just went up yesterday, and from the sound of it you’d think they were expecting maybe the discomfort of a light sunburn as opposed to the tradgedy that the writer of your piece could barely bring himself to speak about.

With our state having now pretty much exited itself from pandemic flu planning, those of us who want to move forward will need to use just the kind of information you came across (and apparently you did so in the middle of the night!). Thanks again, Grace, for maybe helping us to slap our officials silly.

Frankly, with the kind of website this state just put up, I am not sure my officials even attended the same pandemic flu summit that I did, although I swear I saw them there with my own two eyes. Leavitt himself used charts and numbers directly from Connecticut’s own experience with the pandemic in 1918 for a large portion of his presentation. He also told several harrowing anecdotes from the time, replete with the names of the towns we all live in today. That’s all been effectively white-washed now. I understand the reticence of those who lived through it to speak about it, but not the reticence of those in charge now - they need to hear the extent of the potential tradgedy repeated over and over, as do their citizens. They would be well advised to heed your writer’s warning:

To dwell upon this subject as one is impressed by the results of the epidemic would be but a repetition of what has already been said by many and is useless, and we will pass it with the assertion that we have recently, by reason of influenza, gone through the most trying and serious calamity this country has ever experienced..

Tom Ok give me a while - I will stick it in my spread sheet.

Oh yes the orphan numbers are for orphans under 19 and I estimated the number of single parent homes at about 30%

For Tom DVM numbers for 50% and 7% (net 3.5%) Under 5 years 793800 5 to 9 years 899640 10 to 14 years 1224720 15 to 19 years 899640 20 to 24 years 823095 25 to 29 years 759780 30 to 34 years 706860 35 to 39 years 670950 40 to 44 years 589680 45 to 49 years 509355 50 to 54 years 391230 55 to 59 years 334530 60 to 64 years 212625 65 to 69 years 165375 70 to 74 years 164430 75 to 79 years 165375 80 to 84 years 170100 85 years and over 147420

and about 115,000 “orphans” under 19

Goju and Pixie - if you read from Grace RN’s post at 4:08 : “there were in the City of New Haven seven hundred seventy-seven deaths from influenza and its complications.” Think about that. What if 7500 people died in New Haven today? Stamford, Hartford, let alone our little towns?

I’m getting that old uneasy feeling in my stomach again. Time to go re-evaluate my prep level. DH and I are barely over the 20–40 year old mark and have three young children who couldn’t cook their way out of a paper bag. The oldest might be able to do some things to help the younger ones, but what if he is sick too? Not only do I need to teach him more, but DH and I have to come up with contingency plans for their care, teach even the youngest how to use the phone, what neighbors to go to, etc. This whole thing just plain sucks. On a liserable day like today you just want to go curl up in a ball under the bed covers…

DennisC. Thanks

LauraB - I don’t know if you and I and Goju will end up being the best prepared citizens in our state. I am certain, however, that if/when a pandemic occurs we will be the angriest citizens. With action, we know that DennisC’s numbers can be avoided (at least lessened).

Can you imagine the man from New Haven in 1918 believing for a minute that people in 2006 have learned nothing from his tragic experience? And how would he react of he saw DennisC’s numbers now? He would find the lack of action unfathomable.

“He would find the lack of action unfathomable.”

You have it in a nutshell-think of all the folks, scientists, doctors, victims’ families and the survivors- what would they think of us today?

“Too big for our britches” perhaps.

Isn’t there a saying that those who fail to heed history are doomed to repeat it?

Not if we can help it!

Did calculations for the UK with 2003 stats - who knows what the formatting will come out like.

2003 UK

ages All ages 0–15

sex Males Females Males Females population 29,108,000 30,445,700 6,002,300 5,709,900 all deaths 253,852 284,402 2,547 2,124

bf @ 2% 232,864 243,566 48,018 45,679 bf @ 5% 582,160 608,914 120,046 114,198 bf @ 10% 1,164,320 1,217,828 240,092 228,396 bf @ 20% 2,328,640 2,435,656 480,184 456,792 bf @ 30% 3,492,960 3,653,484 720,276 685,188 bf @ 40% 4,657,280 4,871,312 960,368 913,584 bf @ 50% 5,821,600 6,089,140 1,200,460 1,141,980 bf @ 60% 6,985,920 7,306,968 1,440,552 1,370,376

The number of children killed also comes out at 20 times the annual figure.

I’ll try again

2003 UK

population all M 29,108,000 F 30,445,700 0–15 M 6,002,300 F 5,709,900

all deaths in 2003 M 253,852 F 284,402 0–15 M 2,547 F 2,124

bf @ 2% all M 232,864 F 243,566 0–15 M 48,018 F 45,679

bf @ 5% all M 582,160 F 608,914 0–15 M 120,046 F 114,198

bf @ 10% all M 1,164,320 F 1,217,828 0–15 M 240,092 F 228,396

bf @ 20% all M 2,328,640 F 2,435,656 0–15 M 480,184 F 456,792

bf @ 30% all M 3,492,960 F 3,653,484 0–15 M 720,276 F 685,188

bf @ 40% all M 4,657,280 F 4,871,312 0–15 M 960,368 F 913,584

bf @ 50% all M 5,821,600 F 6,089,140 0–15 M 1,200,460 F 1,141,980

bf @ 60% all M 6,985,920 F 7,306,968 0–15 M 1,440,552 F 1,370,376

The number of children killed also comes out at 20 times the annual figure.

So, 93698 0–15 year olds would die of a 2%CFR compared to 4671 in a normal year.

Plus 10 times that 93,698 who will die due to lack of adult care. Nearly 1 million.

Here is a “world clock” with population, births and deaths. 57 million deaths a year without a pandemic.

Now imagine this counting backwards for some time.

bump

My seven year old can easily cook a can of soup, a package of Ramen noodles, a package of Easy-Mac, etc. She can cook Hamburger Helper if there happens to be any hamburger. She can certainly open a granola bar or jar of applesauce. I think to say children under 12 can’t survive without an adult may be putting the age too high. I would think most children over five could handle basic self care. My three year old would have serious problems if both parents and older sister were all sick though. He can open a granola bar. I guess I better buy a ton of them.

This is not to say it wouldn’t be horrible for them but I think they could survive as long as food and water were in the home.

muttcats - I agree, but it also depends on how long you are talking about, what foodstuffs are available, and whether or not there is power. We live in CT, so no power in winter means a freezing cold house very fast. I am NOT teaching my kids how to light a fire in the FP, at least not yet. We have a genny, but it can only do basic stuff (well pump, etc.) and it won’t run forever either. And don’t forget their level of fear - if mom or dad are desperately ill (or worse) imagine how frightening that will be for any child.

bump for attention

bump important thread.

I made these 2 slides for a recent presentation. They are self-explanatory.

I have 3 neices and 2 nephews who all fit into the 12–19 age group. Their parents (my brothers and their SOs) have no idea what is coming. I’ve tried to talk to them all, and one brother says “God will keep us from getting sick”, and the other just doesn’t want to talk about it. It scares the hell outta me that I may (if I’m lucky enough to survive) be the only member of my family left.

BTW—Anon_22 --- Great slides!

Tom DVM – at 20:05 I think the point I trying to make was that mothers have a six sense…the kids will be home from school, long before the pandemic arrives…the regulators will be hemming and hawing over closing schools with no kids in them… …one should never mess with a mother’s intuition.

Not all mothers are created equal. In fact, there are plenty of women with children who are completely lacking in any and all maternal instinct. For many people, children are an accessory, a status symbol. Just because you can pop ‘em out, doesn’t mean you know how to care for them once they arrive.

That said, I do agree that most parents will have a strong reaction once kids start dying. But to echo what anon_22 has already stated, that’s a day late and a dollar short.

Everyone on the wiki needs to read the “What Is TLC” thread, watch the US Dept. of Education webcast, go to school board meetings to pose the list of questions enumerated in the webcast, educate their school leaders about TLC, and hold their feet to the fire.

Edna Mode – at 09:34

That said, I do agree that most parents will have a strong reaction once kids start dying. But to echo what anon_22 has already stated, that’s a day late and a dollar short.

Absolutely, we need them to have a strong reaction NOW. I think the way to do that is to say ‘School closure’ loudly.

sorry that was me, switched PC’s

Anon: Those slides of mortality rates, say it all, so much more than words alone. It’s hard to argue with a combination of realiable statistics and photos. In a nutshell ages 10 to 30 are targeted. My best friends grandmother was in her early twenties and left two babies, under the age of four, to grow up without her both of whom are now in their ninties and are perhaps two of the kindest people I have ever met. The loss of this young mother overshadows our lives, personally and professionally, daily in obvious and unknown ways.

As a side note to this discussion, I was reading an article the other day about the high percentage of children in the U.S. who get their ONLY meal of the day at school. (Provided free of course, through the Lunch Program.) The caretakers of these kids don’t have any food at their homes, moreover, are not prepped in any way, and they will continue to send their kids to school to be fed, until there is no other option. Sick or not. They have no other choice. These are the same kids that don’t even own a coat that fits.

The enlightened people here are in the smallest minority. With no “government assistance” the numbers that will die of pure dehydration and starvation, not to mention other sickness, are going to be high in a moderate to severe pandemic. No community is going to be “prepped” to handle what may be coming, no matter what actions they do take. Even in my immediate family, 6 brothers and sisters, I doubt if any of them have more than a couple days of food in their homes. They simply can’t fathom a disaster occurring of this magnitude, and they are all fairly well educated and have good incomes. Those of us that are well prepped, can in no way, take care of all of those that aren’t, even if we wanted to. Trying to convince people of the risks is sometimes like talking to a sponge. The words are absorbed, but no action is taken. I’m becoming more and more pessimistic of the what the outcome may be all the time.

I have five kids. They are the initial reason why H5N1 and other pandemic issues came to my attention. Every single one of them is in a “danger zone.” They are 2, 7, 10, 14, and 16 years of age. If our home is somehow contaminated … and its not an impossible scenario depending on how fast the pandemic spreads … I am terrified that I could conceivably lose every single one of my children. <shudder> Losing one would be devastating … losing them all would destroy us.

There are going to be many parents in the exact same position. If more parents don’t get their heads out of the rat race and back into the vital needs (vs. the wants of our techno age) of their families and children, it won’t take a pandemic of any size to devastate large populations of families.

I would like to add that in my mind, the number one concern for all communities will be “feeding” the people, not trying to supply medicines/vaccines to the masses. Vaccines will mean nothing when people have nothing to eat or drink.

Snowhound1 – at 10:31

Good point. Without proper nutrition any medications would have little chance of working properly any way.

I hate to carp on a subject … and this one makes me sound like some cynical slum lord … but I’ve seen time and again a child go hungry, but Lord forbid that the mother shouldn’t have her hair and nails done so that she can go party. <sigh>

I have no idea how some of our tenants afford some of the name brand clothes and shoes, hair weaves, nails, etc. they do … yet there is never any food in the house and they receive food stamps and other assistance. Their kids generally get a free back-pack and supplies at the beginning of the school year and at Christmas and wear more expensive clothes than my kids do … but there is never any food in the house.

Priorities are a real problem in certain families and it isn’t based on socio-economic level.

I’ve also noticed that some of the charitable organizations are beginning to have problems with priorities. They are giving families things like electronic games, etc. before they make sure that a family has food in the house and that they have their utilities on.

These issues in priorities need addressing BEFORE a pandemic occurs. The problem is that these problems are as endemic in our society as H5N1 is endemic in many wild bird populations.

The School Lunch Program subsidizes lunches (4.7 billion in fiscal year 2002) to children in about 6,000 RCCIs and almost all schools (93,000). During fiscal year 2002, average daily participation was 28 million students (57 percent of the children enrolled in participating schools and RCCIs); of these, 48 percent received free lunches, and 9 percent ate reduced-price lunches (Table 15-LUNCHANDBREAKFAST-1). The remainder were served full-price (but still subsidized) meals.

http://tinyurl.com/y5o747

How are we supposed to feed 28 million kids?

Snowhound1 – at 10:49 “How are we supposed to feed 28 million kids? “

The sad thing is that is about twice the number of school age kids that are projected to die if the pandemic reaches a 10% death rate. - see numbers near middle of thread.

I imagine, KathyinFla, these parents afford some of those “name-brand clothes”, etc. (aside from issues that you better “look good” to get ahead in most jobs) the same way more well-to-do parents have time for golf, parties, vacations-without-children and go-go careers while their children become alcoholics or monsters amssing aresenals to shoot up schools -by not prioritizing time with their children. And rest assured, if a charitable organization is handing out electronic games, that is because that is what they HAVE because that is what is given to the organization. A large corporation or wealthy individual is most certainly enjoying a very nice tax break from contributing surplus-virtually-worthless products (because a new model is out, for instance) and taking a full retail price tax deduction that makes them more money than selling it on sale. And it looks very nice on a corporate report, “giving to the poor” is profitable when publicized well (often using more money than the contribution). Although, one could think kids of all economic levels do deserve some toys as well. But I guess that is asking too much for them, isn’t it. “the sins of the father” and all that. The food stamp comments make me wonder what all the milk producers do with the extra profits that the millions in government price supports give them that also increase the price of milk (which reduces the value of the food stamps), aside from the taxes we pay used to increase that price. Might we find some new cars, trips to Vegas, and some good Scotch in milk producers’ expenditures?

The food price supports (corporate welfare) do have one possible benefits for disaster planning. For the government-purchased food (200 billion a year!) to raise prices and assure the “free market[haha] capitalistic[haha]corporations” a profit (at taxpayer expense)that not yet has been dumped in the ocean and/or landfills may just be the main stock of food we have for a time! That’s it, the “price support” programs for farm corporations (corporate welfare) was actually a secret pandemic plan! Brilliant political plan! Their idea all along! Nuts.

On the subject of school meals, this is a good document for stats

Food Assistance Landscape 2006 from the USDA.

About 30 million kids participate in the National School Lunch program, of whom 50% are eligible for free lunch.

That gives us 15 million kids.

However, according to the Blendon survey at the Harvard School of Public Health, of those who are eligible for free school meals, only 13% replied that they will have a major problem if schools are closed for 3 months, which is about 2 million kids.

Looking at it in a different way, perhaps we need to find out what these parents do to feed their kids during the summer vacation.

The Summer Food Service Program provides for that, and their figure, interestingly, is also 2 million.

I would assume that if schools are closed for extended periods in a pandemic, the number of school age kids that we need to figure out how to feed will be 2 million, and not 28 million.

2 million is still a big number, but spread out over a country, given enough forward planning, I think it is feasible for communities to find ways to feed those kids.

I don’t know how to say this without sounding silly, but I think “anon_22 – at 14:05″ is a crisp demostration of good thinking! Data first, creativity later (“looking at it in a different way” is creativity), constructivity all the way. Not that you need my encouragement of course, but this way of dealing with each problem deserves to be noted, IMHO, so that’s why I write about it. And after all each single step we’re taking we’re first thinking it with out brains. “Data first” cools down the brain. Thanks!

Fiddlerdave – at 13:55

Nope, I worked for a number of years with the local homeless coalition which includes many area ministries and agencies serving at risk populations … both those with children and those without. One of the reasons why I quit working with the board at the time is because they were beginning to set aside budget dollars … cash, not physical donations … to purchase the higher end toys and clothing for their clients.

While I agree that there is nothing wrong with a kid getting a “good” gift for the holidays, I and several other board members and participants disliked the trend where dollars were being spent at the cost of food for the hungry.

What good are these fancy toys going to do the kids when they aren’t receiving enough nutrition/food so that they can compete in school? As we’ve all seen, the school lunch program isn’t enough, neither is “food stamps” enough to really keep a family going. There is also the WIC program, but that in and of itself is not enough to put proper food on the table for a family.

I’m not sure that many men realize the cost of nails and hair effects. A $100 is a small price for a hair weave, most are considerably more expensive. A good nail job can easily run in excess of $50. Get that done once a month … and let’s not forget the expensive handbag and shoes … and that’s a lot of “fluff” when their kids are going to bed with little to nothing to eat as a result.

I’ve never had my hair and nails done. Never seen the inside of a beauty parlor. Would I like to? Irrelevant though it could sound like I’m jelous … there are other priorities for the money like groceries, fuel for our vehicles, taxes, insurance, futured college educations, etc.

I just really get bent out of shape to see how some of the kids have to live. We try and get our tenants, those in legitimate need, in touch with the property agencies. We’ve also cut many of them slack over late rent. But, it really burns my biscuits to see the choices how some of them … not everyone of course … choose to fail at prioritizing their children and their children’s needs. Its easy to get bitter when you see it day after day. And no matter how you cut it … the closer to the margin you live, the better at prioritizing those dollars you need to be. Hard fact of life.

Bronco Bill – at 08:21

Yes, God may keep them healthy. I’m sure God kept some Christians from being thrown to the lions in Rome, yet not all of them. God didn’t provide Noah with a fully provisioned ark, though He could of. Noah had to roll up his sleaves and get to work. Feel free to relate this to your brother.

anon_22,

In this area you have a large number of agencies that assist with summer food programs. There are also a number that work with that population year round.

Goes something like this … child is in the headstart program and receives a breakfast in the morning and a lunch in the afternoon. This child also has a sibling(s) that attend a morning daycare where they receive a subsidized breakfast and then a subsidized lunch at the school mid-day. Sometimes these children also attend an after-school program where they are provided a snack or late afternoon meal.

During the summer, there are the boys and girls clubs, tutoring/bridging programs as well as a continuation of the subsidized daycare settings where these same children receive meals.

The problem I foresee is that if all of these programs close then more than 2 million children will be at risk.

Additionally, we’ll need to plan for those children who lose one or all of the adults in the residential household. There are a ton of custodial grandparents out there barely making ends meet.

Not to mention, there is a significant number of these kids who also have some other kind of special need(s) such as medication … health and/or behavioral.

Two million may not seem like a lot … but given the population specifics and needs of these children, two million may still overwhelm the system.

Having to figure out how to provide meals for 2 million kids will be better than trying to deal with 2 million deaths. (see 1st and 3rd post)

Society will have to debate the pros and cons and come up with answers.

It’s 5am here. I just finished writing up the Case for early school closure thread.

I need to go to bed.

2 million kids in a country with 56 million school children, that’s 1 in 28.

No one ever said pandemic mitigation will be easy, or cheap.

But if the citizens of the US cannot extend their generosity and community efforts to take care of an extra 1/28 kid per child, what hope do we have for the rest of the world?

To cut to the bottom line of your post, this concentration on people at the bottom for scorn and judgement mixed with the concept they do it all at the public’s expense, at the exclusion of the people who are NOT at the bottom in part because of the substantially larger trough of public dollars that helps keep them fat but by no means any better at priorities for themselves or the good of society at large. I will submit your anecdotal note of the ones who exhibit poor judgement does not reflect the situation of even the majority of the whole of that lower income level, and the waste of much much higher level of public dollars of people who absolutely DO waste much of the money on frivolities (i.e. not food or education) at the higher income levels reflect the poor priorities of our public tax policies, governed by an obsession with the faults of the low end economic players, and ignoring those who control the playing board i.e. are able to arrange substantial, unquestioned, public assistance for themselves.

School fundraising may look pretty foolish in retrospect, since they might have changed community priorities if the fact we’re in a pandemic alert period had been openly covered in the media during the time all the US state summits were occurring. What school parents would do in the face of a pandemic year would be very different from “business as normal” yet kids could learn a lot of practical math, geography, and, safety or self-sufficient skills if the focus and curriculum had been tweaked in preparation.

Those technically eligible for reduced price lunch can still afford to prep. Priorities; meet “needs” before “wants”.

Not buying things on credit you can’t pay off at the end of every month. Doing without fluff like hair and nail salons, racetracks, casinos, lottery tickets, alcohol, cigarettes/cigars, illegal drugs, cut back on expensive nights out and a sitter, cut back on eating out and buy ingredients and cook from scratch, make coffee at home, don’t buy the latest gadget, music, movie, video game, ect. Buy a reasonably-priced fuel-effecient reliable car, pay to maintain it for several years, while saving up for the next car. Use public transit if you have it.

There are usually interesting free local things to do, library passes for museums, free concerts or lectures or art exhibits, there are things that are fun to do in your life that bring you joy that cost nothing but your time (and sometimes if we try to list 20 of them, some of them we haven’t done in a long while).

‘’‘Leadership is required to say to the public, you think Katrina was bad; a pandemic influenza year is coming; “put your house in order” because the federal and state governments already gave notice they cannot help, and you’ll find your local government cannot magically care for everyone, either.

Sacrifices of superficial things are better than not having shelter, food, care, and safety, your health, or children’s lives. (Or losing the workers in your municipality that keep the power grid up, the laws enforced, the water drinkable, and know how to treat the sick and injured, or know how to grow food, or fix machines when they break, ect…)’‘’

Tell the public. Hearing angry complaints now may move on to priorities changing and some trying to prep. Public pressure may move some later to get they will be on their own, so, stop insisting the govt “must keep pandemic from coming, somehow”. Refraining from telling, knowing what chaos and loss and long-term impacts will likely result, is not a rational option.

Abraham Lincoln: If given the truth (the people)can be depended upon to meet any national crisis. The great point is to bring them the real facts.

anon_22 Please take care of yourself! Go to bed!

“How Many Kids Will Die in 1918 Scenario?”

Too many

We have to act to mitigate the effects and try to become more resiliant before we run out of time. H5N1 in this year (or decade) still looks worse than 1918, too.

I agree…Anon_22′s passion for the cause needs to allow her to get some rest as well. :) My best to you Anon_22…your posts are all very thought provoking and for me at times, heartwrenching.

My original intent in my post about kids going hungry without school lunches is that TPTB are planning on the more logistical requirements of dealing with a pandemic, and unfortunately, not necessarily the most basic of life’s requirements. These things must be addressed or all the plans in the world will be a moot point. Despite the somewhat “optimistic” 2 million number, I sincerely doubt that in any of the 28 million kids’ households, they will have done any prepping in regard to food and water, thus the 28 million number is still valid in considering the importance of the availability of food and water. It may not be doable..will these be “acceptable losses”? I honestly wonder what TPTB really discuss behind closed doors of what an acceptable number of casualties would be, if a severe pandemic situation does occur?

Hopefully, before we are faced with a pandemic some more thought must be put towards feeding the masses, the unfortunate, the homeless and for others that have no concept of preparedness. (Which is what 98% of the population?) (Including a lot of the other demographics. Rich people can starve too.) Given some of the numbers you all have posted about CFR’s, ect., on this and other threads, I don’t think anyone outside of fluwikie has a grasp of how much each of us may be asked to respond during and after a severe pandemic. ….I’ve always thought about adoption…perhaps if a pandemic occurs I will be required by circumstance to make it a reality.

Fiddlerdave – at 16:14

I can only speak to my personal experience. My experience lies in the areas of aging and mental health, old and homeless, subsidized housing, and low-income families with children.

I worked in the mental health field for a decade with the 55+ age population fighting against ageism and prejudicial treatment of the mentally ill … but I was not blinded to the bad side of the “system” nor to those whom manipulated the system to their benefit. For the past decade I have worked in the area of low income housing … true as a business owner, but also as an advocate for some of our tenants. Again though, my experience and sympathies to no blind me to the problems.

My grandparents and most of my other relatives, save my parents who were the first to “leave the farm,” were farmers. In point of fact my maternal grandparents were tobacco farmers. They received some subsidies, but still lost their farm right along side many other small farm owners in the 80′s. Does that mean I always agreed with the “system” … no, and certainly not in hindsight.

Many of those subsidies have disappeared in the last couple of decades, just like the so-called stockpile of staple goods that the government used to purchase at better than market prices to help keep the small farmer in business. This was discussed on another thread.

Subsidies of any flavor were always started with the best of intentions but human beings generally have a talent for mucking things up with manipulation. This happens at all socio-economic levels.

What we need to address of the ways that our current systems can best meet the coming issues of a pandemic. Since the current system is primarily devoted to serving the low-income population they may actually be in a better position. 1) they are already in the system. 2) they already know how to work in the system. 3) they already know how to live on how little the system truly has to offer.

Someone inexperienced with dealing with those types of financial and physical deprivations and unused to dealing with all the red tape and mind-numbing run around will have a hard time of it. As an advocate, all be it a part time one, if I can become irritated and frustrated by the system even after 20 years of experience, how much more difficult will it be for someone just getting into the system.

One of the things that worry me is that there will be a lot of orphaned children following a pandemic that have no family member able or willing to take them in. It used to be that families in the community would take orphans in. cousins of my great grandfather raised several children this way in the early to mid 1900′s. They never had biological children, but considered the children they raised to be “their’s.” That was how it was back then.

However, there were also poor farms and orphanages … not all of them good places to be. My great great grandfather and one of his sisters were placed in a orphanage/school that was specifically set up to serve the orphans of civil war soldiers. That orphanage/school continued to operate well into the 20th century.

Most folks have read “Oliver Twist.” Whatever we do, let’s not revert to those types of situations with our children and elderly.

Snowhound1 – at 17:28 and Kathy in FL – at 22:13

I would encourage you to go ahead and contact your state children youth and family department (or whatever your state calls it) and see about a “homestudy”. It takes a while to get through the program (classes, police background check, a visit to your home, references and so on). We will need people like you that are ready, prepared, safe and reliable if TSHTF as we think it might. If your church (faith group) has some children homes you may also want to notify them that you could take in an “orphan” if it comes to that. By my calculations we may be seeing about 362,000 orphans (in the US alone) if the overall death rate reaches 10%. There will be a need.

DennisC – at 22:49

Hubby and I have discussed foster care a few times. When we were younger and had fewer children of our own, we were quite serious about it.

In addition to individual foster care situations, plans for groups homes were sibling groups can be kept together will be needed.

It just struck me that we haven’t even factored the children currently in the foster care system into the “2 million” estimate. These children are totally relient on programs for both food and housing. What happens to all the groups homes that are strapped for staff in the best of times?

Quoted from snowhound1 I sincerely doubt that in any of the 28 million kids’ households, they will have done any prepping in regard to food and water,

My kids get reduced lunch.We are prepped with food and water.

Kathy in FL – at 23:07

Yes that is why I said check with your “faith based” children homes. I work with my church here to get sponsors for a children’s home. (Individuals can sponsor a child at the home) Basically the home has cottages of 10 children and a set of house parents for each. At a 10% CFR or so that means that one of the 10 cottages will be without house parents. So- there will be 10 kids from that one home needing somewhere to go. I am arranging for the children to go to their “sponsor’s” homes if needed. However, right now they can’t do that unless the home has an approved homestudy. My wife and I do have a license if needed but that is just for 1 or 2 children. The next thing to do is to get with my state leg. rep. to see if there can be something done in a declared statewide emergency. The laws just don’t cover such a situation.

DennisC – at 23:29

I’m wondering if each state has its own laws regarding this. Florida is slack in some areas and fairly difficult in others. We’ve had nationally-publicized disasters with regard to children “in the system” whether that is state-custody or foster care.

Another area that we might try and touch is the guardian ad litem system. Basically an advocate system for those that aren’t familiar with it. Advocates familiar with the “system” in their particular area would have valuable knowledge of procedures and requirements to speed up addressing problems and gaps in services.

But one thing to think about, I’ve found that in the last couple of years the low income housing agencies have begun to hire clients … primarily as support staff, but I’ve heard of at least two counselors that were receiving subsidies themselves. I believe this will become a staffing problem that compounds the expected absenteeism issues of a pandemic … these folks have children that are receiving services through SSI or the school system and loss of those dollars will tax an already strained household.

I believe it is possible to prep even if you are income challenged. Heck, I have five kids and we run our own business … but that doesn’t mean that we aren’t income challenged. Those responsibilities trump all the “wants” on our list. But I’ve managed to … although admittedly with time … set aside about 5 months worth of food and I still plan on trying to increase that week-to-week. People, even in economically challenged neighborhoods prep for hurricanes around here. It might not be for as long as is needed for a pandemic, but it would certainly help off-set things.

Are mental health providers preparing for pandemic? I don’t think the local planners are talking to them about it. (And if they are, probably didn’t tell them about supply chain disruption nor current cfr with hospital care.)

And telling the public to wash their hands and stay home if they get sick is not telling them important things they don’t know; about how long pandemics last and what Dr.Nabarro and Dr.Osterholm have warned about fragile JIT systems and collateral deaths.

Forget “panic”; local officials better start being more concerned about public outrage.

Preparedness, Response, and Recovery page 10 of this pdf has an interesting graphic, but I do not see mortuary, nor child protective services on it… nor agriculture, nor mental health care…

p2 with the Homeland Security logo and the “severe, worst-case” “tremendous operational and economic implications” also needs to get shown to more people…

oops that was me again, (of course) sigh.

public outrage

we could ask the question: “what if it happens and you know you weren’t told but they knew?”

show THAT to pols - make them shake in fear OF US

(it works in battle: soldiers are more frightened of their boss than about the enemy - we just need to be the boss)

we could ask the question: “what if it happens and you know you weren’t told but they knew?

Thank you! I’m not one normally for shock language but I’m been saying that whenever I got a chance in Washington DC. That when kids start dying, and parents found out what we know now, they will seek out the politicians and say

“You Knew. Why Didn’t You Do Anything?”

Read what I wrote here in 02:02 2 months ago.

Hello everyone

Have you guys read about this? (from www.newscientist.com)

Bird flu outruns the vaccines.

	•	04 November 2006
	•	From New Scientist Print Edition. Subscribe and get 4 free issues.
	•	Debora Mackenzie

NEW strain of H5N1 bird flu has emerged in China and is poised to start yet another global wave of infection. The human pandemic vaccines now being developed will not protect against it. Worse still, nearly three times as many Chinese poultry are infected with H5N1 now as last year, meaning there is a greater chance of human infections - despite China’s insistence that all poultry be vaccinated against it. In fact, vaccination may be to blame for the new strain. “The human pandemic vaccine now being developed would not work against a virus descended from the new strain” Yi Guan and colleagues at the University of Hong Kong have been testing poultry in markets across southern China for bird flu for years. In 2004, 0.9 per cent of market poultry tested positive for H5N1, including 2 per cent of ducks, a major carrier of the virus. But between the middle of 2005 and June this year the virus turned up in 2.4 per cent of market poultry - a nearly threefold increase - and 3.3 per cent of ducks. The virus is also showing up in chickens for 11 months of the year, up from only four months previously. The reason, says Guan, is a new “Fujian-like” strain of the virus, descended from one first seen in a duck in Fujian, China, in 2005. It caused 3 per cent of poultry infections in September 2005 but was responsible for 95 per cent of infections by June 2006. “The predominance of Fujian-like virus appears to be responsible for the increased prevalence of H5N1 in poultry,” write Guan and colleagues in a study published in the Proceedings of the National Academy of Sciences this week (DOI: 10.1073/pnas.0608157103). “The new ‘Fujian-like’ strain caused 3 per cent of poultry infections in September 2005 and 95 per cent by June 2006” A higher number of infected but apparently healthy birds in Chinese markets for more of the year means a greater risk for humans, says Guan. All but one of China’s 21 officially reported human cases of H5N1 have occurred since November 2005 - after the Fujian strain started its rise. Some of these people lived far away from any known outbreak in poultry, but close to urban poultry markets, suggesting the new strain is spreading silently in some of the world’s most crowded cities. That means there could be many more unrecognised human cases. In China and elsewhere, people with serious cases of flu are only tested for H5N1 if poultry have suddenly died nearby. If seemingly healthy birds are infected with H5N1 and spreading it, they could also be passing it to humans without anyone knowing. “If death of poultry is used as the only indication of H5N1 infection, but the emergence of human cases is ignored, the consequence will be increased transmission of the virus in poultry,” says Guan, who believes surveillance needs to be stepped up to include routine testing of birds throughout areas infected with H5N1. Based on what previous H5N1 viruses have done in China, Fujian now seems poised to start a third epidemic wave, potentially worldwide, following the first in 2004 and H5N1’s spread across Eurasia in 2005. So far the Fujian virus has reached Thailand, Malaysia and Laos. Its sudden emergence suggests that a selection pressure is acting on the virus. In November 2005 China ordered compulsory vaccination of all poultry. The law has been imperfectly applied, however: Guan and colleagues found vaccine-induced antibodies in only 16 per cent of birds tested. What’s more, they found these antibodies do not recognise the Fujian virus, even though they attack the previous strains of H5N1. “This novel variant may have become dominant because it was not as easily affected as other strains by the current avian vaccine,” Guan says. In 2004, an investigation by New Scientist concluded that vaccinating poultry against bird flu can lead to the emergence of novel strains that can circulate undetected in vaccinated birds unless there are scrupulous controls (New Scientist, 27 March 2004, p 6). The risk is that whatever strain emerges might have unexpected features, such as an ability to kill humans. While Guan’s team has no evidence to suggest that the Fujian strain is more virulent or likely to transmit between humans than previous strains, so far it has killed one person in Thailand and caused five of the Chinese cases for which the team has virus samples. “As far as I know all (20) human cases since November 2005 were caused by this virus,” Guan told New Scientist. The discovery is a warning bell to researchers working on human vaccines for H5N1. The pandemic vaccine now being developed by pharmaceutical companies is based on strains of H5N1 isolated from Vietnam in 2004 and Indonesia last year - but antibodies to these strains do not recognise the Fujian strain. This means the vaccine would not work against any pandemic virus carrying surface proteins from the Fujian strain. Guan and colleagues say comprehensive influenza surveillance is needed in both people and animals throughout the region affected by H5N1, both to track the real spread of the virus and to provide updates for vaccine developers.

From issue 2576 of New Scientist magazine, 04 November 2006, page 8–9

Behind enemy lines

THE sudden emergence of a “super-strain” of H5N1 that sweeps away all other strains may seem unsettling, but it is something we could have predicted. Human flu does this all the time. The reason people get flu year after year is because the virus evolves slightly different surface proteins that our immune systems don’t recognise from the last time we had flu. Researchers had thought this was a continual process, with individual mutations being selected for if they give the virus an advantage over the others. Now David Lipman and colleagues at the National Institutes of Health in Bethesda, Maryland, have shown that the process is far more sporadic. Using a large collection of recent flu strains, they showed that H3N2, the most common human strain, generally floats in evolutionary limbo accumulating random mutations, none of which gives any virus an advantage over the rest. As more and more people become immune, flu seasons become milder. Then every few years, one virus happens to collect a winning combination of these individually useless changes that enables it to avoid recognition by human flu antibodies. It out-competes other H3N2 viruses and rapidly becomes the dominant strain that sweeps the world (Biology Direct, DOI: 10.1186/1745–6150–1−34). In 1998, for instance, one strain from Australia acquired a novel surface change, but it wasn’t until 2003, after a few more key mutations, that it suddenly emerged as the most murderous H3N2 of recent years. Lipman’s team suggests that by monitoring these random mutations, we might learn to predict what dominant strain is about to emerge, giving vaccine makers more warning.

Bonjour, mon ami! (J’espère c’est vous.:-) ) I think we have; either on the China threads or daily news, or someplace, been discussing the new fujian-like strain.

We know going about life as usual, waiting trustingly for an effective vaccine, is not what the public needs to be doing right now… though the local powers-that-be seem to be in disagreement with us on that…

Past time for me to step away from the keyboard (running on empty), but hope to see you around later. Have you found your regional thread?

anon_22 – at 17:20 (27 October 2006) “…one of the presentations at the IOM workshop, in which it was pointed out that a 1918-like pandemic would kill the same no of kids aged 19 and below as would normally die in 2 decades from all causes.”

Not true, according to extrapolations using specific age group death rates from 1918–1919 U.S. data. A credible claim would be 6 years.

The number of deaths from all causes for those aged 0–19 years was approximately 55,810 in 2004. (Assumes deaths for those 15–19 and 20–24 are proportional to their relative age group populations.)^1,2 Twenty years at this level would yield aggregate deaths of 1,116,200.

The number of excess deaths from a 1918-like pandemic in the U.S. for those aged 0–19 years at July 1, 2004, is estimated at approximately 334,800. This is about 6 years of cumulative deaths at the annual all-causes fatality level above.

The 1918-like pandemic number is estimated by using published death and population data to derive the specific age group excess death rates for the 5-year cohorts for those 0–19 years old.^3,4,5 These specific rates are then applied to the July 1, 2004, age group population data. The results are shown in the table below.

Using specific rates for each age group is more accurate than applying a total population rate against age group populations. This is because the latter implicitly assumes that all persons in all age groups are equally at risk. However, this assumption is incorrect for the 1918–1919 pandemic, and, therefore, should be avoided.

Notes

1. Miniño, A.M., Heron, M.P., Smith B.L. (U.S. Department of Health and Human Services, National Center for Health Statistics), “Deaths: Preliminary Data for 2004,” National Vital Statistics Reports (June 28, 2006) 54(19), p.8.
2. U.S. Census Bureau, Statistical Abstract of the United States 2006, (Washington: Government Printing Office, 2006) p.13.
3. U.S. Bureau of the Census, Mortality Statistics 1919, (Washington: Government Printing Office, 1921), pp.28,30-31 (PDF file pp.26,28-29).
4. Lindler, F.E. and Grove, R.D. (U.S. Public Health Service, National Office of Vital Statistics), Vital Statistics Rates in the United States 1900-1940, (Washington: Government Printing Office, 1947), pp.840-854,1008-1010 (PDF file pp.844-858,1011-1013).
5. U.S. Bureau of the Census, Fourteenth Census of the United States Taken in the Year 1920, Vol. II, Population 1920, General Report and Analytical Tables, (Washington: Government Printing Office, 1921), p.154 (PDF file p.12).

Marble – at 00:33

I didn’t have time to do this till now. Just a quick question first. I’m wondering where you got the age-specific death rates? I didn’t find that in your references. Do you have a link?

This chart is from Robert Glass Targeted Social Distancing Design for Pandemic Influenza with age specific attack rates for the 3 pandemics.

Anon_22, Ok. This thread HAS MY ATTENTION. School closure seems a very good answer. After reading this, I plan to contact my school and ask a few questions regarding home schooling my children that currently attend public schools. Information is power.

I am like Kathy in Fl — 5 kids. This is such a scary scenario, that I can barely wrap my brain around it.

Anon_22 — would love to know when you think it might be time to begin the home school venture. We know the status quo could be deadly at some point in the future. We have power from lessons learned from the 1918 Pandemic — lessons that can teach us better ways to protect our children.

Knowing when to act is the key. When do we say “enough” to public school and “yes’ to school at home for safety reasons?? This, I think is the million dollar question.

Is there currently a provision that gives parents rights under disaster preparedness to home school without a lot of legal wrangling?

Argyll.

Argyll – at 08:39

Anon_22 — would love to know when you think it might be time to begin the home school venture. We know the status quo could be deadly at some point in the future. We have power from lessons learned from the 1918 Pandemic — lessons that can teach us better ways to protect our children.

I don’t think I have an answer to that. Nor to the parent’s rights to home school question. My own understanding, but this is just guessing, is that you already have rights to home school your kids. Check with your local education authorities to find out their guidelines and requirements.

Now, I’m not against homeschooling, I have friends who have done it successfully and turn out wonderful kids. However, just to be devil’s advocate for a minute, let me ask you this. Would the possibility of a pandemic be good enough reason to homeschool your children? This is a huge commitment and is likely to have permanent impacts, both positive and negative, on your children’s personality, outlook on life, approach to problem solving, etc etc.

My own inclination is to be cautious in taking major steps like that. I would suggest as a bare minimum that you take a large sheet of paper, and write up 2 columns of pros and cons for home schooling, and maybe do it both for if a pandemic really happens, and if a pandemic does not happen for all or most of the years that your children are going to be in school. Apart from balancing pros and cons, you should also look at your pros, whether they are positive or ‘towards’ a positive outcome eg more creativity, or negative or ‘away from’ a negative outcome, eg avoiding getting infected.

Most decisions include both positive and negative motivations, and that’s fine. But I would be very wary if the major motivations are all negatives or ‘away from’s , because 1) when the threat that you are trying to avoid is not present or imminent, you may not be able to sustain the motivation needed for such a major commitment, and 2) you should ask yourself what lessons your kids might be learning if their schooling was driven by running away from something and not so much towards something positive, which IMHO may create more resilient individuals in adult life.

I’ll get off the soapbox now. Thanks for listening. :-)

btw just in case anyone is wondering, I haven’t finished, or started, answering Marble’s question yet. Have to get some data sorted out first.

Knowing when to act is the key. When do we say “enough” to public school and “yes’ to school at home for safety reasons?? This, I think is the million dollar question.

I think you should act now, at whatever level you feel you can:

• Individual homeschooling is an individual option.
• Constructively pushing your community in the direction of more information, a better assessment of possibilities, and more useful policies - that’s also an individual option. It’s something you can do.
• No one can stop you from doing both! Just allot some time to each option and get it done.

If you help your community to think about closing schools proactively, then there will be less transmission (and more care availability) and you will benefit individually too.

That’s the whole point of fluwikie, if you ask me.

Argyll – at 08:39 Knowing when to act is the key. When do we say “enough” to public school and “yes’ to school at home for safety reasons?? This, I think is the million dollar question.

My personal opinion is that we need to close our schools very early - preferably as soon as we see the breakout we all expect to see overseas occur (the “we will know it when we see it” one). If schools don’t close at that point due to confusion on the part of local officials (who may want to discuss and study the matter more), then we need to pull our kids from the schools at that time.

Here’s why, from GreenMom - at 9:31 on the “What Is Your PPF Part VII”:

Any way, computer guys at Los Alamos National Lab have come up with a computer simulation called EpiSim. This info goes straight to Dept. of Homeland Security, Dept of Health and Human Services, and ultimantly to the President. Their findings indicate there is no “wave” but a mere two weeks from the first AF case to the entire country being blanketed.

I love this site.

We’re constantly bouncing up and down from what we do as individuals (or families, gangs, etc) and what we would like to see happening in our communities - starting with the extended family and all the way up to Da World.

Of course both outlooks interact all the time.

The I me mine outlook, and the we are the world outlook.

As I said, I love this site.

I had an interesting conversation with my daughter’s school principal last night. I told her that she would not have to worry too much over whether to close our school because I’d be calling each family in the school myself urging them to withdraw their children as soon as I felt it was legitimitely time to do so. She just kinda looked at me, and I’m not so sure she did not think that was a bad thing. It certainly would take the pressure off the school officials.

Our school is small, btw, so that makes this option both viable and feasible. Not everyone will be able to take this kind of action, but for those in similar small-school environments, where one person’s voice can make a difference, personal attention to the issue at the proper time might make a world of difference.

Marble – at 00:33

Thanks for your input. It was actually rather interesting trying to compute the numbers in different ways. :-)

First of all, probably the most important thing IMO is that these numbers are not given for the purpose of precisely reproducing what actually happened in 1918, but to match the numbers used for planning by governments worldwide, which for a “1918-like scenario” generally uses a CFR of 2%. The attack rate assumptions are given on the HHS site, and they are using an overall AR of 30%, but higher in younger age groups, ie 40%.

Secondly, to be accurate, we need to exclude deaths among infants <1 year old, because they represent a unique set of causes unrelated to the present exercise, and thus cause a massive distortion in the figures. The mortality for infants accounts for just over half of all mortality aged 0–19. eg for the year 2003, the total deaths for age 1–19 was 25514, while for <1year was 28,025.

Then, if we want to match the ‘real’ 1918 scenario from historical data, we can take the excess P&I (pneumonia & influenza) mortality for the pandemic period and project what those numbers might be for the current population. By this method, the number of excess deaths in a pandemic matched with 1918 historical figures, would be 13x the annual deaths for age 1–19, but about 7 for age 0–19. ie this matches your calculation even though we are using different approaches.

The point of this thread, or more precisely, the message behind this, is to illustrate using the projections accepted by TPTB (and therefore not outrageous and out of the realm of possibility) of 40% AR and 2% CFR, the severity of the impact.

I’d hate to see 13 years of deaths in one season, just maybe a tad less than 20 years, if you know what I mean.

So, if we use 2003 figures, the total no of people aged 1–19 was 77,212,779.

Actual 2003 deaths for age 1–19 was 25,514

A 40% AR and 2% CFR would give you 617,702 deaths, which isabout 24X the actual deaths for the year 2003.

(btw if you repeat the calculation including <1 year, you would arrive at about half, ie 12X annual deaths.)

To summarize, for anyone who might be numbers-challenged :-)

For a fictitious 1918-like scenario, currently used for planning, ie 40% clinical attack rate and 2% CFR, the number of deaths for age 1–19 would be the same as 20+ years of normal deaths for that age group.

If we were to try and actually match age-for-age numbers from historical data from 1918, then it comes to a slightly better 13 years of deaths instead of 20+.

I don’t see any reason to think that 2% CFR is “reasonable” for the existing H5N1 virus. The 50% Clinical Attack Rate may be “realistic” but I don’t know why one would think that 2% CFR is realistic. Notice that there was no indication of a high (>50%) flu the few years before 1917/1918 for the H1N1. Instead the CFR rate of the circulating virus in 1917 was slightly lower. So… if you use history and the 1918 model, then you would have to consider the possibility that the CFR would either increase or stay the same just as it did in that time period.

DennisC – at 11:55

Yes, I meant “reasonable” as in accepted by most experts as within the realms of likelihood. I personally think the CFR is wide open. But for planning purposes, and for the purpose of making a point, you have to pick a number. And for me the point is not whether it is going to be a 2% CFR but even for a 2% CFR scenario, the consequences are shocking.

There are times when you have only 15 seconds to make an impact and no second chance if you are discredited. So you can say something like “Do you know that a 2% fatality would kill the same no of kids as normally die in 20 years? AND btw the current fatality is at 67%”

Argyll at 8:39. We’ve done private school, public school and homeschooling. There are pros and cons to each. You might try homeschooling one kid in one subject (I picked up one of mine at 1 p.m. each day and taught Language Arts) to see if you have the stamina/nature that makes this a good choice.

Language Arts was a great thing to home school. Lots of terrific books, films, activities out there. Our local middle school has a fantastic science teacher and there is no way that I could ever match his depth, scope and talent in teaching that topic. I am so glad my kids had that wonderful and exciting teacher (whereas Language arts was problematic at the same school).

Think of it as a canoe trip. There’s one river we call “Education” and it can be done fast, slow, with others, alone, or at different speeds depending on the weather and condition of the canoer. Even in the same family, one person’s trip is not the same as another’s. The important thing is to come out downstream in one healthy piece.

There is much to think about on this thread. I have been reading about BF for over a year and preparing as I can. I started this thread over the weekend and half way through I started to talk with my wife about our 4 kids caring for themselves and us if we died or were down with the flu. As others have said, it is especially sobering. They are ages 7 - 15 and could do reasonably well tending a fire, cooking and cleaning. I doubt the boys would start flushing the toilet while we were sick but that’s another matter:)

Isn’t it funny how our views are conditioned by many unspoken assumptions? I have approached BF in a similar fashion to how I approached Y2K - risk management. I had given much thought to the death of my children, but none to the risk to my wife and I. I am way past the age of believing I was 9′ tall and bulletproof, but guys like me die of old age (read; years beyond now), right? I have a new view entirely due to the beauty of the fluwiki.

We plan to have my father (82) and an unmarried sister with us, at a minimum, so I think an adult will be up and about. My greatest concern would be the death of my wife or me while the other was sick and no other adult was in our home. That may be too much to expect children to handle efficiently.

The death of any of my children would be awful but they have been raised to believe in redemptive suffering so it would be very painful to watch but not without meaning to any of us.

If neighborhood children became orphaned and abandoned we would have to do something. We both believe that action is almost always expected of us when we stumble across others in great need. Coincidence rarely leads to an assumption of responsibility, but a belief that everything happens for a reason often does. What to do is the question.

It would be reasonable to assume the child had been exposed and was shedding virus. That may be similar to myself if I was forced to go to work and was arriving home. So perhaps putting the child into quarantine for 2 weeks would be a way to care for them and protect the rest of our family until we could be reasonably sure risk had subsided. I am thinking of a tent in the backyard with food, clothes, water etc. Heat may take some thought if the child is young. In the meantime we could contact his extended family or authorities.

We have homeschooled for 10 years. Often, the mother wants to do it and the father is against it. He wants his children involved in sports to develop competitive instincts. Dad usually thinks homeschooled kids are bucked-toothed with facial warts and socially awkward. That is a common misunderstanding. Here’s a suggestion; almost every area has homeschool groups that get together for activities or specific classes. They are organized along regional or religious boundaries. Go visit one, you will be very surprised at what you see and will be able to ask as many questions as you like in an informal setting. And by the way, atheists are well represented. In our valley, a very high percentage of college and university professors homeschool their kids to provide educational advantages - sans religion.

School districts push back on homeschooling for a few reasons, but one of the unspoken reasons is matching federal dollars based on head count. This can be $5,000 per child per year. They don’t want to talk about that though.

Thank you,SSOL, for a constructive suggestion on what to do for other children whose parents are sick or dead. I mentioned above I believe the numbers of these uncared-for children to die will probably be equal and in addition to the numbers of children who actually catch the virus and die. Your idea could still be hard, but I think I will prep for that method, but since I don’t have children I’d probably let them in the house. I think a wired intercom with good sound quality would be nice to talk with them, especially at night to reassure and comfort them during the separation time. I am also going to experiment with a piece of dryer vent with saran wrap over one end to make a non-power isolated method of direct voice communication with a sick room in a house, or to a tent, as far away as your hose length.

Thanks for some good thoughts. I think,a side from seeing your own family member sick, watching children wandering and dying, and tuning them away, will be the hardest trial to come. And there will be many.

And what’s to say that the current distribution of both infection and death of H5N1 will change to be more egalitarian in nature.

Currently it is scewed heavily towards the young. They get infected more and die at close to the same rate or higher.

Apply the current distribution and the picture grows even more dark.

It seems fair to think that because the state is not moving swiftly to address BF prep at the individual or community level, that they won’t be able to address a surge of orphans very well or quickly either. That would require leadership and at the upper levels of government there isn’t much of that.

So the job will fall to ‘faith-based groups’ or individuals. The state will come in later. This will be a long-term, major undertaking by private groups.

anon_22 – at 07:12 (15 November 2006) “I’m wondering where you got the age-specific death rates?”

The specific death rates posted here were not published in the referenced sources. Rather, data from those sources were used to derive the rates. Simplified, the method begins with distributing Sep1918-Jun1919 excess deaths by age into 5-year cohorts according to distributions for all 1918–1919 deaths from influenza and pneumonia (all forms). Populations for the Sep1918-Jun1919 5-year cohorts were derived from data for 10-year cohorts using relationships in the 1920 Census. Results for the registration states were extrapolated to the U.S. as a whole using referenced population data.

anon_22 – at 11:15 (15 November 2006) “Then, if we want to match the ‘real’ 1918 scenario from historical data, we can take the excess P&I (pneumonia & influenza) mortality for the pandemic period and project what those numbers might be for the current population. By this method, the number of excess deaths in a pandemic matched with 1918 historical figures, would be 13x the annual deaths for age 1–19, but about 7 for age 0–19. ie this matches your calculation even though we are using different approaches.”

I was unable to duplicate your calculations.

anon_22 – at 11:15 (15 November 2006) (cont.) “The point of this thread, or more precisely, the message behind this, is to illustrate using the projections accepted by TPTB (and therefore not outrageous and out of the realm of possibility) of 40% AR and 2% CFR, the severity of the impact.”

The U.S. Dept. of Health and Human Services (“DHHS”) published no assumptions regarding age-specific rates, including CFR, to apply to any specific age group. Assumptions regarding attack rates are for age groups in general terms (40% for “school-aged children” and 20% average for “working adults” rather than specific age groups, e.g. 20–24 years). A total population CFR of 2.11% can be calculated from Table 1 for the “Severe (1918-like) Scenario.” However, there is no indication DHHS is applying the 2.11% CFR to individual age groups.¹

Using the total population 2% CFR in estimating deaths for particular age groups will produce inaccurate results unless it coincidentally matches the age-specific death rate for an age group.

To make estimates consistent across all age groups, if the 2% CFR is applied to one age group, with that group’s assumed attack rate, then it must be applied to all age groups, with the appropriate assumed AR in each case. Applying a 2% CFR with assumed 40% AR for age groups 0–19 (or 1–19) yields a death rate of 0.80%. Then applying 2% CFR with assumed 20% AR for “working adults” yields a death rate of 0.40%. Thus, this approach leads to the conclusion that children have twice the risk of death as working adults. Since this is the opposite of what happened in 1918–1919, the conclusion is wrong, and, therefore, the analytical approach is clearly flawed. It overestimates the deaths of school-aged children and underestimates the deaths of working adults.

The 1918–1919 U.S. data show that while children 5–19 years old suffered the highest attack rates, as a group they had the lowest specific death rates.² The graph of attack rate versus age posted earlier here by anon_22 (15 November 2006 at 08:11) illustrates the attack rate data. The low death risk to children, relative to other age groups, is best seen by looking at 5-year cohort age-specific excess death rates during the pandemic period Sep1918-Jun1919. However, as mentioned above, these are not published in the sources originally referenced, and must be derived instead. Although I’ve done the calculations, others may feel more comfortable with official data even though they are do not exactly what is needed.

One alternative is published data for 10-year cohort age-specific rates due to all influenza and pneumonia (all forms) deaths for calendar years 1918 and 1919. Not what we want, but close enough to support the point that kids fared better than adults. For example, in 1918, children 5–14 had a specific death rate of 0.1762%. Adults 25–34 had a rate of 0.9926% — 5.6 times that of the 5–14 year olds.³

For 5-year cohort data, there are published figures of crude deaths (i.e., not adusted for age populations) distributed by age and sex for the calendar years 1918 and 1919. For example, in 1918, males 5–9 years old accounted for 2.84% of all registered male deaths from influenza and pneumonia (all forms). Males 25–29 accounted for 14.66% — 5.2 times as many as the 5–9 year olds.⁴

While parents may be concerned about the risk to their children from a new pandemic, in a clone of the 1918–1919 pandemic, they are more likely to die than their kids are.

Notice also that using the 2% CFR across all age groups results in a flat line when graphing death rates versus age instead of the signature “W” curve of 1918–1919.

I agree with the general point that it is valuable to make estimates of the impact of a future pandemic in order to prepare for it and to convince others to do so as well. However, the estimates should be as accurate as possible. This requires using specific age group death rates when estimating deaths for particular age groups.

anon_22 – at 11:26 (15 November 2006) “For a fictitious 1918-like scenario, currently used for planning, ie 40% clinical attack rate and 2% CFR, the number of deaths for age 1–19 would be the same as 20+ years of normal deaths for that age group.”

“If we were to try and actually match age-for-age numbers from historical data from 1918, then it comes to a slightly better 13 years of deaths instead of 20+.”

I disagree with the first conclusion for the reasons stated above.

Regarding the second, applying age-specific excess death rates from 1918–1919 to 2003 populations of those aged 1–19 years results in an estimated 238,700 excess deaths. This is about 9.36 years worth of deaths from all causes of 25,514 in 2003.

Notes

1. U.S. Department of Health Human Services, HHS Pandemic Influenza Plan, (Nov 2005), p.18, online version (rev. 13 Sep 2006)
2. Glezen, W.P., “Emerging Infections: Pandemic Influenza,” Epidemiologic Reviews (1996) 18(1):64–76.
3. Lindler, F.E. and Grove, R.D. (U.S. Public Health Service, National Office of Vital Statistics), Vital Statistics Rates in the United States 1900-1940, (Washington: Government Printing Office, 1947), p.254 (PDF file p.259).
4. U.S. Bureau of the Census, Mortality Statistics 1919, (Washington: Government Printing Office, 1921), p.30 (PDF file p.28).

Still too many young people will die, and society be the worse for it; communities need to be brainstorming and physically preparing, so they can shield, and recover.

I appreciate Marble’s carefully researched post.

9.36 years worth of deaths

A lot.

We might also want to consider how many children per family, then and now. Families are generally smaller now, at least in “western” countries. What that means psychologically I don’t know.

One final element for the equation: we’ve been warned in advance. They (back in 1918) weren’t.

Psychologically, 9.36 looks worse than 20. I know it’s silly, but the data has the appearence of being “harder”, as in “more consistent”, “more difficult to refuse as exaggeration or off-hand calculation”. Worse, in my feelings.

Marble, thank you. I’m sure you are right. As I said, I’m no mathematician, and it was not meant to be a scientifically exact comment, but as something to be used for shock and awe, if one were ever inclined to do so, that is. :-).

I think the issue for me is order of magnitude. When we look at how the world has changed since 1918, and how most people’s life experiences no longer include what would have been commonplace before, we can only get a vague sense of what kind of impact those numbers will have on society. Imagine, in the following chart, the 1918 spike happening in 2006, (again this is not supposed to be mathematically accurate, just an illustration of a concept). How many societies can sustain those kinds of trauma without falling apart?

I am hoping for a CFR of only 2% for the coming pandemic but my opinion is that it will be 10% worldwide and about 8% in the developed nations. As anon_22 and others on this thread point out, even a 2% CFR has a devastating impact on all age groups.

For more on this, Illness and Death During the Pandemic located here at http://tinyurl.com/y52qu8 on the Bird Flu Manual website. In this article, I discuss why I think the CAR and CFR will be 40% and 8% respectively for the coming pandemic.

During the 1918 pandemic, the death rates for those aged 15–44 was much higher than that observed for the <15 age groups. If age specific data is used from 1917 is compared with 1918, here is what is seen (all numbers are deaths per 100,000). Death rose in the <1 year olds from 1474 to 2273, 1–4 year olds from 211 to 718, and the 5–14 increased from 24 to 176. The really big jump was found in the 15–24 year olds from 39 to 580 the 25 to 34 year olds from 59 to 992, and the 35 to 44 year olds from 98 to 554. The deaths reported are from pneumonia and influenza only with other causes excluded.

These issues as well as the CDC’s ration plan for antivirals and vaccines have been the subjects of my attention lately, more on these later.

Grattan Woodson, MD, FACP

Dr. Woodson---

Thank you so much for posting on here. That detailed information on the other web site [http://www.birdflumanual.com/articles/illnessAndDeath.asp|on the possible CAR and CFR] is the only information I’ve ever read that demonstrates that someone is actually trying to come up with realistic numbers instead of blindly assuming low rates simply because those low rates are what the CDC, HHS, and others use. One thing though…

Although you explain the factors that would affect the CFR such as case severity, prognostic type, and treatment setting, unless I missed it you did not discuss what the current CFR is for known cases of avian flu in people in Asia and you did not explain WHY you think that when the virus mutates to the point that we’ve got a pandemic on our hands the CFR is going to fall so drastically. We’ve got a long way to go to get from the current 50% (when the healthcare system is not overtaxed down to 8% (when it will be overtaxed). I know conventional wisdom is that the rate will have to fall because historically (with a really bad pandemic like 1918) it has been in the single digits. But is it not possible that if H5N1 turns out to be the basis for the next pandemic, we will have a CFR that is unprecedented?

A quote from the article: “Type 1 patients are critically ill, Type 2 patients are moderately ill, and Type 3 patients are mildly ill. Simply stated, prognostic Type 1 and Type 2 patients would be those the US Government expects to require hospitalization with the Type 3 patients being those they expect to be treated at home.”

Who’s to say that MOST who gets the pandemic virus won’t be classified as prognosis Type 1 — with a few Type 2 for good measure? Did I miss something? I guess that to get your estimates you divided up people into Type 1, Type 2, and Type 3 based partly on age groups and what their initial health status was before their illness (e.g., chronic health issues and what not). But in 1918 very healthy young people were some of the worst hit.

Please explain why when discussing the severity of illness you didn’t mention anything about the current CFR for the specific virus that is the most likely candidate for launching the next pandemic.

A helping whisper: Pst, April, hey - it’s two square brackets (not one) on each end.

Forum.WHOReportOnInfluenzaResearchSep2006 is about this WHO report (PDF file). There, in page 19, we can read One especially important question that was discussed is whether the H5N1 virus is likely to retain its present high lethality should it acquire an ability to spread easily from person to person, and thus start a pandemic. Should the virus improve its transmissibility by acquiring, through a reassortment event, internal human genes, then the lethality of the virus would most likely be reduced. However, should the virus improve its transmissibility through adaptation as a wholly avian virus, then the present high lethality could be maintained during a pandemic.

We may not feel able to cope with such a thought today.

But it certainly gives even more weight to the “early school closure” strategy. Less cases, same CFR, we gain a bit.

And what about the SIP-for-all strategy? I personally don’t think it’s possible in a short time frame, but we’re free to explore and facilitate!

Thank you, lugon. Sorry that I mussed up my linkoid. That’s what I get for trying to post something before my brain woke up completely.

The Doctor – at 02:46 “CFR ..10% worldwide and about 8% in the developed nations.. CAR and CFR will be 40% and 8% respectively for the coming pandemic”

I think your numbers are in the “right ballpark”. My guess was CFR 10% US,EU, 15% LDC’s and CAR of %50 just looking at the math side (game theory) of things.

I do think civilization will survive but society will change in a big way. (Especially the Soc. Sec system and social programs due to loss of the younger work force).

To make matters worse, the changes in the world since the last pandemic increase the risk that “pandemic waves” may not characterize the coming pandemic. Below is an excerpt from a new publication I am working on, The Coming Pandemic Disaster. During my research for it, it occurred to me that the prior wave behavior exhibited by pandemics was primarily a function of the number and concentration of the susceptible human population and modes of transportation available. Today, the human population is higher than ever before and more concentrated within small geographic areas. Transcontinental travel via jet aircraft will permit the human vectors of the pandemic flu to reach virtually every corner of the world in a very short period of time compared with the past. These factors together with the large number of elderly and infirm within most developed nations and many developing countries all set the stage for pandemic influenza to manifest as one great wave lasting for 6 to 9 months followed by several small “clean up” waves that serve to pick off those escaping infection during the initial attack.

Once impact of this change will be an increase in the transmission rate to 3 instead of the more supportable 2 that CDC planners are praying for. The TR is simply a measure of the rapidity of spread of a disease within a susceptible community. It has a big effect on the CAR and CFR of the infection upon the population.

It is now my best estimate that this is how the pandemic is likely to play out rather than the more subdued effect we would experience should it occur in waves.

An excerpt from The Coming Pandemic Disaster Pandemic waves, a thing of the past? The three 20th-century pandemics occurred in waves. While the event may last for a year or two the action is compressed into 2 or 3 periods of a month or two long each. The Spanish Flu’s first wave was more severe than the usual seasonal flu it but was not all that bad. It was the second wave that re-emerged in September 1918 with a vengeance that caused 90% of the US deaths from the pandemic. The third wave resembled the first wave in severity and was not too bad in the US.

The reason for the wave phenomenon is not known but could be due to the summer heat interrupting the spread of the virus within the human population. Modern intercontinental travel by millions of persons each day could dramatically change the speed with which pandemic influenza moves through the world’s population. This factor together with the highly concentrated human population within urban areas may lead to massive single tsunami-like pandemic flood the inundates the world virtually simultaneously.

An event like this might last from 6 to 9 months depending upon what time of year it began. There would likely be subsequent wavelets of much less intensity for a year or two afterward as the pandemic virus picks off those who escaped its initial grand attack. This scenario would result in a much higher case fatality rate from the direct effects of influenza than would be the case if the pandemic occurred in discrete waves interspersed by disease free periods as in the past. More worrisome is the effect a single prolonged wave of this magnitude would have on the fragile global economy. It would be crushed by an event of this intensity. The civil unrest stemming from this occurrence would be sustained and profound. While it is impossible to predict the impact, during the period of anarchy that followed, great loss of life and property would be the likely outcome.

The uncontrolled growth of the human population since the last severe pandemic is the primary factor that places us at exceedingly high risk from pandemic influenza. The human race’s inability to control its population growth is the principal reason for our present vulnerability. The increase in grain yields through intensive farming techniques has supported the growth in the human population. Food production worldwide depends upon a large number of critical inputs whose supply depends on a smooth running global economy. The advent of a severe influenza pandemic threatens the integrity of the international economy, which could disrupt food production worldwide. Food riots will precede a breakdown in social order.

For April

The worst-case estimate for the coming pandemic is for a case fatality rate of 50%, which would result in the deaths of 25% of the world’s population if the clinical attack rate were 50%. This would amount to 1.65 billion deaths worldwide. This estimate is probably way out of line based upon a number of factors including significant undercounting of current less severe cases by the WHO. In my opinion, the coming pandemic is likely to be severe and have a worldwide case fatality rate of about 10% as was seen in 1918. With a clinical attack rate of 40%, this translates into 264 million deaths worldwide. The CFR I expected in the EU, Japan, and the US is about 8% with the rest of the world suffering a higher 12.5% rate.

Here is an excerpt from The Bird Flu Manual where I make the case the current CFR for H5N1 is overstated for a variety of reasons.

Bird flu lethality is overstated The 1918 flu, like most pandemics, infected 30% to 50% of the world’s population, or approximately 640 million persons at the time. If we assume that approximately 80 million people died during the 1918 influenza pandemic, we find a case fatality rate of approximately 12.5% of those infected. While this estimate is terribly high, it is only a quarter of the 50% case fatality rate currently reported for bird flu. Medical References

Growing evidence indicates that the number of cases of human bird flu infections has actually been much higher, especially in the number of infections that were not fatal. The undercount is partially attributed to conservative methods used by the WHO to confirm bird flu that predictably result in numerous false negative results and the lack of testing of less severely-ill cases of patients with bird flu. Public health watchdogs in Vietnam, Thailand, China, Indonesia, Africa, the Middle East, and India have missed cases of bird flu since only those admitted to a hospital are tested routinely. In Turkey, WHO has stated that it intends to do a more thorough investigation of the outbreak, but as of the summer of 2006, it has not made findings public. While bird flu may not be as deadly as once believed, that does not mean that we have nothing about which to worry. The U.S. government expects our way of life could be severely disrupted by a 2% case fatality rate, a conservative estimate. The consequences of a pandemic become exponentially greater as the case fatality rate increases.

When the bird flu re-emerged in 2003 as a human infection, it was localized in Vietnam, Thailand and probably Southeast China. In Vietnam and Thailand, it infected a couple of dozen people, leading to 12 deaths, and in every case, those with the flu had close contact with infected poultry.

In 2004 the confirmed infection rate accelerated to about 100 cases, with 50 deaths in Vietnam, Thailand, and Cambodia. We have no information on human cases during that time in China although subsequent unofficial reports detail previously unknown outbreaks were occurring simultaneously in poultry.4, In all of the officially confirmed cases, there was close contact between the people infected with sick poultry. The one exception was a case in the summer of 2004 where the only contact the person had was with an infected family member. This case became the first documented person-to-person spread of H5N1 bird flu.13

Between May 2005 and November 2005 in China alone, evidence provided by unofficial sources shows more than 1,000 human bird flu infections and 310 patient deaths. The exact number of cases or deaths and how many were examples of bird-to-man or human-to-human transmission is unknown due to the difficulty in obtaining samples from the right place at the right time. Both national governmental and international public health communities also have shown surprisingly a reluctance to share information. ,

In late June 2005, the first of a number of human cases of H5N1 developed in Indonesia. By the fall of 2005, the individual cases were attributed to casual transmission of the virus from infected birds to man. These initial cases were followed several days later by one or two additional cases among the friends and family of the initial bird flu patients. In many cases, the newly ill had little, if any, contact with infected birds. Related cases such as these are clusters and are consistent with limited human-to-human transmission of the bird flu virus. The limited spread between people means the virus is unable to get very far from the originally infected person. This passage is an example of inefficient transmission of the virus. Additional but less than perfect evidence exist to show limited human-to-human spread of bird flu in Vietnam, Thailand, and probably Cambodia in the form of clusters of the disease since 2003.12

There is also epidemiologic evidence of flu-like symptoms occurring in people living in Vietnam for a six-month period between 2003 and 2004 who had contact with sick poultry. This study’s principal finding was significantly more mild to moderate cases of a flu-like illness in people who had prior contact with sick poultry compared to those with no contact. Extrapolating this data to the whole of Vietnam suggests that as many as 700 mild to moderate cases of bird flu during that period were unseen by medical authorities because people were not sick enough to warrant hospitalization. The policy followed throughout Asia has been to limit testing for the H5N1 virus to those people ill enough to be hospitalized.

As detailed above, evidence suggests that bird flu fails to approach a 50% case fatality rate, a statistic that overstates the true lethality to an unknown extent. For instance, if we add the additional 700 Vietnam from 2004 cases and the unofficial reports on the human bird flu cases in China in 2005 to the WHO total, the case fatality rates drop into the low 20% range. A finding like this drop is exactly what we expect to see as the bird flu adapts itself to humans.

Grattan Woodson, MD

“While parents may be concerned about the risk to their children from a new pandemic, in a clone of the 1918–1919 pandemic, they are more likely to die than their kids are.”

1918 was H1. H5N1 is not a clone and should be looked at for what it does at present.

“Modern intercontinental travel by millions of persons each day could dramatically change the speed with which pandemic influenza moves through the world’s population. This factor together with the highly concentrated human population within urban areas may lead to massive single tsunami-like pandemic flood the inundates the world virtually simultaneously.”

I thought that’s been the whole point all along, (including more than one clade going pandemic or same clade going pandemic independently in many locations and then, those mutating,) meaning; no break between waves, and, no effective “vaccine ex machina” but, my officials aren’t reality-based in their dealing with mere public. -Despite Dr.Osterholm and other putting it quite plainly back when when we could have reorganized at least some of our priorities to try and become more resiliant communities.

crfullmoon – at 19:03

Well, I am a bit dense and have been slow to grasp the significance on the risk we face from the coming pandemic. This is a complex issue. My views of it are updating as more data is absorbed and processed. Dr. Osterholm is without a doubt one of the few persons on the planet who has applied his considerable intellect to this issue and is well out in front of most of us regarding the this issue. His views have had a significant effect on mine and I regard him as one the foremost authorities on the coming pandemic.

Grattan Woodson, MD, FACP

I have no statistics on which to base this so I am shooting from the hip here.

IMHO an increase of inpatient ie in hospital care load of merely 5% in a short period of time-and no further increase-would break the backs of most hospitals large and small. Inadequate numbers of beds, staff, supplies etc.

As a discharge planner I can tell you that a huge percentage of families,nursing homes, assisted living facilties, boarding homes, etc will not take patients back during a pandemic. How are they planning to empty out the hospitals to take care of new patients?

“Street” everyone?

Back in April of this year at FC, another poster (Laidback Al) and I put together a comparison by age group of both cases (data from Sebastion at The Influenza Report)based on the numbers we had at that point (144 with age data of the total cases at that point)

Age -----------------Cases -------------------Deaths Less than 5 ---------−11.8% ------------------−4.5% 5–14 years ----------−28.5% ----------------−26.4% 15–24 years ---------−25.7% ----------------−26.4% 25–34 years ---------−16.0% ----------------−15.4% 35–44 years ---------−13.2% ----------------−13.6% 45–54 years ----------−2.8% -----------------−1.8% 55–64 years ----------−0.7% -----------------−0.9% 65 or over ------------−1.4% -----------------−0.9%

Over 30%* of the deaths are below 15 years old.

Over 72%* of the deaths (more than 2/3) are under 35 years old.

In May of 2006 The Influenza Report updated its numbers to reflect more complete data on 176 cases. http://www.influenzareport.com/ir/figures/ad060530.htm

They reported that:

“An analysis of demographic data published by WHO shows the following age distribution of human H5N1 influenza cases (n=176): 50% of cases were 17 years or younger; 75% of cases were 29 years or younger; 90% of cases were 37 years or younger. Most patients were born after 1968.”

So while the sample size is very low at this point, the distribution is not changing signifcantly. Working from what we have today, though statistically shallow, seems as valid as extrapolating from a similar historic virus (1918).

If 90% of the cases/deaths are below 40 years old, it distorts the impact to apply an even attack rate and CFR across all age groups including 40–50, 50–60 etc..

Doctor at 18:53

How does one know that the any of the 700 flu-like cases in Vietnam were H5N1? Adding them into the mix and thereby reducing the CFR seems a bit premature.

I don’t think anyone would argue that many mild cases have gone unreported though.

I recall other studies being conducted for H5N1 antibodies in people who had had the flu and no positives were identified. (Thailand perhaps?) Hopefully someone will correct me if my memory is false.

Cambodia Cambodian study suggests mild bird flu cases aren’t going undetected Buchy and his colleagues reported on work they conducted last spring in a Cambodian village that had H5N1 outbreaks in poultry and where one of that country’s four recorded cases lived. (All four Cambodians known to have been infected with the virus died.) The researchers tested blood samples from 351 of the villagers looking for the antibodies to the virus that would be proof of mild or asymptomatic infections. They found no signs of additional infections - this despite the fact that many of the villagers had significant exposure to infected poultry.

http://www.fluwikie.com/pmwiki.php?n=Science.Seroprevalence

Grace RN – at 19:49 “How are they planning to empty out the hospitals to take care of new patients? “

They will do what they are doing NOW here in LA! Take the discharged patients and dump them in Skid Row on the street. When you think about it, a high CFR may be a blessing. Its funny, there are so few things we’ve talked about happening in a pandemic that are NOT happening now.

Long thread closed and continued here