From Flu Wiki 2

Forum: Length of Disease

10 October 2006

lugon – at 16:09

flumonitor in Forum.IndonesiaOutbreaksXIV asked “how many days are people ill? and how many days where people ill with H1N1 in 1918?”. The idea would be to check assumptions regarding absentee rate etc. In our pandemic wave in a spreadsheet it’s assumed people are ill for one week. If it’s two weeks (on average) then the cells in the spreadsheet must reflect that, adding the number ill from past week (minus deaths).

What’s the data? What are the assumptions?

lugon – at 16:12

Of course there’s two degrees: well enough so that noone has to take care of me, and well enough so I can work.

James in MT – at 16:24

Good work, to me this is one of the most important parameters in estimating the severity of the pandemic and how it will effect our JIT society. I don’t remember exactly where, but in a recent thread what I seem to remember is that individuals were in recovery for at least a month. I took that as unable to work. I am sure others will be able to quote it exactly. Thanks for all you do on the Flu Wiki.

lugon – at 17:20

I’ve written some changes to the spreadsheet. To the text, not to the formulae.

lugon – at 17:23

Thanks, James in MT.

A month … I must try that spreadsheet and show it to some people in my hometown. :(

crfullmoon – at 17:44

(Not being intentionally gloom and doom, but, weren’t some of those cases only recovering after two weeks, or, 30 or more days, because they had had respirators and other intensive supportive hospital care and meds available?)

lugon – at 17:47

Ok, so it’s supositions. But they must be accounted for in the scenarios, no? Lenght of disease is one of the important parameters. Is it included in “Plans”?

crfullmoon – at 18:10

pdf CBO macroeconomic report has (I think) too-low other numbers, but, assumed 3 weeks (for any out ill, afraid, or caring for ill family).

diana – at 18:20

I read a book awhile back on Indians. One group in Canada was nursed by missionaries and apparently had recovered and were released. They came down with pneumonia almost immediatly and died. This was towards the end of the 1918 pandemic.I’m sure all of you know how weak you are after flu or pneumonia..

11 October 2006

bump – at 12:03

bump

Kathy in FL – at 12:30

What is the length of recovery time for survivors of the current manifestations of H5N1?

Say it takes them an average of 3 days from symptom onset to get to the hospital, you would think that they were out of work for those 3 days.

Add to that the average … median or mode … length of hospital stay?

Then, how long before those surviving individuals returned to their work environment?

The problem is that we are dealing with the current manifestation of H5N1 in those figures … we don’t know, though there is no scientific reason not to assume, that a more effecient H2H2H version of H5N1 will maintain its current lethality and long term effects on its victimes.

Do we have those figures available for lugon to plug into the formulae?

Kathy in FL – at 12:32

So are we talking about …

days from symptom onset to hospital admittance + number of days in hospital + number of days under home health care + number of days not ill but still recovering =

how many days an infected individual can expect to remain out of the work force

Is that correct?

Leo7 – at 17:00

Recovery will depend on your health prior to the infection. Smokers automatically will take longer. People with known resp problems like COPD will take longer. Elderly will take longer etc. These are difficult measures to calculate. Lugon is basically calculating healthy people without pre existing respiratory problems or co infections with other viruses like HIV or HEP C. All the people in the health outliers will take longer to recover. And that is a significant number. I doubt people will be allowed to stay in hospitals after they come off vents or able to stand up and walk a few steps. They will be moved to another set up or home…this is assuming hospitals don’t collapse. At day 50 one of the 32 yo recovered Indonesian male still needed is mom to do everything at home for him, because of fatigue. He was diagnosed with brain infection as well. People who survive will be like newborns—totally dependent on the kindness of others.

lugon – at 18:52

The idea of the spreadsheet would be to let people “play around” with some assumptions, in a very simple way. No outliers, just averages. No assumptions about hospitals colapsing or not colapsing: just severe cases wherever they are - at home or wherever.

I believe simple things help people (myself included) see the big picture clearly. Only then can we start imagining some layers of detail. Then, I guess it’s back to the big picture again to try and “solve” something - or at least “dance with the system”.

Oh, I don’t know!

flumonitor – at 19:08

Thanks Lugon for starting this thread. There is another parameter that may be worth considering. Those at greatest risk of catching flu from an infected person will be, more often than not, members of immediate family as we have seen in family cluster cases so far. So not only do you have ‘time out’ for an infected and recovering individual to consider, but you probably also will have a succession of other family members or carers who, even if the index case is well enough to care for them, will still be unable to return to work.

Looking at the percentage of immediate family members who get ill, plus the period of time of illness onset in the index case through till recovery time of the ‘end’ case would give a period of enforced absenteesism, if the rule is applied that individuals should not go to work as long as there was a sick family member at home. Bearing in mind the hardiness of this virus, to do otherwise would invite someone to bring live virus to work on shoes, belongings or clothing, potentially.

If we think this is a valid scenario, it could make absenteeism duration very long indeed and have a very large impact. Added to this is the question, what will employers do with regard to ‘compassionate leave’ if a family member dies? People grieving are often not able to function at a useful level for some time.

flumonitor – at 19:11

but you probably also will have a succession of other family members or carers who,

should have read

but you probably also will have a succession of other family members or carers who subsequently get sick, and so even if the index case is well enough to care for them, that individual will still be unable to return to work.

Hope what I am trying to say makes sense.

flumonitor – at 19:20

Another point. If we say that your average family unit has two to four grandparents, a couple of adults, and the 2.2 children in the west - along with a grand toal of 2–3 additional siblings. It would be reaosnable to assume the loss fo a parent, sibling or child would be a devastating experience.

What are the probablilities of an individual, in a 2.5% CFR, being affected by the loss of an immeidate member of family? This will give the percentage of employees who are likely to lose a close relative and require time off work. I estimate about 10%.

Can someone check my maths? Because this factor alone would produce quite a problem in itself.

LauraBat 19:34

All I know is seeing that one Indo. case where the guy was on arspirator foe weeks and wasn’t discharged from the hospital for months was very frightening. Granted, not everyone will be like that, but many could be. And an important way to lessen the probability of pneumonia is to rest, rest, rest. I had four mommy friends this year alone come down with pneumonia, all because they were just too busy to take care of themselves.

In Barry’s book, didn’t he write about one doctor who got it, checked himself into a hotel and didn’t emerge for six weeks? If you have to pick a number, maybe the “average” is more like two weeks? And flumonitor has an excellent point - bieng physcailly fit is one thing. Emotionally may be completely different if someone has suffered a signficant loss.

Kathy in FL – at 22:46

I think flumonitor raised a good point to add to the absenteeism thread. What if any household that has actively ill pandemic victims is quarantined so that even if there are one or more work-capable members that are well, they may be required to remain home to prevent further spread of the virus.

That could seriously cause additional subtraction of numbers in the active workforce. And even if there are no legal quarantine situation, would fellow employees really want someone with actively ill people coming to work to perhaps spread it to them and their own household.

Of course, this assumes extremely easy transmissability.

12 October 2006

NS1 – at 01:14

Consider the minimum unit of worker subtraction to be at the single-family level, although illness / casualties could move outwardly to the extended family as well increasing absenteeism further.

H5N1 is its own Force Multiplier.

lugon – at 03:57

NS1 – at 01:14 Consider the minimum unit of worker subtraction to be at the single-family level

I think you mean to say that “families who stand united fall ill (or should be substracted from the workforce) united”? Sure. I’ve been thinking about that too. The unit is not the individual, but the household. Interesting - will have to think more about it.

I hope we’ll start to actually see it. And after that explain it (“make the invisible visible”).

Jewel – at 11:43

I’ve posted this info before but maybe it’s important to repeat here. While reading about the pandemic of 1918 I found several references to the fact that pneumonia developed in flu sufferers if they got out of bed too soon after starting to feel better. It was recommended that the ill stay in bed for a full 2 weeks (and no sitting up) after symptoms started to subside to prevent hypostatic congestion of the lungs which led to pneumonia and death. So we may conservatively be looking at about 3–4 weeks of illness/recovery down time. I think I better add bedpans to my preps.

Brooks – at 12:17

I thought the business continuity recommendations were assuming there could be periods of time when 30% or more of the work force was out (either ill or taking care of loved ones). I assume that is based on a set of assumptions. Are those worth looking at?

Flumonitor – at 13:13

Jewel at 11.43 - are you able to provide any references to this? It is a very important finding that essentially suggests that time out assumptions for continuity plans should be at least three weeks, before any other consideration. Most continuity plans are presently based on an assumption of a five day absence.

Brooks as 12.17: This is one of the assumptions that is commonly used in Business continuity plans to assess impact. The assumption used by some of the most major impact and risk models is presently five days (at least in the UK). We are examining this assumption carefully to test it’s validity, and to independently assess what a reasonable range might be for a period of incapacity of an infected person e.g. 5 days as a best case, 21 - 28 days as a worst case (based on 1918 experience and/ or present H5N1 experience).

However, we need to find hard facts to support what period of time this assumption should be, at a best and wrst case situation.

In the early stages of pandemic planning, the assumption base was to model on the 1968 model. Many models still retain assumptions from the 1968 experience, which may not be accurate nor apply in todays experience. So much is based on this one assumption, we need to have a clear idea of what, based on the evidence, it should be or what the range of days absent by employees from work should be. The period of time an individual will be sick is the first most important figure to determine.

The first and

uk bird – at 14:01

Perhaps we could discuss our worst case flu experiences as a guide? I was a toddler for the 1968 flu and none of my family caught it, so I can’t comment on what a pandemic flu is like. However, about 10 years ago my family and I had a really severe case of the flu.

My sister’s mother in law arrived on Christmas Eve and went immediately to bed. She was ill in bed until she went home with my sister and her husband, 30th Dec. On the 31st all seven of the rest of us came down with the virus. I hadn’t had any direct contact all the while she was infectious so aerosol infection seemed possible.

Having caught the bug, I could barely move for five days. I lost my sence of taste and smell for a month. It was two weeks before I could crawl into work (taking 5 of the 10 working days I took off sick from work during 15 years I worked there). I felt bad for weeks. I had a persistant cought for over six months. We all suffered similar levels of debilitation.

This was a virus that didn’t even make the headlines. How long would you be sick if it had ripped you lungs to pieces?

There are some reports about the recovering SARS victims (I’ll try to hunt one down). They were very weak and prone to illness several years after the initial infection.

You can’t guage how a flu illness will affect the work force using 1918 figures. They were much more hardy and stoic in those days. They also had to work or they starved.

uk bird – at 14:10

Perhaps we could discuss our worst case flu experiences as a guide? I was a toddler for the 1968 flu and none of my family caught it, so I can’t comment on what a pandemic flu is like. However, about 10 years ago my family and I had a really severe case of the flu.

My sister’s mother in law arrived on Christmas Eve and went immediately to bed. She was ill in bed until she went home with my sister and her husband, 30th Dec. On the 31st all seven of the rest of us came down with the virus. I hadn’t had any direct contact all the while she was infectious so aerosol infection seemed possible.

Having caught the bug, I could barely move for five days. I lost my sense of taste and smell for a month. It was two weeks before I could crawl into work (I only took 10 days off sick from work during 15 years I worked there and 5 of them were for that flu). I felt bad for weeks. I had a persistent cough for over six months. We all suffered similar levels of debilitation.

This was a virus that didn’t even make the headlines. How long would you be sick if it had ripped you lungs to pieces?

There are some reports about the recovering SARS victims (I’ll try to hunt one down). They were very weak and prone to illness several years after the initial infection.

You can’t gauge how a flu illness will affect the work force using 1918 figures. They were much more hardy and stoic in those days. They also had to work or they starved.

uk bird – at 14:11

bother!

flumonitor – at 16:52

Latest recorded Indonesian (recovered) case was ill for a period of 18 days before release from hospital

http://www.metrotvnews.com/berita.asp?id=26049

15 October 2006

lugon – at 18:04

text below copied from Forum.KeepingTheGridUp3 Mamabird – at 17:21


Mamabird – at 17:21

Monotreme – at 14:04

Mono T, I am very pleased to see someone like yourself really looking into these possibilities, developing scenarios and brainstorming. We need more of that from every sector. You asked for some input on your latest, and all I can really give you is some conclusions reached by numerous companies associated with several critical infrastructure industries as to how a pandemic might affect their own workforce. So here goes for what it is worth.

The companies I have dealt with primarily focus on clinical infection rates, not case fatality ratios, at least initially. Why, because CIR drives absenteism. The vast majority have patterned their planning around a 1918-like pandemic in which CIR averaged say 30%, but hit the working class age group hard. The absenteism comes as a result of several things, not just the worker that is personally out ill. Some personnel are expected to be away from the workplace because they are primary caregivers of another ill family member, some because public transportation is no longer reliable or available and they have no other means to commute, and many due to school and day care closures. I will add that there is another element very difficult to define, but it relates to fear and panic. Some simply SIP and do not show up.

Now, interestingly under the above absentee reasons, the illness itself has the lowest impact. Although over 30% of the workers are expected to contract this flu bug, the infections are spread out over an eight week period, so some of the illnesses occur early during the pandemic event, and some later. That diversity makes a big difference resluting in weekly peak absenteism due to illness of 16%.

The biggest impact is school and day care closures. Most of the companies determined that about half of their workforce had one or more dependents under the age of 18. Now assuming that half of those must stay home for some part of the pandemic to care and supervise children, then 25% absenteism is due to school closure. Unfortunately, it is an immediate hit on the workforce, unlike the illness which starts, picks up speed, and then begins to die out.

So, at pandemic peak, the companies have 16% out due to illness, 25% out due to school and day care closure, resulting in 41% absenteism. Another 5% may be out due to commute problems. Now I haven’t said anything about CFR yet. The pandemic could actually be H9N2, rather than H5N1. In other words, it might be a flu bug that is highly infectious because we have no immunity, but the CFR may be next to nothing. That would not matter in the above absentee scenario. You would still have 16% out ill, and 25% out because public officials pulled the plug on schools out of fear.

What I can tell you though is that the element of fear and panic leading to workers SIP is very uncertain, with the range of possibilities likey quite large, and this would have to be added to the above figures. When the companies began talking CFR, the planning began to break down because deaths of family members and fellow co-workers was considered devastating. And those dicussions were no where near an assumed CFR of 5%.

In summary, once peak absenteism passes the 50% mark, primarily driven by school closures and SIP, critical infrastructure companies loss an ability to maintain essential elements of operation. So, even with the best intentions and plans, if schools close and local folks SIP, infrastructure begins to collapse and society suffers. That’s not to say we shouldn’t plan like gangbusters in anticipation, but an investment in public education about these issues seems critical to lessen to threat of fear and panic.

Appologies to all for the long post. I bet that’s the last time Mono T asks such an open ended question, huh?

Mamabird – at 18:40

lugon – at 18:04

Length of disease has been an interesting discussion. First, as to the numbers presented in my earlier post, those personnel that were absent from the workplace, either due to personal illness or as primary caregiver, were away for two full weeks. Now let me explain some of the discussion.

It was felt that one week out for the flu was a good assumption if we were talking seasonal flu (Type B, H3N2 and H1N1). However, for pandemic flu it was felt that more time should be added to the seasonl flu absences because people could experience a higher level of disability, longer time of recovery, and because they would also be urged by the companies to stay home until non-symtomatic (basically normal body tempreture). In other words, no sneeking back to work when you could finally raise your head off the pillow like some Type A’s tend to do. You would be caught and sent back home.

But, there was some view that a full two week absence due to more severe illness should also manifest itself in higher case fatality rates. Probably not a bad assumption, but like I stated, most of the scenario was paterned after a 1918-like event, which had CFR of about 2.8%. That’s high, but that was basically the end of the discussion as dealing with the fatality issue was not really appropriate for the planners at that time. Maybe it’s a good time to revisit because H5N1 continues to take on more human characteristics, but has not lost any pathogenicity.

16 October 2006

lugon – at 05:32

off-topic: more and more I’m thinking we need to focus on growing food and energy near our homes + learning to take care of each other at home … a sort of post-globalisation movement which would benefit everyone … i think we already have all the information needed to do that change on a global scale … ah, well

BUMP!

Madamspinner – at 15:41

People who survive will be like newborns—totally dependent on the kindness of others.

And the above is with excellant hospitalization & care !

In this case; as a single person, with no family around; my only hope will be total isolation.

We don’t KNOW what the pandemic will actually DO, until it happens, because of the mutation rate & results. It could be 100 % lethal by then, or it could fizzle out to the point it looks & acts like a “normal” flu. We just don’t know.

I can FIGHT the things I know about !---it’s the things I don’t know about that frighten ME ! :-S

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