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A Severe Pandemic is Likely, Part 3
In reviewing the US State Plans, I have come to the conclusion that there are many, including public health officials, who are apparently unaware of the facts pertaining to the risk of a severe pandemic.. Since planning is heavily dependent on the assumptions made, it’s important that decision-makers, which includes the general public, understand why a severe pandemic is likely.
Although we don’t know what the kill rate of a pandemic strain of H5N1 will be, there is no reason to think that it will be less than the 1918 pandemic strain and many reasons to think that it will be worse, much worse. Historical arguments are non-scientific and ignore basic virology. Risk assessments of the likely severity of an H5N1 pandemic should be based on the very substantial data that has been collected on this virus and not based on what has happened in previous pandemics with different viruses.
Given the available facts, failing to prepare for a severe pandemic is irresponsible and likely to result in the deaths of hundreds of millions of people.
Additional References
Evolution and adaptation of H5N1 influenza virus in avian and human hosts in Indonesia and Vietnam
The viral polymerase mediates adaptation of an avian influenza virus to a mammalian host
Structure and receptor specificity of the hemagglutinin from an H5N1 influenza virus
The excerpts below are from Robert G. Webster, Malik Peiris, Honglin Chen,and Yi Guan, some of the most eminent virologists in the world. They are from a paper published in January 2006. My plea is that we heed their warning.
H5N1 Outbreaks and Enzootic Influenza
Conventional wisdom about pandemic influenza holds that a pandemic is inevitable and that the only question remaining is “When?” The H5N1 virus continues to evolve and spread, with additional human infections occurring in Vietnam, Cambodia, Indonesia, China, and Thailand. If this virus acquires human-to-human transmissibility with its present fatality rate of 50%, the resulting pandemic would be akin to a global tsunami. If it killed those infected at even a fraction of this rate, the results would be catastrophic.
[snip]
We cannot afford simply to hope that human-to-human spread of H5N1 will not happen and that, if it does, the pathogenicity of the virus will attenuate. Notably, the precursor of the severe acute respiratory syndrome (SARS)–associated coronavirus (31) repeatedly crossed species barriers, probably for many years, before it finally acquired the capacity for human-to-human transmission, and its pathogenicity to humans was not attenuated. We cannot wait and allow nature to take its course. SARS was interrupted by early case detection and isolation, but influenza is transmissible early in the course of the disease and cannot be controlled by similar means. Just 1 year before the catastrophic tsunami of December 2004, Asian leaders rejected a proposed tsunami warning system for the Indian Ocean because it was too expensive and the risk was too remote. This mistake must not be repeated in relation to an H5N1 avian influenza pandemic. We must use this window of opportunity to prepare and to begin prepandemic implementation of prevention and control measures.
Will the anonymouses please at least pick a number so we can tell one anonymous from another? Thanks! P.S. numbers 22 and 451 are taken.
Tom DVM—Why are you curious about 1890? Would it matter if it were worse? Do you think they were related? Enough Already— I too wondered how Dr Welch survived…
Monotreme. Thanks. I’d forgotten about it.
I don’t think we need any other quotes…this one pretty much says it all.
That quote should be on the main page of flu wiki when so that you can read it without clicking on anything.
enza, Dr. Welch became ill after investigation the outbreak at Fort Devon outside of Boston on his way back to DC, and spent the bulk of the first wave of the 1918 pandemic recovering in a hotel room in Atlantic City, NJ. He in effect, become so ill he sat out the game and those he had trained actually carried the battle. He survived.
Enza. I just finished reading parts of The Great Influenza…Dr. Welch survived because he was extremely careful…he had determined that anyone getting out of bed too soon, would develop pneumonia…
…he was older and therefore was more likely to get a milder version and when he got sick…he basically stayed in bed for the duration of the pandemic…about eight weeks I believe.
As far as 1890 goes. I was writing about it earlier I think on this thread but it may have been on the pig thread…if you can find it, it will explain things pretty well.
…The World Health Organization and the skeptics argument is that 1918 was a ‘one-off’ a fluke never to be repeated…
…but the fact is that it was repeated in three of the six pandemics of the last two centuries.
Dr. Osterholm et al said that the 1830 pandemic was equivalent to 1918 and John Barry quoted other experts as saying that 1890 was the worst pandemic in the preceeding three hundred years…which would automatically make it worse than 1830 that was supposedly equivalent to 1918…
…therefore, 1918 was the norm rather than the exception and the real outlier, the one that should not be used for comparison is the 1968 mild outbreak that of course, the WHO used for that bogus 2–7 million mortality only crap that they have been using to downplay the risks from a pandemic for years.
This completely changes the way we look at a H5N1 outbreak…it is entirely possible to be worse than 1918 and still be within the normal distribution pattern for a pandemic…
…and makes our collective conclusion that the mortality could be far greater than 1918…more understandable and more significant…in other words…we didn’t have the truth but we were right anyway.
actually, I should have said…that despite the fact, we have not been given the truth, we parsed the real truth from circumstancial evidence and in the end we were right.
re: Dr Welch, I know the story from the book, but wondered what specific home health care or medication was used. But yes, it could have been his age.
So Tom you are saying that a panflu is a ‘very bad thing’ most days of the week and the episodes in the 50s and 60s aere anomolies?
Tom DVM – at 00:11 - I ran the Flu Aide and Flu Surge software from the CDC and found that it could be adjusted if you had the password “influenza” to unlock the protection formula pages and revise according to the developers.
From that I used the 1918 scenario and was able to bump the hospitalization and death rates by a factor of 5 to reflect more of what we had seen in Asia the last 3 years, tweaked down for having advanced warning and a bit more prep (not that it really does much good). It results in a 12.5% CFR and 50% attack rate. In Camden County, NJ (just across the river from Philadelphia), it projects that a population of 518,249 will result in 124,203 likely hospitalizations and 31,381 deaths. There are a little over 1600 non- ICU beds, and 199 adult, ped, and NICU beds with ventilators. By week 2 the hospitalizations are 302% capacity and ICU/ventilator use at 1067% capacity. The term “We’re screwed” is all I can voice when I see this.
I’ve spent most of my life working with number and understanding them. Only once before have I ever encountered anything like this - that being when I was in nuclear power operations and had to calculate reactor power growth at a near “prompt supercritical” event (layman’s term is an atomic bomb).
Even if my modified assumptions are cut in half, there is no way for the health care system in any country to handle this if it does not lose a lot of virulence (like drop to 10% of it’s present rate) to become efficient at H2H. I wish numbers would lie, but 5 tries all came within a couple hundred casualties of the same results.
Earlier I said “I think you are going to need a bigger boat.” from the movie Jaws - when the sheriff first sees this monster-sized shark. Now, I think it is time to sit at the galley, pass the bottle of rot-gut whiskey, and sing “Farewell and ado, you sweet Spanish ladies…” because if our little boat of hope sinks, this thing will be proportionate to humanity being the crew of the USS Indianapolis just after it was sunk.
I agree the numbers look horrific, but we can be fatalistic or we can be hopeful. I wired in a way that i have to be hopeful or there will be no reason to wake up tomorrow…
TRay75 – at 00:40 It is so difficult to accept those numbers, although I have prepped basically far beyond what normal people do even for prepping as that was my life in the fire service. Hope for the best and expect the worst, was the saying we used all the time, so that we would not be overwelmed of circumstances being so difficult we would have a hard time handling. So when I responded, I already had in my mind, the emergency situation would be terrible, and thanks it was not as bad as I thought most of the time. There were times though, that the worst happened as I expected and my mind and body were geared to that level. One reason I prep so heavily, plan so heavily, as I dont like surprises on the negative side…….and your numbers are indeed negative beyond comprehension and I even have a difficult time seeing that as your number show. Wish I had a crystal ball to at least show me when though.
Once more I am in deep appreciation of what you people are doing. 15 years from now I hope I to shout to my grandchildren while we are watching the ‘new’ history channel, “Hey, I remember those people!”
The link provided by Mono at 23:54 describes the evolution of the virus in the most readable and chilling format I’ve seen.
Humanity wasn’t wiped out in 1830, *1890, or 1918. I’m going with the 1890 being the true benchmark outlier because I trust people saying it’s so who know way more about this than I do. I want to know about the survivors in the worst case… even if it means “identifying” the worst case.
I read Barry’s book, but became so interested in Welch that I reread it just researching him. In my book I have made notes and references. (BUT, my daughter snagged my book! She’s reading it. If I ever get into the big town with a book store that sells the book… I’m gonna pick up another copy. Or, I guess I could just order it on line… which would probably happen quicker.) Anyway, it does mention a specific medication he took and that he utilized homeopathic medicine. It wasn’t too clear about what this entailed. There was a lot of homepathic phooey going on at that time. Welch seemed to be able to understandingly focus not on what was not available via the medical areana, nor on the phooey homeopathic and snake-oil stuff, but seemed to be able to understandably hit on what worked. And that included rest to prevent relapse. Maybe it was his age… but I’d like to know if any of his trainees followed his regime. I’d like to know more about his life during this time. More about the doctors he used and the treatments and Rx he was utilizing. I want to know what he ate, how he ate, what he did, and how he did it. I want to know what he was ‘working on’ while convalescing. Did he keep a diary? Honestly, he was the most intriguing part of the book to me!
EnoughAlready – at 01:15
Humanity wasn’t wiped out by the ice age either, but it came awfully close (estimates of 10,000 humans worldwide).
Tom DVM – at 00:00
And remember that quote came before human to human to human in Karo. I seriously doubt that these virologists are less worried now.
Oremus-Which ice age?
Some historians call the period after the Bubonic Plague, “The little Ice age”. A cheery thought-if the flu dosn’t get us, the climate will.
Green Mom – at 08:45 What a cruel joke to those that survive the flu - be wiped out by the climate. Eat, drink and be Merry!
“So Tom you are saying that a panflu is a ‘very bad thing’ most days of the week and the episodes in the 50s and 60s aere anomolies?”
Enza. No that is not exactly what I was saying. It you look at the distribution of the past two hundred years…
…there were six pandemics…two of them, 1830 and 1918 were equivalent…1890 was equivalent or worse than 1918…there were two mild pandemics and there was the extremely mild pandemic of 1968.
In my opinion, based on data new to us, 1918 was not the anomaly (outlier) we were lead to believe it was…
…the real anomaly was 1968.
This means that our conclusion that this pandemic in all likelyhood will be worse than the pandemic of 1918…not only fits within the normal distribution for influenza pandemics but would be expected given the last two pandemics were mild ones.
Again, only one question remains…when?
enza, ask Barry for his probability estimate that there will be a pandemic
in the next 5 years. And what’s his expectation value for the number of H5N1-deaths
in the next 5 years.
And don’t believe, what TomDVM is saying. I bet 2 ducks and a swine
that Barry will confirm that 1918 was way more severe than 1890 or 1830.
this insider tip from CDC - we need a proof. We have such posts here
every now and then and so far they were all fake.
And Monotreme, you should include a quote or such before you starts
threads with such a title. Or do you mean, without timeframe, so it could be in 1000 years ?
Like this “not if but when” ?
Although Peter Sandman said : for a severe 1918-like pandemic it’s an if.
Doesn’t make sense either.I could as well start a thread “death is certain”
or such.
it’s rather amazing how many people have reached the conclusions this thread propagates… it seems as though we’re preparing for the best case scenario (heavy prepping), but expecting the worst case scenario (annihilation)
I doubt the majority of us can/could/will accept the worst case scenario, (we’re hoping we’re wrong)… and will continue to prep as though this will be about twice as bad as 1918
I have no idea what I’m trying to say.. except I’m wondering what I should stick away for my last meal… (wry smile)
sorry about the word propagate.. a more suitable term refused to pop out of my brain
Moeb - I am worried about best/worse case scenarios for a number of reasons. 1) the unkown: We have no idea how bad it will be in terms of infection/cfr rates. Right the CFR is truly frightening and we don’t know if it will decrease. 2) society: society back then was far more capable of surviving difficult situations. If things get even remotely bad(eg. SOME food delvery disruptions, MINOR power outages) I think people will freak. God forbid they don’t have cable TV for a week, let alone necessary medicines, etc. I got thru the LA riots and saw the very worst of people. 3)emotional fall-out: people back in 1918 were not immune to personal tragedy - losing a child was unfortuantely common. Large numbers of dead will effect our society for generations. 4)Economics: given our economc dependence on the world economy, the fall-out could last for years and years. We are at a stage where we have to do some serious savings for kid’s college funds AND the very likely scenario of having to take care of DH’s aging and impoverished parents. No work for an extended period of time means we wipe out our savings and then what?
I hate the “unknown”!
spam – at 09:26
Great handle ;-)
The title of the thread expresses my opinion. I do not read the mind of God, nor claim to. However, I do think the available scientific evidence supports this opinion. I have been careful to provide links to document the facts that lead me to my opinion. You are free to disagree or start another thread called “A mild pandemic is likely”, if you wish.
“moeb – at 09:51 I have no idea what I’m trying to say.. except I’m wondering what I should stick away for my last meal… (wry smile) “
Brownies would work for me. Maybe a nice premium Vodka to wash them down with.
How bout this for a thread title?
H5N1 + JIT = “we are screwed” (thank you to Mike Osterholm for that one)
Hi LauraB. That was an excellent post…it is a little long to put in the quotes thread but it is most definitely worthy.
I do not discuss these things to ‘fear monger’ but out of respect for my colleagues at flu wiki…
Science is built on philosophical ethics and principles…they are the structure that holds science up and we have had many examples recently of what happens when ethics falls…suicides unreported in anti-depressant treated children…cover-ups about the toxic effects of Viox…and I could name non-pharmaceutical examples as well.
We are never told the truth out of disrespect…you are patted on the head out of disrespect because the presumption is that you can’t handle the truth…
…I believe you can handle the truth.
This pandemic will come in its own time…this pandemic has given every indication it will be worse than 1918…
…even so you and your family will have an approx. 80 % chance of coming out unharmed…
…and I think if we look back in history, we would see prolonged periods of expansion following for example the plagues in Europe in the 1500′s and also sometimes significant political reforms occur as well.
One way or another, nature will correct the imbalance between human populations and loss of habit etc…we just don’t know if it will be one hit or many hits…
I am not afraid of H5N1 and you shouldn’t be either…because you are one of the few in the world who now knows the whole truth…
…you will prepare…you will survive…and you will rebuild the world hopefully to be a better place for all children…
moeb – at 09:51
There are two different meanings of “Worst Case Scenario” which we should probably distinguish. There is Worst Case Scenario in terms of case fatality rate (CFR), which I think is the most likely possibility. There is also Worst Case Scenario in terms of societal collapse which may occur, but is not inevitable. One reason I started this thread was to encourage decision-makers to plan for a severe pandemic so that we can avoid societal collapse. I think this is do-able and some areas of the US are doing it.
There will be many deaths no matter what we do, but societal collapse everywhere, even in a very severe pandemic, will not happen, IMO.
People can choose to encourage preparedness where they live. If the authorities do not listen, they can move to a place where intelligent planning is occuring. We cannot control the CFR, but we control our own destinys.
well said monotreme. I can’t change the disease, just how I’m i am going to fight it.
moeb @ 9:51-re last meal Not planning on the best for last. May be too sck to enjoy at that time. Best to have it at the start of SIP, IMHO. From the freezer, lobster meat, hot dog buns, brown buns w/bit of butter in fry pan, a little celery (FD), bit of mayonaise, voila’ lobster rolls! Accompanied by a glass or two of Melanie’s WWFK… Rumor has it that the combo has high anti-flu properties. Will save the bottle of Champagne for the last wave, if still standing.
At this point in time it’s H5N1’s world, we just live in it. But we have an underground movement started, its called the fluwikie.
For those of you who haven’t yet read Daniel Defoe’s “A Journal of the Plague Year” - here are 2 paragraphs that reflect back to us support for our taking seriously this loomin threat. He is writing from the point of view of a survivor and has much to tell us who follow him more than 300 years later. Please excuse the length.
“…nothing was more fatal to the inhabitants of this city than the supine negligence of the people themselves, who, during the long notice of warning they had of the visitation, made no provision for it by laying in store of provisions, or of other necessaries, by which they might have lived retired and within their own houses…”
and,
“…and many families, foreseeing the approach of the distemper, laid up stores of provisions sufficient for their whole families, and shut themselves up, and that so entirely that they were neither seen or heard from till the infection was quite ceased, and then came abroad sound and well…doubtless it was the most effectual secure step that could be taken…”
to reinforce monotreme’s point made at 10:40 - Defoe, in 1665, clearly observed that those people ‘willing to control their own destinies’ survived by refusing to ignore or minimize the impending threat and then by duly preparing for it.
Lisa- And does history not repeat itself?
Snowhound - I know. The reading of his journal was an eery experience. I read it very slowly, which is not my norm. The parallels drawn, especially in regards to preparedness and lack of, are astounding.
Lisa in Southern Maine:
I cannot find Daniel Defoe’s “A Journal of the Plague Year” on Amazon.com. Can you tell me where you found yours, please?
Many thanks.
Whoops, got it. It is Defoe. That was my problem. : )
I had spelled it DaFoe - watching too many movies lately
Monotreme at 10:06, can you add an “IMO” or such then please to the title ? You are misleading readers and you know that.When there is evidence, that the next pandemic will be severe, then there is also evidence that it will not. You seem to concentrate on the former while ignoring the latter. As far as I know, the majority of experts still think that it’s more likely that the next pandemic will be mild(1957) and not severe(1918). Do you agree ? A new thread “A mild pandemic is likely” would suggest that a mild pandemic were imminent and, together with your thread, that at least two pandemics, a mild one and a severe one were imminent.
anonymous – at 20:54
If there is evidence that the next pandemic will be mild, please post them.
Lisa in southern Maine -
I may be wrong, but I do not believe that this is a factual account, rather Daniel Defoe was a writer and this is a work of fiction, really thought provoking work, but fiction none the less. Anyone out there who can back me up?
Lisa in Southern Maine – at 16:21
Thanks, Lisa!
certainly I agree with you Monotreme, this afternoon I was discussing the possibility of moving back to Iowa to face this thing. I do have many concerns about society breaking down here in Mexico. I hope it won’t but I am out of place here being a gringo. I was all excited when I found out about the veggie cellar in my girlfriends family home… and then I thought about the cold. It’s fricken cold there in the winter. If the power goes, the natural gas will probably go too.
it’s never really cold here… what are all you people going to do? What are the non prepped and the elderly going to do? hmmm perhaps there will be an influx south of the border…
takes a chunk of lobster meat in one hand and a special brownie in the other.. grinz.. thanks
I agree with the title of this worthwhile thread.
In early 1918 plenty of people wouldn’t have thought that some flu would kill about, say, 5 times as many people as what was then known as the Great War, aka The War to end all Wars. Yet there had been previous pandemics and plenty of history available.
Then in 1929, only a few prescient people thought that the debt funded economic bubble was rapidly coming to an end, which would see widespread suffering. The roaring twenties were too much fun.
Most people prefer not to foresee negative consequences.
Anon 22 has it right, we’d all like to see reason to believe in a mild pandemic in regards to H5N1
Moeb - Get a tent and put it up inside the house in cold weather. We learned about that from a Wiki writer from Alaska
moeb. About that special brownie…I think you just keep driving right on through Iowa, I’ve actually been there once…a beautiful place…
as I was saying before I became diverted…you should drive right on through Iowa and on into Canada…because I know for sure…Canada is warmer than Iowa…we are tolerant of certain idiosycracies and we have free healthcare…sort of.
Call of the Wild. That was really well put…clear and concise. Thanks.
anonymous – at 20:54
As far as I know, the majority of experts still think that it’s more likely that the next pandemic will be mild(1957) and not severe(1918). Do you agree ?
No. Absolutely not. All the virologists I know are very concerned that H5N1 will cause a severe pandemic. They are prepping like mad. The famous experts like Osterholm, Webster, Peiris, Guan Yi are all concerned about a severe pandemic. See my post at at 23:54. Do you really think they all expect a mild pandemic? I’m sorry, but if you do, you’re having problems comprehending what seems to me to be pretty plain English.
You can always find an “expert” who will say what you want, like Marc Siegel. But the people I respect are very, very concerned.
Seacoast - supposedly the origin of Defoe’s journal is his uncle, who is said to have survived the London plague and who gave him (defoe) accounting recorded in the journal. It’s a great read. He writes first-person, as though he witnessed it all himself. He claimed to have written as realistically as possible events experienced by uncle. My post at 16:26 should have said ‘defoe in 1728?’ clearly observed, or, ‘defoes uncle in 1665 is credited with clearly observing’.
that’s all well and fine.. but did I tell you that before I moved to Mexico I was a landed immigrant in B.C. for five years (lovely women up there).. and before that I spent five years in a little cabin in Alaska… I know cold and I don’t want any of it ;-)
seriously… living in your living room in a tent knowing your property in baja is bathing in warm sun light? I don’t think so…
Monotreme, they are concerned because the probability that the next pandemic will be severe is still high, maybe 30%, but not more than 50% (IMO). Especially the economical risk planning institutions seem to consider a mild pandemic more likely. It’s also what I interpret from the expert-statements, although they seem to enjoy being unclear here. Also the politicians and the majority of people around. They would just invest more and do more if such a bad pandemic were that likely. When you see some pandemic planning, they almost always assume a mild pandemic.
This was weird. First I lost my cookie. Then when I tried to correct it, I lost my post. Then it got so confusing that I thought I might as well delete all that and re-write my post.
Anyway, what I wanted to say was, that I agree with Monotreme in that all the experts that I meet are worried about a severe pandemic. They only differ as to how to tell the government or the public.
There may also be a semantic problem here. One might speculate as to whether the next pandmeic will be mild or severe, but you can’t say that a pandemic caused by H5N1 in the near future is likely to be anything but severe.
but Monotreme, look at the pandemic simulations, pandemic preparation plans, economic risk forecasts, political statements,.., most of them seem to assume a mild pandemic, when the pandemic subject comes up. Don’t you think they would be investing more, if the threat were that big ? Don’t you think, the markets would somehow react ?
Yes, the experts are concerned about a severe pandemic, but they don’t say that it’s likely. Even a small probability would justify being concerned and taking measures. They are unclear about the probabilities, but I don’t think that more than 50% of them would consider it likely(>50%) that the next pandemic will be severe. (1918 or worse). Even for Osterholm this is unclear, I can’t conclude it from anything he said. Webster says: “no one knows” - so how do you extract from that …anything ? No, I don’t think that they _all_ expect a mild pandemic. But most. (>50%) And they consider the probability that the next pandemic will be worse than 1918 significant, but smaller 50% (IMO) It’s a bit tedious to find the quotes to back this, maybe I can do it later. I’d appreciate any help, also quotes which seem to say it’s >50%.
anon_22, yes you can say that. Some do say that, so they can ;-)
Depends how you define “severe”.
Or “caused by H5N1”. If it reassorts with H3N2, would that count ?
And when we are particularly unlucky we might get another pandemic
non-related to H5N1 before(if ever) H5N1 goes pandemic.
Well, hmm, when H5N1 doesn’t go pandemic, then the next pandemic
is quite likely mild.
OK, assume H5N1 goes pandemic, how likely will it be severe ?
History gives no indication of a severe H5N1-pandemic in the last 2000 years.
Virulence might go down, but that’s unclear. Maybe 50%. Even if it goes
down there is ample room for the 12% CFR of 1918. We have antivirals,better communication,quarantine,better science,masks,… to contain an outbreak.
It could be a reassorted virus which is less virulent or which we are immune against. OTOH I don’t dismiss (most of) the other points posted by Monotreme,
But I’m not yet at 50% for the probability that a H5N1 pandemic would be worse than 1918. Maybe 30% ? Or can we agree on 37.5 ? …
I also have actual problems with posting. Better save your edited message before posting.
moeb – at 21:46
seriously… living in your living room in a tent knowing your property in baja is bathing in warm sun light? I don’t think so…
I spend alot of time in Mexico in my youth. It’s a beautiful country. Baja is great. But… Iowa is nice too. In the end, I think it comes down to where you think you are most likely to survive. I don’t know whether Iowa or Baja are better bets.
anonymous, you may be right that there is a good chance that the next Pandemic flu will be a mild one, but this old guy is prepping for the BIG one. If Monotreme and the experts are wrong, all I have to do is eat the leftover preps or donate them to my local food pantry. If you’re wrong, I could very well be dead. No contest, and IMHO, there is a much stronger chance of IT being the BIG one than not. Too many of the leading experts are leaning that way for me to ignore it.
Not to nitpick here, but please take a name. I am getting confused with all the anonymous posters, especially when reading so many threads each day. Thanks for putting your thoughts out here to add to the discussion.
The 1918–1919 Spanish flu pandemic was unique in its lethality and is the anomalous case.
The mortality rates of the Spanish flu pandemic far exceed those of the 1889–1890 and 1830–1833 pandemics. This contradicts any impression that the three were equivalent events, or even that 1889–1890 was the worst.
Estimates for deaths attributable to the 1918–1919 Spanish flu range from 21.5 to 100 million. Based on a 1918 world population of 1.838 billion, these estimates produce population mortality rates ranging from 1.17% to 5.44%, respectively.1,2
The severe 1889–1890 Russian flu pandemic killed approximately 1 million people out of a world population of 1.578 billion, for a population mortality rate of 0.06%.2,3
Thus, the Spanish flu’s population mortality rate ranges from approximately 20 to 90 times that of the Russian flu.
Note that the Russian flu’s population mortality rate of 0.06% is much closer to the 0.03% rate for the moderate 1957–1958 Asian flu pandemic.3,4
Statements that the pandemics of 1830–1833 and 1918–1919 were similar in severity are not based on case-mortality rates, which were low for the 1830–1833 pandemic but exceedingly high for the 1918–1919 event.5
If John Barry is correct in saying the 1889–1890 pandemic was the most severe influenza pandemic of the last three centuries, except for that in 1918–1919, then clearly the Spanish flu pandemic is the extreme outlier — by far the worst of the worst. Nothing else comes remotely close.
Notes
anonymous, the experts that I count are virologists. Financial experts have no idea what the risks are. They are completely ignorant of science. Sadly, this is also true of most politicians and journalists. Even most scientists are not aware of the all the facts relating to H5N1. The number of people competent to judge the risks are probably not more that 10–50. And most of them have expressed serious concerns. I doubt they will ever give you a percentage, but they are preparing and they have advised their governments to prepare in strong terms. Drs. Osterholm and Webster have spoken pretty clearly about this. I really don’t see how you could read or listen to their interviews and come away the impression that they think a severe pandemic is unlikely.
NauticalMan, if the CFR rate was 20 to 30%, what is your opinion the state of society itself? Falling apart? Staying intact? Etc,,,always like to hear what others think on that.
anonymous,
From my post at 23:54
Just 1 year before the catastrophic tsunami of December 2004, Asian leaders rejected a proposed tsunami warning system for the Indian Ocean because it was too expensive and the risk was too remote.
Also, you should know that scientists and engineers repeatedly warned that New Orleans was not properly prepared for a Category 3 Hurricane. Many stories on the subject appeared in the local newspapers for years before Katrina hit. Politicians and financial institutions did not pay attention to these warnings.
Why do you expect pandemic flu to be any different?
Experts can be wrong.
There are experts and then there are experts. However, look at who WHO is placing on their panel in Geneva. Webster, Osterhaus, Cox Tam, … (see my news post for today at 20:37) I don’t think that Webster was selected by accident.
Read the scientific papers, like that of Webster, et al.
“If this virus acquires human-to-human transmissibility with its present fatality rate of 50%, the resulting pandemic would be akin to a global tsunami. If it killed those infected at even a fraction of this rate, the results would be catastrophic. “
Read what Osterholm said: “If the pandemic is caused by H5N1, the avian influenza virus strain currently circulating in Asia, it could kill as many as 1.9 million Americans and infect 30 to 60 percent of the population,” he said, adding that H5N1 is the most powerful influenza virus detected in modern history. … Osterholm said, “I wouldn’t bet my family’s life that it’s not going to happen. ….Even the dead will be contagious. “
If you have a survey of “experts” that says that <50% of them doubt it will be severe- then give your reference and your list of “experts”. If not, then the bottom line is that you are blowing smoke and just do not know.
If you go to the math, you will find that if there is no information on which to base a guess, then your optimum guess is in the middle of the possible range (i.e. 50%). For a CFR, we know that it is possible (what is now seen) that the CFR is about 70% and we know from seasonal flu the CFR can be near zero. So the math would tell you that a CRF of around 35% is your best guess. If you think that the CFR could be as high as 100% (note there is one strain with a CFR now at 91%) then your guess should be 50%.
My guess is that you have no data for what the “experts” guess. If you look you may find news article that say things like “experts say” but they are always un-named sources= figments of the journalist’s mind with no proof, no reference.
Monotreme…I hate to ask. I have been a wikian for what seems like a lifetime now, and somehow, when “Monotreme” posts something, I always read it. Why? Is there something about “Monotreme” that I should be made more aware of? Are you just a fat housewife somewhere, bored with your situation, and posting on the wiki to substantiate a new life that you have made for yourself? I doubt that is true, but for many, maybe they need to “know” who “monotreme” is, might it not be beneficial for the whole? That is, aside from being, an egg laying mammal. >;)Are you a layman who has spent countless hours becoming an expert, or are you an expert who has spent countless hours understanding the layman and explaining things so we “laymen” could understand it? I think a lot of people miss Niman, as they could equate a certain scientific quality to what was supposition, but which Niman attributed to Science, whether or not we agreed with him or not. “Monotreme” has replaced that “science” on fluwiki to some degree…are you up to the challenge? >;)
very good Marble, with all the links ! There were also other pandemics
in ~1830, I think Cholera and maybe another one, I don’t remember exactly.
Maybe that contributed to Osterholm’s confusion.
However the historical argument is not so clear, since world
population increased a lot in the last centuries, more than ever before
(see link 2. from Marble above). Also poultry raised by humans and pigs
increased a lot. This might have changed the situation for H5N1 now.
Snowhound1 --- Oh, you are SO RUDE!!! I take a great deal of exception to your comment “Are you JUST a fat housewife somewhere, bored with your situation, and posting on the wiki to substantiate a new life that you have made for yourself?” I guess that we have your number as being a skinny little arrogant male that feels he can say anything through the filter of the computer network. One of those guys that prefers cleptomaniac drug addicted gambling embezzling single women, rather than chubby gals that have taken on the awesome responsibilities of maintaining their husbands, children, and elder relatives. Women who put others first, by choice and by chance, do tend to be a bit on the fluffy side. I don’t think that Monotreme is a “fat housewife.” I am. For the present. There are reasons for that you cannot comprehend. The context makes it pejorative. Please, get savvy. And change your total attitude. It’s repelling.
Ugh, Snowhound, that’s a snide post. You might label me “just a fat housewife” but I rather like to think of myself as a “Rubenesque Domestic Goddess.” I have read WAYYY too much Fluwiki and have come to very much respect the posts of Monotreme, pogge, anon22, TomDVM and others. Do we really have to post a pedigree before we have valid things to share?
Monotreme, you play with the wording too. (as Osterholm does).
“unlikely” is in common language not the opposite of “likely”.
I would assign 70% probability to “likely” and 10% to “unlikely”.
To be a bit more precise:
I don’t think a representative sample of your 50 leading
virologists would give a majority for those who think that
a H5N1-pandemic would be worse than 1918.
Would you agree with this formulation ?
The financial people and politicians are no experts by themselves, but they
have access to expert opinions. The problem is however, that the
experts are usually being imprecise. How else do you explain that
these financial people and politicians are so wrong as you think ?
They are putting their money and reputation on their estimates.
Or do you think they are lying and give wrong estimates deliberately ?
Monotreme at 23:39, why not ? You just picked two examples there are other examples. Tokyo is preparing for an earthquake that didn’t happen yet, we were preparing for nuclear war, which never happened, swine flu, etc. New Orleans might have been underprepared or just unlucky, I don’t know. Same with Tsunami. Afterwords you always know it better.
Snowhound1 – at 23:59
It’s perfectly OK for you to ask what my qualifications are. I have spelled theses out before. I’m a basic scientist but I am not a virologist or an epidemiologist, although I have worked with viruses. I know alot about sequences but have no clinical experience. I do not want anyone to accept anything I say without question. I try to express myself clearly, but may not always succeed. I do not pretend to be an authority figure. I am not a guru. I am not a prophet. The best thing I can accomplish is to explain a little bit about how science works and point people to useful papers. I think alot here have learned alot of science in the course of trying to understand H5N1, which is a good thing, IMO.
OTOH, the “fat housewife” comment was a bit rude. I’m not either, but it’s not hard to see how someone could be offended as heddiecalifornia was. Scientists come in all shapes, genders, colors, ages and personalities. None of this is relevant to their jobs.
anonymous – at 00:30
Tokyo is preparing for an earthquake that didn’t happen yet, we were preparing for nuclear war, which never happened, swine flu, etc. New Orleans might have been underprepared or just unlucky, I don’t know. Same with Tsunami. Afterwords you always know it better.
Japan has experienced both earthquakes and nuclear war.
Very few people alive today have experienced a severe pandemic. It’s a failure of imagination as well as understanding.
Olymon, and anonymous..I was using the reference simply as an a example of what me may all be…behind our pseudonyms. I make no derogatory comments to the individual. I just remember an e-mail I received from someone years ago that said something along the lines of, do you really have a good visual of who sent you that e-mail?… I guess my point was that I have come to the “feeling”, understanding, or whatever you may call it, that Monotreme, is one, if not the most respected, “pseudonyms” on Fluwiki. His/her profile is somewhat limiting into what we can infer about this individual. I personally “love” Monotreme…I was just questioning, why? Is it just a juvenille crush, or is there something beyond the crush? I really couldn’t care less what Monotreme weighs in a weight class. :)
there is a study from Nov.2005, Baruch Fischhoff et.al
Question:
If there is an outbreak of H5N1 or a similar virus among humans
in the next 3 years,(…),how many people in the world will die
of H5N1 over the next 3 years ?
Experts:25–165 million
“Experts”:6.25–200 million
a 1918-like pandemic would cause more than 165 million deaths today
OTOH, the 25 million deaths are also clearly worse than 1957 or 1968 or 1890 or 1830, so this won’t be considered “mild” either. But apparantly they did expect that H5N1 would lose in virulence a lot compared with the actual 60% CFR
And heddie…I am just a housewife, neither fat nor skinny..Just trying to get by on “normal”. I have been both in my life…fat and skinny.
I think we’d be in Pandemic mode now if it weren’t for the efforts of WHO in Indonesia. The Tamiflu blanket approach has worked at containing known clusters so far, even with some mutation of H5N1.
One thing that hasn’t changed for the better is the host range and the pathogenicity in mammals and chickens, so as a matter of logic and with a little understanding of adaptation, a missed series of H2H cases will eventually let this out, with high CFR, to the world from somewhere.
The real question is where are the missed cases?
anonymous – at 00:24
I don’t think a representative sample of your 50 leading virologists would give a majority for those who think that a H5N1-pandemic would be worse than 1918. Would you agree with this formulation ?
No. I don’t know what they would say. My guess is that they would say “We can’t know for sure, but a pandemic worse than 1918 is a distinct possibility”. But, my post is not based on what the experts would say. It’s based on what I say, based on my understanding of the facts. I don’t claim to be all-knowing, but I do provide links and try to explain why I think what I do. You are under no obligation to believe me.
The financial people and politicians are no experts by themselves, but they have access to expert opinions. The problem is however, that the experts are usually being imprecise. How else do you explain that these financial people and politicians are so wrong as you think ? They are putting their money and reputation on their estimates. Or do you think they are lying and give wrong estimates deliberately ?
I think the financial people and the politicians don’t even know who the experts are. They think the Director of the CDC and Margaret Chan of the WHO are the experts. Dr Osterholm is a real expert. He has been trying to communicate the risk to these people for over a year. There are indications that they are finally starting to figure it out.
Gary Near Death Valley
Will make a comment on your question of 20 to 30% CFR. I am not, repeat, not, going to go near those Fat Housewife, Skinny, arrogant guy comments! Hey, live and let live!
On the serious note of what would happen in a worse case scenario such as this, my feeling is that given the JIT aspects of our economic system at this time, and the inability of most in our society to prepare for any sort of emergency, the probable immediate breakdown of our already stressed medical care system with it’s lack of hospitals, emergency room beds, ventilators, all of which has been well covered here, we are in for an unmitigated disaster. On the other hand, I would like to think that many would rise to the occasion and help their fellow man. When I first found fluwikie, the thing that shook me up and persuaded me to take this all seriously was Canada Sue’s ficitional scenario. Now that looks mild in comparison to what I think could happen. Wish I could be more optimistic. Have seen a lot in my 60 odd years. If I survive the coming Pandemic I am afraid that will be my defining moment in life, not Vietnam, nor 40 years in government, for all its highs and lows. As the man said, I’ve enjoyed the ride in any case. Maybe, just maybe, we, all us good fluwiki folk, will come out on the other end ok. Let’s pray for that, regardless of our religous bent. Great to be part of this group, where so many share their opinions and expertise. Night all…
anyway, I don’t agree with this from the top of this page:
Although we don’t know what the kill rate of a pandemic strain of H5N1 will be, there is no reason to think that it will be less than the 1918 pandemic strain and many reasons to think that it will be worse, much worse. Historical arguments are non-scientific and ignore basic virology. Risk assessments of the likely severity of an H5N1 pandemic should be based on the very substantial data that has been collected on this virus and not based on what has happened in previous pandemics with different viruses.
Given the available facts, failing to prepare for a severe pandemic is irresponsible and likely to result in the deaths of hundreds of millions of people.
Yes I also think it will be a disaster. And like Dr. Webster stated “This is the worst virus I have ever seen!” And it does seem to doing exactly what he thought.
but Osterholm is an alarmist. He is addressing the common people with his
meetings and formulations, not the other experts.
I’m not surpreised, that the risk-assessment-experts don’t pay so much
attention to him. Webster has also lost in credibility. When as he says
“no one knows”, then how can he ?
You can be sure that the financial experts do know about the “who is who”
of the WHO. They spend quite some effort in trying to predict these risks.
But they might not be saying to us, what they really think. However, watch the
markets and you should find out what they think….
World bank estimated recently that a severe pandemic could cost
$2 trillion, yet share-indices didn’t fall. “Normal” economics is still
more important than possible panflu-disruption.
Many of the virology-experts have no good “feeling” for probabilities.
There are studies about this, how bad the experts are in estimating
future events related to the area of their expertise.
I really think, they should also include at least one or two of the math-
or economical experts or risk-assessment, risk-analysis experts
in the panel of the 21 experts which is now being formed to consult WHO
in the possible phases-changes.
anonymous – at 01:43 You seem to have very little concept of a planning basis. Gee when I was in the Fire Marshals Office, asking people to put in smoke detectors, be careful with candles, dont smoke in bed……..guess I just joined the ranks of Dr. Osterholm. Been reading your girades for some time, and of all the people on the fluwikie, you hold the least amount of knowledge in my sight.
So really how come you dont get a name instead of anonymous? What are you hiding?
Anon - share prices didn’t fall, because, like you, most stock analysts also don’t think it will happen. A significiant portion of market pricing, be it stocks or futures such as oil, natural gas, etc. is based on what anaylsyts think “might” happen. That’s why you’ve seen oil prices decline recently - a few months ago they thought Israel/Lebanon would blow up into a full scale war, possibly spreading throughout the entire region, plus they didn’t know what the hurricane season would look like. Now that those threats have lessened, so have oil and gas prices.
However, when SARS broke out in Hong Kong the economy essentially ground to a halt. Schools were closed, businesses closed, workers were forced to take vacation time, international travel to the area slowed to a trickle. And that was for a disease that is far less contagious than influenza. Ramp that impact to a glogbal scale and 2 trillion won’t be hard to reach.
Osterholm wins my undying gratitude for speaking out to the “common people” and for not whitewashing the facts about the possible nature and the likelihood of a pandemic.
By your lights, anonymous, Paul Revere would have been an alarmist. Sometimes, an alarm is needful and a gift.
Open your eyes folks… it is coming. It always comes… sometimes it is mild … sometimes it is not… H5N1 is a beast beyond comprehension. There is no compelling reason for it to attenuate its CFR. there is no reason for it to stop killing our young… there is no reason it cannot become efficient and sustained.
Those who say “it may not happen or we don’t know” are covering their butts.
I, just an ordinary citizen, plan to duck under this mighty wave, and when it passes over, come up for air and get ready for the next one.
Go ahead and believe that it won’t or can’t happen. go ahead and dont prep your home. go ahead and if the unthinkable happens, go to your neighbor for food and put his family at risk.
You naysayers who refuse to look at the facts as they stand will put everyone else in grave danger.
are you lazy? or are you just a nasty human being who doesnt give a rats ass about anybody else?
i believe in the greater good in mankind… so i plead with you… regardless of your “opinions” get ready so you do not become the next person’s burden and put our kids at risk.
Goju…I wish we could put that plea on the TV news…..Like a special report during survivor or any of the mindsucking shows people watch.
Gary Near Death Valley,
I have to agree with you. Planning and prevention are essential facets of successful adult behavior. All you have to do is look back on the simplest aspects of human development to see that people require many years of coaching and guidance on all the little behavioral choices that can help to diminish risk and promote healthy lives. From pre-school through high school, from toilet training to career selection, we have all been coached and guided by family members and by public institutions to develop our own independent capacities for risk management, critical thinking, and decision making. This is part of our culture. So, how come so many people have suddenly gone stupid on us?
Clearly, avian influenza is a risk management exercise of the highest order. Whether or not anyone thinks or feels or fears that a severe pandemic is likely, the fact remains that it is not only possible, it is inevitable. In my admittedly biased assessment, anyone who dismisses the pandemic or downplays the risk has simply not done enough research.
I want to ask everyone who has written on this page: what is your definition of a ‘mild’ pandemic? What needs to happen for something to be considered ‘severe’?
I know I keep repeating myself, but I’m going to use exactly the same example that I used before to challenge those of you who think 12% (or something in that range) CFR is mild.
Hong Kong is one of the world’s most advanced economies. It has more millionaires per square mile than anywhere else in the world. It has a high literacy rate, an extremely low rate of people dependent on welfare. It has one of the best public healthcare systems, and it is small enough for policies to be implemented rapidly and effectively. It has a population of just under 7M.
SARS infected 1733 people there. Within weeks, they had to close ALL hospitals to non-urgent care. All schools were closed. Hotel occupancy went down to single digits. Airports and restaurants were deserted. Unemployment rose to historic highs, and a GDP drop of >2% resulted. In the end, 300 people died.
An influenza pandemic virus with a clinical attack rate of 25% and a CFR of 2% will kill >30,000 people in that city in that same timespan.
How does one calculate the impact of something that kills 100 times the number who died during SARS?
And that is only with a CFR of 2% and an attack rate at the lowest end of estimates.
The biggest flaw of almost all national pandemic planning so far is not in underestimation of the numbers, but in underestimation of what those numbers mean.
Go here for analysis on the effect of globalization on the nature of pandemics.
Malachi – at 07:10 Like a special report during survivor or any of the mindsucking shows people watch.
Hey, don’t go picking on my reality shows.
Malachi – at 07:10
I would respond with a scathing rebuttal, but I need to catch up on the “Dancing With the Stars” episodes I have on my DVR.
Lets see… in my town there are 4000 kids in the school system.
The Costsa pandemic plan which they are following calls for alerting the health dept when 10% of the kids are out sick.
the math:
10% CFR = 40 dead kids before they alert the HD 1% CFR = 4 dead kids… 80% CFR - sorry, i cannot go there.
If one child dies it is one too many… and therefore NOT mild.
HB, is it a WV thing?
LOL!!! I would hope not, but the odds are good.
anon_22 – at 08:18, read that on tv as a public service announcement, too!
(Hm, and there’s also YouTube, right?) ;-)
Some are anonymous, grinding slowly on the internet, and some local officials, face-to-face, are comfortable assuming low probability, virulence of H5N1 going away, people “being able to go back out after 2 weeks and shop”, comfortable making choices for tens of thousands of their neighbors to not get told how to prep for a pandemic year, (more important to keep the current economic/political status quo) and even comfortable not telling people when they are sure many,many,will die, (thinking they will face no consequences?)- “nothing we can do anyway, so why tell them?” - but many more people would say the impact is too costly to not prepare. There are rational things that can be done to get more people, and essential sectors, though a pandemic. Letting Nature take its course and being fatalistic is just not acceptable in people in public trust (and on public payrolls!).
I just found this with google:
http://www.usinsurer.com/pdf/US_InsurerFALL06PDF.pdf
------------------------------------------------
It could be worse. RMS estimates a 20% probability that the next flu pandemic will be more severe than the 1918 outbreak. The risk modeler says many companies may be underestimating their risk if they assume the 1918 pandemic is the worst-case outcome.
------------------------------------------------
now, this is a professional estimate, by a company which works
for insurances and such.
They also say, that there is no upper limit for the severety !
Let’s see:
200million dead:10%
400million dead: 5%
800 : 2.5%
1.6 billion 1.25%
3.2 billion (Webster-scenario) 0.625%
That would be an expectation value of at least 100million panflu-deaths
for the next 10 years !!!
Assuming that a pandemic is extremely likely in the
next 10 years as Peiris said.
I wonder what the calculation for a possible Asian Tsunami was on Dec. 1, 2004. The last serious tsunami, in that area, had killed 25,000 in 1825.
After 5 years we will have miracle vaccines and miracle statins, maybe. Health for all and all that.
(Off topic, but didn’t I see someone say, their local hospital wasn’t even up for a bus crash with 10 critical emergency patients, let alone an influenza pandemic?)
Any pandemic at all will be overwhelming and disruptive and cause deaths; even if no one died from the virus.
If half the people got sick in bed for 3 weeks, things would fall apart in our just-in-time systems, and “poncy scheme” national and household economies.
Add the current fatality rate when you’re the only case in the hospital, with the collateral deaths that would happen if the power is disrupted even for a week, and some get too hot and others get too cold, accidental fires start, no hospital or institutional care for a week, addicts not getting their fixes for a week, people hungry who don’t even have a week of food at home, whatever …
Anon_22: “what is your definition of a ‘mild’ pandemic? What needs to happen for something to be considered ‘severe’?”
We aren’t up to any pandemic at all, and scientists who care about what happens to people are warning us we should have got the public and the local contingency planning taking action months ago, and to act now, while there is still time.
They don’t know how much more time we have, but they know once everyone is sure a pandemic is occurring, it is too late to start preparing; only going to be reactions and repercussions. And “unknown unknowns”.
Can anyone explain to me, using the science, how, with the current CFR we are seeing in human H5N1 cases, an assumption of a CFR closer to 1968 or 1918 can be assumed?
I am not a scientist, but I have read all the science that I can, from Taubenburger to Webster to Osterhaus to Niman. Nowhere in the papers I have read is there an explanation as to how the CFR of H5N1 can be expected to lower (or perhaps I have missed it, which is a real possibilty). I would like to understand better how this might be accomplished.
Any remarks I have seen that posit a very low CFR, or a “moderate” CFR of 1918′s 2.5%, for an upcoming (H5N1) pandemic invariably use the words “might,” “maybe,” “usually,” and “hopefully,” when they discuss, even in scientific terms, the lessening of H5N1’s current CFR. Because policy makers are pinning so much that is vital to these estimates, I would like to see more than the word “hopefully” used to explain the basis for these assumptions - I would prefer to see the science that backs up these claims.
Right now, we know that H5N1 has struck several countries and the CFR has not proven to vary much at all among them (it certainly has not lessened). On what basis, scientifically, can we so confidently predict that the current CFR will not continue at its present level should increased transmisiblity become an issue? Again, this is not a rhetorical question, but a real one.
Pixie. I think we are not seeing the forest for the trees.
Lets focus our attention on one thing…potential. With many pathogens we can draw strict limits as to ceilings for CFR or Mortality or Attack Rate etc. etc. etc.
I think that in considering the potential lethality or H5N1 your mind must encompass a million seemingly unrelated facts…like sunspot activity for instance.
Many on flu wiki could not understand just how unique this virus is when compared to the top ten bad viruses of all time…
…the reason the experts are all running scared at the moment and you will see them get more worried in the next two months is not because of the likelyhood of the threat but because of the known potential of this virus, unseen by myself in my life-time and probably them as well, to bring the world as we know it…’to its knees’.
The Gartner Fellows Interview with Dr. Nabarro December 22, 2005
Nabarro:…”Modeling the total number of deaths is a waste of time.
What the absolutely key thing to have is models and simulations of the progression of the virus, as well as the way in which the virus and society will interact. We actually need those sorts of simulations very, very badly at the moment.”
McGee:If it is H5N1, then will the human genome transmission take place more or less rapidly than with other influenza viruses? How do you view that spreading at this point in time?
Nabarro: “The biology colleagues that I speak with tell me that if the pathogenic characteristics of H5N1 were to be taken forward as it mutates into having a human-to-human transmission capacity, then we would have a virus with high pathogenicity.
So, we really have to hope that if it’s a mutant of H5N1 that causes the next pandemic, it sheds some of the pathogenicity that this current virus has during its mutation.”…
(And we at the Flu Wiki know, “Hope is not a plan”.)
Talking PSA’s - My next move is to create a series of radio PSA’s and run them in my region. I will post them for you to send to your radio station… Saty tuned.
About telling people to shop for 3 months blah blah blah..
I am gathering the managers of my local Market, Parmacy and hardware store to find out how many can shop for how much in any given time frame. It will be useless to have too many people vying for the same resources if the supply cahin can’t handle it.
Thats why it is very important to gauge how much to how many at one time. This is becoming a big part of my thinking for getting the word out.
The last thing we want is a panic now because of demand overwhelming the system.
Pixie. Again, you have well explained why their concern is on an upward trajectory.
They are looking at the same information you are…and they are coming to the exact same conclusion.
The bottom line: the further we go along in the process of examining the behaviour of H5N1…the less the data seems to suggest a mild pandemic or even a pandemic of 1918 porportions.
We have one hope left…and that is that we understand so little about influenza that we may not know that the virulence will automatically decrease or maybe it will never go further than it has today…we just don’t know…they don’t know…and only time will tell…
…we may be watching the pot never boil for some time yet…don’t know!! /:0)
Pixie @ )914
OMHO the ONLY thing than can possibly lower the CFR is IF the officals in Indo have missed a lot of mild cases. And I don`t think that is happening.
Pixie, that could happen when H5N1 reassorts with H1N1 or H3N2 or other strains. Or when it becomes low-path, e.g. by a different cleavage site, or H5N2 can be low-path. Or when we have enough Antivirals or vaccine and it works well. (probably not in the next few years)
Crfullmoon at 9:26: Nabarro: “So, we really have to hope that if it’s a mutant of H5N1 that causes the next pandemic, it sheds some of the pathogenicity that this current virus has during its mutation.”…
That is an excellent demonstration of my position. And that is from Nabarro. That is the problem.
anonymous - I appreciate that a reassortment “could” lead to a lessening of the CFR, but that, again, is a distraction from the reality of H5N1 as it is now. Your explanation that it “can” become low-path via a different cleavage site is the best answer to my question from a scientific standpoint. Can you explain why there is any “hope” that this will, in fact, happen - any indication from the development in the cleavage sites, as things stand at present, that H5N1 “may” go there? Odds?
The reason I bring this up is that if we do not question the “hopefully” and the “maybes” of our assumptions, and begin to base our policy and actions on reality (which in any other endeavor always seems prudent) then we will find our policies and actions to be based not on reality but on “hope,” and as Crfullmoon said, “hope is not a plan,” and it’s certainly not a realistic plan for action.
TomDVM: I understand that they (the experts, viroligists, etc.) are looking at the same information I am, and have come to the exact same conclusion. But until we publicly throw out these safer and oft-repeated milder assumptions, which so many have promulgated and on which so many have based their actions, intelligent policy will not follow. Unless we have some scientific evidence to the contrary, we have to base our policies in current reality.
I am placing my bets on a sky-high CFR or a super-low CFR with a very high CAR, not because that is what is most probable, but because those scenarios may allow civilization to survive or to reboot.
Humans will be too numerous by a factor of ten and will be agitating, destructive, out-of-control infrastructure destroyers, if the overall Grid goes down for more than three weeks.
A sky-high CFR/CAR would freeze people in place, and they would get sick and die very quickly, very little chance for the roaming mob scenarios. The fires would be more accidental rather than purposely set. Lesser CFRs would achieve the same high death rate over a longer period time, but more of the deaths would be collateral due to mayhem. And the infrastructure would be taken out as well.
Anon-22-
To your question-
Mild pandemic- A la 1968 <0.01 % CFR Moderate pandemic = 0.1% CFR Severe pandemic =~ 1% CFR on 30% CAR OR >50% CAR first wave with lower CFR Very severe pandemic 30–50% CAR with ± 10% CFR first wave OR CAR>75% Catastrophic pandemic = >30% CAR with >50% CFR per wave.
And I do think these classifications are meaningful from a personal standpoint.
There is a world of difference between grieving for a beloved grandparent during a mild pandemic, and being a child whose entire family has died during a Very Severe pandemic and the social breakdown that would ensue. Moreover, the needed responses and preparations for each of these stages are different.
Elementary question…have checked FW definitions (not there) but what exactly does CFR and CAR mean?
I know they deal with infection and death but not sure exactly.
Thanks.
OnandAnon at 10:36-Those stages blur and become meaningless once the Grid goes down, collateral deaths merge with the panflu deaths. Once the Grid goes down a very high level of deaths is guaranteed. It is only the ratio of collateral to panflu deaths that changes with each of your stated stages once you exceed the mild and moderate pandemic stages. That is what Anon_22′s recent posting hints at. This is more of a “human nature” or societal problem than a medical problem on many different levels, unless, of course, somebody gets that “silver bullet” vaccine available for all of us.
there is a very nice chart of CFR vs. time at:
http://en.wikipedia.org/wiki/Transmission_and_infection_of_H5N1
CFR = case fatality ratio = no of deaths /no of infected people x 100%
CAR = clinical attack rate = % of population infected with symptoms
A mild pandemic is one where my neighbor or a member of his family becomes sice and dies. A severe pandemic is one where someone in my household becomes sick and dies. It depends on how close it comes to your living room.
If we use the current CFR, an attack rate of 50% and use the WHO age H5N1 death distribution from: http://tinyurl.com/jv6l2
and the distubution of ages from the US census
I estimate the following for US deaths, age deaths
<5 11 million
5 to 9 12 million
10 to 19 18 million
20 to 29 12 million
30 to 39 8 million
40 to 49 6 million
50 to 59 4 million
60 to 69 3 million
>69 1 million
But again, my crank powered crystal ball has not come in yet. This is estimated from a kill rate of about 25% net.
(not counting “collateral damage”…)
Dear Anonymous,
I for one, VERY MUCH appreciate your opposing views on these threads. And I disagree entirely, with those that feel you hold the “least amount of knowledge”. In fact I feel many of your posts, so far, have demonstrated a very level head and a good grasp of the situation.
From what I hear you say, you are are NOT ruling out a Biblical type apocolypse, but you are trying to keep things in prospective.
I value EVERONE’s opinion and I welcome ALL schools of thought.
Personally, I apppreciate hearing optimistic reasoning.
DennisC at 11:22 - So then what you are saying is that if the present CFR rate, which has remained consistent so far among all countries affected, continues, that an H5N1 pandemic would require our policy makers to stress perhaps different strategies for their citizens than they have to date. (Unlike my earlier question at 9:14, this one is rhetorical). Seems reasonable.
What would those policy recommendations be? Are they so severe that policy makers “cannot” recommend them? Can only scenarios for hoped-for “mild” or “moderate” pandemics be spoken of?
Patch, I agree, though I wish he would get a handle. (If only wishing would make it so) : )
Oh, and I wish Tram, ( a poster of many months back), would make a guest appearance on my behalf. He balanced out things nicely. I would like to hear his take on recent events.
Tram, are you lurking??
And what about Devils Advocate and Viral Protein? We are getting to crunch time here. We need some of the old gang back to give us their two bits.
I suggest you all take a look at the rumor thread and DennisC – at 10:39. It may help put several things in perspective.
anonymous - at 11:43 - I’m suggesting that we steer clear of any rumors, or of hopes, and just stick to the reality as it exists in front of us at the present time.
And Patch I too really appreciate anonymous’ (GS?) hard questions and his constant demand for data to back up assertions. It just may be that hearing him do so time and again provided the fuel and the rationale for me to begin to seriously question the insistence on policy recommendations and plans that adhere to scenarios which are “hopeful” when the current data seems to suggest something quite different. (See, GS, people really are listening!).
anonymous at 11:43: What I am suggesting is that we refrain from both rumors and similarly disconnected from reality “hope” that H5N1 will be anything different than what it is at present in a variety of countries.
Patch, I too appreciate the hard questions that anonymous (GS?) asks and have always appreciated his demand for data to back up any assertions. In fact, his sceptical model may have provided the fuel and the rationale for me to begin hard questioning of the assumptions policy makers have promulgated about any potential upcoming H5N1 pandemic.
Now if someone would just step and profer some data to demonstrate why we can expect H5N1’s CFR to decrease (GS?)
Sorry - the first post did not seem to appear, did not mean to double post.
Pixie, I don’t think this “anonymous” is gs. (See what a tangled web we weave when anonymouses proliferate) : )
I propose that if the anonymouses feel the need to set themselves apart from the rest of us rabble that the Mods agree to allow ONLY them to be assigned special monikers, (like Greek letters).
Patch – at 11:32 “Personally, I apppreciate hearing optimistic reasoning.”….isn’t that what the Captain was telling others, on the Titanic
Medical Maven the anonymous at 11:43 was not gs since there was no one from Germany on at that time. see for example:
I think I am beginning to get the hang of this. I guess I just graduated from the “newbie” status.
DennisC-I thought gs was Austrian. I think a couple of his recent statements would seem to indicate that.
Gary near Death Valley at 11:17 - Exactly! It’s like the definition of major surgery and minor surgery: minor surgery = someone else is having the operation, major surgery = YOU are having the operation.
Pixie: Your question, “What is the scientific basis or reasoning that would lead one to believe the pandemic H5N1 CFR will be much lower than it is now?” is a crucial one. (I assume it will eventually “go pandemic” - not a certainty.) As Dennis C’s 10:53 link to Wikipedia stated, the low CFR’s used in most models have little predictive value, but show that we are not prepared even for the lower fatality rates. Although Monotreme (who I respect and who knows more than I do about this) says that it is silly to look to history because this virus is different, isn’t he really looking to history too? What do we really know predictively of viral evolution with respect to the evolution of CFR over time? Maybe nobody can answer your question because we do not know enough. That leaves us all in a bad place. Prepping for 1–2 months might be silly if half of humanity were to die. The social meltdown scenarios would then be right. On the other hand, maybe “only” 30% get sick and “only” 30% of those die. Then we lose 9–10% of our population directly. If we prep and plan socially/economically, we can perhaps hold down the collateral damage. Or maybe the virus will be even less deadly. We can only place our bets and do what we can. Goju is doing more than most. I think we need to step beyond family to neighborhood/town/city levels.
anon-22_ your excellent post at 8:18 seems to have lost its last line. I would love to see the link I assume you meant to post.
MM- I agree that it won’t matter to the victims (much) whether it is a mild or a catastrophic pandemic. It will matter to the survivors, however, and even if you assign a relatively low fragility to civilization, the rapidity and extent of any collapse of infrastructure will depend in large part upon how bad the pandemic is. While I agree that major metropolitan areas are likly to be hardest hit and most vulnerable, I suspect that other communities may be more resilient, and may be affected in different ways by a pandemic of differing severity.
I do not mean to sidetrack anyone from the debate over case fatality rates, but my main motivation for prepping is not as closely related to the CFR as it is to the serious disruptions we will experience in our fragile inter-related networks of supply chains, utilities, and public services. Surely, a high CFR will only make things worse, but even if this pandemic is relatively mild, we should still expect that 25% to 30% of the working population will become sick enough to miss several days of work. Social distancing, layoffs, patient care, and school closings will surely drive the absentee rate even higher. Even with a very low CFR, these disruptions will bring hardship to anyone who does not already have everything they need. However, if the CFR is high, as many of you predict, the ability to SIP for several months could make the difference between life and death.
Dr Dave – at 15:40
“However, if the CFR is high, as many of you predict, the ability to SIP for several months could make the difference between life and death.”
No matter how hard I try, it’s pretty hard to find a reason not to prep. : )
Dr. Dave: The collateral damage aspect depends in part on how seriously prepared companies are for having a third or a half of their workers not showing up. If they can defer maintenance and cross-train, maybe the grids will have only sporadic outages. The supply chain of food, fuel, parts, etc. is also worrisome because there are so many linkages and if a few go out, it doesn’t help if the others still work. Some on Fluwiki are persuaded that even a 5–6% kill rate (25–30% infected and 20% CFR) will cause a meltdown. In addition to the nature of the virus, this probably depends on how spread out a wave is and how much real preparation has gone into making critical systems more robust. I would be more optimistic if I saw more serious corporate preps being made, but perhaps they are not visible to us civilians. Ditto for community and family level preps.
INFOMASS: I work for a large distributor of industrial supplies (generators, motors, pumps, respirators, hard hats, Tyvek clothing, etc.) Our corporate preparations are based upon the folowing 4 assumptions: it will happen, it will spread to all parts of the world in 3 weeks, 40% of the population will become sick, and it will cause a 60% absentee rate. I do not know the source of their speculative data, but I find it interesting to note that my employer is a major provider of emergency supplies for the U.S. government.
Dr. Dave
One more posting like that and I’m buying ANOTHER generator! :-O
“60% absentee rate” ? If people are dying of flu, in a 10 person company 4 will show up? I doubt it. I certainly would not be one of the four. Would you? Lets see Risk: death for you and your family. Reward: be known as the one that showed up during the pandemic, get a gold watch at retirement.
I suspect that the power companies are probably the first in line (after the politicians and maybe the military) to get flu vaccinations.
Our northern California power company has been very aware of their responsibilities to the public in disasters, as evidenced by their responses to the Loma Prieta earthquake. They have a number of scenarios planned for; in this era of deregulation and cost cutting, however, I worry that they indeed will be highly stressed.
Since many of their people also serve in the Reserves and National Guard, I am hoping that they will be fully staffed here when some disaster happens. Likewise, many power companies have relied on surrounding (and even cross-country) Power workers to come in and lend a hand when there are ice storms, hurricans, and so forth. This will probably not be possible during a pandemic.
reality: They are talking about staggered shifts and checkerboard office occupancy, working with respirators, and all that. I am luckier than most. My laptop can be linked to the company mainframe, so I can do most of my work from home.
JWB: I already bought my second generator and now my wife say she wants a third one.
Dr Dave – at 17:20 I see I think I would still stay home. I think others will too.
JWB: I don’t mean to alarm anyone, but my employer has just signed a $19,000,000 contract with the State of California for respirators. They also sell a variety of emergency supplies to the all of the U.S. military branches, the U.S. Postal Service, FEMA, the Red Cross, and hundreds of state and local governments. So, my guess is that my employer did not have to do its own research on the possible effects of a pandemic. My guess is that the government provided this pnademic scenario information to all of its mission-critical vendors with the implicit expectation that they remain solvent throughout the pandemic and capable of delivering essential emergency supplies.
Not quite the same information as the Feds provide at pandemicflu.gov, where they only recommend a two week supply of food and water. I guess I should copy this onto the PPF forum, because this raises my PPF to a solid 9.
Dr Dave. I don’t mean to alarm anyone either…I have spent a lot of time being or following regulators and scientists etc…
…something some of us may not understand fully yet…
…is that they are reading the same information we are…they are having the same discussions we are…and they have come to the same conclusions we have…
…and proof of that will be in their actions in the next few weeks to few months…
…I am currently very worried that a pandemic gets dumped on us during the holiday season when our gaurd is down…unfortunately, mine won’t be this year!!
Thanks for the information.
Dr Dave – at 17:20
“JWB: I already bought my second generator and now my wife say she wants a third one.”
I’m still working on getting a wood stove!
Tom DVM – at 18:06
“Gary Near Death Valley. It is time for anonymous to stop commenting on other’s positions and produce the evidence to indicate why there will be no pandemic or a mild pandemic…
…there isn’t any.”
Tom, there also is no evidence that there will be a severe pandemic. Just because H5N1 is bad now does not mean A) that it will be the strain that goes pandemic or B) That it will be exceptionally lethal.
…………………………………………………………….
Three of the last six pandemics were not mild pandemics…there is a mountain of circumstancial evidence that H5N1, if it results in a pandemic, is not going to be of the mild variety…and since 50% of all pandemics are not mild…this would be expected after the last two mild pandemics including one outlier…
…the evidence has to be circumstancial because that is the nature of our knowledge of influenza in general and also the nature of the beast…
…Now, if you have one shred of information or evidence that clearly indicates that this is either not going to happen or that the result will be mild…please provide it…
…and by the way…you are exactly right…
…”Just because H5N1 is bad now…” is one of those pieces of circumstancial evidence indicating this pandemic is not going to be a walk in the park like the World Health Organization’s friend - 1968.
Tom DVM – at 18:46 Mild or Heavy, it matters not. What matters is the ability of the infrastructure (power and water) to stay up. Even in the most serve of attacks, if they stay up, secondary death rates will be very low. With the lights on, even with people dying around you, hope remains and people will (in most cases) remain human and not become animals.
We all know this is coming the million dollar question is WHEN.
power and water, closely followed by communications, no?
food may come if those other thingies are up and running
it doesn’t look undoable - if we do it
Anon 451. Truer words have not been spoken…
…I do not even want to think about the lights off and I definitely do not want to think about no food…
…SARS by any measure to influenza was miniscule…we have little memory of a mild pandemic…I lived through SARS in my immediate area…the next pandemic is not going to be a cakewalk no matter what it brings…
…there are very few things in life that I can say I am absolutely 100%, no doubt about it, convinced of…
…I am convinced that it is going to be H5N1 and it is going to be bad…
…and if you and I are alive twenty years from now…an H5N1 pandemic will not be the only one we have lived through…
…and I plan on dying in bed…and not as a result of some virus!!
…but if my friend anonymous would like to prove otherwise…then I say put your evidence on the table and let’s discuss it.
Anon 451: The Congressional Budget Office and The World Bank are thinking not millions, not billions, but trillions. I do agree, however, that if we can keep the power on and water flowing there will be an order of magnitude in difference. This is precisely where a mild pandemic could have devastating consequences. Regardless of the CFR, without power and water, the world economy will be undermined and panic will reign.
Dr Dave – at 17:34 So, my guess is that my employer did not have to do its own research on the possible effects of a pandemic. My guess is that the government provided this pnademic scenario information to all of its mission-critical vendors with the implicit expectation that they remain solvent throughout the pandemic and capable of delivering essential emergency supplies.
That’s what I fiqured. It just makes sense that they would have to let you guys know what they think. And I’m GLAD THEY ARE THINKING LIKE THAT! (sort of)
anonymous – at 18:05 Get a wood stove. Soon. They are worth their weight in gold.
lugon - at 19:18 You need telecommunications to keep the grid operating. If that goes down first the powerplants will cascade shortly after.
Speaking of wood stoves, I got a lot of wood that I need to run out and cover. Rain tommorrow. I’ll check back in in about 12 hours. Goodnight all!
Tom- Speaking of the Swine Flu in 1968, I was alive then and I don’t remember anything about it. The more I think about what DemfromCt said about TPTB in health care/human services not wanting to stick their collective necks out again because they are old enough to remember what happened in 68, the more I am convinced he is right on the money. It just seems to me that when something of this magnitude may threaten everyone on earth, a few people’s image/credibility doesn’t matter much, in fact, that is what most of us are doing in our private lives right now. We are taking that risk because our egos are not more important than what COULD happen to us, our loved ones and our fellow human beings who are all in the boat with us. I find it mind-boggling that our leaders could know fully about this and tell their countrymen and women to stock for 3 days and put an extra can of tuna under the bed. This make Ronald Regan calling ketchup a veggtable for poor kids in the Free Lunch Program seem like an ok thing to do.
Not exactly a survey of “experts” but as close as I could find.
US workers believe avian flu outbreak “likely”
US workers are worried about avian flu, finds a Kimberly-Clark Professional survey, and their workplaces are unprepared.
“Seventy percent of respondents said they believed avian flu was likely to hit North America, but only 25 percent responded “yes” when asked, “Has your company engaged in building a plan in the event of an actual outbreak of the avian flu?” Forty percent expressed concern about an avian flu outbreak in their workplace. …”
“The national, online survey was conducted in May and polled employees in health care, science, manufacturing, office buildings, lodging and other industries. Kimberly-Clark Professional issued the voluntary, nonrandom survey using its own industry e-newsletter and received 379 responses.”
Hi seacoast. Having had a fair bit of experience with regulators trying to get the damn horse to drink…including shoving its head under water…I will try and put this in perspective.
Back in 1996, a few people got the message, not least of which Dr. Webster. But many didn’t. They were convinced that H5N1 was never going to cause a problem…they ignored the neon signs flashing in their faces from 1996 until last fall. If you noticed that article about my friend Dick Thompson from the WHO (I wish I knew how to do the URL thingy) he was still downplaying everything in Sept 2005.
All the seriousness began for three reasons. Q. Lake when it became apparent that infected birds could actually fly and spread it around the Middle East, Europe and Africa…then there was the cluster in Turkey…and then there was the cluster in Karo…and there must have been something about that cluster we were not told because it was specifically at that point that they seemed to collectively get the point that there was no way we could escape an H5N1 pandemic…and it was at that time that the USA made a point of announcing publically the release of their Tamiflu reserve to Indonesia.
At that time they found themselves up the creek without a paddle…now four months later, their canoe is on the bottom and they are frantically dog paddling against the current with the faint hope of escaping the inevitable…
…it was all laughing at the ‘fear mongerers’ before…and now they are at the head of the parade…
…next time you see a press conference about this subject…tape it and play it back with the sound turned off…just look at their eyes and their body language…that’s what I do because their words mean nothing anyway.
I am sorry to say that these jobs appear to attract a certain type of person…and then once in a while you run into a Dr. Nabarro…but they don’t last long because the fight takes too much out of them.
closed and continued here.