Some thoughts on Swine Flu

Slowsis · Post by **Slowsis** » 29 Apr 2009 09:36

While I believe that this recent possible pandemic needs the attention of the global medical community, I've noticed some trends which have personally made me much less convinced of the severity of the disease - that is to say how fatal it is, not how virulent or easily spread.

First of all, out of the 159 'suspected deaths' of swine flu in mexico, only 7 have actually been confirmed as the disease. Why the huge gap? Why have people who only went to their doctors in other countries been diagnosed within 24 hours, while many of these mexican cases have not?

Info from WHO

Secondly, out of the nearly 200 cases outside of mexico, every single patient has responded well to treatment, except one toddler in Texas who at under 2 years of age, is in the 'risk' range for mortality from average run-of-the-mill type A Influenza.

Thirdly, the first case of this recent 'swine flu' was diagnosed quite a while ago...
Start of Swine Flu - CNN
.... read near the bottom of the article. One third of the town came down with flu-like symptoms? Were there no deaths? Has testing been done?
This information would lead me to believe that the 'swine flu' has been in circulation for the better part of a month, and has most likely infected tens of thousands of people. Many of these people may have recovered long before the international response to the crisis. This would make those 159 'suspected' (20 confirmed) deaths in Mexico an extremely low mortality rate, especially since most of those Mexican likely did not have access to anti-viral drugs.

Fianlly, this large number of 'suspected' deaths would have been amongst people who didn't know what the 'swine flu' was, and most of these people would have been quite sick before there was an international crisis called. That would indicate that if many of those amongst the dead had received timely medical attention, they would have survived.

Basically we see a large number of people getting infected and not dying in countries which are prepared for the outbreak, while a country which truly has no idea how many of their population has been infected has a large number of 'suspected' deaths. Using Occam's Razor we can deduce that this 'swine flu' is likely no more severe than your average seasonal flu bug, and even if it is more severe, it is only in a marginal way, which through hospital preparedness, can avert all but a few deaths amongst the young and weak (just like the regular flu).

Anyone have any rebutals or input into this?

jay7 · Post by **jay7** » 29 Apr 2009 10:16

~Year 2000 -> Y2k 'bug', "all your computers are going to die!"

~year 2003 -> Sars..."We're all going to die, wash your hands to the bone!"

~Year 2006 -> Bird Flu "We're all going to die! WASH YOUR HANDS!"..

~Year 2009 -> Swine Flu "YOU'RE GOING TO DIE!"...

I see a trend here...

Tsiangkun · Post by **Tsiangkun** » 29 Apr 2009 15:00

Unlike those other flu scenarios, this one is spreading human to human.

Unlike those other cases, this flu has been spread around the globe.

Unlike those other cases, this flu is spreading within communities.

JUST LIKE the 1918 swine flu, this variant is exhibiting a W mortality curve, overwhelming the part of the population with the healthiest and most robust immune systems.

This flu is no joke, and these warning are not a drill. Monday the WHO upped the status to 4, human to human transmission. Today it got raised to a 5, global pandemic imminent. SARS and the avian variant of the flu never achieve human to human transmission. They were news stories because they jumped species, and IF they began to spread, there would be no vaccines, and could kill many people.

The flu occurs globally every few decades, how it spreads determines the number of infections. This flu HAS NOT achieve airborne spreading. Yet. It is spreading through droplets, contact with infected surfaces, and human to human contact.

Slowsis · Post by **Slowsis** » 29 Apr 2009 15:15

Where is your evidence of W mortality curve? Outside of Mexico there is NO mortality (other than the one case I outlined).

From what I can glean, the Mexican government was talking about that (W mortality curve) early in the outbreak, but has not provided any statistical data to back it up. As of yet there has been no reliable data to back those assumptions up.

Also...SARS achieved Human to human transmission. I had a conversation about that just today. SARS Fact Sheet

P.S Y2K Bug.....

Kyle Hewitt · Post by **Kyle Hewitt** » 29 Apr 2009 15:30

Tsiangkun wrote:
the WHO upped the status to 4,

2 members of the who are dead bro

Jeremy · Post by **Jeremy** » 29 Apr 2009 15:46

I don't know about the American media, but in Australia I think the reporting has largely been accurate - although there's been a lot of it. Coincidentally I've been in bed for 5 days with flu, although I'm nearly better now and back at work.

Of course that's really the significance. Even if your chances of dying from the flu are fairly insignificant - the economic costs of lots of people being sick, as well as the panic related to this, are definitely significant. Nobody thinks that swine flu, or any other kind of flu, is going to kill half the world, but certainly within living memory (of old people) there have been flu pandemics that have killed literally tens of millions of people, so there's obviously the potential for something fairly serious.

Contrary to your post, a number of the people who died in Mexico were young adult males, who should be the least likely to die. This has also created some of the concern.

The other thing worth noting is that our understanding and response to diseases has improved dramatically over the last few years. When you talk about SARS and bird flu, I think it's completely illogical to suggest that because the results of those diseases was not dramatic or significant that the threat was exaggerated. Given how much effort was put in to avoiding serious pandemics in those cases, we don't really know how serious they could have been and it's probable that had those diseases appeared 50 years ago the death toll would have been in the millions.

I guess the real question is - how much would you be prepared to gamble on the lives of 50 million people or so? Even though I live in one of the safest places for avoiding global diseases, I am much happier with too much response than not enough.

Jeremy · Post by **Jeremy** » 29 Apr 2009 16:09

Here are two good blogs on diseases, that have a lot of information about the current (probable) pandemic;

http://scienceblogs.com/effectmeasure/

http://scienceblogs.com/aetiology/

This post was particularly informative for the current discussion;

http://scienceblogs.com/effectmeasure/2 ... nd_lit.php

C-Fan · Post by **C-Fan** » 01 May 2009 05:57

jay7 wrote:~Year 2000 -> Y2k 'bug', "all your computers are going to die!"

~year 2003 -> Sars..."We're all going to die, wash your hands to the bone!"

~Year 2006 -> Bird Flu "We're all going to die! WASH YOUR HANDS!"..

~Year 2009 -> Swine Flu "YOU'RE GOING TO DIE!"...

I see a trend here...

If I fire a gun at you 5 times and miss, does that mean you shouldn't be worried when I fire a 6th time?

Kyle Hewitt · Post by **Kyle Hewitt** » 01 May 2009 08:25

C-Fan wrote:
jay7 wrote:~Year 2000 -> Y2k 'bug', "all your computers are going to die!"

~year 2003 -> Sars..."We're all going to die, wash your hands to the bone!"

~Year 2006 -> Bird Flu "We're all going to die! WASH YOUR HANDS!"..

~Year 2009 -> Swine Flu "YOU'RE GOING TO DIE!"...

I see a trend here...
If I fire a gun at you 5 times and miss, does that mean you shouldn't be worried when I fire a 6th time?

naw bro

ted · Post by **ted** » 01 May 2009 09:44

I work for the USDA doing influenza diagnostic work and research.

Jeremy and Cam's comments are spot on, and I would add that testing for presence of Influenza A is a rapid, easy test. Determining subtypes is a pretty painstaking process involving a suite of all 16H and 9N antigens/antisera. Confirming flu is easy but typing it can take days, especially when there are not many labs around the world equipped to subtype human samples.

Furthermore, my understanding is that Mexico reports only inpatient cases while many other countries report all outpatient cases too.

I'm not too concerned right now, aside from Cam's point about mortality. Keep in mind that flu A kills something like 30-40k people each year in the US.

BainbridgeShred · Post by **BainbridgeShred** » 01 May 2009 19:32

The reason this is mainly killing people with strong immune systems is because your body recognizes that this strain of flu is unlike anything it's dealt with before, and thus sends the immune systems responde of a thermo-nuclear blast against it, which takes out the virus but also the host.
Thus the average victim age is 16.

The fact is, the number of deaths is pretty meaningless. What we need to find out is the denominator, the number of infections, divided by the number of deaths. The bad part is it's nearly impossible to figure out how many people have caught this thing and thus to determine how fatal it is.

~Year 2000 -> Y2k 'bug', "all your computers are going to die!"

The reason y2k wasn't worse was a direct result of the founding generation of computer programmers tireless work to correct the system. Unfortuneatly, this generation is retired now, and most computer science majors are dumbfuck java cookiecutter idiots.

BainbridgeShred · Post by **BainbridgeShred** » 01 May 2009 19:34

Anyways, we are overdue for a big pandemic. Usually there's about 2 every century. Is swine flu that pandemic? I doubt it, personally

Colin · Post by **Colin** » 01 May 2009 22:05

My favourite webcomic feels as I do.

Kyle Hewitt · Post by **Kyle Hewitt** » 01 May 2009 22:13

man i love you colin

Slowsis · Post by **Slowsis** » 02 May 2009 06:07

WHO continues to prove my prognosis correct. 360-some diagnosed cases outside if Mexico, 1 death. Obviously the better prepared medical systems of Canada and the US have something to do with this, but still.......

With this data coming in, it raises a critical question. If everywhere else on earth people are getting swine flu and recovering quickly.....whats going wrong in Mexico?

Post by **Zac Miley** » 02 May 2009 13:06

Slowsis wrote:
With this data coming in, it raises a critical question. If everywhere else on earth people are getting swine flu and recovering quickly.....whats going wrong in Mexico?

The US is hoarding all of the space cash.

Jeremy · Post by **Jeremy** » 02 May 2009 19:03

Since you obviously don't read the links I post, let me quote

http://scienceblogs.com/aetiology/2009/ ... c.php#more

What does the WHO's pandemic scale mean? And why is anyone worried about this?
Category: General Epidemiology â€¢ Infectious disease â€¢ Influenza â€¢ Outbreak â€¢ Policy â€¢ Public health â€¢ Various viruses
Posted on: April 30, 2009 2:10 PM, by Tara C. Smith

I've been seeing a lot of comments mocking the current outbreak of H1N1, and a lot of people (and journalists) who don't understand what "big deal" is about the "snoutbreak" of swine influenza, or don't get what the raising of the World Health Organization's pandemic alert phase up to 5 means. I noted here what the alert level meant, but wanted to discuss it a bit more in a full post; after the jump.

So, some comments I've seen thrown about:

This is all just media hype! Lies about the Mexican cases! The WHO just revised their numbers down to 26 cases and 7 deaths! Why should I believe the crap about this aporkalypse?

First, indeed, the Mexican cases stand at 26 cases and 7 deaths--*laboratory confirmed* cases. Even for regular influenza, the number of cases that are confirmed--much less to the level that these are, by the CDC or other high-level labs--is extremely small. We always expect many fewer confirmed cases than reported cases, because for a number of reasons, some people who display all the symptoms of a disease will be difficult to confirm. Maybe they were unable to get to a hospital in time for a sample to be taken; maybe they live in a remote area where it's difficult to ship samples from; maybe they came in too late after their disease had already cleared, and no live virus was present in their system anymore; and on and on. Most of the Mexican cases (the thousands reported) have been suggested to be H1N1 based on symptoms and timing. The current WHO report isn't saying that these 26 cases are the ONLY H1N1 cases in Mexico--these are just the ones they're absolutely, positively, 100% sure are swine flu.

Ordinary flu kills 36,000 Americans a year. Why should I care about this "swine flu," when only a hundred or so cases have been reported in the US?

Yes, ordinary flu is a bitch, and most people don't worry about it one iota. (Mike laments this situation). However, ordinary flu kills these 36,000 people *despite* many of us having some pre-existing immunity to the circulating strains, and a percentage of the high-risk groups receiving vaccination. With these new strains, it's unlikely that the population as a whole will have much cross-protective immunity, meaning higher numbers of people will get sick and die than a "regular" flu year, and all the impact to society and the economy that goes along with an ill population. As rhozack notes:

I live in a town with 65,000 people and somewhere around 300 hospital beds. If 20,000 people have the flu at the same time its like not having hospitals at all. Plus all the services those 20,000 people provide will be stopped at the same time and because of the nature of the thing, a large portion of your health care workers will be in that 20,000.
Now of course, we have no idea currently what kind of levels of illness or hospitalization H1N1 would cause if it becomes established in the population, but this is a situation where there's a small chance of a very bad situation, and so we need to prepare for it as best we can.

Does 7 deaths REALLY constitute a pandemic? Are we that wussy and panic-prone as a society that the WHO freaks out over a couple deaths from the freakin' flu?

And this is what I was getting at with my comment on pandemic phases. The number of deaths don't matter--it's the transmission in the human population that's key. Let's look at their scale:

Phase 1-3 go from no animal viruses reported causing infections to humans up to the presence of a new animal or human-animal reassortant that's caused sporadic cases or small clusters of disease in people, but no sustained human-to-human transmission or community-level outbreaks.

Phase 4 signifies a new virus capable of causing community-level outbreaks. "Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion." This is where we were with the beginning of the outbreak in Mexico.

Phase 5 (and I'll quote directly from WHO here): characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. This is the key--Phase 5 is a signal to governments to get their act together, because the shit is about to hit the fan.

Phase 6, then, is the full-blown pandemic phase. This has not been declared yet. Maybe we won't get to this, the individual outbreaks will burn themselves out, and we'll head back down to a 4 or even 3. But for now, we're still seeing cases increase, and the prudent thing to do is be careful and prepared. Weren't any of these nay-sayers ever Boy Scouts?

Emphasis mine. It's a risk assessment, and despite the probability that it won't be a serious global pandemic (despite Dan's hilarious comment about us being "due" for one), the cost of prevention or mitigation is far lower than the cost of it being serious multiplied by the chance of that happening.

Kyle Hewitt · Post by **Kyle Hewitt** » 02 May 2009 20:40

Zac Miley wrote:
Slowsis wrote:
With this data coming in, it raises a critical question. If everywhere else on earth people are getting swine flu and recovering quickly.....whats going wrong in Mexico?
The US is hoarding all of the space cash.

FLASH! MASTER OF THE UNIVERSE!

Tsiangkun · Post by **Tsiangkun** » 03 May 2009 08:07

Canada is reporting that a man has transmitted his infection to his pigs, indicating the virus can be mobile between species under the right conditions.

Kyle Hewitt · Post by **Kyle Hewitt** » 03 May 2009 20:30

Tsiangkun wrote:Canada is reporting that a man has transmitted his infection to his pigs, indicating the virus can be mobile between species under the right conditions.

lolwut?