Looking back, I see a lot of rather insipid posts (and some nostalgia of sorts). Let’s go old-school a bit and get into a more meaty and nationally (if not globally) topical subject. I speak, as the subject says, of swine flu.
I’m not going to bore with ‘what is it’ – not really. It’s an influenza that is normally pretty much purely found in swine, with the rare exceptions being those who hang around with swine (pigherders, people with pigs as pets, that sort of thing.) One of the Scare Bug Scenarios has always been a bug that jumped species. Most of the focus has been on Avian Flu because of how wide an area the species could cover, but this one’s been pretty good at reminding us how mobile we all are anyway.
No, the big worry is the fact that we don’t have any particular natural resistances. That means we’re more likely to catch it if it decides humans are tasty, and when we get it we’re likely to suffer more – up to and including dying at greater than normal rates.
And so we have Swine Flu which is doing exactly that. Now contrary to popular belief flu isn’t really seasonal. What seasons do is make us more or less likely to be in environments that allow sharing. Packing a bunch of people in a room or building for extended periods of time increases the chance of sharing, be the packing schools or just families huddling away from winter weather. So here’s the deal – come school season we’re going to see an uptick in Swine Flu this year. It will get worse as we get deeper into fall, and it’ll run through most of the winter.
There are a couple of paths of discussion along which I’ll meander here. The first is risk – that is, just how much danger are we all in, anyway. The second will be what can each of us do about it, anyway. As I said, risk first.
Mexico, where this all started, gave us some weird numbers. Now the ‘deaths due to swine flu’ have plummeted from what they were, but even now the death rate (deaths vs lab-confirmed cases) is around 1%. That is a potentially scary number. It is especially so given the death curve is abnormal. ok, that sentence needed a touch of unpacking. “normal” influenza strikes heaviest among the elderly, second heaviest among the VERY young (5 and under), and then runs something of an inverse bell curve — the closer you are to peak, the better chance of surviving. This stuff turned the curve to more of a ‘normal’ bell with the middle having a peak instead of a valley – though the very young are still at fairly high risk (relative to other age groups). In other words, the scare isn’t that 1 out of 100 would die, it’s that the odds are it’ll be a young to middle aged person who dies.
Actually, let’s increase the accuracy of the above. Picture a chart, death rate on the vertical and age groups horizontal. Normal influenza gives us something of a U shape. Swine flu gives us a W with the middle hump pushed toward the left.
Now as I said, the 1% death rate is scary. HOWEVER, it’s not what we’ve seen in the rest of the world. There, the rate has run at 1 to 2 per thousand. That’s a lot more comfortable, though still scary. Hmmm, let’s bring this part into focus before I go on.
According to the CDC approximately 35,000 people die every year from influenza – directly or through complications. (Asthma plus flu is an example – if the combo kills you it’s more likely it as the asthma that actually “caused” the death.) That number is based on approximately 12% rate of infection. In other words, given a population of around 300 million some 36 million will catch the flu during the ‘season’. Of these, about 1 per thousand will die.
In yet another “in other words” the death rate for swine flu is pretty similar to the death rate for ‘normal’ flu. Thing is… there’s more.
The CDC says that between 5 and 20% of the population gets the ‘normal’ flu in a year – 20% is a “bad” year. According to both the CDC and WHO, swine flu is more infectious – 4 to 8 times moreso. We will likely see infection rates of between 40 and 80%. At a ‘mere’ 1 per thousand death rate that gives us four to eight times as many deaths as “normal”.
CONTEXT here – assuming nothing changes, it’s a revisitation of the Asian Flu of 1957. (For most of you, go ask your parents.)
Now the idle thought that might come to mind is, “but our medicine is better. Why is the death rate like the one for 1957?” The quick answer is, it’s that low BECAUSE we’re better at this. Ponder what it might look like otherwise. No, I’m not yet headed for what can each of us do. I’m not headed there because there’s this wild card.
No, I don’t mean Mexico. I mean Argentina. Argentina started having cases show up just like everyone else, and it seemed relatively minor. Their first death showed up in the 17 June WHO report. That was sad, but didn’t seem so wild – at 733 total cases it was between 1 and 2 per thousand, in the world “norm”. But the number of deaths grew a bit more rapidly than the number of cases. In fact, the July 6 report has 60 deaths in 2485 cases, or a death rate of just under 2.5%. There is a quiet but intense investigation underway to answer the question “why”? Hopefully it’s bad reporting. Still, it wouldn’t hurt to keep an eye on the reports from here – and to see if other nations start seeing increasing death rates as well.
At 1 to 2 per thousand and a ‘mere’ 50% infection rate this will be an ugly year in the US. Jump to 2% death rate with 80% infection and we’re repeating 1918.
So NOW it’s time for “what to do.” Well, first and foremost stay clean. The most common infection pattern is infected gets droplets on hand (sneeze, cough, wipes face) and grabs something (like a doorknob). Victim grabs doorknob and picks up microdroplets, then gets them near the face (eat, wipe eyes, rub face…). As a consequence, clean somewhat obsessively. My personal recommendation – what I’ll be doing – is carrying a small container of alcohol cleanser around. I’ll wash my hands after opening doors, before eating, and after handling things I know have been handled by others. Gloves? Not all the time. Masks? Only if I find myself dealing with sneezers or known infected – remember that most infection is from hand to face. Besides, masks of sufficient quality are expensive and need replaced regularly to keep being effective.
ps – bathrooms. Yes, you should wash your hands after. But if you’re in a public bathroom, wash your hands with your disinfectant after exiting that door – too many studies have demonstrated far too many don’t wash. So you wash your hands, grab the infected handle to exit, and… clean, or rub your face. Your call.
On a larger scale, there will be vaccinations. They’re not going to be of typical distribution – main focus is kids and those who deal with kids, then other non-elderly adults who have additional health problems, then health care and emergency professionals. Later, if there are enough doses, the rest of us can have some. Personal bet – a lot of people who SHOULD get these WON’T get them, and we’ll see the flu march onward.
Don’t be surprised at all to see schools close. For that matter, don’t be surprised to see workplaces close as well – or at least try to keep interpersonnel contact to a minimum. If you can arrange things to work at home or in relative isolation, start doing so. Try to save up sick days as well, especially if you can use them to avoid the sickie who thinks he or she is indispensable and comes to infect everyone. If that sickie is you, STAY HOME. You may be indispensable, but if half the department or building is home sick even less will be accomplished in the long run.
Last but not least, don’t panic. Seriously. Yes, it’s more virulent – more likely to infect. However, it’s not (barring Argentina and Mexico) any more deadly than ‘normal’ – and if it is, you’ve time to prepare and cope. It’s not the end of the world. Besides, being prepared and not panicking can put you ahead of the game when dealing with everyone else.
Mental Meanderings 