The number of people who die from seasonal flu every year varies greatly from year to year. No one really knows what it is. The most frequently (mis)quoted figure is 36,000 deaths directly or indirectly, although this figure is a long term seasonal average of excess mortality correlated with flu season. We discussed this in more detail in an earlier post and for the purposes of this one, only the rough order of magnitude is pertinent. Let's just say it's in the tens of thousands -- roughly. Let's also agree on the several hundred thousand hospitalizations from flu or flu related illness -- on average. It turns out that this is roughly the annual mortality from motor vehicle accidents (41,000) and about half the hospitalizations from car accidents (around 500,000). There are roughly 4 million emergency department visits for motor vehicle related injuries (CDC). So with seasonal flu we are talking about a public health problem in the same league as another major issue, death and injury from car wrecks. As long as we are making the comparison, let's pursue some other similarities.
Most people who get in a car accident aren't seriously injured. There are innumerable fender benders occurring hourly in our communities, resulting only in bumps, bruises, lost work time and a lot of upset. I won't even bother to discuss the repair and insurance costs. Mostly people aren't hospitalized or killed. So why don't we talk about "mild" car accidents? Maybe because there's nothing mild about a couple of tons of moving steel hitting something. The potential for catastrophe is always there and there is something almost arbitrary about how it happens, even though there are well known risk factors: being young, having a drink or two, being elderly, exceeding the speed limit, etc. Often we have no risk factors but "catch the disease" from another driver who is at fault.
For seasonal flu the risk factors seem less arbitrary: being old and sick tops the list. If that's our picture (and it is supported by the descriptive epidemiology), mortality from seasonal flu seems almost like part of the order of things. But pandemic influenza has a different descriptive epidemiology. It's the young and relatively healthy that are in the cross-hairs of the virus. To try and soften this by noting that many have "pre-existing medical conditions" is somewhat besides the point, especially when some of those pre-existing conditions aren't that bad (asthma under control) or even unhealthy (pregnancy). If we don't talk about "mild car accidents" why should we talk about mild pandemic influenza, especially when the victims are more like car accident victims than seasonal flu victims?
We aren't trivializing the pandemic by comparing it to something as banal and familiar as a car accident. There is nothing trivial or banal about a car accident. Just as parents of teen drivers lose sleep at night over their children as hostages to fortune, they have every right to lose sleep over flu taking their darlings. Let's stop talking about flu as a mild disease. If we want to be perfectly accurate about most cases, let's call them uncomplicated influenza infections that resolve after an illness of days. This terminology signals there is another category, the complicated infection that doesn't resolve. This is where flu causes death and serious injury.
Like the minority -- but too frequent -- serious car accident.
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If one wants to put future pandemics in perspective, the ethical way to do it is with 'real' numbers.
If 40,000 deaths per year from auto accidents is a real number then that is an appropriate comparison.
However, as usual, what they have been doing for the past five years is making numbers up out of thin air...first to downplay the potential of an H5N1 pandemic and now to downplay the effects of a H1N1 pandemic.
...I just hope at some point they are held responsible.
Tom: Please give an example of a number made up out of thin air, i.e., with no basis at all. I don't understand what you mean or what you are referring to.
So... if someone is headed home from work after experiencing the typically sudden onset of flu symptoms, and their illness compromises their ability to safely operate a vehicle, and as a result they crash and die... does that get counted as an influenza fatality, or an auto fatality?
Racter: This reminds me of George Carlin's riff on parochial school and the kid who insists on asking what happens if you miss your Easter Duty but then cross the International Date Line. Drive safely and wash your hands.
A flu pandemic could happen at any time and kill between 5â150 million people, a UN health official has warned. David Nabarro, who is charged with co-ordinating responses to bird flu, said a mutation of the virus affecting Asia could trigger new outbreaks.
âItâs like a combination of global warming and HIV/Aids 10 times faster than itâs running at the moment,â Dr Nabarro told the BBC.
But the World Health Organisation has distanced itself from the figure.
The WHO spokesman on influenza, Dick Thompson, told a news conference in Geneva that the WHOâs official estimate of the number of people who could die was between two million and 7.4 million.
âThere is obvious confusion, and I think that has to be straightened out. I donât think you will hear Dr Nabarro say the same sort of thing again,â Mr Thompson said.
Bird flu has swept through poultry and wild birds in Asia since 2003. It has killed huge numbers of birds and led to more than 60 human deaths.
Prepared for worst
âThe range of deaths could be anything between 5m and 150m,â the UNâs new co-ordinator for avian and human influenza said in his BBC interview.
Dr Nabarro said he stood by the figure drawn from the work of epidemiologists around the world.
âMy reason for giving the higher figure is simply that I want to be sure that when this next flu pandemic does come along, that we are prepared for the worst as well as for the mildest,â he said.
In an earlier interview with the BBC, he said the likelihood that the Asian virus could mutate and jump to humans was high.
âThe consequences in terms of human life when the pandemic does start are going to be extraordinary and very damaging,â he said.
Because it has moved to wild migratory birds there is a possibility âthat the first outbreak could happen even in Africa or in the Middle Eastâ, he warned.
The comments came as agriculture ministers from the Association of South East Asian Nations (Asean) endorsed a three-year plan to combat the spread of the virus, and pledged $2m to fund research and training.
Dr Nabarro said the number of deaths from any future influenza pandemic would depend on where it started, how quickly it was discovered and the kind of response they got from governments. âI believe that the work weâre doing over the next few months will make the difference between, for example, whether the next pandemic leads us in the direction of 150 or in the direction of five.â
The appointment of Dr Nabarro is an indication of how seriously the UN is taking the threat, the BBCâs UN correspondent Suzannah Price says.
In his new role, he is meant to ensure the UN has a co-ordinated response to bird flu and that it helps global efforts to prepare for any human flu pandemic, our correspondent says.
Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/asia-pacific/4292426.stm
Published: 2005/09/30 15:21:25 GMT
© BBC MMVI
Revere.
As you and I both know, like creative accounting, you can make an epidemiological model say whatever you want it to say, whenever you want it to say it.
"The WHO spokesman on influenza, Dick Thompson, told a news conference in Geneva that the WHOâs official estimate of the number of people who could die was between two million and 7.4 million."
The above was from a model and is, in my humble opinion, also a crime against humanity...
...as we will very likely find out in the near future.
Just a remark on the numbers issue:
The other blog article "How do we know how many people die from flu each year?" says
We don't know how many people die of seasonal influenza each year because there is no list we can use to count them.
Essentially true. But there actually is exactly such a list, at least for the younger-than-18 age group. It is the "pediatric deaths" list published at the weekly FluView site: http://www.cdc.gov/flu/weekly/
This list, together with the ILI-surveillance chart, is one of the (in my opinion) most accurate and unbiased indicators to follow the course of the pandemic and to compare its impact to that of the last regular flu seasons.
So taking the "pediatric deaths indicator", the impact of the pandmic so far (perhaps about just over halfway through the first wave) is roughly one third that of the last seasonal wave (roughly 60:20 seasonal vs. pandmic pediatric deaths )
Interstingly, assuming the attack rate of the next wave to be three to five times higher than that of the current "summer wave" the final impact still would be not so much more severe than a regular bad flu season. At least that is what can be hoped for when looking at the numbers published so far (also assuming that the virus itself does not significantly gain virulence)
Here's a Case Attack Rate (CAR) number made up out of thin air:
Under the headline "A (H1N1) is milder than seasonal flu", published by The Nation (Thailand) on July 4:
The population of Thailand is about 64 million. Dr. Prasert is speculating that âoverâ one out of every 64 Thais would eventually catch pandemic influenza H1N1. (A Case Attack Rate of "over" 1.6%)
However, most flu experts believe that past pandemics have infected closer to one-third of the population.
For instance, âThe reported clinical influenza attack rates in pandemics of the last century are mainly between 25% and 35%,â according to a modeling article published on Australiaâs Department of Health and Ageing website, in a section entitled: âHow infectious is an emerged pandemic influenza virus likely to be?â ( http://tinyurl.com/kk92hq )
And Dr. Prasert's over-reassuring CAR estimate for Thailand is, relatively speaking, bold and brave -- most officials in most countries are not vividly telling their publics that "pandemic" is going to mean really really pervasive, regardless of how virulent the virus is, or how virulent it becomes.
(Notable exceptions: New Zealand and the Philippines have been candid that pandemic flu H1N1 is likely to infect large percentages of their populations.)
Thanks h1n1_watcher
concerning your comment...(also assuming that the virus itself does not significantly gain virulence)
Something I did not understand until recently was pointed out by Dr. Vincent Ranciello in Riding the Influenza Pandemic Wave
http://www.virology.ws/
He mentioned that 1957 and 1968 also increased virulence in subsequent waves.
That means that H1N1-1918 and its two offspring, all increased virulence as the pandemic went on.
I think we can safely assume that H1N1-2009 will do the same...we just don't yet know the degree.
Tom: You only believe data that agrees with our pre-conceived notions, it seems. All the data cited on flu is epidemiological data and all of the numbers Nabarro cited were based on existing data. None of it was pulled out of thin air, as you allege. You apparently do not wish to be held accountable for your misstatements or errors. You only wish to hold others accountable. We all are guessing about what is going to happen, but we try to make our guesses informed by whatever evidence there is. We can argue about the validity of the evidence or the adequacy of the guesses or the competence or expertise of the guesser (in which case we should also have some competence), but continually accusing others is not helpful nor is it intellectually honest when it is itself pulled out of thin air, as your accusations are.
"Numbers out of thin air."
It the argument that conspiracists use to blame the powers that be for not telling us the "truth" about the situation.
I'm so tired of those who "rage against the machine." Claiming that our Health authorities are doing less than their best for amorla purposes..,
In their eyes, everything the CDC, or the WHO says or does is some lie or evil plan to allow the virus to
thin the herd."
This reminds me of a story I seem to remember from when the Three Mile Island reactor accident happened. One of the reporters was asking âwhat is the worst thing that could happenâ, so the person who responded went through the scenario where the core melts down, falls to the bottom of the reactor, goes hyper-critical, the pressure builds up and the reactor explodes, causing the containment building to explode, releasing the entire inventory of fission products into the atmosphere, while at that precise moment a tornado happens by, picks up all the radioactivity and transports it up and down the East Coast dropping just the right lethal amount in each and every population center up and down the East Coast.
The reporter got really annoyed because he knew enough about weather to know that the tornado scenario was extremely and preposterously unlikely, and having it talked about in the same sentence as the core melting down and exploding wasnât going to be inflammatory enough for his news broadcast. He just wanted the core exploding sound bite because everyone is afraid of things labeled ânuclearâ, but on the East Coast, most people have never seen or heard of a tornado in their vicinity ever.
For every well reasoned question trying to understand the problem and what to do about it, there are many trying to spin it for their own purposes.
Okay, I've been watching flublogia bang this particular drum for weeks: This is a pandemic flu, it is not mild, we aren't sure what's going to happen.
I understand that the general population might not get it yet, but *I* get it. I'm hoping you're all wrong, of course, but I'm on board. So here's my question: What can I do about it? What should the general population be doing about it?
I'm washing my hands, avoiding large gatherings when possible, and have stashed 2-3 weeks of food and a week of water in my basement. I work from home, and if needed, I can keep my two kids home this fall and homeschool (thought my husband will still need to leave the house to work).
I have asthma AND I'm overweight, so I'm exercising, eating (and feeding my family) lots of fruits and vegetables, and getting plenty of vitamin D while the sun is here. Am I missing something? Is there anything else the rest of us can do to protect ourselves?
And should you be right -- and again, I hope you're not -- thanks in advance for your work in getting us all prepared.
Curious: Time to head over to Flu Wiki where you will find an active community discussing exactly your question: http://www.newfluwiki2.com/frontPage.do
H1N1_Watcher
Why do you believe A/H1N1 is "just over halfway through the first wave"?
I have a dumb question-with air travel smashing the old timelines for spread of a panflu virus, will there be classic 'waves' of panflu as seen in the past?
Could a traveler/carrier from the Southern Hemisphere come to the US in September this year carrying a somewhat mutated version of the H1N1 now circulating and start a new 'wave'?
Grace: Not a dumb question, but not an answerable one, either. We don't know why there are waves or what determines them or even why flu is seasonal. So the question, while a good one, is also a very hard one.
Like many, I'm pondering what to do if the anticipated second wave hits in the fall and winter. Not too worried about myself. But in our aging, sedentary society, a lot of people fall into the "underlying causes/risk factors" category.
The swine flu vaccine might help. Bulk vaccine is ready in July. It needs to be tested. This article says 60 million doses will be available at the end of October, assuming everything goes as planned.
Will this be a game changer? Got me, hope for the best.
@River:
you wrote:
Why do you believe A/H1N1 is "just over halfway through the first wave"?
This is just a very rough estimate.
Empirically, the duration of pandemic influenza "waves" has been very roughly 3 months on average.
This is also consistent with what we've seen in Mexico with the new H1N1 in 2009.
Furthermore, the most recent ILI-surveillance charts for the US (see http://www.cdc.gov/flu/weekly/) can be interpreted as inidicating a slow leveling-off after a first sharp spike, the typical shape for a peaking 'influenza wave'. So altogether I suppose that we have already seen a significant part of the impact of the first (summer) wave. However it is also very well possible that the first "wave" will not peter out completely but will persist as a "smoldering" virus activity at moderate level well into the fall...then directly taking off from that level for the second wave.
@H1N1_watcher,
Thanks for the very clear explanation. Greatly appreciate it.
Be well!