Swine flu: I beat a dead horse

by revere, cross-posted from Effect Measure

A student once complained that no horse was too dead for me to stop beating it. Long time readers are familiar with that here. Over the years I have said that the best way to prepare for a pandemic -- or any other grave threat to our communities -- is to strengthen its public health and social service infrastructures. While some progress along those lines have been made (the additional training and upgrading of the national laboratory system is what allows us to find swine flu cases), in the main public health and social services have continued to deteriorate and weaken. And with the day of reckoning possibly just around the corner, we are still not facing the problem:

The mild nature of swine flu infections that have been reported to date outside of Mexico may be undermining efforts to get the public to prepare for a range of pandemic scenarios, some experts in public health say.Some officials are already facing accusations that they are exaggerating the threat of the swine flu situation.

âSome people are alleging that weâre hyping the threat. Thatâs not the case,â said Dick Thompson, a spokesperson for the World Health Organization.

âWhat weâre trying to do is to provide the best information possible. To gather that information and to provide it to the public. Because thatâs the best defence, is to have information.â (Helen Branswell, Canadian Press via Edmonton Sun)

 

I've been critical of WHO lately, but I think this is completely on target. Let me extend the argument. I am really repeating what I said earlier today about the Big Picture, but in light of these observations by WHO's Thompson it needs to be said again. And again.

What's important about this virus is its genetic novelty. As far as we know, the human population doesn't have any natural immunity to it. But what people perceive about the virus is its lack of novelty. Clinically it seems a lot like what they are used to with seasonal influenza. It's not (so far) the monster of 1918 and doesn't have the virulence of H5N1. What they are forgetting is what the genetic novelty might mean.

Because there is no natural immunity to this virus, even though clinically it appears to be like garden variety flu to the individual, with respect to the population it has the potential to spread faster and many more people sick than seasonal flu. And remember, seasonal flu is not a walk in the park. It kills an estimated 30,000 people a year.

A bad flu season can fill hospital emergency rooms and in patient beds to the bursting point. We currently have fewer staffed hospital beds per capita than we did in the last pandemic, 1968 (the "Hong Kong flu"). There is no reserve capacity. We can't just add physical beds. Beds don't take care of patients. Nurses and doctors do.

Now take a bad flu season and double it. To each individual it's the same disease but now everybody is getting it at once, in every community and all over the world. In terms of virulence, it's a mild pandemic. It's not a lethal virus like 1918. But in terms of social disruption it could be very bad. If twice as many people get sick, the number of deaths could be 80,000 in the US instead of 40,000. Gurneys would line the hallways of hospitals and clinics. And absenteeism amongst health care workers would compound the problem. Infrastructure would probably survive intact. No need to have your own water supply or electricity generator. But it would be a very rough ride.

All of this could plausibly happen from this virus without it causing anything more than the usual case of influenza. We are pouring tens of billions into infrastructure. I'm a big fan of high speed rail. But the public health and social services infrastructure -- good, job producing infrastructure -- needs attention and needs it right away because of this virus.

I know. The horse is still dead.