Be wise. Be brave. Be tricky. ([info]slithytove) wrote,
@ 2009-04-27 06:05:00
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Current mood: frustrated

Oink.
Ugh. Okay, Swine Flu.

I don't know how bad it's going to be. Yeah, this isn't 1918. We have ventilators, and anti-viral drugs, and intensive care of a sort they didn't, and faster communication between nations. But we also have rapid world-wide travel, which 1918 didn't. Mexico's problem is New York's problem and California's problem within days.

I've also been hearing stuff on the news about how bird flu was over-hyped and SARS was over-hyped, so swine flu is probably also being over-hyped, and we don't really need to worry. This idiot, for example. I just heard the same thing from the CNBC hosts.

That's dangerous, ignorant bullshit. Yes, bird flu was over-hyped. It never showed any disposition to spread to humans unless you raised chickens in your living room. I've never worried much about bird flu.

But SARS was not over-hyped. We came horrifyingly close to a world-wide catastrophe during the SARS episode. It was the Cuban Missile Crisis of infectious disease, and it seems that hardly anyone realizes it. SARS was essentially a mutated version of one of the common cold viruses. It spread like colds spread, and in the winter, in the Northern Hemisphere, every other person gets a cold. It had a mortality rate of 10-20%, which is getting close to Black Death levels. If SARS had gotten loose, a billion people would have died, and human civilization itself would have stumbled.

SARS didn't get loose, because of smart, fast, ruthless doctors and public health officials in Hong Kong, Vietnam, elsewhere in SE Asia, and Toronto, and wherever a case cropped up. Draconian quarantines and travel restrictions were established. Man, did I hear people whine about that. Those whiners are alive today because public health officials ignored them and did what was necessary. It all worked. I was surprised, but greatly relieved.

How bad H1N1 Swine Flu is going to be? Even at its worst, not as bad as SARS. For one thing, the two standard antivirals against influenza seem to work against it. (Until worldwide stocks run out, that is.) Plus, the reported mortality rate from Mexico isn't anything close to the SARS mortality rate. So even at worst, it's doubtful Swine Flu will kill a billion people. Maybe only a couple of million. Or tens of millions.

Or maybe only a few hundred, IF WE TAKE IT SERIOUSLY, YOU BRAINLESS PUNDITS. Grrrrrr.


(52 comments) - (Post a new comment)


[info]dagoski
2009-04-27 01:15 pm UTC (link)
Well, yeah, we have ventilators and all that, but if you get a major outbreak, what happens to all infrastructure? It gets taxed and you have to start rationing care. That means people die either from the flu or because there are people with the flu in the queue before them when they come in with some other serious respiratory ailment. Add in the fact that a lot of people don't have insurance and/or jobs right now and you really compound the epidemic because such people will put off seeing a doctor until the last minute and that brings them into the ER much, much sicker. Even non lethal epidemics need to be taken seriously because of the stress they can put on medical, governmental and even economic systems.

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[info]slithytove
2009-04-27 02:38 pm UTC (link)
That's what I was saying about SARS, and why civilization would stagger. Collapse? Probably not. We wouldn't go back to hunting and gathering. At least not most of us. But there would be an economic depression deeper than any since the Black Death, and global political instability for decades.

Reading back over my post, I think I made my point very badly. What I was trying to say was that Swine Flu, even if everything goes to hell, is unlikely to be as bad as that. But it could still be pretty damned bad, and pundits sneering at the idea that it might be bad aren't helping things. We may need to institute drastic public health measures, and jackasses not believing in the danger, and not respecting those measures, will make things worse.

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(no subject) - [info]dagoski, 2009-04-27 02:45 pm UTC (Expand)
(no subject) - [info]dagoski, 2009-04-27 02:49 pm UTC (Expand)

[info]misofuhni
2009-04-27 01:44 pm UTC (link)
I'm with you, it need not be a huge thing, but it is something to watch with a leary eye as it does it's thrashing about. And yes, the moronic talking heads who say that this isn't too bad aren't helping the situation.

As I was trying to explain to the spouse last night, there is nothing that we can do proactively NOW; this is the sort of thing that you can only react to. The time to be proactive was 50 years ago--and the CDC was. Ad Council campaigns to educate the public about not sharing utensils and cups, covering your mouth when sneezing or coughing with a tissue, then throwing away the tissue, washing your hands--normal stupid stuff you learn in hygiene class--was disseminated and those children grew up and became parents and taught it to their kids.

Now, to remind and convince the kids how important it is now to wash those hands.

On the proactive front, the only thing we can do is on the individual level. Maintain healthy lifestyle habits, take your vitamins, bone up on the Vitamin C and the echinacea (I'm not looking for an argument on naturopathic medicine here. It hasn't been proved to cause harm, either) and keep your own germs to your own self.

(Reply to this) (Thread)

[info]feather802
2009-04-27 11:48 pm UTC (link)
It's the keep your own germs to your own self part I'm a little more concerned about. Current economic conditions do not make taking sick days prudent. Although I personally think you should be rewarded for keeping your damn germs at home, many employers don't necessarily agree. And that's -if- you get paid sick days. Many parents also send sick kids to school since they can't afford to miss work and can't afford to pay for childcare.

(Reply to this) (Parent)(Thread)(Expand)
(no subject) - [info]misofuhni, 2009-04-28 02:29 am UTC (Expand)

[info]sonipitts
2009-04-29 01:54 am UTC (link)
it is something to watch with a leary eye

Great. Now I've got this image of Dennis Leary giving a petri dish the hairy eyeball. And it won't go away. *snork*

(Reply to this) (Parent)

[info]cucumberseed
2009-04-27 02:59 pm UTC (link)
Thanks for the perspective. I'd like to link this.

(Reply to this) (Thread)

[info]slithytove
2009-04-27 03:09 pm UTC (link)
Feel free. Although, as I said to [info]dagoski, I'm afraid I stated my case confusingly. Essentially, what I was trying to say was that I don't think Swine Flu has the potential to be as bad as SARS could have been, but that it still has the potential to be pretty bad, and people shouldn't take it lightly. Also, the idea that SARS wasn't really a danger is badly mistaken.

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(no subject) - [info]matociquala, 2009-04-27 03:19 pm UTC (Expand)

[info]matociquala
2009-04-27 03:05 pm UTC (link)
This. Yes. Underselling isn't any more rational than fearmongering.

And so totally with you on SARS. That was a Near Earth Object of a pandemic crisis. And I was living in Vegas at the time. 0.0

(Reply to this) (Thread)

[info]slithytove
2009-04-27 03:17 pm UTC (link)
I've been reading Vernor Vinge's A Fire Upon the Deep, and I can't get over that line, "You are under Transcendent attack."

Frisson.

This is the first time I've read Vinge. Damn great novel.

(Reply to this) (Parent)(Thread)(Expand)
(no subject) - [info]matociquala, 2009-04-27 03:21 pm UTC (Expand)
(no subject) - [info]slithytove, 2009-04-27 03:42 pm UTC (Expand)
(no subject) - [info]matociquala, 2009-04-27 03:51 pm UTC (Expand)
(no subject) - [info]jrthro, 2009-04-27 03:21 pm UTC (Expand)
(no subject) - [info]kelly_yoyo, 2009-04-28 05:57 pm UTC (Expand)

[info]cypherindigo
2009-04-27 03:09 pm UTC (link)
A couple of months ago, for some unknown reason, I started reading about the 1918 flu pandemic. Within the past 10 years or so there have been some very good books published about it.

And while there are some odd similarities between 1918 and what is being seen now (at least superficially through my none medically trained eyes), we are MUCH better prepaired this time around.

(Reply to this) (Thread)

[info]fidelioscabinet
2009-04-27 03:39 pm UTC (link)
One of the horrific mistakes made during the 1918 pandemic, early on, was allowing groups that were exposed to infection to travel, and so spread the disease--all those troop transfers, from camps with outbreaks, as well as all those war bond rallies, parades, and so on, that no one either dared, or thought it mattered, to transfer. Now I notice the travel warnings and entry-quarantines are going into place all around the world. They're inconvenient, but it's part of what helped us get through the SARS outbreak as well as we did.

They had no vaccine infrastructure for influenza in general to work with, either.

(Reply to this) (Parent)

[info]jrthro
2009-04-27 03:21 pm UTC (link)
I did not realize how bad SARS was, but then I live in the United States, where (as far as I know) it never became a major problem.

(Reply to this)


[info]ckd
2009-04-27 03:21 pm UTC (link)
Of course, Karl Rove was complaining about spending on the CDC and pandemic flu preparations less than three months ago. Maybe he can go hang out with Bobby "vulcanology is the study of Mr. Spock" Jindal.

(Reply to this) (Thread)

[info]rabidfangurl
2009-04-27 07:17 pm UTC (link)
See also: Republicans Stripped Pandemic Flu Preparedness from Stimulus.

(Reply to this) (Parent)

[info]retrobabble
2009-04-27 03:48 pm UTC (link)
Thanks for that. I'm afraid I was one of the one treating this rather lightly, partly because the media here always goes so overboard. :p (And I did get that you said it wasn't as bad as SARS.)

(Reply to this)


[info]rosefox
2009-04-27 03:53 pm UTC (link)
I'm a medical journalist, and pretty inured to medical stories that would make most people freak out. A couple of years ago I attended a conference on pandemic influenza preparedness. I came home shouting wild things about stockpiling cat food and getting a giant first aid kit, and my husband thought I was nuts. After I calmed down a bit, I thought maybe I had been a little nuts too. Then someone says "H1N1 disproportionately affecting otherwise healthy young adults" and I start mentally clearing out my closet so we can keep the MREs in there.

Influenza is scary stuff. SARS is very scary stuff. A lot of that conference was people talking about what they'd learned from SARS, and I lost track of the number of times someone said "We got very lucky". I agree that this particular strain probably won't be as bad as SARS, if we're careful and lucky. Oseltamivir is doing its job, though people really need to stress that it only works well within 48 hours of symptom onset, so if you get any symptoms of the flu, don't put it off and hope you'll get better on your own! But yes, quarantines and travel restrictions work, and if we need them we should absolutely institute them, and that is maybe the one place where the WHO is falling down right now, though at least they haven't ruled out the idea of travel restrictions if things get worse in Mexico.

My report from that conference (co-authored with my mentor, Theodore Bosworth, a top-notch medical writer whom I would gladly recommend to anyone working in this field) is here (warning, big PDF), free for the downloading and reading by anyone who wants to know what the real actual experts have to say about this stuff. It mostly focuses on H5N1 bird flu, but the sections on SARS and 1918 are still very relevant.

(Reply to this)


[info]saint_monkey
2009-04-27 05:00 pm UTC (link)
http://xkcd.com/574/

(Reply to this) (Thread)

[info]slithytove
2009-04-28 03:47 am UTC (link)
I love that. Of course, I usually love xkcd.

(Reply to this) (Parent)
Fuel for the fire
[info]saint_monkey
2009-04-27 05:05 pm UTC (link)
Oh! and also this!
http://www.huffingtonpost.com/jay-gordon/tamiflurumsfeldh1n1-redux_b_191606.html

(Reply to this)


[info]sage_theory
2009-04-27 05:20 pm UTC (link)
I hope I don't sound argumentative here, but I think you may be missing a culprit when you blame people for underselling the severity of Swine Flu. And that's a complete lack of scientific/medical knowledge among the general public about what makes a virus dangerous and how these things work.

Yeah, maybe people here in the U.S. didn't take SARS seriously and feel it was overhyped. And I'm sure there are lots of scientists and doctors who feel that's stupid. But if you're, say, someone who serves hamburgers or fixes cars or works in an office selling paper for a living, exactly how much do you know about viruses and their danger in the first place? How much can you be expected to know.

If the pundits are being stupid, they're responding to a public that doesn't understand when something is serious and when it isn't because they just don't have that kind of information or education. Not to mention that when you say "flu" to the American public, they imagine spending a week on the couch with a bunch of tissues, watching Oprah and missing school and/or work.

It just doesn't conjure that kind of fear in us.

I won't lie. I didn't realize that SARS was serious for a very long time. All I saw was a bunch of Chinese people on the news wearing funny masks and warnings not to go to Toronto. I lived in Kentucky at the time. What was some virus in China and Canada to me?

Same with this Swine Flu. I mean, I live in Queens, NY and most of the people around here really aren't concerned. All we've seen are a bunch of kids who got sick for a few days, stayed home from school, and didn't even need to be hospitalized. For us, it's just a bug going around that might keep you home from work.

Not to mention that the American public is kind of immune to numbers. You tell us that 81 people died? Ha. We can tell you about 11,000 or 500,000 or 2.5 million that died of cancer and HIV and hunger and whatever else people throw mortality statistics at us for.

So, yeah, the pundits are being idiotic and some people are underselling this. But they're not being deliberately stupid. They're being stupid because most of them just don't know.

If you're going to rail against this (and yeah, you should) then maybe acknowledge that part of the reason is because people just don't have the kind of education to know what half this stuff means.

Yeah, maybe SARS was (as [info]matociquala said) a Near Earth Object of a disease, but if you don't have a telescope and a degree in astronomy, a Near Earth Object doesn't mean anything to you.

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[info]slithytove
2009-04-28 02:21 am UTC (link)
If the pundits are being stupid, they're responding to a public[...]

But pundits aren't supposed to respond to the public. They're supposed to be smarter than the public. That's (presumably) why they're pundits, and more worthy to listen to than Joe spouting off at the water cooler. If you're paid to deliver opinions in the newspaper or on TV, they'd better be good opinions. They don't have to be right all the time, but they'd better be right more often than Water Cooler Joe, or why is your boss paying you the long green?

There's no excuse for op-ed writers and TV talking heads to get this one wrong. The info is readily available.

You tell us that 81 people died? Ha. We can tell you about 11,000 or 500,000 or 2.5 million that died of cancer and HIV and hunger and whatever else people throw mortality statistics at us for.

This gets into perception of risk, which is a fascinating issue. But see, people *should* be alarmed, because it's not the number of deaths, but a bunch of deaths close together that gets attention and makes people change their behavior. An airplane crash in which a hundred people die makes the national news. 40,000 deaths a year in random auto accidents doesn't raise a ripple. A hundred deaths within a short period of time from a new infectious disease would normally get attention.

I mean, I live in Queens, NY and most of the people around here really aren't concerned.

There have been several cases in NY. No deaths, yet, and the cases seem to be mild. But let a handful of deaths happen, and people will change their behavior.

The trick is to get them to change their behavior *before* the deaths happen.

Afterward, the hipsters will all say, "See, no one died after all. It was all a bunch of bullshit." Someone will publish mnftiu strips about swine flu on his blog and everyone will say, "Yeah, I knew it all along. They can't fool *me*."

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(no subject) - [info]sage_theory, 2009-04-28 12:12 pm UTC (Expand)

[info]dr_phil_physics
2009-04-27 05:48 pm UTC (link)
Since this hit the news cycles of just the last few days, and I have been reading my stack of science literacy book reports, it has been eerie to read papers about Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It / Gina Kolata (1999). Several students wrote papers saying they could scarcely believe that (a) a flu could kill a lot of people and (b) that it could flair up and travel so quickly.

On the one hand its April and we have moved away from the traditional flu season, but on the other the annual movement of migrant workers for spring planting is going to mix populations that might've been exposed. Michigan is already reporting one case, and Ohio has some. I heard a report this morning that some European governments are suggesting people not jump the puddle for a while.

Of course this weekend I have Penguicon 7.0 to go to, a SF/Linux con, and everyone knows you go to a con for a weekend and come back with con crud. Hopefully it won't be a real winner... I'm still not completely over these stupid sinuses from January.

Dr. Phil

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[info]slithytove
2009-04-28 02:25 am UTC (link)
There's an SF/Linux con? *o*

(Reply to this) (Parent)(Thread)(Expand)
(no subject) - [info]matociquala, 2009-04-28 02:34 am UTC (Expand)
(no subject) - [info]tlatoani, 2009-04-28 02:08 pm UTC (Expand)
(no subject) - [info]matociquala, 2009-04-28 08:05 pm UTC (Expand)
(no subject) - [info]dr_phil_physics, 2009-04-28 05:14 am UTC (Expand)
(no subject) - [info]slithytove, 2009-04-28 07:04 am UTC (Expand)

[info]raphael0877
2009-04-27 08:19 pm UTC (link)
And of course I'm screwed no matter what, bec. even if they ever do develop a vaccine for this, I won't be able to get it bec. I'm allergic to eggs. So can't receive any flu vaccines. Period. Unless I lie to my Dr. and/or don't tell him, and then have to deal with the anaphylactic shock afterwards. So I stick to my compulsive handwashing and not touching any public buttons/handrails/doorhandles with bare hands. And hope no one coughs on me in the halls of my courthouse (a breeding ground of many strains of viruses).

(Reply to this)


[info]dichroic
2009-04-28 12:57 am UTC (link)
I think SARS was taken more seriously in Asia. I live in Taiwan at the moment. If you fly into the major airport here, you will pass by a scanner and see yourself in infrared on a TV screen, with a couple of people at a nearby station watching it carefully - a brilliant way to quickly screen large numbers of people for fever. And when people get sick, even a cold, they wear facemasks. You can even buy fancy ones in different colors and patterns.

On the other hand, what lots of public buildings *don't* have is hot water for handwashing - but then, neither do too many US office buildings.

(Reply to this) (Thread)(Expand)

[info]buymeaclue
2009-04-28 01:33 am UTC (link)
If you fly into the major airport here, you will pass by a scanner and see yourself in infrared on a TV screen, with a couple of people at a nearby station watching it carefully - a brilliant way to quickly screen large numbers of people for fever.

Oh, wow. That's fascinating. Creepy, but fascinating.

(Reply to this) (Parent)
(no subject) - [info]slithytove, 2009-04-28 02:42 am UTC (Expand)
(no subject) - [info]dichroic, 2009-04-28 07:49 am UTC (Expand)

[info]buymeaclue
2009-04-28 01:38 am UTC (link)
Slithy, don't suppose you could explain how flu strains get their names? What do the numbers and letters signify?

(Reply to this) (Thread)(Expand)

[info]matociquala
2009-04-28 12:13 pm UTC (link)
I'm not Dr. Tove, but I do know the answer.

H and N refer to two types of proteins on the surface of the flu virus. There are fifteen types of H protein and nine types of N, I think, unless I have that backwards. Because they are (fairly) easily identifiable, they're used to identify the strain of virus. Sort of--but not really--like blood type in humans.

Jim Macdonald has a good layman's-level explanation of what flu is, how it works, and how it makes one sick at Making Light:

http://nielsenhayden.com/makinglight/archives/011241.html

(Reply to this) (Parent)
(no subject) - [info]slithytove, 2009-04-28 01:30 pm UTC (Expand)
(no subject) - [info]matociquala, 2009-04-28 01:33 pm UTC (Expand)
(no subject) - [info]buymeaclue, 2009-04-28 03:49 pm UTC (Expand)

[info]sunshinepeachy
2009-04-28 03:27 am UTC (link)
I don't know what pundits you are watching, but CNN and the constant updates 24/7 with hourly interviews with SOMEone about the swine flu doesn't seem to be downplaying... I turned on Fox news out of curiosity yesterday and the headline was "HOW TO OBTAIN LIFE SAVING TAMIFLU WHEN GOVERNMENT STOCKS RUN OUT".

How much more seriously should they be taking it?

(Reply to this) (Thread)

[info]slithytove
2009-04-28 07:12 am UTC (link)
I may have been the victim of sampling bias. I checked CNBC, and there's Joe Kernen, lovable but crankish, complaining that previous X-flu outbreaks had been over-hyped, and he wasn't buying this one. I googled 'swine flu', and the second or third news story in the first link was Bill Ralston in NZ, also pooh-poohing it.

I'm glad CNN and Fox have been more serious. Still, two stupid pundits is two too many.

(Reply to this) (Parent)

[info]matociquala
2009-04-28 12:03 pm UTC (link)
Well, we've gone to level four. And it sounds like what's killing the people who are dying is lung damage/cytokine storm/viral pneumonia.

Okay, I am officially concerned.

(Reply to this)


[info]dragonladyk
2009-04-30 05:04 pm UTC (link)
SARS didn't get loose, because of smart, fast, ruthless doctors and public health officials in Hong Kong, Vietnam, elsewhere in SE Asia, and Toronto, and wherever a case cropped up. Draconian quarantines and travel restrictions were established. Man, did I hear people whine about that.

See, and this is part of the news coverage that's bothering me. There's no middle ground. It's either "OMG! Civilization may fall! It's a pandemic! Governments are urging people not to panic, but this is a big deal!" (which leads to a Boy-Who-Cried-Wolf scenario when the doctors' orders work) or "Meh, the governments are over-reacting" (the villagers not believing Peter). There are precious few people pointing out that pandemics are preventable through containment and hygiene and that if everyone stays calm and follows medical procedure, humanity can keep this from being a problem of 1918-proportions.

DragonLady

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