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- Crunching Some Swine Flu Numbers
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- Crunching Some Swine Flu Numbers
Crunching Some Swine Flu Numbers
- By Leva Cygnet
- Published 04/29/2009
- Editorials
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Leva Cygnet
View all articles by Leva Cygnet
and "only 150 out of a population of 110,000,000" are
dead in Mexico. I thought I'd do some analysis on the reported swine
flu numbers regarding what they might be showing, and what you can infer from them.
First off, Mexico is reporting that there are 157 suspected fatalities and 7 confimed. For ease of argument, I'm going to round this down 150. And yes, I know it's likely some of those suspected fatalities died of other things, and equally likely that Mexico is so disorganized and overwhelmed that they're under-reporting matters. I'm going to take the number of "150" and stick with it for this article for math purposes. You can do the same math yourself on any number you chose to play with.
We cannot calculate a case fatality ratio (CFR) from those 150 dead because we don't know how many are sick. Lots of people are, or have been, hospitalized but it's highly probable that many more people are recovering at home. Swine influenza seems to be behaving exactly like one would expect a new influenza to act, and it is not Ebola or Captain Tripps the Death Flu. This means most people will recover just fine in a few weeks on their own and no doctors need be involved.
What we can do is apply various CFRs to the number of dead to figure out how many people might be sick.
Here's some examples:
The 1918 pandemic had a CFR of around 2.5%. (Though this seemed to be highly dependent on personal genetic resistance and the capriciousness of viral mutation; it would make some people mildly ill and, elsewhere, wiped out entire communities.)
Taking a CFR of 2.5% gives us 150 dead and 6,000 total infected.
That, alone, is unstoppable. 6,000 people are way beyond the ability of any city to manage, even one as big as Mexico City. To stop the flu at that point you'd need to identify every single one of those 6,000 people, put them in isolation, and -- assuming no one was infected with a mutated Tamiflu resistant version of the flu -- shove Tamiflu down the throat of anyone who'd been in the same breathing space as the sick person during the period they were potentially infectious.
Flu is infectious for 24 hours before symptoms to as long as 7 days after. If even one of those people took a crowded subway, went to a sports game, or went to a busy night club, during a period that they were infectious ... well. Game's up. Flu is entirely contagious enough to have added scores of new victims just from one subway trip. It's airborne.
At just 6,000 sick people, my logic tells me the flu would be nigh unstoppable.
If the CFR was lower -- if the disease is less lethal -- there will be more sick, of course. A CFR of .5% gives us 30,000 sick. A CFR of .1% gives us 150,000 sick.
Note that a lower CFR is not necessarily a good thing. The way I see it, either we have a disease with a relatively high mortality rate that is spreading and probably unstoppable in the human population, or we have something that doesn't kill very many people, but is so contagious that it's infected tens or hundreds of thousands of people in several weeks. Either isn't a very good scenario.
The second scenario, a wickedly infectious flu that doesn't kill a lot of people, is problematic on several fronts. One, it will kill some, as demonstrated by the numbers coming out of Mexico. And it would really suck to be one of those people, or their friends or family.
If you take a city the size of, say, the Phoenix metro area (two million) and half are infected and .5% die, that's still 5,000 people dead. For the entire US, with roughly 304 million, if half are infected and .5% die, that is 760,000 people. Worldwide, assuming eight billion people, twenty million could die. Odds are, however, that influenza's going to tear through the Third World with a lot more savagery than it hits modern nations, so the global CFR may be worse than what we're seeing now. Mexico may have a lot of poor, but it's nothing like Congo or Somalia or Haiti.
Secondly, aside from the dead, there will be many people who are sick enough to need medical care. If a "mild" but extremely contagious flu strikes, the number of ill could overwhelm the hospitals. Even a mild flu can be devastating to someone with preexisting health problems, or who is young, healthy, and unlucky enough to have an immune system that goes into overdrive. (We're already seeing this in Mexico city -- they have armed guards at the doors of public hospitals who are turning patients away.) There could be shortages of medication, supplies, and hospital beds.
Some quick calculations, using Phoenix for an example: Two million people. 10% sick at the same time gives you 200,000 sick. If just 5% need hospitalization that is 10,000 people. (How many of those 10,000 will die if they don't get the hospital care they need?)
This affects not just flu patients, but everyone for falls ill or is injured for any reason. If all the ventilators are being used and you're in an auto accident and have a chest injury and need one, you're up a creek. You'll die. The equipment wouldn't be available to save you. Plus, anyone who goes into a hospital would potentially be exposed. It would really suck to develop, say, have a treatable heart attack and then die of influenza complicated by your heart disease.
Thirdly, "mild" flu is only mild until you're the one who's sick. Flu is miserable. A mild, uncomplicated case of influenza will knock you flat for a week and, while it might not kill you, it will make you wish you were dead. If tens or hundreds of thousands of people are sick in a city, it can bring normal life in the city to a screeching halt and disrupt things in spectacular ways. (Mexico City is currently experiencing runs on grocery stores. People are panicking and they are literally running out of food.)
Finally, flu viruses have the capability of swapping genetic material with other strains. That's how swine flu was lborn -- likely, a pig was simultaneously infected with avian, swine, and human viruses. The viruses had virus sex and swapped some genetic material and their nasty little lovechild was born. Then some unlucky person caught that new flu virus, and an epidemic began.
During a pandemic, with lots of people sick, we can assume there will be lots of particles of swine flu virus floating around out there. However, seasonal flu isn't going to go away, and seasonal flu and swine flu could swap genetic code and then swine flu could learn some nasty new tricks, like Tamiflu resistance or increased virulence. It could also meet up with something really unpleasant, like avian H5N1 flu, which isn't really adapted well to humans (yet), but which has some genetic code that kills about 60% to 70% of people who are so unfortunate as to catch it from birds.
We really don't want any human-adapted flu to reassort with H5N1. The same thing that happened with the afore-mentioned pig could happen with H5N1 and if H5N1 retained its lethal nature That Would Be Bad.
On the other hand, if the CFR is higher, 150 dead gives us fewer patients. It's not spreading as fast. However, you can calculate the rate of spread of a virus by how many people each person, on average, infects. If each person infects greater than an average of one other person, the outbreak is growing and has pandemic potential. (AIDs, for example, has a very low rate of spread but it's definitely not dying out -- the rate of spread is greater than "1".)
A slow rate of growth, despite a higher CFR, may make swine flu more manageable. It would be easier to implement social controls such as quarantines of the infected, closing public places, and discouraging travel, to reduce the rate of growth even further. Slow the spread enough, and the hospitals don't become overwhelmed. While getting the rate of spread below "1" would be unlikely, it might be possible to keep it from growing in exponential leaps and bounds. Eventually, a vaccine will be created, and we can bring the pandemic to a standstill -- at least in those areas of the world where a vaccination is possible. (The toll that pandemic flu will take on certain third world countries will be appalling.)
However, slowing down the spread of the flu will require communities to accept restrictions that they will find highly unpalatable: schools, movies, restaurants, malls, ball games, parks, public pools, libraries, and more, all restricted or outright closed for business. Travel will be frowned upon and perhaps limited. All this will create massive financial strain on the people whose jobs are affected, with ripples spreading out throughout the economy.
I'm predicting that, if a large-scale pandemic does materialize, it will shake the western world's perception of itself to its core. Many people will die. Normal life will be disrupted on a large scale in ways that haven't happened in decades. The economy will be at the bottom of an outhouse before all is said and done. We will learn we are vulnerable to disasters of this scale, despite our assumptions to the contrary.
Stay tuned. The next few months will be very interesting ...
First off, Mexico is reporting that there are 157 suspected fatalities and 7 confimed. For ease of argument, I'm going to round this down 150. And yes, I know it's likely some of those suspected fatalities died of other things, and equally likely that Mexico is so disorganized and overwhelmed that they're under-reporting matters. I'm going to take the number of "150" and stick with it for this article for math purposes. You can do the same math yourself on any number you chose to play with.
We cannot calculate a case fatality ratio (CFR) from those 150 dead because we don't know how many are sick. Lots of people are, or have been, hospitalized but it's highly probable that many more people are recovering at home. Swine influenza seems to be behaving exactly like one would expect a new influenza to act, and it is not Ebola or Captain Tripps the Death Flu. This means most people will recover just fine in a few weeks on their own and no doctors need be involved.
What we can do is apply various CFRs to the number of dead to figure out how many people might be sick.
Here's some examples:
The 1918 pandemic had a CFR of around 2.5%. (Though this seemed to be highly dependent on personal genetic resistance and the capriciousness of viral mutation; it would make some people mildly ill and, elsewhere, wiped out entire communities.)
Taking a CFR of 2.5% gives us 150 dead and 6,000 total infected.
That, alone, is unstoppable. 6,000 people are way beyond the ability of any city to manage, even one as big as Mexico City. To stop the flu at that point you'd need to identify every single one of those 6,000 people, put them in isolation, and -- assuming no one was infected with a mutated Tamiflu resistant version of the flu -- shove Tamiflu down the throat of anyone who'd been in the same breathing space as the sick person during the period they were potentially infectious.
Flu is infectious for 24 hours before symptoms to as long as 7 days after. If even one of those people took a crowded subway, went to a sports game, or went to a busy night club, during a period that they were infectious ... well. Game's up. Flu is entirely contagious enough to have added scores of new victims just from one subway trip. It's airborne.
At just 6,000 sick people, my logic tells me the flu would be nigh unstoppable.
If the CFR was lower -- if the disease is less lethal -- there will be more sick, of course. A CFR of .5% gives us 30,000 sick. A CFR of .1% gives us 150,000 sick.
Note that a lower CFR is not necessarily a good thing. The way I see it, either we have a disease with a relatively high mortality rate that is spreading and probably unstoppable in the human population, or we have something that doesn't kill very many people, but is so contagious that it's infected tens or hundreds of thousands of people in several weeks. Either isn't a very good scenario.
The second scenario, a wickedly infectious flu that doesn't kill a lot of people, is problematic on several fronts. One, it will kill some, as demonstrated by the numbers coming out of Mexico. And it would really suck to be one of those people, or their friends or family.
If you take a city the size of, say, the Phoenix metro area (two million) and half are infected and .5% die, that's still 5,000 people dead. For the entire US, with roughly 304 million, if half are infected and .5% die, that is 760,000 people. Worldwide, assuming eight billion people, twenty million could die. Odds are, however, that influenza's going to tear through the Third World with a lot more savagery than it hits modern nations, so the global CFR may be worse than what we're seeing now. Mexico may have a lot of poor, but it's nothing like Congo or Somalia or Haiti.
Secondly, aside from the dead, there will be many people who are sick enough to need medical care. If a "mild" but extremely contagious flu strikes, the number of ill could overwhelm the hospitals. Even a mild flu can be devastating to someone with preexisting health problems, or who is young, healthy, and unlucky enough to have an immune system that goes into overdrive. (We're already seeing this in Mexico city -- they have armed guards at the doors of public hospitals who are turning patients away.) There could be shortages of medication, supplies, and hospital beds.
Some quick calculations, using Phoenix for an example: Two million people. 10% sick at the same time gives you 200,000 sick. If just 5% need hospitalization that is 10,000 people. (How many of those 10,000 will die if they don't get the hospital care they need?)
This affects not just flu patients, but everyone for falls ill or is injured for any reason. If all the ventilators are being used and you're in an auto accident and have a chest injury and need one, you're up a creek. You'll die. The equipment wouldn't be available to save you. Plus, anyone who goes into a hospital would potentially be exposed. It would really suck to develop, say, have a treatable heart attack and then die of influenza complicated by your heart disease.
Thirdly, "mild" flu is only mild until you're the one who's sick. Flu is miserable. A mild, uncomplicated case of influenza will knock you flat for a week and, while it might not kill you, it will make you wish you were dead. If tens or hundreds of thousands of people are sick in a city, it can bring normal life in the city to a screeching halt and disrupt things in spectacular ways. (Mexico City is currently experiencing runs on grocery stores. People are panicking and they are literally running out of food.)
Finally, flu viruses have the capability of swapping genetic material with other strains. That's how swine flu was lborn -- likely, a pig was simultaneously infected with avian, swine, and human viruses. The viruses had virus sex and swapped some genetic material and their nasty little lovechild was born. Then some unlucky person caught that new flu virus, and an epidemic began.
During a pandemic, with lots of people sick, we can assume there will be lots of particles of swine flu virus floating around out there. However, seasonal flu isn't going to go away, and seasonal flu and swine flu could swap genetic code and then swine flu could learn some nasty new tricks, like Tamiflu resistance or increased virulence. It could also meet up with something really unpleasant, like avian H5N1 flu, which isn't really adapted well to humans (yet), but which has some genetic code that kills about 60% to 70% of people who are so unfortunate as to catch it from birds.
We really don't want any human-adapted flu to reassort with H5N1. The same thing that happened with the afore-mentioned pig could happen with H5N1 and if H5N1 retained its lethal nature That Would Be Bad.
On the other hand, if the CFR is higher, 150 dead gives us fewer patients. It's not spreading as fast. However, you can calculate the rate of spread of a virus by how many people each person, on average, infects. If each person infects greater than an average of one other person, the outbreak is growing and has pandemic potential. (AIDs, for example, has a very low rate of spread but it's definitely not dying out -- the rate of spread is greater than "1".)
A slow rate of growth, despite a higher CFR, may make swine flu more manageable. It would be easier to implement social controls such as quarantines of the infected, closing public places, and discouraging travel, to reduce the rate of growth even further. Slow the spread enough, and the hospitals don't become overwhelmed. While getting the rate of spread below "1" would be unlikely, it might be possible to keep it from growing in exponential leaps and bounds. Eventually, a vaccine will be created, and we can bring the pandemic to a standstill -- at least in those areas of the world where a vaccination is possible. (The toll that pandemic flu will take on certain third world countries will be appalling.)
However, slowing down the spread of the flu will require communities to accept restrictions that they will find highly unpalatable: schools, movies, restaurants, malls, ball games, parks, public pools, libraries, and more, all restricted or outright closed for business. Travel will be frowned upon and perhaps limited. All this will create massive financial strain on the people whose jobs are affected, with ripples spreading out throughout the economy.
I'm predicting that, if a large-scale pandemic does materialize, it will shake the western world's perception of itself to its core. Many people will die. Normal life will be disrupted on a large scale in ways that haven't happened in decades. The economy will be at the bottom of an outhouse before all is said and done. We will learn we are vulnerable to disasters of this scale, despite our assumptions to the contrary.
Stay tuned. The next few months will be very interesting ...
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Comments
Comment #1 (Posted by cathy)
Rating:








Absolutely the best analysis of this subject I've seen. I've been telling people the "mild" flu scenario is actually scarier than the "fatal" flu scenario because of the possibility of mutation. I am getting that frozen "this chick is crazy" smile a lot.
Comment #2 (Posted by Justin)
Rating:








This is a good article to see some numbers, but the fact that you don't know that viruses don't reproduce sexually makes me questions every single fact you have.
Viruses are a thing (not quite an organism cuz they don't eat, breathe, sleep, etc) that latches onto a cell it has a specific inclination towards, and injects it's genetic material into the said cell. Next, that material hijacks the cell, turning it into a virus factory.
They don't have virus sex creating new virus. There is no virus love child.
Comment #3 (Posted by Bob)
Rating:








Justin... just because people say things that don't reproduce sexually have sex doesn't mean they don't know that thing doesn't reproduce sexually! Virus sex is obviously sexier than "these viruses will meet in a person and mix genetic material" and virus love child is sexier than "the hybrid of H1N1 and H5N1." Throw out the whole argument for one silly little thing. Get a life loser! Maybe have some virus sex while you're at it.
Comment #4 (Posted by omni)
Rating:








How nice it would be for the numbers to actually be as low as "150" in Mexico. Great job on the numbers, things could definitely be getting out of hand.
Comment #5 (Posted by anonymous)
Rating:








A little knowledge is a dangerous thing.
Comment #6 (Posted by Hyde-D)
In the next few months, I just hope you don't get the food in the mouth virus because otherwise that you'd be mistaken. Nothing else could have been more interesting when you are.
Comment #7 (Posted by tek)
Rating:








One word: misconceptions!
Comment #8 (Posted by anonymous)
Rating:








Over 30,000 people a year die in the US from plain old Seasonal Influenza alone, so why don't people freak out about that? The number is over 250,000 for worldwide cases! Because people associate the flu with the common cold, but OMG, add in an exotic and an people panic and MAKE THINGS WORSE! Wash your hands often, don't sneeze on people, and don't mess with your face without washing your hands! It might also help if people got off their asses and worked to keep themselves healthy by eating a balanced diet and exercising.
People keep wondering what caused this, well it isn't rocket science! It is called Ecology! Diseases are a normal part of the environment, hell, they are older than any other living thing! It is in a disease's (whether parasite, bacteria, virus, etc.) favor to linger without killing quickly. If it kills quickly it can't spread. If an ecosystem is healthy, it has checks in place to prevent major collapses, but when it is messed up (as are most of the ecosystems in the world) due to disturbances like overpopulation, the buffers are gone and there is usually a massive death toll. People eventually either gain immunity from previous years infections or die. Take a look at the genocide of Native Americans from Old World diseases like smallpox. The Europeans carried it but weren't affected by it because it had existed in their population for centuries. Native Americans didn't have that luxury.
In our case, we may be lucky. If they can get enough vaccines made, we would effectively be speeding up the ecological process. If people continue to panic and take Tamiflu at the first sign of a sniffle then we are setting ourselves up for disaster.
