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Friday, October 21, 2005

Bird flu

The bird flu is sweeping into Europe and people are getting into a tizz despite calming voices, draining the supplies of anti-virals and forecasting doom. But what are the actual risks? One medical correspondent at Instapundit says it won't be like 1918, because basically we are a century down the track and live in a much different world,
As a medical researcher, I want to make a gentle but sincere plea to the blogosphere to calm down this flu hysteria just a bit. The main way that flu kills is by predisposing its victims to "superinfection" by bacterial illnesses - in 1918, we had no antibiotics for these superimposed infections, but now we have plenty. Such superinfections, and the transmittal of flu itself, were aided tremendously by the crowded conditions and poor sanitation of the early 20th century - these are currently vastly improved as well. Flu hits the elderly the hardest, but the "elderly" today are healthier, stronger, and better nourished than ever before. Our medical infrastructure is vastly better off, ranging from simple things like oxygen and sterile i.v. fluids, not readily available in 1918, to complex technologies such as respirators and dialysis. Should we be concerned? Sure, better safe than sorry, and concerns about publishing the sequence are worth discussing. Should we panic? No - my apologies to the fearmongers, but we will never see another 1918.
At Gene Expression they sum it up with
Now, don't get me wrong, I am not arguing that everything will be perfectly fine, I am not that Pollyannaish, there will be infections. But, either most will recover, or few deaths will happen in segments of the population who are immune-compromised (the already ill, the elderly, the very young) or who do not have adequate access to antibiotics (the very poor). But our society has advanced to a point that these deaths will be few and far between.
Which they followed up with a comparison to SARS,
A Canadian investment firm issued a report on avian flu recently. They argue that the indirect (economic) effects of a pandemic will be devastating over and above any loss of life. Their strongest evidence comes from an analysis of the economic impact of SARS on affected countries. The world-wide death toll from SARS was small (~775 people), but its impact on GDP growth was substantial.
Retard economic activity too much and you'll probably kill more people indirectly than the flu would. The flu, if it becomes virulent in humans, will of course cause havoc in underdeveloped countries, the countries that live now like we did in 1918 with poor knowledge of sanitation, no antibiotics, high levels of other diseases, people immune compromised already by AIDS and thos living with dormant TB. But panic and over-reaction in richer countries will not help them one bit and will worsen their plight. Bird flu in the West will be like the Southpark SARS episode ("Stanley, listen to me. I have SARS. There's only a ninety-eight percent chance that I will live.") but it won't be much of a joke for your average African.

Posted by Chefen | 10/21/2005 06:24:00 PM


Blogger Bernard Woolley said...

A few points to make...

1. Antibotics are having a harder and harder time against bacteria now. Just think of the so-called superbugs that we've had in our very own hospitals here in New Zealand.

2. Bird Flu to date has not been selective in its victims. It has affected fit and healthy people as well as old and young. This implies that we do not necessarily have better immune systems than in the past - especially with some of the crap food we eat, lack of exercise and increased obesity, at least in western society.

3. Yes our medical infrastructure is vastly better, but that won't help us because it is already operating at capacity. Our hospitals have to send people home in winter when the mildest flu does the rounds. Our hospitals also likely don't have enough of key equipment like ventilators that are required for flu. Part of the problem here is that hospitals are designed to manage a background level of sickness in society, and they are not designed to handle the surge required when many people fall sick at once. Just like we may not be able to handle a mass casulaty incident in New Zealand. We're just operating too close to our capacity.

But overall, yes, there is no reason to panic and overact. But people do. Just like terrorism and just like other areas. The whole reason this occurs?

The MSM.

This is only occuring because of the attention being given to H5N1 in the media.

10/21/2005 07:05:00 PM  
Blogger Chefen said...

Points taken Bernard, but,

1. Antibiotics still work against an enormous range of infections, particularly those likely to be caught while suffering the flu.

2. The flu doesn't have to be selective, even if you are healthy you get infected. However most people will get over it without fatal secondary infections. We don't have latent diseases as in 1918 and the vast majority of the population gets enough food and good hygiene to avoid further infections.

3. Yes that is a problem, but home is probably the best place for most people anyway. Save the hospital care for the elderly and truly vulnerable. But that is true without flu anyway, as anyone who has waited in an A&E queue knows. There generally aren't enough doctors around anyway, but whose fault is that? How many people has everybody met who were very bright and able but didn't quite make the cut for the limited med school intakes?

As always a bit of prevention, like just washing your hands regularly and avoiding contact when ill, goes a long way in mitigating much of the spread.

But yes, whipping up anxiety and hysteria in rich Western countries is about the most pointless and counterproductive action possible.

10/21/2005 07:17:00 PM  
Blogger Xavier said...

The important thing to remember about the 1918 'flu epidemic is that it tended to strike the healthiest people: young and fit, as opposed to the very young or old and infirm. We are very much cleaner than we were, but that is only in western nations, and we are very, very much more mobile. Further, the new strain of avian flu has a mortality rate 10x higher than the spanish flu. Although less people are likely to get infected, a greater proportion of those that do will die. It's really just a numbers game.

10/21/2005 07:36:00 PM  
Blogger Bernard Woolley said...

Oh, I agree. This is the problem with all the navel-gazing currently going on. We are not going to know what it is going to be like until it has happened and we have the benefit of hindsight.

Interestingly, it may turn out to be like the Y2K bug (which many people in the MSM seem to have been comparing it to). Had we completely ignored the Y2K warnings, things could very well have turned to custard. By the very fact that many organisations spent a lot of money assessing and treating Y2K issues, it turned out to be a non-issue for nearly all. So, people assume that because nothing happened it was a waste of money. It may not have been, because the very actions that were taken to minimise the risk could have turned a potentially huge event into a non-event. It may be the same with H5N1, in that if we did nothing, the worst could very well happen. But now that everyone is doing so much, it could well also become a non-event.

Once again, it is likely that we won't have a decent control group to say whether it was our actions that minimised the risk, or just because of the way that H5N1 mutated (when it possibly does).

10/21/2005 07:36:00 PM  
Blogger Bernard Woolley said...

Xavier, also, it is likely that the mortality rate will decrease if it is to become widely spread. Compare say Ebola which kills quickly, but never seems to spread that far because it kills its hosts too quickly, against our more common strains of influenza which spread far and wide but don't kill many. As the mortality rate increases, it becomes harder to spread.

10/21/2005 07:41:00 PM  
Blogger Xavier said...

High mortality and Rate of mortality are necessarily two different concepts. Ebola and Avian flu have similar mortalities, but the rate of mortality for ebola is much higher (i.e. how quickly it kills), and is the limiting factor of its spread. Further, ebola existed in areas with low population densities which further decreased its potential for transmission. Polio similarly remained a chronic threat, despite having a very high mortality, but a low rate of mortality

10/21/2005 08:09:00 PM  
Blogger Gooner said...

I thought SARS was going to finish us all off?

10/21/2005 09:44:00 PM  
Blogger Xavier said...

No, SARS was a variant of the same virus that is associated with pneumonia, and a very poor transmitter. It was very much a flash in the pan, and has gone on the path of becoming just another endemic human disease

10/21/2005 10:24:00 PM  

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