Thursday, April 30, 2009

Will Swine Flu Be an Economic Tipping Point?

Pandemics have been with us for a long time, are ongoing, and have never gone away.

Anyone heard of malaria, HIV, cholera, or tuberculosis?

All are huge killers, with millions dying every year across the globe, and no one blinks.

Regular-old influenza is a seasonal pandemic we have already normalized.

Consider this: in the average year, 30,000 to 50,000 people die in the U.S. from the flu, and across the globe the death toll is about 20 to 30 times that.

Ho hum. Let us bury the dead, stay calm and carry on.

So what's new about the swine flu pandemic that has everyone aflutter?

Well for one thing, the speed of transmission is pretty darn impressive.

A hat tip to the airlines and mass transit which have helped make that possible.

Another issue is that this stuff may be pretty virulent. We don't have a good denominator to work with yet, so we're not sure, but there's some small sign this strain of flu might be a bit stronger than the stuff we normally see. That, combined with the speed of transmission, gives epidemiologists a reason to worry.

The good news is that we are not living in the world of 1918.

We have better communications, better monitoring abilities, and more health care interventions than we did back then.

The bad news is that today's flu is being spread much faster, and our vaccine-producing technologies are still very old-fashioned, very slow, and very labor-intensive.

The bottom line here is that there is no way to make enough vaccine to stop a pandemic once it begins to really roar down the track.

We will just have to ride it out.

Another bit of bad news is that our crowded world has become a particularly flu-friendly place, and we are likely to see more of this kind of thing in the future.

As a 2005 article entitled "Preparing for the Next Pandemic, put it:

It is sobering to realize that in 1968, when the most recent influenza pandemic occurred, the virus emerged in a China that had a human population of 790 million, a pig population of 5.2 million, and a poultry population of 12.3 million; today, these populations number 1.3 billion, 508 million, and 13 billion, respectively. Similar changes have occurred in the human and animal populations of other Asian countries, creating an incredible mixing vessel for viruses.

Another bad sign
is that the current flu epidemic appears to be striking a disproportionately high number of healthy people between the ages of 18 and 40 years, which suggests a virus-induced "cytokine storm" may be occurring inside today's swine flu victims.

In a cytokine storm, the human immune system is pushed over the edge, and an auto-immune "do-loop" leads to acute respiratory distress syndrome, and that can lead to the kind of death knell numbers we saw back in 1918. As Michael Osterholm noted back in 2005:

If we translate the rate of death associated with the 1918 influenza virus to that in the current population, there could be 1.7 million deaths in the United States and 180 million to 360 million deaths globally.

So should we all be freaking out?

  • No.

  • Yes.

Paradoxically, both answers can be true at the same time.

The chance of any one individual actually dying from swine flu, even under a worst-case scenario, is not very high.

That's the good news.


The bad news is that a real pandemic could lead to schools and offices shutting down, restrictions on airplane travel, and a shuttering of subway and train lines.

Add to that economic catastrophe, a further drop in productivity due to people getting sick, and well people being forced to stop work in order to take care of family members who are sick, and the undertow of an economic vortex could be set in motion.


What if the next pandemic were to start tonight? If it were determined that several cities in Vietnam had major outbreaks of H5N1 infection associated with high mortality, there would be a scramble to stop the virus from entering other countries by greatly reducing or even prohibiting foreign travel and trade. The global economy would come to a halt, and since we could not expect appropriate vaccines to be available for many months and we have very limited stockpiles of antiviral drugs, we would be facing a 1918-like scenario.

.... we could vaccinate fewer than 500 million people — approximately 14 percent of the world's population. And owing to our global "just-in-time delivery" economy, we would have no surge capacity for health care, food supplies, and many other products and services. For example, in the United States today, we have only 105,000 mechanical ventilators, 75,000 to 80,000 of which are in use at any given time for everyday medical care; during a garden-variety influenza season, more than 100,000 are required. In a pandemic, most patients with influenza who needed ventilation would not have access to it.

We have no detailed plans for staffing the temporary hospitals that would have to be set up in high-school gymnasiums and community centers — and that might need to remain in operation for one or two years. Health care workers would become ill and die at rates similar to, or even higher than, those in the general public. Judging by our experience with the severe acute respiratory syndrome (SARS), some health care workers would not show up for duty. How would communities train and use volunteers? If the pandemic wave were spreading slowly enough, could immune survivors of an early wave, particularly health care workers, become the primary response corps?

Health care delivery systems and managed-care organizations have done little planning for such a scenario

Bottom line: An already weakened global economy could be pushed into a very serious free fall.

... Or not.

After all, as I noted at the beginning of this post, the world is being assailed by "pandemics" all the time, and yet we, as a species, continue to roll forward without too much of a hitch in our giddy up.

Death? That old thing?

Who cares about AIDS, or cholera, or malaria?

Let's talk about something interesting, like Mel Gibson's divorce.

Of course, that will change quickly if over-educated white people start dying by the train full. Then it really will be time to panic!

That said, I seriously doubt that swine flue will be the Last Waltz.

Let us remind ourselves, however, that unless we change the way we do business, there will be a Last Waltz some day, and disease will be part of that.

As Issac Asimov noted in a speech entitled "The Future of Humanity,"

"There is no need to decide whether to stop the population increase or not.

There is no need to decide whether the population will be lowered or not.

It will, it will!

The only thing mankind has to decide is whether to let it be done in the old inhumane method that nature has always used, or to invent a new humane method of our own [i.e. family planning and birth control].

That is the only choice that faces us; whether to lower the population catastrophically by a raised death rate, or to lower it humanely by a lowered birth rate.

And we all make the choice."


Or as I like to put it: "If we continue to breed like rats, then one day we are sure to die like flies."

In the interim, however, please pass the bacon.



Gina said...

Assessing risk is really tough for most people. Consider in your neck of the woods when you had the D.C. sniper, and lots of people wouldn't leave their homes unless it was absolutely necessary.

Turns out that meant less carnage. Not because fewer people were shot -- odds of that were slim in any case -- but because they didn't get into auto accidents.

I've got confirmed H1N1 cases not eight miles from here, and I'm still probably more likely to be killed driving to the store for that cupcake I'm craving to bits right now.

Doug said...

Well written Patrick.

Know where I can get some antibiotic in bulk - you know, just in case?
(Oh, and coffee and liqueur)

retrieverman said...

It's not arrived in my neck of the woods yet.

So to prepare for it, I bought some hand sanitizer, which I will start to use when it arrives. (I know some people who have bought the painters' masks, which do prevent infection. Anyone who buys surgical masks for this situation is a moron. Surgical masks keep you from infecting someone. They don't stop the flu from affecting you. The only mask that will work is the painters' mask.)

And that is the best precaution anyone can do right now. That and pay attention.

But panic-- that's what Americans are good at. And it's quite humorous to watch.

chip1972 said...

Dunno about the virulence of this virus. According to this story, the consensus is this flu is actually less dangerous than earlier flus, including the 1918 one.,0,3606923.story

PBurns said...

Good article Chip. Thanks! Time will tell if this new strain is something to worry about. If the DNA folks are right, and this spring strain of swine flu "only" creates another flu season that kills 10,000 people, is that a "good" outcome? As compared to what? It's not like we will be missing the traditional flu season -- it will come around in the Fall. It's all additive.

Ten thousands deaths is not much in the sea of things, of course. Not something to panic about -- unless it's someone in your family.

The real news will be if this gets us started down the road to talking about how we need to have a better plan for pandemics. The GOP laughed off that notion when it was in the stimulus package. Instead of focusing on a plan to slow the flu, which kills 20,000 to 50,000 people a year every year, they wanted us to ramp up for more war spending in Iraq in case someone, somewhere, **might** decide to throw a grenade into a subway and kill 10 or 100. Maybe the best investment this nation could make is if we spent a few hundred million on a national "teach in" on relative risk. Think of the money that idea could save!!