H1N1 vs. 1918 vs. The Stand
@JonHutson posted a link to this Wired infographic late Thursday night. My first take when reading it was, “Man! I wish I’d have thought about comparing the fictional doomsday virus in Stephen King’s The Stand with H1N1.” But then I read the supporting text and was really turned off by the whole thing. My complaint is something that’s been bothering me about a lot of the dismissive thinking about swine flu.
My specific problem with this graph is the modeled 1918 flu. We don’t, unfortunately, know exactly what happened in 1918. We have a curve that shows three distinct spikes in mortality due to influenza and a W-shaped curve that shows that old, young and young adults died from this disease. The author of the infographic takes the final R0 (2.7) and a stab at a CFR (up to 5, he says) and models a flu with those parameters. The CFR is just plain wrong, of course, more than doubling the widely-accepted CFR of 2.1. And the R0, well, I can’t specifically knock it, but as we’re seeing with this H1N1, R0’s vary from place to place, and over time. Places like NYC were seeing tons of transmission a few weeks ago, but they weren’t seeing that type of transmission in other places. And some places are now seeing high transmission, as New York’s transmission seems to be dropping. When one builds a model that has no flexibility and more than double the accepted death rate, of course it’s gonna look worse than what’s going on now.
But this speaks to my more general complaint–the dismissiveness with which folks are addressing this flu. I’ve heard, from extremely intelligent people, that this is nothing to be worried about; it’s nothing like in 1918. Tens of millions of people died then, and we’ve only seen, what a couple of hundred deaths? Why get all worked up over that? It’s the same as the infographic in that it’s comparing a full pandemic, with all the twists and turns and mega-waves and mitigation successes and failures and comparing it with the beginning of the initial wave of a flu pandemic.
These people who do this minimize that first chart I mentioned earlier, where there was an initial wave in June and July of 1918 when a not insignificant number of people died from an unusual summer flu (kinda sounds like what we’re seeing now, right?). They then extrapolate what we’re seeing now as the recipe for how this flu will act from start to finish. I worry that this type of thinking will only get worse as this wave recedes and flu cases stop occurring in the States. In the three twentieth century pandemics, the initial wave was by far the most mild. Reading stories from 1918, there was no idea that the summer flu was placing any amazing stress on the health care community. It was unusual, and while they were probably stretched, it didn’t break the hospital’s backs (kinda sounds like what we’re seeing now, right?). Then it came back–worse. Each and every time.
Could this flu come back in the fall and winter and really sock us? I don’t know. Nobody does. But to write an article for as robust a publication as Wired telling folks not to worry, we’ve got this all figured out, and it’s not as bad as Stephen King says it might be–well, that’s dangerous.
All we know so far is that this has only happened four times in the last hundred years. And each time it does happen, lots of people get sick and die. Will this one bring society to it’s knees? Dunno. I hope not, but I’m not the one on the wall yelling, “All clear!”
Image borrowed from best-horror-movies.com, with thanks!