Flu fact of the day

by on April 30, 2009 at 7:43 am in Medicine | Permalink

Here is Revere at Effect Measure:

We currently have fewer staffed hospital beds per capita than we did in the last pandemic, 1968 (the "Hong Kong flu").

He offers further wise words and note that this hypothetical projection is one of the better case, mutation-free scenarios:

Now take a bad flu season and double it. To each individual it's the
same disease but now everybody is getting it at once, in every
community and all over the world. In terms of virulence, it's a mild
pandemic. It's not a lethal virus like 1918. But in terms of social
disruption it could be very bad. If twice as many people get sick, the
number of deaths could be 80,000 in the US instead of 40,000. Gurneys
would line the hallways of hospitals and clinics. And absenteeism
amongst health care workers would compound the problem. Infrastructure
would probably survive intact. No need to have your own water supply or
electricity generator. But it would be a very rough ride.

All of this could plausibly happen from this virus without it causing anything more than the usual case of influenza.

1 Tom T. April 30, 2009 at 8:32 am

40,000 people die of the flu each year without raising a blip on society’s radar, but twice that number raises the specter that our infrastructure will collapse? Because of gurneys in the hallways? Really? That’s one hell of a tipping point.

2 babar April 30, 2009 at 9:17 am

i was thinking that hank paulson would be a great for a pledge drive fund raiser for NPR — he did a fabulous job for the banks in october — but it might be worth deploying him to spread panic for this upcoming flu drive.

3 John Jenkins April 30, 2009 at 9:31 am

Yes, this could be as bad as West Nile Virus, or SARS, or Bird Flu (one or two of which I recall Prof. Cowen beating the same drum over). That is, not a problem at all and an insignificant blip overhyped by a media looking for anything to cover. I guess, just like economic predictions, if you keep predicting something bad, eventually you’ll be right; but that doesn’t mean that your predictions make any more sense.

4 davidc April 30, 2009 at 10:17 am

There are projects for home mead infrastructure for a pandemic. This one for example http://panvent.blogspot.com/
I wonder how bad things need to get before you need to build your own ventilator?

5 Tom T. April 30, 2009 at 10:41 am

Mike B, those are all good points. I just think that it’s going to take a lot more than 80,000 deaths to have a serious impact on society at large.

davidc, if you’re going to all that trouble, just do like revere and build your own *hyper*ventilator. 🙂

6 8 April 30, 2009 at 11:19 am

One gun-shot victim too many can delay planned surgeries and overload stressed ICUs. The 80,000 potential deaths aren’t going to be spread out, they will be localized, arrive in waves and the deaths will be clustered at the peak.

7 ZBicyclist April 30, 2009 at 11:40 am

Wait. I get it now. If they put you into a hospital at $0000 per day, your flu only lasts 7 days.

If you treat yourself at home with stuff you got at Walgreens, your flu will probably last a week.

8 athelas April 30, 2009 at 12:29 pm

From the Science in Society blog, a look at a few flu-related Google widgets.

“Considering the hubbub about H1N1, it may surprise you that Flu Trends shows that influenza levels in the US are low and steady. In the media blitz as new cases are discovered, it’s important to keep in mind that the normal seasonal flu causes 36,000 deaths a year. While swine flu is newsworthy because of its potential to mushroom into a full-blown pandemic, in absolute numbers it is still a minor player in the disease world.

While the disease cannot be acquired by eating pork, pig farmers are naturally concerned that calling H1N1 “swine flu† will hurt sales. However, the disease did originate in pigs, recombining with avian and human flu viruses, so it is unlikely that the industry’s calls for it to be redubbed will be heeded. (†Mexican flu† was one suggestion, and I can think of at least one group that would be riled up over the name.)”

9 spencer April 30, 2009 at 12:34 pm

The fact that we have fewer hospital beds per capita is largely irrelevant to the issue. The dominate reason the number of bed per capita is lower is that demand has been reduced. So this metric provides little or no guidance as to whether we
would have sufficient beds to deal with the increased demand a pandemic would create.

10 Gordon Mohr April 30, 2009 at 2:00 pm

Tyler has otherworldly powers of calmness on almost every issue… except flu. It’s his kryptonite.

Is fewer hospital beds than 1968 necessarily a bad thing? (Are number of beds correlated with better outcomes?) Don’t hospitals sometimes transmit diseases? In a period of widespread infection, might not advice change: if your only symptoms are flu, follow this treatment course at home?

Also, everyone bandies about the 36,000/”about 40,000″ flu deaths per year number. I have too. Turns out that may be a significant exaggeration caused by fuzzy categorization. The real number could be 1/10th that, or even less. See this note from a respectable source on problems with the top-line number (free reg req’d):

http://www.bmj.com/cgi/content/full/331/7529/1412

11 Mr. Econotarian April 30, 2009 at 2:08 pm

“Say it were possible, albeit expensive, to build a rapid flu vaccine mass-production infrastructure.”

http://www.nytimes.com/2004/10/17/health/17flu2.html?_r=1

“In recent decades, many drug companies in the United States abandoned the manufacture of vaccines, saying that they were expensive to make, underpriced and not profitable enough. Flu vaccine can be a particular gamble, because the demand for it varies from year to year and companies throw away what they do not sell because a new vaccine must be made each year to deal with changing strains of the virus. Some companies dropped out because of lawsuits, and others because they determined that it would not pay to retool aging vaccine plants to meet regulatory standards.”

“One reason companies have given up making vaccine, industry officials and other experts say. is the difficulty in meeting regulations for quality control and safety. A change in the approach to regulating vaccine production might also have contributed to problems in meeting the standards.

In the 1990’s, contamination of blood products by the AIDS virus and other incidents led to criticism of the agency’s inspections of so-called biologic products, which are made from living cells. In the late 90’s the agency tightened its inspections of factories making biologics.

The new system, which took effect for vaccines in 1999, led to more compliance violations and contributed to the spate of shortages in pediatric vaccines that began in 2000, according to a 2002 report by the General Accounting Office, now known as the Government Accountability Office.

Older factories have had particular trouble meeting standards, experts say.

“Over time the barriers to make vaccines and stay in this business have gone up, but the prices for old vaccines haven’t gone up that much,” said J. Leighton Read, the founder of Aviron, the company that developed the nasal spray flu vaccine.”

12 jt April 30, 2009 at 2:49 pm

Tyler has written plenty about how “public health is one of the best ways to spend government money, as it is (often, not always) a true public good”.

What I’m wondering is if there isn’t an even more direct financial case for stuff like pandemic prevention. The direct hit to government revenues from a panic-driven economic contraction might be big enough to justify public health spending even beyond what is justified by summing up all of the individual benefits to better public health.

13 Ryan Miller May 1, 2009 at 8:51 am

Tyler, looks like you’ve been suckered by some bad data. Look here for the origins of the “36k” number: http://www.naturalnews.com/026169.html — not the ranting bit at the top, but the journal cite at the bottom. Looks like “twice a bad flu season” might happen all the time, and I’m sure there is some increased hospital crowding, but obviously pretty manageable. Time frame shortening is obviously a more difficult effect to measure.

14 SSAMSUNG P30 laptop battery May 18, 2009 at 8:43 am

i was thinking that hank paulson would be a great for a pledge drive fund raiser for NPR — he did a fabulous job for the banks in october — but it might be worth deploying him to spread panic for this upcoming flu drive.

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