Dr Michael T. Osterholm, Director of the Center for Infectious Disease Research and Policy, Associate Director of the Department of Homeland Security’s National Center for Food Protection and Defense, and Professor at the University of Minnesota’s School of Public Health, in the July/August Foreign Affairs:
Dating back to antiquity, influenza pandemics have posed the greatest threat of a worldwide calamity caused by infectious disease. Over the past 300 years, ten influenza pandemics have occurred among humans. The most recent came in 1957-58 and 1968-69, and although several tens of thousands of Americans died in each one, these were considered mild compared to others. The 1918-19 pandemic was not. According to recent analysis, it killed 50 to 100 million people globally. Today, with a population of 6.5 billion, more than three times that of 1918, even a “mild” pandemic could kill many millions of people.
A number of recent events and factors have significantly heightened concern that a specific near-term pandemic may be imminent. It could be caused by H5N1, the avian influenza strain currently circulating in Asia. At this juncture scientists cannot be certain. Nor can they know exactly when a pandemic will hit, or whether it will rival the experience of 1918-19 or be more muted like 1957-58 and 1968-69. The reality of a coming pandemic, however, cannot be avoided. Only its impact can be lessened. Some important preparatory efforts are under way, but much more needs to be done by institutions at many levels of society.
Take some time to read the whole thing. This CDC piece is useful, as well.
Me, I’m gonna go kiss my son and stock up on shotgun cartridges.
(h/t Tom Maguire)
Wouldn’t kissing help spread an outbreak?
Maybe any flu outbreak (originating in Asia or vicinity) can wait until after 2008, when it can’t be blamed on G.W. Bush.
Quote: “Dating back to antiquity, influenza pandemics have posed the greatest threat of a worldwide calamity caused by infectious disease.”
Uh, I think we’re getting a little extreme in our rhetoric here. Cholera was a MUCH worse worldwide pandemic in antiquity. And in modern times, the two winners are Malaria and HIV/AIDS, followed by Tuberculosis. Interesting that the two winners have progressed to their current horrible state due to the effects of PC Liberal thinking.
When HIV/AIDS began, sane epidemioligists wanted to perform quarantine and sexual partner tracking to eliminate the disease, but were thwarted by Gay and anti-Reagan activists. This at a time when the spread might have been controlled.
Malaria could be eradicated by treating homes in effected areas with DDT, but Green Pseudoenvironmentalists effectively banned its use.
Both of these diseases have killed FAR more people, both per year and over time, than this avian flu is projected to cause.
I dunno – is it too early to propose a postulate for the new millennium that there is literally nothing that the Left cannot find some way for which to blame Bush?
jpickens – I think you’re wrong, influenza is far and away the worst pandemic disease ever.
Cholera is not a disease of antiquity, it was isolated in India until the early 19th century, and it was essentially wiped out in the industrialized world by the start of the 20th. Influenza epidemics have been recorded as far back as 412 BC. I’m having trouble finding numbers on total deaths from cholera outbreaks, but they seem to be number in the hundreds of thousands or low millions at the highest. Influenza killed 1 million people in a “mild” pandemic in 1889-1890.
Normal (not epidemic) flu kills 250 to 500k people every year, while malaria kills 100k worldwide.
HIV/AIDS has killed over 20 million people since 1981. Influenza killed at least that many people in about 12 weeks in the 1918 pandemic.
Influenza is the worst pandemic disease to ever strike, nothing else is even close.
OK, that’s it.
I’m gonna buy the Tamiflu I’ve been looking at online. Any thoughts on what’s the “best” online pharmacy, kids?
And by “best”, I mean “will actually ship me a medicinal product that chemically resembles the composition of tamiflu when I send them money”.
I’m convinced that the bubonic and pnumonic plagues that literally depopulated many parts of the world during a series of epidemics that culminated in the loss of 1/3 of Europe’s population is the worst pandemic disease in history.
No we’re not. Flu and pneumonia kill more people every year than AIDS and malaria combined. It is also the only one of the top infectious diseases that periodically mutates into a much more deadly form or potentially crosses species lines. A global outbreak of a flu strain as nasty as the Spanish flu could easily kill more people in a year than AIDS and malaria killed in the entire 20th century.
Hasn’t the bird flu been a “problem” in Asia for the last few years off and on and they’ve had a total of what, 16 deaths?
Dario – 60 odd deaths total, so yes. But the 1918 flu was an avian virus that killed a few thousand people in early 1918 before mutating into the form that killed 50 to 100 million. It’s probably only a matter of time before the H5N1 mutates into a form that can pass from human to human, and that’s when we’ll have a problem.
Joe – The bubonic plague was terrible for Europe, but didn’t kill nearly as many people worldwide as influenza, either in raw numbers or percentages.
You guys are a cup of sunshine today.
t/w “Off” – as in I’m off to find something cheerful.
And do you people have to sit so close to the monitor? Turn your head, for $%&#’s sake…
What about those of us who feed the birds in our yards and put up houses for the sweet things to take up residence in next spring?
Not smart?
c – APPEASER! They’ll kill you last.
Ha, Matt!
T/W “feed”… and the compulsion to put out seeds and suet is stronger than ever
uh, guys, Bush will be president until Jan 20, 2009, so of course bad stuff that happens in 2008 will be blamed on him.
tw: farm, as in “I wouldn’t bet the farm that they won’t find ways to blame Bush well into the 2020s”.
I don’t know.
I lived in Hong Kong during Sars. The way I was treated in the US when I returned with my children when the schools were closed in Hong Kong has left a bad taste in my mouth.
The amount of fear in the US was irrational. The fear-mongering was worse.
I don’t know whether to be legitimately concerned, or if I just think the US public has to be scared over something at every moment. Whether its Y2k or terrorism or bird flu or SARS, someday someone will do a study on why the most protected people in the history of earth are so constantly frightened.
Or maybe my cynicism will target me to be the first killed. Either way, I’m sure the US will welcome me back with open arms if I have to leave Asia if an outbreak occurs.
Cholera is a disease caused by poor sanitation and dirty drinking water. Reliable sewers and clean water solves the problem. Malaria and yellow fever are tropical diseases that are spread by insects. They are not a problem in temperate climes. Influenza, by contrast, spreads people to people and goes everywhere. And these days it really means everywhere. The mobility of ordinary people in 1918 was restricted by the reality of the war. That isn’t the case today.
This is not a political issue. The flu will kill “liberals” and “conservatives” with equal force (and finality). The last thing we need facing this particular situation is repetition of the cartoon crap that passes for political dialogue in this country.
Bush seems to a least trying to get the federal government ready to deal with it. I hope so. This is clearly beyond any state’s capacity.
Ya know, after all the MSM bullshit about Katrina, Rita, and any number of other artificially inflated stories, I can’t help but think that this is just another pile of “what-if” bullshit.
I would think that the odds of this alleged pandemic are just about the same as they were last year, and will be next year. I might be wrong, but who cares? Why die a thousand deaths if you only have to die once? The best thing about being a recovering ____________ (insert just about anything here), is that you know there is absolutely nothing you can do about things like this “pandemic”.
Que sera, sera…
most people with decent immune systems don’t die of the flu but of secondary infections like pneumonia any more. Also, with motrin and tylenol to keep fevers down, and good hydration and warm, dry homes to recover in, the flu is easily survivable.
And Matt, your post about percentages killed by black plague and flu is wrong. (digging out old microbiology/epidemiology text somewhere). I’m not good on population numbers of, say, medieval London, but I’d guess old Yersinia pestis has pretty good stats in the old death world series.
One thing I’ve worried about is the fact that a couple of biological weapons have symptoms that look like flu for the first couple of days (anthrax and plague). By the time tests show the real cause of the illness they are pretty much terminal because of toxin build up in the body. The hesitation to prescribe antibiotics for what are likely viral infections, while understandable because of concerns about induced drug-resistance, could be deadly in the early stages of a biological attack.
word is stay. stay happy!
so, when you order that tamiflu, get some nice keflex or doxycycline to go with it! two great tastes that taste great together!
Or jump right in with Cipro. Expensive as hell, be sure to take a 10 day course.
NO! I’m not a doctor. the above is tongue-in-cheek
word is seem…I may also order the canadian tamiflu as I don’t want to seem paranoid. and frankly, if I have the flu, the last thing I feel like doing is driving to the damn doctor.
If you can get some of that Canadian Tamiflu, get some for me. I’ll pay you back, plus postage.
I would like to point out that Hong Kong had a problem with the bird flu in 1998, when (I think) 16 people died. Why the bird flu wasn’t getting all this attention then is beyond me. Why now?
I do want the US government to be prepared. I want citizens to be prepared, too. How will they react if quarantined? Is that something that can happen, even, in current-day America?
But I know that during SARS, I had friends I hadn’t seen in a year that wouldn’t see me out of fear they would catch SARS from me. People that wouldn’t see my parents after I had left for fear they would catch something. I had friends who’s families wouldn’t see them at all, made them stay in hotel rooms for 10 days rather than allowing them to visit. US Doctors who didn’t want patients from Hong Kong to come in to their offices.
I think of that, and I think Americans tend to overreact a bit.
amyc – According to my quick calculations the 14th century plague killed 25 million out of a world population of about 450 million for 5.5 percent. The influenza epidemic of 1918 killed 50 to 100 million of 2 billion people for 2.5 to 5 percent. So it’s close right there.
But there were only a handful of plague epidemics from 1200 to 1900, and none killed nearly as many as the 14th century one. There have been millions killed by influenza at least a dozen times in history, and there are 250 to 500k killed <i>every single year<i>. Nothing compares to plain old flu.
Well, almost every major pandemic starts out as a bird flu. Once it jumps to humans, it could be quite deadly. And we generally expect about 3 a century. We’re statistically due, which is why so many people are so concerned about this particular strain.
From what I understand, we’ve got an experimental vaccine and the government has commissioned 20 million doses so far. No telling if it’ll work.
MayBee – If we’d taken those sorts of precautions (10 day quarantines after travel, etc.) during real epidemics it would have saved thousands of lives.
Perhaps Americans are so scared of diseases like this because they’re, well, scary. And we have so much to lose.
Matt Moore-
I’m not disputing that the diseases are scary and we have much to lose. I’m just wondering aloud if we have a way of getting scared in a disproportionate measure when considering actual probablity.
Which is why I used the SARS example. At the time, it got about as much news coverage in the US as Bird flu is now. In Hong Kong, about .02% of the population even ever got sick from SARS. Yet people feared me to a point beyond any rationality.
Certainly, if we had used those measures during real epidemics (or pandemics), thousands of lives would have been saved. And certainly, some countries used quarantines even during Sars.
My question is just how good are we at sorting out real dangers vs. how scared we are at the danger of the month?
Is this so dangerous that it deserves the daily attention? SARS got that daily attention, and it wasn’t worth the fear- especially in the US.
MayBee —
My question is just how good are we at sorting out real dangers vs. how scared we are at the danger of the month?
And the answer is—crappy. Abysmally poor.
Part of that is the Press. They’ve become firmly fixed on sensationalism as a way to sell stories and/or programs—well, actually as a way to sell soap and brassieres, but you know what I mean. If there’s anything at all that’s scary, they’ll blow it up into The End Of The World As We Know It hoping Joe Average will eagerly grab the paper to find out the Latest Outrage. (It doesn’t seem to be working so well, but they literally don’t know any other way to go about it.)
Underlying that—we’re a remarkably safe society. Things that, in other countries, would be passed on with regret and little comment are startling here. Yet we seem to be frightened all the time. Why?
The science fiction writer Jack Vance once suggested that this is evolution in action. Human beings evolved in circumstances that included saber-toothed tigers and other Animal Friends, and offered no protection against thunderstorms, hurricanes, tornadoes, earthquakes, solar flares… the whole list. They were frequently scared shitless. Nowadays we don’t have that, but we still have the physiological and mental defenses we evolved against it all.
It’s like the story of the family who lived right by the train track. When the 2:05 didn’t come through on schedule, everybody woke up, startled: What the H.. was that? If we don’t have anything to be frightened of we’ll manufacture something, because we’re literally built to be scared all the time.
Vance suggested that the solution might be a corps of dedicated public servants, the Public Terrifiers or Ferocifers, whose mission is to scare the crap out of everybody at least once a week, as their constitution requires for health. I’m generally skeptical about Governmental solutions, but that might be better than the NYT scare-of-the-week.
Regards,
Ric
tw: study. Evolutionary psychology is a fascinating study.
Maybe I can put my earlier post another way.
Anyone read Michael Crichton’s “State Of Fear”? Or more specifically, the author’s “afterword”?
I’ll go MayBee one better. This is a media created shitstorm, all out of proportion to reality. Without the 24 hour news cycle, this probably wouldn’t even be a story. When you die, you die. Then it won’t matter anyway.
Just relax and picture ol’ Shep grimly sitting behind the controls of this story. There. Does that help?
And also, hasn’t anyone noticed yet that life’s a bitch, then you DON’T die?
Well, when you die you die, so why bother worrying?
Sorry, I don’t hold with that, I’d rather not die for a good long while yet. Maybee’s reservations are sensible, but I don’t think this is a media created scare event. It’s only a matter of time before H5N1 or some other varient mutates into a form that is both deadly and highly contagious.
#8 is a good all-round bird shot.
SB: friends
feathered
Wow you guys, great posts. Thank you.
And Ric
I so believe that. Absolutely.
I’ll find the site that has it “without prescription required!!!!” It also sells valium and all sorts of other neat stuff. It is extremely expensive, and I’m trying to decide if it’s worth paying myself the 80 bucks for my time and the hassle of sitting in a Dr. office. One of the joys of military spousedom is moving so frequently that you never have a Dr. who knows you and trusts that you are not an idiot.
Saw an interesting show the other week that argued that the Black Death was not, in fact, bubonic or pneumonic plague, but rather a variety of hemorragic (sp?) fever.
They made some interesting arguments, but I’m nowhere near educated enough to make a conclusion either way.
Having done some digging and reading on the subject of vaccines and infectious diseases to write a number of essays and posts, I wanted to share some of the references I’ve found. (Jeff, if you feel I’m hogging bandwidth, you’re welcome to blast me.)
From my post “On the Emerging Avian Flu Problem” from 25 September:
On September 22, Rick Moran, aka “Superhawk† administrator of Rightwing Nuthouse  posted a fine and timely article on the emerging threat of Avian Flu, which seems to be cropping up in a number of Asian locations.
• The BBC’s online news reported in an article dated 15 August that the so-called “Bird Flu†had spread westward as far as the area of Chelyabinsk, where the Ural Mountains form one of the last geographic speed bumps to the spread of the disease from Asia into Europe. The disease primarily affects wild aquatic birds and domestic poultry, and the Chelyabinsk region is blessed with thousands of lakes that migratory aquatic birds in huge numbers visit in passing. The virus has already required massive culling of market-raised poultry in some areas, and may be expected to devastate the local farms there as it has in several other Asian regions.
At the time of that article, Russian sources indicated no human cases in Chelyabinsk, even though a virus strain found in humans in nearby rural areas was identified as the type that had caused human fatalities elsewhere.
• In Jakarta last week, health authorities have confirmed that several workers at the city’s Ragunan Zoo have been infected with the strain of Avian Flu identified as the “H5N1†virus, after the virus was isolated from 19 birds that are part of the permanent zoo population. (“H_N_†is a code for the protein sequencing that effectively distinguishes various viruses, and in turn suggests anti-viral strategies to the researchers.) The same report indicates a handful of infections in people not connected to the Zoo, of whom one 37-year-old woman died.
It may seem like a lot of fuss over a handful of humans infected out of a population of billions. We hear of avian flu year after year, and it’s had enormous economic consequences in some areas, causing the outright deaths and preemptive destruction of hundreds of millions of poultry in the last few years.
But this time, things could be very different.
There are several factors that make it so. One is the virulence of the virus, even just considered in its effect on the birds. In some outbreaks, the virus killed almost every single chicken infected. That level of lethality is bad enough for its economic impact, but it is particularly sobering if it conveys along with communicability among different species.
And in fact, the H5N1 strain of Avian flu has learned to jump from birds to humans, and though it has not yet spread widely, the record demands attention. Considering how outraged people were last fall over the anticipated shortages of vaccine, you’d think there might be a little more interest. After all, this particular version of the flu gives every indication that it poses a very real and potent threat, not just an inconvenience.
…
One writer who has done a tremendous job of framing the challenge of infectious diseases in the last decade is Laurie Garrett.
You might recall her as NPR’s eloquent science reporter for a decade, wrote an excellent book a few years back, “The Coming Plague.†Reading even just a few chapters of that book will give you a pretty good sense of the real problems involved in identifying and preparing for new infectious diseases, and the political and social hurdles in implementing policies and medical programs.
More recently she has written an excellent comprehensive article for Foreign Affairs, the online e-magazine published by the Council on Foreign Relations.
It’s lengthy  some 5,000 words, or about 13 pages  but you can’t read it and walk away with any lingering doubt that it’s worth preparing against the threat posed by Avian Flu and its sibling strains. In the first paragraph, she points out that Avian flu has killed about 50 percent of documented patients infected since 1997. A few paragraphs later she relates that examination of U.S. records from the “Spanish Influenza Pandemic†of 1917 to 1918 indicate a mortality rate of about ONE PERCENT of all persons infected.
Ironically, where we have become accustomed to warnings that young children and the elderly are thought to be most vulnerable to flu outbreaks of the last few decades, the Spanish flu was most savagely fatal among young adults, possibly because the older populace had gained partial immunity from several nationwide flu outbreaks some decades earlier.
To sum up, Avian flu is on its way. With a bunch of unpleasant relatives simmering in the background. We need to pay attention, and support the folks who actually get things done, instead of just posing and pontificating. In many ways, Jonathan Swift’s book “Gulliver’s Travels†pinpointed the absurdity of political wrangling in all societies at all times. We’re like a bunch of oysters clamoring for a ban on chowder recipes.