Flu outbreak....

[skammer]

Ah, you did post sources in the first part of this thread...my bad.

I am out, bored of this, got some thinking at least.

Skam

 

[Brian Jones]

I am out, bored of this, got some thinking at least.

Skam

I don't why you're out, or bored -- you still haven't addressed many insightful and convincing counterpoints made by others.

 

[HikingMano]

It is my understanding that it is a new strain, but not that humans haven't been getting (and surviving 100% in the US) swine flu for years. Like I said before, even if the rate of infection increases the mortality rate is unlikely to increase.

Capt, you keep saying that the mortality rate is unlikely to increase, and I would like to know why you believe that (Not trying to get in a pissing contest, just trying to understand your view). For one, this strain is rather unique in it being a hybrid between porcine, avian, and human strains. This is not the first time that humans have gotten swine flu yes, but my understanding is that this is not typical swine flu. I don't think you can generalize the term "swine flu" and our past experience with it to the specific attributes of this strain, which experts are still trying to ascertain.

We don't know why the disease in Mexico is so severe while the US cases of the same strain infection are so mild. We don't know what factors may be playing a part in the behavior of this strain in Mexico vs. here. There might be some other pathogen in Mexico and absent in the states that is causing some kind of unfortunate synergistic effect. We don't know. It is so new, that the experts don't know how it's going to behave. I just don’t understand what you’re basing your predictions on.

If reports are accurate, the virus is killing young healthy adults, which is not the typical behavior of seasonal flu and would seem to me to have a direct impact on mortality. The disease resulting from this strain seems to be more severe judging by the deaths (if the stats are accurate). You admit that infections seem to be higher in this new strain. But if its transmissibility is a characteristic of that strain, why aren’t you considering virulence in the same way? Maybe I'm thinking about this the wrong way, but if transmission capability and virulence are both directly proportional/related to mortality, wouldn't an increase in either result in higher mortality?

In another sense, you take the same seasonal flu, throw it at a population, a certain number of old adults and children die and gives you your mortality number. Now, take a novel strain and throw it at that same population. If we make three assumptions (1: the transmission capability of this new strain is the same as the seasonal or increased, 2: the severity of the disease is increased as supported by the deaths of young healthy adults, and 3: It affects the old adults and children just as much if not more than the seasonal flu) wouldn't the mortality go up? As it stands now, we don't really know anything definitive about the transmission capability and virulence of this new strain (in locations other than Mexico), so how can we predict mortality in general based only on what we currently know?

I think the only thing we can do now is hope for the best and toe the “better safe than sorry” line (hygiene!) in order to slow any further spread.

The 'secondary effects' are the most interesting part of this for me right now. While we aren't close to seeing full scale interruptions of services, it's obvious by looking at Mexico that it's possible. You can rant about the low mortality of the flu or not, but the possibility of people and services closing up shop to various degrees is something to consider.

I missed it when you mentioned it earlier Christof, and only picked it up again after Mistwalker brought it up again, but that is a great point :thumbup: The secondary effects are definitely something to consider. (now that I just got through nit-picking on the mortality thing )

 

[CaptInsano]

Capt, you keep saying that the mortality rate is unlikely to increase, and I would like to know why you believe that (Not trying to get in a pissing contest, just trying to understand your view).

Because for the mortality rate to increase something would have to change. There is no reason to think anything will suddenly change. This strain is already doing what it does. Unless hundreds of people currently convalescing suddenly kick for some bizarre reason. That's possible. Not very likely.

For one, this strain is rather unique in it being a hybrid between porcine, avian, and human strains. This is not the first time that humans have gotten swine flu yes, but my understanding is that this is not typical swine flu. I don't think you can generalize the term "swine flu" and our past experience with it to the specific attributes of this strain, which experts are still trying to ascertain.

What are the distinguishing pathological characteristics?

We don't know why the disease in Mexico is so severe while the US cases of the same strain infection are so mild. We don't know what factors may be playing a part in the behavior of this strain in Mexico vs. here. There might be some other pathogen in Mexico and absent in the states that is causing some kind of unfortunate synergistic effect. We don't know. It is so new, that the experts don't know how it's going to behave. I just don’t understand what you’re basing your predictions on.

Why do you automatically dismiss the most obvious explanation, the disparities in healthcare? What makes a much more unlikely coincidence of infection jump into your mind over something we already know to have an effect on mortality rates? The experts know a lot about how its going to behave because it is behaving right now and has been for the last couple of weeks. The observations are already there to be made. From these observations inferences about this strain can be made.

If reports are accurate, the virus is killing young healthy adults, which is not the typical behavior of seasonal flu and would seem to me to have a direct impact on mortality. The disease resulting from this strain seems to be more severe judging by the deaths (if the stats are accurate).

Young, healthy adults . . . who live in mexico. All the ones in the US are still alive. I'd need to see more data concerning the ages and health status of the fatalities to make any kind of statement about that. Any reason why the strain would be particularly virulent against the strongest demographics? Not that I can think of. Even if it did, the rate of mortality wouldn't be altered. It could have a different effect on the workforce, though.

You admit that infections seem to be higher in this new strain. But if its transmissibility is a characteristic of that strain, why aren’t you considering virulence in the same way?

Because we are already seeing virulence. Virulence doesn't get worse when more people are exposed. I see higher rates of infection compared to swine -human flu, not compared to seasonal flu.

Maybe I'm thinking about this the wrong way, but if transmission capability and virulence are both directly proportional/related to mortality, wouldn't an increase in either result in higher mortality?

No. An increase in transmission alone would simply bump the numbers of infected and the number of fatalities up without affecting the ratio. The rate of mortality would stay the same without an increase in virulence. This is barring shortages of equipment and services as I have mentioned before, mind you. But if you wanted to look at it as a comparison between swine-human flu and swine-human-human flu instead of swine-human flu to seasonal flu, then I would say that this new strain is more transmissible than swine-human flu.

In another sense, you take the same seasonal flu, throw it at a population, a certain number of old adults and children die and gives you your mortality number. Now, take a novel strain and throw it at that same population. If we make three assumptions (1: the transmission capability of this new strain is the same as the seasonal or increased, 2: the severity of the disease is increased as supported by the deaths of young healthy adults, and 3: It affects the old adults and children at least no worse than the seasonal flu) wouldn't the mortality go up? As it stands now, we don't really know anything definitive about the transmission capability and virulence of this new strain (in locations other than Mexico), so how can we predict mortality in general based only on what we currently know?

Unless you are also prepared to assume that mexico is devoid of old people and children, I think we can effectively do away with 2 of your other assumptions.

 

[koyote]

one major distinguishing characteristic that you are trying to dismiss is that this is a new flu. It's not regular swine flu, which has VERY poor swine to human transmission and practically nonexistent human-human transmission.

I have had surgery in Mexico. I have had Surgery in spain, I have had surgery in the US. I even had an Icelandic doctor cut some excess stuff out of my head once. You bring up the disparity in health care in an overly simplistic manner. There is very good health care in mexico- and very poor health care. You are more likely to find what I'd call 'deregulated witch-doctors' there than in the US, but the good health care is generally pretty good.

It is entirely possible that other envrionmental factors are responsible for the apparent increased mortality in Mexico. It is also possible that we don't know enough to say much. We currently are leading the world in number of confirmed cases here in the US - but some of those cases (such as the kid down the road from me) are recovered and no longer have the flu. We may have people dead from the complications that were not tested. We really don't, and can't know.

 

[koyote]

Unless you are also prepared to assume that mexico is devoid of old people and children, I think we can effectively do away with 2 of your other assumptions.

Not so. You can have an increased mortality rate among healthy persons without affecting significantly the mortality of the 'young and old' (which is a sound byte that refers to persons with weaker immune system responses and persons with increased capacity for rapid dehydration. That's a hint.)

 

[shotgunner11]

MSNBC reports that Ned Beatty has caught it.

That's it! I'm freakin' buggin' out.

If Dick Tracy can get it, what's next, Chuck Norris with the sniffles.

 

[CaptInsano]

Not so. You can have an increased mortality rate among healthy persons without affecting significantly the mortality of the 'young and old' (which is a sound byte that refers to persons with weaker immune system responses and persons with increased capacity for rapid dehydration. That's a hint.)

Absolutely not. Not without increasing the over all rate of mortality. Unless one other group dies less often, another group cannot die more frequently without altering the overall rate of mortality.

We can use a simplified model. 15 people become infected with seasonal flu. 5 old timers, 5 children, and 5 young, strong healthy adults. Lets say it kills 20% of the very old and the very young, or 1 out of 5 in those groups. That's an overall mortality rate of about 13%.

Now let's say a new flu infects the same number of people, but is virulent enough to kill 20% of the young, strong, healthy adults as well (paradoxically enough it somehow does this without increasing casualties in other groups.) Now 1 out of 5 in each group die. That would yield an overall mortality rate of 20%.

You can't kill more of any one group and keep the mortality rate the same unless you kill less of another group. No matter who is more susceptible, this disease would have to increase its peak mortality rate by 33% to 50% just to be as dangerous in mexico as the seasonal flu is in America.

 

[CaptInsano]

one major distinguishing characteristic that you are trying to dismiss is that this is a new flu. It's not regular swine flu, which has VERY poor swine to human transmission and practically nonexistent human-human transmission.

I don't see stating that it is more transmissible than the regular swine flu we've dealt with as dismissing that characteristic. I also don't see how that distinguishes it from seasonal flu.

I have had surgery in Mexico. I have had Surgery in spain, I have had surgery in the US. I even had an Icelandic doctor cut some excess stuff out of my head once. You bring up the disparity in health care in an overly simplistic manner. There is very good health care in mexico- and very poor health care. You are more likely to find what I'd call 'deregulated witch-doctors' there than in the US, but the good health care is generally pretty good.

Its like that in many places, and money helps. Like I said, we don't know much about the demographics in the populations largely infected. They could have good health care or poor healthcare. You could speculate that peole who deal with pigs and people who deal with people who deal with people who deal with pigs might not have the greatest healthcare mexico can provide. That's not really a supportable assumption, though. However, I very much doubt that anyone would choose to receive care in a random mexican hospital over a random US hospital if given the choice, and for good reason. I would take that into account along with the fact that disparities in healthcare is a more plausible explanation than swine flu not liking mexicans.

It is entirely possible that other envrionmental factors are responsible for the apparent increased mortality in Mexico. It is also possible that we don't know enough to say much. We currently are leading the world in number of confirmed cases here in the US - but some of those cases (such as the kid down the road from me) are recovered and no longer have the flu. We may have people dead from the complications that were not tested. We really don't, and can't know.

We're next door to mexico and share many of the same environmental factors in places. Its not at all surprising we have more confirmed cases here. I'm also not surprised that we have a vastly different mortality rate. Any word of spread south of mexico?

 

[Watchful]

That's it! I'm freakin' buggin' out.

If Dick Tracy can get it, what's next, Chuck Norris with the sniffles.

Dick Tracy was Warren Beatty. Ned Beatty is Otis from the original Superman.

Here's a thought: on average, 96 Americans die of the plain old regular flu every day. Number of Americans who have died of swine flu since the media hysteria: mmm... so far, none, thankfully. Not saying it won't happen--sorry to say someone in the US probably will--but my point remains that there are much bigger health things to worry about.

 

[CaptInsano]

It probably will happen.

 

[koyote]

Absolutely not. Not without increasing the over all rate of mortality. Unless one other group dies less often, another group cannot die more frequently without altering the overall rate of mortality.

This is why I hate these petty little debates. I did not, in any way, state that the overall mortality rate would not increase if a specific segment of the mortality rate increased. I said that you can have an increase in mortality in one area- healthy 20-45 age group- without increasing the mortality rate of other individual segments. Please read. Carefully. This gets tiring.

 

[CaptInsano]

This is why I hate these petty little debates. I did not, in any way, state that the overall mortality rate would not increase if a specific segment of the mortality rate increased. I said that you can have an increase in mortality in one area- healthy 20-45 age group- without increasing the mortality rate of other individual segments. Please read. Carefully. This gets tiring.

Sure you could. Which is why I brought up the absence of the other groups. If the group you referenced did have an increase in mortality in the presence of the two other groups not experiencing a change in mortality, then the overall rate of mortality would increase. The overall rate of mortality did not increase over that of seasonal flu. Therefore unless these other groups were not present or did experience a change in rate of mortality, this strain is not more virulent in the group you referenced. This is a process of elimination.

 

[Ramm9]

A couple of interesting points here that were news to me.

People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well.

http://www.marinflu.org/swine.aspx

 

[koyote]

Sure you could. Which is why I brought up the absence of the other groups. If the group you referenced did have an increase in mortality in the presence of the two other groups not experiencing a change in mortality, then the overall rate of mortality would increase. The overall rate of mortality did not increase over that of seasonal flu. Therefore unless these other groups were not present or did experience a change in rate of mortality, this strain is not more virulent in the group you referenced. This is a process of elimination.

You seem to be under the impression that I have made a claim that something is definitvely happening with regards to increased mortality rates. I have not. I did say "You can have an increased mortality rate among healthy persons without affecting significantly the mortality of the 'young and old' (which is a sound byte that refers to persons with weaker immune system responses and persons with increased capacity for rapid dehydration. That's a hint.)" I said that because you seemed to be stating that there is no way a flu strain can have an increased effect on one segment of the population without having an increased effect on other segments. You seem to have found a natural law that states that is more 25 year olds die then more 5 year olds MUST die.

And I'll stand by my statement. I can demonstrate with another word problem if I need to.

You seem to be arguing that a flu we don't have enough data bout to make any firm judgments on cannot a: be more deadly than regular seasonal flus and b: cannot have an increase in mortality among the 'healthy 20-45" age group as the 1918 flu did. That's fine if you say "may not" instead of "is not" or "can not".

It's not fine to make blanket statements like this when the discrepencies between reports on death tolls are so great and we don't have good numbers- hell, even the seasonal averages for P&I rates in the US aren't accepted by all educated parties as reasonably accurate to begin with.

We have one group yelling TEOTWAWKI, another group yelling that nothing bad CAN POSSSIBLY happen, and a large group who is examining their responses in light of what is being reported and what effects can be seen- which are currently looking like secondary effects. Crime and essintial services seem to be the big worries right now.

 

[CaptInsano]

You seem to be under the impression that I have made a claim that something is definitvely happening with regards to increased mortality rates. I have not.

I don't think you've definitively said much of anything. You want to talk about hypotheticals, which is fine. But even hypotheticals are going to have to follow a reasonable pattern of logic.

I said that because you seemed to be stating that there is no way a flu strain can have an increased effect on one segment of the population without having an increased effect on other segments. You seem to have found a natural law that states that is more 25 year olds die then more 5 year olds MUST die.

Probably not a law. Strong natural suggestion? You bet. Unless it is somehow specifically virulent against the strongest population that will generally be the case. But apparently it is more virulent to Mexicans than Americans for no apparent pathological reason, so why not pick an illogical age demographic to complement that as well?

And I'll stand by my statement. I can demonstrate with another word problem if I need to.

No, its certainly possible. It just isn't very plausible.

You seem to be arguing that a flu we don't have enough data bout to make any firm judgments on cannot a: be more deadly than regular seasonal flus and b: cannot have an increase in mortality among the 'healthy 20-45" age group as the 1918 flu did. That's fine if you say "may not" instead of "is not" or "can not".

I am able to make reasoned inferences on what it can do based on what it is doing now. Based on what it is doing now it probably isn't going to be abnormally virulent to mexicans or abnormally virulent to young adults when compared with seasonal flu. We'll know more about it as more study is done concerning its spread and pathology.

It's not fine to make blanket statements like this when the discrepencies between reports on death tolls are so great and we don't have good numbers- hell, even the seasonal averages for P&I rates in the US aren't accepted by all educated parties as reasonably accurate to begin with.

The discrepancies between credible reports on death tolls are not so great.

We have one group yelling TEOTWAWKI, another group yelling that nothing bad CAN POSSSIBLY happen, and a large group who is examining their responses in light of what is being reported and what effects can be seen- which are currently looking like secondary effects. Crime and essintial services seem to be the big worries right now.

You seem to be under the impression that I am yelling that nothing bad CAN POSSIBLY happen. I am not.

 

[koyote]

Probably not a law. Strong natural suggestion? You bet. Unless it is somehow specifically virulent against the strongest population that will generally be the case. But apparently it is more virulent to Mexicans than Americans for no apparent pathological reason, so why not pick an illogical age demographic to complement that as well?

Given the results of the 1918 edpidemic, this is not unreasonable, nor illogical, and does in fact form the basis for a lot of the concern people are showing. A disproportianate increase in the mortality rates of the 'healthy and active' population would most probably be due to a flu variant causing the immune system to go into an overdrive state and killing the people normally least affected in very high numbers.

This is really core to the whole discussion of possibilities in this flu outbreak. And you may not think it is plausible, as you've stated, but it has happened in the past. This is one case where a lot of us are hoping history doesn't repeat itself, but are looking at history for lessons on what is plausible and possible.

The discrepancies between credible reports on death tolls are not so great.

Interesting. Earlier today the discrepency just between the Mexican government and the WHO reports was over 20%. I classify that as large, though I find neither of those numbers particularly credible at this point.

 

[HikingMano]

Because for the mortality rate to increase something would have to change. There is no reason to think anything will suddenly change. This strain is already doing what it does. Unless hundreds of people currently convalescing suddenly kick for some bizarre reason. That's possible. Not very likely.

I guess I see that point. It's already having it's effect, if it were going to turn bad, then we should expect to see a drastic increase in the number of people dying.

What are the distinguishing pathological characteristics?

Why do you automatically dismiss the most obvious explanation, the disparities in healthcare? What makes a much more unlikely coincidence of infection jump into your mind over something we already know to have an effect on mortality rates? The experts know a lot about how its going to behave because it is behaving right now and has been for the last couple of weeks. The observations are already there to be made. From these observations inferences about this strain can be made.

Young, healthy adults . . . who live in mexico. All the ones in the US are still alive. I'd need to see more data concerning the ages and health status of the fatalities to make any kind of statement about that. Any reason why the strain would be particularly virulent against the strongest demographics? Not that I can think of. Even if it did, the rate of mortality wouldn't be altered. It could have a different effect on the workforce, though.

You already asked this of Skammer, and I think he was right to tell you we don't know. Just because no one knows doesn't mean you assume there are no distinguishing pathological characteristics. I did not dismiss disparities in healthcare, I'm saying we don't know the effects. We don’t know HOW MUCH of an effect a difference in healthcare actually has. You feel that the obvious answer is differences in healthcare while stating that you'd need to see more data to make any kind of statement. As for reasons a strain would be more virulent against the strongest demographics, sure, the proposed "cytokine storm" has historical precedent, that could be one. I'm sure there are other possible reasons. You still seem to be ignoring the simple fact that the reason the experts are getting upset is because this flu is thought to be killing people who shouldn’t be dying with normal flu. I don’t believe that can be explained away entirely with a disparity in healthcare. If so, why wouldn’t leading experts say “oh well duh, Mexico doesn’t have as great a medical system as other places, that is obviously the reason people are dying and we can therefore discount this as a threat.”

Because we are already seeing virulence. Virulence doesn't get worse when more people are exposed. I see higher rates of infection compared to swine -human flu, not compared to seasonal flu.

No but if a strain is virulent enough to kill non-immunocompromised individuals, that is something to consider. No one has defined the virulence of this strain yet, so we can’t know just how bad it is yet.

No. An increase in transmission alone would simply bump the numbers of infected and the number of fatalities up without affecting the ratio. The rate of mortality would stay the same without an increase in virulence.

Again, we don’t know the virulence so there’s no way you can quantitatively compare rates between this strain and a seasonal flu strain or human-pig strain, especially this early on. We can qualitatively say that this strain is thought to kill non-immunocompromised individuals though. So an increase in transmission as pointed out, plus a possible increase in virulence since young healthy people are dying (this would mean it is MORE virulent than the normal seasonal strain), leads to an increase in the rate of mortality.

Unless you are also prepared to assume that mexico is devoid of old people and children, I think we can effectively do away with 2 of your other assumptions.

You completely missed my point and that was probably my fault due to the wording. I see Christof has addressed this though and got my point, and you pretty much said the same thing in post 168. I was trying to say that all other factors the same, the demonstrated increase in transmittance in combination with an increase in virulence for one demographic (non-immunocompromised individuals) would result with an INCREASE in mortality OVERALL as compared with the seasonal flu. It is a possible outcome, depending on virulence of the new strain, (which as it stands now, looks to be worse than seasonal flu simply because it can kill the strongest demographic). That’s why I laid out the assumptions. You just seem to be ignoring the fact that in contrast to normal seasonal flu, this strain might be killing otherwise healthy young individuals. That is an increase in virulence as compared to seasonal flu.



Anyway, my main point is, we don’t know yet. I just think you can’t say there is no reason to believe it’ll be nothing more than seasonal flu part duex and that mortality rates are unlikely to increase. I think at this point we can say, there MAY not be an increase in mortality and this might not turn out to be anything significant. But that’s as far as I think we can go given the information that is available.

 

[HikingMano]

Given the results of the 1918 edpidemic, this is not unreasonable, nor illogical, and does in fact form the basis for a lot of the concern people are showing. A disproportianate increase in the mortality rates of the 'healthy and active' population would most probably be due to a flu variant causing the immune system to go into an overdrive state and killing the people normally least affected in very high numbers.

This is really core to the whole discussion of possibilities in this flu outbreak. And you may not think it is plausible, as you've stated, but it has happened in the past. This is one case where a lot of us are hoping history doesn't repeat itself, but are looking at history for lessons on what is plausible and possible.

Exactly. That is what it boils down to, the reason people are nervous, and the reason the US has declared a health emergency.

 

[BrianB]

I found it ironic to find out about this right after watching both seasons of Jeremiah (TV series where the EOTWAWKI was brought on by disease, man-made though), but I think it's a bit too early to tell what's going to happen here.