The Meaning of Swine Flu, the Universe, and Everything

Wait a second. First we couldn't get away from that swine flu story, although we were told that it had affected less than 100 people in Mexico and only a handful here in the US. It was getting round-the-clock high decibel coverage on all channels. Twitter, our new electronic central nervous system, was going ballistic. Andy Borowitz seemed to be on to something when he wrote, "CNN Warns Swine Flu Could Continue Through Sweeps."

By May 7 the Associated Press and others were writing stories about the overhyped flu. It seemed resolved in a lot of people's minds: Just another overplayed media story.

But wait. Now the World Health Organization is reporting nearly ten thousand cases of the virus worldwide, with more than half of those occurring in the United States. "We are not out of the woods," a CDC director said (on CNN.) 16 schools have been shut down in New York after an assistant principal died of H1N1. Cases are "ballooning fast" in Japan and elsewhere, says Forbes. UN Secretary General Ban Ki Moon alled for international solidarity, which includes ensuring that "all have access to drugs and vaccines."

We went from apocalypse to afterthought in about two weeks, and now we're swinging back. It's hard to know what to think. Here's a way to reconcile some of the different and seemingly contradictory perspectives we've been hearing, which include:

It's no big deal. The CDC estimates that 36,000 people die each year as the result of regular flu. Very few people have died from swine flu, but it's all people can talk about. It's an overhyped phenomenon, a distorted perspective caused by media sensationalism.

It's an emergency. An assistant principal dies in New York. 103 students at nearby schools develop flu-like symptoms. Then a toddler dies in Queens. Forget the statistics: Death is a singular tragedy for the deceased and everyone who loved them. Why take chances?

It's unlikely I'll get it. 5,000 people have it in the US. Even if that number increases a hundredfold my chances of getting it are still only one in six hundred. And it probably won't be worse than any other flu.

I should take serious precautions. I should carry disinfectant and wash my hands regularly. I should stay home if I'm not feeling well, and should look for instructions from my local health authorities.

Let's take the last two statements first. Which is correct? The answer, based on what we know now, is: Both. It's unlikely you'll get it, but you should take precautions anyway. You should be taking some precautions already to avoiding getting routine illnesses. But you should be even more careful with swine flu.

Why? To use Homeland Security symbolism, our individual threat level is "yellow" but our collective risk is "orange." Your chance of getting it is low, and you don't need to be too concerned about your own health right now unless you have other complicating conditions. But you should be concerned about all of us. As more people get it, the chance of pandemic increases. And a pandemic is a catastrophe. So even though your individual risk is low, our collective risk level is high enough that you should take precautions - for humanity's sake, if not your own.

Concepts from risk management should help. Your risk of contracting it is low, and the outcome if you got it probably wouldn't be severe. The chance this could become a pandemic is also low - but the outcome would be catastrophic. So we need to treat the possibility of pandemic very seriously.

Tyler Cowen does a good job of summarizing the way this kind of risk analysis should be conducted:

A one percent chance of one hundred million deaths is, in expected value terms, one million deaths and that is a big deal. Probably the United States is less vulnerable than it was in 1918, but how many people would die in China, India and many other locales? How much disruption to trade, travel, and the world economy would take place? Even in the United States, our public health systems would break down quickly and render many modern medical advances useless (e.g., when would the Tamiflu run out?)"

Expected value calculations are a good way to look at problems of this kind. And the fact that the United States is less vulnerable than it was one hundred years ago does not mean it isn't vulnerable at all. What's more, the deaths of millions abroad should concern us for both selfish (e.g. economic) and altruistic reasons.

This kind of risk analysis should be standard operating procedure in the business community. That's why it's still surprising when business-friendly politicians strip money from the budget because they think bad events aren't likely to happen (e.g. Bobby Jindal's mockery of volcano monitoring, or Susan Collins' removal of flu pandemic money from the stimulus budget). Remember: A low-probability event plus a high-loss outcome = cause for concern.

To sum up, based on what we know today: Swine flu is not that grave a threat to us as individuals, but it's a serious danger for all of us - collectively. Think of it as an exercise in interconnectedness, a real-world and scientific example of that "one world" talk we're always getting from pop stars and movie actors.

Because we are interconnected: A farmer coughs while tending livestock in Mexico. At lunch he shakes hands with his cousin the policeman, who writes a ticket for a visiting tourist later that day. The tourist goes home to Belgium, where his colleague leaves the next day to visit his cousin the day-care worker in New York. A week later a 16-month-old child dies in Queens.

It could have happened that way. We don't know. And washing your hands today might save thousands of lives in Bangladesh or West Africa next month. We don't know. But we do know that, in a a very literal sense, that "one world" business is real. It's a good reason to take health precautions. It's a good reason to support flu management and other risk management funds in the Federal budget. And it's a good reason to care what happens anywhere and everywhere in this interconnected world.

RJ Eskow blogs when he can at:

A Night Light
The Sentinel Effect: Healthcare Blog

Comments

[TommyMcCarthy]

Away from Huffpo for awhile....­I came looking for my fellow ex-Utican; RJ Eskow's take on some of the recent political developments regarding health care reform.

Instead, I found this well written, highly PRACTICAL piece

"You can't always get what you want...but if you try sometimes.­...."

I look forward to hearing from Mr. Eskow on what is his field of expertise;­...i.e. the looming heathcare reform debate (hopefully not deBACLE)..­.as well as any other topic he might care to address

A piece about the old home burg might be instructive as to what happens to a health care system built and funded by an industrial base after that base is long gone....an­d that system is left largely with retirees and the indigent (too often one and the same)

Highest regards
tm
St. Elizabeth's 74'-5

[dmac]

The common worker who goes to work when sick may be responding to their employer's inhumane regulations. I work for a company making $40million in annual sales and hourly workers are not given any latitude on 'personal days'. If you are sick, you take vacation days (all of 80 hours a year until you've worked for the company for ten years) or you don't get paid. And hourly employees may not be able to afford a 20,40, 60, 80, 100% reduction in their weekly pay packet....­which doesn't even address the cost of going to the doctor.

It could be community irresponsibility AND personal responsibility all at the same time.

42: Don't forget it's Towel Day Monday, May 25th. Just make sure your towel is well washed, and that you always know where it is.

[dsws]

"And a pandemic is a catastroph­e."

A pandemic is a global epidemic, or in older usage an epidemic throughout the country or region under discussion. If there's a global epidemic of something that just gives you two days of sniffles and then goes away, it's still a pandemic.

Flu is fairly serious, no matter what strain it is. But swine flu is looking like a global epidemic of something a little less serious than the flu that was already going around -- in other words, a pandemic and not a catastrophe.

It still needs to be monitored. It could turn out to be worse than is looking likely now. But it's looking no worse than ordinary seasonal flu.

[RJ Eskow - Huffpost Blogger]

Your definition is not correct. As the World Health Organization states, "A pandemic can start when three conditions have been met: a new influenza virus subtype emerges; it infects humans, causing serious illness; and it spreads easily and sustainably among humans." Note the "causing serious illness" passage; your example doesn't qualify. Milder diseases such as the one you describe might spread in an "epidemic," but pandemics are both broader and more severe.

The WHO goes on to say that pandemics involve "the establishment of efficient and sustained human-to-human transmission of the virus." Anything that meets the above qualifications will cause widespread inconvenience for many, and quite a few deaths as well.

I would call that a "catastrop­he."

Reference: http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/

[dsws]

A whole page of definitions, none of which mentions severity: http://www.google.com/search?q=define:pandemic

Even WHO doesn't always stick to its own definition: "'A pandemic is basically a global epidemic -- an epidemic that spreads to more than one continent,' says Dan Epstein, a spokesman for the Pan American Health Organization, a regional office of the World Health Organizati­on."
http://www.webmd.com/cold-and-flu/features/what-is-pandemic

It makes sense for an operational definition specifically of flu epidemic or pandemic to be based on deaths or some other measure of severity, since the vast majority of cases of flu-like symptoms are never tested to see what strain they are, or even if they're flu at all. However, even the swine flu causes serious illness -- but apparently in a smaller percentage of those who catch it than is typical for existing flu strains.

[dsws]

"WHO Declaration of Swine Flu Pandemic Appears Imminent"
http://www.forbes.com/feeds/hscout/2009/06/09/hscout627942.html

Still doesn't look catastrophic to me.

My son's school closed for a week because people there tested positive for the H1N1 flu. The last day before it closed, he went to school as usual. That evening, he had a fever. He slept most of the day the next day, and that was about it for him. His little brother had a milder fever a few days later, and a few sniffles. I got muscle aches and I'm still coughing and sneezing just over a week later. My wife took two sick days.

[mergina]

Why is humanity such a mess?

[BeachBubbaTex]

Because we refuse to think of ourselves as a part of nature. I get the "big brain thing," but all of these issues have a common theme: an inability to recognize that we are reaching the physical/biotic limits of this planet. Unfortunately, our history suggests we only learn our lessons by touching the stove.

[ORSunshine]

I just wish people would get over the idea that eating pork is suddenly now "risky." Gah. Misinformation and hysteria lead to strange economic outcomes.

[sheilaofmiami]

I too was looking for 42, nice intro to this!!!

Yes, the hardest part of this is to convince people to stay home when they feel sick.

People are sure, either their company will fold without them for a week, or that their job will not be there when they get back, so they use the public transportation system, coughing and wheezing, and then they cough on the papers they then hand off to someone else, and now 15 people have a bad cold, or worse.

MRSA is ugly stuff, and it come crop up when you least expect it. Staying out of hospitals is one way to reduce the chances of getting it.

The more we think we control, the less control we have.

[quidam56]

Four or five years ago a little know hospital acquired bug called MRSA (Methicillin Resistant Staphylococcus Aureus) was showing up in our schools. We couldn't figure out why kids were getting and dying from MRSA who had never stepped foot into a hospital, nursing home or emergency room. Health care has gone the way of Wall Street, Profit Care comes ahead of Patient Care. The very institution advertising health care we trust and depend on to keep us safe and cared for is polluting our communities with MRSA. Last Fall, there were recommendations for children age six months on up to get a flu shot because of complications when MRSA was part of the picture. Shamelessly, many people in America will end up in an ER with other kids with or without the flu in a breeding ground for MRSA/VRE. It's sad when the consequences of greed is killing kids. I know what is advertised in East Tennessee and southwest Virginia as quality health care is nothing at all in comparison to what took the health care system three years to disparage their own advertising as misleading and false. It's all on public record in Greeneville, TN Federal Court. Case no. 2:04-cv-375. You can also check out lots of information on my web site if you want to see what really is "the acceptable standards of health care". http://www.wisecountyissues.com/?p=62

[USAFree1]

I live in NE TN and am very saddened by the lowering of standards in medical treatment. I've lived here ten years and have watched the level of medical care slip. I am educated and aware of my own health conditions. The greatest defense a patient has is to be or become informed before making any major medical decisions. I met a woman in radiology at a local medical treatment center who had been treated for breast cancer. She had been "burned" by radiation. The entire right side of her torso looked like a heavily burned shell. I don't know any other way to describe it. She had me touch her skin, and it felt like a turtle's shell. I was appalled by this. She was quite stoic about her situation and said that they had killed her; she just wasn't dead yet. The allowing of HMOs and privatization of health care is killing us all. Allowing health insurance providers to rule health care should be illegal. I fear we shall not live to see this country taking health care and making sure we all get the best there is. We are already seeing waffling by Congress and the Obama Administration on the whole health care issue. I suppose the pain isn't great enough for the collective American public to get up off their butts and make things right. As an old minister once said, "How long dear Lord? How long?"

[BeachBubbaTex]

I thought the answer would be "42" (and that I wouldn't like it).

Thanks for the clear explanation of risk and especially how little instances of personal responsibility do (or can) have long term consequences.