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Generational Dynamics Web Log for 2-May-2009
Rapid worldwide H1N1 swine flu spread is raising big concerns for the Fall.

Web Log - May, 2009

Rapid worldwide H1N1 swine flu spread is raising big concerns for the Fall.

People need to focus on they should do individually to prepare.

The mainstream media stories on the current pandemic flip-flop back and forth between saying that the worst is happening and saying that the press is being too alarmist. The purpose of this article is to describe exactly what's happening and what's likely to happen.

This is very frightening stuff. I strongly urge all web site readers to keep their heads and start making some hard decisions about what you should be doing to prepare. This is no time to bury your head in the sand.

Based on dozens of articles I've read, reflecting the views of experts in the field, here is my summary of where we are:

A worldwide pandemic is imminent. Hundreds of millions or billions of people will be affected, although symptoms will be mild for 97% of the people. The age group 25-44 is most seriously affected. However, schools, businesses and public events in many large cities will probably be closed or canceled for days.

The virus will fizzle in the Northern Hemisphere by July. However, with the winter flu season beginning in the Southern Hemisphere, it will probably continue there.

There'll be a second wave in the Northern Hemisphere in the Fall. If it follows historical patterns, then it will be more serious than the current wave. If it follows the 1918 pattern -- and this is the great unknown today -- then tens of millions of people will be killed.

It's worth noting that the DNA sequences for the flu viruses found in the US and Europe are almost completely identical to those found in Mexico, and so we would expect the same results. Much of Mexico, especially Mexico City, is completely shut down, and it's likely that the same thing will happen in cities in America and Europe in the next month.

The timeline

Timeline: Three waves of 1918 Spanish flu pandemic <font face=Arial size=-2>(Source: CDC)</font>

Timeline: Three waves of 1918 Spanish flu pandemic (Source: CDC)

The graph on the right comes from a CDC analysis of the 1918 Spanish flu pandemic.

As you can see from the graph, there were three waves: June 1918, Oct-Dec 1918, and Feb-Mar 1919. The worst was the Fall 1918 wave.

If we look back at the four previous major flu pandemics -- 1889, Spanish flu pandemic of 1918, Asian flu pandemic of 1957, and Hong Kong flu pandemic of 1968 -- they all followed the same pattern. A spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease. However, in all but the 1918 case, the Fall wave was still fairly mild.

Thus, based on history, we can expect the current pandemic to fizzle around July (except in the Southern Hemisphere), but then return in a more virulent form in the fall. The fear is that we'll follow the 1918 pattern, and the Fall wave will be extremely virulent.

Target demographic: Ages 25-44

The swine flu serotype is different seasonal flu in that it targets a specific age group, around ages 25-44.

This can be seen in the following table from the CDC web site, which shows the number of confirmed cases and number of deaths in Mexico, April 1-27, 2009:

    TABLE 2. Number of patients and deaths from laboratory-confirmed
    infection with swine-origin influenza A (H1N1) virus (S-OIV), by
    age group --- Mexico, April 1--27, 2009*

    Age group (yrs)   No. infections       No. Deaths
    ---------------   --------------       ----------
    <5                5                    0
    5-19              4                    2
    20-39             9                    3
    40-59             6                    2
    >60               0                    0
    ---------------   --------------       ----------
    Total            24                    7

As you can see from the above table, even though there have been only a few deaths, the preponderance have been in the young adult age group.

Death by age group, 1918 Spanish flu pandemic. Deaths per 100,000 people. <font face=Arial size=-2>(Source: CDC)</font>

Death by age group, 1918 Spanish flu pandemic. Deaths per 100,000 people. (Source: CDC)

The graph on the right comes from a CDC analysis of the 1918 Spanish flu pandemic. The dotted line shows a typical seasonal flu pattern of deaths -- most of them occur among the very young or the very old.

But in the 1918 case, the number of deaths spiked in the 25-44 age group.

The reason is that these patients die of a "cytokine storm." The patient seems OK for 2-3 days, but then the patient develops pneumonia. This is most dangerous for people in the 25-44 year old range, because these people have strong immune systems. The disease creates a "cytokine storm": the person's lungs overreact by generating a "storm" of cytokines, chemicals that are produced by the immune system. The stronger the immune system, the greater the overreaction, and the more cytokines that are produced. The result is that the cytokines flood the lungs and make breathing impossible. The very young and the very old are less likely to die this way, because their immune systems aren't as good.

Dr. Henry Niman, who runs the Recombinomics web site, recently gave a lengthy interview on the current situation. The full video is here.

The flu outbreak in Mexico actually began in January or February. Niman estimates that there have been 200,000 cases in Mexico, but they've been extremely mild, so they weren't really noticed until they began to get more serious in March. Of the 200,000, he estimates that about 2000 cases (1%) led to pneumonia, and of those 2000 cases, about 10% have died.

According to Niman, there are three ways in which the current virus is following the same path as the 1918 virus:

Virus: It's the same kind of H1N1 swine virus today as in 1918. In the 1889, 1958 and 1967 pandemics, there were different flu serotypes.

Timing: It's only starting to spread late in the flu season, and it's very mild. The 1918 flu was very mild in the spring and summer, but became much more dangerous in the Fall.

Target demographic: 25-44 year olds, in 1918, and today.

Thus, Niman is certain that a full-scale pandemic will occur in the next month or so, and that there's a good chance that the virus will follow the same path into the fall as the 1918 virus. This could lead to hundreds of millions of deaths worldwide.

I don't know what words to use to quantify this. The best I can come up with is this: There appears to be a non-trivial probability that an extremely virulent swine flu pandemic will occur in the fall. But whether "non-trivial probability" is 1%, 5%, 10% or 15%, I really don't know.

Anti-viral drugs and vaccines

There are two anti-viral drugs available today, Tamiflu and Relenza. According to Niman, "The problem is that seasonal flu H1N1 is resistant to Tamiflu, and so as the virus moves thru the human population, including the southern hemisphere, it will interact with the seasonal H1N1, which is Tamiflu resistant, and there's a good chance that the resistance will transfer over to the swine flu. So in the fall, the virus that emerges will probably be Tamiflu and Relenza resistant."

Another issue has to do with vaccines.

According to the CDC, "All of the genes of all of the viruses that we’ve examined to date are 99% to 100% identical." This means it will be "somewhat easier to produce an influenza vaccine, because the viruses that are spreading are so similar to each other."

I personally have some difficulty seeing how a vaccine could make much difference to the world as a whole.

Let's assume the best scenario: A vaccine is developed by September, and it's still effective against whatever mutated virus emerges in the Fall.

Then we're still talking about a world with 6.5 billion people, and I doubt that more than 1-2% of them could be vaccinated before the flu season begins. So we're still talking about the potential of huge worldwide mortality, assuming that the virus is extremely virulent.

The 1976 Swine Flu fiasco

A number of articles are comparing today's situation to the 1976 swine flu fiasco.

I've actually written about that before. 1976 was 58 years after the 1918 Spanish flu pandemic, and the details of the 1976 fiasco provide remarkable support to the "58-year hypothesis." For more information see, "The Iraq war may be related to the bombing of Hiroshima and Nagasaki."

For our purposes here, the point is that the 1976 episode even really was a fiasco, a totally irrational panic. As part of the panic, the government manufactured millions of doses of swine flu vaccine, most of which were unused. In attempt to get people to agree to be vaccinated, the government produced promotional ads. Here's a video of some of the promotional ads.

Eating pork

A number of countries, including Russia, China, South Korea, Kazakhstan, Ukraine, Serbia, Croatia, Thailand, United Arab Emirates, Indonesia, Saint Lucia, and Ecuador, have imposed partial or complete bans on imported pork from Mexico and the US.

This is entirely futile, since it's impossible to catch swine flu from swine. It's true that one form of the virus infected pigs, but the mutated virus affecting humans is completely different, and cannot be transmitted by pigs.

This is different from the bird flu virus. The H5N1 bird flu virus can infect both birds and humans. In fact, it was just last week that a child in Egypt died of bird flu, and may have contracted it from chickens.

However, no such thing is possible from H1N1 swine flu. Pigs cannot get sick from the human form of the virus, and humans cannot get sick from the pig form. They're completely different viruses. So banning pork imports is completely irrational.

Update: Apparently this is no longer true. A news story reports that "Canada reported the world’s first case of the swine flu jumping to pigs from a human, probably after a farm worker in the province of Alberta became ill during a trip to Mexico." (Paragraph added 2-May)

What you should do

You should plan on getting used to hearing the phrase "social distancing." It refers to a policy of reducing contact between people. This means closing schools, restaurants and other businesses, and canceling public events.

What will you do when that happens? What will you do if the stores in your neighborhood or town are closed? What will you do if the kids have to stay home from school? What will you do if you and your family are quarantined in your home?

These are things you can prepare for today -- while you're well, while stores and schools are still open. You can stock up on canned food. You can buy a couple of board games to pass the time. You can be prepared with medicines. Something as simple as tissues can make a difference.

You don't have to spend a lot of money, so that if this whole flu scare fizzles, then you haven't lost anything. But this is the time to keep your head and make some specific plans for how you and your family will survive if the worst happens.

(Comments: For reader comments, questions and discussion, see the Swine Flu Pandemic thread of the Generational Dynamics forum.) (2-May-2009) Permanent Link
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Generational Dynamics Web Log for 2-May-2009 Rapid worldwide H1N1 swine flu spread is raising big concerns for the Fall.