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Innerbrat
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Shall we be sensible about this? 
30th-Apr-2009 05:05 pm
full of shit
My usual response when some sickness hits the news is to roll my eyes and change the channel, telling myself it has little to do with me and will probably amount to nothing and it's not worth worrying about. Earlier this week - because the alternative is thinking about dinosaurs, which just goes to show that priorities really get skewed when you're struggling with a PhD - I decided to crawl out of my "epidemic scare stories are boring exercises in mass hysteria" hole in the ground and educate myself.

My conclusion after a few hours was that epidemic scare stories are boring exercises in mass hysteria and my time would be better spent learning about a group of animals that have been extinct for 65 million years.

But then the brain processes kicked in, and I started paying attention to what people were saying  - and by 'people', I don't mean the mainstream media, who as always are screaming loudly for no other reason than that announcing the new apocalypse is more fun than talking about money or whether or not we should prosecute confirmed warcrimes.

The BBC are currently hosting a page called: Swine flu: How serious a threat? basically seems to say "we just don't know yet: probably not too bad but 'flu is unpredictable." WHO have upgraded the influenza pandemic alert to level 5, on a scale of 6. This doesn't mean that we're 83% of the way towards the need to be ware of the walking dude; the alert scale is more structured than that:
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
It's not about the numbers - how may or few people have suffered from or died from the 'flu yet, but recognition that transmission is occurring. The reason to worry is not in the numbers of people affected, but in the potential. This is the lack of understanding that accounts for my usual blase attitude towards disease outbreaks; I saw what I thought of small numbers and lots of people talking about what 'could' happen, and my cynical hat comes out. After all, I'm used to not talking about what could happen in favour of focusing on what has happened - everything I study has long since stopped evolving.

Viruses don't stop evolving. They're famous for it, in fact. They have a very rapid lifecycle that promotes response to selection pressures, and a very great part of those selection pressures is the immune systems of the host organisms; in this case humans and pigs. The basic tenants of evolution is very simple: the environment (host organism) changes, and the organism changes to continue living in it; at the same time, organisms change for other reasons, and this could open up new environments for the organism to live in. When H1N1 crossed from pigs to humans, it showed that evolution in action, and opened up a whole new environment to live in, with whole new challenges in our response (both immune and social) to overcome, and because it's a new virus, we can't predict how it will react. But we can be sure of something: we won't have hard evidence that this is a definite threat until it's too late to do anything. We know this is a 'flu virus, but that's like knowing that an animal is a bird; until it's been observed and studied we won't know whether we're dealing with a pigeon or an albatross, and if we wait until we know... I'm trying to fit this into a Coleridge analogy, but it's just not working. You can do your own.

There have been, so far, relatively few worryingly serious cases, but even plain old run of the mill regular 'flu is nasty if you're unlucky. This is a new virus, and as such the human population has no natural immunity to it (yet); so whether a case of it is serious or not, it has the opportunity to spread fast. And when viruses spread fast, they evolve fast. So even if it is no worse than seasonal flu right now, by the time it's had the chance to spread more it will be able to evolve further and it could get worse. Still, we've no real idea how potentially bad it is in its current form, because we just don't know.

"Hope for the best, plan for the worst" is, as always, a helpful rule of thumb. What we need to be doing now; what by all accounts it seems we are doing, is encouraging sensible behaviours to reduce spread, to stock up on anti-viral drugs, and to prepare ourselves to provide healthcare at home and aid abroad when needed. It's possible this might all blow over, and the me of earlier this week will be justified in bitching to myself about how it's a big storm in a tea-cup; I certainly hope so; if only because I think the way the tabloids are screaming about Parmageddon is not justified in any way.

In an ideal world, every global healthcare system should be able to handle an outbreak of something nasty, as outbreaks happen, but they're not, and as long as healthcare stays shocking underfunded, they're not going to be. The best we can do is recognise when new threats appear and prepare as well as we can as fast as we can.

So don't panic; panicking solves nothing and we don't know that we're all going to die. But deliberately being contrary does no good, either. Just because some people are overreacting, it doesn't mean there's nothing to react to, and joining the collective chorus in order to put down valid concerns could wind up being just as harmful if - I'll emphasis the big if - we do end up with an humanitarian disaster we could prevent with the right action now.

Oh, and those facemasks? Only prevent you transmitting the virus; they don't prevent you catching it. And they make you look like a prat.

Some helpful Pages
Effect Measure's Swine Flu category
The Flu Wiki
H1N1 Flu outbreak map
Ben Goldacre on the same subject
Opinions 
30th-Apr-2009 04:00 pm (UTC)
But what if you draw a little piggy snout on your mask to mess with people? (Or better yet, a mask that is shaped/colored to look like a piggy snout?)
30th-Apr-2009 04:02 pm (UTC)
Or mustaches. There's mustached masks in Mexico.
30th-Apr-2009 04:05 pm (UTC)
Guy Fawkes flu-prevention masks? O_o
30th-Apr-2009 04:02 pm (UTC)
Yeah, I'm going to go along with the 'prat' model.
30th-Apr-2009 04:05 pm (UTC)
Or maybe a really dedicated fan of the Pink Floyd "Animals" album.
30th-Apr-2009 04:08 pm (UTC)
*nods* Agreed.

It's the issue of spread that makes this a different threat so far from H5N1, which can currently only be transmitted from bird-human not human-human (though it would not take a great deal of mutation to change that).

The most reassuring thing my sources have said so far is that apart from in Mexico, most of the flu cases from this have been relatively mild - that could of course be because in most other countries there have been much fewer cases and the mortality rate is about 10% (Compared with 50% for H5N1).

If you're looking for a good source, I have found Promed updates, which you can get emailled to you if you're really keen, to be a useful and non-hyped means of getting information often a little ahead of the media. http://www.promedmail.org/pls/otn/f?p=2400:1000:
(Deleted comment)
30th-Apr-2009 04:12 pm (UTC)
About the same as if they were using 'terrorists', I think.

I like how I'm now an authority on prats.
30th-Apr-2009 04:20 pm (UTC)
I think it's level 6, because internet transmission of that plan just happened.
(Deleted comment)
30th-Apr-2009 04:21 pm (UTC)
But deliberately being contrary does no good, either. Just because some people are overreacting, it doesn't mean there's nothing to react to

Good gravy, thank you for this. I just about want to smack every person who's all LOL UR OVERREACTING THIS IS NO BIG YOU SHOULD BE CALM, because heaven forbid people not react to things the same way you do.
30th-Apr-2009 04:24 pm (UTC)
But your argument relies on evilution. Since evolution doesn't exist, we have nothing to worry about!

Viruses changing ... pft. You science folk and your crazy ideas!
30th-Apr-2009 05:40 pm (UTC)
Clearly God has created Swine Flu from scratch to smite the world for [fill in whatever reason you think God should be smiting about].
30th-Apr-2009 05:46 pm (UTC)
My thing is, if people are saying this is God's retribution for things done in the United States, why is it hitting Mexico hardest thus far?
30th-Apr-2009 05:48 pm (UTC)
Nobody important or possibly human lives in Mexico, I guess. :(

I really wish folks would think stuff through before assigning motives to God but I guess that is not really very fun.
30th-Apr-2009 05:52 pm (UTC)
And of course God is only concerned about what happens in the United States so it makes sense that He'd start a global pandemic to punish the United States.
30th-Apr-2009 06:36 pm (UTC)
I wish all this sarcasm was hyperbolic unrealistic mocking sarcasm.
30th-Apr-2009 08:48 pm (UTC)
I've seen people blaming the jews and gays already. /eyeroll.
30th-Apr-2009 04:30 pm (UTC)
I would quite like to wear a face mask anyway, because I would go that step further than just drawing a moustache on it, I'd glue a big fake Darwin beard to it. How improved my ruminations would be with such a beard to stroke!
30th-Apr-2009 04:30 pm (UTC)
Thank you for writing this.
30th-Apr-2009 04:46 pm (UTC) - linkspam/today in awesome
User misslucyjane referenced to your post from linkspam/today in awesome saying: [...] midnight (CST, I believe.) (I am mentally going POIT!POIT!POIT! about this. Just so's you know.) * reminds us to be sensible re: the piggy sniffles. I was trying to remember the last time I had the flu last night, and I think the answer ... [...]
30th-Apr-2009 05:31 pm (UTC)
Hi - ended up here via misslucyjane - just wanted to tell you I loved this. And so true about the face masks - I have been waiting for people to figure out that you can catch a virus via your eyes so that they'll wear masks and goggles...
30th-Apr-2009 08:48 pm (UTC)
Or pick it up with your hands and touch your face later.
30th-Apr-2009 08:59 pm (UTC)
I think Hazmat suits are in order...
30th-Apr-2009 05:44 pm (UTC)
I was starting to get really scared, since we've got a couple of probable cases in the neighboring town, so I did a lot of web-trawling (and a lot of going, "No, no, TELL ME IF I AM GOING TO DIE FROM IT!!!! I know how to not get sick!") and came to the conclusion that it is probably not something to worry terribly about, at least for myself and my immediate circle.

Though I am still slightly scared, but that's just because of the spectre of cytokine storm. D:
30th-Apr-2009 08:47 pm (UTC)
Thank you. This is the middle ground I was trying to convey in my latest post but as usual you explain it in a much more articulate manner.:)
30th-Apr-2009 08:52 pm (UTC)
What interests me is the speed and spread of transmission, from (as far as is known) one patient a few weeks ago to a few hundred across globe today.

I really had no idea a disease could spread that fast.

Fascinating stuff this epidemiology business isn't it?
30th-Apr-2009 09:05 pm (UTC)
Can if it's airbourne. Plus we now have all the interconnecting means of travel we didn't have 100 years ago, like planes.
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