Swine flu: why we are party poopers

Thank you for this, Revere. The final point in particular was one that hadn't occurred to me. I doubt most people who have this idea were planning to self-quarantine after exposure.

I agree, knowingly infecting yourself is dumb. But going through hoops to avoid being infected, like staying home, or cancelling travel plans is equally dumb. I get the flu about 1-2 times per decade. Feel real bad for 3 days, weak for another 1 week, a cough that might linger another week. No fun, but it's not a real big deal for those who are otherwise healthy, and seasonal flu is not going away.

Obviously, this new strain should be monitored by the professionals, and preparations should be made for a possible pandemic, while everyone else should go along with their lives, business as usual. That quarantine in a Hong Kong hotel is a perfect example that what people have the most to fear is draconian measures by government for political reasons.

Not to mention the fact that even if you could procure the pathogenic guest of honor, the chance that you would become infected, in any case, would be roughly three in ten. Even with the 1918 H1N1, once it ramped up to its most lethal potential, it still failed to infect about 70% of the total global population. And not for lack of exposure, either.

And I've seen a recent figure that suggests that of all those who encountered the initial "benign" strain, approximately 30% subsequently succumbed to the effects of the strain that precipitated the second wave. So, let's see, here; you have a 30% chance of acquiring the "benign" strain, to begin with; and then you still have a 30% chance of dying, still, if you should subsequently encounter the utterly berserk strain. Yeah, I like that combination of odds; that's really going to persuade me to participate in a scheme that is astonishingly stupid.

No one can save you from being an idiot, of course; but then in the end it simply may not matter, anyway. All that stupidity simply going to waste; my, that would certainly be a shame. Especially since that commodity is, sadly, unquestionably in such critically short supply, in this country.

Jeeez,some people will do anything for sick days.....

So maybe people who want to do flu parties could hold pandemic-prep-parties instead?

Get together with a group of like-minded people and buy non-perishable supplies by the case, then divide them up. Including flu essentials like Chicken & Stars, soda crackers, Kleenex & cough drops, powdered Gatoraid, and whatever comfort items the kids (we're all kids when we have the flu) need.

I'm not a prep nut. Really! I just think everyone who can afford it should ALWAYS have 2 weeks of food in the house at all times. So when y'all get sick you can STAY HOME instead of coming to the store when I'm trying to shop!

1) Am I wrong in judging that the following AP News Story was written by idiots?

"Flu overhyped? Some say officials 'cried swine'"
http://news.yahoo.com/s/ap/20090508/ap_on_re_us/us_med_swine_flu_hype_9

2) The swine flu appears to be spreading rapidly at the moment. Given that there are a lot of people in the CDC high risk group (elderly, diabetics, etc.), a highly infectious flu could kill a fair number of people even if it turns out to be ,for the average person, no more deadly than the normal seasonal flu.

3) Why did the writers give so much space to the opinions of uninformed people on the street? Does the News Media think that the opinions of the casually ignorant should be given equal weight to the judgments of health care experts? Is that "balance"?

4) I'm not arguing that the experts are always right --but if the News Media is going to encourage random passerby to shoot off their mouths re flu containment policy, shouldn't the reporters at least ask those interviewees to provide some facts and detailed logic to support their arguments?
Maybe ask them to debate an actual health care professional?

5) It also seems to me that stupid stories like this by the Associated Press encourages irresponsible behavior like the Swine Flu parties.

I wonder if possession of a supply of Tamiflu would make this a more viable option, if only slightly? The stuff is likely to be ineffective upon the next encounter with this virus anyway, and availability of an effective vaccine is by no means a foregone conclusion either. I'm continuing to take all precautions, and certainly couldn't see myself actually seeking the thing out under any circumstances, but I do occasionally find myself toying with the idea of just not being particularly careful about avoiding it. Prompt initiation of antiviral therapy would not preclude enough viral replication to insure immunity to the virus in its present form, would it?

To paraphrase that 70s hit song:

Do a little dance,
Make a little love,
Get flu tonight!

You did not just make the NY Times, but you also made CNN web site's front page, with a link to this blog. See http://ac360.blogs.cnn.com/2009/05/07/parents-kids-swine-flu-parties/

Revere's post doesn't give proper weight to the fact that there are risks with all three strategies (avoid, intentionally contract, act normally), and that we need to see a formal comparative risk analysis (complete with a clear account of the mathematics, values, and assumptions involved) in order to make an informed decision.

This is a probability problem. If you're going to argue against a certain strategy, then you do so by presenting numbers, not by listing some of its risks (acknowledging a strategy's risks won't disprove its appropriateness when it is in competition with two other risk-riddled strategies).

Seriously, for the benefit of all who follow you, please get a few professional mathematicians to model this.

If there are any mathematicians out there reading this, please consider actively participating and posting your models here.

Thanks.

Bubstubber, after careful consideration of the factors as they've been presenting in a number of posts here, I think I've got the math worked out:

? + ? = ??

In case this wasn't obvious: the probabilities (and hence, possibly the strategies) will vary by demographic.

No math needed to see why these flu parties are a terrible idea. Every person the virus infects allows it to reproduce millions upon millions more times. For each replication there is a chance that a mutation could cause the virus to be more virulent than the current swine flu strain.

Currently the strain is very mild and with everyone enacting a little common sense shouldn't pose that large of a threat. These Flu Parties are not as wise of an idea as pox parties. In fact these flu parties are both foolish and irresponsible in that they just keep the strain going and give it more opportunity to aquire more genetic mutations.

Don W., you are right on point. The reality here is that public health warning systems are designed from studies of past pandemics to reduce exposure and spread of the virus. While the current outbreak may not have lived up to their fears, it shows that there was a very effective communication plan to the masses, and response from the private and public institutions.

lol Racter. Yes, we do indeed lack a lot of necessary info at right now.

But revere (and the CDC et al) should still clearly set up the equations anyway. Showing the variables as complete unknowns (as opposed to estimates or actual results) should just drive home the point that people lack the appropriate info to make an informed decision about whether avoidance or acting normally are better strategies.

Pharmacist,

You're misconceiving the scope of the problem.

The disease will probably frolic and mutate in the southern hemisphere this summer and return back to the us in the northern half this fall...REGARDLESS of whether a few people in the U.S. or Canada have some flu parties.

The extraordinarily slight bump that you would give to the overall odds of unfortunate mutation are overwhelmed by concerns of personal safety.

Wouldn't most people take a pill that would increase their odds of survival X%, despite the fact that doing so raises the odds of a pandemic by 0.0000000000000001%?

Darn it, meant to say 0.0000000000000001X% (forgot the X)

"Prompt initiation of antiviral therapy would not preclude enough viral replication to insure immunity to the virus in its present form, would it?"

I've read that antibody production doesn't peak for 7 days, but I'm not sure what that means with regards to how much good it would do to smother the infection at various stages before that.

I think the people who want to hold flu parties have never had an actual case of bona fide influenza. Their past cases of 'flu' have probably all just been bad rhinoviruses.

The only flu virus I ever want to have again is flumist.

Go on! Lick the pig! You know you want to.

Although I am not a proponent of self-innoculation of this flu, I just had a thought as to why some people might consider a 'flu party' a valid idea.

When I was young in the 1950s, it was common for families in my neighborhood to bring their children to visit a child who was sick with diseases like chicken pox. The idea was for all of the children in the group to get sick at once, so it would be 'over and done with'. After everyone recovered, the children would be immune to future outbreaks, allowing social interactions within the group to continue on without interuption until the next disease surfaced.

Marsha: Exactly, that's obviously the logic people are using. But influenza isn't chickenpox: I don't know very much about chickenpox but presumably it's pretty stable if one infection can confer immunity for a lifetime. By contrast, the rate of mutation of influenza means you might not be immune to a version only a few months down the line, so the chickenpox party strategy simply doesn't work.

I think the rationale with chickenpox parties is that adult chickenpox is said to be much worse than childhood chickenpox.

In the UK, parents want their kids to get chickenpox at some stage. It is also believed that you will most-likely get one infection per lifetime.

Deliberate infection with a nasty disease that mutates quickly seems to go against the principles of chickenpox parties to me.

bubstubbler: We are a big proponent of models, but they have their place. This is a matter of principle as much as numbers. The models are very good for qualitative behavior but not for predicting actual risk. We know. We teach modeling and do it for a living. We know too little about everything that goes into a model, from host susceptibility to this virus to clinical spectrum to transmission probability and much more. You would be making the model bear more weight tthan it can sustain. Moreover, if you got a result like, the risk of a fatal outcome is one in 500, what would you do with that information?

Re "it was common for families in my neighborhood to bring their children to visit a child who was sick with diseases like chicken pox. The idea was for all of the children in the group to get sick at once, so it would be 'over and done with'."
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I'm not sure that hospital emergency rooms like to manage things in that same manner. For one thing, I don't think they have an unlimited supply of life support systems.

It is idiotic for the News Media to wink at behavior that will likely cause of tidal wave of High Risk patients (those with asthma, diabetes,etc) to hit our emergency rooms in a month hence.

Of course, if the virus does become widespread enough during this wave, and if immunity to the present strain does confer enough protection against mutated (/reassorted) strains, the best strategy for high riskers would probably be to keep their heads down now, and hope to see some herd immunity this fall and winter.

So many IFs

dmcw and maybe others: you realize there is now a chickenpox vaccine? Texas and possibly other states are mandating it for children.

Not only is there a chickenpox vaccine, but a shingles vaccine as well (I believe the current recommendation is anyone over 65 with a normal immune system should consider the shingles vaccine. Ask your practitioner. I think it's about $300, though.)

Once you've had chickenpox, you won't get chickenpox again, but the virus can hide, dormant, in nerve roots and re-emerge as shingles if your immune system ever weakens, most commonly in people's old age.

Old folks with shingles is where the kids catch chicken pox these days. That's why it never quite dies out.

er, anyone over 65 who has had chicken pox, that it. I think it's a live virus vaccine, which means if you gave it to someone who'd never had chicken pox or who was already immunosuppressed even though they had had chicken pox, they might get sick.

Revere,

If you don't have enough info to lay out why (quantitatively speaking) intentional contraction is not the correct strategy, then you absolutely, positively, with 100% certainty lack the info needed to make the positive claim that it is the wrong strategy and that one of the other two (avoid or behave normally) is better.

That is an indisputable fact, and it entails that your unfounded/unsupported/unjustified guess on the relative appropriateness of the strategies is worthless.

Worse, if you don't openly admit this, then you're either mentally incompetent or you're operating on some shady ulterior motives.

If intentional contraction is silly due to a lack of relevant info, then the following statements are directly implied (since we also lack the relevant info to support these strategies):

"It is silly to avoid flu parties."
"It is silly to avoid infection from the 1st wave."
"It is silly to not change your normal behavior."

Sorry revere, but made a blatant error in logical reasoning, and I'm calling you on it. Don't get defensive, just suck it up, admit your mistake, and post a retraction that clearly explains why your admitted lack of info means you can't say one way or the other which of the 3 general survival strategies is best.

Be honest with these people. And yourself.

Bub, your ideas about certainty and indisputability appear to differ somewhat from mine, but I propose this: the immediate threat posed by this virus is more certain than the future threat simply because we have direct evidence that it exists right now, while the future threat remains entirely theoretical. It's just as possible that we may never hear from this virus again (for some values of "just as", and with full acknowledgement that I don't have those available).

I like the herd immunity strategy better the more I think about it. A person with no social conscience might consider encouraging flu parties, but refraining from actually attending them (holing up in a remote cabin for some weeks instead).

bubstubbler: I'm not bothered by you ad hominem argument. It's the internet. OTOH, you don't seem to know much about the subject matter. So please lay out your quantitative reasoning (which you indisputably have) for having these parties and possibly involuntarily infecting others. Or if there is no computer model do you get to do whatever you feel lilke? Since the data aren't available to predict what this virus is going to do, please call CDC and tell them to close up shop as all their advice is incompetent or has an ulterior motive. LOL.

Oh, well. It's the internet.

http://www.liquidmatrix.org/blog/wp-content/uploads/2009/01/troll.jpg

so much for trying to embed an image. :sigh:

Lisa: So you found a picture of me on the net? LOL.

Revere,

I'm not the one making positive claims about one strategy being superior/inferior, YOU are. I'm saying three things:

1) Based on what little data we have from past pandemics, it is well within the bounds of reasonable possibility that contracting the virus now will prove to be the best strategy for surviving the overall pandemic.

2) We CANNOT know the correct strategy until we have the numbers (this should be a steadily refining process that gives best estimates at time t for various demographics).

3) You made a basic logical error in pre-judging the strategies before attaining the minimum quantitative data needed to make such a judgment

Your response is to throw up a straw man and totally misrepresent what I'm saying (you pretend/lie that I'm saying intentional contraction is the best strategy).

Look, if a person can't know A or B without knowing C, it is logically invalid to say, "We don't know C, but A is wrong and B is right." This is basic logic. You made an invalid move, I called you on it, and you're either too incompetent to understand why it's invalid or you're just too proud to admit you were wrong.

Furthermore, you seem to indicate a continued failure to understand the situation by saying things like this: "Moreover, if you got a result like, the risk of a fatal outcome is one in 500, what would you do with that information?"

You wouldn't have asked that question if you understood the point of a COMPARATIVE risk analysis. The whole point of COMPARING risks is to see which path is riskier, and to do that you'd also have to have the risk values for the other strategies (relative to each demographic), like this:

Strategy 1: overall risk of death = 1/500
Strategy 2: overall risk of death = 1/200
Strategy 3: overall risk of death = 1/50

So then you'd know what strategy to pick if you wanted to maximize your odds of survival. You would then take this info into account as you weighed it against additional personal factors (e.g. Could you self-isolate far better than the average person?) and preferences (is it worth putting out effort to improve your odds?).

As I stated already, even though we don't know all the values to plug into our equations, the equations should still be on display front and center, with best-to-date estimates (and the explanations behind them) assigned to the variables.

Bub, if you take some time to search back through the archived posts on this site, you'll find that one of the most regular posters has been crying for "probability estimates" for years. If you find that you aren't getting the numbers you want either, you might consider adopting his approach: do the footwork yourself.

Re Racter at 31: "I like the herd immunity strategy better the more I think about it. A person with no social conscience might consider encouraging flu parties, but refraining from actually attending them (holing up in a remote cabin for some weeks instead)."
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What a GREAT idea. Especially for the ASIAN herds:

"PARIS (AFP) - Preventing the swine flu that is spreading across the globe from infecting patients sick with the deadly H5N1 avian flu should be a top priority, especially in Asia, top experts said Thursday.

If both viruses wind up in the same individual, they could mix genes and mutate into a form that is both very pathogenic and easily transmitted among humans, said John Oxford, a virologist at London Queen Mary's School of Medicine and Dentistry.

"We don't want a situation where you have a virus with the spreadibility of the pig virus with an H5 stuck on it. That is something we worry about, to put it mildly," he said in a phone interview.

On an influenza "Richter scale" of concern, if an ordinary seasonal flu rates a level three and the swine flu a level five, then bird flu on its own would be a six and "an H5N1 virus swapping genes with a pig virus would be the highest of all, at least a seven", Oxford said."

Ref: http://www.brunei-online.com/bb/fri/may8w18.htm

Don, you've got a good point there. In particular, I expect a lot of us aren't looking forward to the inevitable news that the virus has reached Indonesia. Oh well. Scratch one more brilliant plan.

bub; Maybe I reply to you as I do because: your comments were ad hominem and because you are the one who doesn't understand this. You think there are "equations" that will give you the answers you seek. There aren't. If you read the link to my series on modeling you will see that "the equations" are anything but firm and there are many possibilities. So maybe I reacted as I did because I do understand it and you don't.

So what kind of "equations" are you looking for? Ordinary differential equations? Partial differential equations? Stochastic models? Agent based models? And what parameters do you want to plug into which ones?

Meanwhile advice has to be given and steps taken while you look in your college textbooks for the definitions.

I don't care if you want to run the risk of infecting yourself -- or not. But if you do or tell others it's OK or you don't know if it's OK, then you also will likely allow others to be involuntarily exposed. There is no model for that. That is public health practice.

Feel free to construct your own equations if it makes you feel better. If you understood this you wouldn't be asking for "equations' and you wouldn't think that these models could give you "the answer." Read the antiviral model series if you want to seehow professionals do it and then, when you want to talk specifics instead of hypotheticals, I'm glad to do that.

HSalutations to all,

As some of you know I am a Metis Ojibway.

You are free to get yourself infected, but you better get to the up-hills because YOU have no RIGHT to infect our villages.

Do not do that and come to village volontarely infected.

Freedom of One ends where the Freedom of the Community begins.

This is at this Time totally irrespectable and unacceptable to the Communities.

Do not promote this at this Time, it could create virulent Tribal Reactions.

Achak Snowy Owl

Okay. Perhaps no one can really know a correct strategy at this stage, so the idea of self-innoculation seems fool-hardy. But, let's consider that this model has already been applied, if not uncannily: in that high school in Queens, NY where it first appeared. With eight cases discovered, and a large number falling ill while at classes, the school closed for eleven days. Although I don't know exact numbers, it was reported locally that over 1000 students eventually fell ill, out of a population of about 2700. Additionally, a neighboring public school where some of the prep schools siblings attended also had cases.

Perhaps this will prove useful information should a next wave occur.

As long as you DO NOT impose it on the Community do what you want and isolated long enough.

Do not fool with this. Virulence is not the solle attribute of virus, ya know.

Snowy

I love this blog. Really appreciate the original post and the airing of the arguments.

It seems that because we don't know everything, some people are prepared to discard all that we do know, all that we have learned about reducing risk, to opt for a return to primitive practices.

It says a lot about where we are at ideologically, that people can even contemplate such selfishness. Let ME get this 'mild' strain and screw everybody else who comes after! Some people are so alienated from their own humanity. I take it that if the "mild" illness is too unpleasant, scooping up the tamiflu for themselves while it still works is also part of the master-plan?

Because the selfish are contemplating these actions, some already socially excluded, chronically ill people may potentially 'choose' to self isolate.

What about the people without health insurance, who get infected because of their neighbours' 'parties'?

As a public health nurse with health problems, this makes me so angry. I have already been ill four times this year and my health is not what it was, so I am a little anxious on my own account, not panicking you understand. Nevertheless, if the proverbial hits the fan, I will do my best for society and volunteer to go back into critical care for the duration, as I have the skills. It disgusts me that health workers could be exposed to a mutating virus because people have spread it around on purpose.

No disrespect intended to the very clever people here, but it is not rocket science. All people are being asked to do is take measures that are reasonable for their own circumstances, to delay the spread of this virus as much as is possible, so that some of the people who are most at risk could benefit from a vaccine.

Part of me hopes that the party people will reconsider, when they think about the potential effects on others. I also hope that they don't really mean it, that it is just a cultural expression of their resilience to all the fear out there from massive recession etc.

Revere,

A second way you misrepresent my comments is to classify them as ad hominem attacks. An ad hominem attack is where person A disregards the issue and instead focuses on trying to undercut B's claims by attacking something about his personality, looks, belief system, etc.

I have been the one trying to get you to focus on the actual issue, and you're the one who is instead getting defensive, trying to gain credence by name-dropping math terms (lol), and attacking me as some sort of ignorant bumpkin who shouldn't have the gall to want to see the probability-based reasoning used in making such decisions laid bare for all to see.

Let me be perfectly clear: I could not possibly care less about your personality, appearance, heritage, age, color, spiritual beliefs, etc. I care only about the arguments and evidence.

You are claiming that intentional contraction of the first wave is foolish. In order for this to be foolish for someone wanting to maximize his odds of survival, contraction of the first wave must result in far worse overall odds of survival for the total pandemic.

But you have not given a cogent account of how you came to determine that contraction of the first wave results in far worse overall odds of survival for the total pandemic. (Your list of reasons against flu parties don't provide any sort of adequate support for your determination. Why? Because when comparing 3 problematic strategies, it is irrelevant to point out that #1 has problems and isn't some idyllic solution. Why? Because doing so doesn't provide any relevant differentiation.)

stillarebel,

You said, "It seems that because we don't know everything, some people are prepared to discard all that we do know, all that we have learned about reducing risk."

The whole point of this discussion is about how to best reduce risk of death over the course of all waves.

The ones who choose to behave normally are the ones who are discarding all we know.

Most of the ones who intentionally contract or actively avoid the virus are the ones who are trying to use "all that we have learned about reducing risk."

bubs: I'm not going to waste more time on this. You were the one who brought up equations and accused me of ulterior motives or incompetence.

Please feel free to go out and exposure yourself to a known case. \ But when you do, also have the decency to lock yourself up for 14 days or until you stop shedding virus. Don't put health care workers and innocent people at risk because of your personal decision.

It is your position that I don't have any reason to advise against this, although the post gives four or five. If those aren't cogent enough for you then we are at an impasse. They aren't good enough for you. Fine. I have no more to say on the subject to you.

Seems to me that having a flu party to intentionally contract this virus so that you will have antibodies available should it make it back around again is akin to intentionally having a car accident because, statistically speaking, every adult driver will have one in her/his lifetime and you want to ensure yours a minor one.

Wow! Such brilliance should never be underestimated!

Well, the idea is not without some logical basis, as revere notes in the OP:

"the virus might return with a vengeance next flu season in a more severe form, it currently is a mild disease, and there is no protective vaccine for it at the moment and uncertainty as to when there might be or its availability."

Add to that one more uncertainty: the possibility that it may aquire resistance to oseltamivir (it's already resistant to amantadine). I've already admitted to having found that logic compelling enough to entertain at least briefly. But it fails on closer scrutiny.

I don't really view it as a simple failure to grasp statistics (though there is quite a bit of that going around), but if I did want to make that argument, I'd begin by pointing out that the return of the virus in more virulent form hasn't actually happened yet, and may not happen at all. I would continue by pointing out that over the entire course of, say, a two-year pandemic, something like half or two-thirds of the people in the world could reasonably expect not to contract either form of the virus. (Eventually, most probably would aquire immunity, but there would at least be an excellent chance of doing so through vaccination rather than infection).

Trading away those odds doesn't seem very logical.

you could, you could, you could.
How can you evaluate these possibilities against each other
without trying to measure them, trying to assign probabilities to them ?
How can you ever come to a reasonable conclusion, like you claimed you did here, without such evaluation and calculation ?
You can almost always find reasons for and against some ideas, just listing them without weighting them
is not very useful.

And how about swine-parties , trying to catch current
swinish H1N1 ? Most swine workers have antibodies
and the disease is reported to be mild in humans.

What about the American swine vaccine ?
Can it be given to humans ?

bubstubbler, here you find the guy

> crying for "probability estimates" for years

as racter "formulates" it :

http://www.setbb.com/fluwiki2/viewforum.php?f=10&sid=368676acf0eceab4a5…

you may also want to check racter's replies
to him at fluwikie and revere's replies here in the
archives of effectmeasure ("no one knows...")

At one point, referring to people as Homo economus had some popularity. But the reality is that most people don't think of themselves first and foremost as economic agents, but as human beings and citizens.