Over 1,000 dead from the Swine Flu. And...?

The Wall Street Journal has just reported that over 1,000 people in the Americas, according to data released by the World Health Organization, have died from the Swine Flu. They seem to think you should be alarmed.

The global A/H1N1 swine flu pandemic has claimed 1,154 lives since the outbreak was identified in April, data published by the World Health Organization showed Wednesday.

The Geneva-based health agency also said that the number of laboratory-confirmed cases stood at 162,380 worldwide as of July 31.

The WHO has estimated that 2 billion people, or one in three of the world's population, will have been infected by the virus by the end of the pandemic.

And I say to you: so what? I don't say this flippantly or with no concern for life, but I say this because infirm, elderly, and sickly people are supposed to die from the flu. For most of us, getting the flu is like getting a bad cold. We get a fever, runny nose, cough, aches, pains, lose our energy, lose our appetites, and generally feel lousy for a week or two. Our bodies fight the infection, generally win, and then we recover.

For some people, they don't win. Either the flu gets into their lungs and causes pneumonia, their weakened immune system gets attacked by something else, or their body cannot successfully regulate their own temperature and they overheat to death. (Other causes happen, too, these are just the ones I know of off the top of my head.)

But yes, the flu kills a small percentage of people who get it. Here's the part I don't get: the Swine Flu is no more dangerous than Regular Flu. Why are we all riled up? From a report on globalsecurity.org:

During a typical year in the United States, 30,000 to 50,000 persons die as a result of influenza viral infection. Frequently cited numbers are 20,000 deaths each year, and 37,000 annual deaths. About 5-10% of hospitalizations for influenza lead to fatal outcome in adults.

In normal years, although most influenza infection is in children, the serious morbidity and mortality is almost entirely among elderly people with underlying chronic disease. During influenza epidemics from 1979-80 through 2000-01, the estimated overall number of influenza-associated hospitalizations in the United States ranged from approximately 54,000 to 430,000/epidemic. An average of approximately 226,000 influenza-related excess hospitalizations occurred per year, with 63% of all hospitalizations occurring among persons aged > 65 years.

So yes, there's a new strain of flu going around. There's a good chance that you might get it. And it's just as dangerous as the regular old flu that -- if you're anything like me -- you've probably had a few times before.

Are you elderly? Are you a newborn? Are you sickly, with underlying chronic illnesses? Are you pregnant? These are the people who are at risk for dying from the Swine Flu, but these are also the people at risk of dying from the flu at any given time. If you fall into these categories, you should be taking exceptional care of yourself anyway. So -- even though I'm not that kind of doctor -- I recommend taking care of yourself, but please be sensible, not paranoid. At this point in time, Swine Flu is actually less widespread than good old influenza.

And don't let the media get away with using big, round numbers like "1000" to scare you.

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I agree. I think it´s mostly media-hype because this flu is a comeback from the Spanish Flu. The one that killed alot just after the First World War.
Scream Black Death and people go beserk. And that´s a disease that´s simply cured with anti-biotics.

By CanInternet (not verified) on 05 Aug 2009 #permalink

Completely right caninternet, and as we all know, bacteria never become resistant to antibiotics so we're in the clear.

I believe the problem is that this flu is preferentially killing young, healthy people--some infants but also a number of teenagers and folks in their 20's and 30's who would not ordinarily die from the flu. Also, notably, a number of pregnant women who seem to be most at risk. If you are over 65 there seems to be no additional reason to worry though.

It's obvious you haven't been reading Revere closely enough. This flu may have a similar overall infection rate and similar overall morbidity/mortality to seasonal flu, but the susceptible population is both qualitatively and quantitatively different.

The elderly have been relatively untouched by H1N1, probably due to immunity acquired in the 1957 "Asian" flu epidemic. In contrast, many more than usual young adults are being infected, and more than the expected number of them are needing hospitalization or are dying. There is far less "herd immunity" to H1N1 in people under 60 and no vaccine will be available until after the start of the flu season, so there is increased likelihood of greater incidence of infection, morbidity, and mortality in this younger population in the flu season starting this fall.

You might wander over to Effect Measure to get an answer to your "so what?"

Part of the problem is that this one isn't just killing the "old and infirm." In fact, geezers like me who were around for the 1957 pandemic seem to have an edge over green kids like you. This one is, among other things, hitting pregnant women harder than usual.

However, the major issue is that since the population immunity is lower than usual this is going to hit especially hard in a numerical sense. With just the usual number of secondary infections and other complications which are normally survivable with medical care, we won't have the capacity to care for people and therefore more than usual will die. Not just from the flu itself but also from breakdown of services.

What happened in 1916, for instance, was that so many people got sick that there weren't enough up and walking around to take care of the ill. When the hospital staff is all down in bed with the flu, who takes care of the patients? Not, mind, that we have enough hospital beds anyway.

I suspect that you wouldn't like an epidemiologist lecturing you on physics. Think about it.

By D. C. Sessions (not verified) on 06 Aug 2009 #permalink

D.C., I don't intend to trump revere on medical issues. He's certainly more informed about what's going on than I am.

But revere doesn't generally talk about news like this, http://news.bbc.co.uk/2/hi/americas/8031132.stm

Which is exactly what I want to warn people against. Yes, there's yet another pathogen out there that's dangerous to you. chezjake, you're absolutely right. But, I ask you this: does it matter? Even though I'm in the "new high-risk group" (and that's true), I've got a life to live, and I'm comfortable saying "so what?" to the danger. I think that's the only reasonable way to go right now.

I'm not lecturing about medicine, I'm advocating living despite the dangers that are out there.

He does have a point so. The strain contributes to 5% of the overall death rate, and within that 5% we have a shift towards younger, usually less affected people. And even with the occasional trip to revere, I haven't seen data how this compares to the usual death rates by new flu variants; is the "overwhelmingly affecting old people" for regular flu 95% of the usual death (in which case we have zero change to the overall numbers) or 99.5% (significant change percentile wise, but the total number of new cases will probably not even show within the usual yearly spread of the data).

He in the above post being Ethan, was trying to answer to DCS.

This post reminds me of this quote by Terry Pratchett's Light Fantastic:
'He always held that panic was the best means of survival; back in the olden days, his theory went, people faced with hungry sabretoothed tigers could be divided very simply into those who panicked and those who stood there saying "What a magnificent brute!" and "Here, pussy."'

Humans are faster than horses on short distances since they have fewer legs to sort out.

let's put perspective on the 1000 deaths by swine flu.

(i got this by googling "car fatalities per year")

"Highway fatalities account for more than 94% of all transportation deaths. There were an estimated 6,289,000 car accidents in the US in 1999. There were about 3.4 million injuries and 41,611 people killed in auto accidents in 1999. The total number of people killed in highway crashes in 2001 was 42,116, compared to 41,945 in 2000. An average of 114 people die each day in car crashes in the U.S."

so, an average year has about 40000 car deaths per year in just the US. the swine flu has killed 1000 world wide in ~3 months, or about 4000 deaths per year. that is a factor of 10 difference.

you are more likely to get killed in a car crash. also, that is just car crashes. factor in starvation, other diesease, earthquakes, fires, hurricanes, lightning, meteors, alien abductions, etc and the death toll from the swine flu so far is insignificant.

At least, Rob, the swine flu is more likely to get you than the LHC is. But still, yes, a little perspective would be much appreciated.

Just a quick reply to the first two replies. Viruses don't respond to antibiotics. You can't take, for example, penicillin for swine flu any more than you can for something like HIV.
CanInternet, is it really a resurgence of Spanish Flu? I thought that it just shared the same H1N1 protein markers but is a different strain. The disease itself sounds like it progresses differently. Spanish Flu destroyed the lungs fairly quickly and this new one has more general symptoms and is a lot more mild. Where did you see that?

Uh... please note that it's not even flu season in the north yet. And this strain *is* different - the mortality is a bit higher (probably), and importantly the infection rate is higher. So for hospitals that generally "just" cope with a bad flu season (which is most), a *very* bad flu season means that the excess infection rate are pretty much all untreated.

So yeah, it's not much worse than regular flu - but surge capacity barely meets regular flu. Now, with 1. more infection and 2. panic leading more people to front up at emergency, you've got a real possibility of over-full capacity. And given that every X population over capacity translates directly into more dead people (if you need a ventilator, you need a ventilator), the effect can be quite dire.

Most southern hemisphere countries are doing well - cancelled surgery and other cuts have freed up enough capacity to deal with the excess. But only just, and southern countries generally have pretty small populations and pretty decent healthcare. For those northern hemisphere countries with much larger populations and worse health care, it's likely to be a very bad flu season - which, I repeat, hasn't even started yet.

So where Revere et al are coming from is the issue of surge capacity - no-one has much. Even a little bit worse in terms of a virus can translate into a heap worse in death and general panic. If a bucket of water is going to just barely fill my bath up, with little sloshing over the side, two buckets will mean a whole bucket's worth of water pouring onto my floor.

...and given this is a novel strain, there is the small, but very real possibility that it could get a lot nastier very quickly. Sure, media panic is flat out stupid (leaving the public thinking "scientists" are crying wolf), nevertheless some pressure on decision makers to ramp up public health - to provide more ramp-up capability - is potentially a good thing.

Being in med school does have its privileges and while I can't even remotely claim to be an expert, I have had the good fortune to sit in on several dinner talks with physicians. The latest one was an ER/Infectious disease doctor who was pointing out that not only is H1N1 affecting a different group of patients more aggressively but it is also following the pattern of the Spanish Flu of appearing at the end of the flu season, kind of hiding out for a while and then wreaking havoc when the next season rolled around. The ER docs at the dinner seemed very concerned about the overall lack of space for patients and even though they do have contingency plans they believe that they could definitely improved. They are keeping a very close eye on the southern hemisphere right now...

I never said that anti-biotics work on viruses. I said that the Black Death is easily cured by anti-biotics.
But that even that the Black death is curable, but people still panick hearing the name of the feared disease.

By CanInternet (not verified) on 06 Aug 2009 #permalink

PS Mena
Your other question was answered by MtotheJ.

By CanInternet (not verified) on 06 Aug 2009 #permalink

Yeah neither the first nor the second post said the flu wasn't a virus and they also didn't suggest treating it with antibiotics :p

But thanks for the primer.

Ethan: nah, the LHC is much more likey to kill us. i saw the Daily Show segment. since the LHC either will, or will not destroy life, the universe and everything, the odds are 50-50.


excuse me now, i am going to buy a lottery ticket, since the odds are even with death-by-LHC.


'... -some infants but also a number of teenagers and folks in their 20's and 30's who would not ordinarily die from the flu."

Infants are always a victim of flu. Assuming many elderly have caught this swine flu, the fact that they're not dying in droves means that it's not really a bad flu. The bit about young healthy people dying is a vicious lie spread by attention-seeking news organizations. The young to middle aged people who have died of the flu had horrible health problems.

By MadScientist (not verified) on 07 Aug 2009 #permalink

" Your all wrong"!
It's the vaccine that will be the killer...
All the medicial staff, will either be dead already and or dying....

By Jenene Worley (not verified) on 14 Aug 2009 #permalink