How the 1918 Flu Spread Across America (2017)
smithsonianmag.com
smithsonianmag.com
This is a picture of him, along with his headstone and declaration of intent to become a citizen:
- https://ibb.co/xggjjnJ (Photo)
- https://ibb.co/vvnSqMg (Headstone)
- https://ibb.co/zmNzdC9 (Declaration)
Google Maps for his Denver, CO address:
Corona virus is more typical in that it's primarily killing the very old or otherwise ill.
https://www.worldometers.info/coronavirus/coronavirus-age-se...
From what I can tell they aren't completely sure what happened here. One theory I read is that WW1 reversed the trend of what happens with flu: if you had mild symptoms, you stayed on the front line. If you had severe ones, you got shipped back home on crowded trains and ships. This is in contrast with regular life - if you get a mild flu you still go out, but with severe flu you tend to stay at home.
I don't think Corona virus will turn out this way. But it also doesn't seem exactly correct to say Corona virus isn't like the Spanish flu. There's lots of possible outcomes as it continues to go global. We just don't know.
> There were two waves to the Spanish Flu. Wave 1 started like the standard flu - it was mild, hitting mostly the old and ill, and not terribly deadly. Wave 2 is when it mutated, spread like wildfire, and killed 2% of the world population.
That's sounds similar to the 1977 swine flu. It mainly infected people in their 20s or younger, because it was likely a lab escape of a then-extinct 1950s flu strain. Older people were unaffected because they had already acquired immunity.
https://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H1N1...
Indeed, the problem with the coronavirus is that a better immune system can yield an overly intense immune reaction. If this happens, it yields a blockage of the lung capillaries. Hence, it becomes impossible to breathe. This extreme state lasts for about 2 days. This period might be only survived by utilizing a special type of breathing machine.
This over-reaction of the immune system does, however, happen to a lesser amount if the immune system is in a poor condition.
Hence, the coronavirus might, again, yield a survival of the weakest (like in 1918).
Source: an interview with the German virologist Prof. Dr. Dr. Alexander Kekulé, here: https://www.zdf.de/uri/a4719bf9-a2c5-4c66-ad92-105cd8dcfcba (in German)
Another example where we draw inferences on something phenomena, without taking into account the broader context (in this case incidence rate)
It's hard to know whether the elderly and the ill are simply the first wave of casualties or not.
[0] https://www.theguardian.com/world/2020/feb/06/whistleblower-...
I'd figure they would get exposed more quickly, but the outcome would be, on average, the same as anyone else. Perhaps the stress of working during a health crisis exacerbates the disease, or perhaps they have a more active immune system from constant exposure to new pathogens?
One fascinating thing they mentioned is that a large number of people in China smoke, especially among the elder generation that is experiencing the highest mortality rate. On the podcast, they mentioned that this is essentially a comorbidity, because your lungs are already partially shot by the time you get Covid-19 (and then viral pneumonia).
"Why did so many young adults die? As it happens, young adults have the strongest immune systems, which attacked the virus with every weapon possible—including chemicals called cytokines and other microbe-fighting toxins—and the battlefield was the lung. These “cytokine storms” further damaged the patient’s own tissue."
The more robust immune response was a large cause of the increased mortality.
I think the war definitely helped spread it as living conditions were rough and there was plenty of migration.
Just think, 30 years ago, all of that information would've taken years to put together, if you even could've put it together! Just fascinating.
[1]: A "Kuckuckskind" (German for "cuckoo's child") is a child who's social father is not their biological father. However, this is unkown to both the child and the father, only the mother knows this. I didn't find prove if this is an actual english analogy, so... here you go.
My ancestry is from Romania, Poland, Ukraine, and Belarus. I haven't been able to track back into Eastern Europe except for Poland, where a relative hired a professional genealogist who managed to go back to the 1700s. I have no way to verify that information is accurate. On the Romanian branch, I have third cousins who only immigrated to the US as adults and we were able to piece together some bits from photos and postcards that were passed down.
At some point, I'd like to figure out the provenance of my surname (Soffian). Typically names ending in "ian" are Armenian, but I'm fairly confident the Soffian branch of my ancestry is from Ukraine. (Armenia never had much of a Jewish population so it would be unlikely.)
I have a friend who tracked his ancestry into English royalty. He's got a tree with over 10,000 names on it.
In the cuckoo's child case, as far society knows the child has two legitimately married parents.
Doesn't work for outside UK IPs. It is on TPB, though.
I see that Switzerland has imposed a ban on gathering of 1000 or more in response to COVID19 - maybe other countries should consider doing the same?
The only way you could legally be physically detained in quarantine at a conference would be by a sworn offer (e.g. a police officer) acting on a government order.
"Isolation is used to separate ill persons who have a communicable disease from those who are healthy. Isolation restricts the movement of ill persons to help stop the spread of certain diseases. For example, hospitals use isolation for patients with infectious tuberculosis.
Quarantine is used to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill. These people may have been exposed to a disease and do not know it, or they may have the disease but do not show symptoms. Quarantine can also help limit the spread of communicable disease."
Seems like the only real distinction is in terms of whether on not you're currently ill, but fundamentally they both restrict movement.
From HIMSS [1]: "Screening procedures established by the CDC will be conducted on site throughout the conference; HIMSS and the Orange County Convention Center will consult health teams at Orlando Health when necessary.
Should screening reveal an elevated risk for an attendee, the person will be isolated immediately to prevent exposure to conference participants."
[1] https://www.himssconference.org/updates/himss-update-coronav...
[2] https://www.hhs.gov/answers/public-health-and-safety/what-is...
On the cruise ship, which is known for being full of old people, there were 3 deaths out of ~750 known cases. Almost everyone dying so far has had another medical issue or been very old. Reports now say that many people testing positive have no symptoms at all and aren't getting sick. There have been zero deaths of children so far, which is unlike the flu. The youngest death was in his mid 30s.
Everyone should chill. Visit with your parents or compromised friends on FaceTime for a few weeks. Wash your hands. Don't go to work sick. If you're pregnant take extra precautions. Otherwise live your normal life.
Actually it's 6 out of 705. [0][1] May seem like a small difference, but a 0.8% chance of dying is 8x more than the flu.
Never mind the fact that the data out of China, Italy, Japan and Iran is all trending around the 2-3% CFR calculated and published in multiple peer reviewed journals. [2][3]
(However, South Korea might be reason for hope.)
>or been very old
It bothers me immensely when people mention it's "just old people". I'm not sure why I should "chill" about my parents having an 8% chance of dying if they contract this. [3]
[0] https://bnonews.com/index.php/2020/02/the-latest-coronavirus...
[1] https://www.worldometers.info/coronavirus/
[2] https://jamanetwork.com/journals/jama/fullarticle/2762130
[3] http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9...
There's a good chance being confined to a cabin in a cruise ship and acquiring COVID-19 is more detrimental to someone than if they had a community acquired infection going about their normal life.
Being restricted like that implies they're getting significantly less exercise than they would normally, and the stress combined with lack of sun can do a number on someone's sleep cycle. That in turn can influence cognition, especially in the elderly, and I imagine increases the chances of being dehydrated/etc...
It's like being in a hospital, which tends to do a number on most people, but without supportive around the clock care.
I agree with not fomenting panic. However, "had another medical issue" means diabetes, which alone covers 11% of the US population, and has so far been associated with a mortality rate of about 8%. This likely includes at least one family member in more or less every US family.
It's entirely reasonable to view that as a compelling reason to avoid things like major conferences with significant inter- and trans-national mass transit.
It's still quite scary to see how diabetics have a very high risk with the virus. Luckily the treatment I get with my closed loop gives me an easy access to excellent control.
People from the cruise ship are still in the process of dieing. 2 more deaths occured today.
The number of recovered cases from the cruise ship is low, so naive inference on death rate so far is misleading.
[0]https://www.nationalgeographic.com/science/2020/02/here-is-w...
Second, there have deaths of people in there 20's a casual google search of 'youngest death coronavirus' yields that information as the first result.
And if you believe every young death (or every death) in Hubei province is being publicized, you haven't been paying attention.
I do agree that it's important not to panic, but we absolutely should be taking social distancing measures to reduce the r0.
tl;dr- "directing them to coordinate all statements and public appearances with the office of Vice President Mike Pence"
> AP FACT CHECK: Democrats distort coronavirus readiness
> Democratic presidential contenders are describing the federal infectious-disease bureaucracy as rudderless and ill-prepared for the coronavirus threat because of budget cuts and ham-handed leadership by President Donald Trump. That’s a distorted picture. For starters, Trump hasn’t succeeded in cutting the budget.
> He’s proposed cuts but Congress ignored him and increased financing instead. The National Institutes of Health and the Centers for Disease Control and Prevention aren’t suffering from budget cuts that never took effect.
However he did indeed cut the people tasked to deal with pandemics.
https://foreignpolicy.com/2020/01/31/coronavirus-china-trump...
> But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.
> In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10.
Without devolving into an inevitable political shouting match, what would the purpose of that move be?
Although, that's traditional thinking, and this president is anything but traditional. So maybe you're right.
https://thehill.com/homenews/media/485025-ap-fact-checkers-f...
https://foreignpolicy.com/2020/01/31/coronavirus-china-trump...
To satisfy it, the government has to show that it has a compelling state interest and that their solution is narrowly tailored to serve that interest.
Curfews for public safety after natural disasters like fires and floods, or to prevent spread of disease, or in times of extreme civil unrest like riots have been found to meet the strict scrutiny standard.
Since a ban on large gatherings is less of an imposition on your freedom of assembly than a curfew, I'd expect that it would be allowed.
Freedom of speech doesn’t mean you can falsely yell “active shooter” in a crowded theater.
Freedom to bear arms doesn’t mean you’re allowed to own nuclear weapon or a surface to air missile battery.
Freedom of assembly doesn’t mean you can go where you want, when you want.
Other needs and limits can preempt these “rights” so they’re not really right at all.
I hope I don't sound critical of this. I'm not. I'm in favor of empowering public health departments, with accountability and oversight and judicial review, to do what is needed to prevent massive tragedy. I'm just putting it bluntly: our case law on this topic is reasonably well-settled, and one-sided, as pertains to epidemics. (Now, as pertains to vaccinating...)
The CDC has a variety of history pages [0] about the Spanish Flu. The main one acknowledges that there isn't a "universal consensus" about the virus's origin, but doesn't assert any of the other alternative explanations.
The theories that the Spanish Flu might have actually come from China seem to be more recent. Such as this one in 2014 [1] that found reports from 1917 of Chinese suffering Spanish Flu like symptoms. But his explanation for how the first known case in the West was in Kansas – that thousands of Chinese workers were sent to labor around the world – seems really speculative.
Given that there isn't compelling evidence to think the Spanish Flu started elsewhere outside of Kansas, it is funny how not only did it get the name of "Spanish Flu", but also that Kansas managed to not have a long-lasting reputation for terrible disease, even though the Spanish Flu killed more people than (IIRC) all the other 20th century pandemics combined.
[0] https://www.cdc.gov/flu/pandemic-resources/1918-commemoratio...
[1] https://www.history.com/news/china-epicenter-of-1918-flu-pan...
> We cannot say for certain that that happened in 1918 in Haskell County, but we do know that an influenza outbreak struck in January...The report itself no longer exists, but it stands as the first recorded notice anywhere in the world of unusual influenza activity that year.
And later in the article:
> Although some researchers argue that the 1918 pandemic began elsewhere, in France in 1916 or China and Vietnam in 1917, many other studies indicate a U.S. origin. The Australian immunologist and Nobel laureate Macfarlane Burnet, who spent most of his career studying influenza, concluded the evidence was “strongly suggestive” that the disease started in the United States and spread to France with “the arrival of American troops.” Camp Funston had long been considered as the site where the pandemic started until my historical research, published in 2004, pointed to an earlier outbreak in Haskell County.
Wikipedia has a write-up on the various theories of origination here: https://en.wikipedia.org/wiki/Spanish_flu#Hypotheses_about_t...
Does anyone know where I can learn more about the "miasma" model of disease? Whenever I'm looking up old plagues / diseases / etc. etc., they bring up the "miasma" model.
But what is the miasma theory (or pseudo-science?) that people used to believe in? And how does it differ from our modern germ theory?
Ex: I know plague doctors wore airtight masks and waxxed leather to suit-up and protect themselves from the "miasma" of the plague. As an early sanitization model, it probably worked (at least, "worked" as much as modern masks work on untrained laypeople). But where did the miasma model fall short compared to germs?
The miasma theory fell short compared to germ theory in several respects. While germs can be transmitted through air, for instance, they can also be transmitted through water, physical contact, etc. -- so miasma theory was spectacularly unhelpful in dealing with diseases like cholera, which is transmitted through water. There are also lots of situations where germs can be present even though there's no obvious bad smell, so miasma theory is no help there. Germ theory can explain why a doctor who doesn't sanitize his instruments between operations can pass an infection from one patient to another, for example; miasma theory cannot. And since it identifies the germ as the underlying vehicle of transmission, germ theory provides a means of protection -- kill the germ and you prevent the transmission. Miasma theory had no explanation for what exactly in the supposed miasma was causing the transmission, so its prophylactic utility was limited.
It's one of those things where people very early on made an intuitive observation (that being in places full of things that smelled bad tended to make people sick), and since that observation was "good enough" to make it useful in a lot of cases, it became part of the conventional wisdom. But once the scientific approach started finally being applied to medicine, its limitations became clear.
If you read the debates on how miasma works, you can totally see reasonable rational arguments if you strip away a few generations of scientific knowledge.
Some of the mitigations would've been effective, but the mechanism was all wrong. It doesn't permit person-to-person transmission, so you could be in a place with "good air" and still be transmitting disease while thinking you can't.
I fear many governments and leaders are going to use this as an excuse to take full control and become the tin-pot dictators they want to be through those same draconian measures.
So here we are.
What's worse - everyone taking a month off to work from home and watch Netflix with their closest ones, or do nothing and risk high numbers of casualties and rapid spread?
We're fortunate to be in an industry where WFH has relatively little cost, and we can afford to get ahead of this in a way that other industries can't. We don't have to wait for the government to give us guidance. For people doing technical tasks, IMHO, the cost/benefit tipped in favor of WFH yesterday.
This friend called the Center for Disease Control before flying back and asked them if he should do anything, like maybe quarantine himself in his home; they said no. No one questioned him when be boarded the plane to the states. When he left the plane he was asked if he had traveled to China and he said no; they waved him through.
My friend feels reasonable safe, their thinking was is that since they worked a good distance from the cruise ship, they should be fine. They are quarantining themselves for the two weeks, on their own, out of their own personal sense of caution.
IMHO, the CDC should be more careful. Japan continues to see more cases show up.[1] It doesn't seem unreasonable to me that the CDC should quarantine everyone coming from Yokohoma, Japan. Especially if their work was somehow related to the quarantined cruise ship.
Science reported three days ago[0] that maybe people who directly interacted with the cruise ship maybe weren't careful enough...
"Normally, those supporting a quarantine don’t have to be quarantined themselves, presuming they use personal protection equipment (PPE)—masks, gloves, goggles, and gowns. 'But the available evidence suggests that PPE was not appropriately used on board,' Hunter says. He believes the officers who worked onboard the Diamond Princess should have been quarantined once the problems with infection control came to light. If such lax management had resulted in the infection of government officials in the United Kingdom, 'I suspect criminal proceedings would follow,' Hunter says."
[0]: https://www.sciencemag.org/news/2020/02/coronavirus-infectio...
Previously only people who were in contact with infected people showing symptoms or were in China (previously Wuhan) would be allowed to get tested. This may be missing a ton of aystompatic people walking around who don't know they have it, and may be spreading it to other people [1]. Your friend most certainly should have been tested and possibly self-quarinited.
Fun story, an area in northern Italy, Lombary decided to test more broad, not just the people showing symptoms and they found 600 people (only roughly 200 showing symptoms). It seems that no one really cares about the other 400 infected people walking around because "they aren't coughing and spreading it like a symptomatic person".
The funny part is a bunch of other Italian areas got mad at Lombardy for testing broadly and spiking the total number of infected in Italy. It's like shooting the messenger. The Lomary official had a great quote (this comes from [2]):
> Lombardy officials said they preferred to know who had the virus.
> “Either you hide problems under a carpet, or you lift the carpet and you clean the floor,” Attilio Fontana, the region’s president, said in an interview in his office, with views over a foggy and eerily quiet Milan, 29 floors above the virus hunters.
[1] https://www.nytimes.com/2020/02/26/health/coronavirus-asympt...
[2] https://www.nytimes.com/2020/02/27/world/europe/italy-corona...
https://www.ucdavis.edu/news/message-campus-community-covid-...
In addition to the confirmed Solano county case (unknown transmission), three UC Davis students are currently in isolation, with one showing symptoms (tested, pending results).
I can not stress this enough, if you have the ability to do something at relatively little cost, which will delay or prevent the unnecessary spread of this virus, you have a moral obligation to execute on that ability. If you live in a major city or a city near one, it is probably in your community already, and the key thing that will reduce the deaths in this outbreak is reducing the peak load on hospitals.
Hospitals will be placed under extreme strain, and the quality of care will decline with the volume. A significant proportion of those suffering confirmed COVID-19 require oxygen and/or ventilatory support. Ventilatory support in hypoxemic patients relies on many highly specialized personnel and consumable resources, and keeping the rate of infection low enough that these facilities are sufficient is of great importance.
Do not hesitate to act now, even if you will be questioned later on your authority to do so.
It's probably a bit late for this stuff from a containment perspective. But it would help reduce the r0.
Speaking personally, I have to decide by mid March if we should take our trip to Legoland in San Diego. Right now I'm leaning towards "no". And I don't imagine the outlook will be much better in just 2 weeks.
Maybe because it's not needed yet? We are talking about a few cases in a country of 300+ millions inhabitants. Even if we assume that there are many unreported cases, we can still assume that the risk is extremely low.
It's notoriously hard to assess probabilities of low events, so I would simply follow recommendations from experts, and so far my government hasn't emitted any specific restrictions (besides avoiding traveling to China and a few other places).
You are in a better position to assess your personal cost of WFH than the government is.
Because they're being told it is "contained in the U.S."
The worst case scenario right now is that some people might lose their grandparents a couple years early -- which is obviously incredibly sad, but also not something worth crashing the world economy over.
I do not have this opinion of my parents or any other immuno-compromised individual. Your worst-case-scenario is absolutely the worst-case scenario in many individual's minds.
If the greater good is not the extension of the life of those around us what exactly are we trying to do here?
There are many things worth crashing the world-economy over. Slavery was one. Climate change probably another.
Asking for a 90 day slow-down to prevent real-world deaths is probably one of the more concrete and predictable things we could do compared to most other altruistic choices facing us today.
I originally took your point to be that the current risks, although sad, are acceptable and we face greater peril from slowing down economic activity.
Although I see trade-offs to everything I see economic activity fundamentally as in service to the quality of life of a person and would rather take the sadness of losing greater economic gains to the sadness losing significantly more people.
There is always a balance to this and I could interpret what you said as having a different perspective on what the current risks are but without additional context, I took it as I did.
"Colleagues mourned the death of Peng Yinhua, a 29 Yo doctor who postponed his wedding to fight the COVID-19 outbreak"
"Liu Zhiming, the director of Wuhan Wuchang hospital, died at 51 Years old"
"Dr. Li Wenliang died at 33 Yo.
"Xia Sisi, 29, was a digestive physician working at Hospital in Wuhan. She died Sunday morning"
"Huang Wenjun, 42, deputy chief physician at the department of respiratory medicine at Xiaogan Central Hospital also died Sunday".
Any sources for that theory?
"The worst case scenario right now is that some people might lose their grandparents a couple years early"
in those numbers, but I can't find anything like this.
Come again?
The initial premise of which is that the townsfolk talk war up as a glamorous and noble thing, so all the boys enlist at the outbreak of WWI, only to find what absolute hell it is.
Actually makes me want to go back and read the book. Or maybe re-read? I don't remember if we read it before we watched the film.
[1] https://www.goodreads.com/book/show/355697.All_Quiet_on_the_...
Administrating the test for it is both expensive, and time consuming, so the gross number of known infections is likely to be substantially underreported because of selection bias (why run expensive RNA analysis on a blood sample if the person is having mild cold symptoms?). There are probably a bunch of other confounding factors, such as most people getting it are probably asymptomatic or just think they have a typical cold/flu. It also appears to be non-lethal to children, as opposed to seasonal influenza.
In simple gross numbers, more people die in car accidents every day than the current worldwide totality for this virus. Comparing against US CDC stats, it isn't even remotely close to statistical estimates for flu deaths so far this year in the US alone(~16k).
My suspicion is if you concede that gross numbers of COVID19 infections are substantially underreported, the death rates fall into line with typical flu, maybe marginally worse.
The reasonable response to this is what people should already be doing for influenza: practice good hygiene, stay home if you're sick, take caution when interacting with at risk populations to minimize their exposure, etc.
As for sources, if you look in the thread I respond citing WHO, NEJM, KCDC, etc as evidence for my assertions/assumptions.
WHO's clickbait ten tips for conoravirus include statements such as "Most people will have mild disease and get better without needing any special care." [1]
If you read the stuff they've been publishing, you'll get quotes such as "Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases", and "Recognize that COVID-19 is a new and concerning disease, but that outbreaks can managed with the right response and that the vast majority of infected people will recover;" [2]
They also discuss how we're already seeing the death ratio dropping substantially, and treatment is being improved: "In China, the overall CFR was higher in the early stages of the outbreak (17.3% for cases with symptom onset from 1-10 January) and has reduced over time to 0.7% for patients with symptom onset after 1 February (Figure 4). The Joint Mission noted that the standard of care has evolved over the course of the outbreak." [2]
CDC publications and announcements follow similar sentiments.
Edit: adding NEJM quote that supports my assumption about sampling issues: "We found a lower case fatality rate (1.4%) than the rate that was recently reportedly, probably because of the difference in sample sizes and case inclusion criteria. Our findings were more similar to the national official statistics, which showed a rate of death of 3.2% among 51,857 cases of Covid-19 as of February 16, 2020. Since patients who were mildly ill and who did not seek medical attention were not included in our study, the case fatality rate in a real-world scenario might be even lower. Early isolation, early diagnosis, and early management might have collectively contributed to the reduction in mortality in Guangdong." [3]
[1] https://www.who.int/dg/speeches/detail/who-diretor-general-s...
[2] https://www.who.int/docs/default-source/coronaviruse/who-chi...
Also am I reading that correctly that they are including pneumonia in the "mild or moderate" category?
I'm not sure where you're getting "no big deal" from, I never said or implied anything of the sort. It appears to be comparable to influenza, which is serious and warrants a serious response, but not cause for any panic. Flu already poses a serious risk to the elderly, yet we don't see widespread panic year over year.
Mild pneumonia is also known as atypical/walking pneumonia. In the source material they state that they classify mild pneumonia as a moderate infection. See figure 5. Most cases of atypical pneumonia don't require hospitalization, as the primary characteristics are just cold symptoms that don't go away in a week.
We're going to start seeing more data coming out of South Korea in the coming weeks that is likely to be far more reliable than what the CCP would show. Currently the fatality rate appears to be ~0.5% and trending downward. [1]
[1] https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=00...
As crude as it sounds there haven’t been that many deaths. Yes this seems to have outbreaks in waves but that’s about the only scary part.
We should be alert but not anxious!