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Comment by cycomanic | Hacker News Reader

> My conclusion to all this was kind of a sad lightbulb moments -- all the past pandemics, they didn't magically end. People just got tired, it became too expensive or politically inconvenient, we collectively turned away and pretended "it went away". The quarter-century timeframe on the Antonine plague looks starkly realistic in this light.

You make it sound like it's just a political decision, but a main reason why attention fades because the virus just becomes less deadly. E.g. the Spanish flu killed >20 M people, and yes you're correct it didn't go away, essentially every current flu virus can be traced back to the Spanish flu. People are just not dying from it to the same degree, so naturally we pay less attention.

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Its worth noting that its hard to tell whether a virus became more deadly or whether the most at risk died early.

You can normalize by age groups, that's still possible.

And either way, outcome is the same. Virus is not killing as much as it did.

> You can normalize by age groups

Does that work? If genetically predisposed to dying from something, if it gets most of those predisposed they can’t get it again.

> Virus is not killing as much as it did.

Even that really is impossible to say. Our methods and frequency of testing for CoV-2 infections, both before and after death, have changed dramatically. Previously we were telling everyone to get tested when they feel sick at all, and considering anyone who dies after testing positive to be a Covid death. Now we rarely test and only considering it a Covid death when its as obvious a death from any other cold. We simply can't compare the numbers at all, at best we could say we have drastically reduced how often we mark Covid as the cause of a death.

Noe the excess deaths data has absolutely reverted to pre-pandemic levels, but again we were horrible about collecting unbiased data. Excess deaths actually seem to line up better with the vaccine rollout than with the initial viral outbreak. That could be completely coincidental and a sign that the virus was more deadly in its second year, but again we didn't collect the right data and don't know because during the rollout no one was willing to (or allowed to) consider that the vaccines could be killing people, leaving us with a gap in data that would have been really handy to now be able to definitively show that it was a more deadly virus killing people rather than the vaccine itself.

In 2020 those in power in the media and government told us that left unchecked, the virus would overwhelm hospitals and cause even more people to die, and to some extent that did happen.

The pandemic is over because if you go to the hospital now, on a random day, there are empty beds, and there isn't a COVID ward. There doesn't have to be careful testing and whatnot to know that the pandemic is over. You can just look around. It's either over or so minor that calling it a pandemic seems to be a misuse of the word.

> Excess deaths actually seem to line up better with the vaccine rollout than with the initial viral outbreak.

This seems to be a bizarre statement. I can't speak to other countries, but at least in England the widespread rollout of vaccines (just beginning in January 2021) only started at the end of the final major spike in excess deaths.

It's simply not possible for excess deaths to line up better with vaccine rollout than with the initial outbreak, because both major spikes in excess deaths were before mass vaccination rollout.

https://www.gov.uk/government/statistics/excess-mortality-wi...

That’s kinda the same thing. All nature is a balance, and as the rock shapes the river, the river shapes the rock.

I think the answer is called reversion to the mean.

As in a bunch of factors go into how nasty a virus is based on which and how it infects cells and how it manages to suppress the immune system, etc.

Particular substrains can be more or less nasty but will tend to evolve towards some normalized mean nasty.

Except in the case of Covid the host is contagious before symptoms develop, so there is no evolutionary pressure on it to be less deadly (i.e. give itself more time to spread by not killing the host).

No, not an exception.

It is common for people to become contagious before symptoms. But contagiousness is not a binary on/off switch. As your virus load increases, you get others sick more easily. And the result is that most people continue to become more contagious as they develop symptoms.

But there is also a second factor. We have multiple layers of immune defenses. COVID is very good at getting past our initial defenses and getting us sick. Over and over again. But if you've had it once, you have the ability to ramp up against it quickly in a way that limits how sick you can get from it. So if you've ever had it, it is now much less deadly for you. (Unless you become immunocompromised.)

Evolutionary pressure doesn't factor into this. Imagine the virus doing a random walk over a bell curve of virulence. On average an outlier is going to mutate into a not outlier.

SARS-1 was an outlier, very deadly. SARS-2 s probably not an outlier.

That said I think a virus can evolve to the point where it's arguably a different virus in which case the median virulence can change.

Fun fact: while the IFR of the seasonal flu is around 0.1%, there's around a 2.5% chance you will die from it.

The thing about endemic diseases is that we get them over and over and over. Eventually it gets you.

I was really hopeful at the beginning of the COVID-19 pandemic that we would start taking the flu more seriously. There was essentially no flu season that year because of the precautions taken for COVID; we are actually removing one of the strains from flu vaccines next year because it went extinct.

Things have changed since 2019. In 2023, only around 1.5% of deaths were from the flu; of course, another 1.5% of deaths were from COVID. So as things stand now, instead of a 2.5% chance that we will eventually be killed by our major endemic respiratory disease, there's a 3% chance we will eventually be killed by one of our two major endemic respiratory diseases.

> The thing about endemic diseases is that we get them over and over and over. Eventually it gets you.

The bigger thing is that the IFR differs dramatically based on age, and eventually you either die from something else or get old.

If it weren't for the IFR going up with age, you'd still have a very low lifetime chance of dying from the flu.

Yes and no; younger people also die less.

The flu death rate in the 0-4 age bracket for the 2022-2023 was 1.2 per 100k, compared to 26.6 per 100k for the 65+ age bracket. Meanwhile, the death rate of the 1-4 age bracket [different sources; different buckets] was only 28 per 100k, compared to 2000 per 100k for ages 65-74 or 15,000 per 100k for ages 85+.

So, flu deaths are a larger percentage of child deaths than than elder deaths, even though most people who die of the flu are old. The answer to "How can we most readily lower child mortality?" is always going to be "Keep infectious diseases under control."

The largest portion BY FAR of everyone's lives (beside infant fatalities) is the portion between 4 and 65.

There is no way the fatality rate of someone with my health profile or the health profile of the average HN user has a 2.5% chance to die from the flu this year. That must be including sick and/or elderly.

Most people don't die every year; 2.5% [well, 1.5% last year] of the people who die, die of the flu.

> Most people don't die every year

I don't think anyone dies every year. Just once. /s

Thanks, apologies for the misunderstanding. I wonder what the number is for pneumonia.

2.5% of deaths caused by flu is not the same as a 2.5% chance of dying of the flu, though.

Unless you do something unusual, that's almost exactly what it means. (Almost exactly because new causes appear, and those chances won't stay constant during your life.)

No.

US population: 330M

Deaths per year (approx): 3.46M (call it 1% of the population)

2.5% of deaths: 86,500 people

Number of flu infections, per year: 9M .. 41M

2.5% chance of dying of flu: 225,000 .. 1,025,000 people

Number of deaths due to flu, per year: 4,900 .. 51,000

Actual chance of dying of flu (2010-2022): 0.01% - 0.5% [0]

[0] min ((4900/41000000), 4900/9000000)) .. max (51000/41000000, 51000/9000000)

The OP didn't say "per year". You added that one gratuitously.

It makes no difference at all. But whatever set of statistics you use has to represent the same period. We could use daily deaths from flu, or decadal deaths from flu, or forthnightly deaths from flu .. as long as the total deaths we're comparing with cover the same period.

Thanks for this breakdown, I was too tired to protest but I completely agree with your interdiction.

I mean, I began by saying:

> the IFR of the seasonal flu is around 0.1%

We're all going to die some day. Based on current causes of death, there's a 20% chance, give or take, that it will be heart disease. A 20% chance it will be cancer. A 2% chance one of us will die from kidney failure. And around a 1.5% chance it will be from the seasonal flu, which has an IFR of 0.1% or less.

Anyway, bringing this back around to the Spanish flu, it's fascinating, to me, that if you were alive in 1918, there was around a 1% chance you would die, that year, of the Spanish flu, and around a 2% chance you would die, years or decades later, of a seasonal flu. Pandemics get you upfront, all at once, epidemics get us eventually, over time.

"x% chance dying of the flu" has two vastly different meanings.

"If you die, then the cause of death is to 2.5% the flu" is one meaning. Likely close to correct.

"With 2.5% you will die this year a death caused by the flu" is another. Unlikely to be correct.

This doesn't seem correct. Deaths per year are around 3.5M; deaths from flu vary between 5k and 50k.

TBH I'm not sure where I'm getting the 2.5% number from; it's the one that stuck in my memory from the last time I dug into this data. It's entirely possible that my memory is wrong or the data I was looking at represented an outlier in flu deaths.

For the 2023 / 1.5%, I referred to the provisional vital statistics for 2023: https://wonder.cdc.gov/controller/datarequest/D176;jsessioni...

Looking at past years (https://www.cdc.gov/nchs/data/databriefs/db355_tables-508.pd...), I get more like 2%, even for bad flu years like 2018. So that 2.5% number is probably either completely misremembered or based on provisional data that has since been revised downward.

Yeah, 1 - 1.5% seems inline with most data. That is: about 1.5% of all deaths are deaths from flu.

However, deaths among those infected by flu are much, much smaller than this (because the number infected is much, much bigger than the total number of deaths)

>Fun fact: while the IFR of the seasonal flu is around 0.1%, there's around a 2.5% chance you will die from it.

That's an incorrect statement unless the age distribution of people on this forum exactly matches the age distribution of the US population, which it doesn't. The overwhelming majority of flu deaths are concentrated in the elderly; someone under sixty is orders of magnitude less likely to die than someone older than eighty.

I don't think this has to be incorrect. Or that your "unless the age distribution...." needs to be true either.

Everyone eventually dies. When that happens, as things currently stand, it will be a 2.5% chance the cause will be the flu.

You might die young or old. Across those possibilities, it is 2.5%

That can be consistent with the idea that if you were to die next year, it probably (i.e., much less than 2.5%) won't be the flu because you are a young person.

Except that current strains can't be traced back to the 1918 strain - they are separate strains, not descendants. We don't really know why the 1918 strain disappeared.

It’s important to note that data during the initial part of the pandemic was grossly inflated.

The statistics and cause of death was attributed to COVID if you simply had presence of the virus in your body regardless how you died.

The virus was especially good at killing the elderly. It’s plausible that once those people in the population died, naturally the kill rate went died.

> You make it sound like it's just a political decision, but a main reason why attention fades because the virus just becomes less deadly

That's an interesting point, right? I don't know that we have so much control over our attention, living in the age we do. Mass media and advertising, the two pillars of a massive propaganda machine (in a sense of building consensus) continue to pump out opinions, which shape our perception of reality.

In that sense, our attention to the pandemic did not have a chance to develop organically, but it was rather guided and instrumented by the mechanisms in place. The relatively smaller subset of society that controls them (not in a conspiratorial way, but in a practical "business pays for minutes of airtime / ad impressions" way) gets to decide how we perceive world events.

I'd posit (given historical datasets and what we see in wastewater) that the level of infection across communities is roughly comparable to the past few years (why wouldn't it be? nothing's changed after all in our behaviour). It's only in public perception that the pandemic has diminished.

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