The Next Pandemic: Not if, but When
nytimes.com
nytimes.com
I get a lot of my pandemic prevention information from the Center for Infectious Disease Research & Policy,
http://www.cidrap.umn.edu/cidrap/index.html
which, to be sure, has an institutional reason to raise awareness of risks of pandemics, but which also links to a lot of current, sound science reporting on infectious diseases.
Novel strains of the influenza viruses or novel strains of coronaviruses are scary to thoughtful epidemiologists because they can be spread by the everyday activity of breathing. If a new coronavirus infection has a high case mortality rate, high virulence, and long latency period, it could kill many people before any of us have a chance to practice the isolation that eventually shut down the spread of SARS back in 2003. Every year, a lot of people get the flu, and a more virulent and more lethal strain of flu--especially one for which current seasonal flu vaccines provide no immunity--could kill a lot of our friends and neighbors.
We are likely to have a decent universal vaccine within the decade. Example, one test by Inovio used a unmatched vaccine on the 1918 Flu with lethal dose in mice. All the controls died but none of the vaccinated. This type of vaccine would reduce the chance greatly that something like a bat flu would emerge without us being prepared. These universal vaccines are made by bacteria or other very fast to produce and cheap methods, compared to the popular egg method today.
The biggest issue which the WHO has been working on is to make sure poorer countries have the know-how and distribution networks to ensure they can make and deliver current and next gen vaccines. This is especially important if access to antibiotics is not common and easy.
You're either preemptively addressing survivors, or you forgot to look in the mirror...
:-/
Of course this isn't a reason to be complacent.
Anyone who understands what the word "Pandemic" means should also understand that pandemic disease is an inevitability.
The question is what can we do as a society (or societies) to reduce transmission, mitigate the severity and treat the afflicted if possible. It's why Public Health is so important.
(And to be fair to the author, the piece doesn't seem to pick the super weird frame that the title of the piece does. As Mitt Romney pointed out during the election regarding his GM bailout piece, the authors don't write the article titles)
Furthermore, click on the author's name and get taken to his personal website... Where you can admire his book being promoted. And it's about scary diseases in the world that will kill us all.
Please.
Hong Kong Flu (1968–1969), "killed an estimated one million people worldwide." http://en.wikipedia.org/wiki/Influenza_pandemic#Hong_Kong_Fl...
Asian Flu (1957–1958), "Estimates of worldwide deaths vary widely depending on source, ranging from 1 million to 4 million." http://en.wikipedia.org/wiki/Influenza_pandemic#Asian_Flu_.2...
Spanish Flu (1918–1920), "It infected 500 million people across the world, including remote Pacific islands and the Arctic, and killed 50 to 100 million of them—3 to 5 percent of the world's population at the time—making it one of the deadliest natural disasters in human history."
"Most influenza outbreaks disproportionately kill juvenile, elderly, or already weakened patients; in contrast the 1918 pandemic killed predominantly previously healthy young adults." http://en.wikipedia.org/wiki/1918_flu_pandemic
That was the big one, and if you talk to your elders they'll remember the first hand stories they heard about it. Few families escaped unscathed, I lost a great-uncle. A repeat would be catastrophic, and efforts to avoid it are not "overhyped", except by the always excitable media. To dismiss such a well documented, in living history threat as being "for the benefit of pharma companies" is beyond blind.
The Spanish Flu clouds the issue somewhat, as it's always the first thing people think of when they hear the words "flu epidemic" but it's also the most unusual of all such epidemics.
[1] Wikipedia - tourism
Modern mass tourism is pretty bad as well, but it's a far cry from having all of the young men in your town getting shipped out and back in again.
It's been awhile since I've read up on it, but the speed at which it spread, prior to air travel, was frighteningly fast.
It's true that in any normal year more people die from known diseases, and that pandemics are a rare occurrence. But when they happen they kill a lot of people. The 1918 flu pandemic killed 100 million people. 1 out of 20 inhabitants on the planet. And remember that this was back when we didn't fly around the planet giving a virus the possibility of spreading to the entire globe within a few days.
That's why pandemics are so scary - when they kill they kill a sizable portion of the earths population.
We can identify reasons that disease transmission rates may be lower. We can also identify reasons a pandemic would travel more easily, such as air travel and more open borders in Europe.
There are surely many factors that would only be identified as impactful after the fact. Likewise, we can't predict the virulence or transmissibility of any future virus.
Pandemics belong in that class of rare events where it's impossible to predict the likelihood, the impact, or the timeframe.
All this to say, you're correct that a 1918 pandemic is unlikely. But I don't think that's meaningful.
With the exception of washing hands (which we don't do nearly enough) and the vague "modern medical tech", none of this would help against a flu pandemic at all...
My reference to medical tech is the whole system of diagnostic testing and patient monitoring. It allows for early identification, quarantine, etc... We also know a heck of a lot about proper bio safety procedures in medical centers to lessen the spread of disease through health care workers.
Again, not arguing that a pandemic like 1918 can't happen at all. I'm just saying that we're not showing up completely clueless and unarmed to a gun fight. We're bringing a knife this time :)
We have more people, and more rapid air travel, and denser cities than ever before... and yet no pandemics on the scale of the 1918 flu.
Maybe, having more people, more rapid air travel, and denser cities is actually helping herd immunity?
Any nasty virus has milder cousins. Milder cousin viruses spread faster, because those infected keep going to work and traveling, and show/suffer fewer symptoms. And these milder cousins serve as a natural inoculation against the nastier versions.
We simply can't conclude anything from the statement 'no pandemics on 1918 scale since 1918'.
3,000 years from now, looking back, people might say that 1918 was the start of the end of pandemics, or that 1918-2013 was an unusually quiet period that preceded a major pandemic.
With such a limited timescale, how can we possibly tell?
On the other hand, I'm sympathetic towards public health agencies, because to effectively head off a pandemic you have to detect it and take action early. However, if you're going to err on the side of caution, there are going to be a lot of false alarms, which in turn is going to lead to public relations fatigue about the whole issue. Then you're going to have a problem mustering a response if a pandemic actually comes up. It's a difficult problem.
One suspicion I have that leads to this problem is that we've never before had the tools to so easily & rapidly track the progress of a particular strains of flu virus - I suspect that really we just don't know about what the range of characteristics about the transmission rates really are to this level of detail, so really we don't precisely know how to accurately forecast if a virus at early stages will lead to a pandemic.
There's two factors to flu virus : spread and severity. The last influenza pandemic may have been "overhyped" and exploited by pharma companies, but we were also lucky that it had high spread but relative low mortality rate.
The NCoV seems to have a high mortality rate. "Prevention is preferable to cure" (moreover when there isn't any cure ready yet).
Edit: my upvote seems to have moved it out of grey.
The following articles I wrote explains a lot more of the details of what influenza is and why people wrongly think it was over hyped http://www.followsteph.com/2009/10/29/its-only-the-flu/
That said, a lot of the work done to get us to where we are is a big part of why they are not as scary as the hype.
I'm not sure we can predict when we'll have universal vaccines, as I understand it we've only recently gotten some serious traction on them ... we hope. But it is possible we'll get them fairly soon.
The pipeline on flu vaccines look very promising, and IMO, we will have an effective universal vaccine within ten years. The next generation of vaccines can be made by bacteria or other methods that do not require 1 egg for 1 vaccine. This makes them cheaper, much faster to produce, and easier to distribute.
One test that amazed me was Inovio used a unmatched vaccine on the 1918 Flu with lethal dose in mice. All the controls died but none of the vaccinated.
And "cytokine-storms can be very fast and lethal (I've read of cases of apparently well individuals dying in their sleep, presumably from that), but they did not account for most of the deaths"?
If so, was this true for the "healthy younger adult" cohort that were disproportionately killed in 1918? (I.e. not the typical young children, elderly and compromised patients who are the normal majority of flu victims.)
Hmmm, in that case we have to wonder why the previous pandemic wasn't so lethal. But from everything I've read, "If you learned one flu pandemic, you've learned one flu pandemic", to quote one expert. And it's frightening how little we really know, like we don't really know why it tends to break out in winter....
BTW, I've read you can generally get 3 doses of antigen per egg (note to others, what we think of the egg is one cell, it's the multicell egg membrane in which the viri grow). Although, with three different antigens per dose of vaccine, that gets you back to 3 eggs produce 3 doses. Except they're talking about doing two strains of type B: http://en.wikipedia.org/wiki/Influenza_vaccine#2013-2014_Nor....
Compared to the exponential growth of say ecoli bacteria, any of the current egg solutions are vastly inferior for production speed and expense. This is especially important for poorer countries, aid, and health initiatives.
The secondary infection I am talking about was due to common respiratory flora.
See: http://www.nih.gov/news/health/aug2008/niaid-19.htm
or from wiki: "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred."[30] The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.
The worry wasn't that avian flu or the swine flu would kill a lot of people in their current states, but that they would mutate into something considerably more dangerous. The swine flu, for example, was known to spread easily but wasn't _yet_ very lethal. The avian flu (H5N1) didn't _yet_ spread easily, but was very lethal.
If the swine flu mutated into something more lethal or if the avian flu mutated into something more communicable, then everyone would probably know someone that died from either virus. And that's exactly the worry with these new crop of viruses, and why it's important to react with extraordinarily measures -- to prevent them from becoming something much worse.