Tuesday, April 28, 2009

"Social Distancing" strategies to contain deadly pandemics (swine flu or bird flu) present a Catch 22 for politicians (and for the economy)

MSNBC has a rather alarming article about “social distancing” strategies, with the rather bombastic title “Best swine flu strategy: Stay away, everyone: Little-known ‘social distancing’ plans could close schools, gathering spots”. The story, by JoNel Aleccia is here.

The basic problem is a chicken-egg. Social distancing containment matters only work before a pandemic becomes deadly. It could shut down whole industries and cost many more jobs and livelihoods, permanently, and have a major impact on social structures and freedoms later. It might not be possible for many kinds of businesses to recover from a prolonged showdown. And it might not be necessary.

The MSNBC story has a poll which shows surprising (and disturbing) visitor support for social distancing even without much evidence of virulence. I voted “No” but was very much in the minority.

Writers say, the strategies worked partially in the 1918 Spanish Flu pandemic. There is some discussion of this in Peter Jennings’s book “The Century”.

And the mandatory social distancing strategies imposed in China and other asian countries in 2003 lasted for several months, but economies recovered. There is an interesting story on VOANews “Swine Flu Outbreak Reminds Hong Kong of SARS”, link here.

Measures like this were not adopted in the 1957 and 1969 pandemics, and the death toll was moderate, compared to 1918, and the genotype for those viruses was milder.

One theory of aggressive social distancing is to give authorities time to make a vaccine. Patrick Oppmann has a story on a CDC mathematician who simulates disease containment strategies, including social distancing, "Expert on flu's spread says new strain here to stay", link here. Done in time, containment, quarantines and social distancing can drop the death rate by 2/3 -- but what it that death rate would be small anyway? We don't know in time. The Centers for Disease Control (CDC) has a web subsite on social distancing, "Public Health Law Program: Social Distancing Law Assessment Template" link here.

But a big problem is that the US has outsourced much of its vaccine manufacture, and it cannot make an adequate supplies in less than six months.

Mexico seems to want to be re-opened for business about May 6. There is some indication that the rate of spread has slowed.

But the big problem seems to be the likelihood that tens of thousands of people in Mexico were exposed but recovered without medical intervention, so the death rate may have been greatly overstated.

On the other hand, the deaths seem to be in young adults, which is the pattern of the Spanish Flu (the cytokine storm issue).

In practice, it sounds like, in the U.S., the virus would have very low morality, but it needs to be treated quickly. Most likely it will behave like other flus. Remember, ordinary flu kills about 36000 people a year in the U.S. It is the unpredictable nature of the new virus, which may well be getting weaker as it spreads, which puts politicians in an untenable position, as well as the rapid spread of inconclusive information from medical labs, not possible in the 1970s.

I believe that I got the swine flu shot in 1976 while living in New York. In 2002, despite having a flu shot in the fall of 2001, I got a sudden flu-like illness while vacationing in California (and this is very rare for me). I had a sudden, severe cough and high fever and chills, which subsided after a night in bed in the motel. I felt better, and went to bars and restaurants. (How many people did I infect?) Then it came back a few days later for another spell of two days, then resolved. I was very weak during those spells. Afterwards, there was a lot of chest congestion. I think that I was exposed to a novel flu virus (not covered by vaccine) that simply didn’t get on the CDC radar screen. Probably most people recovered and developed some resistance. This 2002 virus might even have been an animal virus similar to the Mexican virus today. It was not virulent and burned itself out, becoming just part of the mix of everyday germs that we coexist with and develop resistance to. CDC should look at what happened in California in 2002.

Remember, social contact generally strengthens immunity against most things. Adults generally don’t get as sick as kids with ordinary things because they’ve had years to build up immunity. Kids exposed to many viruses and bacteria earlier in life often are less sickly as teens.

Another thing to remember: when Americans return from Mexico, they often have fevers because of mild gastrointestinal illness caused by lack of previous exposure to less sanitary food (harmless to locals). That could cause them to be detained.

I do wonder how visitors feel about this dilemma.

Note the Wednesday April 29 editorial in The Washington Times, "Swine flu hysteria: Beware of bureaucratic cures for supposed epidemics", link here. Read it and weep. I think that this time The Washington Times has it right. On Friday May 1 the Washington Times published a "letter of the week" called "fear the flu", by Mark E. Koltko-Rivera, Executive vice president and director of research, Professional Services Group Inc., New York City, link here.

Picture: How would "social distancing" affect GLBT businesses? See my GLBT blog here.

Update: April 29

One toddler who had visited Mexico has died in Texas. The child was from Brownsville, TX (a border town) and had visited Mexico. He had been hospitalized in Houston. The Dallas Morning News story is here.

A Virginia company, Novavax, may have an experimental vaccine for H1N1-swine in about ten weeks. The site is marked red by McAfee, but I think it's a "false positive" (pun and irony intended); you can go yourself.

April 30, 2009

John M. Barry, a visiting scholar at the Tulane/Xavier Center for Bioenvironmental Research, has an interesting op-ed in the April 28, 2009 New York Times, "Where Will the Swine Flu Go Next?" link here. His radio interview on NPR described flu viruses as "mutant swarms" out of Stephen King -- each infected cell produces millions of particles, only a few of which are infectious. No, this is not the "super flu" of Stephen King's "The Stand" but he fears that it just could turn into that some day.

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