Irrationality watch: Among the pandemicists

Posted on April 28, 2009 by Heather Mac Donald

There were over 100 auto fatalities a day in the U.S. in 2008, a number that was celebrated for being so low.   So far, there have been no deaths from the swine flu outside of Mexico, where 149 fatalities are suspected.   Is there any hope that we are going to avoid a pandemic overreaction to the disease?

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12 Responses to Irrationality watch: Among the pandemicists

  1. pzed says:
    April 28, 2009 at 11:08 am

    an ounce of prevention…

    last 3 pandemics killed 33k, 70k, and 675k in the US. 2008 motor vehicle deaths numbered 37k. i’d say an overreaction is better than no reaction.

    but anyways, the obama administration is determined not to screen border crossings, so i’d say some ppl are keeping their cool. for better or worse.

  2. Mr. F. Le Mur says:
    April 28, 2009 at 1:16 pm

    “There were over 100 auto fatalities a day in the U.S. in 2008…”

    If you believe CDC figures (see below), there were also about 100 flu deaths per day in the US (yearly average).

    If you believe in the “CDC and flu vaccine makers” conspiracy (I do, to some extent), it’s quite rational on their parts to “overreact.”

    “Are US flu death figures more PR than science?”:
    http://www.bmj.com/cgi/eletters/331/7529/1412

    I’m less worried about the flu than about being drowned by a hot polar bear, or whatever it is “those people” keep worrying about.

  3. Gary says:
    April 28, 2009 at 3:52 pm

    It is a faulty comparison. Automobile deaths (in the aggregate) are independent events. There is no reason to believe that automobile deaths today will be related to automobile deaths tomorrow.

    Not true for deaths due to an infectious agent.

  4. TrueNorth says:
    April 28, 2009 at 4:09 pm

    I think caution is entirely appropriate for any outbreak of a new infectious virus. The costs involved in a false alarm are trivial compared to the costs that would be incurred in the event of a real pandemic.

  5. vij says:
    April 28, 2009 at 5:22 pm

    “…outside of Mexico, where 149 fatalities are suspected.”

    But that’s the thing. Mexico is where the flu broke out, so why wouldn’t there be some worry that the virus might have the same effect elsewhere?

    Usually, a garden variety flu kills the very young, the very old, and the already very ill. But the swine flu casualties in Mexico (now at 152) have been mostly young, healthy adults. So it’s also because of this profile that there is an excess of concern.

    And this is precisely how the flu pandemic of 1918 started out. In many places, people experience only mild symptoms. But as the flu passed through several generations, it became far more virulent and deadly. And, again, the majority of deaths from the 1918 pandemic were young adults with healthy immune systems.

    I agree that this is not the time to panic. I’m not wearing a mask or unnecessarily stockpiling my medicine cabinet yet, trust me. But it seems to me that being cavalier about this is also somewhat irrational, or at least premature.

  6. Anthony says:
    April 28, 2009 at 6:33 pm

    @Gary

    “It is a faulty comparison. Automobile deaths (in the aggregate) are independent events. There is no reason to believe that automobile deaths today will be related to automobile deaths tomorrow.”

    I don’t understand this comment. Flu deaths are related to other flu deaths by common pathways of transmission, viruses, and carriers. Auto deaths are related to other auto deaths by common roads, laws, and drivers.

  7. Mike says:
    April 28, 2009 at 10:23 pm

    @Anthony
    “I don’t understand this comment. Flu deaths are related to other flu deaths by common pathways of transmission, viruses, and carriers. Auto deaths are related to other auto deaths by common roads, laws, and drivers.”

    While driving to work tomorrow, I have no reason to assume (in fact, I have a great of experience which leads to me assume otherwise) that my risk of getting in a car crash- be it due to a flaw in the road layout or the stupidity of a fellow driver- will be any different from the risk I assumed at any other point in the many years of my commute. On the other hand, if I received word that the Bubonic plague had suddenly broken out in my community, I would have a good reason to assume that my risk of contracting an infectious illness had greatly increased, relative to the risk of contracting an infectious illness that I assumed had been operative prior to the outbreak.

    Unlike an outbreak of an infectious disease, one can assume that the risk of a car crash remains constant, assuming that the relevant risk factors (road conditions, driver skill, etc) also remain so. Thus, if there was a freak accident on the freeway that I normally commute to work on, which was not caused by a change in road conditions or driving credentials, I can safely assume that it was a “freak” occurrence, and not trouble myself over it. A viral outbreak, on the other hand, represents a disturbance of previous conditions, changes in variables, or what have you.

    I hope understand Gary’s comment more clearly now. If not, I will try to elucidate more clearly.

  8. cc says:
    April 29, 2009 at 12:46 pm

    “On the other hand, if I received word that the Bubonic plague had suddenly broken out in my community, I would have a good reason to assume that my risk of contracting an infectious illness had greatly increased, relative to the risk of contracting an infectious illness that I assumed had been operative prior to the outbreak.”

    Yes, but this is not the Bubonic plague. This particular strain of flu is spreading in much the same way regular flu does, and the effects the swine flu has on those who catch it (with the exception of those in Mexico) are no different from regular flu. In other words, this is no Bubonic plague. This is the flu! A new strain, yes, but new strains pop up every year. And that’s the point. Is this reason enough to panic and stock up on face masks because it’s receiving 24-hour coverage on CNN?

  9. Anthony says:
    April 29, 2009 at 2:03 pm

    @Mike

    Thx. I think I understand. It is the threat of further deaths, as opposed to some (for now) relatively small number of deaths, that makes a significant response to flu deaths an appropriate response and not an “overreaction”.

    I think Heather’s right, though, about how the media treats the number of people who have died already – that is, they treat it not just as important because it is a harbinger, but significant in its own right. Relative to yearly auto deaths (in the tens of thousands), it isn’t – yet, anyway.

    There is also clearly an element of media sensationalism here – because it can be made into a dramatic story in aggregate with a plot arc in a way that soul-numbingly regular auto deaths do not.

  10. vij says:
    April 29, 2009 at 4:04 pm

    “There is also clearly an element of media sensationalism here – because it can be made into a dramatic story in aggregate with a plot arc in a way that soul-numbingly regular auto deaths do not.”

    I understand. But I think part of the problem – paradoxically enough – is that for all the media sensationalism, they’re not putting enough information out there. Now I’m hearing 7 people in Mexico died of the flu; now it’s back to 150. The reporting isn’t consistent. And why are Mexicans dying when no one else is? We don’t have an answer. And if the WHO raised the threat level of a pandemic to a 5 (out of 6), then isn’t the so-called overreaction justified?

  11. vij says:
    April 29, 2009 at 4:23 pm

    One more thing. I’m watching the Obama news conference. The swine flu was the first thing he addressed. He is recommending that all schools with confirmed cases be closed for the interim. Texas has already closed some of their schools.

    Is the president, the Texas state government and the WHO overreacting with their latest comments and decisions? Maybe. I’m not qualified to say. But when the public sees these things happening, can we really still fault them for a “pandemic overreaction”?

  12. Punditarian says:
    May 10, 2009 at 10:23 am

    The point is not the absolute number of deaths from the flu, but the number of deaths compared to the total number infected, i.e. the case-fatality rate.

    Two things will determine whether the H1N1 pandemic will be a major problem or not, and only two things: the attack rate and the case-fatality rate.

    The attack rate is the percentage of the total exposed population who will develop the flu.

    The case-fatality rate is the percentage of those who develop the flu who will die.

    In a typical year, if memory serves, epidemic flu has an attack rate on the order of 25% and a case-fatality rate of less than 0.2%.

    The initial concern about the Mexican cases was the report of over 100 deaths with fewer than 2,000 known infections. That would indicate a virus exhibiting far more virulence than usual. And if the virus antigens are indeed quite novel, the attack rate would be expected to be higher than average.

    The numbers to date are very small and incomplete. In the United States, based on preliminary reports of the number of close contacts of flu-infected people who also develop the flu, the attack rate appears to be a little higher than usual, but not terribly so. As of today, there are about 3,000 cases, about 100 hospitalized, and there have been 3 recorded deaths.

    It is looking to be of usual virulence. So we can expect over the course of the next year, no more than 50,000 deaths attributable to this virus.

    That’s about 50 times as many deaths as were recorded in Louisiana during Katrina, so I think this H1N1 influenza is a disaster. But at this point, it doesn’t look like it will be nearly as bad as the 1918-1919 pandemic flu.

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