Impact of 5 percent mortality

[kent nickell]

Most of the history here was taken from Barry's 'The Great Influenza'

The 1918 pandemic had about a 5% mortality rate for infected patients. If you take the US population of 300 million and take an attack rate of an easily transmissible virus as 30% that would mean 100 million infected. A 5% mortality would be 5 million deaths. Even worse is that with pandemic viruses the death rate is disproportionately large in the 20-45 year age group. One in every 67 soldiers in the US Army died of influenza in 1918 and its complications, nearly all of them in a ten-week period beginning in mid-September.

Factors today that are better than 1918 include better antivirals and antibiotics and better supportive care such as oxygen therapy and ventilators.

Factors worse than 1918 include worse secondary bacterial pathogens such as MRSA (methicillin resistant staph), more overcrowding esp in major cities and a more vulnerable population with more underlying conditions including HIV, people on chemotherapy, obesity and associated diabetes.

It took roughly six weeks from the appearance of the first cases for the epidemic to peak and then abate in civilian areas, and from three to four weeks in a military camp with its highly concentrated population.

The mortality rate in 1918 at Cook County Hospital in Chicago for all influenza cases ? not just those who developed pneumonia ? was 40%. In the US hundreds of doctors and nurses were dying.

In developing countries where some of these problems are accentuated deaths rates of at least 10% seemed to be not uncommon. India in particular seemed to have been hit particular badly in 1918. In the Indian subcontinent alone, it is likely that close to twenty million died. The virus also apparently killed around 7% of the entire population of Iran and Russia. In the Fiji islands 14% of the population would die in the sixteen days between Nov25 and Dec10. In Mexico as much as 4% of the population may have died.

?This level of morbidity and mortality led to the near social collapse of many American cities and did lead to the collapse of many local governments. Fear of uncertainty and lack of trust in local authorities due to lack of truthful reporting appeared to contribute to this. This fear helped lead to the fact that many died that only needed hydration, food and rest to survive but few were willing to come to their aid. Leadership must make whatever horror exists concrete. Only then will people be able to break it apart.?(Barry, The Great Influenza)

Comparisons of today to 1918 are of course hypothetical as the viruses are different and the social and economic conditions are different. However, there does seem to be some similarities in the way the disease is tracking?.

 

[appleblossom]

Re: Impact of 5 percent mortality

Factors today that are better than 1918 include better antivirals and antibiotics and better supportive care such as oxygen therapy and ventilators.

would there be enough of these to go around in a true epidemic situation to make an appreciable difference in fatality rates?

 

[kent nickell]

Re: Impact of 5 percent mortality

It seems that both are going to be much more limited than we would like esp with an increasing severity as well as the skilled people to deliver them...

 

[appleblossom]

Re: Impact of 5 percent mortality

that's why I remain a bit skeptical about our ability to fare any better in 2009 than we did in 1918. Medicine has advanced in leaps and bounds technologically, but has a limited capacity to deal with serious illness on the scale we are facing this fall.

 

[wotan]

Re: Impact of 5 percent mortality

would there be enough of these to go around in a true epidemic situation to make an appreciable difference in fatality rates?

Look how long some of the people who are surviving are spending on vents, over a month in some instances! There will likely be a point at which there are not enough vents or ICU beds to go around. Since we could not prevent the spread of the virus, we can only delay the inevitable should it be as violent as 1918.

 

[peter m]

Re: Impact of 5 percent mortality

"Comparisons of today to 1918 are of course hypothetical as the viruses are different and the social and economic conditions are different. However, there does seem to be some similarities in the way the disease is tracking…."

One difference from 1918 to today is the disease back then seemed to spread mostly via railroad routes and ships. Today the chief transmission vehicles would be rapid spread mainly via airplane travelors, truckers, international/domestic freight mail carriers, bus passengers, auto travelors, which would indicate a much more rapid dissemination of this disease worldwide .

The heavy usage of the automobile( at least in USA) in the present age may cut down on disease transmission rates somewhat( more in certain cities such as LA which are dominated by auto usage), as each person is somewhat incubated in automobiles most of the time.

Also from J barry: entire Eskimo villages in Alaska, and Labrador native settements were simply wiped out literally. The pandemic reached deep into isolated Aleutian villages and equally isolated jungles villages from Africa to New Guinea. No place was safe and only ruthless quarantee and isolation measures, such as shutting out visitors completely, would ensure that a settelment escaped the pandemic. American Samoa did not get the disease at all because the authorites immediately adopted these ruthless isolation and quarantee measures against all visitors , but being an island does help.

[B]The similarities to today and 1918 is that again the governments are ineffective/late as usual in their isolation & quarantee procedures, or too late in taking apppropriate counermeaures. As in 1918 there is not the political will to impose stringent isolation/ quarantee measures, especially in the USA. As in 1918 the US gov't will turn out to be incompetant & bungling, like a dinosaur wallowing around in a huge swamp, attempting to deal with the upcoming crsis. Flu fighting technology and medicine may have improved from 1918 but people do not change, and the US gov't will have the same ineffective hacks and dim- witted bureacrats dealing the SW flu pandemic as in 1918.[/B]

 

[tyto]

Re: Impact of 5 percent mortality

I wonder if the insurance companies could handle it. Hard-working folks paying life insurance premiums for decades only to have the companies go bankrupt or declare a force majeur in a severity 5 pandemic. Of course, if all the beneficiaries die too then the insurance companies would be thrilled. Sad but true.

 

[JimO]

Re: Impact of 5 percent mortality

that's why I remain a bit skeptical about our ability to fare any better in 2009 than we did in 1918. Medicine has advanced in leaps and bounds technologically, but has a limited capacity to deal with serious illness on the scale we are facing this fall.

We have a nurse friend who works with people on vents and she's concerned about the potential ethical dilemma medical professionals will be faced with. Suppose a small hospital has flu victims on all their available vents and there is a car accident with someone needing emergency ventilation. Medical professionals will have to triage and make life-and-death decisions for people that, under normal circumstances, could be saved.

 

[JimO]

Re: Impact of 5 percent mortality

I wonder if the insurance companies could handle it. Poor hard-working folks paying premiums for decades only to have the companies go bankrupt or declare a force majeur in a severity 5 pandemic. Of course, if all the beneficiaries die too then the insurance companies would be thrilled. Sad but true.

Wow! I hadn't even though about the financial impact as it relates to insurance. Even with few deaths, a lot of serious cases could break some of the insurance carriers, or even hospitals who have to care for a lot of uninsured patients.

 

[wotan]

Re: Impact of 5 percent mortality

Wow! I hadn't even though about the financial impact as it relates to insurance. Even with few deaths, a lot of serious cases could break some of the insurance carriers, or even hospitals who have to care for a lot of uninsured patients.

Will life insurance pay out to victims of a pandemic? Granted, young people are less likely to carry life insurance, but many I am sure do carry rather hefty policies to provide for their children.

 

[colormyquilt]

Re: Impact of 5 percent mortality

Kent. Thank you for this post re: John Barry's The Great Influenza.

It is amazing how history can, and does, repeat itself. In that respect, there is so much information made available in Barry's book that is helpful in understanding the h1n1 virus today in terms of a virus from 100+ years ago.

Communication and dissemination of information to the public was very similar to today. He does a very good job of presenting the facts supporting this with extensive information re: the war, the military, the disease within the military, governments' responses to the war, propaganda presented throughout the pandemic itself so as to support each governments' position.

What I find impressive is the history he provides re: the medical response to "the new disease which presented in a manner not witnessed prior." He reports so much that occurred medically behind the scenes- man-hours of research/ testing/ among the most prestigious/ and the frustration of those in the medical fields when unable to address the disease, it's morbidity and mortality in a timely manner. An unbelievable investment in time, hours, and hope. There were so many who did so much of what had to be done.

In re: counts of illness, deaths, even underlying medical conditions, information is provided in a manner which states the facts. This is helpful, I think, because it permits the reader time to digest, time to understand. For myself, the similarities are blatant. And the factors playing a role in this are equally apparent and similar.

As frustrating as our current situation is, we know others have been there before. We are blessed today with a communication system that permits information to travel around the world, and into parts of the world never imagined before, with the click of one button. In 1918, the medical field did not initially address the disease in terms of being a virus. One hundred years later, we have this information. Or believe we do. Yet, it's power continues to confound the best in the field. We do not know what to do with a disease that today can violently kill a healthy young person in a manner of days, even hours.

This virus is new in terms of genetics. It's severity is not. It's CAR, CFR, we do not know and is subjective to many factors. In 1918, those ordinary people like you and me were not able to pull up this information to help them deal with their crises. For in most instances, around the world, it was about taking care of the ill and burying the dead. And, in some circumstances, not being able to bury the dead.

Barry's book is a great read. Information is power.

 

[kent nickell]

Re: Impact of 5 percent mortality

I agree that our political response and overall communication has been far from perfect but compared to President Wilson saying practically nothing relative to the pandemic in 1918 to the military or civilian populations and newspapers rarely carrying anything but attempts at morale boosting I thought this was a fairly comprehensive, forthright article... (and good to see Dr. Niman's work being recognized)

http://www.nytimes.com/2009/07/10/health/10flu.html?_r=2&ref=health

Obama Warns of Swine Flu Resurgence

By DONALD G. McNEIL Jr.
Published: July 9, 2009

BETHESDA, Md. ? The Obama administration warned Americans on Thursday to be ready for an aggressive return of the swine flu virus in the fall, announcing plans to begin vaccinations in October and offering states and hospitals money to help them prepare.

?The potential for a significant outbreak in the fall is looming,? President Obama said by telephone link from Italy to the White House?s H1N1 Influenza Preparedness Summit, held at the National Institutes of Health.

With good planning, ?we may end up averting a crisis,? Mr. Obama said. ?That?s our fervent hope.?

The summit meeting was jointly led by the secretary of health and human services, Kathleen Sebelius; the secretary of homeland security, Janet Napolitano; and the secretary of education, Arne Duncan. It gathered health and school officials from across the country and took questions by video link from the governors of several states, most of whom wanted to know who would pay for preparations like the vaccination drive.

Vaccinations will begin in October only if tests scheduled to begin in August prove that the vaccine is safe and effective. Even then, officials expect only tens of millions of doses to be ready, so they will have to decide who is vaccinated first. The most likely candidates, Ms. Sebelius said, are school children, health care workers, pregnant women and people with asthma or other conditions that make the flu riskier.

While health officials were careful to warn that there was no evidence that the flu had mutated into a more dangerous form, they noted that it seriously disrupted some cities, including New York, in the late spring and could do worse as the fall flu season begins.

?This flu is not over,? said Dr. Thomas R. Frieden, the new head of the Centers for Disease Control and Prevention, describing its continuing spread in more than 50 summer camps, the large numbers of cases seen in Chile, Argentina and Australia, which are now at the beginning of their flu season, and the initial detections of three cases resistant to the drug Tamiflu.

At the flu?s peak in May, Mr. Duncan noted, 726 schools were closed across the United States. Decisions on closing schools will be made locally, he said.

Officials from New York and Texas described the difficulties they had in deciding which schools to shut down and how hard it was to explain why they picked those they did.

Both schools and businesses need to prepare for the possibility of several weeks of high absenteeism, Ms. Napolitano said. She also reminded governors that not only the obvious services, like hospitals and schools, would be affected.

?As a former governor, I can say: make sure your payroll continues,? she said. ?Whoever processes your checks, make sure they have a backup.?

Ms. Sebelius outlined actions the federal government was taking. It will offer $260 million in ?preparedness grants? to states and cities for the vaccination drive and $90 million to hospitals preparing for surges of cases. (Congress has already appropriated $1 billion for vaccine ingredients and up to $7.5 billion more for testing, buying and distributing vaccine if health officials decide it is safe and effective.)

The Health and Human Services Department is also remaking its Web site, www.flu.gov, to be the central repository of information for everyone, including parents, school officials and doctors. And it will hold a contest, asking Americans to film their own public-service announcements about flu.

?This is a YouTube challenge to everyone,? Ms. Sebelius said. ?The best will be aired nationwide.?

Health officials said that they were aware of fears that a Tamiflu-resistant strain of the virus was already spreading silently in the United States, but that they had not seen evidence that it was a threat.

The worry stems from a single case found in a teenage girl who flew to Hong Kong from San Francisco on June 12. According to Hong Kong media reports, she was found to have a fever during a routine airport screening and was hospitalized as a precaution and tested.

The girl was never dangerously ill, was not treated with Tamiflu and recovered. But the sequence of her virus, released last week by the authorities in Hong Kong showed that it had a mutation, known as H274Y on the neuraminidase gene, making it resistant to Tamiflu, a neuraminidase inhibitor.

The fact that the girl had a resistant strain without being treated suggests that she caught an already resistant virus from someone else, presumably in Northern California, said Henry L. Niman, who runs a Web site tracking flu mutations (recombinomics.com).

The Centers for Disease Control and Prevention has intensified its monitoring in Northern California, and no other samples with Tamiflu-resistant virus have been found.

Therefore, Dr. Frieden said, ?it does not appear to be widespread.?

Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said there was little reason to worry unless it became the dominant strain.

?But certainly you want to keep your eye on it,? Dr. Fauci added.

Different strains of virus ?compete? with one other each year, and the drug-resistant strains do not always win. But a Tamiflu-resistant strain of seasonal H1N1 flu utterly crushed its rivals during the last American flu season, rising to 99 percent of sequenced samples.

Also, Tamiflu-resistant strains can sometimes be successfully treated with Relenza, another neuraminidase inhibitor, with older flu drugs like rimantadine, or even with larger Tamiflu doses.

?It does worry me, though we know enough to expect this,? said Dr. Anne Moscona, a flu treatment expert at Weill Medical College of Cornell University.

?It strengthens the argument for more Relenza in the stockpile,? Dr. Moscona added, referring to the national stockpile of supplies for an influenza pandemic.

 

[blacknail]

Re: Impact of 5 percent mortality

Insurance companies won't have any issues paying claims as long as the death rate (from all causes) stays below 2%. If the death rate exceeds that, there are "death bonds" which will be called in, but there are only a few billion of those around. Last time I checked, the pricing on death bonds has not been affected by H1N1 SOIV. After that, insurance companies will liquidate longer term assets such as resource reserves and real estate. The problem of course is that if so many people die, real estate values will be worthless because all the people who died won't need homes and offices. Life insurance companies should have been investing in funeral homes to balance the risk I guess. Insurance companies have been lowering Term rates for some time because the death rate in the under 50 group has been falling for decades and if that group starts dying off in droves, it will have a huge impact on the pricing and profitability of Term Insurance policies for years to come. Certainly now is a very good time to buy term insurance because the rates are so low and that probably is going to change because of the financial crisis anyway. Insurance companies are already getting more risk averse and less willing to take on substandard risks (people who have underlying conditions) and so the companies with the tightest underwriting will outperform the ones who approve everyone as this group seems to have a higher risk of dying from the new flu.

 

[colormyquilt]

Re: Impact of 5 percent mortality

?This flu is not over,? said Dr. Thomas R. Frieden, the new head of the Centers for Disease Control and Prevention

?make sure your payroll continues...Whoever processes your checks, make sure they have a backup.?

There is information we would like to have about this virus. There is information we would like to have from those dealing directly with this virus. This includes information from those overseeing much of the programming re: this virus and response to the virus.

What stood out powerfully, in Barry's recount, was President Wilson's non-verbal response to the pandemic. A purposeful non-verbal response. For all so many reasons he may have felt justified in doing. Can history repeat itself?

With the information available to us today in re: spread of virus around the world in 3 months or less/ no vaccine/ no guaranteed treatment/ death of young, healthy children in days or less/ closing of summer camps/ quarantining of military/ quarantining of prisons/ rapid severity of disease for some with major organ failure- violent destruction of lungs, are we reacting differently than those, living in the 1918 pandemic, would have reacted with this same information?

Again, information is power.

 

[peter m]

Re: Impact of 5 percent mortality

"There is information we would like to have about this virus. There is information we would like to have from those dealing directly with this virus. This includes information from those overseeing much of the programming re: this virus and response to the virus."

We have much superior medical technology and the educated, intelligent & literate person has at his fingertips a wealth of info available off the internet to take measures for their own safety. The problem is that the educated folks,such as on this board, are a minority few.

Especially in the larger USA cities we have almost 3rd -type conditions, deteriorated slums and overcrowding, along with 3rd- world level hospital facilities. I took my elderly mom to my local ER at a major Hospital here in Long beach(Ca) and she had to wait 6 hrs to get treatment and admittance to the ER room. While there the level of care even in the ER rooms was not up to par, and the adjoining ER waiting rooms were filled to the brim with screaming kids and a packed roomful of waiting patients, and this was on a normal night in March before the first wave flu hit. BTW LA was barely touched the first round of flu. Imagine when the second more deadlier waves of flu hits in LA and SCal come late Sept /October how crowded the big city ER's will be. It will be pandemonium.

LA area has already seen 10-13 trauma centers shut down due to treating too many uninsured patients. That will further exacerbate matters. Plus there is a shortage of trained nurses all across the USA, an estimated 100,000 shortfall in the nursing profession. During the 1918 pandemic a good % of doctors and nurses themselves fell ill with the flu, and quite a few of those who became critically ill died. Patients were left untreated and uncared for due to attrition of medical staffs from the pandemic.

In an even moderate-level pandemic(assuming we are lucky) such as we are surely to see this fall the big city ER's will explode with uninsured patients. The present US economic depression will exacerbate this upcoming pandemic crisis, and swell the ranks of the uninsured.

I live in LA and i can tell u as a fact that the LA hospitals/ER's will crash and collapse this fall/ winter from dealing with massive pandemic waves, & from having to deal with massive waves of uninsured patients. This will not be reported by the big city papers and the US & local authorities, due mostly to politics & 'PC'. Again as in 1918 , they will downplay and manage the reporting, in fact will propagandize it to make the vast majority of led-by the nose sheeple think that the gov't is dealing effectively with the pandemic, even as deaths in ICU's rise exponentially.

Don't expect your gov't ,whether local/ state/ county/ Feds level to deal with this pandemic effectively. They can and will print out masses of documents and make them available online from their websites, but in the actual nuts and bolts/ day to day managing & dealing with the crisis as it occurs they will be shown to as bumbling and ineffective as in 1918-1919.

 

[the doctor]

Re: Impact of 5 percent mortality

An excerpt from The Coming Pandemic Catastrophe, Chapter 8

By Grattan Woodson

Chapter 8: Pandemic?s Long-Term Impact on Health and Disability
The medical consequences of pandemic influenza are usually spoken of in terms of the number of persons who become ill with the disease and die rapidly due to it or its complications. What is not well appreciated is death rates within the population will remain quite elevated for several years after a pandemic occurring today, based upon the 1918 Spanish Influenza experience. Data from the Insurance Institute for the years 1912 through 1923 clearly show the effect of the pandemic on crude death rates in 1918 as well as a sustained increase in this statistic for at least five years afterward.

Crude death rates in U.S. before and after 1918 pandemic
Year	1912	1913	1914	1915	1916	1917	1918	1919	1920	1921	1922	1923
Rate	10.0	12.3	8.9	15.7	27.0	17.4	301.8	99.0	70.5	11.3	31.0	44.1
Rates are Deaths per 100,000 persons; U.S. Population in 1918 was 100 Million Data from the Insurance Information Institute

These data show the crude death rate averaged 15 per 100,000 persons annually in the six years before the 1918 pandemic. During the pandemic year of 1918, the crude death rate was 302. In the five years following the pandemic, the crude death rate averaged fifty-one, more than three times the average rate seen in the six years before 1918. This translates into an excess death rate of 165 people per 100,000 or about 165,000 persons in the United States over this five-year period.

Obviously some of the deaths seen in the years during and after the First World War are related to injuries suffered in that conflict. Recent studies show the principal cause of death among U.S. solders during WWI was influenza rather than war wounds. In fact, of the solders dying during WWI, only one in five died as a result of conflict, with four in five dying primarily of influenza or post-influenza pneumonia.

An analysis of excess mortality following pandemic flu in 1918
While the cause of the excess mortality seen in the five years after 1918 is not provided by the crude death rate statistic, it is reasonable to assume that the majority of these deaths were in patients who survived bouts of influenza-associated severe organ damage documented by clinicians during the pandemic. Some of the deaths can also be attributed to mini-waves of H1N1 Spanish Flu observed in the United States for several years following the actual pandemic in 1918-19.

Seasonal influenza is primarily a pulmonary disease that rarely affects other organ systems. The ferocity with which Spanish Flu attacked patients? lungs and the severe, often-fatal damage it caused in other organ systems was not something doctors at the time had seen before with influenza or any other disease. Armed with advanced laboratory techniques, scientists today studying the 1918 flu have determined that many of these unique pathological features of the Spanish Flu were caused by lethal polymorphisms contained within the H1N1 genome. A polymorphism is simply a variation in a small area of a gene. This slight rearrangement of the nucleotides that compose the gene results in a characteristic that is different from that seen in other members of the same viral family without the change.

These particular polymorphisms are called lethal because the characteristics they code for caused unusually severe damage to the lung and other organ systems, resulting in much higher death rates than seen in patients with common seasonal flu. Specifically, the Spanish Flu expressed lethal polymorphisms that mounted aggressive and destructive attacks on the lung, brain, kidney, liver, and blood coagulating system. Most patients who suffered significant organ damage during the Spanish Flu died soon thereafter. The majority of deaths in excess of those expected during the 1919-23 period were probably those who lived through the acute injury phase of the disease but whose lives were significantly shortened by the organ damage suffered. The severe stress influenza places on the body is commonly associated with disabling heart attacks and strokes that can lead to death from congestive heart failure, pulmonary embolism, and sepsis. These complications, seen today with seasonal flu, were also seen during the 1918 pandemic and were another reason for the excess deaths in the years after that time.

There is also data linking prior pandemic influenza infection in 1918 with an increased risk for the neurological disorder Parkinson?s disease. This disabling and eventually fatal condition began to emerge in the late 1920s and early 1930s in patients who survived the 1918 pandemic. On average, patients with this condition survive about eight years after developing its symptoms. It is not known how a prior infection with influenza could cause Parkinson?s disease but it is speculated that these patients suffered non-lethal brain injury during the pandemic that ultimately resulted in the development of this condition.

The H5N1 genome contains many lethal polymorphisms seen in 1918
As detailed in Chapter 2, genetic studies released in the past few years found that H5N1 bird flu has accumulated most of the same lethal polymorphisms in its genome that were present in the H1N1 Spanish Flu during the 1918 pandemic. The high case fatality rate seen today with bird flu is due to both cytokine storm affecting the patient?s lungs and to multi-organ failure, a characteristic of extra-pulmonary viral infection. A severe pandemic caused by H5N1 will be accompanied by a large number of people who die during the pandemic soon after developing the flu. Undoubtedly, though, as was the case in 1918, there will be many others who survive their acute illness but are temporarily or permanently disabled by the infection or its complications. These include previously healthy people who survive significant lung injury from viral pneumonia, ARDS, and/or post-influenza bacterial pneumonia as well as those that sustain significant extra-pulmonary primary viral infection of the brain, heart, liver, and kidney. Many others who suffer a disabling but not fatal heart attack or stroke due to the stress of their illness will also survive.

Advances in medical care since the 1918 pandemic have improved the prognosis for patients after suffering disabling organ damage from a variety of causes, including the injuries described above. In the past, these patients would not have survived for long with injuries this severe, which probably explain the increased crude death rates seen during the half-decade following the 1918 pandemic. Many people disabled by these conditions today live for many more years with a modicum of quality of life and a few are even able to return to work.

An epidemic of insolvent disability and health insurance plans
While the alternative model presented in Chapter 3 on Pandemic Illness and Death predicts that about three percent of the U.S. population will die from influenza during the pandemic, the number of disabled flu survivors will exceed this number by two or three times. The care of these people will fall primarily upon the shoulders of their families. Public and private disability and medical plans will be especially hard hit by the cost of both disability income support and medical expenses. Complicating this situation is the fact that these claims will be coming in at virtually the same time rather than being spread out over many years as is actuarially contemplated by all insurance plans. The number of persons working and paying premiums to these plans will be reduced as some will be dead, others disabled, and still more unemployed due to the economic depression caused by the pandemic.

Under these conditions, many employer-sponsored and insurance company health and disability plans will experience extraordinary claim demands that will exceed their ability to pay. These under-funded plans will enter bankruptcy defaulting to the Social Security system, Medicaid, and Medicare. Social Security payments begin at the date of disability but Medicare medical benefits do not begin until two years after this date. This means that disabled flu survivors whose employer-sponsored health plan has become insolvent will be responsible for their own medical expenses until two years pass or they become impoverished and qualify for Medicaid.

Economic implications for the U.S. government?s social safety net
As the insurer of last resort, the U.S. government will be saddled with a huge and unplanned for financial outlay at a time when its tax income will be markedly reduced. If we assume that future government spending remains at the 2008 level of $2.9 trillion annually during the pandemic year and for the three years afterward, during which the country is mired in economic depression, the affect on the budget deficit will be profound. Some idea of the magnitude of this problem can be gleaned by projecting the impact of influenza on the country?s workforce and U.S. government tax revenues during that period.

A simple economic model based upon a pandemic of the severity detailed in this book would result in U.S. unemployment averaging twenty percent over a four-year period beginning about two months after the pandemic outbreak. Three percent of the working population will be dead from the flu and, conservatively, another six percent will be disabled. Tax revenues with this model would fall by at least twenty-nine percent during this period. What?s more, since the families of the deceased workers and the disabled and their families would be drawing new entitlement benefits, these new outlays will further increase the cost of the Social Security program. Unemployment benefits would also increase government spending. The outlays for the care of those already on Medicare and Medicaid for treatment of acute influenza, as well as continuing chronic treatment of elderly and disabled flu survivors whose health was impaired due to their illness, will be much higher than current levels. Future outlays by the Social Security program, Medicare, and Medicaid would be offset to the extent that current beneficiaries succumbed to their illness during the pandemic, but this is far from a happy prospect.

This very unsophisticated model suggests that the U.S. budget deficit would rise to about $1.5 trillion annually if spending were maintained at current levels for the four years of the pandemic and economic depression. Of course, the impact of inflation, the value of the dollar, U.S. Treasury Bond interest rates, additional stimulatory spending by the government, corporate bankruptcy, paying unemployment benefits beyond the statutory period, and the affect of civil disorder within the country would all raise this estimate considerably.

Crisis driven legislation; a fact of U.S. political life
The increased demands placed upon the Medicare and Social Security Trust Funds under these circumstances will advance the time when they will become unable to support those entitled to these benefits by many years. The U.S. government will be faced with this crisis at the same time it is grappling with the medical, social, economic, and international devastation caused by the influenza pandemic. Under these conditions, our government leaders will be severely stressed. Many will have been quite ill, some will have died, but all will have been personally and tragically affected by the pandemic in many ways. The decisions they make during this period of great physical and emotional stress are likely to have a profound impact on our way of life for generations to come.

It is unfortunate that this country has a history of not dealing with problems until they reach crisis proportions. The major political parties in the United States have both moved away from the center and become more polarized. They have systematically removed or marginalized those within their parties who previously occupied the center. With this change has come the loss of their ability to build coalitions across party lines required to pass major reform legislation. While politicians in the United States are clearly the standard bearers of this unstable form of government, it is We the People of the United States who shoulders this shame. Our politicians simply reflect the views of the voters, and only the voters can improve the despicable way the United States is governed.

While I wrote this book with an H5N1 pandemic in mind, the above comments apply to any severe pandemic. By severe I mean one with a CAR of 50% and a CFR of >4%.

GW

 

[zimagail]

Re: Impact of 5 percent mortality

many of them impoverished recent immigrants...
this is racism, sorry, where someone was born is not important in this discussion

 

[the doctor]

Re: Impact of 5 percent mortality

many of them impoverished recent immigrants...
this is racism, sorry, where someone was born is not important in this discussion

Speaking of these human beings, here is another excerpt from The Coming Pandemic Catastrophe


Chapter 5: Our Vulnerable Food Supply
The unsustainable size of the human population
From a purely biological prospective in the short run, our species, through technology and the benefit of favorable weather for the last hundred years, has outwitted the natural impediments to unrestrained population growth. These factors have created the conditions for a human population explosion that has crowded out many other species and resulted in environmental imbalances due to the vast increase in the number of humans on earth. During the twentieth century, the human population tripled to 6.6 billion. This growth in percentage and absolute terms is unprecedented for our species and constitutes an exponential phase in our numbers, a biologic event that in the past with other species has always been followed by a rapid and dramatic die off as the balance of nature is restored.

Regrettably, there is very little to be done about our population size or its continued growth. Many have sounded the warning claxon but most of humanity remains deaf to its clear and unmistakable cry. Since humankind has been unable to control itself, this task will default to the ultimate arbitrator of life and death on earth, Mother Nature.

There is really nothing anyone can do about this now, as it is much too late. Our only option is to sit by and wait for Nature in Her guise as the Grim Reaper to administer the bitter medicine. Research into this problem has led to the conclusion that a worldwide crop failure is the tool nature will use to control the human population. There are more than a few ways this could occur, with some being common and others rare events. They include natural disasters and manmade ones. There is hope that we can prevent the manmade causes for crop failure. On the other hand, there is no way to avoid the catastrophic natural disasters, which will all happen given enough time. A failure of world food production is the weakest and most vulnerable link underpinning and supporting the rise and maintenance of the human population. It is certain that this calamity will happen at some point; the when and how are a matter of speculation. One of the most likely causes for a worldwide crop failure in the near future is a severe influenza pandemic that disrupts food production, processing or distribution.

Food shortages, starvation, and civil disorder
Widespread food shortages will predictably result in a breakdown in civil order, leading to great loss of life that will add significantly to those who succumb directly to the influenza virus and starvation. Conflict between nations desperate to obtain what food supplies remain can be expected to occur. State failure, civil war, and coup d??tat will become commonplace for years following this catastrophe, even after food supplies become more plentiful. All these human events will contribute to the death toll. Under these conditions, the human population will be particularly vulnerable to epidemics of fatal diseases presently held at bay like cholera, tuberculosis, plague, and pneumococcal pneumonia.

These thoughts bring to mind the writings of the nineteenth-century economist Thomas Malthus who first published his observations on the factors limiting human population growth in 1798. While Malthus had many supporters, history has proven his critics correct in debunking his prediction that exponential human population growth would outpace agricultural production before the end of the nineteenth century leading to the catastrophic prediction quoted below.

?The power of population is so superior to the power of the earth to produce subsistence for man, that premature death must in some shape or other visit the human race. The vices of mankind are active and able ministers of depopulation. They are the precursors in the great army of destruction, and often finish the dreadful work themselves. But should they fail in this war of extermination, sickly seasons, epidemics, pestilence, and plague advance in terrific array, and sweep off their thousands and tens of thousands. Should success be still incomplete, gigantic inevitable famine stalks in the rear, and with one mighty blow levels the population with the food of the world.?
Thomas Malthus

Economists point out that Malthus failed to apprehend the Green Revolution, globalization, and the prolonged period of supportive climatic factors present during the twentieth century, which allowed food production to rise as fast as the population. As a result, some refer to him as ?the failed profit of doom.?

Malthus erred in not giving human ingenuity sufficient credit and in his timing of the catastrophic human die off, but his basic prediction will probably be proven correct in the long run. The deadly sin of hubris has led humankind to declare premature victory over the forces of nature that Malthus knew and understood to hunt man just as wolves and wild cats control the populations of deer and other herbivores.

Politics and food policy
Food has been so plentiful in the world?s developed nations since 1950 that those born after this time take this largess for granted. Governments of all advanced nations have followed a policy that keeps the supply of food high and the price low. The politics of this is simple; most people in the economically advanced nations live in cities and are employed in the non-farm economy where they produce ninety-five percent of the GDP for these nations. For instance, based on data from the U.S. Department of Agriculture from 2002, farm worker productivity has risen to the point in the United States where less than one in fifty-four of the 167 million Americans employed in that year produce most of the food consumed in the United States as well as a surplus supporting millions of others the world over. What?s more, only one in three of these workers is classified as a wage or salaried employee while the remainder are farm proprietors.

The burden of this food policy comes at the expense of those who produce food, like the 890,000 U.S. farm laborers who perform the vast majority of the hand labor in the fields and on the farm. Farm profits are kept so low by this food policy that small farmers are unable to operate at the economies of scale required to make a reasonable profit for the resources invested. Over the last sixty years in the United States, this has led to the demise of the small farmer and the ascent of gigantic agribusiness enterprises that now produce most of the grain, produce, and meat in this country.

Wages and salaries paid to farm workers by both the remaining independent farmers and U.S. agribusiness is low compared with those employed in the non-farm economy. This fact and the hard physical labor required for this work has made it difficult to find people to perform it. As a result, many farm workers in the United States are undocumented aliens or those with limited emigration status with guest worker visas in the EU. These workers often live in very overcrowded conditions, have little or no access to health care, and are socially invisible to the society they serve.

The food policies of the advanced economies have been exported to the less developed nations by default through the power of the international commodities markets that normalize prices paid to farmers for their goods worldwide. In the poorest nations, forty-two percent of the working population is employed in agriculture, twenty-two times the number seen in the United States. The impact on farmers and employed farm workers in the less developed nations of the world is the same as in the wealthy nations; it keeps them poor and disadvantaged.

Despite the growth in world food production during the twentieth century, the United Nation?s Food and Agriculture Organization (FAO) estimates that over 800 million people do not have enough food to eat today and nearly two billion have nothing like real food security on an ongoing basis. Virtually all these people live in the undeveloped nations. Failure of world food production for any reason will impact these persons first and most severely resulting in starvation of the majority.

Not everyone working in agriculture is disadvantaged, impoverished or poorly educated. There are many good jobs in the farm economy that require high skill levels and expertise. These persons, though, do not perform the hand labor still required in the field and slaughterhouse.

Human population, technology, and the weather
The unbridled increase in population since Dr. Malthus made his predictions is an outgrowth in part of the industrial revolution and the bounty it produced. The tools and technology developed over the last three centuries has led to the shared delusion that we are no longer subject to forces of nature. Today many unconsciously invest their fellow men with Olympian powers that give them the potential to overcome any and all obstacles produced by the natural world.

Archeological evidence from prior eras provides ample proof of the burden our ancestors had coping with the natural world. Beginning in about 1900, the planet began to warm, creating a climate where advances in agriculture could be readily exploited. The vast increase in world food production since that time presaged the human population explosion it supported.

While the technological advances in horticulture permitted humankind to exploit these favorable environmental conditions, the supportive weather pattern we have enjoyed over the last century is what made our agricultural success possible in the first place. This favorable period is but an eddy in the geologic lifespan of the planet and not very typical of the past and probably not of the future either.

Climate change has been a constant feature even without our release of excess carbon dioxide and other manmade chemical pollutants into the atmosphere, which many now think explains the rise in global temperature seen recently.

From the accompanying world temperature graph, it is quite clear that the temperature of the earth began rising in about 1900 and the rate of increase has been the same throughout the last one hundred years. This is a surprising finding, because if global warming was indeed due to carbon
dioxide release by industrialization, the rate of climate change should have picked up as the burden of gas increased. This is not what the data show and is an interesting anomaly. Whether or not global warming is really due to man?s release of greenhouse gases or not, there is little question that polluted air and water are undesirable and that global fossil fuel production will peak someday, if not already. That our stewardship of the earth?s environment has been abysmal is not debatable. The question is can we change our behavior quickly enough to prevent the extinction of our species from a poisoned environment? We still have a chance to avoid this embarrassing demise but how much time is anyone?s guess.

The Green Revolution and good weather
Food production per acre has increased dramatically in the last century through the combined effect of skilled and unskilled labor, fertilizers, irrigation, hybrid seeds, herbicides, pesticides, machinery, advances in horticultural science, efficient commodity markets, bank credit, and favorable weather conditions. There is no doubt that the inputs contributed by humankind have been critically important to this success, but it is the benign weather condition that has been the key factor.

Good weather is the most important independent variable in the food production equation upon which everything else depends. Today, all the best arable land on the planet is already under cultivation. Some has already been ruined by over farming. More is being consumed by the growth of cities. Intensive use of resources, especially irrigation, has permitted the exploitation of marginal areas as well. Fresh water resources are being exhausted at a rapid rate due to its use in agriculture and to support large human populations.

As Malthus pointed out, human population growth and agricultural production are interdependent; both rising in parallel over the last few millennia. It is unlikely that agricultural production can continue to grow exponentially in the future as it has during the Green Revolution. In fact, the FAO reports that world food production peaked in the early 1990s and has been in a slow decline since. The ?low hanging fruit? generated by science and technology has already been harvested. Future growth in yields will require the widespread adoption of genetically modified foods and more intensive use of resources like fertilizers, herbicides, and pesticides but is likely to be incremental rather than exponential as seen during the twentieth century.

Pandemic influenza?s impact on food security
Pandemic influenza is a natural event that is both common and very likely to occur soon. A major pandemic of the severity of the 1918 Spanish Influenza occurring today is likely to be much worse than in 1918 due to burgeoning world population and its concentration within urban areas. The manner in which a pandemic could affect world food production relates to its effects on workers within both the non-farm and farm economies. Large-scale absenteeism due to illness and death will interrupt the orderly flow of the inputs needed to maintain world food production at current levels.

Illness and death among the vulnerable agricultural workers who perform the menial labor in the fields and food processing facilities worldwide is a factor which will keep food production reduced for years into the future even after the non-farm economy has begun its long recovery. These workers are among the lowest paid and are quite unprepared to survive the ravages of a deadly influenza pandemic. In the United States for instance, Mexican immigrants, most of whom are undocumented, compose a large percentage of agricultural and food processing workers. They do much of the hand field labor and perform a considerable portion of the most undesirable slaughterhouse work within U.S. agribusiness. These workers are for the most part in the age fifteen to forty-five group predicted to take the brunt of the pandemic storm once it arrives.13

This same demographic holds for farm laborers employed in other major food-producing nations, be they advanced or undeveloped. In 1918, this age group suffered higher death rates than any other. World food production everywhere is dependent upon men and women within this demographic who are those most likely to succumb to pandemic influenza. In their absence, who will perform the stoop labor, hand planting, and picking needed to plant, maintain, and bring the crops in? Very few citizens of the developed nations produce food work in agriculture today and those that do are primarily employed in skilled positions. Obviously this is an unstable situation that places everyone at risk should the world experience a major pandemic in the future, an event that has become increasingly probable and soon.

Replacing the absentee field and food processing workers will be very difficult as most people employed in the non-farm economies of the world have no experience with hard physical labor and are too weak and soft to perform this work well even if they could be persuaded to do so. Meat processing in the United States and Europe is highly dependent upon this disadvantaged demographic. It is difficult to imagine finding additional native-born American or European replacements for the absentee Mexican, Turkish, or North African employees ready and able to work in a chicken processing plant or a cattle or swine slaughterhouse.

Obviously, food security is an important condition for maintaining civil order in any society. Food shortages will not be well tolerated by people who have never been hungry before, which includes most people alive today in the developed nations. A failure in world food production during a major influenza pandemic can result from an interruption of inputs critical to agricultural production and/or absenteeism of farm and food processing workers. Civil disorder is an obvious consequence of worldwide famine.

One world crop failure and billions starve
It will come as a surprise to many that the great achievements in food production are really quite fragile and subject to collapse from a variety of circumstances. The coming pandemic?should it be as severe as many others?will, I expect, lead to a significant decrease in world food production for a year or longer due to sickness and death among farm workers, food processors, and distributors. It will also interrupt the supply of inputs critical to the success of world agriculture, causing crop yields to fall precipitously. Given the fragile dependence of the present human population on continuous high productivity of world agriculture for its sustenance, the only logical outcome from just one world crop failure is mass starvation for as many as half the human population.

 

[Zac]

Re: Impact of 5 percent mortality

An excerpt from The Coming Pandemic Catastrophe, Chapter 8

By Grattan Woodson

A simple economic model based upon a pandemic of the severity detailed in this book would result in U.S. unemployment averaging twenty percent over a four-year period beginning about two months after the pandemic outbreak. Three percent of the working population will be dead from the flu and, conservatively, another six percent will be disabled. Tax revenues with this model would fall by at least twenty-nine percent during this period.

...

This very unsophisticated model suggests that the U.S. budget deficit would rise to about $1.5 trillion annually if spending were maintained at current levels for the four years of the pandemic and economic depression.

I think your predictions may be optimistic since the US budget deficit is already approaching $1.5 trillion annually (last report was $1 trillion for the past 9 months) even now. Likewise, official statistics already place the narrowest measure of unemployment at 9.5% and the wider measure (U6) at 16.5% Most states and municipalities have already seen their tax revenues plummet with many states seeing 20-30% declines. And I would think the insurance companies are not in pristine condition either given the financial crisis in progress. And this is all before the pandemic.

 

[the doctor]

Re: Impact of 5 percent mortality

I think your predictions may be optimistic since the US budget deficit is already approaching $1.5 trillion annually (last report was $1 trillion for the past 9 months) even now. Likewise, official statistics already place the narrowest measure of unemployment at 9.5% and the wider measure (U6) at 16.5% Most states and municipalities have already seen their tax revenues plummet with many states seeing 20-30% declines. And I would think the insurance companies are not in pristine condition either given the financial crisis in progress. And this is all before the pandemic.

Yes, you are correct, but I wrote this book in 2007 when things were rather rosier economically.

GW