Christian Rivers
Senior Moderator
I post this opinion piece from a Jakarta paper in the psychosocial section as a point of discussion. Two items strike me. The tone of the article may generate distress and turmoil even if we agree with many of the facts. Second, he states that only 400 actual tests for H5N1 have been conducted in Indonesia and explains that is the reason for not knowing the true fatality rate for avian flu in humans. That figure is far below what I would have expected based on the certainty of statements published in other settings.
In order to address the fear of pandemic flu, the principles of risk communications and the posts in flutrackers.com about Dr. Sandman’s work are most helpful. An important key in risk communication is compassionate competence. Maybe a good exercise is to try to take the facts in this article and re-write it constructively.
CR
http://www.thejakartapost.com/detaileditorial.asp?fileid=20060718.E02&irec=1
Avian influenza risk: A reality check
Jakarta
Bird flu kills people, and does so with frightening alacrity. More than half of those infected with the H5N1 strain of influenza died, despite good clinical care. We know that one of its predecessors killed 40 million people around the globe long before the age of commercial aviation, automobiles, and mega cities. That virus killed only 1 to 2 percent of those infected.
Imagine H5N1 infecting far more people with far greater speed and very high mortality rates -- it is an apocalyptic vision. Such an event would turn the course of human history in a few short, terrifying months. Or we could see a super volcano that causes an ice age, or a massive meteorite strike that does much worse.
All of these scenarios have two things in common: They are science fact, not fiction, and they are very unlikely across the extremely brief span of time represented by a hundred years (less than a blink of the eye in geologic time). Defining significant as sufficient to change the course of biological history, the last significant super volcano was 70,000 years ago (go see its footprint at Lake Toba), and the last significant meteor strike was 65 million years ago. Pandemic influenza is no geological event. These occur every 30 years or so, and we are overdue.
A pandemic will happen, and H5N1 is a good candidate -- with some important and often overlooked caveats. In providing consulting to corporations preparing for a pandemic, I have been surprised by the expectation of calamity and the consequent extreme measures being planned.
When pressed for a rationale to justify these measures, they explain coping with a virus that kills most of the people it infects -- like Ebola or some other super deadly microbe. What most of these lay planners fail to grasp is the extremely low probability of the virus causing a pandemic to be as deadly as H5N1 now appears to be.
There are two compelling reasons for this optimism:
First, H5N1 itself may not be all that deadly.
Sec0nd, Darwin would object to a virus that rapidly kills most people and yet manages to spread around the globe. Health officials around the globe have done a horrendously poor job in getting this hopeful and truthful message across to the public.
On the first point we should all understand that H5N1 virus may well have a mortality rate far below the roughly 50 percent death rates seen among those diagnosed. Why? The diagnosis of H5N1 is extremely challenging.
It requires highly skilled scientists equipped with very expensive gear and extremely carefully chosen reagents. Only two laboratories in Indonesia are capable of doing it reliably, and between the two of them they have examined about 400 people since the middle of last year.
People with fever and the sniffles will not get this diagnostic testing. They must be severely ill. Absolutely no one knows how many people have been infected by H5N1 and recovered after a completely unremarkable illness. It is too difficult and expensive to screen the tens of thousands of people needed to come up with a true fatality rate for this infection.
On the second point, Darwin's natural selection is at work. Viruses have to obey these rules, too. Humans and viruses have been around long enough for us to have a grip on what is likely or not. There are well known examples of viruses that rapidly kill most people they infect -- smallpox, Ebola, Lassa, Marburg, to name just a few.
These awful viruses have more than high mortality in common -- they do not cause pandemics. They erupt periodically in pockets of outbreaks or epidemics, and then vanish. In stark contrast, the most widespread viruses -- infecting us day in and day out, like a cold virus, or cold sore virus -- also happen to be the most benign.
That contrast is no accident. Viruses that kill efficiently severely limit their own ability to proliferate. Their severely ill host inspires fear among potential new hosts, and the rapid death of the host further limits the chances of transmission. A rapidly lethal virus capable of causing a pandemic would have to possess an array of characteristics currently unknown to science. HIV comes close, but its success hinges upon the fact it is very slowly lethal.
Responsible scientists could not reasonably allow for a forecast of pandemic with a virus killing more than half of those infected. It is possible, but it is in the realm of probabilities found in geologic time and events. If it has happened in human history, we don't know of it.
When pandemic influenza finally occurs, and it will, we are not likely to see mortality rates going much higher than 1% of those infected. Yes, that will kill many millions of people and it will be very unpleasant -- but it will not be a human calamity that changes the course of our biological history. That is, unless we let it do so.
If people do not come to work for fear of a deadly infection (that in reality is not so deadly), we face far greater risks as a species by loss of the thing that sustains almost all of us: our economically woven society. Food appears on our table because we buy it from people who go to work. Electricity comes into our homes because people go to work to provide it for a fee. We fly in airplanes managed by people who go to work. People who go to work provide us security in maintaining law and order.
Franklin D. Roosevelt said it best, "We have nothing to fear but fear itself." Organizations planning for the pandemic should focus on getting the workforce to come to work. It is the failure of workplaces that poses, by far, the greater danger to us all.
Employers should address fear of this virus because it is more dangerous than the virus itself. Governments should make the investment needed to gauge the real danger of a virus like H5N1, rather than simply put out the death toll among the most severely ill. People need to go to work, even if there is some biological risk -- and they will if they know what they are facing and have the tools needed to minimize that risk.
In order to address the fear of pandemic flu, the principles of risk communications and the posts in flutrackers.com about Dr. Sandman’s work are most helpful. An important key in risk communication is compassionate competence. Maybe a good exercise is to try to take the facts in this article and re-write it constructively.
CR
http://www.thejakartapost.com/detaileditorial.asp?fileid=20060718.E02&irec=1
Avian influenza risk: A reality check
Jakarta
Bird flu kills people, and does so with frightening alacrity. More than half of those infected with the H5N1 strain of influenza died, despite good clinical care. We know that one of its predecessors killed 40 million people around the globe long before the age of commercial aviation, automobiles, and mega cities. That virus killed only 1 to 2 percent of those infected.
Imagine H5N1 infecting far more people with far greater speed and very high mortality rates -- it is an apocalyptic vision. Such an event would turn the course of human history in a few short, terrifying months. Or we could see a super volcano that causes an ice age, or a massive meteorite strike that does much worse.
All of these scenarios have two things in common: They are science fact, not fiction, and they are very unlikely across the extremely brief span of time represented by a hundred years (less than a blink of the eye in geologic time). Defining significant as sufficient to change the course of biological history, the last significant super volcano was 70,000 years ago (go see its footprint at Lake Toba), and the last significant meteor strike was 65 million years ago. Pandemic influenza is no geological event. These occur every 30 years or so, and we are overdue.
A pandemic will happen, and H5N1 is a good candidate -- with some important and often overlooked caveats. In providing consulting to corporations preparing for a pandemic, I have been surprised by the expectation of calamity and the consequent extreme measures being planned.
When pressed for a rationale to justify these measures, they explain coping with a virus that kills most of the people it infects -- like Ebola or some other super deadly microbe. What most of these lay planners fail to grasp is the extremely low probability of the virus causing a pandemic to be as deadly as H5N1 now appears to be.
There are two compelling reasons for this optimism:
First, H5N1 itself may not be all that deadly.
Sec0nd, Darwin would object to a virus that rapidly kills most people and yet manages to spread around the globe. Health officials around the globe have done a horrendously poor job in getting this hopeful and truthful message across to the public.
On the first point we should all understand that H5N1 virus may well have a mortality rate far below the roughly 50 percent death rates seen among those diagnosed. Why? The diagnosis of H5N1 is extremely challenging.
It requires highly skilled scientists equipped with very expensive gear and extremely carefully chosen reagents. Only two laboratories in Indonesia are capable of doing it reliably, and between the two of them they have examined about 400 people since the middle of last year.
People with fever and the sniffles will not get this diagnostic testing. They must be severely ill. Absolutely no one knows how many people have been infected by H5N1 and recovered after a completely unremarkable illness. It is too difficult and expensive to screen the tens of thousands of people needed to come up with a true fatality rate for this infection.
On the second point, Darwin's natural selection is at work. Viruses have to obey these rules, too. Humans and viruses have been around long enough for us to have a grip on what is likely or not. There are well known examples of viruses that rapidly kill most people they infect -- smallpox, Ebola, Lassa, Marburg, to name just a few.
These awful viruses have more than high mortality in common -- they do not cause pandemics. They erupt periodically in pockets of outbreaks or epidemics, and then vanish. In stark contrast, the most widespread viruses -- infecting us day in and day out, like a cold virus, or cold sore virus -- also happen to be the most benign.
That contrast is no accident. Viruses that kill efficiently severely limit their own ability to proliferate. Their severely ill host inspires fear among potential new hosts, and the rapid death of the host further limits the chances of transmission. A rapidly lethal virus capable of causing a pandemic would have to possess an array of characteristics currently unknown to science. HIV comes close, but its success hinges upon the fact it is very slowly lethal.
Responsible scientists could not reasonably allow for a forecast of pandemic with a virus killing more than half of those infected. It is possible, but it is in the realm of probabilities found in geologic time and events. If it has happened in human history, we don't know of it.
When pandemic influenza finally occurs, and it will, we are not likely to see mortality rates going much higher than 1% of those infected. Yes, that will kill many millions of people and it will be very unpleasant -- but it will not be a human calamity that changes the course of our biological history. That is, unless we let it do so.
If people do not come to work for fear of a deadly infection (that in reality is not so deadly), we face far greater risks as a species by loss of the thing that sustains almost all of us: our economically woven society. Food appears on our table because we buy it from people who go to work. Electricity comes into our homes because people go to work to provide it for a fee. We fly in airplanes managed by people who go to work. People who go to work provide us security in maintaining law and order.
Franklin D. Roosevelt said it best, "We have nothing to fear but fear itself." Organizations planning for the pandemic should focus on getting the workforce to come to work. It is the failure of workplaces that poses, by far, the greater danger to us all.
Employers should address fear of this virus because it is more dangerous than the virus itself. Governments should make the investment needed to gauge the real danger of a virus like H5N1, rather than simply put out the death toll among the most severely ill. People need to go to work, even if there is some biological risk -- and they will if they know what they are facing and have the tools needed to minimize that risk.
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Que voulez-vous? la plusse belle langue du monde c'est celle de ma m?man!