The Lancet: Estimation of potential global pandemic influenza mortality

[pandemicflu.ca]

Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918?20 pandemic: a quantitative analysis

http://www.thelancet.com/search/res...uster=thelancet&search_text1=pandemic&x=0&y=0

The following is a summary of the article on the Medical News Today website:
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=59714

___________________________________

Flu Pandemic Could Kill 62m With Poorer Countries Most Affected
22 Dec 2006

If a worldwide flu pandemic like the one in 1918-20 were to strike today it could kill between 51 and 81 million people, with 96 per cent of deaths being in poorer countries. This was the conclusion of a US study led by Professor Chris Murray of the Harvard Initiative for Global Health.

The study is published in The Lancet.

The researchers used high-quality vital registration data of deaths occuring at the time of the 1918-20 pandemic. From these figures they estimated what the likely globaly mortality would be from a flu pandemic if it happened today.

In a podcast interview, Professor Murray says that the impetus for the research came from listening to colleagues talk at meetings about what the death toll from a flu pandemic might be. Estimates ranged from 50 to 100 million to as many as 1 billion deaths worldwide, but nobody had yet made a systematic attempt to quantify it.

They decided to have a go, and started by examining the data for the three major flu pandemics of the 20th century: the 1918-20, the '57-58 and the '68-70. The figures for the last two were not large enough to give a reliable starting point for their analysis, so they focused on the 1918-20 pandemic.

However, one of the first problems they encountered is establishing a reliable estimate of the number and distribution of deaths that occured as a result of the 1918-20 pandemic.

The only casualty count they could rely on was what they call in the paper "vital registration data". In the more developed, higher income countries, tight legislation governs the reporting of births and deaths. This is not the case in the less developed world. 250 years ago Sweden was the first country to bring in such legislation, and gradually others followed suit.

By 1918-20 most of what we now call the developed world, Western Europe, North America, Australia, New Zealand, had reliable vital statistics registration. This also applied to the colonies such as the Philippines, Taiwan, Sri Lanka, and especially India. This gave the researchers confidence to go ahead and use 1918-20 data based on registered deaths.

The deaths were recorded by date, age and sex. However, Prof Murray and his team found that the reasons given for death were not a reliable method for working out the number of deaths due to flu. So instead they looked at the overall pattern of mortality in each region for the time before, during and after the pandemic and calculated in a consistent way, the "excess mortality". On this basis they estimated the number of deaths resulting from the pandemic for each region affected. And they came up with a very wide range which they went on to try and explain.

The death toll of the 1918-20 pandemic ranged from a low 0.2 per cent of the population in Denmark to an astonishing 4.4 per cent of the population in India. Even within India there was huge variation by province, for instance for the Central Provinces and Berar the figure was over 7 per cent.

If we put that into context in today's terms, about 1 per cent on average of the world's population dies every year. So for India, during the pandemic of 1918-20, the annual mortality went up fourfold.

To project from the 1918-20 data to produce an estimate for today, the scientists looked for explanations of these large variations. One very simple one is the socioeconomic differences between the countries. They found a strong correlation between the deaths due to pandemic and the income per head of the countries affected. They went ahead and did the extrapolation, taking into account socioeconomic status (based on income per head), and the age structure of the countries, since the highest mortality appeared to be in young adults.

Prof Murray accepts that basing the projections on socioeconomic status and age profile could be debatable, but it does give a figure to work with, and it is based on a systematic, quantitative analysis using reliable vital registration statistics.

Their final estimate ranges from 51 to 81 million deaths worldwide (with a median, or mid-range value of 62 million). And they estimate that 96 per cent of these would be the poorer countries. The reason they estimated this last figure as so high is because of two things. Since 1918-20 the more developed countries have become much richer, thus increasing their socioeconomic status in the "model". And the second reason is the younger age profile of the less developed world.

Professor Murray pointed out that this 62 million should be viewed as an upper limit since they did not take into account factors like improved symptom management, treatment of secondary pneumonia (which develops after the flu and was a major killer in the 1918-20 pandemic), vaccination, and so on.

He also says that while the world has paid a lot of attention to the risk of a flu pandemic, and there has been a "remarkable concerted response among high income countries", not much attention has been paid to what is practical for the low and low to middle income countries, which according to this study would carry the major burden of deaths.

Prof Murray says the public health message is "Don't let the perfect be the enemy of the good. We need to think of strategies that might work in these poorest settings. It doesn't seem likely that vaccination strategies are ever going to reach the poorest communities in a time frame that would be beneficial." He goes on to say that "we have to look at this problem from where most of the burden and the harm is going to be and think of strategies that will benefit those populations".

"Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918�"20 pandemic: a quantitative analysis."
Prof Christopher JL Murray DPhil email address a Corresponding Author Information, Prof Alan D Lopez PhD b, Brian Chin ScB a, Dennis Feehan AB a and Prof Kenneth H Hill PhD.
The Lancet 2006; 368:2211-2218
DOI:10.1016/S0140-6736(06)69895-4



Written by: Catharine Paddock
Writer: Medical News Today
Article URL: http://www.medicalnewstoday.com/healthnews.php?newsid=59714

 

[Gnosis]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

Professor Murray pointed out that this 62 million should be viewed as an upper limit since they did not take into account factors like improved symptom management, treatment of secondary pneumonia (which develops after the flu and was a major killer in the 1918-20 pandemic), vaccination, and so on.

Seems like a small number to me.

 

[Jeremy]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

I feel that the 62 million number hinges on the sick having accesibility to appropriate medical care.

Which, in a pandemic, will not always be the case.

I feel that the 62 million is a lowball and the mortalities that will be incurred will be much, much higher.

 

[Laidback Al]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

The statistics in this article are interesting but not applicable to a pandemic in the 21st century. The authors argue that socioeconomic differences account for the greatly divergent death rates between "poorer" countries and "richer" countries in the 1918 pandemic. The fallacy in applying this argument to a potential pandemic now is that the concept of "rich" and "poor" are different today than in 1918.

In 1918, the social and economic differences between rich and poor, while great, were not anything like the disparity between the rich and poor nations that we see today. In 1918, most families, even in rich countries, were still rural or agrarian based. Citizens of rich countries simply has better access to clean water and excess resource production, i.e. additional stores of home grown food and livestock such as chickens, cows, and pigs.

"Rich", in today?s world economy, is not measured by stores of food or livestock, but by paper wealth and real property, i.e., cash holdings, stocks, bonds, and real estate. All of the wealth in today?s world economy is dependent on a Just-In-Time (JIT) delivery and distribution system. The disruption of JIT economy by a pandemic will have a devastating effect on citizens of rich countries.

In the event of a pandemic, citizens of rich countries might be immediately reduced to the socioeconomic situation of citizens in "poorer" countries. I believe an argument could be made that citizens in poorer countries, because of the economic hardships they face on a daily basis, may fare better in a pandemic than citizens in a rich country. Once the fragile economic structures disintegrated in a rich country, all of the paper wealth and real estate will not provide for better access to health care nor allow citizens to obtain basic staples such as clean water, food, and energy.

While the mortality numbers from 1918 do show differences between "rich" and "poor" countries, I don?t think the data can be used to predict the mortality rates for various countries around the world in the event of a 21st century pandemic.
<SUP></SUP>

 

[gsgs]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

there is also the danger, that we get many waves or even many
different pandemics, since H5N1 has big diversity with different
strains and little cross-immunity.

Once one strain gains the ability of effivient h2h it might be transferred
to others by the then increased number of mutation/reassortment/recombination opportunities and adaptions
in/to humans.

 

[4-ABBA]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

LaidbackAl and gsgs -- both of your posts above are very insightful: Supply chain and global economics will create enormous new post-pandemic liabilities.

I would also add that: (A) The population shift from agrarian to metropolitan living, and (B) The speed of travel between cities / nations will amplify viral movement in incalculable measures. The closer proximity of humans, and their increased speed of movement, has made this "petri dish" a far more potent growth medium for any virus..

 

[Snowy Owl]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

A modern day Spanish Flu could kill 51-81 million people in single year: study

http://www.cbc.ca/cp/health/061221/x122113A.html

An influenza pandemic of the severity of the 1918 Spanish Flu could claim between 51 million and 81 million lives worldwide if it were to happen today, with most of those deaths occurring in the developing world, a study released Friday says.

The authors said such an event would more than double the number of deaths - from all causes - that the entire world now experiences in a single year. And based on the patterns of 1918, they said 96 per cent or more of the lives lost would be in resource-poor countries.


"The evidence from 1918 is pretty impressive that in poor communities the death rate was just extraordinary. This is a remarkable increase in mortality in just a short period of time," said lead author Dr. Chris Murray, director of Harvard University's Initiative for Global Health.


The study, funded by the U.S. National Institute of Aging, will appear in Saturday's issue of The Lancet. Murray's co-authors are from Harvard, the University of Queensland, Australia and the Johns Hopkins Bloomberg School of Public Health in Baltimore.


The head of the World Health Organization's global influenza program admired the work, but said while it is an interesting exercise, it doesn't really change the task facing those working to prepare the world to weather a future pandemic.

"In terms of disease control and pandemic response and those sorts of thing, the bottom line is no matter what approach you take, the figures are pretty big and the steps needed to prepare for it are substantial," Dr. Keiji Fukuda said from Geneva.
​

"And even if you take a much more modest approach, the numbers are still pretty big."


A U.S. infectious diseases expert challenged the paper's suggestion that the developed world would get off relatively lightly from a 1918-like pandemic, saying the study and an accompanying editorial underestimate the effect of globalization on supply of essential goods and overestimate the capacity of developed world medical systems to cope with a crush of gravely ill people.


"The paper and the editorial have no sense at all of a modern global just-in-time economy, where the kind of drugs and medical services that they assume will be available in a modern world just won't be there," said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.


But the author of the editorial, Dr. Neil Ferguson of Imperial College in London, supported the paper's assertion that the developing world would take a far bigger hit and contested Osterholm's prediction that supply chain disruptions would amplify the impact of a pandemic in developed countries.
"A pandemic is a relatively short-lived thing," said Ferguson, a leading mathematical modeller.


"There may be crises over a few weeks, but I would be skeptical whether we would face famine and the sort of food shortages and other problems that would lead to dramatically enhanced mortality. I just don't find it plausible."


Osterholm had earlier predicted a 1918-like pandemic could kill between 180 million and 360 million worldwide.


Those numbers, and others, are what inspired Murray and his colleagues to do this work. They had attended meetings of influenza experts where death projections were raised. The estimates varied wildly - from a low of two million to 360 million to even one billion people.


Murray said there seemed to be little science attached to those projections, so he and his colleagues set out to see if they could come up with an evidence-based estimate.


They went looking for death registries from the time, finding good records for 27 countries. In the case of India and the United States, they were even able to mine data from nine provinces and 24 states respectively.
In each case, they looked at nine years of deaths - the three years before 1918, the three years during the pandemic and the three after. They averaged the years before and after to come up with a standard death rate for that jurisdiction, then attributed any excess deaths that occurred in 1918-1920 to pandemic influenza.


They made exceptions for Britain and France to factor out the death toll of the First World War, and in Finland to account for a civil war that overlapped the end of the Spanish Flu. Murray said similar adjustments were not made for Commonwealth countries like Canada, Australia and New Zealand that also fought in the First World War.


They then used the excess mortality rates - which varied from a low of 0.2 per cent in Denmark to a high of 7.8 per cent in parts of India - to calculate what a pandemic of similar virulence would do to the current global population.


Murray admitted he and his co-authors were startled by the projection they arrived at; they were expecting something more in the range of 10 million excess deaths.


He said the research points to a need to start looking for realistic ways cash-strapped countries can try to minimize the death toll, given that expensive antiviral drugs and scarce flu vaccine are likely to be unavailable except in the richest countries.


Murray recommended increasing production and use of antibiotics in developing countries. Antibiotics can fight the secondary infections - generally pneumonia - that can follow influenza.


And he suggested public health officials should consider whether aggressively scaling up use of the new pneumococcal vaccine in the developing world could arm people to survive a pandemic. The vaccine protects against strains of bacteria that can cause pneumonias after influenza.


Neither antibiotics nor pneumococcal vaccine would be protective, though, against an influenza strain that kills mainly by causing a viral pneumonia. It is believed that was a feature of the 1918 pandemic, though viral pneumonia didn't play as significant a role in the two more recent pandemics, the 1957 Asian flu and the 1968 Hong Kong flu.

 

[Snowy Owl]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

New flu pandemic could kill 81 million
http://www.onelocalnews.com/newhopecourier/ViewArticle.aspx?id=36898&source=2

By MARIA CHENG, AP Medical Writer



LONDON - A flu virus as deadly as the one that caused the 1918 Spanish flu could kill as many as 81 million worldwide if it struck today, a new study estimates. By applying historical death rates to modern population data, the researchers calculated a death toll of 51 million to 81 million, with a median estimate of 62 million.


"We expected to end up with a number between 15 and 20 million," Murray said. "It turns out we were wrong."


The 1918 flu outbreak killed at least 40 million people worldwide. But flu pandemics have varied widely in their severity. The most recent, in 1957 and 1968, were relatively mild, killing 2 million and 1 million people worldwide respectively.


The researchers compared death rates during the pandemic to average death rates before and after. That revealed how much the pandemic flu contributed to death rates, a figure called excess mortality. They then applied the excess mortality data to worldwide population data from 2004.


One surprise in the new study was the huge variation in how different countries would be affected by a pandemic.



The study estimates that 96 percent of the deaths would occur in the developing world. Murray and colleagues noted there was a 30-fold or more variation in mortality.


Determining the mitigating factors might help avert a catastrophe. "If we can answer that question, we may unlock the mysteries behind which non-pharmaceutical strategies could significantly decrease mortality," said Murray.

"We know that even if we have much lower numbers of deaths worldwide than in 1918, the world will be severely stressed," said Dr. Keiji Fukuda, coordinator of the World Health Organization ?s Global Influenza Program. "Speculating about the possible numbers is an interesting exercise, but the really important thing is, what do we do about it?"


Another question is the impact a flu pandemic would have on those infected with HIV . Seasonal influenza exacts a heavy toll on those with weakened immune systems. So, in the case of a new pandemic flu, Murray?s estimate might be optimistic.


However, experts think that if H5N1 were to evolve into a strain easily transmissible between people, it would also become less deadly.


Still, there is no guarantee that H5N1 would become less deadly.


If it doesn?t, "we would be in for a devastating impact," said Gust. "All bets would be off."

? 2006 The Associated Press. All rights reserved.

 

[Harpsong]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

Spanish flu would be scourge today
Outbreak like the 1918 pandemic could kill up to 80 million people
By HELEN BRANSWELL The Canadian Press


An influenza pandemic of the severity of the 1918 Spanish Flu could claim between 51 million and 81 million lives worldwide if it were to happen today, with most of those deaths occurring in the developing world, a study released today says.

The authors said such an event would more than double the number of deaths ? from all causes ? that the entire world now experiences in a single year. And based on the patterns of 1918, they said 96 per cent or more of the lives lost would be in resource-poor countries.

"The evidence from 1918 is pretty impressive that in poor communities the death rate was just extraordinary. This is a remarkable increase in mortality in just a short period of time," said lead author Dr. Chris Murray, director of Harvard University?s Initiative for Global Health.

The study, funded by the U.S. National Institute of Aging, will appear in Saturday?s issue of The Lancet. Murray?s co-authors are from Harvard, the University of Queensland, Australia and the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The head of the World Health Organization?s global influenza program admired the work, but said while it is an interesting exercise, it doesn?t really change the task facing those working to prepare the world to weather a future pandemic.

"In terms of disease control and pandemic response and those sorts of thing, the bottom line is no matter what approach you take, the figures are pretty big and the steps needed to prepare for it are substantial," Dr. Keiji Fukuda said from Geneva.

"And even if you take a much more modest approach, the numbers are still pretty big."

A U.S. infectious diseases expert challenged the paper?s suggestion that the developed world would get off relatively lightly from a 1918-like pandemic, saying the study and an accompanying editorial underestimate the effect of globalization on supply of essential goods and overestimate the capacity of developed world medical systems to cope with a crush of gravely ill people.

"The paper and the editorial have no sense at all of a modern global just-in-time economy, where the kind of drugs and medical services that they assume will be available in a modern world just won?t be there," said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

But the author of the editorial, Dr. Neil Ferguson of Imperial College in London, supported the paper?s assertion that the developing world would take a far bigger hit and contested Osterholm?s prediction that supply chain disruptions would amplify the impact of a pandemic in developed countries.

"A pandemic is a relatively short-lived thing," said Ferguson, a leading mathematical modeller.

"There may be crises over a few weeks, but I would be skeptical whether we would face famine and the sort of food shortages and other problems that would lead to dramatically enhanced mortality. I just don?t find it plausible."

 

[4-ABBA]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

:surrender: The articles above are based on one gigantic assumption: That H5N1 will turn out to behave like Spanish Flu. Everything hinges on CFR and attack rate. In this respect, H5N1 is in a different class altogether than 1918's virus.

 

[Mellie]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

The articles above are based on one gigantic assumption: That H5N1 will turn out to behave like Spanish Flu. Everything hinges on CFR and attack rate. In this respect, H5N1 is in a different class altogether than 1918's virus.

Most articles are based on gigantic assumptions.

How CFR will turn out is how it will turn out.

Right now CFR is very high unless there are more cases of flu that have gone undetected. Will the pandemic flu bug have such a high CFR? Who knows?

For comparison and planning purposes, it makes sense to me to pick a "bad case scenario" rather than a "worst case scenario" in order to bring home some points and get people engaged.

For most people, if the situation is deemed to be too bad, unpredictable and uncontrollable, they are likely to say "why bother? We can't do anything anyway." It's a learned helplessness response to what they perceive to be a completely unpredictable and uncontrollable situation.

In my opinion, it's key to first engage people and to get them involved in getting ready. Once started, they can often be persuaded or inspired to do a bit more and a bit more.

In motivation research it's the difference between "foot in the door" vs "door in the face" techniques -- or raising the temperature gradually vs tossing the person in the boiling water in one fell swoop. Of course, different people have different comfort zones for looking at new and potentially scary ideas.

The gains in pandemic planning that I've seen made over the last year have come about largely through the foot-in-the-door process. Sure, it's lucky we've had time to let that process work a bit and hopefully we'll have more so we can continue it. Like LMonty, I sometimes get impatient that things aren't going faster and people don't see how we could as Osterholm analogizes, "turn over that starter on that John Deere tractor and have it roar to life in just a moment."

When you get right down to it, speculating about how many people are going to die has no real purpose, at least in my opinion, beyond confronting the thought now that people will die and allowing that awareness to motivate planning at several different levels.

Most high level planning has alternative modes for a certain lower % of people out, a higher % of people out, and often a third highest level % of people out. Past a certain number of people ill and dying, we're absolutely going to have to count on local and family responses to infrastructure failure, not federal ones. Planning to shelter in place and help our communities get ready as best they can is what it's all about in my opinion.

 

[AlaskaDenise]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

New flu pandemic could kill 81 million
..........Determining the mitigating factors might help avert a catastrophe. "If we can answer that question, we may unlock the mysteries behind which non-pharmaceutical strategies could significantly decrease mortality," said Murray.

"We know that even if we have much lower numbers of deaths worldwide than in 1918, the world will be severely stressed," said Dr. Keiji Fukuda, coordinator of the World Health Organization ?s Global Influenza Program. "Speculating about the possible numbers is an interesting exercise, but the really important thing is, what do we do about it?" ..........

We cannot change much of this situation, but we CAN learn and disseminate information about non-pharma strategies!!!

Time spent debating numbers won't save lives, but time spent on do-able strategies will save lives....that is where my time will be spent.

.

 

[4-ABBA]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

...Most high level planning has alternative modes for a certain lower % of people out, a higher % of people out, and often a third highest level % of people out. Past a certain number of people ill and dying, we're absolutely going to have to count on local and family responses to infrastructure failure, not federal ones. Planning to shelter in place and help our communities get ready as best they can is what it's all about in my opinion.

Mellie--I agree entirely. Preparation is the only real leverage we have.

Two extremes de-motivate people to prep:

The "end of the world as we know it" is just as de-motivating as "1918 fatalities mostly occurred in poorer countries."

 

[cozodapo]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

I think this is an excellent and accurate critique of this paper and a better picture of the reality. It is why it is more important to empower people with information than to pretend to be able to provide infrastructure based or JIT-based services in times of crisis.

The statistics in this article are interesting but not applicable to a pandemic in the 21st century. The authors argue that socioeconomic differences account for the greatly divergent death rates between "poorer" countries and "richer" countries in the 1918 pandemic. The fallacy in applying this argument to a potential pandemic now is that the concept of "rich" and "poor" are different today than in 1918.

In 1918, the social and economic differences between rich and poor, while great, were not anything like the disparity between the rich and poor nations that we see today. In 1918, most families, even in rich countries, were still rural or agrarian based. Citizens of rich countries simply has better access to clean water and excess resource production, i.e. additional stores of home grown food and livestock such as chickens, cows, and pigs.

"Rich", in today?s world economy, is not measured by stores of food or livestock, but by paper wealth and real property, i.e., cash holdings, stocks, bonds, and real estate. All of the wealth in today?s world economy is dependent on a Just-In-Time (JIT) delivery and distribution system. The disruption of JIT economy by a pandemic will have a devastating effect on citizens of rich countries.

In the event of a pandemic, citizens of rich countries might be immediately reduced to the socioeconomic situation of citizens in "poorer" countries. I believe an argument could be made that citizens in poorer countries, because of the economic hardships they face on a daily basis, may fare better in a pandemic than citizens in a rich country. Once the fragile economic structures disintegrated in a rich country, all of the paper wealth and real estate will not provide for better access to health care nor allow citizens to obtain basic staples such as clean water, food, and energy.

While the mortality numbers from 1918 do show differences between "rich" and "poor" countries, I don?t think the data can be used to predict the mortality rates for various countries around the world in the event of a 21st century pandemic.
<SUP></SUP>

 

[AlaskaDenise]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

I agree with Cozodapo 100%. If "developed" countries would provide truthful information to their citizens, & people heeded the warning & prepared, their worst case situation would have a better outcome.

However, as I read various flu forums, there are too many residents dependent on the JIT economy, who cannot see they should prepare to be self sufficient, i.e., NOT just stockpiling, but prepared to live independent of the JIT economy (like "underdeveloped" countries ).

.

 

[JJackson]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

Firstly a very warm welcome to Cozodapo, I have read your 3 posts to date and have to agree with all the points you have made. To have someone posting from West Africa with knowledge of Government, NGO & local issues will be a very great help and I do hope you can find time to continue to post.

One point which has bothered me for some time and has been highlighted as an omission in this and ? as far as I can tell without details of model parameters and weightings ? most other models is the shift in populations densities. It is not just that the worlds population has greatly increased it has radically redistributed. The proportion of the world?s population living in cities with a population in excess of one million has rocketed. This has two main effects when considering pandemic impact firstly, while these people may be ?wealthier? than their rural cousins - in terms of monetary net worth - they are dependants for the essentials of life (water & sewage, food and heat). Secondly, they are in very high population densities with commensurately high levels of social interaction and greater difficulty in reducing the number of those interactions if they need to source essentials and work to maintain income.

As pointed out by Al, net worth is a poor measure of wealth if it is not readily convertible on to the essentials, a bank statement with a lot of zeros on it has no more food value than one covered in red ink ? unless you have had the forethought to convert some zeros into essentials before any supply chain disruption.

I apologies for not including links or hard data, I had read an excellent report showing how common (now) & rare (then) connurbations are/were shortly before this paper was released but have been unable to find it again. If anyone has links please post.

 

[DRJJ]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

Yes, welcome cosodapo!!

I am in absolute accord with your critique. In a matter of days, the urban rich and poor will become our most impoverished and vulnerable group. I have had some difficulty with some of the flu preparation literature which includes statements to the effect that a lot of food can be grown on a balcony.

I do not think that high rise life is sustainable during a serious pandemic, even with supplies on hand. An electrical failure will result in individuals having to negotiate stairs that are 5, 10, 25 and 50 stories high. Obviously, many citizens, rich and poor, cannot traverse 25 flights of stairs regularly. A plumbing leak could and would take out many apartments and in a very short time could render an entire building uninhabitable. A clean water failure will result in wide spread disease and sick individuals will not be able to reach medical care...if the care is available. A total water failure will result in a building becoming a cesspool overnight. With sealed windows and no ventilation system, the high rise will trap foul air, contaminated with human waste, mountains of garbage and, it follows, rampant disease.

And individuals, having "escaped" from the high rise, become urban refugees, faced with a world of hugh mounds of garbage, rotting corpses,and human waste. Rats and filth will be everywhere very shortly. Roving bands of desperate people will loot and ravage those more vulnerable than themselves in a desperate effort to get some security, food, water and shelter.

Many cites, like New Orleans...Remember Katrina... and New York or Boston or San Francisco are bordered with rivers/bays and bridges/tunnels which make quarantine and isolation fairly easily achieved. New Jersey is not going to welcome NY urban refugees, anymore than NO neighboring parishes welcome NO refugees during Katrina. And when the refugees carry disease and death, the level of force they will be met with will make the neighboring NO parishes reaction look like a kindergarten dust up.

Even the USA poor expect fairly easy access to crisis medical care...via the emergency room, but drugs to treat the diseases which will accompany such a crisis will be gone in a week or two.

In the face of a pandemic, the rich and the poor will enter unimaginable poverty almost immediately.



I believe that every family that wishes to survive and lives in a high rise urban environment should make plans to shelter in some other place.

 

[cartski]

Re: The Lancet: Estimation of potential global pandemic influenza mortality

This is a very interesting and readable study. We're going to hear a lot about it, IMO.

Not to detract from the important message the authors make to focus "on practical and affordable strategies for low-income countries where the pandemic will have the biggest effect..." p. 2216, I cannot help thinking that this statement will be used to provide the high-income countires with a false sense of securtiy. Over-assuring statements and policies may develop from this study. Using it as evidence to support a NIMBY bias, in other words.

In the discussion part of the paper a couple of statements should raise the anxiety level for the developed world:

"Concerns about increase travel and mixing which lead to larger epidemics might not alter our extrapolations since the historical record suggests that nearly all human populations were eventually exposed to the 1918-20 influenza virus" p. 2216

and

"However, there is no logical or biological reason why that pandemic [1918-20] - albeit very severe - should represent the maximum possible mortality in a future pandemic..." p.2216

So, we're all going to be exposed. And, the mortality rate could be a lot different than in 1918-20.

While the next pandemic will "overwhelming focus in the developing world", it's certainly an error to assume that it will leave the developed world relatively unscathed.

J.