How worried should we be about the Swine Flu?
The mortality in Mexico is shockingly high: 81 cases out of 1300, or about 6%. The great Spanish Flu pandemic, on the other hand, had a mortality of about 2.5%. Normal rates for flu are less than a tenth of 1%, with most of those deaths occurring in people who are already weak: children, the elderly, the immunocompromised. The Spanish Flu hit hardest the 15-34 age group, who seem to have been done in by their own strong immune response. It's not clear which pattern this flu follows.
But mortality is not the only consideration; transmissability also matters a great deal. Something like 25% of Americans ultimately got Spanish Flu. But animal viruses usually aren't that efficient at moving from human to human. And the quicker and deadlier a virus is, the less likely it is to spread--the victims die before they can pass it on.
At first glance, though, this one seems to have gotten pretty good at passing from human to human. A few days after we first hear of it, it's in New Zealand, Hong Kong, Spain, the US. To be sure, we don't have large troop movements from the area of infection, thoughtfully bringing it home with them. Nonetheless, with modern travel, if it is transmissable, it will be nearly impossible to stop. Hong Kong is implementing strong quarrantine measures--but Hong Kong is a small island.
The bright side is that mortality here seems to be a lot lower--nonexistant so far. People living in poorer countries tend to have weaker immune systems for the obvious reasons. And the strain that's arrived here may just not be as deadly as the one still in Mexico.
Still, this seems more worrying than SARS was, and SARS was pretty worrying. And if it gets much bigger, it will deal a heavy blow to an already struggling world economy, because this will have deep impacts on global trade flows.
Copyright © 2009 by The Atlantic Monthly Group. All rights reserved.
I don't know how efficient and diligent Mexico's public health system may be, but it's not impossible that the total number of cases is higher, perhaps substantially higher, than the 1,300 reported. If indeed there are many unreported cases, the death rate may be lower than initial estimates (figure that nearly all deaths will be reported).
You seem to be using "morbidity" in a sense with which I am not familiar. Can you explain?
Yes, I am an idiot. Correcting.
Megan, why not delegate this topic to your friend Derek Lowe, from In the Pipeline? Circle of competence in punditry.
Ta.
Early reports seem to indicate that the Swine flu is responsive to conventional drugs such as Tamiflu.
For that reason, I'd think it would be far less concerning than SARS, for which clinical trials did not identify effective drugs until mid 2005, 2.5 years after the outbreak.
Of course, that mostly mitigates things in developed countries which have quick access to conventional drugs. Even Mexico is woefully short on Tamiflu and rationing it heavily, though it appears the production of Tamiflu could be ramped up quickly.
Call me crazy, but I think the production of Tamiflu cannot be ramped up quickly, unless things have changed over the last three to four years.
I am not an expert, and don't know all the particulars. But Roche's representatives said the following:
"The Roche spokeswoman said 5 million units of Tamiflu -- 2 million of which are already with the WHO -- have been donated and are stockpiled for emergency use. She added that if requested the company would be able to speed production of the drug."
Also recall Roche went through a big capacity increase in 2006 , but as of now is only producing 215M vs. the peak production of 400M doses two years ago. Looks to me like there is room for a ramp up; Roche just doesn't want to get hung out to dry again like in 2006 when countries asked for more production and didn't follow through with orders.
Oops, missed a backslash.
Interesting and good to know.
I'm struggling with this sentence:
They may have higher mortality due to lack of medicine/health care/clean water; they may live with a higher number of contagious diseases.
But they may also have stronger immune systems because they don't turn around and take antibiotics every time they get a sniffle or ear ache or sore throat. They may have stronger immune systems because they have more contact with animals and dirt.
The use of phrases like "for the obvious reasons" should be avoided because it adds nothing to the argument. If it truly is obvious, then you can just say "[p]eople living in poorer countries tend to have weaker immune systems." If it is not truly obvious, then you've essentially made a leap in logic without providing any support for that leap.
I am still asking myself what these obvious reasons are. What is it about living in a poor country that makes one's body less able to fight disease?
Um, the widespread malnutrition and untreated chronic disease?
Zic, you're overstating the probable scope of the hygiene hypothesis. The evidence most strongly points at a link between hygiene and autoimmune diseases such as asthma, allergies, and type 1 diabetes. Autoimmune diseases aren't immune system deficiencies -- they are actually immune system overreactions, where the body attacks its own cells as though they were invading germs. The rising prevalence of autoimmune deficiencies doesn't necessarily say much about the ability to mount sudden defenses against infectious disease.
"But they may also have stronger immune systems because they don't turn around and take antibiotics every time they get a sniffle or ear ache or sore throat."
Maybe our difference is over what constitutes "poorer countries", but have you lived in one? Yes, they take antibiotics every time they get a sniffle or sore throat, but to be fair, they probably only take half a course and then stop once they're feeling a bit better. All the better to bread resistance, my dear....
By 'bread', I meant breed, of course. Sorry!
Last time I looked, the mortality rate here was the same as in Mexico. Two and a half percent of the eight cases here equals zero. It's a little early to say it's "nonexistent."
Oops--six percent. Still rounds off to zero, so the substantive point holds.
I'm gonna double down on the bacon and hope for the best.
Your post titles seem to have jumped the shark with "Streetcar Desires". The latest ones are bordering on self-satire.
I think I read somewhere that Mexico is only reporting hospitalized cases and deaths, so the real mortality rate is unknown since the total number of cases in Mexico is either unknown or unreported.
Still, this seems more worrying than SARS was, and SARS was pretty worrying.
SARS wasn't worrying and this isn't worrying if you think about it for a moment. Did you change your life in any way because of SARS? How many "epidemics" can we have before we realize that a few cases and no deaths is not an epidemic?
SARS had over 8000 cases and almost 800 deaths, and spread quickly even despite a lot of measures designed to contain it. 10% mortality and a fairly quick spread, even through standard hospital procedures, is a fairly scary disease. Yeah, nothing too terrifying happened that time, but it could have been a lot worse. Being worried about it was entirely reasonable.
SARS had over 8000 cases and almost 800 deaths, and spread quickly even despite a lot of measures designed to contain it.
Out of 6B people worldwide. I'm sorry, but that isn't an epidemic. More people died of the regular flu that year than SARS. More people are shot to death in the US every year than the total number of SARS cases world wide.. We have more traffic fatalities in the US than the total number of SARS cases worldwide. Only about 300 SARS cases in the US, our of a population of 300M. There were no deaths from SARS in the US. In 2007-2008 for children under 18 we had 83 deaths from influenza.
In short, SARS wasn't an epidemic and a minor threat to public health in the US. I can't predict the future, but based on past performance (SARS, West Nile Virus, Bird Flu) the threat to the US is low.
SARS was not an epidemic, it was a potential epidemic. Just because nothing(in the grand scheme of things) did happen doesn't mean that there was no danger. Megan referred to it as "pretty worrying", which is an entirely accurate phrase. Nobody's claiming that it's the second coming of the Black Death, just that it had the potential to be pretty bad.
I was working in infection control at the time of SARS, and on a SARS project for a while. SARS was very close to being very bad.
Saying SARS wasn't a risk because less people died than in traffic accidents is like saying that a nuclear missile was dropped on New York, but it didn't go off, and only a few hundred people were killed in the impact so it was no threat.
"Did you change your life in any way because of SARS?"
When I went back to Hong Kong a few years later, I was surprised at the many changes in daily life because of SARS. Having two sets of different-colored chopsticks for each person at restaurants, and having them bring the big bowl of tea just so we could rinse off our personal eating bowls, seemed like a fairly lasting and visible change. Eating is important to the Chinese, and they changed their rituals substantially because of this one round of disease.
Or by 'we', did you only mean people far, far away who had barely even heard of it?
Megan, the Mexican health minister (or whatever, didn't catch his title) pointed out in a news clip I saw that most of the American cases are children, who have generally not had fatal cases of swine flu in Mexico. The implication is that we can't really know anything about the relative severity of the strain we've got until it's infected a number of the most-affected demographic, young adults.
"quarantine" is spelled with one "r," not two.
the final vowel in the word "nonexistent" is not "a."
pandemics cause or have mortality rates of 2.5%. they do not "have a mortality of about 2.5%."
i'm not even going to get into the other errors of grammar and usage. this is just what jumps out from a cursory glance at the post. the quality of this piece is barely sufficient for a high school newspaper, let alone a supposedly respectable institution like the atlantic. i know blogging is an informal medium but mcardle is butchering the english language (fun game: count how often she starts a sentence with "and" or uses a gratuitous semicolon in an attempt to appear educated) and it's not necessary to do that to write in an internet-appropriate tone. i'm not saying that everything has to be 100% perfect, just that journalism is supposed to have some basic standards, and if you're not going to submit your work to a copy editor, you should at least run a spell check using a program that catches a mistake like "quarrantine."
I am amazed that someone who feels qualified to pronounce on other people's mastery of the English language can yet be so ill-educated as to believe that it is wrong to start a sentence with "And". To quote Shakespeare:
if you had actually bothered to read my comment before blindly jumping to your little heroine's defense, you'd see that i do not believe that it is "wrong" to start a sentence with "and." there are several situations, such as the one you just quoted, in which it's perfectly acceptable. but there's a reason most english teachers tell their students not to do it: as mcardle eloquently demonstrates, unless you're doing it right, (for example, in a dialogue, such as the quote you offered) you sound like a third-grader telling you about his day. especially if you repeat it several times. what's truly amazing (and laughable) is the implicit comparison between shakespeare and mcardle) that you draw by justifying mcardle's sloppy writing with a passage from the bard. so, tracy, if i'm "ill-educated" (even though i didn't actually say what you're accusing me of being ill-educated for saying) for allegedly believing that it's "wrong" to start a sentence with "and," what does that make megan? if simply believing in the common yet overzealous falsehood that it's always wrong to start a sentence with "and" makes you "ill-educated," you must have some truly acrimonious condemnation in reserve for people who misuse semicolons and spell poorly.
typo: strike end parenthesis from "mcardle)" in 9th line
Point of reference: when one endeavors to correct others on their alledged lapses in understanding the use and function of English language structures, it might be a good idea to capitalize the first word of each sentence and all proper nouns. It would also be a good idea to not make the its/it's homonym error, not use sentence fragments, avoid the use of unnecessary and confusingly-worded parantheticals, avoid the use of contractions, and perhaps engage in some general proofreading to improve the brevity and the general grammatical structure of the prose. Also, the rule for not beginning sentences with conjunctions not only includes "and," it also includes "but," and you might wish to avoid that one, as well.
If you have any other fun toys for me to play with, feel free to include them in your next response.
If you're going to correct someone correcting someone else, it's best to pick on errors they have actually made. Please point out where, exactly, I misused it's/its. For further grammar nazi fun, I could point out that both sentence fragments and starting a sentence with a conjunction (as I have pointed out elsewhere in this thread) are sometimes acceptable for stylistic purposes. And while the topic of "doing some general proofreading," aMouseforallSeasons, "parenthetical" contains only two instances of the letter "a." Nice try, though.
Also, you all might want to google "ad hominem tu quoque."
*while we're on the topic of general proofreading
I see you are now capitalizing the first word of each sentence, as well as proper nouns, something that is not normally excused even in colloquial written conversation. Great work! I look forward to watching your further progress in the days and weeks ahead.
You caught me napping on the use of "it's". One out of eight is still a pretty good average for college credit, and I guess we now know why contractions are considered poor form, seeing how easily they can be misread.
As for your attempt to press charges of tu quoque, nice try, but no. It was your decision to don the sash of a self-sytled expert in language and then demand certain linguistic standards from the blog hostess, therefore it is fair for anyone else to demand that you first demonstrate competence in the subject.
"You caught me napping on the use of "it's"."
Leaving aside the irony of your failure to properly punctuate that sentence, you have an interesting definition of "napping." It seems to be a little closer to what the rest of the world would call "making shit up." So, if by "caught you napping," you mean "caught you making shit up," then yes, indeed, I did "catch you napping."
Wow. To be honest, my friend, it probably would have been a safer decision to scurry away after accusing me of a whole host of grammatical errors that I didn't actually commit. So, kudos for sticking around and having the guts to admit that you were inventing errors out of whole cloth.
You might want to re-read the definition of an ad hominem tu quoque. At the risk of appearing repetitive, it is the logical fallacy of attempting to show that an argument is invalid by pointing out how the arguer allegedly makes the same mistake s/he is condemning. The reason it is a logical fallacy is because whether or not your opponent is guilty of what s/he is condemning, this changes nothing about the truth value of his/her initial accusations. To put it simpler, your being so obsessed with Megan's honor that you're willing to make an ass out of yourself by calling people out for mistakes they didn't make does NOT make her grammatical errors any less incorrect. I do not need to "first demonstrate competence" in order to point out Megan's mistakes or your mistakes. They are mistakes regardless of my level of competence--which turns out to be a lot higher than you thought.
On a stylistic rather than purely logical note, an ad hominem tu quoque fallacy is bad enough when the personal accusations you're making are true. When the person isn't even engaging in the behavior of which you're accusing them--that's just embarrassing.
"Point of reference: when one endeavors to correct others on their alledged [sic] lapses in understanding the use and function of English language structures, it might be a good idea to capitalize the first word of each sentence and all proper nouns."
Just another point of reference: when you're trying to correct other people who are correcting other's "alledged" lapses, you should at least run what you're writing through a spell-check program. To quote one of the funniest grammar nazis I've ever met: "If you have any other fun toys for me to play with, feel free to include them in your next response."
Since you were kind enough to scan Megan's blog post for grammatical errors, I think we should do the same for you.
Capitalize the pronoun I.
Capitalize the first letter of the first word of each sentence.
Capitalize the first letter of names of people.
Capitalize the name of languages, races, nationalities, and
religions.
This is just what jumps out from a cursory glance at the comment. I know commenting on a blog is an informal medium but Lapsang Souchong is butchering the English language and it's not necessary to do that to write in an internet-appropriate tone.
wow. i put in the whole disclaimer about blogging being an informal medium precisely to forestall this type of brain-dead response from people who are so in love with mcardle that they're willing to pretend that they think my lower-case typing is just as bad, if not worse, than an ivy league grad spelling "nonexistent" "nonexistant."
okay, first of all: the fact that i type without capitalizing letters does not change the fact that megan mcardle, who graduated from upenn, does not know how to spell the word "quarantine."
second of all: somehow i doubt that you've never seen someone on the internet typing without capitalization before, so i'm going to assume that either a) you think you're being smart and funny by pointing out something obvious or b) that you don't understand the difference between making one consistent stylistic choice based on the informal medium in which you're writing and making basic errors of spelling and grammar. i noticed you couldn't pick out any problems other than capitalization, so i'll presume that you limited your little "critique" to a rule i am obviously aware of breaking. to be honest, "rbenchley," i didn't "scan" megan's blog post for grammatical errors. i was simply reading it and the utter clumsiness of her writing prompted me to register an account and comment. apparently this has offended the internet white knights who have taken it upon their mighty shoulders to defend lady mcardle's honor with the raw bloody steel of their swor...i mean, keyboards. maybe you're hoping to pull an ann althouse here, but i gotta inform you, the chances are pretty slim.
Lapsang, I'm not going to derail this comment thread further by responding to the grammar police, other than to note that I'm not taking the SATs, and that while I am a mildly atrocious speller, you must not malign my alma mater. Unlike, apparently, whatever august institution you attended, it did not offer college-level spelling.
This may seem strange to you, considering that it was, indeed, an Ivy League school, but perhaps you will be heartened to learn that some of the finest writers in the English language have been horrible spellers and appalling typists, which is why publishers pay copyeditors.
But I digress. First ban warning: I don't feel that your undoubtedly heartfelt cri de coeur against my violations of the grammar standards established by the Educational Testing Service, and parroted by English teachers across the land, has improved this comment thread. You are welcome to type in all lower-case any critiques of my ideas you'd care to offer, but if you want to take on my writing style or my spelling errors, please confine it to personal email.
I see that the blogmistress herself has descended to my level. Hello, "John Galt." (Seriously? "John Galt?") Since my typing without the use of the capitals seems to be problematic for you and some of your fans, and since people seem more interested in focusing on that than anything else, I am demonstrating herein my capability to use proper capitalization. While you are not taking the SATs, as another commenter pointed out, a spell check program would take care of most of these mistakes. I'm not maligning your august institution--Columbia and UPenn are brother misfits in the Ivy League.
I am, in fact, Megan, well aware that some very fine writers indeed have no grasp of orthography or grammar. This is why I am employed as a proof reader by McGraw-Hill. I realize that not every post can be sent off for proofreading before submission, but some of the errors here were just too outlandish to go unmentioned in a magazine with standards as high as the Atlantic's.
As for your "ban warning," feel free to wave about your e-penis as much as you see fit. This is the first and probably last time I have ever found something you have contributed to this site to be worth comment. However, I do find it rather ironic that you say "I'm not going to derail this comment thread further..." and then proceed to leave two quite detailed comments in response to these issues. Like many female Ayn Rand worshippers, you seem to have quite a comfortable little hugbox (look it up) here, and in terms of your accusation that my comments have not "improved this comment thread" you might do well to look at some of your fans (and indeed yourself) when asking who derailed this thread. I hope this little exercise has boosted your ego sufficiently, "John Galt."
People in poorer countries do not necessarily have weaker immune systems. People generally have greater tolerance to pathogens that are prevalent in their environments, due to the work of "memory" lymphocytes, which recognize and quickly respond to antigens (or similar antigens, depending on the required degree of specificity) that they've exposed to previously. We'd be much more susceptible to symptomatic infection, if you dropped us off in some place with "unfamiliar" bugs. Our relative abilities to fight off this virus likely has mostly to do with how similar it is to viruses that are endemic to our areas.
Complicating the matter is the fact that this virus strain, H1N1 might be most dangerous for people with the strongest immune systems. The Spanish flu, which caused as epidemic in 1918, was a similar strain, and caused infection by triggering our white blood cells to over-react, and to release toxic cytokines into the lungs. In other words, it caused a dangerous autoimmune reaction. I'm not sure if this is the mechanism of pathogenicity for the current swine flu. However, it seems that this virus is largely affecting mainly young, healthy adults, which makes me suspect that this is the case.
"one consistent stylistic choice based on the informal medium in which you're writing"
So it's just a really annoying affectation?
no, sean, it's laziness, to be perfectly honest. does it make it difficult for you to read? does it obscure the message? no. am i the only person who does it? no. does it make some sort of "statement"? you'd have to be an idiot to think so. but there's a big difference between doing something consciously and making mistakes that any copywriter can catch. also, to be honest, this is sort of an "ad hominem tu quoque" situation. whether or not i capitalize my writing doesn't make megan's mistakes right and i suspect it doesn't even annoy you. i think what *does* annoy you is that someone is talking shit about a female conservative blogger. in my experience, that annoys their readers in a unique way that is more extreme and, to me, more amusing than any other type of "libertarian" or "objectivist" idiocy out there.
All right, I must respond to this: yes, writing in all lower-case does make it difficult for me, and most people, to read. If this surprises you, try reading an eighteenth century author with the original capitalization and punctuation. Finding upper case when your brain expects lower-case, and vice versa, disrupts the flow of thought, and it takes quite a long time to learn to read a new case system naturally.
I honestly find it annoying. Particularly with the compression of the spaces between sentences on comment posts, a long paragraph with no capitalization is hard to read.
Your laziness is ok but Megan's laziness (not using a spellchecker) is not. Interesting.
of course, because there's no difference whatsoever between what's expected of someone getting paid to write blog entries for the web site of one of america's most highly-respected magazines and what's expected of an anonymous commenter from the web. interesting indeed.
Lapsang,
You may want to minimize your use of the phrase "the fact that". It's unnecessary in most cases, and unfortunate in others, as E.B. White noted in The Elements of Style.
Megan,
No one is a perfect speller, but you know what helps? Firefox's automated spell check. Why not use it?
While you're right that I sometimes use that phrase when it is not needed, there are some cases White glosses over where it's technically avoidable but the alternative sounds more awkward. Consider the following:
"They were arguing over the ramifications of the fact that he failed to use proper capitalization."
What is one to do? "....the ramifications that he failed to...?" "over the ramifications of his having failed to...?" Both sound awkward and forced. Strunk and White are useful, but not always canonical. An interesting take on The Elements of Style: http://chronicle.com/free/v55/i32/32b01501.htm
So, guess there's nothing else to be said about swine flu. Sure is glad that's over so that we can focus on them dam women consevitives bloggers with there bad gramar and speling.
Or mabe we should ignore doosh bags that apparently needs to complane bout the existance of femail conservitives bloggers?
That little noise you heard was your joke flapping around frantically on the floor, gasping for air as it died pathetically. You should have left it in your brain.
Mabe you didnt like the joke b/c it called you a doosh bag? Or is it b/c you went toan IV leage school and you are a proof reeder?
thanks for illustrating megan's point about how i'm the one degrading the quality of this thread. also, i'm still in school, so, um...you're just failing on multiple levels here. congrats on that one.
Your in skool and for fun hangout on messege boreds and play gramar cop and congradulate yourself on being smart, and I im the 1 faling on multiple levels. Its 1 thing to be an old hasbeen and have nuthing better to do then to sit around and skrew with messege boreds, but its quite another to do so when your supposedly in kollege. You must do well with the ladies (men?) with a soshul life like this. Will you pick up a good lookin ladie (man?) with your tails of smak talk from Megan's message bored?
megan, you must be so proud of commenters like Johnson_85...i see you really keep a high level of discourse as the standard around here.
Getting back on topic, is it time to take another look at the 'canned food & ammo' portfolio?
I'm still waiting for the infestation argument, i.e., humans are an infestation, so nature will evolve methods to thin the population, as the black plague once did in Europe, and AIDS is now doing in Africa. Doesn't it go hand-in-hand with canned foods and ammo portfolio? Or is cans-and-ammo creationist, infestation evolutionist?
People living in poorer countries tend to have weaker immune systems for the obvious reasons.
Not so sure that this is a good thing. My understanding is that most flu deaths among 20-50 year-olds are the result of a massive immune overresponse. Basically, your own body shreds your lungs trying to fight off the bug. That's why this one (and the Spanish flu) so disproportionately kill non-children and the non-elderly.
As much as I hate to interrupt this fascinating discussion of spelling, grammar, usage, and netiquette, _The Washington Post_ supports my assertion that the Mexican government is only reporting hospitalizations and deaths, not CASES and deaths. They are currently reporting 149 deaths and 1,995 hospitalized pneumonia cases (over 1000 of which have been sent home).
The current case-fatality rate for serious, hospitalized cases of pneumonia is a little upwards of 7% at this point. People living in poorer countries tend to have poorer publich health statistics for the obvious reasons.