The misallocation of attention and resources on rare but spectacular risks, to the detriment of dealing with mundane but far more lethal ones, is something I’ve personally commented on more than once; our skewed psychology of risk is still not widely appreciated enough. But in the course of making a reasonable point about stereotypes and our lack of empathy with the other, John Watson, in purporting to analyze the risks of epidemics, demonstrates a pretty poor understanding of risk himself. In a nutshell, Watson argues that we are overly worried about the comparatively minor threat of swine flu, and ignoring developing-world killers like tuberculosis, malaria, and AIDS.
We should, undoubtedly, try to do more to fix these humdrum killers in developing countries (not to mention indoor air pollution, which kills comparable numbers of people throughout India and China). But that doesn’t mean that the concern about swine flu is in any way unjustified, or discriminatory towards the developing world.
It is entirely true that, at this point in time, the current flu outbreak has infected a relatively small number of people so far, and killed very few. But when we talk about analysing risks, we’re not interested in what has happened, we’re interested in what might happen, and trying to estimate two things – the probability of a bad event occurring, and the impact of that bad event. It’s then we go to the historical precedents, and get to the 1918 Spanish flu epidemic killed tens of millions of people, many of them otherwise healthy adults. That’s probably close to the worst-case scenario. More recent epidemics have also killed millions, through the developing as well as the developed world. From a risk analysis perspective, the probability of a re-run of the Spanish flu is pretty low, but the impact of such an event would be very serious – and would presumably have its greatest impact in the developing world, particularly in sub-Saharan Africa with its very high rates of HIV, by the way. So, until we have more information that allows us to rule out the worst-case scenario, it’s entirely rational to throw the kitchen sink at slowing down this bug as much as we possibly can.
Furthermore, any risk analysis can’t simply do a casualty count. It matters whether illness and injury come over a long period, or as in a burst that overwhelms the community’s ability to cope. It matters whether deaths are localized or widespread. And, to put it bluntly, it matters who dies. The final two reasons are why we’ve paid infinitely more attention to the 170-odd people who died in the Victorian bushfires than the comparable numbers of elderly people who died in the heatwave preceding it. A flu pandemic may not be localized, but it will be relatively sudden and might, possibly, kill disproportionate numbers of young adults.
If John Watson had have chosen military expenditures, for instance, to make his point, he would have been on pretty solid ground. But to claim that the current attention being given to swine flu is an example of “panic about relatively minor or remote risks” is just flat wrong, at this point in time.
Good points Robert – just quickly Bruce Schneier has an excellent rundown on risk and how we perceive it.
www dot schneier dot com slash essay-155
Problems of risk come up regularly in rockclimbing as well – low risk (depending on attitude of course!) but very high consequences if something does happen (albeit only a small group is effected).
This, of course, assumes that the establishement in the first world actually wants to save these people in the developing world.
Actually – my understanding is that people with weakened immune systems stood a better chance with the Spanish Flu because the way people predominantly died is thought to have been by a massive immuno-over-reaction to the virus. So it was the young and healthy who were at greatest risk.
It’s a very interesting issue though. As it happens I’m currently booked on a holiday to the USA in early June – the biggest swine flu risk I can identify is sitting in a plane with people who may have it. I don’t envy my mate, who is heading to Mexico on Saturday (in theory) for a seaside holiday.
What would you do?
Where did all the recent palaver about “risk” come from?
Agreed on the argument, but for what it’s worth about twice as many people died in the heatwave (374) according to the Vic Govt (there is a formal report out with detailed data but I don’t have a URL for it).
I would figure that lots of larveologists know about the basic risk equation, Robert. It’s the key policy argument for drastic CO2 cuts, after all.
The hard part to remember is the meta-risk. Being confident that you have identified and managed risks is … a risk. There’s the risk that you’ve underestimated impact and therefore are underprepared, or overestimated and therefore wasted resources. Where does it end? I’m not sure, it could be turtles all the way down.
Then there’s smart alecks muttering about Pascal’s Wager. And then you get into a kind of twisted tit-for-tat version of Pascal’s Wager where dire consequence is answered with still more dire consequence and eventually we’re all going to a hundred different hells.
I don’t mean to lecture at you Robert. You know more about this than I do, I’d bet. There’s a risk I’ve come off as a smug git again …
I think Watson is right to depict the swine flu brouhaha as an over-reaction. There’s not a shred of evidence as yet to suggest that this recombinant strain will have any more significant an impact than any other influenza strain in a normal season. Thousands of people die from boring old bog standard flu viruses every year.
The emergence of new strains is always cause for heightened surveillance – and flu strains are notoriously volatile – but the hysteria around this is out of all proportion. For instance there’s no evidence that pigs pose an ongoing transmission risk to humans. Humans are an ongoing transmission risk to humans. But Egypt plans to slaughter all the pigs in the country (upon which the Coptic Christian minority utterly depends) anyway.
Maybe it’s simply the case that the initial wildly exaggerated reporting out of Mexico (it appeared in San Diego at the same time but with less fanfare) fanned the “next Spanish flu” anticipatory flames. Global public health systems geared up as media attention rose to a crescendo and public – and hence political – concern grew. In these circumstances, the trip point is reached as public health pandemic response plans meet media briefing needs and news cycle responses fed into overall government media management strategy. After that the cycle runs until continuing viral inability to deliver on the initial headline promise has the inevitable effect.
In the meantime it’s good to remind people about hand-washing and not going out when you’re going to cough and splutter over your fellow citizens. But it’s not a great outlook for pigs.
You have completely missed the point.
Because of my social status in a wealthly country, I am virtually guaranteed protection from these other “traditional” diseases.
But Swine Fever is transmitted person to person, and I might get it. My status and the country I live in are no protection.
It is time to throw every resource at it. to hell with the cost. It ME that is in danger here.
good post though
Good post Robert, although having come from an organisation for which Risk was the new deity, I was a bit worried at first. But I think your reasoning is good.
Why shouldn’t the precautionary principle apply here too?
Oh, sure, there’s overreactions all over the place. Slaughtering pigs in Egypt is pointless, thermal scanners at Australian airports are pointless, the psychiatrists allegedly writing prescriptions for Tamiflu for their wealthy eastern suburbs patients are indulging a largely pointless overreaction.
Wot Geoff said.
I could understand the panic if it were 100% guaranteed fatal or it caused hideous disfigurement or a horrendous death like that of haemorrhagic fever. But its the flu, a more intense kind of ‘cold’.
The figures coming out of Mexico of 159 deaths revised down to 7 and then back up again makes one wonder what exactly is going on and then realise that noone actually knows.
In words, said with a bit of a grin, from our one time health Minister Tony Abbott when being interrogated about our preparedness for Avian flu. “Something’s going to kill you, eventually. So stop panicking.”
I wonder what the a priori risk of a triple re-assortment, (such as this one is, human,swine,avian) virus would have been estimated as. My guess is small, but nonetheless it’s happened. The risk we now have to consider is that of this H1N1 franken-virus re-assorting yet again with its co-evil twin, the seasonal H1N1 strain now rampant in New York and picking up the tamiflu resistence mutation it’s got, H274Y.
Since viruses are not alive, just a bit of DNA wrapped in some proteins, and replication doesn’t incur a metabolic opportunity cost to them, ( the host provides the machinery) they are a lot like, say, Kerry Packer after he’s just skinned Alan Bond, feelin real good and lucky, booking out a whole floor of a pokie palace, just 5c machines so he can have virtually unlimited spins, with a team of button pushers working them flat out in search of a machine going ping. In virus terms that’s incorporating a mutation that helps getting past host defenses, intrinsic or pharacological. Influenza ones are negative-strand RNA viruses, they have a very high mutation rate, (because rna polymerases don’t have the proof-reading function of DNA polymerases), think Kezza paying someone to doctor the machines into being big payers. I’m thinking there’s not much chance of the crucial tamiflu resistence mutation/reassortment not happening, the numbers are on their side, they never give up. And lest we forget, this is a new strain, there is no in-situ immunological response ready for the body to to call to action. We don’t want this fat lady to even warm up her tonsils if we can remotely possibly help it.
The boffin on the 7.30 report made the point that the 1918 pandemic strain (H1N1 like this in case you hadn’t picked that up) only had 1 – 2% fatality rate , yet managed to rack up the equivalent of about the population of the US in fatalities, and infected about a third of the world’s population. In about 6 months. So just cos folks say this one doesn’t have the pathogenicity of h5n1, which is a really nasty piece of work, doesn’t mean it’s benign. I don’t know about this one, but I remember reading about a case of tamiflu resistant h5n1 patient who survived, just, but he was 2 weeks on a respirator machine. What they call a cytokine storm happens, you basically drown in your own immune reponse juices. How many respirators you reckon we can put on deck? Hundred? Try a few dozen.
Frankly I’d like to see them switch the airport screening machines on immediately. Roxon running up the white flag that it’s inevitable it’ll get here is crap. I’d rather pay a tax levy to getting them happening, and completely paranoid quarantine measures besides. Hell, I’d give up lattes AND chardonnay to pay for the staff and machines and premises. I’m thinking even tourism Australia could turn “Sure, it’s cramped in quarantine for the first few days when you get there, but that’s why Australia is the flu free continent. When we say you’ll make lifetime friends there, it’s not an empty promise” into a winner ad campaign. Australia had an excellent infection and survival record in the 1918 H1N1 campaign, only because it had a strict quarantine approach. Lest we forget, we are GirtBySea, there can be a payout on that. Sounds like level 6 is about to be called by WHO. They’ve said pandemic plans should be activated. Machines activated @ midnight. Just out of interest, can anyone find an N95 mask at a chemist? Not a particle mask, or a surgical mask, N95 is the one with the right pore size. There’s none in my suburb, but we’ve got multiple hospitals close by, we would have been first in line for their stockpile spree when they had early warning early this month.
2000 Computers, 2008 Money, 2009 Health, http://www.youtube.com/watch?v=0MdqiLmrww4
There you go.
Hey 36,000 yanks died of yer common bog ordinary flu last calendar year.
But if you are looking for a really good freakout, it is quite plausible that with the few decades we could will experience:
A massive depression, coupled with the collapse of a key resource, undermining traditional economic models.
Even as the global economy recovers, a global war erupts, a horrifying accident triggered by political systems overwhelmed by increasingly rapid communications, a tragedy multiplied by the almost casual use of chemical weapons.
The end of this war coincides with the emergence of a pandemic the likes of which the world has never seen, killing millions upon millions — and, combined with the war, almost eliminating an entire generation in some parts of the globe.
After the pandemic ebbs, a brief, heady economic boom leads many to believe the worst has ended. Unfortunately, what follows is a global depression even more massive than the previous one, causing hyperin?ation in some of the most advanced nations, and leading directly to the seizure of power by totalitarian, genocidal regimes.
Followed by an even greater world-wide war, nearly wiping out a major culture and culminating in a shocking nuclear attack.
Cheer up, it’s already happened. The first half of the last century.
Dont’ blame me for your sudden attack of future panic. He started it.
Fuck, I blew that last line. The phrase “historically hysterical” should have been deftly slid in there.
Robert – it’s almost impossible to tell how many “people died as a result of the heatwave” and keep a straight face.
No way of telling if Mr Oldergent went off two days earlier because it was so hot or because he was stressed because of the GFC or because he was sick of life or because god called him.
I really have no idea if swine flu is a beat up or not, but I get very, very sick of the people who say “well its only killed x people so why are we wasting resources on it?”
I remember seeing something in the late 80s about what a waste of money AIDS research was because so many fewer people had died of it than various other diseases, which were less well funded. They explicitly said this was because Gays formed a tight-knit lobby group that demanded money in a way more defuse diseases couldn’t.
I lose track whether AIDS is now the largest single cause of lost life-years, but it’s certainly shot way past most of the other diseases mentioned back then. The aim of the game is to know where the ball is going, not where its been.
yeah and what the ever sensible Mr Honnor said: cover yer mouth when you cough or nose when you sneeze.
Wash your hands.
Even better use your arm to cover your mouth when you cough – you are less likely to spread disease than if you use your hand.
“…or because god called him.”
Or rather overheated from something he spent too much time with online.
A shorter Nabakov: don’t learn from history, condemned to repeat.
S/he omitted one thing with her/his “it’s already happened” rhetoric…. but not here
at least not re: the 1918 pandemic
The minimum global fatality estimate I’ve seen is 50 million, out of then world population of 1800 million, ie 2.8%. Influenza cases were first recorded late 1918 in Australia with the greatest number of deaths occurring in 1919, about 12,000 deaths. Our population was about 5 million then, so @ the 2.8% global fatality rate, we would have been up for about 140,000 ie about tenfold more than that which eventuated. We must have been doing something right.
That was strict quarantine. New Zealand didn’t have border control, and influenza arrived there three months earlier than here, and had 3 fold greater mortality rate. Tasmania had very strict quarantine, managed to stave off arrival for 7 months after the mainland, and got its mortality rate down to .81/1000 poulation, one of the lowest worldwide. Western Samoa, on the other hand, the worst, lost about 20% of it’s population. (On the other hand, Anzacs had amongst the highest death rates for WW1 itself. For effect of the war on individuals, families and Australian society, see ‘The Broken Years’, Gammage, 1974)
Obama admitted to some chagrin that the border door couldn’t have been locked before the mexican influenza horse had bolted through. We have an excellent chance here, being GirtBySea, of really minimising the damage, if we just show the good sense and diligence our grandparents did. Yeh right, as if. A nod is as good as a wink in the land of the long white lurk.
“A shorter Nabakov: don’t learn from history, condemned to repeat.”
Huh?
My last substantial comment on this thread basically boiled down to “don’t panic, we’ve already been through worse and come out stronger.”
But speaking of spinning the issue…
“…before the mexican influenza horse had bolted through.”
What’s wrong with the name “swine flu”?. An all time great pandemic tag.
“it’s almost impossible to tell how many “people died as a result of the heatwave”…”
It’s not that hard. Compare the mortality rate during the heatwave with previous years for the same period. Then compare the months following the heatwave:
1) there’s a fall in deaths following the heatwave, giving the amount of the deaths that were ‘brought forward’.
2) there’s an increase in deaths, giving additional people who were made severely frail by the heatwave.
3) the mortality rate quickly returns to normal.
(Is it possible 1 and 2 cancelled each other out to give 3? Doesn’t make any difference to the result for how many “people died as a result of the heatwave”.)
“because he was stressed because of the GFC or because he was sick of life or because god called him.”
In which case, Mr. Oldergent’s was just one of the normal, non-heatwave related deaths for the period.
Good post and an important issue in the general sense as well as in the immediate swine flu context. Good risk assessment and management is or should be central to virtually every policy or resource allocation decision, and a comment plaintively querying where the risk “palaver” comes from I find rather sad. Please keep reminding us at regular intervals how important it is. Not least during some of the big government vs small government arguments. That governments are on the whole very bad at assessing and handling risk is an often forgotten element in those.
I do take mild issue though with your suggestion that Watson’s argument would have been OK if only he’d taken aim at military expenditure. It seems to me contrary to your own argument that we generally over-estimate probability and under-estimate impact in risk assessment. If we get our risk assessment wrong in defence strategy, we finish with world war two. It is the ultimate high impact risk.
I am not arguing that defence risk and resource allocation are necessarily done very well at the moment – see above re Governments being bad at it. I just don’t think the apparent blithe assumption that it is somehow obvious that health expenditure is more justifiable than military expenditure is correct. The same risk assessment principles you outline should apply.
And, yes, I agree it was a throwaway line and I am being over-picky in fastening on it.
My dear Ms/Mr/s Nab: I suspect we are in susbstantial agreement that yes, there’s no need to panic. I should have been more careful with cavalier quotes from the epigram canon, let me rephrase: If we learn from history, we could get an even better result than our forbears did, which as I tried to point out, was exemplary, a tenfold reduction of the global mortality rate.
I will dare to quibble about your use of the first person: unless you and your mates are centenarians plus, to say “we have been through it” is ok as a figure of speech, but misses the point that we, on average, and medially, boomers and younger, have zip real experience of the chips being really down, across the national board. Bushfires, droughts and flooding rains, the whole Dotty Mac deal, yes, but they are essentially localised and sporadic, quite different to being besieged by an enemy as creative and belligerently alien as an antisense strand RNA virus, like these buggars are.
As a logical and strategic weapon designed specifically for the task of wreaking havoc on paradigmatic {dsDNA-> +mRNA-> aa’s-> functional proteins} organisms like us, they are the pretty much the ultimate in lean and mean, the original silver bullets. Unfortunately we are the targets. They are perceived by our systems as so wtf strange that they illicit extra strong immune responses, the very robustness of the immune system of people in their metabolic prime becomes their own worst enemy. Not to put too fine a point on it, we drown in our own defense fluids. Oddyseus had nothing on these guys when it comes to clever dickery and allegedly re-deploying for own purposes the cue-the-immune-reponse palladion. All these little f’ers have to do is BringTheirOwn (negative strand RNA template) mRNA polymerase cause civilised organisms just don’t have call for that sort of deviate functionality. Once that first infctious particle gets it’s first +ve strand cuckold mRNA payload copy into the system, they’re away, 110% vendor finance. (Hmm, thinks: they must have a way of making copies of -ve strand infectious particle RNA to move onward and outward, on there quest for being the Dr Who meets St John of the Apocolypse finale scenario script. HTF? I’ll have to look that perverse mechanism up.)
The closest I can get to a neo-human metaphor for their MO, apart from resurrecting big Kezz with a bottomless bag of zacs playing merry mayhem at the pokie palace, is our very own Kev: I’m convinced the tories designed and spawned him in secret lab a generation ago, he’s chipped to lay waste to the economy in one term, make it look like it is labor’s fault, and lay the way for the tories to be gratefully handed the keys for a menzies length term. Notice how the pinky ring turned up on his left hand at about the same time as he did in old Beezers? That’s how he’s fed the control signals from I reckon.
I’ve got a great deal of respect for these demonic little sub-life forms because I used try to do, 20 years ago, exactly what these blighters do, make conservative point mutations to genes encoding strategic functional protein. My excuse was basic molecular biology structure/function research, plus 15 years later a therapeutic drug came out of it, only cos overseas investment came to the party. Oh what a difference, in terms of substrate specificity, intracellular location, processing pathways, a changed nucleotide base can make, in the lab, in life, in sickness, and in prevention and cure. Ironies abound: the tools molecular biologists, genetic engineers, use are often derived from these same arcane “organisms” peculiar metabolic arsenal: Avian Myeloblastosis Virus Reverse Transcriptase, now that’s what I call a cordless drill when it comes to building a gene library. Those whom the virii would destroy, first they give their tools to, just to make the battle interesting.
But particularly: the natural substrates of the enzymes I was tinkering with are exactly the same sugar moities these influenza viruses have selected to use as a beachhead into us. I went white when I came across a Russian paper showing: Treating (primate model) (likely pandemic virus entry point= airway epithelium) with (enzyme I cloned the gene of, sequenced, redesigned, etc ) prevents bird flu virus infection, changing the cell-surface locks as it were. The obvious, a prophylactic throat spray, is probably not a good idea, the attachment molecules the virus just happens to choose for its nefarious purposes will no doubt have a native function which probably should be left alone. Taking just the knowledge of exactly just what it is the virus is irresistably attracted to, and laying a honey trail to a dmz briar pit of viral doom could have legs. I see there are smart masks, not exactly available to you and me, but existent, which by the sound of it do pretty much that, trap and irreversably bind the infectious viral particles on the outside of the mask: careful disposing with that exposed virus fly paper Eugene, don’t touch. I’m thinking ViruTrap air conditioner filters like that handling the atmosphere exchange zone between infectious hotspots like quarantine stations and clinics.
There’s a 3 para rule? Now you tell me.
,
sally r – I suspect that the numbers are too low to draw any real conclusions. I’m sure you can do what you said but I reckon to be meaningful it would need to be over the same months over a few years and a range of temperatures.
It’s not keeping me awake at night.
Caroline @ 11, the flu IS a serious illness. It isn’t a cold (except to all those wimps who insist that their ordinary cold is flu so they can get some sympathy). People die of flu (rate of 0.1%, according to Wikipedia) but they don’t die of colds.
The issue is that the 1919 Spanish flu is known to have had a very high infection rate (up to 50%)and a death rate of 2-20%. This recombinant swine flu is a form of flu to which humans have no immunity, so we can reasonably expect to see elevated rates of infection and death, one hopes not as high as the worst case.
The discrepancies in the Mexican figures are between the deaths apparently caused by a flu and the bodies which have actually been tested for the new virus — I’d guess Mexico doesn’t have lots of labs around to run the testing.
I also assume that the number of hospitalisations and deaths from flu in Mexico is unusually high, or why is the WHO paying so much attention? They have plenty of other things to think about.
FX – that’s basically what the Vic gov’t did to arrive at 374 excess deaths (that’s excess over the normal for that week, which is already higher than the year-round average for heat-related deaths for obvious reasons). That and what Sally R said.
I found the URL for the report.
josh – so you are going to go all factual, reasoned, analytical and evidence based on me now. Throwing the url of an actual study at me – Play fair – this is the internet.
A really important determinant of the death rate from a pandemic is not just the virulence of the bug but the nutritional status of the population; that’s why the biggest proportion of deaths from Spanish flu was in India and China, and why the plague could wipe out a quarter of the world’s population in the 14th century. Those countries that have left Malthus behind will have far lower death rates.
I wonder if the Mexican victims were poor or not?
An observation on population statistics and an individual perception of the statistic. Prior to a by-pass operation I was advised that the risk of dying was about 6 percent. Now we are advised that the risk factor for the H1N1 virus is about 1-2 percent. My view of both of these risk factors as they apply to me is vastly different. Agewise I am almost over the yardarm. I have heart disease. I have emphysema. I live in a regional area of Australia with long waiting lists for appointments with medical practitioners. Looking at it fairly and squarly my risk factor is 50% – i.e. either I get the flu and die or I don’t. I think even money is still a good bet.
The other unknown for pandemics, derrida derider, is the existence of the antivirals and of antibiotics to treat secondary pneumonia (assuming this flu doesn’t cause cytokine storms). But the point about nutrition is important.
Good luck, liela!
Don’t forget that there is a 50% probability that the Large Hadron Collider will destroy the world:
http://www.thedailyshow.com/video/index.jhtml?videoId=225921&title=Large-Hadron-Collider
So we all leant….. what was it again?