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Tag: education

MKAILVVLLY

Those of you who do not live directly beneath a rock may have heard about this whole “swine flu” thing. Unfortunately, there is a considerable amount of misinformation and confusion in the public consciousness, and the media at large seems not to be helping much in the panic-mitigation department.

So before you start building your vault, a few points to keep in mind:

1. First of all, calm down.

2. There is still no compelling reason to believe that this strain, influenza A(H1N1)1, is significantly more virulent than a typical seasonal influenza.

Your run-of-the-mill flu season has a case-fatality ratio of very roughly 0.1%, or 32% of hospitalizations [1]. Let’s narrow that to the 19-to-64 demographic, which could be most susceptible to this current outbreak (an unusual pattern seen in pandemic flus and likely caused by an overly robust immune response in healthy adults [2]), and is least susceptible to the seasonal flu. Within that population, CFR is about 0.03%, or 7% of hospitalizations [1]. Past influenza pandemics have had CFRs of anywhere from 0.1% in the 1957 and 1968 outbreaks to 2.5%2 in the 1918 “Spanish flu” [3].

In contrast, the CFR in the case of influenza A(H1N1) could be anywhere from 3.1% (an upper bound, based on a maximum of 8 laboratory-confirmed influenza A(H1N1) deaths out of a minimum of 257 laboratory-confirmed influenza A(H1N1) cases worldwide, from WHO figures available at time of writing) to 0.0016% (a very conservative lower bound, based on an approximate hospitalization rate of 0.4% of all cases in the 19-64 demographic in a typical flu season [1], with which an attack rate was extrapolated from 2000 estimated hospitalizations in Mexico).

Using figures that are quite popular in the press gives a CFR of about 7.5% in Mexico (some 150 deaths in 2000 hospitalizations, the latter very dubiously assumed to be equal to the number of cases). Because of the unreliability of the “suspected” case count in Mexico, I am not convinced that this particular CFR estimate is useful at all, even as an upper bound. It’s far more likely that the actual CFR falls somewhere between 0.0016% and 3.1%.

All of these numbers don’t tell us very much (except that it is highly unlikely that this is some epic killer virus), but that’s exactly the point. Just because (thanks in large part to the surveillance infrastructure put into place in the wake of the “avian flu” panic) this (potential) pandemic has been spotted, there is no reason to assume that we have any solid evidence suggesting that the virulence of this pathogen is particularly high. However, this may very well change as time goes on and as the situation becomes clearer, and it certainly does not mean that the virus is not dangerous.

3. Virulence is not the same as pathogenicity. Perhaps more precisely, the concepts are not the same, though the terms may often become scrambled in the fray. The salient point is that while influenza A(H1N1) has proven highly pathogenic (i.e. it is highly infectious and spreads rapidly), there is not much evidence to suggest that it is especially virulent (i.e. it has not been associated with unusually high mortality or morbidity). So while governments everywhere are preparing for the possibility of a pandemic, the severity of the disease (to wit, the “causing serious illness” criterion from the linked WHO document) is far from clear at this point. And hopefully I was able to convince you in Point 2 that there is as yet no reason to suspect any greater virulence from this strain than a typical seasonal flu strain.

4. Influenza A(H1N1) has a few key differences to Severe Acute Respiratory Syndrome (SARS) and influenza A(H5N1) or “avian flu”. For one, both SARS and avian flu were much deadlier; the SARS outbreak in Hong Kong had a CFR of about 14-17% [4], while the avian flu has a CFR of something like 14-33% [3]. However, avian flu never demonstrated efficient human-to-human transmission, which made it a very deadly disease that was unlikely to spread quickly. Likewise, SARS has never been observed to be contagious before the onset of symptoms, which significantly increases the likelihood that a person at risk of transmitting SARS can be identified by basic surveillance. Influenza A(H1N1), while appearing (for now) to be far less virulent than either of these two recent serious respiratory disease outbreaks, is also considerably more likely to spread rapidly and become pandemic.

5. There is a lot of talk in the news about “suspected” and “probable” cases of influenza A(H1N1). When these words are used by a media outlet, then frankly all bets are off. On the other hand, if a news report quotes a health official referring to a case as “probable” or “suspected,” that official is (hopefully) adhering to the CDC’s Case Definitions for Infection with Swine-origin Influenza A (H1N1) Virus (S-OIV):

A confirmed case of S-OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests:

  1. real-time RT-PCR
  2. viral culture

A probable case of S-OIV infection is defined as a person with an acute febrile respiratory illness who is positive for influenza A, but negative for H1 and H3 by influenza RT-PCR

A suspected case of S-OIV infection is defined as a person with acute febrile respiratory illness with onset

  • within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or
  • within 7 days of travel to community either within the United States or internationally where there are one or more confirmed cases of S-OIV infection, or
  • resides in a community where there are one or more confirmed cases of S-OIV infection.

You can make of that what you will. It seems to me that there is probably no logistical barrier preventing health care entities other than the CDC from confirming the influenza A(H1N1) subtype, except for one reason or another it doesn’t count as “confirmed” unless the CDC does it.

6. When I first began considering and looking into the actual severity of the whole “swine flu” panic, I thought exactly the same thing that Obama said earlier this week: this flu outbreak (and likely pandemic) is, based on the information we currently have, a cause for concern but not alarm.

If there is one good thing that has come out of what is arguably a gross overreaction by the American media, it is a heightened awareness of the importance of public health and good hygiene. So remember kids, listen to the President and wash your hands.

References

[1] Weycker, D. et al. Population-wide benefits of routine vaccination of children against influenza. Vaccine 23, 1284-1293 (2005).

[2] Kobasa, D. et al. Enhanced virulence of influenza A viruses with the haemagglutinin of the 1918 pandemic virus. Nature 431, 703-707 (2004).

[3] Li, F. C. K. et al. Finding the real case-fatality rate of H5N1 avian influenza. J Epidemiol and Community Health 62, 555-559 (2008).

[4] Jewell, N. P. et al. Non-parametric estimation of the case fatality ratio with competing risks data: an application to Severe Acute Respiratory Syndrome (SARS). Statist Med 26, 1982-1998 (2006).


1I have used the nomenclature preferred by the World Health Organization as of 30 April 2009.

2The 2.5% CFR figure for the 1918 pandemic, though almost canonical, seems highly questionable given the estimates of 20-100 million deaths at a time when the world had a population under 2 billion. In any case, data from that pandemic are likely iffy at best.

we don’t want your kind here

Q: “I don’t trust Obama, I have read [sic] about him. He’s not… He’s not… Errr… He’s an Arab.”
A: “No, ma’am. No, ma’am. He’s a decent, family man, a citizen that I just happen to have disagreements with…”

Colin Powell offers the correct answer to the Muslim/Arab “attacks,” and it is truly a pity that Obama has not yet spoken out about this:

But the really right answer is, what if he is? Is there something wrong with being a Muslim in this country? The answer’s no, that’s not America.

We’ve come so far since those bad old days, one could be forgiven for believing that we’ve made some progress. That is, until one has observed that which is the conservative “pro-America” (if by America you mean bigotry) population.

McCarthy would be proud

Michele Bachmann expresses a nonsensical, ideologically inspired and dangerous view that demonstrates a complete lack of understanding about America and its founding ideals. To call those who are critical of government policy and structural inequities that cause suffering (i.e. a failure to realize the ideals of America, whatever that even means) anti-American is not only profoundly idiotic, but smacks of the violently nationalistic attitude that empowered the most terrible regimes the world has ever seen.

peasants tell tales

The following is an excerpt from Chapter 1 of The Great Cat Massacre by Robert Darnton. It is his rendering of a tale “more or less as it was told around firesides in peasant cottages during long winter evenings in eighteenth-century France.”

Once a little girl was told by her mother to bring some bread and milk to her grandmother. As the girl was walking through the forest, a wolf came up to her and asked where she was going.

“To grandmother’s house,” she replied.
“Which path are you taking, the path of the pins or the path of the needles?”
“The path of the needles.”

So the wolf took the path of the pins and arrived first at the house. He killed grandmother, poured her blood into a bottle, sliced her flesh onto a platter. Then he got into her nightclothes and waited in bed.

“Knock, knock.”
“Come in, my dear.”
“Hello, grandmother. I”ve brought you some bread and milk.”
“Have something yourself, my dear. There is meat and wine in the pantry.”

So the little girl ate what was offered; and as she did, a little cat said, “Slut! To eat the flesh and drink the blood of your grandmother!”

Then the wolf said, “Undress and get into bed with me.”

“Where shall I put my apron?”
“Throw it in the fire; you won’t need it any more.”

For each garment – bodice, skirt, petticoat, stockings – the girl asked the same question; and each time the wolf answered, “Throw it on the fire; you won’t need it any more.”

When the girl got in bed, she said, “Oh, grandmother! How hairy you are!”

“It’s to keep me warmer, my dear.”
“Oh, grandmother! What big shoulders you have!”
“It’s for better carrying firewood, my dear.”
“Oh, grandmother! What long nails you have!”
“It’s for scratching myself better, my dear.”
“Oh, grandmother! What big teeth you have!”
“It’s for eating you better, my dear.”

And he ate her.

I should say that this conveys at least some meaning regarding the condition of peasant life in 18th century France. At any rate, I hereby endorse HIST 395 as a cool class.

va, tosca

Two weeks ago I saw Seattle Opera’s production of Tosca. It is quite an amazing opera, and this production was marvelous, if not especially distinct. Greer Grimsley made an amazing Scarpia, and I definitely want that cloak from the Te Deum scene (of which no pictures can be found on the internet, sadly).

The United States House of Representatives has managed to maintain a strong stand against the lies and fear-mongering of the Republican party and the Bush Administration on the issue of retroactive immunity for telecommunications corporations. Of this I am glad, though often it seems as though not enough is being done. In this and many issues, it is exceedingly clear that ignorance plagues Americans. The case against retroactive immunity is so blatantly compelling that no informed citizen with a functional brain should support immunity; yet somehow it does not draw sufficiently widespread and scathing criticism as to kill the idea entirely.

Ich bin ein Berliner

As a matter of principle I believe it is important to evaluate all information from primary sources when making decisions of significance (e.g. the presidential election, the question of whether the event is actually significant notwithstanding, i.e. accepting the assumption that it is). This is the only way to avoid being misled by deliberate or accidental misinformation. Examples of the former include basically anything from Faux News, anything out of the Bush administration regarding FISA/PAA, and so on. Of the latter, a general example would be inaccurate popular science, such as the “Equal Transit theory.”

But a tremendous hindrance exists, making this principle difficult to put into practice: we (as a people) are not well educated. To be sure, many of us will come to be proficient in a particular discipline, while some will never be very knowledgeable about anything at all. But we are called upon to make decisions that would ideally require extensive knowledge in practically every discipline. This makes it incredibly difficult to evaluate all issues with which we will be faced, unless we manage to confine ourselves to a world in which all we have to decide is whether Britney Spears should ever have more children.

For instance, who actually understands global warming? In attempting to weigh the consensus view against dissenting ones, I realized that I don’t know the first thing about how to analyze or approach the data. And I would be highly skeptical of anyone who claims to understand the scientific bases of the global warming issue, unless they are able to support such a claim by explaining the mathematics behind the models.

gaydolf titler

Work finally begins on the Tbr2 project, focusing for now on the SVZ. Since this is really no longer my project it’s become considerably less exciting, but the pursuit of knowledge and other vague concepts remain intact.

Today’s youth in America suffer from a tremendous lack of proper education in history and the arts. I think this is not only a sign of the epic failure of our education system, but more significantly a reflection of the undervaluation of history and knowledge itself in our society. Ignorance is why so many Americans are fooled by the half-truths and outright lies fed to us by the institutions of power and repeated by the media ad nauseam. It is impossible to make an informed decision (e.g. when deciding who will best govern us at all levels) without having a thorough knowledge and understanding of the facts and the consequences of proposed actions.

A better understanding and awareness of history (and particularly the ability to think critically about such things) on the part of Americans would all but eliminate the possibility of a tragedy like the Bush Administration ever recurring. But that is nothing but a distant fantasy that will likely never be realized in this world.

Yet another area in which the United States of America leads the world. Americans sure do like being #1. I would write a paragraph or two on how terrible the system of “justice” is in the United States but I feel that this subject would more appropriately fall under Nate‘s “jurisdiction,” if you will.

In closing, I would appreciate any insight as to why the water in Drumheller Fountain was brown today.