Flu Pandemic Thinking
N.B.: I'll use the Hats Notation suggested by EdB here: http://www.edwdebono.com/debono/msg01p.htm
hW:
- Less than 60 days ago a few people were diagnosed with a novel type of influenza virus.
- After that, more than 40 thousand people have been diagnosed in more than 70 countries.
- About a week ago the World Health Organisation declared the situation "a pandemic". http://www.who.int/csr/disease/swineflu/en/index.html http://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pan...
- Pandemics have happened in the past. Each has been different.
- Each pandemic is felt locally as a series of epidemics, each one called a "wave" cos the number of cases per week goes up for some weeks, then goes down again.
- More often than not, the second wave means more deaths than the other waves. See picture at http://content.nejm.org/cgi/content/full/NEJMp0903906
- Severity is not just lethality. http://www.who.int/csr/disease/swineflu/assess/disease_swineflu_ass...
- The European Center for Disease Control suggest the most likely scenario includes a second wave in Autumn 2009. http://www.ecdc.europa.eu/en/Health_topics/pandemic_influenza/Likel...
- The world has changed since 1918, 1957 and 1968 in many different ways: more people, more transport, more information, more science, more chronic disease and older people, etc. http://gapminder.org
- The WHO says the effects of pandemics are Disease, Death and Disruption. Disease rates (percentage of population who fall ill) have varied in different pandemics (20-45%) and age groups (the young's average is 40%, not 30%). Deaths have happened in the old and frail, and sometimes in the young and healthy.
- Today there are more specialists than ever in history.
- It's been said that complex systems may not be particularly resilient if enough specialists "fail" (ill, dead or not happy to go to work).
hR:
- I feel the most important aim here is saving lives, mostly those of the young (precious and disruptive).
- My hunch is the Autumn wave will be "strong" even if it's not more deadly. I'm not sure this 2009 pandemic will behave like a 1918, and I'm not sure it won't, either.
- I feel there are huge oportunities in fresh thinking.
- I'm not certain people here will take this as a serious challenge. I feel it is.
hH:
- We may feel the need for better information. At that point, it may be late to do certain things, and the right time to do others.
- It looks to me one of the things the world is in need of is this: ideas so that we'll be able to keep essential activities going on while reducing transmission. That means hG, a lateral thinking challenge for ideas big and small. Ideas could be shared freely, perhaps public domain or other open license, so that there's the possibility of adapting them to different locations.
- If people here need hW, I'm ready to give links as and when I can.
- So, hG anyone? More hW needed? hH to provide some specific focus? I'm doing other things these days, so feel free to just jump in, help each other, and all those things we humans can do. :-)
hW:
- Less than 60 days ago a few people were diagnosed with a novel type of influenza virus.
- After that, more than 40 thousand people have been diagnosed in more than 70 countries.
- About a week ago the World Health Organisation declared the situation "a pandemic". http://www.who.int/csr/disease/swineflu/en/index.html http://www.who.int/entity/mediacentre/news/statements/2009/h1n1_pan...
- Pandemics have happened in the past. Each has been different.
- Each pandemic is felt locally as a series of epidemics, each one called a "wave" cos the number of cases per week goes up for some weeks, then goes down again.
- More often than not, the second wave means more deaths than the other waves. See picture at http://content.nejm.org/cgi/content/full/NEJMp0903906
- Severity is not just lethality. http://www.who.int/csr/disease/swineflu/assess/disease_swineflu_ass...
- The European Center for Disease Control suggest the most likely scenario includes a second wave in Autumn 2009. http://www.ecdc.europa.eu/en/Health_topics/pandemic_influenza/Likel...
- The world has changed since 1918, 1957 and 1968 in many different ways: more people, more transport, more information, more science, more chronic disease and older people, etc. http://gapminder.org
- The WHO says the effects of pandemics are Disease, Death and Disruption. Disease rates (percentage of population who fall ill) have varied in different pandemics (20-45%) and age groups (the young's average is 40%, not 30%). Deaths have happened in the old and frail, and sometimes in the young and healthy.
- Today there are more specialists than ever in history.
- It's been said that complex systems may not be particularly resilient if enough specialists "fail" (ill, dead or not happy to go to work).
hR:
- I feel the most important aim here is saving lives, mostly those of the young (precious and disruptive).
- My hunch is the Autumn wave will be "strong" even if it's not more deadly. I'm not sure this 2009 pandemic will behave like a 1918, and I'm not sure it won't, either.
- I feel there are huge oportunities in fresh thinking.
- I'm not certain people here will take this as a serious challenge. I feel it is.
hH:
- We may feel the need for better information. At that point, it may be late to do certain things, and the right time to do others.
- It looks to me one of the things the world is in need of is this: ideas so that we'll be able to keep essential activities going on while reducing transmission. That means hG, a lateral thinking challenge for ideas big and small. Ideas could be shared freely, perhaps public domain or other open license, so that there's the possibility of adapting them to different locations.
- If people here need hW, I'm ready to give links as and when I can.
- So, hG anyone? More hW needed? hH to provide some specific focus? I'm doing other things these days, so feel free to just jump in, help each other, and all those things we humans can do. :-)
Replies to This Discussion
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Permalink Reply by Sinclair McLay on -
Fair enough - but any new thinking in this challenge - if not needed in this pandemic - may have value in the next.
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Permalink Reply by Lucas Gonzalez on
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hW:
>The Americans and others are already working flat out on a vaccine for swine flu.
They say 4-6 months until first doses are ready to market.
Longer to have large number of doses.
It takes 2 weeks to build up immunity.
Less than 2 months have passed since first cases.
Second pandemic wave may come sooner than vaccines for a number of people.
Flu vaccines are particularly non-perfect. Specifically, they will be for first-wave virus, not for second-wave virus.
>There is uncertainty about the severity of the pandemic
Information is less than perfect, which is why we may feel the need to think.
>A new flu breeds more fear than the actual danger of the flu itself
We don't know if current concern, which varies from zero to a lot, is proportional to future damage, which apparently is too soon to know.
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>It may never happen
The second wave may never happen? Historically, flu pandemics happen in waves. At least 2 waves.
Another pandemic may never happen? Historically, there have been 3 flu pandemics each century, on average.
What's feared, which is a bad second wave, may never happen? True. But it's more likely than a third arm coming out of my chest. ;-)
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>any new thinking in this challenge - if not needed in this pandemic - may have value in the next
hY:
Ideas may be useful for others with less resources.
If others cope better, that may be useful for us too, because the world is connected.
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Permalink Reply by Sinclair McLay on
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Mood masks, team masks, flag masks, hero masks, masks with your own photo - hopefully smiling on them -
No Entry Sign masks with a pigs face on them, music masks, see through masks, Gucci masks, perfumed masks, chameleon masks, breath freshening masks, feedback masks, husband and wife masks,
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Permalink Reply by Sinclair McLay on
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Advertising masks, whisky masks, dating masks, ipod masks that stream lyrics across them, communicating masks, Matisse masks, translation masks,
prayer masks, beard masks, moisturiser masks, tongue game masks, kissing masks, The Daily Mask, Death masks, gossip masks, facebook masks, thinking masks
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hH:
Ok, now. Let's assume masks don't work too well. Not in crowded places, so we want to have less crowds. But still we want to keep essential stuff moving.
hW:
I do need to find a few links about how useful masks are believed to be, in community settings.
hB about masks is if people feel safe but they aren't then it may even be counterproductive. Arguable if people understand the limitations of masks.
Anyway, the question now becomes: How, without masks?
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Permalink Reply by Sinclair McLay on
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Darn ! I was quite enjoying that mask stuff !
OK Anither White Hat
Are we completely sure trasnsmission is person-to-person?
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hW:
>Are we completely sure trasnsmission is person-to-person?
Yes. Some of it is believed to be indirect, through surfaces. Which is why cleaning surfaces is said to be of some use. Trouble with this kind of evidence is, when people do that, they are also doing other things so it may be difficult to know which of the preventive measures did the job.
The other 2 ways are through large-ish droplets, those that fall to the ground soon, so that keeping our distance works. And through small-ish droplets, those that stay in the air for longer, so that keeping our distance works less. It's generally believed large-ish droplets matter more, I'd say.
On the other hand, about the "completely sure" part, what matters is to reduce a significant number of transmission events. Look at it this way:
1) Let's say on average each patient infects 2 other people. Each of those 2 people would in turn infect 2 other, and so on. The average time between "generations" is 3 days, so from 1 to 2 it's 3 days, from 2 to 4 it's another 3 days, from 4 to 8 it's another 3 days ... and from 1024 to 2048 it's another 3 days. Of course, in any given community the epidemic burns itself out when so many people have been infected that it's difficult to find 2 new people from each patient. So yes, at some point it goes 1x2x2x2 ...x1.5x1.3x1.1x0.9 ... and with a multiplication number below 1 the epidemic starts to go down.
2) So, for the first part of the epidemic, if we have "x2" we go from 1 to 1024 in 10 steps, which would be 1 month. Because it's 3 days per step.
3) Now, can you compute it with "x1.9" or "x1.8"? It's not 1024, but rather a lot less. Please don't take my word for it, compute it, and imagine your healthcare system can cope with 700 but not with 1024. See what's meant by "reducing transmission"?
hH:
Every bit counts so let's have ideas in that area, which I truely believe is an Idea Sensitive Area if there was one.
hW:
It's believed the "multiplying factor" is now around 1.5. In the Northern hemisphere Summer.
No, I don't know what it's like in Argentina, Chile and Australia. It's probably not less than 1.5, I'd say.
That number is an average, and inside a school it might be much larger. If each students in a school comes closer than 3 feet of 200 different people each day, with classes and busses and corridors and lunchtime, then it doesn't take a lot to have a number that's larger than 2 in that setting.
hR:
Thanks for your continued thinking effort. :-)
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Permalink Reply by Sinclair McLay on
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Schools - a mathematical model to reduce contact. Could play with some variables:
Staggering arrivals, lunches, opening at night, teachers coming to classrooms instead of pupils moving around etc
Sitting on your own. If people were encouraged to sit on their own - where possible - for 30 mins or an hour a day this may help. People could read, think, contemplate, do yoga, compose emails, take long baths, work on anti-virus strategies etc.
Could even ask Games companies to offer free gaming to youngsters so they could sit alone at pc's...
Paying people to stay indoors?
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Permalink Reply by Sinclair McLay on
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Where resources allow, video-conferencing classes ?
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Permalink Reply by Sinclair McLay on
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White Hat again
Are there any environmental factors we should be paying attention to ? - temperature, wind, altitude, humidity, cloud cover, coastlines etc
Green Hat - proximity tax - especially in relation to building design and planning.
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