September 30, 2005
Economic Collapse Avoidable During An Influenza Pandemic

Sherry Cooper and Donald Coxe of Canadian brokerage BMO Nesbitt Burns paint a very bleak economic picture should a dangerous flu such as the H5N1 avian flu develop into a deadly human pandemic strain.

They warn investors the economic fallout out of a pandemic would inflict pain across sectors and around the globe.

Airlines would be grounded, transport of goods would cease, the tourism and hospitality sectors would evaporate and the impact on exports would be devastating, Cooper wrote.

I agree the tourism and hospitality sectors would shrink to very small sizes. Also, gardener services would probably be banned as would most home maid services and lots of other home services that risk bringing workers into contact with lots of different residents. But the collapse of transportation is avoidable by reorganizing society into a large number of cocoon mini-societies that have very little contact with each other but which still move goods between the isolated nodes. I call this idea "workplace cocooning".

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, agrees with Cooper and Coxe that an influenza would have a huge impact on trade volumes (at least that is my interpretation of his statement).

"All the other catastrophes we've had in the world in recent years at the very most put screen doors on our borders. This would seal shut a six-inch steel door," Osterholm said.

Certainly resorts, hotels, and the airline industry will take huge hits from a hihgly lethal pandemic. But I do not buy this argument for all industries. Yes, if people panic so far out of their minds that they act really dumb then all transportation would cease and economies would collapse. But operators of transportation equipment can still work without getting exposed to influenza during a pandemic. It just takes some thoughtful reorganization of how things work.

The best approach I can see for reducing a pandemic disease's economic disruption and death toll is to have people live in workplaces for extended periods of time under quarantine conditions. I call this "workplace cocooning".

Take container ships and oil tankers as examples. The operators of those massive vessels do not need to get off the ships when in port. They also can avoid having port workers get on those ships. Container ships get off-loaded with huge cranes. The ship crews could hook cabling on containers to offload the containers if necessary. The food and other supplies for the ships could be replenished using cranes to lower supplies onto decks. Ship crews could stay on the ships for months ("workplace cocooning") without getting anywhere near local people when in ports.

Granted, the sailors would be fairly isolated for months. But look at teams of scientists in the Antarctica who stay down there for months. Oh how about explorers on ships in previous centuries. They were even more isolated and with far harsher and more dangerous conditions. Oil tanker crews similarly could just stay on board for months and visit many ports while staying safe distances from locals in ports.

Sailors do not want to stay on ships for many months. But they do not want to be unemployed or dead either. Sailors will face a choice of either signing up to get paid for long stretches on ships or being left on land and unemployed. Given those choices plenty of sailors would sign up for long stretches of work that allowed them to escape possible death from a pandemic sweeping the world. To get crews onto ships without chance of influenza spreading from an infected crew member the crews will need to initially go into a quarantine facility for perhaps 10 or 12 days to make sure none of them are already infected. But once they've gotten through their initial quarantine period in quarantine areas set up in port facilities they can get sent onto ships.

What about port workers? Simple enough: At the beginning of pandemics ask port workers to volunteer to move inside the gates of ports to live and work basically in a quarantined port isolated from the surronding society. Again, workplace cocooning. National Guard or police could enforce a policy of very limited exit and entry at each port. Most containers could be brought in via trains and the train operators could be under strict orders to never leave their trains while in ports.

What about train operators? Similar story to the port workers. Train operators would rarely leave their trains except at places selected for them to live isolated from the surrounding populations. Put some travel trailers or mobile homes in some train yards and arrange for food and other needed goods to be brought to the communities of train workers.

What about truck drivers and warehouses? Warehouse workers could also live in quarantine. Add some cots, futons, microwave ovens, refrigerators and the like to warehouses. Then the people who work in warehouses could stay in them for 24 hours a day and 7 days a week for weeks and months at a time.

Truck drivers could back trucks up to warehouse entrances but truck drivers would be required to keep their windows rolled up and not to exit their vehicles while getting loaded and unloaded at warehouses. Truck drivers could also live in isolated communities. Forget about going into restaurants at truck stops. Food could be cooked up by heavily covered and masked cooks and delivered out to places where the truckers could pick it up after delivery people have left. Or the truckers could just carry lots of sealed food that they eat cold or cook in their own microwave.

The basic pattern here is that personnel in each link in transportation chains could work without ever coming into close proximity with personnel who work in other links. The touching of surfaces touched by workers from other stages of transportation or breathing air which has cough droplets put there by workers from other stage can be made extremely unlikely. Methods of delivering food and other supplies could get worked out. If someone who operates a transportation company or trade association can't figure out how to greatly reduce exposure between workers who would basically be in different quarantine groups then that company should hire me as a consultant. I'll come up with procedures and techniques to reorganize businesses to operate as cocooned quarantine work groups.

Economies can reorganize to reduce human-to-human exposure by orders of magnitude. The workers will have to live and work in isolated groups for long stretches of time and many workers will have to say good bye to their families and live in workplaces for many month stretches. But economies do not have to collapse. Production and distribution of most types of goods does not have to stop.

In future posts I'll address retail food and goods distribution and also expand on other ideas for creating lots of isolated business units that can still carry on producing and distributing goods.

Share |      Randall Parker, 2005 September 30 01:27 AM  Pandemic Prepare Business


Comments
Engineer-Poet said at September 30, 2005 7:12 AM:

I don't see this happening.  It calls for the near-instant creation of large amounts of housing at work sites, which itself would call for a lot of travel and mixing of people.  People don't like isolation, and they'll break quarantine.

Then there are the rich and powerful.  It takes only one who feels "the rules don't apply" to carry the infection either themselves or in their entourage.  The only way to stop this is to eliminate the problem of people carrying the virus, meaning they've got to be immune.

Vaccinating all hands on a ship before it departs for the United States wouldn't be all that big a deal once vaccine is available.  Vaccinating all shorehands and all truck drivers wouldn't be all that hard either.  Once transmission via those routes are blocked, outbreaks will be much easier to isolate and stop.

Randall Parker said at September 30, 2005 9:12 AM:

E-P,

Creation of housing? Why do you think that necessary?

First off, ships already have housing in them. Second, warehouse hallways or office spaces can get turned into places to put cots. For some warehouses tents can get pitched on rooftops.

A lot of long haul trucks have sleeping cabs. They just need places to park.

Rich and powerful: I expect they'll stay out of warehouses, trains, truck cabs, and ships. Look, I'm not proposing an approach to keep all people healthy. I'm proposing an approach to allow basic transportation and manufacturing to keep working.

Also: mobile homes, motor homes, travel trailers, and the like will be available. People out of jobs will sell theirs to raise money. There will be substantial unemployment, especially in the service sector. Hair salons, nail salons, restaurants, and other obvious places where lots of people interact will take a big hit.

Those laid off service job workers will be willing to go into quarantine for a couple of weeks and then, say, become cooks in ports and in cocooned businesses.

Engineer-Poet said at September 30, 2005 12:00 PM:

Many (most?) workplaces haven't the sanitary facilities required to handle a substantial number of residents.  Mobile homes require plumbing, sewer and parking space that may not be available fast enough if at all.

This is not a small problem by any means.  Worse, a badly-executed attempt to ameliorate things might be worse than a near-shutdown.

Randall Parker said at September 30, 2005 12:11 PM:

E-P,

Workplaces have enough plumbing to handle use of sinks and toilets for their workers. If they just restrict themselves to workers they'll have enough capacity.

The mobile homes would be for sleeping, not potty. Also, portable potties could be brought to some sites just as is done for construction.

Showers: Navy style. Hey, this isn't luxurious. But it beats dying and the collapse of transportation and manufacturing infrastructure.

Cots and futons would provide places to sleep.

Also, take hotels that will be abandoned by travellers and turn them into combination office spaces and living spaces.

jlw said at September 30, 2005 12:52 PM:

Actually, I think the ship quarantine idea is a sound one, especially with container ships where the crew need not touch the cargo. It might work on long-distance trains, though I worry not only about train crew breaking quarantine, but also unauthorized persons hitching rides in empty boxcars. To be honest, air frieght operations might have the easiest time with this sort of situation, in as much as the crew can be based at a hub such as Memphis and need not interact with ground crew where the cargo is loaded on unloaded.

Expanding this to warehouses and ports seems unworkable, however, and relying on quarantines in such places would be dangerous. Better to assume that those places would have contact with the surrounding community and work on strengthening the barrier between them and the transient crews.

What I'm a bit concerned about is the cargo itself. How long can the virus persist on surfaces? Fresh produce would most certainly have to be eliminated. What else? Considering the risk at hand, I'd rather start at figuring out how to keep the flow of essentials--food and medicine foremost--going and add what can be done safely from there instead of trying to keep the entire widget and bauble flow in tact during the crisis.

Randall Parker said at September 30, 2005 1:04 PM:

jlw,

Influenza virus can survive on surfaces for 2 to 4 hours typically.

I agree that air freight ought to be able to continue. Air freight handlers also could live in their freight buildings.

Why don't you think ports are quarantineable?

I realize that some warehouse workers will cheat. Warehouse workers will still need to wear face masks, gloves, eye goggles, and other protective gear. But people who are found to have left facilities can be banned from returning.

What barriers do you suggest between truck drivers and warehouse workers? I see tractor trailers as being long enough to allow good separation between freight handlers and drivers in their separate cabs. However. UPS, Fed Ex, DHL, and other local delivery truck operators face a much more difficult problem with isolation of drivers from warehouse loaders. The drivers could leave their trucks while the trucks are being loaded.

BTW, I once worked as a UPS unloader. Started work at 3 AM during Christmas rush season.

James Bowery said at September 30, 2005 1:27 PM:

I ran a similar proposal past the primary metrosexual collaborative blog:

http://www.kuro5hin.org/story/2005/9/8/151120/7737

They don't like my paleolithic/neolithic boundary orientation to demics -- its "evil" to be like the people from which you originate as it is the "original sin" of the neotheocratic zeitgeist -- but it is worth noting the proposal and their reactions because metrosexuals are likely to be hit hardest by the transformations required by the rapid evolution of human pathogens.

Marvin said at September 30, 2005 3:16 PM:

What you are talking about is not specific to Avian Flu. These measures might be considered for any very contagious (easily spread), very virulent (high morbidity and mortality) pathogen. When discussing general measures against general threats, it is better not to give the impression of focusing exclusively on one rather unlikely potential culprit. Doomsday has many potential causes. The problem with focusing on H5N1 or any other single pathogen, toxin, or threat, is that it is usually the one you do not expect that gets you. As long as you are focusing on general measures against general threats, you are more likely to stimulate measures that will be somewhat effective against whatever actually happens. I see that you have discovered how entertaining Doomsday can be.

Randall Parker said at September 30, 2005 3:51 PM:

Marvin,

I figure your or my odds of getting killed in an influenza pandemic are orders of magnitude higher than getting killed by terrorists, an earthquake, a hurricane, or a number of other threats.

Another flu pandemic is coming sooner or later. I figure it is better to discuss how to handle it in advance while we can still discuss it calmly and at leisure. Waiting till the moment when we know it has started would leave far less time to think out and talk out possible responses. So I see my posting on this as prudent.

jmgordon said at September 30, 2005 4:19 PM:

If we can avaoid an outbreak for another 20 to 30 years, I'll bet technology will solve the shipping issue. I'm pretty sure we'll see fully automated cargo ships and port shipping facilities by then.

Jeffrey Gordon

Bob Badour said at September 30, 2005 4:29 PM:

Jeffery, with signs of crossover already happening in Asia, that's a really, really big if.

Marvin said at September 30, 2005 5:10 PM:

Another interesting doomsday was the Swine Flu, and Gerald Ford's response.

It is easy in the modern media era to build public awareness and anxiety over any given issue very quickly. Most people would be chagrined at how easily they are manipulated. The chagrin would come later, of course. For now, luxuriating in pure unaldulterated panic is preferred. Much preferred. Ahhhhhh! See?

My point is that you are right to address the general concept of a major pandemic from some pathogen or mass toxicity from some radioactive or other toxin, and its possible effect on the provision of vital goods and services. Preparation for that type of general catastrophe can come in handy for many different things that might happen. Focusing on a will-of-the-wisp specific virus in conjunction with such general and stringent measures involves a great deal of faith, and can lead to great disillusionment when "the one" threat fails to manifest. Not to mention the likelihood of devoting a lot of resources to one particular problem out of a possible thousands.

Randall Parker said at September 30, 2005 5:46 PM:

Marvin,

No, I do not see. You've made this argument before. I've replied why I think you are wrong.

My argument.

1) Not all public fears are equally unfounded.

2) Some fears aren't even in the public imagination before disaster strikes. Look at 9/11. Some small number of people (and I was in their ranks) was saying that catastrophic terrorism was a great enough risk to justify wiping out the Taliban and Al Qaeda in Afghanistan. But there was little support for doing much.

3) I see little sign of pure unadulterated panic. In fact, I see widespread complacency. If the public was seriously concerned then the government would be pressured into stockpiling far more Relenza and Tamiflu, face masks, other protective equipment, antibiotics, respirators, and other equipment. The US government would be putting up the money to cull bird stocks in Indonesia. Other stuff would be getting done.

4) Focusing on bird flu right now makes sense because it really is hopping over into humans and killing a high percentage of the afflicted. It is also showing up in an increasing number of other species. It is also mutating to become more lethal in mice. It is also spreading across the globe in birds, creating more opportunities to hop into humans.

5) Many of the preparations for a disease pandemic are specific to disease pandemics. Toxins and nuclear radiation involve smaller areas and very different responses.

6) Controlling spread of influenza even requires different strategies than controlling SARS or smallpox. Influenza has a longer incubation time than SARS and hence is orders of magnitude less likely to show up during a long air flight. So it can spread much more easily across longer distances.

7) A particular problem out of thousands: But this is one of the higher risk problems. We've had flu pandemics in the last century and one of them killed perhaps 40 to 100 million of a much smaller world population. That strain was less lethal than bird flu.

Look, I roll my eyes at peak oil disaster scenarios and argue that even if peak oil comes sooner we can adjust more rapidly than the doomsters claim. I roll my eyes at the climate doomsters too. I also think the Islamic terrorism threat has been both exaggerated and that our elites have avoided the most obvious ways to deal with it because they love cheap Hispanic immigrants. But an influenza pandemic is a very reasonable fear, especially with a highly lethal influenza mutating away in southeast Asia.

peter Andonian said at September 30, 2005 6:27 PM:

Randall,
We should obviously be doing more about a severe threat like bird flu. We won't, until it acutally happens. People don't REALLY believe it can happen until it does. Even if we Know intellectually that it will. Also, there is a large contingent of people who beleive fervently in rule based responses, which are obviously totally inadequate in a real emergency. Need a fast manufacturing facility for a new vaccine? well, we need permits, impact statements, ect... New vaccine? well, it needs FDA approval. Not emough docs to give vaccines? we can't have non professionals giving shots... rule reliant people- not good in an emergency.

Randall Parker said at September 30, 2005 6:39 PM:

Peter,

Yes I agree. Governmental, business, and private individual preparations will all be grossly inadequate. Preparations have been grossly inadequate for years. We should have made much bigger efforts to develop faster and more scalable ways to make vaccines. We should already have lots of stockpiles for a big pandemic.

Having said all that, my thinking at this point is to come up with techniques and practices to use during a pandemic. Hence this post and future posts that will provide more ideas.

Rules: I wonder how much that attitude will last even in a massive killer pandemic. Will we return to an attitude more like we had during WWII when rule books got thrown out and things were done really rapidly? I do not know.

But ask yourself what you can do. Do you have shelf space for supplies? Can you hold back from buying stuff you want for fun and instead buy supplies and build up cash to pay builds and live isolated during a pandemic?

Keep in mind that you might need to wait a year or two for a vaccine. What are you going to do personally to survive and avoid infection while waiting?

jlw said at September 30, 2005 7:12 PM:

Randall:

My issue with quarantining ports and warehouses is that it ups the number of bodies under isolation by an order of magnitude. Although your idea in this area are workable in theory, I think the fewer people directly dealing across regional boundaries, the better. By isolating only the flight/train/boat crews, it not only reduces the number of people under this sort of harsh quarantine, but it really emphasizes the importance of isolating them. Psychologically speaking, the more people under quarantine, the weaker the quarantine regime will be.

Randall Parker said at September 30, 2005 7:22 PM:

jlw,

People are going to be quarantined into their homes if they aren't quarantined into businesses. If they are quarantined into businesses the economy can still function.

If there are few quarantines then many more will get sick and die. Businesses will suffer from much higher rates of absenteeism, as much as 30% if past experience is a guide.

Of course compliance will be a problem. But there are ways to up compliance. For example, a warehouse could staff its offices and warehouse areas with multiple members of same families. Get husbands and wives with no kids at home and put them into a warehouse or factory together. Also, recruit girlfriends and boyfriends onto staffs in a building.

Look at nuclear power plants or other electric power plants. We need these things to work. Why not have utilities buy up motor homes and travel trailers and put them in parking lots for people to live in who work in the facility?

Bumpy Light said at October 1, 2005 9:32 AM:

The thought does occur that isolating people from the disease in this manner will ensure the immediate survival of large numbers of people who would have in earlier centuries become infected and died. This means large numbers of people susceptible to the disease will be available for years for a resurgence of the same strain or similarly virulent strain mutated during the pandemic, which begs the question of just when would it be safe to relax these draconian isolation regimes. How long could societies world-wide keep it up, given the extreme pressures to rebuild economies?

Still, a reasonable, if terribly expensive, standoff with the disease would allow time for researchers to frantically pour the considerable resources of a still-large world economy into developing an effective vaccine for it.

susan said at October 1, 2005 9:51 AM:

Oh pleez, 9/11 was not the first time Islamic-fascist terrorism attacked the western world. (a quarter of a century of Islamic terrorism has shown us that it certainly is not the last)

Just as people ignore the rising tide of Islamic-fascism by burying their heads in Hollywood entertainment, just as people ignored AIDS for twenty years by keeping the bath houses open and denying the concept that having multiple sex partners spreads the disease, just as people ignored fourty years of flooding threats in a city sinking below sea level by spending all their time believing a Hurricane is a famous NO drink, people will ignore the avian flu pandemic because sciencegod believes itself to have found an embryo cure-all which will save everyone on planet earth from all dis-ease. People will believe themselves invincible up until the point they begin to see their neighbors drop dead and by then it will be too late. Perhaps pandemics are nature's way of confronting Modern man's myth that human beings can somehow live unrestrained forever in glorious Utopia.

What is so striking is that the chances for dying in an automobile accident are far greater than any of the above yet people willingly advocate we drive tiny little death traps because our heads are buried in eco-imperialist Sierra Club.

Fredrick Hayek was right, socialism (Liberalism in the extreme) really does lead down The Road to Serfdom.

Lou Minatti said at October 1, 2005 9:57 AM:

I have asked this before (not here) but never received an answer.

Most Americans (as well as Canadians and Australians) now live in suburbs. Single-family dwellings separated from other dwellings. Since we live more "spread out" with less contact with others, does this make us less susceptible to avian flu than someone living in Hong Kong or New York or London? Can we stay cocooned in our homes for a year or so while waiting for a vaccine to become widely available, venturing out rarely (with a respirator and rubber gloves) in order to pick up food? I'd rather suffer through an economic depression than risk being one of millions of dead Americans.

Marvin mentioned the swine flu scare. I vaguely remember the terror people felt (I was about 8 at the time), and I remember my grandparents rushing to get vaccinated. I certainly hope that avian flu is more hype than reality, like swine flu was. But I am not so sure.

Garson Poole said at October 1, 2005 10:28 AM:

More than a decade ago there was a number one bestseller entitled "The Hot Zone" by Richard Preston. The book raised intense public fears of the Ebola virus that can cause gruesome hemorrhagic fever. The popular 1995 movie “Outbreak” was inspired by the book. Also, more than a decade ago Pulitzer-winning journalist Laurie Garret wrote a book with the fatalistic title “The Coming Plague: Newly Emerging Diseases in a World Out of Balance”. The fear of biological disasters from viral and bacterial diseases is easily aroused in the public imagination but this fear does not necessarily lead to many concrete actions.

Here are some of the biothreats that I recall have been highlighted in the mass media in the past years in the US:

The fear that the Swine flu would become pandemic
The fear that Ebola would become pandemic
The fear the Hanta would become pandemic
The fear that West Nile would become pandemic
The fear that SARS would become pandemic
The fear that an avian flu would become pandemic
The fear that the AIDS virus would mutate into a more easily transmissible variant
The fear the smallpox would be accidentally or deliberately re-released
The fear that smallpox would be bioengineered into a weapon and re-released
The fear that the anthrax bacterium would be used as a weapon

Of course, some of these biological agents have killed millions of people, e.g., the AIDS virus and smallpox. But when a particular threat of biological devastation is popularized and yet the worst-case scenarios depicted are unrealized then many members of the public become apathetic or cynical toward warnings of “doom”.

General preparations for a pandemic or a biological attack are very important and valuable, but I think it makes sense not to overly particularize the threat. When a threat is specific and it does not materialize than that can damage the entire preparatory process for other dangers. (I think that is one of Marvin Minsky’s points discussed above.) On the other hand pragmatically, some politicians seem to require specific threats to provide strong impetus. Perhaps a collection of threats should be presented to motivate general preparations.

Randall Parker said at October 1, 2005 11:53 AM:

Garson,

I never took most of those fears seriously. I was worried about SARS. But it makes you sick too quickly to travel as easily as influenza. So a SARS outbreak could be stopped a lot more easily.

Influenza remains my biggest disease worry.

Lou Minatti,

You are right. If people are willing to stay isolated in their suburban homes and can afford to do so then, yes, their odds of getting the flu would be very very low.

The problem of course is feasibility. A person who can barely make their mortgage payments who has big credit card debts who has only enough food on hand to last for a couple of weeks would be hard pressed to withdraw from the economy for a year. Hence my argument for "workplace cocooning".

Garson Poole said at October 1, 2005 12:19 PM:

There was a previous article about preparations for the avian flu on this blog entitled "Comparing National Tamiflu Stockpiles Against Flu Pandemic Threat". Today in the UK Times there is an article suggesting that Tamiflu resistant strains are emerging. Here is an excerpt:


A consignment of antiviral drugs bought by the Government for £186 million to protect the public against a bird flu pandemic could be rendered useless after the emergence of a resistant strain of the virus. Experts in Hong Kong gave warning yesterday that the human H5N1 virus which surfaced in northern Vietnam this year was showing resistance to Tamiflu, the drug widely considered the best chance of protecting the population.

Preparing for potential biological emergencies certainly is difficult.

Tree said at October 1, 2005 1:04 PM:

Mr. Parker:

Thanks very much for raising this topic. I wonder if you, or any blog readers, have read John Barry's well written book "The Great Influenza"? I finished it over the long Labor Day weekend, just before Katrina hit, and was startled to watch public officials show the same behaviors towards natural disasters in both 1918 and 2005. I am presently noticing the same denial towards a deadly flu pandemic that people showed for terrorist strikes and levee breaks. I'm not as eloquent as Mr. Barry; I wish I could convey to you the picture of rotting corpses piled on porches in Philadelphia or convey the dread, panic and horror that isolated families from each other. This year, police in New Orleans looked to the safety of their families and abondoned their posts, as did workers in 1918. Do you honestly believe that workers in any industy will tolerate quarantine whilst their families are dying at home?

agnostic said at October 1, 2005 1:07 PM:

I read _Plague Time_ a few months ago, and I tend to agree w/ Paul Ewald that there's too much emphasis on the possibility of pandemics of highly virulent infectious diseases. If it's highly virulent, that strain will fizzle out in terms of how widespread it is since the hosts will be too racked out or dead to pass it on. If it's widespread, the strain will have to be mild enough to let folks go about their daily business passing it on. The exception is a disease that's spread via a "third party" vector like malaria (mosquito) or dysentery (contaminated water). Those highly virulent pandemics are under control in the first world. The only real way for influenza to reach that level is if people are packed together like chickens in a mass poultry farm, say the WWI trenches or hospitals. Now, even during the Spanish flu pandemic it still went to quite a few places and killed quite a few people before predictably fizzling out once the mass-poultry-farm conditions no longer held, and that's certaily something to prepare for.

However, I think too often the pandemic prevention discussions treat the possible pandemic as if it had the potential to become the next malaria, rather than something that would rock a population to some extent before fizzling out. It's not to down-play this "rocking," but in a world where you can't do everything at once, I think it gets more attention than it deserves. Think of where we'd be in R&D if all the time, mental energy, lab resources, funding, etc. that've been invested in pandemic prediction had been invested in investigating the possible infectious nature of heart disease or other chronic ailments. I'll bet most people would gag if they saw what was cultured from their toothbrush, yet the ADHA glibly brushes this aside saying that while it's covered in microbes, most of them are harmless -- perhaps the flu and herpes, but generally harmless. Oh really? Because chronic ailments have more cryptic chains of cause & effect, it takes more investigative effort to declare that.

Also, it's more of a public health concern b/c no one will easily admit the problem of microbe-encrusted toothbrushes, unlike the case of a pandemic, since viewing your toothbrush as a scumrag would create huge cognitive dissonance -- it makes you appear less benefective. Most people don't even use the same eating utensil twice w/o blasting it w/ piping hot soapy water for an hour. Yet when it comes to the thing they scrub the inside of their mouth with at least once a day for their entire lives, they don't pay a second thought to it's filthiness.

Think of how many people use a toothbrush, and how many actually do something to sterilize it (like using mouthwash afterwards, or even throwing it out every 2-3 months)? And how many die of heart disease? This is just one example, and it might go nowhere, but it's the kind of thing we should be investing our time, money, and effort into since the cumulative impact of such things is much larger than that of a potential flu pandemic.

Randall Parker said at October 1, 2005 1:14 PM:

Garson,

I never took most of those fears seriously. I was worried about SARS. But it makes you sick too quickly to travel as easily as influenza. So a SARS outbreak could be stopped a lot more easily.

Influenza remains my biggest disease worry.

Lou Minatti,

You are right. If people are willing to stay isolated in their suburban homes and can afford to do so then, yes, their odds of getting the flu would be very very low.

The problem of course is feasibility. A person who can barely make their mortgage payments who has big credit card debts who has only enough food on hand to last for a couple of weeks would be hard pressed to withdraw from the economy for a year. Hence my argument for "workplace cocooning".

Randall Parker said at October 1, 2005 1:24 PM:

Tree,

I haven't read the book. Yes, I expect governments to fail in ways that make the Katrina response seem quite competent by comparison. Keep in mind that with the Hurricane Katrina aftermath people could come from many other states to help. But during a pandemic the problem is everywhere and everyone will want to stay away from everyone else.

My argument is that private businesses could, without much government help, reconfigure themselves to greatly reduce the risk of disease transmission. Groups can organise together to work together if they isolate themselves together as groups.

I'm trying to put the meme out there that businesses can decide on their own to not panic and workers can organise to protect themselves as groups and yet still produce goods and make money and buy goods they need to survive.

As for quarantines and families: A lot of people live alone. Most households are now single persons if memory serves. So all those singles could go into workplace quarantine without leaving behind anyone at home. Others have spouses. Well, if the spouse could get hired by the same employer then problem solved.

Is workplace quarantine for everyone? No. But it could make a huge beneficial difference during a pandemic.

agnostic,

You are missing the disease model where the disease does not immediately make you sick and so has time to spread. That is what sets influenza apart from SARS: greater transmissibility for a longer length of time before disease symptoms appear. Also, diseases can make you sick but take some days to kill you.

You are also missing the very obvious point that 1918 happened. Diseases not going to be highly lethal and spread all over the world person to person? Well, how'd the 1918 pandemic happen then?

jprime said at October 1, 2005 1:33 PM:

For those of you who are morbid investors, I actually did some research on stock pikcs for Avian flu. Here are a few stocks worth considering in preparation for either a real pandemic, or a much more likely SARS-like scare of one.

(DISCLAIMER & WARNING: I am NOT a professional financial analyst or expert; I have no inside knowledge or priviledged information. These are just observations & picks based on my personal thoughts and research. Before investing in any of the stocks listed below, you should do your own research and/or consult a professional financial advisor or money manager. I, my family, & friends do currently own all of the stocks listed below):

-3M (MMM) got a huge boost during the SARS crisis due to its production of surgical masks and health-related products, could get a similar boost from an Avian flu scare.

-Pfizer (PFE) makes Purell (the hand disinfectent), along with various Statins (which have annecdotally been shown to reduce influenza mortality) and dozens of over-the-counter disinfectants and flu remedies (and given the recent flooding, hurricane-induced travel, and crowding in the South...I'd guess that this will be a nasy cold/flu season regardless of H5N1)

-Sinovac Biotech (SVA) specializes in the research, development, commercialization, and sale of human vaccines for infectious illnesses in China. It has one of the few flu vaccine production license given out by the Chinese government. This is a high-risk stock, and I'd recommend that it should not comprise more than 3% of one's total portfolio.

-Hemispherx Biopharma, Inc (HEB) a biopharmaceutical company, engages in the clinical development and manufacture of drugs for the treatment of viral and immune-based chronic disorders. This is a high-risk stock, and I'd recommend that it should not comprise more than 3% of one's total portfolio.

-Vical (VICL) engages in the research and development of biopharmaceutical products for the prevention and treatment of serious or life-threatening diseases. This is a high-risk stock, and I'd recommend that it should not comprise more than 3% of one's total portfolio.

-AVI Biopharma (AVII) engages in the development and commercialization of therapeutic and antiviral products based on NEUGENE antisense and cancer immunotherapy technology. This is a high-risk stock, and I'd recommend that it should not comprise more than 3% of one's total portfolio.

Jay Currie said at October 1, 2005 2:02 PM:

To a degree the response is going to depend on the ease of transmission of the agent. Gloves and a mask may be enough and will limit the need for quarantine. Or limit the duration of the quarantine. At the moment we do not have sufficient information to really assess what the threat level is or will be.

The other question is the duration of the outbreak. This will be controlled by a) how fast a vaccine can be developed, b) the lethality of the agent. SARS was lethal enough that it burnt itself out (at the cost of dozens of lives) fairly quickly. However an agent which was deady in, say, 20% of the cases would last a long time but would create - we hope - a class of survivors who would be immune. As people caught the agent and most survived the economic disruption would be reduced.

The vaccine question is more difficult. We don't know if the agent will mutate around broad spectrum anti-virals. We do know that the time from isolation of the agent to the production of a specific vaccine seems irreducibly fixed at six months and that full production may take another few months after that.

It may be impossible politically, but the real means of quarantine is to require individuals travelling from the aflicted regions to be kept in isolation for a week or two upon arrival so as to ensure they are symptom free. And that needs to start now. If that is not viable then at least restricting the ports of entry for people from Viet Nam and Indonesia would give uninfected nations a fighting chance.

However, once there is hard evidence of human to human transmission serious thought needs to be given to prohibiting travel to uninfected countries from infected ones. There are very few absolute reasons why individuals need to travel and an early and complete travel ban might provide a critical few months of safety.

Bumpy Light said at October 1, 2005 2:04 PM:

It's been interesting to read many cogent thoughts, such as upon limiting infection spread at nexi of the shipping industry. At the risk of repeating a question that nonetheless didn't seem to appear in this thread, what of the infection nexi at supermarkets (mostly in the industrialized world) and bazaars (mostly in the third world)? The purchase of food for home preparation and consumption is a major reason people congregate in large numbers. How will people purchase food without undue risk of infection transmission during a serious pandemic?

Probably much the same question applies to the purchase of general goods at other large shopping centers, such as Wal-Mart.

Randall Parker said at October 1, 2005 2:16 PM:

Bumpy Light,

I am going to write another post that is about retail distribution during a pandemic. A few of the points I'll be making:

- Home delivery is better than shopping in stores.

- Home deliverers should not get signatures (or perhaps get them some other way). Packages should be left and the receivers should come out after delivery personnel have left.

- Stores could reorganize to take orders and accept payment over phone/web and deliver goods to the door so that people do not have to come inside.

- Store personnel should do "workplace cocooning" where possible.

- Make large purchases so that purchases can be made less often.

- Go shopping in off hours to reduce concentrations of people.

- Everyone in store areas would need to wear masks, gloves, and other protective gear.

Bumpy Light said at October 1, 2005 3:01 PM:

The idea of home delivery of food and general goods is interesting. A thought that occurs is the manufacture and installation at homes of individual "isolation lockboxes", accessible from outdoors, for food and general goods, perhaps containing refrigerators and freezers for foods that require them, to allow at least several hours for potential virii to die off. Perhaps the cost of such lockboxes could be shared by small neighborhood groups of people known to each other to be free of infection.

A variation on this is individual lockboxes located at or near supermarkets and general goods stores, for holding food or general goods for pickup by customers who take upon themselves some responsibility for collecting safely (with gloves and special containers), and leaving in temporary isolation inside their homes, such food and general goods. Perhaps this would be less expensive and work better.

BTW, Mr. Parker, have you considered setting up, say, a wiki to better organize various thoughts on infection control during a serious pandemic? There are several high-bandwidth public-interest hosting services (to memory) that would quite likely be willing to host such a wiki without cost to yourself (outgoing traffic could be very costly otherwise if the wiki gathered the attention it deserved).

Garson Poole said at October 1, 2005 3:54 PM:

Randall Parker suggests "Packages should be left and the receivers should come out after delivery personnel have left." Bumpy Light mentions the "manufacture and installation at homes of individual "isolation lockboxes"" for home delivery.

During the dot-com e-commerce mania many companies investigated ideas for delivering goods when homeowners were absent. Here is a link to a Salon article on the topic and here is an excerpt:

Better package-traps might help. DVault in Highlands Ranch, Colo., has created a curbside box that works like a public mailbox, with a pull-down handle that opens the box enough for a package to be dropped in, but not so much that a wayward hand can lift your deliveries. And, according to an August, 1999, Wall Street Journal article, Christopher Kaletka, a high school chemistry teacher in Cleveland, is working with aerospace engineer Pat Sebastian to develop a box that can be buried in people's yards. Despite an initial price tag of about $300, MentalPhysics' Griffin expects such bins will become as common as a coffee maker -- "appliances for the millennium."...

Streamline takes a novel approach to solving the "Sorry we missed you" problem. For $30 a month, the company will not only schlep your stuff across town, but will install an electronic lock to your garage or basement and lend you a fridge or shelves, so they can make secure deliveries even when you're not home. It's like giving the milkman a key, but only to your refrigerator, says Kate Carswell, a Streamline marketing manager. ...

Home delivery companies like Webvan went bankrupt in spectacular fashion and the idea of home delivery to lock boxes did not become ubiquitous. But fear of contagions can shift behaviors over time.

Randall Parker said at October 1, 2005 5:16 PM:

Garson,

The economics for home delivery become way more favorable once most people on a street want deliveries. Instead of a UPS truck stopping at every 20th house (and I do not know what their typical ratio is) imagine it is every 5th house. Also, imagine scheduling delivery from a grocery store where you do not demand delivery on a particular day. Order ahead and give a 3 day window. Then grocery stores could ship out once an area has enough orders to fill up a delivery truck.

My point on home delivery is that it would be a way to keep goods flowing while eliminating the need for large numbers of people to come into close contact. You wouldn't have to worry about the last pair of hands that touched your grocery cart 5 minutes previously (and that LIFO stack for grocery carts is a recipe for disease spread) if you never went to the grocery store. Granted, gloves and face masks would help.

Fly said at October 1, 2005 6:08 PM:

Randall,

This seems to be a very worthwhile exercise. If you develop workable solutions, then the Internet will spread the info. Individuals could contribute info related to their own jobs. The plans will then be ready when needed. (Bumpy’s Wiki suggestion is good.)

Regarding food:
“- Make large purchases so that purchases can be made less often.”

Shift food production from perishable products to those with a long shelf life.

Garson Poole said at October 1, 2005 6:11 PM:

Randall Parker said "home delivery become way more favorable once most people on a street want deliveries." I agree with you and my post was not intended to be overly critical of the home delivery concept. I was trying to provide some background that might be useful. In fact, the company Peapod survived the dot-com shakeout and it provides an online grocery shopping and delivery service (in a limited geographical area).

cj said at October 1, 2005 6:16 PM:

Another point of infection that needs to be addressed is public schools. I'm thinking of communicating with my local school district re: their plans for closing schools AS SOON AS a bird flu case is identified -- but, frankly, I think they'd consider me a nut case. Still, given that, in my experience, the local school is a petri dish of every contagion, there needs to be some sort of procedure in place to deal with this issue at the school level. Anybody have any suggestions -- or know of any school districts that are currently making plans for such a contingency?

Hugh Angell said at October 1, 2005 6:31 PM:

I see the UN came down heavily on its top flu official for daring to suggest that Avian
flu could kill 150 million people. Dr. David Navarro, who I note is a doctor and holds the
position of coordinating the UN response to avian flu problems was told to shut up and
quickly overuled by the 'spokesman' for the World Health Organization and said the WHO
'official' estimate was 7.5 million.

http://news.bbc.co.uk/2/hi/asia-pacific/4292426.stm

Asian mortality has been alarming to say the least. And those are just the cases that made
it to hospital. Since the nature of the virus, should it become communicable between
humans, is not yet known suggests that any estimate is conjecture.

Randall, I think you are assuming people will come to work just because they are needed.
As we have just seen in New Orleans that may not be the case. Just because it might be
possible for railroad, port, and other workers to come to work doesn't mean they will.
If you have to leave your family to go to some quarantined work environment doesn't mean
you will. Human experience suggests otherwise. You may get sick and die by staying with
your infected children but my guess is a locomotive or ships captain is going to do just
that. To hell with 'society'. As Margaret Thatcher famously said "there is no society, only
individuals and their families"

As you previously suggested and as the Captain of the Titanic said as his ship plunged
beneath the waves " That's the way of it sometimes, its everyman for himself". Got my
masks today. Still no Tamiflu. Got to see if my HMO doctor is willing but one can't just
burst into his office and ask for it anymore than one can ask for a supply of codeine
'in case I get a toothache' at least in my experience. Any ideas on how much food one
would need to stay out of touch for an pandemic of this nature?

Randall Parker said at October 1, 2005 7:22 PM:

cj,

Schools would be closed very rapidly in event of a pandemic. I saw one report (which I can not find again googling) of a simulation study on a high lethality influenza pandemic where the simulation was run with and without closing US schools. The total death toll was 3 times greater if the schools remained open. Schools are a huge transmission belt for influenza viruses.

Hugh,

There'll be no shortage of labor during a pandemic for a few reasons:

1) Lots of industries will shut down due to risk. Just forget about going to a holiday resort or a barber shop or a or movie theater. So lots of labor will be available.

2) Lots of people live check to check. They can't stop working.

3) Lots of people live alone and do not have a family to be separated from. So they can go do workplace cocooning.

4) Some people work in isolated conditions anyhow. Suppose you are a farmer in the great plains. Well, why not get up every day and go to work? Or how about lumberjacks? They could camp in the woods with travel trailers and never come into contact with civilization. In some cases they could just send logs down river and the logs could get picked up by people they never see. Or suppose you are a Salmon fisherman in Alaska. Why not do workplace cocooning with your crew when in port and spend most of your time at sea? (and governments could temporarily lift fishing quotas to make this possible)

When you go to see a doctor ask for prescriptions for:

- amantidine
- rimantadine
- Tamiflu
- Relenza
- Antibiotics for secondary infections.

Bumpy Light said at October 1, 2005 8:45 PM:

People have been known on occasion to purchase animal antibiotics on the theory that they are just specially packaged and labelled versions of bulk antibiotics suitable either for people or for animals. In another vein, there seem to be many places on the Internet which offer "remote diagnosis" for prescriptions such as for antiviral drugs, or which may not even require prescriptions. If a primary-care physician is anal-retentive about allowing individuals to plan in advance to defend their own health, then there may be alternatives.

Great care should be exercised to avoid fraudulent operations and counterfeit pharmaceutical supplies. The contents of this post do not constitute medical or legal advice, and should not be construed as such. Individuals should make their own decisions based on all available information.

Agnostic said at October 2, 2005 12:51 PM:

The 1918 pandemic happened primarily due to the unique conditions on the Western Front where people were packed as closely together in the trenches and overflowing hospitals as chickens in a mass poultry farm, and they were as immobile -- leave the trenches and you got shot, and the wounded in the hospitals couldn't go anywhere. Such people don't need to be mobile in order to spread the disease: they just cough and the dozen people right next to them can get it and pass it on throughout the dense network. The strain probably originated among US army recruits in the US but didn't reach pandemic proportions until it met the ideal welcoming conditions at the WF. Once it spread from the WF, it killed a fair amount of people, again more so when they were packed together as in the case of the Indian army. But its intensity fizzled w/in 6 months and by one year, two years tops it was completely gone. And though the '20s were difficult times, the most deadly flu pandemic didn't bring the gears grinding to a halt.

So, as long as we don't recreate WF-like conditions, a super deadly flu strain won't have an initial environment to flourish in before spreading -- and ultimately sputtering. Again, that's not to discount the deaths that could happen *even if* it's not as nasty as the 1918 pandemic. However, even that most deadly of pandemics "only" killed 25 - 50 million, about 1% of the world's population at the time, and it's only happened once. AIDS has killed roughly in the same neighborhood of 25 - 30 million, but it is still going and shows no signs of stopping. Malaria has been going on for quite awhile. And these are the obvious ones to look at. Heart disease may have an infectious cause; it too has killed many more than 25 million, and the bodies are still piling up. Not to mention the burden these known or potentially infectious diseases place on the economy (health costs etc).

I hate to sound callous, but every public health official has to decide which scourges are worse than which others, given finite resources to work with. Given the historical and continuing impact of known and potentially infectious diseases like malaria, AIDS, heart disease, et al, I'd rather invest the resources in fighting them than a possible flu pandemic. Again the evolutionary view is key here -- we are not "due for" another 1918-level flu pandemic since it's been so long since the last one. The next 1918-level pandemic will surface when the environment favors selection of high virulence, and we can control the environment so that we don't live in WF-like conditions. The same is true of human-level intelligence -- the next such species will emerge when selection pressures allow it, not according to a cycle of time.

Agnostic said at October 2, 2005 12:56 PM:

Sorry, I meant to reply about the model where you show no signs, spread it, then collapse. I'll grant that's something to definitely worry about, but if the virulence approaches 1918 levels it'll knock you out in bed w/in a few hours and you'll die w/in a few days. Think of the most benign form of HIV, the one that's passed from mother to child. This has the longest period of showing no symptoms before striking the host dead. The most virulent strains are those found among very promiscuous gay men and prostitutes -- once you get it you show signs pretty quickly. But HIV does different things than the flu. Highly virulent HIV will allow you to pass it on a few more times since it doesn't knock you out w/ an unbearable fever, sore throat, lung trouble, etc. If you caught a highly virulent strain of the flu, you'd be out pretty darn quick and then die in a few days.

Rachel said at October 2, 2005 1:22 PM:

I think that it's very important and worthwhile to consider and discuss these things now.

That said, you're overlooking the psychological effects of such a situation. Yes there are small groups of researchers isolated in Antarctica. They're screened specifically to see if they can handle such extreme isolation. The military screens people serving on submarines for such concerns. So do intelligence agencies. Even so, I know a few polar researchers have had to be evacuated because they couldn't handle it. There are many folks who've been pulled from submarines for similar problems. And those are people who CHOSE to put themselves in such a situation, have something to do, and are being paid. Now tell people that they CAN'T leave...

Ever had cabin fever? People get NUTTY when cooped up for a week. Imagine living with some of your least favorite coworkers for a month or more with no respite. People in the situation you're describing will have problems with boredom, depression, anxiety, loss of privacy, interpersonal conflicts, and misplaced sexual tension. That's not to mention the risk of disease inherent in living in close quarters under stress.

When you're discussing this type of problem you have to consider the lowest common denominator. The person who's just sure that it won't happen to them. The person who freaks out when confined to a building the size of the superdome. The people who are going to panic about this no matter how useless and counterprodctive panic is. People can find a way around every wall.

Randall Parker said at October 2, 2005 2:00 PM:

Agnostic,

H5N1 in humans takes a typical 2 to 4 days to manifest symptoms according to reports I've read. Then it is far more lethal than the 1918 strain. So you are knocking down a strawman. Try responding to what we actually know about H5N1 rather than to a strawman of your imagining.

As for WWI conditions: How about Southeast Asian conditions today? Those conditions are so good that every week at least one person gets the flu. The flu already has lethality. It already has a long enough period of transmissibility once a person gets it before symptoms show. What it lacks is ease of transmissibility.

To achieve ease of transmissibility it probably needs a mutation that allows it to replicate at lower temperatures and therefore higher up in the relatively cooler areas of the respiratory tract (it currently replicates deeper in lungs and the lower digestive tract of humans which is atypical). Replication at higher points in the respiratory tract would put more viral particles in coughs. That would increase transmissibility. H5N1 currently requires a higher temperature to replicate due to higher temperatures found in bird bodies. But it is spreading into non-bird species where it will get selected for to replicate at lower temperatures. The CDC published a report on tiger infections for example.

The mutations needed for higher temperature replication would very likely occur on genes which are not involved in determining lethality. So greater ability to spread would not necssarily lower lethality. So the nightmare scenario of a flu strain more deadly than 1918 that also spreads easily is not out of the question.

Randall Parker said at October 2, 2005 2:58 PM:

Rachel,

Yes, not everyone will be able to stand living in a workplace quarantine. Some will leave. But some will stay.

People will have to put up with hardships during a pandemic. They'll have to choose which hardships they are willing to put up with. Stay at home, make no money, and get poor? Oh, and feel cooped up at home too? Or stay at work and feel cooped up and annoyed with fellow workers? Or wander the streets and get picked up by the police for quarantine violations? Or go to the country and camp? Or do something else?

mariana said at October 2, 2005 3:09 PM:

This talk of housing at work sites is interesting as Google's newly proposed headquarters at NASA includes the construction of housing.

Randall Parker said at October 2, 2005 3:51 PM:

Rachel,

Yes, not everyone will be able to stand living in a workplace quarantine. Some will leave. But some will stay. I do not deny that staying in a workplace under quarantine conditions 24 hours per day 7 days per week for weeks and months on end will be stressful.

People will have to put up with hardships during a pandemic. They'll have to choose which hardships they are willing to put up with. Stay at home, make no money, and get poor? Oh, and feel cooped up at home too? Or stay at work and feel cooped up and annoyed with fellow workers? Or wander the streets and get picked up by the police for quarantine violations? Or go to the country and camp? Or do something else?

Dave L said at October 2, 2005 6:00 PM:

In response to agnostic, I'm a dental student at the University of Maryland and we're extremely interested in bacterial infections in the mouth, and not just how they affect teeth and gums but also how they affect the rest of the body. Two quick examples are a study linking gingivitis with heart disease was big news last year and this summer one of my friends was researching chlamydia in the mouth - and there's lots more like that. There's a whole ton of dental research going on here at U Maryland, at the CDC, and at other dental schools around the country. So while you may not know about it because dental research may not make big headlines (I certainly have trouble finding articles for my blog withouth looking at journals) but there's actually a lot of interest in the microbes found on your toothbrush.

Randall Parker said at October 2, 2005 6:14 PM:

Rachel,

Housing at workplace sites would have additional benefits beyond reducing pandemic disease risk:

1) Fuel saved.

2) Vehicle operation cost saved.

3) Time saved commuting.

4) Reduced risk of dying in an accident.

5) Less pollution.

6) Better ability of employees to respond to emergency job needs (not an issue for most jobs though).

Dave L said at October 2, 2005 6:31 PM:

Also they recently developed a vaccine for the avain flu and are making a good quantity of it. Not enough to vaccinate the whole country but probably enough to vaccinate people likely to spread the disease and if it becomes a pandemic more can be made (unless you think it's going to kill the whole world in a couple of months). Not to mention since the avian flu has never been transferred from human to human and apparently isn't all that great at transferring from chickens to people considering the number of people who have gotten it there's no reason to assume it's suddenly going to mutate so it can, and doing so might change the nature of the virus significantly. Also we don't know how many people got milder symptoms but were diagnosed as having an ordinary flu the lethality rate may be much higher than it really is. Not to mention that while the reason we haven't had any terrible flu pandemics in decades might just be luck it might also have something to do with the vast improvement in health care we've had. I saw a UN estimate that said there could be 150 million deaths from the avian flu, but its absurd to think that an outbreak of the flu now is going to be as bad or worse than it was ninety years ago in the aftermath of a world war. Seriously if you think about it our knowlege of disease, the infrasturea available to deal with disease, everything we have is much better. We develop a new flu vaccine every year. We have an array of antivirals. In 1918 they didn't even have pennicillin (not that it would have helped with the flu, but the point is that medicine was in its infancy compared to what we can do now). If god forbid avian flu does turn into a pandemic and kill hundreds of thousands of people that would be a disaster. But there's no way it's going to kill millions like people are afraid of.

Dave L said at October 2, 2005 7:07 PM:

Oh and as for quarantining people coming into the country to avoid the spread of disease I suppose that would include all the illegal immigrants and smugglers coming in from Mexico or for that matter Canada (yes there is smuggling and illegal entry of people from Canada too, just less of them). Although if there was a pandemic I doubt we could even keep an island like Hawaii uninfected. On the bright side I looked over at the CDC website (http://www.cdc.gov/flu/avian/gen-info/avian-flu-humans.htm) and there have been even fewer infections and deaths than I thought. Also for comparison the 1918-1919 Spanish flu caused 500,000 deaths in the US. More recently 1957-1958 caused about 70,000 deaths in the US and the 1968-69 Hong Kong flu cause about 34,000 deaths in the US. These were bad diseases but they didn't cripple the country - and we haven't had another pandemic since then. People go around saying that a new flu pandemic is a certainty but it's really just a possibility - and a possibility that we've been preparing for very actively. If the asian flu does change from a disease that affects a handful of poultry workers to a full blown pandemic there's every reason to think that it will be least deadly pandemic yet not the most.

Dave L said at October 2, 2005 7:31 PM:

Oh and as for quarantining people coming into the country to avoid the spread of disease I suppose that would include all the illegal immigrants and smugglers coming in from Mexico or for that matter Canada (yes there is smuggling and illegal entry of people from Canada too, just less of them). Although if there was a pandemic I doubt we could even keep an island like Hawaii uninfected. On the bright side I looked over at the CDC website (http://www.cdc.gov/flu/avian/gen-info/avian-flu-humans.htm) and there have been even fewer infections and deaths than I thought. Also for comparison the 1918-1919 Spanish flu caused 500,000 deaths in the US. More recently 1957-1958 caused about 70,000 deaths in the US and the 1968-69 Hong Kong flu cause about 34,000 deaths in the US. These were bad diseases but they didn't cripple the country - and we haven't had another pandemic since then. People go around saying that a new flu pandemic is a certainty but it's really just a possibility - and a possibility that we've been preparing for very actively. If the asian flu does change from a disease that affects a handful of poultry workers to a full blown pandemic there's every reason to think that it will be least deadly pandemic yet not the most.

Arrogantatheist2 said at October 2, 2005 9:48 PM:

Randall you are really falling for the media scare tactics on this issue. You've been able to see through the histeria over peak oil, but you and a lot of other futurists are worried about this flu pandemic.

What you are talking about for steps to prevent this is draconian police state tactics. And incredible state control over the population. Which is exactly why the people who want that control are pumping up the Avian flu and other alleged dangers to the our nations. They know they need to make the people afraid to justify that kind of a loss of freedom.

Randall Parker said at October 2, 2005 10:15 PM:

Arrogantatheist2,

You are obviously confused. If no pandemic happens there will be no "draconian police state tactics". No one is going to use the threat of a future pandemic to force people to live in their workplaces.

Once the pandemic happens I do not expect anyone in the private sector to be forced to stay at their jobs. But some sharp employers could decide to offer their employees two choices: Live in at their jobs or get laid off.

Randall Parker said at October 2, 2005 10:28 PM:

Arrogantatheist2,

If a pandemic comes alternatively I could see employers say "If you work in building A you will be able to live there completely isolated from the disease. But if you work in building B you will be at risk of dying from the disease due to fellow employees exposing you to it."

I can also imagine some of my readers going to their employers and asking to create quarantined workpaces where they could work and stay in safety.

Bob Badour said at October 3, 2005 5:59 AM:

Dave L,

Available data do not support your hypothesis that improved medicine reduced the spread of influenza in later outbreaks.

From an Encarta encyclopedia article on the topic:

The [1918-19] virus was exceptionally lethal; many of the deaths were among young adults age 20 to 40, a group usually not severely affected by influenza.
...
Before the 1957-1958 pandemic subsided, an estimated 10 to 35 percent of the world’s population had been affected. The overall mortality rate, however, was comparatively low.
...
In the United States, an estimated 30 million people were infected [with the 1968-69 strain] and there were some 33,000 influenza-related deaths.

We can calculate that the 1967-1968 mortality rate was just over 0.1% (partly attributed to its similarity to the 1957 strain.) While I have found no actual numbers, the article characterizes the 1957-1958 strain's mortality rate as "comparatively low".

To get an idea of the 1918 mortality rates, see these figures from a pandemic workshop summary:

In U.S. Army camps where reasonably reliable statistics were kept, case mortality often exceeded 5 percent, and in some circumstances exceeded 10 percent. In the British Army in India, case mortality for white troops was 9.6 percent, for Indian troops 21.9 percent.

Other sources state the mortality rate for pregnant women varied between 23% and 71%.

The 1918-1919 strain was 100 times as lethal as the 1967-1968 strain. The lower numbers of deaths in later pandemics had more to do with reduced lethality than with control of the spread of the disease. And the reduced lethality was attributed to similarity to previous strains rather than improved treatments. In fact, vaccine development ramped up just in time to be too late.

For a little perspective:

The world population in 1918 was only 28 percent of today’s population. Adjusting for population, a comparable toll today would be 175 to 350 million. By comparison, at this writing AIDS has killed approximately 24 million, and an estimated 40 million more people are infected with the virus.

For a little more perspective, the H5N1 strain is as much as 7 times as lethal as the 1918 strain and 700 times as lethal as the 1967 strain:

[H5N1] causes severe disease in humans, with a high case-fatality rate (reportedly at about 70%, although adequate surveillance data are lacking to accurately define the rate).

WHO has officially recognized 116 cases [of H5N1], 60 of them fatal as of September 29, 2005

If a pandemic outbreak of H5N1 spread as rapidly and as widely as the Spanish Flu, we might expect between a billion and two and a half billion deaths given current populations and assuming 7 times the lethality. Projections of only 150 million deaths seem already to factor in improved pandemic response -- perhaps optimistically so.

Rachel said at October 3, 2005 10:56 AM:

I think it's important to distinguish between essential infrastructure jobs and nonessential jobs. People working at water and power companies, police and emergency services, healthcare workers, (by the way there was a BBC poll last week of 6000 NY health workers that found that only 48% would be willing to work in the event of disease related mass casualties, something to consider,) snowplow drivers, truckers, refinery workers, etc. Compare those jobs to say, insurance agents, wait staff, media, lawyers, various manufacturing jobs, bank employees...

Would we want those people to keep working? Would they want to keep working? A pandemic will cause a massive economic hit simply because all the people employed in the service sector are going to lose business. How can the waitress living check to check afford to buy food or essentials, even if they're on the shelves, if she's not working for months? How many waitresses are there in the US? How many small businesses are there? How many people live on a fixed income?

What if you're quarantined at home and you need a plumber? How will we keep all the kids home from school from sneaking out to see their friends? How will we find the manpower for quarantine enforcement nationwide? It'll be much trickier if we're allowing the limited movement you're describing.

Your ideas would help to keep the entire country from grinding to a total standstill, but there will certainly be a months long plunge in economic activity. Would the construction industry keep going? Would the leisure and hospitality industry keep going? Would the education industry keep going? Those areas make up huge chunks of the economy. Turn them off for a few months and we will have a recession. That's not even taking into account post-event reduction in demand due to mass casualties, which will depend on how the bug mutates.

I'm not trying to argue that you're wrong. I'm trying to get some detailed elaboration going on so that these ideas will be out there when we need them. This is a worthwhile discussion.

Randall Parker said at October 3, 2005 11:10 AM:

Rachel,

Precisely because so many people live check to check I expect any business that wants to create a quarantined live-in "workplace cocoon" will find plenty of applicants for jobs in the "cocoon". I hope the idea of creating quarantined businesses gets a lot of attention once a pandemic starts. It could save a lot of lives and reduce the economic costs of a pandemic.

You mention children who sneak out: Children are absolutely the biggest problem in an avian flu pandemic. One report I saw had the total pandemic death toll as over 3 times larger if schools remain open. Yet parents count on schools to act essentially as babysitters.

Boarding schools ought to remain open but with quarantines around their premises. No one gets in or out except for occasional supply deliverers. I even think that summer camps for children should get staffed up to take kids and convert to year around schools and become quarantined areas designed to protect the kids.

Here's the really bad news on children and H5N1: H5N1 killed about 9 out of 10 infected children in Thailand.

The disease has been particularly deadly for children. In Thailand, 89% of patients under the age of 15 years died an average of nine or 10 days after illness onset.
Randall Parker said at October 3, 2005 1:32 PM:

Rachel,

Be sure to see my new post " Influenza Hits Preschoolers First". I list some proposals for protecting children from a highly lethal pandemic.

Gary said at October 5, 2005 11:36 AM:

Humans are supposed to be smarter than birds, since birds have bird brains. So instead of allowing birds to kill up to “150 million” humans, why don't the humans kill the birds first? Instead of spending billions on vaccines that will become useless every time the virus mutates, spend the money developing chemical or biological weapons that will cause wild birds, chickens, ducks, etc., to become extinct.

Personally, I think the bird flu will kill many billions of people, and cause a severe worldwide depression that will last a minimum of ten years. Because each time the virus mutates, it’ll take another six months to develop a new vaccine -- during which time 150 million more people will die.

Darren Duvall said at October 7, 2005 7:13 AM:

All these points are well-taken. Yes there have been bioscares in the past that didn't pan out, but that doesn't mean that some forethought is irresponsible. This is potentially an exceptionally bad bug, there is no way to predict at this point whether the genetic alterations responsible for transmissibility will lower the lethality of the H5N1 virus. It's possible that the reshuffling necessary to render this virus transmissible will drastically lower the pathogenicity of the virus -- it would be hard to increase the pathogenicity at this point, with a 55% mortality rate it's already equal to some of the hemmorhagic fever filoviruses in killing potential.

I, too read 'The Great Influenza' by John Barry and I think Bush's time was spent better doing that than meeting with whatsername. I don't see the US response at this point as being less-than-proactive and the fact that Bush is talking about it fairly frequently is (I hope) a clue that he is taking it seriously and encouraging the rest of the government to do the same. No doubt Al Qaeda, patient consumers of our media, will do their best to trumpet any serious outbreak as a biological warfare effort of theirs and will do their best to magnify any discord and fear in the population. Anything that severs political support from the government furthers their ends, I wouldn't put it past Jemm'a Islamiya to intentionally infect some people and attempt to send them here as suicide coughers.

The economic disruption is worse than you are considering, I think, Mr. Parker. I work odd hours on call and sometimes end up in Wal-Mart late at night, there is usually a profusion of pallets all over the store after 11pm or so. Katrina has given a good example of the limitations of efficient inventory distribution and the Big Box store model. Most of the larger stores only hold at most 3-4 days worth of goods for sale, a supply that can be knocked out of existance in several hours by panic buying. My town was in the path of Rita and was literally sold out of bottled water, for basically no reason -- we got a whopping 4" of rain. It's more than just the ports and air terminals, it's every McLane's and Target and Wal-Mart and other national vendor's distribution center.

Limiting contact of personnel with packaging is a good idea, and I can imagine tents set up behind every grocery store and other large distribution point where palletted goods are exposed to a few hours of UV light to hasten viral death -- but this is in every town in the country. I seriously doubt we have that many UV bulbs in the nation, and we'll probably have a vaccine before we have enough UV lights. One option is to spray down every package with a dilute bleach solution -- but we don't have that much bleach, either. And even if your big-box retailers can stay resupplied, with the rumormongering and general hysteria caused by a normal season's URIs and lesser influenza strains superimposed on the H5N1 scare, people are going to go to market less and less often. There will be a huge consumer-driven drop in GDP, IMO. We won't be the only ones in the world to see that and we will likely get hit by H5N1 in a less-devastating fashion than others, but the economic hit of a transmissible and virulent H5N1 will be a big stool sandwich and we'll all take a bite. Our communities are likely far less self-sufficient than they were in 1918-19.

It's going to be a bear if we have a real outbreak, and this issue is best considered IMO on a locality-by-locality basis. What's more important: regular resupply or quarantine of incoming goods? How do you handle a 10% population reduction, I mean, where do you put the bodies?

Randall Parker said at October 7, 2005 10:07 AM:

Darren Duvall,

I agree that retail distribution would be a really big problem. This is why I am encouraging people to stock up more food in advance.

I'm going to write a more lengthy post on how to do retail distribution during a pandemic. A few points:

- more home delivery.

- UV is not necessary since influenza survives only 2 to 4 hours on an exposed surface.

- The resupply of big box stores would need to be done by people wearing full protective gear.

- My proposal for live-in workers in businesses extends to retail stores. Let people order outside and have their goods collected up by workers who are in the stores. Keep shoppers outside.

bob brouse said at October 19, 2005 12:09 PM:

hi there, im not much of a specialist but lived through SARS in toronto canada.
the health people got sick first, with only a tiny number of infections many people
stayed home from work,our underground tunnels were virtually ghost sites and hoarding went on.
as well we put useless equipment at the airport, and they got sick as well. even though few people
of hundreds of thousands got sick face masks were sold out, water was hoarded,people stopped
going to work and that i can see no one learned anything, certainly tourism was wiped out.
after that i lived through the blackout. by th beginning of day two, no one had batteries,
stores were closed there were loads of traffic accidents, water was gone, bank machines had stopped working, restaurants closed because of spoiled food, people who had health gear in their apartments were dying, and as gentle as we canadians are looting had begun. still no one seems to have learned anything. all this to say that if any of the numbers you folks are suggesting are anywhere near real it will be anarchy simple as that.

Lee said at October 21, 2005 9:21 AM:

If the Avian Flu really does turn into a pandemic, how do you think it will affect the world's economy? My husband is wondering how to invest his current retirement savings since he is only about 3 years away from retirement. How did the Spanish Flu affect the economy and investments? Where did most people who survived the Spanish Flu economically as well as physically have their money invested?

Randall Parker said at October 21, 2005 10:13 AM:

Lee,

The world economy would certainly shrink. But some sectors would be hit worse than others. Think about what you spend money on that is optional (e.g. a trip, a restaurant outing, new clothes) versus that which is necessary (basic food ingredients, drugs for serious conditions). You and everyone else will avoid outings to public places where you would otherwise spend money. Hotel business would go way down. Grocery sales would not go down as much.

If people quarantine at home and workplaces they'll drive less. That means less demand for cars and fuel and car parts. But airlines will be much worse hit.

If the fatality rate is high then a resulting housing surplus will cause housing price drops.

Rick Redfield said at November 26, 2005 8:38 AM:

I can't believe what I am reading! You people are out of your minds. You are clueless about human nature. NONE of these plans would have a PRAYER of working. The veneer of human civilization is unbeliveably thin. The Chicago Bulls win a basketball championship and hundreds riot, smashing storefronts and burning places. Cities BARELY work now! Rush hour is a misnomer here in Chicago. The highways are JAM PACKED most of the day. ROAD RAGE is a constant feature. And this is during NORMAL times! People will go crazy, smashing and stealing anything they can get. Do you think truckers will live in cabs in bitter winter weather with no water or food for months? THIS IS CRAZY TALK. ANY major event that even mildly disrupts the day-to-day workings of our extremely overtaxed civilization brings on ANARCHY. In Louisiana, people were SHOOTING at rescue helicopters!

Millions live in huge cities utterly dependant on distant, complex and fragile support systems for water, food, electricity, gas, etc. etc. In 1979, Chicago endured a SNOW STORM that drove people to acts of murder over shovelled out parking spaces!

We can fund a war in Iraq but can't even begin to mount an effective countermeasure for such an event. Imagine a Katrina level disaster IN EVERY MAJOR CITY OF THE COUNTRY!

Get real, people

Kay Preparedness said at December 9, 2005 5:20 PM:

What an interesting discussion! I can see why there is so little planning for very serious flu pandemics. We all have such different points of view!!

My thought is that I have no (nor does anyone else) idea how likely a very serious (1918 style) pandemic is. It all depends on too many variables that we have no way to predict. The issue is, hope for the best and plan for the worst. This is the one area of disaster planning where most of us have absolutely no protection. Think of how much we spend on other types of things like fire insurance, earthquake insurance, health insurance plus building code costs, emergency kits and on and on and yet there is almost nothing we as individuals, families of small communities have done to prepare for a serious flu pandemic. In spite of the fact that it is something that everyone of us has an ancestor go through.

Speaking of individuals or families I think we should all take a lesson from the Mormons (I am not one but can't help but admire this aspect of their beliefs). It is not so hard to stockpile food for 6 months to a year. I know not everyone can afford to do this but we are a nation of spoiled, fairly prosperous people, and a great many of us could do this. It is just another way to have savings in the bank. Even people with very little income can do some stockpiling of basic foods, like a big sack of bean and rice and powdered soups and such. Costco is full of non-perishable foods that are cheap. Every person who can reduce the number of times he has to go out of his house to get something at the store by even 50% will be reducing his exposure to flu germs by a large amount.

I strongly agree with the idea of isolating yourself with you food stockpile. With a little planning ahead it can be done practically. It would be good to join forces with other family members or with friends to share resources.

We can also examine how vulnerable our lives are to various types of breakdown, like long term power failure and try to take steps to be able to deal with them.

Communities can also make plans just like the job cocooning and the system suggested for retail stores to minimize contact.

A community could get leaders together and decide in advance at what point in an impending flu pandemic the communit would close schools and cancel all public/private gatherings and meetings and such. That way the principle or school board is not struggling with the decision and all the pressures from working parents on his own. It would be something that was cooperatively pre-decided to close things down as a preventitive at the first report of a flu case (of the dangerous type) in your state or whatever.

There are so many areas that I think could be pre-planned to lessen the negative societal impacts.

Thanks for letting me get this off my chest.

Jeff said at January 15, 2006 4:44 PM:

Someone suggested early in the thread that suburbs might make us less vulnerable. I disagree. They will mean that any outbreak will spread very quickly throughout a metropolitan area. For example. I live in the Seattle area, which is roughly 60 miles North to South from Everett to Tacoma , and 20 miles East to West from downtown Seattle to Redmond. Throughout are mixed urban and suburban areas, and it is common for people to live on either end of the area and commute to the other. It is also common for people to commute from the center of the city 60+ miles into the surounding countryside.

If this situation did not exist, an outbreak would have to spread progressivly in a radiant fashion from one end of the area to another. Instead, one person can get sick in Tacoma, go to work in Redmond and gives the disease to their co-workers. Then those co-workers commute to homes throughought the metropolitan area. In those homes they can pass the disease to their partners. In most cases those partners also work, and they can then repeat the process. The result would be very rapid transmission throughout the metropolitain area, perhaps almost as rapid as would be seen with a public gathering. If schools were not closed this would just accelerate the spread.

In my opinion the only solution is for companies to plan ahead and discuss the plans with their co-workers before a pandemic strikes. They need to be clear that within a short period of the first sign of a pandemic infection occuring the doors of their workplace will be closed. Anyone who wants to work had better be on the job at that point. In industries which operate more than one shift, this might actually do a great deal to help the problem of absent employees, because workers would be available to work longer hours, and might even welcome it as an alternative to boredom and worry. another advantage of prior planning is that workers will have a chance to rationally plan what course they will follow in the event of a pandemic, rather than reacting in fear and panic. People could have a chance to inform their employers of their plans, allowing employers to estimate their staffing levels.

One other note is that the measures would not have to be maintained for the entire year plus duration of the pandemic. They would at most need to be maintained until vaccines are available, or about six months.

Randall Parker said at January 15, 2006 5:39 PM:

Jeff,

While I agree that urban sprawl and long commutes will help spread a pandemic disease I disagree that vaccines will be available in 6 months. Several issues to consider:

1) Vaccines take time to develop. For influenza strains that are a greater departure from previous strains the development time takes longer. Development of vaccines for H5N1 has been going on for years and still effective vaccines for current H5N1 strains have not reached production readiness.

2) Vaccines take further time to manufacture.

3) Vaccine production capacity is a fraction of the world's population. Granted, Western countries have more vaccine production capacity and heroic efforts will be made to scale up production. But it may take a year or two for all the Western populations to be vaccinated.

Justine said at December 2, 2008 1:11 AM:

Randall,

Thank you for the work you are doing.
It is now Dec. 2008.
I hope you will continue to pursue
issues such as this.
Thank you for taking your time - you are appreciated.

- A single Mom

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