April 22, 2007
Early Isolation Reduces Pandemic Losses

Philadelphia's public health officials were slow to react to the 1918 influenza epidemic and their slow reaction cost many lives.

By the time officials there grasped the threat of the virus, it was too late. The disease was rampaging through the population, partly because the city had allowed large public gatherings, including a citywide parade in support of a World War I loan drive, to go on as planned. In four months, more than 12,000 Philadelphians died, an excess death rate of 719 people for every 100,000 inhabitants.

The story was quite different in St. Louis. Two weeks before Philadelphia officials began to react, doctors in St. Louis persuaded the city to require that influenza cases be registered with the health department. And two days after the first civilian cases, police officers helped the department enforce a shutdown of schools, churches and other gathering places. Infected people were quarantined in their homes.

Excess deaths in St. Louis were 347 per 100,000 people, less than half the rate in Philadelphia. Early action appeared to have saved thousands of lives.

Until vaccines become widely available the extent of deaths from a highly lethal flu pandemic depend on how far governments, businesses, and individuals will go to reduce exposure of humans to other humans. Coming advances in biotechnology will decrease the length of the window from when a flu strain starts spreading to when vaccines become available to stop it. But if a dangerous pandemic started right now we'd be facing 6 to 12 months before vaccines become available in developed countries and longer in less developed countries.

Recent research papers show that extensive isolation of populations instituted starting early in a flu pandemic can greatly reduce the death toll.

This month, researchers published two new studies in The Proceedings of the National Academy of Sciences comparing public-health responses in cities like St. Louis and Philadelphia.

Using mathematical models, they reported that such large differences in death rates could be explained by the ways the cities carried out prevention measures, especially in their timing. Cities that instituted quarantine, school closings, bans on public gatherings and other such procedures early in the epidemic had peak death rates 30 percent to 50 percent lower than those that did not.

If something with the lethality of the avian H5N1 flu breaks out into the human population with mutations that make it easily transmissible then you are going to face a decision: how much will you change your home and work life and family life to reduce or eliminate your exposure to others? Suppose the flu strain is like the 1918 strain and hits the middle aged much harder and, if infected, you face a 10% or 20% chance of dying. What would you do and sacrifice for a year to avoid dying? Mind losing your job or becoming very poor or isolated?

In the extreme you could go home with lots of food stocks and other supplies and stay there for 6 to 12 months. Or, if you live in an apartment building where sitting at home does not totally eliminate exposure risks (think of those Hong Kong apartment buildings which spread SARS infections through ventilation systems) then you could move out into a wilderness cabin or a houseboat or motorhome at an isolated location.

If you work in an occupation which is amenable what I call "workplace cocooning" (quarantined workplaces where people never leave or enter) then you can come through in better economic shape. Unless you already have all the money you need working through a pandemic is the best way to get through it.

Share |      Randall Parker, 2007 April 22 03:00 PM  Pandemic Quarantine


Comments
Neil Shotton said at April 22, 2007 5:33 PM:

It is amazing. It would take very little to educate the population; three months food, extra water. Monitor the news and sign up for an alert. Then stay home when a pandemic hits. When it happens, these simple steps make the death toll goes way down and the speed with which it passes goes way up.

This costs very little. We can educate people on hurricanes but not this. Go figure.


Mike Anderson said at April 22, 2007 5:57 PM:

Sounds like I need to be able to convert my college classes to 100% online distance education. Then I can continue teaching while my students and I all sit out our quarantines, with no time lost! This is an especially timely discussion, since my university is soliciting ideas for disaster planning.

Randall Parker said at April 22, 2007 7:01 PM:

Mike,

Yes, online education would work during a pandemic. You could do live video feeds. Or if the internet connections were too slow you could record the lecture part of your courses at high res and then let people download them entirely before watching them. Then do Q&A at a lower video resolution.

Every year the internet connection speeds will go up. So this'll become even easier in the future.

In fact, a pandemic would be a great time to ramp up adult education. Stay home and earn an MBA while sitting out the pandemic. Or get a masters in some other subject. Or take courses toward a technical certification of some sort.

Every sector of the economy that can find ways to do more virtually or more with my "workplace cocooning" idea is a sector that could avoid a big hit due to need for reduced human contact.

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