Public health interventions and epidemic intensity during the 1918 flu pandemic(pnas.org)
pnas.org
Public health interventions and epidemic intensity during the 1918 flu pandemic
https://www.pnas.org/content/104/18/7582
35 comments
Well keep in mind for COV19 that your survival rate will be much higher if there's enough beds/people to treat you. Looks like with an overburdened medical system the lethality for those going to the hospital is somewhere under 5%. For hospitals not overburdened it's under 1%.
Absolutely this, regarding any conclusions people might draw for the current pandemic. I'm almost surprised that peak flattening had a measurable effect on total outcomes at all given the state of medicine in 1918. They hardly understood the difference between viral and bacterial infections back then. Medicine still can't do anything against a new virus, but the art of giving the body a longer time to fight it has advanced considerably. And as far as I understand it, bad cases off CIVID19 draw themselves out much longer than the 1918 flu
That may be true, I wonder what other cultural factors are at play as well. It may have been that people were more self-sufficient then, and thus it was not as disruptive to isolate.
It seems appropriate to bring up on International Women's Day that women's labor at the time was largely that of 'homemaker' - a highly self-sufficiency oriented role. To put it in tech terms, there were a lot more people WFH, and a lot less dependencies on external services. Women were only 20% of the labor force at the time vs 47% today [1].
I say this NOT to advocate for a return to this state, just pointing out a large factor to consider, one often overlooked.
[1] https://www.dol.gov/agencies/wb/about/history
It seems appropriate to bring up on International Women's Day that women's labor at the time was largely that of 'homemaker' - a highly self-sufficiency oriented role. To put it in tech terms, there were a lot more people WFH, and a lot less dependencies on external services. Women were only 20% of the labor force at the time vs 47% today [1].
I say this NOT to advocate for a return to this state, just pointing out a large factor to consider, one often overlooked.
[1] https://www.dol.gov/agencies/wb/about/history
Well, sorta:
> Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (≈20%) and less statistically significant than that for peak death rates.
> Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (≈20%) and less statistically significant than that for peak death rates.
Spreading them out is hugely important if hospital beds and other available healthcare resources are in short supply, though.
This is actually a good point. The mortality rate for the coronavirus is lower if ventilators or supplemental oxygen are available. But we have limited numbers of ventilators.
So if we can blunt the peak infection rate, more people will survive, even if the total number of cases is the same.
So if we can blunt the peak infection rate, more people will survive, even if the total number of cases is the same.
There’s a brilliant animated gif that explains this visually
https://twitter.com/SiouxsieW/status/1236721200291655680
https://twitter.com/SiouxsieW/status/1236721200291655680
Looks like it's also not entirely correct in what it wants to convey. If assumption is that having overall amount of cases under health care capability threshold lowers total amount of deaths then area of the second chart should be much smaller. Now they look approximately equal, which means overburden health care system or not, it didn't make a difference.
You sure about that? An overburdened health care system will cause people to die that otherwise would not have. A patient, for example, who needs a ventilator for some condition other than COVID-19, but can’t get one. These are not reflected in the area under the curve.
Yep, you're right, it's more for a total deaths chart. But I would expect it to be visible even in total cases chart, since less people should be out on the streets spreading the disease.
This article is about death rates, not infections rates. Spreading out deaths does not have similar benefits.
But hurts all the small businesses and people who are laid off due to prolonged closings.
People shouldn't mock your concern.
Economic declines cause very real harm to real people -- mostly the working poor.
People lose their jobs, their houses, and their healthcare in recessions.
You may feel immune if you're a tech worker -- and you may be for a time -- but you're not immune to layoffs either.
Economic declines cause very real harm to real people -- mostly the working poor.
People lose their jobs, their houses, and their healthcare in recessions.
You may feel immune if you're a tech worker -- and you may be for a time -- but you're not immune to layoffs either.
I suspect that at some point the risks from economic harms will outweigh health concerns. I'm not sure exactly what that will mean but I don't think we can assume the world and its controlling elites will sit by as we roll back to the stone age, regardless of the health outcome.
This is where the government should step in with stimulus and direct aid.
Absolutely. Many economical government interventions have terrible unintended consequences due to creating bad incentives, but one time fixes for emergencies completely outside of the domain of the businesses in question do not have that drawback. Nobody would structure their business for maximum pandemic bailout.
PS (edit): oh, and it also wouldn't really keep businesses from preparing for a pandemic, because of pandemics strike one once in several decades this will be long enough for market forces to have preparing companies displaced by those who don't. The market favors the optimist who bets on no pandemic happening in their lifetimes.
PS (edit): oh, and it also wouldn't really keep businesses from preparing for a pandemic, because of pandemics strike one once in several decades this will be long enough for market forces to have preparing companies displaced by those who don't. The market favors the optimist who bets on no pandemic happening in their lifetimes.
A collapsing healthcare system doesn't?
Submitted title was "Cities with early interventions to 1918 flu had ~50% lower peak death rates". We've reverted it now.
The site guidelines say: "Please use the original title, unless it is misleading or linkbait; don't editorialize."
https://news.ycombinator.com/newsguidelines.html
The site guidelines say: "Please use the original title, unless it is misleading or linkbait; don't editorialize."
https://news.ycombinator.com/newsguidelines.html
It says "lower peak," not merely "lower." It doesn't seem terribly misleading to me.
I don’t think that’s correct. If you look at the graph, the area under the curve is much lower for the city with the later, lower peak.
The full area you’re quoting seems to say that implementating multiple interventions had an impact, but no single one had an effect if done on its own.
Relevant section:
> Cities with more early NPIs also had fewer total excess deaths during the study period (Fig. 2 b, Table 2, 1918 total), but this association was weaker: cities with three or fewer NPIs before CEPID = 20/100,000 experienced a median total excess death rate of 551/100,000, compared with a median rate of 405/100,000 in cities with four or more NPIs (P = 0.03).
They also noted second waves of infection only occurred once restrictions had been lifted. If we delayed a peak till a vaccine was developed or an existing treatment discovered, we could lower deaths further.
The full area you’re quoting seems to say that implementating multiple interventions had an impact, but no single one had an effect if done on its own.
Relevant section:
> Cities with more early NPIs also had fewer total excess deaths during the study period (Fig. 2 b, Table 2, 1918 total), but this association was weaker: cities with three or fewer NPIs before CEPID = 20/100,000 experienced a median total excess death rate of 551/100,000, compared with a median rate of 405/100,000 in cities with four or more NPIs (P = 0.03).
They also noted second waves of infection only occurred once restrictions had been lifted. If we delayed a peak till a vaccine was developed or an existing treatment discovered, we could lower deaths further.
Your ‘in other words’ is flatly incorrect. No single intervention had an association, but cities that enacted those interventions did have a lower cumulative death rate.
Although the potential benefits of NPIs are supported by mathematical models, the historical evidence for the impact of such interventions in past pandemics has not been systematically examined.
My recollection:
There is a book called The Hot Zone that examines the successful containment of Ebola by "uneducated savages" in the jungles of Africa.
The village elders decided to barricade roads and stop letting in outsiders. They told their people "Don't go to the white man's hospital" because you would go with something fixable, like a broken leg, and die of Ebola, which was killing like 90 percent of people.
They quarantined you by insisting you stay home if you got sick. They would leave food on your doorstep for you. If the food sat there untouched for three days, they burned your hut down without going in to check if you were alive.
Obviously, I'm not advocating for burning people's houses down. But it's an interesting case study of successful containment using non-pharmaceutical interventions.
If you are willing to throw things out, disinfect like crazy, limit social contact, etc, there's a lot you can do without drugs to stop the spread. But it's damnably inconvenient and most modern people's seem to want to take a pill and carry on as usual. We seem extraordinarily averse to being inconvenienced.
My recollection:
There is a book called The Hot Zone that examines the successful containment of Ebola by "uneducated savages" in the jungles of Africa.
The village elders decided to barricade roads and stop letting in outsiders. They told their people "Don't go to the white man's hospital" because you would go with something fixable, like a broken leg, and die of Ebola, which was killing like 90 percent of people.
They quarantined you by insisting you stay home if you got sick. They would leave food on your doorstep for you. If the food sat there untouched for three days, they burned your hut down without going in to check if you were alive.
Obviously, I'm not advocating for burning people's houses down. But it's an interesting case study of successful containment using non-pharmaceutical interventions.
If you are willing to throw things out, disinfect like crazy, limit social contact, etc, there's a lot you can do without drugs to stop the spread. But it's damnably inconvenient and most modern people's seem to want to take a pill and carry on as usual. We seem extraordinarily averse to being inconvenienced.
1918 has some good lesssons about controlling viral spread, but there are some key differences with COVID19.
1918 hit 20 year olds the worst while this virus targets the elderly. The biggest issue now is the need for ICU care to survive. We know mortality rates but that implies care, otherwise it turns into Wuhan. Only 90,000 ICU beds in the whole U.S. and this is the situation happening in Italy right now.
So since the virus is more or less endemic, spreading infections over time is the best way to save lives. Washing hands and canceling all big group events at least until summer are the teo obvious moves.
1918 hit 20 year olds the worst while this virus targets the elderly. The biggest issue now is the need for ICU care to survive. We know mortality rates but that implies care, otherwise it turns into Wuhan. Only 90,000 ICU beds in the whole U.S. and this is the situation happening in Italy right now.
So since the virus is more or less endemic, spreading infections over time is the best way to save lives. Washing hands and canceling all big group events at least until summer are the teo obvious moves.
I built https://sneezemap.com to help track local infection levels
[Edit] US cities screenshot: https://imgur.com/a/Vzm9wN5
[Edit] US cities screenshot: https://imgur.com/a/Vzm9wN5
> Enable location access to see the map.
??? Thanks but no thanks.
??? Thanks but no thanks.
Anyone creating a health related website of this sort: Please email me.
I'm working on a thing and would love to be able to include things like this.
I'm working on a thing and would love to be able to include things like this.
Awesome!
> Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic.
In other words, a similar amount of people died regardless of these interventions, but the cases were spread out over a longer time period. They also note that the virus spreads as soon as interventions are relaxed, suggesting many cities just delayed the infection.
Edit: thanks for the comments below - my comment was just to point out that these interventions didn't cut the death rate in half, as a quick reading of the submitted headline might suggest.