The Flu (Health)

[Mick Harper]

[Chad]

Some data on ILI (Influenza Like Illness) in Italy in recent years:

[Wile E. Coyote]

Is it racist to suspect that the Germans are lying about their figures? I only ask as they, or rather their car manufacturers, lied about fuel emissions and, worse still, the Luftwaffe brought down granny's ceiling during the war.

The German fatality rate of just 0.3 per cent, compared to 7.9 per cent in Italy.

[Wile E. Coyote]

Germany is China's (the analysis is a bit Trumpian) biggest trading partner in Europe. The number of Chinese living in Germany has seen rapid growth in the last few years.

The initial outbreak in Germany was thought to have occurred in January, after a Shanghai business woman visited a company near Munich. A scientific paper claimed that she had no symptoms, she was described as being "well, with no sign or symptoms of infection but had become ill on her flight back to China”. This was subsequently found not to be the case.

She was ill whilst meetings took place, in January.

Mysterious.

[Wile E. Coyote]

Despite having produced a paper that advised carriers might not possess symptoms, the Germans are well ahead of their neighbours in testing. Indeed they put their low fatality rate down to their success in testing, and having the right resources to deal with the pandemic.

[Mick Harper]

Chad's trenchant post (I'm not dissing yours, Wiley) goes to the heart of the AEL's view (I think I speak for us all) of the coronavirus phenomenon. Unless it exceeds the 20 million (to a hundred million, estimates vary wildly and significantly) deaths of the Spanish Flu, we are in familiar territory. None of the previous visitations have prompted anything other than passive acceptance with some, as we have come to call them, containment measures. The striking thing about all of the modern epidemics is that they had no effect. Twenty-to-a-hundred million deaths are a drop in the ocean of history. Looking back, we were correct to adopt this strategy. What is, is what was.

Unless we have evidence to the contrary. The world has chosen to see this one differently. Maybe it is different, maybe these are different times, maybe we can do more now than passively accept. But it's the same AE basilisk stare. On the other hand it must be recognised that we have been wrong-footed quite frequently so far. Fair?

[aurelius]

I'm going to pitch in with a rather scattergun approach and half expect to receive a bullet or two in return.

Correct me if I misunderstand, but Chad's Italian stats are over 4 years so 68,000 flu deaths over 4 years = 17,000 per annum on average. We have only had Covid 19 in Italy for 2-3 months, say a quarter of one year and that has yielded nearly 5,000 deaths on current estimates*. It is doubted whether this form of flu has the same seasonality so potentially we could extrapolate 4 x 5,000 in this scenario giving 20,000 deaths and over 4 years, 4 x 20,000 deaths if we don't find a silver bullet. So on that basis we are talking 80,000 over a comparable 4 year period
* https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

But we don't know when Italy's figures are going to stop rising even in this quarter. And people will continue to die from 'normal' flu as well.

If countries did nothing and carried on as if nothing was happening Frau Merkel's estimate of 80% of the population getting it may not be far off the mark. The virus would die out unless it achieved an advantageous mutation, because most of the people to pass it on to had become immune; we would have a sort of bell curve.

According to the UK stats we have a worryingly high death rate per the number of cases, currently 233 out of 5,067 but that is challenging to interpret due to factors such as the amount of testing and where the UK sits in the elderly population table (Italy supposedly has the highest proportion of elderly people in Europe).

At least we are below the exponential curve which is somehow comforting,

https://twitter.com/Egbert_PengWu/status/1241428498415263744

which would have put us at over 7,000 cases by today.

There are still three local authorities in England without recorded cases including Telford & Wrekin and NE Lincolnshire (I forget the other) and at the top end lots of London boroughs and Hampshire the worst affected county, with 138.

https://www.arcgis.com/apps/opsdashboard/index.html#/f94c3c90da5b4e9f9a0b19484dd4bb14

[Mick Harper]

I don't trust (m)any of these statistics. The reason is an AE one: experts cannot be trusted to say "we don't know". Epidemiology in particular because it is fighting for recognition in probably the most competitive of all the academic arenas, the medical sciences. They have been thrust into the limelight and they know it's twist-or-bust but not 'stick'.

One glaring one, as Chad almost said, is that it would take a bold pathologist to say, in the current climate, "Yes, she had the virus; yes, she died; I cannot safely conclude that a caused b." Especially when the bodies are racking up and Emilia Fox is nowhere to be seen.

We can certainly say that the least tested segment of the population is people who had the virus and showed no symptoms. That alone must be skewing the outcome conclusions. We should, however, be chary of bell curves -- the Black Death had a bell curve.

[Chad]

[Mick Harper]

I'd be interested in how "flu deaths" are defined and/or counted. In an average year, we are told, several thousand mainly elderly people with the famous 'underlying health issues' die of the flu. Correct me if I'm wrong, but these would not be regarded as in any way surprising, more 'freeing up bed space'. So they will get either no post mortem or a perfunctory one. At best we could say that several thousand people a year die in close proximity to flu.

Curiously, there is an etymological history. When me and Chad were young, flu did not exist. You had a cold, sometimes a streaming cold, sometimes a very bad cold indeed -- we had to call the doctor in. 'Influenza' was something else, a full-blown illness like diphtheria or whooping cough.

Then something changed. Maybe folk memories of the Spanish Flu had faded or it may be something to do with television cold cure adverts. Dunno, but for some reason when you rang in sick, you could not say, "I've got a cold." It had achieved the status of 'the sniffles'. You were expected to man up, come in and feel a bit miz. So you said you had flu. You never, curiously, used the word 'influenza'. That's my folk memory anyway, others may confirm or deny.

[Chad]

Confirmed.

[Chad]

[Mick Harper]

That is both fascinating and significant on two counts

1. Since, as I understand it, you die not 'of flu' you die because of respiratory failure that is consequent with what the virus is doing to your respiratory tract (or whatever), I find it difficult to believe that this is not a) ambiguous and b) difficult to judge without a full autopsy. There is also an AE point: hospitals may have a built-in tendency, policy-driven or otherwise, to inflate/deflate flu figures.

2.Since this is a numbers game, the careful ignoral that like (flu) is not being compared to like (coronavirus) is glaring.

[Boreades]

[Mick Harper]

Most valuable to have another health professional on call. As long as he/she/it agrees with us.

Nobody will be interested but Imperial College saw the debut of M J Harper onto the national stage when my brother was head honcho of a conference held there called Threats and Promises of Science back in the days of Swinging London. My contribution was to write a scathing critique of the conference and leave it in my brother's room. Since it was intended for his eyes only I rather went to town. He didn't realise it was from me and had it circulated round the conference to the extreme ire of all concerned. Ah, happy days. Whatever happened to M J Harper?