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    The McMaster Department of Philosophy has now put together the following notice commemorating Barry: Barry Allen: A Philosophical Life Barry…

What lies ahead, and remembering the 1918 “Spanish flu”

Take a deep breath, and then read this report out of Imperial College London which is very sobering but not alarmist, although it confirms, regretfully, some of my worries on an earlier thread.  I'll quote from the report and then add a few entirely personal recollections afterwards, although perhaps they will resonate with those of some readers of the right age.  Comments are open for those with knowledge and perspective to add their own observations, links etc.  From the new report:

Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. Each policy has major challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option.

We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound. Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

In short, it won't be "business as usual" (in universities or elsewhere) by next fall, barring some dramatic development in treatments or some other unexpected events.  We may be living in the "new normal" for a year or more.

But let's put this in a bit of context.  My mother's mother, Helen Foy, who was born in 1903 and died in early 1993, lost three of her older siblings to the Spanish flu more than a century ago:  they were all in their late teens or early 20s as I recall.  They grew up in what Grandma Helen always called "the Pennsylvania Dutch" country (where the Amish still live, although the Leinart family(Helen's maiden name) was not Amish; you can see some of her paintings here.)  Despite the rural setting, she still lost three of her six or seven siblings during that awful time.   Her mother died in the early 1920s, "from a broken heart" as Grandma Helen would always say when recounting these tragic events.   Our new pandemic, fortunately, mostly spares the young, a fact not lost I'm sure on all parents.  The fatality rate of the new pandemic is also lower than Spanish flu, most of whose victims died ultimately of bacterial infections that could not be treated.  If the cost of avoiding the kinds of horrific losses Grandma Helen's family suffered a century ago are "social distancing," telecommuting where possible, and cancelled trips and public events, they are costs I hope we can all bear.

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10 responses to “What lies ahead, and remembering the 1918 “Spanish flu””

  1. Robert A Gressis

    I apologize if this is discussed in the report you linked to, but I have a couple of questions:

    (1) Imagine the USA gets lots and lots of tests out there and tests lots and lots of people. If we have a policy of gradual reintroduction of people who have overcome COVID-19 into the workforce, then could we maintain suppression for a long time?

    (2) Imagine we chose to intentionally infect the young while maintaining suppression for the elderly and then, after enough young people have it, gradually infect the elderly, but only to the point that our medical system can handle it (all the while boosting our medical supply). Could this work to maintain suppression while also avoiding a global depression?

    (3) There has been talk of drugs starting to "work" on COVID-19. I take it what this means is not that it prevents people from getting it, but rather that it increases the survival rate of people who take such drugs. Was this mentioned in the paper?

    BL COMMENT: Just on #2, it's not possible. Even the UK is waking up to that!

  2. I certainly have no expertise in epidemiology etc. to critique Ferguson et al's paper, of which I've read the summary and will read the rest when I've time.

    But sitting in a business seeing the impact of some of the measures already taken, contemplating these being extended over the timescales discussed here (e.g. 18 months until a vaccine may be available) is very hard. As the paper says 'Long-term suppression may not be a feasible policy option in many countries'.

    The impact of such measures is borderline impossible to quantify (much harder than the narrow epidemiological question) but amounts to wholesale social and economic transformation compressed into a relatively brief period and with no legitimating mandate other than emergency powers to combat an emergency that will not be experienced unless it is not prevented. This is nuts. I do not expect such measures to be taken and therefore expect hundreds of thousands of incremental fatalities per country over the period of the outbreak. We can't prevent this: the discussion here at times reads like a reductio ad absurdum demonstrating this fact – telling people to remain in their homes for 18 months is not even coherent.

    The optimal strategy is to use a blend of suppression and mitigation, to use the lingo in this paper, to keep the maximum load of critical cases requiring intensive care at any one time within manageable levels. Whether our leaders can chart such a course remains to be seen.

  3. PS I like your grandmother's paintings! The children playing in one of the images are very moving in light of the sad events you recount.

  4. Thank you.

  5. Robert A Gressis

    Right, I agree that #2 is not possible. But 18-month suppression is also impossible, as is allowing 2 million people in the USA to die from the disease. So, some impossible thing will end up being possible. Or am I missing something?

  6. 18-month complete suppression is impossible, but substantial suppression for 18 months is. I take it that's one of the takeaways from this report, but am happy to hear other views.

  7. In order to get suppression, what is needed is an R0 below 1.0. In S Korea, they've been able to get down to about .3 with their measures. This should quickly bring down the absolute number of infections, but will very likely not eliminate them entirely. It may be possible with far less radical measures to keep the R0 hovering around 1.0. Perhaps those measures will be sustainable for a good period of time.

    One way to think about what keeping R0 around 1.0 is that it is roughly half of the R0 if no measures are taken, which is just a bit above 2.0. If one reduces the number of contacts infected people have with others down to half the number when they are unconstrained, that should do the trick. Of course, we won't necessarily know who's infected right away, so that we may need to require people in general to observe practices that reduce their number of potentially infectious contacts to 50% of those of normal times. And of course such measures as wearing masks in general shouldn't be too onerous, if we have access to them.

    Maybe permanent containment at a very low level might be quite feasible.

  8. Stuart Newman provides an interesting historical perspective on global and lesser pandemics in his Getting Viral Counterpunch essay. He is the author of a book titled The Biotech Juggernaut.

  9. Confused Philosopher

    Destroying the entire economy is also going to lead to many deaths. They may not be immediate or so vivid or easy to pass on through social media, but they are an inevitable consequence of public policy proposals like, "Let's put all of NYC under lockdown for an indeterminate amount of time."

    Like it or not, we are all Utilitarians now. It will be really hard to balance the trade-offs, but by killing the economy we are also, you know, killing actual people.

  10. A few observations: (1) the lockdown will not destroy "the entire economy," but will severely damage some segments of it affecting millions of people; (2) how much death results will depend heavily on what the government does or does not do in response, that remains to be seen; (3) economic destruction will also result from unchecked disease spread. But I don't disagree with your bottom line. Capitalism is an irrational way to produce what people need, and that becomes clear at moments like this, where production is held hostage to private decision and pursuit of profit, rather than enlisted to meet human needs.

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