Charlie's Diary

Charlie, the last two links go to the same page.

At the same time let's note this: in the US there are 20 identified cases. 1 of those have been hospitalized. The scary thing about pandemics isn't just that lots of people get sick... it's that lots get VERY sick and a sizeable percentage die. Bird flu was scary because of the high mortality rate and the fact that none of the current meds seemed to do much to help. If it ever becomes human transmissible and maintains that virulence it will be very, very bad.

Swine flu seems like a very bad flu, but it has a low mortality rate (so far, knocking on wood) and current, widely available flu drugs like Tamiflu seem effective against it. The bottom line is that we should do the common sense things but that panic is simply not warranted. Concern? Yep. Stocking up on months of rations and not venturing out? No.

Excellent thoughts, Charlie. One note; the "how to wash your hands" link appears to go to the same page as the "flu kit", and I don't see the hands wash instructions anywhere there (in comments, etc...though I could be missing it). Just wanted to point that out in case it's a cut and paste error; good handwashing instructions are worth a lot.

Paul: link fixed.

Rick: there are suspected cases (flew in from Mexico: got flu: in hospital) only a few miles away from here (in Scotland). There are suspected cases in New Zealand, Canada, France, England, and Germany, not to mention bits of the US. There are an estimated 1300 identified cases and 80-odd deaths in Mexico City, although there may be very many more cases that haven't been formally diagnosed. (Let's hope so, because that would mean the mortality rate is lower than 80 out of 1300 would suggest).

This all suggests it's highly contagious between humans (unlike H5N1 bird flu) and with modern transport technology it is probably already in your home town. It's too late to hole up in self-imposed quarantine and live off the tinned beans.

When I was working for UBS in Switzerland a couple of years ago they sent all employees 'pandemic survival kits' containing face masks, alcohol hand wash, thermometer, paracetamol, etc. It's not much, but it's a significant portion of the list you linked to, and it might make all the difference if things go bad.

I have not heard about any UK companies doing the same, but it makes a lot of sense for them to do so, for business continuity alone, if not moral responsibility :).

Charlie, are you still going to be speaking in London on Friday, or are you going to be hiding in your flu shelter :->?

FWIW, the advice to businesses from the Department of Health does not include face masks, on the grounds that they are the least effective means of control and might give people a false sense of security, undermining the need for more important behaviour changes. But if used intelligently, I expect they will add a little protection. See here - http://www.dh.gov.uk/en/Publichealth/Flu/PandemicFlu/index.htm.

Agreed on all points. However, even if the mortality rate is about the 6-7% that those numbers suggest it's not reason for panic. Common sense precautions taken seriously, yes, but I already see incipient panic in some quarters. People are notoriously poor evaluators of their own risk, though, and I worry that we'll tip from unawareness into pure emotion and bypass reason. I still remember the surveys after 9/11 that showed about half of the US citizens thought that they or their immediate family would be victims of a terrorist attack in the next year despite the incredible unlikeliness of that actually happening - it a perception fueled by raw emotion and press hype, not any reasoned evaluation of the facts.

I don't mean to be callous, but let's look at some numbers. Say 1m cases of swine flu eventually happen and 60,000 people die. On a human scale that's a horrific tragedy, but when you consider that the easily exposed population (people relatively near cities with airports or within a hop of a major airport) is perhaps 1 billion the risk of any one of us being exposed, much less dying, is pretty small. Even if one increases those numbers tenfold the odds of it affecting you or me remain small (though the tragedy then would truly be horrible).

It's certainly time to take the usual precautions more scrupulously but not to panic and start walking around in masks refusing human contact. Here's hoping, too, that the various health organizations can bring this under control before anything like 60,000 people die.

Lee: yes, I'll be speaking in London. (Also: signing books at Forbidden Planet at lunchtime on Friday, and doing a Kaffeeclatsch for SciFi London on Sunday at lunchtime.)

I might bail out of some or all of next month's US trip, but only if things truly go nuclear (i.e. it goes pandemic and it's as bad as the 1918 Spanish flu, or the border/travel restrictions get ramped up to that level). That's a purely pragmatic decision: I know where my GPs surgery and my nearest hospital are, whereas overseas I'd be relying on travel insurance and hoping for the best.

Rick: the UK government's worst case contingency plans for H5N1 flu going pandemic ranged up to 750,000 dead (1.25% of population) and 20-30% infected. (Read: 2.5 million dead in the USA, and 100 million needing time off work due to illness.)

The deaths would be bad enough -- we're talking mass graves here -- but the dislocation caused by 20-30% of the population needing 1-2 weeks off work within the same 2 month time span would be terrifying. That's not a health issue, it's a logistics/economics one. It doesn't even have to be particularly lethal to have bad effects -- Singapore's GDP took a 3.8% hit in 2003 when SARS hit, even though the death toll wasn't above two digits.

All good. I'm looking forward to the ORG talk; interesting topic, interesting speakers, and money for a good cause.

Having just read the first 3 of the merchant princes last week (last of your back catalog I had not read), I can say I'm looking forward to the next couple. I did not know about the signing, not really my thing, but it might be novel to own a signed Stross :).

The economic fallout of a pandemic would be pretty nasty on top of the ongoing liquidity problems; quite a few of the banks are still in pretty vulnerable positions.

Four confirmed cases in the Maritimes and two confirmed in BC: http://www.calgaryherald.com/Health/Canada+confirms+first+swine+cases/1536236/story.html

On the other hand... http://www.reuters.com/article/latestCrisis/idUSN26489623

If Tamiflu was not a prescription drug, many people might stock up on it, when they could, after a flu scare. If and when a pandemic happens, people would be better prepared. As it is, we must rely on government stockpiles, which, I think, would not be sufficient for a 1918 type pandemic.

Rick says 'let's look at some numbers. Say 1m cases of swine flu eventually happen and 60,000 people die'. I wonder where those numbers come from. I've seen more scary numbers
http://canprep.ca/forum/viewtopic.php?t=128

Of course I have to be suffering from a particularly bad, but not lips turning blue, flu while this is happening. Paranoia issues.

For reference: just over 40,000 people die from the flu each and every year.

It is interesting to note that (at least as far as I can tell) most people in the US who have gotten it have not even been hospitalized. I strongly suspect that the final death rate will be much lower than the initial reports in Mexico because when the thing first appeared, patients were likely just sent home with the flu.

The idea that there will be 210,000,000 deaths is pure alarmism at this stage.

"Rick: the UK government's worst case contingency plans for H5N1 flu going pandemic ranged up to 750,000 dead..."

Yes. But the mortality rate of H5N1 is FAR higher than the single digit percentages we're seeing so far with swine flu and it did not respond to the anti-flu drugs that governments have stockpiled (Relenze and Tamiflu). H5N1 != swine flu by a LONG shot... it's why I said "Bird flu was scary because of the high mortality rate and the fact that none of the current meds seemed to do much to help. If it ever becomes human transmissible and maintains that virulence it will be very, very bad."

In fact it's exactly these false equivalences that shouldn't be drawn - both are influenza and both are variants that we don't have immunity against. That doesn't make them the same thing. It's exactly this "OMG, this is just like that other killer flu" reaction that I find worrying. Let's evaluate and react to this thing in front of us, not that other thing over there.

@Astrolabe - those numbers are completely alarmist and he's irresponsible to float them. His logic is so incredibly poor I can't begin to give him any credibility whatsoever.

1) Start with the 6 billion number - that presumes every single person on the globe is exposed. This is incredibly unlikely. Think about it for a moment... Remote tribes in Mongolia will be exposed? EVERY SINGLE PERSON in China and India will be exposed? Or is it more likely that something less that every man, woman and child on the planet will be exposed?

2) "The virus will be in every country within 30 days of outbreak." Really? it's in Burkina-Fasso right now? Zimbabwe? EVERY country? It's very likely in some significant percentage, but EVERY? Where's the support for this assertion? Or right, there is none.

3) "CAR 50% x CFR 7% x 6 billion = 210,000,000 deaths from the flu directly." Really? Hey kids! If you take made up numbers and multiply them you too can come up with silly conclusions!! Take Alarmist Math 101!

Let's look at a recent pandemic the 1968-69 Hong Kong flu. Wikipedia reference here: http://en.wikipedia.org/wiki/Hong_kong_flu#Hong_Kong_Flu_.281968-1969.29

"This pandemic of 1968 and 1969 killed an estimated one million people worldwide. The pandemic infected an estimated 500,000 Hong Kong residents, 15% of the population, with a low death rate. In the United States, approximately 33,800 people died."

Hmm, this virulent flu infected only 15% people in Hong Kong NOT every single person there despite the fact that HK is very densely populated. What happened to the 100% exposure, 50% infection rate? The world population in '68 was about 3 billion... why were there only 1m deaths and not about 105m as the above logic would predict? Could it be that the doctor you cite is... full of excrement? Why would he publish such alarmist numbers? Oh, hold on...

"I have written about these factors in detail in The Coming Pandemic Catastrophe available on Amazon.com ,which I do shamelessly hereby self promote.

And you were wondering why I was concerned about needless panic...??

Don't forget the CDC website for the "official" info from the US:

http://www.cdc.gov/swineflu/

Something that got slightly ignored in the US cases is that most of them are outside of the probable mortality range for this bug. A lot of them were young teenagers, and the others were over 40. The supposed danger ages for this bug are in the 20-40 range. From the early accounts, only one of the US cases has been between 20 and 40, and that one ended up in the hospital (but got better).

There also seems to be two separate swine flu substrains going around, one really bad, one not. There are also several other viral diseases going around in Mexico right now, and there could be a problem with multiple infections in some cases. The CDC compared 14 samples from Mexico to the known cases in the US, and only half of the samples (7) matched the flu virus found in the US. The other seven? They don't know what they are yet - no match.

That said, this one doesn't seem to be as bad as some folks are painting it, but considering how iffy things are in Mexico right now, I'm certain we're only getting part of the story. Whether it's the good part or the bad part, who knows?

As far as the "only 6% mortality" issue: yeah, that's scary. Not "The Stand" scary, but not something you want landing on an already-stressed world economy.

A typical flu strain infects 25% to 50% of the US population, and only kills about 0.1% - and that's usually among the very young and the very old, not healthy young adults.

Possibly useful tip - how to make rehydration salts at home:

12 flat teaspoons of sugar, one flat teaspoon of salt, dissolve in 1 litre of clean water. Repeat as needed. Drink until it don't taste good any more. (You find that if you're actually dehydrated, it tastes like sweet ambrosia - but just like salty sugar water once you've rehydrated enough.)

This is the UN standard mix, recorded by PJ O'Roarke in 'Holidays In Hell'. Used it myself for years - way cheaper than shop-bought, no nasty additives.

rick:
"Hmm, this virulent flu infected only 15% people in Hong Kong NOT every single person there despite the fact that HK is very densely populated. What happened to the 100% exposure, 50% infection rate?"

The Hong Kong flu you're talking about was neither very virulent (15%, as opposed to 25% to 50% for the more widespread and easy to catch strains, with 30% being typical), nor deadly (between 0.1% and 0.5% mortality). It was what they call a Category 2 pandemic. The current swine flu has already been categorized as a Category 3, with a potential to move well up the scale if the early reports turn out to be true about infection rate and mortality.

cirby,

My point was more to shoot holes in specious logic than anything. If you want to grab little bits of what I'm writing feel free, but it's not really productive. For example, I didn't claim that a 6% mortality rate was trivial but rather that it's nothing like H5N1's 50%. And while this pandemic *may* move up the severity chain, it's right now classed as less serious than the HK pandemic.

Again, I'm not here to say "oh, this is all hype, nothing to see" but rather to ask that we keep this in some kind of perspective. Claiming that this could easily kill 210m people is alarmist and irrational. Even equating this with H5N1 isn't, right now, justified since it seems to have a significantly smaller mortality rate and responds to the flu drugs we have. If either changes it will be incredibly worrisome. Even now, it's a serious concern... just not worth the panic I've seen elsewhere.

rick:
"If you want to grab little bits of what I'm writing feel free, but it's not really productive."

Actually, it was a big bit (about a third of your post), and there are much better comparisons than a minor flu strain from a few years back - unless you truly are trying to minimize the possible problems with the current outbreak.

In communicability, age groups affected, and (supposed) mortality, the one you need to compare with is the 1917 Spanish Flu. Using something fairly weak as a comparison? Not a good choice - except to point out that a minor (in comparison) flu strain caused a million deaths worldwide. What would a truly severe one do?

By the way - some reports are coming in that suggest that it doesn't really respond that well to things like Tamiflu if you're in the wrong age group (some doctors in Mexico City are saying it doesn't work at all on what they've been seeing in their hospitals). And, once again, there's a strong possibility that the strain we're seeing in the US is a different one than what's causing the high death rates in Mexico...

As far as panic? Haven't seen any here. Seen people worrying about it. Seen what might be overreacting. Talked to some folks who were more in the "dammit, I don't need this right now" sort of mood. Not a lot of panic. I'm sure there are some people panicking like mad, but they're the same ones who panic when they're five minutes late for work.

Um, Bruce Sterling's article seems to have been removed...what's that about? Fear of lawsuit?

LiveJournal’s RSS scanner has a cache of Sterling’s post.

One thing about proper handwashing-- be sure to get both thumbs. People have a nasty tendency to miss properly going over a thumb (I forget whether it's dominant or non-dominant) when washing their hands.

So this article just hit a tech blog I follow - http://www.techflash.com/venture/Veratect_sounds_alarm_on_Swine_flu_outbreak_43742807.html. Interesting startup that uses tech and live analysts to provide early warning about things like this. They apparently alerted the CDC to this in March. Twitter feed here if you're interested: http://twitter.com/Veratect. No connection to them (didn't know they existed even though they're local... sigh) but it's an interesting use of technology to address a very niche problem.

I said "Rick says 'let's look at some numbers. Say 1m cases of swine flu eventually happen and 60,000 people die'. I wonder where those numbers come from."

I'm cynical enough to find irony in his reply: 'Hey kids! If you take made up numbers and multiply them you too can come up with silly conclusions!!'

IMPORTANT
Rehydration mix values given so far are WRONG

CORRECT Mix is as follows.

4 parts Sugar or Glucose
4 parts Salt (NaCl)
2 parts Sodium Bicarbonate (NaHCO3)
1 part "Cream of Tartar" ( Sodium Hydrogen Tartarate )
Add water to dissolve.

Carter: WIRED seem to have lost everything in BruceS's blog since March 12th! My money is on a CMS whoopsie.

Alarmism

In the early stages of a potential flu pandemic, there is great uncertainty about what the final mortality figure will be. This is because the mortality rate (and as far as I know, the infection rate) are uncertain, and might change; and because the final mortality depends in an exponential-like way on the infection rate.

There is therefore often a small but not insignificant chance that the final mortality rate will be very high. People have different opinions about whether publicly announcing this is a good idea, and whether it is alarmist.

My personal preference is that I don't want the information I see to have had alarming possibilities erased. Further, I would argue that publishing the alarming possibility is not alarmist if i) it is not vanishingly unlikely, and ii) there are measures (such as those in Charlie's original post) that people can take to mitigate the effects of disease.

With luck, the flu panic means that the crowds will stay away in droves from Charlie's gig for the ORG, allowing me to get it. The tickets sold out some time between me checking there were some left, and me logging on to get one. In between I bought a bus ticket - so I might see you in the pub afterwards.

It's not that hard to make your own rehydration formula. You should have just about everything you need already.

http://rehydrate.org/solutions/homemade.htm

dave b: It's easy when you're feeling okay; but if you're trying to make up rehydratyion formula when you've got flu or are recovering from the flu, having pre-packs is a good idea.

Chris: pub afterwards! For sure. (I expect I'll need a drink after trying to keep up with Cory for a couple of hours ...)

Here's a Yahoo cache of Bruce Sterling's Wired article:

http://74.6.239.67/search/cache?ei=UTF-8&p=http%3A%2F%2Fblog.wired.com%2Fsterling%2F2009%2F04%2Fpractical-tips.html&y=Search&rd=r1&fr=yfp-t-501&u=blog.wired.com/sterling/2009/04/practical-tips.html&d=Ujn5sExISsqq&icp=1&.intl=uk

Meanwhile, over on XKCD, Randall Munroe reinforces all my prejudices about Twitter :)

"the dislocation caused by 20-30% of the population needing 1-2 weeks off work within the same 2 month time span would be terrifying"

Well, at the supermarket at the weekend, people were buying canned food like they were going to stop making it soon.

I'm not talking about "buying a few extra cans of soup", They were filling baskets and trolleys and stopping only when the weight was becoming unmanageable.

That sort of thing is ALSO likely to have an effect, especially given (for example) the British population's habit of panic-buying petrol at the slightest provocation.

EU health commissioner advises Europeans to postpone non-essentail travel to Mexico and USA due to swine flu.

Guess what? I'm due to travel to Seattle for LOGIN, and then on to Baltimore for Balticon, ten days from now.

I'm not cancelling the trip yet. However ...

I will definitely cancel the trip if (a) one or both cons are cancelled due to public health/travel restrictions, or (b) I or my wife come down with swine flu.

And I might cancel the trip if the situation changes drastically for the worse over the next 9 days.

Being ill is miserable. Being ill in a foreign hotel room is worse. Being ill in a foreign hotel room, trying to deal with a foreign healthcare system, in the middle of a pandemic, has got to absolutely suck.

Charlie @ 32: It also tells me that Randall likes Questionable Content. 'Hannelore' is a character from that webcomic.

The Saskatchewan government is testing four suspected cases of swine flu:
http://www.cbc.ca/canada/saskatchewan/story/2009/04/27/swine-flu.html

Even if this outbreak burns out in the next couple of days, it's economic impact will be huge. Mexico takes in a lot of tourist cash but in the last couple of years it has developed a bad rep with a lot of Northern America's travelling class. Add disease fears to fears of crime, and all that tourism money vanishes.

Mexico really can't withstand another economic hit right now. Even a best-case disease scenario is going to make a lot of their revenue vanish. Expect the gangs/militias in the interior to take full advantage of the situation.

greg @ 25:
Rehydration mix values given so far are WRONG

CORRECT Mix is as follows.

4 parts Sugar or Glucose
4 parts Salt (NaCl)
2 parts Sodium Bicarbonate (NaHCO3)
1 part "Cream of Tartar" ( Sodium Hydrogen Tartarate )
Add water to dissolve.

That sounds like far too much salt. Saline solution is only 0.75% salt (7.5g per litre) and less is better than more.

Dave b's link@29 gives 1 level teaspoon of salt and 8 level tablespoons of sugar to 1l of water.

(Sorry about the formatting error: the quote should have been all in italics).

Somebody (Halimede) commented on Misia's LJ that Sambucol (elderberry extracts) can be effective at treating flu. Among others it ramps up cytokine production, particularly TNF alpha (http://www.ncbi.nlm.nih.gov/pubmed/11399518?dopt=Abstract), so if a cytokine storm plays part in H1N1(swineflu)-induced pathology, this may be a double-edged sword.

Might be worth a look. I'm going to hunt for some more papers.

Charlie @8

I wouldn't put too much stock by those official numbers if I were you. They were massaged down to stop things looking too bleak - and they assume a totally working, efficient, NHS - with in addition doctors and nurses all staying at their station.

Oh, and they didn't use the 1918 flu as a basis, they used the 1958 and 1968 ones as the model.

I just listened to the Chancellor of the U. of Hawaii on the radio. She is a flu researcher. The strain is H5N1. Those who received vaccinations in the 70's may have protection from H5N1. Those who receive vaccinations in the past 2 years were inoculated against H1N1 which provides some protection against H5N1.

I'm not sure what to think of this. We have 40 cases in the US, 28 are from a single school trip to Mexico, no deaths. I appreciate the quick response, but I am not shaking in my boots.

Are you absolutely sure that she said the swine flu cases have been H5N1? I thought all the reports to date, including the CDC, have been saying type A, H1N1.

It's the Asian-originated strain of avian flu which is H5N1 (and amantadine-resistent) and thus worrying the epidemiologists so much.

Rehydration Packets: I'm sufficiently seriously ill that I have to have 32oz of rehydration fluid every day. I used Gatorade until my sugar started going up, and since I have renal disease, that would have been likely to trigger diabetes. I don't need another disease. So I found Sqwincher (this is where I buy it -- I use two packets & 40oz a day) which has Splenda in it and use that. You can find more about it here. It was developed for firefighters and other people who work in a lot of heat.

Hi team, surely the sugars in rehydration solution are just to make you want to drink it? As long as it contains lots of water, and salt at a low enough concentration that you can actually absorb it (ditto the sugar, of course), shouldn't it work just fine?

I'd be pretty careful about sterilisation if I were going to make up bottles of dilute sugar solution for later, mind you...

No, the sugars are important too. As for pre-mixes, just mix the sugar and salt together and store it in baggies or jars. Add water as needed.
http://en.wikipedia.org/wiki/Oral_rehydration_therapy

Chairman Bruce's blog has been restored.

Try energy gels used by athletes. You can keep a handful of them next to your bed along with a big bottle of water. The good ones also taste okay, and you can get them in a wide variety of flavors. The higher-priced ones have a decent dose of vitamins and trace elements, too.

I keep a couple of boxes of Crystal Light hydration packets around the house. They're sugar free, but there's a lot of ways to get the carbs (mix a little sugar in the bottle, or just eat some hard candies), and they have a moderate dose of electrolytes. Indefinite storage, too.

The strain is H1N1

Absorption of glucose in the gut is an active process, and carries sodium across, hence the effectiveness of adding a small amount of glucose, or sucrose, to the small amount of salt in a large amount of water - the combination is absorbed _slightly_ better than water in adults.

The advantage is larger in small children.

The WHO have distributed spoons for measuring, the quantities involved are small
http://rehydrate.org/solutions/talc.htm

http://www.ncbi.nlm.nih.gov/pubmed/3346932
People tend to put too much salt in, try hard not to.

Try water.

Ian_M: Didn't know that about salt and sugar uptake being linked in the intestine. Something to add to the first aid kit.

Future ice ages could be avoided even more easily with small quantities of halofluorocarbons, which are long-lived and have a high global warming potential. (Picked this up from RealClimate, who would have got it from James Hansen.)

The thing that bothers me about so-called "proper" handwashing - apart from the fact that nobody, does it, or does it often enough, is that it is extremely wasteful of water/soap/whatever. Imagine the increase in water usage in the UK if everyone followed best practice handwashing technique every time they scratched their - ahem - nose. None of the advocates of proper handwashing address this fundamental question.

The same is true of barrier methods such as disposable gloves.

Realistically, there have to be times when you do it "right" and those when the "quick scrub under a tap" or even "wipe with a damp cloth" will do.

Kevin: the time to do it "right" is when you're in the middle of a pandemic (or about to enter an aseptic/sterile suite such as an operating theatre).

@Kevin (49):

I just did a quick test. Using proper hand-washing technique, one hand wash in my bathroom sink comsumed 800ml of water.

On average, people go to the loo six times a day. So, that's 4.8l of water used.

Flushing the toilet once consumes 8 litres. One shower consumes about 80 litres of water. In total, an average UK person consumes 150 litres a day on average, but if you include hidden water costs (food production, etc), we soak up about 4,600 litres a day.

In other words, the "extreme" waste of properly washing your hands, if instituted country-wide, will increase the UK's total water usage by 1/1000th.

That's assuming that no-one washed their hands at all before, and that you're making no effort to use minimum water. Realistically it's probably more like 1/2000th.

I seem to recall that one of the top WHO bods said in an interview that, if he could choose one commandment for the entire world to improve the quality of life, he wouldn't be able to choose between "love thy neighbour" and "wash your hands".

Gotta say, it sounds like an increase that we can live with...

(Figures from The Guardian and uswitch.com)

Charlie @ 49. Agreed. However, most don't distinguish between in the middle of a pandemic/about to enter an operating theatre and, say, washing vegetables. And, note we are talking about ordinary joes, not medical personnel here.

Hugh @ 51. Charlie posted a link to Jon MacDonald's blog. Jim writes: "Wash your hands before and after preparing food, after using the toilet, and any time they are grossly contaminated". I don't he's talking about surgeons do you? I love that "grossly contaminated". How do we decide what is grossly? That could be a _lot_ of handwashings everyday, not just after going to the toilet. But how many people can honestly say they do this all the time? If not, then the precautions are surely useless, of course.

Further, he talks of washing for somewhere between 15 seconds and 1 minute (estimates vary), each time. Under running water you could burn through a litre of water easily in 5 seconds (depends on rate of flow. Turn on a tap for a few seconds and measure). It sounds to me like you are underestimating badly.

I made some estimates and I guess the increase could be equivalent to about 500 million litres of water per day just for the UK. That assumes about 70% of people wash their hands 5 times extra each day for 30 seconds per wash using around 2.5 litres of water per wash.

@ Kevin: For God's sake man, stop washing with the tap on full blast. You're not trying to douse a fire here. All you need to do is get your hands wet and then rinse the soap off.

Those of use in semi-arid climates thank you for conserving our planet's precious fresh water.

Three confirmed cases in New Zealand now. The results came back from the WHO lab in Melbourne. Air travel has made us a global village. Me, I'm going to work as usual but will be more aware of people around me. And will be washing hands "properly" (seconding Charlie's comment @50).

Concerned, yes; alarmed, no.

I think we worry too much about swine flu megadeaths. I've spent some time looking into what things were like back during the time of the last industrialized nation flu megadeaths, and I tell you, Sterling's right.

Of course, we only have to think back to December to remember a time when a really annoying-to-have flu got wide coverage, so I'm not about to suggest that won't happen again, or that you shouldn't bother washing hands when the moment's right.

Kevin, I have a faucet aerator switch on all of my faucets. Turn the water on long enough to get your hands wet, flip the switch to turn it off temporarily while keeping the temperature, rub the soap over your hands, then flip the switch back on to rinse, and turn the water off.

I also do the flipping when I wash dishes or veggies, or brush my teeth, etc., and save a good bit of water.

There are times to worry about saving water. Fighting a fire, washing your hands in a flu pandemic, climbing a mountain; these are not the times in question. Similarly, the time to worry about saving fuel is not on take-off.

Regarding some of the original concern over the swine flu, let's put some of the numbers in perspective. Something like 35,000 - 40,000 US citizens die every year due to the flu in general. So, assume a whopping 5% fatality rate. I figure that leaves us here for the last three days:

Regular flu US fatalities: 330
Swine flu US fatalities: 0 (2 unconfirmed in California)

Regular flu US infection: ~6500
Swine flu US infection: 64 (last I saw)

In both cases fatalities and infection are less than 1% of the average flu toll in the United States. The flu can be pretty serious, and any death by disease is tragic. But I have to agree with the esteemed Mr. Sterling, the flu remains the snot nosed little sister of real plagues.

There is a Cochrane Review of Interventions for the interruption or reduction of the spread of respiratory viruses http://www.cochrane.org/reviews/en/ab006207.html
which endorses handwashing.

Reading one of the referenced studies, the US army had useful results from getting recruits to wash their hands five times a day. You don't need to obsess over it to get a measurable risk reduction.

Bill: do you know what a logistic growth curve looks like? The first stages of a massive explosion in infection rates looks like nothing special. Population ecology 101.

This is not to say I'm running around thinking that the sky is falling, but your numbers prove nothing at this point: we need to know how transmissible the disease is, and how nasty, before we can say anything about how bad it might get. Sensible precautions are, well, sensible.

I'm going to quote someone from Warren Ellis's message board here: "I'm not really feeling Sterling's point here. Yeah, AIDS is the new normal - after the loss of a good chunk of a generation and a major shift in sexual behavior, sure. A whole lot of people took it on the chin to get to that point. So now we should just ignore early warnings about potential new pandemics because, whew, we rode that last one out?"

How is a disease that killed at least 20 000 000 people over 2 years just the 'snot nosed little sister' of real diseases? Personally I have my doubts that this version of flu is the next big one, but I've seen waaaaaay too many people just shrug and say "Can't happen here, don't worry about it". Don't panic, sure, but don't stick your head in a hole either.

May I point something out?
Mexico has had the only fatalities, and Mexico City has atrocious air quality. Anyone with a respiratory infection would struggle there. The deaths may be due to environmental variables rather than the virulence of the flu.

Yeah, air quality and lung damage is probably a big part of it. I've also seen posts from people in Mexico City saying that this outbreak is rumoured to have started in December but was covered up by the authorities. So its had lots of time to build a body count.

And I just googled the rumours and found this: http://www.timesonline.co.uk/tol/life_and_style/health/article6188732.ece

For more articles google 'Carroll farms Mexico' if you're interested.

So this variant seems to have been working its way through the population for several months now. Based on the evidence so far, I'd say this outbreak will probably not be the big one. But that doesn't warrant being careless.

@60 Chris: Agreed, sensible precautions are great. And, I absolutely agree that if the disease explodes we haven't seen anything yet. My only point was that currently the regular flu is immensely more dangerous than the swine flu and most people don't wash their hands after, say, exiting the subway.

@61 Ian: Agreed. The flu is a huge threat to the population at large where the quality of water, healthcare...life is significantly lower than here in the US, or other more developed countries. But, I would ask, where have you seen people saying no way never here? All the news coverage I've seen has been about the spread of the disease, the closing of schools, and how great the thank-god-we-found-a-use-for-that-bio-terrorism-money-we-got thermal imagers to screen air travelers.

I think everyone could use the talking down. The only talking down I've seen is the fight against the scurrilous rumor that the delicious ham sandwich I enjoyed today might be the cause of the swine flu. I had the same experience with the Asian bird flu, so I was prepared for this one.

The swine flu is dangerous. But, tomorrow, I'm more worried my 4th floor porch will inexplicably break away from the building whilst I'm enjoying the fresh air. Or accidentally pulling a vending machine down on myself. Which I've done once before. Which I'm told makes that alot more likely to happen to me again. Side to side folks. Side to side.

@63 Ian: That is an interesting article. I just finished reading Neal Stephenson's Zodiac. Given that article, it seems I was potentially/unintentionally timely in my reading.

Bill @64: Not here, but I've seen a couple of people on other forums/boards with the attitude that swine flu is no big deal because, hey, it's just the flu. I've also seen posts by Americans to the effect that 'even if this does get bad, it won't get bad here in America so why worry?'. And I've overheard conversations that ran along similar lines.

The major media want to scare you, because that makes it easier to sell you crap, so they overhype the possibility of a pandemic. But far too many Northern Americans seem to think that serious influenza outbreaks are a thing of the distant past and we'll all be okay so long as we don't lick any Mexicans.

As for your porch, I suggest never going outside again. it's the only way to be sure. And you should seal your doors and windows with duct tape.

@astrolabe - my numbers were off the cuff what ifs not even meant to be accurate but to show that even a lot of people being infected isn't that serious on a global scale though the human cost is. Your 'source' however is trying to put forth his silly numbers as if they had some basis in reality. While you're being oh so cynical, try refuting the logic in my response. Start with telling us how every man, woman and child will be exposed to swine flu. His logic is as laughable as it is self-serving.

This is overblown so far. As Bill points out above hundreds die each week from regular flu. Could swine flu explode into a pandemic that reminds us of 1918? Perhaps. But the healthcare system is vastly more sophisticated now than then as are communication and, well, everything. This isn't 1918 so let's stop pretending that everything would play out just the same.

As for cirby's not seeing anyone panicking... look around. Note the nervousness in the market, the people buying canned food, etc. Hell, look at the posts here worrying about having rehydration formula and masks. Get a grip folks... concern is warranted, but this isn't even close to a pandemic at this point. Let's hope it doesn't become one.

Funny you should mention that... I did some reflecting and I'm now watching the news out of my own Situation Room, aka my parents' basement. Mold may become a problem in my immediate future. Also I'm typing this while pinned to the floor by the foosball table. It was a prophylactic measure.

My point wasn't to argue that disease disaster can't happen, particularly in the US. All it took was Max Brooks literary endeavors to teach me that lesson. I just don't think this is the one. I remember SARS. Everybody with the facemasks that don't stop viruses and the 14 deaths. I mean, you could look back and say 14 million facemasks and travel cordons and non-stop life-threatening news coverage stopped the world's deadliest throat tickle.

It just doesn't seem like we have a real face-melting type of flu here. I'd say it would take about 5 geographically scattered face-melting-flu deaths for me to chain up the doors and live off ramen and boiled water for five or six months. Probability and maths forgotten.

Also, in an emergency situation duct tape clearly sits atop the list.

Marilee @ 57: That is an interesting idea, thanks.

Alex @ 58: Agreed, to a point. However, the point is we are not - yet, quite - in a flu pandemic. Similarly, the time to worry about fuel consumption is before you get on the plane.

Bill @ 58: The media panic about flu has no correlation to the number of deaths. If there is a single death outside Mexico, watch the frenzy.

The number of confirmed deaths has been revised down by a factor of three after re-testing. Mexicans check their sums.

I wish I could wash my hands in a meaningful way at work, but no such luck.

1) No paper towels. I get to hold my hands under an air-blower dryer, which coats my wet hands in mold and mildew.

2) There are three doors between the washroom and where I sit to work. Every door requires that I use the door handle-- I can't shoulder it open. So I pick up whatever people who didn't wash their hands put on it.

Given the above factors, it makes me laugh to see the poster from the local health unit saying that washing your hands is good for your health. I want to say, "True, but..."

J Reynolds@70 get one of the little bottles of alcohol hand sterilising gel for after you wash and keep it in your desk. It's also great for when you are out with the kids and they want to eat but there is nowhere to wash hands...

Sterling quote:
"There is always some flu around and flu is always killing some people. Even when a raw mutant flu manages to kill off more people than a shooting-war, flu has never ravaged whole cities as cholera or the Black Death can do. As awful pandemics go, flu is like the snotty-nosed little sister of awful pandemics."

Hmmm, 1918 flu pandemic revisited:

Estimates were 20 million to 100 million dead, right? Nothing to worry about at all.

Worst affected was Western Samoa, a territory then under New Zealand military administration. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed.

I guess it just doesn't matter anymore to research a subject you are actually going to write about.

You may panic now.

J. Reynolds: grab a pack of paper tissues. Use one to open the toilet doors. Discard in bin after use. Ditto Lee's suggestion on the alcohol gel.

rick@67: You're right, it's not 1918 anymore. In 1918 New Zealand could close its borders completely to keep flu out (except we made an exception for the ship carrying the prime minister, and 8000 people died). Try closing a border now.

I have some friends who are currently on the receiving end of the US health "care" system, and I doubt you're prepared for a major public health disaster. Sorry sir, your insurance doesn't cover epidemics, go home and die quietly.

Having said all this, I'm a work today with a runny nose. Sure it's just hayfever :)

According to NBC, one US swine-flu-related death today and the WHO has raised to level 5.

J Reynolds @ 70: when I went to Tokyo, I was shocked to discover that all the bathrooms there have blowers that actually *work*. Not the week Western ones that blow moist air and take five minutes to dry. These were clean, efficient, and could dry a hand in about five seconds.

Chris L @ 75: The US system does emergency response fairly well. It just has problems with chronic preventative care. And cost.

The bad news is that there's a nasty influenza virus floating around. The good news is that the global economic crisis ate my job, so I have time to spare if I get sick.

Always look for the silver lining, I say.

Chris @75: The health care system in the US could definitely use an overhaul for some of its practices. But, I would separate the performance of a country's general health care system from its ability to respond to a pandemic.

Steve @77: The US may never recover its losses to the Japanese in the Great Blower Race of '87.

Ian @78: Exactly. Plus, silver is a very useful ingredient for many homeopathic remedies. Also, it defeats most curses and all werewolves. So, you got that going for you.

Okay, so the US health care system isn't the greatest. One death reported so far, but that was a small child that was actually Mexican, and if I got the facts correct, was also an illegal immigrant (i'll leave the closing of the borders to those that wish to argue the point). However why are we so narrow mined in our vision. How many deaths so far in Mexico? Can we state the fairly obvious that Mexico's health care system is horrible, inept, or any other choice adjective one uses to describe something as deplorable?

Let's go one step beyond though into the realm of religion and swine flu. Did you see where Egypt (yup, Muslims on yet another fatwa binge) wanted to slaughter it's pig population of 300,000? (BTW, Egypt has yet to report a case of the swine flu) The farmers whose livelihood depends on those pigs turned the "pig butchers" away with rocks and I am sure some choice words. Same thing in Jordan apparently as well. Better get Obama to get on television and officially designate a name change to quell the belief that this "swine" flu actually came from swine...

Thome: so you're an American then? Welcome to the internet. I'm from New Zealand, I have NFI what you're smoking...

Bill @79, I have silver in one of my prescribed meds. :)