# 3563
Everyone, understandably, wants to try to put a number on the two big unknowns with the pandemic of 2009.
The Attack Rate, and the CFR.
In my last blog (see ECDC: Planning Assumptions For A Fall Wave) the ECDC (European Center For Disease Control) attempted to put some numbers to the type of fall wave they could expect in the EU.
While they are quick not to call their numbers a prediction, they come up with a likely symptomatic attack rate of 30%, and a CFR (Case Fatality Ratio) of .1% to .2%.
And based on what we’ve seen to date, and assuming the virus does not mutate towards greater virulence (or an older demographic) and antivirals remain effective and available, those numbers seem reasonable to me for most EU countries.
Of course, the virus could mutate and over time and antivirals could lose their effectiveness. A pandemic can last for years, and the ebb and flow of the virus – and its severity - can change from year to year.
As goes Europe, probably will go the United States and most other Industrialized nations, including Japan, Australia, and New Zealand.
And if we accept the ECDC estimates, we can make some quick and dirty calculations regarding the number of people who might be sickened or die this fall and winter from this pandemic virus.
At the .1% CFR, and a 30% attack rate, the number of deaths in the United States would be just over 2.5 times what we normally see in a flu season.
Of course, normally, most of the deaths we see come from an elderly subset of our population. With this novel H1N1 virus, we’ve seen an age shift towards much younger victims.
The impact of 90,000 US deaths – assuming that a great many of those will be children and young adults – would certainly be more than 2.5 times as great as a normal flu season.
In other words, the numbers don’t tell the whole story. But of course, these number may not be right, either.
They are based on very preliminary observations. And a .1% CFR may even be overstated for some industrialized countries.
What we should not expect is that this pandemic will affect all regions of the world equally; that the burden of this pandemic will be the same in Lagos, Nigeria as it is in Lincoln, Nebraska.
For much of the developing world, antivirals, vaccines, or even basic hospital care are simply not going to be available. The CFR is, therefore, likely to run higher there than in the industrialized world.
Additionally, countries and regions with a younger median aged population, such as is typically seen in Africa, the Middle East, and parts of Asia are likely to see a higher number of infections due to the age shift of victims.
Agencies like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, and others are working around the world every day to combat poverty and disease, and are going to be on the front lines during any pandemic.
To get an idea of what some of these agencies are dealing with, I would invite you to visit some of their websites.
They could use your support.
A few months ago, I highlighted a new project called H2P, or the Humanitarian Pandemic Preparedness project.
The H2P project is geared towards promoting community & district-level pandemic flu preparedness and response in developing countries.
Many of the resources are available in multiple languages.
This Initiative comes through the hard work of a number of NGO’s and partner organizations, including USAID, IFRC, CORE Group (including American Red Cross, CARE, & Save the Children), AED, InterAction, & several UN agencies, including WHO, WFP, & UN OCHA:
H2P is a resource rich website which offers Guidance and Policy documents, Planning Tools, Training Modules, Focus Areas and Communication and Advocacy information.
Given the limitations of surveillance and reporting from most of the world, and our own inability to put good numbers on the number of influenza deaths each year here in the United States, I doubt we’ll ever get a very good handle on the true impact of this (or any other) pandemic around the world.
The last moderate pandemic – in 1957 – is believed to have killed between 1 million and 4 million people globally. That is a pretty broad range of estimates, and illustrates the difficulty in trying to quantify these things.
All pandemics are local, however.
And while what happens in China, or India, Nigeria, or globally may be tragic . . . what happens in your community, neighborhood, and family are likely to be of greatest importance to you.
While time to prepare is short, there is still much that you, your family, and your community can do to prepare for this fall’s flu season.
Our first line of defense is we need to practice good flu hygiene all of the time; cover our coughs and sneezes, wash our hands frequently (or use alcohol sanitizer), and stay home when we are sick.
But beyond that, and getting the recommended flu vaccines this fall, there are many things we should be doing.
Businesses that haven’t prepared, need to begin now (see Quick! Who's Your CPO?).
Individuals should be preparing as well (see Creating A Culture Of Preparedness and Pandemic Solutions: Flu Buddies).
There has never been a better time to volunteer to help with the American Red Cross, The Medical Reserve Corps, CERT, or your Neighborhood watch.
We are truly only prepared as our surrounding community is. There are roles to play for everyone, including civic organizations, schools, and church.
The apparent `mildness’ (a relative term) of this first wave of H1N1 is heartening news, and we may find that the pandemic of 2009-2010 turns out to be far less serious than first feared. But influenza viruses are unpredictable, and we’ve a long way to go before the final chapter of this pandemic play is written.
The impacts, particularly in the health care delivery field, are likely to be significant even in a low fatality pandemic. And if it is you, or a loved one that is severely hit by the virus, you won’t think of this pandemic as having been `mild or moderate’.
Good enough reasons to take this pandemic threat seriously, and take steps now to prepare for the fall.
For more information on preparedness, you can go to any of these reputable sites.
FEMA http://www.fema.gov/index.shtm
READY.GOV http://www.ready.gov/
AMERICAN RED CROSS http://www.redcross.org/
For Pandemic Preparedness Information: HHS Individual Planning Page
For more in-depth emergency preparedness information I can think of no better resource than GetPandemicReady.Org.
