Guess That’s Why It’s Called The Low Country

#211


In my post paramedic career, I was a construction estimator, and then a computer programmer/software designer. So I have a penchant for numbers, tidy lists, and small details. During the inflationary spiral of the 1980’s, I was responsible for tens of millions of dollars worth of construction budgets, both residential and commercial, and battled long and hard against continually escalating costs and diminishing returns.


Given my background, it is inevitable that I am fascinated by the numbers game played by the experts in Pandemic influenza. I watch with great interest as assumptions are made, and plans are devised based on these numbers.


And I watch with a bit of horror, as well.


The public can read one day that a pandemic might claim between 2 million and 7 million lives worldwide, and the next day read about the potential loss of a billion people. We are told the virus might infect 30% of the world’s population, and then, a day later we hear it could be 60%.


Most of these numbers, I suspect, are agenda driven. They are designed to promote a specific response in the reader. Usually reassurance. And as such, they should be carefully scrutinized.


One such case I ran across recently comes from the South Carolina Pandemic Plan.


First, I’ll throw out a few numbers of my own, just for comparison.


Estimates of deaths in 1918 from the Spanish flu run from a low (and largely discounted) 20 million people, to upwards of 100 million. Today, most scholars use the 50 million number, but accept it may be low. Back then; we had roughly 1.8 billion people, while today we have 6.5 billion. In other words, we have 3.6 times as many people today as in 1918.


Assuming a pandemic of equal virulence to 1918, and our current population, we could expect a global death toll ranging from a low of 72 Million to a high of 360 million people.


Of course, if the next pandemic is worse, the numbers go up.


In the United States, we had roughly 100 million people in 1918, and roughly 650,000 died from the influenza. That works out to 1 death out of every 153 citizens. The actual death rate was probably higher, as records weren’t always kept, but we’ll go with this conservative number.


This works out to a death rate of 6,500 people per million of population. In some countries, like India, the death rate was much higher.


With that in mind, let’s look at the South Carolina Pandemic Plan, released on October 31st of this year, where they state:

An influenza pandemic affects between 30% and 50% of the population. If 30% of South Carolina’s population were stricken by a pandemic, 1,200,000 would seek medical assistance and up to 17,000 would need hospital care. There could be from 2,000 to 5,000 deaths, and the effects of a pandemic would last six weeks or more in a community.


How they arrived at these numbers is a bit of a mystery. They seem a bit low to me. Actually more than a bit, but I’m trying to be kind.


First, they automatically went with the lowest attack rate of 30%, and then low-balled from there.


Taking their worst-case scenario of 5000 deaths (S.C. population is roughly 4 million), they are assuming only 1 person in 800 would succumb to the virus. Somehow, they’ve decided the next pandemic will only be 1/5th as severe as the 1918 pandemic.


I hope they are right. Because an event of equal severity to 1918 would claim roughly 26,000 lives in that state. Not 5000.


The assumption that only 17,000 people would need hospitalization is also highly suspect, although it may be that’s the maximum number they feel they could accommodate. To date, we’ve seen no mild cases of H5N1 Avian Flu, and essentially all patients have required hospitalization. But if there are no rooms available, I suppose the point is moot.


The other gem in this little plan is the notion that the effects of a pandemic would last `six weeks or more’. The `or more’ is their way out, I suppose. The waves in 1918 lasted considerably longer than six weeks, and there were 3 of them, spread over 18 months.


If they are, indeed, basing their contingency planning on these figures, they are likely to come up far short of what they will need should a severe pandemic strike.


Somewhere, someone decided they would plan for a mild pandemic. And sadly, South Carolina isn’t alone. Other states and agencies have shown the same tendencies. There is great reluctance to plan for anything approaching a repeat of 1918. Whether this stems from a failure of the imagination, or trying to work towards a budget, I can’t say.


The truth is, the next pandemic could be less severe than 1918, equal to it, or possibly even worse. We don’t know right now.


But if we are basing our pandemic planning on a best-case scenario, we are planning to fail.