Swine flu: that's all, that's all folks

I have to say something about Guido Girardi, the Chilean senator. This time his math didn’t fail him. What he said is logical, and I quote:

“it is key that we have five million doses for at least five million people, because this influenza, if it is that contagious, can easily infect two or three million people in Chile, and if it kills five percent, in the event that it affects two million, we could easily have 100 thousand dead”.

If the mortality rate of swine flu is 5%, and 2,000,000 people get infected, then 100,000 people will die. Simple arithmetic, numbers don’t lie.

Good for Girardi, he knows how to multiply.

None of this means his reasoning is correct.

The problem is the premise he starts from. Where did Girardi get the idea that 2,000,000 Chileans are going to be infected? Why do we need five million antivirals? (because there is no vaccine yet).

Just like the other time this character warned us about the terrible danger of dioxins, I did a little digging and found some interesting things, my main source being the World Health Organization (WHO) itself.

The case of bird flu

First, let’s look at the case of bird flu, which produces a more severe flu than what has been observed so far in Mexico, according to Ximena Aguilera, an expert at the Pan American Health Organization (La Segunda, April 28, p. 4).

Bird flu emerged in 1997 and reached its peak in 2005, the year in which PPD deputies Sanchez, Acorsi and Girardi demanded that the patent on the antiviral TAMIFLU be lifted in order to supply the doses needed to protect us from this tremendous threat (a ridiculous request, because at the time TAMIFLU had no patent in Chile :).

Well, here is the table of bird flu cases worldwide (taken from the WHO itself):

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO 23 April 2009

Country 2003 2004 2005 2006 2007 2008 2009

Total cases deaths cases deaths

Azerbaijan 0 0 0 0 0 0 8 5 0 0 0 0 0 0 8 5

Bangladesh 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0

Cambodia 0 0 0 0 4 4 2 2 1 1 1 0 0 0 8 7

China 1 1 0 0 8 5 13 8 5 3 4 4 7 4 38 25

Djibouti 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0

Egypt 0 0 0 0 0 0 18 10 25 9 8 4 16 0 67 23

Indonesia 0 0 0 0 20 13 55 45 42 37 24 20 0 0 141 115

Iraq 0 0 0 0 0 0 3 2 0 0 0 0 0 0 3 2

Lao People’s Democratic Republic 0 0 0 0 0 0 0 0 2 2 0 0 0 0 2 2

Myanmar 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0

Nigeria 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1

Pakistan 0 0 0 0 0 0 0 0 3 1 0 0 0 0 3 1

Thailand 0 0 17 12 5 2 3 3 0 0 0 0 0 0 25 17

Turkey 0 0 0 0 0 0 12 4 0 0 0 0 0 0 12 4

Viet Nam 3 3 29 20 61 19 0 0 8 5 6 5 3 3 110 55

Total 4 4 46 32 98 43 115 79 88 59 44 33 26 7 421 257 Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases.
All dates refer to onset of illness.

Let’s see…, how many cases in Chile? Zero, 0, none, nothing.

In 6 years, 421 cases, with 257 deaths, in the whole world! (well, not the whole world, 15 countries)

Where are the 10 million cases that were predicted in 2005?

Let’s calculate the incidence.

In the case of Indonesia, with a population of 193 million (as of 1994), that gives us an incidence of 5 cases per 10,000,000 inhabitants!!!

By the way, the incidence of bird flu in Chile is 0, the same as in the USA, which bought millions of treatments for a disease that never showed up in that country.

Do you know what the incidence of the current swine flu would be, the way things are going so far? 15 cases per 10,000,000 inhabitants.

If these figures held, if this incidence could be projected onto our reality (not a very rigorous thing to do, but are we really that different from Mexico?), then Chile would have 22 cases and, given the 5% mortality rate, 1 death from this disease.

22 infected and one death (LNDS)

vs.

2 million infected and 100,000 dead (Girardi)

Who do you want to bet on, my sloppy calculation or Girardi’s math?

How things come to light

It turns out that the drug TAMIFLU, the one more doses are being requested of, the same one Girardi wanted stripped of its patent in 2005, is produced by the pharmaceutical company Roche, using a patent developed by GILEAD Sciences Inc, a patent that will remain in force until 2016.

An interesting fact: GILEAD was founded by, among others, Donald Rumsfeld, who was a member of the board until he took office as secretary of defense in the younger Bush’s administration.

There is a controversial episode: the Bush administration’s decision, in November 2005, to spend more than 1 billion dollars buying Tamiflu to prepare for the imminent arrival of the coming bird flu epidemic. In 2005 it was estimated that bird flu would affect 10,000,000 people worldwide.

You can come up with all the conspiracy theories you like. What catches my attention is that after treating 41 cases (40% of the cases reported in Vietnam so far), Ngyen Tuong Van, the doctor in charge of the ICU at the Center for Tropical Diseases in Hanoi, Vietnam, concluded that TAMIFLU is useless as a treatment for bird flu!

In March 2009 the WHO published a study of the degree of resistance of the current mutations of the H1N1 virus to oseltamivir (Tamiflu), split into two groups of countries and different periods.

In the first group, mostly southern hemisphere countries, Chile among them, the virus’s resistance to oseltamivir was 44% (13% in Chile), measured in the April-September 2008 period.

In the second group, with northern hemisphere countries, the virus’s resistance to oseltamivir was 95%! That was in the last quarter of 2008 through January 2009.

And swine flu?

One thing needs clearing up: pigs have had this flu for a long time. It is nothing new; in fact it is an endemic disease among pigs in the United States. There have been pig-to-human infections in the past.

You don’t get swine flu from eating pork, which is why the WHO decided to stop calling this new variant of influenza swine flu.

It is an unusual combination of genes from the swine flu virus and the human flu virus, a mutation of the Influenza A virus, subtype H1N1.

So let’s leave Porky and his friends alone, and focus on this variant of human influenza.

Is this new disease that terrible?

Influenza kills some 300,000 people a year.

For this new flu, caused by a variation of the A H1N1 virus, 365 cases had been reported as of May 1, in 13 countries (none in Chile), with 10 deaths, 1 in the USA and 9 in Mexico, according to the WHO.

The thing is, an outbreak of A H1N1 caused the famous Spanish flu of 1918-1919.

There are many interesting things, and some murky ones, about this famous Spanish flu.

• The flu did not originate in Spain. It got the name because Spain did not take part in the war and therefore did not censor the news about this flu; it was the country where the pandemic was most widely reported at the time.
• It is believed to have originated in Kansas, in the barracks of soldiers getting ready to go fight in Europe.
• Because of wartime censorship, nobody really knows how many people died. Some say 2 to 5% of the population of the time died, and the death toll estimates range from 20 million to 100 million. It is even claimed that more people died of this disease than in the First World War.
• How many people did it affect? Nobody knows that either; the figures range from 25% to 50% of the world’s population (some 2 billion people at the time).
• Between 2004 and 2005, using frozen tissue from people who had the disease, the A H1N1 virus that caused the Spanish flu was recreated in vitro. It is kept in a biosafety laboratory at the CDC in Atlanta.

However, the scientists who have studied this new outbreak in Mexico say that this time it does not have the virulence of the Spanish flu.

Dr. Nancy Cox, “flu chief”, has said the good news is that “we do not see the markers for virulence that were seen in the 1918 virus”.

On the other hand, the outbreak has not shown the geometric spread that was initially expected, which is good.

So, should we be this worried, this alarmed?

I don’t think so.

Maybe there is a conspiracy behind this, aimed at selling millions of doses of medication, or maybe it’s the same as always: instead of conspiracies, what is really behind it is stupid behavior by the people who have to make the decisions.

Cartoon taken from La Pulga Snob.