(Saturday Morning Breakfast Cereal)
Quotation of the Day for August 7, 2011
“A study of history shows that civilizations that abandon the quest for knowledge are doomed to disintegration.”
- Bernard Lovell
The CDC in the US have come out with some interesting new numbers on H1N1.
They now estimate that 22,000,000 US residents have contracted H1N1. Of those, 98,000 have been hospitalized and 3,900 have died.
Several weeks ago I very conservatively estimated an 11 in 1,000,000 chance of dying from H1N1 and a 176 in 1,000,000 chance of being hospitalized because of it, vs. a 10 in 1,000,000 chance of serious vaccine complications. I advised that the shot was therefore a good bet.
The chance of serious vaccine complications has not changed, so we’re still looking at 10 in a million there. But those US numbers now indicate that we’re comparing that to a 177 in 1,000,000 chance of death and a 4,454 in 1,000,000 chance of hospitalization from H1N1 itself (that’s about 1 in 224).
It seems you are in fact 445 times more likely to end up in hospital because of H1N1 than because of the vaccine for it. And of course those numbers also indicate that you’re 17 times more likely to die of H1N1 than you are to have a serious complication from the vaccine.
The numbers will keep changing, of course, as H1N1 progresses and as we keep figuring out new ways to count things, and those US numbers may not reflect the situation in Canada, but at this point there’s no way it’ll ever look better than my conservative estimates.
So yes. Get the shot, when you can.
(Also, I admit I am amused that people are calling H1N1 “hiney”. Heh.)
It’s making me a bit crazy that people are avoiding the H1N1 vaccination. You’d rather be flat on your back for a week with fever, cough, body aches and a bad headache than have one small needle-stick and a vaguely sore arm for a day? Well, to each his own. But let’s look at the relative risks.
First, let’s do some math, just based on the known numbers.
As of yesterday, there have been 95 deaths due to H1N1 in Canada, and roughly 1600 hospitalizations. How can we estimate what our personal risk might be?
Well, that’s tricky, because they stopped reporting the number of actual cases of flu some time ago. So for the moment, let’s assume everyone — all thirty-four million of us in Canada — were exposed and got sick. That’s the most conservative assumption we can make when we’re calculating odds about how many people have died, right? That so far we’ve all been exposed and only ninety-five people have died?
A one in a million chance of dying would then have caused 34 deaths across the country, but there have in fact been 95 deaths, so in this case your odds of dying would be roughly three in one million. Your odds of being hospitalized are about sixteen times that (1600 vs. 95), if we continue along the same trajectory of illness, so about 48 in one million.
Of course, we know the actual rate must be higher, because NOT everyone has been exposed or has become sick, and yet we still have those 95 deaths: the 95 deaths have come from a smaller number of people than thirty-four million. So let’s use a less-conservative estimate, one that’s currently being proposed as reasonably likely, and say a quarter of the population — 25% of 34 million, so 8.5 million people — get sick, and we still have those 95 deaths. Then what are your odds? Basic math puts it at about one in 90,000, or about eleven in one million. And your odds of being hospitalized are still about sixteen times that, 176 in a million, or 1 in about 5,700.
We know the true odds are higher for two reasons. One, not even a quarter of the population of Canada has become sick yet, and we still have those 95 deaths and 1600 hospitalizations, so the true odds of death or hospitalization even now are higher than my calculations above. Two, we know more people will be hospitalized and more people will die, again raising the odds, since people are still getting sick.
But for argument’s sake, let’s just use the eleven-in-a-million number, even though we know it’s too low.
OK, now on to the vaccine.
Serious reactions to flu vaccines are normally about a 1 in 100,000 occurrence. We can reasonably assume this vaccine will be similar, since it’s been made in exactly the same way as previous vaccines have been made: you pick the strain, you grow it in eggs, etc.
Sometimes really strange reactions happen, like dystonia (which can also be caused, as I understand it, by the flu itself, and is a one-in-a-million kind of thing) or Guillain-Barré Syndrome (although getting the flu shot does not increase your odds of contracting Guillain-Barré generally, and is also about a 1-in-a-million risk).
Sometimes the flu vaccine is how people discover they’re allergic to eggs (since it’s grown in eggs) and they go into anaphylactic shock. This is apparently one of the most common bad reactions, and it is why responsible clinics will make you sit there for ten or fifteen minutes after you get the shot — they’re making sure you’re not going to go anaphylactic on them. But it is extremely, extremely rare for people to die from getting a flu shot.
The complication numbers here are pretty solid, known numbers; we’re not pulling them out of the air as we are in calculating death & hospitalization rates from actual flu. I won’t get into the adjuvanted vs. non-adjuvanted issue here, but the complication rates out of Europe for adjuvanted vaccines generally seem to be comparable to the 1 in 100,000 figure I’m using here.
So getting the shot is a 10 in a million (=1 in 100,000) kind of risk. Even if you’re one of the unlucky ten, though, you’re most likely still alive. And here I will repeat that because the shot is made with dead virus, you cannot contract the flu from the vaccine.
Compare that to the chance of hospitalization if you do contract flu, which we conservatively calculated above to be 176 in a million. You’re about eighteen (remember these are low estimates) times more likely to end up in the hospital if you get the flu than if you get the shot.
Also, compare that 10 in a million risk of complication from the vaccine to the 11 in a million (again, estimating conservatively) risk of death from actually contracting the flu.
They’re comparable numbers. But which risk would you rather take? The one that leaves you alive, or the one that leaves you dead?
Last week I did something to my back.
For the first couple of days, I could barely move without insanely excruciating pain shooting up my spine, stopping my breath and making me gasp. It reminded me of back labour, except it was even more painful. I was creeping around very gingerly, holding my lower back and making grumbly-gaspy old-lady noises whenever I had to stand up or sit down.
What did I do to myself? Well, the last time I did something similar (although much less severe) to my back, it was right before I went to Bermuda. The only possible similarity in the circumstances between then and last weekend: shaving my legs for the first time in months. I did nothing unusual other than that in either circumstance. So I am forced to conclude that I’ve been totally disabled by a shaving injury, and not even the exciting dramatic kind with spurts of blood and bandages and things. I don’t even get a good story out of it.
Pathetic.
I have, in the past week, had a chance to experiment with and review pretty much all legal methods of pain relief, and so for public benefit and scientific interest here are my experiences with the many forms of back-pain analgesia. I measure pain terms of a typical pain scale from 0 (no pain) to 10 (excruciating, can’t think of anything else).
Aspirin: 1 point of pain reduction
Tylenol: 1 point of pain reduction
Ibuprofen (Advil): Zero. No pain reduction at all. Very disappointing and a bit surprising.
Naproxen (prescription): Zero. This really surprised me, since naproxen is usually good for physical/anti-inflammatory/muscle-y stuff — it’s great for arthritis.
AC&C (aspirin, caffeine, codeine): 2 points of pain reduction. My usual over-the-counter treatment for migraines wasn’t as useful here as I had expected.
Robacexet (Tylenol + methocarbamol): 3 points of pain reduction. Be sure to buy the coated version of any methocarbamol-containing product, because it is as bitter as quinine. Blech.
Robacexet (Aspirin + codeine + methocarbamol): 4 points of pain reduction. You have to ask the pharmacist for this stuff; it’s hidden behind the counter. Millions of thanks to Twitterer height8 for this tip.
A535 Dual-Action patches: 2 points of pain reduction. The patches really do last for four hours, and are less awkward than a hot water bottle stuffed down your pants if you need to be out and about. Plus you end up smelling kinda minty, which I’ll consider as a plus. And you can use this in combination with some sort of drug, so its 2 points of pain reduction are more useful than it initially appears.
A535 lotion: 1 point of pain reduction, and it doesn’t last long — maybe half an hour? Side note: it’s always bothered my scientific self that rubbing something on skin can do something useful for bone stuff like arthritis, but damn, the stuff does work for the arthritis in my hands for whatever reason (I’m sure it messes with how nerve endings interpret information or something), so I thought I’d give it a try for this too. Not really worth the bother in this case.
Hot water bottle: 3 points of pain reduction. How I love my hot water bottle, despite its annual dramatic structural failure and need to be replaced. However, there is only so much you can do that is productive while lying face-down with a hot-water bottle on your lower back.
2 glasses of red wine (an accidental discovery): 5 points of pain reduction.
Why? Why does red wine work well when normal drugs don’t, and when it doesn’t work at all for any other kind of pain? It is a mystery. Also, it’s deeply impractical — while two glasses of wine aren’t enough to be seriously impairing, they are enough to fog one’s brain a bit and they certainly aren’t the sort of pain solution you can deploy repeatedly throughout, say, one’s work day. At least not in my line of work (and I have lovely colleagues who, when they discover me lying flat on my back on a boardroom table to rest my back, skip the WTF? reactions and launch more-or-less directly into work-related conversations).
Anyway, one week later my back is feeling significantly better. Still, I’ve had a reminder about the immense respect I have for people who live with chronic pain — pain is one thing when you know or think it will be temporary, but quite another when it is likely to be long-term or permanent. It takes immense guts and determination to live a semi-normal life, to think through the fog that pain puts in your head, and to not be intensely crabby all the time. I bow to you all.
I’ve been doing my best to restrain my usual cynicism about the hysterical media coverage of health issues in the case of the swine flu, as until quite recently there have been too many unknowns to do much other than shrug and say “we’ll see”.
But it seems now that we do know some things:
1. It’s not terribly lethal, although (like the 1918 flu) it does seem to have a tendency to kill youngish, otherwise healthy people. I’ve seen death rate estimates up to 6% – which makes it several times more lethal than the 1918 flu, which had about a 2.5% mortality rate. That means that if you’re an excitable news type you get to say “200%+++ more lethal than the 1918 pandemic!!!!” because that makes it sound very dramatic indeed. But it also means, if you think about it, that even if you do catch it you stand 94 chances in 100 of recovering. Or to put it another way, a bit better than 15 chances in 16.
We should thank our collective lucky stars that if this genie is as out of the bottle as it seems to be, at least it’s a 6% — or less? It’s early days still, and the rural Mexican experience may not reflect the global experience, particularly that part of the global experience that has ready access to modern medicine — lethal genie with a 1-week incubation and not a 50-80% lethal genie with a disastrously long 3-week incubation like, say, Ebola.
Also, let’s remember that plain-Jane annual influenza strains are responsible for at least 700 deaths a year in Canada (possibly up to 2500). Not to sound callous, as every single preventable death is a horrible tragedy, but this flu may not even push us over normal numbers. (The potential difference which might not be reflected in the numbers, of course, is that we’re more used to influenza killing the very young and very old, not — as in this case — youngish adults.)(Like me.)
BoingBoing reposted this analysis of the 1918 numbers, which is useful in that it takes a sensible and calming approach. However, it also doesn’t tell us much that’s really applicable. Yes, we have good public health measures and near-instant communications now so perhaps less than 1918′s 28% of people would catch the thing. But on the other hand, we now have air travel which totally changes the game. It allows people to cross the globe well within the incubation period of the virus, and this sort of transmission has in fact already happened. No more do we have the leisurely plagues of old, which you could see coming across the world towards you for weeks or months before they arrived. I’d like to see some solid epidemiological modelling of air travel’s potential effects on this influenza virus’ transmission before I’ll be ready to agree we’re comparing apples to apples when we look at 1918. Anyway, it may be a reassuring piece to read.
2. Eating pork can’t give you the flu. Throwing out your pork products is entirely pointless. Enjoy your bacon, folks. It’s fine and it’s actually counterproductive to do otherwise and leave dead pigs moldering about. Better to clean up the pigs’ waste, which attracts flies which are (or seem to be) the actual swine-to-human disease vector in this case. The flies seem to be more of an issue than the pigs, and they are certainly more of an issue than processed pig flesh from the butcher. (If you eat or otherwise consort with flies that regularly feast on pig waste, you may wish to temporarily or permanently cease that practice.)(And look into therapy.)
3. It can be transmitted from one person to another. So the surgical masks are not necessarily pointless, depending on where you are in the world. I’m certainly comfortable taking the Toronto subway without one. In Mexico City, on the other hand, a mask is maybe not the worst idea, at least this week.
It ought to be pointed out that there are many kinds of “surgical masks”. I have not yet seen recommendations about which types are most appropriate for this purpose, so many of the people you see wearing those masks in pictures in the newspaper may not be doing as much as they think they are. Still, even the worst mask keeps you from touching your potentially icky fingers to your mouth and nose, so that’s something.
At this point, though, in Toronto I’d say just wash your hands after you get off the subway (which you probably do anyway). Or ride your bike.
4. It’s responsive to the more common antivirals in our current arsenal.
My conclusion: there’s no need to freak out just yet.
Yes, it’s making its way around the globe, and we can’t stop it.
Yes, it could easily mutate and become more deadly, although this is not generally a successful tactic for viruses; usually viruses become less lethal over time so its victims are better able to spread it. You can’t do much to spread your virus if you’re completely flattened by it, lying alone in your room.
Yes, the flu is a whole lot of no fun — someone online today used the expression “she felt she’d have to get better in order to die,” which well reflects my own experience with it.
Indications at this point seem to be that if you do catch it, the odds are heavily on your side, even more so if you are able to receive modern medical assistance in the form of antivirals and such.
So. You know. Keep calm and carry on, and never mind the excitable media.
But listen to the MOH and wash the heck out of your hands*. Think of it as an excuse to buy yourself some nice hand lotion.
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* I’ll insert a corollary plea here: kindly do NOT use hand sanitizers unless you’re somewhere that totally lacks running water. Those things a) stink and b) are helping breed the superbug that WILL kill us all.
There’s been a lot out this week about the discovery of a proto-turtle with a plastron (front plate) but no shell. Very cool!
Turtles are extremely interesting in an evolutionary sense because it is completely not clear how their shells developed. This new discovery begins to answer one part of that question — OK, it seems the front bit of the shell began to develop, and then later on the dorsal part joined it.
But it still leaves unanswered the main question of turtle evolution, which is: how on earth did the turtle’s hips and shoulders end up inside its ribcage? Think about it for a minute. What is the interim stage there? And why would it ever have been evolutionarily successful given the wide selection of large predators back when turtles were developing?
This isn’t a criticism of the interpretation of the new fossil turtle find at all, just a general statement about the extreme mysteriousness of turtles. Who have been the same for 150+ million years now (vs. our 200,000-ish). Whatever they’ve got, it works. But we may never know how they got there.