We have exactly one pandemic we can look to that falls under what has been designated the entrance point to be categorized as severe. As defined by the US CDC a severe pandemic hits the threshold when at least 30% of a population falls ill and at least 2% of those die.
Just as a Category 5 hurricane begins when winds reach 156 mph (250 km/h) that does not preclude a Cat5 storm from being stronger, or have wind gusts significantly higher, there is no scientific support for the belief that a severe pandemic cannot have a fatality ratio of greater than 2%. In point of fact, there were many places around the world that experienced significantly higher fatality ratios during the 1918 pandemic, it being the one and only example we have to look to with any degree of confidence (such as it is, confidence that is).
I titled this entry Poverty of Aspect because, as Karl Duncker coined the phrase, it refers to taking the more restrictive view as opposed to the broader on issues and problems. We see this repeatedly from many of those who make pronouncements about how the next severe influenza pandemic will behave. Assuming our one example defines the outside parameter of all that is possible.
Recently I have focused on "The Message", the problems of communicating it, and the failure to heed; I thought I would go ahead and create a category for this phenomenon. With what I heard at the IDSA conference, and what I anticipate I will hear at September's HHS PHEMCE workshop I figure I may be spending a goodly bit of "blogging time" continuing to focus on all things communication and perception, or at least as I see them, understand them, or wish them to be. With the slowdown in the news on the Avian Influenza PanFlu front, I'm also guessing that I will have the time to chew on this at leisure. Not only the time, but plenty of examples to trot out as well.
The first place to start is with the above stated 2% fatality rate assumption for an outside parameter.
I get the sense that when most people say that a 2% CFR (Case Fatality Ratio) is as bad as it could get they honestly believe it. Furthermore, they believe that in our modern times with all of our modern healthcare and our modern, more hygienic lifestyles, even the 2% CFR is so outside the probable as to be nearly impossible to conceive. But, because 1918 had a 2% CFR (more anecdotal assumption than hard fact) most everyone is left with no supportable alternative but: OK, maybe it could be that bad, but it's not at all likely.
A fresh example of this hit Flublogia today [thanks kobie @ FW], this little snip from AScribe Newswire Political Boarders, Health-Care Issues Complicate Pandemic Planning:
In addition to staffing and community coordination issues, the researchers also found that misunderstandings about projected mortality and illness rates are creating panic.
"In several counties, many planners are anticipating devastating impacts that even exceed the worst case scenarios historically," Avery said. "The confusion results in a sense of helplessness among some planning teams because they believe any planning will be rendered useless by the magnitude of the problem."
To counter this, the researchers suggested more explanations by federal, state, international and academic experts about statistics and surveillance. [emphasis added]
Perhaps the researchers would find it beneficial to do a tad bit of review themselves:
September 2006 WHO report:
One especially important question that was discussed is whether the H5N1 virus is likely to retain its present high lethality should it acquire an ability to spread easily from person to person, and thus start a pandemic. Should the virus improve its transmissibility by acquiring, through a reassortment event, internal human genes, then the lethality of the virus would most likely be reduced. However, should the virus improve its transmissibility through adaptation as a wholly avian virus, then the present high lethality could be maintained during a pandemic. [emphasis added]
We may not understand the why behind the lethality but that does not change the fact that it is highly lethal. And while there is no way of knowing with certainty what the properties of a pandemic strain of H5N1 would be, it is foolish, in the extreme, to ignore the possibility that a wholly avian H5N1 , though adapted to humans, could retain much, or a significant portion, of its current lethality.
The AScribe Newswire report is a providential example of Poverty of Aspect. Because 1918 was only thus and so, nothing can be worse – just ask the government and statisticians.