Ok, so this outbreak of flu really isn’t good. Mainly, obviously, for the people who have it, and the people who’ve died of it, and the relatives of the people who’ve died of it. But also for people like me for whom fear of infection/ contamination is a major trigger of assorted mental weirdnesses. My anxiety levels are through the roof, as you might expect, but the paranoia is getting a look in too (that person looks a bit peaky, I wonder…OMG! he just deliberately sneezed in my direction…), and the depression is on the case with an overwhelming sense of impending doom and utter hopelessness.
I feel like I’m living inside one of those novels/ films where everyone’s died and a few hapless souls wander in a desolate wasteland. I look out of the window and expect to see bodies littering the pavements, not kids playing football. I am, in short, not coping especially well.
But, my rationality hasn’t completely deserted me, and I’ve been trying to find information to look at that can act as an antidote to my inbuilt catastrophism.
I guess the first and most obvious thing to say to someone like me who believes that, in these kinds of things, the worst will always come to the worst is that, even if we were unlucky enough to witness a major pandemic of a exceptionally virulent strain of flu, most people wouldn’t die. The 1918 outbreak was the worst in recent times, and even then, the overwhelming majority of people didn’t die, or even get ill.
In addition, medical treatment has come a long way in the last 91 years. If the 1918 outbreak were to be replicated now, it would be reasonable to expect a lower mortality rate, especially in countries with advanced healthcare systems. Even with its many well-publicised problems, the NHS is, in global terms, an advanced healthcare system. In any global pandemic, the UK will not suffer the highest mortality rates. Sadly, countries like Mexico probably will.
The specifically good news in the field of advanced healthcare is that it has already been confirmed that the new strain is susceptible to Relenza, which can be used to limit the severity of flu in the most serious cases. The UK maintains stockpiles of Relenza, precisely for such a scenario as is currently playing out in Mexico.
Of course, most flu pandemics are a lot less serious than the 1918 one, killing only a few per cent of the totals who died back then. And, as I’ve already said, most people didn’t die in 1918. We’re talking really quite limited risk of death here, even if things pan out in the most doom-laden way.
Also, the World Health Organisation (who are generally cautious in their statements) are currently saying only that the outbreak has the potential to develop into a pandemic but the Centers for Disease Control in the US (who take a generally more proactive stance) are saying essentially the same thing. I have given myself a bad case of The Fears by reading a blog maintained by an US epidemiologist who is decidedly alarmed, but this is a blog I have only read this morning, so I have no means of assessing how alarmed (or even alarmist) this person generally is. Even this blog is emphasising that truly earth-shattering consequences are not massively likely (not that this has prevented some commenters quoting Revelations, or recommending that everyone stockpile a 6 month food supply and retreat into a bunker, which is pretty much what I feel like doing).
I have also tried to keep reminding myself that it is perfectly possible to have a pandemic of a non-fatal illness – the term pandemic simply refers to how widespread the illness is, not how serious it is for each individual who is infected. The common cold is a pandemic. (Er…I think – I don’t actually know how widespread each individual strain is, but I can’t imagine the virus stops neatly at national borders.) Even if/ when a pandemic is declared, this doesn’t automatically mean everyone is going to die.
Anyway, this is relevant to a striking difference in the reports coming out of Mexico and elsewhere. In Mexico, people are dying; elsewhere they are not. In fact, outside Mexico not only are they not dying, they’re not even experiencing serious symptoms, let alone life-threatening ones. (Apart from one patient in California, and she was already suffering from a compromised immune system, and she recovered and was discharged from hospital within a week.) Outside Mexico, so far, all the cases have been mild and self-limiting. In other words, we’re talking a few days in bed feeling rotten, at the worst. This raises the possibility that the mortality rate for the new strain may actually be quite low.
In Mexico, investigations have so far focussed only on those who became ill enough to requite hospitalisation. Clearly, when disease has progressed to this stage, death is more likely – if normal winter flu was only assessed in terms of people who required hospital treatment, it would seem a lot more deadly than it does if it is assessed in terms of all of those who are infected, the overwhelming majority of whom don’t need hospitalisation. The cases elsewhere have been detected mainly as a result of hyper-vigilance resulting from the alarm over the situation in Mexico – ordinarily people turning up to see doctors or hospitals would have been told they have a mild respiratory virus and sent home, with little or no investigation into the precise nature of the virus.
This raises the possibility that many of those who are infected will only be mildly unwell (i.e. experience symptoms no worse than the average person would experience if they caught ordinary seasonal flu), with only a few people going on to develop the severe symptoms that can lead to death. Of possible relevance here is that the disease is thought to have been in circulation in Mexico since at least 22nd March, and yet the most alarmist mortality figures I have seen have suggested only up to 200 people may have died (the official suspected death toll is lower: the confirmed death toll lower still). Even 200 potential deaths out of perhaps tens of thousands of people infected is not necessarily a cause for drastic alarm. (Although the fact that those who are dying do not fit the standard profile for flu-related deaths would still be worrying.)
Of course, reassuring myself on the basis of mortality rates is a potentially risky strategy, because there is always a danger these will go up. In fact, one of the reasons the outbreak is seeming so alarming at the moment is that death rates seem to have gone up so dramatically over the weekend, but these are, in most cases, reassessments of people who died weeks ago, not fresh deaths.
There is also another potential anomaly, in that samples from a few of those who have died in Mexico have been analysed, and it has been established that some of them were not infected with the new strain of flu. If this is confirmed when more widespread testing takes place over the next week or so, then this raises the very strong possibility that at least some of the people dying in Mexico are dying of something other than the new strain of flu, or that the new flu is interacting with something else to produce a worse outcome in some patients. If the new strain of flu is readily transmitted, but the other underlying cause is not, this might explain why people outside Mexico who have been infected with the new strain of flu seem, so far, to only be experiencing mild symptoms, rather than life-threatening ones.
There is one final thing that I think is quite reassuring – the nature of what alarms doctors and epidemiologists. These groups of professionals are alarmed because of unexpected deaths that seem to be resulting from a virus no-one had heard of a few weeks ago, and about which they know almost nothing. In other words, they are concerned because the virus is an unknown quantity, not because it is, in and of itself, a major cause for alarm. This is perhaps something that’s obvious to everyone else, but it’s definitely an area where my thinking is faulty If I see an expert worried about something, I assume it must be because they know something terrible is going to happen, not just because they’re afraid something might. And, as with any group of people charged with protecting the public, they’re entirely correctly veering on the side of caution, even if that has the unfortunate side-effect of making over-sensitive souls like me panic.
I guess this has been a written example of the way I ‘talk myself down’ from my various irrational ideas and beliefs. Certainly, I’m feeling calmer now than I was back when I started this post (which was a while ago, as I had to do a certain amount of frenzied pacing to expel some of my nervous energy). It perhaps gives an insight into why I insist so…er…insistently on thinking about things rationally, and for myself. I have to, because I have a terrible habit of picking up on other people’s fears and anxieties and running with them to an excessive degree, even if those people are doing everything they can to talk themselves out of those fears.
On balance, the rational part of me expects that the general fear about this new strain of flu will ratchet down fairly rapidly. I expect it will be found not to be as deadly as is currently feared. (Even the alarmed epidemiologist blogger I mentioned has become fractionally less alarmed over the last 18 hours or so, as more detailed information about the infected school pupils in New York has emerged – reports that over 200 people may have been taken ill, but none seriously.) I also expect it will be found not to be as all-consuming as is currently feared – i.e., that it will remain in isolated pockets, even if those pockets are geographically widely spread, rather than affecting a significant proportion of the word’s population as a whole. The UK media will, clearly, have kittens if there’s a confirmed (or even suspected) case in the UK, but if this doesn’t happen I expect the story will have pretty much faded out of the news agenda within a week or so. Even if there are UK cases, I expect that by this time next year the outbreak will only be being mentioned in deliberately scary Channel 4 documentaries reminding us at length how much worse it could have been.
Of course, I could be quite, quite wrong in all my predictions.
Anyway, I’m going to end this post with a potential heads-up. As I’ve mentioned, this kind of story is a significant trigger for me, and has the potential to send me into various states of non-coping in fairly short order. So, if I disappear from this blog for a while, and from commenting more widely around the blogosphere, don’t panic and think something terrible has happened to me. It will just mean that I’m needing some time to clamp my head back together. It’s possible, for example, that I’ll have another flare up of thinking that I can be infected with a physical illness via my net connection – I once spent a few days absolutely convinced of it, although I think I’ve got better at challenging my own thoughts since then. But still, and especially if the media make a big song and dance of it, I may need to take some time off blogging over the next little while. I’ll try not to, though.