(click the picture or here to see it full size!)

A quorate majority of the Institute for Collapsonomics (known as the IfC in casual speech) passed this Flu Code themed mural today. We were somewhat surprised to see the IfC-like logo on it.

Sometimes the universe is a stranger and more wonderful place that we usually believe.

1> Initial reports from Mexico were of a potentially civilization-threatening flu: infectious as hell, killing one in twelve of those it infected.

2> Response to that threat was lax: school closures were slow, testing / masks / etc. at airports didn’t happen.

3> Complacency is not warranted because of bad data.

As I’ve said many times, I’m not a pessimist, I’m an alarmist, and I stand by that position: when there’s a credible threat of this magnitude – and panflu at these levels is a very, very strong threat – doing what it takes now is a sane and rational choice.

More on flucode later today.

DO I NEED A FACE MASK?
You may have seen face masks being given out to the public in other countries on the news. However, the available scientific evidence shows that these basic face masks don’t protect people from becoming infected.

The best way to protect yourself and stop the spread of flu viruses is by using and disposing of tissues and washing your hands, as explained on the previous page.

Remember to CATCH IT, BIN IT, KILL IT.

However, some relatively new research published in the CDC Journal of Emerging Infectious Diseases appears to contradict the NHS statement about protection from masks.

In a world-first clinical trial of the efficacy of masks, researchers found adult mask wearers in the home were four times more likely than non-wearers to be protected against respiratory viruses, including the common cold.

The findings – published recently in Emerging Infectious Diseases, the journal of the US Centres for Disease Control and Prevention – have global implications and are particularly relevant to efforts to combat the spread of flu pandemics and other emerging respiratory diseases such as SARS.
…
The study is the first randomised controlled clinical trial of masks to be conducted internationally. Researchers at UNSW, Sydney’s Westmead Hospital, Imperial College (London) and the National Centre for Immunisation Research studied more than 280 adults in 143 families in Sydney during the winter seasons of 2006 and 2007.

The full paper about flu mask effectiveness is available here. There is a less technical article about the flu mask effectiveness study here. There is even a video from one of the researchers involved, Professor Raina MacIntyre.

There is even technical evidence (measured from mask performance in a lab, rather than in actual use around infections) that masks you can make at home provide some degree of protection.

Please make an assessment of the situation and pass this on if you think it is important.

Flu Code is a public health initiative which recommends the use of masks and other non-pharmacutical responses to pandemic flu. Please check it out.

In a world-first clinical trial of the efficacy of masks, researchers found adult mask wearers* in the home were four times more likely than non-wearers to be protected against respiratory viruses, including the common cold.

The findings – published recently in Emerging Infectious Diseases, the journal of the US Centres for Disease Control and Prevention – have global implications and are particularly relevant to efforts to combat the spread of flu pandemics and other emerging respiratory diseases such as SARS.

http://www.sciencedaily.com/releases/2009/01/090126082530.htm

The prototype [home made] mask achieved a fit factor of 67 for 1 author with a Los Alamos National Laboratory (LANL) panel face size of 4, a common size. Although insufficient for the workplace, this mask offered substantial protection from the challenge aerosol and showed good fit with minimal leakage.

http://www.cdc.gov/ncidod/EID/vol12no06/05-1468.htm

Please spread these links around widely. This is vital data.

I’m about to find that sixth gear I’ve been sitting on all this time that I’ve been idling in 5th gear at 120 mph in the dark on iced over roads.

Enjoy.

And though it’s far too soon to panic, people who wish to take precautions against infection should see the CDC’s recommendations and Vinay Gupta’s Flu Code.

From Wired’s swine flu primer.

I was really pleased they covered the Flu Code.

The 1918 flu infected something like a third of the population globally. CAR (Case Attack Rate) = 33%.

Something like 2% to 5% of those infected died. For our calculation we will use 2%. CFR (Case Fatality Rate) = 2%

18 million people * 33% * 2% = 120,000 dead.

(118800 to be precise.)

That’s equivalent to forty 9/11s happening in a single year. In New York City alone. But a pandemic flu would affect the entire world at once.

Do you understand why we are so worried about pandemic flu now? We don’t know that the swine flu will be as bad as the 1918 flu – there are some signs it could be significantly worse and other signs it might not be nearly as bad. But the concern is real, rational and rooted in history. Nobody gets to mock those who are working on reducing our exposure to this threat.

The “elephant sitting in the room” is the thing which everybody knows is important but nobody will talk about. It is a taboo.

The “black swan” is an extreme or unlikely event which shreds prior risk management strategies.

A “black elephant” – the phrase came out of an Institute for Collapsonomics meeting with @dougald, @freecloud, @hexayurt, @LloydDavis & @MikeBennet – is an event which is extremely likely and widely predicted by experts, but people attempt to pass it off as a black swan when it finally happens. Usually the experts who had predicted the event – from the economic crisis to pandemic flu – go from being marginalized to being lionized when the problem finally rears its head.

Right now, our society is littered with black elephants. Can you name yours?

1> What’s the CFR?
The lethality of a flu is known as its CFR (case fatality rate): the odds of dying if one is infected.

We have poor data from Mexico. Something like 1600 cases, something like 100 fatalities. Rumors of many more fatalities circulate, but there is also a rational expectation that many milder cases went undetected. The data from Mexico gives us a near certain upper bound on the CFR of the flu: about 7%. It’s extremely unlikely to be worse than that even when all the data is in.

The lower bound, however is unknown at this point. I haven’t even seen initial estimates from any major source. So we’re guessing. Broadly speaking the terrain in terms of public health response is similar from maybe 0.5% to 2% or 3%: the final death tolls would be very different, but the preventative measures are fairly similar.

2> What’s the CAR?
The infectiousness of a flu is known as its CAR (case attack rate): the percentage of the population that gets infected. Death toll is CAR * CFR * Population size. This number gets very large very quickly.

There are two factors which affect the CAR of an organism: its own biology, and its environment. We want to be bad hosts: masks, hand washing, keeping away from crowds (“social distancing” as it is called in the trade) to keep the CAR down as far as possible. At this point we don’t know much about the nature of the bug – just how infectious is it? But we do know how flu spreads in general – airborne droplets of moisture from sneezes and coughs, mostly – so we know how to be bad hosts. (see follow the flu code)

We’re in a situation here where we don’t exactly understand our opponent, the flu, but we do understand ourselves and how to stay away from our opponent, and that is a pretty good start. We have partial control of the CAR. We should use it.

3> How widespread is it?
Scary maps aside so far we don’t have major outbreaks outside of Mexico. So far everybody infected that I’ve read about had been to Mexico or was in extremely close proximity for prolonged periods with people who had. We’re not seeing – so far – reports of somebody sneezing on a train and infecting 80 people.

Now… is that because it has a long incubation time (very, very bad) or because it’s just not that infectious (very, very good) or just because we don’t have data yet? (most probable)

The fundamental deal
Behavior so far, interpolated from available data, is perfectly consistent with an outbreak that could kill a hundred million people. It’s also consistent with a much milder situation. The critical question is “why are the reports from Mexico so much worse than those from the USA?” and, right now, nobody knows.

What we do know is that we can control the CAR by changing our behavior including doing things like simply staying at home for weeks or months while major outbreaks pass by. If everybody in Mexico could go home, right now, for a month the odds are they would re-contain the flu. People who are sick would not infect very many if any other people, and the infection would slow down or die out. We can deploy this kind of approach to any infectious organism, but it is particularly important for pandemic flu threats.

The hard part is getting people to do it. So what you can do, for yourself and for others, is to do your bit to lower the CAR of any flu that gets lose in your country, town or city. Get ready to go home, stay home, and wait. Get ready to use masks and very, very frequent hand washing. These things, done effectively, done as a society, are probably as effective as a vaccine at stopping pandemic diseases. But to get that level of protection, everybody has to work together to deny the virus any place to replicate. By keeping safe, we keep our friends safe, and if everybody does that, very, very few people will get ill.

The internet is an ideal platform for massive behavioral change. It is our collective immune system. Get ready.

If the swine flu or bird flu goes fully pandemic, rapid response as outlined in the Pandemic Flu / Swine Flu Orientation and Action Guide is the kind of stuff that can save the lives of you, your family and your friends. Collective action can defeat these organisms, and we need to be prepared to take it.