http://newfluwiki2.com/showDiary.do?diaryId=2356

You know, I’ve been keeping my head down over here for a while, but I think it is time to come out of the woodwork.

As you know, I wrote a piece called Severe Panflu Response Strategies (SPRS), which examines a scenario with a CFR of 50% and a CAR of 50% – the 50/50 scenario – as a bad, but not worst, case.

The paper is here:

http://guptaoption.com/6.SPRS.php

And there is a video presentation here:

http://files.howtolivewiki.com/SPRS-panflu/Severe%20Panflu%20Response%20Strategies.html

To my mind, there are basically three scenarios which are worth paying attention to. They are:

CFR 0.5 – an awfully nasty winter influenza
CFR 5 – a repeat of the 1918 flu
CFR 50 – H5N1 goes pandemic without getting much less lethal

So the first thing is that this shows possible activity over two orders of magnitude – three if you count a CFR 0.06. This is a very, very broad range of possible problems. It’s unrealistic to expect the same approaches which offer promise at CFR 0.5 to still offer promise at CFR50.

I’m not really concerned about CFR 0.5. Bluntly, not that many people die, and my professional focus is on catastrophe management: it’s not a catastrophe.

CFR 5 is bad, but is manageable using a strategy which I call Die With Your Boots On (DWYBO.) DWYBO is very simple: everybody goes to work wearing their masks and gloves, which cuts the CAR somewhat, but those who get sick only die a small percentage of the time, and so society largely continues – this is basically how the 1918 flu was handled most places. The traditional Flubie Response Measures are *highly* effective in a DWYBO scenario because they cut exposure and therefore personal risk significantly and, if widely adopted, produce a sort of herd resistance.

DWYBO has some other, less-pleasant names. I’m not saying it would be a uniform response, either.

But a repeat of the 1918 flu is not going to be the end of civilization. Even if the power goes out in some places for a while, it’s not going to be the end of civilization. It might be inconvenient, a few people may die unnecessarily due to system failures, but a CFR 5 flu does not TEOTWAWKI make. It’s just not *that* bad, particularly when met with modern epidemeology and stuff like the humidity countermeasures which are discussed in the SPRS article.

That leaves CFR50. DWYBO breaks down somewhere between CFR5 and CFR50 because, past a certain point, people feel that they aren’t just risking death but actually committing suicide by turning up for work. They just won’t do it.

CFR50 is TEOTWAWKI but not because you wind up with armed bands of hoodlums competing with the police and army for territory in the developed world. I’m sure you might get a bit of that sort of thing in states and countries with a lot of space and an independent attitude but for the most part, in the historical situations in which a massive plague wiped out a significant part of the world, social order and group cohesion remained: black death, smallpox in Iceland, european diseases in North and South American had enormous CFRs and, as far as we know, anarchic pillaging was not a big part of what happened.

In CFR50, though, the lights go out. And they stay out, possibly for years in some areas. But odds-are that even in that scenario, if you are in a climatic zone which is habitable without power for either heat or drinking water, or at least where people are organized enough to fell the local forrest, improvise wood stoves, and keep on keeping on, most of the people who don’t die of flu will make it. A small percentage will die because of lack of access to medicines, but it is a fairly small percentage of the population compared to the number who will die of flu.

Will society recover from a blow like that? Yes, almost certainly. Smallpox wiped out 1/3 of Iceland’s population in 1750 or there abouts, and they coped. The Black Death messed up Europe something horrible and… well… it was a mess before, and a mess afterwards, and a worse mess in between, but people did not go feral as a mass.

Most of the stuff which is vulnerable to cascade failure is conveniences. A few people will die if the gasoline stops coming, but most people will just be very, very inconvenienced. Similarly for things like clean water supplies – most cities have rivers and bleach lasts a long, long time. Your local swimming pool has enough chlorine to disinfect water for the town for a long, long time.

There are a lot of engineers around. In a crisis, they’ll start figuring things out. I’m not saying it will be perfect, but we are enormously resilient and flexible, largely because of the abundant oversupply of pretty much everything. I have real worries about people living in very cold climates (Minneapolis, all of Canada) and very dry climates (Arizona) where they have real supply chain dependencies – those guys are genuinely vulnerable. Similarly, I have some concerns about food security, but as the paper outlines, we have a six month supply of calories for America and Europe, and probably South America, a good bit of Africa, and so on. (you’ll have to read the paper to find out why.)

Some work is required to make a 50/50 scenario more survivable. The CAR can be brought down a long, long way by disciplined action now, particularly on things like the humidity intervention and school closure policies. The push for fast development of vaccines is very important. Moving around the food supplies ahead of time is important too.

But this is a shadow that all of our ancestors faced and survived. Yes, society is a lot more fragile than it was, but it’s also dozens and dozens of times more abundant. Even a high CFR flu is not the Apocalypse – it’s a tragedy, like many that have gone before, and if it comes, we’ll wish we were more organized, but in the past thousand years humanity has been through worse not just once or twice, but many, many times.

We need this historical perspective: as a species, we’ve been through worse over and over again. This is something that happens from time to time (pandemics, not necessarily flu) and we cope. Our ancestors dealt with it, we’ll deal with it, but it will be a lot easier if we can get the Governments off their fat asses and respond to the realistic threat presented, of course, but organized public lobbying with panflu preparedness die-ins outside of the white house seem like they are a long, long way away.

But that seems like the sort of pressure that it might take to get governments oriented correctly to the scale of the threat, and to do the stuff that only they can do (i.e. massively fund fast vaccine research, get humidity schemes in place for airports and other public buildings) done.