Doing the math on flu

Historically, flu pandemics have come in two or three waves, lasting a total of 13-23 months. In other words, the need to take Tamiflu — by first responders, health care workers and ordinary citizens — could go on for months and months, or even years. U.S. public health officials have said they plan to buy 20 million doses of Tamiflu, but that would be enough to treat only 200,000 people (fewer than the number who would attend a seven-game World Series) for 100 days. And the retail price per pill is around $8, so the expense to treat that small number of people for that amount of time would be $160 million.

According to various models, in the absence of sufficient amounts of an effective vaccine — which is not yet within reach — to blunt a pandemic we would need to treat perhaps a third to a half of the population with Tamiflu. Do the math: 100 million people for 100 days equals 10 billion doses, at a retail cost of $80 billion, in order to blunt the pandemic’s first wave.
Dr. Henry I. Miller, techcentralstation

In the real world there is not going to be enough Tamiflu if avian flu breaks out. Plus, there is some evidence that avian flu may be resistant to Tamiflu.

This will mean the only means of containing the flu will be quarantine. However, quarantine for a year or perhaps two is going to be tremendously difficult to sustain. While it is possible to close the schools and the theatres and the malls, there will be increasing resistance especially if the initial efforts are successful. The problem will be most acute when the first wave of the flu has been contained. At that stage people who have been stuck in their houses with no work and next to nothing to do are going to want to go out. Which may well mean the second wave will be more lethal than the first.

If H5N1 mutates and is able to easily pass between humans slamming the border shut, minimizing personal contact, getting used to gloves and masks for limited, necessary, shopping, keeping the kids inside or in the backyard are all going to be vital to shortening the epidemic and, we hope, reducing the number of dead. With the R&D Dr. Miller recomends we may be able to develope and manufacture a vaccine quickly. Which will be of little comfort if you are already dead.

The biggest difference between the potential H5N1 pandemic and the 1918 pandemic is this: in 1918 there was absolutely nothing but quarantine to protect the public and there was no prospect of any protection being developed. They had no clue what a virus was much less how to make a vaccine for a specific virus. We do. To a degree, the public health job will be to keep as much of the population alive as possible while a vaccine is developed. And to do this there is going to have to be massive co-operation from the public itself.

The more information is made available, the more planning can be done in a public manner, the more aware people are made of the potential lethality of this virus, the greater the chances are that the death count can be reduced. The clock, however, is ticking and it does not look as if Tamiflu is going to do more than protect the first responders - if it works at all.

Written by jay on October 17th, 2005 with no comments.
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