Whether it is a function of the Recency Bias, or mere ignorance, this infographic suggests Swine Flu worries are wildly overblown:

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disease_fatalities_550

via Information is Beautiful

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UPDATE: December 11, 2009

WSJ: 47 million Americans (one in six people in the U.S.) were sickened with swine flu from April to mid-November

9,820 of them died . . .

Category: Psychology, Science

Please use the comments to demonstrate your own ignorance, unfamiliarity with empirical data and lack of respect for scientific knowledge. Be sure to create straw men and argue against things I have neither said nor implied. If you could repeat previously discredited memes or steer the conversation into irrelevant, off topic discussions, it would be appreciated. Lastly, kindly forgo all civility in your discourse . . . you are, after all, anonymous.

44 Responses to “H1N1 (swine flu) Fatality Rates: Overreaction?”

  1. Paul says:

    Well, the swine flu tracker at Google is a misleading mess.

    That said, I don’t agree flu worries are entirely overdone, per se.

    While we don’t have epochal levels of people dying, pace 1918, there was no way to know that in advance. The transmissibility of this virus is remarkable, with the CDC saying last week that one-in-five school-age kids had influenza in the last three weeks. Similarly, the dominance of H1N1 is impressive, with 99% of typed viruses in the U.S.

    being H1N1 — it has squeezed everything else out of the market, as it were. Finally, while overall mortality is low, it is much higher than normal among populations usually little-affected by these things.

    Given genetic drift and selection pressures, this could very well have turned out much, much worse.

  2. The Curmudgeon says:

    It’d be more dangerous waiting in line overnight to get vaccine (as I saw folks doing recently in an AP photo) than just getting the damn virus.

    In fact, regular old flu is more dangerous than H1N1.

    But, as Rahm likes to say, never let a good crisis go to waste…even if there isn’t one.

  3. leftback says:

    LB is more worried about the next more virulent variant, and the possibility of avian-swine flu recombination.

  4. M says:

    At best you’re only looking at half the story. Fatality rate * infected population = deaths. Assuming it infects as many people as the seasonal flue your numbers say it is 5 times more deadly.

  5. rob says:

    When I can catch AIDS by drawing in the air someone just coughed in, then I’ll have a little more faith in this graphic! Talk about an apples to oranges comparison! Think I’ll just strap on a condom and be about my merry way.

  6. Bruce Wilder says:

    Fatality rates for H1N1 are also skewed against our usual expectations: it is not the old, but the young, who are most vulnerable.

    We count deaths, but don’t measure years of expected life lost, and we should. Even a small bias in fatality rates toward the very young, would magnify the significance of H1N1.

  7. rob says:

    LB: Couldn’t that “avian-swine” hybrid be called “When Pigs Fly” flu?

  8. Transor Z says:

    Thank you, M, beat me to the punch. Barry, need to know incidence per 1000 to quantify.

    17,000 H1N1 cases reported to CDC this season so far: http://www.cdc.gov/flu/weekly/

  9. Transor Z says:

    Getting hit in the head by a falling grand piano dropped from a 10th floor window has a 95+% fatality rate.

    Doesn’t happen much outside of Laurel & Hardy, though.

  10. DL says:

    Helps sell newspapers (to continue with the thread from last night).

  11. call me ahab says:

    well . . .to put a human face on this my daughter Anna has the swine flu a few weeks ago-

    poor kid was done in for about 10 days- which is quite a while- fever for about 5 of those days- and developed a chest cold which she is now recovering from- out of school about 7 or days-

    her real close friend got the swine a day after she did-

    so- not the end of the world- but- worst than most- appears to last a while- and appears to be pretty contagious

  12. matt wilbert says:

    When was the last time you met someone with plague? The incidence rate is kind of important.

    This is the kind of debunking that give debunking a bad name. Think “Superfreakonomics”.

  13. sinomania says:

    “Epidemic? Why this whole country is run on epidemics…Where you been? Big business, price-fixing, crooked TV shows, income tax finagling, souped-up expense accounts…” — HUD (as played by the great Paul Newman).

    SARS – now there was some hysteria! Of course it made for great media distraction as we bombed our way into Iraq.

  14. Patrick Neid says:

    Screaming fire in the theatre has been the rage this last year or so.

  15. stevesliva says:

    While mortality rate is one measure where it’s not *that* scary, one reason the health authorities make a big deal about H1N1 flu is that it is leading to lots of hospitalization and cost that is preventable from both vaccination and care in not getting coughed on or transmitting the infection if you catch it.

    My wife’s working in a pediatric ICU right now, and there are enough otherwise healthy children coming in and ending up on respirators to make the unit quite a bit more full than normal. I’m sure that for the parents of those children, the H1N1 is terribly scary, even though even most of the kids who hit the ICU recover completely.

    I think it’s very difficult to get a handle on whether the hype in outbreaks like this is overblown unless you’re seeing firsthand the tail of the distribution, where the higher mortality/morbidity is really apparent. H1N1 has been known from the start to have a little fatter tail when it comes to mortality… that’s enough for it to look like a raging epidemic in hospitals.

    Get vaccinated! Sucks if you turn out to be one of the worst affected!

  16. constantnormal says:

    @LB 2:56 pm

    Fear not, the avian flu is an H5N1 strain while the swine flu is the more common H1N1 variant, and as such they are fundamentally structurally different. Not much danger of them mixing it up.

    A more significant fear would be if some future variant of avian flu were spread by mosquito. The Scandinavians, Russians and (northern) Canadians would inherit the globe.

  17. Transor Z says:

    @ahab: glad to hear your daughter is doing well.

  18. Rikky says:

    tough decision if you have little ones. no one wants to be on the wrong side of that bet. i’ve spoken to 4 doctors and they’ve all said do not get the shot primary reason is its not time tested. i have little ones and am undecided. if obama has his own kids vaccinated then that might nudge me ;)

  19. steve,

    you have some links to data/info on the vaccine’s efficacy/safety?

    or, maybe, it’s more like this http://clusty.com/search?input-form=clusty-simple&v%3Asources=webplus&query=CDC+refuses+CBS+FOIA ?

  20. gusgus says:

    From a public health perspective, a 0.5% fatality rate from a flu virus is very bad — it’s five times the lethality of the seasonal virus. The virus is infectious and likely to become endemic in the general populace this year. Many, if not most people will be exposed to H1N1 at some point. Now if only 10% of Americans contract the virus, that’s 1 in 10 Americans, that’ll lead to 33 million infections. With a fatality rate of 0.5%, that’s 165 000 mortalities.

    That’s nothing to sneeze at, no pun intended

  21. bdg123 says:

    It’s amazing how many people are now flu research scientists, claiming H1N1 is no great shakes, or believe the US and world governments are out to cleanse the world of overpopulation by inoculating people with a death drug.

    Officials are worried about transmission rates which they say are much higher than any recent flu strains. So, if 20-40% of the population gets H1N1 as some worst case scenarios say is possible, we could have one hell of a mess on our hands. And that 0.5% mortality rate could translate into millions of people dead across the world. Then we have the problem of any virus mutating, which apparently has not happened yet. But it seems this virus has some characteristics which concern scientists.

    Too many people are blowing this off as just another flu virus. That may happen or it may not. Health officials have no way of knowing what exactly will happen in advance but there is reason for concern. Especially if it mutates.

  22. freejack says:

    Pandemics are like airline highjackers with boxcutters. Not likely to run into one, but you want to take prudent steps* all the same.

    http://www.youtube.com/watch?v=W57pnVhEhjU

    *as with investing in markets, consult with someone who knows what he’s talking about.

  23. TDL says:

    Everyone might find this investigative report by CBS of interest. Apparently there is a very high false positive rate for swine flu. Also, the CDC stopped counting how many people actually contracted swine flu.

    http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml

    Regards,
    TDL

  24. constantnormal says:

    Just the blindingly obvious, like the extremely rapid expansion of the set of infected people (as shown by the Google Flu Trends data), is enough to formulate an argument for vaccination, merely on economic grounds.

    Even if the vaccine turns out to be only 40% effective, the reduction in economic impact is sufficient to justify the concerns about getting people vaccinated. The tiny fraction who actually die can be ignored in this gross analysis — of course, if they happen to be someone close to you, the story is a lot different.

    If people bring the flu to work and spread it around, I am all in favor of docking their pay to cover the subsequent economic outages from the spread of the virus. THAT would make people sit up and pay attention a lot more than any fears of what might improbably happen to them if they should contract the virus, or any groundless fears of what the vaccine might do to them. A proof of vaccination should serve to protect employees against such penalties.

    Works for me — I’m retired. And I’ve already had my fun with the flu this season.

  25. leftback says:

    LB knows some REAL virologists and they are watching this carefully. Not that this H1N1 isn’t bad in terms of its public health impact, but it’s the next one they are worried about now. Viruses are very good at mutation.

  26. danm says:

    From a public health perspective, a 0.5% fatality rate from a flu virus is very bad — it’s five times the lethality of the seasonal virus.
    ————
    This spring, I’m pretty sure my son got it. The hospirtal didn’t even want to see or test him unless he was having trouble breathing… too many peopl erunnung toi the hospital for the test.

    So if we got it, we don’t know and they don’t know. We survived but we’re not in those stats.

  27. Paul Jones says:

    As long as government money could end up in someone’s pockets, a crisis will be created.

    If you have an idea in your mind that this won’t lead to your personal despair, banish it forever.

  28. EAR says:

    My wife is a doctor, I’m not, our two boys are wonderful little men.

    She’s not worried, I have moved from silently terrified in the spring to worried now, the boys are getting their vaccines next Monday.

    I’m going to try to abridge our trick or treating without angering them. If someone answers the door looking ill I will behave as if my sons are President and VP and I’m the Secret Service for Halloween.
    And, of course, my wife and I will eat most of their candy.

    Of course, I spent most of the summer silently terrified of a simultaneous second financial crisis – swine flu pandemic in the fall. So far, so good… (?)

  29. techy says:

    highly contagious….i am guessing almost 50-70% of the populations will come in contact with this virus, i can already see many people infected.

    that said…..most people have nothing more than fever and discomfort for few days.

    but it is a reason for worry because young people dont have immunity….and some of us perfectly healthy looking maybe the worst case scenario……the one in 200.

    and for the conspiracy theorist….imagine the money involved…. almost 1 billion doses of antiviral, more than that of normal flu vaccine and on top of that swine flu vaccine…

  30. BeerdedOne says:

    STOP! WAIT! This data is seriously flawed. Visit the original site and you’ll see the that creator has amended this data numerous times after being corrected by others.. and the updated graph still has some serious consistency issues.

    ~~~

    BR: It appears they added a chart showing survival time outside the body.

  31. David Merkel says:

    The figure for swine flu severity looks high. Even the one for seasonal flu seems high.

  32. fenner says:

    Here in a public school in Ct, something went through recently that knocked out 30% of my son’s fifth grade class. My wife and I contracted it too. Fever that came and went for a few days, a bad cough, sometimes a cold. My daughter had something similar in August, low fever, deep cough for 10 days. At the time the CDC was saying that there was a 98% chance that anything like this was Swine Flu, and that they had stopped testing for it. So, only one student, as far as we know in the entire school (with at least 100 absences out of 350) was actually tested for it and that student turned up positive. Note whatever my daughter had seemed to immunize her against what the rest of the family had a month later.

    Why am I writing this. I believe that the above graph is completely inaccurate. I believe that far more people have had contact with it and that it is far less severe than the media and govt. is portraying it. In fact, looking at the world wide reported incidences and the deaths from confirmed cases, I would guess the incidences are at least 20 to 40 times higher than reported. Why? Are they really swabbing people in destitute South American countries?

    I can’t understand this unless it has to do with unloading the 3.5 billion dollars worth of vac’s. The private school near us, Hotchkiss reported 80 cases, all confirmed of H1N1 just before our public school was hit. Also there were multiple camps in our area that contracted the swine flu over the summer. These cases were also confirmed.

    Would somebody please explain this? Not a chance in hell I’m putting the vaccine into my children if they’ve already had it.

  33. fenner says:

    Update: a friend in Westchester brought their at risk daughter, 10, to their pediatrician after she contacted flu like symptoms, including fever and cough. The pediatrician said they had been instructed to not test anyone except the most severe cases. The mother pushed for the test, but they would not do it in the end. The daughter has an autoimmune disease.

  34. royrogers says:

    BR, you are venturing into an area where you have no expertise, that is the medical field and
    epidemiology . First of all the fatalities are concentrated on the younger population rather than the older population, and it is still 5X higher than the seasonal flu.

    I am not saying the older population is more expendable, but there is not much known at this point with regards to the final mortality rate as the swine flu has yet to peak.

  35. I am neither a doctor nor an expert on viral infections — but I thought this depiction of the virus presented an interesting perspective about how we perceive things.

    As investors, we tend to over react to newer information (Recency Bias).

    The point of placing this here is not about the virus, but about the psychology of you Humans.

  36. investorinpa says:

    Barry, as a health care worker who is very actively involved in making sure the swine flu does not affect our facilities, here’s the real rub on this H1N1 flu virus…
    1) It is very contagious and easier to pass along since most don’t have antibodies to this
    2) It is not much more dangerous than the regular flu
    3) It affects a different subset of individuals (kids and young adults) who simply haven’t been around the world long enough to have had some variant exposure to parts of the strain of the virus.
    4) The H1N1 virus may peak in terms of its ability to infect in the next 2 weeks. If it does, this will be a great relief..if it does not peak until mid December right before the regular seasonal flu takes hold, look out below…

  37. Master Shake says:

    gusgus writes:
    From a public health perspective, a 0.5% fatality rate from a flu virus is very bad — it’s five times the lethality of the seasonal virus.

    I agree. However, in order to calculate the fatality rate correctly, you have to have an accurate denominator. H1N1 apparently has a high percentage of asymptomatic cases. For example, there’s this report from Peru from July.

    http://emssolutionsinc.wordpress.com/2009/07/31/peru-33-percent-of-h1n1-cases-are-asymptomatic/

    Quote: New information from the flu ravaged Southern Hemisphere. The Peruvian Ministry of Health (MINSA) disclosed that 33 percent of people infected with H1N1 influenza pandemic are asymptomatic – they present with no symptoms of the disease.

    I’m no infectious disease expert, but that seems to be a very high number of asymptomatic caases. Are these being taken into account when computing the fatality rate? I don’t know.

    On a more personal level, our neighbors have three girls who all came down with H1N1 a couple weeks ago. It laid them up 2-3 days max. I teach (harangue, really), my girls about keeping their distance from hacking, coughing, and slobbering schoolmate and to practice good hand hygiene. So far, so good.

  38. rmorris24 says:

    Barry,

    I think the cases are being vastly overstated. Hospitals are no longer testing for the H1N1 virus because the costs are too high. They are assuming that if the quick standard influenza test comes back negative that it must be H1N1. CBS News has more color:

    http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml

  39. Darkness says:

    H1N1 kills the way SARS does (not at all the way the seasonal flu does) by infecting the deep lung and swamping it so you cannot get oxygen. Once you are short of breath and your lungs are filling with fluid, there is precious little modern medicine can do for you except hope you are one of the lucky on the 50/50 coin toss you’ve got left.

    90,000 American dead compared to 35,000 for the seasonal flu, add on top of that that the dead will be young people in the prime of their lives . . . and the over-reaction is where? We’ve spent a Trillion and counting revenge-bombing the crap out of some uninvolved country over 3,000 lives. Forget over-reaction, how about we start with consistency?

  40. fenner says:

    There are 1000 deaths, my guess is that there have been 5 million cases of Swine Flu in the US thus far. None but the most severe cases have been tested for. Fear not.

  41. fenner says:

    Consider the facts worry warts:

    According to the World Health Organization, fewer than 5,000 people have died around the globe from this variant of swine flu. In any normal year, influenza causes between 250,000 and 500,000 deaths worldwide.

    In the Southern Hemisphere, the winter flu season is now over. In spite of dire predictions, only 185 people died from swine flu in Australia – considerably fewer than the roughly 3,000 who succumb to seasonal influenza in that country each year.

    And no, it wasn’t because the population was immunized. Australia’s vaccination campaign against swine flu took off last month.

  42. royrogers says:

    “Barry Ritholtz Says:
    October 27th, 2009 at 9:55 pm

    I am neither a doctor nor an expert on viral infections — but I thought this depiction of the virus presented an interesting perspective about how we perceive things.

    As investors, we tend to over react to newer information (Recency Bias).

    The point of placing this here is not about the virus, but about the psychology of yo”

    THANKS BARRY, your the man, I love this site because you are unbiased and have an open mind. I read your comments with great admiration and I commend you for not taking my post off even though, perhaps I was too blunt.

    There has yet to be enough data and these charts, although may be true at the moment are inconclusive. There is at the moment an outbreak where I live, my daughters class had over 10% of the students out with the flu(probably H1N1), it is a serious outbreak as this time of the year, the infulenza rate is usually not that high in the area.

    As other posters have suggested, the hospitals stopped the test for it, not enough resources. I work in public health unit and I am in the health field, but not an expert on this and I hope that people do take the threat with an open mind.

    I believe the mortality rate is considered to be significantly higher than the common flu and it seems to me the contagiousness is also higher than the common flu, again, the data is sketchy at the moment as I make assumptions from the patients/people around me.

    On a relative basis, it is considered a safer flu for the elderly because it is believed
    that a form of this strain was infective long ago.

    THanks !!

  43. BETSY MCKAY says:

    About 1 in 6 Americans Hit With Swine Flu

    New CDC Estimates Show Number of Cases Surged in the Fall; Toll Is Particularly Heavy for Adults Under Age 64

    Approximately 47 million Americans, or about one in six people in the U.S., were sickened with swine flu from April to mid-November and 9,820 of them died, the Centers for Disease Control and Prevention said Thursday, indicating the new virus spread widely before cresting last month.