Washington, DC, October 11, 2005 --  

President Bush's inflammatory comments about using American troops to enforce a flu quarantine have heightened public fears about a possible avian flu pandemic. But before Americans go completely overboard in a flu scare, they would be well advised to consider a few stubborn facts -- facts that have been completely ignored throughout the ongoing terrorism scare. Every American -- every single one -- is going to die some day. And common diseases and mundane accidents are far, far more likely to take their lives than a flu pandemic, terrorism, or any other more sexy cause.

In the four years since 2001, America has been frightened into implementing onerous security measures at home, curtailing civil liberties, and fighting expensive wars overseas -- all because a group of backward, mostly uneducated Arabs somehow managed to pull off a high-profile mass murder of 2996 people.¹ But each year since September 11th -- not once, but every single year -- about the same number of people (3149 in 2002) have died from fire or smoke inhalation.² Significantly more people have died each year from drowning (3447), and far more people have died from falling (16,000) and poisoning (17,000)³.

Every single year since the deaths on September 11, 2001, 15 times as many people have died in traffic accidents -- about 45,000⁴ each year -- yet nobody thinks twice before jumping in the car to fetch a quart of milk from the store. America doesn't water-down its constitutional protections to make its highways safer. Nobody is put in jail without trial, or tortured by government goons to bring traffic accident rates down.

If America were run by a coldhearted, emotionless computer, its reaction to terrorism would probably be to do nothing. The numbers of people killed are so small, compared with other causes, that responding is not worth using up valuable resources. While it is unrealistic to expect that living breathing people will ever make cool and calculating decisions like a computer, as time passes and emotions ease, it is reasonable to expect people to behave a bit more rationally. Four years later, it's time for America to move on.

Unfortunately, "moving on" for Americans means moving on to another irrational fear: Avian flu. Alarmist public health officials have been whipping Americans into a frenzy with predictions of millions of deaths from an upcoming pandemic. The reality, however, isn't nearly as exciting. Every year, ordinary strains of flu, or flu-related pneumonia kill 60,000 people in America -- mostly in the young, the old, or people with weak immune systems.⁵ These deaths happen like clockwork.

What changes in a pandemic are the numbers. When a brand new flu virus crosses from animals to humans, people have little or no immunity. New viruses usually have a higher kill rate -- the percentage of people who get the infected that end up dying. In the United States, run-of-the-mill flu viruses have a kill rate of less than 1 percent.⁶ In history's worst flu pandemic of 1918, the virus' kill rate was 2.6 percent.⁷ New viruses also tend to have higher rates of infection, meaning more people get them in the year after they emerge than older viruses.

These two factors -- the rate of infection, and the rate of death for the infected -- lead to higher death tolls in pandemics than in typical flu seasons. But for most people, the rate of dying from the flu in a pandemic is still very, very small.

That fact however, has done nothing to stop the fear mongers, who have been making bogus casualty predictions for a pandemic based on the H5N1 strain of avian flu virus. It is common to hear that in the first human outbreak of this strain in Hong Kong in 1997, six people died out of 18 hospitalized, yielding an incredible death rate of 33 percent. Similar reports about more recent outbreaks in Vietnam and Thailand have yielded death rates of 50 percent or more. Such high death rates have then been used in mathematical formulas to come up with enormous numbers of people killed in world wide pandemics. Some predictions have said hundreds of millions of people would die.

But this is an outrageous misuse of statistics. To begin with, the actual death rate from H5N1 in humans is certainly much smaller than 33 percent. Calculations based on hospitalizations fails to take into account the probably much larger group without symptoms severe enough to require hospitalization, or even be detected.

Secondly, pandemics never have such high kill rates for a variety of reasons. If a virus kills its host quickly, then it fails to spread, thereby stopping an outbreak before it has a chance to get started. Also, in order to spread easily between people, a new flu virus has to mutate to take on gene characteristics more typical of existing flu viruses. If past experience is a guide, such genetic changes greatly reduce a new virus' kill rate.

Nobody knows if the H5N1 avian flu virus will ever become a human flu virus. And if it does, nobody can predict how infectious it will be or what percentage of victims it will kill. If there is a pandemic and it is similar to the 1968 or 1957 pandemics,⁸ the result would be a significant increase over normal regularly yearly flu deaths, but nothing for most people to get scared about. Only if there is a pandemic to rival the worst pandemic on record -- the pandemic of 1918 -- is possible that many more Americans will be killed than normal.

So is this a scenario you should be scared about? Maybe. If the H1N1 avian flu virus becomes a human flu virus, and if it then becomes as deadly as the virus that caused the 1918 pandemic, and if you then happen to be among the minority of people who would catch it, and then if you then don't have an effective vaccine, and then if you then can't get or don't respond to anti-viral medication, and if you then happen to be amongst the tiny 2.6 percent of people unable to fight it off, then you would die.

That's way too many ifs to make me scared. But if you must be afraid, then better to fear the flu than a repeat of September 11th. Even in 2001, the year of the worst terrorist attack in American history, the death risk from the mediocre flu strains circulating was far, far higher than the death risk from terrorism. After four years of irrationally fearing Osama, a new source of irrational fear seems somehow refreshing.

Related Web Columns

Death by Hubris, The High Price of Rationed Medicine, February 1, 2005

Irrational Destruction
Air Safety in the Terrorist Age, November 13, 2001

Panic Attacks, The Advancement of Hypochondria by the Press, July 27, 1999

Notes:

1. September 11th Victims List Web Site, As Posted October 10, 2005

2. U.S. Center for Disease Control, National Vital Statistics Reports, Deaths: Final Data for 2002, October 12, 2004

3. Ibid.

4. Ibid.

5. Ibid.

6. New York Times, World Health Agency Tones Down Alarm on Possible Flu Pandemic, October 1, 2005

7. Ibid.

8. Ibid.