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October 28, 2014

Epidemics in History

Interesting piece about epidemics through history. The most surprising thing to us was that cholera was the most common disease (at about half of the most recent epidemics/pandemics). The screen snap below shows just the tail end of the graphic:

epidemics.png

The other interesting insight was that in a world where global population has exploded, borders are porous, and people have the ability and means to travel almost anywhere on earth in just a few hours, every successive epidemic kills fewer and fewer people.

Even in remote areas like West Africa.

Posted by Cassandra at October 28, 2014 08:23 AM

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Comments

But what about Killer Klown Syndrome? How many died from that?

Posted by: Dixie Normous at October 28, 2014 01:46 PM

every successive epidemic kills fewer and fewer people

Those aren't listed in chronological order. E.g., the SARS epidemic (2002-3) killed 774, while swine flu (2009) killed 284,000.

Posted by: Tom at October 29, 2014 07:57 AM

Comment of the day - I'll correct my mistake (and credit you, Tom :).

Thanks for pointing that out!

Posted by: Cass at October 29, 2014 08:09 AM

Actually, I think this deserves its own post because not only was I wrong, I was REALLY wrong.

Posted by: Cass at October 29, 2014 08:29 AM

No matter how bad a disease is, it makes a huge difference in the death toll how rich a society is: how much extra food, how much advanced supportive care is available for people who may survive as long as they can be kept warm, fed, and hydrated long enough to fight off the infection, how close society is to total collapse and famine if too many adults are too sick to hunt or tend the fields, how likely we are to find new medical treatments or vaccines before the disease burns itself out naturally. Rich societies are an extremely recent development.

Ebola is scarier than many epidemics because of the razor's edge of competence to deal with it: below a certain number, we're quite good at containing it and holding down the death rate. Above a certain number, we could be overwhelmed--and then kicks in the full impact of a roughly 50% mortality rate among an overwhelmed population. We don't know quite where that tipping point is, but the experience in Dallas did not build confidence. What is building confidence, I think, is that we're not seeing any cases developing out of casual contact, either before symptoms declare themselves, or even early in the symptomatic phase. I was awfully relieved to see that Thomas Duncan managed to infect only the nurses who treated him in his terminal stage and not any of the many people who had close contact with him in his apartment.

Posted by: Texan99 at October 29, 2014 10:00 AM

Ebola is scarier than many epidemics because of the razor's edge of competence to deal with it: below a certain number, we're quite good at containing it and holding down the death rate. Above a certain number, we could be overwhelmed--and then kicks in the full impact of a roughly 50% mortality rate among an overwhelmed population.

I think this is a great observation. The problem with risk here is that at some point contagion literally "goes viral", shutting down both our ability to treat the sick and our ability to carry out the normal functions of life. And the time to prevent disaster is in the beginning, before we are overwhelmed.

The good news is that epidemics die a natural death too - killing off too many hosts naturally limits further spreading of the disease. But that's a pretty unpleasant method of containment :p

The modern sense of complacency is a real killer. I'm actually not in the least worried about my chances of getting Ebola. I have flown several times in the past two months. But if a few sensible precautions (like the Army sensibly deciding to quarantine low risk personnel returning from West Africa)can avert disaster, I really can't see a good argument for not taking them.

Posted by: Cass at October 29, 2014 10:10 AM

Epidemics stop when R-zero drops below 1.0. We've seen it drop below 1.0 in Africa in previous outbreaks, largely through the unimaginably brutal process of killing so many people in a small, isolated community that there was no one left who was well enough, or who cared enough, to stay with the dying victims. We may have seen it drop below 1.0 in the U.S. recently, when we kept the number of simultaneously infected victims under the 12-20 level that can be accommodated in our highest level of secure beds.

It remains to be seen whether R-zero can be dropped below 1.0 in any conditions between those two extremes. I certainly hope so, because we seem nearly determined to conduct the experiment.

Posted by: Texan99 at October 29, 2014 01:51 PM