This is the second of three posts about the INFORMS Annual Meeting.
I enjoyed a talk by Dr. Richard Larson of MIT about the timely topic of H1N1 and operations research. I tuned out much of the alarmist news prior to the conference (to keep my sanity) and instead adopted a rigorous handwashing regimen. Larson’s talk highlighted the many opportunities for addressing H1N1 issues using operations research, including:
- Queuing for vaccinations.
- Reneging on vaccinations (some health care workers are refusing required vaccinations).
- Timing the vaccinations (before the prevalence peaks) is important for reducing risks, since youths are particularly susceptible to dying from H1N1..
- Locating facilities to manage surge capacity when the epidemic hits.
- Correctly diagnosing and isolating cases of H1N1.
- Supply chains for vaccinations.
Larson and his collaborator Dr. Stan Finkelstein takes a different kind of focus, looking at personal choices, such as hand washing, coughing into sleeves, avoiding handshakes, and avoiding crowds. They examine this issue through non-pharmaceutical interventions. Someone infected with H1N1 infects about 1.5 people in the next 24 hours (on average). This value is the mean of a random variable, which depends on personal choices (like handwashing). He examines the conditions under which the average number of infections decreases below 1.0, when the virus essentially dies out (Similar to my reasoning on vampire populations).
Finkelstein, a medical doctor, discussed some of the policy results. Initial reports suggested that H1N1 has a fatality rate of about 50% (Spanish flu has a FR of 3%). After an initial panic, flu fatigue set in. And the first wave of H1N1 resemble seasonal rather than pandemic flu. But after the recent panicking, many of us simply have not been motivated to improve our personal choices to reduce H1N1 transmission. Case in point, elbow bumping pictured below (instead of hand shaking) did not catch on at the conference as I had hoped. And the anti-bacterial hand gel was not located in useful places at the conference, so I used my own personal stash of anti-bacterial lotion after shaking hands.
I hope some of this research is used to lessen the impact of H1N1 this year before I am transformed into a germ-a-phobe.
October 23rd, 2009 at 2:37 pm
Wow – an FR of 50% is rather frightening. Do you know if that’s the current figure? I made a cursory search of the Internet a few weeks ago looking for similar statistics, but wasn’t able to turn up very much at the time.
October 23rd, 2009 at 3:05 pm
The FR of 50% was the alarmist early estimate. I think the FR is now believed to be close to the seasonal flu, although the H1N1 FR is higher for young people than seasonal flu.
October 26th, 2009 at 7:24 pm
That’s encouraging! I did a bit more digging and came across these rather provocative FR estimates:
0-4 years: 0.17%
5-24 years: 0.22%
25-49 years: 1.5%
50-64 years: 3.33%
65 years and over: 5.24%
Which are supposedly from a leaked CDC document. Strange pattern of FRs, if accurate. (a link to the PDF is available at this blog, which discussed the above a bit: http://monotreme1000.wordpress.com/2009/08/10/age-structure-and-case-fatality-rate/)
October 28th, 2009 at 6:09 am
My baby (two months old at the time), recently had H1N1, and my wife was sick at the same time but was never diagnosed. I had a soar throat around the same time and loaded up on Zicam and all sorts of juices –I felt bad for about the length of one NFL football game (I tell folks that I had h1n1 for 20 minutes).
The point is, I imagine that the reported CDC FRs are highly inflated due to the amount of folks that only have very mild symptoms. In fact, the doctors would not even test my wife for h1n1, they only tested the baby because he can’t discuss his symptoms.
I imagine that the FRs are for confirmed cases and it seems that they are only testing the patients that are now showing severe symptoms. The younger age groupings could have a substantially higher FR because more are tested early in the symptoms.
October 28th, 2009 at 8:10 am
Doug and Philip, Thanks for your insight and feedback. Diagnosis problems persist in any health problem in which you are testing for disease. If you test for something, you will find it. But those with and without a diagnosis are biased samples, because not everyone receives the same level of testing (as Doug noted). After seeing Philip’s updated FR estimates, I am much less worried about H1N1. This is good because the surge seems to have hit already, which means that vaccination isn’t going to have a big impact.