Off-Topic Friendly Message on Swine Flu

I submitted this for the AMA-MSS conference as a Scientific Issues Committee member. I thought I'd share it here for anyone interested, even though it has nothing to do with running.

Swine Flu: Pork or Peril? - Samuel Mackenzie, CSI


"Even though it killed at least 40 million people in less than a year, the 1918 influenza pandemic's most alarming feature may have been that it nearly extinguished the basic humanitarian impulses that bind civil society together."

The quotation is from John Barry, author of The Great Influenza: The Epic Story of the Deadliest Plague in History.1 It's an account of death and suffering by infectious cause that may strike today's physicians as near fiction by virtue of the sheer enormity of the epidemic. At this writing, basic humanitarian impulses are intact, but another strain of the influenza virus has come knocking at civil society's door. On April 27, 2009 the World Health Organization raised its global alert level regarding the spread of swine flu to Phase 4.2 While reminiscent of a color-coated U.S. Homeland Security Terror Alert level, the Phase 4 label is indeed grounded in science, as it indicates the virus's capability of sustained human-to-human transmission.3 More recent community infections of H1N1, a reassorted swine flu strain of Influenza A virus, put the virus's potential a mere phase away from a pandemic by WHO standards, at Phase 5.

That said, in an age in which 250,000 people in the world die from AIDS every month and over 2 billion are infected with M. tuberculosis,4 is swine flu such a public health nightmare that it warrants upwards of $3 billion in prevention and containment?5 (President Obama requested one and a half billion dollars of that sum for the development of a vaccine.) And as large as $3 billion sounds, the expenses associated with local, state, and federal programs likely pale in comparison to those more hidden costs: School and work closures, misguided bans on pork trade, and limits on travel to and from infected countries. Swine flu, or the more porcine-friendly H1N1, has taken the lives of 117 people to date--97 from Mexico, 17 from the U.S., 2 from Canada, and 1 from Costa Rica.6 For reference, 35,000 die from different strains of flu in the average year.7

Looking at these numbers, it would seem on the surface that our spending is a misappropriation of resources. However, stopping the story there ignores two key facts in the swine-flu story: First, transmission of H1N1 is occurring in the warmer months. Since it's confined to North America at this point, it's not a stretch to expect an increased incidence as we move into the fall and winter. Second, we may not have seen this virus in its most deadly form. When two RNA viruses trade their segmented parts upon coinfection of a cell, we call the process reassortment. This is the mechanism by which this particular virus was born in its swine host, and it could now just as easily take place in infected human cells leading to increased virulence and easier transmissibility. If that happened, we just might have another Great Influenza on our hands.

So the question remains: Are the measures we're taking truly worth it or is fear driving our decision-making on the policy level? Taking a utilitarian cost-benefit approach to global health, I consulted the 2008 Copenhagen Consensus Report.8 Each year, eight renowned economists (five of whom were Nobel laureates last year) prioritize several proposals related to the ten biggest global challenges (e.g. malnutrition, diseases, education, air pollution, etc.). To be fair, swine flu was not submitted for consideration, but the top three recommendations for efficacious global spending were 1) vitamin A and zinc supplements for children, 2) the Doha development agenda, and 3) iron and salt iodization. TB case finding and treatment came in at number 13.

What's frustrating about epidemic prevention is that it's impossible to evaluate the value of a good program since its goal will always be to maintain the status quo. If our programs fail, on the other hand, we'll know it. Maybe then, swine-flu will make the top-ten list.

1 Barry, J. (2004) The Great Influenza: The Epic Story of the Deadliest Plague in History. Viking Press, New York.

2 World Health Organization. (2009) Statement by WHO Director-General Margaret Chan: Swine Influenza. [http://www.who.int/mediacentre/news/statements/2009/
h1n1_20090427/en/index.html] Accessed: 29 April 2009.

3 World Health Organization. Current WHO phase of pandemic alert. (2009)
[http://www.who.int/csr/disease/avian_influenza/phase/en/index.html] Accessed: 29 April 2009.

4 CDC. (2007) Extensively drug-resistant tuberculosis—United States, 1993–2006. MMWR, 56: 250-253.

5 AP. (2009) Swine Flu Costs Ohio $44,000 Per Day. Columbus Dispatch. 11 May 2009.

6 AP. (2009) Mexico's Death Toll Reaches 97. Deccan Hearald. 30 May 2009. [http://www.deccanherald.com/content/5269/mexicos-swine-flu-death-toll.html] Accessed: 30 May 2009.

7 Rugman, J. (2009) New Yorkers Resist Swine Flu Panic, For Now. [http://blogs.channel4.com/snowblog/2009/04/29/new-yorkers-resist-swine-flu-panic-for-now/] Accessed: 30 May 2009.

8 Copenhagen Consensus. (2008) [http://www.copenhagenconsensus.com/
Home.aspx] Accessed: 30 May 2009.

John Walker Interview

It's a pretty short interview, but I'm posting it because Walker has always been one of my favorites. Even as an older guy (he's 57 now), you can easily get a sense of how tough this guy was. I really enjoyed the stories last year about him betting on Willis to take gold in the Olympic final.


Walker has PR's of 1:44.92, 2:16.6, 3:32.4, 3:49.08, 4:51.4, and 7:37.49. Many of these were WR's at the time, and he was the first guy to ever break the 3:50 mark. As he states in the interview, however, what makes an athlete great is his capacity to win a gold medal, which Walker did in 1976 in Montreal. (As an aside, this was a year in which several African countries boycotted the games due to the New Zealand rugby team touring through South Africa. [It makes about as much sense to me as it does to you.] Walker's winning time was the slowest since the 1956 games, though it was a tactical race and he closed in 50 point.)

Fast HS Times

I'm sorry that I missed this. We've had some good local high school miling as of late. Chris Stogsdill popped a 4:07.93 full mile on May 1 and FM's Alex Hatz wasn't far behind (4:10.80). We've still got a lot of track to go in the next few weeks, but I'm pretty sure these times are up there in the national ranks right now.

Results here.

Stogsdill interview here.

New Online Running Log!

I've broken down and gotten a Flotrackr account, about a year after it was cool. For anyone out there looking for a place to record their running, I highly recommend it. It's my personal belief that writing down your running is good for three reasons: 1) It keeps you on top of it, 2) It provides you with a record to look back on when you're looking to adjust your training, and 3) It's fun.

New running log here.

(You might have to register to see, though I think I set everything to public. Can someone let me know?)

Quick Half for Steve

Another nice performance by my superior training partner, Steve Hicks took second in the Utica Half Marathon this past weekend with a time of 1:09, averaging just under 5:17's on what he described as a flat but windy course.

2009 Mountain Goat

Congrats to training partner Steve Hicks who was fourth at the Mountaingoat this past weekend behind Mike Barnow's Westchester guys. If anyone finds the article about Steve, let me know.

I will gladly pay you Tuesday for a hamburger today!

Dave Moorcroft Day

Slammed!

In my manic state before the two final exams before the big exam before plenty of more exams in the years to come, I was finalizing the dates for what I've labeled the "Upstate Mile Series."  If you don't like the terminology, I'm talking about the Ithaca Festival Mile, Charlie McMullen Memorial Mile, and Wilbur Duck.  Anyway, maybe my brain is fried but I thought it was a bit hard to find the date for the McMullen event.  I did end up finding it eventually, but before I did, I came across another site via Google search.

I guess the kid that won last year blogged about his experience doing so.  He didn't say anything nasty about me, but reading his account was a firm reminder of how racing when you're out of shape isn't the most fun thing in the world.  Thus, it pissed me off.  For those of you who are too lazy to click on the link above, here are the last three paragraphs:

"Sam Mackenzie has put a small gap on the rest of the pack. I've got one lap to catch him. I'm holding pace for the time being. It's the fastest pace I've run yet in the race, but I've got some reserves and I want to keep them in the wings, ready to deploy. With 200 meters remaining I've worn down Mackenzie's lead, but there is still a gap. I'm not right on his shoulder and I'm thinking, oh, it's ok. I'll wait for the final 100. Deja Vu. What am I thinking? I'm not making this mistake again. I kick hard at 200 meters.

I catch Sam on the homestretch. I'm throwing everything I've got down into the track. I want to pass with confidence-wilting speed, but I don't have that much of a kick and Sam is moving fast, so I pass him real slowly. The track, the stands, the spectators are flying by, but from my frame of reference Sam is moving back slowly. It feels so unnatural to be running at top speed and, oh, look, there's this other object floating by like a boat nudged by a breeze.

There's two sets of cones near the finish and I don't know, so I run on through both of them. First place. 4:20.47 is most certainly a personal best for a real and true mile. It's raining again afterwords and I feel good. I'm breathing big whale breaths. I probably feel good because the air is cool and all that wicked pollen has been flushed. It is a good day."