Can we beat influenza

Following my post on pandemic whataboutery, James Joyner had some interesting thoughts, noting that

Interestingly, Quiggin doesn’t circle back to the third example from his introduction: influenza. Will Americans, having been conditioned to lockdowns during this pandemic, be more likely to implement them again for lesser ones? Or will this be a Never Again moment?

I was thinking over a post on this topic when I read that New Zealand is planning to use the testing contact tracing system set up for the coronavirus to stamp out sexually transmitted infections. So, the idea is obviously in the air.

Unless we get a perfect vaccine, it’s likely that we will be dealing with both Covid and influenza for the foreseeable future. So, I’m going to assume we maintain social distancing, at levels sufficient to keep Covid suppressed – that means lots of handwashing, crowd limits based on 4sq m per person, and continuous testing and tracing.

Coming back to influenza, the lockdown against Covid-19 has ensured that, for all practical purposes we wont have our usual winter influenza epidemic this year. That’s another thousand or so lives saved, to set against the rightwingers and contrarians who advocated letting thousands die from coronavirus in the interests of business as usual.

Influenza has several big differences from Covid. First, we know how to make an annual vaccine, even if it’s not perfectly effective. Second, kids are hugely effective spreaders of flu. Finally, infectious people mostly have symptoms.

That implies several features of the response. We need to aim at universal vaccination, and make it compulsory for those likely to come into contact with vulnerable groups and children. That includes not only health care workers and teachers but also other children. Having established the principle of “no jab, no play” for the standard “childhood diseases” we should extend it to influenza.

For the rest of the population, we need free provision of the vaccine and constant advocacy, including remorseless shaming of antivaxers, deniers and do-nothingers. These groups should be treated like drunk drivers and speeders, and their advocates in the rightwing media should be treated as the monsters they are. This will lay the ground for an even more vigorous response if we get a Covid vaccine.

Because asymptomatic influenza is less common, ensuring that everyone has access to sick leave, and that occupation health and safety laws require employers to send sick workers home would make a big difference. We need to end the culture of “presenteeism”, under which taking a “sickie” is considered a far bigger problem than turning up sick.

In this context, Johnson and Johnson (makers of Codral) should be required to run a long term advertising campaign repudiating their old slogan of “Soldier On”. In the new post-globalist world, I’d see no problem with shutting down their Australian operations if they refuse. We’ve imposed stringent border restrictions on individuals to suppress this pandemic, and we should be much tougher on corporations.

Finally, masks. Because we suppressed the virus so successfully, Australian policymakers have dodged the issue. But it’s pretty clear they reduce transmission of all kinds of respiratory disease.

Would this package work? Universal vaccination by itself would get close. The flu vaccine is said to be about 60 per cent effective, and this is also the immunity rate required for herd immunity. So, if we added hygiene, social distancing and testing/tracing, suppression should be a feasible strategy.

26 thoughts on “Can we beat influenza

  1. I’d like to suggest amending building codes to make it compulsory to provide hand washing facilities in public lobbies without having to go to a toilet. Also, toilets should be “hands free” – e.g., doors that open automatically and faucets that operate with sensors.

  2. There are several universal influenza vaccine candidates that target say the conserved M2 protein (as opposed to targeting the more variable H and A antigens the seasonal flu vaccines target).

    The issue is that with isolation, contract tracing and viral suppression, phase 3 trials will be less useful in assessing the validity of vaccine candidates. If we push yearly seasonal flu across the entire population, this will get even harder. We need to consider human challenge trials, for better or worse.

    I would suggest some incentive is tied to getting the universal vaccine and boosters every 5 or 10 years. For example, health insurance subsidy or higher Medicare levy if you don’t get it. No Jab, no play/No welfare policies as are widely in effect.

  3. I might be wrong, but I can’t help wondering if this is another case of economist forgets that there may be other academic disciplines that have already considered this question. Isn’t this what public health is about?

  4. Interesting idea. Something good will come from this terrible pandemic. I always have the flu injection but couple this with safe distancing and hand washing will give me good protection. I think masks on planes should be a requirement. Yes, we are all forced to think about how infections spread.

  5. Imagine a world where everyone carried around a small but powerful computer with them. At random intervals through the day people take it out and press it against their face. The computer also has a microphone that is always on and so can monitor a person’s breathing. Not only that, but it keeps track of people’s positions and who they have come in contact with. So this device could not only monitor temperature and breathing to determine who is likely to be sick with a cold or flu, but also automatically notify people they have come in contact to warn them to take precautions against spreading it.

    Compete science fiction of course. You’d have to pay me $1,000 a month to compensate me for the loss of privacy that carrying such a device around would entail.

  6. These self-styled “contrarians” have shifted tactics from finding novel ways to argue that the economic and social status quo can’t be changed to arguing that preserving the status quo is worth sacrificing tens of thousands of lives.

    Technology has progressed to the point where many people now have options open to them (mainly through things like remote learning and working, Telehealth, state directed hygiene and health initiatives and changes in welfare provision) and this is an unwelcome development for those wishing to preserve out-dated norms and inequities. The status quo has been disrupted in places like Australia where a federal government was out-witted and out-manoeuvred into a lockdown by state governments. A lockdown that has saved lives, but one that has laid bare the disproportionate costs born by sections of society and challenged people’s complacency that we had a functioning or even remotely fair safety net. It has also provided a stark contrast between styles of governance.

    The contrarians also don’t understand (or more likely don’t care) that most employees (even union members) don’t have choices open to them to be able to choose to work from home or take sick leave when they are sick. There are very strong social and economic norms controlling people’s choices that took a lockdown to change.

  7. Seqaugur @3 This is a blog, not an academic journal. I express my views on a range of issues, and encourage commenters to respond. I don’t require economics degrees from commenters, nor do I regard one as a disqualificatio

  8. While we of course shouldn’t slack off on eliminating a number of other diseases which are endemic in a number of developing countries, it is well past time for an organized international effort to reducing the toll of influenza. While influenza has a natural reservoir in birds, most of the cooking of new strains that sicken people occur in people. If the developed world consistently has a high level of vaccination then the number of new nasty strains we’re exposed to will greatly decline. If we write it down in our planners so we don’t forget and make a point of getting the whole world developed by say 2040, then we can mostly eliminate influenza. Then we could see about curing birds of influenza, although that’s probably not what we should be focusing on right now.

  9. We could beat influenza assisted with these 3 technologies as examples. Real time testing with visual readout – analogue –
    1. “stress; performance; emotion tracking; life and contact logging; personality representation; or behavior change practices” …
    2. “glasses’ frame with flexible electrodes near the ears (EEG sensor) and eyes (EOG sensor)” …
    3. “portable, battery-powered pairs with a smartphone, detects viruses could also detect other biological markers”.

    Ronald at 11:00 am says “Imagine a world where everyone carried around a small but powerful computer with them…. Compete science fiction of course.” 

    Then is now…

    “Ambiguity as a Resource to Inform Proto-Practices: The Case of Skin Conductance
    Skin conductance is an interesting measure of arousal level, largely unfamiliar to most end-users. We designed a mobile application mirroring end-users’ skin conductance in evocative visualizations, purposefully made ambiguous to invite rich interpretations. Twenty-three participants used the system for a month. Through the lens of a practice-based analysis of weekly interviews and the logged data, several quite different—sometimes even mutually exclusive—interpretations or proto-practices arose: as stress management; sports performance; emotion tracking; general life logging; personality representation; or behavior change practices. This suggests the value of a purposefully open initial design to allow for the emergence of broader proto-practices to be followed by a second step of tailored design for each identified goal to facilitate the transition from proto-practice to practice. We contribute to the HCI discourse on ambiguity in design, arguing for balancing openness and ambiguity with scaffolding to better support the emergence of practices around biodata.”

    The researchers built the glasses’ frame with a 3D printer and then added flexible electrodes near the ears (EEG sensor) and eyes (EOG sensor). They also added a wireless circuit for motion/UV sensing on the side of the glasses and a UV-responsive, color-adjustable gel inside the lenses. When the sensor detected UV rays of a certain intensity, the lenses changed color and became sunglasses. The motion detector allowed the researchers to track the posture and gait of the wearer, as well as detect when they fell. The EEG recorded alpha rhythms of the brain, which could be used to monitor health. Finally, the EOG monitor allowed the wearer to easily move bricks around in a popular video game by adjusting the direction and angle of their eyes. The e-glasses could be useful for digital healthcare or virtual reality applications, the researchers say.

    Detecting real biological viruses with a smartphone
    The device is about the size of a brick (small enough in ? 5-8yrs)
    with a slot on top in which you place a smartphone such that its camera looks through a small lens to the inside of the device. Through a custom-made smartphone app, individual viruses can be seen. 

    Viruses are held in place on a clear surface in tiny cavities lit with an LED. The surface and fluid surrounding it were designed so that only when a cavity has a virus inside does incident light — the light that directly hits the surface — from the LED redirect up to the camera, manifesting in a bright pixel in an otherwise dark void. Each cavity is 48 femtolitres (quadrillionths of a litre) — it would take over 10 million of these to hold a single human tear.”

  10. Australians don’t seem to have taken to masks. At my local shopping center today I was one of perhaps one in fifty wearing them.

  11. I think masks are a distraction. I argue this here as part of my review of what Japan did right in managing this epidemic. Example: Yesterday on my way to work (wearing a mask) I sat next to an old man who had pulled his mask down and was picking his nose. My mask gives me no protection against the boogers he leaves on the train handrails (which I have to grab because I am recovering from a knee reconstruction!)

    I have also wondered at the goal of eliminating influenza. I think we now have in place the tools and experience to try. We could institute a two week lockdown every year, say at the beginning of December, with a more aggressive vaccination policy preceding it and better use of hand-washing and case isolation throughout November and December. Then the reopening of the economy in mid-December would also be the beginning of the end of year parties and closing down of the year, with New Year as the celebration of the beginning of a healthy new year. It would be even easier in Australia since the lockdown could be done in July, which is a good-for-nothing month when no one wants to go out anyway. With lockdown, case isolation and a general anti-influenza campaign in July, very high levels of vaccination might not be needed, so vaccination of just the elderly and vulnerable and health care workers might be enough.

    I also think we have now got no further excuse to delay on eliminating tobacco use. We were willing to completely shut down our economies for two months and significantly restrict everyone’s civil liberties (except Dom Cummings, obviously) to prevent a disease that kills 1% of people it affects; tobacco kills 50-60% of everyone who uses it, and the economic and civil liberties consequences of eliminating this poisonous habit are minor. There is no further justification for allowing this habit to continue, and yes although there are civil liberties reasons, we have now seen that the state is willing to fine people who don’t have any disease for refusing to wear a mask. There is absolutely no reason now, given we allowed this, to say that banning smoking cannot be done because of civil liberties. It’s time to act to end it.

  12. Let us not get ahead of ourselves. Let us ask ourselves if we can beat COVID-19 first. So far it seems not. Only a handful of sizeable nations seem to have held off the first wave so far. This is “held off” not “beaten”. These are;

    1. China;
    2. Japan
    3. Sth Korea;
    4. Taiwan;
    5. Australia;
    6. New Zealand.

    Four of them are island nations and one is a peninsular nation (Sth Korea) with such a hard military border, with a DMZ and no man’s land, that it might as well be an island. The rest of the world has failed dismally or is so relatively globally unconnected that the first wave hasn’t hit it yet. We are just at the beginning of this global COVID-19 pandemic. Without a vaccine, we will be fending off waves of it for years to come.

    The performance of the USA is both instructive and disturbing. Subjected to the challenge from COVID-19, the USA has failed on all fronts. It has failed politically, socially, economically, medically and epidemiologically. The robustness and systems integration of a person or a nation is put to the test by any serious challenge. The USA in facing a serious challenge now. It has failed thus far and is falling apart before our eyes.

    The USA is beginning to disintegrate. Can they arrest this? Maybe, but only time will tell. Thus far the USA has shown not one sign that it can cope in an integrated, healthy and systematic way with this challenge. This shows how weak the USA really is and how corrupt and rotten to the core is its entire system. None of this criticism of the USA should be interpreted as me saying the other superpowers are wonderful. They are not. Indeed, all the superpowers (USA, Russia, China) are to be feared greatly. They are separately and together the greatest existential threats to the rest of humanity by far.

  13. Iko, with regard to whether or not we can beat COVID-19 the answer is… yeah. It’s just a respiratory virus. Asking whether or not we can beat it is like asking if Bruce Lee could defeat a snail in hand to eye stalk combat. The only way he could fail is if he decided not to try or if, for some reason, he waited for the snail to come to him while standing inside a dumpster fire.

    Admittedly, we have seen both these responses to the Coronavirus. But I’m sure the leadership of the UK, US, Sweden, Brazil, etc. will come to their senses any moment now…

  14. Ronald,

    The COVID-19 virus has the following features and is affected by the following realities;

    (a) pandemic around the world;
    (b) highly contagious;
    (c) no vaccine as yet;
    (d) a vaccine might be technically impossible or ineffective *;
    (e) might be able to mutate;
    (f) immunity might or might not persist; and
    (g) many humans are acting highly irrationally in response to the dangers it presents.

    This is a potent brew of unknown risks. Everything might pan out well, excepting for the millions who will actually die from it and for the tens to hundreds of millions who will lose close relatives and livable incomes. However, the chances that the global situation will become much worse are much greater. Australia is currently living in a protected bubble. Most of the world is spiraling down the black hole of economic and societal collapse. Look at the USA right now. What a mess. They are staring societal collapse, martial law or civil war in the face.

    As a Bloomberg article has said, “Washington is starting to look a lot like Moscow in the 1990s.” I was in the Soviet Union up until just 9 days before the 1991 Soviet coup d’état attempt. I saw and heard a lot of things that were very indicative of looming trouble. This included heating sustained small arms fire at night around Kiev Station in Moscow. My wife and I were on the 8th floor of a near empty and half-unfinished hotel across the road from the station. Just 9 days out of the Soviet Union (in Scandanvaia we started seeing news of the coup d’état on the news. While touring Russia, I had said to the wife. “What a mess! This place can’t go on like this.” My words proved remarkably prescient.

    When we were touring the USA last year (last Fall) I said to my wife; “What a mess! This place can’t go on like this.” My words have proved remarkably prescient once again. It was clear the USA was decaying and had deep, systemic problems. The COVID-19 crisis is proving that and the USA is not coping.

    About 1.7 billion of the world’s population is handling this crisis passably well, including China. The other 6 billion are in a mess and spiraling down the plughole. I don’t see how this can end well but look I hope I am proven wrong.

  15. Beating COVID is an aspiration, coping with COVID is the reality.

    COVID has brought governance into sharper focus ie, do economies take
    precedence over public health or should the reverse prevail.

    History would indicate that poor public health has poor outcomes for both governments and economies but it seems that the US and the U.K. are to test that theory.

  16. akarog,

    The US is seeing civil uprisings all across the country right now, so I guess we have our answer. Of course, it’s not just poor public health systems, it’s the gross inequality and rampant injustice overall.

    The Chinese billionaires’ dynasty will be chuckling over their wagyu and Grange Hermitage, their lobster and Dom Perignon right now… and making plans to bring forward the invasion of Taiwan.

  17. akarog, watch over the next few weeks as European states and the USA attempt to “cope with” coronavirus. It’s going to be horrific. There is no “coping with” this virus, until a vaccine arrives. The only option is to eradicate it.

  18. There are apparently a few people who have strong reactions to influenza vaccinations. At present these people can get a medical attest that allows these people to enter say an age care facility where a close relative resides (all other restrictions remaining).

    I assume compulsory vaccination would still allow this procedure.

    Personally I would prefer convincing people to be vaccinated, including lengthy and frustrating debates with anti-vaxers and I would definitely support work place measures to prevent the spread of influenza particularly in urban areas.

    I have seen the consequences for a pretty little girl whose parents did not let her be vaccinated – very sad.

    IMHO, a distinction should be drawn between actions or behaviour by individuals in public places versus private. The issue is the effects of an individual’s behaviour on others rather than themselves. Hence a family with children has, IMO, different responsibilities to an individual who lives as a semi-recluse and a public transport user has different responsibilities to a semi-recluse in his or her own car.

    In short, personal freedom comes with personal responsibilities toward others. Any decision on public measures should attempt to maximise personal freedom while protecting everybody. I imagine this is easier in a society without ideological anti-vaxers.

    Tangentially, the other day I read an article in the smh in which the author described Australians’ reaction to Covid 19 restrictions as being “complying with orders”. It seems to me it is empirically not easy to distinguish between a population that is ‘compliant with orders’ because they are submissive to orders and a population that follows the orders because these orders make sense to them.

  19. I view public health as being more comprehensive than weighing babies and annual flu shots. The inequality in opportunities and access to essential services needs to be addressed. A disabled society is not a productive society.

  20. I agree, akarog. But JQ tends to take issues in smaller steps, which has advantages.

    Your point fits of course into the core area of major contemporary issues in economics: income and wealth inequality.

  21. Speaking of disease, it seems to me that Trump is a bigger threat than COVID and that anyone who is within his sphere ends up dead, or in gaol, or mad, or all the above.

    Boris and his foot soldiers, blessed by his holeyness, now appear to be descending into a pit of burning fire.

    Now is a good time to build a Trump firewall.

  22. I don’t think China will be happy with the civil unrest in the US and they might have to make concessions to keep the peace, as it were.

    If nothing else, the French Revolution stimulated political debate.

  23. “Coming back to influenza, the lockdown against Covid-19 has ensured that, for all practical purposes we wont have our usual winter influenza epidemic this year. That’s another thousand or so lives saved, to set against the rightwingers and contrarians….”

    I guess if that’s the case, then I’m wondering when it was you or anyone else advocated a lockdown or social distancing before 2020 to save some number of the 3102 people who died in 2018 (the most recent year for which I’ve seen figures) from Influenza and pneumonia ? I don’t recall anyone ever suggesting lockdowns or social distancing, just get a vaccine. Maybe those lives didn’t/don’t matter as much ?

    As for anti-vaxxers, I’m reasonably OK with vaccines, but if more people actually looked at the drug companies filings with the FDA or TGA for most of their drugs in regards to side effects (which ALL drugs have) and potential bad outcomes, I suspect very few people would blithely line up for a jab without asking a few more questions.

  24. Bryan, seriously, has no one suggested social distancing to you to avoid spreading colds and flu? What kind of childhood did you have where no one taught these basics to you? Cover your mouth when you sneeze, keep your cold to yourself, don’t come near me you virus riddled bag of disease… that sort of thing? I think I’m starting to understand how the UK and US could mess things up so badly.

  25. Ronald – I think you’ve completely missed the point. In any case, it’s a big difference from your Mum telling you to do those things and the State mandating it. Also in regard to your comment, the pharmaceutical industry regularly promotes their products during the flu season as things to allow “good employees” to soldier on and continue to go to work. Not sure we’ll see too much of that sort of promotion from now on.

  26. Can we beat influenza?
    Yes, we can!

    Wow. ” from 20,032 cases in the first three months, to 504 in April and May.”.

    Flu deaths prevented as cases plummet amid coronavirus lockdowns, AMA says

    But Immunisation Coalition data shows the number of cases in 2020 has plummeted since coronavirus lockdowns were introduced — from 20,032 cases in the first three months, to 504 in April and May.

    Australian Medical Association (AMA) SA president Dr Chris Moy said the number of flu deaths prevented since the coronavirus pandemic began was probably “quite significant”.

    “It may have, up to this point, saved more people than it’s actually killed, and certainly the response to COVID has actually saved a lot of people,” he said.

    “The only proviso to that is that it is possible that we may have actually delayed an [influenza] outbreak.

    “But I think [the number] will still be less, because we have a far more highly immunised population this year than we have had in previous years.”

    Coronavirus update: Follow all the latest news in our daily wrap.

    Last year, there were over 900 influenza-linked deaths in Australia.

    But until the end of last month, federal authorities had only been alerted to 36 “laboratory-confirmed influenza-associated deaths” in 2020, according to the Australian Influenza Surveillance Report.

    The Immunisation Coalition
    “Who are we?
    The Immunisation Coalition is a not for profit organisation, and is the leading voice in whole-of-life immunisation in Australia, protecting all Australians against communicable diseases.

    We collaborate with like-minded organisations such as Primary Health Networks (PHNs), Public Health Units, Government health departments and other groups that fight vaccine hesitancy.

    We are a champion for immunisation education, providing timely, accurate and scientifically informed information about vaccines and the diseases they prevent.”

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