circa 2009
Swine flu of 1976: lessons from the past
In 1976, a late winter outbreak of swine flu at a military base in the USA led to fears of a devastating pandemic. President Gerald Ford announced a plan to vaccinate everyone in the country. By the end of the year, 40 million out of some 200 million Americans were vaccinated for the new strain, but no pandemic appeared and public health credibility suffered. Dr Harvey Fineberg tells the Bulletin why his 1978 study of that public health response is still relevant today.
Q: What lessons can we draw from the swine flu response 30 years ago, when dealing with today’s threat of a pandemic?
A: The first lesson is to avoid over-confidence about scientific insights. Major flu pandemics arise on average only about three times every century, which means scientists can make relatively few direct observations in each lifetime and have a long time to think about each observation. That is a circumstance ripe for over-interpretation. For example, in ’76 having seen the so-called “Asian flu” of ’57 and the so-called “Hong Kong flu” of ’68, some experts believed that flu pandemics tended to recur on an 11-year cycle and they were prepared for an outbreak in the late 1970s. The idea of an 11-year cycle turned out to have no predictive value.
the discussion
Imagine that you enter a parlor. You come late. When you arrive, others have long preceded you, and they are engaged in a heated discussion, a discussion too heated for them to pause and tell you exactly what it is about. In fact, the discussion had already begun long before any of them got there, so that no one present is qualified to retrace for you all the steps that had gone before. You listen for a while, until you decide that you have caught the tenor of the argument; then you put in your oar. Someone answers; you answer him; another comes to your defense; another aligns himself against you, to either the embarrassment or gratification of your opponent, depending upon the quality of your ally's assistance. However, the discussion is interminable. The hour grows late, you must depart. And you do depart, with the discussion still vigorously in progress.
- Kenneth Burke
Government discusses major flaws in masks mandates
Masks (also referred to as “barrier face coverings”) are products worn on the face… Currently available retail devices are often untested, with unknown protective capability.
Physical discomfort with use, particularly in hot and humid environments.
Contact dermatitis with extended wear.
Inability to effectively communicate with others using facial expressions.
Speech intelligibility.
Lack of understanding of the device’s features.
Fogging of eyeglasses during use.
Difficulty finding a device that is the proper size.
Cochrane Mask Studies
…The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID‐19 pandemic.
There is uncertainty about the effects of face masks. The low‐moderate certainty of the evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of randomised trials did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks during seasonal influenza. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness. Harms associated with physical interventions were under‐investigated.
There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, especially in those most at risk of ARIs.
diminishing returns
In economics, diminishing returns is the decrease in the marginal (incremental) output a production process as the amount of a single factor of production is incrementally increased, while the amounts of all other factors of production stay constant.
The law of diminishing returns states that in productive processes, increasing a factor of production by one, while holding all others constant ("ceteris paribus"), will at some point return lower output per incremental input unit. The law of diminishing returns does not decrease the total production, a condition known as negative returns. Under diminishing returns, returns remain positive, though they approach zero
