Planes, Trains and Automobiles

If you ask some epidemiologists how pandemics spread, they will hem and haw but not give you a direct answer. I will. People spread the virus. If people don’t move, the virus doesn’t move. That’s the fact, Jack.

For some reason, mostly having to do with politics I suppose, many in public health will do anything to hide the simple fact that movement restrictions are the only way to slow down pandemics in their early phases. There have been many “modeling” studies that “prove that movement restrictions don’t work”. These “studies” use imaginary data with assumptions guaranteed to give the desired results. However, if we look at what happens when movement restrictions were imposed in real-life pandemics, we make an interesting discovery. They work. The work great.

From McLeod et al. 2008

While it was in force, the maritime quarantine used by American Samoa from November 23, 1918, appeared to exclude pandemic influenza (2). Once influenza did reach this jurisdiction in 1920, no recorded deaths were attributed to influenza (in a population of ≈8,000) (8). In contrast, influenza spread rapidly through Western Samoa (now named Samoa). The impact was amplified by a lack of medical assistance and by food shortages in the area. Western Samoa had the worst death rate for any country or territory recorded in the 1918 pandemic, losing 19%–22% of its population (2).

There are many other examples of the empirical effectiveness of movement restrictions. You can find some of them here.

If you find the reality of empirical evidence is embarrassingly contrary to the fantasy world of models you would prefer to live in, what do you do? You state the obvious and draw false conclusions of course!

Today, there was an attempt to interpret a statement of the obvious as a reason not to close airports. Allow me to lead you through the twisted logic. We start with a paper that describes: “Transmissibility and geographic spread of the 1889 influenza pandemic” by Valleron et al. This paper comes to the rather obvious conclusion that even before the airplane was invented, viruses were capable of spreading around the world. I think most of us knew that. We all know that people in 1889 had access to ships and trains and horses. In fact, any student of history knows that plagues were usually transmitted at ports and trading cities. Determining that influenza traveled 631 miles a week in 1889, the speed of transportation at that time, is interesting, but not especially surprising.

What I find bizarre is how this rather pedestrian study is being interpreted in the press. The headline at the LA Times describing this study shouts: “You don’t need modern transportation to fuel a flu pandemic“. Well, no shit Sherlock. Most of us are aware of the fact that there were pandemics (plagues) before the invention of the aeroplane. However, the author of this article saves the murder of logic for the last paragraph where she writes:

Mathematical models suggested that speedy international air travel was not a crucial factor in the spread of the swine flu and that grounding flights would have been pointless. The French researchers say their results bolster that theory.

Whoa there! First, those “models” are nothing more than wishful thinking and/or agitprop designed to discourage policy makers from taking the only effective step that can slow a pandemic in its early stages. Recall that movement restrictions have been shown to work, over and over again, in actual pandemics. Second, a study describing how a pandemic virus moved in 1889 tells us absolutely nothing about the effect of airport closures in 2009.  Let me make some obvious statements.

1. In  1889 (and 1918), people traveled long distances by boat, trains and horses. Thus, if you wanted to stop a pandemic from spreading back then, you would need to stop people from using those means of transportation. When this was actually attempted, see the Maritime Quarantine in Samoa for an example, movement restrictions worked great.

2. In 2009, people travel long distances by planes, trains and automobiles. Thus, if you want to stop a pandemic from spreading today, you would need to stop people from using those means of transportation. This was *not* attempted in 2009, on the express advice of the WHO and the CDC, and hence the virus spread throughout the whole world without restraint.

3. In 1889, the technology to create a vaccine did not exist. Today, it does. If we had implemented movement restrictions at the beginning of this pandemic, we would have bought enough time to develop a vaccine. We only needed another 2-4 months. Because we did not get those 2-4 months, hundreds of thousands, perhaps millions, of people died. Most of them were children, pregnant women and middle-aged adults in their prime.

Public “Health” officials and politicians responding to pressure from corporations killed the people who died in this pandemic because they did not use a tool that was certain to work. Perhaps when they look in the mirror and see the ghosts of the dead behind them, they try to reassure themselves with fantasy models and twisted logic. But I have news for them.

The blood will never wash off your hands.

References

McLeod et al. (2008) Protective Effect of Maritime Quarantine in South Pacific Jurisdictions, 1918–19 Influenza Pandemic. Emerg Infect Dis. March.

Valleron et al. (2010) Transmissibility and geographic spread of the 1889 influenza pandemic. PNAS.

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Filed under Outbreak, public health, Science

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