Living in the Midst of a Flu Epidemic

I live in Korea, which has the second largest number of confirmed cases of the new coronavirus, after neighboring China of course. Koreans have a tendency to react with extreme caution and/or outrage, and with near-perfect unanimity, to such highly-publicized concerns. Thus, libraries have been shutting down indefinitely, schools and universities (including mine) are delaying the start of spring semester, and small businesses (coffee shops, restaurants, independent retailers of all kinds) are suffering deep losses as almost everyone in this very outing-obsessed country is suddenly staying home. On the other hand, no one is being dragged out of his house in the dead of night and locked in secret quarantine zones, as has apparently become the norm in Wuhan, China. That’s kind of nice.

A flu, even a particularly acute one, is a flu, not bubonic plague. Though it would certainly be desirable to halt its spread, the truth is that so far, according to the latest official estimates I have seen, the Korean fatality rate from this latest virus is barely one percent of all confirmed cases (9 out of 893 cases as I write this), which is not so extreme with a winter flu bug. It is true that this one has spread quickly in some regions of the country, but the death rate does not suggest anything close to the catastrophic event that the irresponsible news media, along with an equally irresponsible social media, tend to promote in the hearts of many laymen by using such scary-sounding terms as “epidemic” and “pandemic.” (Are most people aware that there are “flu epidemics” every year, everywhere?)

Furthermore, current fatality rates in all affected countries are likely to drop substantially once officials get a fuller handle on how many people have really been infected. In other words, the sheer newness of the outbreak has caught everyone unprepared to make any sort of accurate estimate as to how many people worldwide have actually contracted this bug, so that the real number — undoubtedly much greater than the currently-confirmed cases — will likely diminish the overall percentage of deadly cases in the long run.

That said, it is inescapably disconcerting to see masks on ninety percent of the people one passes on the street, as is now the case here, and to receive daily government alerts about newly discovered cases in one’s area. All the optics conspire to set one on one’s heels, to shake one’s foundational beliefs, confidence, and common sense, and even to curtail some people’s will to forge ahead with everyday life.

Such conditions — general social unease, bordering on mass anxiety — provide an excellent and ultimately beneficial impetus to refocus one’s view of the world through the lens of learning.

Today I read a 2015 academic study of the normal impact of influenza (all types) in South Korea. The authors noted that since many deaths related to influenza are never so labelled, due to the patients never having been confirmed as flu cases, mortality numbers derived from direct reporting of laboratory results must be assumed to underestimate actual flu-related deaths. They therefore chose instead to base their study’s calculations on a statistical model designed to adjust for likely but unconfirmed flu cases, and which model produces an account of flu-related deaths referred to as “the excess mortality estimate.” (“Excess” in this case meaning “beyond the normal death rate expected prior to factoring in seasonal influenza outbreaks.”)

Here is the result of the study, in the researchers’ own words (boldface added):

From 2003–2004 through 2012–2013 (10-year period), a total of 2,570,939 deaths were reported in Korea, with an average crude mortality rate of around 10 deaths per 100,000 people each week, and a slightly higher mortality rate during the winter (Appendix Figure 1). During this period, Korea experienced two influenza epidemics in most years, with the first peak in the early winter (December through January) followed by a smaller peak in the late spring (April through May). The pandemic influenza A(H1N1) virus emerged in 2009 (denoted “pH1N1”) has replaced the preceding seasonal influenza A(H1N1) subtype (denoted “sH1N1”) since 2009.

Based on the fitted regression model with R2>82%, influenza was associated with an excess of approximately 2,900 deaths on average each year in Korea, accounting for about 1.2% of all deaths in a given year. The average annual influenza-associated excess mortality rate was 5.97 per 100,000 people for all causes with annual estimates ranging from 2.04 in 2009–2010 to 18.76 in 2011–2012 (Table 1). The overall excess mortality was higher in years in which A(H3N2) was predominantly circulating. It was estimated that 3.84 all-cause deaths per 100,000 people were associated with infection of influenza A(H3N2); sH1N1 and influenza B caused an average of 0.76 and 1.45 excess deaths per 100,000 people each year, respectively. The estimate for pH1N1 was smaller and not statistically significant.

To further emphasize the bold conclusion quoted above, “influenza was associated with an excess of approximately 2,900 deaths on average each year in Korea, accounting for about 1.2% of all deaths in a given year.”

Granting that the current coronavirus epidemic is still ongoing, I nevertheless feel it is extremely worthy of note that as of this writing, the official Korean death count related to confirmed cases of this outbreak is nine (9). Nine so far, out of almost nine hundred confirmed cases of infection with the virus.

In a normal year, 2,900 Koreans die due to complications of influenza viruses of one sort or another. This virus has so far claimed just nine. That number will likely rise, perhaps a great deal, over the coming weeks. Will it rise enough to make 2020 an unusual year for flu-related deaths in Korea — I mean a real outlier year, as the level of news and social media obsession would have us believe? I don’t know. Let’s wait and see. I just thought this bit of sobering reality might be of some use, since the people who make their living or seek their popularity by creating excitement — particularly of the negative sort — seem uninterested in presenting what they call “the facts” within any proper context. 

I am wearing a mask these past few days, especially in public places, whether indoors or outdoors. I have no wish to project phony bravado, or to appear discourteous to my neighbors, friends, and co-workers. But I do, on the other hand, like my rational faculty too much to give it up to the pressures of public anxiety without a fight. 

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