If everywhere stayed home all the time, they would never get sick and would unlikely encounter an accident. If everyone stayed off bikes, there would never be a bike accident. It's all about balance. Telling people to stay off planes and out of classrooms at this stage of the flu is absurd.

VP Biden might avoid getting Swine Flu via his strategy, but he's long suffered from Foot in Mouth disease.

Why did Obama tap him for VP again?

If you can shoot someone in the face while being VP, I think it pretty much shows how worthless the office is.

Obviously being in close proximity to other people increases the chance of catching the flu. The question is whether the increased risk is great enough to warrant the costs of everyone avoiding the subway. Health experts seem to be saying no.

Mexico is taking more extreme precautions, but that is because the virus has already spread so broadly there. Although the number of known US cases is increasing they are still among a relatively small and currently contained population, mostly friends and relatives of those who traveled to Mexico for spring break. So containment at this point is focused on those individuals rather than the general population.

If everyone stayed out of cars, there would never be a bike accident.

Fixed that for you :-).

DAS said: "Why did Obama tap him for VP again?"

Um, because he's very smart and experienced in matters of supreme importance to the US such as foreign policy. Duh.

Would you prefer our previous president with Head Up His Ass disease, along with his VP who had Head Up YOUR Ass disease?

Ezra - you're wrong, in the larger sense. He described two things to avoid, both involving mass transit. Even if his call were responsible at this time, that's not enough to decrease the reproductive rate

He was very wrong in that he didn't stress the importance of hand-washing, coughing into a sleeve, and staying home when you're sick. So the many millions of people who weren't planning on traveling by air, and never travel by subway, can go about their business thinking that they are safer. Their transmission rate will be unchanged until they take the reasonable precautions.

You dug too far down into the details.

If everyone stayed out of cars, there would never be a bike accident.

There will still be bears...

OK, I'm not an epidemologist, but two things strike me about the Great Swine Flu Panic of 2009: A.), it turns out to be an ordinary mild flu, so it seems like the hype is way out of hand, but B.) nobody has immunity, which means that if it really reaches pandemic status, everybody gets it, the nation is idled for weeks and a shit ton of people die, as happens with the weakest flu strain.

So hey, what the hell, scare the crap out of us, Joe. Probably do us some good.

Richard Burr? Really?

I mean come on Ezra - if Yglesias wants to continue embarassing himself by pushing this "Burr nearly started a bank panic, talking about something that happened 6 months ago" meme, that's one thing. But that doesn't mean that you need to prosititute your intellectual integrity repeating this arrant nonesense, just because he's a friend of yours.

What is wrong with what he said. If your travel in a plane, train, subway, cab, etc. is non-essential, why not avoid it? If you can tele-conference, do your classwork via the web or close cirsuit TV, why not do it? It is not only being prudent for your health, it is being concerned for your family, co-workers and everyone else. Just because he is blunt and not always PC doesn't mean he is not speaking the truth wisely.

Am I reading that chart right?

If so, the smartest thing we could do right now is keep our children home for the next few weeks.

I can't believe I'm defending Biden, but the point of avoiding crowded enclosed areas isn't for personal concern about catching the flu - for 99% of people it just means they'll feel crappy and miss a few days work - it's about stopped the spread of the flu and letting it die back by avoiding creating new vectors by traveling a lot after being in close quarters with others. With a 2-day incubation period, there are lots of people who think they are well enough to travel who could be spreading it.

i don't see what the outrage is over biden's statements, and I sure don't understand the snark in these comments ("If everywhere stayed home all the time, they would never get sick and would unlikely encounter an accident. If everyone stayed off bikes, there would never be a bike accident. It's all about balance. Telling people to stay off planes and out of classrooms at this stage of the flu is absurd.")

Um, no, it's not absurd. It's called "a good way to avoid an unpleasant communicable disease at a time of increased risk".

One variable to keep in mind is that transmission is also cut off by population immunity. With a pandemic virus, nobody has immunity. What we are seeing with this bug is an easy transmission, human-to-human, probably because of the lack of immunity.

This pandemic will move to level 6 within days, it already is: spreading to two or more WHO regions. Level 5 means two or more countries in one WHO region (The Americas). It it has spread beyond regional in less than a week.

Right on, Ezra. Biden is 100% correct. I'm sure a lot of people can postpone a trip or telecommute. The objective is to make these places *less* crowded for a couple of weeks only.
I guess all your commenters work for the travel industry... :)

We could also shoot the people that become infected (or ill, or come close to an ill person). In fact let's nuke cities with reported cases. That'll surely help.

The question is one of effectiveness vs cost: will it be a lot more effective if everyone stays home (even when almost no one has the illness) vs isolating people and treating people who have been near a confirmed case? It *seems* like it might help, the question is whether it is worth it?

The CDC, who makes a business of this sort of thing, seems to think the current recommendations will be effective given the circumstances.

If it spreads a lot further they might start suggesting those sorts of things.

The point is it probably isn't going to make a big difference if a bunch of people without the illness congregate, and most people now aren't sick.

The problem is not whether Joe was right or wrong, but that what he said was a significant and unexpected ratcheting up of the "what you should do/not do" rhetoric coming from the government, and it suggests that government officials are privy to information about this thing being much worse than we are told.

People have a right to ask "hey, why is the Vice President telling his family to stay off of subways, but nobody is telling MY family to stay off of subways? What do they know that I do not, and why are they keeping it to themselves?"

Wrong. Inducing panic now -- meaning a run on emergency rooms, hoarding of antivirals, etc -- is worse than urging reasonable caution. So far this is a relatively mild flu, at least among populations with access to good public health.

Yeah, or there's this...

http://www.latimes.com/features/health/la-sci-swine-reality30-2009apr30,0,3606923.story

All of the information, Biden’s included, is originating from a fundamental lack of information. We don’t have a large enough sample of data to determine if this flu is worse than the average flu so all actions depend on your own sense of prudence.

Sure, this flu could end up being just a bonus flu season. People die every year during flu season and it would therefore take a significant amount of data to determine if swine flu is stronger than the average flu. Lacking that data, public health officials are erring on the side of prudence; particularly around children, elderly and the immuno-compromised. And we are erring on the side of prudence because, frankly, we do know that no one has an immunity and, again, lacking data, we have to proceed accounting for the possibility this could be really, really bad.

You could stay off the subways by riding your bike :-).

In general, catching this flu, or not catching this flu, is not the largest risk in your life. The largest risk for most US citizens is diseases of the unfit -- heart attack, stroke, effects of long-term high blood pressure, and diabetes. Year on year, that's a much larger killer than almost all flu epidemics (and it also makes you more vulnerable to the flu, should you catch it). And the best way to catch diseases of the unfit, is to use cars for all your travel; no biking, no walking to/from mass transit, etc.

And if the news is not telling you this, perhaps they don't have your best interests in mind, eh?

Biden is being honest.He may have gone further than the whitehouse wanted but hes right about what should be avoided till we get a grip on this outbreak.I got the same recommendations from a freind who works for the CDC and is now incomunicado in Mexico.Its always better to be safe than sorry,no?

Have you ever stopped to consider that maybe the vice president of the united states has been given information that you haven't, and that maybe his passing along personal advice to his close relatives might be based on that briefing?

" The overview was prepared for the World Bank."
Is there any irony in that?

"If everyone stayed out of cars, there would never be a bike accident.

Fixed that for you :-)."

Sorry, anonymous, but I just witnessed a bike accident in which one moving billboard ran up into another, fell over and hurt her leg. :-o

Both Travis and POTUS mention "coughing into your sleeve" but isn't it more important to SNEEZE into your sleeve?

Sneezes, after all, really propel the bad stuff in a wide area.

Not that I'm suggest people should NOT cough into their sleeves, but I just think POTUS and others need to add "sneeze" in there, too.

The question is one of effectiveness vs cost

Indeed. While there is a cost incurred by not using the subway, in most cases there is no cost incurred by not flying (unless you're in the travel biz). Airplanes have always (well, since the advent of pressurized cabins) been a great way for disease to spread. You've got a group of random people enclosed in a (relatively) airtight container for an extended period, and dry air being recirculated many times. Do you really need to make that trip? Probably not, what do you need to do that you can't do it closer to home?

As a bonus, if you don't fly, you won't have to deal with the goons from Fatherland Security.

Biden was right, as far as he went. He didn't say anything panic-inducing, what he said was simple common sense. And, while panic is absolutely NOT the correct reaction, it is important to be *aware*. The number of confirmed cases worldwide has multiplied almost 10 times over in the past 3 days, and the US now has more confirmed cases than Mexico ... and they're spread across the US.

Wash your hands, folks, and cover your coughs, and if you get sick stay home from work and stay away from people with compromised immune systems (and we all know plenty of them). Use your heads and we'll get through this just fine.

wow. we should all stop riding the subway? are you kidding? then all of nyc would shut down. which would shut down the economy here and make the recession worse. same goes for this ridiculous idea to close the mexican border. I don't know if you've noticed, but in the US this just as serious as any old flu at this point. you and joe biden need to stop speaking about that which you don't know. thanks.

"People have a right to ask "hey, why is the Vice President telling his family to stay off of subways, but nobody is telling MY family to stay off of subways?"

Um, I think the VP just DID tell you.

I think another thing to be mentioned is to move travel time, if you can. Use the subway outside rush hour, for example.

"In general, catching this flu, or not catching this flu, is not the largest risk in your life." What do mean by "in general"? This is not a "general" case. This is a specific case of a communicable disease to which no one is immune. A disease that regularly causes death. A disease that can be caught from a doorknob. AND a disease you can protect yourself from and that is time-limited.

So I disagree that your analogy is apt. Starting now to ride a bike to work might help you avoid the sneezer on the subway, yes, but it's rather stupid advice for the population "in general" as a way to avoid the flu.

It is especially bad advice for those who are elderly or immune-suppressed, like those of us who may be avid bicyclists but who have had a transplant.

Since I DO have a transplant, I'm going to avoid crowds for the next few weeks, have my hand sanitizer with me at all times, and wash my hands twice as frequently.

Whether this is a mild flu or not, the critical factor here is how quickly it is spreading. Even a very mild flu will cause a LOT of strain on emergency rooms, and we will need to treat secondary infections - often the real killer.

For that reason alone, reducing the rate of spread - right now - is important, and Biden was absolutely correct. Stay home, distance yourself, etc. Keep R down and spread out pandemic a bit.

Further, *we do not know if this is minor or not yet*. The data from Mexico, the only data which is from a sufficiently large sample, implies this is VERY severe. Maybe there is something else giong on there, maybe the sampling is off. Hopefully so, because if worlwide mortality rates are anything like what we're seeeing in Mexico, this is going to be absolutely disastrous. Far, far worse than 1918.

Which is another reason to avoid contact now - to give ourselves a jumpstart on the vaccine.

Millions take public transportation every day. They don't really have another means to get to work, not having cars, or the wherewithal to go tens of miles over bridges and thru traffic some other way.

If they suddenly did, they would STILL be in close contact with those who would be walking, biking, and so forth, over bridges etc. Or even sidewalks (e.g., Time Square area of Manhattan).

Is jury duty being canceled too?

Remember, this all started with, Last night, I spent some time with Arin Dutta's "The Effectiveness of Policies to Control a Human Influenza Pandemic: A Literature Review." Let's think again about how we spend our evenings, please.

I read John Barry's "The Great Influenza" (2004) - about the 1918 pandemic, 3 or 4 years ago. One point I still remember was that those leaders who took it as their main task to project optimism and avoid panic, were usually wrong and did a great deal of harm. And since we were in a World War at the time, the temptation to do so was especially great.

I say Biden's more right than wrong. Read Barry's book. It's the best thing out there.

Many of Biden's impolitic outbursts come from a desire to show that he has access to power and information that others don't. As in the famous "mark my words, within six months..." quote. His vanity is at war with his seriousness, and anything he says that smacks of a desire to demonstrate that he is in the know, should be dismissed out of hand.

The thing that brings down the transmission rate is not healthy people staying home, it's sick people staying home.

It doesn't really matter if you reduce the number of people on public transportation by 10 or 20 percent. If the sick person gets on, the disease will be transmitted at roughly the same rate.

This is why screening at airports and such is part of the key to reducing the spread, and why quarentines work by sequestering the sick people.

Obama was right on last night when he said "if you feel sick, don't go to work, don't take public transportation" or something similar.

Biden's just being Biden and saying something stupid and ill-timed.

TV has been scaring people for weeks now, while WHO and many world health organizations are walking the fine line between prevention and panic.

So the VP goes to the TV and says the right thing: take preventive steps -- and he's being criticized for that?

C'me one, leave politics aside for a second...

I've been meeting friends at a local restaurant on Tuesday nights for years. This week we didn't go. Probably won't go next week either. Biden's right: it's not stupid to be cautious. And besides, this wasn't policy. He was saying what HE would do and what he's telling family members to do.

And also, he likes the flavor of his own shoes.

Hmmmm interesting. So you're saying that (and the chart shows it as well) if the flu virus reproduction rate increases, then more people will get infected with the virus. That's very interesting -- how "greater reproduction" equals "more" -- and yet, so simple.

I do know that it is easier to bash someone than try and figure out if he is correct, but I think the President uses Joe to come out and tell the 'hard truths'...Then everyone can jump on it and say how dumb Biden is, etc. etc. while that little kernel of truth keeps ricocheting around your brain. The WH can laugh and say 'That's our Joe', the travel industry, the trains, the buses and all THEIR lobbyists are happy the PRESIDENT didn't say it and they rush to smear Joe. It's ALL good...or in work terms 'win win'...

Biden's controversial comment refers to a possible method of reducing transmission of the flu. So far there has been little audible discussion of what people could do to mitigate the consequences if many people become ill at once. Let me be specific about prudent steps that could taken ahead of time.

You coud accumulate food and water at home in case supplies are interrupted.

On medication: while antivirals and antibiotics require prescriptions, CDC says over-the-counter cold and flu medications will give symptomatic relief (but don't give them to children under the age of two; don't give aspirin-containing drugs to teenagers or younger). You might check that you have some of these on hand, just in case. Aches and fever can be helped with acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®, Nuprin®), and naproxen (Aleve).

You could download and print out the Centers for Disease Control and Prevention's home care advice (just as the stores might be empty if this hits hard, the hospitals will definitely be full) - it's at the CDC site, or search for the terms "swine influenza" "taking care of a sick person in your home"

www.cdc.gov/swineflu/guidance_homecare.htm

And finally, here's a doctor's advice about dealing with being sick without help - based on going through it herself:

http://www.fluwikie.com/index.php?n=Consequences.HomeAlone

I prefer to call it the Smithfield flu.

Some people's reading comprehension is pretty bad here. He didn't say, don't take the subways, he said don't do it if you've got reasonable alternatives. I live in Manhattan; I can walk to work easily, or I can take the subway. It makes more sense right now for me to the do the former. That's not panic, it's just common sense. And yes, some people don't have that option, and I don't hear Biden saying that they should just quit work or shut down the city's economy or any of other crazy shit that is seemingly being attributed to him.

Oh, and my walk to work takes me through Times Square. Even at its worst, the time you spend in close proximity to high numbers of people is nothing like you experience on the subway.

Telecommuting? Not everyone who lives in my neck of the woods is a Silicon Valley yuppie who is privileged to have that sort of job. Some of us rely on public transportation (and if everyone in the Bay Area stopped taking BART, Caltrain and MUNI, Silicon Valley itself would shut down quickly) and *need* it to get around. Way to go Biden for stroking more people's paranoia!

those of you who keep seeing people with heads up their asses must have mirrors on the walls of your small intestines.

Biden has already paid for himself 50 times over for brokering the deal that got Arlen Specter to switch parties.

Joe Biden, gaffs and all, has given the democrats the power implement policies without having to wait for the midterm election - which means no more timidity, less of the political cat-and-mouse, and health care without the danger that if we wait, the number of republican senators might increase in the midterms, thus making the number and severity of concessions much worse, and giving the republicans a better argument for their relevance.

Joe Biden may have single-handedly saved Obama's agenda.

He can line my anus with mirrors for all I care and I'll still be grateful.

The question is really, do we want to stop the flu?

I would probably agree with Biden on this one if the disease were more serious, but this is the flu. Maybe I am missing something, but the symptoms for the vast majority of Americans (who have health care, have had prenatal care, have a decent health care system, etc.) are not life threatening.

But, if I had a three-month-old or I had an elderly person living with me, Biden's comment makes sense.

"The thing that brings down the transmission rate is not healthy people staying home, it's sick people staying home.It doesn't really matter if you reduce the number of people on public transportation by 10 or 20 percent. If the sick person gets on, the disease will be transmitted at roughly the same rate."

Yeah but the issue is, people are infected AND infectious several days before they realize they are ill. So they go about their regular business, spreading the infection until they get symptoms and sequester themselves. If you reduce the DENSITY of people in public places, you automatically reduce the chances that the currently unwittingly ill ones will infect others.

Fort Worth, Texas has closed its public schools in response to the swine flu situation. (My parents live there so I've got an interest!)

If car, bike and hunting accidents were caused by infected human in close proximity breathing, coughing and sneezing on one another all of you who have so much to say about this bit of sound advice would have something to talk about but because they aren't your comments are just more hot air spreading toxic waste

If car, bike and hunting accidents were caused by infected human in close proximity breathing, coughing and sneezing on one another all of you who have so much to say about this bit of sound advice would have something to talk about but because they aren't your comments are just more hot air spreading toxic waste

But but but if we don't keep repeating that Joe Biden is a "Gaffe Machine" over and over and over then people might forget that it's just buying into complete bullshit rightwing message peddling, (just like Edwards' grooming and Dean's scream) and in fact is virtually nonexistent when compared with Bush Jr.'s regular verbal diarrohea outbursts.

The question is really, do we want to stop the flu?

The 1918 flu had a mortality rate of 2.5%.

We don't know where Mexico is, but early numbers were at 6.5%.

Yes, most flus are relatively minor. Some are very, very dangerous. We don't know for sure if this one is minor, dangerous, if this is an inconvenience or a disaster.

Avoiding public gatherings or confined spaces until we do know, maybe until we have a vaccine (since this flu will also surely mutate), is good and sound advice. And washing hands, etc.

"Um, no, it's not absurd. It's called 'a good way to avoid an unpleasant communicable disease at a time of increased risk'."

Exactly! I don't know why anyone would want to second guess the seriousness of this pandemic except unless the mere idea of it is too uncomfortable to contemplate. If 50 million people died back in 1918 from a virulent flu strain, imagine the numbers of people who will die the next time a truly killer flu virus finds its way into the human biomass.

So either there is or there is not an especially harmful variety of influenza on the loose. The world health organizations say there is. And with that in mind, it certainly makes sense to avoid aggregating in confined spaces.

"The thing that brings down the transmission rate is not healthy people staying home, it's sick people staying home.

It doesn't really matter if you reduce the number of people on public transportation by 10 or 20 percent. If the sick person gets on, the disease will be transmitted at roughly the same rate."

You are missing the obvious. If there are fewer healthy people to infect, then fewer people get sick. The transmission rate therefore goes down.

"The thing that brings down the transmission rate is not healthy people staying home, it's sick people staying home."

Actually, you are generally infectious 2 days prior to symptoms and 7 days during/after symptoms. Which means, 22% of your overall infectious time is *BEFORE* you or anyone else can tell that you are sick.

Traditionally, most disease transmission occurs during this not-visibly-infectious stage. Obviously, given the choice between the sniffling guy and the healthy looking one, you'll edge closer to the healthy one, often far closer than you would were the sick one not "pushing" you away. As a result, even though they are putting out fewer contagions with each breath, they are far more likely to infect you than the sick people.

Stopping healthy people from getting on the airplane might have little effect on the overall public health, but stopping "healthy" people from doing the same will do wonders. I'd guesstimate it at about a 2x or 3x differential.

OK, I'm not an apidemiologist either, but I know deaths, when they occur, will be measured in the n per 10,000 or n per 100,000 range. Since we've had so few cases, it's a little soon to say it's so mild we don't need to worry about it, isn't it?

Not to go all elitist, but shouldn't we be listening to the people who study flu outbreaks? I mean, your garden variety run of the mill flu kills about 30,000 people a year in the US. This strain is particularly worrying because it kills people with strong immune systems. In fact, the stronger your immune system, the worse off you'll be if you are infected. If the immunologists and virologists at the CDC say this could be the real deal, that's good enough for me.

You are missing the obvious. If there are fewer healthy people to infect, then fewer people get sick. The transmission rate therefore goes down.

It's true, it will go down, but very little. Getting R down from a whole plane/subway car to half of a plane/subway car does very little to stem the spread of an outbreak. You'll notice this in Ezra's graph as well. Going from R = 1.1 to R = 1.4 gives a huge jump in the infection rate. Going from R 1.7 to R = 2.4, (a larger increase both in absolute and relative terms) gives a much smaller jump in the infection rate.

Essentially, in controlling an outbreak the behavior of people who are exposed/infected is *vastly* more important than people who are currently healthy. Only once there are more people infected than can plausibly be identified and isolated does it make sense tell people to avoid going out in public (and this is largely as a way to control the sick people).

It's a fair point that people who are contagious don't know for a couple of days, but at this point the caution Obama urged is much more appropriate than what Biden said.

As someone mentioned what Obama's saying echos what the professional epidemiologists at the CDC are saying.

While politically incorrect because it may cause people to think twice before taking an airline trip, or even a bus or train trip, and we all know how much the airline and travel industries are hurting during this economic downturn, Joe Biden’s advice makes a lot of common sense.

From personal experience, we all know that colds and flues travel quickly in confined environments. That is why schools are asked to close down and you see the residents of densely populated Mexico City riding buses and subways wearing facial masks.

I wrote about a personal experience which proves the point in my blog at www.healthplansplus.blogspot.com.

The point of avoiding crowded enclosed areas isn't for personal concern about catching the flu - for 99% of people it just means they'll feel crappy and miss a few days work - it's about stopped the spread of the flu and letting it die back by avoiding creating new vectors by traveling a lot after being in close quarters with others.

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