This past week Bloomberg ran a piece (here)about the newest generation of computer simulation being utilized to inform the US government of likely impacts of disasters, both natural, and not, and PanFlu is one of the disasters being modeled. While I applaud the efforts, to say nothing of the technical sophistication, it is a science that has genuine limits. (All emphasis that follows is mine)
[snip]
While scientists can simulate some behavior, they haven’t been able to create a computerized version of the human thought process. “What’s really tripped us up is the cognitive,” said Bill Wimbish, a retired Army colonel who uses simulations in teaching crisis management at the National Intelligence University in Langley, Virginia. “It’s hard to model irrational behavior.”
We may not be able to model human behavior in a disaster, but we can be informed of how they have reacted in the past, irrational or otherwise.
The closest thing that we can point to that would inform us of human behavior to the threats of a severe PanFlu event is the (pneumonic) plague, and there are any number of historical accounts to draw upon.
How would a large urban population likely respond to the news that something with a frightful fatality rate? I look to two examples: the appearance of pneumonic plague in 1994 in Surat, India, and Daniel Defoe’s A Journal of the Plague Year.
First, the recent history:
Psychological effects of the 1994 plague outbreak in Surat, India
Military Medicine, Dec 2001 by Ramalingaswami, V
The plague outbreak in Surat, India in September 1994 stirred a nationwide panic and a near international isolation of India. These are aspects that need serious attention. A large amount of damage to India’s image and an immense economic loss occurred. Some advice for the future is suggested.
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In August 1994, a village in Maharashtra State experienced an outbreak of suspected bubonic plague, which was followed by an outbreak of suspected pneumonic plague in the city of Surat in Gujarat State in September 1994.
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“During September 1994, government hospitals and private clinics in the City of Surat in the… state of Gujarat reported an increasing number of patients with a highly fatal illness resembling acute pneumonia. Based on clinical laboratory and radiological findings a presumptive diagnosis of an outbreak of pneumonic plague was made.”‘ Between August 26 and October 5, 1994, 5,150 suspected cases of pneumonic or bubonic plague were reported from eight states of India, including 2,793 from Maharashta state, 1,391 from Gujarat state, 749 from Delhi, and 169 from five other states.’ A total of 167 cases were confirmed by serology by October 5, and there were 53 deaths, 49 from SUrat.2
It has been estimated that India incurred a 3- to 4-billiondollar loss in the span of 2 to 3 weeks. In one night, an avoidable exodus of 600,000 people fled Surat by whatever means available, including horse carriage, ox car, or even on foot. Of course, no train tickets were available, so people just jumped on any train. Doctors fled the city saying, “this plague, nothing can be done.”
The city of Delhi, some 1,200 km from Surat, immediately began to go into a state of panic. People were showing the reverberations of the scare from the plague in Surat. A newspaper clipping from that time was headlined “Plagued by Doubt.” People used available materials for masks to protect against infection. For example, women wearing saris would bring the cloth up and cover their nose and mouth. I do not know what the pore size would be or whether it would protect against plague aerosols.
Hospitals in Delhi were flooded.
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Chaos reigned supreme, rumor was the ruler. Lack of accurate information, lack of transparency, was the bane of the whole thing. This is the first thing that I would emphasize: Transparency, be transparent and provide the information. Come out and do not hide. Present the samples to the Institute of Medical Sciences and wait for the results. This should be the public posture all the time.
Of course, the international impact was tremendous. Export orders were cancelled from India with no notice. The effects on the economy of India were very serious. The atmosphere was jittery all around. The Gulf States, where 1.5 million Indians earn their livelihood, severed all links with India and forced an asphyxiating commercial quarantine on India. India’s vegetables, most fruit, flowers, garment industry, tourism, and foreign investment were all affected. In this age of instant communication, this is sad. Of course, you cannot blame them; they did this out of the belief that they were protecting themselves by not allowing vegetables and other products from India into their countries.
The capital city of Delhi was in the clutches of a scare. People purchased and hoarded tetracycline. There was no tetracycline left on the market. It was all gone. A little runny nose and a cough, you were immediately rushed to the hospital. India’s tourism industry was ruined overnight. The streets were empty in Bombay, in Delhi, and even in distant place like Calcutta (some 1,500 km away from Surat). Betel leaves are chewed by Indians. Even though we are not on the best of terms with Pakistan, we still provide them with betel leaves. Pakistan suddenly stopped buying betel leaves because of the plague. The scare was even felt in Russia.
We must also address the issue of distinguishing between naturally occurring events or outbreaks and weapons of mass destruction (WMD) events and develop our technological armory to be able to make an early distinction. The speed of response of state governments in our third world countries cannot match the speed of travel, which can spread the message all over, even before the state government is aware. In fact, we often hear about such outbreaks from the media and TV before the government is aware that such a thing has taken place.
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A
Journal of the Plague Year, first published in 1722, is none the less very approachable for the modern reader and I highly recommend it to those who have not, as yet, taken it up. There are genuine lessons and insights that are applicable even in the first decade of the twenty-first century.
The book opens:
It was about the beginning of September, 1664, that I, among the rest of my neighbours, heard in ordinary discourse that the plague was returned again in Holland; for it had been very violent there, and particularly at Amsterdam and Rotterdam, in the year 1663, whither, they say, it was brought, some said from Italy, others from the Levant, among some goods which were brought home by their Turkey fleet; others said it was brought from Candia; others from Cyprus. It mattered not from whence it came; but all agreed it was come into Holland again.
This is akin to the Flu Obsessed (a term already used in Oct05 to describe the people who concern themselves with PanFlu) watching H5N1 in distant lands and worrying about a very bad thing coming our way. It is also interesting to note for the fact that even with advanced warning the officials and residents of London did nothing by way of actions ahead of the plague’s arrival at the outskirts of the city that might have lessened the impact once it did take hold. Those that took action to protect themselves waited until the very last, and many of those too late.
Further in, telling of when the plague arrives in London:
Till this week the city continued free, there having never any died, except that one Frenchman whom I mentioned before, within the whole ninety-seven parishes. Now there died four within the city, one in Wood Street, one in Fenchurch Street, and two in Crooked Lane. Southwark was entirely free, having not one yet died on that side of the water.
I lived without Aldgate, about midway between Aldgate Church and Whitechappel Bars, on the left hand or north side of the street; and as the distemper had not reached to that side of the city, our neighbourhood continued very easy. But at the other end of the town their consternation was very great: and the richer sort of people, especially the nobility and gentry from the west part of the city, thronged out of town with their families and servants in an unusual manner; and this was more particularly seen in Whitechappel; that is to say, the Broad Street where I lived; indeed, nothing was to be seen but wagons and carts, with goods, women, servants, children, &c.; coaches filled with people of the better sort and horsemen attending them, and all hurrying away; then empty wagons and carts appeared, and spare horses with servants, who, it was apparent, were returning or sent from the countries to fetch more people; besides innumerable numbers of men on horseback, some alone, others with servants, and, generally speaking, all loaded with baggage and fitted out for travelling, as anyone might perceive by their appearance.
This was a very terrible and melancholy thing to see, and as it was a sight which I could not but look on from morning to night (for indeed there was nothing else of moment to be seen), it filled me with very serious thoughts of the misery that was coming upon the city, and the unhappy condition of those that would be left in it.
From pg 75 of the Barnes and Noble edition:
I must here take further notice that nothing was more fatal to the inhabitants of this city than the supine negligence of the people themselves, who, during the long notice or warning they had of the visitation, made no provision for it by laying in store of provisions, or of other necessaries, by which they might have lived retired and within their own houses, as I have observed others did, and who were in a great measure preserved by that caution….
A bit further along…
And here I must observe again, that this necessity of going out of our houses to buy provisions was in a great measure the ruin of the whole city, for the people catched the distemper on these occasions one of another, and even the provisions themselves were often tainted; at least I have great reason to believe so; and therefore I cannot say with satisfaction what I know is repeated with great assurance, that the market-people and such as brought provisions to town were never infected.
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However, the poor people could not lay up provisions, and there was a necessity that they must go to market to buy, and others to send servants or their children; and as this was a necessity which renewed itself daily, it brought abundance of unsound people to the markets, and a great many that went thither sound brought death home with them.
So, we have clear warning that when a threat is on the horizon we should take responsibility to guard the safety and wellbeing of ourselves and our loved ones, to the best of our ability, before the threat arrives on our doorsteps. While chaos and irrationality may not fit snuggly into computer models, they need to be accounted for none the less.
Have the modelers mentioned in the opening of this entry taken into account the lessons of history about the irrational behaviors that we may be safe in assuming? I don’t know the answer to that question, but I do know that expert knowledge is highly specialized. Those that model disaster may not be students of history, and those that inform the modelers of the likely epidemiology of a disease outbreak may not be students of human psychology.
What would 600,000 residents, laden with possessions, attempting to flee the city of New York all at once, as happened in Surat in 1994, look like? Or, 5% of the population of the greater metropolitan area of New York, a much more mind boggling, and infrastructure overwhelming, number of people? To be fair, this has actually been looked at, although no answer to the problems it would create currently exists.
And, what of those left behind, as Defoe put it:
…it filled me with very serious thoughts of the misery that was coming upon the city, and the unhappy condition of those that would be left in it.
History speaks to us, is anyone, other than the Flu Obsessed, listening?
SZ
