WASHINGTON (Reuters) - The death rate from the pandemic H1N1 swine flu is likely lower than earlier estimates, an expert in infectious diseases said on Wednesday.
New estimates suggest that the death rate compares to a moderate year of seasonal influenza, said Dr Marc Lipsitch of Harvard University.
"It's mildest in kids. That's one of the really good pieces of news in this pandemic," Lipsitch told a meeting of flu experts being held by the U.S. Institute of Medicine.
"Barring any changes in the virus, I think we can say we are in a category 1 pandemic. This has not become clear until fairly recently."
The Pandemic Severity Index set by the U.S. government has five categories of pandemic, with a category 1 being comparable to a seasonal flu epidemic.
Seasonal flu has a death rate of less than 0.1 percent -- but still manages to kill 250,000 to 500,000 people globally every year.
A category 5 pandemic would compare to the 1918 flu pandemic, which had an estimated death rate of 2 percent or more, and would kill tens of million of people.
An estimate published in the journal Eurosurveillance last month by the French Institute for Public Health Surveillance put the mortality rate far higher, at 0.4 percent for all age groups.
HIGHER MORTALITY?
Lipsitch took information from around the world on how many people had reported they had influenza-like illness, which may or may not actually be influenza; government reports of actual hospitalizations and confirmed deaths.
He came up with a range of mortality from swine flu ranging from 0.007 percent to 0.045 percent.
Either way, having new information about how many people were infected and did not become severely ill or die makes the pandemic look very mild, he said.
"The news is certainly better than it was in May and even better than it was at the beginning of August," Lipsitch said.
But another expert cautioned this does not mean the pandemic will not have severe effects on people and communities because it will infect more people than seasonal flu usually does in any given year.
"This is not a severe pandemic," said Dr. Jeffrey Duchin of Seattle & King County Public Health and the University of Washington.
"We are going to see probably twice as many people die from the flu as we do in a typical flu season. That is tens of thousands of people. And many of these people are going to be younger."
H1N1 swine flu was declared a pandemic in June after flashing around the world in six weeks, in part because most people have virtually no immunity to it. Experts all said a true death rate would not be clear for weeks because it is impossible to test every patient and because people with mild cases may never be diagnosed.
This lack of information made the epidemics in various countries and cities look worse at first than they actually were, Lipsitch said. People sick enough to be hospitalized are almost always tested first.
"Yes, there's been hype, but I don't think it's been an outrageous amount of hype," Lipsitch said.
Seasonal flu is usually far worse among the elderly, who make up 90 percent of the deaths every year. In contrast, this flu is attacking younger adults and older children, but they are not dying of it at the same rate as the elderly do during seasonal influenza, Lipsitch said.
Saturday, September 19, 2009
Thursday, September 17, 2009
Justice in Gaza
Richard Goldstone, the former chief prosecutor for war-crime tribunals on Rwanda and the former Yugoslavia, is the head of the United Nations Fact-Finding Mission on the Gaza Conflict.
By RICHARD GOLDSTONE
I ACCEPTED with hesitation my United Nations mandate to investigate alleged violations of the laws of war and international human rights during Israel’s three-week war in Gaza last winter. The issue is deeply charged and politically loaded. I accepted because the mandate of the mission was to look at all parties: Israel; Hamas, which controls Gaza; and other armed Palestinian groups. I accepted because my fellow commissioners are professionals committed to an objective, fact-based investigation.
But above all, I accepted because I believe deeply in the rule of law and the laws of war, and the principle that in armed conflict civilians should to the greatest extent possible be protected from harm.
In the fighting in Gaza, all sides flouted that fundamental principle. Many civilians unnecessarily died and even more were seriously hurt. In Israel, three civilians were killed and hundreds wounded by rockets from Gaza fired by Hamas and other groups. Two Palestinian girls also lost their lives when these rockets misfired.
In Gaza, hundreds of civilians died. They died from disproportionate attacks on legitimate military targets and from attacks on hospitals and other civilian structures. They died from precision weapons like missiles from aerial drones as well as from heavy artillery. Repeatedly, the Israel Defense Forces failed to adequately distinguish between combatants and civilians, as the laws of war strictly require.
Israel is correct that identifying combatants in a heavily populated area is difficult, and that Hamas fighters at times mixed and mingled with civilians. But that reality did not lift Israel’s obligation to take all feasible measures to minimize harm to civilians.
Our fact-finding team found that in many cases Israel could have done much more to spare civilians without sacrificing its stated and legitimate military aims. It should have refrained from attacking clearly civilian buildings, and from actions that might have resulted in a military advantage but at the cost of too many civilian lives. In these cases, Israel must investigate, and Hamas is obliged to do the same. They must examine what happened and appropriately punish any soldier or commander found to have violated the law.
Unfortunately, both Israel and Hamas have dismal records of investigating their own forces. I am unaware of any case where a Hamas fighter was punished for deliberately shooting a rocket into a civilian area in Israel — on the contrary, Hamas leaders repeatedly praise such acts. While Israel has begun investigations into alleged violations by its forces in the Gaza conflict, they are unlikely to be serious and objective.
Absent credible local investigations, the international community has a role to play. If justice for civilian victims cannot be obtained through local authorities, then foreign governments must act. There are various mechanisms through which to pursue international justice. The International Criminal Court and the exercise of universal jurisdiction by other countries against violators of the Geneva Conventions are among them. But they all share one overarching aim: to hold accountable those who violate the laws of war. They are built on the premise that abusive fighters and their commanders can face justice, even if their government or ruling authority is not willing to take that step.
Pursuing justice in this case is essential because no state or armed group should be above the law. Western governments in particular face a challenge because they have pushed for accountability in places like Darfur, but now must do the same with Israel, an ally and a democratic state.
Failing to pursue justice for serious violations during the fighting will have a deeply corrosive effect on international justice, and reveal an unacceptable hypocrisy. As a service to the hundreds of civilians who needlessly died and for the equal application of international justice, the perpetrators of serious violations must be held to account.
By RICHARD GOLDSTONE
I ACCEPTED with hesitation my United Nations mandate to investigate alleged violations of the laws of war and international human rights during Israel’s three-week war in Gaza last winter. The issue is deeply charged and politically loaded. I accepted because the mandate of the mission was to look at all parties: Israel; Hamas, which controls Gaza; and other armed Palestinian groups. I accepted because my fellow commissioners are professionals committed to an objective, fact-based investigation.
But above all, I accepted because I believe deeply in the rule of law and the laws of war, and the principle that in armed conflict civilians should to the greatest extent possible be protected from harm.
In the fighting in Gaza, all sides flouted that fundamental principle. Many civilians unnecessarily died and even more were seriously hurt. In Israel, three civilians were killed and hundreds wounded by rockets from Gaza fired by Hamas and other groups. Two Palestinian girls also lost their lives when these rockets misfired.
In Gaza, hundreds of civilians died. They died from disproportionate attacks on legitimate military targets and from attacks on hospitals and other civilian structures. They died from precision weapons like missiles from aerial drones as well as from heavy artillery. Repeatedly, the Israel Defense Forces failed to adequately distinguish between combatants and civilians, as the laws of war strictly require.
Israel is correct that identifying combatants in a heavily populated area is difficult, and that Hamas fighters at times mixed and mingled with civilians. But that reality did not lift Israel’s obligation to take all feasible measures to minimize harm to civilians.
Our fact-finding team found that in many cases Israel could have done much more to spare civilians without sacrificing its stated and legitimate military aims. It should have refrained from attacking clearly civilian buildings, and from actions that might have resulted in a military advantage but at the cost of too many civilian lives. In these cases, Israel must investigate, and Hamas is obliged to do the same. They must examine what happened and appropriately punish any soldier or commander found to have violated the law.
Unfortunately, both Israel and Hamas have dismal records of investigating their own forces. I am unaware of any case where a Hamas fighter was punished for deliberately shooting a rocket into a civilian area in Israel — on the contrary, Hamas leaders repeatedly praise such acts. While Israel has begun investigations into alleged violations by its forces in the Gaza conflict, they are unlikely to be serious and objective.
Absent credible local investigations, the international community has a role to play. If justice for civilian victims cannot be obtained through local authorities, then foreign governments must act. There are various mechanisms through which to pursue international justice. The International Criminal Court and the exercise of universal jurisdiction by other countries against violators of the Geneva Conventions are among them. But they all share one overarching aim: to hold accountable those who violate the laws of war. They are built on the premise that abusive fighters and their commanders can face justice, even if their government or ruling authority is not willing to take that step.
Pursuing justice in this case is essential because no state or armed group should be above the law. Western governments in particular face a challenge because they have pushed for accountability in places like Darfur, but now must do the same with Israel, an ally and a democratic state.
Failing to pursue justice for serious violations during the fighting will have a deeply corrosive effect on international justice, and reveal an unacceptable hypocrisy. As a service to the hundreds of civilians who needlessly died and for the equal application of international justice, the perpetrators of serious violations must be held to account.
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Sixburgh
