Robert Redfield, director of the Centers for Disease Control and Prevention (CDC), called on US citizens to use the coming months to prepare — and get their flu shots to prevent worsening second wave of the coronavirus infections.

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” he was quoted as saying in an interview with the Washington Post published late Tuesday.

“We’re going to have the flu epidemic and the coronavirus epidemic at the same time,” he said, AFP reported.

The US has recorded more than 800,000 confirmed cases of COVID-19 since the start of the pandemic, according to a tally from Johns Hopkins University, with 44,845 deaths — the most reported of any country.

Billions of people around the world have been ordered to stay at home in recent months as governments try to prevent the highly contagious coronavirus from overwhelming healthcare systems.

The US, like other countries, has scrambled to secure enough ventilators and personal protection equipment for medical staff while the death toll mounts.

Redfield said the virus arrived in the US just as regular flu season — which itself can strain healthcare systems — was waning.

If the two diseases had peaked at the same time, he told the Post, “it could have been really, really, really, really difficult” for health systems to cope.

Getting a flu shot ahead of next flu season, he said, “may allow there to be a hospital bed available for your mother or grandmother that may get coronavirus”.

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Epidemiology incorporates everything from geography to complex mathematics in its effort to understand the spread of disease. Here are some basic epidemiological concepts that can help you get past the panic, misinformation, and xenophobia that tend to drive conversations around a newly emerging illness.

Spread it out

One quantity scientists use to measure how a disease spreads through a population is the “basic reproduction number,” otherwise known as R0 (pronounced “R naught,” or, if you hate pirates, “are not”). This number tells us how many people, on average, each infected person will in turn infect. While it doesn’t tell us how deadly an epidemic is, R0 is a measure of how infectious a new disease is and helps guide epidemic control strategies implemented by governments and health organizations.

If R0 is less than one, the disease will typically die out: Each infected person has a low chance of passing the infection along to even one additional individual. An R0 is larger than one means each sick person infects at least one other person on average, who then could infect others until the disease spreads through the population. For instance, a typical seasonal flu strain has an R0 of around 1.2, which means for every five infected people, the disease will spread to six new people on average, who pass it along to others.

Measles is a champion disease in this respect. Its R0 is usually cited between 12 and 18, meaning each person with measles infects between 12 and 18 new people in an unvaccinated population. In the era before widespread vaccination, measles could easily sicken an entire school’s worth of children. Vaccinate your kids!

“Herd immunity” also depends on R0. The more people immune to a disease in a population, the fewer are available to be infected. If immunity reaches a critical level through vaccination or just naturally running out of new people to infect, the disease is starved out. Herd immunity is easier to achieve for lower R0 values because the disease doesn’t spread as readily.

But it’s important to remember that R0 is a statistical estimate of how a disease spreads in a particular population if it’s left unchecked. SARS and MERS both have higher R0 values (between two and five) than the seasonal flu, but never spread widely enough to become worldwide epidemics. Flu, on the other hand, is always widespread despite having a relatively small basic reproduction number: The United States Centers for Disease Control (CDC) estimate between three and 11 percent of the US population gets sick with the flu every year.

That brings us back to the coronavirus now known as COVID-19. Because the disease is fairly new to medicine, researchers are still tabulating the data required to calculate R0 more or less in real-time. As of February 19, 2020, estimates placed R0 above 1.4 but below four, well within the range for other coronaviruses like SARS.

Deadly serious

Another important number for understanding diseases is the “case fatality rate” or CFR: What percentage of people who have a disease die from it? On one extreme, we have rabies, which has a 99 percent fatality rate if untreated. On the other is the common cold, which has a relatively high R0 but is almost never fatal (the exceptions being mostly immunocompromised people). The seasonal flu has a low CFR, but enough people get it every year that the CDC estimates as many as 30,000 Americans may have died from it between October 2019 and February 2020.

Similarly, measles is extremely infectious, but rarely fatal (though its spooky effect on the immune system can make victims susceptible to other life-threatening diseases). Smallpox was less infectious with an R0 of five to seven, but its CFR of roughly 30 percent made it devastating. Measles, though less serious, has such a high infection rate that it needs a much larger vaccinated population for proper herd immunity; smallpox vaccines achieved herd immunity at much lower rates and wiped the illness out entirely by 1980.

The CFR for an emerging disease like COVID-19 is remarkably hard to estimate accurately, simply because all the numbers involved are relatively small. A preliminary calculation from February 8, 2020, estimates CFR of about 1.4 percent — meaning out of 1,000 infected people, around 14 will die — but that’s based only on cases from outside China. The numbers will likely shift over the next weeks and months, but the CFR for COVID-19 seems to be lower than for SARS and MERS. However, the high concentration of cases in one region of China is putting huge stress on the health care infrastructure, which is a concern for any major epidemic.

Knowing what we don’t know

Epidemiology is a game of iterated function systems (IFS) and approximations. Case fatality rates, basic reproduction numbers, and other quantities are derived from real-world data using mathematical models of disease. Because infections depend on a complex set of conditions, including things like weather and holiday travel, two outbreaks of the same virus might result in different-looking epidemics. That’s why R0 is usually given as a range of numbers and we hedge our language: Not because our models are bad, but because reality itself is messy.

At the same time, epidemiology demystifies disease and guides how we deal with it. It both models how diseases jump from nation to nation in our interconnected age and show that citywide quarantines and travel bans don’t curtail the spread of infection very much — while seriously disrupting the lives of the people who aren’t infected, along with their respective economies. And finally, epidemiology lets us compare COVID-19 to other epidemics, to inform us how bad it currently is and how widespread it might become if governments don’t handle it properly. We might not know everything about COVID-19 yet, but the knowledge from epidemiology helps us understand what it will take to beat it.

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TEHRAN (Iran News) – CEO of a knowledge-based company said Iranian flu vaccine will hit the market in a few months after obtaining the necessary permits.

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Another 2,197 people who came into contact with infected people were isolated, with 765 so far released from observation, National Health Commission vice-minister Li Bin told reporters, adding that there was already evidence that the virus was being spread through “respiratory transmission”.

“Recently there has been a big change in the number of cases, which is related to our deepening our understanding of the disease, improving diagnostic methods and optimizing the distribution of diagnostic kits,” Li said, Reuters reported.

As China vowed to tighten containment measures in hospitals, the World Health Organization (WHO) was due to hold an emergency meeting on Wednesday to determine whether the outbreak of the new coronavirus constitutes a global health emergency.

The virus, originating in the central Chinese city of Wuhan in Hubei at the end of last year, has spread to Chinese cities including Beijing, Shanghai, and Macau, as well as the United States, Thailand, South Korea, Japan, and Taiwan.

The Chinese government has been providing daily updates on the number of cases in a bid to head off public panic, as millions of people prepare to travel domestically and abroad for the country’s Lunar New Year celebrations starting this week.

“At present, during the Lunar New Year, the rise in the mobility of the public has objectively increased the risk of the epidemic spreading and the difficulty of prevention and control,” Li warned, noting that the mutation of the virus could also bring further risks.

Fears of a pandemic similar to the Severe Acute Respiratory Syndrome (SARS) outbreak that started in China and killed nearly 800 people in 2002-2003 have roiled global markets, with aviation and luxury goods stocks hit particularly hard and the Chinese Yuan tumbling.

On Tuesday the death toll stood at six with about 300 confirmed cases.

WHO spokesman Tarik Jasarevic said new cases of the coronavirus would appear as China stepped up monitoring. “If you increase surveillance and testing you are likely to get new numbers,” he added.

Li said there was as yet no evidence of “super-spreaders” capable of disseminating the virus more widely, as happened during the SARS outbreak, but authorities were alert to the potential danger.

Fifteen medical personnel are among those infected in China. Symptoms include fever, coughing and difficulty breathing. The viral infection can cause pneumonia and can be passed from person to person.

Though the origin of the virus has yet to be identified, WHO said the primary source was probably animal. Chinese officials have linked the outbreak to Wuhan’s seafood market.

The new virus was adapting and mutating, underscoring the challenges for health authorities in controlling the outbreak, Gao Fu, the director-general of China’s Center for Disease Control and Prevention, told a news briefing.

Officials found to have covered up infections would be a “sinner for eternity before the Party and the people”, the Chinese Communist Party’s Central Political and Legal Commission said in a post on its WeChat social media account that was subsequently deleted.

Taiwan President Tsai Ing-wen called on China on Wednesday to share “correct” information about a new coronavirus and for the WHO not to exclude Taiwan from collaboration on the outbreak for political reasons.

Taiwan is not a member of the WHO due to the objection of China, which considers the island a Chinese province with no right to participate in international organizations unless it accepts it is part of China.

Taiwan on Tuesday confirmed its first case of the coronavirus, a woman returning to Taiwan from Wuhan.

Taiwan joined Australia in warning citizens to avoid travel to Wuhan, and airports around the world have stepped up screening of travelers from China.

“I want to call on our nationals please not to visit this region if not necessary,” Tsai wrote on her Facebook page. Tsai also ordered tour groups from Wuhan not to come to Taiwan for the time being.

Chinese-ruled Macau confirmed on Wednesday its first case of pneumonia linked to the newly identified coronavirus and tightened body-temperature screening measures in casinos and around the city.

Qualifying boxing matches for Asia and Oceania region for the 2020 Olympic Games in Tokyo set to take place in Wuhan in February have been canceled due to fears over the virus, Japan’s Kyodo news agency said on Wednesday.

However, the Australian women’s soccer team, the Matildas, were still preparing for a trip to Wuhan for Olympic qualifiers early next month, head coach Ante Milicic has said.

Hong Kong’s Cathay Pacific Airways Ltd (0293.HK), one of the airlines affected the most by the SARS outbreak, said it would allow flight attendants to wear a surgical mask while operating mainland China flights due to concerns over the new virus.

The Cathay Pacific Airways Flight Attendants Union said it had received a “tremendous” amount of messages from members concerned over catching the virus, and attendants on all flights should have the option to wear a mask.

“All of them are worried about the risk they are taking every time they go to work,” the union said on its Facebook page.

Cathay’s website said that with immediate effect, rebooking, rerouting and refund charges would be waived for all tickets arriving to or departing from Wuhan through Feb. 15.

China’s aviation regulator late on Tuesday told mainland carriers to refund or change flights to Wuhan without charge at the request of passengers, which analysts at Daiwa said had affected more than 24 airlines.

Some other travel firms are also allowing free cancellations on bookings to Wuhan.

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TEHRAN (Iran News) – A senior Iranian Health Ministry official said that an ongoing flu epidemic has claimed the lives of 56 people since its outbreak more than a couple of months ago.

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Flu is sweeping the United States, killing at least 37 children and sending the most people nationwide in search of medical care since the 2009 “swine flu” pandemic, US officials said Friday.

This year, the most common strain of influenza is H3N2, and nearly every state has been hit hard, said the US Centers for Disease Control and Prevention.

“For the past three weeks, the entire country has been experiencing lots of flu, all at the same time,” said Dan Jernigan, director of the Influenza Division at the National Center for Immunization and Respiratory Diseases, part of the CDC.

This marks the “most flu activity since 2009,” he told reporters on a conference call.

A total of 6.6 percent of all people going to clinics and emergency departments so far this season did so because of the flu, he said.

“This is the highest level of activity recorded since the 2009 pandemic, which peaked at 7.7 percent.”

The 2009 H1N1 pandemic, then known widely as “swine flu,” swept 206 countries and overseas territories and killed more than 6,770 people, according to the World Health Organization.

If the 2009 pandemic is not included for comparison, because it was considered such an outlier, the most recent season when as many people sought care for the flu in the United States was 2003-2004, when the level peaked at 7.6 percent, Jernigan said.

What really sets this season apart is that “flu activity became widespread within almost all states and jurisdictions at the same time,” said Jernigan.

“Flu activity has stayed at the same level — at the national level — for three weeks in a row, with 49 states reporting widespread activity.”

The bulk of flu cases have been among senior citizens — those 65 and older — and baby boomers aged 50-64.

The true severity of this season will not be known for months, until all the data is collected and analyzed.

The season can run from October to May, meaning it is only about halfway over.

“In past seasons that are like this one, we have estimated that by the end of the season, 34 million Americans had gotten the flu,” Jernigan said.

During H3N2 outbreaks in past seasons, about 56,000 people on average have died, he added.

“We anticipate there will be more pediatric deaths this year,” he added, saying the actual number of children who have died from the flu so far this season may be twice the current estimate.

A big concern is the high number of cases of H3N2, which tends to be more deadly than other types of the flu.

Health officials are still urging people to get vaccinated despite questions about the shot’s effectiveness.

“The vaccines just don’t do that well against H3N2,” said Jernigan.

“The immunity that was gathered last year may not be enough to prevent another wave of H3N2 this year.”

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