Four small cities may have played an outsize role in spreading deadly flu

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People stand in line to get vaccinated towards a virus spreading in Omaha, Nebraska, in 2009.

AP Photo/Nati Harnik

Four small cities may have played an outsize role in spreading deadly flu

You’d suppose new viruses begin spreading first in large cities, with their packed city streets and huge worldwide airports. But a brand new examine challenges this concept. Researchers have discovered that over the past influenza pandemic, the virus first gained a U.S. foothold in 4 smaller cities in the Midwest, the Southeast, and California’s Central Valley. From these hubs it engulfed your complete nation, ultimately sickening greater than 60 million individuals and killing greater than 12,000.

The findings recommend these looking for to fight large epidemics must look past the main inhabitants facilities, says epidemiologist Dennis Chao of the Institute for Disease Modeling in Seattle, Washington, who was not concerned with the examine. “Anything we can learn about forecasting [flu’s] spread is useful.”

The concept that main cities and their airports are essential drivers of worldwide contagion makes intuitive sense, and it’s supported by mathematical fashions. But fashions don’t all the time replicate actuality. Researchers choose real-world information to trace how an epidemic spreads. Yet for influenza, fine-grained epidemiological information have been all the time onerous to return by.

That modified with the 2009 pandemic. For the primary time, researchers had entry to geographically tagged digital well being claims to insurance coverage firms that confirmed the place individuals received sick on the native stage.

When Stephen Kissler, an epidemiologist on the University of Cambridge in the United Kingdom, and his colleagues analyzed these information and used them to construct a brand new mannequin of how flu unfold, they discovered that packed metropolises comparable to New York City and San Francisco, California—residence to eight.6 million and 1 million individuals, respectively—weren’t the place the pandemic picked up steam. Instead, four cities that are home to between 100,000 to 600,000 people each were the hubs that “seeded” the U.S. epidemic, they report in a paper in press atEpidemics: Grenada, Mississippi; Albany, Georgia; Stockton, California; and Omaha, Nebraska. Three-quarters of all U.S. instances had its origins in one in all these cities.

“The ‘Hollywood’ notion of a highly infectious pandemic [starting in a major city] is not the way things happen in reality,” Kissler says. The outcomes imply that components past inhabitants density and journey are essential, he says. For occasion, earlier work has hinted that faculty begin dates would possibly play a role—younger children usually function viral incubators in their group—or the diploma to which a inhabitants has prior immunity from current infections. Sheer coincidence probably performs an enormous role as effectively.

Sean Moore, an epidemiologist on the University of Notre Dame in South Bend, Indiana, praises the brand new examine. He says future work also needs to have a look at the genetics of the virus itself, as a technique to monitor it from place to position. “I’m sure the reality of the pandemic was more complicated than can be measured with the [current] model.”

Kissler subsequent desires to look at the years instantly previous 2009 to gauge whether or not the annual waves of seasonal influenza take off from smaller cities as effectively, or whether or not that was one thing distinctive to the 2009 pandemic. “Pandemics can be very surprising things,” he says. “We need to be prepared for the unpredictable.”

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