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Sir Liam Donaldson is the Chief Medical Officer of the United Kingdom (that's Great Britain for those of you in Rio Linda). Sir Liam is not prone to making rash statements. He is of the Stiff Upper Lip persuasion, pip pip and all that, the prototypical British understated gentleman. And not every British subject gets knighted, which should also tell you about what favor he curries in Whitehall and at Buckingham.

Sir Liam has just released estimates of British deaths that might occur from swine H1N1v influenza, and they are 1) staggering, and 2) a complete and total vindication of my blog where I estimated that up to 400,000 Americans could die.

The British government, for official planning purposes,  now estimates that as many as 65,000 British subjects could perish from swine influenza. This, despite the fact that their government acquired enough Tamiflu to treat a quarter of their population, and were recently engaged in discussions (even considering the global financial meltdown) to buy more -- enough anyivirals for half its population.

Now Sir Liam did say the real death toll in Britain could be somewhere between 3,000 and 750,000 (!) persons. Wow, that's quite a swag there, Sir Liam. But it is understandably large, since no one really knows yet what the final Case Fatality rate (CFR) will be.

The British government, you see, is using the exact same math that I used -- the same precise calculations, including a conservative "fudge factor" - to make its official planning estimates. the math is refreshingly simple.

According to the CIA, Great Britain has a population (as of July 2008) of 60,943,912, more or less.  Half of those people are named "Ian."  Just kidding. Using the 30% figure, the British government expects 18,283,000 or so to be infected, and around 9 million to be seriously ill.  The 65,000 dead equates to a case fatality rate of .003, or .3 percent.  This is in contrast to the current USA CFR of .0056 and the global CFR of .0045. 

So the British are expecting two things to occur: First, they fully expect this virus to gain rapid and extremely efficient methods of human-to-human transmission.  Second, they are hoping for a moderation of the lethality of the virus as it gains increased communicability.  Both are reasonable assumptions.

Contrast this dire British warning with the decided lack of vocal response from the American government.  Considering that seasonal flu kills nearly 40,000 Americans a year, and assuming a current CFR of half a percent, why isn't anyone in Washington using the same dire (and realistic) warnings?  This is yet another example of poor risk communication.  The same people who are preaching transparency (and absolutely not practicing what they preach) are at great risk of blowing it in preparing Americans for a second, more powerful wave of pandemic flu.