Thursday, November 30, 2006
Monday, November 20, 2006
Saturday, November 18, 2006
Well, just as there is some headway, another problem raises its head. The ability of our current leaders to provide vaccine for us is probably the main issue determining how many die and how many are saved during pandemic. We can hunker down and isolate from the flu for a while, but if that time is too long, supplies, patience, even broken appliances may end out isolation. Having less flu vaccine is not a good thing.
http://news.yahoo.com/s/ap/20061117/ap_on_he_me/bird_flu_vaccines
Well, I am very happy to have managed to have my party in Las Vegas in December before any mutation. Perhaps it will all hold off until I am dead of something else. At least I have modeled the proper response when the kids have to face pandemic.
http://news.yahoo.com/s/ap/20061117/ap_on_he_me/bird_flu_vaccines
Well, I am very happy to have managed to have my party in Las Vegas in December before any mutation. Perhaps it will all hold off until I am dead of something else. At least I have modeled the proper response when the kids have to face pandemic.
Thursday, November 16, 2006
More virus analysis
These changes would have to occur for the virus to mutate.
http://abcnews.go.com/US/wireStory?id=2655618
http://abcnews.go.com/US/wireStory?id=2655618
Thursday, November 02, 2006
Lake log October 30, 2006
We woke up to the first snow of the season. I know many of you, having just endured that Buffalo area storm perhaps can't celebrate with us, but it certainly was stunningly beautiful to greet sunise frosted in over an inch of white.
The fish have stopped biting off the dock. If I want to catch them, I have to look for perch and pretend to be fishing through the ice.
***********************
On Halloween we had one trick or treater whose dad decided to walk the length of our dark street and to our lighted house. We had debated buying any candy, but I was glad I had the bag of Reeses's peanut butter cup.
Jacob was 5 or 6 at most and was very talkative and opinionated. With his round glasses he looked just like a miniature version of that kid who gets the Red Ryder B-B gun in the old Jean Shepard You'll-shoot=your-eye-out story.
"Who do we have here?" Elizabeth asked.
"I want you to guess." Jacob responded.
" I guess you are Harry Potter."
"No." responded Jacob, "I am Jacob disguised as Harry Potter."
So much for confusing objective and subjective reality.
I fished out a couple peanut butter cups, dropped it in his plastic pumpkin, and decided to add a fine local apple I had just bought that day. I showed it to Jacob's dad, so he would know that it was safe and would not just toss it away.
"An apple is NOT a treat!" asserted Jacob Harry Potter, and he buzzed me with his magic wand to punctuate this truth.
"Well, I did also put in the two peanut butter cups," I explained.
His outrage was appeased.
*********************
Tomorrow we are going up to Yarmouth, Maine. Elizabeth has a conference, and I am tagging along. With my cold almost completely gone I suspect it will be a delightful journey.
As you walk into winter,
Enjoy!
Lake log October 30, 2006
We woke up to the first snow of the season. I know many of you, having just endured that Buffalo area storm perhaps can't celebrate with us, but it certainly was stunningly beautiful to greet sunise frosted in over an inch of white.
The fish have stopped biting off the dock. If I want to catch them, I have to look for perch and pretend to be fishing through the ice.
***********************
On Halloween we had one trick or treater whose dad decided to walk the length of our dark street and to our lighted house. We had debated buying any candy, but I was glad I had the bag of Reeses's peanut butter cup.
Jacob was 5 or 6 at most and was very talkative and opinionated. With his round glasses he looked just like a miniature version of that kid who gets the Red Ryder B-B gun in the old Jean Shepard You'll-shoot=your-eye-out story.
"Who do we have here?" Elizabeth asked.
"I want you to guess." Jacob responded.
" I guess you are Harry Potter."
"No." responded Jacob, "I am Jacob disguised as Harry Potter."
So much for confusing objective and subjective reality.
I fished out a couple peanut butter cups, dropped it in his plastic pumpkin, and decided to add a fine local apple I had just bought that day. I showed it to Jacob's dad, so he would know that it was safe and would not just toss it away.
"An apple is NOT a treat!" asserted Jacob Harry Potter, and he buzzed me with his magic wand to punctuate this truth.
"Well, I did also put in the two peanut butter cups," I explained.
His outrage was appeased.
*********************
Tomorrow we are going up to Yarmouth, Maine. Elizabeth has a conference, and I am tagging along. With my cold almost completely gone I suspect it will be a delightful journey.
As you walk into winter,
Enjoy!
Lake log October 30, 2006
We woke up to the first snow of the season. I know many of you, having just endured that Buffalo area storm perhaps can't celebrate with us, but it certainly was stunningly beautiful to greet sunise frosted in over an inch of white.
The fish have stopped biting off the dock. If I want to catch them, I have to look for perch and pretend to be fishing through the ice.
***********************
On Halloween we had one trick or treater whose dad decided to walk the length of our dark street and to our lighted house. We had debated buying any candy, but I was glad I had the bag of Reeses's peanut butter cup.
Jacob was 5 or 6 at most and was very talkative and opinionated. With his round glasses he looked just like a miniature version of that kid who gets the Red Ryder B-B gun in the old Jean Shepard You'll-shoot=your-eye-out story.
"Who do we have here?" Elizabeth asked.
"I want you to guess." Jacob responded.
" I guess you are Harry Potter."
"No." responded Jacob, "I am Jacob disguised as Harry Potter."
So much for confusing objective and subjective reality.
I fished out a couple peanut butter cups, dropped it in his plastic pumpkin, and decided to add a fine local apple I had just bought that day. I showed it to Jacob's dad, so he would know that it was safe and would not just toss it away.
"An apple is NOT a treat!" asserted Jacob Harry Potter, and he buzzed me with his magic wand to punctuate this truth.
"Well, I did also put in the two peanut butter cups," I explained.
His outrage was appeased.
*********************
Tomorrow we are going up to Yarmouth, Maine. Elizabeth has a conference, and I am tagging along. With my cold almost completely gone I suspect it will be a delightful journey.
As you walk into winter,
Enjoy!
Tuesday, October 31, 2006
Discouraging News
http://abcnews.go.com/Health/story?id=2616595&page=1
There is a new strain now resistant to fowl vaccines. This whole game is like playing Whack-a-Mole and hoping that all of a sudden the More does not find a way to leave his hole in the wooden box.
There is a new strain now resistant to fowl vaccines. This whole game is like playing Whack-a-Mole and hoping that all of a sudden the More does not find a way to leave his hole in the wooden box.
Wednesday, October 25, 2006
More whining
http://www.dvdtalk.com/reviews/review.php?ID=24635
Here is the attitude that worries me. There has been scientific warning for years now on possible pandemic, but when it actually catches the mainline press and raises consciousness, then everyone thinks it must happen on schedule, sooner rather than later, or it is just a joke. It doesn't happen in a few months and Oh well........
This is what happened in New Orleans. There was always a possibility of an intense hurricane, but because people were warned so many times, they got used to it, and did not take precaution.
Scientists tell us pandemic will come. Tomorrow or in a decade. Individual preparation is all that is needed. Put away a little food, Prepare for being home a lot. Back up your energy needs. Plan.
We all wait for the emergency. Then it is too late. I have seen the inconvenience, shock, and fear that just 9 days of power loss and a little storm caused in Buffalo and that was when all surroundings areas could rally to help, when neighbors could help neighbors and when no one was dying of the trouble.
Listen, the World Health Organization may not get top news billing every day, but they say this is a huge world wide danger. People need to prepare for it just like they do for a house fire. Our houses that have never burned in 100 years still have smoke detectors, electrical inspections, fire extinquishers. Larger buildings install sprinkle systems.
This kind of whining is very irresponsible. It suggests that there is a plot to put people in panic for no reason when actually there is a panic that dysfunctional families and communities will be at a total loss if this hits and people ought to at least know the danger.
And it isn't like there is no news. There is news every day of folks attempting to make vaccine, making plans, testing wild birds, it just does not get in the daily news on the top of the page. And it won't. Every day someone has their car inspected too and problems corrected, but it is the car crashes that get the media attention.
Remember the joke about the farmer with the leaky roof. On sunny days he noticed nothing, but when it rained and roof leaked, well, who could fix the roof in the rain?
All the farmer with the leaky roof ended up was wet. The farmer with pandemic roof leaks may end up dead or worse yet, with dead children.
Here is the attitude that worries me. There has been scientific warning for years now on possible pandemic, but when it actually catches the mainline press and raises consciousness, then everyone thinks it must happen on schedule, sooner rather than later, or it is just a joke. It doesn't happen in a few months and Oh well........
This is what happened in New Orleans. There was always a possibility of an intense hurricane, but because people were warned so many times, they got used to it, and did not take precaution.
Scientists tell us pandemic will come. Tomorrow or in a decade. Individual preparation is all that is needed. Put away a little food, Prepare for being home a lot. Back up your energy needs. Plan.
We all wait for the emergency. Then it is too late. I have seen the inconvenience, shock, and fear that just 9 days of power loss and a little storm caused in Buffalo and that was when all surroundings areas could rally to help, when neighbors could help neighbors and when no one was dying of the trouble.
Listen, the World Health Organization may not get top news billing every day, but they say this is a huge world wide danger. People need to prepare for it just like they do for a house fire. Our houses that have never burned in 100 years still have smoke detectors, electrical inspections, fire extinquishers. Larger buildings install sprinkle systems.
This kind of whining is very irresponsible. It suggests that there is a plot to put people in panic for no reason when actually there is a panic that dysfunctional families and communities will be at a total loss if this hits and people ought to at least know the danger.
And it isn't like there is no news. There is news every day of folks attempting to make vaccine, making plans, testing wild birds, it just does not get in the daily news on the top of the page. And it won't. Every day someone has their car inspected too and problems corrected, but it is the car crashes that get the media attention.
Remember the joke about the farmer with the leaky roof. On sunny days he noticed nothing, but when it rained and roof leaked, well, who could fix the roof in the rain?
All the farmer with the leaky roof ended up was wet. The farmer with pandemic roof leaks may end up dead or worse yet, with dead children.
Wednesday, October 18, 2006
Bird Flu Vaccine might be a very good one
This is the best vaccine news I have read in a long while:
http://news.yahoo.com/s/ap/20061018/ap_on_he_me/pandemic_vaccine
http://news.yahoo.com/s/ap/20061018/ap_on_he_me/pandemic_vaccine
Monday, October 09, 2006
Another attempt at a good spin
Anything to calm the public. In Iraq we won the war and lost the peace. In Bird Flu we are state of the art in control of the chickens who might get it, but if it becomes a people disease, our government says we are unprepared, that like Katrina this is a job for local and state government, that we are individually responsible for protecting ourselves, and that we ought to be weekly putting a can of tuna and some powdered milk under the bed as a hedge against starvation. Hardly seems like a "state of the art" plan to me. Unless you are a chicken.
http://today.reuters.com/News/CrisesArticle.aspx?storyId=N05401262
http://today.reuters.com/News/CrisesArticle.aspx?storyId=N05401262
Thursday, September 28, 2006
Virus mutates easily
This is not really new information, but it is resubstantiated by this report. It is going to be a long, anxious winter.
http://news.yahoo.com/s/ap/20060928/ap_on_he_me/un_bird_flu
http://news.yahoo.com/s/ap/20060928/ap_on_he_me/un_bird_flu
Call for more drugs
I don't like hearing of the drug resistant strains. Scary stuff.
http://www.abc.net.au/news/newsitems/200609/s1749795.htm
http://www.abc.net.au/news/newsitems/200609/s1749795.htm
More research into immune response as killer
One of the great ironies of this strain of flu, like its cousin in 1918 is that it is often the immune system that kills the victim. That is one of the suggested reasons why so many young people die when they get the disease. Here is some new research with mice exploring that phenomena.
http://abcnews.go.com/US/wireStory?id=2499374
http://abcnews.go.com/US/wireStory?id=2499374
Tuesday, September 12, 2006
Air travel and spread of flu
Not that this is new information, but it does confirm by a study what most took for granted.
http://abcnews.go.com/US/wireStory?id=2422029
http://abcnews.go.com/US/wireStory?id=2422029
Monday, September 11, 2006
Bird Flu Compared with Common Flu
A new study in Vietnam throws some detailed light on why this flu is so deadly. It also stresses early treatment with Tamiflu.
http://www.abc.net.au/science/news/stories/2006/1737677.htm
http://news.yahoo.com/s/ap/20060910/ap_on_he_me/bird_flu_humans
http://article.wn.com/view/2006/09/11/Study_shows_need_for_early_use_of_Tamiflu/
AND FROM PANDEMIC NEWS:
http://www.abc.net.au/science/news/stories/2006/1737677.htm
http://news.yahoo.com/s/ap/20060910/ap_on_he_me/bird_flu_humans
http://article.wn.com/view/2006/09/11/Study_shows_need_for_early_use_of_Tamiflu/
AND FROM PANDEMIC NEWS:
Paris - New research conducted among bird flu victims in Vietnam
shows the H5N1 virus replicates massively before unleashing a
dangerous inflammatory response by the immune system, indicating
that patients should be given antiviral drugs as soon as possible.
Published online Sunday by the journal Nature Medicine, the study
focuses on 18 Vietnamese who caught bird flu in 2004 and 2005, 13
of whom died.
Samples were taken from these patients to assess the level of H5N1
virus in the throat, and compared with other patients who had two
strains of ordinary human flu.
H5N1 patients had much higher viral loads than counterparts with
the human virus. In addition, high levels of H5N1 also triggered a
"dysregulation" of cytokines - messenger proteins in the immune
system - which in turn caused inflammation and worsened the
patient's condition.
"The focus of clinical management should be on preventing this
intense cytokine response, by early diagnosis and effective
antiviral
treatment," says the paper, lead-authored by Menno de Jong of the
Oxford University Clinical Research Unit in Ho Chi Minh City,
Vietnam.
The antiviral of choice in fighting H5N1 is oseltamivir, which
is made
by the Swiss group Roche and commercialised under the brand Tamiflu.
Tamiflu is not a cure for flu. It brakes replication of the virus,
thereby
easing inflammation which is the cause of most flu symptoms and
speeding the time to recovery.
Roche recommends that Tamiflu be administered within 48 hours to
treat ordinary seasonal human flu, and says work is under way to
fine tune treatment for bird flu.
Millions of doses of Tamiflu are being stockpiled by governments
and the World Health Organisation in the event of a global
flu pandemic.
Some experts warn against over-reliance on Tamiflu, fearing
that the
drug could be of limited use if the H5N1 virus, at present
transmissible
from birds to humans, mutates into a form that could make it easily
contagious among humans.
In the Vietnam study, 17 of the 18 cases received Tamiflu.
The drug
appears to have had little effect, but probably because
it was
administered too late to prevent the cytokine cascade,
the paper
said. - Sapa-AFP
Thursday, August 31, 2006
More good news
CLUES TO TREATMENT OF BIRD FLU A review of medical literature published during the 1918 Spanish flu pandemic suggests that transfusions from people who survived the flu may have helped others who became sick. Navy researchers combed old publications to determine what strategies might have been effective for fighting the last pandemic flu. They believe that transfusions from someone who successfully survived the flu virus may be a viable way to treat victims of the current circulating H5N1 bird flu. This research was published in the Annals of Internal Medicine.
I heard a report on this on NPR. It seems pretty plausible. Maybe it will save some lives. One good thing is to have so many people working in different ideas before there is pandemic. In 1918 the scientists had to start for square one. They were not even sure if it was influenza or some new disease. At least we have the pathogen at the starting gate.
I heard a report on this on NPR. It seems pretty plausible. Maybe it will save some lives. One good thing is to have so many people working in different ideas before there is pandemic. In 1918 the scientists had to start for square one. They were not even sure if it was influenza or some new disease. At least we have the pathogen at the starting gate.
Tuesday, August 29, 2006
Interesting flu case
This will help show not only if pregnant women can be treated with Tamiflu but if it at all helps slow up this virus.
http://news.yahoo.com/s/ap/20060828/ap_on_he_me/bird_flu_pregnancy
http://news.yahoo.com/s/ap/20060828/ap_on_he_me/bird_flu_pregnancy
Monday, August 28, 2006
Progress on vaccine
This is good news, but of course it might not protect people from a mutated virus.
http://news.yahoo.com/s/ap/20060828/ap_on_he_me/china_bird_flu_vaccine
http://news.yahoo.com/s/ap/20060828/ap_on_he_me/china_bird_flu_vaccine
Saturday, August 26, 2006
Recent conversations - reading
It was a surprise to me at a poker game last night to find a fellow player had attended meetings at his workplace in which information on the flu had been shared and preparation begun for planning in case of pandemic. He seemed annoyed to have more work added to his routine agenda. Or maybe he just thought it was useless to plan when if pandemic hit, his place would be shut down.
Again, however, I encountered responses I find everywhere. One attitude that said, "Well, if my friends and family are going to die, I might as well die with them." Another that this was terrible and not much can be done, let's face it with humor.
I think preparation would help. Even small things like stockpiling food and preparing a family plan can save lives.
I am disappointed that there is not more leadership in government. As a county we mobilize to fight the big terrorists, but these little life forms hunting us are seen as a state and local responsibility. It seems odd to me. They certainly don't stay in one state or locality.
Disturbing was to hear that masks are not available right now and being bought up and stockpiled by government and health agencies. I had read this in other places but it also seems to me that I have seen some masks still available. I'll have to do some checking to see.
I just finished Barry's book on the 1918 influenza and while I won't say I can remember all the details, I did cull some interesting ideas.
SPREADING: Some of the threads were common to other reading. I age group hit was 20-40. The most common reason it is spread is overcrowding. In 1918 it was War related activity that helped spread it. Soldiers moved around from place to place. Even parades to sell war bonds helped.
INDIVIDUAL AND COMMUNITY ACTION: Getting people to stay home and observe a few simple hygenic practices might easily have prevented some death.
DENIAL: Denial was even more widespread in 1918 because the government had completely dominated what could be printed and distributed in the press and the country had mobililzed to avoid spreading any truth that might affect the morale of the country in fighting war, so the influenza was under reported, falsely minimized, called other diseases, or simply ignored. I see the strong force for denial today. Happily some government and work places are preparing, but homes are underprepared. Simply stocking a little xtra food might make it possible to save lives in family and community.
MATHEMATICS: The development of the flu follows the same regression to the mean as does gambling. Waves of virus that are particularly mild may mutate toward the more severe while the worst case bugs mutate toward milder version. Randomness and the patterns of randomness again dictate how the disease develops.
FEAR: Reaction of individuals and communities to fear creates denial. Enormous energy must be exerted in order to get people to face fear. And yet if too much is said then panic sets in. It is a strange dilemma for educators even if motives for deciding how much information to disseminate are all simply to help people survive. In 1918 motives had nothing to do with the flu; the country had a single motive, to win the war. Everything else had to be sacrificed to achieve that goal and if anyone suggested differetly they were imprisoned by government or killed by vigilantes.
ETHICS: What to do in the face of pandemic is a difficult ethical problem. We want to help the people around us, but going to their aid can further spread the disease. In 1918, panic restricted people's altruism so that health professionals did not rise to calls for help, many people did not go to work, and people stayed away from others so they could not help them. Where once they might have brought food to the sick or dying they were afraid to catch the disease. I'm caught particularly in this problem. I guess I become a conservative on this issue because I want first to protect my family and survive. This Blog seemed a way to satisfy my responsibility to my community. As an educator I can best help by getting information out to people.
So faced with the tension between survival and being a helpful person to those I know, I settled on this Blog. So far it has failed to be of much benefit except to a very few. Sometimes I thing only spammers read this thing. So I tend to get a bit cynical. It reminds me too much of teaching inner city kids my entire life when so few wanted to learn anything I knew.
On the other hand as a tool to collect information for myself, the Blog works. In effect my thoughts and ideas on this topic are quarrantined just as my family will be when pandemic hits.
The author deals with people who selflessly work to help others and continue in the face of great risk. Many die. Still they are the heros. So figuring the right action is difficult.
SCIENCE: I suppose that I am picking up the prejudice of the Barry but I kept thinking in reading the book that science rather than war should be the focus of our society and that we are missing a great opportunity in these days of scientific wonder not to invest more in discovering things. Without some very smart people and their hard work to find the cause of disease our lives would be a lot different today. Tomorrow could be even better.
TERRORISM: Of course, that same knowledge in the hand of terrorists would reek an awful cost on America. If the virus is studied and described in detail then it can be grown and perhaps even genetically created and spread around the country. The result would cause a lot more panic than a couple airplanes in the towers. Barry says, " A weaponized influenza virus could be the equivalent of a worldwide nuclear holocaust." However, I think that is overstatement. Nuclear disaster leaves an unlivable planet. Even the worst pandemic will leave survivors who have developed immunity and their environment will be as healthy as it ever was, more healthy in fact because pollution will be greatly reduced.
Again, however, I encountered responses I find everywhere. One attitude that said, "Well, if my friends and family are going to die, I might as well die with them." Another that this was terrible and not much can be done, let's face it with humor.
I think preparation would help. Even small things like stockpiling food and preparing a family plan can save lives.
I am disappointed that there is not more leadership in government. As a county we mobilize to fight the big terrorists, but these little life forms hunting us are seen as a state and local responsibility. It seems odd to me. They certainly don't stay in one state or locality.
Disturbing was to hear that masks are not available right now and being bought up and stockpiled by government and health agencies. I had read this in other places but it also seems to me that I have seen some masks still available. I'll have to do some checking to see.
I just finished Barry's book on the 1918 influenza and while I won't say I can remember all the details, I did cull some interesting ideas.
SPREADING: Some of the threads were common to other reading. I age group hit was 20-40. The most common reason it is spread is overcrowding. In 1918 it was War related activity that helped spread it. Soldiers moved around from place to place. Even parades to sell war bonds helped.
INDIVIDUAL AND COMMUNITY ACTION: Getting people to stay home and observe a few simple hygenic practices might easily have prevented some death.
DENIAL: Denial was even more widespread in 1918 because the government had completely dominated what could be printed and distributed in the press and the country had mobililzed to avoid spreading any truth that might affect the morale of the country in fighting war, so the influenza was under reported, falsely minimized, called other diseases, or simply ignored. I see the strong force for denial today. Happily some government and work places are preparing, but homes are underprepared. Simply stocking a little xtra food might make it possible to save lives in family and community.
MATHEMATICS: The development of the flu follows the same regression to the mean as does gambling. Waves of virus that are particularly mild may mutate toward the more severe while the worst case bugs mutate toward milder version. Randomness and the patterns of randomness again dictate how the disease develops.
FEAR: Reaction of individuals and communities to fear creates denial. Enormous energy must be exerted in order to get people to face fear. And yet if too much is said then panic sets in. It is a strange dilemma for educators even if motives for deciding how much information to disseminate are all simply to help people survive. In 1918 motives had nothing to do with the flu; the country had a single motive, to win the war. Everything else had to be sacrificed to achieve that goal and if anyone suggested differetly they were imprisoned by government or killed by vigilantes.
ETHICS: What to do in the face of pandemic is a difficult ethical problem. We want to help the people around us, but going to their aid can further spread the disease. In 1918, panic restricted people's altruism so that health professionals did not rise to calls for help, many people did not go to work, and people stayed away from others so they could not help them. Where once they might have brought food to the sick or dying they were afraid to catch the disease. I'm caught particularly in this problem. I guess I become a conservative on this issue because I want first to protect my family and survive. This Blog seemed a way to satisfy my responsibility to my community. As an educator I can best help by getting information out to people.
So faced with the tension between survival and being a helpful person to those I know, I settled on this Blog. So far it has failed to be of much benefit except to a very few. Sometimes I thing only spammers read this thing. So I tend to get a bit cynical. It reminds me too much of teaching inner city kids my entire life when so few wanted to learn anything I knew.
On the other hand as a tool to collect information for myself, the Blog works. In effect my thoughts and ideas on this topic are quarrantined just as my family will be when pandemic hits.
The author deals with people who selflessly work to help others and continue in the face of great risk. Many die. Still they are the heros. So figuring the right action is difficult.
SCIENCE: I suppose that I am picking up the prejudice of the Barry but I kept thinking in reading the book that science rather than war should be the focus of our society and that we are missing a great opportunity in these days of scientific wonder not to invest more in discovering things. Without some very smart people and their hard work to find the cause of disease our lives would be a lot different today. Tomorrow could be even better.
TERRORISM: Of course, that same knowledge in the hand of terrorists would reek an awful cost on America. If the virus is studied and described in detail then it can be grown and perhaps even genetically created and spread around the country. The result would cause a lot more panic than a couple airplanes in the towers. Barry says, " A weaponized influenza virus could be the equivalent of a worldwide nuclear holocaust." However, I think that is overstatement. Nuclear disaster leaves an unlivable planet. Even the worst pandemic will leave survivors who have developed immunity and their environment will be as healthy as it ever was, more healthy in fact because pollution will be greatly reduced.
Monday, August 21, 2006
new scare in Nepal
This might not be our H5N1 but it is not good news.
http://www.postchronicle.com/news/original/article_21234978.shtml
http://www.postchronicle.com/news/original/article_21234978.shtml
Monday, August 14, 2006
Saturday, July 29, 2006
good news on vaccine
http://abcnews.go.com/Health/wireStory?id=2237838
But keep the fine print in mind:
Because it is impossible to predict which influenza strain will spark the next pandemic, it is equally impossible to produce a vaccine that will be completely effective.
Friday, July 21, 2006
USA-No Plan Again
I don't know, it is not surprising to me that the government does not have a plan.
Why, isn't it enough to just put an extra can of tuna fish under the bed?
http://news.yahoo.com/s/ap/20060721/ap_on_he_me/bird_flu_testing
http://www.abc4.com/news/national/story.aspx?content_id=CEE6EDF8-E35D-41AA-AC65-B51E01BECD4D
"The senators (and that includes our own Hilary ) said the department is relying too heavily on states and that many states don't have enough personnel to help coordinate."
Why, isn't it enough to just put an extra can of tuna fish under the bed?
http://news.yahoo.com/s/ap/20060721/ap_on_he_me/bird_flu_testing
http://www.abc4.com/news/national/story.aspx?content_id=CEE6EDF8-E35D-41AA-AC65-B51E01BECD4D
"The senators (and that includes our own Hilary ) said the department is relying too heavily on states and that many states don't have enough personnel to help coordinate."
Sunday, July 16, 2006
Overview of Fatalities
http://online.wsj.com/public/resources/documents/retro06-avfludeaths-date_desc.html?mod=blogs
Good summary with details surrounding the deaths.
Good summary with details surrounding the deaths.
Indonesia still a virus breeding ground
Indonesia is still a good candidate for the mutation that will mean pandemic.
http://news.yahoo.com/s/ap/20060716/ap_on_he_me/indonesia_bird_flu
"Indonesia's caseload is increasing faster than any other country in the world — with all of its deaths occurring in the last year. The government says it cannot afford to routinely cull fowl in infected areas."
http://news.yahoo.com/s/ap/20060716/ap_on_he_me/indonesia_bird_flu
"Indonesia's caseload is increasing faster than any other country in the world — with all of its deaths occurring in the last year. The government says it cannot afford to routinely cull fowl in infected areas."
Tuesday, July 11, 2006
One man's passion to educate
This article both outlines the problems in awareness and highlights one fellows mission to raise awareness. I thought my blog was a way of knocking on doors in my "community" but I can count on one hand the people who have gained anything by reading this one. My last two comments were particularly disappointing as they were strangers trying to sell something on their blog and spamming this one.
http://www.duluthsuperior.com/mld/duluthsuperior/15012910.htm
http://www.duluthsuperior.com/mld/duluthsuperior/15012910.htm
Wednesday, July 05, 2006
Three different strains in Nigeria
http://news.yahoo.com/s/ap/20060705/ap_on_he_me/bird_flu_nigeria
Not good news. If this is spreading quickly and changing, it has even more opportunity to mutate into pandemic
Not good news. If this is spreading quickly and changing, it has even more opportunity to mutate into pandemic
Sunday, July 02, 2006
More bird flu cases coming
WHO predicts that there will be more virus activity in the colder months and that means more opportunity for mutation. I have sort of mellowed in my fears because so far there was just that one mutation that could not start pandemic. Also, I have prepared pretty much all I can prepare. But this raises my anxiety level a tad again.
http://www.abc.net.au/news/newsitems/200607/s1676278.htm
http://www.abc.net.au/news/newsitems/200607/s1676278.htm
Saturday, June 24, 2006
Friday, June 23, 2006
Progress in vacine development
http://today.reuters.com/News/CrisesArticle.aspx?storyId=L2295663
I hope this is as good as it reads.
I hope this is as good as it reads.
It did mutate but not enough for pandemic
http://news.yahoo.com/s/ap/20060623/ap_on_he_me/bird_flu
It was a close call, however, and I sure wish that Indonesia gets its act together soon.
It was a close call, however, and I sure wish that Indonesia gets its act together soon.
Wednesday, June 21, 2006
Indonesia still a hot spot
Indonesia needs help if they will have any chance of controling the flu from spreading among birds.
http://news.yahoo.com/s/ap/20060621/ap_on_he_me/indonesia_bird_flu
http://news.yahoo.com/s/ap/20060621/ap_on_he_me/indonesia_bird_flu
Wednesday, June 14, 2006
Emergency Rooms
A little investment in this problem would do us more good than war.
http://abcnews.go.com/Health/wireStory?id=2075299
http://abcnews.go.com/Health/wireStory?id=2075299
Some vaccine progress
Hope this does help humans, but at least the ferrets are safe now and it is good news to see labs working on the possibilities:
http://abcnews.go.com/Technology/wireStory?id=2076284
http://abcnews.go.com/Technology/wireStory?id=2076284
Monday, June 12, 2006
Wednesday, June 07, 2006
More quotes from Mike Levitt
http://abcnews.go.com/Health/story?id=2045194&page=1
"We could have four to five hurricanes during a pandemic, a bio-terror incident, natural disasters — all during a pandemic. We need to preserve our capacity to respond" by keeping the military and other first-responders healthy and able to work, Leavitt said.
"We could have four to five hurricanes during a pandemic, a bio-terror incident, natural disasters — all during a pandemic. We need to preserve our capacity to respond" by keeping the military and other first-responders healthy and able to work, Leavitt said.
Sunday, June 04, 2006
Saturday, June 03, 2006
WHO announces a plan for action
http://abcnews.go.com/US/wireStory?id=2020205
Seems unrealistic to me, but at least folks are thinking and planning. The real enemy is how fast they expect the flu to move. And then there is the question of what real good Tamiflu will do anyway.
Seems unrealistic to me, but at least folks are thinking and planning. The real enemy is how fast they expect the flu to move. And then there is the question of what real good Tamiflu will do anyway.
Bird Flu warning service
http://www.mobilemagazine.com/content/100/340/C8111/
I guess the writer of this blurb thinks this is exploitation, but for what it is worth, here is a cell phone offer for emergency alerts.
I guess the writer of this blurb thinks this is exploitation, but for what it is worth, here is a cell phone offer for emergency alerts.
Thursday, June 01, 2006
Tamiflu Concerns
http://us.f372.mail.yahoo.com/ym/ShowLetter?MsgId=1343_1300192_13306_1481_6835_0_22796_19472_2052142320&Idx=0&YY=66783&inc=25&order=down&sort=date&pos=0&view=&head=&box=Inbox
While this is certainly a politically slanted article, it is worth some thought.
My own feeling is that this is not all conspiracy, but that Tamiflu is the only thing now that anyone guesses might shorten the length of the flu and save some lives. It is not just used in this country, but is being stockpiled in many of the others and used right now to treat the latest victims in Indonesia. In fact, most people are worried we will have too little.
Still, things are intertwined in ways that make you wonder.
(Thanks again to Ann for this one)
I still think that staying home and hunkering down while we wait for a vaccine is the best defense if this thing mutates.
Click here for more discussion of Tamiflu
And here
And here
This indicates how much it is in demand.
While this is certainly a politically slanted article, it is worth some thought.
My own feeling is that this is not all conspiracy, but that Tamiflu is the only thing now that anyone guesses might shorten the length of the flu and save some lives. It is not just used in this country, but is being stockpiled in many of the others and used right now to treat the latest victims in Indonesia. In fact, most people are worried we will have too little.
Still, things are intertwined in ways that make you wonder.
(Thanks again to Ann for this one)
I still think that staying home and hunkering down while we wait for a vaccine is the best defense if this thing mutates.
Click here for more discussion of Tamiflu
And here
And here
This indicates how much it is in demand.
Wednesday, May 31, 2006
Latest Indonesian update
WHO is monitoring the situation in Indonesia and so far the news still god news.
The World Health Organization has just released the following update
to the situation in Indonesia. Let's keep our fingers crossed and hope
that everything is contained.
Avian influenza situation in Indonesia update 16
31 May 2006
Situation update
Indonesian health authorities and WHO have further
strengthened their response to the family cluster of cases
in Kubu Simbelang village, Karo District, North Sumatra. As
of today, 54 surviving family members and other close
contacts of cases have been identified and placed under
voluntary home quarantine. All of these people, with the
exception of pregnant women and infants, are receiving the
antiviral drug, oseltamivir, for prophylactic purposes.
Public health teams visit these people daily, checking for
symptoms.
In addition, active house-to-house surveillance for
influenza-like illness is being conducted throughout the
village, which has around 400 households. A command post for
fever surveillance has been functioning in the village since
last week.
As of today, no new cases suggestive of H5N1 infection have
been detected since 22 May. This finding is important as it
indicates that the virus has not spread beyond the members
of this single extended family. No hospital staff involved
in the care of patients, in some instances without adequate
personal protective equipment, have developed the disease.
The last person in the cluster, who developed symptoms on 15
May and died on 22 May, refused hospitalization. He moved
between two villages while ill, accompanied by his wife. The
wife is under surveillance and has not developed symptoms.
Despite multiple opportunities for the virus to spread to
other family members, health care workers or into the
general community, it has not, on present evidence, done so.
Current level of pandemic alert
Based on an assessment of present evidence, WHO has
concluded that the current level of pandemic alert is
appropriate and does not need to change. The level of
pandemic alert remains at phase 3. This phase pertains to a
situation in which occasional human infections with a novel
influenza virus are occurring, but there is no evidence that
the virus is spreading in an efficient and sustained manner
from one person to another.
WHO has recommended continued close monitoring of the
situation in Kubu Simbelang for the two weeks following 22
May, the date when the last known case in the cluster died.
As a precautionary measure, Indonesian authorities have
decided to extend this recommended period to three weeks.
Preliminary results of the investigation
This information differs in some details from information
released in previous updates, but is derived from extensive
investigations by senior national and international
epidemiologists, from WHO and the US Centers for Disease
Control and Prevention, who have developed a clearer picture
of the situation.
The cluster involves an initial case and seven subsequent
laboratory-confirmed cases. All cases are members of an
extended family: sisters and brothers and their children.
Family members resided in four households. Three households
were next-door neighbours in the village of Kubu Simbelang,
Karo District, North Sumatra. The fourth household was
located about 10 kilometres away in the nearby village of
Kabanjahe.
The initial case in the cluster was a 37-year-old woman who
sold fruits and chillies at a market in the village of
Tigapanah. Her stand was located about 15 metres away from a
stand where live chickens were sold. The investigation
uncovered no reports of poultry die-offs in the market.
However, the woman kept a small number of backyard chickens,
allowed into the house at night. Three of her chickens
reportedly died before she became ill. She is also known to
have used chicken faeces from these household chickens as
fertilizer in her garden.
A parallel agricultural investigation has not, to date,
detected H5N1 virus in PCR tests of approximately 80 samples
from poultry, other livestock and domestic pets, and chicken
fertilizer taken from the vicinity.
The initial case developed symptoms on 24 April, was
hospitalized on 2 May, and died on 4 May. No samples were
collected for testing prior to her burial, but she is
considered part of the cluster as her clinical course was
compatible with H5N1 infection.
The initial case had one sister and three brothers. The
sister and two of the brothers subsequently developed
infection. The remaining cases occurred among children in
these families.
The confirmed cases include five males and two females with
an average age of 19 years (range from 1 to 32 years). Six
out of the seven confirmed cases developed symptoms between
3 May and 5 May. These cases include two sons of the initial
case, her brother from Kabanjahe, her sister, the sister's
baby, and the son of a second brother living in an adjacent
house. This second brother, the last case in the cluster,
developed symptoms on 15 May. Six out of the seven cases
were fatal.
Exposures
On the night of 29 April, nine family members spent the
night in a small room with the initial case at a time when
she was severely ill, prostrate, and coughing heavily. These
family members included the initial case and her three sons;
the brother from Kabanjahe village, his wife, and their two
children; the 21-year-old daughter of another brother (who
did not become infected); and another young male visitor.
Following this event, three family members the woman's two
sons and the visiting brother from Kabanjahe developed
symptoms from 5 to 6 days later.
The woman's sister, who lived in an adjacent house,
developed symptoms at the same time, as did her 18-month-old
daughter. Prior to symptom onset, this sister, accompanied
by her daughter, provided close personal care of the initial
case.
The last case in the cluster provided close care for his son
throughout his hospital stay, from 913 May. The son was a
frequent visitor in the home of the initial case and was
present there on 29 April.
Google to follow infected birds
This in from Ann.Experts are using Google's mapping software to help prepare for the arrival of the bird flu. The software will help identify areas with affected flocks and isolate them from other flocks. The bird flu is expected to arrive this summer. See article below
thanks Ann:
http://today.reuters.com/news/newsArticle.aspx?type=technologyNews&storyID=2006-05-30T230035Z_01_N25133792_RTRUKOC_0_US-BIRDFLU-MAPPING.xml
thanks Ann:
http://today.reuters.com/news/newsArticle.aspx?type=technologyNews&storyID=2006-05-30T230035Z_01_N25133792_RTRUKOC_0_US-BIRDFLU-MAPPING.xml
Tuesday, May 30, 2006
Pigeons
http://news.scotsman.com/latest_international.cfm?id=797742006
While songbirds fed in backyard feeders do not seem at risk, my favorite boyhood bird does seem to be in trouble. One of the Indonesian deaths was due to a fellow cleaning pigeon feces out of a gutter. And this story of a pigeon game stopped shows the extent that the bird flu has affected raising pigeons. I'm wondering what will happen to all the pigeon racers here if migratory birds bring the bird flu this way.
Of course, Indonesia just goes about business as usual:
http://news.yahoo.com/s/ap/20060520/ap_on_he_me/bird_flu_ignored_warnings
And is isn't that there wasn't other warnings:
http://discuss.agonist.org/smf/?board=6%3baction=display%3bthreadid=20552
Other pigeon notes, some of them reassuring:
http://www.abc.net.au/news/newsitems/200510/s1487872.htm
http://www.msnbc.msn.com/id/12466226/
http://www.purebredpigeon.com/avianflu.htm
http://www.healthcentral.com/newsdetail/408/1508144.html
Friday, May 26, 2006
Latest from Indonesia
http://abcnews.go.com/Health/wireStory?id=2003790
http://www.abc.net.au/news/newsitems/200605/s1648827.htm
http://abcnews.go.com/Health/AvianFlu/wireStory?id=1997826
http://www.nytimes.com/2006/05/24/world/asia/24birdflu.html
Well, no pandemic yet. Maybe we will be lucky and slip out of it with H5N1.
http://www.abc.net.au/news/newsitems/200605/s1648827.htm
http://abcnews.go.com/Health/AvianFlu/wireStory?id=1997826
http://www.nytimes.com/2006/05/24/world/asia/24birdflu.html
Well, no pandemic yet. Maybe we will be lucky and slip out of it with H5N1.
Thursday, May 25, 2006
Analysis of the Indonesian cluster
Scary week. But it was good to see the flu covered by the New York Times and National Public Radio. Somehow they managed to fit this topic in between corruption and incompetency of government action (Iraq, stolen Veteran's SSN, corruption in Congress, increasing debt, gas problems)
As far as I can tell while the cluster in Indonesia is a scary one ( the virus moved from bird to person, then to another person and then AGAIN to yet another person) it does not signal the beginning pandemic. There was no change in the nature of the hook the virus uses to infect and so it will not move efficiently from person to person. That explains why, even though the stupid Indonesians actually sent the infected people back out into the larger community for a while (until they got sicker and returned to the hospital to die) no spread seemed to be occuring in Indonesia.
It all does point out how unprepared some of these countries are. This is not the first such cluster in Indonesia. This virus has been hanging around for a couple years now and every so often there is a scare there because a cluster developes. Folks figured that Vietnam would be the most likely source of pandemic, but that country has gotten their ducks in line (so to speak) and pretty much pushed the damn bug out of the poultry population.
But Indonesia is another story.
Also worrying was that our government sent a huge shipment of Tamiflu to some "unnamed" Asian country this week. I hate it when we have to make everything a secret. It was an odd move because supposedly we are trying to stockpile Tamiflu here and definitely do not have enough for a real pandemic if it happened this week. So why send it abroad? One logical conclusion is that some American leaders thought this was going to happen this week in Indonesia. I wish they'd tell us a little more intelligent information about these things instead of that paternalizing, simplistic little speech that Leavitt gives, suggesting that everyone weekly put a can of tuna fish and a box of powdered milk under his bed. His idea of self reliance. His positioning post Katrina in order to establish that the Federal government can be of no help in pandemic emergency. It is the pre FDR theory of governemnt, every person for themselves.
Blue, red, conservative, liberal aside. The most frustrating thing in modern politics is that we are treated more and more like children than citizens. Of course, the real question is why we consistently like to put stupid people in office. If anyone looks smart in the race, the average American bristles and votes the other way.
As far as I can tell while the cluster in Indonesia is a scary one ( the virus moved from bird to person, then to another person and then AGAIN to yet another person) it does not signal the beginning pandemic. There was no change in the nature of the hook the virus uses to infect and so it will not move efficiently from person to person. That explains why, even though the stupid Indonesians actually sent the infected people back out into the larger community for a while (until they got sicker and returned to the hospital to die) no spread seemed to be occuring in Indonesia.
It all does point out how unprepared some of these countries are. This is not the first such cluster in Indonesia. This virus has been hanging around for a couple years now and every so often there is a scare there because a cluster developes. Folks figured that Vietnam would be the most likely source of pandemic, but that country has gotten their ducks in line (so to speak) and pretty much pushed the damn bug out of the poultry population.
But Indonesia is another story.
Also worrying was that our government sent a huge shipment of Tamiflu to some "unnamed" Asian country this week. I hate it when we have to make everything a secret. It was an odd move because supposedly we are trying to stockpile Tamiflu here and definitely do not have enough for a real pandemic if it happened this week. So why send it abroad? One logical conclusion is that some American leaders thought this was going to happen this week in Indonesia. I wish they'd tell us a little more intelligent information about these things instead of that paternalizing, simplistic little speech that Leavitt gives, suggesting that everyone weekly put a can of tuna fish and a box of powdered milk under his bed. His idea of self reliance. His positioning post Katrina in order to establish that the Federal government can be of no help in pandemic emergency. It is the pre FDR theory of governemnt, every person for themselves.
Blue, red, conservative, liberal aside. The most frustrating thing in modern politics is that we are treated more and more like children than citizens. Of course, the real question is why we consistently like to put stupid people in office. If anyone looks smart in the race, the average American bristles and votes the other way.
Tuesday, May 23, 2006
Great news for chickens
http://abcnews.go.com/US/wireStory?id=1991394
And of course what keeps the chicks safe, keeps us safe too, in a trickle down sort of way.
And of course what keeps the chicks safe, keeps us safe too, in a trickle down sort of way.
http://www.blogger.com/img/gl.link.gif
http://abcnews.go.com/International/wireStory?id=1995111
So there was a human to human transmission but apparently no recombination or mutation to suggest that there will be more. Hope Indonesia gets its act together soon.
So there was a human to human transmission but apparently no recombination or mutation to suggest that there will be more. Hope Indonesia gets its act together soon.
Monday, May 22, 2006
Buffalo 1918 survivor
http://www.suntimes.com/output/health/cst-nws-flu21.html
This Buffalo woman's blood may hold the clue to a vaccine.
This Buffalo woman's blood may hold the clue to a vaccine.
Saturday, May 20, 2006
Probably not mutated In Indonesia
http://archive.gulfnews.com/articles/06/05/20/10041314.htmlLooks like we got lucky again in Indonesia, but I sure hope they get their act together soon.
Thursday, May 18, 2006
People and Pigs have it in Indonesia
http://today.reuters.com/News/CrisesArticle.aspx?storyId=JAK28830
Very worrisome news from Indonesia.
Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, leading to a strain that can easily infect people and pass from person to person.
Very worrisome news from Indonesia.
Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, leading to a strain that can easily infect people and pass from person to person.
Wednesday, May 17, 2006
http://www.shns.com/shns/g_index2.cfm?action=detail&pk=INSURANCEFIRMS-05-16-06
Here is how a pandemic might affect the insurance industry.
Here is how a pandemic might affect the insurance industry.
Tuesday, May 16, 2006
Indonesia - not good news
There is a recnt cluster of bird flu fatalities in Indonesia which has health officials worrying about the possibility that the flu was able to spread from person to person. Keep an eye on that news.
Bird Flu ABC special
While I was away Elizabeth taped the bird flu ABC special for me and I've just watched it. It did seem to cover briefly all the aspects of the flu, but in much too much a sensational manner for my taste. Here are the weaknesses as I see them:
1. While ARDS was mentioned once in passing, I doubt that any viewers really got the sense of cytokline storm that hit the first victim and accounted for his early death. Certainly is was not explained as it would have been say in an episode of CSI.
2. I just damned sick of seeing the insides of bodies on all these current television shows. I've buried most of my family and learned what killed them and why without having to see inside their body cavities. This is just exploitive sensationalism.
3. The ending was unrealistic. It is highly unlikely that two mutations would occur in such a short time and from my understanding of the 1918 precedent they cite, this was simply two waves of the same virus strain as it moved in and out of a population. There have been three pandemics this century and another will come in some form, some time. When has there ever been two in a row? And what are the odds that they would be both worst case senarios? The pandemics in 1957 and 1968 did not capture my attention at the time. They were mild killers.
4. Survival techniques were not dramatically developed. Everyone did the wrong things. Once couple was plain lucky and so they could dance on the top of a building, but no one managed to survive by preparation. Part of this is because they present the urban and suburban population but no one from rural America. Quarrantine was seen as a stupid idea imposed by government, rather than the major way of waiting out the distribution of vaccine. The message again was that communities somehow working in close connection with one another (without masks or gloves by the way) could win somehow just with a smaltzy sense of love. The truth is that small groups, hunkered down and staying out of group meetings have the best chance of survival especially if they get some food in ahead of time.
5. In the end this movie provided no hope. It was like the fighting of the movie monster. Just when you thought the coast was clear, up comes Jason again out of the lake, his chain saw running. I see pandemic as very different from other massive disasters (global warming, nuclear war) because the individual and small family group can prepare and provide, as long as they don't wait until the last minute. And the wait in quarrantine is just until vaccine gets distributed and the 50% of people who do contract (but do not die from the flu) get working again. The movie might have shown an example of a rural family who had provided ahead of time and who waited out the vaccine manufacturing and distribution delays?
6. On the other hand it did present some of the problems: food and supply shortages, insurance company defaults, economic difficulties, panic in the streets, looting and loss of lawful control of populations, overcrowding of hospitals. It did a good job showing the need to take respirators away from very sick people because there are not enough of them available in today's hospitals. And the politics seemed very believable. It balanced the information on the effectiveness of Tamiflu. Good cast too. I like these actors, especially old Stacy Keach and Justina Machado, who is such a cutie.
7. Mass graves is an exaggeration.
And in the end I am glad they did it because it rasies the consciousness of people. But we had guests this weekend whose final resistance to preparing even a bit was to say, "I don't think I really want to survive such a disaster anyway." This movie would not help those folks move from fatalism to acts of survival.
This review seems pretty sound:
http://www.pandemicflu.gov/news/birdfluinamerica.html
1. While ARDS was mentioned once in passing, I doubt that any viewers really got the sense of cytokline storm that hit the first victim and accounted for his early death. Certainly is was not explained as it would have been say in an episode of CSI.
2. I just damned sick of seeing the insides of bodies on all these current television shows. I've buried most of my family and learned what killed them and why without having to see inside their body cavities. This is just exploitive sensationalism.
3. The ending was unrealistic. It is highly unlikely that two mutations would occur in such a short time and from my understanding of the 1918 precedent they cite, this was simply two waves of the same virus strain as it moved in and out of a population. There have been three pandemics this century and another will come in some form, some time. When has there ever been two in a row? And what are the odds that they would be both worst case senarios? The pandemics in 1957 and 1968 did not capture my attention at the time. They were mild killers.
4. Survival techniques were not dramatically developed. Everyone did the wrong things. Once couple was plain lucky and so they could dance on the top of a building, but no one managed to survive by preparation. Part of this is because they present the urban and suburban population but no one from rural America. Quarrantine was seen as a stupid idea imposed by government, rather than the major way of waiting out the distribution of vaccine. The message again was that communities somehow working in close connection with one another (without masks or gloves by the way) could win somehow just with a smaltzy sense of love. The truth is that small groups, hunkered down and staying out of group meetings have the best chance of survival especially if they get some food in ahead of time.
5. In the end this movie provided no hope. It was like the fighting of the movie monster. Just when you thought the coast was clear, up comes Jason again out of the lake, his chain saw running. I see pandemic as very different from other massive disasters (global warming, nuclear war) because the individual and small family group can prepare and provide, as long as they don't wait until the last minute. And the wait in quarrantine is just until vaccine gets distributed and the 50% of people who do contract (but do not die from the flu) get working again. The movie might have shown an example of a rural family who had provided ahead of time and who waited out the vaccine manufacturing and distribution delays?
6. On the other hand it did present some of the problems: food and supply shortages, insurance company defaults, economic difficulties, panic in the streets, looting and loss of lawful control of populations, overcrowding of hospitals. It did a good job showing the need to take respirators away from very sick people because there are not enough of them available in today's hospitals. And the politics seemed very believable. It balanced the information on the effectiveness of Tamiflu. Good cast too. I like these actors, especially old Stacy Keach and Justina Machado, who is such a cutie.
7. Mass graves is an exaggeration.
And in the end I am glad they did it because it rasies the consciousness of people. But we had guests this weekend whose final resistance to preparing even a bit was to say, "I don't think I really want to survive such a disaster anyway." This movie would not help those folks move from fatalism to acts of survival.
This review seems pretty sound:
http://www.pandemicflu.gov/news/birdfluinamerica.html
Sunday, May 14, 2006
Still more good news
http://www.nytimes.com/2006/05/10/health/10cnd-flu.html?_r=1&ex=1147492800&en=34534b3b2a87983d&ei=5087%0A&oref=slogin
If the flu fails to show up here in the Fall, we will be spared a lot of difficulty for the poultry industry and lessen the chance of more dire circumstances.
And if this science is good, this strain may never mutate and we may have time to prepare for the eventual pandemic.
less likely
http://www.nytimes.com/2006/03/23/science/23flu.html?ex=1147752000&en=f7d8dff884b46054&ei=5070%3Ca%20href=%22http://www.nytimes.com/2006/03/23/science/23flu.html?ex=1147752000&en=f7d8dff884b46054&ei=5070%22%3E%3C/a%3E
If the flu fails to show up here in the Fall, we will be spared a lot of difficulty for the poultry industry and lessen the chance of more dire circumstances.
And if this science is good, this strain may never mutate and we may have time to prepare for the eventual pandemic.
less likely
http://www.nytimes.com/2006/03/23/science/23flu.html?ex=1147752000&en=f7d8dff884b46054&ei=5070%3Ca%20href=%22http://www.nytimes.com/2006/03/23/science/23flu.html?ex=1147752000&en=f7d8dff884b46054&ei=5070%22%3E%3C/a%3E
Meanwhile some countries lie and drag feet
http://www.washingtonpost.com/wp-dyn/content/article/2005/10/19/AR2005101902147.html
Here is the problem. When governments are too corrupt to act, the disease has a chance to get a foothold.
Here is the problem. When governments are too corrupt to act, the disease has a chance to get a foothold.
Saturday, May 13, 2006
Good news
http://www.nytimes.com/2006/05/14/world/asia/14flu.html?ex=1305259200&en=41357a0296e3fda5&ei=5089&partner=rssyahoo&emc=rss
Good news here. As it wanes, the odds of mutation go down too.
Good news here. As it wanes, the odds of mutation go down too.
Friday, May 12, 2006
Here is a note to ponder
This came from the company that I bought masks and gloves from last month:
Greetings,
You have purchased products at our site http://www.respirators.us .
As a result of a number of factors surrounding the Avian Flu scare (including
the ABC movie on the Bird Flu) we have been informed by our manufacturers that
a shortage in mask/respirator stock will occur very soon.
We apologize in advance and we will remove all products from our site that are
not available.
Regards,
Respirators Inc.
Greetings,
You have purchased products at our site http://www.respirators.us .
As a result of a number of factors surrounding the Avian Flu scare (including
the ABC movie on the Bird Flu) we have been informed by our manufacturers that
a shortage in mask/respirator stock will occur very soon.
We apologize in advance and we will remove all products from our site that are
not available.
Regards,
Respirators Inc.
Bird Flu Survey
http://abcnews.go.com/Health/wireStory?id=1872540
I don't know where these concerned people are, but I don't hear a thing about this issue. This is a good article, however, and touches on many relevant issues.
I don't know where these concerned people are, but I don't hear a thing about this issue. This is a good article, however, and touches on many relevant issues.
Thursday, April 20, 2006
See you in a month
Well, I am gone for three weeks so this will have to do for a while.
I'd advise any readers. (Hmmmmmm. Do I actually have any readers?) to stock up on some latex gloves. If the Federal Government has decided to stockpile millions of them, then they won't be available for you and me.
Soon, I won't be the only one talking about all this. ABC will start the ball rolling and the other networks will have to follow. About time I think.
Well, I'm off to play some random games that don't have deadly outcomes. I wish all of life was as easy as a game of poker where the most that can be lost is money.
I'd advise any readers. (Hmmmmmm. Do I actually have any readers?) to stock up on some latex gloves. If the Federal Government has decided to stockpile millions of them, then they won't be available for you and me.
Soon, I won't be the only one talking about all this. ABC will start the ball rolling and the other networks will have to follow. About time I think.
Well, I'm off to play some random games that don't have deadly outcomes. I wish all of life was as easy as a game of poker where the most that can be lost is money.
Tuesday, April 18, 2006
Does this sound familiar?
http://today.reuters.com/investing/financeArticle.aspx?type=bondsNews&storyID=2006-04-18T224607Z_01_N184659_RTRIDST_0_BIRDFLU-HOSPITALS.XML
One the main reasons to take some personal responsibility for the potential of pandemic is that there will not be help if it hits. The Feds have already indicated that they can't help. And here is what hospitals cannot do. Note that venilators are probably the single most useful way of helping those who catch a H5N1 flu bug stay alive. But they just are not going to be there.
Just like Katrina. Nobody can do nothing. The Feds say it is not their job. The locals say they don't have funds or manpower. If it is Arab terrorists, we can mortage into two or three coming generations of taxpayers for wars that cost billions and last years and years, but a little attacking bug that will be gone in two years, that is just not a real enemy I guess.
Such a shame. Were we to win a war against H5N1 we would have no difficulty managing the subsequent peace as we do when we invade other countries. That effort would be a win/win.
Whatever happens with this current scare, everyone agrees that a pandemic is coming sooner or later. I suggest we vote in some people who will invest in hospital preparedness and get our National Guard home so they can guard the nation.
One the main reasons to take some personal responsibility for the potential of pandemic is that there will not be help if it hits. The Feds have already indicated that they can't help. And here is what hospitals cannot do. Note that venilators are probably the single most useful way of helping those who catch a H5N1 flu bug stay alive. But they just are not going to be there.
Just like Katrina. Nobody can do nothing. The Feds say it is not their job. The locals say they don't have funds or manpower. If it is Arab terrorists, we can mortage into two or three coming generations of taxpayers for wars that cost billions and last years and years, but a little attacking bug that will be gone in two years, that is just not a real enemy I guess.
"Peacock said much of the response to a pandemic will involve very basic medical care -- including triage, or sorting out which patients cannot be helped except through heroic measures. Those patients are going to get some morphine and get sat in a corner. That is the definition of a disaster -- need exceeds resources," Peacock said.
Such a shame. Were we to win a war against H5N1 we would have no difficulty managing the subsequent peace as we do when we invade other countries. That effort would be a win/win.
Whatever happens with this current scare, everyone agrees that a pandemic is coming sooner or later. I suggest we vote in some people who will invest in hospital preparedness and get our National Guard home so they can guard the nation.
Pandemic Movie Coming Soon
http://smallscreen.monstersandcritics.com/article_1156414.php/ABC_to_take_on_avian_flu_during_sweeps
SURPRISE! BIRD FLU TO ARRIVE ON ABC
Entertainment columnists were taken aback Tuesday when ABC announced that it would be broadcasting a made-for-TV disaster movie about avian flu on May 9. The network had succeeded in keeping the production of Fatal Contact: Bird Flu in America, starring Stacy Keach, Joely Richardson, Ann Cusack and Justine Machado, completely under wraps. The announcement "came as a complete surprise in a business nearly devoid of surprises," wrote Michael Starr in the New York Post. In its announcement, ABC said that the movie "follows an outbreak of an Avian Flu from its origins in a Hong Kong market through its mutation into a virus transmittable from human to human around the world." Co-producer Diana Kerew told the Post that the network had kept the project secret because "The world changes very quickly, and we wanted to make sure at the point we were ready to unveil [the movie] that we were accurate and up-to-date." John M. Barry, author of the bestseller, The Great Influenza: The Story of the Deadliest Pandemic in History, about the 1918 Spanish flu, served as a consultant on the project. Meanwhile, NBC announce that it plans to take an in-depth look at the avian flu with a series of reports on the Today show and Dateline NBC.
Good, maybe if we can put out a fictional account, someone will take some serious notice.
SURPRISE! BIRD FLU TO ARRIVE ON ABC
Entertainment columnists were taken aback Tuesday when ABC announced that it would be broadcasting a made-for-TV disaster movie about avian flu on May 9. The network had succeeded in keeping the production of Fatal Contact: Bird Flu in America, starring Stacy Keach, Joely Richardson, Ann Cusack and Justine Machado, completely under wraps. The announcement "came as a complete surprise in a business nearly devoid of surprises," wrote Michael Starr in the New York Post. In its announcement, ABC said that the movie "follows an outbreak of an Avian Flu from its origins in a Hong Kong market through its mutation into a virus transmittable from human to human around the world." Co-producer Diana Kerew told the Post that the network had kept the project secret because "The world changes very quickly, and we wanted to make sure at the point we were ready to unveil [the movie] that we were accurate and up-to-date." John M. Barry, author of the bestseller, The Great Influenza: The Story of the Deadliest Pandemic in History, about the 1918 Spanish flu, served as a consultant on the project. Meanwhile, NBC announce that it plans to take an in-depth look at the avian flu with a series of reports on the Today show and Dateline NBC.
Good, maybe if we can put out a fictional account, someone will take some serious notice.
Myth vesus Fact
http://www.thestate.com/mld/thestate/news/nation/14360881.htm
This is a pretty good restatement of bird flu currently and of pandemic potential. It sorts the facts from the overreaction (myth).
This is a pretty good restatement of bird flu currently and of pandemic potential. It sorts the facts from the overreaction (myth).
Monday, April 17, 2006
Bird Watchers and Feeders Risk nothing
http://toledoblade.com/apps/pbcs.dll/article?AID=/20060416/COLUMNIST22/604160348/-1/SPORTS09
A number of sources have written to stop bird watchers and backyard feeders from worrying, especially this season before any virus has reached our shores.
A number of sources have written to stop bird watchers and backyard feeders from worrying, especially this season before any virus has reached our shores.
Sunday, April 16, 2006
US prepares for pandemic
http://www.washingtonpost.com/wp-dyn/content/article/2006/04/15/AR2006041500901.html
http://news.yahoo.com/s/ap/20060416/ap_on_go_pr_wh/bird_flu
The US is now preparing to face the potential threat of pandemic as best it can on the Federal level. Plans are still evolving, but here is the latest in details available.
http://news.yahoo.com/s/ap/20060416/ap_on_go_pr_wh/bird_flu
The US is now preparing to face the potential threat of pandemic as best it can on the Federal level. Plans are still evolving, but here is the latest in details available.
Friday, April 14, 2006
Hawaii Preparing
http://news.yahoo.com/s/ap/20060414/ap_on_he_me/hawaii_flu_pandemic<
Having experienced other ravages of diseases this tourist destination is making preparation for possible pandemic.
"Hawaii's airport plan calls for a nurse to take a swab from a potentially infected passenger on any plane, at the gate, or inside the airport. If tests show the traveler has the H5N1 variety, authorities are prepared to quarantine the entire jet. Officials are also ready to cordon off a gate or other section of the airport to isolate people exposed to the passenger."
Having experienced other ravages of diseases this tourist destination is making preparation for possible pandemic.
"Hawaii's airport plan calls for a nurse to take a swab from a potentially infected passenger on any plane, at the gate, or inside the airport. If tests show the traveler has the H5N1 variety, authorities are prepared to quarantine the entire jet. Officials are also ready to cordon off a gate or other section of the airport to isolate people exposed to the passenger."
Thursday, April 13, 2006
Wednesday, April 12, 2006
Indonesia worried about Complacency
http://economictimes.indiatimes.com/articleshow/1486627.cms
Such an odd polarization in respones. Some news writers worry about over reaction; this post worries about underreaction. This is the case when such a world altering possibility rests in the genetic roll of evolutionary dice.
Such an odd polarization in respones. Some news writers worry about over reaction; this post worries about underreaction. This is the case when such a world altering possibility rests in the genetic roll of evolutionary dice.
Tuesday, April 11, 2006
Vaccine techniques may change
http://www.abc.net.au/news/newsitems/200604/s1614276.htm
Response to the threat of bird flu and an understanding of how poorly we are equipped to respond to pandemic may change the way we manufacture vaccine.
Response to the threat of bird flu and an understanding of how poorly we are equipped to respond to pandemic may change the way we manufacture vaccine.
Monday, April 10, 2006
Closing schools in Brits planning
http://abcnews.go.com/International/wireStory?id=1823009
Since this flu if it evolves would target young people, closing schools is part of the defense plan.
Since this flu if it evolves would target young people, closing schools is part of the defense plan.
Ethical questions
http://bird-flu-symptom.info/news/bioethicist-to-offer-insights-on-avian-flu/
Some of the ethical questions to be asked in pandemic.
Some of the ethical questions to be asked in pandemic.
Sunday, April 09, 2006
Marc Seigel again Argues Against Danger
Marc Seigel is one of the very few voices against the alarm that bird flu news has generated. Some think it is just a way to promote his book, but it does give us hope that the warnings might be over blown.
http://www.latimes.com/news/opinion/commentary/la-oe-siegel6apr06,0,3341586.story?coll=la-news-comment-opinions
http://www.latimes.com/news/opinion/commentary/la-oe-siegel6apr06,0,3341586.story?coll=la-news-comment-opinions
Saturday, April 08, 2006
How the Brits are handling garden birds and feeding
http://news.bbc.co.uk/1/hi/uk/4887878.stm
The issue of what to do with bird feeders is one we will probably have to face by fall of this year. Here is an interesting discussion.
The issue of what to do with bird feeders is one we will probably have to face by fall of this year. Here is an interesting discussion.
Friday, April 07, 2006
Good over view with great illustrations
This article gives a good overview of the flu with illustrations so you can better understand what happens as well as what we hope never happens.
Thanks Ann
http://health.howstuffworks.com/bird-flu.htm
Thanks Ann
http://health.howstuffworks.com/bird-flu.htm
Virus mutation seen as unlikely
http://news.scotsman.com/health.cfm?id=532872006
An argument that mutation is unlikely based on the past behavior of his virus.
Still, it is a good thing to start preparing.
"There will be a pandemic eventually, and there is no reason to suppose it won't be a severe one. It will be a new virus attacking a population which won't have any immunity. It will sweep through the world very quickly," Prof Pennington said.
"We still don't have the capacity to make vaccines quickly enough and it is a difficult thing to do. We still have a lot of research to do to make better vaccines. Most virologists are still unhappy about the level of funding going into flu virus research, but they are happier now than they were a few years ago.
"The fact that H5N1 has been there as a threat - because it has infected and killed people, which puts it into a special category - has helped stimulate the world into action."
An argument that mutation is unlikely based on the past behavior of his virus.
Still, it is a good thing to start preparing.
"There will be a pandemic eventually, and there is no reason to suppose it won't be a severe one. It will be a new virus attacking a population which won't have any immunity. It will sweep through the world very quickly," Prof Pennington said.
"We still don't have the capacity to make vaccines quickly enough and it is a difficult thing to do. We still have a lot of research to do to make better vaccines. Most virologists are still unhappy about the level of funding going into flu virus research, but they are happier now than they were a few years ago.
"The fact that H5N1 has been there as a threat - because it has infected and killed people, which puts it into a special category - has helped stimulate the world into action."
Wednesday, April 05, 2006
More warnings on cats
If pandemic hits, cats should be kept inside.
"The Osterhaus team acknowledge that no-one knows if an infected cat can pass on H5N1 to humans.
Just as unknown is whether the animal, by harbouring the virus, can help it to mutate into a pandemic form -- a pathogen that is not only lethal for humans but contagious, too.
But, they say, this risk cannot be ruled out, and precautions should thus be incorporated into the guidelines of the WHO, the Food and Agricultural Organisation (FAO) and the World Organisation for Animal Health (OIE)."
http://abcnews.go.com/Health/story?id=1808386
http://news.bostonherald.com/localRegional/view.bg?articleid=133863
http://www.khaleejtimes.com/DisplayArticle.asp?xfile=data/theworld/2006/April/theworld_April157.xml§ion=theworld&col=
"The Osterhaus team acknowledge that no-one knows if an infected cat can pass on H5N1 to humans.
Just as unknown is whether the animal, by harbouring the virus, can help it to mutate into a pandemic form -- a pathogen that is not only lethal for humans but contagious, too.
But, they say, this risk cannot be ruled out, and precautions should thus be incorporated into the guidelines of the WHO, the Food and Agricultural Organisation (FAO) and the World Organisation for Animal Health (OIE)."
http://abcnews.go.com/Health/story?id=1808386
http://news.bostonherald.com/localRegional/view.bg?articleid=133863
http://www.khaleejtimes.com/DisplayArticle.asp?xfile=data/theworld/2006/April/theworld_April157.xml§ion=theworld&col=
Interesting interview/very comprehensive
========================================
Interview with Dr. Michael Osterholm
========================================
Professor of public health and director of the Center for Infectious Disease, Research and Policy at the University of Minnesota. He co-authored the book entitled Living Terrors: What Americans Need to Know to Survive the Coming Bioterrorist Catastrophe.
(from www.survivetheflu.com)
A couple of weeks ago we sent you an article about Dr.
Michael Osterholm 'On the Perils and Politics of Avian
Flu'. Below you'll find an interview conducted by City
Pages (Online News and Arts Weekly of the Twin Cities) with
Dr. Osterholm. We think you'll find it highly informative.
The CP interview: Dr. Michael Osterholm of the University of
Minnesota's Center for Infectious Disease Research and
Policy talks about the flu bug that could bring the world to
its knees.
BY STEVE PERRY
Scare headlines about the possibility of a deadly flu
pandemic have been with us for a few years now, ever since
the H5N1 bird-flu virus that first appeared in Hong Kong in
1997 resurfaced in the region in 2003. But in the past month
the drumbeat of such stories has grown faster and louder:
Avian Flu Arrives in Poland. Turkey. Azerbajian. Germany.
Denmark. And, just last Friday, Israel. The good news,
according to Dr. Michael Osterholm, the director of the
University of Minnesota's Center for Infectious Disease
Research and Policy, is that the arrival of infected birds
in North America—sometime this year, in the estimation of
most experts—is not likely to result in large numbers of
human infections with the virus, because most domestic
poultry in this part of the world is raised in factory-farm
isolation units that prevent contact with wild birds.
The bad news is that that's pretty much the only good news.
What matters in judging the prospects for a human pandemic
version of H5N1 (the name is shorthand for the chemical
structure of two of the virus's key components,
hemagglutinin and neuraminidase) is not so much the global
reach of the bird version, but the question of if or when
the virus mutates to a form that's easily passed from human
to human. If that happens anywhere in the world, says
Osterholm, the virus would likely start hitching rides with
travelers and seed itself around the globe in a matter of
days or weeks.
Of the hundred-plus human cases of H5N1 flu recorded so far,
the vast majority have involved bird-to-human transmission,
mostly among open-air poultry handlers in Asia. In addition,
there are confirmed clusters in which it has passed from
person to person, though none of those has yet resulted in a
breakout of the virus. One thing is clear, however: In its
present form, H5N1 has killed over half of the people it's
infected. The great flu pandemic of 1918-19, by contrast,
killed about 5 percent of its victims.
Will it cross over? If it does, can it possibly remain as
deadly? Though Osterholm notes that viruses usually do lose
strength as they spread—it's not really in their own
evolutionary interest to kill the majority of their hosts—he
believes the only responsible answer on both counts is we
don't know. But it's not just the characteristics of the
virus that worry him.
One of the things that sets the former Minnesota state
epidemiologist apart from other public health officials is
his attention to the fate of the medical and social
infrastructure in any serious contagious outbreak. With
respect to bird flu, his outlook recapitulates in many ways
what he had to say in his 2001 book about bioterrorism
preparedness, Living Terrors—much of the human toll in
death, hysteria, and anarchy would be exacted not by
infection but by the wide-scale breakdown of global supply
chains and just-in-time delivery systems for vital goods and
services. 'I think [Health and Human Services] Secretary
[Mike] Leavitt has been brutally honest in telling American
communities, you're going to be on your own,' says
Osterholm. 'And I think he's right.'
City Pages: Let me start with the question of the likelihood
of a global flu pandemic. Yesterday alone, I saw two wire
service headlines with radically different-seeming
implications, one indicating that the H5N1 avian flu is
likely to go global within six months, and another
speculating that the threat of human transmission may be
passing as we speak. Is it possible to say, based on the
epidemiological evidence, how likely a human flu pandemic is
in the next six months, the next year, the next two years?
Michael Osterholm: First of all, let me take a step back and
say that's a typical question we hear from the public. But
it's almost like asking, how many apples can you harvest
from the ocean? Because flu pandemics are like earthquakes,
hurricanes, and tsunamis—they occur. There's going to be
another one. There have been 10 in the last 300 years. What
you're really asking, I think, is will it be H5N1? It's
important to understand that when you're preparing for
pandemic influenza, you're preparing for something that will
happen. To say anything to the contrary would be like
saying, now that Katrina's happened, we'll never have
another hurricane like it.
Will H5N1 be the pandemic strain, and will it occur in the
next six to twelve months? The answer is, we don't know.
What is troubling about this virus is that this thing has
continued to mutate from its earliest days, in Hong Kong in
1997. And what is very, very troubling to us is that it's
mutating in very similar fashion to the way the 1918 virus
did. We went back with the 1918 virus and found all eight
genes of that virus in tissue samples—five from soldiers'
pathology slides that had been stored away, three from the
recovered corpse in Alaska. They didn't have any live virus,
but they've been able to make the virus from those eight
genes. And by studying that, they could determine how it
actually mutated and jumped directly to humans from birds.
It didn't go through other species as the 1957 and 1968
viruses did, where a bird and a human virus got together,
most likely in a pig lot, because pigs happen to be the
universal recipients for both [birds and humans].
They combined to make a third, dumbed-down virus that caused
mild pandemics.
The 1918 virus jumped right from birds to people. There was
no combining with other viruses. One of the problems we've
had is, if you look at the 1918 virus and this one, they're
in essence kissing cousins. Genetically, these things look
very similar. Frank Obenauer and colleagues just published a
paper the last week of January in Science, and they actually
have gone back and looked at the full genetic codes for 169
avian virus genomes, dating way back. They looked at 2,169
distinct avian virus genes. There were two viruses that
showed a protein tag at the end of one of the nonstructural
genes that actually looks to help cause the cytokine storm
that makes this a unique illness.* And guess which two
viruses they were: 1918 H1N1, and the current H5N1.
Then, when you look at the Turkey virus—that thing mutated.
This is the case of the young girl in Turkey who died from
her infection, and so did her uncle. We definitely have
clusters where it's not just bird contact [spreading the
virus]. The uncle's only exposure to this virus was riding
in the ambulance with her from hospital one to hospital two.
He became ill three days later and died. Her virus has now
been fully sequenced, and there were three mutations that
occurred in that virus, between the bird version and hers.
One was the substitution of a glutamic acid with lysine at
the 223-hemagglutinin position. That is what changes it from
a bird-receptor virus to a human-receptor virus. The second
thing was two other substitutions that served to make it
look more and more like a human virus.
So this thing just continues to march. Changes are occurring
in it all the time. [Human-to-human transmission] could
happen tonight. Or it may never happen. But I don't know
what will keep it from happening, because when you have this
kind of worldwide bird population as we do now—China's a
good example. In 1969, during the last pandemic, China only
had about 12 million chickens. Now it's got over 15 billion.
CP: Do you think the rise of poultry farms of vast scale has
contributed to the viral soup that influenza viruses grow
in?
Osterholm: Not really, and I'll tell you why. When you look
at the rise of the really big bird operations, they are
actually raised in these bio-security barns, which people
have all kinds of problems with for entirely different
reasons—humaneness and that kind of thing. They actually are
very safe, generally speaking, because they keep the wild
birds and the domestic birds separate. It's in Asia where
you have all these small 20-, 40-, 50-chicken operations
where the birds are living in open space with you—that's
where the vast majority of the chicken population is at in
the developing world. A good example is Turkey, where we're
seeing the first cases outside of Asia now. This is taking
the virus out of a tropical area and putting it in a
temperate area that gets cold. Every night, those people
bring their chickens into the house. It's just a very
different mindset.
And for as much as this is going to come here someday,
[bird-to-human transmission] is not going to be a big risk
factor to humans on this continent, because other than
free-ranging organic birds that are out there, domestic
birds aren't going to be at big risk.
CP: Can you explain in lay terms what makes a strain like
H5N1 novel, and so potentially deadly?
Osterholm: Well, there are three things that make a strain
of influenza virus potentially capable of causing a
pandemic. First of all, you have to have a situation where
you've got a novel or a new strain, meaning you don't have
any antibody protection against it. Then you have to have
one that is able to go from human to human. That's what we
don't have yet. The third thing is, it has some virulence
characteristics that make it cause severe illness.
This virus is quite different from what we see with the
standard annual flu, and what we saw in 1957 and 1968,
because of the cytokine storm it causes. In 1918, the vast
majority of the people who died were healthy young people,
20 to 40 years of age. And that was in large part because
they had the strongest immune systems.
CP: You're saying that the symptoms that cause fatalities,
aside from secondary bacterial infections, are actually a
function of the immune system working overtime.
Osterholm: That's it. And that's what we're trying to
understand at this point, in terms of how to best prevent
this [immune reaction]. And right now it doesn't look like
there's much you can do. I mentioned this 'kissing cousins'
phenomenon. If you put 1918 H1N1 into animal models at very,
very low doses, it basically kills all of them in 24 hours.
The lab science people had never seen that. At 16 to 24
hours, that virus was different from anything they'd ever
seen in killing these animals. The only virus that was
similar was H5N1, and it was fatal at much lower doses. H5N1
is the most powerful influenza virus we've seen in modern
human history.
What makes them so similar is that they both cause this
cytokine storm phenomenon.
CP: Which essentially results in a person's drowning in his
or her own blood as it fills the lungs, right?
Osterholm: It's even worse than that. You get that kind of
leakage, yes, but it also goes in and begins to shut down
all your vital organs. It's a domino effect. Your kidneys go
down, then your liver goes down, you have all this
destruction through necrosis of your lungs and your internal
organs. Everything goes.
CP: In the limited human sample we've seen so far, this
influenza has exacted a much higher mortality rate than the
1918 flu. Are there mechanisms that tend to dilute the
virulence of a strain as it spreads?
Osterholm: That's a really critical question. We can only
anticipate that this will attenuate. Meaning that once it
starts spreading in humans, it will lose some of its punch
in order to better adapt to humans. That's traditional with
virtually all agents you see like this. The thing that is
very difficult to talk about is, we don't know how much. If
this were to go human-to-human—we talk about a worst-case
scenario in terms of what happened in 1918, when roughly 2.5
percent of the world's population died. Of those who
contracted it, roughly 5 to 6 percent of populations died,
varying by age.
The mortality rate so far for this virus is around 55
percent, so this virus would have to attenuate a lot to get
down to that level. And we do have good data. There are not
a lot of mild, asymptomatic infections out there [with
H5N1]. We're now aware of six studies involving over 5,000
close contacts of H5N1-infected people, in Indonesia,
Vietnam, and Hong Kong, in which less than one person per
thousand contacts had evidence of an H5N1 infection that was
missed—that is, a mild infection.
This [virus] is not causing a lot of asymptomatic infections
right now. Some people are saying there's a lot of mild
[H5N1-related] illness all over out there, but it's just not
true. That means we're not artificially inflating the
mortality rate by missing a lot of infections. I'm actually
pretty confident that the real mortality is almost that
high.
So for that number to drop all the way down to a couple
percent is a pretty big drop. Which says to me that when
people talk about 1918 as a worst-case scenario, well, maybe
that isn't the worst-case scenario. That's hard for people
to hear, because then they think you're really trying to
scare the hell out of people. But you know what? It's just
the data.
If this virus were to ultimately go human-to-human, none of
us know what the human mortality would be.
CP: Does the fact that it seems to be gaining more currency
in other mammal species augur one way or the other for its
becoming transmissible from person to person?
Osterholm: None of us know. In 1918, for instance, we don't
know whether it infected cats and dogs. We've been trying to
find that out. Nobody's got that data. There just weren't
good reports. It surely can't be good that it's adapting to
more species. It says that the lung receptors of chickens
aren't the only ones that will take this virus. And we know
humans surely will take it, on the off chance that they're
exposed [to infected birds].
The bird-to-cat thing is not new. Some people have made a
lot out of the German situation. That's not new. The Bengal
tigers at the Bangkok Zoo died two years ago. They got fed
H5N1-infected chickens, and 50 of the Bengal tigers died.
They also transmitted to each other—there were cats there
that did not eat the chickens. Even Albert Osterhaus's work
of the past couple of weeks, which has been really important
to confirm it, was not a surprise.
CP: I wanted to ask you about a scenario you described in
your New England Journal of Medicine article from last year,
'Preparing for the Next Pandemic.' If a flu strain
transmitted from human to human did break through in some
part of the world, how would you expect events to unfold
over the first weeks?
Osterholm: Well, look at what's already happening with the
bird situation. You've got countries like South Korea
saying, don't go to Egypt. You've got a lot of bird
embargoes already taking place. If you saw this morning's
Wall Street Journal, the travel industry in Europe is
tanking. And this is a non-threat to a vast majority of
humans. What we're concerned about is that if this takes off
in a given area, it's going to move around the world
quickly, just like SARS. Last year 750 million people
crossed a national border somewhere in the world, either by
plane, automobile, or on foot.
These things move fast. With SARS, we had one physician from
China who came to Hong Kong, stayed in the Metropole Hotel
on one floor where there were nine other individuals he
infected just through breathing the air. They then took it
to four different continents in the next two days. That
gives you kind of a model, though influenza is much, much
more infectious.
I was very critical of those models that came out last fall
that suggested you could put a blanket over this with
Tamiflu. My whole criticism was practical—that you would
never find this quick enough and confirm it. Despite the
fact we now know Turkey was going on for weeks before we
understood what was happening over there, it was only last
week that the uncle's isolates were confirmed, almost eight
weeks after the fact.
CP: There's been a lot of covering up by some governments,
hasn't there? It's been repeatedly alleged of the Chinese.
Osterholm: Exactly. So my whole point is that before anyone
will have even figured out that this is going on with any
certainty, it'll be gone—the cow will be out the barn door.
With influenza, that's just...it's something you can't pull
back in.
CP: Periodically we see stories about the race to derive
vaccines, but that's not conceivable, is it, until we know
which viral subtype will break through?
Osterholm: Well, even that's a misconception, I think. The
concern we have is that people all want to know if some new
vaccine is 'the answer.' The problem is, we do need a new
vaccine. We're dealing with a 1950s-technology vaccine with
only one update. Right now, given the amount of virus needed
to make vaccines for H5N1—it needs a lot more antigen [than
typical flu strains]—our total worldwide capacity right now,
in one year's time, is only enough vaccine to protect
100-200 million people worldwide. That's in one year after a
pandemic starts. And that's it. You can't make any more,
given the limited capacity we have.
So you know what? It doesn't matter if we invent vaccines if
we can't manufacture them. This is a point I've tried to
make over and over again. We also are approaching this from
a very American-centric point of view, which in the end will
be the death of us. What's going to happen is, even if we
could produce vaccines for our country in a timely manner,
this global just-in-time economy we live in today is going
to see the rest of the world shut down. Eighty percent of
all the drugs we use in this country—all the childhood
vaccines, everything—come from offshore. Your cardio drugs,
your cancer drugs, your diabetes drugs, 80 percent of the
raw ingredients come from offshore. I could go through a
whole laundry list of other critical and essential products
and services that come from offshore. If the rest of the
world experiences a pandemic, we're still screwed. That's
what people don't understand. Somehow they have this
attitude that we can wall ourselves off in the Eighth
District of Minneapolis and be okay.
The bottom line is, it will be years, even at the
accelerated rate we're going now, before we even get the
right candidate-vaccines. Then they still have to be
approved. No company's going to embark on building
manufacturing capacity without the certainty of a market.
And second of all, they have to know exactly what vaccine
will be used and how they need to develop their plant. All
this means that an influenza plant, from start to finish,
would probably take three to five years to build.
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CP: Why don't we have the capacity to produce more in the
way of basic vaccines here in the U.S.?
Osterholm: Because it's all about the market. Today, many of
the anti-infective antibiotics and vaccines are not
considered blockbuster products for any pharmaceutical
company. We have a number of our childhood vaccines that are
down to a single manufacturer now. If you go to the Society
for Health Care Pharmacists' website, you'll see a list of
42 drugs today that are in short supply because of the
just-in-time supply chain. Now, you put on top of that
products that are marginal in their [profit] return, and it
becomes a loss leader for these companies [to make
vaccines]. They want out of it.
This is not true just for vaccines, but also for
antibiotics. There, we tell people to hardly use them, and
only for specific purposes and limited periods. It's not
like the lifestyle drugs, where you're taking your statins
for the rest of your life. So they just don't see the
profitability [in antibiotics]. We're in real trouble. And
it's not just with respect to the flu.
CP: The one easy-to-use drug that's been shown to arrest
H5N1 in humans is Tamiflu—
Osterholm: Well, that's not really true. There's no evidence
that it makes a difference in H5N1 infection. I have a slide
here showing that the case mortality rate in Vietnam was
identical for those who got Tamiflu and those who didn't. I
actually believe Tamiflu could work, but the problem is,
we're applying it in the H3N2 [average seasonal flu] model.
Seasonal flu grows up much slower in a human, so that if you
get the drug into somebody two days after their onset, you
can still have a pretty measurable impact on the severity of
their illness and the likelihood they'll have complications.
With the H5N1 virus, the virus storm that precedes the
cytokine storm is so remarkable in those first 24 hours that
if you don't have the drug onboard in those first 24 hours,
it may only have limited impact.
The second thing is, we're using the same dosage levels we
use for H3N2 [seasonal flu]. This is a very different virus.
We may have to double the dosage for twice the length of
time. We have anecdotal data on people who got the drug
early and appeared to do better, but then, after the typical
five-day course was stopped, they died on day ten.
The problem we have is not whether Tamiflu is available and
will work, but can you get it soon enough and in high enough
amounts? How do you get the drug to somebody in the first 12
hours of their illness? The second thing is, when people
talk about having 20 million or 40 million protective doses,
what does that mean? If we're going to have to use twice the
dose for twice as long, that means maybe you've got
one-fourth as much of the drug you think you have.
That's the story on H5N1 and Tamiflu. I think it can work,
but it won't work the way we're approaching it.
In the next five years, with [Tamiflu manufacturer] Roche
outsourcing all of the production they can, our best
guesstimate is that—using the old, low dosage standards—we
could probably produce enough Tamiflu to treat about 7
percent of the world's population in the next five years,
because of the precursor chemicals needed and the
complicated nature of making this stuff. That's the sum
total of production capacity. It's no panacea.
CP: How would you rate the public health infrastructure in
the U.S. for its ability to deal with massive numbers of
very ill people? You wrote in the NEJM last year that our
system lacks 'surge capacity' to deal with a lot of sick
people at once—why is that?
Osterholm: It's much deeper and bigger than the public
health system. It's really the total care system. For
example, I talked [in that article] about the 105,000
mechanical ventilators? On any given day, 70,000-80,000 of
them are in use, and in a normal flu season we butt up
against the 100,000 mark. We have no excess capacity there
whatsoever. Just right here in our own Twin Cities, we've
reduced intensive care beds by 20 percent in the last four
years, as a matter of cost containment.
We'll run out of masks and respirators overnight, because
it's a global just-in-time supply chain. There are two
manufacturers who have the largest share of the market
there, but with virtually no surge capacity. We'll run out
of IV needles. We'll run out of IV bags. We'll run out of
drugs very quickly. Remember I talked about the 80 percent
offshore figure? Go to the Society for Health Care
Pharmacists' website and you'll see what I'm talking about.
So the whole medical system will collapse, at a time when we
still need drugs for heart attacks, cancer, and everything
else. We'll be in freefall. That may sound scary, but it's a
reality. And unlike Katrina, where the hurricane did some of
the destruction and separated people from health care
through evacuation or otherwise, the same thing's going to
happen here in every city, town, and village in this country
as well. We're all going to need things at the same time,
and there won't be any products.
At this Business Continuity Summit we just had, we actually
had a major discussion in which a lot of voices expressed
concern about the internet—that it doesn't have the backbone
and elasticity that everyone thinks it has, and just a
limited surge could bring down the internet.
Right after Katrina, when FEMA was trying to rescue itself,
they put out a call for anyone who had a refrigerated truck
unit to come and sit in one of several parking lots in the
Gulf states down there, in case they had 10,000 bodies, etc.
A contingent of them went. Not all of them, by any stretch
of the imagination. Within 72 hours, major food
manufacturers throughout the United States reported that
they couldn't ship their goods. They had no trucks. We have
a razor-thin capacity in this country right now on virtually
everything. They had to get FEMA to release the trucks.
Cities like Seattle have already come to the conclusion they
won't be able to have refrigerated trucks, because of that
issue. For their work with corpse management, for example,
they've already mapped out where every one of the ice arenas
in Seattle is. Because you won't be able to bury people,
either. In 1969, during the last pandemic, the average time
from when a casket was made until it was in the ground was
about six months. Today it's a little over a month, and in
some areas of the country it's less than that. There's no
surge capacity in casket manufacturing. Today, crematorium
space in this country is a just-in-time situation too. This
means we would quickly run out of the ability to handle
bodies in a timely, respectful way. That's in a moderate
pandemic, not at all like 1918. Everything now is done on
the basis of just-in-time delivery systems.
Now, think about Katrina. As horrible as it was seeing the
Superdome, seeing shots of bodies rotting would kind of take
you over the top. What really offends the sensibilities of
most Americans is when you see the dead handled in a
disrespectful manner. I worry that one of the tipping points
in a panic/fear situation over pandemic flu would come when
we can't, in a timely way, handle the bodies or get them
into cold storage. Those are issues we haven't dealt with at
all.
CP: Your answer to this is partly implicit in all you've
said, but let me ask you to sum up how you'd rate the U.S.'s
and Minnesota's state of preparedness for a pandemic.
Osterholm: I think the U.S. right now is leading the way in
terms of the overall issue of pandemic influenza
preparedness. The problem is that, for much of the
developing world, they don't have a lot to prepare for. They
don't have sophisticated supply-chain issues. In some ways I
think they're better off than we are, because they already
live a very simple, hand-to-mouth existence. For us, with
our complicated supply networks, we have a long, long way to
go. And I think that's as much a private-sector issue as a
government issue. I think Secretary Leavitt has been
brutally honest in telling American communities, you're
going to be on your own. And I think he's right. You know
how you creep, then you walk, then you run? We're still on
our knees.
CP: What kind of measures might we in the Twin Cities expect
to see undertaken in the short term if an outbreak did reach
the U.S.?
Osterholm: I can't say. I don't know. I know that the
governor today, in his State of the State address, said that
he's just committed $10 million to influenza preparedness.
What that means, I can't say. We don't have the details yet.
When the virus gets to this continent as a bird virus, it's
important that we not overreact and misinterpret it to mean
that now the pandemic's here. This will be an important
issue for poultry, but as I pointed out, I think most of the
poultry in this country—aside from the free-range organic
poultry—is going to be pretty well-protected.
It's about the birds and it's not about the birds. It's
about the birds now, but when real pandemic influenza
occurs, the birds become inconsequential. It's
human-to-human transmission that matters then. That's where
we're not any better prepared here than anyone else in the
world.
CP: How would you rate the media's performance in covering
this story—too salacious, too understated, just right?
Osterholm: It's like talking about the weather, I
guess—depends on which day, and where. There have been some
outstanding reporters on this issue. Helen Branswell, from
Canadian Press, covered SARS and has become the primary
person on this. She's done it as well as anybody. On the
whole, it has been poorly covered in the sense of
distinguishing H5N1 in the bird population from pandemic
influenza. That part has not been covered in depth. The
issue about covering preparedness—no one has really gone
into depth and explored the supply-chain issues to say,
okay, what does this all mean? Let's take a community and
say, what would happen here? We're so fixated on the news
cycle that it's too often about, 'what new country has just
been infected with bird virus?' and not really get into the
issues. Ted Koppel at Nightline did an excellent series of
stories and asked good, hard questions. But now he's gone
and Nightline hasn't picked it up since he left.
*Cytokines are a class of proteins produced by white blood
cells whenever the body finds itself responding to an
infection. They vary in function—some cytokines attack
invading microbes directly, others relay chemical messages
from cell to cell, still others bind with cells in the
hypothalamus region of the brain to produce fevers.
Cytokines are toxic not only to infectious agents in the
body but to the body itself: Much of the pain and discomfort
that accompany illnesses like the common flu, for example,
are in effect hangover symptoms from the toxic effects of
the body's own immune response. The term 'cytokine storm'
refers to the immune response that occurs when the body is
confronted with an infectious agent that reproduces at great
speed and in huge volume. This 'viral storm' generates an
equally huge immune response—the cytokine storm—that can
take such a toll on lung tissue (the main battleground where
the virus and the immune system face off) that it deprives
vital organs of enough oxygen to function, and sets off
cascading organ failure.
========================================
Stay Healthy & Safe.
Bob & Julie
www.survivetheflu.com
Interview with Dr. Michael Osterholm
========================================
Professor of public health and director of the Center for Infectious Disease, Research and Policy at the University of Minnesota. He co-authored the book entitled Living Terrors: What Americans Need to Know to Survive the Coming Bioterrorist Catastrophe.
(from www.survivetheflu.com)
A couple of weeks ago we sent you an article about Dr.
Michael Osterholm 'On the Perils and Politics of Avian
Flu'. Below you'll find an interview conducted by City
Pages (Online News and Arts Weekly of the Twin Cities) with
Dr. Osterholm. We think you'll find it highly informative.
The CP interview: Dr. Michael Osterholm of the University of
Minnesota's Center for Infectious Disease Research and
Policy talks about the flu bug that could bring the world to
its knees.
BY STEVE PERRY
Scare headlines about the possibility of a deadly flu
pandemic have been with us for a few years now, ever since
the H5N1 bird-flu virus that first appeared in Hong Kong in
1997 resurfaced in the region in 2003. But in the past month
the drumbeat of such stories has grown faster and louder:
Avian Flu Arrives in Poland. Turkey. Azerbajian. Germany.
Denmark. And, just last Friday, Israel. The good news,
according to Dr. Michael Osterholm, the director of the
University of Minnesota's Center for Infectious Disease
Research and Policy, is that the arrival of infected birds
in North America—sometime this year, in the estimation of
most experts—is not likely to result in large numbers of
human infections with the virus, because most domestic
poultry in this part of the world is raised in factory-farm
isolation units that prevent contact with wild birds.
The bad news is that that's pretty much the only good news.
What matters in judging the prospects for a human pandemic
version of H5N1 (the name is shorthand for the chemical
structure of two of the virus's key components,
hemagglutinin and neuraminidase) is not so much the global
reach of the bird version, but the question of if or when
the virus mutates to a form that's easily passed from human
to human. If that happens anywhere in the world, says
Osterholm, the virus would likely start hitching rides with
travelers and seed itself around the globe in a matter of
days or weeks.
Of the hundred-plus human cases of H5N1 flu recorded so far,
the vast majority have involved bird-to-human transmission,
mostly among open-air poultry handlers in Asia. In addition,
there are confirmed clusters in which it has passed from
person to person, though none of those has yet resulted in a
breakout of the virus. One thing is clear, however: In its
present form, H5N1 has killed over half of the people it's
infected. The great flu pandemic of 1918-19, by contrast,
killed about 5 percent of its victims.
Will it cross over? If it does, can it possibly remain as
deadly? Though Osterholm notes that viruses usually do lose
strength as they spread—it's not really in their own
evolutionary interest to kill the majority of their hosts—he
believes the only responsible answer on both counts is we
don't know. But it's not just the characteristics of the
virus that worry him.
One of the things that sets the former Minnesota state
epidemiologist apart from other public health officials is
his attention to the fate of the medical and social
infrastructure in any serious contagious outbreak. With
respect to bird flu, his outlook recapitulates in many ways
what he had to say in his 2001 book about bioterrorism
preparedness, Living Terrors—much of the human toll in
death, hysteria, and anarchy would be exacted not by
infection but by the wide-scale breakdown of global supply
chains and just-in-time delivery systems for vital goods and
services. 'I think [Health and Human Services] Secretary
[Mike] Leavitt has been brutally honest in telling American
communities, you're going to be on your own,' says
Osterholm. 'And I think he's right.'
City Pages: Let me start with the question of the likelihood
of a global flu pandemic. Yesterday alone, I saw two wire
service headlines with radically different-seeming
implications, one indicating that the H5N1 avian flu is
likely to go global within six months, and another
speculating that the threat of human transmission may be
passing as we speak. Is it possible to say, based on the
epidemiological evidence, how likely a human flu pandemic is
in the next six months, the next year, the next two years?
Michael Osterholm: First of all, let me take a step back and
say that's a typical question we hear from the public. But
it's almost like asking, how many apples can you harvest
from the ocean? Because flu pandemics are like earthquakes,
hurricanes, and tsunamis—they occur. There's going to be
another one. There have been 10 in the last 300 years. What
you're really asking, I think, is will it be H5N1? It's
important to understand that when you're preparing for
pandemic influenza, you're preparing for something that will
happen. To say anything to the contrary would be like
saying, now that Katrina's happened, we'll never have
another hurricane like it.
Will H5N1 be the pandemic strain, and will it occur in the
next six to twelve months? The answer is, we don't know.
What is troubling about this virus is that this thing has
continued to mutate from its earliest days, in Hong Kong in
1997. And what is very, very troubling to us is that it's
mutating in very similar fashion to the way the 1918 virus
did. We went back with the 1918 virus and found all eight
genes of that virus in tissue samples—five from soldiers'
pathology slides that had been stored away, three from the
recovered corpse in Alaska. They didn't have any live virus,
but they've been able to make the virus from those eight
genes. And by studying that, they could determine how it
actually mutated and jumped directly to humans from birds.
It didn't go through other species as the 1957 and 1968
viruses did, where a bird and a human virus got together,
most likely in a pig lot, because pigs happen to be the
universal recipients for both [birds and humans].
They combined to make a third, dumbed-down virus that caused
mild pandemics.
The 1918 virus jumped right from birds to people. There was
no combining with other viruses. One of the problems we've
had is, if you look at the 1918 virus and this one, they're
in essence kissing cousins. Genetically, these things look
very similar. Frank Obenauer and colleagues just published a
paper the last week of January in Science, and they actually
have gone back and looked at the full genetic codes for 169
avian virus genomes, dating way back. They looked at 2,169
distinct avian virus genes. There were two viruses that
showed a protein tag at the end of one of the nonstructural
genes that actually looks to help cause the cytokine storm
that makes this a unique illness.* And guess which two
viruses they were: 1918 H1N1, and the current H5N1.
Then, when you look at the Turkey virus—that thing mutated.
This is the case of the young girl in Turkey who died from
her infection, and so did her uncle. We definitely have
clusters where it's not just bird contact [spreading the
virus]. The uncle's only exposure to this virus was riding
in the ambulance with her from hospital one to hospital two.
He became ill three days later and died. Her virus has now
been fully sequenced, and there were three mutations that
occurred in that virus, between the bird version and hers.
One was the substitution of a glutamic acid with lysine at
the 223-hemagglutinin position. That is what changes it from
a bird-receptor virus to a human-receptor virus. The second
thing was two other substitutions that served to make it
look more and more like a human virus.
So this thing just continues to march. Changes are occurring
in it all the time. [Human-to-human transmission] could
happen tonight. Or it may never happen. But I don't know
what will keep it from happening, because when you have this
kind of worldwide bird population as we do now—China's a
good example. In 1969, during the last pandemic, China only
had about 12 million chickens. Now it's got over 15 billion.
CP: Do you think the rise of poultry farms of vast scale has
contributed to the viral soup that influenza viruses grow
in?
Osterholm: Not really, and I'll tell you why. When you look
at the rise of the really big bird operations, they are
actually raised in these bio-security barns, which people
have all kinds of problems with for entirely different
reasons—humaneness and that kind of thing. They actually are
very safe, generally speaking, because they keep the wild
birds and the domestic birds separate. It's in Asia where
you have all these small 20-, 40-, 50-chicken operations
where the birds are living in open space with you—that's
where the vast majority of the chicken population is at in
the developing world. A good example is Turkey, where we're
seeing the first cases outside of Asia now. This is taking
the virus out of a tropical area and putting it in a
temperate area that gets cold. Every night, those people
bring their chickens into the house. It's just a very
different mindset.
And for as much as this is going to come here someday,
[bird-to-human transmission] is not going to be a big risk
factor to humans on this continent, because other than
free-ranging organic birds that are out there, domestic
birds aren't going to be at big risk.
CP: Can you explain in lay terms what makes a strain like
H5N1 novel, and so potentially deadly?
Osterholm: Well, there are three things that make a strain
of influenza virus potentially capable of causing a
pandemic. First of all, you have to have a situation where
you've got a novel or a new strain, meaning you don't have
any antibody protection against it. Then you have to have
one that is able to go from human to human. That's what we
don't have yet. The third thing is, it has some virulence
characteristics that make it cause severe illness.
This virus is quite different from what we see with the
standard annual flu, and what we saw in 1957 and 1968,
because of the cytokine storm it causes. In 1918, the vast
majority of the people who died were healthy young people,
20 to 40 years of age. And that was in large part because
they had the strongest immune systems.
CP: You're saying that the symptoms that cause fatalities,
aside from secondary bacterial infections, are actually a
function of the immune system working overtime.
Osterholm: That's it. And that's what we're trying to
understand at this point, in terms of how to best prevent
this [immune reaction]. And right now it doesn't look like
there's much you can do. I mentioned this 'kissing cousins'
phenomenon. If you put 1918 H1N1 into animal models at very,
very low doses, it basically kills all of them in 24 hours.
The lab science people had never seen that. At 16 to 24
hours, that virus was different from anything they'd ever
seen in killing these animals. The only virus that was
similar was H5N1, and it was fatal at much lower doses. H5N1
is the most powerful influenza virus we've seen in modern
human history.
What makes them so similar is that they both cause this
cytokine storm phenomenon.
CP: Which essentially results in a person's drowning in his
or her own blood as it fills the lungs, right?
Osterholm: It's even worse than that. You get that kind of
leakage, yes, but it also goes in and begins to shut down
all your vital organs. It's a domino effect. Your kidneys go
down, then your liver goes down, you have all this
destruction through necrosis of your lungs and your internal
organs. Everything goes.
CP: In the limited human sample we've seen so far, this
influenza has exacted a much higher mortality rate than the
1918 flu. Are there mechanisms that tend to dilute the
virulence of a strain as it spreads?
Osterholm: That's a really critical question. We can only
anticipate that this will attenuate. Meaning that once it
starts spreading in humans, it will lose some of its punch
in order to better adapt to humans. That's traditional with
virtually all agents you see like this. The thing that is
very difficult to talk about is, we don't know how much. If
this were to go human-to-human—we talk about a worst-case
scenario in terms of what happened in 1918, when roughly 2.5
percent of the world's population died. Of those who
contracted it, roughly 5 to 6 percent of populations died,
varying by age.
The mortality rate so far for this virus is around 55
percent, so this virus would have to attenuate a lot to get
down to that level. And we do have good data. There are not
a lot of mild, asymptomatic infections out there [with
H5N1]. We're now aware of six studies involving over 5,000
close contacts of H5N1-infected people, in Indonesia,
Vietnam, and Hong Kong, in which less than one person per
thousand contacts had evidence of an H5N1 infection that was
missed—that is, a mild infection.
This [virus] is not causing a lot of asymptomatic infections
right now. Some people are saying there's a lot of mild
[H5N1-related] illness all over out there, but it's just not
true. That means we're not artificially inflating the
mortality rate by missing a lot of infections. I'm actually
pretty confident that the real mortality is almost that
high.
So for that number to drop all the way down to a couple
percent is a pretty big drop. Which says to me that when
people talk about 1918 as a worst-case scenario, well, maybe
that isn't the worst-case scenario. That's hard for people
to hear, because then they think you're really trying to
scare the hell out of people. But you know what? It's just
the data.
If this virus were to ultimately go human-to-human, none of
us know what the human mortality would be.
CP: Does the fact that it seems to be gaining more currency
in other mammal species augur one way or the other for its
becoming transmissible from person to person?
Osterholm: None of us know. In 1918, for instance, we don't
know whether it infected cats and dogs. We've been trying to
find that out. Nobody's got that data. There just weren't
good reports. It surely can't be good that it's adapting to
more species. It says that the lung receptors of chickens
aren't the only ones that will take this virus. And we know
humans surely will take it, on the off chance that they're
exposed [to infected birds].
The bird-to-cat thing is not new. Some people have made a
lot out of the German situation. That's not new. The Bengal
tigers at the Bangkok Zoo died two years ago. They got fed
H5N1-infected chickens, and 50 of the Bengal tigers died.
They also transmitted to each other—there were cats there
that did not eat the chickens. Even Albert Osterhaus's work
of the past couple of weeks, which has been really important
to confirm it, was not a surprise.
CP: I wanted to ask you about a scenario you described in
your New England Journal of Medicine article from last year,
'Preparing for the Next Pandemic.' If a flu strain
transmitted from human to human did break through in some
part of the world, how would you expect events to unfold
over the first weeks?
Osterholm: Well, look at what's already happening with the
bird situation. You've got countries like South Korea
saying, don't go to Egypt. You've got a lot of bird
embargoes already taking place. If you saw this morning's
Wall Street Journal, the travel industry in Europe is
tanking. And this is a non-threat to a vast majority of
humans. What we're concerned about is that if this takes off
in a given area, it's going to move around the world
quickly, just like SARS. Last year 750 million people
crossed a national border somewhere in the world, either by
plane, automobile, or on foot.
These things move fast. With SARS, we had one physician from
China who came to Hong Kong, stayed in the Metropole Hotel
on one floor where there were nine other individuals he
infected just through breathing the air. They then took it
to four different continents in the next two days. That
gives you kind of a model, though influenza is much, much
more infectious.
I was very critical of those models that came out last fall
that suggested you could put a blanket over this with
Tamiflu. My whole criticism was practical—that you would
never find this quick enough and confirm it. Despite the
fact we now know Turkey was going on for weeks before we
understood what was happening over there, it was only last
week that the uncle's isolates were confirmed, almost eight
weeks after the fact.
CP: There's been a lot of covering up by some governments,
hasn't there? It's been repeatedly alleged of the Chinese.
Osterholm: Exactly. So my whole point is that before anyone
will have even figured out that this is going on with any
certainty, it'll be gone—the cow will be out the barn door.
With influenza, that's just...it's something you can't pull
back in.
CP: Periodically we see stories about the race to derive
vaccines, but that's not conceivable, is it, until we know
which viral subtype will break through?
Osterholm: Well, even that's a misconception, I think. The
concern we have is that people all want to know if some new
vaccine is 'the answer.' The problem is, we do need a new
vaccine. We're dealing with a 1950s-technology vaccine with
only one update. Right now, given the amount of virus needed
to make vaccines for H5N1—it needs a lot more antigen [than
typical flu strains]—our total worldwide capacity right now,
in one year's time, is only enough vaccine to protect
100-200 million people worldwide. That's in one year after a
pandemic starts. And that's it. You can't make any more,
given the limited capacity we have.
So you know what? It doesn't matter if we invent vaccines if
we can't manufacture them. This is a point I've tried to
make over and over again. We also are approaching this from
a very American-centric point of view, which in the end will
be the death of us. What's going to happen is, even if we
could produce vaccines for our country in a timely manner,
this global just-in-time economy we live in today is going
to see the rest of the world shut down. Eighty percent of
all the drugs we use in this country—all the childhood
vaccines, everything—come from offshore. Your cardio drugs,
your cancer drugs, your diabetes drugs, 80 percent of the
raw ingredients come from offshore. I could go through a
whole laundry list of other critical and essential products
and services that come from offshore. If the rest of the
world experiences a pandemic, we're still screwed. That's
what people don't understand. Somehow they have this
attitude that we can wall ourselves off in the Eighth
District of Minneapolis and be okay.
The bottom line is, it will be years, even at the
accelerated rate we're going now, before we even get the
right candidate-vaccines. Then they still have to be
approved. No company's going to embark on building
manufacturing capacity without the certainty of a market.
And second of all, they have to know exactly what vaccine
will be used and how they need to develop their plant. All
this means that an influenza plant, from start to finish,
would probably take three to five years to build.
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CP: Why don't we have the capacity to produce more in the
way of basic vaccines here in the U.S.?
Osterholm: Because it's all about the market. Today, many of
the anti-infective antibiotics and vaccines are not
considered blockbuster products for any pharmaceutical
company. We have a number of our childhood vaccines that are
down to a single manufacturer now. If you go to the Society
for Health Care Pharmacists' website, you'll see a list of
42 drugs today that are in short supply because of the
just-in-time supply chain. Now, you put on top of that
products that are marginal in their [profit] return, and it
becomes a loss leader for these companies [to make
vaccines]. They want out of it.
This is not true just for vaccines, but also for
antibiotics. There, we tell people to hardly use them, and
only for specific purposes and limited periods. It's not
like the lifestyle drugs, where you're taking your statins
for the rest of your life. So they just don't see the
profitability [in antibiotics]. We're in real trouble. And
it's not just with respect to the flu.
CP: The one easy-to-use drug that's been shown to arrest
H5N1 in humans is Tamiflu—
Osterholm: Well, that's not really true. There's no evidence
that it makes a difference in H5N1 infection. I have a slide
here showing that the case mortality rate in Vietnam was
identical for those who got Tamiflu and those who didn't. I
actually believe Tamiflu could work, but the problem is,
we're applying it in the H3N2 [average seasonal flu] model.
Seasonal flu grows up much slower in a human, so that if you
get the drug into somebody two days after their onset, you
can still have a pretty measurable impact on the severity of
their illness and the likelihood they'll have complications.
With the H5N1 virus, the virus storm that precedes the
cytokine storm is so remarkable in those first 24 hours that
if you don't have the drug onboard in those first 24 hours,
it may only have limited impact.
The second thing is, we're using the same dosage levels we
use for H3N2 [seasonal flu]. This is a very different virus.
We may have to double the dosage for twice the length of
time. We have anecdotal data on people who got the drug
early and appeared to do better, but then, after the typical
five-day course was stopped, they died on day ten.
The problem we have is not whether Tamiflu is available and
will work, but can you get it soon enough and in high enough
amounts? How do you get the drug to somebody in the first 12
hours of their illness? The second thing is, when people
talk about having 20 million or 40 million protective doses,
what does that mean? If we're going to have to use twice the
dose for twice as long, that means maybe you've got
one-fourth as much of the drug you think you have.
That's the story on H5N1 and Tamiflu. I think it can work,
but it won't work the way we're approaching it.
In the next five years, with [Tamiflu manufacturer] Roche
outsourcing all of the production they can, our best
guesstimate is that—using the old, low dosage standards—we
could probably produce enough Tamiflu to treat about 7
percent of the world's population in the next five years,
because of the precursor chemicals needed and the
complicated nature of making this stuff. That's the sum
total of production capacity. It's no panacea.
CP: How would you rate the public health infrastructure in
the U.S. for its ability to deal with massive numbers of
very ill people? You wrote in the NEJM last year that our
system lacks 'surge capacity' to deal with a lot of sick
people at once—why is that?
Osterholm: It's much deeper and bigger than the public
health system. It's really the total care system. For
example, I talked [in that article] about the 105,000
mechanical ventilators? On any given day, 70,000-80,000 of
them are in use, and in a normal flu season we butt up
against the 100,000 mark. We have no excess capacity there
whatsoever. Just right here in our own Twin Cities, we've
reduced intensive care beds by 20 percent in the last four
years, as a matter of cost containment.
We'll run out of masks and respirators overnight, because
it's a global just-in-time supply chain. There are two
manufacturers who have the largest share of the market
there, but with virtually no surge capacity. We'll run out
of IV needles. We'll run out of IV bags. We'll run out of
drugs very quickly. Remember I talked about the 80 percent
offshore figure? Go to the Society for Health Care
Pharmacists' website and you'll see what I'm talking about.
So the whole medical system will collapse, at a time when we
still need drugs for heart attacks, cancer, and everything
else. We'll be in freefall. That may sound scary, but it's a
reality. And unlike Katrina, where the hurricane did some of
the destruction and separated people from health care
through evacuation or otherwise, the same thing's going to
happen here in every city, town, and village in this country
as well. We're all going to need things at the same time,
and there won't be any products.
At this Business Continuity Summit we just had, we actually
had a major discussion in which a lot of voices expressed
concern about the internet—that it doesn't have the backbone
and elasticity that everyone thinks it has, and just a
limited surge could bring down the internet.
Right after Katrina, when FEMA was trying to rescue itself,
they put out a call for anyone who had a refrigerated truck
unit to come and sit in one of several parking lots in the
Gulf states down there, in case they had 10,000 bodies, etc.
A contingent of them went. Not all of them, by any stretch
of the imagination. Within 72 hours, major food
manufacturers throughout the United States reported that
they couldn't ship their goods. They had no trucks. We have
a razor-thin capacity in this country right now on virtually
everything. They had to get FEMA to release the trucks.
Cities like Seattle have already come to the conclusion they
won't be able to have refrigerated trucks, because of that
issue. For their work with corpse management, for example,
they've already mapped out where every one of the ice arenas
in Seattle is. Because you won't be able to bury people,
either. In 1969, during the last pandemic, the average time
from when a casket was made until it was in the ground was
about six months. Today it's a little over a month, and in
some areas of the country it's less than that. There's no
surge capacity in casket manufacturing. Today, crematorium
space in this country is a just-in-time situation too. This
means we would quickly run out of the ability to handle
bodies in a timely, respectful way. That's in a moderate
pandemic, not at all like 1918. Everything now is done on
the basis of just-in-time delivery systems.
Now, think about Katrina. As horrible as it was seeing the
Superdome, seeing shots of bodies rotting would kind of take
you over the top. What really offends the sensibilities of
most Americans is when you see the dead handled in a
disrespectful manner. I worry that one of the tipping points
in a panic/fear situation over pandemic flu would come when
we can't, in a timely way, handle the bodies or get them
into cold storage. Those are issues we haven't dealt with at
all.
CP: Your answer to this is partly implicit in all you've
said, but let me ask you to sum up how you'd rate the U.S.'s
and Minnesota's state of preparedness for a pandemic.
Osterholm: I think the U.S. right now is leading the way in
terms of the overall issue of pandemic influenza
preparedness. The problem is that, for much of the
developing world, they don't have a lot to prepare for. They
don't have sophisticated supply-chain issues. In some ways I
think they're better off than we are, because they already
live a very simple, hand-to-mouth existence. For us, with
our complicated supply networks, we have a long, long way to
go. And I think that's as much a private-sector issue as a
government issue. I think Secretary Leavitt has been
brutally honest in telling American communities, you're
going to be on your own. And I think he's right. You know
how you creep, then you walk, then you run? We're still on
our knees.
CP: What kind of measures might we in the Twin Cities expect
to see undertaken in the short term if an outbreak did reach
the U.S.?
Osterholm: I can't say. I don't know. I know that the
governor today, in his State of the State address, said that
he's just committed $10 million to influenza preparedness.
What that means, I can't say. We don't have the details yet.
When the virus gets to this continent as a bird virus, it's
important that we not overreact and misinterpret it to mean
that now the pandemic's here. This will be an important
issue for poultry, but as I pointed out, I think most of the
poultry in this country—aside from the free-range organic
poultry—is going to be pretty well-protected.
It's about the birds and it's not about the birds. It's
about the birds now, but when real pandemic influenza
occurs, the birds become inconsequential. It's
human-to-human transmission that matters then. That's where
we're not any better prepared here than anyone else in the
world.
CP: How would you rate the media's performance in covering
this story—too salacious, too understated, just right?
Osterholm: It's like talking about the weather, I
guess—depends on which day, and where. There have been some
outstanding reporters on this issue. Helen Branswell, from
Canadian Press, covered SARS and has become the primary
person on this. She's done it as well as anybody. On the
whole, it has been poorly covered in the sense of
distinguishing H5N1 in the bird population from pandemic
influenza. That part has not been covered in depth. The
issue about covering preparedness—no one has really gone
into depth and explored the supply-chain issues to say,
okay, what does this all mean? Let's take a community and
say, what would happen here? We're so fixated on the news
cycle that it's too often about, 'what new country has just
been infected with bird virus?' and not really get into the
issues. Ted Koppel at Nightline did an excellent series of
stories and asked good, hard questions. But now he's gone
and Nightline hasn't picked it up since he left.
*Cytokines are a class of proteins produced by white blood
cells whenever the body finds itself responding to an
infection. They vary in function—some cytokines attack
invading microbes directly, others relay chemical messages
from cell to cell, still others bind with cells in the
hypothalamus region of the brain to produce fevers.
Cytokines are toxic not only to infectious agents in the
body but to the body itself: Much of the pain and discomfort
that accompany illnesses like the common flu, for example,
are in effect hangover symptoms from the toxic effects of
the body's own immune response. The term 'cytokine storm'
refers to the immune response that occurs when the body is
confronted with an infectious agent that reproduces at great
speed and in huge volume. This 'viral storm' generates an
equally huge immune response—the cytokine storm—that can
take such a toll on lung tissue (the main battleground where
the virus and the immune system face off) that it deprives
vital organs of enough oxygen to function, and sets off
cascading organ failure.
========================================
Stay Healthy & Safe.
Bob & Julie
www.survivetheflu.com
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