View Full Version : Pandemic Flu
OK, last time with the pandemic flu warning, I promise. I don't want to be Chicken Little, but I saw a lot of heavy hitters with "deer-in-the-headlights" looks in their eyes last week.
I'm as far as you can get from a QP. I mostly hang out with virologists and clinical researchers. I followed NDD here from another forum to read a review, and I stayed because I like the no-BS environment. Anywho, I sent this out to some family/friends and thought I'd put it out here...take it or leave it.
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As some of you know my company develops software for the medical research community. I am not a primary researcher -- I just carry water for those who are. I met w/ several of these scientists last week and the buzz was all about a paper to be released on 16 March in the respected journal Science (writen by very bright buys at Scripps and CDC). It has them all very spooked; it's found here:
http://www.sciencemag.org/cgi/content/abstract/1124513v1
I'll cite the (incomprehensible) abstract and then present the explanation I was given by a virologist/geneticist.
"The hemagglutinin (HA) structure at 2.9 angstrom resolution, from a highly pathogenic Vietnamese H5N1 influenza virus, is more related to the 1918 and other human H1 HAs than to a 1997 duck H5 HA. Glycan microarray analysis of this Viet04 HA reveals an avian {alpha}2-3 sialic acid receptor binding preference. Introduction of mutations that can convert H1 serotype HAs to human {alpha}2-6 receptor specificity only enhanced or reduced affinity for avian-type receptors. However, mutations that can convert avian H2 and H3 HAs to human receptor specificity, when inserted onto the Viet04 H5 HA framework, permitted binding to a natural human {alpha}2-6 glycan that suggests a path for this H5N1 virus to gain a foothold in the human population."
I know, sheesh. Here's what this means: They gene-sequenced the H5N1 (bird flu) virus that killed many people in Viet Nam last year and compared it with H5N1 virus originally isolated in 1997. The Vietnamese virus has mutated to a form very similar to that of the 1918 strain that caused the last big pandemic without losing it's lethality. Further, the probable mutation path suggests that the current highly pathogenic H5N1 virus can easily mutate for human-to-human (H2H) transmission.
This is Very Bad Juju according to them. The Case Fatality Rate (CFR - percentage of those who present with symptoms and then subsequently die) of the current strain is very high - around 55%. All official projections for CFR if a H5N1 pandemic breaks loose hover around 1.5 - 2.5 %. Why about 2% and not 55%? Three reasons: 1) the alternative is unthinkable; 2) 2.5% was the death rate in 1918 (although note that's an average - 7% of all 20-40 year old Bostonians died in October, 1918 along with 50% of all pregnant women); 3) the thinking was that as the virus mutated to H2H form it would lose much of its lethality.
The fact that the H5N1 virus has mutated so far while remaining extremely lethal is very sobering.
Note that a CFR of about 50% would not mean that half the poplulation would die, but that half of those infected would die. If a pandemic followed 1918 infection rates, that would mean 25-30% would catch it. A CFR of 50% would mean 37.5 million Americans could die.
See Bob Webster here (you'll have to watch a commercial):
http://abcnews.go.com/Video/playerIndex?id=1725519
He's one of the top virologists in the world, and arguably the top guy in H5N1. He comes off a bit dotty, but that's due to an editing hack job and nervousness. He's sharp as a tack. Note that this topic is the third-rail of virology; making this type of warning endangers ones reputation . Mike Leavitt, Director of DHHS ("Should we wrap that can of tuna fish with duct tape before we store it under the bed?") is getting this treatment:
Government officials are officially insane. Several years ago Homeland Security Secretary Tom Ridge advised Americans to protect themselves against terrorism by buying duct tape and plastic sheeting (to wrap themselves up in it?) Now HHS Secretary Mike Leavitt says Americans should store tuna fish as a precaution against bird flu.)
In a remarkable speech over the weekend, Secretary of Health and Human Services Michael Leavitt recommended that Americans start storing canned tuna and powdered milk under their beds as the prospect of a deadly bird flu outbreak approaches the United States.
What he actually said was it would be prudent to begin gradually stockpiling food.
Can this turn out to be nothing? Most defnitely. Could this be "the defining event of the last 1000 years" as one scientist said to me? Possibly. I suggest you do your own research and make up your own mind. Google will point you to many sites (www.pandemicflu.gov, www.who.int, etc.) but a good one that consolidates the medical, social, and economic issues is http://www.medcko.com (formerly fluwikie . com).
The Reaper
03-18-2006, 13:33
MW:
Can you tell us what the same people had to say when SARS was going to kill us all?
I do believe that it is prudent to have a generator, spare gas, radio, flashlight, extra batteries, a first aid kit, a little cash, and some hard rations for a week or two of natural disasters of all kinds on hand, but haven't we seen a lot of this "disease de jour" promotion that is going to kill us all?
TR
TR -- I hear you and believe me I hope you are right. I have two healthy teens. I guess what I didn't effectively communicate is how poisonous it is to a scientific career to display any hint of hyperbole about an issue such as this. To have respected scientists voice concerns like this is...worrisome.
In a display of SA I will now answer your direct question:
SARS was not a walk in the park. If it had a shorter generation cycle it could have been very nasty, given its infectivity rate. The following is all 20/20 hindsight given that flu-SARS comparisons weren't being made at the time of the original SARS outbreak.
I know the virologists are much less concerned about a new SARS outbreak for a variety of reasons. Note that these guys were counseling calm at the time -- as soon as the long generation time and nosocomial nature were determined (mid-cycle of the outbreak). Until then it was anyones guess. I do know these guys are more afraid of flu than Marburg or Ebola -- they've said so.
-- SARS was basically a nosocomial infection, i.e. caught in a hospital environment. Most of those infected were health care professionals. (Exception: Chinese apartment building where contaminated water + interlinked air vents + welded doors (quarantine) = 321 cases from one index case.
-- SARS is a coronavirus that is not shed until symptoms exist. It was very infective (each SARS patient infected three others on average, although that Chinese apartment skewed this a bit in my opinion) but it was slow (the geration-to-generation time was 10 days). So, one infection on day 1, three new infections on day 10, nine infections on day 20, 27 cases by day 30, and so on. The slow nature of the spread allowed quarantine and containment.
-- The influenza virus is shed for four or more days before symptoms appear, so an apparently healthy individual can be be spewing virii for a long time before they are isolated. Flu (historically) has a lower number of infections per index case: two new infections per index case but it has a very fast generation rate of three days. This means that one case multiplies into 1024 new infections in 30 days. Each of those 1024 cases in turn becomes a source for 1024 new infections in a month. Pandemic flu is said to spread "explosively" and the analogy is apt. Think of this in the context of our world population distribution. The military is stressing MOUT because there is more UT (I think there were 12 cities of 1 million pop. in 1918 and now there are over 500). One respected researcher -- Osterholm -- has said that panflu would kill more in the first hour than died in the entire SARS epidemic.
-- SARS was eventually traced to a small population of Chinese horseshoe bats. It made it into the human population probably due to the Chinese prediliction to eat anything organic. H5N1 has a vast resevoir in birds: house sparrows, ducks, chickens, geese, swans, grouse -- virtually everything that flaps wings.
-- H5N1 kills by cytokine storm, i.e. it turns the immune system against the patient. The stronger the immune system, the greater the chance of death. (Hence my worry about my kids).
-- Historical probability. There were three outbreaks of pandemic flu in the last 100 years -- one savage and two weak ones. Epidemiologists have evidence of periodic outbreaks - averaging 3 per century with one major one per century - going back 400 years. These guys expect flu to hit again eventually and see H5N1 as having all the hallmarks of a potential Big One.
-- Stunning lethality of H5N1 -- researchers are talking about innoculating 100 chicks with H5N1 and having 100% lethality in 12 hours. With other flu they see 12-18% in a week.
I must go. I'll finish later.
Team Sergeant
03-18-2006, 17:50
I must go. I'll finish later.
Please do.
Very sobering and interesting read, thanks MW.
TS
ghuinness
03-18-2006, 18:23
I'm curious. I am concerned with WNV, not so much for me, but my four-legged friends. For them it is fatal, not necessarily so for me. (Incidentally, started using these patches and they seem to work: http://www.skeet-x.com/).
Since WNV is carried by mosquitos that pick it up from infected birds, I've been wondering why I don't hear about a mosquito transmitted variant on bird-flu. Not possible?
thanks
Jack Moroney (RIP)
03-18-2006, 20:42
Now I am making an assumption that migratory species of birds could be a great vector to move this flu from country to country. I would also imagine that folks that raise fowl for sale/sport that have migratory species freely mix with them are potential human sources for the species jump. Has anyone, or have you come across, species specific carriers for migratory birds? As most flyways are North-South it would appear that the hot zones to watch would be poultry farmers that operate in and around flyways. What a tremedous opportunity for some terrorist organization to "weaponize" bird flu using migratory species. Interesting read.
I believe that the virus uses the bird as it's end host, so the blood meal that a mosquito ingests in not enough to allow it to proliferate. This is bound to change, since a lot of viral diseases (e.g. Lassa fever, equine encephalits, etc) are mosquito borne vector diseases. Given the probablity of mutation with the virus, anything could be possible.
MW:
I do believe that it is prudent to have a generator, spare gas, radio, flashlight, extra batteries, a first aid kit, a little cash, and some hard rations for a week or two of natural disasters of all kinds on hand, but haven't we seen a lot of this "disease de jour" promotion that is going to kill us all?
TR
TR -- You are already mostly there, I guess I was aiming this at those who aren't. I don't know your situation, but I added bleach for H20 purification (I'm in the northern Chicago suburbs with Lake Michigan water -- we have 5 days of chlorine I'm told) and decon, oral rehydration solution mix (sugar and salt will do), ibuprofen/tylenol etc., TP and hygiene supplies, and went to 90 days on the food.
Last week I received from a client a pallet with another 90 days of dehydrated food for four (Mountain House), N95 masks x 300, hospital booties and 2 empty 55 gal barrels for water. Next Tuesday I am getting audited on my disaster plans by a different group (backup power, succession planning, isolation plans for staff i.e. work-from-home options, etc. etc.). I am also basically being forced to put all our source code into escrow. They joke they are worried we will win the Powerball and decide to retire and leave them high and dry. We never had a whiff of this with SARS.
I am planning my life as if this will NOT hit -- the family is still going diving in Mexico soon -- but I am prepared for the worst. When it doesn't hit I'll open up a Mountain House store.:)
The conversation over beers last week included whether to bring this up in the press, with family, etc. One guy said "What if you were on a beach in
Phuket on Dec 26, 2004. The sky is blue and the seas are calm. Your cell phone rings and God says 'There's a 50/50 chance there'll be a tsunami in one hour.' Would you run around warning people?" Fear of humiliation is a powerful thing -- I debated long and hard before posting this thread. I remember someone telling me about a guy who choked on a piece of steak and ran into the resaurant bathroom to die rather than make a scene.
My program finished running, gotta go.
CoLawman
03-19-2006, 00:29
Last week I received from a client a pallet with another 90 days of dehydrated food for four (Mountain House), N95 masks x 300, hospital booties and 2 empty 55 gal barrels for water. Next Tuesday I am getting audited on my disaster plans by a different group (backup power, succession planning, isolation plans for staff i.e. work-from-home options, etc. etc.). I am also basically being forced to put all our source code into escrow. They joke they are worried we will win the Powerball and decide to retire and leave them high and dry. We never had a whiff of this with SARS.
I am planning my life as if this will NOT hit -- the family is still going diving in Mexico soon -- but I am prepared for the worst. When it doesn't hit I'll open up a Mountain House store.:)
Hmmmmmmmmm..........it occured to me that I could do the same thing, take the family to the mountains. But then reality struck home.
1. My occupation and my wife's (nurse) occupation do not allow a run for the hill strategy.
2. Many on this board are employed in public service so they too are ruled out.
3. Our military is ruled out.
4. Those dependent upon a steady income are ruled out.
What it boils down to is a very small percentage of the population would be able to close up shop and head for the hills to wait it out.
I enjoyed reading your posts and do not feel it was anything more than an informed and educated sharing of "insider" information.
So you have successfully peaked my concern.
I think for me personally I will treat it like the West Nile ( in which several people of my work were infected) take the maximum precautions allowed and limited by my life.
Now I am making an assumption that migratory species of birds could be a great vector to move this flu from country to country. I would also imagine that folks that raise fowl for sale/sport that have migratory species freely mix with them are potential human sources for the species jump. Has anyone, or have you come across, species specific carriers for migratory birds? As most flyways are North-South it would appear that the hot zones to watch would be poultry farmers that operate in and around flyways. What a tremedous opportunity for some terrorist organization to "weaponize" bird flu using migratory species. Interesting read.
False alarm, the program's only halfway done. Too bad, I'm tired.
Jack-
It's a given nowadays that migratory birds are the primary vector for spread, but the guy who first proposed this in '96? was savagely attacked by the bird-hugging community (it exists) and many scientists who were opposed to factory farming (assumed culprit). There's a flyway for shore birds that goes from Nigeria, where H5N1 is currently endemic, up to Canada. From there it will inevitably infect the migratory waterfowl in N. Am. Go short on Tyson chicken (joking, it's too late, that boat has sailed).
You are correct that those in contact with fowl will be monitored here for H2H transmission. But most feel that this will occur in Nigeria, China, or Indonesia and the pandemic flu will have a Boeing or Airbus vector. That said, it could happen anywhere first.
Weaponization is being discussed (there are some who think that West Nile was the first bioterror agent). More interesting, though, is the fact that China and WHO are both hoarding the genetic sequences from many recent isolates (human deaths). Viet Nam is playing ball. Some speculate that China is scrambling to be the first to create an effective vaccine and are trying to cripple the West's efforts. The economic and geopolitical benefits that would accrue to the country disbursing an effective vaccine are obviously great. There is a "Free the Sequences" movement in the scientific community, complete with teeshirts.:) WHO is just in magic cookie land. I think they want to make sure that the Thrid World isn't left out when a vaccine is made so they are fiddling while Rome burns and deals are negotiated. Morons. At the top, I mean. The guys in the trenches are excellent.
Sorry for rambling.
Hmmmmmmmmm..........it occured to me that I could do the same thing, take the family to the mountains. But then reality struck home.
1. My occupation and my wife's (nurse) occupation do not allow a run for the hill strategy.
2. Many on this board are employed in public service so they too are ruled out.
3. Our military is ruled out.
4. Those dependent upon a steady income are ruled out.
.
How about THESE apples (this is in response to the SARS blip when so many health care workers abandoned ship):
http://lfpress.ca/newsstand/CityandRegion/2006/03/01/1467449-sun.html
"Sweeping new Ontario emergency legislation has health-care workers afraid they may be forced to choose between protecting their families and a jail sentence if a flu pandemic hits the province.
Bill 56 has raised alarms with doctors, nurses and other health-care workers because it contains a clause that gives the Ontario cabinet power to “authorize” any person reasonably qualified to provide services in a declared emergency.
The penalty for violating the proposed law is a fine of up to $100,000 and a year in jail for each day the order isn’t obeyed."
CoLaw --
I'm a fatalist -- having food and being isolated won't help in my opinion, although others disagree. In the 1918 H1N1 pandemic "they" estimate that 98% were exposed while only 25-30% got seriously ill and about 2.5% of those died. That tells me everyone will get exposed eventually. Having food and potable water does mean you'll eat if transportation is disrupted, as many expect. Also I'll have enough to pass out to the neighbors.
Finally, I need a faster cluster...off to bed.
.
JAGeorgia
03-19-2006, 16:15
All;
Ok, lets settle down a bit. Although some of the extrapolation may not be impossible it does not reflect what is going on in the "real world" right now.
Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu.
Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available.
Seasonal flu, avian flu, and pandemic flu are not the same.
Before Avian Flu could be a candidate as a cause for Pandemic Flu it would have to mutate to H2H transmission, be virulent, AND cause a global outbreak.
These last three occurring at the same time makes it very unlikely, but not impossible.
DHHS Secretary Michael Leavitt recommended storing canned tuna and powdered milk under your bed as an example of items that would be useful in case you decide to employ "social distancing" to avoid contact with infected persons in case of Pandemic Flu. These are not the only items worth storing. You might wish to practice "social distancing" for a month or so by not having to go to the grocery store. I think I'll add some canned veggies and soup. You can think of more ways to avoid infected people IF there is a pandemic! If there is no pandemic you're still prepared for other disasters.
The 1918 Pandemic Flu occurred before the age of antimicrobials. Being severely ill makes one more susceptible to complications like pneumonia. Although I am unlikely to stockpile Tamiflu, I sure intend on knowing where I can get some IF there is Pandemic Flu. Last time I had the Seasonal Flu I took it and felt great after two days (though I took the full course).
It is tempting, maybe even fun, to draw similarities between Pandemic Flu, Avian Flu, Seasonal Flu, West Nile, SARS, and the like, but the truth is that they are each distinct. They have different causes, different modes of transmission, and to some degree different treatment and prevention. Lets not go off the deep end. A Zebra looks somewhat like a horse with stripes. That doesn't make one.
To keep up with what's happening, go to http://www.cdc.gov/ and choose "Avian Flu" or "Pandemic Flu". There's a reason there are two different links there.
Be Well. :)
What is the reason you like bleach over a good hand pump water filter (MSR Water Works)?
If you are stocking up on food you should also think about a "disaster kitchen". A camp stove plus a supply of fuel for it. For example my stove, an MSR Whisperlite Internationale Multi Fuel Stove, used about 1.5 liters of kerosene a week. I was cooking two hot meals and a pot of coffee for 4 people each day. Kero sucks to burn, it is dirty and smokes like a Cuban. If you can get white gas do so, it burns clean enough to use inside, not that I would recommend that. A few easy to clean pots, plates and mugs. Something convenient to store your purified water in. Two big low tubs to do the dishes and laundry in. I will be glad to go on if asked, I lived "outside" for two years so I am pretty good at it.
The Reaper
03-19-2006, 17:43
What is the reason you like bleach over a good hand pump water filter (MSR Water Works)?
The chlorine bleach can be used to decontaminate surfaces and objects as well as purify water.
STB/HTH is even better, but may be overkill for a flu virus.
TR
Okee doke, all settled. :o I really feel like a tinfoil-hat-wearing Cassandra but I'll respond and then return back to my lane (Errr...TR - I know I have no lane, that means I'll shut up.)
JAGeorgia - Sir, I never meant to imply that there is an ongoing pandemic. In the start of this thread I cite a very new study whose authors include respected CDC and Scripps researchers. They present troubling evidence that H5N1 "binding" molecules have mutated to become very close in structure to the 1918 pandemic virus. At the same time the virus has not lost any of its lethality. The researchers say this is "worrisome." I am not nearly as smart as these guys so I ask LOTS of stupid questions. I determined that "worrisome" translates into "holy shit" in normal-speak. There was talk at a recent meeting (beer talk, not formal presentation talk) of a 50/50 chance of this going pandemic. Now, I wouldn't bet this month's mortgage on a coin toss but that's enough to make me think prudent, thoughtful preps are in order.
Couple that with what are to me weirdass extraordinary preps and demands by my gov and pharma clients and a little bell went off. I felt obligated to share.
Your differentiation between avian, seasonal, and pandemic flu is concise and correct, but misleading when you go into the 'zebra' analogy. All influenza A (the kind that passes into humans) has a single origin: birds. (A geneticist told me that the virus could be 275 million years old, meaning it originally infected dinosaurs -- cool/freaky, eh?) The seasonal flu that my wife got in January, the H5N1 that's killing birds, and the 1918 H1N1 variant that caused a pandemic all have the same primary source.
I only brought up SARS because TR asked a direct question about it. It was a good question, and when TR asks a question I have learned it is never rhetorical. (I am still awaiting a rebuke because it wasn't a very direct answer.) :)
The only differences between avian, seasonal, and pandemic influenza viruses are 1) the ability to infect human cells via aerosols and 2) resistance levels in the target population. The 1918 H1N1 pandemic flu didn't go away, it became seaonal flu after post-pandemic resistance developed (well, it did go away but it slowly mutated into seasonal flu variants over the years).
I'd like to niggle another point: there has been, and continues to be, human-to-human transmission. It is limited in nature and very inefficient. This fact is generally not bugled from the rooftops, primarily because it would kick the WHO alert level up a notch to level 4 and that would trigger mandatory action that probably isn't warranted at this point. You will hear "there has been no H2H transmission yet" all over the standard media. But, see the New England Journal article below. It's old (6 months ago is ancient, things are moving fast) and there are newer human-to-human cases in China, Turkey and possibly Iraq, but it's the only published cite I have without searching. It documents numerous H2H cases:
http://content.nejm.org/cgi/content/full/353/13/1374
The key point is that there is only one case of H2H transmission to health care workers (Vietnamese nurse; she survived). Health care workers are canaries in the coalmine. WHO has said they will begin unprecedented containment measures (massive anti viral administration to whole populations) when three hospital workers at a single site are infected (proposal circulating in draft form, can't cite).
Social distancing is only half the reason for stored supplies. Supply chain disruption is the other one. We live in a just-in-time world where a single wobble has profound consequences. If the projections come true and 40% are infected simultaneously then the Pringles may not make it to the shelves for a while.
If you haven't already got Tamiflu if the coin toss comes up 'tails' then I'll wager you won't be getting it (unless you have a 'priority' job -- health care, police, water/electric, etc.).
Regarding antibiotics -- there are some made in the CONUS but for a variety of reasons (tax boondoggles) many are made overseas with JIT deliveries. Ask a pharmacist about back orders and shortages that exist now, when skies are blue.
Finally, canned government web sites are good for basic prep information but you have to consider how politcal they are. For instance, the WHO site draft documents currently circulating for review say pandemic "may be imminent." The "imminent" word was as carefully avoided in official WHO communications as the word "genocide" was in US gov releases about Rwanda when that was going down. Words have power in these matters and can force action.
Well, I'll go because I feel a bit weird. I certainly hope that this comes to nothing -- that the coin toss comes up 'heads' this time -- and that the truly smart people working on this have the time to come up with good solutions for the next time. The upside to all of this is that truly novel approaches to prevent pandemic in the future are being developed and we just need another year or so to get them going. Happy days to everyone.
4. Before Avian Flu could be a candidate as a cause for Pandemic Flu it would have to mutate to H2H transmission, be virulent, AND cause a global outbreak.
These last three occurring at the same time makes it very unlikely, but not impossible.
Dad,
Can you tell us a bit about what's involved in clearing each of these stage gates, including how the probabilities are modeled. I.e., what are the drivers, etc.?
BTW, mugwump, JAGeorgia has a tinfoil hat too, but he only wears it to water the lawn, not when hanging out with the lab nerds at CDC. :p
The Reaper
03-19-2006, 20:46
I have no issues with you posting this and discussing it professionally since it is of general interest and you seem to have a better handle on it that I do.
Since there is a scare of the year (Y2K, SARs, etc.), I just wanted you to clarify whether these were the same Chicken Littles making dire predictions as before, or people who exhibit professional conduct and do not panic over every potential crisis.
As I stated before, I think that it is only prudent for citizens to prepare themselves for as many natural disasters as is practicible. People should not demand that the US Government evacuate them, save them, feed them, water them, house them, rebuild their homes in a flood plain, give them money, etc. Between hurricanes, storms, tornados, eruptions, quakes, tsunamis, droughts, floods, fires, pandemics, and the metric ton of manmade disasters, intentional and otherwise, it is every American's responsibility to be prepared as much as possible, or accept the consequences stoically.
Are you taking 90 days as the planning figure because that will be the time for the disease to infect (and kill) everyone that it is going to, or because of some other factor?
TR
TR
RE: the Chicken Little scenario. It is extremely difficult to assess risk in these situations. The technical issues are mind-boggling and the hard data subject to varying interpretations. It's not hard to infer how conflicted I am about this.
Your earlier question about SARS was a good one. I only knew one of my current crop of colleagues in the SARS days and he was extremely concerned, right up until what turned out to be the mid-point of the outbreak. Once they estimated the long case generation time -- the 27 cases in 30 days thing I referenced above -- he rapidly went from condition red to yellow even while the media were in full panic mode. He said it could be contained. In retrospect his yellow-red-yellow stance was consistent with the data available at the time. He is in full red mode now.
I've tried to articulate how cautious these guys are -- it sounds like JAGeorgia can probably chime in here. Being/appearing hysterical when the cold facts don't support it is professional suicide. The only thing worse is falsifying data. Robert Webster at St. Jude is one of the few talking to the media about his fears at this time. He's the guy in the ABC News segment I linked to. He's older and is at the point where he says what he thinks I've been told.
With all that said I truly think this is a crap shoot whether it hits or not. I pray it does not.
As far as 90 days...not totally arbitrary but close. I followed a guideline for a year's supply for one person and if I can gather all the chicks back to the nest there are four of us. The pallet I got from a client was the same: one year for one person (sixteen cases of Mountain House with six #10 cans per case -- the Blueberry Crumble is pretty good ;) ). This was supposed to be for me alone -- morons. They sent Tamiflu for me alone too -- one course. I said "thanks, that's for my daughter." They caught the hint and sent 3 more courses.
I've been told and have read that "bad" pandemics (typically 3 pandemics per century with one being "bad") go through the population in three waves lasting 180 days each. I've been told to figure on up to 1.5 years until it burns completely out. I've also been told 6 - 12 months. In the 1918 pandemic the first wave was weak -- nearly indistinguishable from the background seasonal flu. The second wave was by far the worst and resulted in the lion's share of deaths.
Dad,
BTW, mugwump, JAGeorgia has a tinfoil hat too, but he only wears it to water the lawn, not when hanging out with the lab nerds at CDC. :p
JAG -- I use the Aluminum Foil Deflector Beanie, how about you?
http://zapatopi.net/afdb/
A balanced, accessible newspaper article that addresses TR's question about Chicken Little:
http://cnews.canoe.ca/CNEWS/Canada/2006/03/19/1495802-cp.html
"When we initially started talking about this and to today, we were always saying: We don't know if H5 is going to be the virus, we don't know if it is going to be a bad pandemic, when it will strike, any of that stuff," Thompson says from Geneva.
"All of that seems to me now lost. It seems to me that in everything I'm reading, it's a lock."
uboat509
03-20-2006, 09:14
Something else that I think that some people are missing is the economic impact of this disease. Take Africa as an example. If (probably when) H5N1 gets going in Africa it will be devastating, not because of all the peole who die from the disease itself but when a huge percentage of the chickens die from the disease or are culled as a precaution it will remove a vital protein staple from their diet. Even if not another African ever becomes infected with H5N1, it will affect them deeply. Although we are a long way from that in this country there could certainly still be some serious consequences. We had ONE mad cow and how many countries placed embargoes on our beef? How many people decided to forego beef? Chicken is a staple in a lot of people's diets here in America as well and while no one is going to starve here simply because they can't get chicken I can certainly see it having a profound effect, econmicaly on the country.
SFC W
TR - I asked someone I trust about amount of food. In true scientist fashion I didn't get a straight answer, but she did send this:
5671
5670
Scenario of Human Spread of H5N1: Los Alamos National Laboratory computer simulation based on air travel
in which H5N1 influenza virus is carried by airline passenger from an outbreak, say in Asia or Africa, to Los Angeles, California.
Map 1 shows the high infection rate in Los Angeles by Day 50 after virus began spreading human-to-human. Map 2 shows that in twenty days, by Day 70, the virus has spread across the United States. Map 3 shows that by Day 90, six weeks into the
pandemic, nearly all of the United States is enflamed red with high numbers of bird flu cases. Map 4 shows by
Day 110, the number of flu cases is beginning to decline. Map 5 shows that by Day 130, four and a half
months later, the virus is in decline. Computer map simulations in 2006 by Tim Germann,
Los Alamos National Laboratory EpiSims project.
Nice sim, but I was most excited by the fact she used the word "enflamed" (no such word) and the term bird flu (wrong in context).
She also sent this from the pandemic.gov site:
1.1.10. In an affected community, a pandemic outbreak will last about 6 to 8 weeks.
1.1.11. Multiple waves (periods during which community outbreaks occur across the country) of illness could occur with each wave lasting 2-3 months. Historically, the largest waves have occurred in the fall and winter, but the seasonality of a pandemic cannot be predicted with certainty.
So 12 weeks of food is probably not logically defensible if mult. waves are anticipated.
Edited to add: The explanation is apparently from Germann and not her. Her spelling and syntax remain annoyingly perfect.
Sir, if over 90% of the population is likely to be infected, wouldn't it be more beneficial to get sick early on, when your stock levels are high and you can help out more with keeping things running because you are either immune to the flu or dead?
Martin
The Reaper
03-20-2006, 13:56
Shocked to see the D+70 to D+90 change.
If you were going to need anything imported from Asia, you won't be seeing it for a while with all of the SoCal port and transport workers out of commission.
JIT construction will be over as well, but industries idling and workers staying home may help slow or ameliorate the spread of the disease while it wrecks the economy.
Martin:
My thoughts as well. If the hospital can save you, you better be there before D+90.
Wonder what percentage will never get sick from it by lack of exposure, immunity, or some other variable?
TR
Ha, another "known unknown". It might be more virulent first or last. My preps revolve around my teenage kids. They are healthy as horses and therefore (pardoxically) most at risk, if 1918 patterns are followed.
I like the way you think, helping to keep thngs running.
Shocked to see the D+70 to D+90 change.
That's the short generation time -- all of those 1024 cases at 30 days, each creating another 1024 in 30 another days.
Wonder what percentage will never get sick from it by lack of exposure, immunity, or some other variable?
In the last big one (1918-1919) about 70% didn't get sick. The current thinking is that 98% were exposed. Of the lucky 70% some unknown percentage were asymptomatic Typhoid Mary types.
Ha, another "known unknown". It might be more virulent first or last.
English comprehension issue on this end. Especially the last sentence, not sure I'm following you if you're talking about the waves (which would say the other way...). :confused:
Martin
Warrior-Mentor
03-20-2006, 14:39
Mugwump,
Have you read Tipping Point (http://www.gladwell.com/tippingpoint/index.html)?
Just curious.
JM
The Reaper
03-20-2006, 14:51
That's the short generation time -- all of those 1024 cases at 30 days, each creating another 1024 in 30 another days.
In the last big one (1918-1919) about 70% didn't get sick. The current thinking is that 98% were exposed. Of the lucky 70% some unknown percentage were asymptomatic Typhoid Mary types.
Yeah, but people were much more isolated then.
The odds of someone showing up in East BF, North Dakota who had been in a major city recently was pretty low. The US population was much more dispersed and there was less travel, except for the returning vets. I knew people who had never left the county they were born in. The long range transportation nodes were pretty much limited to rail, and ship. No planes to bring it in from overseas in eight hours or less, while travelers were still asymptomatic. Domestically, the same applies on rail service here. Fewer travelers, shorter distances, longer travel times (days, rather than hours) back then.
Medical care in most of the country was still largely doctor visits, rather than hospital based, though I suppose the Doc could be a vector till he showed symptoms. The spread of cases in hospitals was likely lower, as people stayed home, were treated at home, and were cared for at home only by immediate family members.
These factors would lead me to note that the spread of a similar bug today would be less detectable, less capable of isolation, faster disseminating, more difficult for hospitals unaccustomed to mass casualties, and more disruptive to society.
On the positive side, we have the advantage of being able to see/understand the threat, ID it, take precautions, treat patients more effectively (in low numbers) and possibly develop a vaccine or treatment.
TR
ghuinness
03-20-2006, 17:54
With all the talk about H2H and H5N1 I thought I would post something that is not getting much attention in the media. Man's best friend is already fighting the flu.
Cornell University documented in Sept 2005 that some dog fatalities in 2004 were caused by the Equine Flu virus H3/N8. The Equine Flu jumped from Horse to Dog.
Anyway, it is real, it is contagious and if you haven't heard about it, here are some details. Suggest talking to your local DVM about your area and the risk.
About 10% of the dogs which get this need to be euthanized. This was first identified in the USA. Depending on the vet you talk to you will get a different opinion about it's ability to spread.
http://wsunews.wsu.edu/detail.asp?StoryID=5452
http://www.vet.cornell.edu/news/dogflu/
.02
English comprehension issue on this end. Especially the last sentence, not sure I'm following you if you're talking about the waves (which would say the other way...). :confused:
Martin
Sorry Martin, your English is fine it's my communication skills that are lacking.
Our Secretary of Defense Donald Rumsfeld likes to talk about "known unknowns", which are questions we have identified but don't know the answers for, and "unknown unknowns" which are the questions we are not even bright enough to ask yet, i.e. those problems which appear unexpectedly.
The question about whether it is better become ill early in the cycle is a "known unknown", a question -- asked by many -- for which we don't know the answer. There are many factors. One guy I know often says "Let me give you an extremely technical answer -- we don't know." What he means is he could discuss the factors for an hour but, at the end of all that, the answer would still be "nobody knows."
In my last sentence I was trying to say I admire your spirit. I like your attitude of wanting to help out as soon as possible. People complain about young people all the time, but most of the ones I know are smart, hard working, patriotic, and just plain interesting. I suspect you are like that too.
.
.
A question I asked early on was "How do you know when efficient human-to-human transmission has started?" In other words, when should you start worrying about that first case flying into LAX?
Note that the following IS NOT that event, although I'll keep an eye on details as they emerge:
http://www.mosnews.com/news/2006/03/20/azerflu.shtml
March 20, 2006 -- Experts from the World Health Organization suspect 14 more people are infected with bird flu in Azerbaijan where two girls died of the the H5N1 virus earlier this month, Interfax reported Monday.
A group of WHO experts reported their suspicions after visiting the Salyansky district of Azerbaijan, 150 km to the south of the capital Baku...
These cases could all be in poultry workers or rural chicken-lickers. It may turn out to be some other disease entirely. But that said, this is what you are looking for: a largish cluster like this reported all at once. The fact that WHO has linked their name to the report lends credibility, even if blood tests have not been performed yet.
As details emerge, you should begin worrying if many of the sick had no direct contact with fowl. Of even greater concern would be if some of these are health care workers. If you hear that three or more health care workers have come down with H5N1 you must consider that international borders could close. :eek:
That's what scares the liver outta me -- being out of the country if it comes to Katie-bar-the-door.
.
Bellerophon
03-20-2006, 19:28
More interesting, though, is the fact that China and WHO are both hoarding the genetic sequences from many recent isolates (human deaths). Viet Nam is playing ball. Some speculate that China is scrambling to be the first to create an effective vaccine and are trying to cripple the West's efforts. The economic and geopolitical benefits that would accrue to the country disbursing an effective vaccine are obviously great. There is a "Free the Sequences" movement in the scientific community, complete with teeshirts.:) WHO is just in magic cookie land. I think they want to make sure that the Thrid World isn't left out when a vaccine is made so they are fiddling while Rome burns and deals are negotiated. Morons. At the top, I mean. The guys in the trenches are excellent.
Sorry for rambling.
Social distancing is only half the reason for stored supplies. Supply chain disruption is the other one. We live in a just-in-time world where a single wobble has profound consequences. If the projections come true and 40% are infected simultaneously then the Pringles may not make it to the shelves for a while.
Shocked to see the D+70 to D+90 change.
If you were going to need anything imported from Asia, you won't be seeing it for a while with all of the SoCal port and transport workers out of commission.
JIT construction will be over as well, but industries idling and workers staying home may help slow or ameliorate the spread of the disease while it wrecks the economy.
TR
When the price of gold shot up I dumped what I had and while making the transaction I was intrigued to find that the Asian makets were the driving force behind the surge in demand.
I am by no means a metal trader. I took the opportunity to sell high. If the gossip I heard at the trader's counter is true and the Asian market is the force behind the shift, could that indicate that the East is hedging in favor of a pandemic?
If this is the case it won't change my behavior at all. However, I am concerned that it could be a quality indicator of how serious those with access view the threat. More interesting, though, is the fact that China and WHO are both hoarding the genetic sequences from many recent isolates (human deaths).
Outside precious metal, Real Estate would be the only other indicator I would be worried about and by the time I see the writing on the wall with that one it is probably too late for most people to care.
Are there any real economists who can to contribute to this thread? Please speak up, because I am close to the ragged edge of my capcaity to interpret economic indicators in this arena.
....The pallet I got from a client was the same: one year for one person (sixteen cases of Mountain House with six #10 cans per case -- the Blueberry Crumble is pretty good ;) ). ......
Mountain House is showing all it's # 10 cans as out of stock. Darn. I do like their foods.
A few things set aside for a rainy day is never a bad thing. Acetaminophen and Ibuprofen are real easy to come by in the stores right now. In pills and oral solutions. Plus electrolyte solutions for hydration. $20 a week for a couple of months can fill up a few small boxes. If something hits the stores will be cleaned out quicker then bread and milk is before a huricane.
Some good ideas in some of the above replies.
Pete
RE: Y2K
I told a guy who was going on and on about how everything was going to stop at midnight on that night. I told him my coffee pot was real stupid. It didn't care if it was making coffee at 5:00 AM on the 1st of January 1900 or 2000. All it knew was that at 5:00AM it turned on and made coffee. And guess what. When I got up that morning my coffee was ready to drink.
He said "That's fine about the pot but what about your car?" I said that my car would wake up on the first and go "Gee, great. I don't have to go to the Doc and get a checkup for 100 years or 3,000 miles, which ever comes first.":D
Are there any real economists who can to contribute to this thread? Please speak up, because I am close to the ragged edge of my capcaity to interpret economic indicators in this arena.
I'm no economist and I didn't even stay at Holiday Inn last night, but I do have insomnia.
Outstanding discussion of supply-chain risk managment and the economic implications. My pharma clients are advised by these guys: http://www.amrresearch.com/avianflu/
World Bank assessment of East Asia pandemic impact: http://tinyurl.com/pvkk4
BMO Nesbitt Burns An Investor’s Guide to Avian Flu written by Dr. Sherry Cooper: Executive Vice-President, BMO Financial Group; Chief Economist, BMO Nesbitt Burns; Global Economic Strategist, Harris Bank (spooky smart lady) http://www.bmonesbittburns.com/economics/reports/20050812/avian_flu.pdf
Notes from a Sept 2005 Deutsche Bank flu conference Bulls, Bears and Birds:
Preparing the Financial Community for a Pandemic. Note the appendices, good web sites referenced:
http://crofsblogs.typepad.com/h5n1/files/deutsche_bank_flu_conference.pdf
-------------------
Edited to say: The AMR supply chain is mostly members only, sorry.
I've referenced this before but it's worth a repeat: Preparing for the Coming Influenza Pandemic
Dr. Grattan Woodson, MD, Decatur GA, and David Jodrey, PhD.
http://www.fluwikie.com/uploads/Consequences/NewGuideOct7b.pdf
The Reaper
03-20-2006, 21:12
I saw that they are out myself and don't think that you really need the Mountain House foods.
The advantage of the MH is the light weight, long shelf life, and lack of cooking requirements. You have a way to cook and they are delivered to your home, where you are storing them. For this, you pay extra. Like a 90 day bare supply of MH for four people is going to be close to $2000. Figure it out. Food is not cheap. Special freeze dried food is going to be more.
I have a camp stove and a gas grill. As a minumum, I can boil, bake, fry, and grill. Get an extra propane cylinder or two, or get the gas company to hook your grill to your home tank. I have a generator. As long as I have fuel, I can use my microwave, coffeepot, fridge, etc. a few hours per day.
For food, look around at the meals your family likes. Most families without a gourmet cook or a lawyer have a 10-30 meal main course rotation they use. Get a Betty Crocker cookbook, like Grandma had. A few MH type meals for tough days or for a treat would be nice, as would a few items like the canned freeze dried hamburger. What do you eat while camping?
Figure out how to replace refrigerated items, as they may not be available or power may fail. Keep a large cooler on hand. Buy any less perishable product substitutes like powdered milk, canned cheese, powdered eggs, canned butter, dehydrated or canned meat, etc.
Buy and store staples. Flour, salt, sugar, yeast, coffee, corn meal, honey, oil, beans, rice, oatmeal, grits, pasta, shortening, etc. Peanut butter and jelly. Ramen. Mac and cheese. Cans of soup. Hard candy. Get canned veggies and fruit. SPAM may make a comeback. I like mine fried.
Get a way to store a large amount of water, or be prepared to purify and boil it.
Paper plates may come in handy, definitely plastic bags of all sizes, foil, paper towels and toilet paper. Get extra bleach and HTH if you know how to use it. Don't forget the hand sanitizer, tissues, Tylenol, aspirin, Ibuprofen, etc.
No need to order a tractor trailer load of supplies and an additional 10'x20' storage unit. Just buy a little extra each time you go shopping, maybe 10% more. Or an extra large box, like they sell at Sam's. Find a place near the kitchen to keep it, easily accessible. Like the pantry used to be, for those who can remember them. Hang a list nearby and keep an inventory. You use it, you replace it next time at the store. Never go zero balance on a critical item. You see the epidemic coming, stock up, but don't wait till them to start or you may be too late.
Start cooking the foods you have selected and serving it to your family now. You will learn how to best prepare it, what you forgot, and what they like and don't like. No one wants the pancakes without syrup or at least jam till they are really hungry. Once you have completed your stash, start rotating the stock. First in, first out. Get the family used to eating it. Keep the perishables only in the qualtity you can use before they spoil.
This is not rocket science, people, except for those of us who are used to pre-prepared food and take out, or do not know how to cook from scratch. Lewis and Clark fed 35+ people for two years off a few barrels of salted pork, flour, hominy, biscuits (probably hard tack), beans, coffee, sugar, dried apples; a portable, dried soup mix something like a concentrated meat broth, 200 pounds of beef tallow, 50 pounds of lard and the expedition favorite, whiskey. The rest, they found in nature along the way, learned about/bartered from the local Indians, or killed/caught.
Surely, with all we know now, we can get together enough stuff in our homes to last us for a few months of reduced supply. Don't be on your roof with a sign, starving when the time comes. Get on it people.
HTH.
TR
Are there any real economists who can to contribute to this thread? Please speak up, because I am close to the ragged edge of my capcaity to interpret economic indicators in this arena.
Security and commodity prices should not be relied on for anything in this instance. Where the buying and selling decisions of millions of investors acting on their own interpretations of all available information occur, and where information asymmetries are caused by differences in individuals' abilities to process information, not the availability of quality information itself, then security prices and their relative fluctuations can be information rich.
But that is a very tricky business, and this is not an instance where investors are necessarily well-informed. Like every other complex phenomenon, a disease pandemic's course will be determined by multiple interacting contingencies, few of which many people can say much about with any certainty. So what you are likely to see is herd behavior and security prices that reflect the aggregate view, not security prices that point to the fundamentals. IMNSHO, a broad swath of the equities trading in the US and Europe today have already seen their valuations become detached from fundamentals. I could walk that square with you all week, but it's not the point of this thread.
My advice is to make whatever preparations you are comfortable with and stick to your current investment strategy, perhaps holding a bit more cash in reserve than usual. Don't make yourself crazy looking for leading economic indicators of a public health crisis.
Don't make yourself crazy looking for leading economic indicators of a public health crisis.
I would just like to have some of my retirement $$ intact after any potential hit. I've lived on $9,000/year and know it can be done, but I wouldn't want to do it again.
I've gone to 50% cash -- sorta reflects my take on the odds for a pandemic.
I had friends in London who were currency traders and I know commodities traders now. It's a mugs game for the average Joe to get into that racket.
Sir mugwump, what is your estimate in how strong the symptoms are at outset? Specifically, the possibility of attracting the disease and driving.
Thanks.
Martin
Sir mugwump, what is your estimate in how strong the symptoms are at outset? Specifically, the possibility of attracting the disease and driving.
Thanks.
Martin
Martin, please, drop the sir. I work for a living. Sir mugwump brings up a mental picture of me oozing out of medieval armor, like a tube of Pillsbury biscuits after you whack it on the table edge.
Nobody knows about the symptom severity. I would think it is not safe to drive with any flu, seasonal or pandemic.
Decide what is your "tipping point", the point at which you think the flu has gone pandemic. Have a plan to get where you are going and then move as soon as your tipping point is reached. In the meantime, forget about it and live your life -- there's a good chance nothing will happen. This is what I have agreed with my son, who is your age and at university.
Several people I know have said they will use the "three sick nurses/doctors" rule as their tipping point. But be aware that close to 1 billion Chinese have no health care at all. Check Google News once per day, but don't worry excessively.
.
Okie, mugwump. :)
I don't tend to worry excessively in anything else than failing my friends and those I respect. It may sound repulsive, but I think contingency planning and preparations are fun, while remembering that the carrying out part is likely to be painful.
---
This blog article "H5N1 - does it live up to the hype?" (http://aetiology.blogspot.com/2006/01/h5n1-does-it-live-up-to-hype-redux.html) might be interesting to some.
Take care,
M
Okie, mugwump. :)
This blog article "H5N1 - does it live up to the hype?" (http://aetiology.blogspot.com/2006/01/h5n1-does-it-live-up-to-hype-redux.html) might be interesting to some.
Take care,
M
Tara is a hottie but her blog is out of date, and even her old data are misleading. New research presented this week at the CDC supports a case fatality rate of 54% and no cases of mild flu.
The studies cited in her blog entry test the hypothesis that for every serious H5N1 illness/death, there are many more mild cases that go unreported. This is very important information to have, because if the premise is true then the 55% death rate is just plain inaccurate. Tara the Hottie points out the major flaw in the two studies cited, but then proceeds to use the data to support her premise that the flu is actually much less dangerous than reported.
The fatal flaw: the investigators went into a region where there were H5N1 flu deaths up to 12 months after the fact and asked if anyone sneezed or coughed around the time of the deaths. If they had, they were chalked up as having a presumptive mild case of H5N1. No blood tests were performed. It was a huge study, and the results were very comforting (they concluded that there were many, many cases of mild H5N1 because many people remembered sneezing or coughing -- one cough was enough).
The study has been widely criticized for obvious reasons: who can remember if they sneezed a year ago, and if they can, why should you assume it was caused by H5N1?
The results of a more scientifically rigorous study were presented this week at the CDC conference:
ATLANTA (CP) - New data from Cambodia presented at an international conference Monday suggest mild or symptomless human cases of H5N1 avian flu may not be occurring.
Many have hoped that the world is overestimating the virulence of the H5N1 virus, based on an assumption the disease surveillance systems in affected countries might not be sensitive enough to pick up mild infections.
But if the work presented at the International Conference on Emerging Infectious Diseases is borne out by additional larger studies, it would suggest the current case fatality rate of roughly 54 per cent might indeed be close to reality.
.
.
.
The researchers went to a village where the chickens were infected and one person died from H5N1...
The researchers tested blood samples from 351 of the villagers looking for the antibodies to the virus that would be proof of mild or asymptomatic infections. They found no signs of additional infections - this despite the fact that many of the villagers had significant exposure to infected poultry.
http://tinyurl.com/etydb
Also, note that the two healthy Turkish brothers Tara cites ("H5N1 virus does not always lead to illness") who were "positive" for H5N1 were actually found out to be "negative". There are two tests: a quick but inaccurate PCR throat swab and a slow but accurate blood test. The results were reported after the swab, and they were wrong. Nothing sinister about the initial report, and Turkey did a good job -- you just have to wait for the blood test to be sure. I don' know of asymptomatic cases to date.
.
While the recent report I cite above is bad from the lethality perspective, it highlights how difficult it is to catch H5N1. The doctor who intubated a patient and veterinarians who dissected dead chickens (none knew about H5N1 at the time) all had negative blood tests.
Also, the cluster of H5N1 human deaths in Azerbaijan and 14 additional human illnesses were attributed yesterday to young women collecting feathers from dead swans. Horrible for the families, but good news from the pandemic perspective.
Someone should send out a memo in Azerbaijan.
Encouraging News out of the CDC Conference: (big conference going on, I wasn't invited :) ) the good news is on page 2
http://tinyurl.com/ewbhq
Everyone is reporting this under "Closing schools won't help" but this is the money shot in my opinion:
Much more likely to help slow the spread of bird flu and other viruses is home confinement of anyone who is ill or exposed. The study found that under certain circumstances, infection rates could be reduced up to 52 percent and death rates up to 60 percent by home confinement.
The paper's authors speculate that school closings during a pandemic would result in hordes of kids hanging out in malls, etc. I hope we're not that collectively stupid that we'd let our kids treat a pandemic as a snow day, but who knows?
I had been resigned to the fact that exposure couldn't be avoided. This provides good evidence (although indirect) that social distancing may work as a prevention strategy.
Situation in Azerbaijan:
http://www.who.int/csr/don/2006_03_21a/en/index.html
Mildly worrisome is the fact that the 14 suspected cases reported yesterday are not mentioned, so the swan-feather cause should only be attributed to the older cases discussed here. Continue to check the news for clusters of cases that may indicate h2h.
A good daily summary is here (interesting the USN is providing support in Azerbaijan; WARNING this is a flaming liberal site -- welcome to my life, these are the kind of people I work with):
http://effectmeasure.blogspot.com/
Mosnews is reporting that WHO now has 14 suspect cases under investigation. The suspect cases may be the product of an ongoing house to house surveillance effort for influenza like illness (ILI) being done by local medical teams. A US Naval Medical Research Unit (NAMRU3) is providing laboratory support.
More research fom today's CDC presentations.
http://www.forbes.com/lifestyle/health/feeds/hscout/2006/03/22/hscout531699.html
Bottom line: seasonal flu infects cells high in the respiratory tract while H5N1 needs to get very deep into the lungs. This more than like explains why h2h is currently so inefficient. The article also presents as fact the "...that many people have tested positive for exposure to H5N1, but have never developed actual infection or illness." They even discuss it with a guy who has a book out. This is patently false.
"The evidence for widespread asymptomatic infections is just not there,'' Michael Perdue, a World Health Organization scientist working on the global influenza program, told Canadian Press correspondent Helen Branswell.
"The (more recent) studies that have been done, one of the reasons frankly that I think they haven't been followed up on, is they haven't found many positives. You don't get too excited about all negative serology (blood work)."
Dr. Scott Dowell, director of global disease detection and preparedness at the U.S. Centers for Disease Control in Atlanta, agrees: "If there was mild or asymptomatic H5 infection and that was relatively common and the severe cases we're picking up were the tips of the iceberg, then if you look at family members or hospital contacts or cullers, you would expect to be seeing some of these," he told CP's Branswell.
"If you forget the serology and you just say 'Well, let's look at symptoms,' we're not seeing clear evidence of mild symptoms on these cases (either). So my interpretation has been and still remains actually that if there's a lot of mild or asymptomatic cases, it's not clear to me where they are."
More research fom today's CDC presentations.
Hang in there mugwump;
I find this thread very informative and follow it right regular.
Pete
Hang in there mugwump;
I find this thread very informative and follow it right regular.
Pete
Will do. Just please tell me to shut up if this stuff is over the top.
I have the patience of a three-year-old. I have to just sit and wait for 5-7 minutes umpteen times per day as programs compile or I wait for a device to complete a run. I scan news sources and jot these notes during these times.
It's therapeutic.
So here's one for you: what do you do when you live under a major flyway and your dog takes to goose poop like a metrosexual with a bottle of Hugo Boss?
5684
Eats it, rolls in it, would string it on a necklace and wear it if he could, LOL. He will bear watching if the flu gets into the Canada geese.
.
March 22 interview with Dr. Michael Osterholm, associate director of the Department of Homeland Security, director of the U of Minn Center for Infectious Disease Research and Policy (CIDRAP), and Chair of the HHS's National Science Advisory Board on Biosecurity.
This guy is well-respected but he makes people very uncomfortable. Interesting read. Osterholm is the guy who got DHS to initiate supply-chain studies with U. of Chicago economists.
"...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."
Sobering. This guy pulls no punches.
http://citypages.com/databank/27/1320/article14219.asp
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CoLawman
03-22-2006, 23:46
...
It is getting late............but I have somehow lost my place. WTF!!! Did you post this on the wrong thead? Great information and wanted to add my experience with a perilymph fistula caused by a dive accident or weightlifting.......but not sure how that ties into what I came here to read........going to take my spins and fistula to bed.:D
This is what I was trying to post last p.m. and screwed up:
There's a lot of talk in the popular media about two new studies, presented at the CDC conference on 22March2006, which document binding sites in the body for seasonal flu vs. human infection with avian flu. Seasonal flu binds with receptors high in the respiratory system while avian flu must penetrate deep into the lungs before infection takes place. This is very important information and it jibes nicely with other data that's been released recently. For instance, it explains why there have been very few people with antibodies to the avian flu and no symptoms (why no mild infections). Most seasonal flu infections start as bronchitis. If the bronchioles can't be attacked then a much higher viral load, inhaled deeper into the lungs, is needed to cause the disease (and antibody formation). This virus is nasty all on its own, but if it starts as pneumonia deep in the lungs then the chances of survival are much less. Not a formula for mild infections.
This is maybe really good news if the worst does happen. I haven't seen discussion of this yet, but this research may explain a mechanism for a dramatic decrease in the death rate -- from the current 55% down to something approaching the 1918 levels of 2.5% -- if this vrius ever "learns" to spread efficiently in humans. My thinking: to pass efficiently it must attack higher in the lungs - the bronchioles. If the flu starts from the git-go as a (milder) bronchitis instead of a (life threatening) pneumonia then you have a greater chance of fighting it off. This doesn't address the cytokine storm but that's another kettle of fish.
We know that transmission from birds to humans and from human to human is quite difficult. This study seems to explain why that transmission is so inefficient. What I don't understand is why this is being touted as "proof it may never cross to humans." Don't we already know transmission is inefficient? Yes. Don't we already know that mutation is required to make viral binding more efficient in humans? Yes. The paper cited at the top of the thread documents changes to the exact sites that this new research addresses. Does this downgrade the threat level? I emailed a researcher and this is what I got (and f-me, it's mostly gibberish to me too). I include this to show how hard it is to get an anser out of a scientist.
I'll let you know if I get an answer in English on whether this research lowers the threat level.
I've already put this out in public so pass on at will. As the two recent papers about binding of H5N1 to human respiratory-tract-cells show, recombination of H5N1 might not be required and a series of single-nucleotide-changes could do the trick.
I measured the “clustering” of mutations of the genes (this might indicate recombination):
PB2:223:496, 7497:15,353:620,,120:599, 979: 7, 637:1131
PB1 75:428, 483:17,266:590,, 81:492, 385: 5, 620: 996
PA 192:383, 820:17,340:651,, 77:484, 448: 5,1119:1387
HA 385:526, 859:47,489:660,,156:499, 360:15,1072:1224
NP 310:413, 584:15,260:663,,163:298, 281: 4, 876:1253
NA 169:527,10414:24,244:673,,176:369, 2341: 2, 830:1242
M 357:473, 2104: 5,224:755,,106,127,15054: 1, 735:1793
NS 204:510,42870:16, 39:764,, 27:343,34789: 3, 602:1966
the exact meaning of the numbers is hard to explain, but the 2nd value after “:” is always from a randomized run. The 2nd part after “,,” considers only 3rd position mutations (in codon), these often don’t change the properties of the virus.
Everyone all together: "WTF?"
Finally, nice journal article on the differences between the three pandemics in the last century -- with a picture. I like pictures.
http://content.nejm.org/cgi/content/full/353/21/2209
.5685
Well, FWIW I got an answer on the new resarch vis-a-vis threat levels. This receptor research apparently hasn't changed any minds -- those who think the threat is overblown still think that way and those who think H5N1 may go pandemic haven't changed their minds either. I was referred to look up info on the young girl and her uncle who died in Turkey. The implication is that this was a h2h case and genetic analysis showed the point mutations had already occurred which are being touted as unlikely in the popular press in light of this new research ("nearly impossible", "like winning the lottery twice", etc.).
Don't get me wrong, this research is considered very significant -- it just doesn't answer the 'big' questions.
This is in the Michael Osterholm interview I cited @ 20:31 yesterday:
"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."
New question: if it mutated, why didn't it spead?
..
Layman's question, Mugwump:
If the bronchioles receptors theory proves valid, how critical is that information to both vaccine and possible weaponization efforts?
-Seth
Layman's question, Mugwump:
If the bronchioles receptors theory proves valid, how critical is that information to both vaccine and possible weaponization efforts?
-Seth
Smart questions, layman. I should say "I'll give you a very technical answer: I don't know" but I'll plow through anyway. I wasn't going to talk about the following because it's, well, worrisome and I don't know how useful this is at this stage. But, you asked so...the weaponization, or stupidization potential is at the end after some exposition/explanation.
First. The data in these papers are good, and the receptor results are accepted as indisputable at this stage. So it's not an "if valid" scenario. I can say this without sounding petty because I don't do research, but this isn't rocket science. There has been so little work done on flu that there is low hanging fruit, research-wise, all over the place. These papers are actually more important for mapping the distribution of alpha 2,6 receptors ("mammal" receptors found in the upper respiratory system) and alpha 2,3 receptors ("bird" receptors found deep in the human lung and in bird guts) than they are in answering questions about the virus -- regardless of how the press is spinning it. Note they used isolates from 2004 - a snapshot from the past. What the papers do is describe "what was", probably not "what is" and definitely not "what will." Since the samples in this study were obtained, the virus has split into two distinct genetic branches and had multiple mutations in each branch. It's good work and more like it is needed but the crystal ball is still as murky as before, at the end of the day.
What the newspapers don't tell you is that "they" (see below) already know the gene sequence needed to code the receptor mutation that will cause the H5N1 pandemic. They've even actually created the virus :eek: - pray they don't let it loose. They are now arguing about how the proteins produced by these "key mutations" get folded into the proper shape for the proper lock-and-key fit. This field is moving very quickly.
As far as vaccine efforts go, no, it doesn't help. That two-branches split I mention has really made things more complicated. What will help is the virus not mutating for at least another 12-18 months so we can get vaccine manufacturing infrastructure in place. Note that Congress, world governments, WHO, industry, and academia all have to pull together on a crash basis even then. The odds of that happening are left to the reader to calculate. The receptor research might assist in developing new tools to help identify any h2h virus that breaks out. But realistically, any such breakout will probably be identified epidemiologically -- by the 16 then 32 then 64 then 128 etc. cluster that is first identified.
Check out Minor Mutations in Avian Flu Virus Increase Chances of Human Infection. It discusses in a more understandable way the original study that I cite in the first message of this thread. Note that they've actually inserted the "bad" genes into the Viet04 H5N1 virus and created a virus :eek: with the affinity for the alpha 2,6 receptors (the "Oh, crap!" ones). I repeat - :eek: .
http://www.scripps.edu/newsandviews/e_20060320/avian.html
"The study showed that relatively small mutations can result in switching the binding site preference of the avian virus from receptors in the intestinal tract of birds to the respiratory tract of humans.These mutations, the study noted, were already "known in [some human influenza] viruses to increase binding for these receptors."
The bird gut receptors they refer to are the alpha 2,3 ones, and the human resp. tract ones are the alpha 2,6 mentioned in the "bronchiole" study. You will note that this study directly contradicts the statements of the Japanese researchers and the press who imply many difficult mutations are needed ("odds akin to winning the lottery twice"). Such is science and human nature.
“Our recombinant approach to the structural analysis of the Viet04 virus showed that when we inserted HA mutations :eek: that had already been shown to shift receptor preference in H3 HAs to the human respiratory tract, the mutations increased receptor preference of the Viet04 HA towards specific human glycans that could serve as receptors on lung epithelial cells,” Wilson said. “The effect of these mutations on the Viet04 HA increases the likelihood of binding to and infection of susceptible epithelial cells.”
These guys are at Scripps, that DOD-research-center-in-Maryland-that-we-won't-name, and the CDC -- so hopefully their containment is up to snuff.
If they can engineer a flu virus into a pandemic form, someone else can do it. I don't figure it's easy, but then I've got a gene sequencer on a bench in the next room that they say can sequence a whole human genome in a month. I still have to cypher out how the dang thing works, though.
It would be pretty stupid to do if you didn't have a vaccine, but there you go.
I am out of the country for a week, not cowering under my bed covered in tinfoil.
Later.
Thank-you for reply, Mugwump.
I appreciate your prespective and time, on this topic.
Have a safe journey.
-Seth
Stargazer
03-24-2006, 12:58
If they can engineer a flu virus into a pandemic form, someone else can do it. I don't figure it's easy, but then I've got a gene sequencer on a bench in the next room that they say can sequence a whole human genome in a month. I still have to cypher out how the dang thing works, though.
Mugwump, which system do you have?
Mugwump, this is a great thread, thanks for starting it.
Out of curiosity, I did a quick search to see how seriously Australia is taking the issue. The answer is pretty damn seriously.
According to figures released last year, Australia now has one of the largest per-capita on-shore stockpile of anti-viral drugs in the world The current stockpile will cover 20% of the population should a pandemic break out.
Interestingly, to get that much on-shore, we pretty much cornered virtually the entire tamiflu world market for about 12 mths. This is in addition to both current hospital supplies and to off-shore expected supplies. The govt also stockpiled huge amounts of syringes and surgical masks, and got over 300 extra ventilator machines in. All this in addition to working on developing a proper vaccine, and on getting enough anti-virals to bring the stockpile up to the WHO recommended 25% pop. coverage.
The biggest expenditure though is in what we are spending to help SE Asian countries develop their agricultural surveillance and lab testing capabilities, as that's currently where the greatest threat seems to come from.
http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2005-ta-abb251005a.htm
With all of the talk about bird and human receptors I thought a picture would be worth 1,000 words. The hemagglutinin that bind to the alpha 2,6 receptor (mammal, upper respiratory tract) are on the left and right -- the middle one binds to alpha 2,3 receptors (bird gut, deep in the human lung). The speculation is that if a mutation occurs that eliminates the little isthmus in the middle of the H5 variant (like happened in the 1918 version) then H2H transmission would be possible.
5760
This is from a great article by Taubenberger et al, the guys who resurrected the 1918 virus.
http://www.mcdb.ucla.edu/Research/Goldberg/HC70A_W05/pdf/CapturingKillerFlu.pdf
Two articles about the same pandemic simulation. Note that Switzerland and France are the sites of the two companies with whom the US has contracted for bird flu vaccine (Sanofi Pasteur and Berna Biotech Ltd -- just as with sneakers, bath towels and pharmaceutical feedstock, we don't have any manufacturing capability on-shore anymore).
Koombayah Europe (or spin A)
BRUSSELS (Reuters) - A European exercise to simulate an influenza pandemic showed the countries involved were reasonably prepared but exposed flaws in the system used to report national health crises, officials said on Thursday.
http://today.reuters.co.uk/news/newsArticle.aspx?type=worldNews&storyID=2006-03-30T152857Z_01_L30736363_RTRUKOC_0_UK-EUROPE-INFLUENZA.xml
Every-Man-For-Himself Europe (or spin B)
Plans by Switzerland to seal itself off in the event of a flu pandemic triggered "serious concern" by other countries during Common Ground, a recent simulation exercise, because of its strategic location as home to many drug and vaccine manufacturers...Similar concerns were raised about France, another important drug production centre, which also said it was considering border closures. However, French officials stressed they would exempt pharmaceutical workers and materials from travel bans.
http://news.ft.com/cms/s/62e60ba6-c0e0-11da-9419-0000779e2340,_i_rssPage=3f6a0854-c8f8-11d7-81c6-0820abe49a01.
India
Worrying news from India -- another one of those things to watch. Note that there has been significant culling of birds lately in the West Punjab region and that H5N1 presents as both pneumonia and encephalitis in the very young. There are many reasons for infant mortality in India, but they are historically the biggest prevaricators when it comes to reportable diseases (they make the Chinese look good). :
Deaths of a dozen children since Tuesday, six of them within 12 hours yesterday, rocked Burdwan Medical College and Hospital last night.
[snip]
Murshed said of the 12 deaths, six occurred within a span of 12 hours yesterday. “The babies, suffering from meningitis, pneumonia and septicaemia, died because of cardiac failure and malnutrition.”
http://www.telegraphindia.com/1060401/asp/bengal/story_6042980.asp
The Reaper
04-03-2006, 18:49
Maybe we could trade them trial lawyers for vaccine and pharmaceutical manufacturers?
TR
2006.04.04
HONG KONG—Authorities in the central Chinese province of Henan are holding more than 400 university students in isolation after they contracted a mystery fever. Meanwhile, authorities in Shanghai have called for better preparedness as the highly pathogenic avian influenza spreads.
The students, from the Henan University of Science and Technology in the city of Luoyang, were being held at an undisclosed location other than the university hospital, a local employee said, confirming earlier official media reports.
“The students with high fever symptoms are quarantined...at a specific place,” an employee at the No. 1 University Hospital told RFA’s Cantonese service. “But we don’t know how many students are there now.”
http://www.rfa.org/english/news/2006/04/04/asia_birdflu/
NOTE: There is NO confirmation that this is H5N1 and no word of deaths-- there is a WHO team on the way. There are conflicting reports on this -- the original reports said they were hospitalized and then released, then that they were quarantined "at a different place than the hospital", then this one which appears to be a combination of the two.
.
For "...new technologies that radically accelerate the manufacturing of protein vaccines and protein-based therapeutics..."
Only 3 million doses -- hey, where's mine? I particularly like the award floor, though.
Category of Funding Activity: Science and Technology and other Research and Development
Expected Number of Awards: 999999999999999
Estimated Total Program Funding: $999,999,999,999,999
Award Ceiling: $999,999,999,999,999
Award Floor: $999,999,999,999,999
CFDA Number: 12.910 -- Research and Technology Development
Cost Sharing or Matching Requirement: No
Eligible Applicants
Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility"
Additional Information on Eligibility:
Agency Name
Defense Advanced Research Projects Agency
Description
Accelerated Manufacturing of Pharmaceuticals (AMP) BAA06-31, Proposals Due 1600 ET, June 21, 2006, POC: Michael Callahan, M.D., DTM&H, DARPA/DSO; Phone: (571) 218-4596. DESCRIPTION The Defense Sciences Office (DSO) of the Defense Advanced Research Projects Agency (DARPA) is seeking proposals for new technologies that radically accelerate the manufacturing of protein vaccines and protein-based therapeutics. This program is a key component of an overall DARPA focus to accelerate the insertion of critical therapeutics essential for the military. The vision of the Accelerated Manufacturing of Pharmaceuticals (AMP) program is to create an extremely rapid, flexible and cost-effective manufacturing system capable of producing three million doses of GMP-quality vaccines or monoclonal antibodies (mAB) within 12 weeks....
http://www.grants.gov/search/search.do?mode=VIEW&oppId=8774
The Reaper
04-04-2006, 10:43
mugwump:
You are doing a fine job here of keeping us updated. Thanks.
TR
mugwump:
You are doing a fine job here of keeping us updated. Thanks.
TR
You're welcome.
We apparently got a sneak peek at the Germann data (see the 3/20/06 13:09 post). This should be interesting when it comes out.
LOS ALAMOS, N.M., April 3 (UPI) -- Los Alamos, N.M., scientists say supercomputer models of a national bird flu emergency have generated "stark" results.
Researchers from the Los Alamos National Laboratory in New Mexico, the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle used the supercomputer to predict the possible course of an avian influenza pandemic, given today's environment of worldwide connectivity.
The large-scale, stochastic simulation examined the nationwide spread of a pandemic influenza virus strain, such as an evolved avian H5N1 virus, should it become transmissible human-to-human.
The simulation produced a city- and census-tract-level picture of the spread of infection through a synthetic population of 281 million people during 180 days. It also examined the impact of interventions, from antiviral therapy to school closures and travel restrictions.
The study's authors -- Timothy Germann, Kai Kadau and Catherine Macken of Los Alamos and Ira Longini of the Fred Hutchinson Cancer Research Center and the University of Washington -- presented the study online in the Proceedings of the National Academy of Science. The study will appear in print in the April 11 issue of the journal.
This surprised me, and probably has broad application to all infectious disease.
According to a guy who knows these things (no cite yet, I've asked for one) the #1 correlate in those who contracted the flu in 1918 and then survived was immediate bed rest at the first sign of symptoms. Those who tried to tough it out and go to work had a significantly worse outcome.
Now this raises questions in my mind like maybe those who stayed home were better able to miss a day's wages (were richer) and had better nutrition, or better access to nursing support, etc. but it's interesting nonetheless.
This surprised me, and probably has broad application to all infectious disease.
According to a guy who knows these things (no cite yet, I've asked for one) the #1 correlate in those who contracted the flu in 1918 and then survived was immediate bed rest at the first sign of symptoms. Those who tried to tough it out and go to work had a significantly worse outcome.
Now this raises questions in my mind like maybe those who stayed home were better able to miss a day's wages (were richer) and had better nutrition, or better access to nursing support, etc. but it's interesting nonetheless.
Not to mention that they'd further infect others. I get VERY annoyed when people are obviously ill and continue to come to work and expose the rest of us to their ick.
My newest boss (ughhhh) seems to think it "looks better" to take sick days as vacation days, something about not being thought of as unreliable. I responded that if I'm sick it's no vacation...thanks but no thanks.
Great thread and info mugwump, thank you. I know where I'm headed when this would hit Chicago. :D
A very interesting article in today's WSJ relates "statins could be part of a world-wide effort to reduce morbidity and mortality from avian flu," says Joe G.N. Garcia, chief of medicine at the University of Chicago and a leading lung-disease researcher.
Statins are anti-cholesterol drugs like Lipitor and Zocor, not the ones where you should seek immediate medical attention if your erection lasts longer than four hours.
Note that most humans who contract H5N1 present with ARDS at admission (bleeding from the nose, gums and rectum). Either they are in the late stages when they hit the hospital or ARDS is an early event with this type of flu.
In a demonstration of situational ethics, I have appended the full article for non-subscribers, minus one sentence. I consider this "fair use." Mods, if you disagree, please let me know.
WSJ article on statins (http://online.wsj.com/google_login.html?url=http%3A%2F%2Fonline.wsj.com% 2Farticle%2FSB114410498838815817.html%3Fmod%3Dgoog lenews_wsj)
Even Without a Vaccine, Existing Drugs Show Promise In Treating Bird Flu
By THOMAS M. BURTON
April 4, 2006
No one knows whether an avian flu pandemic will ever strike, or if a viable vaccine will be found before it does. But many of the life-threatening symptoms of the flu resemble other conditions that are occurring in thousands of patients now, and the drugs to treat these conditions could be used to treat the bird flu, researchers say.
One of those conditions is acute respiratory distress syndrome, or ARDS, a lung condition involving inflammation and fluid buildup that often follows viral pneumonia and septic infections. Drugs to treat such conditions may be useful for treating bird flu, even if vaccines and antivirals aren't available.
.Because the avian flu virus acts much the same way as ARDS, researchers are now hard at work studying drugs currently used to treat ARDS that could have the potential to fight bird flu too. "We have a lot to offer people if the flu should strike." says Michael A. Matthay, a researcher at the University of California-San Francisco.
Some of the drugs are exotic and experimental, used so far only on mice. Other pills are household names, such as Merck & Co.'s cholesterol drug Zocor and the generically available asthma drug albuterol. Some are in-between, like Eli Lilly & Co.'s Xigris for septic infections, which is used in emergency settings at thousands of dollars a dose.
What these medicines have in common is the ability to fight the constellation of lethal symptoms of ARDS, which some researchers call "vascular leak" because the walls of blood vessels supplying the lungs grow inflamed and porous, causing fluid to seep into the lungs. About 75,000 Americans die annually from ARDS and related conditions, according to critical-care physicians. Researchers at leading institutions like the University of Chicago, the University of Michigan and UCSF are working on ways to treat vascular leak, partly by enhancing the walls of capillaries that supply the lungs.
"If vaccinations do not prevent it, therapy for bird flu is no different than for the inflammatory process of ARDS," says Augustine Choi, chief of pulmonary and critical-care medicine at the University of Pittsburgh Medical Center.
The avian flu virus has killed more than 100 humans since its detection in Hong Kong in 1997. Recent research suggests that because it mostly infects cells deep in the lung, it might be difficult for the virus to spread from person to person. However, some doctors say the deep-lung viral attack may make people cough more heavily and thus make the illness highly transmissible. The government hopes it can ward off a flu epidemic with its stockpile of antiviral drugs and with vaccines in development, but that's far from a certainty. The Asian strain of H5N1, which is known to mutate rapidly, has shown resistance in human cases to antivirals. A recent test of a vaccine in development by the U.S. government and France's Sanofi-Aventis SA had only tepid success.
Doctors are optimistic that statins, the class of cholesterol-lowering drugs that includes Zocor and Pfizer Inc.'s Lipitor, could play a role. That's because statins also fight the inflammation that causes leaky vessels. Although these drugs aren't currently prescribed for respiratory illnesses, "statins could be part of a world-wide effort to reduce morbidity and mortality from avian flu," says Joe G.N. Garcia, chief of medicine at the University of Chicago and a leading lung-disease researcher.
At the University of Chicago, pulmonologist and critical-care doctor Jeffrey R. Jacobson and colleagues have produced ARDS in mice, then hooked the mice up to miniature ventilators as humans with avian flu might be. The mice were then tested with treatments like Zocor, generically called simvastatin. The researchers found that simvastatin relieved vascular leakage and enhanced the artery-wall barrier keeping fluids in -- and that these findings "have broad clinical implications."
"We've clearly demonstrated that these drugs affect blood-vessel function," Dr. Jacobson says.
There's also evidence that statins can help in humans in respiratory distress. Doctors at Ben Gurion University in Israel found that, of patients admitted to the hospital with acute bacterial infections, use of statins made a big difference. The 2004 study of 361 patients found that 19% of the no-statin patients needed intensive care when their infections progressed to severe sepsis, versus 2.4% of those who had taken statin drugs.
While the study involved using statins as a cholesterol drug, researchers believe giving them early in treatment could produce similar beneficial effects for respiratory illnesses. Using Zocor "would be the lowest-hanging fruit" of possible drugs for bird flu because it's relatively inexpensive, and already widely available, Dr. Garcia says.
It also could get patients off ventilators faster. That's important because the ventilator itself can cause injury to the lungs. And if an epidemic were to strike, ventilators could become a scarce commodity.
Dr. Garcia and colleagues have found that experimental drugs that mimic a naturally occurring compound in the body, sphingosine 1-phosphate, produced "significant decreases" in vascular leakage in animal tests. Scientists also have found that Lilly's Xigris, already on the market, appears to build up capillary walls that hold in fluid. UCSF's Dr. Matthay and colleagues are investigating the use of the asthma drug albuterol in ARDS patients. It acts, he says, by "removing fluid from the air spaces of the lungs, and it may also work by decreasing inflammation of the lungs."
And if bird flu never strikes, much of this research will nevertheless be vital: The University of Chicago's Dr. Jacobson says that, at any given time, more than one-fourth of patients in the medical intensive-care unit are suffering from acute respiratory distress and related conditions.
WSJ article on statins (http://online.wsj.com/google_login.html?url=http%3A%2F%2Fonline.wsj.com% 2Farticle%2FSB114410498838815817.html%3Fmod%3Dgoog lenews_wsj)
More...
This statin thing may be the real deal. This study deals w/ bacterial infection, but the inflammatory response is similar in viral infections.
Lipitor ain't cheap, but at least it's widely available.
"...Severe sepsis developed in 19% of patients in the no-statin group and in only 2.4% of the statin group (P<0.001)..."
Prior Statin Therapy Is Associated With a Decreased Rate of Severe Sepsis
AHA Statin Study (http://circ.ahajournals.org/cgi/content/abstract/110/7/880)
I know where I'm headed when this would hit Chicago. :D
LOL I've heard that before. I've gone mute on this subject except for here and with my brothers and professional contacts.
I told my wife when she said "Tell them to stop sending all this crap -- where is it going to go?" that if the flu really hit it would all be gone in five days. She has 7 bros. and sisters, all raving Democrats--the really Dean-wing loony sort--whose idea of planning is to have a sign that says "Help ME!" for waving on the roof. We all get along...usually. If things get dull at family gatherings my smart-ass daughter will walk into the room and whisper "Hillary". Like throwing a road flare into the California chaparrel in August. :)
I've always taken The Reaper's approach to this stuff: being prepared is just common sense, a duty really, and is not difficult. There are a hundred things that could throw a spanner into the works. I buy disability insurance and hope to never use it. Same with this stuff.
It's interesting, really. The old-school, pioneer spirit of being prepared for contingencies is perceived by many as "giving in to fear."
/Rant off :)
"What I can say is the infection is now under control, and we can't give any further information,"
Ooookay. Edited to add: Maybe Chikungunya or something else? If they are not lying then it doesn't sound fluish. Given the current climate and China's history of bald-faced lying, "open and honest" would probably have been the better strategy.
Henan authorities refuse to reveal cause of university flu outbreak
Shanghai. April.3 INTERFAX-CHINA- Henan Department of Health has
refused to reveal the cause of a flu-like outbreak which has infected
400 students at a university in the province.
Students at Henan University of Science and Technology, in Luoyang
city, started to become ill on March 26 which resulted in many needing
hospital treatment - as many as 400, according to state media.
Henan Department of Health said laboratory tests showed the infection
is not type A or type B influenza.
Interfax asked vice director of the disease control and prevention
division of Henan Department of Health, Shan Xinguo, why so many
students contracted the disease at the same time, but he declined to
give any details.
He said, "What I can say is the infection is now under control, and we
can't give any further information,"
Shan Xinguo said the students had contracted upper respiratory tract
infections.
He said, "It's normal for students to have upper respiratory tract
infections, especially in spring. And at colleges, students are
concentrated, so it's easy for many students to become infected with
the disease at the same period of time."
Another official from Henan Department of Health, who declined to be
named, said the situation is now under control, and the fever was
starting to pass.
"The reason why so many students developed fever continuously still
remains unclear," she said, "We are still investigating the matter,
but we are sure the students are not victims of an epidemic influenza
infection."
She said the main symptoms of the sick students were fever and joint
pains, and that most recovered one or two days after medial treatment.
Shan Xinguo said the ill students had been quarantined and treated,
and that some TCM preparations have been sent to students to prevent
the disease. Over 2000 dormitories as well as 130 classrooms are now
being sanitized twice a day.
As of April 2, ten students were still in hospital for clinical observation
http://www.curevents.com/vb/showthread.php?t=44938
AngelsSix
04-04-2006, 19:32
Okay...wait a minute. Isn't this the same damn thing that happened in the late 80's when we found out that even thought the smallpox virus had been eradicated, the Russians were still (and so were we, for that matter) conducting biological tests and so forth to make a super virus? The idiots killed a bunch of people because they let Anthrax get out of one of their labs....who's to say that the same thing hasn't happened here? Who's to say this isn't genetically engineered with the express purpose of wiping people (or their food source) out??
Ideas??
AngelsSix
04-04-2006, 19:38
From the CDC site: Infected birds shed influenza virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated secretions or excretions or with surfaces that are contaminated with secretions or excretions from infected birds. Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.
Mug: So while the bird's poop may be infectious (interesting that a virus can survive outside of the body so long) the possibility that the dog gets it??? Good question....what we need to know here is how the virus works to attack the immune system....I guess.:confused:
From the CDC site:
Mug: So while the bird's poop may be infectious (interesting that a virus can survive outside of the body so long) the possibility that the dog gets it??? Good question....what we need to know here is how the virus works to attack the immune system....I guess.:confused:
Yes, poop is infectious. We have parks around here where you can't even walk because of all the feces -- Canada Geese produce a pound of it per day. The situation is worse in cool weather which prolongs the life of most viri.
RE: Immune response. H5N1 causes high rates of ARDS and what is called "cytokine storm." Very high rates of replication in the cells and production of a "come kill me" messenger molecule cause the body to ruthlessly attack infected cells and their contiguous healthy neighbors. It's the body's version of a Russian retreat in 1941 -- scorched earth. Because this virus attacks multiple organ sites -- lymph nodes, brain, gut, kidneys, etc. this is obviously a strategy which has...drawbacks. Autopsy reports are truly scary. I won't point to any, these are mostly kids and I find them very sad. They can be found via Google.
RE: biowarfare agent.
This certainly IS a biowarfare agent but I doubt that anyone purposefully engineered it.
Unconstrained human population growth has led to a revolution in food production technology (factory farming) and an unprecedented level of beef, pig, and bird production. It's stunning really. There are production facilities in Thailand (Charoen Pokhand, or CP) modeled on the Tyson Chicken model (including predatory business practices that wipe out small farmers, usually via cosy deals w/ the governent) who have taken the system one step further: their chicken are on the first floor and they crap directly into the food troughs of the pigs in the basement. Appetizing, eh? Amazingly efficient, as birds have inefficient guts and there's much residual nutrition in their feces, but incredibly stupid from a disease standpoint. Both chicken and pigs get the flu, remember.
Remember the guy John Huang who made an illegal $250,000 donation to the Democratic National Committee in 1996? It gave Clinton a black eye for about a week as the Huang-Clinton photo op pictures were trotted out. (Note to self--no glad hand pictures when I become president) Anywho, that money was from Charoen Pokhand. To keep this even, it must be pointed out that Neal Bush, George W's brother, also has a joint venture w/ CP. This company is a far-eastern powerhouse with very close ties to the Chinese (owner is an ethnic Chinese) and Thai govts.
When I express doubts about Chinese government press releases, this is one reason why (there are many others).
So, long story short: never attribute an event to malice when human stupidity is a reasonable alternative. In large measure we've done this to ourselves.
.
Okay...wait a minute. Isn't this the same damn thing that happened in the late 80's when we found out that even thought the smallpox virus had been eradicated, the Russians were still (and so were we, for that matter) conducting biological tests and so forth to make a super virus?
Ideas??
Biosecurity around the world sucks. We and the EU are probably the best of the bunch but ambitious scientists will always cut corners. I've seen stuff done in level 3A that scares the bejeezus outa me.
In 1977 the H1N1 virus, which had been for all intents an purposes extinct (replaced by H3 variants in the population) escaped from a Soviet or Chines lab. Nobody 'fessed up to it of course but from the location of the initial infections one of the two were the culprits. I am unclear why it didn't spread -- residual immunity? vigorous measures?
RE: biowarfare agent.
This certainly IS a biowarfare agent but I doubt that anyone purposefully engineered it.
.
Before anyone miscontrues this, I mean a natural biowarfare agent. For years now I've thought of the analogy of humans/earth and cancer/body as apt.
There are demonstrated "ecological defense mechanisms" for trimming populations which overshoot the carrying capacity of the environment. Like those California hillsides that hadn't seen fire for a decade, I think we're due.
Many virologists talk about these little-buggers-that-aren't-even-alive as if they are voracious, malevolent predators that are "trying" to get us, "trying" to mutate. It's totally silly on its face but useful for focusing the mind and not totally inconsistent with what's happening on the ground.
...guess they were wrong.
http://www.trend.az/?mod=shownews&news=17680&lang=en
Azeri Health Ministry sends tests of 43 people to London laboratory in relation to bird flu
Source: Trend
Author: S.Babayeva
05.04.2006
The Azerbaijani Health Ministry has sent tests of 43 people with bird flu suspicion to the London laboratory for more exact diagnosis.
The samples, taken from 43 patients addressed to medical institutions, include tests of the 2 girls undergoing treatment in Childish clinical hospital 2. H5N1 diagnosis of one girl was earlier confirmed as a result of laboratory search, while the Ministry did not reveal the virus in the samples of the second girl as a result of examination through PCR equipment.
“Nevertheless, the tests of the both girls were sent to the London laboratory for examination. The state of the patients is stabile and they make recovery,” the Ministry stressed.
According to the Ministry, the results of the tests are due to be presented soon.
It should be mentioned that laboratory searches confirmed existence of virus H5N1 at 7 people. Despite appropriate treatment, 5 of them died. One has patient recovered, while other undergoes treatment in Childish clinical hospital 2.
.
Part of a recent email from an Indian colleague -- he can't type fer crap but he's OK -- he thinks Apu is the most morally upright character on the Simpsons. He will defend that position against all comers and will include impeccable impersonations.
Note Mumbai = Bombay and Dharavi is the largest slum in that city. At the end he is saying that the population density there is 590,000 people per square kilometer. :eek:
India suffered greatly in 1918. While US life expectency feel by 10 years it fell by 22 years in India. Johnsom and Mueller recalculated Indina Mortality statistics and now think 18.5 million total deaths were likely. Mumbai was hit most cruelly. When the first crop of the year was due to be harvested and the second planted more than 50% mobidity was experienced. Avialability of food fell most precipitously and prices roes greatly.
Note that now Dharavi has a population density of 590^^3/km^2. I am so fearful for my city.
.
Today's big controversy (at least among my colleagues :) ) is courtesy of Dr David Nabarro, UN avian-flu coordinator. Yesterday in a "stay calm" interview with the BBC in regards to the first British bird death, Nabarro climbed down from his consistent warnings regarding the probability of a human H5N1 pandemic. He was (and is) at a UN-hosted H5N1 conference in China when the statement was issued, and the tone is consistent with several other statements released yesterday.
I have heard from an attendee that there is enormous pressure to tone down pandemic warnings from official sources. Some reasons:
==I paraphrase this but...Realistically, nothing much can be done to mitigate a pandemic, so let's not cause any unintended consequences
==Poultry is a critical protein source for much of the world. Parts of Africa, India, etc. have mean IQ scores 20%-30% below world averages due to protein starvation during key childhood development windows. "Culling and fear" have led to total loss of flocks in many areas.
==Pirate hardwood lumber camps in Indonesia and Africa have switched to bush meat to replace the lost poultry in their diet. Some predict all primates in Africa (chimpanzee, gorilla, bonobo) and Indonesia (orangutan) will be extinct in the wild by the end of 2007.
==Economic consequences to small farmers in developing countries.
==Economic consequences to Western economies.
==The human herd is on the brink of panic (Huh? Where?)
==Etc. etc. there are more but you get the drift
Interesting, eh?
The relevant part of yesterday's Nabarro BBC interview is below, followed by an interview in the Time about a week earlier and a rather stark address to the UN in December.
BBC TV1 Interview 05Apr2006
"We do make the general precaution that people should not be in contact with diseased wild birds either sick or dead because there is a very, very small chance perhaps that the virus can affect humans....."
...
"We are concerned about this bird flu virus, because of its impact potentially on the poultry industry. We're concerned about it because of the very low possibility that it can affect humans. Remember the number of humans that have been affected is incredibly small and there is a very distant possibility that we have been talking with people about that this virus could under extreme circumstances mutate and become human to human transmitted. But these are very very low probability issues, we do have to be prepared for them and just we perhaps don't always get the message right that the fact that this has been discovered in wild bird is not in itself any cause for alarm for people's health and well being."
New York Times, 28Mar2006
Dr. Nabarro describes himself as ''quite scared,'' especially since the disease has broken out of Asia and reached birds in Africa, Europe and India much faster than he expected it to.
''That rampant, explosive spread,'' he said, ''and the dramatic way it's killing poultry so rapidly suggests that we've got a very beastly virus in our midst.''
Mutations making it less lethal to humans may, paradoxically, be bad news, he said. A disease that kills half of those it infects often burns out before it reaches new victims, while one that leaves 98 percent of its victims alive, as the 1918 flu did, rapidly reaches hundreds of millions because it has so many carriers.
December, 2005 at the UN:
Well, the messages are very clear. We have an awful lot more to do with the current bird flu epidemic.
It is really not under control at all, and that means we have to build up vet service quickly to get on top of it.
The longer it's there, the longer we have a virus close to humans that is capable of mutating and causing a pandemic.
And the situation is very, very serious indeed.
The pandemic will kill when it comes. But more seriously perhaps, it will do massive economic and social damage, because our systems of trade, finance and governance are interconnected and will not survive the impact of a pandemic on workforces. We need to be able to deal with both the human consequences and the economic, social and governance consequences if we're going to survive it.
And believe me, the pandemic could start tomorrow. By the time the pandemic starts, preparation will be too late.
So, you should be doing this now, and that's my message."
Edited to add: these buried birds were all killed by H5N1 and not culled.
Nigeria: Villagers Arrested for Eating Carcasses of Bird Flu Chickens
from the Daily Trust (Abuja), April 6, 2006
http://allafrica.com/stories/200604060230.html
Starving villagers in Jos, Plateau state, who exhumed and ate the carcasses of bird-flu infected chickens were arrested by the police, government officials said yesterday.
The Chairman, Sub-committee on Sanitation and Transportation of the Plateau State Bird Flu Committee, Mr Joseph Pate, expressed shock that some villagers of Dong in Jos North local government area, had gone to the dump site to exhume the infected birds to form part of their meals.
Pate said the infected birds were from a farm in Jos and had been buried on Monday after they were conf-irmed to have died of the flu.
The chairman said the action of the people has exposed them and others to the deadly virus, noting that it could lead to death.
The Police Public Relations Officer, Mr Isa Adejoh, was not available to comment on the arrests.
An official of the Ministry of Health, Mr Iliya Azi, told the News Agency of Nigeria (NAN) that the villagers' action was condemnable.
Azi said the consumers of the carcasses stand the risk of being infected because the cells in the dead chickens had the bird flu virus.
...THE US of A!
I am being told (by Apu) that there's a widespread conspiracy theory that Tyson Chicken is behind the whole avian flu issue. Just as the CIA flew planes into the WTC to forge a rationale for a war on Islam, Tyson has engineered this whole thing gain global hegemony in poultry. That's why there's no bird flu in the USA -- American chickens are immune.
Business
‘International conspiracy behind bird flu’
Press Trust of India
Posted online: Thursday, April 06, 2006 at 1620 hours IST
Mumbai, April 6: The poultry industry, which has been hit hard by the bird flu, sees an ‘international conspiracy’ behind the bird flu outbreak of the disease at Navapur in Maharashtra.
<snip>
"We see some international conspiracy in the entire episode which sent two lakh farmers out of business in 30 days. Since the consumption (of chickens and eggs) has come down to less than 10 per cent, it is a huge loss of more than Rs. 7000 crore," they said adding every day loss is about Rs. 200 crore to the industry.
JAGeorgia
04-07-2006, 05:43
The following is the text of today's release re:Influenza Activity for the US as found in the Morbidity and Mortality Weekly Report (MMWR)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a4.htm?s_cid=mm5513a4_e for those who are interested.
"Weekly
April 7, 2006 / 55(13);368-370
Update: Influenza Activity --- United States, March 19--25, 2006
During March 19--25, 2006,* the number of states reporting widespread influenza activity† decreased to 16. Sixteen states reported regional activity, 13 reported local activity, and five reported sporadic activity (Figure 1).§
The percentage of specimens testing positive for influenza remained at the same level as recent weeks in the United States. During the preceding 3 weeks (weeks 10--12), the percentage of specimens testing positive for influenza ranged from 30.6% and 28.6% in the South Atlantic and East South Central regions, respectively, to 9.7% in the Pacific region. During this period, 60.3% of isolates from the Mountain region have been influenza B. Other regions reporting >30.0% of recent isolates as influenza B include the East North Central, West North Central, West South Central, and Pacific regions. The percentage of outpatient visits for influenza-like illness (ILI)¶ during the week ending March 25 remains above the national baseline.** The percentage of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold for the week ending March 25.
Laboratory Surveillance
During March 19--25, World Health Organization (WHO) collaborating laboratories and National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories in the United States reported testing 3,158 specimens for influenza viruses, of which 681 (21.6%) were positive. Of these, 77 were influenza A (H3N2) viruses, 70 were influenza A (H1N1) viruses, 347 were influenza A viruses that were not subtyped, and 187 were influenza B viruses.
Since October 2, 2005, WHO and NREVSS laboratories have tested 110,066 specimens for influenza viruses, of which 13,532 (12.3%) were positive. Of these, 11,989 (88.6%) were influenza A viruses, and 1,543 (11.4%) were influenza B viruses. Of the 11,989 influenza A viruses, 4,875 (40.7%) have been subtyped; 4,629 (95.0%) were influenza A (H3N2) viruses, and 246 (5.0%) were influenza A (H1N1) viruses.
P&I Mortality and ILI Surveillance
During the week ending March 25, P&I accounted for 7.7% of all deaths reported through the 122 Cities Mortality Reporting System. This percentage is below the epidemic threshold†† of 8.2% (Figure 2).
The percentage of patient visits for ILI was 2.5%, which is above the national baseline of 2.2% (Figure 3). The percentage of patient visits for ILI ranged from 1.4% in the East South Central region to 3.5% in the West South Central region.
Pediatric Deaths and Hospitalizations
During October 2, 2005--March 25, 2006, CDC received reports of 19 influenza-associated deaths in U.S. residents aged <18 years. Sixteen of the deaths occurred during the current influenza season, and three occurred during the 2004--05 influenza season.
During October 1, 2005--March 18, 2006, the preliminary laboratory-confirmed influenza-associated hospitalization rate reported by the Emerging Infections Program§§ for children aged 0--17 years was 0.79 per 10,000. For children aged 0--4 years and 5--17 years, the rate was 1.88 per 10,000 and 0.22 per 10,000, respectively. During October 30, 2005--March 18, 2006, the preliminary laboratory-confirmed influenza-associated hospitalization rate for children aged 0--4 years in the New Vaccine Surveillance Network¶¶ was 3.0 per 10,000.
Human Avian Influenza A (H5N1)
No human avian influenza A (H5N1) virus infection has ever been identified in the United States. From December 2003 through April 4, 2006, a total of 191 laboratory-confirmed human avian influenza A (H5N1) infections were reported to WHO from Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey, and Vietnam.*** Of these, 108 (57%) were fatal (Table). This represents an increase of one case and one death in Indonesia and four cases and two deaths in Egypt since March 24 and the first human infections with avian influenza A (H5N1) reported in Egypt. The majority of infections appear to have been acquired from direct contact with infected poultry. No evidence of sustained human-to-human transmission of H5N1 has been detected, although rare instances of human-to-human transmission likely have occurred (1).
Reference
Ungchusak K, Auewarakul P, Dowell SF, et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med 2005;352:333--40.
* Provisional data reported as of March 24. Additional information about influenza activity is updated each Friday and is available from CDC at http://www.cdc.gov/flu.
† Levels of activity are 1) widespread: outbreaks of influenza or increases in influenza-like illness (ILI) cases and recent laboratory-confirmed influenza in at least half the regions of a state; 2) regional: outbreaks of influenza or increases in ILI cases and recent laboratory-confirmed influenza in at least two but less than half the regions of a state; 3) local: outbreaks of influenza or increases in ILI cases and recent laboratory-confirmed influenza in a single region of a state; 4) sporadic: small numbers of laboratory-confirmed influenza cases or a single influenza outbreak reported but no increase in cases of ILI; and 5) no activity.
§ Widespread: Arkansas, Connecticut, Delaware, Indiana, Kentucky, Maine, Maryland, Massachusetts, New York, North Dakota, Ohio, Rhode Island, South Carolina, Vermont, Virginia, and West Virginia; regional: Georgia, Hawaii, Illinois, Iowa, Michigan, Minnesota, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, Pennsylvania, South Dakota, Tennessee, Texas, and Wisconsin; local: Alabama, Alaska, California, Colorado, Florida, Idaho, Kansas, Missouri, Nevada, Oklahoma, Oregon, Washington, and Wyoming; sporadic: Arizona, Louisiana, Mississippi, New Mexico, and Utah; no activity: none; no report: none.
¶ Temperature of >100.0°F (>37.8°C) and cough and/or sore throat in the absence of a known cause other than influenza.
** The national baseline was calculated as the mean percentage of visits for ILI during noninfluenza weeks for the preceding three seasons, plus two standard deviations. Noninfluenza weeks are those in which <10% of laboratory specimens are positive for influenza. Wide variability in regional data precludes calculating region-specific baselines; therefore, applying the national baseline to regional data is inappropriate.
†† The expected seasonal baseline proportion of P&I deaths reported by the 122 Cities Mortality Reporting System is projected using a robust regression procedure in which a periodic regression model is applied to the observed percentage of deaths from P&I that occurred during the preceding 5 years. The epidemic threshold is 1.645 standard deviations above the seasonal baseline.
§§ The Emerging Infections Program Influenza Project conducts surveillance in 60 counties associated with 12 metropolitan areas: San Francisco, California; Denver, Colorado; New Haven, Connecticut; Atlanta, Georgia; Baltimore, Maryland; Minneapolis/St. Paul, Minnesota; Albuquerque, New Mexico; Las Cruces, New Mexico; Albany, New York; Rochester, New York; Portland, Oregon; and Nashville, Tennessee.
¶¶ The New Vaccine Surveillance Network conducts surveillance in Monroe County, New York; Hamilton County, Ohio; and Davidson County, Tennessee.
*** Available at http://www.who.int/csr/disease/avian_influenza/en.
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Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
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There have been several public/quasi-official about-faces lately regarding pandemic risk. Time to reassess the Chicken Little Quotient, I thought. I polled six people who are working, either directly or indirectly, on the pandemic flu issue. I asked them about the odds of human pandemic starting this year, next year, and "eventually." I asked for no explanation, qualification, or waffling -- just three numbers. I then asked if they thought the risk of pandemic had moderated in the last three months.
1. "Three percent chance per month, two percent if there's no major religious festival in India, China, Indonesia, or SE Asia. "
2. "I'm a biostatistician and epidemiologist -- I'd be drummed out of the guild if I answered those questions... <snip ENDLESS waffling> ...Clearly there's a risk, and no, it hasn't changed. If anything the Azeri clusters indicate slightly increased risk....<snip MORE endless waffling>..."
3. "You know my position...<snip>... I don't think this H5 will catch and I still think H9 will emerge from N Europe."
4. Paraphrased --> "Who the hell knows... Stop asking irrelevant q's... I have sympathy for Nabarro... I'm busy...Go back to work."
5. No answer.
6. 30%, 40%, 100%, No.
You can't tell from the responses, but #1 is probably the most concerned. He considers a 2-3% pandemic risk the most significant risk in his life. He continually makes the point that if you have lifestyle risks (smoking, excessive drinking, overweight, inactivity) that those should be addressed as the most signif. factors in decreased life span. He has no kids and is a bit self-centered, but he's right I guess.
Bottom line, there doesn't seem to be any concensus for a decrease in risk. That said, no one thinks it's a lock that this particular strain will break out although there is obviously some "significant" (but essentially unquantifiable) risk that it will.
I will now follow #4's advice (He's the guy who says "I will give you a very technical answer: I don't know")
.
.
In true scientific fashion, the more you learn the less you know. A paper in this month's Emerging Infectious Diseases (CDC) shows how little we know. In 1951 a seasonal flu outbreak in Liverpool, Eastern Canada and parts of New England was much more severe than even the 1918 pandemic. Why only in those locales? Who knows. Why was this so virulent?
Who knows.
Liverpool flu deaths on the left, total mortality from all causes on the right.
5785
CDC - 1951 Epidemic (http://www.cdc.gov/ncidod/EID/vol12no04/05-0695.htm)
Influenza poses a continuing public health threat in epidemic and pandemic seasons. The 1951 influenza epidemic (A/H1N1) caused an unusually high death toll in England; in particular, weekly deaths in Liverpool even surpassed those of the 1918 pandemic. We further quantified the death rate of the 1951 epidemic in 3 countries. In England and Canada, we found that excess death rates from pneumonia and influenza and all causes were substantially higher for the 1951 epidemic than for the 1957 and 1968 pandemics (by >50%). The age-specific pattern of deaths in 1951 was consistent with that of other interpandemic seasons; no age shift to younger age groups, reminiscent of pandemics, occurred in the death rate. In contrast to England and Canada, the 1951 epidemic was not particularly severe in the United States. Why this epidemic was so severe in some areas but not others remains unknown and highlights major gaps in our understanding of interpandemic influenza.
FYI my response to a query from our London office:
My gut feel is that the gov't reassurances are correct: it is safe to eat properly cooked poultry. I suspect that it will remain safe to eat even if you get H5N1 in factory flocks. It's true that you must handle the raw poultry and there is the possibility of cross-contamination. Use standard precautions for handling raw poultry -- over here 60% of all supermarket chicken is contaminated with multiply-resistant enteric bacteria as it is.
Unless you are a tiger/cat/other feline, eating H5N1 contaminated chicken is just not a vector. If it were, there would be thousands more human cases. I would most assuredly NOT give any chicken to a cat. And keep your cat indoors -- WHO has just initiated a big feline H5N1 study as cats are a suspected vector in several human cases where there is no other apparent H5N1 contact.
In Thailand in 2003 there was widespread H5N1 infection in poultry. Entire flocks were being wiped out, but no culling was going on and corporate chicken-processing plants were working overtime during this period. To quote The Global Threat of Avian Flu by Mike Davis:
An angry trade unionist at one factory outside the capital told the Bangkok Post after the scandal broke: "Before November we were processing 90,000 chickens a day. But from November to January 23, we had to kill 130,000 daily. It's our job to cut the birds up. It was obvious they were ill: their organs were swollen. We didn't know what the disease was, but we understood that the management was rushing to process the chickens before getting any veterinary inspection."
It is generally assumed that scores of thousands of H5N1-infected chickens got into the food chain with no untoward effect except for 50 dead tigers.
..
Mountain House 40% off, 2 years gone on 7 year shelf life, free shipping over $50.
http://www.mtnhse.com/miva/merchant.mv?Screen=CTGY&Store_Code=M&Category_Code=MCDL
India again...
http://www.asianage.com/main.asp?layout=2&cat1=5&cat2=154&newsid=218538&RF=DefaultMain
AP Maoists say bird flu threat a hoax
Hyderabad, April 8: The troubled poultry industry got support from unexpected quarters: the CPI (Maoists), which said that bird flu was "a gigantic hoax" and "a conspiracy" of US pharma companies to sell their vaccine and "the master plan of the US to enter the Indian poultry industry". It has asked the public to reject US chicken products as they "contain hazardous preservatives".
I found the first (oldest) Germann simulation on the Los Alamos web site when I was looking for something else. I believe this is the one simulating international entry into Dallas via one infected traveller with an Iowa City terminus.
http://www.lanl.gov/news/images/bird4x3red.mov
...from a public health worker in the trenches.
"Africans digging up the carcasses of dead chickens to eat is not surprising to me. I spent three weeks in small villages in Kenya in February and made these observations: More sick, feral cats than I’ve ever run into anywhere. Live chickens running under my feet in restaurants. Live chickens transported to market while tied by their feet on the luggage racks on top of cargo vans. Lacking refrigeration, chicken producers transport birds live to be slaughtered on the site where they are cooked and served—at restaurants, hotels, hospital kitchens, schools, etc. Village-raised chickens were thriving in spite of the drought because they live on worms in the cow dung. Often every person and every animal in a community shares the same water source—a hole dug in the ground catching rainwater—cats, dogs, goats, cattle, chickens, wild animals, humans. Kenyans in Nairobi told me that people in the villages don’t know about disease and would not be alarmed by death among their animals or their people because disease and death are so tragically common there. They would not report it. Even worse, many places in Africa have no health care system and no authority to report to. Considering the drought, AIDS, malaria, infectious diarrhea, militia raids—who would notice a cluster of twenty or even fifty people dying of H5N1? If the virus jumps in Africa, we won’t know until the disease is a raging epidemic in the large population centers."
All of which corroborates this (note that samples mentioned at the end were ruined by lack of refrigeration):
Reuters AlertNet- “NAIROBI, April 10 (Reuters) - Bird flu may have infected people in West Africa and weak health systems in the region could be delaying detection of human cases, a World Health Organisation official said on Monday…”
…”“So far, there is no confirmed human case of avian flu virus infection in West Africa but this is not a reason to say there is no human case,” Honore Meda, a WHO medical officer who represented the health body at a bird flu seminar in Nairobi, told Reuters in an interview. “There is a risk and probability of human cases occurring in West Africa but there’s no evidence to say there is or there is not a human case. But so far we are not in a position to confirm firmly that there’s no detected human case,” he added.
The WHO said in February that it planned to test samples from four Nigerians, including a woman who died, for bird flu. However, the samples failed to yield a clear result…”
more… http://www.alertnet.org/thenews/newsdesk/L10653318.htm
One dead swan, lots of controversy. There's a major pissing contest going on in Britain between David King, a physical chemist advising the Dept. of Trade, and Liam Donaldson, the physician researcher who heads the Dept. of Health. Similar conflicting reports from trade and health officials are coming out of China ("China is free of H5N1" vs "Two new human cases have been identified").
Expect the same when the first dead birds are found in CONUS -- the US poultry industry is scrambling to put scientists on retainer. The strategy to be employed is being called the "blanket of reassurance".
"Two of the government's senior scientists are at loggerheads over the risk of a human flu pandemic. As experts in Scotland continued the search for birds infected with the H5N1 virus, confusion reigned in the Department of Health and the Department of Trade and Industry over just how great a risk it represented.
Britain has been preparing for a human pandemic for more than a year and has spent millions stockpiling antiviral drugs and drawing up emergency plans to be put into action if an outbreak occurs.
Yesterday Sir David King, the Government's chief scientific adviser in the DTI, said a human flu pandemic was "not inevitable". That flatly contradicted remarks by the Government's chief medical officer, Sir Liam Donaldson, of the DoH, that a human pandemic was inevitable. Sir Liam has said several times it was a question of "when, not if" a pandemic struck."
http://news.independent.co.uk/uk/health_medical/article357007.ece
This is a compilation from the last couple of days.
===================================
Common catch phrases around my house: "You say your feet hurt?", "220, 221, whatever it takes", and "That's more than I wanted to know about dolphins". This online influenza/virology textbook (http://www.influenzareport.com/influenzareport2006.pdf) may be more than you want to know about dolphins, but it's got good pictures (I like pictures) and is fairly up-to-date. Avian flu starts on page 46 or so.
====================================
Anthony Fauci and other USGOV public health leaders should get relatively high marks for calm and accurate communication (especially as opposed to the CF coming out of the UK and China). The following is admittedly heavy on the reassurance but it is accurate:
Bird flu is not likely to change overnight so that it spreads from person to person, nor is it likely that a sick bird migrating to the US will trigger human illness, the government's top bird-flu scientist said.
"One migratory bird does not a pandemic make," Dr Anthony Fauci, the National Institutes of Health's infectious disease chief, said in an interview Tuesday with The Associated Press.
What are the odds that the H5N1 strain of bird flu will spark the next worldwide influenza epidemic? There is no way to know, Fauci said. Reassuringly, it must undergo a series of genetic changes before it could become contagious among humans instead of just birds.
Scientists might see those signs while studying the virus itself, but an early warning would be if doctors or nurses caring for someone who caught H5N1 from a bird in turn got sick, Fauci said.
"It is entirely conceivable that this virus is inherently programmed that it will never be able to go efficiently from human to human," he said.
"Hopefully the epidemic (in birds) will burn itself out, which epidemics do, before the virus evolves the capability of being more efficient in going from human to human."
But the government must prepare for the worst - "it would be unconscionable not to" - as officials gear up in case bird flu does spark a human pandemic, he added. Fauci advocated personal preparedness, suggesting that people stock up on canned food and water, as they would for a hurricane or other storm, the AP reported.
You are going to see more and more news reports that assert there is little risk of bird flu in the States ("Expert says bird flu no imminent threat"). These reports will be actually discussing the risk of infected birds on US soil (there are none yet) infecting humans inside the CONUS. One of the prime motivating factors is mitigation of economic damage wrought by an ill-informed public. I can't argue with that sentiment.
==================
A little known fact: It is estimated that more Indian poultry farmers have committed suicide after facing financial ruin (from H5N1 flock deaths, uncompensated culling, and the crash of poultry prices) than have died from H5N1 worldwide. Yesterday:
"In India, seven more poultry farmers committed suicide because the H5N1 virus destroyed their livelihood, according to an AFP report that cited information from a farmers' organization.
The H5N1 infections and subsequent culling that have swept India have cost the industry $1.8 billion in 6 weeks, the National Egg Coordination Committee said today. "
On a related note:
ReuteraAlertNet- “TOUL PREK, Cambodia, April 12 (Reuters) - When her 3-year-old daughter died of bird flu, Choeun Sok Ny expected sympathy from fellow villagers in Cambodia. All she got was abuse after the death drew government culling teams but no compensation.
“Our neighbours are unhappy with us because they lost all their chickens and ducks after my daughter died,” the 23-year-old said, clutching a photo album of her daughter, Mon Puthy, who became Cambodia’s fifth bird flu victim last month.
“They should care about their lives more than their chickens. But they don’t,” she said, the tears rolling down her cheeks as she explained the local backlash that epitomises the problems of bird flu monitoring in the poorest corners of the globe.
If governments in countries like Cambodia, where most people have to get by on a dollar a day, do not compensate properly for poultry lost in anti-bird flu culls, villagers will do all they can to ensure possible outbreaks are covered up…”
more… http://www.alertnet.org/thenews/newsdesk/BKK260524.htm
===================
Fauci's reassurance aside, if a pandemic develops it will almost certainly vector on an intercontinental jet from sub-Sahara Africa, Egypt, China, or Southeast Asia. Note: over 900 million Chinese (total pop. 1.3B) receive $0.01 in public health expenditures per year. That's right, about one US penny is spent per Chinese peasant per year on health care. That figure is higher, sometimes far higher, for the growing middle class who live in the booming cities. The Chinese peasants' loss of all healthcare and education benefits is only one of the dirty little secrets in the "Chinese miracle". For the last 15 years or so, if a peasant gets sick it's traditional medicine or nothing. This means there is essentally no disease surveillance for close to a billion people. The quid pro quo for the recent very positive WHO pronouncements coming out of China is reportedly a promise by the Chinese government to increase public health care spending. Ha, maybe they'll double it -- don't spend it all in one place!
The situation is the same in many parts of India, Burma, Cambodia, Egypt, sub-Sahara Afric, etc. Just one more example: Nigeria has the biggest population in Africa with 1 in 6 Africans being Nigerian. Total health care spending averages $0.04 per Nigerian per year with three of those cents coming from NGOs (for AIDS education primarily). Again, a situation where there is basically no surveillance going on.
=====================
China is desperately trying to string together 14 days of "no news" so they can declare H5N1 eradicated. No such luck. Note that WHO was informed of the following case on 30Mar but the report was just released via back channels today. If you want to see evidence of China's rise in power and influence you don't have to look farther than this: WHO is in China's back pocket.
CHINA: News ban for Guangzhou's suspected second bird flu case, sources say
Tuesday, April 11, 2006
"A suspected second human case of bird flu has emerged in Guangzhou but authorities have imposed a news ban on reporting the case, sources said yesterday.
A source at the Guangzhou No1 People's Hospital said a 41-year-old woman, identified as Ms Li, was admitted on March 25 with unexplained pneumonia. The source said experts confirmed two days later that Ms Li had the H5N1 virus but the case had yet to be reported by official media. The woman lived in the Xihua area of Guangzhou's Yuexiu district."
http://www.asiamedia.ucla.edu/article.asp?parentid=42711
Mumps may have been spread via air travel: CDC (http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyid=2006-04-13T180020Z_01_COL364787_RTRUKOC_0_US-MUMPS-CDC.xml)
Africa / SW Asia: Scattered H5N1 human cases continue to pop up in Egypt, Sudan, Nigeria, Pakistan, etc. All follow the typical pattern of infection after intimate exposure to poultry. The dice continue to roll with each of these new infections but H2H transmission is not indicated. Huge swaths of Africa have no surveillance in place.
India: what a mess. No one knows what is going on there. There are suspected cases -- some which indicate clusters with possible inefficient H2H transmission -- but the collection and storage techniques being employed have rendered all samples useless. The only lab in India is overwhelmed and is not accepting any more samples for H5N1 testing until October.
Burma: See India, then add in a paranoid, totalitarian government and 1.5 million "displaced persons" living in the bush. WHO has estimated over 100 poulty outbreaks and privately believe there are human cases.
China: effing China. On Monday, the top-brass 'WHO Whores' gave the Chinese government a pat on the back for "honesty and transparency" in their reporting of H5N1 outbreaks. This was reported Tuesday:
HONG KONG, April 18 (Reuters) - Authorities have culled about 8,000 chickens in a poultry farm in China's eastern Shandong province after 400 chickens died there last week, a Hong Kong newspaper (http://www.alertnet.org/thenews/newsdesk/HKG354013.htm) reported on Tuesday.
The South China Morning Post said the farmer, identified only by his surname Chen, was ordered by officials not to talk about the cull as "it was a state secret". He and his wife were given injections on Sunday, but they did not know what they were for.
Indonesia: This definitely one place to watch closely. There is a new cluster reported with 8 cases from one family: 2 unconfirmed dead, 4 confirmed in hospital, 2 suspected in hospital. Jakarta Post (http://www.thejakartapost.com/detailnational.asp?fileid=20060419.D06&irec=9)
USA: Many in the biz believe there are already H5N1-infected waterfowl in Alaska/Northern Canada. None reported yet, of course. There was a period of "this whole pandemic thing is overblown" which is currently being replaced by "we're all going to die!" Nothing has changed, really. Nobody knows what is going to happen, and it remains prudent to make reasonable preparations. Recent simulations by MIT, UofC, IMF and various trade associations confirm that supply-chain disruption will caused significant effects if a pandemic does hit.
Expect "Bush is trying to distract attention from Iraq" when the US pandemic plan is finally released this week.
...
WASHINGTON — Poultry processed in China will be allowed to enter the United States despite outbreaks of deadly bird flu in China, the Bush administration said Thursday.
Critics said the imported poultry will put public health at risk. The Agriculture Department said the meat would be fully cooked and perfectly safe.
"It will have been processed," said Richard Raymond, the department's undersecretary for food safety. "Cooking will kill the virus, if there is any virus, in poultry meat."
<snip>
"It is an outrage that the U.S. is going to open our borders to imports of poultry from China _ a country that lacks the fundamental safety functions in its processing plants, has questionable export practices, and a country where a deadly animal disease and possible pandemic is running rampant," said DeLauro, top Democrat on the House Appropriations Committee's agriculture subcommittee.
http://www.chron.com/disp/story.mpl/ap/politics/3808465.html
How much you wanna bet that 1M tons is shipped over and 6M tons comes back?
A snip follows from my 04-05-06 post about Charoen Pokhand, the massive Thai/Chinese poultry company with intimate ties to the Chinese govt. Hmmmm.....
"Remember the guy John Huang who made an illegal $250,000 donation to the Democratic National Committee in 1996? It gave Clinton a black eye for about a week as the Huang-Clinton photo op pictures were trotted out. (Note to self--no glad hand pictures when I become president) Anywho, that money was from Charoen Pokhand. To keep this even, it must be pointed out that Neal Bush, George W's brother, also has a joint venture w/ CP. This company is a far-eastern powerhouse with very close ties to the Chinese (owner is an ethnic Chinese) and Thai govts.
When I express doubts about Chinese government press releases, this is one reason why (there are many others)."
Well, things are not going so well on my work front, as evidenced by some recent public reports of failure to achieve "seroprotective efficacy" with experimental vaccines (translation: it didn't work well enough).
Things are getting...twitchy...again. Nothing has really changed with the virus or the odds, but a fatalism is setting in. Maybe it's recent setbacks. We seem to have swung back to "...it's not a matter of 'if' but 'when'..." once more. Same thing in the Texas two-step that is crisis communications. Only two weeks ago Nabarro (WHO) and Fauci (US) were talking about "very, very slight chance" of a global pandemic. Nabarro is back into condition red, at least today. I think China has them shook.
===============================================
What's really happening in China?
"Local health officials in China have failed to report possible human cases of bird flu to the central government, according to a person familiar with the matter, raising the possibility that some officials may be concealing suspected cases and that the death toll in China is higher than the official tally of 12."
http://online.wsj.com/google_login.html?url=http%3A%2F%2Fonline.wsj.com% 2Farticle%2FSB114604274112236286.html%3Fmod%3Dgoog lenews_wsj
===============================================
New human cases continue to pop up in Indonesia, Pakistan, China, Russia, etc. Many cases have no obvious link with exposure to infected birds. Smart people are now beginning to think the mechanism of infection is fecal/oral and not respiratory. Keep the dog out of the goose poop when the geese are flying this fall. And wash your hands.
===============================================
Indonesia or China remain the odds-on choice of locale for a breakout. The H5N1 virus has mutated into two major clades and a whole slew of subtypes. The clade which infected clusters of humans in Egypt/Turkey/Azerbaijan had approximately a 20% CFR [edit: case fatality rate] while with the subtype in Indonesia it's more like 70%. Except for a recent cull in Bali, Indoneisa does not support culling of infected flocks.
===============================================
The average age of an H5N1 case fatality is 14. Scares me to death.
===============================================
I've been told that internal GAO studies have speculated that infrastructure collapse could kill more Americans than the flu in a major pandemic. I do not have a cite (and I doubt there ever will be one) but this simulation in Davos addresses the issue. (Buy another sack of rice.)
Influenza Pandemic Simulation Reveals Challenges in Delivering Essential Services During Widespread Outbreak; Exercise by the World Economic Forum and Booz Allen Hamilton Finds Potential Strains on Healthcare and Telecommunications Infrastructure
http://home.businesswire.com/portal/site/google/index.jsp?ndmViewId=news_view&newsId=20060427005564&newsLang=en
Some excerpts:
"Governments will likely direct the general population to stay in their homes, and to minimize social contact. As a result, the government may need to assume national control, as in wartime, of critical infrastructure and resources including food, fuel, and health care. In addition, governments will need to assume responsibility for the “last mile” in delivery of food and other critical supplies to the populace."
...
"Quite likely by day 28 all systems will have fallen apart."
...
"Military must be involved in the response to help keep the peace and deliver essential goods and services."
...
"Telecommunications will likely be overwhelmed early in the pandemic. Some experts speculated that the Internet could shut down within two to four days of the outbreak. This implies that government and businesses must coordinate and plan for the use of alternative communications channels—and telecommuting will not be a viable option."
http://www.boozallen.com/media/file/Influenza_Pandemic_Simulation.pdf
===============================================
I've been thinking about water supplies lately ("Quite likely by day 28 all systems will have fallen apart") so I thought I'd pass this on, it's what a woman I know uses for H20 in the 3rd world when in the bush. It is functionally equivalent to the Katadyn camp filter--a filter, not a purifier--which means it does not kill viruses. In the bush she pre-filters through cloth, siphon filters through the ceramic candle, and then treats w/ a viricide (think 8 drops/gal Clorox in a home situation). She sometimes has to drink out of communal mud puddles and swears by this technique. The candle can be repeatedly brushed clean - she said up to 200 times (???) for "thousands of gallons depending on what you are starting with." The Katadyn model claims 300 cleanings for up to 26,000 liters and this is supposed to be a better filter so that's probably in the ball park.
The ceramic candles are 9" vs. the 7" in the Katydyn camp filters although they will fit as Katadyn replacements per the web site. The whole shebang is 1/3 the cost of the Katadyn.
http://www.pwgazette.com/gravity.htm
Small world, from another site, on the water filter my friend recommends:
"If you get the Pure Water system, I would go with a straight Doulton ceramic candle on one end (no carbon block core), and a GAC/KDF inline filter on the other end. The ceramic candle will filter out anything bigger than 0.5 micron in diameter. The GAC/KDF filter will remove dissolved heavy metals and chemicals like solvents, fuels and pesticides. This setup will actually work better than expensive filters like the Berkefield, because the Pure Water siphon filter is a two-stage cartridge system that uses the exact same ceramic filter as the Big Berkey, with an additional chem-removing second stage. The Big Berkeys are around $240.
Royal Doulton Super Sterasyl ceramic 'candle' filters last forever. They do not need to be replaced; only cleaned occasionally with a Scotchbrite pad. The GAC/KDF inline filters should be replaced after a certain number of gallons, so you should get some spares for those.
If you have questions, call Pure Water and ask for Gene. He is incredibly knowlegeable and helpful. And I do not have any affiliation with Pure Water, other than being a very satisfied customer."
Tamiflu/oseltamivir is a real bitch to synthesize. The starting point is a very scarce and expensive ingredient called (-)-shikimic acid. Shikimic acid is derived from fermentation of Chinese star anise fruit. Yes, from that China. Complete synthesis requires over a dozen steps and can take 12 months.
Nobel prize winner Elias J. Corey at Harvard University has developed a new quick, high yield route that replaces this cumbersome process and uses inexpensive starting materials.
"Our synthetic pathway has several advantages over the current Roche production method," Corey says. "It is shorter, doesn't involve any hazardous substances, begins with very cheap starting materials that are pennies per pound, and has excellent overall yield." Corey's overall yield is about 30%—about twice that of the commercial route..."
This discovery is worth untold millions to Harvard and Corey, yet they placed the method into the public domain.
Roche, in my opinion, now has to step up and license the drug, for token amounts, to all comers.
If you have a well.
http://www.simplepump.com/
This is a 700 dollar hand pump that runs in parallel to your electric system.
If I use some redneck engineering I am convinced that I can find a much more affordable solution to get water out of my well.
Stargazer
05-01-2006, 09:25
Although Roche researchers declined to comment on the new synthetic routes, a spokeswoman says the company is in contact with the authors of both papers. Both the technical potential and regulatory impact of any new route still have to be explored, she comments. In his group's paper, Corey, who serves as an adviser to Palo Alto-based Roche Biosciences, thanks Roche researchers in Switzerland for their encouragement.
Roche has been obtaining the shikimic acid starting material via extraction from Chinese star anise fruit and fermentation processes. It has recently signed up more than 15 external contractors to help it expand production of both intermediates and finished materials (C&EN, March 20, page 10). With this help, Roche says it will be able to produce 400 million flu treatments annually by the end of 2006.
Whereas the Japanese researchers have applied for a patent, Corey and coworkers have put their process in the public domain. "I hope the work will stimulate others to work on different ways of synthesizing Tamiflu," Corey says. "Although our route is already very efficient, it's conceivable that when you put new developments together, you'll have an even better and cheaper process. I think the Tamiflu supply problem is solved."
http://pubs.acs.org/cen/news/84/i18/8418notw1.html
If you have a well.
http://www.simplepump.com/
I passed this on to some who do -- thanks.
I just got word today that mud-puddle lady -- I've posted her report from Nigeria and her water filtration recommendation -- was stopped by Maoist rebels on a road in Chhattisgarh state in India. They were held for 4 hours, roughed up a bit, and had all of their equipment and vehicles stolen. They were released shaken but essentially unharmed.
They were attempting to set up a satellite lab for use in disease surveillance. All that gear, smashed or stolen.
The guy who passed on the report says the Indian govt. is not in control of that state. I didn't know the Maoists were that powerful in India.
The USGOV pandemic response plan to be released tomorrow does not call for complete border closure. This is a good thing -- nothing will stop this from arriving on our shores if it ever develops overseas and we need to keep the economy going at some level. The plan also allows flexibility in limits placed on internal travel.
http://news.yahoo.com/s/ap/20060502/ap_on_he_me/bird_flu_plan
There's a big conference going on in Singapore that's produced interesting bull session topics: the "Yank Tooth" scenario and the "Fire Break" response. Note that these are "blue sky" proposals being discussed by epidemiologists and public health professionals as an academic exercise and neither represents an official policy. That said, these are both being modeled.
Yank Tooth is a working definition of a strategy where absolutely NO CONTAINMENT is attempted. Internal and international travel is not curtailed and antivirals are not used in an attempt to limit spread (deemed pointless by all but WHO). No social distancing, school closures, etc. The idea is to shorten the total length of the pandemic as much as possible -- to yank the tooth out with a string -- versus stretching out the event with containment strategies -- wiggling the tooth out. All efforts will be made to keep infrastructure going -- water, food, finance, security -- and critical personnel get first crack at whatever is available vaccine/antiviral -wise. This plan reflects growing concern over infrastructure collapse and civil unrest.
"The report envisions possible breakdowns in public order and says governors might deploy National Guard troops or request federal troops to maintain order. The military also could be activated to enforce travel restrictions and deliver vaccines and medicines, the report says."
All I can say is, nice idea, but my kid still stays home from school.
Fire Break is a contoversial counter-strategy. It envisions rushing out a potentially dangerous, poorly-tested, live, attenuated (weakened) virus as a nasally-administered vaccine even if the vaccine would be known to infect and kill up to one in a thousand (projected ~ deaths due to the vaccine = 300,000 if total coverage). Now, live attenuated vaccines are on the market now (FluMist) and they are very safe. The Fire Break plan is just a "what if we could put together such a vaccine, should it be used" type scenario. Inherent to any risk/benefit discussion is an estimate for the pandemic death rate. If you think that the "...government is preparing for a worst-case scenario of up to 2 million deaths in the United States" then I have a bridge I want to sell to you. The worst case is that the Indonesian strain breaks out and the current death rate does not moderate: 30% get sick with a 75% CFR = 67.5M deaths. Fire Break starts looking good even with a self-induced death rate of 1%.
On a much brighter note:
The following is called a "holy grail" in the vaccine world because it provides protection against virtually all clades/strains of flu. It is very good news that it worked in animal models. I have no involvement with this.
Yahoo- “WASHINGTON (Reuters) - A bird flu vaccine being developed by San Diego-based Vical Incorporated (Nasdaq:VICL - news) protects mice and ferrets against the feared H5N1 avian influenza virus, the company said on Tuesday.
It may also offer potential as a “universal” flu vaccine because it targets parts of the virus that all flu strains have, Vical and researchers testing the shot said.
This so-called cross-protection would mean that new vaccines would not have to be formulated every flu season and could provide a chance to stockpile vaccine ahead of a pandemic.
“A vaccine that provides cross-protection against more than one strain of flu is important for addressing a pandemic flu threat because it is likely that the H5N1 virus could mutate before it becomes transmissible from human to human,” Dr. Richard Webby of St. Jude Children’s Research Hospital in Memphis, Tennessee, who tested the vaccine, said in a statement…”
http://news.yahoo.com/s/nm/20060502/bs_nm/birdflu_vaccine_dc
RE: my 4/23 2300 post: "Smart people are now beginning to think the mechanism of infection is fecal/oral and not respiratory." Several of the latests human cases have no direct contact with infected poultry but are living directly under migratory flyways. Now, a possible explanation -- The SE Asian clade has mutated.
OXFORD, England -- The H5N1 strain of the avian-influenza virus has mutated, say scientists, although the mutation is not the much-feared change that would make the virus more easily transmissible between humans, possibly causing a pandemic.
Influenza expert Dr. Robert Webster of the St. Jude Children's Research Hospital in Memphis, TN, USA, told scientists at a Singapore conference organized by the medical journal The Lancet that H5N1 is now able to survive for longer in warm, moist conditions.
Scientists had hoped that reports of avian-influenza outbreaks would slow during the summer months, as older samples of H5N1 were most transmissible during the cooler months, from fall to early spring.
Webster warned against such complacency.
"When we tested the virus in Hong Kong from 1997, the virus was killed at 37 degrees Celsius [98 Fahrenheit] in two days. The current H5N1 is still viable for six days at 37. H5N1 at room temperatures can stay [alive] for at least a week in wet conditions.
"One of the often overlooked facts about influenza is that it's more heat stable than people realize, especially under moist, damp conditions ... Don't trust it."
As the virus becomes more resilient in warm, moist climates, such as those found in Southeast Asia, Webster warns, it is also adapting itself to water, raising the distinct and unnerving possibility that untreated water may no longer be potable.
"This means that water supplies for feeding chickens, or water supplies where people are swimming and water supplies for villages have got to be treated," he said.
http://www.msnbc.msn.com/id/9686290
The following are all second hand (from my one and only employee in Singapore) or third hand reports from the Lancet conference in Singapore.
=============================
WHO are sitting on samples from the recent Turkish deaths and are resisting intense pressure for their release. Scuttlebutt says they will show reassortment of H5N1 with an H3 strain that led to increased H2H trasnmission (accounts for the increased cluster activity in the Tukish outbreak) and decreased case fatality rates (from 50-75% in S Asia down to 33% in Turkey/Azerbaijan. The word is that quick action (rapid and widespread antiviral adminstration) headed off a potentially nasty situation. Turkey is getting big-time props behind the scenes. Look for an EU reward, maybe? This may explain statements from WHO: "we can contain outbreaks if we work fast enough".
=============================
Yi Guan’s study of H5N1 strains show that these all evolved from parent strains originally from south China. Vietnamese and Indonesian descendents have proven to be fairly stable once they emerged, but new subtypes are being formed in South China all the time. The natural reservoir for H5N1 is in S China --- Guangdong.
=============================
Historical evidence for bird die-offs in 1908-1918 was not found. There is speculation that the 1918 H1N1 strain was significantly less virulent than the current H5N1 when it went H2H. There was additional speculation that this may have implications if H5N1 goes H2H; it may be more lethal than the 1918 strain because it is starting from a more lethal strain. I have no idea what historical data were perused -- how sure are these guys on their results? Xiaolian please expand.
“I’ve worked with flu all my life, and this is the worst influenza virus that I have ever seen, said Robert G. Webster, a virologist at the St. Jude Children’s Research Hospital in Memphis, Tennessee. “We have to realize that this influenza virus in poultry becomes systemic … If that happens in humans, God help us."
=============================
Genetics may predispose some people to catching this flu and may account for family clusters. There are many father-children and mother-children clusters but not a single husband-wife-children cluster. Lack of containment labs and Muslim burial practices and cultural/religious autopsy proscriptions mean no tissue samples to test. Only six post-motems have been obtained in toto.
=============================
More scuttlebutt: recent Chinese shipments of equipment, material and lab supplies to N Korea may be "for cause" although hotly denied by Korea, surprise surprise.
=============================
Commentary:
--I've been trying to find out something about canids and flu and the first snip seems to indicate that dogs/coyotes are at risk if H5N1 gets into migratory fowl this autumn. Sick/dead birds and feces are all risks. This probably has implications for use of retrievers and upland game dogs if there is a season this fall.
--Qinghai outbreaks are watched for because: 1) this region seems to "lock" mutations into avian H5N1 2) birds widely disperse from there and carry the mutations everywhere
--Good stuff is happening on the vaccine front. Money is being allocated in the right places and new techiques are proving to have great potential. The bad news is we are still 36 months away -- but that's down from 60 months using the old techniques.
==================================
An unpublished report from 2005 by The National Institute of Animal Health in Bangkok indicated that dogs could be infected with the virus, but the associated disease was not detected. Researchers tested 629 village dogs and 111 cats in the Suphan Buri district of central Thailand. Out of these, 160 dogs and 8 cats had antibodies to H5N1, indicating that they were infected with the virus or had been infected in the past.
There were news reports of a stray dog dying from bird flu (H5N1) in Azerbaiijan in March. Affected cats in Europe appear to have become infected by eating infected poultry or wild birds. It is possible dogs could be infected the same way.
==================================
AP
DANANG, VIETNAM: Only half of the human bird flu cases detected by countries are being reported to the world health organisation within two weeks, a response time that must be improved to head off a potential flu pandemic, a senior WHO official said on Saturday.
==================================
Bird flu outbreak confirmed in China
(Xinhua/chinadaily.com.cn)
Updated: 2006-05-05 15:42
The Chinese Ministry of Agriculture Friday confirmed outbreak of bird flu among wild birds in a remote areas Qinghai Province, northwest China.
The outbreak was confirmed by the national bird flu laboratory on Wednesday, and the number of dead wild bird had risen to 123 by Thursday, the ministry said on its website. This is the second time H5N1 has turned up in Qinghai, a region of high-altitude plains and mountains that sits on a prime migration route for birds between Siberia and South Asia.
The Reaper
05-07-2006, 09:01
That does it.
I'm building a flamethrower.
Everyone, make real sure you call before coming over. I recommend that if you sound like you are sick, you not come by. If you come anyway, bring hot dogs and marshmallows. :D
TR
Qinghai Lake, part 2 (this is extra credit -- no quiz -- these are notes I wrote up for my daughter's AP bio teacher)
Summary: Qinghai Lake was the site in NW China where one of the "species barriers" for human-to-human transmission was breached. This mutation is now stable in H5N1 from this region and gives the strain it's name: the Qinghai Lake strain. This strain has circulated around the world in the waterfowl that frequent the region. Qinghai H5N1 could more easily gain the last mutations necessary for efficient h2h, by reassortment or recombination during dual infection or via point mutation, because it is starting with fewer barriers. Qinghai strain could reassemble or recombine w/ H7 to either breach the last barrier or confer to H7 its nasty properties.
...
There are roughly four viral processes: entry into the cell, replication inside the cell, exit from the cell, and overcoming host defenses. For any virus to be infective in humans it must be able to accomplish each of these four stages. Note that there are levels of efficiency within each of these categories. The current Qinghai Lake isolate shows, on a scale of 1 to 10, respective scores of 2/10/2/10 in humans for entry, replication, exit, and defense. (Note that these are my subjective scores and viruses aren't ranked this way by scientists -- don't teach that they are.) So, it can't get into or out of human cells very well, but it produces massive numbers of copies when it does and these viruses are very good at dodging host defences.
Note that having a score of 10 for "replication inside the cell" can "trump" other low scores. For example, in human infections the virus doesn't need to escape the cell because it produces so many copies the cell bursts. So many viruses are released that even though the "cell entry" score is a 2 there is massive and widespread systemic infection once it starts. ("Quantity has a quality all it's own." This virus also exhibits wide tissue tropisms but that's another can of worms.)
So, the current avian flu when infecting birds is a 10/10/10/10 -- the worst anyone has ever seen. And it's a 2/10/2/10 in humans. The differences between the two are the "species barriers" you hear talked about. There are several genetic sequences that are though to code for these species barriers which prevent efficient h2h in humans. The number of sequences is open to debate: one (rather large) camp says 2, one says 7, and another 10.
One of the key H5N1 mutations necessary for efficient H2H is E627K (a particular structure of the E6 protein). It is the mutation that gave H5N1 a score of 10 for "replication inside the [human] cell". All 16 H5N1 isolates that we have from dead birds at Qinghai Lake had E627K. This genetic pattern is so distinctive that we now call this strain the Qinghai strain. This strain, which has inside of it one of the key sequences for efficient h2h, has passed around the world inside migrating waterfowl. It is found in Turkey, Germany, Egypt, Denmark, etc. Qinghai Lake is like O'Hare for geese -- they go to the 4 corners of the earth from there.
This is also why the recent H7 infection in Britain (and probably other places in Europe which haven't been found yet) is of concern. All reported European sequences for Qinghai H5N1 isolates have also had E627K, including the buzzard isolate from Denmark this year. Dual infections involving H7 and H5N1 could allow the acquisition of E627K by H7. The acquisition could be driven by reassortment or recombination. H7 with E627K could be more virulent in humans and be easily transmitted between humans. The increased efficiency of human infections could also be acquired by H5N1 via recombination with the receptor binding domain on H7.
The concern with Qinghai Lake infections are: 1) an additional species barrier could be breached there and "locked" into the H5N1 genetic sequence 2) If that happens it will be widely disseminated via migration routes.
[In my mind specifics are not important: I would NOT test on vocab: E627K, H5N1, H7, etc. The fact that viruses can reassort or recombine during dual infections, that there are protein-based species barriers coded by genes, and that point mutations are another source of change are key points. People in general begin to think of viruses as "trying to get us". Point out that these changes are statistical ones which confer greater or lesser adaptation to the environment -- that is all. These things are robots not boogey men.
That does it.
I'm building a flamethrower.
Everyone, make real sure you call before coming over. I recommend that if you sound like you are sick, you not come by.:D
TR
Actually I'm starting to get encouraged, even though some things are trending towards grim at the moment. Many other things are going in the right direction.
--I just found out that there's a paper to be released soon that shows TamiFlu in combination with amantadine works against all recent isolates of the Qinghai strain. Amantadine is cheap as dirt and plentiful.
--According to scuttlebutt, Roche is going to open-license TamiFlu production using the new technique developed at Harvard.
--Money is being spent in the right places -- we will go from zero to five CONUS state-of-the-art vaccine plants in 9 months. We may be slow to start, but when we get our dander up we can still produce.
--The companies I work with are on a war footing with this -- we have been on a 12/7 work schedule for months and will continue. Granted, we won't have any vaccine for the first wave if it hits this year, but who's to say it will hit this year?
--There are unprecedented levels of cooperation among governments, industry and academia. Quite amazing really.
--There is an emerging realization among govt's that we are all interconnected; a plague in Nigeria is a disaster of potential biblical proportions in the US. Now, I think this means the Brit/German civil service should be hired to straighten these failed states out with the US on call for ass-whuppin', but that may not be popular :o (there were good sides to colonialism). The Chinese are incredibly proud people -- world opinion will sway their health care practices.
--There is a H20 pumping station in the next town. I called and offered to get trained for an emergency. The supervisor was looking into it and took my name. He said I was the third person to offer and he did not scoff at the idea. Even if this hits we will pull through.
--There are big problems on the horizon: energy, health, climate, population, water, etc. No population of organisms on Earth has survived a vertical growth curve like this without collapsing. We have to learn how to solve these problems and this is as good a trial run as any.
6052
The Reaper
05-07-2006, 14:39
What is the big leveling out between AD and now that stalled us at 300 Million, plague, famine, or war?
TR
What is the big leveling out between AD and now that stalled us at 300 Million, plague, famine, or war?
TR
300 million is the estimated carrying capacity of the earth without the use of fossil fuels (and given the boneheadedness of the average human). This figure is empirical and is based upon the leveling-off you observed. The relatively rapid increase in population from 100M to almost 300M was due to a revolution in political, religious, financial, agricultural, and transportation systems (think highly organized, expansive civilizations: Rome, China, Indus valley, MesoAmerica). "They" speculate that another 200M could have been added to the 300M that existed in 1000 A.D if all of the systems in place were refined to the Nth degree.
Throw in coal/oil/gas for industry, transportation, fertilizers/tractors, storage, heating, etc. and the sky's the limit for as long as the party lasts. That's what goosed population growth from 1600 A.D until now - you can go from 300 M to 6.5 B in just 400 years. (Consider transportation in the US alone -- before the rail system was widely established in the last half of the 1800's there were localized famines while other geographic areas had bumper crops.)
All of the above -- plague, famine, and war -- contributed to the leveling off of population growth around the birth of Christ. But it's a chicken/egg thing, I think (damn chickens again). Were these factors a cause of the leveling or an effect of approaching the carrying capacity? I would bet on the latter.
That's why I laugh when I hear the "blood for oil" accusations. It's a long, nasty fall from 6.5 Billion to 300 Million, and the only thing holding us up (right now) is oil. If that ain't worth fighting for I don't know what is.
Does daily childhood exposure to this (http://www.danoday.com/audio/costume.mp3) explain mugwump's career path?
The Reaper
05-08-2006, 09:07
It's a long, nasty fall from 6.5 Billion to 300 Million, and the only thing holding us up (right now) is oil. If that ain't worth fighting for I don't know what is.
Thanks for the explanation. As far as population hanging on oil, I have to respectfully disagree.
There are plenty of alternatives, even continuing with the internal combustion engine, they just aren't economically worthwhile yet.
That is why I tell people that we will never run out of oil. When all of the high quality, shallow pockets are exhausted, and oil hits a couple of hundred dollars per barrel to extract, we will research the alternatives more vigorously and seriously look to other means. Alcohol, coal, hydrogen, electric, nuclear, photovoltaics, or whatever. Oil will still be used for petrochemicals, till it hits some further price point, then we will create an alternative to that as well.
Politically (and economically), can you imagine the ramifications if we no longer needed to import ANY oil?
Just my .02.
TR
Thanks for the explanation. As far as population hanging on oil, I have to respectfully disagree.
There are plenty of alternatives, even continuing with the internal combustion engine, they just aren't economically worthwhile yet.
That is why I tell people that we will never run out of oil. When all of the high quality, shallow pockets are exhausted, and oil hits a couple of hundred dollars per barrel to extract, we will research the alternatives more vigorously and seriously look to other means. Alcohol, coal, hydrogen, electric, nuclear, photovoltaics, or whatever. Oil will still be used for petrochemicals, till it hits some further price point, then we will create an alternative to that as well.
Politically (and economically), can you imagine the ramifications if we no longer needed to import ANY oil?
Just my .02.
TR
TR,
I think you hit the nail on the head. In fact Wired magazine talked in depth about the rise in oil prices and why it's a good thing for America. Here's the links to the articles.
http://www.wired.com/wired/archive/13.12/energy.html
http://www.wired.com/wired/archive/13.12/gas.html
I'm not exactly sure how accurate the science is in the articles but they do put forward some good ideas. Sorry about the hijack...
I agree that a rise in prices is a good incentive to conserve and develop alternatives. Too bad everyone ignored scientists, economists, and George Will :lifter who all pushed for an energy tax on gasoline capped at $3/gal. The money that is now going to Iran/Venezuela/Arabia etc. could have been invested in an energy self-sufficiency Manhattan Project.
When looking at these schemes you have to think of net joules of output relative to development/production costs in joules. If it takes more energy to make than it will produce in its lifetime it is a non-starter. Current schemes are accounting boondoggles that use cheap energy to make the photocell/wind turbine/tidal generator on the assumption that rising energy prices will produce a net financial profit. Unless there is a radical change in design or a radical drop in production cost (cost in joules, not dollars) photovoltaics and wind energy both will never achieve break-even.
I haven't seen the net energy cost to build a nuke plant but my gut feel is they are still winners, as are coal plants. The best thing we could do is quickly research a way to sequester Co2 from coal combustion. There are plans in place to pump the CO2 into salt water aquifers for long term holding.
The Reaper
05-09-2006, 11:18
Despite the constant warnings, the American sheeple have done little to prepare for this potential catastrophe.
Today, I went ahead and ordered the water filtration products mentioned earlier. Handy to have, whether it is bird flu, or a hurricane. My family farm is less than 25 miles from the state capital here, and after a relatively recent hurricane, was without power for two weeks. Just prudent to be prepared for natural or manmade disaster. Or wait for the government to help you.:rolleyes:
The few who have prepared have cleaned Mountain House and Tamiflu vendors out. BTW, the Senate has yet again rejected malpractice lawsuit limits. This sort of tort reform may have made it feasible to rebuild this country's moribund vaccine industry, but it looks like that will have to wait again, and we will be dependent on non-US vaccine makers to bail us out.
I think that the TV show tonight may spur a few people towards preparedness, and many more toward panic.
http://reuters.myway.com/article/20060508/2006-05-08T210841Z_01_N08206383_RTRIDST_0_NEWS-BIRDFLU-TELEVISION-DC.html
IMHO, anyone who wants to lay in a few supplies and has not already had probably best act before this program airs.
TR
A couple years ago we got hit with a relatively low-key hurricane and the whole area was without power for like a week. It's amazing what most of us take for granted; electricity, clean running water, lights, refrigeration... showers. People were calling themselves Amish because of the way they were suddenly forced to live.
I think I'll add water filtration system to my list.
“Do not wait until you are thirsty to begin digging a well.”
-- Chinese proverb
http://www.pandemic-plans.com/docs/HowToPrepareForAPandemic_V1-1.pdf
This was just released today. It has good checklists (mandatory crucial, helpful) and implementation schedules at the end. (He says I shouldn't have bought cooking oil yet; he's right in retrospect.)
It strikes the right tone for my tastes, and he stresses that this thing could be non-existent or mild:
• Mild: You will change little about your daily activities, except to curtail exposure to crowds.
• Medium: You will ensure that distancing is carefully practiced, careful handwashing is followed, and exposure to the public is very limited, including trips to the grocery store.
• Severe: You execute your full plan.
• Ultra: You execute your full plan and take extraordinary precautions to ensure isolation.
Interesting-- thanks for the link.
I've been holding off on this but I hear (Chatham House Rule (http://en.wikipedia.org/wiki/Chatham_House_Rule)) that the PCR test is positive for H5N1. Niman talks in shorthand -- the "extended time period for symptoms and admissions is cause for concern" because it implies h2h transmission. If they all come down at once it implies simultaneous exposure to a vector. If it's one-little, two-little, three-little indians then that implies serial h2h. Note there are no reports of sick health care workers or illness outside the family, so this looks like "inefficient h2h."
Recombinomics (http://www.recombinomics.com%2FNews%2F05100602%2FH5N1_Sum atra.html)
The above description of a large familial cluster in North Sumatra, Indonesia is cause for concern. Other reports indicated the mother has also died at an earlier date. The relatives have H5N1 bird flu symptoms and the extended time period for symptoms and admissions is cause for concern.
The number of fatalities has now grown to three and the condition of additional family members continues to deteriorate.
Familial clusters of H5N1 in Indonesia have been noted previously, but this is the largest suspected cluster reported to date.
When I said a while back that things were disappointing on the work front, this is what I was referring to and couldn't really say...an excellent article, extremely well researched.
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20060510/bird_flu_vaccine_060510/20060510?hub=Health
Edited to add: HA! Talk about spin. This (http://news.scotsman.com/latest.cfm?id=704782006) vaccine is worse than the one I considered a failure -- the Frogs always claim success. Two 30 microgram injections plus adjuvant working 40-50% of the time is atrocious. A typical flu shot is a single 15 microgram dose.
Summary: A relatively cheap solution was previously presented for filtering water down to 0.5 microns. This will filter out bacteria, protozoa, cryptosporidium, giardia etc. but not most viruses. You must disinfect the filtered water as well. (Note that disinfectant alone will kill viruses and bacteria, but not cryptosporidium and sometimes not giardia spores. You should filter AND disinfect.)
A one pound package of 60% calcium hypochlorite (commonly sold as a swimming pool "shock" chlorinator at approx. $3 per 1 pound package) will disinfect about 11,000 gallons of water. (Get a few packages: by adding 7 teaspoons of 60% HTH to 2 gallons of water you get a 6% solution, equivalent to strong bleach, for disinfecting.)
I know it's easy to re-contaminate water by introducing untreated droplets from container threads etc. but I don't know how to avoid that. Maybe someone who does could chime in.
-----------------------------------------------------------
It was mentioned way back in this thread that HTH was an effective water disinfectant if you knew how to use it -- and I didn't.
I checked into this and found that HTH = "High-Test Hypochlorite" = NSN 6810-00-255-0471 = calcium hypochlorite powder containing 70% free chlorine by weight. HTH is a very strong oxidizer used to provide the sanitizing property of chlorine without requiring the storage of large quantities of liquid bleach. HTH is widely used by the military and NGOs for water purification and decontamination. If kept dry it stores indefinitely without losing potency.
Military-grade HTM -- 70% free chlorine by weight -- is a particularly strong oxidizer. You aren't going to find it easily because it is just that much more dangerous to store. You will be able to find 60% free chlorine calcium hypochlorite sold as "pool shock" for use in swimming pools. Pay close attention to the package -- it should say "60% available chlorine" or "60% free chlorine by weight". I purchased HTH® SUPER SOCK IT Shock 'N Swim. (Be careful, you'll find 45% and 50% available chlorine formulations by the same manufacturer as well -- you don't want those.) It is sold in one pound packages. I paid $2.39 for a package at Ace Hardware. A very few pool shocks add cyanuric acid as a stabilizer -- you do NOT want a product with that added.
6078
I found numerous protocols on the net for sanitizing water with 70% HTH like this one from the EPA:
"Add and dissolve one heaping teaspoon of high-test granular calcium hypochlorite (approximately 1/4 ounce) for each two gallons of water. The mixture will produce a stock chlorine solution of approximately 500 mg/L (1%), since the calcium hypochlorite has an available chlorine equal to 70 percent of its weight. To disinfect water, add the chlorine solution in the ratio of one part of chlorine solution to each 100 parts of water to be treated. This is roughly equal to adding 1 pint (16 oz.) of stock chlorine to each 12.5 gallons of water to be disinfected."
Others protocols start with same formula for the stock chlorine solution but say to add 1.25 ounces of stock solution per gallon (equivalent to 15.6 ounces per 12.5 gallons).
If you use the same EPA recipe with 60% HTH you will get a 0.86% solution instead of 1.0% This means you should use 1.45 ounces per gallon of this weaker solution instead of 1.25 ounces. I consider this an advantage as 1.5 ounces is a standard jigger size used in mixing drinks. You just add one 1.5 ounce shot glass of stock solution per gallon of water to be treated. (There are different size jiggers - be careful)
So, the protocol modified for 60% free chlorine granular calcium hypochlorite:
1. Add and dissolve one heaping teaspoon of 60% available chlorine
granular calcium hypochlorite (approximately 1/4 ounce)
for each two gallons of water.
2. This 2 gallons of 0.86% free chlorine is your stock sanitizing solution. DO NOT DRINK IT.
3. Add 1.5 ounces of stock solution to each gallon of water to be treated.
4. Mix thoroughly and allow to stand for 30 minutes. The water should have
a slight chlorine odor; if not, repeat the dosage and allow to stand for another
15 minutes. If the treated water has too strong a chlorine taste, it can be
made more palatable by allowing the water to stand exposed to the air for a
few hours or by pouring it from container to container to aerate it.
About the water you want to disinfect: If it's cloudy, prefilter the water through a coffee filter. You can get 1000 filters for a couple bucks at Sam's or wherever. Alternatively let the water stand until it settles and then draw off the clear stuff. Then siphon-filter it through the ceramic candle as previously discussed. Then disinfect. Double the treatment if the water is cold.
-----------------------------------------------------
Pool shock at 60% is still a strong oxidizer. "Strong oxidizer" means it gives up oxygen when in the presence of a fuel source. It should be stored in a dry location, apart from fuel sources. If you store it unopened in a small tupperware container (throw in a 1.5 oz jigger and teaspoon as well) you should be good to go, and the container will be useful if you ever have to open the package and start using it. That said, this stuff isn't rocket fuel and is safely stored on store shelves every day. Just keep it away from the Bullseye and the turpentine.
-----------------------------------------------------
62.4% calcium hypochlorite (60% available chlorine)
One pound = 16 oz
4 teaspoons/ounce X 16 ounces/pound = 64 doses per pound
64 doses X 2 gallons = 128 gallons of stock solution
128 gallons of stock solution X 128 fl ounces per gallon = 16,384 fl ounces stock solution
16,384 total ounces / 1.5 ounces per gallon treated = 10,922 gallons treated
(Still no transmission to health-care workers, so not a tipping point in my estimation.)
Two more family members in the Indonesian cluster reported here 10May2006 11:05 have now died, for a total of five deaths from the original eight in the cluster. Two of the surviving hospitalized family members escaped from the hospital and fled back to their home town. They were apprehended by the Indonesian army and returned to isolation.
"In fact was two again the patient that suspect bird flu. Namely Jones Ginting (25), and Obviously Ulina br Ginting, the daughter was 8 years old. However both of them forced left the hospital, although being not yet permitted. Currently both of them in the supervision of the Health of the Karo Regency of the Service."
"Brenata became casualties was killed fifth that was expected terjangkit bird flu in Medan, North Sumatra.
The child was 18 months old was killed after could be treated intensive in RSU Adam's Centre the Owner, Medan."
Twelve more new cases are now in hospital with presumed avian flu. No word of serological confirmation -- but when several deaths are reported in an area anyone with a respiratory infection is presumed to have BF. The fact they are being "treated intensive" is worrying, though.
"While 12 assumption patients of other bird flu were still being treated intensive in RSUP Adam the Owner.
Worry with the spreading of this deadly virus, the Government of the North Sumatran Province instructed the Health Service of the Karo Land to sterilise the area that it was suspected became the source of the spread.
The sterilisation was carried out in a radius of one kilometre.
Officially North Sumatran Livestock Breeding carried out the vaccination and spraying in the house environment of the casualties."
http://www.liputan6.com/view/7,122737,1,0,1147446036.html
Machine translation via Toggletext
http://www.toggletext.com/kataku_trial.php
------------------------------------------
The first human H5N1 case in sub-Sahara Africa, a 2-year-old girl in Djibouti, is now part of a presumed cluster.
"Three of her siblings are undergoing investigation for possible infection. Their samples have been sent to the same laboratory," Cheng told Reuters in Geneva. "They have flu-like symptoms," she said.
http://news.yahoo.com/s/nm/20060512/wl_nm/birdflu_djibouti_who_dc
I've been adding to my stash one item at a time. Checking the exp. date and getting as far out as I can. If nothing else as time goes on I'll start rotating stuff in/out of the stash.
I'll start adding in hand sanitizers/wipes, stuff along that line now.
Ya' know, with food, water and medicine eating up this thread not not has gone into waste disposal. City water shuts down and people will have to take a shovel to the back yard. Toilet paper????? Man, I need to run out to the base and get a big box to stick in the attic.
Other than the water filtration stuff, everything can be used by a family at one time or another. $20 a week can add up to a right good stash of stuff by this fall.
Pete
I've been adding to my stash one item at a time. Checking the exp. date and getting as far out as I can. If nothing else as time goes on I'll start rotating stuff in/out of the stash.
That's what we've done. Small pantry in the kitchen and shelving in the basement. Run out of peanut butter in the pantry? Hit the "7-11" in the basement and replace it the next trip to the store. Other than Spam and canned chicken, we don't have anything down in the basement that we don't normally eat. (Fried spam w/ black crust, mayo, and a tiny dab of yellow mustard is one of the best sammitches known to man. When I can open the windows again it will go back on the menu -- the wife gags at the smell.) We have some stuff in quantities that won't be rotated in 2 years but I'm willing to write that off.
The wife handles TP, trash bags, disposable plates and plasticware, paper towels, wipes, detergent, soap, feminine products, clothesline and pins, etc. I have access to water, so I'd be bucket-flushing the toilets. I've been told the treatment plant will go to "pass-through" mode (no treatment, just dump) so the toilets will work. If we're told not to use toilets -- Mark 1 shovel.
An autumn target for being ready is probably prudent. I still think "within 10 years" is a possibility for when this might hit, but I'm obviously not ruling out "soon."
Now this is a little strange:
The World Health Organisation's Maria Cheng said: "Three others are under investigation." She said samples from the three patients, believed to be from the same family as the child, had been sent to the United States-run laboratory in Egypt that first confirmed the presence of H5N1 in Djibouti on April 27.
http://www.news24.com/News24/Africa/News/0,,2-11-1447_1931921,00.html
The case was confirmed by the US Navy (the only US lab in Egypt as far as I know) on April 27 and was only reported yesterday?
Thompson says a concerted effort is under way in Djibouti to try to contain the spread of the disease. He says his organization has sent supplies of Tamiflu antiviral medication, which has proven to be effective against the disease. Protective equipment for doctors and nurses has also been delivered to hospitals.
http://www.voanews.com/english/2006-05-12-voa50.cfm
The WHO says this:
Another WHO official said the affected family lives in an impoverished rural village near Djibouti's border with Somalia and kept chickens.
And Djibouti says this:
Djibouti health officials said they were surprised that the region's first cases appeared in the country, as most of the population are nomadic pastoralists who keep cattle, sheep and goats.
Chicken is considered a luxury by most of the population. About 90 % of the poultry eaten in the country is imported frozen.
So the impoverished family owned chickens, considered a luxury?
Sounds to me like WHO are trying to play whack-a-mole with a cluster that's been known about for over two weeks. Well, scuttlebutt says outbreaks have been contained twice before, in China and in Turkey, so I'll assume they know what they are doing.
A sixth person in the Sumatran cluster has died - apparently an 18-month-old girl, rest her soul. There is no word on the 12 additional cases outside the original 8 family family members - the reports have been neither confirmed nor denied. There is CHR talk of suspected additional cases beyond those 12 but it is all third-hand.
Using WHO's methodology (number of deaths/number confirmed H5N1) this outbreak has a 100% fatality rate.
A worrisome note: a nurse who treated some family members of the original cluster is now reported to be showing symptoms of flu. Some reports say she had the sniffles prior to exposure to those who died, others say the symptoms developed after exposure. Until her PCR testing comes back showing otherwise, garden variety seasonal flu is definitely a possibility. She is in isolation and is being treated with antivirals.
Note that infection of a HCW has happened before - in Viet Nam - and the nurse recovered and the outbreak was contained. (As a matter of fact there hasn't been a VN or Thai case in a year.)
Both individuals who fled the hospital and who were retrieved by the army are now reported to be dead.
Apparently, many (all?) in the home village of the six who died are being treated with antivirals and are under quarantine. I infer from the reports that WHO has initiated their "blanket treatment" plan, in at least a limited fashion, and seem to be all over this.
My take on this? It's got my attention but it doesn't yet cross the threshold for evidence of efficient H2H, although there is strong circumstantial evidence of H2H. It is the largest cluster to date, but is still small for a trigger event. There will be many additional "suspect cases" reported in the coming days if it is 'the' outbreak -- or there will be a news blackout.
Not noted in this article, but the vector for the Sumatran cluster is being attributed to "fertilizer" by offical Indonesion press release. I assume this means the spread of poultry manure (which is common worldwide, including in the US).
The following is subscription, last line (byline) removed, I personally claim "fair use."
From the Wall Street Journal:
Bird Flu Deaths Checked For Human Transmission
By NICHOLAS ZAMISKA
May 14, 2006 7:46 a.m.
An unusually large cluster of suspected bird flu cases among eight members of an extended family in Indonesia has caught the attention of local and international health officials on guard against any sign that the virus has evolved to spread easily among humans, the possible prelude to a pandemic.
After attending a recent family gathering, eight family members living on Sumatra island fell ill. Six of them have died in the past week or so, according to Nyoman Kandun, director general of disease control and environmental health at the Ministry of Health in Jakarta.
Local tests, which so far have proved very reliable, have shown that five of those family members were infected with the H5N1 virus, a deadly bird flu strain, although a laboratory in Hong Kong is currently in the process of confirming those results.
With similar, albeit smaller, human clusters in the past, health officials have presumed that the family members all fell ill after contracting the virus from the same sick birds -- all but ruling out the possibility of transmission among people.
The World Health Organization has sent a team to investigate, although Sari P. Setiogi, a spokeswoman for the health agency in Jakarta, said on Thursday that "it is still too early for conclusion at this stage." She was unavailable for comment on Sunday.
A nurse who attended to some of the patients also came down with an influenza-like illness, although she seems to have shown symptoms prior to treating the patients, according to Dr. Kandun. She and others in the family's village are currently being tested for the virus.
Since last year, there have been 33 human cases of bird flu that have been confirmed by the World Health Organization. Of those, 25 have been fatal.
More Chatham House Rule intel.
There is gibbering, slavering fury among the the public and private sector researchers who are responsible for vaccine development and production.
They are all watching this Indonesian outbreak very closely, believe me. Understand that this whole vaccine production thing is a race that starts when the "bad" virus is isolated. These French, British and American vaccines you are reading about? They are all using a virus isolated in 2004. Nobody knows if they will have any affect on a real pandemic virus. "The" vaccine will have to match "the" mutant strain that is causing the pandemic. Obviously, this means that the sooner vaccine research facilities get "the" virus samples the better.
Research facilities want the current Sumatra strain delivered yesterday so they can begin gearing up in case this turns out to be a true outbreak.
So couriers are rushing around the world with containment vials, right? Wrong. The scuttlebutt is that Indonesia is sitting on the current virus WHILE INTERNATIONAL COPYRIGHT PROTECTION IS FILED FOR and WHO is complicit. Can you believe that? Further, the US Navy's NAMRU-2 facility in Jakarta has received the samples from the sick health care worker and the other 12/16/20 suspect cases (the numbers are changing and are in doubt) but is constrained from releasing the results by prior agreement with Indonesia. Only WHO is allowed to release the results, and only after testing is completed in their "official" Hong Kong laboratory, and that could take another week.
So, they already know if the HCW has H5N1 and whether there's been secondary and/or tertiary H2H transmission but they won't release the results because they come from a nasty US military lab -- and that would embarrass both Indonesia and WHO.
So now everyone is left reading the tea leaves. World-class researchers, the QPs of their fields, are wasting time doing the speculation mambo, trying to second-guess idiots who want an "Islamic Vaccine". Some humans are just a waste of good skin.
I was sent the following along with this info:
Indonesia is seeking copyright protection for any bird flu vaccine developed by a locally-based U.S. Navy laboratory, officials said Wednesday.
A contract for the NAMRU-2 medical unit expires Dec. 31 and will only be extended if an agreement can be reached that is beneficial to Indonesia, said foreign ministry official Arif Havas Oegroseno.
That would include a guarantee that the government would be rewarded financially if a bird flu vaccine was developed using Indonesian strains of the virus.
Such a deal could generate “billions and billions of dollars,” Oegroseno noted.
http://www.navytimes.com/story.php?f=1-292925-1399098.php
jasonglh
05-14-2006, 22:23
Thanks all for a very informative thread I have been checking it daily for updates. From the information here I have been able to stockpile enough stuff to go 3 months if needed. My wife and I both work critical care in different hospitals so this could be a future concern for both of us.
One concern I have is that during the SARS thing the hospital I work at ran out of N95 masks. When they got tight they advised us to keep 1 and when we had to go into the room to use one of the yellow masks on top of it because it is fluid resistant. I am really not comfortable with that and certainly not sure thats the way to approach a potential shortage of masks should the Pandemic hit. The hospital says they have a good supply of them but thats what they said last time. They have updated all of our negative pressure room equipment over the last few months so at least I have that going for me.
Just to add to my paranoia there is a Tyson chicken plant near me and they haul live birds and truckloads of poulty waste right through the middle of town. It smells lovely in the morning let me tell you. :(
Well, CONUS mask production is a fraction of what is needed -- thank our glorious tort system once again.
Many companies irresponsibly handed out light-duty N95 masks to workers performing demolition, sandblasting, etc. Under such conditions directions state they need to be replaced every half hour, but they weren't. They clog quickly under those conditions (weren't designed for long-term use) and users begin to suck air around instead of through the mask. The result is silicosis. So, who to sue? 3M of course, deeper pockets. The profits made didn't justify the risk and they began pulling out of the market and basically ceded it to the Chinese. To their credit they are cranking up as much as they can but they lack the manufacturing capacity the handle the needs.
As a professional you may be interested in Reusability of Facemasks During an Influenza Pandemic: Facing the Flu found here. (http://www.nap.edu/catalog/11637.html) You must register but the download is free. They address the numbers needed by a large hospital over the course of an outbreak. I believe the number is in the millions -- no hospital has that many on hand and supply-chain disruption would prevent replacement. That's why they looked into re-use (conclusion - it can't be done).
The Reaper
05-15-2006, 08:30
mugwump, as informative and helpful as your posts are, everytime I see you have put up a new one on this thread, I can't help but think, "Uh oh, what is the latest bad news?" :D
I have seen masks and gloves being washed, autoclaved (I think), and hung on a rack to dry in an OR in Paraguay. I wondered how well it worked. The OR looked like the one Frankenstein was assembled in. I told my NCO that if anything happened to me, get me out of country or kill me quickly before they could make a mess of it.
I recently ordered some N95 masks and gloves and I believe that I got a good deal. The masks seem to be high quality and were about a buck each, so the price seemed right. Gloves were good quality and were inexpensive. Easy to find with a google search, supplies are okay for now (a few items were out) but IMHO, are guaranteed to disappear if and when HTH transmission occurs.
Keep it coming, we can take it.
TR
Things only became murkier overnight but there are no new cases reported, which is very good news. There are reports of "panic" in the region where the cluster originated, possibly caused by an Indonesian official who said 320 were under observation and 128 had been confirmed with H5N1. That figure of 128 is exactly the number of officially confirmed cases over the last 2 years so it's more than likely a summary of the situation up to now that was misinterpreted. Keep that in mind if the general media pick up on this.
It appears that the deceased toddler I reported as a girl was actually a boy.
The general media had swung into one of their euphoric cycles ("Bird Flu Threat Over?", "Bird Flu Threat Overblown", "No Avian Flu in Europe", "Avian Flu Eliminated in Asia"). Then comes infection and a million bird cull in Romania, 25,000 birds dead in NW China (may be a vaccine that backfired), Djibouti, and this in Indonesia. Expect another swing toward "We're all going to DIE!"
My current assessment is that this is NOT a breakout, given what we know. I would expect reports of many more scores of infections today and over the next couple of days if it were. It is definitely worth keeping an eye on.
PS - Someone told me that the NAMRU-2 facility is still in Jakarta but is not there "officially" as the lease agreement was never officially renewed when it expired at the end of last year. That may explain the lack of official test results from them.
The Reaper
05-15-2006, 08:51
PS - Someone told me that the NAMRU-2 facility is still in Jakarta but is not there "officially" as the lease agreement was never officially renewed when it expired at the end of last year. That may explain the lack of official test results from them.
I hear you.
After the potential for Indonesia to be a starting point for a pandemic (which means we would have to assist them), and all of the help we have given them with their other problems, the thought that they want money to allow the NAMRU to stay there and a commission on any vaccine developed from an Indonesian strain makes me sick.
Profiteering could mean that they lose their status as the world's most populous Muslim nation.
TR
mugwump, as informative and helpful as your posts are, everytime I see you have put up a new one on this thread, I can't help but think, "Uh oh, what is the latest bad news?"
Yeah, I know, I feel quite bad about that actually. Not the way I want people to think of me.
It's definitely a point of discussion with my colleagues. The absolutely best outcome - no pandemic, or a very mild one - paints us as Y2K crackpots (actually the one they talk about is swine flu). The worst outcome (pandemic soon w/ no effective vaccine) brands us as criminally negligent incompetents responsible for the deaths of millions.
Nice.
We all have families and hope we turn out to be crackpots. Rather a strange position for prideful people.
Edited to add: :boohoo :boohoo
:o
Still strange and conflicting reports coming out of Sumatra, but the good news is this whole thing is being watched carefully. There have apparently been no new secondary/tertiary cases spinning off of the large family cluster, and no new reports of infected HCWs other than that first one (all HCWs involved have been swabbed - negative - but remain under observation). There is still no source identified for the infections; all local poultry and pigs have tested negative (and then destroyed anyway). The "fertilizer" scenario is being investigated but so far is not panning out as a cause either.
There are a couple of hysterical reports in the popular media of four more human cases, with the implication that these are related to the family cluster. This does NOT appear to be the case. There are 4 more human cases, but they are in Jakarta, not even the same island, and they fit the pattern of isolated cases in young people in close contact with infected poultry.
No word on the previous report of 12 additional cases in hospital. Government comms, in a word, suck and conflicting info is forthcoming. This appears to be incompetence and not conspiracy.
Indonesia is now attempting to get $900 million in financial aid from the international community to combat avian flu, so the likelihood of a press blackout is remote; it's in their interest to spread the word to get the aid. I am told that the Indonesian government has accepted the fact that the tourism industry has taken an irretrievable hit in the short term, and now they are trying to prevent a similar effect on foreign investment/capital outflows. There will more than likely be forces that will attempt to quash "negative" reports but at least there's a counterweight in place.
In a rare display of candor, a mid-level WHO functionary said that sending $900 million to Indonesia would be like shoveling it down a rat hole. I'm sure he's looking for a new job.
I'm in Brussels -- an unplanned trip.
See the dates, I couldn't get to PS.com yesterday on the corporate net I have access to. If this posts it will be via the dreaded thumb drive.
About the best advice I can give over the next few days regarding WHO/Indonesia is "ignore what they say, watch what they do." In the US, NAMRU-2 has to be feeding intel back to the USGOV. If Leavitt starts another intense round of "local communities must prepare" then listen to him.
Last minute: there is concern that pigs may be a vector in Sumatra.
2006May16
Sumatra update:
Pretty much same as yesterday. I confirmed as far as I can that NAMRU-2 is still up and running in Indonesia and is testing samples but is not releasing results. It's still an unknown about the 57 samples flown to Hong Kong, no word's leaked. I would hope we'd see some recognizable USGOV activity if they had inside knowledge of a breakout via NAMRU2. I haven't heard of any so I have to assume that is a very good sign.
All the talk here is how incompetently the cluster was handled in Sumatra. The word about those two who "escaped/fled" was that no nurses would enter the room to render care and the patient/relative in the next bed was in the last stages of H5N1-induced ARDS (oozing blood from all orifices). The woman got dressed and walked out, taking her child with her. (That hospital was one affiliated with NAMRU-2 and is a "center of excellence". Eek.)
The consensus here is that this is a worrying development but not the breakout. The next 2 days will tell for sure.
People here are really, really pissed about Romania. There is evidence that the poultry processing plant knew the chickens were infected w. H5N1 but shipped them out anyway. There's a big EU vote on membership for Romania -- really bad timing.
300 mg caffeine + 400 mg Provigil = good stuff
2006May17
Sumatra update:
Mostly very good news. No evidence of the 1-3-9-27-81 etc. spread that would indicate effiecient H2H. More worrisome: no vector found for the outbreak, all local livestock have come up clean for H5N1 and the "fertilizer" vector has been dismissed. The index case for the cluster began showing symptoms 2 days prior to the large family gathering where she apparently infected the other family members. Non-lineage infections are in the cluster (spouses not related by blood got ill). "More efficient" H2H is assumed, but not the big one. No word on results of the 57 samples sent off for testing. No word on the 12 reported to be under "care intensive".
One more "local official" death of a child from H5N1 in Jakarta. Several more children are quite ill.
BTW, WHO has moved to a new info release strategy: a "local official" release to the local press and community and a "global official" after lead-pipe-cinch confirmation is done by an offical lab.
I suspect the credence given the "local official" release in Indonesia is based upon its NAMRU-2 source.
B2B is spreading in the rest of Indonesia. Two villages in Russia are under quarantine but only because of a large local B2B die-offs.
The Romanian woman suspected of having H5N1 dosen't. The EU vote went OK for Romania.
There was comment here that Russia knew how to handle these things because of their totalitarian history. Sobering thought.
I am now leery of giving credence to press reports of "local panic". The Frogs here insist on saying masses of Americans "panicked after seeing a teledrama about avian flu." It must be so, Le Monde reported it. I've learned not to argue with Frogs - the whole "wrestle with pigs" thing.
One Frog also wanted to know "What happened to Britney Spears, she used to be hot?" Well they're not always wrong.
300 mg caffeine + 400 mg Provigil = bad stuff, even my hair hurts
shadowflyer
05-17-2006, 22:17
I just read all 29 pages of this...again...thanks for the education and information MW.
One of the guys in the meeting yesterday has a wife in the EU bureaucracy. She mentioned to him that there was "civil disorder" associated with quarantines put into effect in Romania -- shots were apparently fired. This is all I could find (no report of gunplay):
Revolt in Codlea
Several inhabitants from a street in Codlea city, where the quarantine was declared after the avian virus was discovered, and yesterday at noon started forcing the gendarmes’ forces, in the attempt to leave the area. The people are revolted that they can no longer leave the street, as the quarantine was declared in the area because dead sick birds coming from Drakom Silva farm were allegedly thrown there. The inhabitants also say they want to leave the area because they have no food and accuse the authorities of discrimination, as they are Roma ethnics.
Two children from Codlea have been brought to ‘Matei Bals Holspital’ in Bucharest, suspected of having avian flu.
http://www.nineoclock.ro/index.php?page=detalii&categorie=homenews&id=20060517-5140
This is not a coherent trip report because much said was proprietary and boring/procedural, but I can jot down observations.
--People are taking the events in Indonesia very seriously -- more seriously than news reports suggest.
--Indonesia and WHO are playing a very high stakes poker game and the chips are the genetic sequences of the viruses isolated from the 30-odd people who have died from H5N1 in Indonesia. They treat the information as proprietary and simply refuse to release this information to the scientific community at large. Lots of reasons are being floated. Some say that WHO are getting back at the west for not putting AIDS anti-retrovirals into the public domain. Some say there is back room negotiation going on, well above the pay grade of anyone I was meeting with, to ensure that the West doesn't hog all of the vaccine that might result from the sequences. And then there's the biggie -- greed. Untold billions can be made from an effective vaccine. Personally, I think they are walking on eggshells with the Indonesian govt. They are twitchy, paranoid, and playing this out day by day.
This failure to release sequence data is REALLY STUPID as there are untold numbers of researchers who could be working on this issue who are currently out of the loop. Withholding the sequences has not caused critical-path vaccine problems with the Big Pharmas yet, there is still much preliminary work that needs to be done. I am positive the sequences will be released by someone at exactly the point they are required, but I doubt it will be by the Indonesians or WHO.
--There is a very strong belief that, if and when released, the sequences will show that the virus has mutated into a form that is passing from mammal-2-mammal (specifically between pigs and humans).
--Pig to human transmission is a Big Deal. Pigs represent significant wealth to owners and there will be heroic efforts made to hide them during any cull attempts (Assuming Indonesia ever works up the stones to perform a cull of anything).
Assume there will be new conspiracy theories involving NAMRU2, pigs, and the US -- with a strong Islamist angle.
There is no firm data that demonstrates that pigs have siliac acid receptor distribution similar to Man (those alpha 2,6 and alpha 2,3 receptors discussed higher in the thread) but it is presumed to be the case. If the virus has adapted to pigs then it is much closer to finding man to be a good host. Worrisome. Ten out of 11 pigs tested recently came up positive for H5N1, and as it turns out, infected pigs have been showing up since the middle of 2005. WHO attributed the positive test results as contamination from chicken feces. Pigs are very much like humans (their mitral heart valves are transplanted into scores of thousands of humans) and are considered an "incubator" for flu mutations.
--Crisis communications are getting worse, not better. Both WHO and the Indonesian govt. are issuing contradictory reports, sometimes simultaneously. What you don't here may be as important as what you do.
Perfect example of Indonesian BS. This was released today. It is totally contradicted by the serology, animal testing in the village, the staggered infection onset dates in the family, etc. This is akin to "There are no American tanks in Bghdad!"
See why they won't release the sequences?
Pravda 05/19/2006 13:04
Indonesia 's health minister on Friday ruled out human-to-human transmission of bird flu among four family members who died from the virus earlier this month on Sumatra island, saying they had been infected by poultry.
"According to local DNA sequencing tests, they got the virus ... from poultry," Health Minister Siti Fadilah Supari said. She said she was awaiting confirmation from a World Health Organization-accredited laboratory in Hong Kong , but was confident the results would match.
The family members did not contract the H5N1 bird flu virus through human to human transmission, Supari told reporters.
Bird flu has killed at least 30 people in Indonesia and more than 100 people worldwide since it started sweeping through poultry populations in Asia three years ago.
WHO confirmed this week the death of the four family members and the infection of a fifth on Sumatra island from bird flu, raising concerns the virus might have mutated into a form easily passed between humans. Most human cases of bird flu have been linked to contact with infected poultry, reports the AP.
Two new worrisome reports: 1) Three additional family members from the original cluster have reportedly fallen ill -- no serology yet [edited to add: no cite, from the CHR grapevine] 2) Indonesia is not allowing anyone into the cluster village. They say the people in the village don't want visitors. Weak.
http://www.metrotvnews.com/berita.asp?id=16929
WHO failed to visit the PATIENT's VILLAGE BIRD FLU 18/05/2006
21:12 - the Indonesian Archipelago/Great Nine News
Three members the Health Body of the World.
(Metro the TV) Metrotvnews.com, the Karo Land: three people of the team of the Health Body of the World (WHO) today failed to visit the village of six positive patients bird flu in the Karo Land Regency, North Sumatra, on Thursday (18/5).
The team's three doctors of the handling of this WHO bird flu visited the Land Regency Karo on Thursday morning by being accompanied by the official of the North Sumatran Health of the Service. However, their visit was cancelled because of being refused by the local community
Because of being refused, the WHO team changed his plan by visiting the Kabanjahe Public Hospital.
This the hospital that the first time treated the eight patients suspect bird flu.
Tim WHO co-operated with the Department of the Health to find the cause of the emergence of the bird flu virus in the Karo Land Regency.
WHO admitted that results of the laboratory test against blood, the waste and the poultry saliva as well as the land in the Simbelang Fortification Village were not found by the existence of the virus avian influenza.
Amantadine is relatively cheap and plentiful and is currently effective against the Indonesian H5N1 clade. I am going to order some online -- I'll post a source after I've checked it out (these operations ship FedEx to avoid postal regulations so it should be quick -- I have some known legit samples for comparison). Note that the clade could turn resistant in a heartbeat, but treatment for a family of 4 for $20 seems well worth the risk.
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
1: J Infect Dis. 2006 Jun 15;193(12):1626-9. Epub 2006 May 9. Related Articles, Links
Click here to read
Distribution of Amantadine-Resistant H5N1 Avian Influenza Variants in Asia.
Cheung CL, Rayner JM, Smith GJ, Wang P, Naipospos TS, Zhang J, Yuen KY, Webster RG, Peiris JS, Guan Y, Chen H.
State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Pokfulam, Hong Kong SAR, China.
We examined the distribution of genetic mutations associated with resistance to the M2 ion channel-blocking adamantane derivatives, amantadine and rimantadine, among H5N1 viruses isolated in Vietnam, Thailand, Cambodia, Indonesia, Hong Kong, and China. More than 95% of the viruses isolated in Vietnam and Thailand contained resistance mutations, but resistant mutants were less commonly isolated in Indonesia (6.3% of isolates) and China (8.9% of isolates), where human infection was recently reported. The dual mutation motif Leu26Ile-Ser31Asn (leucine-->isoleucine at aa 26 and serine-->asparagine at aa 31) was found almost exclusively in all resistant isolates from Vietnam, Thailand, and Cambodia, suggesting the biological selection of these mutations.
http://www.bloomberg.com/apps/news?pid=10000080&sid=a7CJ0uPPpg.g&refer=asia
I haven't heard more about this one than what I've read in the press, but there appears to be another outbreak in Indonesia -- this time in Java.
...A 20-year-old man died in East Java's city of Surabaya today after he had been treated in the Budi Mulia Hospital since May 9, the Antara state news agency said. Samples from the man were sent to Jakarta for testing to confirm H5N1 infection, the report said.
Eleven other people are being tested, including three who are under quarantine in Surabaya with avian flu-like symptoms, Antara reported...
Now for some light diversion from the bird flu scare...(My partner in London sent me this -- it's apparently causing some consternation.)
http://www.dailyrecord.co.uk/news/tm_objectid=17105559&method=full&siteid=66633&headline=ebola-fears-as-brit-dies--name_page.html
Edited to add: Kinda shitty news for the cabin crew and passengers if true, but ebola is readily containable in the first world.
mugwump, as informative and helpful as your posts are, everytime I see you have put up a new one on this thread, I can't help but think, "Uh oh, what is the latest bad news?" :D
Keep it coming, we can take it.
Same here TR - Mugwump very informative posts. It should make us think more about "were" we live. Funny (not really) how Americans don't think about the way they "travel" and what is "out there". Here in the Great USA you have it so well.
Thanx for the INFO
VG
"That the H5N1 virus may be able to be spread to humans drinking or swimming in contaminated water has now been officially recognised..."
http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf
This has implications in a variety of situations: drinking water from, or swimming in, bodies of water where migratory birds frequent (prior to any potential pandemic); hunting waterfowl (prior); or distancing-in-place during a pandemic (supply-chain disruption will almost surely stop chlorine deliveries and human H5N1 sheds huge quantities of viruses in feces -- a novel situation for influenza). Fecal contamination of water could prove to be a vector for past and future human cases.
[Our local Little League fields have an adjacent lake where large numbers of ducks and geese frequent and local dogs chase them into the water -- it's great sport for the dogs and fun to watch, geese are very scrappy and many dogs back down. I was at a game yesterday where a Golden Retriever did a coat-shake maneuver next to a viewing stand and got about 20 people wet in one go. That might be less funny if geese w/ avian flu migrate from Canada this fall.]
==============================================
About that new cluster in Surabaya, Indonesia. It is significant because it comprises a teacher and student. (No word on the 12 in quarantine reported earlier)
http://www.mediaindo.co.id/berita.asp?id=100362
"...a new cluster of confirmed or suspect H5N1 bird flu cases in Surabaya. The confirmed case (38F) was describe in the WHO update. She developed symptoms on May 2, was hospitalized on May 7, and died May 11. The above report indicates her child is now hospitalized with bird flu symptoms, consistent with human-to-human transmission within a family."
Another suspect case (20M) died today, but the same hospital has admitted two additional suspect cases, a teacher (30F) who died earlier, and her student (18M) who is in critical condition and on a respirator.
The geographical cluster in Surabaya thus has one confirmed and four suspect cases. Two of the suspect cases have died, and the student of one has been hospitalized. Similarly, the child of the confirmed case has also been hospitalized."
================================================
Finally, an article by Helen Branswell. She's a Canadian journalist who's won the Pulitzer for non-fiction. If it's under her byline, it's accurate and balanced.
"Bird flu cases in Indonesia raise questions about pandemic containment plan"
http://cnews.canoe.ca/CNEWS/World/2006/05/20/1590247-cp.html
.
There was a new death today (22May2006) in the original cluster chain from N. Sumatra. While transmission is far from "efficient" it isn't as inefficient as it once was.
The cite below is from Henry Niman, who is a somewhat controversial guy. His facts are always spot on but people sometimes (often) disagree with his interpretations. He is the consummate outsider whose "ridiculous" ideas become conventional wisdom with unnerving regularity (he was the first - in 1998? - to warn that wild waterfowl, specifically bar-headed geese, would carry H5N1 around the world; he was ridiculed for that). Someday I'll discuss reassortment vs. recombination vs. point mutations as modes of flu mutation. Niman was the pioneer of the recombination theory, which was originally scorned but is now one of those "well of course that's how it works" things.
Recombinomics (http://www.recombinomics.com/News/05220603/H5N1_Transmission_Chain_Indonesia.html)
May 22, 2006
The growing H5N1 bird flu transmission in Medan, Indonesia has raised transmission and transparency concerns. The cluster has now grown to eight, and seven members of the cluster have died. H5N1 has been confirmed in all except the index case and the disease onset dates indicate there have been three generations of human-to-human (H2H2H) or possibly four generations (H2H2H2H).
Every lung cancer case in the US can be linked to poultry -- it's a fact. But that doen't mean poultry cause lung cancer.
"The WHO has been extremely concerned that none of China's 18 confirmed human cases to date have occurred in areas where outbreaks in poultry were previously reported. In most of the cases thorough investigations after the fact have pointed to some possible exposure to poultry. But the lack of obvious links disturbs international public health authorities."
Article from the great Helen Branswell (http://chealth.canoe.ca/channel_health_news_details.asp?news_id=17701&news_channel_id=1020&channel_id=1020)
GENEVA (Reuters) - The United States has sent a supply of Tamiflu to Asia to help the region prepare for a human outbreak of avian influenza, U.S. Health and Human Services Secretary Mike Leavitt said on Monday.
Leavitt did not say how much of the medicine -- recommended by the World Health Organisation (WHO) as a frontline treatment against a pandemic flu outbreak -- was sent, or where it would be stored.
"The United States government has just deployed treatment courses of Tamiflu to a secure location in Asia. The shipment is currently in transit and it will arrive later this week," he told journalists during the WHO's annual assembly in Geneva.
"I am not going to specify the amount or the location, but I want to make clear that we are beginning to deploy it," he said.
GENEVA (Reuters) - The United States has sent a supply of Tamiflu to Asia to help the region prepare for a human outbreak of avian influenza, U.S. Health and Human Services Secretary Mike Leavitt said on Monday.
Leavitt did not say how much of the medicine -- recommended by the World Health Organisation (WHO) as a frontline treatment against a pandemic flu outbreak -- was sent, or where it would be stored.
"The United States government has just deployed treatment courses of Tamiflu to a secure location in Asia. The shipment is currently in transit and it will arrive later this week," he told journalists during the WHO's annual assembly in Geneva.
"I am not going to specify the amount or the location, but I want to make clear that we are beginning to deploy it," he said.
Sorry, I should have expanded, this is not the time to be cryptic or coy. First, let me say that I do NOT have any inside info beyond what I am gleaning from news reports. With that out of the way...
Mike Leavitt is the straightest shooter on this issue in the USGOV. NAMRU-2 is feeding sequence data and viral isolates back to facilities in the US -- don't know this for a fact but it's just common sense. If he says "..I want to make clear that we are beginning to deploy it" then he is telling us something, i.e. there has been a major uptick in the concern level by those in the know.
Couple this with recent comments from China's Vice premier Hui Liangyu 21May2006: "Summing up and analysing the epidemic's current development both inside and outside the country, the... situation is not optimistic." This is a very stark assessment for a high govt official.
We don't have enough TamiFlu for even a fraction of the US population, so if it's being sent overseas that's a pretty strong message.
If you've been sitting on the fence on this issue, well...let's just say I think I'd be much more comfortable right now having my preparations complete so I could watch events unfold. Even if we dodge this particular bullet this mess is going to go on for years. Get ready so you can forget about it and go on with your life.
.
Martial law has been declared in a European capital, 13,000 people have been quarantined, 40 streets have been blocked off and all businesses in the area shut down, there are reports of 4 people in quarantine, 2 are dead from H5N1 in Iran and an unspecified number are hospitalized and no report of it on the six o'clock news? Impressive journalism.
I did learn that Britney Spears almost dropped her baby recently (while holding an alcoholic beverage) and is apparently being visited by CPS.
Bucharest - About 13 000 people were quarantined in the Romanian capital Bucharest on Monday as troops and police sealed off streets in response to the city's second bird flu outbreak, officials said.
The mayor of the southern fourth district, Adrian Inimaroiu, said residents would be cut off and all businesses in the area would be closed during the quarantine period of up to three weeks.
The move came after the agriculture ministry earlier on Monday confirmed the presence of the H5 bird flu virus in dead chickens found in the neighbourhood, the latest of dozens of outbreaks of avian flu in Romania this spring.
"About 40 streets have been blocked" in the Luica quarter, Inimaroiu said, urging residents to stay calm.
He said the quarantine would last for a "period of a week to 21 days and all the institutions in this quarter will be closed".
"About 2 500 birds from this area will be slaughtered as rapidly as possible," the mayor said.
A neighbourhood on the northern outskirts of the capital was put under quarantine on Sunday evening with fences blocking a dozen streets and police preventing anyone from going in or out, except for medical emergencies.
This is a combination of news reports and Chatham House Rule emails:
Roche donated 3 million doses of Tamiflu, to be used as a fire break when a pandemic started. Half of this stockpile is in the US and half is in Switzerland. The deal is, it is only to be released under authorization of the WHO. The protocol for the release is detailed at the end of this message (sorry for the crappy formatting, it's from the WHO pandemic influenza draft protocol for rapid response and containment). This is all published fact.
Anyway, on to scuttlebutt, but informed scuttlebutt: Leavitt (USGOV HHS Secretary) is of the opinion that the pandemic has already started, or its start is imminent: "...the situation represents a transition in the behaviour of the virus likely to result in efficient and sustained human-to-human transmission" in the words of the protocol.
The word is that the WHO is in disarray -- it's top dog stroked out and died yesterday -- and Leavitt has taken it upon himself to release the Tamiflu. The strategy he is using: he is robbing Peter to pay Paul by sending US-purchased Tamiflu and withholding the Roche-donated Tamiflu. This pre-positions the stuff for rapid use (which he must think is worth a try -- lotsa luck) and still keeps the original amount of US stocks on hand. Slick. He's 1) sent a message 2) gotten the stuff where it might do some good 3) not really sent any of our very limited stock 4) called out Indonesia for lying about H2H.
Note that three of the four conditions in the protocol that presage "efficient and sustained human-to-human transmission" -- nos. 2, 3, and 4 -- have been met and there are rumors about no. 1.
mugwump
Containing the event
The rapid response and containment operation
The decision to launch a containment operation
An attempt to contain an emerging pandemic virus at its source is a demanding
exercise and a resource-intensive operation. Moreover, supplies of antiviral drugs reserved for use to support such an operation are finite and not easily replenished, and must therefore be used judiciously. For these reasons, the decision to initiate activities aimed at rapid containment should be triggered by compelling evidence that the situation represents a transition in the behaviour of the virus likely to result in efficient and sustained human-to-human transmission. Such evidence will derive from a combination of clinical,
epidemiological, and virological findings as guided by the following criteria:
1. Moderate-to-severe respiratory illness (or deaths) in three or more health care workers who have no known exposure other than contact with ill patients, and laboratory confirmation of H5N1 infection in at least one of these workers.
2. Moderate-to-severe respiratory illness (or deaths) in 5 to 10 persons with
evidence of human-to-human transmission in at least some, and laboratory
confirmation of H5N1 infection in more than 2 of these persons.
3. Compelling evidence that more than one generation of human-to-human
transmission of the virus has occurred.
4. Isolation of a novel virus combining avian and human genetic material or a
virus with an increased number of mutations not seen in avian isolates from one or more persons with moderate-to-severe respiratory illness (acute onset), supported by epidemiological evidence that transmission patterns have changed.
:)
"The chair is against the wall. The chair is against the wall."
In what some are calling a preamble to an escalation to pandemic Phase 4, the WHO have finally recognized that the Indonesian cluster in Sumatra was caused by H2H, and probably H2H2H transmission.
http://quote.bloomberg.com/apps/news?pid=10000087&sid=adYneL14QhK8&refer=home
:)
"The chair is against the wall. The chair is against the wall."
Mugwump, thank you for the continued flow of information, but don't stop now please provide follow up to your last few threads.
Mugwump, thank you for the continued flow of information, but don't stop now please provide follow up to your last few threads.
It's time to scream, shout and run about when mugwump posts "The chair is against the doorknob.":D
Not that any here would do that, or that any not here would notice.
But we will be ready.
Pete
mumbleypeg
05-23-2006, 13:43
:)
"The chair is against the wall. The chair is against the wall."
First they insisted it wasn't human to human transmission. Thanks for the posts.
Mugwump, thank you for the continued flow of information, but don't stop now please provide follow up to your last few threads.
Not much new, awaiting test results on Iranian, Romanian, etc. samples and watching events unfold in Indo. I can give you some observations and my assessment of where we are right now.
People are really wondering about Romania's quarantine efforts. Shutting businesses, stopping food deliveries, using the army for coerced quarantine seem a bit extreme for bird infection, but maybe they are the ones who've got it right. Who knows, time will tell.
Europeans I work with think Leavitt is showboating by releasing the US Tamiflu. But, they truly hate us and would say something snotty regardless. Others think it's a smart gesture for signaling his opinion that we are in pandemic Phase 4, but doubt the Tamiflu will ever be used in Indonesia -- like pouring it down a rat hole. Personally, I hope it's being prepositioned for the military in Iraq, A'stan, Korea, Guam.
No one I know thinks that a breakout with an RO > 1 can be contained if it occurs in China, Indonesia, or India. Not even with boatloads of Tamaflu.
The WHO are playing a political game and are playing "parse the sentence" silly buggers in press releases. They know things have gone futher than they will admit. No one is willing to play hardball with Indonesia.
There is rank pessimism about the situation in Indonesia. A smart guy I know has said "notice how the flu cases are being reported by major medical centers?" His point is, it's like the drunk who lost his keys at night, somewhere between the bar and his car, searching under the streetlight because that's where he can see. There is a strong possibility that the same kind of clusters as those found close to primary med centers in Sumatra and Java are dotted all over rural Indonesia, "in the dark" so to speak.
The people in rural Indonesia are like people anywhere, I'm sure. The govt. is apparently held in very low esteem in the countryside and there is great distrust of health care workers (including from the WHO). Contrary to popular belief (and govt statistics) a large proportion of them are not Muslims but animists. They are not stupid but they are ignorant, and the govt. programs to spread the word about H5N1 have been pathetic.
There is so much dengue, TB, "normal" pneumonic disease, and chikungunya fever in Indonesia, India, etc. and the death rate from infectious disease is normally so high in these areas that it takes something truly extraordinary to create a stir. For example, there are estimates that 2 million Indians have contracted chikungunya and hundreds have died from it in the last several months. A few more flu deaths wouldn't be noticed.
My take? We are in Phase 4 and in retrospect have been since 2005. We are seeing inefficient H2H (and H2H2H) transmission of H5N1, and it is getting incrementally more efficient as time goes on. Birds have something to do with some cases, but very few.
I do not think we have reached the tipping point yet.
I think the breakout, if it occurs, will be heralded by a "bolt out of the blue" report of hundreds of seriously ill poor people in Nigeria, rural China or the sticks of Indonesia. The outbreak will only come to light when it is finally diagnosed in a privileged person in the middle/upper class.
It's possible that one of these clusters that are "under the streetlight" will be the one that goes ballistic, but pure probability argues against it. The breakout will probably be from that cluster cooking away out in the dark, in the poor slobs who have no access to health care.
I think the current press coverage is contemptible. The GW Bush administration has staked out a position on BF, so the liberal press (esp. the LA Times and NY Times) continue to pour out "Y2K with Feathers" stories. As an example, Robert Webster (a true expert) said he thinks that H5N1 **in birds** won't arrive in N America this year because he doesn't think the infection made it to Canada from Siberia or Nigeria this spring. Fine. But, that doesn't warrant "Expert Says No Bird Flu in US This Year" headlines. Very misleading. Right before the breakouts of avian H5N1 in Denmark, Hungary, Romania, Slovenia, etc. last week, the press was bugling that H5N1 was eradicated in Europe. WTF? Can't someone give a real expert a jingle before they publish this crap?
The only honest report will say nobody knows what is going to happen, because that's the truth. The risk is getting incrementally greater as time goes on, true, and that should be discussed. If it does hit, it could be horrendous. So, we should prepare. It's a given in crisis communications that people have to be frightened before they change their normal patterns of behavior. This constant drumbeat that people shouldn't be afraid is bullshit. It delegitimizes any climate for preparation as it mocks the few who do prepare. Jeez, only in America is it a God-given right to never be frightened by life.
I know some very gutsy people who are scared shitless by this virus.
I think the USGOV should spend less time and money on vaccines and more on food and fuel storage and infrastructure redundancy. Vaccines are critical, but there comes a point where more money doesn't help. Spend it on something useful.
mugwump out
:)
"The chair is against the wall. The chair is against the wall."
That is such an inside joke that I am probably the only one who could get it. It's a line from a guilty-pleasure/crappy movie called Red Dawn where survivalist kids go up into the mountains following a Soviet invasion of the US and stage a guerrilla war. In the movie, the line I quoted is from a radio show on Radio Free America or some-such sending messages to the resistance.
I was making fun of myself.
I don't normally discuss my work or H5N1 with anyone in the neighborhood, most are flaming liberals ("HELP ME" signs) and I learned my lesson with my in-laws. I made an exception with my best neighbor-friend who moved to the other side of town. I voiced my concerns about the pandemic and infrastructure fragility and he came back with "So are you going up into the hills with a rifle to play Red Dawn? [holding nose and making static noises] 'The chair is against the wall. The chair is against the wall. John has a long mustache. John has a long mustache.' "
A-hole. He came around on his own -- he owns a food distribution company and he couldn't get his stuff to WalMart one week (HUGE $$$ loss) when congestion in the Texas rail network sidelined his product. That made him see the supply-chain light. Stubborn, maybe, but stupid he ain't.
I don't think we've reached a tipping point yet, but I do think that things have gotten a notch worse.
I'm quite proud of that whole, drunk - streetlight analogy by the way. I'm going to trademark it, if I can be sure I didn't read it somewhere else first. Now that I think of it, it came from an old joke. Never mind.
jfhiller
05-23-2006, 15:26
Encouraging stuff. I'm headed to Turkey on Thurs for 2 weeks. Hope I'm not the one to bring a little gift for my fellow Americans on my return. That's not the way one wants to spend his 15 minutes in the spotlight...
Peregrino
05-23-2006, 16:11
That is such an inside joke that I am probably the only one who could get it.
Mugwump - You were doing so well too! :rolleyes: Now you lose all the cheese points you accumulated with a really cool inside jab (that was a little too pointed to pass for a poke) by explaining yourself. You forgot that at least a portion of your audience has studied GW from a professional viewpoint and we remember where Milius drew his inspiration. (And it wasn't a "crappy" movie so much as a "cheesy" one.) BTW - Excellent thread. You've been carrying the full load and I for one appreciate what you've done and the tone you've taken. I've sat in on real world contingency op intel briefs that weren't as professional or informative. A balanced reporting of information and (clearly identified) analysis gives the rest of us what we need for reasoned risk assessment and helps guide our mitigation plans/preparation. Holding a rational middle ground between "Chicken Little/stock the bunkers and fend of the hordes" and "it can't happen here" is a difficult job. Please keep up the good work. Peregrino
Mugwump - You were doing so well too! :rolleyes: Now you lose all the cheese points you accumulated with a really cool inside jab
Story of my life.
I defer to your judgment on cheesy vs. crappy, but I must respectfully remind you of the scene where Lea Thompson stares into the fire and says:
"Things are different now" [stare into the fire...hold...hold it...wait for it, CUT!]
Huh? Huh? <elbow> You remember. That said, I still watch it every time it comes on tv. Good Soviet armor and multidimensional bad guys.
Thanks for the high praise. (sorry about the elbow) mugwump
In what some are calling a preamble to an escalation to pandemic Phase 4, the WHO have finally recognized that the Indonesian cluster in Sumatra was caused by H2H, and probably H2H2H transmission.
http://quote.bloomberg.com/apps/news?pid=10000087&sid=adYneL14QhK8&refer=home
I find it interesting (but not surprising) that the financial media have on average the best coverage of the pan-flu issue. They put out the occasional boneheaded article where they take WHO pronouncements at face value, but it's generally quite good.
Now on to Maxim. How did Kate Beckinsale not make the 2006 Hot 100? Inconceivable.
mumbleypeg
05-23-2006, 17:50
I was in a Doctors office last July. He had written a preparedness document for a government agency. He had a large section on H5N1. I though it was interesting. Last summer I wasn't ready to keep duct tape and masks in my car. He gave me a lecture on how to seal my car. It seemed very alarmist at the time.
It seems sensible now.
Oh! Wolverines!
Encouraging stuff. I'm headed to Turkey on Thurs for 2 weeks. Hope I'm not the one to bring a little gift for my fellow Americans on my return. That's not the way one wants to spend his 15 minutes in the spotlight...
No worries mate, someone has to do it. Save me a respirator.
There are reports of 80 in hospital for H5N1 and 10 dead in Bandung, East Java. This is not true. It's the result of a bad translation job on an Indo news release that's been picked up by the press. The 80/10 is a summary of all cases in Java since Feb' 2005, and the 80 figure includes unconfirmed cases.
jasonglh
05-23-2006, 20:29
Now on to Maxim. How did Kate Beckinsale not make the 2006 Hot 100? Inconceivable.
Obviously the apocalypse is upon us.
Thanks for all the updates mugwump.
To all that have provided input into this thread. Cheers to you all. I watch TV now looking to see what is posted on here to come up on Local to National to International news. Not until today did I see something about Romania Cases.
Mugwump please keep up the post (updates). This has to be one of the BEST Threads on the net. Everyone making commits add to the substance of what this Thread is about - Thanks. I read here then go to search online to see what others or the news has to say about it (post).
Now What to do - get a flu shot - make sure my family does or run out and get that kiddy pool and some duct tape. :D
Thanks
This woman is aces...
http://ca.news.yahoo.com/s/23052006/2/xhealth-indonesian-bird-flu-cluster-human-human-human-spread.html
By Helen Branswell
(CP) - The large cluster of human cases of H5N1 avian flu being investigated in Indonesia may represent the first time the virus has been seen to ignite two successive waves of human-to-human spread, the World Health Organization said Tuesday,
A spokesperson said the agency has not yet started the process of reviewing whether the global pandemic alert level should be raised to Phase 4 from the current Phase 3.
But Maria Cheng said it is conceivable that WHO might convene a meeting of the panel of experts who would advise on that decision - depending on what further investigation in the affected area reveals.
"This is the first time we have seen cases that have gone beyond one generation of human-to-human spread," Cheng told The Canadian Press.
"It is an evolving situation and it is possible we would convene the task force if we saw evidence the virus was changing."
According to the WHO's six-level pandemic staging plan, Phase 3 is no human-to-human spread, or only on rare occasions after close contact with a sick individual. Phase 4 is a small cluster or clusters of limited and localized human-to-human spread, a pattern suggesting the virus had not yet become fully efficient at infecting people. Phase 6 is a pandemic.
Cheng noted the pattern of infections in this cluster seems to point away from a substantial change in the transmissibility of the virus. So do the genetic sequences of two viruses retrieved from this group of people. A statement from the WHO said analysis of those viruses showed "no evidence of significant mutations."
But a veteran U.S. infectious diseases expert said he's worried the world may be seeing something different with this group of cases.
"Certainly there've been more cases in this cluster than we've had before," said Dr. D.A. Henderson, of the Center for Biosecurity of University of Pittsburgh Medical Center.
Previous cases of human-to-human transmission of the H5N1 virus are believed to have happened, but it is thought that in those earlier instances the virus died out after one generation of person-to-person spread.
There has been a clear pattern in all these cases: A family member, closely tending someone severely ill with the virus, becomes infected, presumably through exposure to large amounts of virus. And that pattern appears to hold in the Indonesian family cluster, Cheng said.
Henderson, who wasn't so sure, suggested in this case it seems illness has spread beyond caregivers to others in the family. An 18-month-old girl and a 10-year-old boy are among the dead.
"They all had contact, but it was not the kind of contact we've had described before, where the caregiver would be really heavily exposed," he noted.
"And from that standpoint, I find this worrisome. And I think there is an awful lot of information we need about those cases and the circumstances."
Cheng said if new cases began to emerge where people with only passing contact with a case became infected "certainly our level of alarm would increase."
"We haven't seen any evidence that's the case," she added. "So far we haven't identified cases outside this family cluster."
Expert investigators from the WHO and the U.S. Centers for Disease Control believe a woman who died in early May infected some members of her extended family, including a 10-year-old nephew.
During his illness, the boy's father helped nurse the child. The boy died on May 13. Two days later his father started developing symptoms . On May 22, the father died.
Cheng said the current theory is that the index case infected her nephew, who infected his father.
The first case, who died on May 4, was not tested before her burial and is not factored into the WHO's official case count. Investigators in the village of Kubu Sembelang in the Karo district of North Sumatra are watching closely for any evidence the virus is continuing to spread among contacts of the family. Cheng said 33 people are under observation, though she had not heard whether any of them are showing signs of illness.
Some are being given the flu antiviral oseltamivir or Tamiflu. Others were not. Cheng wasn't clear why all the contacts were not taking the drug.
But there have been reports that the rapid and devastating decimation of this family - eight people have become ill, seven have died - has triggered a local crisis of confidence with surviving residents of the village demonstrating fear and hostility to authorities. It was reported, for instance, that the man who died on May 22 refused to take Tamiflu. He fled from the investigators and authorities and lived on the run, sheltered by friends, for the final four days of his life.
"We are still not getting the level of co-operation we would consider optimal," Cheng admitted. Additional WHO personnel are being sent to the village. Included in the group is an expert on social mobilization - the art of gaining local trust and co-operation in the high tension setting of an infectious disease outbreak.
Now What to do - get a flu shot - make sure my family does or run out and get that kiddy pool and some duct tape. :D
Thanks
MtnGoat, I've stopped with the "you might find it prudent" line I was following before. I say, yes, definitely start getting ready now. It's important to get your wife dialed in. Double up on your food purchases now if you can. Beans, rice, oil, flour, yeast, sugar, salt, honey, canned goods, pasta, multivitamins, Spam/tuna, add-water pancake mix, syrup, whatever the kids need -- in short anything that you normally eat and that stores well and yo can rotate. TR gave a good summary near the top of the thread.
And yes, you should think about having some way to store water. The thin plastic drop cloths for lining the bathtub, the wading pool, plastic jugs, whatever. I like the wading pool thing because it's cheap and takes up very little room until you decide you need it. Find the pool shock - hardware store? - and get two packages, one for disinfectant and one for water purification. Print out the instructions and put it w/ it (something I just did). You might get sick first, make sure there are written instructions for everything for your wife.
Get rubber dishwashing gloves. Clothesline and clothes pins. A pet hamster (not really, just checking if you were still reading).
Get a big jug of generic Tylenol (acetaminophen), generic diarrhea pills (loperamide hydrochloride), Morton Lite Salt and baking soda and sugar for oral rehydration solution, a thermometer, drinking straws, jello/broth/ginger ale for recovery. A 5 gal paint bucket with lid for the sick room. Lots of soap.
Paper goods: my wife had the seasonal flu and I was amazed how much kleenex she went through. Paper towels and tp.
Twelve cases of 5.56. Oops, TR says no.
Yes, everyone in your family should get flu shots. Remember that there will be garden variety seasonal flu going around too, and you don't need to be weakened by that. If you and your kids haven't already gotten the H. influenzae vaccination, get that as well. The "H flu" vaccine has nothing to do with viral flu, even though it shares part of the name. This vaccination is given to prevent bacterial meningitis, bacterial ear infections in kids, and most importantly for this discussion, one specific type of common bacterial pneumonia. If, God forbid, this pandemic breaks out and you or yours catch it, you will of course fight it off. What you now are at risk for in your weakened state is catching bacterial pneumonia. The H flu vaccine can prevent some of those infections (those caused by Hemophilus influenzae type B). It's worth getting. My guess is that you might have already gotten this shot -- meningitis outbreaks are common in the military -- and it might be part of your kids shots already. Check on your wife.
Well, I'm covering old territory. There's a decent checklist in a message above.
Do this, start now. I just had a rather sobering conversation with a level-headed pro who shares my views: neither of us would be surprised to wake up to news of 150 cases in Indonesia or India. Let me be clear, nobody knows, certainly not me, it could sputter along like this for another two years or die out completely. Then we can all laugh and breath a sigh of relief. But if it breaks out with its current fatality rate...heaven help us because nobody else is going to.
First they insisted it wasn't human to human transmission. Thanks for the posts.
"They" think people are fools who can't be trusted with the truth.
I argue with these idjits every chance I get. Their position is summed up as follows: "If we tell the truth, the locals in the "hot zone" will bolt for the hills and spread the disease further. We've seen it before."
My response: Well what do you expect? You tell them "trust me, no problem here, move along, everything's fine" and then keep repeating it over and over even in the face of what is obviously bad news. Then one day you say "Oh, shit!"
You see it all the time in the US popular media. "Don't panic." Has anyone seen people panicking?
There is a presumptive new family cluster in Bandung. One man died in hospital last night (24May06), his brother is in intensive care and is't going to make it, and a third sibling is sick at home.
There are additional clusters that continue to cook along in Jakarta and Surabaya.
Note that I said yesterday at 19:19 not to worry about reports coming out of Bandung about 10 dead, 80 sick. I was correct in that assessment at the time, those figures represent a re-cap of cases since 2005. It is likely that media reports will make a muddle of these reports and at least some will combine the new and old reports.
There is still no evidence of a breakout in these reports, but it is obviously "worrisome" (remember?, "Oh, Shit!") that these familial clusters keep cropping up.
The concern remains: what is happening out there in "the dark?"
Crap, I gotta remember to compose in Notepad and cut and paste to here. Just lost a long post (my fault, not the board's) with a carefully documented argument. I will summarise as I don't have time to recreate it:
The WHO are lying SOSs.
Once again the WHO have taken an opportunity for a "teaching moment" and have decided instead to lie and carefullly parse their communication so as to mislead the public.
GENEVA (AP)--A family of eight people infected with bird flu in Indonesia may have passed the disease among themselves rather than individually catching it from poultry, but the World Health Organization is leaving its pandemic alert level unchanged, the agency said Wednesday.
"All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness," said a WHO statement. "Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing."
Notice how they refer to the new reality as if it is old hat: "...directly linked to close and prolonged exposure to a patient during a phase of severe illness"; as if that is business as usual and should somehow be comforting. How many times has it been put out that "this is a disease of birds" or "it requires close and unusual contact with infected poultry to cause human infection" and "this disease, on extremely rare occsaions, has passed from bird to human -- it does not pass from human to human." Beyond that, the statement is a bald-faced lie. From the previously cited Branswell article, (22:53) speaking of the "close contact by care-giver" explanation:
Henderson [Dr. D.A. Henderson, of the Center for Biosecurity of University of Pittsburgh Medical Center], who wasn't so sure, suggested in this case it seems illness has spread beyond caregivers to others in the family. An 18-month-old girl and a 10-year-old boy are among the dead. "They all had contact, but it was not the kind of contact we've had described before, where the caregiver would be really heavily exposed," he noted.
The agency's alert level remained Wednesday at 3, where it has been for months. That means there is "no or very limited human-to-human transmission." WHO spokeswoman Maria Cheng said it was unlikely the agency would raise the alert level in the immediate future.
From the WHO protocols: "Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans." I think this adequately describes the current situation. Why are the WHO's own guidelines being ignored?
"We haven't seen evidence from Indonesia that the disease is passing easily from human to human," Cheng told The Associated Press. She said WHO had considered convening a meeting of experts to debate whether to raise the alert level, but had decided that the current situation didn't merit that step.
"We had discussed that," she said. "But that is not going to happen."
Bwaa!! WTF? I certainly HOPE you haven't seen evidence! If "...the disease is passing easily from human to human" with an 80% case fatality rate then we are in the middle of a full-blown pandemic and it's literally, not figuratively, literally the end of civilization as we know it. What is it with these people?
The agency has suspected that in rare cases bird flu may have passed from one person to another, but it usually has been caught by people from chickens and other poultry.
Wait a minute...what? "The agency has suspected that in rare cases bird flu may have passed from one person to another..." Since when? They have consistently stated, up until now and in total disregard of the facts, that all human infections have been caused by intimate contact with infected birds or their feathers. Were you lying then or are you lying now?
WHO said that testing indicated there had been no significant mutations in the virus.
Notice the qualifier "significant." This is already being reported in the popular press as "no mutations." There has been a mutation in the one isolate released to GenBank by NAMRU-2 and I'm told it is significant. I'll discuss it when I understand it.
mugwump out
I've just been called to an impromptu meeting but it's in the US, probably through Friday. My usual hotel is full and I don't know if the roach motel I'm in has net access -- getting out on the corporate net is usually problematic, they are pretty paranoid.
So, just business. I have not duct-taped myself into a closet.
mugwump
Last post:
WHO web site: "...no evidence of significant mutations."
CNN report: "...genetic sequencing has shown the H5N1 bird flu virus has not mutated."
See what I mean. WHO sucks.
You guys get "The chair is against the wall", obscure as that is, but nobody at this meeting got "cluster cluck."
So I'm at this flu meeting and it's getting a bit tense so I say "The situation in Indonesia is a real Cluster Cluck," which I think is pretty funny on several levels. All I get is fish looks. In retrospect I don't think they're conversent with the term I was playing off of. With Peregrino's comment about cheese points in mind I did not attempt to explain.
The take-home sound bite from the meeting is this Sumatra cluster isn't it yet, although more cases between now and June 6 could change that assessment (varying incubation times are proposed for new cases, with June 6 representing the outside date). Personally, I thnk if we dont see a bunch of additionial cases in the next 3 days we've dodged a bullet.
I'll write more impressions when I get home. I wish I could have taped one guy's presentation for you -- he compared the flu virus with a weapon. It was kinda 'out there' but pretty cool nonetheless. I'll try to recreate his points from my notes.
A straw poll revealed 3 attendees took prophylactic Tamiflu for the trip -- airport worries. Wussies.
mugwump
Last post:
WHO web site: "...no evidence of significant mutations."
CNN report: "...genetic sequencing has shown the H5N1 bird flu virus has not mutated."
See what I mean. WHO sucks.
The WHO are lying SOSs.
Mugwump - Between you and what I see and read this is some great Info. Please keep it up. about you losing all those cheese points - yo get them back just like the rest of us. Well most of us. :D Just keep the thumb pointed out so you can give that good point jab.
This an excellent thread!! We appreciate what you've done and posted and what you have done. Great rational middle ground, I think, between "Chicken Little" and get the Play pool ready Hunny to get the LaMas ammo to "fend of the hordes".
Its really found to read and search the Net to see CNN or someone report how nothing is really happen with the "Bird Flu" But anyone that can read between the line can see what is going on and is going to happen with this. So please keep up all of the good post.
VG
I recommend that you go read this, top post and nonlocality's follow-up:
http://www.flutrackers.com/forum/showthread.php?t=6497
I'm pretty sure I know this guy -- verrry bright. Sounds like him, anyway. Everyone on FluTrackers is anonymous.
This is a very good post and basically summarizes a position that was staked out yesterday -- viral load estimation, branching of infection trees, and generation series are much better predictors of panedmic.
Note his estimate that we'll have sufficient time to finish (not start, finish) preps once a breakout has occurred. This was debated pretty strenuously after-hours, I'll recap when I get time.
mugwump
I'm pretty sure I know this guy....
Nope, it's not him or he's not admitting that it is. Ha, if someone asked if Mugwump was me I'd say "No" too. So who knows.
Meeting highlights:
-- Don't expect a vaccine. You will hear happy noises, like with the Montpellier crowd, but the vaccines will be pigs wearing lipstick -- failures dressed like successes. Everything so far is taking huge doses plus adjuvants in two injections. The industrial scale-ups still aren't working. This failure is all published (albeit covered in lipstick), and not CHR. The market analysts on Wall Street know too so I'm not telling tales out of school. Sorry.
Like the prior palavers with the flu-bies, the most interesting stuff was over beers.
-- People with contacts in the field are talking about additional unreported clusters. Disconcerting, but according to these guys not the end of the world. They suggest forgetting about microscopic examination of each cluster and just get excited if/when the H2H chain gets longer than 6 weeks. See nonlocality's post linked above this post. He is an epidemiologist from the way he talks and if it's not the guy I think then all of these guys are talking among themselves and have reached a consensus, because this is pretty much exactly what I heard was his position.
-- A really smart guy is most worried about Africa because of the high incidence of AIDS. It's really weird, but apparently because their immune systems are so compromised, AIDS patients are less affected by flu initially. The flu usually kills by causing the host immune system to go into overdrive -- you are basically killing yourself on instruction from the virus. Weak immune system, like w/ AIDS and you get a less self-destructive immune response. They expect close to 100% fatality in AIDS patients eventually, but they will be ill for a longer period of time. This gives the virus more time to mutate, or to reassort with any other flu they might be infected with, and more time to pass it on. Apparently these immunocompromised patients are excellent breeding grounds for flu.
-- No one believes the WHO any more. They have completely buggered themselves. The "no mutation" comment, i.e. genetic sequence of human viral isolates is identical to chicken viral isolates is bullshit. I've been working on a post to explain this but it's complicated and it's still too technical. Soon, I hope, although I suspect for many it will be more than you want to know about dolphins.
-- Really-smart-AIDS-guy's girlfriend (also a public health wonk) says the US food supply can not support even a small percentage of the population stocking up for even 30 days, much less 90. That's why official recommendations say 72 hours to 2 weeks. They know it's not enough but it's like everything else -- food exports are a major source of foreign exchange and help offset our huge trade imbalances, China is sucking up food and holds massive dollar reserves, Africa is a basket case with Zimbabwe out of the export picture, etc. etc.
I have no cites on this and I haven't even started looking into this. She was cute, had really blue eyes, and after 4 beers I was believing anything she wanted to say. If anyone knows anything about national food stockpiles please post it.
-- The CDC, WHO, sovereign nations (China, Indo, Turkey, Azer'an) and anointed researchers (old boy network) with access to the genetic sequences are hoarding them -- I've been reporting on this for a couple of months now. It's not due to bioterrorism fears -- the entire H1N1 sequence is published and that could cause a pandemic. NAMRU-2 also published an entire H5N1 sequence before they were reined in by the USGOV. If a pandemic breaks out the individuals responsible for hoarding sequences will be hunted down and killed. I truly believe this. It's a crime against humanity in the name of profit, personal glory, or just sheer bloody-mindedness.
I might think of more but it's late and the Knob Creek and branch is calling.
mugwump
The WHO has a new web site (http://www.who.or.id) tracking events in Indonesia.
It's very slow -- probably a lot of traffic.
Indo map (http://www.who.or.id/eng/php/map/humans_and_poultry.gif) of bird and human cases. It's already out of date, with the six new deaths made "official" today MIA but it's still useful.
Not yet in the WHO releases: There appears to be a new cluster that's broken out in Bandung Java near the location of the brother/sister group reported in post 5/24 08:20. (I have to apologize for that, by the way. I reported that as a man and his brother when it was brother/sister. I'm trying to be careful, but the machine translations are having trouble with gender and honorifics.) The reports are still only in Malay at this point. It will probably hit the general press in a couple of days.
I'm probably going to slow down on the blow-by-blow accounting of the flu clusters. The clusters are getting more frequent and I expect that trend to continue. I will continue to watch this and I am still getting email alerts from folks in the field and others who are following this closely as well. The way things stand now, it could have started already unbeknownst to anyone or we might see these little clusters popping up for another two years.
I'll certainly let everyone know if it reaches the point where I'm filling the wading pool or if I would refuse to travel. :munchin
mugwump
My wife wouldn't listen to me, but she did listen to Oprah.
Her avian flu show with Osterholm (CIDRAP, Associate Director, Department of Homeland Security) repeats tomorrow 30May06. Osterholm does his usual thang, i.e. pulls no punches and scares the crap out of people. Pretty sobering stuff.
If you've got a female on the fence this is a good show to have her watch.
mugwump
RALEIGH, N.C. - If a flu pandemic strikes North Carolina, state officials don't want people going to the movies. Instead, they want them to stockpile food, medicine and water - and stay home.
http://www.charlotte.com/mld/observer/news/local/14690101.htm
I'm told NC is getting it all into one sock. Apparently, they have a plan to get porta-cabins stocked with food on location of water and electric facilities. The plan is to isolate essential workers and their families so infrastructure can be maintained. Can anyone confirm this? Sounds very sensible. If power and water can be maintained it simplifies things enormously.
RALEIGH, N.C. - If a flu pandemic strikes North Carolina, state officials don't want people going to the movies. Instead, they want them to stockpile food, medicine and water - and stay home.
http://www.charlotte.com/mld/observer/news/local/14690101.htm
I'm told NC is getting it all into one sock. Apparently, they have a plan to get porta-cabins stocked with food on location of water and electric facilities. The plan is to isolate essential workers and their families so infrastructure can be maintained. Can anyone confirm this? Sounds very sensible. If power and water can be maintained it simplifies things enormously.
Mugwump
Funny I was going to post what the local news put out today on the Flu. Come here to find you have posted something already. Cease to amaze me with you insight and post.
Don't know about the Porta-Cabins, but I'll ask to locals within the Gov't "seats" to see what they say about this here in town.
Thanks
"..."I don't think anyone can understand it unless you come here and see it for yourself," said Steven Bjorge, a WHO epidemiologist in Jakarta. "The amount of decentralization here is breathtaking."
He said Health Ministry officials often meet with outside experts to formulate plans to fight bird flu, but they are rarely implemented.
"Their power only extends to the walls of their office," Bjorge said, adding that the advice must reach nearly 450 districts, where local officials then decide whether to take action."
Bird Flu Explodes in Indonesia (http://www.forbes.com/home/feeds/ap/2006/05/31/ap2784294.html)
There were reports in the press over the weekend that varying numbers of people (35 to 56, I think, depending on the report) from the village in N Sumatra where the largest cluster was centered -- contacts of the family that died -- were placed on Tamiflu and put under quarantine. I received an email from a WHO worker bee who has visited the village: there is no quarantine in effect and they aren't taking the Tamiflu. [Added: http://www.antara.co.id/en/seenws/?id=13632]
WHO are trying to get local witch doctors to infuse the Tamiflu with "warding powers" (good spirits) so the people will take it.
I shit you not.
My contact has been in meetings where strategies are argued over, agreement is reached, a press release written, and then absolutely nothing is done. He says the only efforts being made are to appear to be doing something. There is no attempt made to actually accomplish anything.
No one is in charge. (I know, sounds like the US Senate.)
Thankfully there are no signs that the North Sumatran contacts are ill.
mugwump
There are CHR reports that throat and nasal swabs are coming up positive in recent H5N1 cases in Indonesia. This is significant. Nasal swabs were consistently negative in the past.
All Type A influenza (and H5N1 is a type A flu) start as a gut disease in birds. These bird viruses are adapted to reproduce most effectively at temperatures of 105 F, the core temperature of your average fowl. Because optimal H5N1 replication temperature is significantly warmer than human body temperature - the human nasal tract has a temp of about 94 F - this trait is considered one of those "species barriers" that makes it currently difficult for the virus to jump into humans.
These positive nasal swabs are a possible explanation for the increase in cluster sizes we are seeing in Indonesia. The fact that H5N1 is being cultured from samples in the human nose and throat may mean that the virus has mutated to replicate more efficiently at lower temperatures. Viruses are much more efficiently spread when they are replicating high in the respiratory tract versus deep in the lungs.
One tiny mutation can allow this "cold adaptation" to take place and the location of this change is well documented (http://jvi.asm.org/cgi/content/full/75/11/5398). This tiny change, while potentially quite important, could still fall into WHO's carefully parsed definition of "no significant change." (It depends what the meaning of "is" is.)
We would know for sure if this mutation has occurred if WHO would release the genetic sequences of the recent H5N1 viruses. The change would be so obvious even I could identify it. Kinda makes you wonder why they refuse to release the sequences, eh?
Note that this tolerance for cooler temperatures, while very important to any adaptation in humans, would need to be coupled with a change in preference of receptor sites -- that sialic acid conversion from 2,3 to 2,6 previously discussed. There's no evidence that this has happened.
The thinking now is that this mutation is only big enough to create a brief "window" where an infected person is passing around the virus - probably before they become severely ill. By the time a sick person gets into the hospital, the "window" is closed -- the virus has moved deep into the lungs -- and the patient is no longer infectious.
If this is true, I expect that sooner or later an apparently healthy family member of a sick person will be brought into the hospital when they are spewing viruses and are infective. Several nurses will probably get sick. This will cause fairly widespread panic (health care workers are canaries in the coal mine) and the stock market will most likely have a bad day. But, it probably won't signal the outbreak -- just another larger cluster that will most likely be contained.
So, bottom line, steel yourself for more clusters, some of which might be quite scary and highly played up by the press. But until you see rapidly growing clusters in a short time span -- 2-4-8-16-32 over a week -- there is no immediate danger of a breakout. That said, I still think when it comes, we'll hear of hundreds already sick in a "bolt from the blue" announcement ("There are disturbing reports coming out of Nigeria/China/Indonesia that hundreds...")
mugwump
Some questions that the above post raised w/ others who read it:
--Nose swabs were taken in Turkey/Azer/Egypt patients and were negative. This was the cause of many false negatives.
--In Indonesia, small numbers of viruses remain in the nose at the time swabs are taken -- not enough to cause disease but enough to identify. It is thought that exposure to large numbers of viruses is still needed to pass H5N1 in it's current poorly-adapted state. So, the virus can be identified in the nose when the person is severely ill but there are too few at that time to cause disease. The "window" is closed in these people. This is a theory, but one supported by experimental evidence (all fatal Qinghai strains have the "cold adaptation").
This will come out tomorrow in the respected journal Nature.
"What caused the suspected human-to-human transmission at Kubu Sembelang is still a mystery. Nature has learned that the cases differed from past Indonesia cases, in that they had much higher viral loads in the throat and nose. Human-to-human transmission is more likely through droplets coughed from the nose and throat than from infections further down the respiratory tract.
Mutations in cases in Turkey earlier this year showed a substitution of glutamic acid with lycine at position 627 in the PB2 component of the polymerase gene. The mutation is thought to allow the virus to survive in the cooler nasal regions. This mutation has not been publicly reported in Indonesia previously, but Nature has learned that it occurred in at least one case in August 2005. "
Long, but worth the read...
Breaking the silence: “If this was a test to see whether Indonesia could contain a virus, they failed miserably” (http://declanbutler.info/blog/?p=41)
mugwump
Long, but worth the read...
Breaking the silence: “If this was a test to see whether Indonesia could contain a virus, they failed miserably” (http://declanbutler.info/blog/?p=41)
mugwump
Ouch. I think a few lazy reporters and secretive lab workers just got their toes stomped on.
Ouch. I think a few lazy reporters and secretive lab workers just got their toes stomped on.
I hope so. Hoarding sequences represents a crime against humanity.
I'm a pragmatist. When people at a meeting were wringing their hands, "Oh why can't we get the sequences?" I suggested it might be expedient to bribe, steal, or blackmail to get them. Bribery will work in Indonesia, theft will work anywhere, and blackmail could be as simple as a few full-page ads in major daily newspapers. If that doesn't work, everyone has something they don't want to lose...Make 'em an offer they can't refuse.
These people hoarding sequences were all betting that, while a high-consequence threat, H5N1 pandemic has a low-order probablility. That assessment -- probability -- is rapidly worsening. I expect that the sequences will shake loose soon.
If anyone thinks this is all too dramatic, well...I have sat through presentations where the terms "cultural breach", "national and trans-national dissolution" and the more graphic "civilization buster" have been discussed.
mugwump
Hey Mugwump;
For the people who are following things can you boil down to plain "American Talk" a few things about Flu and bird flu in general.
I've seen some wild numbers thrown about and with such a big world population even low %'s will be big numbers. Also preventive measures, isolation, distancing will impact infection rates but.......
If the bird flu goes H2H and hits a populated area what's the ball park right now on % that gets the flu and, of that, the % that dies. Mortality rate?
Way back in this thread there was a link to a spread map but I was wondering if things have changed any.
Pete
I've seen some wild numbers thrown about and with such a big world population even low %'s will be big numbers. Also preventive measures, isolation, distancing will impact infection rates but.......
If the bird flu goes H2H and hits a populated area what's the ball park right now on % that gets the flu and, of that, the % that dies. Mortality rate?
Pete
What are the odds this will break out? If it hits, what will the CFR be? Those are the $64,000 questions.
I can give you a really complicated answer: nobody knows. The Reaper put in one of his posts a 0.5% to 50% mortality rate and that roughly covers the range I've heard discussed.
The semi-official number used in pandemic planning in the US is a 2% case fatality rate. It is also assumed that 30%-40% will become ill. Using 300 million as the US population x 30% infection rate x 2% CFR = 1.8 million dead in the US. A significant number of survivors would have mid-term to long-term damage to lungs, kidneys, etc. Say another 7% of those who fell ill will have problems: 6.3 million.
Why 2% CFR? Well, it's just the custom (and the alternative is unthinkable). Someone once calculated a 2% CFR for the 1918-1919 Spanish Flu pandemic and that figure just stuck. More recent estimates for the actual 1918 pandemic CFR range from 6%-18%. In some places it was truly horrific: the average life expectancy in India fell by 22 years and 50% of the population fell ill, 18.5 to 25 million died.
What has everyone scared shitless is the current CFR of H5N1 (the pink line is total number of cases, the blue line the average CFR):
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About 60% -- bad juju. Note that the graph does not include May, which was a very bad month. Eight of nine died in the large Sumatran cluster (89% CFR) and three of three in the last cluster (100%).
The conventional wisdom is that as the virus adapts to humans it will become less lethal. That doesn't seem to be happening. In fact, it seems to be geting more lethal as it adaps. Mind you, it has at least one big mutation to pick up before it's off to the races. The lethality could drop if it does. Or then again it might not.
Like I said, nobody knows.
If the CFR remains at 60%, the death toll in the US would be 54 million. Worldwide, 1.17 billion. Hence the discussion of a "civilization buster."
There is still a significant chance that H5N1 never breaks out. The one guy who cooks up the last mutation needed for a pandemic could get hit by a bus before it is passed on. Nobody knows.
That said, the trend is worrisome.
mugwump
Q. Why did the Chicken Cross the Road?
* Special Forces Command: The chicken crossed at a 90-degree angle to avoid prolonged exposure to a line of communication. To achieve maximum surprise, the chicken should have performed this maneuver at night using NVGs, preferably near a road bend in a valley.
* Army Personnel Command: Due to the needs of the Army, the chicken was involuntarily reassigned to the other side of the road. This will be a 3-year controlled tour and we promise to give the chicken a good-deal assignment afterwards. Every chicken will be required to do one road-crossing during its career, and this will not affect its opportunities for future promotion.
* Army Foreign Technology Center: This event will need confirmation; we need to repeat it using varied chicken breeds, road types, and weather conditions to confirm whether it can actually happen within the parameters specified for chickens and the remote possibility that they might cross thruways designated by some as ‘roads.’
* Tower: The chicken was instructed to hold short of the road. This road-incursion incident was reported in a Hazardous Chicken Road-Crossing Report (HCRCR). Please re-emphasize that chickens are required to read back all hold short instructions.
* Army Materiel Command: Recent changes in technology, coupled with today’s multipolar strategic environment, have created new challenges in the chicken’s ability to cross the road. The chicken was also faced with significant challenges to create and develop core competencies required for this new environment. AMC’s Chicken Systems Program Office (CSPO), in a partnering relationship with the client, helped the chicken by rethinking its physical distribution strategy and implementation processes. Using the Poultry Integration Model (PIM) CSPO helped the chicken use its skills, methodologies, knowledge capital and experiences to align the chicken’s people, processes and technology in support of its overall strategy within a Program Management framework. The CSPO convened a diverse cross-spectrum of road analysts and retired chickens along with MITRE consultants with deep skills in the transportation industry to engage in a two-day itinerary of meetings in order to leverage their personal knowledge and capital, both tacit and explicit, and to enable them to synergize with each other in order to achieve the implicit goals of delivering and successfully architecting and implementing an enterprise-wide value framework across the continuum of poultry cross-median processes. The meeting was held in a park-like setting enabling and creating an impactful environment which was strategically based, mission-focused, and built upon a consistent, clear, and unified Mission Need Statement and aligned with the chicken’s mission, vision, and core values. This was conducive towards the creation of a total business integration solution. The Chicken Systems Program Office helped the chicken change to continue meeting its mission.
* Command Post: What chicken?
June 1 (Bloomberg) -- European governments need to intensify their preparations for a possible influenza pandemic as more people are exposed to bird flu, raising the risk humans will get the disease, the European Union's health agency said.
``The spread of the H5N1 virus across Africa and Asia means more people than ever are now being exposed to it,'' the European Centre for Disease Prevention and Control said in an e-mail today. ``We do not know sure whether bird flu is going to mutate into a human pandemic virus. However, we are getting nearer to finding out.''
* Command Post: What chicken?
I thought you were going here:
* Indonesian Government: "What chicken?" :)
Pat
I thought you were going here:
* Indonesian Government: "What chicken?" :)
Pat
Ain't that the truth.
Okee doke, here's one for you to chew on now that I've brought up "the end of civilization as we know it." (That's what the epidemiologists call it -- the survivalists had already trademarked "the end of the WORLD as we know it.")
There's a type of vaccine called a DNA vaccine. Basically, this vaccine is a small ring of DNA, called a plasmid, that carries instructions on how to make viral proteins. It's delivered into the skin (the epidermis, the top layer) via a very small needle. Your own skin cells take up the DNA and start pumping out viral proteins (the HA hemaglutinin receptor, let's say) according to the plasmid instructions. In effect, you have turned your skin cells into little vaccine factories.
Your body recognizes the viral proteins as foreign. This triggers an immune response, and your body starts pumping out antibodies against the viral protein. Your bloodstream becomes full of these antibodies, which attack and help destroy the H5N1 virus if you are ever exposed.
The beauty of this vaccine is that it can be made by any competent university molecular chemistry lab once its structure is worked out. We could make enough in 1 month to theoretically vaccinate the world. If the virus mutates, no worries. Just tweak the plasmid, FedEx it to all the universities, and crank out the new formulation.
Vaccine guys are heroes. There's a picture of them on the cover of Maxim, receiving the Nobel prize from Kate Beckinsale. You can't really see mugwump, he's way in the back -- that's his ear and elbow on the right. For some reason, Kate is soaking wet, and smells like jasmine...or maybe she's in that leather outfit from Underworld...I haven't really decided quite yet.
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Anyway. Here's the alternative universe. The vaccine guys create this wunder-vaccine, as in Kate-universe. Except now when the people are exposed to the H5N1 virus, an out-of-control inflammatory response is triggered. Everyone who was vaccinated dies a relatively quick but truly horrible death (ARDS, oozing blood from every orifice). Or, 15% of the people who were vaccinated get malignant melanoma. Or, 6% of those vaccinated go into toxic shock. Or...you get the drift. Something horrible happens.
Vaccine guys are villains. There's a picture of them on the cover of Time magazine, being led off to jail. That guy in the front? That's mugwump. He didn't have much to do with all this but he was somehow pushed to the front when the picture was snapped. Mugwump shares a cell with Cyrus-the-virus.
This is a true story. The Kate-universe and the Cyrus-universe are both possible. DNA vaccines exist. They are being administered to chickens every day (but they only have a six-week life span until they are converted into KFC). They have been tested in ferrets. And no ethics committee in the world will allow them to be tested in humans under the conditions I've laid out. It would be a crap shoot. I certainly wouldn't volunteer to be one of the guinea pigs.
So, at what projected case fatality rate is the risk worth the potential benefit? Trust me, it's being debated, along with mandatory vaccination programs.
mugwump
that's his ear and elbow on the right.
I'm no doctor, but I've seen one on TV. That's not your elbow! :D
Pat
The media will probably pick up on a nurse having bird flu in Bandung, Indonesia, as health care workers are the canaries in the coal mine. The nurse had treated the brother and sister who recently died of confirmed H5N1. As I said at the bottom of post 5/32 21:32, this is to be expected and isn't a huge deal in and of itself. Infection control is horrible in Indo; these people often don't even use masks.
She appears to be improving and may have had a mild case -- or it might be something else altogether.
Note that the nephew of the siblings who died (the two the nurse treated -- have I confused you yet?) also was just confirmed to have H5N1 and he has recovered. Surveillance is so poor in Indo that there may be many mild flu cases that go unreported. We just don't know and there is no money for blood studies that would find out.
This is some really good news. A Brit company has gotten a DNA influenza vaccine through Phase I (initial safety testing in man) and has shown that the vaccine appears to work at the highest dose.
This is the plasmid DNA vaccine that I described in the Kate/Cyrus post. It looks like they may get to meet Kate in Stockholm, assuming nothing untoward happens to the experimental subjects.
The good news is that this is the type of vaccine that can be made by the gallon by any competent university lab. And since the dose is three millionths of a gram, a few gallons means a lot of doses.
The journal Vaccine where the results are published is a well-respected, peer reviewed scientific journal.
http://www.medicalnewstoday.com/medicalnews.php?newsid=44435
mugwump
There is momentum building around some research into acute respiratory distress syndrome (ARDS) and ACE-2 inhibitors and ACE-2 blockers.
ARDS is what kills many of the people with avian flu. It causes your blood vessels to leak, filling your lungs with blood and fluid, and results in blood oozing from every orifice. It is caused by an overly aggressive immune response by your own body. In essence, the flu doesn't kill you, your own immune system does you in.
Research shows that something called angiotensin converting enzyme (ACE) is involved in the chain of events which leads to ARDS. ACE is also involved in blood pressure control in the body, and there are whole classes of drugs which inhibit ACE or which block its action: ACE inhibitors and ACE blockers. If you have hypertension, there's a good chance you are taking an ACE inhibitor now.
There is mounting evidence that these ACE drugs can help prevent ARDS, or at least lessen its severity.
These drugs are in good supply and are as cheap as dirt to produce. I'll update you as the data firm up.
mugwump
This will be in Sunday's NY Times.
June 4, 2006
Human Flu Transfers May Exceed Reports
By DONALD G. McNEIL Jr.
In the wake of a cluster of avian flu cases that killed seven members of a rural Indonesian family, it appears likely that there have been many more human-to-human infections than the authorities have previously acknowledged.
The numbers are still relatively small, and they do not mean that the virus has mutated to pass easily between people — a change that could touch off a worldwide epidemic. All the clusters of cases have been among relatives or in nurses who were in long, close contact with patients.
But the clusters — in Indonesia, Thailand, Turkey, Azerbaijan, Iraq and Vietnam — paint a grimmer picture of the virus's potential to pass from human to human than is normally described by public health officials, who usually say such cases are "rare."
Until recently, World Health Organization representatives have said there were only two or three such cases. On May 24 Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention in Atlanta, estimated that there had been "at least three." Then, last Tuesday, Maria Cheng, a W.H.O. spokeswoman, said there were "probably about half a dozen." She added, "I don't think anybody's got a solid number." And Dr. Angus Nicoll, chief of flu activities at the European Center for Disease Prevention and Control, acknowledged that "we are probably underestimating the extent of person-to-person transmission."
The handful of cases usually cited, he said, are "just the open-and-shut ones," like the infections of nurses in the 1997 Hong Kong outbreak and of a Bangkok office worker who died in 2004 after tending her daughter who fell sick on an aunt's farm.
Most clusters are hard to investigate, he said, because they may not even be noticed until a victim is hospitalized, and are often in remote villages where people fear talking. Also, he said, by the time doctors from Geneva arrive to take samples, local authorities "have often killed all the chickens and covered everything with lime."
The W.H.O. is generally conservative in its announcements and, as a United Nations agency, is sometimes limited by member states in what it is permitted to say about them.
Still, several scientists have noted that there are many clusters in which human-to-human infection may be a more logical explanation than the idea that relatives who fell sick days apart got the virus from the same dying bird.
For example, in a letter published last November in Emerging Infectious Diseases analyzing 15 family clusters from 2003 through mid-2005 in Southeast Asia, scientists from the disease control centers, the W.H.O. and several Asian health ministries noted that four clusters had gaps of more than seven days between the time family members got sick. They questioned conventional wisdom that only one, the Bangkok office worker, was "likely" human-to-human.
In one Vietnam cluster, not only did a young man, his teenage sister and 80-year-old grandfather test positive for A(H5N1) avian flu, but two nurses tending them developed severe pneumonia, and one tested positive.
In another questionable case, the Vietnamese government's assertion that a man developed the flu 16 days after eating raw duck-blood pudding was publicly ridiculed by a prominent flu specialist at Hong Kong University, who said it was more likely that he got it from his sick brother.
Dr. Henry L. Niman, a biochemist in Pittsburgh who has become a hero to many Internet flu watchers and a gadfly to public health authorities, has argued for weeks that there have been 20 to 30 human-to-human infections.
Dr. Niman says the authors of the Emerging Infectious Diseases article were too conservative: even though the dates in it were fragmentary, it was possible to infer that in about 10 of the 15 cases, there was a gap in onset dates of at least five days, which would fit with the flu's incubation time of two to five days. And in a study published just last month about a village in Azerbaijan, scientists from the W.H.O. and the United States Navy said human-to-human transmission was possible. That conclusion essentially agreed with what Dr. Niman had been arguing since early March — that it was unlikely that seven infections among six relatives and a neighbor, with onset dates stretching from Feb. 15 to March 4, had all been picked up from dying wild swans that the family had plucked for feathers in a nearby swamp in early February.
While Dr. Niman is an irritant to public health officials, his digging sometimes pushes them to change conclusions, as it did in the recent Indonesia case. The W.H.O. at first said an undercooked pig might have infected the whole family, but Dr. Niman discovered that the hostess of the barbecue was sick two days before the barbecue and the last relative was infected two weeks after it.
His prodding, picked up by journalists, eventually led the W.H.O. to concede that no pig was to blame and that the virus probably had jumped from human to human to human.
The health organization's periodic updates on the number of avian flu cases and the death toll concentrate on cases confirmed by laboratories. The updates use no names and are often cleared by the affected country's health minister.
Dr. Niman, by contrast, trolls local press and radio reports and uses Google software to translate them — sometimes hilariously — looking for family names, onset dates and death dates.
For example, a May 15 report quotes a village midwife named Spoilt describing the death of a woman in Kubu Sembilang, Indonesia and the hospitalization of one of her sons:
"Praise br Ginting experienced was sick to last April 27 2006, with the sign of the continuous high fever to the temperature of his body reached 390 C was accompanied by coughs... Added Spoilt, second casualties Roy Karo-Karo that also the son of the uterus from Praise br. Gintin after his mother died last May 3, also fell ill, afterwards was reconciled to RSU Kabanjahe."
Dr. Niman contends that the largest human-to-human cluster so far was not in Indonesia, but in Dogubayazit, Turkey, in January. W.H.O. updates recorded 12 infected in three clusters, and quoted the Turkish Health Ministry blaming chickens and ducks. Dr. Niman counted 30 hospitalized with symptoms and said the three clusters were all cousins with the last names of Kocyigit and Ozcan, and that most fell sick after a big family party on Dec. 24 that was attended by a teenager who fell sick on Dec. 18 and died Jan. 1.
A patriarch, Dr. Niman said, told local papers that the two branches had had dinner together six days after the 14-year-old, Mehmet Ali Kocyigit, had shown mild symptoms. He died on Jan. 1, and several other young members of the two families died shortly after, with other relatives showing symptoms until Jan. 16. No scientific study of that outbreak has been released.
Dr. Niman also said clusters were becoming more frequent, especially in Indonesia. Just last week two more emerged there, one including a nurse whose infection has not yet been confirmed. With 36 deaths, Indonesia is expected to eclipse Vietnam soon as the world's worst-hit country.
Dr. David Nabarro, chief pandemic flu coordinator for the United Nations, said that even if some unexplained cases were human-to-human, it does not yet mean that the pandemic alert system, now at Level 3, "No or very limited human-human transmission," should be raised to Level 4, "Increased human-human transmission."
Level 4 means the virus has mutated until it moves between some people who have been only in brief contact, as a cold does. Right now, Dr. Nabarro said, any human transmission is "very inefficient."
Level 6, meaning a pandemic has begun, is defined as "efficient and sustained" human transmission.
Ms. Cheng of the W.H.O. said that even if there were more clusters, the alert would remain at Level 3 as long as the virus dies out by itself.
"A lot of this is subjective, a judgment on how efficiently the virus is infecting people," she said. "If it becomes more common, we'd convene a task force to raise the alert level."
http://www.nytimes.com/2006/06/04/wo...gewanted=print
Reply With Quote
If you can plow through it, this (http://www.recombinomics.com/News/06050601/H5N1_Phase_Evolution.html) report from Henry Niman summarizes the history of clusters, the genetic changes found in the clusters, and the game the WHO are playing with the pandemic alert levels.
Henry Niman is the gadfly (a spooky-smart gadfly) who has been riding the WHO for over 18 months. He's qoted extensively in the NY Times article cited in a post above. Niman is an 'outsider' whose theories and positions have initially met almost universal scorn and are now almost universally acknowleged to be correct (although verrry grudgingly acknowleged; he's rubbed a lot of people's noses in the chicken poop).
mugwump
Peregrino
06-05-2006, 08:21
Henry Niman is the gadfly (a spooky-smart gadfly) who has been riding the WHO for over 18 months. He's qoted extensively in the NY Times article cited in a post above. Niman is an 'outsider' whose theories and positions have initially met almost universal scorn and are now almost universally acknowleged to be correct (although verrry grudgingly acknowleged; he's rubbed a lot of people's noses in the chicken poop).
mugwump
I like him already, especially since the stuff he's rubbing their noses in is what they keep trying to package and sell to the world as chicken salad. Keep it coming, it's fascinating reading. And it ties in well with the hurricane preparedness plan (great excuse to prep for a lot of contingencies). Peregrino
I like him already, especially since the stuff he's rubbing their noses in is what they keep trying to package and sell to the world as chicken salad. Keep it coming, it's fascinating reading. And it ties in well with the hurricane preparedness plan (great excuse to prep for a lot of contingencies). Peregrino
Will do.
One thing you should know about is his predilection for referring to 'cleavage sites.' He never really explains it, but this is referring to a spot on the hemagglutinin (HA) molecule that is used by the virus as the docking grapple for attaching to the cell. If sequences are published (and through Niman's tireless goading, they are starting to trickle into GenBank) the HA and NA portions usually arrive first, because they are critical mutation sites for a final breakout. Cleavage sites are good ways to compare strains of H5N1.
There isn't a lot of actual significance to the cleavage site, except it allows you to differentiate between what Niman considers 'bird' H5N1 and 'mammal' H5N1. Niman has been saying for a while now that human-to-human transmission is much more efficient than bird-to-human. When you think about it, there are scores of thousands of contacts between infected birds and humans, with very few infections. But once a human becomes infected, there is a much greater change for H2H transmission -- like in Sumatra.
Niman doesn't believe that the current crop of cases are coming initially from birds but from a mammal reservoir -- possibly pig or cat. This is ominous. If the initial vector is birds, as the WHO desperately tries to ascribe to every case, then there is very little selective pressure for the virus to adapt to mammals and humans. (Why would the virus gain any advantage by adapting to a mammalian body temp of 96F when a bird's temp is 105F?) Any breakout would depend on a fluke mutation in birds, which in a similar fluke would be passed to a human. But, if the virus is coming from a mammal, then there is significant selective pressure for the virus to adapt to mammalian receptors, body temperature, defense systems, etc.
There are data going back to 2001 which show H5N1 is pandemic in Indonesian pigs.
This is the first time in history we've watched a potential pandemic develop -- everything has been historical up to now. Nobody knows what is going to happen. That said, Niman has an uncomfortable track record of being right.
mugwump
:)
http://www.who.int/csr/don/2006_06_06/en/index.html
6 June 2006
For the past four days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in four nurses who were involved in the care of confirmed H5N1 patients.
Test results have now convincingly ruled out H5N1 infection in all four nurses.
Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.
The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.
The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present.
The other view:
http://www.recombinomics.com/News/06060601/HCW_Flu_Indonesia_4.html
Include cases up to 06Jun06. They still don't include 12 confirmed cases in Turkey because the onset dates can't be nailed down. Weak.
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Something funny in graph # 2.
Around Sep 04 it looks like 100% death rate and much lower around Apr 05. The rest of the time it looks like around 50/60%.
Could it be that the flu is more wide spread but just making a number of people slightly sick? With the focus on people at deaths door is the flu spreading under the radar?
Pete
Something funny in graph # 2.
Around Sep 04 it looks like 100% death rate and much lower around Apr 05. The rest of the time it looks like around 50/60%.
Could it be that the flu is more wide spread but just making a number of people slightly sick? With the focus on people at deaths door is the flu spreading under the radar?
Pete
You're looking at outcomes from 3 separate clades, or strains rolled into a single graph. The 2004 strain -- the original southeast Asian strain -- was extremely nasty. A second strain is in the middle east in Egypt, Turkey and Azerbaijan and had a 30% to 40% CFR in December 05 - January 06. The third strain is the one in Indonesia now, which is actually three variations of the same strain: one nearly identical to the flu infecting birds in the area and two others from Sumatra and East Java which many are now assuming are coming from some mammal reservoir (probably pigs and cats). The CFR bounces from nearly 100% to 40% to 75% in six weeks: April - May 06. Small sample size has a lot to do with the large variation.
You are absolutely correct: there could be more mild cases that aren't being reported. There could also be more clusters with serious cases and deaths than are being reported as well. Surveillance and reporting are so crappy in China, Indo, Burma, Africa, etc. that no one knows.
It goes beyond simple ignorance. There are reports of whistle-blowers in China being beaten, jailed, and even killed for reporting human H5N1 infections (one example here (http://story.irishsun.com/p.x/ct/9/id/8943aa73d91a7482/cid/45d771c7290844e9/))
I attended a congressional briefing by Dr. Robert Webster (St. Jude Children's Research Hospital, Memphis, TN) on the Risks of Avian Influenza sponsored by the Joint Steering Committee for Public Policy. Dr. Webster has studied avian influenza for over 30 years and is a source of great information on avian influenza (H5N1). He confirmed a bit of good news that I have heard as rumor in the scientific community: this year's seasonal influenza vaccine might provide limited protection against some strains of H5N1. That is great news if true. This doesn't mean the seasonal flu shot will save the world, but if there was an influenza pandemic sooner rather than later, the seasonal vaccination could "buy us some time" until a vaccine is developed for the circulating H5N1 strain(s). -- Mote Dai
http://www.dailykos.com/story/2006/6/8/20401/71732
jasonglh
06-15-2006, 12:06
Mugwump you were talking about geese once:
Geese blamed for Lake Tahoe pollution (http://news.yahoo.com/news?tmpl=story&cid=2627&ncid=2627&e=2&u=/ap/20060614/ap_on_sc/polluting_geese_1)
Spencer said the bottom of Lake Tahoe is covered by up to two inches of goose feces in some areas. A 10-pound Canada goose can produce four pounds of nitrate- and phosphate-rich feces every day.
It went on to say they were going to trap 400 and innoculate them for disease but not which.
I haven't been posting panflu reports as in the past, mostly because I'm deathly sick and tired of the whole topic. There have been additional deaths, additional H2H clusters, and recurring idiocy from all governments and agencies involved. Coverups are increasing in scope. Long story short, the recent pattern continues.
The virus appears to be marching toward a breakout and there is a growing sense of inevitability, even among former pandemic sceptics and agnostics.
The following two articles summarize fairly well the situation in China and Indonesia. I've separated the two countries and precede the articles with some analysis.
============
China:
There is growing concern that there is widespread human H5N1 in the Chinese countryside. It is speculated that the virus is being spread in a "more efficient" manner, but still not so efficiently as to cause the big breakout.
The chickens have come home to roost. The Chinese have been using 'poorly formulated' (crappy) H5N1 poultry vaccines for 2 years now. The concern has always been that these vaccines would be effective enough to keep the inoculated chickens alive but not effective enough to keep them from becoming infected. This now appears to be the case. Official reports state that up to 1% of all marketed poultry are infected with H5N1 while appearing to be healthy. Back channel reports state this figure could be as high as 15%. This is why Hong Kong has prohibited importation of poultry from the mainland.
There is a whiff of official panic coming from Hong Kong.
http://usinfo.state.gov/usinfo/Archive/2006/Jun/16-316446.html
Washington – Chinese and international health officials have verified another human case of avian influenza, and the mystery of how the 31-year-old truck driver was exposed to the disease is causing some concern in Guangdon province and Hong Kong.
Chinese health authorities confirmed the case June 16, saying the ailing man still is alive, although in critical condition. In investigating the possible route of his infection, it has been confirmed that prior to his infection, he had visited a local market where live poultry were being sold. Thus far, there is no confirmation that he had direct exposure to ailing birds.
Inability to make that direct link to an animal carrier of the H5N1 virus that has been plaguing East Asia for more than two years is causing some genuine concern in Hong Kong.
Health Secretary York Chow of the special administrative region of Hong Kong told Radio-TV Hong Kong that he is concerned about this case for several reasons. The sick man has no apparent history of contact with sick animals; rather, he comes from the city and not from the countryside where the virus has been more common. Chow also is concerned that the case is occurring in the hot summer; most of China’s avian flu cases have occurred in winter.
“So we have a suspicion -- and we cannot confirm it yet -- that the virus might be more virulent and more widespread than we expected,” Chow said in the interview. “We need to monitor the situation closely to see if there is continuity of this pattern.”
===================
Indonesia:
All information coming from the Indonesian health services is being totally ignored by the public health community. It used to be that the term "local confirmation", as in "the tests were confirmed locally" was code for results coming from the US NAMRU2 facility. This is now not always the case. Indonesian official press releases are now sometimes citing an Indonesian lab that is highly suspect.
Numerous nurses (4-9, reports vary) who treated H5N1 patients have come down with the flu -- officially, the seasonal flu. They were all given high-dose Tamiflu/amantadine combined treatment at the first sign of symptoms and all have recovered. Despite official assurances that they were not infected with H5N1, many suspect otherwise.
I won't include any of the NYT article cited below, it's pretty complete. I'll only add that the single death reported on 14 June is actually part of an apparent H2H cluster; two siblings died previously but were buried before samples were taken.
http://www.iht.com/articles/2006/06/16/news/flu.php
InTheBlack
06-17-2006, 11:41
>>>
this year's seasonal influenza vaccine might provide limited protection against some strains of H5N1.
>>>
Are you referring to the 2005/2006 vaccine, or the 2006/2007 vaccine? I presume the 2005/2006 is the only one available at the moment, if there is any left ???
When I checked a couple weeks ago I couldn't find any online sources that had _any_ antivirals in stock, not even Amantadine or Relenza (zanamivir).
>>>
this year's seasonal influenza vaccine might provide limited protection against some strains of H5N1.
>>>
Are you referring to the 2005/2006 vaccine, or the 2006/2007 vaccine? I presume the 2005/2006 is the only one available at the moment, if there is any left ???
When I checked a couple weeks ago I couldn't find any online sources that had _any_ antivirals in stock, not even Amantadine or Relenza (zanamivir).
ITB: Post an introduction and fill in your profile, please.
The 2006-2007 vaccine is the one which confers partial immunity. Make sure your kids are immunized -- they still stupidly give priority to the elderly (wrong strategy, even w/ seasonal flu).
Immunizations will start in August.
The antivirals are gone.
InTheBlack
06-17-2006, 12:03
Profile etc done right after-check now.
Which component is the 'active ingredient?'
http://www.cdc.gov/flu/professionals/vaccination/composition0607.htm
>>>
The panel recommended that vaccines to be used in the 2006-07 season in the U.S. contain the following:
an A/New Caledonia/20/99 (H1N1)-like virus;
an A/Wisconsin/67/2005 (H3N2)-like virus (A/Wisconsin/67/2005 and A/Hiroshima/52/2005 strains);
a B/Malaysia/2506/2004-like virus (B/Malaysia/2506/2004 and B/Ohio/1/2005 strains)
The influenza vaccine composition to be used in the 2006-07 season in the U.S. is identical to that recommended by the World Health Organization on February 15, 2006.
>>>
Profile etc done right after-check now.
Which component is the 'active ingredient?'
No idea. I'd say the H1N1 component but that is just a guess based on the matching neuraminidase subtype. I was taking Webster's word on it. ;)
There's a new vaccine that protects ferrets against the Vietnamese H5N1 -- not even in Phase I yet though.
Hong Kong and the Shenzhen Centre for Disease Control and Prevention have initiated stepped-up surveillance, with mandatory reporting of any pneumonia of unknown origin in a patient who traveled to Guangdong Province in the previous 7 days. So far 38 case have been identified. Note that all are awaiting test results and NONE have been verified as infected with H5N1.
The Chinese are clearly shaken. Referring to the latest human H5N1 infection:
University of Hong Kong microbiology head Yuen Kwok-yung said the Shenzhen case was abnormal and worried the disease would spread in winter.
"If there are human infections from June to August, it means the virus is extremely active. I am worried that a major outbreak will happen in winter," he said.
mugwump
http://www.chinadaily.com.cn/bizchina/2006-06/17/content_619313.htm
H5N1 virus may have mutated
By Teddy Ng and Chen Hong (China Daily)
Updated: 2006-06-17 09:01
The latest human bird flu infection on the Chinese mainland is worrying as it shows the H5N1 virus may have mutated and become as infectious in warm months as in cooler ones, Hong Kong's health chief said on Friday.
The virus thrives in lower temperatures and is usually most infectious in the cooler months between October and March.
But confirmation on Thursday that a 31-year-old truck driver in the southern city of Shenzhen has been infected has caused uneasiness.
"Is this because the virus has changed, so that it is highly infectious all year round? Or, if it is happening in summer, winter would be even worse?" said the Secretary for Health, Welfare and Food, York Chow.
He said the virus might have become "more virulent and spread wider than we've expected," though its mutation was not confirmed.
"If that is the case, the risk for humans to be infected in the future is higher," he added.
<snip>
If there are human infections from June to August, it means the virus is extremely active. I am worried that a major outbreak will happen in winter," he said.
jasonglh
06-21-2006, 23:58
Mugwump I saw this over at the Wall Street Journal. From what you have seen is it fairly accurate reporting?
A Closer Look at Bird Flu's Victims (http://online.wsj.com/public/resources/documents/retro06-avfludeaths-date_desc.html)
Mugwump I saw this over at the Wall Street Journal. From what you have seen is it fairly accurate reporting?
A Closer Look at Bird Flu's Victims (http://online.wsj.com/public/resources/documents/retro06-avfludeaths-date_desc.html)
Yes, this looks complete. The WSJ is generally good, although whenever you see "An investigation conducted by provincial health authorities..." in commentary you should always take it with a grain of salt.
Despite the Indonesian exhortations to the contrary (repeated in the commentary of the cited WSJ compilation), the genetic sequences of the viral isolates indicate that the infection vector is not birds in most cases, but appears to be mammalian in origin. Pigs? Cats? Who knows, no one considers it important enough to look, I guess.
Those wacky Chinese -- you may have caught the story in the mainstream media about their latest shenanigans . A Chinese researcher sent a letter to the New England Journal stating there was a human H5N1 infection in China in 2003, two full years before the first "official" case. Helen Branswell does her usual excellent job telling the story.
Mystery thickens around report of early Chinese bird flu case (http://www.cbc.ca/cp/health/060623/x062320.html)
Mystery thickens around report of early Chinese bird flu case
16:14:27 EDT Jun 23, 2006
HELEN BRANSWELL
(CP) - The mystery surrounding a report by Chinese researchers that contradicts Beijing's official line on how long China has been having human cases of H5N1 avian flu took a twist Friday that suggests someone may have tried to block the report's publication in a prestigious medical journal.
Hours before the official release of this week's issue of New England Journal of Medicine, editors at the journal received a series of e-mails from someone purporting to be Dr. Wu-Chun Cao, one of the authors of the report which had been submitted by eight Chinese scientists.
But on Friday, editors at the journal spoke by phone with someone they believe to be Cao. He categorically denied having sent the e-mails and told the journal he and his co-authors stand behind their report...
The Chinese are bad, maybe only second to the Indians in their desire to "manage the message." That said, ALL governments have desperately tried to spin the H5N1 issue.
Those Canadian geese that staggered around on Prince Edward Island for 12 hours with obvious central nervous system damage and then died when their guts essentially turned to mush? "No evidence of H5N1." The true story is there was no evidence of any infection because the samples were left to rot. The initial tests (repeated twice for a total of three results) reported Type A H5 flu. The only question was whether it was H5N1 or H5N2. The fact that they couldn't find any of these viruses points to gross incompetence or a cover-up. The message "move along, all's well, nothing to see here" was major spin.
Note that geese are highly resistant to low-pathogenic H5 and CNS symptoms are the hallmark of highly-pathogenic type A flu. If a goose staggers with CNS problems and then dies with a liquefied gut and kidneys that's a pretty good indication we're not talking about low pathogenic H5.
Note that the only issue that I see here is the handling of the case. I think it's inevitable that H5N1 will reach the Western Hemisphere and if properly handled it will have no more effect than it did in Western Europe, i.e. major economic hit but not a big deal pandemic-wise. I guess honesty from a government is too much to ask. Note that the new Canadian Health Minister said of a recent Mad Cow case (prior to becoming MoH and I paraphrase here): "That rancher should have shot, shoveled and shut up."
I was going to also talk about WHO's recent admission that "well, maybe there was some mutation in those Indonesian cases where we said there was no mutation" but the sun is shining.
The consensus among the people I work with is that the risk of panflu will spike Oct '06 through May '07. A few are now predicting a breakout during that time. These are sober, serious people who are now saying it is their opinion that there is a 100% chance of panflu within the next year.
That said, we won't get off that easy; a clear cut answer is not in the cards. One hardass scientist I respect -- imagine The Reaper taking a different path in life -- doesn't think H5N1 will break out at all. He thinks it will mix with another strain in the next couple of years and hit us that way. But even he is wavering, I sense. Many other smart folk are still firmly in the "it might be spreading in China today, it might not hit for 5 years" camp.
But I repeat: the consensus among the people I work with is that the risk of panflu will spike Oct '06 through May '07. The level of risk -- the probability of a breakout -- is being debated, but this 6-7 month window of increased risk is agreed upon.
I've talked about Pneumovax before: it's a vaccine against pneumococcal bacteria. It has no effect on flu viruses. What it can do is protect you and yours from a follow-on bacterial pneumonia after you've survived the flu. In the 1918 pandemic, it's possible that up to a third of the deaths were due to complications from bacterial pneumonia. (I also have 500 hits of Augmentin on hand just in case -- it's off patent, relatively cheap and readily available over the 'net. This stuff is all made offshore and will disappear immediately.)
Get vaccinated with Pneumovax II now. Make sure your kids have been vaccinated. This is a safe, mainstream vaccine -- you won't be perceived as a tinfoil hat type, just a responsible parent. Don't mention bird flu, or you'll get a smug talk about how the vaccine doesn't work against the flu. When this years' seasonal flu vaccine arrives, get that too. Make sure your kids are vaccinated. In this country we still incorrectly focus on the elderly so "conventional wisdom" may argue against your healthy kids being vaccinated against flu. Smile and insist. There's plenty to go around this year so there should be no problem.
Remember, all the alpha male "I'll protect my family" crap goes out the window it you're the first one down.
mugwump
More on statins, the cholesterol-lowering drugs, and panflu. This looks like a real and beneficial effect -- Clinical Infectious Diseases is a respected and peer-reviewed journal. Note that Zocor, Merck's statin, just came off patent and a relatively cheap generic version is already approved for sale.
http://www.cbc.ca/cp/health/060626/x062616.html
TORONTO -- Cholesterol-lowering drugs called statins might help fill a void in the global medicine cabinet during a flu pandemic, an American scientist argues in an upcoming issue of a medical journal.
The drugs, which appear to fight inflammation and the damage it can inflict, might be useful to help modulate the impact if the virus that causes a future flu pandemic is one that induces an overactive immune response, said Dr. David Fedson, a retired academic researcher.
"The next influenza pandemic may be imminent. Because antiviral drugs and vaccines will be unavailable to people in most countries, we need to determine whether other agents could offer clinical benefits," Fedson wrote in a commentary to be published in the July 15 issue of Clinical Infectious Diseases (currently published online).
"They (statins) might be the only agents that could alter the course of a global pandemic."
In an interview from his home in France, Fedson noted that statins might mitigate the damage if the flu virus responsible for the next pandemic provokes an immune response similar to what it's believed was seen in the 1918 Spanish flu - or the severe disease triggered by the H5N1 avian flu strain which is currently the source of significant concern.
That response - a cascading over-reaction of the immune system called a cytokine storm - can actually do more damage than it fixes.
I like this guy -- a Marine pilot's take on pandemic flu only partially posted below. See the documents at the bottom of his post (cite). The Washington State statistics get a bit intense, but a good blunt take on the situation.
"I will make no further efforts to warn you, nor will I permit any one of you to attempt to make me feel responsible for your welfare after the fact because you failed to act. It is very important that you understand that truism."
Perfect.
mugwump
http://www.fluwikie.com/pmwiki.php?n=Opinion.SurfersViews
Date: June 17, 2006
From: Surfer
To: All Bubbas
Subject: This is Not a Drill
1. I am not telling you this because I want to score points. I don’t need to. I am not seeking your approval. I am stating fact. I am telling you this because I value you.
2. I sincerely hope, for all of our sake, that I am wrong in my assessment. I don’t think that I am.
3. As a top gun pilot, however, I do think that I am reasonably qualified to both observe and then make an accurate assessment. I am telling you what I see. Take it or leave it. I hope you take it. Most of you won’t.
4. Print the attached three documents. Print this document. Do this so you can have a hard copy in your hand. Do not attempt to read the electronic version while staring into a monitor; because if you do, you will become predictably distracted, and will soon ignore this critical alert.
5. Read the documents. Read them at least twice. Carefully.
6. In the end, you may or may not agree with the facts stated in the documents. That is your decision. I, however, now have a clear conscience. I have warned you.
7. I am raising the big red flag… and waving it for all it is worth. That is what is important to me. My moral obligation to warn you as a friend/relative/neighbor ceases now.
8. I will make no further efforts to warn you, nor will I permit any one of you to attempt to make me feel responsible for your welfare after the fact because you failed to act. It is very important that you understand that truism.
9. I will not spend any more of my valuable time trying to convince you of the threat. If you don’t “get it” now, you probably will not until “get it” until it is too late. Last chance. Please “get it.” Now.
Check Six.
Surfer
In an assessment that is, I fear, shared by most, I have been officially taken off of the "critical personnel" list. We passed our succession planning audits and the software source code is in escrow.
I'm not giving back the Tamiflu. :p
I haven't updated things for a while. Some highlights:
The WHO recently released an assessment which concurs with post #232: 4Q 2006 through 2Q 2007 is a period of high risk.
http://www.newstarget.com/019548.html
"If this pattern continues, an upsurge in cases could be anticipated starting in late 2006 or early 2007," the report said, adding that further analysis was needed. "Moreover, the widespread distribution of the H5N1 virus in poultry, and the continued exposure of humans suggest that the risk of virus evolving into a more transmissible agent in humans remains high."
The first H5N1 bird death in Spain was reported today 07Jul2006. Note that the death occurred six weeks ago -- they were apparently thinking about it for a while. Note also that Spain is on the East Atlantic Flyway (see post #109 for an interactive map) as are Nigeria, where H5N1 in birds is endemic, and Prince Edward Island, Canada, where we are told that those geese didn't die of H5N1 (even though the samples were spoiled and couldn't be properly tested). Hmmm...
When you are looking at the flyway map, check out the convergence of migratory routes in West Africa. Now marvel at the fact that scientists have made the amazing discovery that there are three, count them, three different strains of H5N1 in Africa. They can't figure out how that happened. A cookie to the first PS.com'er who can come up with a viable theory.
Bird flu is again breaking out here and there all over Europe, apparently from those migratory birds that were reported to be "free of any bird flu" earlier in the year. There are recent reports of mass chicken die-offs in Thailand and back-channel rumors of the same in Viet Nam. Note these are the two success stories recently touted by the WHO. Large die-offs in migratory birds continue in northern China and Siberia. Russia is the only country that is doing a decent job of releasing genetic sequences, which show continued genetic mixing of polymorphisms in waterfowl. It'll be interesting in the autumn when these new strains are brought south during the fall migration (one of the reasons for the increased risk late '06-'07).
In Indonesia, the pace of bird infections/die-offs in commercial operations and backyard poultry is quickening. Things remain totally out of control. There is still no culling going on, and at this stage of the game it's probably too late anyway. The WHO are supposedly close to acknowledging that the majority of recent cases have no link with poultry (there are two clear-cut cases/small clusters linked to poultry manure but the rest are genetically different from strains found in poultry).
On the human infection front, things are murky. The recent human cases in China are recovering after heroic intervention. The truck driver apparently has brain damage (Parkinson's-like tremors and memory deficits, same as the only survivor in the H2H2H2H Indonesian cluster) which were also common in H1N1 survivors in 1918. There are several recent reports of children dying in Indonesia from bird flu (late June through early July). Reporting is so poor that it's impossible to determine whether these are new cases or old cases which are being confirmed. I'm working on the assumption that there continue to be isolated clusters percolating in the hinterlands.
I'm hearing that this is being called "American flu" in India and Indonesia. Apparently started by the Maoists in India, the conspiracy theory states we already have a vaccine and are either a) trying to corner the world poultry market and/or b) trying to wipe out 50% of the world's population so we can march in and take over. Nice.
mugwump
Apparently the "swindling" this poor slob was guilty of was trying to get govt. compensation for the geese he culled.
July 11, 2006 6:50 a.m. EST
http://www.allheadlinenews.com/articles/7004178032
Nji Che - All Headline News Staff Writer
Beijing, China (AHN) - A Chinese farmer who reported bird flu outbreak to the government was sentenced to close to 4 years in jail on Tuesday. The Chinese court found the farmer guilty of fraud and blackmail.
Xinhua, China's state news agency, quoted the court ruling as saying, "The defendant used measures such as fabricating facts and hiding truth to swindle public and personal property ... so he should be punished for two crimes."
The victim, Qiao Songju, is a goose farmer in the eastern province of Jiangsu. Songju was arrested a month after he reported bird flu outbreaks in the Chinese province of Jiangsu in October.
Songju denied some of the allegations. However it remains unclear if the charges were based on his bird flu reports, which later turned out to be true as the infection was later reported and confirmed by national authorities.
Chinese authorities are currently considering imposing fines for media outlets that report emergencies, such as riots, natural disasters and outbreaks of diseases such as SARS or bird flu. If finally approved, Chinese media would require an authorization before reporting such emergencies.
As I mentioned at the time, I smelled rotten fish when WHO released their "no significant mutations were found, please move along, nothing to see here" pronouncements after the H2H2H2H cluster.
From CIDRAP - "Report: H5N1 mutated rapidly in Indonesian cluster" (http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jul1206mutate.html):
The magazine says that 21 mutations were identified in a virus from the father of the 10-year-old boy, involving seven of the virus's eight genes, suggesting that the virus was evolving rapidly as it spread. In addition, from one to four mutations were found in viruses collected from five other patients.
The story says one of the mutations confers resistance to the antiviral drug amantadine, a finding not reported by the WHO.
Another article from Time Online (http://time.blogs.com/global_health/2006/07/mutations.html):
Thursday, Jul. 13, 2006
Secret Sequences
When H5N1 avian influenza hit a family in rural Indonesia in May, killing seven of eight people infected, it marked the most serious known incidence of human-to-human transmission of the virus.
< (snip>
At the time the WHO issued reassuring statements that there had been "no significant mutations," but an article in this week's Nature (subscription required) argues that the UN health agency may have been underplaying the situation. Nature obtained greater detail on the genetic sequences of the Sumatra viruses and found that they had accumulated a number of mutations—which suggests that the virus was evolving rapidly as it spread from person to person.
Is evolving a bad thing?
Could this "evolve" into something "only" as deadly as the 1918 outbreak?
Or would it evolve and stay as deadly?
Questions, questions.
Revere is the pseudonym of a flaming liberal researcher/public health maven who believes ill of all things Bush and well of all things U.N., including the WHO. When the WHO lose the good will of Revere, they're in trouble.
You can check out his take on the "no mutations" story here (http://scienceblogs.com/effectmeasure/2006/07/who_damaged_goods.php#more). Look at the comments following his blog entry -- Andrew Jeremijenko was the XO of the US Navy's NAMRU2 research facility until last December.
http://www.cdc.gov/ncidod/EID/vol12no06/05-1468.htm#Figure
6483
Drop it in the slurry pit:
"If it's really needed, you actually have the mask on and you are next to somebody who has influenza, then that mask is catching influenza droplets. So then when you are done with it, it is really contaminated," she said.
"It has to be appropriately washed, cleaned maybe with some bleach. It is somewhat like a dirty diaper (but) at least a dirty diaper that has poop in it, you can see that it is contaminated and you don't put it in your pocketbook."
The Bangkok Post reports that avian H5N1 has apparently re-emerged in northern Thailand, big time. Reports vary, but 30-34 people are under quarantine with flu symptoms. No test results yet.
Thailand is under review for an extension of their EU poultry import ban, so I expect major spinning from the government. Remember, this is the home country of CP and their powerful poultry lobby.
From the Bangkok Post article (http://www.bangkokpost.com/News/14Jul2006_news16.php)
The mysterious deaths of birds in Chachoengsao's Bang Khla district and some provinces in the Northeast have triggered another avian influenza scare. Hundreds of birds, including poultry, have died from unknown causes in the eastern province of Chachoengsao over the past week.
<snip>
In Nakhon Ratchasima, 30 patients with flu-like symptoms have been put in quarantine, while fowls have died mysteriously in nine tambons in the province.
mugwump
The WHO have spoken! (http://www.bloomberg.com/apps/news?pid=20601080&sid=ahKTpB5eQCM4&refer=asia) We've been awaiting your orders, great overseers.
Dimwits.
Work on Pandemic Flu Vaccines Must Start Now, WHO Report Says
July 15 (Bloomberg) -- Work on vaccines used to protect against a flu pandemic must start immediately, even though the effectiveness of the treatments might not be known until after a global outbreak ended, the World Health Organization said...
The Reaper
07-16-2006, 07:57
It is a real shame that litigation and governmental inaction have destroyed the American vaccine industry.
Greatest nation on the planet, unable to meet its own basic needs.
TR
Dimwits.
Work on Pandemic Flu Vaccines Must Start Now, WHO Report Says
July 15 (Bloomberg) -- Work on vaccines used to protect against a flu pandemic must start immediately, even though the effectiveness of the treatments might not be known until after a global outbreak ended, the World Health Organization said...
Dimwits, I have a better word for them.
They are just now putting this out. I hope that this has been spoken in close doors. To start makeing vaccines now is a joke.
jfhiller
07-17-2006, 14:51
Business Standard is reporting success in developing bird flu vaccine. Seems that the vaccine is for the birds :rolleyes: (not people), but the article wasn't entirely clear. Here's the lead:
"Scientists of the Indian Council of Agricultural Research (ICAR) have succeeded in developing an indigenous vaccine against the dreaded bird flu disease which had surfaced in February last in Navapur and Jalgaon districts"
I don't have the expertise to evaluate this, but here it is for those of you who do.
http://www.business-standard.com/economy/storypage.php?leftnm=lmnu2&subLeft=1&autono=98384&tab=r
This is a poultry vaccine. It's very unclear in the article whether it's for birds or humans. There is hot debate whether vaccinating birds is a good approach in the long run. It keeps the chickens alive but it doesn't prevent them from becoming infected. By some estimates 1% to 15% of all poultry sold in Chinese "wet markets" is infected with H5N1 while still appearing healthy because of vaccination.
The fears are 1) because the birds appear OK there is more chance for contact w/ humans, leading to illness and 2) because the birds live longer there is greater chance they will get dual infection with H5N1 and a H3 flu, increasing the risk for genetic re-assortment.
The Indians are just proud of themselves. There are numerous poultry H5N1 vaccines...if things get bad enough you may get inoculated with one before this is all over. :eek:
Well the county health clinic says they have plenty of "H" Flue AKA pneumonia AKA meningitis shots available. 20 bucks a pop, first come first served.
If my team medic told me I needed a shot I got a shot.
Good 50/50 shot to take just in case to better yor odds?
And you medicos out there, just what is the connection between the meninges and the lungs? I think Mugwump covered the basics back around page 16 (?).
InTheBlack
07-17-2006, 22:08
Odd, haven't gotten a daily update since 6/22. Glad I checked back manually.
What's Augmentin for & what do I say I want it for to get the prescription?
Odd, haven't gotten a daily update since 6/22. Glad I checked back manually.
What's Augmentin for & what do I say I want it for to get the prescription?
Augmentin is a broad spectrum antibiotic which is now off patent and relatively cheap. It can be used for a variety of infections in a pinch. It's particularly good if you are treating bacterial pneumonia in an outpatient setting. Bacterial pneumonia often occurs after a bout of viral influenza.
When I ordered it I said "My credit card number is..." and that's about all they cared about.
mugwump
Research from NAMRU-3. Thank God for the US Navy, about the only group worth anything...
Qinghai-like H5N1 from Domestic Cats, Northern Iraq (http://www.cdc.gov/ncidod/eid/vol12no08/06-0264.htm)
Significant on many levels: cats are second only to primates in their similarity to human respiratory and receptor systems (pigs are a close third apparently, I always thought they were more similar -- live and learn); there are 60 million feral cats in the US and 50 million "outside" domestic cats and all hunt/eat wild birds; cat-to-cat infection is extremely efficient.
Obviously there will be implications if you have an "outside" cat and live near a flyway after H5N1 spreads to N. Am.