Pandemic Flu

[mugwump]

Originally Posted by Martin

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...).

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.

.

.

[mugwump]

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.

That's what scares the liver outta me -- being out of the country if it comes to Katie-bar-the-door.

.

[Bellerophon]

Originally Posted by mugwump

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.

Originally Posted by mugwump

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.

Originally Posted by The Reaper

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.

Originally Posted by mugwump

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.

[Pete]

Originally Posted by mugwump

....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."

[mugwump]

Originally Posted by Bellerophon

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/econo.../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/f...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/Cons...GuideOct7b.pdf

[The Reaper]

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

[jatx]

Originally Posted by Bellerophon

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.

[mugwump]

Originally Posted by jatx

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

[mugwump]

Originally Posted by 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?" might be interesting to some.

Take care,
M

[mugwump]

Originally Posted by Martin

Okie, mugwump.

This blog article "H5N1 - does it live up to the hype?" 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.

.

[mugwump]

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.

[mugwump]

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.

[mugwump]

More research fom today's CDC presentations.

http://www.forbes.com/lifestyle/heal...out531699.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."