Pandemic Flu

[mugwump]

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/conten...ract/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]

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

[mugwump]

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]

Originally Posted by mugwump

I must go. I'll finish later.

Please do.

Very sobering and interesting read, thanks MW.

TS

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)]

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.

[booker]

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.

[mugwump]

Originally Posted by The Reaper

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]

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.

[mugwump]

Originally Posted by Jack Moroney

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.

[mugwump]

Originally Posted by CoLawman

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/CityandR...67449-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]

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.

1. 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.
2. 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.
3. Seasonal flu, avian flu, and pandemic flu are not the same.
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.

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.

[Sten]

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]

Originally Posted by Sten

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

[mugwump]

Okee doke, all settled. 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.