I think all those 33.7 miles outside of major metropolitan areas will be safe. :p

Damn! I just looked at the map... you couldn't revise that to 33.65mi could you? :O

I wonder how much Ro could be reduced if everyone wore a P95 mask in public. Or even a placebo paper mask just to reduce hand-to-face contact.

Things look stable to me...
 

I thought I'd give a status update on Indonesia and Thailand.

I'm always a bit concerned that something might be cooking away in the weeds, out of sight. But that said, the two high profile outbreaks in Thailand and Indonesia look pretty stable to me. Additional cases are being reported daily in both places, but my take on this thing is that the Ro, the number of new infections produced by each existing illness, is currently 1 or less. This means that I think these outbreaks are going to stabilize and burn out.

Note that Tamiflu "blankets" are in place in both regions: daily double doses administered to symptomatic patients and daily single doses to those without symptoms.

You don't talk about Ro unless you have human-to-human transmission. I am firmly convinced that is the case in both Thai and Indo. It's not very efficient, but it's H2H.

The WHO and the Indonesian government are going to absurd lengths to redefine "cluster" so the Indo cases don't fit. They say it can't be a cluster because the infections are occurring over too wide an area, are not limited to family members, and are too spread out time-wise. Well, earth to Indo, epidemics follow lines of social contact and not just family and geography, and a gap between infection 1 and 2 is an argument for H2H and a cluster, not against.

On the more disquieting end of the stick, cluster size keeps growing: the Indo one now looks to be about 20 folks and the previous one was what, 8? I don't know what this means. There is speculation that the virus is becoming more adapted to mammals in some yet-to-be-discovered animal that is passing it on to humans.

On to China. China recently pitched a world-class hissy fit at the WHO and Thailand over statements that the strain of virus in Northern Thailand came from China. This was simply a statement of fact -- it was the Qinghai strain which originated in China (well, they all originated in China, but this one more recently). After furious behind-the-scenes attacks by China, much apologizing, retracting, and kowtowing ensued. I am told that the Chinese are extremely afraid of drops in foreign investment and potential effects on their Olympic showcase efforts if the words "China" and "bird flu" become linked in people's minds. Doesn't bode well for transparency in China.

mugwump

Watch what they do?
 

Someone sent me this link and I don't know what to make of it. I think the Thais are doing pretty much everything they can, but 800,000 people? What would the US govt have to know to get a similar proportion of the population working on combating AF?

800,000 'bird flu busters' set for door-to-door campaigns
SUPHAN BURI, Aug 23 (TNA) - Launching a door-to-door campaign against bird flu, Thailand's Ministry of Public Health is set to send over 800,000 health volunteers to educate people at home on how to prevent the deadly virus, according to Caretaker Public Health Minister Pinij Jarusombat on Wednesday.
...<snip>...
Public Health Ministry permanent secretary Prat Boonyawongwirot said that in the 24 hours from 6am on August 22, some 79 patients with flu-like symptoms were hospitalised in 22 provinces, quarantined and
monitored for possible bird flu, awaiting laboratory tests to indicate whether they carried the deadly virus or not.

800,000 'bird flu busters' set for door-to-door campaigns

mugwump

No problems, just a weekly update.

Indonesia keeps...simmering is a good word. There are three hot spots currently active and all three look like low-Ro clusters: West Java, North Sumatra and Sulawesi.

The West Java one (reported here under Cikelet (village cluster) and Garut (region) is a bit worrying because it has survived a full-court-press tamiflu blanket and several sloppy poultry culls and two door-to-door, look-under-the-bed detailed poultry culls. They even started compensating the locals $1.90 per "tail", as they call it, during culls. This is more than local market value (chicken ain't so popular right now) so there's little incentive to hide flocks. Still, there are more cases daily. The good news is there are no more deaths. That Tamiflu is looking better and better.

When are they going to start looking for a different vector? The gene sequences in poultry viruses and people viruses are different in the region.

Al Reuters: Four treated in Indonesia for H5N1 symptoms

Thailand is doing a great job, at least that's what I've been hearing. They also employed a brilliant strategy of over-estimating the problem: they have some 3,000 people under observation for bird flu. The vast majority come up negative, approaching 100%, so they look good. Great PR in my book.

China: who knows?

mugwump

Pandemic Transmission: Update
 

Remember: All models are wrong, some models are useful.

I've been shown an update of the Los Alamos Scenario of Human Spread of H5N1 infection model that I cited here. I am not authorized to release the sim at this time, but will do so as soon as I can.

Bottom Line: the new sim has EVERY air hub city infected within 92 hours of the first efficient H2H H5N1 case entering the country. There is no real change to the endpoint of the whole country turning red, it just happens much faster.

I'm still trying to find all of the changes to the inputs of the original model, but I'm told two of the changes were: 1) they assumed improved transmission vectors via airport hubs as seen in the recent Midwestern mumps outbreak; and, 2) dramatically increased Ro (number of new cases caused by a single index case) found in long-haul airline passengers (think Asia-N Am intercontinental flights) who are cooped up for more than eight hours with a symptomatic or asymptomatic flu patient.

Doesn't really change anything except the time you'll have to prepare if you were assuming you were in, or close to, a city that wouldn't be an entry point. Basically every city with a major or regional airport is now a simultaneous entry point.

mugwump

There was a good article in the March 2005; Scientific American concerning "EpiSims".

"EpiSims unleashes virtual plagues in real cities to see how social networks spread disease. That knowledge might help stop epidemics"

It also discussed the airport hubs and the model showed just how fast the virus might spread..... good reading.

TS

Or as my former prof Dr. Richard Zeckhauser used to say, "The great art of modeling is appropriate simplification." :D

Thanks for this TS, I'll check out the article. From what I've found so far, Episims may be what is being used in the H5N1 models.

http://episims.lanl.gov/

mugwump

U of M DTRA Report
 

The University of Michigan Medical School Center for the History of Medicine has just put up a web synopsis of a report it prepared for the Defense Threat Reduction Agency (full report here--pretty interesting)

Their mandate was to identify and characterize communities that experienced extremely low infection/death rates during the 1918-1920 "Spanish Flu" pandemic. Check out Bryn Mawr College -- target-rich environment (prime death age group), very close to Philadelphia (one of the hardest hit cities) yet no deaths.

Bottom line, if you're not interested in the whole nine yards: button up.

Executive Summary Conclusions:

(1) Protective sequestration (the shielding of a defined and still healthy group of people from the risk of infection from outsiders), if enacted early enough in the pandemic, crafted so as to encourage the compliance of the population involved without draconian enforcement measures, and continued for the lengthy period of time at which the area is at risk, stands the best chance of protection against infection. When implemented successfully, protective sequestration also involves quarantine of any outsider who seeks entry, self-sufficiency in the supplies necessary for daily living, enforcement of regulations when necessary (including fining and jailing), and the ability of those sequestered to entertain themselves and maintain some semblance of a normal life.

(2) Available data from the second wave of the 1918-1920 influenza pandemic fail to show that any other NPI [edit - non-pharmaceutical interventions] (apart from protective sequestration) was, or was not, effective in helping to contain the spread of the virus. American communities engaged in virtually the same menu of measures, including: 1) the isolation of ill persons; 2) the quarantine of those suspected of having direct contact with the ill; 3) social distancing measures, such as the cancellation of schools and mass gatherings; 4) reducing an individual’s risk for infection, (e.g., face masks, hand washing, respiratory etiquette); and 5) public health information campaigns and risk communications to the public. Despite these measures, most communities sustained significant illness and death; whether these NPI lessened what might have been even higher rates had these measures not been in place is impossible to say on the basis of available historical data. Moreover, we could not locate any consistent, reliable data that would support the conclusion that face masks, as available and as worn during the 1918-1920 influenza pandemic, conferred any protection to the populations that wore them.

mugwump

I've got a couple of problems with these conclusions;

First the population of the US in 1918 was 103 million. (About a third of what it is today)

IMO while "Protective sequestration" might have worked in 1918 it will not work today.

In 1918 a person could not travel 3-6 thousand miles in one day. In 1918 not everyone had a car, a TV, the internet, (instant means of communications) telephone or access to a worldwide airline capable of handling millions of passengers per day. Let's not forget the high speed interstate system and SUV's very capable of off-road travel (in the US one out of eight owns an SUV).

I would predict as news of the virus spreading hits the media, and the media in turn places their "spin" on it a large portion of the current population of a "target city" will be on the move. Personally I would not want to be in a city of millions when this virus strikes due to the catastrophic social breakdown that might/will occur.

IMO when the virus strikes a city of one-half million and up all hell is going to break loose. (see New Orleans during Katrina) As soon as the virus victims overwhelm the local emergency services, fill the hospitals, exhaust the medical supplies and personnel, chaos will ensue.

We need not worry about the use of "draconian enforcement" either; the entire US military could not contain one city the size of Los Angles. Does anyone actually think the military could contain every city in the US with a population over half a million? We cannot even control movement in our border areas and we’re only dealing with a few thousand a day there (and they're mostly on foot). IMO protective sequestration only works in hollywood movies.

My conclusion if and when this virus strikes and it turns out to be a very deadly virus, we are going to see what true anarchy really looks like, especially in the big cities and densely populated areas around the country. We are no longer considered "the Greatest Generation" and I do not see most of the citizens (and illegals) of the United States waiting patiently in their homes while the effects of the virus fade.
My .02

You're not alone in your assessment. The more carefully this potential scenario is thought through, the more horrific the consequences become. A high Case Fatality Ratio (I've been chastised by a flu-weenie for incorrectly using "rate") would be catastrophic -- "civilization buster" and "viral Chicxulub" have been tossed around in conferences I've attended.

I'm not totally pessimistic. It hasn't broken out yet in spite of us humans doing just about everything wrong. It may be this virus's species barriers are just too high a hurdle. If we make it until next May I'll feel much better. As things stand now with recent reappearances in Egypt, Sub-Saharan Africa, Azerbaijan, Cambodia, VietNam, etc. I think this winter will be a real test.

The best-case scenario is no pandemic and this whole brouhaha wakes people up to the possibilities, and we get better surveillance and vaccine infrastructure out of the exercise.

If it does break, I still believe that "protective sequestration" or SIP ("shelter in place" in Homeland Security-speak) is the only viable option for a single home. It will work if scrupulously applied and preparations are made for food, water, medicine, shelter, entertainment, etc. Clearly, security/anarchy is the wild card even for those who are prepared to hunker down. Personally, I'm not optimistic about the chances of three well-armed civilians, in a frame house with no cover, vs. a determined mob.

RE: the military -- You probably wouldn't be surprised if you saw the hand-wringing that goes on in discussions I've sat in on WRT the use of the military/martial law/posse comitatus. It all revolves around leftie paranoid fantasies of Republicans not lifting martial law when the pandemic is over. There is never any doubt that the military could restore order nation wide if "let off the leash." Sheesh.

In my mind the key is keeping the grid up. I don't think that will happen.

mugwump

H5N1 found in bin Laden and Mohammed Atta!
 

No, not those bin Laden and Mohammed Atta (are these names the Anglo equivs of Smith and Jones?). More suspected Egyptian H5N1 cases -- up to four now. Last para seems to indicate extensive spread among birds in other provinces.

Now that migrating birds are moving back south, things are going to heat up in Africa and Southwest Asia.

Machine translation:

The Directorate of Health became seizure of bin Laden, Mohamed Atta - five years - and his mother, an evening full Qasim Sawamah east of the village center Akhmim in hospital on suspicion of haemorrhagic disease caught the avian flu. Also been sent samples of bin Laden, an evening for analysis at the Ministry of Health.

The National Committee to face bird flu headed by Dr. Hatem Al-Gabali, Minister of Health that it had to take measures to isolate and execution of poultry suspected of carrying the virus after an outbreak among domestic birds last week in the revival of the rain and Kobba and the eighth district in Cairo.

It also emerged in the cases of Giza and Dakahlia, Damietta, Qena, Qalubia and Beni Suef.

mugwump

[Edit - Looks like bin Laden/Mohammed Atta are the same 5 y.o. boy - the mom doesn't rate a name in the report.]

Interesting cultural tidbit that a 5 y.o. Egyptian boy should be named bin Laden/Mohammed Atta. Nothing like naming your kids after the "Islamic hero/martyr du jour". Makes you wonder how his parents/family/culture really feel about "The Great Satan". Any recent conspiracy reports in the Islamic presses blaming us for the virus (again)? :munchin Peregrino

I wouldn't be surprised, but no, I haven't seen/heard any recent reports from the ummat al-mu'minin. An acquaintance did tell me her NGO pulled out of India because of Maoists whipping up the peasantry with tales of US plans for poultry hegemony. Two total equipment wipeouts by bandits and one beating were enough for her.

mugwump