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/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).

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.

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

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.

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.

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.

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.

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.

.

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. :)

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 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.

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

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.

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/2...495802-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."

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:

Attachment 5671
Attachment 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

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.

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.

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

Mugwump,
Have you read Tipping Point?
Just curious.
JM

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

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

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.

.

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When Has the Balloon Gone Up?
 

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.

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Tin foil hat zone
 

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. 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.

# 10 cans
 

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

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

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

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.

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

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.

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