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.

[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 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.

[mugwump]

Commentary:

--I've been trying to find out something about canids and flu and the first snip seems to indicate that dogs/coyotes are at risk if H5N1 gets into migratory fowl this autumn. Sick/dead birds and feces are all risks. This probably has implications for use of retrievers and upland game dogs if there is a season this fall.

--Qinghai outbreaks are watched for because: 1) this region seems to "lock" mutations into avian H5N1 2) birds widely disperse from there and carry the mutations everywhere

--Good stuff is happening on the vaccine front. Money is being allocated in the right places and new techiques are proving to have great potential. The bad news is we are still 36 months away -- but that's down from 60 months using the old techniques.

==================================

An unpublished report from 2005 by The National Institute of Animal Health in Bangkok indicated that dogs could be infected with the virus, but the associated disease was not detected. Researchers tested 629 village dogs and 111 cats in the Suphan Buri district of central Thailand. Out of these, 160 dogs and 8 cats had antibodies to H5N1, indicating that they were infected with the virus or had been infected in the past.

There were news reports of a stray dog dying from bird flu (H5N1) in Azerbaiijan in March. Affected cats in Europe appear to have become infected by eating infected poultry or wild birds. It is possible dogs could be infected the same way.

==================================

AP

DANANG, VIETNAM: Only half of the human bird flu cases detected by countries are being reported to the world health organisation within two weeks, a response time that must be improved to head off a potential flu pandemic, a senior WHO official said on Saturday.

==================================

Bird flu outbreak confirmed in China
(Xinhua/chinadaily.com.cn)
Updated: 2006-05-05 15:42
The Chinese Ministry of Agriculture Friday confirmed outbreak of bird flu among wild birds in a remote areas Qinghai Province, northwest China.

The outbreak was confirmed by the national bird flu laboratory on Wednesday, and the number of dead wild bird had risen to 123 by Thursday, the ministry said on its website. This is the second time H5N1 has turned up in Qinghai, a region of high-altitude plains and mountains that sits on a prime migration route for birds between Siberia and South Asia.

[The Reaper]

That does it.

I'm building a flamethrower.

Everyone, make real sure you call before coming over. I recommend that if you sound like you are sick, you not come by. If you come anyway, bring hot dogs and marshmallows.

TR

[mugwump]

Originally Posted by The Reaper

That does it.

I'm building a flamethrower.

Everyone, make real sure you call before coming over. I recommend that if you sound like you are sick, you not come by.

TR

Actually I'm starting to get encouraged, even though some things are trending towards grim at the moment. Many other things are going in the right direction.

--I just found out that there's a paper to be released soon that shows TamiFlu in combination with amantadine works against all recent isolates of the Qinghai strain. Amantadine is cheap as dirt and plentiful.

--According to scuttlebutt, Roche is going to open-license TamiFlu production using the new technique developed at Harvard.

--Money is being spent in the right places -- we will go from zero to five CONUS state-of-the-art vaccine plants in 9 months. We may be slow to start, but when we get our dander up we can still produce.

--The companies I work with are on a war footing with this -- we have been on a 12/7 work schedule for months and will continue. Granted, we won't have any vaccine for the first wave if it hits this year, but who's to say it will hit this year?

--There are unprecedented levels of cooperation among governments, industry and academia. Quite amazing really.

--There is an emerging realization among govt's that we are all interconnected; a plague in Nigeria is a disaster of potential biblical proportions in the US. Now, I think this means the Brit/German civil service should be hired to straighten these failed states out with the US on call for ass-whuppin', but that may not be popular (there were good sides to colonialism). The Chinese are incredibly proud people -- world opinion will sway their health care practices.

--There is a H20 pumping station in the next town. I called and offered to get trained for an emergency. The supervisor was looking into it and took my name. He said I was the third person to offer and he did not scoff at the idea. Even if this hits we will pull through.

--There are big problems on the horizon: energy, health, climate, population, water, etc. No population of organisms on Earth has survived a vertical growth curve like this without collapsing. We have to learn how to solve these problems and this is as good a trial run as any.

population.jpg

[The Reaper]

What is the big leveling out between AD and now that stalled us at 300 Million, plague, famine, or war?

TR

[mugwump]

Originally Posted by The Reaper

What is the big leveling out between AD and now that stalled us at 300 Million, plague, famine, or war?

TR

300 million is the estimated carrying capacity of the earth without the use of fossil fuels (and given the boneheadedness of the average human). This figure is empirical and is based upon the leveling-off you observed. The relatively rapid increase in population from 100M to almost 300M was due to a revolution in political, religious, financial, agricultural, and transportation systems (think highly organized, expansive civilizations: Rome, China, Indus valley, MesoAmerica). "They" speculate that another 200M could have been added to the 300M that existed in 1000 A.D if all of the systems in place were refined to the Nth degree.

Throw in coal/oil/gas for industry, transportation, fertilizers/tractors, storage, heating, etc. and the sky's the limit for as long as the party lasts. That's what goosed population growth from 1600 A.D until now - you can go from 300 M to 6.5 B in just 400 years. (Consider transportation in the US alone -- before the rail system was widely established in the last half of the 1800's there were localized famines while other geographic areas had bumper crops.)

All of the above -- plague, famine, and war -- contributed to the leveling off of population growth around the birth of Christ. But it's a chicken/egg thing, I think (damn chickens again). Were these factors a cause of the leveling or an effect of approaching the carrying capacity? I would bet on the latter.

That's why I laugh when I hear the "blood for oil" accusations. It's a long, nasty fall from 6.5 Billion to 300 Million, and the only thing holding us up (right now) is oil. If that ain't worth fighting for I don't know what is.