Pandemic Flu

[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.

[The Reaper]

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

[mugwump]

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.

[Pete]

Originally Posted by mugwump

....The pallet I got from a client was the same: one year for one person (sixteen cases of Mountain House with six #10 cans per case -- the Blueberry Crumble is pretty good ). ......

Mountain House is showing all it's # 10 cans as out of stock. Darn. I do like their foods.

A few things set aside for a rainy day is never a bad thing. Acetaminophen and Ibuprofen are real easy to come by in the stores right now. In pills and oral solutions. Plus electrolyte solutions for hydration. $20 a week for a couple of months can fill up a few small boxes. If something hits the stores will be cleaned out quicker then bread and milk is before a huricane.

Some good ideas in some of the above replies.

Pete

RE: Y2K

I told a guy who was going on and on about how everything was going to stop at midnight on that night. I told him my coffee pot was real stupid. It didn't care if it was making coffee at 5:00 AM on the 1st of January 1900 or 2000. All it knew was that at 5:00AM it turned on and made coffee. And guess what. When I got up that morning my coffee was ready to drink.

He said "That's fine about the pot but what about your car?" I said that my car would wake up on the first and go "Gee, great. I don't have to go to the Doc and get a checkup for 100 years or 3,000 miles, which ever comes first."

[The Reaper]

I saw that they are out myself and don't think that you really need the Mountain House foods.

The advantage of the MH is the light weight, long shelf life, and lack of cooking requirements. You have a way to cook and they are delivered to your home, where you are storing them. For this, you pay extra. Like a 90 day bare supply of MH for four people is going to be close to $2000. Figure it out. Food is not cheap. Special freeze dried food is going to be more.

I have a camp stove and a gas grill. As a minumum, I can boil, bake, fry, and grill. Get an extra propane cylinder or two, or get the gas company to hook your grill to your home tank. I have a generator. As long as I have fuel, I can use my microwave, coffeepot, fridge, etc. a few hours per day.

For food, look around at the meals your family likes. Most families without a gourmet cook or a lawyer have a 10-30 meal main course rotation they use. Get a Betty Crocker cookbook, like Grandma had. A few MH type meals for tough days or for a treat would be nice, as would a few items like the canned freeze dried hamburger. What do you eat while camping?

Figure out how to replace refrigerated items, as they may not be available or power may fail. Keep a large cooler on hand. Buy any less perishable product substitutes like powdered milk, canned cheese, powdered eggs, canned butter, dehydrated or canned meat, etc.

Buy and store staples. Flour, salt, sugar, yeast, coffee, corn meal, honey, oil, beans, rice, oatmeal, grits, pasta, shortening, etc. Peanut butter and jelly. Ramen. Mac and cheese. Cans of soup. Hard candy. Get canned veggies and fruit. SPAM may make a comeback. I like mine fried.

Get a way to store a large amount of water, or be prepared to purify and boil it.

Paper plates may come in handy, definitely plastic bags of all sizes, foil, paper towels and toilet paper. Get extra bleach and HTH if you know how to use it. Don't forget the hand sanitizer, tissues, Tylenol, aspirin, Ibuprofen, etc.

No need to order a tractor trailer load of supplies and an additional 10'x20' storage unit. Just buy a little extra each time you go shopping, maybe 10% more. Or an extra large box, like they sell at Sam's. Find a place near the kitchen to keep it, easily accessible. Like the pantry used to be, for those who can remember them. Hang a list nearby and keep an inventory. You use it, you replace it next time at the store. Never go zero balance on a critical item. You see the epidemic coming, stock up, but don't wait till them to start or you may be too late.

Start cooking the foods you have selected and serving it to your family now. You will learn how to best prepare it, what you forgot, and what they like and don't like. No one wants the pancakes without syrup or at least jam till they are really hungry. Once you have completed your stash, start rotating the stock. First in, first out. Get the family used to eating it. Keep the perishables only in the qualtity you can use before they spoil.

This is not rocket science, people, except for those of us who are used to pre-prepared food and take out, or do not know how to cook from scratch. Lewis and Clark fed 35+ people for two years off a few barrels of salted pork, flour, hominy, biscuits (probably hard tack), beans, coffee, sugar, dried apples; a portable, dried soup mix something like a concentrated meat broth, 200 pounds of beef tallow, 50 pounds of lard and the expedition favorite, whiskey. The rest, they found in nature along the way, learned about/bartered from the local Indians, or killed/caught.

Surely, with all we know now, we can get together enough stuff in our homes to last us for a few months of reduced supply. Don't be on your roof with a sign, starving when the time comes. Get on it people.

HTH.

TR