Pandemic Flu

[mugwump]

What's this? The WHO spank the Chinese and acknowledge the elephant in the parlor, all in the same week.

...in the new report, the WHO says if the virus becomes easily transmissible between people as a result of mutation,".. then the present high lethality could be maintained during a pandemic."

The report also raises concern about vaccine. It says, "Efforts to develop a vaccine that confers adequate protection have been greatly complicated by the emergence of ... diverse viruses..."

The report adds ".. Decisions about which vaccines to stockpile may be premature."

Infectious Disease expert Dr. Michael Osterholm says, "We have no evidence that these vaccines will protect, and on top of it, we just don't have the production capability." So even if an effective vaccine is created, it most likely can't be manufactured fast enough to be distributed to all those who would need it.

http://www.kare11.com/news/news_arti...storyid=138212

Edited: Better article.

New Zealand, Australia, and Singapore assume in their pandemic plans a 30% fatality rate with 40% of the population showing symptoms. In the US we assume a 0.25% to 2% fatality rate (with layered responses) with 30% showing symptoms. I'm guessing that Australia's preparations for 30% CFR with a 0.25% actual CFR would be the optimal scenario.

[InTheBlack]

What about using a non steroid like Albuterol to keep the lungs open?

And it might be convenient to add chemical cold packs to the emergency supplies. I forget what the chemical is, but we did it in high school chemistry class. Might be cheap to just buy from a chemical supplier.

[mugwump]

Originally Posted by InTheBlack

What about using a non steroid like Albuterol to keep the lungs open?

And it might be convenient to add chemical cold packs to the emergency supplies. I forget what the chemical is, but we did it in high school chemistry class. Might be cheap to just buy from a chemical supplier.

You should really check out Fluwikie.com. There are some physicians there and albuteral, albuterol and ipratropium combo, inhaled steroids, yada yada have been discussed backwards and forwards. You can find anything over there (they'll even interpret your dreams) but the signal-to-noise ratio is getting lower and lower. Check out the Nepal thread if you don't want to sleep tonight.

It's ammonium nitrate. Don't buy in volume.

[InTheBlack]

I can't figure out how to do an effective search in the Wiki organizational paradigm. Results don't have dates attached.

I did find this when looking for a copy of the actual Los Alamos computer model, as opposed to articles _about_ it(Mug, why was your updated info confidential? ):

http://www.lanl.gov/news/index.php/f.../story_id/9178

Los Alamos licenses avian flu modeling and simulation software
Contact: Hildi T. Kelsey, hkelsey@lanl.gov, (505) 665-8040

LOS ALAMOS, N.M., October 12, 2006 -- Company to run flu impact models for government, public, and private organizations

Santa Fe-based CIVA (The Company for Information Visualization and Analysis) signed an agreement to license Los Alamos National Laboratory's epidemiological modeling and simulation system, called EpiCast. Developed by Los Alamos scientists Tim Germann, Kai Kadau, and Catherine Macken, EpiCast was designed to help epidemiologists understand the spread and impact of an Avian Influenza (H5N1) pandemic. SNIP


I found the online report of the first Los Alamos study here, although the print version might differ:

http://www.pnas.org/cgi/reprint/103/...urcetype=HWCIT

[mugwump]

I'm hearing corporate scuttlebutt that contracts for security at the Sanofi facility in Sweetwater, PA and the GlaxoSmithKline site in Marietta, PA have been handed out to Blackwater by DHS. I'm hearing that the $100M DHHS contract w/ Sanofi is for sufficient vaccine to cover all military personnel (4 million doses = 2 million people covered).

Does this rumor pass the smell test?

GSK have been making noises about security lately: GSK predicts unrest if bird-flu mutates

"People don't realise the disorder which comes from a scary event such as a true pandemic. It is not going to be the time to line up to your friendly pharmacist because there will be hundreds of people there. There will be panic episodes," Mr Garnier said.

[Surf n Turf]

Originally Posted by mugwump

I'm hearing corporate scuttlebutt that contracts for security at the Sanofi facility in Sweetwater, PA and the GlaxoSmithKline site in Marietta, PA have been handed out to Blackwater by DHS. I'm hearing that the $100M DHHS contract w/ Sanofi is for sufficient vaccine to cover all military personnel (4 million doses = 2 million people covered).

Does this rumor pass the smell test?

Mugwump

The Sanofi Pasteur Facility is on Discovery Drive in Swiftwater, PA.
The are doing a massive build / renovation to the facility, that includes metal (but no razor wire) fencing.
We drove by on Sunday, and all that security we could see was a “rent a cop” at the gate, and one security truck parked by the entrance building, ---- but we were not looking for extra secutity.

From outward appearances, it does not look like the place is a secure facility.
I have some friends that work there, and will check out any increase in security.
They did make an announcement on October 18, 2006 that they had a H5N1 pre-pandemic vaccine That neutralizes additional circulating H5N1 virus. See the pdf file

http://www.sanofipasteur.com/sanofi-...is-pasteur.jsp

BTW, this is the facility that two years ago, “suddenly” discovered 200 million doses of flu vaccine in one of their freezer vaults. Their inventory was screwed up as they are switching to a new (SAP) computer system.

SnT

Edited for clarification

[mugwump]

Thanks, Surf n Turf. Security at big pharmas has always seemed akin to that currently at airports: intrusive/annoying and only marginally effective for folks walking in the front door; non-existent for commercial cargo and guys walking across the back 40. No offence meant to guys running airport security, I know it's better in some places and it's nearly impossible to accomplish.

I suspect that even if the rumor is true there wouldn't be any extraordinary security presence during normal times.

According to open sources, Sanofi is supposed to be through with their DHSS run -- the vaccine is in inventory.

[mugwump]

Just an update, there's no change in pandemic status...

Bird-to-bird (B2B) transmission has reemerged or developed in China, S. Korea, Sudan, Nigeria, Egypt and Ivory Coast (and is most likely pandemic throughout Africa at this stage).

Small human clusters (H2H transmission status unknown) have emerged in Egypt and continue to be reported in the local Indonesian media. None of these reports are breaking into the MSM, and it's debatable whether they deserve to. The bottom line on human cases: no change in status over what's been seen over the last several months. It's worrying that the latest human cases have appeared in Africa, given its high incidence of AIDS, but its not reason to batten down the hatches.

Charter House reports say that Indo is mounting a full-court press to keep BF out of the news (both carrots and sticks: payments to reporters for "cooperation" and threats/harassment for "unpatriotic reporting"). China is aggressively publicizing every report of avian or human H5N1 in Indo in an increasingly desperate attempt to de-link "H5N1" and "China" in the public consciousness. Recent open attacks on China by the WHO have rattled cages.

News which won't surprise most who follow this issue: a recent study demonstrates that the two rapid tests for human H5N1 don't work and produce false negatives.

Finally, a really good journal article which summarizes the current status of H5N1: H5N1 Influenza — Continuing Evolution and Spread
Robert G. Webster, Ph.D., and Elena A. Govorkova, M.D., Ph.D. . Highly recommended.

From the above, a map showing the spread of the existing viral sub-types. You can see why vaccine developers are worried; each color represents the need for a different vaccine. The current vaccines are for the clade that's spread into Korea/Japan.

H5N1_spread.jpeg

[The Reaper]

Good leading article from the front page of the Raleigh paper today on BF and how the state of NC is preparing.

Scary stuff. At least here in NC, the state is preparing and one in three victims would have a ventilator available. Nationwide, the number seems to be more like one in seven.

http://www.newsobserver.com/102/story/514902.html

Good secondary report also on the front page on shortages of resources and how triage works.

http://www.newsobserver.com/102/story/514895.html

THis may energize some of the locals to make some hurricane-like initial preparations. Probably not enough to get the politicians to dedicate more resources to it, especially when there are more pressing causes, like bridges to nowhere.

Well taken point made that the standard US disaster response of bringing in resouces from unaffected regions to help will not work with pandemic flu.

Mug, if you think the entire articles are worth posting, let me know so that I can cut and paste before it is taken down.

TR

[mugwump]

TR --

Great articles, both of them, but especially the first. Jim Nesbitt did an exceptional job. It certainly doesn't sugar-coat the issue. It's impressive that he used the projection for a 1918 pandemic when presenting ventilator requirements.

Along with the state of Washington, NC is generally considered in the top tier for preparedness. But, considering they have only prepared for a pandemic as severe as that in 1968 (the mildest in the last 200 years and not even noticed by the general population) that fact only highlights how weak most state plans are. It's probably unreasonable to try to prepare for a 1918-level pandemic; plans for 1957 intensity are probably the sweet spot.

I've heard that NC will sequester power and water workers if a pandemic hits -- which is the key to limiting collateral damage in my opinion -- but I don't know what plans have been made for their families. The fact that all of the military will most likely be vaccinated should help enormously. [The vaccine will most likely be for the 'wrong' H5N1 clade, so it won't prevent infection, but studies show it will most likely prevent death.]

The longer this holds out the better, obviously. If we make it through this winter without going up in flames then the tissue-culture production of vaccine will start coming on-line in time to hopefully protect HCWs, police and infrastructure workers.

[mugwump]

Man, the News & Observer is going after the flu, hammer and tongs. A good historical report of the Spanish Flu in NC: http://www.newsobserver.com/105/story/514837.html

[InTheBlack]

You need to wear the respirator everywhere you go. Unless you trust that the quarantine on travel will really prevent anyone who is infected from getting there.

Hospitals may stop functioning. You need to be prepared to be on your own - this thread has a lot of info on doing that.

[InTheBlack]

Don't get all Howard Hughes on us!

Pathogenic organisms are generally degraded by sunlight and by other microscopic organisms present in soil. When someone sneezes, the stuff dries out on whatever surface it landed on. It stays there unless mechanically agitated. Even if someone was sneezing directly into the roof air intake of a building, its unlikely that enough particles would make it to one person's lungs to infect them.

It would be interesting if Mug knows the minimum number of virus particles needed to infect a person with seasonal flu, and if any extrapolations have been made to H5N1. And how sensitive the flu virus is to environmental degradation.

Masks generally do less to prevent inhalation (esp the paper masks that really leak all over the poor 'seal' against your face) than to remind you not to put your hands on your face/eyes/nose/mouth, because your hands pick up stuff off of surfaces.

In a recognized public health emergency, society won't stand for people sneezing in public; they should be sneezing into their own mask and then go home.

[mugwump]

Originally Posted by InTheBlack

Don't get all Howard Hughes on us!

It would be interesting if Mug knows the minimum number of virus particles needed to infect a person with seasonal flu, and if any extrapolations have been made to H5N1. And how sensitive the flu virus is to environmental degradation.

Masks generally do less to prevent inhalation (esp the paper masks that really leak all over the poor 'seal' against your face) than to remind you not to put your hands on your face/eyes/nose/mouth, because your hands pick up stuff off of surfaces.

In a recognized public health emergency, society won't stand for people sneezing in public; they should be sneezing into their own mask and then go home.

Catching up...

There are disputes about flu transmission. Some say surface transmission only, some say aerosols, some say both. I'm in the "both" camp. There's enough anecdotal evidence from airline passenger infections to support aerosols spreading disease.

Minimum viral load for flu infection hasn't been established. We know very little about flu, actually. It's "just flu" after all. People are scrambling to gather this data now.

You're right about mask leakage and the "don't touch face" reminder, but N95 masks have been shown to work. Don't laugh, but there are recommendations to pull a nylon stocking section over your head/mask to snug the mask to the face and prevent peripheral air leaks, sort of like a "Haines Sheer Taupe" Ranger band. I think it works by making you so embarrassed to be seen that you stay home.

[mugwump]

Things are blissfully quiet on the Panflu front. Korea and Africa are hot with avian H5N1 but few to no human reports. It is assumed that avian infections continue unreported in China (Korea states their current infections are a new strain from "Mid-Western China" wherever that is.)

I was recently in Singapore and no one trusts any report coming from Indo or China, or not coming from Indo/China. Their attitude is healthy in my opinion: get ready and then forget about it -- nothing else to do.

Avian H5N1 is considered pandemic in Africa now with the odd human case in Egypt bubbling to the surface. Things were much worse last year at this time in SW Asia/N Africa.

Folks I work with are puzzled about the current lack of human cases but are obviously very pleased. That said, no one is letting their guard down.

Finally, make plans to pull home any loved ones at the first sign of trouble in the US. Federal pandemic planning leans heavily on travel restrictions and quarantine and a new study seems to back this up: The effect of travel restrictions on the spread of a moderately contagious disease

Results

We find that a ban on journeys longer than 50 km drastically reduces the speed and the geographical spread of outbreaks, even when compliance is less than 100%. The result is found to be robust for different rates of inter-municipality transmission intensities.

Conclusions

The study supports travel restrictions as an effective way to mitigate the effect of a future outbreak.

Probably the same total number of infections will occur with or without travel restrictions. So why even try? Because you flatten the curve of the rate of infections. By that I mean you decrease the number of people infected at the peak at the expense of making the infection cycle last longer. Right now people are worried about collapse of the medical systems and infrastructure as much as the disease itself (correctly). In a mild to moderate pandemic, flattening the peak might keep the grid and financial systems up.