Pandemic Flu

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I found the first (oldest) Germann simulation on the Los Alamos web site when I was looking for something else. I believe this is the one simulating international entry into Dallas via one infected traveller with an Iowa City terminus.

http://www.lanl.gov/news/images/bird4x3red.mov

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...from a public health worker in the trenches.

"Africans digging up the carcasses of dead chickens to eat is not surprising to me. I spent three weeks in small villages in Kenya in February and made these observations: More sick, feral cats than I’ve ever run into anywhere. Live chickens running under my feet in restaurants. Live chickens transported to market while tied by their feet on the luggage racks on top of cargo vans. Lacking refrigeration, chicken producers transport birds live to be slaughtered on the site where they are cooked and served—at restaurants, hotels, hospital kitchens, schools, etc. Village-raised chickens were thriving in spite of the drought because they live on worms in the cow dung. Often every person and every animal in a community shares the same water source—a hole dug in the ground catching rainwater—cats, dogs, goats, cattle, chickens, wild animals, humans. Kenyans in Nairobi told me that people in the villages don’t know about disease and would not be alarmed by death among their animals or their people because disease and death are so tragically common there. They would not report it. Even worse, many places in Africa have no health care system and no authority to report to. Considering the drought, AIDS, malaria, infectious diarrhea, militia raids—who would notice a cluster of twenty or even fifty people dying of H5N1? If the virus jumps in Africa, we won’t know until the disease is a raging epidemic in the large population centers."

All of which corroborates this (note that samples mentioned at the end were ruined by lack of refrigeration):

Reuters AlertNet- “NAIROBI, April 10 (Reuters) - Bird flu may have infected people in West Africa and weak health systems in the region could be delaying detection of human cases, a World Health Organisation official said on Monday…”

…”“So far, there is no confirmed human case of avian flu virus infection in West Africa but this is not a reason to say there is no human case,” Honore Meda, a WHO medical officer who represented the health body at a bird flu seminar in Nairobi, told Reuters in an interview. “There is a risk and probability of human cases occurring in West Africa but there’s no evidence to say there is or there is not a human case. But so far we are not in a position to confirm firmly that there’s no detected human case,” he added.

The WHO said in February that it planned to test samples from four Nigerians, including a woman who died, for bird flu. However, the samples failed to yield a clear result…”

more… http://www.alertnet.org/thenews/newsdesk/L10653318.htm

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One dead swan, lots of controversy. There's a major pissing contest going on in Britain between David King, a physical chemist advising the Dept. of Trade, and Liam Donaldson, the physician researcher who heads the Dept. of Health. Similar conflicting reports from trade and health officials are coming out of China ("China is free of H5N1" vs "Two new human cases have been identified").

Expect the same when the first dead birds are found in CONUS -- the US poultry industry is scrambling to put scientists on retainer. The strategy to be employed is being called the "blanket of reassurance".

"Two of the government's senior scientists are at loggerheads over the risk of a human flu pandemic. As experts in Scotland continued the search for birds infected with the H5N1 virus, confusion reigned in the Department of Health and the Department of Trade and Industry over just how great a risk it represented.

Britain has been preparing for a human pandemic for more than a year and has spent millions stockpiling antiviral drugs and drawing up emergency plans to be put into action if an outbreak occurs.

Yesterday Sir David King, the Government's chief scientific adviser in the DTI, said a human flu pandemic was "not inevitable". That flatly contradicted remarks by the Government's chief medical officer, Sir Liam Donaldson, of the DoH, that a human pandemic was inevitable. Sir Liam has said several times it was a question of "when, not if" a pandemic struck."

http://news.independent.co.uk/uk/hea...icle357007.ece

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This is a compilation from the last couple of days.

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Common catch phrases around my house: "You say your feet hurt?", "220, 221, whatever it takes", and "That's more than I wanted to know about dolphins". This online influenza/virology textbook may be more than you want to know about dolphins, but it's got good pictures (I like pictures) and is fairly up-to-date. Avian flu starts on page 46 or so.

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Anthony Fauci and other USGOV public health leaders should get relatively high marks for calm and accurate communication (especially as opposed to the CF coming out of the UK and China). The following is admittedly heavy on the reassurance but it is accurate:

Bird flu is not likely to change overnight so that it spreads from person to person, nor is it likely that a sick bird migrating to the US will trigger human illness, the government's top bird-flu scientist said.

"One migratory bird does not a pandemic make," Dr Anthony Fauci, the National Institutes of Health's infectious disease chief, said in an interview Tuesday with The Associated Press.

What are the odds that the H5N1 strain of bird flu will spark the next worldwide influenza epidemic? There is no way to know, Fauci said. Reassuringly, it must undergo a series of genetic changes before it could become contagious among humans instead of just birds.

Scientists might see those signs while studying the virus itself, but an early warning would be if doctors or nurses caring for someone who caught H5N1 from a bird in turn got sick, Fauci said.

"It is entirely conceivable that this virus is inherently programmed that it will never be able to go efficiently from human to human," he said.

"Hopefully the epidemic (in birds) will burn itself out, which epidemics do, before the virus evolves the capability of being more efficient in going from human to human."

But the government must prepare for the worst - "it would be unconscionable not to" - as officials gear up in case bird flu does spark a human pandemic, he added. Fauci advocated personal preparedness, suggesting that people stock up on canned food and water, as they would for a hurricane or other storm, the AP reported.

You are going to see more and more news reports that assert there is little risk of bird flu in the States ("Expert says bird flu no imminent threat"). These reports will be actually discussing the risk of infected birds on US soil (there are none yet) infecting humans inside the CONUS. One of the prime motivating factors is mitigation of economic damage wrought by an ill-informed public. I can't argue with that sentiment.

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A little known fact: It is estimated that more Indian poultry farmers have committed suicide after facing financial ruin (from H5N1 flock deaths, uncompensated culling, and the crash of poultry prices) than have died from H5N1 worldwide. Yesterday:

"In India, seven more poultry farmers committed suicide because the H5N1 virus destroyed their livelihood, according to an AFP report that cited information from a farmers' organization.

The H5N1 infections and subsequent culling that have swept India have cost the industry $1.8 billion in 6 weeks, the National Egg Coordination Committee said today. "

On a related note:

ReuteraAlertNet- “TOUL PREK, Cambodia, April 12 (Reuters) - When her 3-year-old daughter died of bird flu, Choeun Sok Ny expected sympathy from fellow villagers in Cambodia. All she got was abuse after the death drew government culling teams but no compensation.

“Our neighbours are unhappy with us because they lost all their chickens and ducks after my daughter died,” the 23-year-old said, clutching a photo album of her daughter, Mon Puthy, who became Cambodia’s fifth bird flu victim last month.

“They should care about their lives more than their chickens. But they don’t,” she said, the tears rolling down her cheeks as she explained the local backlash that epitomises the problems of bird flu monitoring in the poorest corners of the globe.

If governments in countries like Cambodia, where most people have to get by on a dollar a day, do not compensate properly for poultry lost in anti-bird flu culls, villagers will do all they can to ensure possible outbreaks are covered up…”

more… http://www.alertnet.org/thenews/newsdesk/BKK260524.htm

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Fauci's reassurance aside, if a pandemic develops it will almost certainly vector on an intercontinental jet from sub-Sahara Africa, Egypt, China, or Southeast Asia. Note: over 900 million Chinese (total pop. 1.3B) receive $0.01 in public health expenditures per year. That's right, about one US penny is spent per Chinese peasant per year on health care. That figure is higher, sometimes far higher, for the growing middle class who live in the booming cities. The Chinese peasants' loss of all healthcare and education benefits is only one of the dirty little secrets in the "Chinese miracle". For the last 15 years or so, if a peasant gets sick it's traditional medicine or nothing. This means there is essentally no disease surveillance for close to a billion people. The quid pro quo for the recent very positive WHO pronouncements coming out of China is reportedly a promise by the Chinese government to increase public health care spending. Ha, maybe they'll double it -- don't spend it all in one place!

The situation is the same in many parts of India, Burma, Cambodia, Egypt, sub-Sahara Afric, etc. Just one more example: Nigeria has the biggest population in Africa with 1 in 6 Africans being Nigerian. Total health care spending averages $0.04 per Nigerian per year with three of those cents coming from NGOs (for AIDS education primarily). Again, a situation where there is basically no surveillance going on.

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China is desperately trying to string together 14 days of "no news" so they can declare H5N1 eradicated. No such luck. Note that WHO was informed of the following case on 30Mar but the report was just released via back channels today. If you want to see evidence of China's rise in power and influence you don't have to look farther than this: WHO is in China's back pocket.

CHINA: News ban for Guangzhou's suspected second bird flu case, sources say

Tuesday, April 11, 2006

"A suspected second human case of bird flu has emerged in Guangzhou but authorities have imposed a news ban on reporting the case, sources said yesterday.

A source at the Guangzhou No1 People's Hospital said a 41-year-old woman, identified as Ms Li, was admitted on March 25 with unexplained pneumonia. The source said experts confirmed two days later that Ms Li had the H5N1 virus but the case had yet to be reported by official media. The woman lived in the Xihua area of Guangzhou's Yuexiu district."

http://www.asiamedia.ucla.edu/articl...parentid=42711

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Mumps may have been spread via air travel: CDC

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Africa / SW Asia: Scattered H5N1 human cases continue to pop up in Egypt, Sudan, Nigeria, Pakistan, etc. All follow the typical pattern of infection after intimate exposure to poultry. The dice continue to roll with each of these new infections but H2H transmission is not indicated. Huge swaths of Africa have no surveillance in place.

India: what a mess. No one knows what is going on there. There are suspected cases -- some which indicate clusters with possible inefficient H2H transmission -- but the collection and storage techniques being employed have rendered all samples useless. The only lab in India is overwhelmed and is not accepting any more samples for H5N1 testing until October.

Burma: See India, then add in a paranoid, totalitarian government and 1.5 million "displaced persons" living in the bush. WHO has estimated over 100 poulty outbreaks and privately believe there are human cases.

China: effing China. On Monday, the top-brass 'WHO Whores' gave the Chinese government a pat on the back for "honesty and transparency" in their reporting of H5N1 outbreaks. This was reported Tuesday:

HONG KONG, April 18 (Reuters) - Authorities have culled about 8,000 chickens in a poultry farm in China's eastern Shandong province after 400 chickens died there last week, a Hong Kong newspaper reported on Tuesday.

The South China Morning Post said the farmer, identified only by his surname Chen, was ordered by officials not to talk about the cull as "it was a state secret". He and his wife were given injections on Sunday, but they did not know what they were for.

Indonesia: This definitely one place to watch closely. There is a new cluster reported with 8 cases from one family: 2 unconfirmed dead, 4 confirmed in hospital, 2 suspected in hospital. Jakarta Post

USA: Many in the biz believe there are already H5N1-infected waterfowl in Alaska/Northern Canada. None reported yet, of course. There was a period of "this whole pandemic thing is overblown" which is currently being replaced by "we're all going to die!" Nothing has changed, really. Nobody knows what is going to happen, and it remains prudent to make reasonable preparations. Recent simulations by MIT, UofC, IMF and various trade associations confirm that supply-chain disruption will caused significant effects if a pandemic does hit.

Expect "Bush is trying to distract attention from Iraq" when the US pandemic plan is finally released this week.

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WASHINGTON — Poultry processed in China will be allowed to enter the United States despite outbreaks of deadly bird flu in China, the Bush administration said Thursday.

Critics said the imported poultry will put public health at risk. The Agriculture Department said the meat would be fully cooked and perfectly safe.

"It will have been processed," said Richard Raymond, the department's undersecretary for food safety. "Cooking will kill the virus, if there is any virus, in poultry meat."

<snip>

"It is an outrage that the U.S. is going to open our borders to imports of poultry from China _ a country that lacks the fundamental safety functions in its processing plants, has questionable export practices, and a country where a deadly animal disease and possible pandemic is running rampant," said DeLauro, top Democrat on the House Appropriations Committee's agriculture subcommittee.

http://www.chron.com/disp/story.mpl/...s/3808465.html

How much you wanna bet that 1M tons is shipped over and 6M tons comes back?

A snip follows from my 04-05-06 post about Charoen Pokhand, the massive Thai/Chinese poultry company with intimate ties to the Chinese govt. Hmmmm.....

"Remember the guy John Huang who made an illegal $250,000 donation to the Democratic National Committee in 1996? It gave Clinton a black eye for about a week as the Huang-Clinton photo op pictures were trotted out. (Note to self--no glad hand pictures when I become president) Anywho, that money was from Charoen Pokhand. To keep this even, it must be pointed out that Neal Bush, George W's brother, also has a joint venture w/ CP. This company is a far-eastern powerhouse with very close ties to the Chinese (owner is an ethnic Chinese) and Thai govts.

When I express doubts about Chinese government press releases, this is one reason why (there are many others)."

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Well, things are not going so well on my work front, as evidenced by some recent public reports of failure to achieve "seroprotective efficacy" with experimental vaccines (translation: it didn't work well enough).

Things are getting...twitchy...again. Nothing has really changed with the virus or the odds, but a fatalism is setting in. Maybe it's recent setbacks. We seem to have swung back to "...it's not a matter of 'if' but 'when'..." once more. Same thing in the Texas two-step that is crisis communications. Only two weeks ago Nabarro (WHO) and Fauci (US) were talking about "very, very slight chance" of a global pandemic. Nabarro is back into condition red, at least today. I think China has them shook.

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What's really happening in China?

"Local health officials in China have failed to report possible human cases of bird flu to the central government, according to a person familiar with the matter, raising the possibility that some officials may be concealing suspected cases and that the death toll in China is higher than the official tally of 12."

http://online.wsj.com/google_login.h...googlenews_wsj

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New human cases continue to pop up in Indonesia, Pakistan, China, Russia, etc. Many cases have no obvious link with exposure to infected birds. Smart people are now beginning to think the mechanism of infection is fecal/oral and not respiratory. Keep the dog out of the goose poop when the geese are flying this fall. And wash your hands.

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Indonesia or China remain the odds-on choice of locale for a breakout. The H5N1 virus has mutated into two major clades and a whole slew of subtypes. The clade which infected clusters of humans in Egypt/Turkey/Azerbaijan had approximately a 20% CFR [edit: case fatality rate] while with the subtype in Indonesia it's more like 70%. Except for a recent cull in Bali, Indoneisa does not support culling of infected flocks.

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The average age of an H5N1 case fatality is 14. Scares me to death.

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I've been told that internal GAO studies have speculated that infrastructure collapse could kill more Americans than the flu in a major pandemic. I do not have a cite (and I doubt there ever will be one) but this simulation in Davos addresses the issue. (Buy another sack of rice.)

Influenza Pandemic Simulation Reveals Challenges in Delivering Essential Services During Widespread Outbreak; Exercise by the World Economic Forum and Booz Allen Hamilton Finds Potential Strains on Healthcare and Telecommunications Infrastructure

http://home.businesswire.com/portal/...64&newsLang=en

Some excerpts:

"Governments will likely direct the general population to stay in their homes, and to minimize social contact. As a result, the government may need to assume national control, as in wartime, of critical infrastructure and resources including food, fuel, and health care. In addition, governments will need to assume responsibility for the “last mile” in delivery of food and other critical supplies to the populace."

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"Quite likely by day 28 all systems will have fallen apart."

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"Military must be involved in the response to help keep the peace and deliver essential goods and services."

...

"Telecommunications will likely be overwhelmed early in the pandemic. Some experts speculated that the Internet could shut down within two to four days of the outbreak. This implies that government and businesses must coordinate and plan for the use of alternative communications channels—and telecommuting will not be a viable option."

http://www.boozallen.com/media/file/...Simulation.pdf

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I've been thinking about water supplies lately ("Quite likely by day 28 all systems will have fallen apart") so I thought I'd pass this on, it's what a woman I know uses for H20 in the 3rd world when in the bush. It is functionally equivalent to the Katadyn camp filter--a filter, not a purifier--which means it does not kill viruses. In the bush she pre-filters through cloth, siphon filters through the ceramic candle, and then treats w/ a viricide (think 8 drops/gal Clorox in a home situation). She sometimes has to drink out of communal mud puddles and swears by this technique. The candle can be repeatedly brushed clean - she said up to 200 times (???) for "thousands of gallons depending on what you are starting with." The Katadyn model claims 300 cleanings for up to 26,000 liters and this is supposed to be a better filter so that's probably in the ball park.

The ceramic candles are 9" vs. the 7" in the Katydyn camp filters although they will fit as Katadyn replacements per the web site. The whole shebang is 1/3 the cost of the Katadyn.

http://www.pwgazette.com/gravity.htm

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Small world, from another site, on the water filter my friend recommends:

"If you get the Pure Water system, I would go with a straight Doulton ceramic candle on one end (no carbon block core), and a GAC/KDF inline filter on the other end. The ceramic candle will filter out anything bigger than 0.5 micron in diameter. The GAC/KDF filter will remove dissolved heavy metals and chemicals like solvents, fuels and pesticides. This setup will actually work better than expensive filters like the Berkefield, because the Pure Water siphon filter is a two-stage cartridge system that uses the exact same ceramic filter as the Big Berkey, with an additional chem-removing second stage. The Big Berkeys are around $240.

Royal Doulton Super Sterasyl ceramic 'candle' filters last forever. They do not need to be replaced; only cleaned occasionally with a Scotchbrite pad. The GAC/KDF inline filters should be replaced after a certain number of gallons, so you should get some spares for those.

If you have questions, call Pure Water and ask for Gene. He is incredibly knowlegeable and helpful. And I do not have any affiliation with Pure Water, other than being a very satisfied customer."

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Tamiflu/oseltamivir is a real bitch to synthesize. The starting point is a very scarce and expensive ingredient called (-)-shikimic acid. Shikimic acid is derived from fermentation of Chinese star anise fruit. Yes, from that China. Complete synthesis requires over a dozen steps and can take 12 months.

Nobel prize winner Elias J. Corey at Harvard University has developed a new quick, high yield route that replaces this cumbersome process and uses inexpensive starting materials.

"Our synthetic pathway has several advantages over the current Roche production method," Corey says. "It is shorter, doesn't involve any hazardous substances, begins with very cheap starting materials that are pennies per pound, and has excellent overall yield." Corey's overall yield is about 30%—about twice that of the commercial route..."

This discovery is worth untold millions to Harvard and Corey, yet they placed the method into the public domain.

Roche, in my opinion, now has to step up and license the drug, for token amounts, to all comers.

[Sten]

If you have a well.

http://www.simplepump.com/

This is a 700 dollar hand pump that runs in parallel to your electric system.

If I use some redneck engineering I am convinced that I can find a much more affordable solution to get water out of my well.

[Stargazer]

Although Roche researchers declined to comment on the new synthetic routes, a spokeswoman says the company is in contact with the authors of both papers. Both the technical potential and regulatory impact of any new route still have to be explored, she comments. In his group's paper, Corey, who serves as an adviser to Palo Alto-based Roche Biosciences, thanks Roche researchers in Switzerland for their encouragement.

Roche has been obtaining the shikimic acid starting material via extraction from Chinese star anise fruit and fermentation processes. It has recently signed up more than 15 external contractors to help it expand production of both intermediates and finished materials (C&EN, March 20, page 10). With this help, Roche says it will be able to produce 400 million flu treatments annually by the end of 2006.

Whereas the Japanese researchers have applied for a patent, Corey and coworkers have put their process in the public domain. "I hope the work will stimulate others to work on different ways of synthesizing Tamiflu," Corey says. "Although our route is already very efficient, it's conceivable that when you put new developments together, you'll have an even better and cheaper process. I think the Tamiflu supply problem is solved."

http://pubs.acs.org/cen/news/84/i18/8418notw1.html

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Originally Posted by Sten

If you have a well.

http://www.simplepump.com/

I passed this on to some who do -- thanks.

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I just got word today that mud-puddle lady -- I've posted her report from Nigeria and her water filtration recommendation -- was stopped by Maoist rebels on a road in Chhattisgarh state in India. They were held for 4 hours, roughed up a bit, and had all of their equipment and vehicles stolen. They were released shaken but essentially unharmed.

They were attempting to set up a satellite lab for use in disease surveillance. All that gear, smashed or stolen.

The guy who passed on the report says the Indian govt. is not in control of that state. I didn't know the Maoists were that powerful in India.