Bird flu after 22 months

When we first began to cover the bird flu problem -- back in 2004 -- it wasn't being discussed much anywhere, including the blogs. We started talking about it for two main reasons. First, it seemed to us, as it seemed to many informed public health scientists, that this was a possible freight train coming down the tracks. We didn't know then (nor we know now) how far the train was, whether it would get all the way to us or how fast it would be going if it did get to us. But we could feel the vibrations on the tracks and we knew enough about train wrecks of the past to worry. That was the first reason.

The second reason is more complex. For us, the response (or lack of response) to the genuine possibility of a pandemic of influenza from an avian subtype that had already shown itself capable of infecting humans to deadly effect, was a grotesque metaphor for failed public health leadership, both in our on country (the US) and most everywhere else. The US CDC was preoccupied with a phantom bioterrorism threat and remodeling the agency and US public health in general to respond to the Bush administration message: "be afraid, be very afraid."

CDC Director Gerberding's complicity in this will be her shameful legacy at CDC (along with a wrecked agency). Her "staying on message" delayed by at least a year, maybe two, the need to send a signal to state and local public health authorities that it was time to get busy planning. A signal was needed because state and local officials were struggling to keep their heads above water after a tax cutting frenzy had weakened routine public health. Every day was a battle to put out fires and rescue the sick and weak. Planning for a pandemic was not on the agenda, and CDC didn't put it on the agenda for them. CDC's disbursal of "bioterrorism funds" did more damage by distorting public health and in general making us less safe (see our post here. This was the counterpart to the Bush administration Iraq debacle, which we now know even their own intelligence establishment is saying has made us less safe.

Now it's almost two years later and the bird flu train has not arrived. But the tracks are vibrating more strongly, we can hear the engine noise more loudly and we know the train is in the vicinity, crashing through half the world's poultry flocks, flicking off various other mammalian host species and the occasional human (251 at last count). We know much more about the virus than we did two years ago, but some of what we have learned is that what we thought we knew was wrong. That's progress, but of a peculiar sort. Still no effective vaccine in production and no likelihood of significant quantities for several years, if then. Uncertain quantities of antivirals on hand and with uncertain efficacy. And public health systems still tottering on the edge, with social service systems weakened as well. These are gross failures of government, and those government failures are traceable to gross failures in leadership.

The leadership void is in every sector, including my own, academia. There are notable exceptions. Dr. Michael Osterholm of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota warned us early, often and persistently, and he continues to do so. But many flu scientists have continued business as usual in a setting that is anything but usual. Sharing of information, including isolates and sequences, has improved (under pressure it must be said) but there is still a long way to go. Dr. Ilaria Capua of Italy has shown genuine leadership in this area, but it has not been an easy sell. Overall, I am not proud of leadership in academic science.

Government? WHO has had its ups and downs. They've made many mistakes which have damaged their credibility, its most precious asset. Now they need a new Director General and most of think they are going to screw this one up, selecting a diplomatic "go along to get along" type instead of one willing to break some china. They are still centrally important and we need to strengthen the hands of the best in the agency by our support and criticize the worst. The record of the US has been mixed. Health and Human Services Secretary Leavitt has done the right thing by going to all the fifty states to rally them to the need to prepare. But the administration he is part of, and the party in power that supports it, has done incredibly little to provide the resources to get ready. Worse, as noted above, they have hurt us. There has been some genuine progress on the local and community planning front. Not the "plans," most of which are probably worthless, but the process of getting together, talking, mobilizing the community. Baby steps, but steps nonetheless. And even the small amount that has been done will pay off handsomely if the balloon goes up.

The conventional print and broadcast media are also a mixed bag. Some really terrific flu reporters have emerged, the standout by any measure being Helen Branswell of Canadian Press. She has been joined by others such as John Lauerman at Bloomberg, Maggie Fox at Reuters, Nick Zamiska at the Wall Street Journal, Declan Butler at Nature and a few more who write about the subject occasionally but well for some of the large news outlets. For the most part, though, the reporting has been terrible. Superficial, often inaccurate, just repackaging of official press releases or repetition of clearly false mantras. The broadcast media are largely absent. Worse than terrible.

Then there's the internet. The official sources have their sites, of varying quality but they are usually not very timely. Plain vanilla. The real flavorful ones come from the active flu blogs and wikis, chief among them (I'm prejudiced, of course) The Flu Wiki. Started in June 2005 as an experiment in community participation in pandemic readiness it has grown to a sizeable venue with two separate parts, an active Forum or Discussion section, that buzzes with the latest news, analysis and speculation; and a resources section (the wiki proper) that has links, original postings and resources of all kinds. This site is not a bird flu site, per se. It is a public health blog, but we have done quite a lot of bird flu here because of our broader interest in public health leadership and how citizens can participate in and make public health better. Along with our wiki partners DemFromCt and Melanie Mattson we started The Flu Wiki in 2005. Those two, joined by our tech guru pogge and our colleague, moderator and friend, anon22, now do the heavy lifting. I am more a shadowy figure in the background but keep a hand in policy decisions with my colleagues.

In addition there are numerous flu forums, each with its own small community and character. Feisty, cantankerous, informative, maddening, exhilarating. Something for everyone but also not to everyone's tastes. And there are the blogs. There are quite a few now in FluBlogia (the term for the flu-oriented sites of the blogosphere) and I will risk hurting the feelings of some really excellent sites by mentioning only two, Crawford Killian's H5N1 (crof's blog) and The Coming Influenza Pandemic. These functions primarily as newsfilters, combing the net for bird flu news and commentary of interest and providing the links with some excerpts and some brief comment. If you look at our left sidebar you'll see a bunch of other great sites in our blogroll. Try them. Many people also like to see what's up at Henry Niman's company site, Recombinomics. It's not a blog, because comment isn't allowed, but Henry has his own special take on things and a loyal following. Again, I'm prejudiced, but I view the internet as the most significant development in the collection and dissemination of pandemic flu related news in the last two years. By far.

This site, despite its interest in the bird flu problem, isn't a news filter, leaving that to others. In the early days we reported every case, but that's not needed now because others do it exceptionally well. We usually hang back for a bit to take the measure, hoping that our commentary and observations add some value to a raw reporting of developments. We think this is even more necessary now, two years down the line, because it is harder and harder to see the big picture.

And what is the big picture? Here's a picture, at least, a slightly updated version of the same graph we put up last week:

i-60e60913a13643eb97e3a956b9494e32-Slide1_0919.jpg

Source: WHO Western Pacific Region Office/p>

This shows three flu seasons, starting in late 2003 - 2004, 2004 - 2005 and now 2005 - 2006. The first has a big but narrow spike in southeast asia. Then there is a small gap, a few sporadic cases in the summer and a second season, also southeast asia. This time the bump is wider because of more cases. From now on there are no gaps. Every month has brough us at least one human case. In the summer of 2005 we see the geographic spread represented by the different colors, chiefly Indonesia. This is a new clade or lineage of the virus that has spread out of asia. The 2005 -2006 hump is significantly wider still. As we head into the new flu season, 2006 has already surpassed 2005 in new cases (97 in 2005, 102 and counting in 2006) and we still have more than three months to go.

There has also been evidence for some time of small clusters with all the hallmarks of person to person transmission. In a few cases this has been demonstrated, but mostly we are in the dark about how people are getting sick from this virus. Exposure to infected poultry probably predominates, but there are sufficiently many cases where no exposure history has been obtained that we need to also consider other reservoirs. Person to person transmission has occurred, but so far it has been rare. Yet today comes news of yet another suspected three person cluster in Indonesia, the country where the largest cluster to date (8 cases) also occurred.

So the pot still boils and we don't know what the new season will bring. We can't get off the tracks, so we should get ready to manage the consequences.

More like this

I'm not afraid. Bush will protect us.

To the author of "Bird Flu After 22 Months" I would really like to hear from you by email. There is another blog you might be interested in participating in.

By Claudinne (not verified) on 27 Sep 2006 #permalink

Beautifully written piece. I like your conceit of train coming down the track, hearing the vibration, etc.

This 22 month summation should be printed out and archived safely in as many places as possible... want the public and history books to get it straight.

(Now, for the internal "peanut gallery" reaction on the subject of pandemic trains:

"Chugga-chugga, Chugga-chugga -Weeee'rrr scrrooooowed!-")

By crfullmoon (not verified) on 27 Sep 2006 #permalink

I related to the blogosphere that Dr. Frist came to Memphis to visit with Dr. Webster last year when he was trying to get funding for avian flu. He came in in the morning to the air center and was fine looking, fresh in fact. He came back four hours later and looked like a train had hit him. I questioned one of the staffers and he said that Webster had given him the bad news. Webster was saying that the entire planet would get this in some form eventually. Yeah, they had the modelings then.

Frist went back to Congress and asked for more money. They got about four billion (about 13.33) per citizen. He asked for double that. The door was left open for more money but not just now. Democrats and a few Republicans tried to tie it to Iraq and to get out of there. The smart ones knew that if H5N1 starts hard and heavy that we will be out of there anyway. They would simply don their masks and suits, climb onto planes and be back within 3 weeks.

So is it a lack of leadership? You danged skippy it is but not a particular adminstration-its politics. No government has ever reacted in time to a pandemic or a disaster to suit some. There have been glaring examples of that. Katrina could have been a lot less but the law stood in the way of good common sense. Blanco doesnt sign the federalization for three days, Bush doesnt mobilize because of the law. Good common sense said send them anyway, but he could have been impeached if he did. So people died as a result of politics. Bush should have said "F-you" to Blanco.

Disastrous? 1918 was a good example of that and how the states did an incredible job on their own because they had to. Pandemic-Well we know a lot more, but we have a lot more people and throwing money at it is a start. But will it change the outcome? It is almost inevitable now and I doubt there is a epidemiologist, communicable disease specialist, or a bio-warfare researcher that doesnt think its not coming. We can only hope and prepare for a least case scenario. The worst case would end all democracy on this planet and we might be plunged into a warlord type of world. He who has the biggest guns and the most people will win.

Dont give up of course, but I fully think its time to get the word out. Confirmed clusters in Indonesia (3-4) mean the train Revere mentioned is likely about to start to pull into the station and then head for other places.

Edmund-The time for bashing Dems and Republicans is over I think. Tell me you have gotten your family and at least three other families prepared by getting pissed, arguing, making them do whats necessary. I have had a hell of a time just getting the Pakistani family down the street to understand what is happening. Everyone on my street (all four miles now) have prepared and now my Paki family. The translations go thru the 12 year old....Yeah, get them prepared for the four months of fun and games and then it will be time to bitch about it post pandemic. I dont think that even giving up 4 billion more would stop this stuff because of the other countries that are involved. I believe that it was inevitable from the beginning. Nature is just doing some house cleaning. We might have saved "SOME" if universal healthcare was in place but that isnt quantifiable. It might be a benefit but would they save any real numbers? I dont know. I doubt if anyone really could say. The 22 months Revere refers to is really almost 10 years now and it mirrors the disease that were mentioned by the Chinese mandarins pre-1918 flu for almost 5 years prior to its outbreak. Get ready for a whackin'.

By M. Randolph Kruger (not verified) on 27 Sep 2006 #permalink

Great summary!

Just looking at your graph, it suggests to me that the Vietnamese "clade" was the deadliest yet--far more so than Indonesia. And yet I don't get that sense from you or others. Why would it "look" worse if it wasn't--or was it?

Not being a scientist I found Revere's ringing of the bell a grim reminder of what we had all been thinking about this time last year. Living in rural southwestern France, we were kept on high alert by the officials. Everyone over 65 or with fragile health is entitled to free flu shots every year, and although these weren't bird flu vaccines, you should have seen the crowded country Doctor's offices. For very old people the nurses and doctors were making the rounds on all the little back roads.

The markets were full of farmers complaining that no one was buying poultry. I must admit that I took advantage of the great deals on Foie Gras and beautiful chickens to stock in the freezer for Noel. After a couple of greatly publicized scares but no actual human bird flu cases, it all blew over and all of the poultry farmers let their birds run free again.

But this year NOT ONE WORD from the government. Everything is completely normal and one would think that there was no more threat at all. The geese will soon be flying up from Africa and instead of looking at them as potential death squads we will again be admiring their beautiful formations and muttering that winter is just around the corner.

But I guess we should keep our ears to the tracks as it were. Thanks for the very informative expose, Revere. I guess I didn't have enough to worry about....

O'Leary: "I guess I didn't have enough to worry about...."

That's my job.

Name: Remember these are cases, not death. You can't judge lethality from this. If you go here and look at the third graph down you'll see outcome. Case fatality ratio is very hard to judge from these data but it doesn't necessarily look worse to me. We probably don't have the full denominator for this calculation and no way to model ascertainment easily, so I wouldn't try to draw conclusions from this.

Thanks Revere for the well done summary. I too appreciate the big picture presentation.
M. Randolph Kruger: nice post.

Just a comment on the ready availability of information on Bird Flu. Two bills to limit influenza pandemic (and other health) information available to the public on pandemics from government are going through both the U.S. House and the Senate. Under the blanket of "national security" much of the data now available would be classified and unavailable, publication could be a crime.

It looks like they are going to pass.

Seems like the health news suppression we have castigated China about is coming home here to the U.S. of A. The powers that be are not taking well to the idea of citizen participation (meddling?) via internet in the decisions of government. We are a Republic, after all.

By Pogie's Mom (not verified) on 27 Sep 2006 #permalink

Revere: When these earlier cases, such as the vietnamese clade, were occuring, were they or those exposed being treated with tamiflu to the extent they have been in the more recent outbreaks in indonesia this year? If not, does that indicate that the virus is increasing in virulence....taking the difference in treatment into account?

By mary in hawaii (not verified) on 27 Sep 2006 #permalink

Pogie's Mom: What are those bills? This is the first I've heard of it. I am extremely interested to know what this is about.

MiH: The best mesure we have now to indicate virulence is case fatality ratio and there is no decent way to estimate it with the data we have. The numbers would be expected to bounce around a lot (since they are fairly small) and we don't know how ascertainment in the denominator and numerator are varying over time and over space. You can make guesses, you can speculate, you can go with a gut instinct. But you can't estimate it quantitatively with these data and I frankly don't see the virulence increasing. But that's just me. Your mileage may vary.

I found this (and some interesting additional information and detail) on a posting by Snowy Owl on Flutrackers today.

Bills are S.3678 Burr R-NC and Kennedy D-MA "Pandemic and All Hazards Preparedness Act" and
H.R. 5533 Eshoo D-CA and Rogers R-MI "Biodefense Pandemic Vaccine and Drug Development Act of 2006."

Looks to me they are circling the wagons.

By Pogie's Mom (not verified) on 27 Sep 2006 #permalink

MRK:

I prefer to criticize and prepare. They do not exclude each other.

For you to say this is inevitable anyway, nothing could have been done to stop it, etc., I think is dodging the main point Revere and others have been making: we could have had years of advance preparation, gotten our vaccine programs in better shape, had more and better research done, clinical trials, blah, blah.

"No government has ever reacted in time to a pandemic or a disaster to suit some."

This is the first time that we've been able to see an approaching flu pandemic. The warnings have been coming from experts for years. Nothing has been done until recently. It could have. We may not have been able to stop this or any other virus, but we could have better protection from it at this point. We don't.

The train metaphor is both very appropriate, and very evocative here, Revere. And it works equally well for both the pandemic and its victims. Clawdia, over at CurEvents.com, has as a signature line, "There's a train leaving nightly, called "when all is said and done..." W. Zevon.

The quote is from Warren Zevon's song "Keep Me In Your Heart." Warren wrote the song, with the help of Jorge Calderon, for his last album. Warren's death, as the result of lung cancer, was fast approaching, when the song was written. The train metaphor is employed here from the passenger's perspective. A plausible, affecting anthem, for all those who will be taken by the coming pandemic...and those they will leave behind.

Keep Me In Your Heart

Shadows are falling and I'm running out of breath
Keep me in your heart for awhile

If I leave you it doesn't mean I love you any less
Keep me in your heart for awhile

When you get up in the morning and you see that crazy sun
Keep me in your heart for awhile

There's a train leaving nightly called "when all is said and done"
Keep me in your heart for awhile

Sha-la-la-la-la-la-la-li-li-lo
Keep me in your heart for awhile

Sha-la-la-la-la-la-la-li-li-lo
Keep me in your heart for awhile

Sometimes when you're doing simple things around the house
Maybe you'll think of me and smile

You know I'm tied to you like the buttons on your blouse
Keep me in your heart for awhile

Hold me in your thoughts, take me to your dreams
Touch me as I fall into view
When the winter comes keep the fires lit
And I will be right next to you

Engine driver's headed north to Pleasant Stream
Keep me in your heart for awhile

These wheels keep turning but they're running out of steam
Keep me in your heart for awhile

Sha-la-la-la-la-la-la-li-li-lo
Keep me in your heart for awhile

Warren Zevon

(There is a very fine video of the song posted at youtube.com; just type - warren zevon keep me in your heart - into the search box.)

I'm going to southern california next week to visit my kids and their families. I hope it's not the last time we see each other. I haven't been able to get any of them to take the threat of a pandemic seriously thus far, so I plan to tell them to imagine what the situation would be like if there were no electricity in their entire area for 3 to 4 weeks, and to simply prepare as if that were what would happen. I am hoping that is a reality they will find more acceptable: The idea of a deadly flu killing half the people in town is just too much to take in, I think. Too morbid, too horrific to face, it brings out the fatalist in most people, that or outright denial. But no electricity, and its ramifications, that's something they can deal with. I pass it on to you as an idea of how to get people to at least do something to prepare. I've been using that approach with my students lately too, and it seems to be taking hold.

By mary in hawaii (not verified) on 27 Sep 2006 #permalink

http://www.ombwatch.org/article/articleview/3598/1/1?TopicID=1

Above is the link to the discussion of the House and Senate bills that Snowy Owl provided.

From a quick look----my impression is that there is no need to anticipate big brother censorship of bird flu discussion or news---restrictions will be on the scientific data produced.

I believe we do need restrictions on any scientific data that could be picked up and used against us. In a loving world this would not be needed---but Americans in general are hated more and more each day by the rest of the world.

I am sad to say we do nothing to discourage this hatred---we only seem to feed it.

Revere,
You keep ranting over and over again as follows:
"...mostly we are in the dark about how people are getting sick from the virus. Exposure to infected poultry probably predominates."
What scientific evidence do you have to prove your conclusion that exposure to infected poultry leads directly to infection with H5N1?
I know this quote from Niman will probably make you angry. But please think about what this quote means:
"The match failures indicatge that H5N1 positive poultry in the area of H5N1 positive patients may simply lead to H5N1 testing in patients and infection of alternate hosts in the area, rathen than directly to humans, which have an H5N1 that fails to match the poultry sequences."
In this latest cluster in Indonesia, dogs were fed sick chickens. The owner of the dogs also had a pig. This individual became ill with H5N1.
You know there is no match between the sequences from chickens and the sequences from humans. So where is the evidence that chickens are the vector? You are ranting a myth. Please stop

Sorry again.
The quote from Niman should say:
"The match failures indicate that H5N1 positive poultry in the area of H5N1 positive patients may simply lead to H5N1 testing in patients and infection of alternate hosts in the area, rather than directly to humans, which have an H5N1 that fails to match the poultry sequences."
But the only sequence that matches is from a cat.

MRK
Just imagine how much the $2 BILLION a week we spend in Iraq could go to finding a vaccine for this and other things, fixing NOLA, and our shredded infrastructure around all of the USA.
Critisism of the current idiots in office is warranted and well deserved for this reason alone.

By G in INdiana (not verified) on 28 Sep 2006 #permalink

William,

Niman may be right here, but he just may be wrong, too. Correct me if I'm wrong on any of these points, but here's how I've come to understand this issue.

As Niman has pointed out, very little sampling of dead poultry in these outbreak areas is done. Few of these kinds of sequences have been released. So it's not conclusive that the sequences don't match, although it is possible.

Still, the poultry outbreaks correlate with the human outbreaks, and while Niman's hypothesis of selection bias is a possible explanation for this, it is a possibility based on another possibility. Just reasonable speculation.

I imagine it needs to be demonstrated more adequately that poultry exposure is probabaly not the source of most human infections before most health scientists begin taking up this position.

Edmond,
Andrew Jereminko, a virologist that worked many years in Indonesia, stated on this blog site the only sequence match they have is from a cat. Therefore there is no evidence that poultry is the vector.
It is that simple. You do not have to be a rocket scientist to understand there is no match sequence match between poultry and humans, period.
So all the bullshit about poultry being the vector is just that, bullshit. And Revere should know better.

william: Andrew is not a virologist. He is an epidemiologist. He swabbed one kitten and got what looked like part of a sequence that was the same as human but not avian. There were very few avian sequences available at that time. He has never said he didn't think poultry ws an imortant reservoir to my knowledge.

Poultry are not a vector. They are a reservoir. We don't know the mode. They are, so far as we know, the largest reservoir out there with the most contact/exposure with humans. That is the main reason for thinking they are the significant reservoir for most cases. We know little about the prevalence in any other reservoir or what reservoirs there may be.

I don't know what you know about sequence matching, william, but it doesn't sound like you know much first hand. Too much handwaving for me. You never seem to have met a conclusion you weren't willing to jump to as long as it met some kind of predetermined notion you had. I'll stick to science.

MIH. Re: Electricity. If it comes and it really pops us the electrical grid will collapse and maybe permanently or what would seem to be permanently. Once it goes down it takes a surge of almost 50% just to turn everything back on thats left on and no one around to turn it off. It might be a long swim but as long as you and they are prepared then you'll get to see them again. I aint happy about whats happening either but its the cards in combat you are dealt that you have to play with.

G in IN. Sorry G, but most of that money is already earmarked for the military ANYWAY as part of the normal budget. Some of it is definitely over that budget because of continuing operations. Like you say though, some of it could come back and be used for preparations but unless you can convince the majority of 435 and the incoming new president, you are going to be stuck with Iraq and a VERY likely attack on Iran within the next 18 months. Criticizing everyone is what we do and are allowed to do. I dont disagree with your statement that it COULD be used elsewhere but I havent seen any infrastructure crumbling as you put it. But capitalism and socialist healthcare dont mix and it will keep it from ever coming into being. Medicare along with Social Security will account for every dollar taken in even if they raise taxes in 15 years. So forget UniCare. It simply will cost too much. I guess you have to decide what the priorities are just as they do in Congress. Bird flu is WAY up on my list only because of information. Talk to the electeds around here and they simply dont understand whats happening. That likely is the reason we dont have more money voted from the Fed level. So that leaves the coming disaster to the States and they are as dumb as a box of rocks every damned last one of them. They are actually telling the health care workers that it will be okay to reuse a contaminated mask if you simply place it into a plastic bag for three days as the virus according to them will be dead by then.

Dont worry about Medicare and Soc. Security if this comes. They will dump them like a visiting mother in law because its going to get down to one thing and that is internal and external security. H5 or one of its cousins is going to take the young people as a rule so there aint going to be anyone paying in when it comes time for me to retire. Inflation/Interest rates will go thru the roof to higher than what it was during Jimmy Carter. Third world nation stuff and maybe worse because its all based on someone buying the debt as bonds and T-bills. Aviation will be crippled even worse than it is now, transportation very limited. Gas though will be at 1960 levels according to the API if it takes 20%of the planet. See not all bad.

Edmund-Now ask yourself if you are old enough to remember Vietnam. Common sense said bail out in '65 and how long did it take to leave? Be happy that we arent losing more.

"Mr. President, you cannot fight a holding action war...Robert E. Lee to Jefferson Davis 1863"

So as they all hate us, be glad I am not President because dead people dont try to kill you.

ah-huh!

By M. Randolph Kruger (not verified) on 28 Sep 2006 #permalink

MRK:

I am glad we aren't losing more years of preparation. But I'm angry that we aren't prepared already.

I'm not sure how you mean to compare the current footdragging on pandemic preparations with the war you mentioned.

Its easy Edmund. Knee jerk idiots as politicians and governmental administrators. They see terrorists all over the place and yeah, they are there now arent they. On the other hand, bird flu has killed proportionately .000038% of the planets population. They reacted to the Gulf of Tonkin shootout as an act of war and responded with god knows how many billions but for sure 50,000 american lives. H5 hasnt gotten onto their radars yet because the phone isnt ringing. It rang like crazy during the G of Tonkin. Watch what happens when it goes full high path H2H2H>. The phone will ring but it will be too late.

We are going to get smoked by this stuff and they will still be negotiating with the demographics and thoughts that its stoppable because they are politicians and administrators. What is it Revere, full bore production of a vaccine might produce 4 million doses worldwide after an antigenic fix? Be happy in knowing that democracy will fall in front of this and law as we know it will end.

Yeah, I am pissed we are not more prepared too Ed but its the fundamentals to this that are going to finish us off and start the cycle again.

By M. Randolph Kruger (not verified) on 28 Sep 2006 #permalink

Correct me when I am wrong.

1) We have vaccines that don't work and antivirals that won't work.

2) We will have no antibiotics, oral electrolyte powders, prednisolone tablets, over the counter anti-fever drugs such as acetominophen or Ibuprofen.

3) We will have no hospitals, ventilators, intensive care or doctors or nurses to examine our children and give assistance.

Wow...this is going to be a riot!!

If we could only convince them to forget their 'magic pills' for a moment...long enough to ensure adequate supplies of the supportive therapies that will without doubt, save lives from secondary infections, we might have a decent fighting chance to save some kids...what do you think?

Tom: Not exactly how I would put it but I end up at the same place as you. The antivirals may well work but we may not be able to get them to those who need them in time and in sufficient quantities and they may not work in all cases or for the duration. We don't know.

If we had the time and the will we could make a vaccine but everything suggests we have neither.

The rest is probably about right. We don't seem to be able to provide adequate health care systems or public health or social service infrastructure. Too busy making war and too cheap to do it.

Something in life we just have to accept. This may just be one of them...maybe at the cost of more lives than all of the previous wars since the stone age combined. Do what you can where you can but when it comes, just grit your teeth and bear it.

By M. Randolph Kruger (not verified) on 28 Sep 2006 #permalink

" Do what you can where you can but when it comes, just grit your teeth and bear it."

Randolph. If I have no other choice but to...'just grit my teeth and bear it'...then I have some friends that had better get ready to run!!

MRK..you have a wide range of savvy and a willingness to take a chance on expressing your opinions, so I am going to ask you to comment on this. What do you foresee as the world wide economic repercussions of an H5N1 pandemic? (this is considering the fact that - relative to 1918 - the global economy is much more tightly linked and interdependent, and at the same time much shakier and more fragile, especially as so much is tied up in loans and credit, debts that require a stable future to ensure their value.) If say 15% of the world's population were to die from this flu within a year's span, how many banks would collapse, and how many businesses and industries, and how many more people might then die from "collateral damage" such as starvation, other diseases, suicide etc? Scientists don't seem to want to make predictions of such things, leaving that to the film makers and sensationalists, but isn't a profound global economic collapse quite possible, especially considering the poverty and near starvation levels of many of the world's people already?

I can grit my teeth and bear it, from where I sit, because of the relative isolation of my island and the abundance of local agriculture, fish etc. We have enough daily rainfall to keep us in drinking water just by putting out some barrels. But my kids all live in the reclaimed desert called Southern California, where virtually no food is produced locally, where everything is dependendent upon pumped in water and driven in supplies, and the loss of electricity would be a virtual death knell for millions. Like Tom, I have some friends (kids and grandkids actually) that had better get ready to run. And from the tone of most of you lately, this is a rapidly approaching "when", not "if" train.

By mary in hawaii (not verified) on 28 Sep 2006 #permalink

M in H. The official story is 3%. I and others keep questioning this number at every posting to our emails for status. So what else could they say? If H5N1 comes today H2H and its Indonesian version its killing this year at about 88% of everyone that gets it. Death Sentence in fact. My GUESS is that it could take half of the planet if it loses kill rate for infectious rate.

The power grid will fail in Hawaii within two to three weeks when no fuel is delivered for the turbines. With water and fish you are halfway there. As long as you can isolate yourself up in the hills away from people you should be okay. Its the idiots who think that their Jag should run and that dont know how to fish that you have to worry about.

Your comments about interconnected global economies is very well taken. I saw a graphic a few weeks ago for the "3%" number and it was like 3 trillion dollars in damage across the first three years. Afterwards it was nothing but straight up for the economy. This is and would be the uptake post-flu depression followed by the rebirth. Those jobs would come home to the USA because no one will take the chance on getting hammered in another wave for supplies.

Debts, global indebtedness, credit cards, home loans. Forget them for at least three to five months. It will be actually impossible for them to foreclose and delivering the mail is believe it or not the one method of communication that for once will suffer. Process servers will not serve for fear of getting the bug. The courts will be closed and the backlog of cases at "3%" would be astronomical when they did open back up. Most of this is unsecured debt anyway. The new bankruptcy laws would be done away with as fast as the bill could hit the house floor/senate too.

Collateral Damage-Tons of it. Businesses would fail undoubtedly and money literally might become worthless. Its backed up by what in a pandemic? You get someone who wont take a dollar for a can of pork and beans and then you got a real problem. Starvation in lieu of goods. Agrarian economies would spring up all over the US. He who could grow food will be king. Forget Cheney and the oil thing too. Oil will be plentiful, gasoline though might be very scarce for quite some time. Mind this is a 3% event.

There is the starvation thing in itself. There is a 40 day supply of food in the world right now. Those of you who have gotten my "Total Disaster List" will see what happened in the stores in advance of Hurricane Rita. It was a panic and that was for only 3 days of food. You can have a copy of it. The on the shelf supplies in every city is ranked at two days of sustenance. We would need food for four months for every person, more if just heading into winter. 1700 calories a day minimum. 3500 if you are working in it. Hard to even store that much. Those shelves would go bare in under 24 hours and stay that way. Collateral damage-starvation, shootings of looters and foragers. We would be very slow to adapt in the US. The goofy little nations of the world would do better than us. Oh and that Jag would be used to pull a plow.

Southern California-The most unprepared place in the US behind NY. They should have a plan to bail out to Northern Nevada IN THE MOUNTAINS and ensure that there will be no contact with people. Your fish and water idea is good. Living in a tent out in the boonies might be their way out. Little cold though. But make sure they are WAY out there as the same foraging will occur on a smaller scale there. Guns and ammo?

Punch up "flu-aid" in your browser. Look at the CDC numbers for the 3%. Its interactive. Change the number of doctors, beds and you start getting that sinking feeling. Will you see your family again? Sure Mary, just as long as they have a plan. It might be five years if its a 15-30% event but you would see them. Less time if it is less severe.

This all depends on the fact that it comes, comes high path and its more than 3%. We can handle about 8% before devastating damage occurs.It will be borderline at that number. ANYTHING I am told beyond that will start impingeing on democracy and all the doomsayers will be right at that point. I indeed have heard martial law spoken of. But the other words that were going to be used with it were, "Who will be able to enforce it?" Food riots they can deal with, but not a city thats mobilized to throw the military out. King Bush? No way! But a governor run barony might be close because the law will still be in effect. You want to eat? You haul bodies or whatever they tell you to do. I can see that and starting with Louisiana. When martial law is declared most people dont understand the power that a governor has. It ranks right up on three star general power in a combat zone. They can order hangings without trials, executions, stockpiling of food on the mansion lawn. Everything that Marcos and his wife did.

Get the kids a bailout plan. Stockpile around the area. Me, I got 2000 gallons of stabilized fuel buried in tanks on my five acres, a years worth of MRE's and the lighter "battle rations", 500 gallons of water, a well digging machine and four generators. Thats the light story. If you want my list let me know... memphisservices@bellsouth.net. Thats what I have, on the list! Do I think its coming? You danged skippy I do. I apologize for the length of this Revere.

By M. Randolph Kruger (not verified) on 28 Sep 2006 #permalink

MRK---You certainly have a way with words! Have you thought about writing a novel while you are in self-quarantine? Please add a manual typewriter to your stash!

Nearly no one can prep as you have. However, I do like the following company for non-electric supplies, and highly recommend them. Here is a hand well digging tool for shallow wells:

http://www.lehmans.com/shopping/product/detailmain.jsp?itemID=360&itemT…

I do believe you are getting carried away with the power of the governors though.

"When martial law is declared most people dont understand the power that a governor has. It ranks right up on three star general power in a combat zone. They can order hangings without trials, executions, stockpiling of food on the mansion lawn. Everything that Marcos and his wife did."

If it gets like you describe above---I will be happy and grateful to pass on to see God and eternity. We will always have a personal choice whether or not we want to continue our efforts to be a survivor. Some fight, some take flight---it is human nature. I do not want to witness human nature unfold at its worst. Hopefully the TV will be out of service.

I am praying that humankind will rise to the occasion and take care of each other as much as possible.

It is possible. If wealthy corporations and individuals would focus on stockpiling goods NOW for all the people in their community, some misery and fallout could be avoided.

Their enormous sums of money will probably be worthless paper or only numbers buried inside a dead computer screen during a pandemic. Storage of NECESSITIES for the future is the way to invest in America right now.

It is possible that people will join together after it is over. We will all be sharing and carrying heavy loads of grief.

VOLUNTEERS from all over America have been helping Katrina victims for over a year. They are STILL there helping.

It is possible that the MAJORITY survivors of the pandemic will be good-hearted people. Mean-spiritedness in America may be an illusion swallowed from the government failures, daily "bad only" news, and morbid entertainment industries.

Perhaps it is time to think POSITIVE about what we can do AFTER we survive to help a recovering community. We cannot stop the pandemic happening.

We can think about positive steps we can take now to limit all the misery in our area after it is gone. We cannot stay in self-quarantine forever. We cannot rely on government. We have to think for ourselves.

People are not in the habit of thinking. They need to start now.

Thanks Randy.
It is a chilling picture, especially if this is what to expect at 3%, and chances are if it happens it's going to be much higher than that. I really appreciate your idea about where my family could head for survival. It's a good one. Either the mountains of Nevada, or if they procrastinate too long they can head for the lakes in the nearby San Bernandino mountains (although that will be more crowded and thus dangerous).The boys are not wusses, both were in the military and know how to use a gun, and would defend their families without a blink. Not much at fishing, though. But if I can at least give them a starting point, a plan that is doable and simple enough that they will at least consider making some kind of preparations, they could stand a chance. I owe you.
aloha.

By mary in hawaii (not verified) on 29 Sep 2006 #permalink

A possible flu pandemic overshadows all party and/or nationalistic interests. I would hate to see the world death toll, or the deaths in one this sites families be higher because partisanship undermined the administrations message to be prepared.

Our president warned the public to get ready. How many did not listen because he has been painted with a broad brush as an idiot?! Complaints about our leaders should be kept to specific criticisms which can be weighed and evaluated on the merits of the critique. Emotional or ad hominim arguments designed to damage the credibility of a party or person do suceed, but they succeed unjustly and with consequences. Inflamatory or slanderous statements damage the truth and disrupt the level playing field of political debate more than they help a cause.