Denialist editorial at British Medical Journal

Thanks! There are a surprising number of rapid response comments already.

Revere(s): May I just say that I have been following this blog for about a year, and I find it to be one of the best sources of information and wisdom going around for public health policy news, with not a hint of FAF-ism ;) ...cheers.

An excellent reply from Greg Dworkin...could I add that it seems like the BMJ article is looking at a caricature of the people who are concerned by flu pandemics. i.e. the flu 'survivalist' who has his two years of rations stored in cabin in the backwoods somewhere.

That said, I sometimes wonder whether some of the earnest and concerned individuals who work to raise the profile of bird flu aren't hampered by that very need to communicate. Media tend to focus on the extremes and the immediate. They aren't interested in an official who communicates their concern about readiness for something which might occur in a year (or five)...they prefer to show the official who predicts doom and gloom in the next month. So honest science evaporates, while the wild predictions float to the top of the news cycle.

Flu is a serious problem, and I think most people would accept that, but they will turn off to the threat (and to the health community's pleas for vigilance) if a foretold apocalypse doesn't eventuate. The Swine Flu vaccination program in the 70s is probably a case in point.

If only striking a balance between alarmism and honesty weren't so difficult...and weren't so hampered by the structure of the media.

Thanks, Jon (that's my response, btw, that Revere cites in the above post).

Here's a post I wrote in Feb 2006 on exactly that subject.

H5N1: The Risk Communication Dilemma

...
Arnold Monto, a preeminent epidemiologist and flu expert at the University of Michigan School of Public Health puts it this way (from a webcast on 1/24):

"Most of us believe that the probability of an H5N1 pandemic is low but real and because it's real and would have enormous consequences, active and vigorous response is necessary".

H5N1 is one nasty virus that many people are tracking. But despite careful language, no matter what we say, any posting on H5N1 will attract posters levying the charge of 'fear mongering'. Or that Rumsfeld stands to make millions because of tamiflu investments (it's true, but irrelevant).

I think Sandman is right. Treat people like grown-ups and tell them the truth. Every expert who studies this virus is extremely concerned, and even those like Monto, or Peter Palese from Mount Sinai, or Ian Lipkin from Columbia, or Anne Moscona from Cornell, or Robert Webster from St. Jude (all eminent in their field) who think the chances of this virus going pandemic are low, also think (like Monto) the chances are also real and the consequences are enormous.

Now what would a grown-up do with that information?

When you read the facts about the influenza pandemic of 1918 killing up to 40 million people ... I'd be b####y worried about Bird Flu!

See: http://www.blockbusterbooks.co.uk/thelazarusstrainprologue.html

Reading this BMJ article reminds me of Bush on the aircraft carrier, the "Mission Accomplished" banner flapping in the breeze. . .

I have been concerned about pandemics since the mid eighties when it seemed to me that AIDS was a problem that, despite the confident words of journalist experts, might not meet an easy solution. Fortunately, AIDS did not turn out to be as virulent a disease as I anticipated in those days.

SARS and H5N1 next aroused my concern. I suspect (contrary to views expressed herein) that the longer H5N1 continues without becoming pandemic in humans, the less likely it is to eventually go pandemic. Medical science is in it's infancy, and (at least to my inexpert mind) it appears that the mutation to lethality might not be as probable as it could have been.

However I would like to point out that my paranoia is not so easily diverted. Pandemics of various types are a fact of life in our universe. (1918, '57, '68, '88 {index AIDS case?}). If it isn't H5N1 it will be something else, and infectivity & lethality are as random as the time period to the next pandemic. As population increases, so personal distance decreases, & the likelihood of a new pandemic should logically increase, my guess is proportional to the square of population increase.

The Reveres concentrate on H5N1, but are flexible as to other bugs. That attitude reflects my perception of the pandemic risk.

Those who comment on these pages seem to share my assessment. Most pandemics can, in the general case, be defended by reducing social distances to a bare minimum. Those who write here also seem to be aware of that (e.g. MRK).

I thank the Reveres and and commentators on this blog for providing the most professional and balanced blog that I have found on the WWW for Pandemic information.

DemFromCT,

I think you are wrong about Dr. Webster thinking a H5N1 pandemic is a low probability event. He is quoted in the official Massachuesetts pandemic flu powerpoint as saying that the odds are 50/50. I believe he has expressed this opinion on TV and in many interviews.

Do you have a link for the contrary view?

Monotreme, my post was from a year and a half ago. Since then, I think you're right that Dr. Webster's upped the odds, though i don't know exactly where he stands today other than agreeing that the risk is real.

Here are some Webster quotes I found by searching FluWiki ;-)
http://www.cbc.ca/fifth/nextpandemic/interviews_webster.html

Q.How likely do you think it is that something like the influenza virus could mutate into something like 1918 ever again?

A.Whether or not we could have another 1918-like outbreak? The answer is absolutely yes. The H5N1 virus that's currently causing problems in Asia could easily mutate to produce a 1918-like pandemic. 1918 caused something like 2.5 per cent mortality globally. Lets look at what the H5N1 is doing in Asia at the moment. More than 50 per cent of people being affected are dying. Imagine what would happen if that was transferred to a global situation.

The only thing that this virus hasn't learned yet is how to transmit between humans. If that happens, we are in great trouble in the world. 1918 would seem like a duck walk. This would be much, much more severe.

Q.There are meteorites that have a 1 in 80,000 chance of hitting the Earth - where does this fit on that scale?

A.One of the questions that I'm frequently asked is how likely is this to happen. I spent my whole life working with influenza and I have never seen such a pathogenic virus.

Here in Memphis we sit on the Madrid fault, an earthquake fault line. The last major earthquake in Memphis made the Mississippi River flow backwards for a week and created a huge lake. When we plan for influenza we have to think about the planning for rare events like earthquakes.

The hospital at St. Jude's Children's Research Hospital is built to stand a class 10 earthquake. And so we should be globally thinking about what would happen if this virus spreads. In other words, we need to think about the possibility that this virus will really happen.

Shouldn't we plan the design of a hospital to withstand a force 10 earthquake? Of course we should. And of course we should prepare for this virus. We have to realize that influenza has been in the world forever, almost. It goes back to the time of the ancient Greeks.

This virus has always occurred. And it's inevitable that there will be a pandemic. The most likely one at the moment is H5N1 and I tell you, you should prepare for it. It is probably the biggest threat to mankind at the moment.

btw, quote from Webster that I cite above was from 2005.

My interpretation:

Pandemics are rare events, but they are inevitable. H5N1 is the most likely flu virus to cause a pandemic. It could go pandmemic with a CFR of over 50%.

We should prepare for this.

Add in Websters speech and comments from January here in Memphis/Collierville and you have a for sure in his opinion disaster in the making.... He got me on the one about no chlorine to disinfect the water supplies for major cities along with general filtration (e.g. Atlanta and Lanier, Oklahoma City Atoka to Draper, Phoenix and Las Vegas from Lake Mead). Have to have power to pump it, have to have materials to filter it, have to have chemicals to disinfect it. He still says he has three months in the basement worth of food, water, etc.

I wonder how many people out there are really prepared for this kind of stuff?

Bar-I would buy that argument about it not going pandemic but only if the case numbers were dropping or leveling. They arent. Webster doesnt necessarily say its going to be H5N1. He does say that a pandemic is inevitable though. Webster is one of a group over at St. Jude. Look up papers with Leneva, Webster, Godorovsky, Webby and you can see a lot of what they are doing is trying to find holes in the virus to stop it. What might we do if no vaccine is ever found? Social distancing might be done by the virus in whatever form it is on arrival. It simply culls the people itself to achieve it.

MRK

I would buy that argument about it not going pandemic but only if the case numbers were dropping or leveling. They arent.

I absolutely agree.

There are 2 distinct issues, I believe. One is whether there is a risk of a severe pandemic from this virus and when. The other one, rarely spoken but intuitively known by many, is the amount of time and resources needed for governments as well as communities and individuals to prepare for such a pandemic.

In addition, ultimately, what actions an individual should or can take is entirely within the rights of that individual to decide; no one has the right to take that decision away from them. However, for those who choose to boost their own ability to survive by prepping, even a moderate level of self-sufficiency and resilience can take many months for most people to achieve. Unless and until we get to a point when we are able to accurately predict a pandemic with enough lead time for preparation, governments and health officials have the duty, indeed the obligation, to inform the public of the grave risk to their lives that a pandemic might bring.

The duty of governments to adequately inform the public so they can take appropriate actions to protect themselves should they choose to, is exactly the same in ethical and practical terms as their duty to warn the residents of New Orleans 24 hours before Katrina hit that city.

Failure to do so constitutes negligence of the highest order, IMHO.

Susan I agree. But government has been doing their loudest (considering) warning they are able. As with Katrina, this is a states issue until they cant handle it and call for federal assistance. The USGovt cant do a damned thing for Katrina's or WTC's unless there is a clear threat to national security and then as with the War Powers Act, not without notification to Congress. This is the body of the Posse Comitatus Act. Its the reason that until Blanco federalized the disaster in Katrina, GWB couldnt act as it would have been an impeachable offense. He got a bad rap and having Brown as FEMA director didnt help.

Here is the relevant part of the Act.

Sec. 1385. - Use of Army and Air Force as posse comitatus

"Whoever, except in cases and under circumstances expressly authorized by the Constitution or Act of Congress, willfully uses any part of the Army or the Air Force as a posse comitatus or otherwise to execute the laws shall be fined under this title or imprisoned not more than two years, or both".

Blanco knew it, she was told at least four times by different people including on Air Force One and it was Nagin that was the tie breaker. He told her he was going to go out in front of the camera's and tell them who was responsible. Her beef? The troops would not be under her control. The ragging about " We need everything you have" wasnt a declaration by the governor of a state. She knew it.

In any event I doubt that many have really prepared. I question often the number of people around the airport and I must be doing a good job since last year because its now up to about 20%. It was about 3%. The block is secure and interlopers if B. Flu should arrive have said they would take kids and put them into barns for isolation and feed them. At least they would have food and shelter. The parents as was agreed will be on their own. The three attorneys on the couple of streets have papers assigning custody to the families that would be in a lottery. Even the Pakistani family has agreed and to boot even though they are Muslims, they said that they would do as the Mahatma did and raise the child they are assigned as Christians. Things are coming around a little. When Haidar said that in our little meeting there was a pause and then a round of applause. Then they all said that if anything happened to him or his wife that if there were no other family members that the lottery would be used to give their children a family, and that they would be raised as Muslims.

Instead of dying, I would rather that the guy in the above BMJ article didnt tell people not to prepare. Get this one wrong and there is no question, you will be dead from a multiplicity of opportunities by the Reaper. You cold survive by pure dumb luck, but I doubt it. Both Brownie and Blanco are gone, lets hope the states have their acts together else we will fall apart like a two dollar watch waiting for the USGovt to act. They wont sign the statements because it wont matter a bit, and they also lose control when they do.

Tony Delamothe challenges H5N1 to prove it is a problem is valid. "Originally there more papers on AIDS then there where patients." - Tony Delamothe. We only have 317 cases of H5N1 with only 191 deaths. So where is the ROI? Like AIDS and unlike TB, H5N1 is a virus we do not have a vaccine for. Now AIDS is considered a pandemic. Unlike AIDS, H5N1 maybe easier to spread.

As Jon Herington noted "concerned individuals who work to raise the profile of bird flu aren't hampered by that very need to communicate. Media tend to focus on the extremes and the immediate." The media has to because there is so much to cover these days.

I thank Dr. Dworkin, SusanC and others for posting as much as Tony Delamothe for showing the other side of the coin.

Just ask yourself - what is the ROI on not doing anything?

Pandemics happen. Now with internet and WHO we can see them start. This can be bad because if they do not go as planned then people ask why all the fuss. Yet if you wait till the problem is real there is not enough time to make plans, test them and be ready.

Those who have prepped say it takes a few months to a year to do depending on how much prepping you do. H5N1 is not a short term flood or heat wave but a long term event. Unlike other events this could hit the whole world with no help coming in from other places.

When bad things happen there are those who are prepared and those who are not. Those who are prepared suffer less. They also put less of a strain on public services as they can take care of themselves.

Regards,
Kobie
"Be prepared"

I believe one of the problems for people to overcome in preparing, is prepping for extended periods of time. It is a drain on finances, emotion, etc. I understand completely, that many are prepping for extended periods. But it's my understanding, that even in 1918, the "bulk" of the infections occurred in any given area within a 6 week period (at most) and in a bell shaped curve.

It's a much easier task, IMHO, to try to prepare for the very worst...or the peak of the cycle, rather than a long term SIP.

Mr Kreuger:

First, you are a wonderful example of what can be accomplished even in a diverse community if a committed individual is willing to initiate action.

I wish I could agree that government has been doing its best to get the warning out. I cannot.

I also must disagree, at least in part, with your conclusions on governmental authority at a federal level.

The USGovt cant do a damned thing for Katrina's or WTC's unless there is a clear threat to national security and then as with the War Powers Act, not without notification to Congress.

The threat to national security is clear, the imminence of the threat is subject to debate, but the long lead time and concentrated effort required for preparedness is not. But the real issue at this point is not the emergency authority necessary for applications of the military resources to this problem. It is civilian resources that form the point of this particular spear.

So while the military can prepare itself for pandemic and prepare for its historical and likely future role in assisting civilian authorities in this kind of disaster, it is the civilian segments of our federal government that already have both the authority and obligation to ensure that sufficient federal resources are created and allocated to insure domestic tranquility, provide for the common defense and promote the general welfare.

The potential impact of even a moderate pandemic on both the people and the critical infrastructure of the country easily justify such an effort.

The federal government is currently acting within self-imposed budgetary and mission limitations that are inadequate to the pandemic storm that may lay in our future path.

Appropriate efforts to encourage individual and local preparedness need not rely on abdication by the federal government of its larger role to protect and serve the interests of the country at large. We are at pre-Katrina (should we strengthen the levees?) stage of this event - where planning and investment in actual preparedness can still save lives and avert the worst consequences of disaster.

It is at this point that we are particularly ill served by exercises of cynical denial by medical journal editorialists and half/measures by any level of government. We deserve and should expect more from both.

That's very true Patch but what you are not factoring in is those extended supply lines and a just-in-time economy where the warehouse has wheels or floats...

...in 1918, more than 90 % of the world's population lived on small farms and their warehouse was in the back yard and their cold cellar.

Tom,

JIT, understood. Seeing Katrina woke me up to how fragile things can be. But remember, they weren't prepared (obviously).

My point was, that everyone should prepare in some way. I'm not sure many are capable (or convinced) enough to prepare long term. But preparing short term could make a big difference. TPTB need to prepare long term. Revere has made some good posts in that regard.

This article did make me raise my eyebrow....there are a couple good points. Not good, if you are convinced already, I admit. But the article does help explain the views of the "other side".

Patch.

I am all for the other side...but they seem unwilling to engage in an ethical scientific debate.

So far, the totality of their evidence seems to b...'trust me'.

By all means...lets see some scientific evidence.

ITTW-Well, you cant expect them to start a panic like they did with the swine flu now can you. Too much knee jerk there and the guys making the calls got handed their papers. This is a slow run as far as I can tell towards an inevitable end...pandemic. Of some kind that is. Preparations are the same for floods, flu, bad water, Brownie and Blanco ineptness. It does take years unless you are flush with cash. You modify as you go. My neighborhood I think will do well but someone speaks of ROI?

Okay, so if the government spent a trillion dollars it wouldnt help much. Still going to do about the same number of people as it has been. Nothing including the ventilators seems to help. You get sick, you die or you get well. The get well so far has been about at a cost of an average of 120,000 USD. If 1/3rd get sick and they go half of that the numbers will bankrupt the system. Social Security, AIDC, roads, bridges, all go to zero money.

We cant do enough for this. It goes to personal responsibility and the ROI is that you get to live in a bright and shiny new world with 1/3rd or so less drains on it. It would be about a year to two years before we would be able to start polluting the air and water again. Long enough for the Earth to catch a breather itself. Forward looking. Assumption made that I would make it.

Patch-Katrina was politics and a media storm as much as an actual one. Mississippi signed their federalization request and got aid in only two days rather than five in LA. So I guess we can see the difference here. As for the threat to national security... The above denotes that there are doubters. Doubters vote and pay taxes. They have an ear or two as well in DC. So how do you do anything more than spend money on the maybe? Better than that, how do you get the doubters to spend money before it happens on the maybe? It doesnt work until we get hit and then its too late. Kind of like "Leave the city now" in NO. Oh, its never flooded down here.....

MRK - You are certainly a ray of sunshine...aren't you?

I'm not sure how you can make such broad statements. At least not while maintaining any credibility.

I've been watching BF for awhile myself. I'm familiar with everything you said. I admire what you've done for your neighborhood. But I don't think "this thing" is inevitable. Possible, yes. I could even swallow hard and listen to you say "probable". But hearing you say "inevitable" at this point, leaves me wondering what makes you so much smarter than the experts. Who by the way, all seem to agree a pandemic is inevitable at some point, but not necessarily an H5N1 pandemic.

I know you are about to tell me how I can believe anything I want and that when the SHTF, my family and I will die or most assuredly suffer greatly. That's OK...I'm used to being degraded by folks on both sides of the issue. I'm crazy for preparing...or not preparing.

But regardless, I'm not crazy when I disagree that this is inevitable. And if I'm right, why do you keep insisting it is inevitable?

Patch.

There have been ten pandemics distributed consistently over the last three hundred years.

With that in mind, would you please explain the following: "...I disagree that this is inevitable."

Thanks

Rather than explain, I think restating with a bit more clarity should suffice.

I disagree that an H5N1 specific pandemic is inevitable.

Sorry...the "this" should have been stated more clearly. And if H5N1 specific was not what MRK was talking about, then HE should have been more clear as well.

With a few exceptions, I believe most experts on the subject refrain (if nothing else) from stating an H5N1 pandemic is inevitable. My point was perhaps MRK should refrain as well, because I think he loses credibility, especially since he is less than an expert. He has some good thoughts and has done some good things. I get nervous when I see people like him (self educated expert) stepping onto infirm footing...and I believe stating an H5N1 specific pandemic is inevitable is infirm footing.

Furthermore, I'm not sure that "consistent distribution" of pandemics over the past 300 years is accurate. The distribution over those 300 years is less than "consistent" isn't it? Anywhere from 3 years separation to 40+, as I recall.

Patch-With all due respect I believe that the term "inevitable" is being used by just about every "expert" out in the flu field. Hell, I have most of them here in Memphis. I am also an "expert" in the field of national incident management as an NIMS-800 manager. I hold as much horsepower in the event of a Katrina or bird flu disaster as a four star general. Most people cant pass the courses. But I am not beating my own drum here. I am not a flu expert but I have unrestricted access to some of the best here in Mempho, they think that we have a much better than average chance of seeing it in the next couple of years. I hope they are wrong, they hope that they are wrong. If BF comes cruising in with the manner that 1918 came in then the bragging rights are going to be that one mind set was right, and the other was wrong. All things in this country as we know it will change and/or end. I would though like for you to write up what your credentials are Patch. I think Revere believes something is down the road for us. Tom definitely does and the federal government has diverted a lot of DHS money to preparations.

So do you have an inside track that it wont be coming?

ITTW-You made reference to the federal government doing more for the public welfare, domestic tranquility etc. The plan is that the federal government will do everything that they can to keep the major infrastructures up. The states were told that they had to prepare for bird flu on their own. Remember the states had to produce a plan to qualify for federal assistance money? Most produced a few documents that were good and bad, some are still out there doing.

We sent a BOXLOAD of money to the WHO for BF eradication efforts. It was sent to Indonesia, Thailand, Vietnam, China? So what did we get? The most supreme denialism that there is...they stole it. They culled but didnt stop growing birds on infected ground, they let their birds co-mingle with wiildfowl that were endemic with it. And as with the money we give to the UN, there was and is no accountability once its gone.

That was I believe 500 million. If they dumped THAT into research and I dont give on big crap if it did go to Baxter or someone else if it produced a vaccine, then I would be happy. Contract bird bug fixes. But, it didnt and it hasnt. So here we sit two years after the "Ebola Flu" that broke out in China that whacked most who got it. We still dont know what happened. We likely never will. It is the doubters who will go, the uneducated and the poor and they will go in the hundreds of thousands. Thats if it comes. If not then we spent a lot of money for nothing. I'll take the chance they are right with the money.

Patch-I again reassert a simple fact. That fact is that if it comes and it has a high CFR the BMJ has done a terrible injustice to the people and will result in dead people. To get it wrong means you will die of flu, starvation, cold in certain areas, heat, dehydration. Right means you and family might have a chance. Not a great one, but I would put it at 100% better chance than someone who hasnt done anything.

It takes millions to win a war, but everything you have to lose one.

MRK - I've said it before, you know your stuff. You are a self educated expert. I don't deny that. Your emergency certification is praise worthy. I don't know enough about it to determine your level of "security", so I have to take your word for it. I respect you and others who put the time in.

But you are mixing fact and speculation....even in your own writing. And that's the problem I have with your post (often, by the way). You said these two things in one of your latest posts:

1. "....Patch-With all due respect I believe that the term "inevitable" is being used by just about every "expert" out in the flu field."

2. ".... I am not a flu expert but I have unrestricted access to some of the best here in Mempho, they think that we have a much better than average chance of seeing it in the next couple of years."

OK...you can't have it both ways. Define the difference (if any in your mind) between inevitable and better than average chance. To me, there is a BIG difference. I told you earlier...I could swallow "better than average chance". But I can't yet swallow "inevitable".

Get out your dictionary and look up inevitable. It means:

"incapable of being shunned; unavoidable; certain."

Perhaps a severe H5N1 pandemic is certain, but no one knows that for sure, so you can't say inevitable. Period. If you do, you are no better than a fortune teller. And have about as much credibility.

I've heard people say that H2H H5N1 transmission was already happening in large numbers. I've heard people say that "it" was destined to happen months ago and that time has come and passed. Predictions such as these and terms like inevitable (again, H5N1 specific) make us (me included) look like fear mongers, and therefore unreliable, in my opinion.

Surely someone agrees with me? I'm not trying to split hairs here. Probability seems to be the $64K question and I'm not laying down and swallowing inevitable. That's all.

By the way, I'm fully (FULLY) (F-U-L-L-Y) in agreement with Revere, that we need to revamp public health care and using H5N1 as a launchpad, if necessary, is fine with me.

Again surely I'm not the only one who feels this way?

I'm a long-time lurker and very occasional commenter, and I agree with Patch 100%.

As to whether an H5N1 pandemic is inevitable, I'm reminded of a story about a famous astronomer whose name escapes me. Years ago, a magazine wired him wanting his opinion on whether there was life on Mars. The magazine told him he could send a 500-word response collect. Imagine their reaction when he wrote "NOBODY KNOWS" 250 times!

Thanks aces...I was beginning to feel as though I am from Mars!! :-)

Avian flu or any pandemic that was worth its salt as was 1918 flu, would eliminate this country as a world power. This most assuredly NOT the time to implement it if for no other reasons but the costs to have a desireable outcome, not to mention the undesireable ones.

I guess Patch you need to get with those experts who are using inevitable over and over again, not me. I am just repeating what they, the experts are saying. Some that I have access to say inevitable. Some are saying better than average chance and that group is limited.

Explain it in my mind? Here it is. Pandemic occur with regularity. Statistically speaking we are over due for a pandemic, mild or severe or what have you. We are also statistically WAY over due for a major pandemic of biblical proportions. E.g. Plague. There have been like three of those I believe but it comes in about 600 year or so intervals on that. Smallpox is another bad one.

But on any given day or year I wouldnt put it at more than 25% of our chances of seeing it that day or year. But, if you take the total number of years we havent seen something like this, our chances of seeing it go up. Statistics are like models. Everyone has one. I can without blinking an eye tell you that EM-DAT which monitors this stuff shows an almost straight up line for just about everything people killing and its based upon the past events being graphed out. The truth of this lies somewhere in the underworld of reality. If I saw cases dropping over in Indon and SE Asia I would breathe a sigh of relief. I dont want to have to start over if and when something causing the fatalities that we have the potential for. Right now what you are saying is true like the BMJ, but why continue belaboring it? If you are right and I am wrong I will more than happily say it. Get it wrong and you and family are dead. Take your pick. Why keep working the point over and over? Hey, I'll give it to you that you might be right, but I seriously doubt it.

As for Mars Aces... I dont think that Mars fits in with what this shit could do. If I dont know, I still prepare like it is until the absolute all clear is sounded.

Patch, I would agree with you fully-- IF you can guarantee to me that you are right, and that the risk of pandemic-causing sustained human-to-human transfer of H5N1 is and will remain ZERO. But what if you're wrong?

What's the cost to prepare? A lot of groceries in my basement, which we'll eat over the next year or give to the food bank. I'd rather be wrong and a little sheepish over my funny preparations, than to have you be wrong and live in your house during a pandemic.

I'm preparing because experts in public health and influenza have told me that they are very alarmed over the relatively high risk of mutation of the H5N1 virus. If they were meteorologists and said the same thing about a tornado here in my part of the country, I wouldn't argue--I'd head for the basement.

AnnieRN. Just have to say that the above is a beautiful piece of writing. Thanks.

I'll say it again MRK. I was talking about an H5N1 SPECIFIC pandemic and your use of the word inevitable. Not EM-DAT. You make it difficult to discuss anything when you jump all over the board. Why continue to belabor it???

AnnieRN - I don't think I ever said ZERO probability. Nor was a disagreeing that a pandemic of some sort is inevitable. I was questioning MRK's use of the word inevitable in terms of H5N1. I've read the experts and their concern over H5N1 mutations. If you read some of my previous posts, I'm not against prepping and have prepped myself, to some extent. You are preaching to the choir.

Just to clarify my own views (I can't speak for Patch): Everyone should make personal preparations for some sort of disaster. Maybe it'll be H5N1 next month or HThis NThat next year. Then again, maybe it'll be another 9/11 or another Katrina. We live in uncertain times, and bracing yourself in advance can only help!

I think the appropriate questions to ask "the experts" if there are any left at this point... is whether H5N1 will have an impact on seasonal-pandemic influenza at some point in the future, by reassortment or recombination, if it does not mutate directly to become the etiological agent of the next pandemic. A piece of H5N1 can be as dangerous as the whole virus.

I believe H5N1 will be the direct cause of a future pandemic...however, there are so many candidates in the wings now, another like H7N? may be first.

And yes Patch, I predicted the pandemic would start between Boxing Day 2006 and the end of May 2007 and was wrong...and I am grateful that we are still on 'God's time' as Dr. Nabarro described it.

If that brings you comfort...great. I wouldn't count the battle over just yet though.

Yes "carrying all the" Aces, what we're all facing is an HThis NThat transgenic pathogen -- who the frack knows what the H2H version will turn out to be!?!

Nor would I ever say its going to be H5, there are plenty of bugs out there that have caused pandemics, cholera, typhoid, smallpox. The point is Patch that if you looked at EM-DAT all of the things that kill people went almost straight up starting with Carters administration. Quakes, bugs....bout the only thing missing is an asteroid. This is what I am saying and it is even if you are not a "thief in the night" person. People are getting routinely whacked now by just about everything unusual. Four months of supplies in the basement with a bailout bag in the car is not a bad idea. H5? Maybe. My bet its some abberation of it but with the base being for the most part the H5 virus. Each time a novel flu has appeared, its gone to eating people. IMO this is the one thats going to get this generation and hard. For me to change my mind it would take the CFR's and the total cases to start dropping. Not happening for the time being.

Glad to hear about your Pakistani guy MRK. A labor of love, so to speak, and your hard work paid off, congratulations.
Last time I heard, an expert was someone who had five years of knowledge on any given subject.
What is it that really has your goat Patch? It really can't be MRK as his contributions are priceless, candid, serious and compassionate all rolled into one. Is it this technique that rubs you the wrong way?
I learned many a years ago that truth constantly contradicts its self. Is that what's bothering you? Conflicting truths or a world filled with people in denial over one thing or another?

Lea: I don't understand your reaction to Patch. Let me say again I am very fond of Randy and think that underneath he is one soft hearted lunk. But sometimes you have to dig down pretty deep to find it and with all due respect he says a lot of things that on the surface are anything but compassionate sounding. Some of them are downright cruel sounding. Moreover I think Patch has been making a perfectly good point and has been trying hard to pin Randy down to exactly what he thinks is inevitable. Inevitably without a time window also isn't very informative. Randy has a tendency to jump on his horse and ride madly off in all directions and it is perfectly fair to try to rein him in. I like him too. But no one gets a free pass around here, not even me.

Understand your comments revere. My time is limited when it comes to comments here, like you I'm stretched very thin. That puts me at a disadvantage and perhaps unless the comment can be thorough I should lurk more often rather than comment. Would like to be able to dedicate more energy to this but it's not doable for now.

Basically I was asking Patch if there's something else that is weighing heavy on his heart and maybe this particular subject prompted a reaction. That's all, nothing personal. All human's have a trigger point.

I guess perhaps that I do run in some directions at times, who doesnt?. For me its because of that military "be prepared for everything" mentality that I was trained into. I think Patch misunderstands what I am saying here. It doesnt make a tinkers damn which one comes for us EM-DAT issues, or H5N1, H7N7 or whatever. I think it is inevitable that "it" is coming for us and soon. My own Total Disaster List shows for my area that the biggest threat right now is a quake, followed closely on its heels with a pandemic flu. That will be a neck and neck race in three years statistically speaking. Bird flu would pass it very quickly after that unless cases suddenly start to drop.

The effects though are the same as are the needs. It doesnt matter....We are rapidly turning to lunch for the Reaper on this planet and its not getting any better. In fact everytime we go out and save yet another person that would have likely died I submit that we might be hastening all of our demise by "something." Something being every category on the EM-DAT list. I am fortunate to be in the middle of incident recovery for the central US and of course the state and that give me access to information. I HAVE to think things all the way to the end conclusion and if thats a bit tangental, sorry folks. If one doctor told me something contrary to Bob Websters info, then I would be polite, listen and then toss that crap into the trash can. If 20 did, then I would sit down and read it and then go and run my traps for secondary opinions. Unlike Tamiflu I dont think this is an Adderall protocol where the drug companies come up with the criteria for who is ADD, or needs Tamiflu in ever increasing doses, its bird flu and not necessarily H5N1. I repeat that, H5N1 isnt necessarily the one thats going to get us. We might see a mild shot of it and then have it roar back in during the second season and then it gets us. Who knows? I dont but I prepare and have others prepare like swimming lessons on the Titanic.

This ship WILL go down soon from "it". What "it" is I dont know. I used to get this same feeling in the military when we were in Indian country. Taking cover was the first thing I did when it happened. That is what I want everyone to do. In our particular venue "it" is likely defined as a bird flu of not totally unknown capabilities. Be prepared.

Do I read a lot? TONS of info cross my desk from everyone from various branches of government to the local airport authorities. I get a briefing once a week on the read of the gov on many things. BF is one of them. But its not the only one. Imagine the horror that I encountered when I plucked out a new seismic map before anyone else had seen it and found the new EMA office was to be situated right on a previously unknown fault line.

Patch, the federal government says prepare for an avian flu pandemic. All the flu-boy experts say "inevitable". If its H5N1 or for the lack of a better hard term designation by antigen letters and numbers "avian flu", then whats the difference. You get just as sick and die if its like H5N1 W/WO the letter codes on your forehead when you get it and you are sitting in a warehouse ward. So and dont take it wrong, if you have anything that contradicts decisively the "experts" and I include Tom DVM in that group because vets are sure to get it first, then let 'er rip. Else we go to a neutral corner and wait and see who is right. Me, I hope Patch is right. I am getting too old for this shit.

Just to clarify--the post labeled with my name, dated "July 4, 2007 08:13 a.m." wasn't written by me. My guess is that someone accidentally put my moniker into the "name" box--with the intention of addressing it to me--instead of their own. (Although I'm not averse to being complimented. Thanks. :)

MRK - Without admitting it, it appears to me that you are backing off stating that an "H5N1 specific pandemic is inevitable ". Perhaps I've misunderstood something along the way, but I'm not aware of any true experts stating that either. That's been my point all along. All your EM-DAT information is interesting, but quite frankly, not relevant to H5N1 unless of course, you are cooking up a special brew of disasters. Which is fine. I'm just concerned about HPAI and specificially H5N1. By your own admission, H5N1 is potentially world changing. I think lumping it into some of the other possible disasters trivializes it.

Lea, MRK is passionate about this subject. And perhaps you've rarely read my ramblings, but I often swim upstream here. I stay up on H5N1 and perhaps I'm trying to convince others...or maybe just myself, that some of the things I read from flublogia are not destined to happen. I'm no expert, but I have a very heavy science background, so I'm both interested in and concerned about H5N1.

Revere, thanks for the opportunity.

MRK - I know what inevitable means, but for the record....I don't think I'm "right" about any of this. I don't know. I have no corner or side to go to.

Patch-Please, H5N1 is the one single AI out there right now thats putting the hurt on people. H7N7 is a bad cold compared to it. So lets just leave it as H5N1 for now unless you have another one that we dont know about. You seem to vibrate in tune with contrarianism. Pick one, stick with it. I do and I would say that since most are saying H5N1, then I would mostly agree with them...they being the experts and all. I wont be dissapointed if its H7N7 with some variant of H5 in it or if SARS comes rolling in instead. I also wont be dissapointed if it doesnt come. Is your name Bunton?

All I have to do is try to ensure that the masses dont starve, freeze or dehydrate to death if it does come. Now thats something that I am an expert at with more than 5 years worth of experience. EOT

MRK at July 5, 2007 04:11 PM said:

"...You seem to vibrate in tune with contrarianism. Pick one, stick with it. I do......"

I give up!! ME contrary? ME? Somebody pinch me...I MUST be dreaming, or crazy. I can't believe I'm the only one sitting here scratching my head.

I hate to take off on another tangent, but I don't think pandemics are exclusive. If H7N7 takes off, so be it. But that doesn't mean H5N1 is any less of a risk, generally (generally, because I know there are other facets to that arrangement). It's not a contest to see which one gets to infect humans and the loser goes home.

I'm sorry...I'm not familiar with Bunton.

Randy your a gentlemen. Best wishes. And I truly do thank you for your contribution to the Emergency Response program, as well as your service to our country.

Patch-If you look back start to finish on this particular posting, you'll see that I dont mention anything but avian flu until something like #6. Its you who brought up the specific H5N1 item.

I didn't read the entire article, but the original post was about a BMJ article, which appears to me, to speak directly to H5N1. I guess I made the assumption that's what we were talking about. You talked, very early about the costs of treating patients with H5N1..so I assumed that's what you were talking about as well. And when you said, "inevitable, I thought that was what you were talking about.

On July 3 at 4:46, you said:

"..This is a slow run as far as I can tell towards an inevitable end...pandemic.."

I tried to clarify H5N1 specific, cause you were bouncing all over the place.

I'll let you have the last word.

Oh...and at July 3, 2007 12:26 PM you also said:

"....Patch-With all due respect I believe that the term "inevitable" is being used by just about every "expert" out in the flu field."

And again, that was after I was trying to narrow the conversation to H5N1 in the previous post.

Sorry...the last word is now yours.

EOT

Maybe I can have a go at it? My DH and I have a standing joke that if I die before he does, I'll pre-arrange to have "I told you I'd get the last word" engraved on my tombstone.

Thanks to all for the thought-provoking interaction. (And we don't call it "fighting" at my house. It's "intense fellowship"! ;)