Effect Measure

Bird flu: betting, insuring or investing?

Bird flu is still flu and one expects an uptick of cases during “flu season” which usually gets underway in earnest in December. So from that perspective it isn’t a surprise that December has seen human fatalities from bird flu in six countries: Pakistan, China, Vietnam, Egypt, Burma and, of course, Indonesia. Once the Pakistani cases are officially confirmed and added to the December tally for this flu season it will make it the worst December yet, but we shouldn’t read too much into this. Flu seasons are notoriously variable and the numbers bounce around a lot from year to year. But . . .

For the same reason we shouldn’t make that much out of this December likely being the worst yet, we shouldn’t make that much out of the fact that the last bird flu season case total was less than two years ago, which so far was the worst on record. We don’t know enough about the annual dynamics of the disease or the many factors that influence reporting, diagnostic accuracy and surveillance accuracy in the affected areas. It seems very probable we will be seeing many more cases reported next month and the months thereafter with a downturn not until late spring. That’s if the usual pattern repeats itself.

The problem, of course, is that the usual pattern might not repeat itself. I can think of no biologically plausible reason a divergence from the pattern would take the form of a sudden disappearance of the disease in humans. Of course it’s possible. We don’t really know what this disease is going to do. But if the pattern is going to be broken the most likely scenario would be a sudden increase in human disease as the virus’s random search happens on a new recipe to make copies of itself in us. From the virus’s point of view, we are 6 billion pieces of meat, laid out before it in a most appetizing manner.

The only thing I feel confident about is that the virus is out there, infecting host cells whenever possible. The means (cells of which hosts) to make new copies of itself are not a matter of relevance for an individual virus particle but the overall success in terms of the sheer number of infected cells paints the epidemiological picture. How much a part of that picture will be made up of infected humans we don’t know at this point. There seems to be no obvious reason why it should confine itself primarily to bird cells, however. In terms of sheer mobility and the variety of ways for a virus to get around, humans must be towards the top of the list of other species likely to be a good host. That’s looking at it evolutionarily. There may be severe biological constraints for the virus.

But I wouldn’t bet on it. In fact if I were laying a wager, I’d put the money into building a better defense: sound public health and social service infrastructures and the many other ways that make up resilient and robust human settlements (aka “communities”). Done the right way it isn’t even a wager or more euphemistically, not even an insurance policy.

It’s an investment that will pay off with certainty in many other ways, whether a pandemic comes or not.

Comments

  1. #1 Andrew Jeremijenko
    December 27, 2007

    Revere,
    I agree investing in bird flu preparedness is a necessity. When dealing with businesses and governments, they have to be convinced of the cost of the pandemic to their sector and the cost of not investing. It is important to learn to speak their language and to put preparedness into sustainability, loss of productivity, shareholder value terms; language they think in every day to get it on the agenda.
    In my opinion, the world is tiring of bird flu. It is not considered one of the top ten risks in the business I work in despite my best efforts. Y2K with feathers and other language is enabling people to laugh at it and put it down the priority list and ignore in my view, the higher risk level.
    I have experienced myself an adaptation to higher risk, that occurs over a period of 6 to 12 months. e.g. after a bomb in Indonesia, there is a period of panic where children and adults stay at home, then they start to resume normal activities with some trepidation and after a while you are comfortable with the higher level of risk. It is not that there will not be another bomb, it is just that the risk has become acceptable. Daniel Kahnemann, a Nobel laureate is a good person to read when it comes to humans, risk perception and risk adaptation.
    I feel that many are now comfortable with the higher level of risk bird flu poses, and aren’t prepared to invest until something happens. Perhaps we need to wait for an event to start pushing again. Lets just hope the event is a jump in level to pandemic phase 4 rather than a jump to phase 5 or 6. The thing about risks is sometimes we are scared of the wrong risks. A pandemic will come, it is just the timing that is in doubt, but that allows people to adapt to the higher risk.

  2. #2 anon
    December 27, 2007

    but, we are investing already.
    So, of course the question not-to-be-avoided is:

    how much should we invest ?

    revere ?

  3. #3 revere
    December 27, 2007

    anon: No, we are not investing in public health. We are investing in procurement for a specific threat. My suggestion is we invest in more all purpose uses that work whether there is a pandemic or not. I also suggest you decide what you mean by “probability” (aka risk). There is more than one notion of it and it seems to me yours is not the one used in probability theory.

  4. #4 herman
    December 27, 2007

    “I feel that many are now comfortable with the higher level of risk bird flu poses, and aren’t prepared to invest until something happens.”
    When Andrew Jeremijenko speaks, you should listen intently to what he has to say; because he worked in Asia for many years; and knows very well the risk level for bird flu has increased.
    He is concerned the alert level might go suddenly from 3 to 5 or 6. Do you realize what that would mean? No matter how much WHO attempts to conceal this higher risk level in order to protect economic interests, nature may soon overcome all attempts by governments and WHO to conceal the truth. If a bird flu pandemic arrives, you will not only have to worry about being killed by the virus; even worse, you will have to worry about being disabled for life, if the virus damages your heart, brain, or other organs. And with a possible mortality rate of 60%, the spanish flu pandemic of 1918, which killed a possible 100 million, may look like a joke in relation to the number the bird flu virus may kill or disable.
    Nothing will be done until it is too late.

  5. #5 Helblindi
    December 27, 2007

    WHO has confirmed ONE case in Pakistan, probably because they couldn’t call a dead man asymptomatic. All the others turned out to be so and therefore left out of the count. A Christmas miracle?

  6. #6 anon.yyz
    December 27, 2007

    Herman,

    I think the WHO will do the world some good if the panel of experts is convened to review the overall level of risks. The best time to announce a Phase 4 is when people are beginning to fall asleep. Short of the news of a large cluster, the public will not fall into a state of panic if Phase 4 is announced in the spring, after it is clear that the ‘flu season’ is over. This gradual escalation will IMHO be much more effective in supporting the marathon of pandemic preparation than bursts of scary news.

  7. #7 herman
    December 27, 2007

    “WHO has confirmed ONE case in Pakistan, probably because they couldn’t call a dead man asymptomatic. All the others turned out to be so and therefore left out of the count. A Christmas miracle?”
    Anon,
    Please read this paragraph very carefully. In all due respect to you, I would request you think about what has happened in Pakistan. Those rotten bastards, called WHO representatives, have concealed the longest chain of H2H ever seen by man. They get down on their knees to those government officials in Pakistan, who instruct them to do everything they can to conceal H2H to save the poultry and tourism industry. WHO is a joke, and they have the function of creating the illusion they are investigating the spread of bird flu.
    They are criminals, because they conceal the truth for economic and political reasons, of the obvious spread of human to human bird flu, that will soon kill millions.
    And when you die of bird flu, they will spit on your grave and smile, as they go to the bank to make a deposit.

  8. #8 revere
    December 27, 2007

    herman, anon.yyz: I don’t know how many cases will be counted in Pakistan. They have yet to enter any in their 12/26 tally. If you read the Update it is ambiguous. And before you criticize WHO, note that they sent a team to Peshawar, a dangerous place. In effect, they risked their lives to gather information.

  9. #9 anon.yyz
    December 27, 2007

    revere,

    I didn’t exactly agree with Herman’s sentiment. I posted what I posted.

  10. #10 herman
    December 27, 2007

    “•The preliminary risk assessment found no evidence of sustained or community human to human transmission.”
    This summary by WHO is a joke. They encounter the longest human chain of bird flu ever seen by man, and they refuse to provide any information regarding any genetic changes, even after sending samples to London for examination.

  11. #11 herman
    December 27, 2007

    Revere,
    When are these con-artists at WHO going to release the following information regarding the chain of H2H in Pakistan:
    age, gender, disease onset dates, hospital admission dates, dates of death, and the relationship between the confirmed cases.
    As you well know, this is critical information to determine if there was or was not human to human contagion, in a chain that lasted for almost 2 months and included 10 people.
    Please tell WHO to put up or shut up.

  12. #12 Helblindi
    December 27, 2007

    revere: The most recent WHO count http://www.who.int/entity/csr/disease/avian_influenza/country/cases_table_2007_12_27/en/index.html is dated December the 27th and it lists only one confirmed case in Pakistan. The Pakistan sitrep for today mentions only one case and no indication of potential others, “Additional laboratory analysis, including gene sequencing, is ongoing” is, well, additional – it more likely refers to further analysis of the one confirmed sample rather than other samples, in which case it would not be called “additional” and it would refer to “analysis of other samples is ongoing”, wouldn’t it? If you know of other samples still being worked on in London or in Cairo, please, let us know.

  13. #13 revere
    December 27, 2007

    Helblindi: Drafted a post for tomorrow about it, but I couldn’t tell from the Update what was still being done (or not). It is possible there was only one confirmed case (and the other fatal which wasn’t confirmed). If there were infected but asymptomatic cases we they are still cases of infection. It may be this is being re-run or they were in fact negative. I can wait to see. I’d rather the data were right when released than released prematurely and corrections required. But WHO will have to be careful about transparency, here.

  14. #14 Helblindi
    December 27, 2007

    revere: I couldn’t agree more about the careful wording of messages and transparency. What worries me is the absolute lack of mention of other cases in the Pakistan sitrep, apart from this: “At the request of the Pakistan Government, a WHO team traveled to Pakistan to participate with national authorities in the ongoing investigations of several suspected cases of human H5N1 infections”, especially as a fortnight ago an earlier sitrep stated quite clearly: “Samples taken from the suspected cases have tested positive for H5N1 in the national laboratory and are being forwarded to a WHO H5 Reference Laboratory for confirmation and further analysis.”

    Either way, there is reason to worry – either WHO for some reason plays down the significance of the other cases or the Pakistani national lab is more or less useless in identifying H5N1 infections. I do not know which is worse, to be honest. Anyway, I am looking forward to your post on the subject (will you also discuss the three unconnected cases in Egypt over the last 48 hours?).

  15. #15 Helblindi
    December 27, 2007

    My bad, I have forgotten the third option – Tamiflu blanket giving false negatives. Is there a way to peer under it in the samples?

  16. #16 Dave Briggs
    December 28, 2007

    But I wouldn’t bet on it. In fact if I were laying a wager, I’d put the money into building a better defense: sound public health and social service infrastructures and the many other ways that make up resilient and robust human settlements (aka “communities”). Done the right way it isn’t even a wager or more euphemistically, not even an insurance policy.

    It’s an investment that will pay off with certainty in many other ways, whether a pandemic comes or not.

    I agree wholeheartedly! When you spend the resources to confront a problem and it, at the same time synergistically works to confront other problems you can gain many fold rewards that might not have even been obvious at the start!
    Dave Briggs :~)

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