Brief H5N1 status summary

I am far from complacent, but the charts confirm what I've been thinking. Compared to last year, thus far, things have cooled a little. That is welcome news.

I'm sure there are many who will suggest that cases are simply not reported and therefore, artificially lowering the numbers. While that is possible, with world attention focused on each outbreak, I find it difficult to believe there a large number of cases missed.

On the other hand, the red is suspiciously random in geography (on the map). It would seem that the red would be more contiguous.

Thanks for charts and summary. Again, I am FAR from complacent, but tonight I will take a break from my anxiety and take Dr. Bob's advice and enjoy my glass of wine!

The BBC news web site has a more detailed map which gives you much more data although how accurate it is I do not know.It shows that during the first half of 2006 there was a new human case of the flu every 2.08 days with a 63% fatality rate.
In the second half of 2006 there was a new flu case every 4.97 days with a death rate of 76%.
So far this year there has been a new human flu case every 5.88 days but the death rate is 100%.
Once again I am not sure of the accuracy or even if I have analyzed the data properly.They are interesting maps though.

Wayne: I don't pay much attention to the fluctuating case fatality rate because it is composed of so many elements, including the timeliness and quality of medical care. The incidence rate (thenew cases per unit time) is more informative, but is also subject to the quality of surveillance in various countries, which varies widely. I am not convinced that either transmissibility or virulence has changed, not because I think it hasn't, but because I don't have any informative evidence one way or another.

As to the accuracy of the maps, none are exactly "accurate" in a pure sense, but the ones I showed are the officially confirmed cases. They are probably an undercount but they make it possible to make a comparison over time more easily as the criteria are more constant.

There looks to be no timeliness nor quality of medical care
available during a pandemic year, so, the current
cfr, with antivirals and ventilators, should be of great public interest.

That map sure has suspiciously blank spaces, some from lack of monitoring ability at all, and some from govts making sure nothing much gets reported?

(No wild birds with H5N1 in North America at all? Not what US reporters were told to expect in 2006 - tptb must have changed their minds, and decided not to tell at all; too worried the press would panic the public/economy with "low-path" H5N1 reports?)

crfullmoon -

There have been several articles, suggesting that migrating birds are not the primarly mode of H5N1 (HPAI) spread.

I think it's safe to say, that many were surprised, when HPAI H5N1 failed to show up in North America in 2006. I saw predictions of a matter of weeks, in January 2006.

As I said in my orginal post here, I am suprised that the red is not more contiguous. It would stand to reason it should be. There are probably some events going unreported. But I'm somewhat impressed with the work being done to (at least attempt to) eradicate H5N1.

I've come to the conclusion, after seeing some polling information, that a majority of people concerned about a pandemic. I think TPTB and the MSM have done a fairly good job of alerting people. I'm not sure that the degree of concern has been properly conveyed, but there is a fine line between alerting and inducing panic.

I also believe, that lack of preparation and perhaps the lack of acknowledgement of the serious nature of the threat in general is due more to people concerned about appearing "crazy". All of us know the ridicule we endure. Some tolerate it better than others. And some aren't afraid of being wrong.

Patch's # 3 paragraph is acceptable but not realistic. If this is the big bannana coming there isnt a thing we can do except to slow it. In relation to line one its very apparent that its borne in by birds, but then goes transgenically to other animals via like type bases. It wratchets up. Then there is the Russian bullshit factor... its bio terrorism but we have it under control and its going to be gone in two weeks.

There is a pondering of that red continuity Patch that goes on each and every day on another side of the Internet. No ryhme or reason it just is. My drinking buddy virologist says that he can only say that the animals (vectors, human and non human) are susceptible in different ways. He pointed out the 1918 flu and how it appeared to have rolled kind of funny out of China, lollyied around in and around Turkey in 1905, then into France where it may have done a Lisa the GP 160 kills, and then a few here and there that they didnt know other than to say it was a bad pneumonia in a place where bad pneumonia was common.

As for appearing crazy I wish I could post a picture here of the supermarkets in the Gulf that were under siege a day before Rita for just a 3 day supply of food/water. Preparedness likely has a mathematical equation associated inversely with insanity. If you are x prepared or y not prepared by percentage, when it comes you will be allowed to act d as the deviation of the percentage of normal or crazy. From that you can move it to another set of equations. If y is not prepared by percentage and we ascertain that from lack of preparedness that x equates to the total number of deaths as a factor of y, then the first few cases will determine what we will have after the big banana arrives.

Try that kind of math on the average citizen of the world.... Probably only 1 out of every 20 will understand it, less than that will do something about it.

MRK - First, you seem to flip-flop. In this post you say, "If this is the big bananna". In the past, you seemed convinced it is.

It may go "transgenetically" but sustained efficient transmission in any other host species is unknown, to my knowledge.

Second, I disagree, that it's unstoppable. Every event is a new one. The past histories of pandemic freight trains simply can't be taken for granted. This medium alone (the Internet) has vastly improved the distribution of information and could effect the outcome. It's a bit like herding cats and I'm not suggesting we can whip it...I'm saying it's a possibility. I've said in another post, it's possible, that "the" mutation has already happened and never found a host, due to our identification and culling action. Maybe we've already avoided a pandemic??? Maybe H5N1 is not capable of making the jump.

Disease has no set of rules. This I understand. But so must you.

As for you mathmatics, I think 1 out of 20 understanding your formula may be a bit optimistic. I know I'm still scratching my head.

Patch.

There have been ten pandemics in the past three hundred years.

Three of the last six pandemics of been of approx. equivalent virulence...1830, 1890 and 1918.

The longest interpandemic in history is 42 years...we are at 39 yrs. and counting.

There are a long list of pandemic potential viruses including H7, H9, H3N8 and Nipah and SARS and etc...or what if Norwalk virus mutates to increase virulence.

The mutation rate of every type of pathogen (virus, bacteria, mosquito vectored viruses etc) has accelerated in the past decade with one exotic pathogen emerging approx. each year.

Are you telling us that despite all of these probabilities, an imminent pandemic (within 5 years) is a remote possibility?

No flop Patch, just pointing out that you might get the idea, I definitely do but to get anyone other than at the wiki, or here or one or two of the other places on the net to get it is about zero.

Vietnam for instance whipped it. They just call it something else now like pneumonia or dengue. Problem solved. Indonesia finally figured it out, but its likely too late there.

You also are assuming that there will be some sort of warning sign. I think that almost 2/3rds of the planet with it in birds is just that. We have it here in the US but its not high path. Is it a certain bird or is it being magnified by mice? Dunno, dont care. All I know is that if it starts and you even reach the 5% of the 1918 that they tout we will be in such deep doo so fast that we wont be able to respond. We have jets now that could spread it in days. There wont be any Tamiflu blankets thrown over it. It apparently doesnt work even in the onesy-twoseys that are happening now. As with crfullmoon, I only see dead people when they get it.

High path is going to be the key. If it infects all the birds who in turn infect all of the other mammals out there its inevitable that some high path version will infect humans sooner or later. That term is beaten up though. You have have a high path version of flu that doesnt kill you. It could be highly infectious and mild. In light of the graphics of other places on the web I wouldnt bet my life or yours on it.

As for the equation-If you dont prepare it means that you will be acting crazy in a percentage to your state of preparedness. Sitting on top of what you need to make it sucking on a fudgesicle while HBO reruns are on in a heated house while the kids take turns pot shotting the foragers is a nice place to be. Your crazy factor wll be about zero at that time. If you dont prepare as it wades in on us and in a highly pathogenic manner and iwth a high CFR, the math will be used to determine how many kills they can estimate against cases for flu, stavation or freezing to death by the numbers that it generates in the first few weeks and adding in the variables of cold, supplies, and even up to the number of ventilators and successful outcomes. Still scratching? Put in Flu-Aid into a web browser search. Very informative from the CDC and this is the program they are sending out to the states to determine the CFR's, beds needed, etc. Big math game that will play out in people that will expect Unkle Samuel to show up with the cavalry, only this time they wont show.

Tom, I'm not sure what factors create the "30 year" average. I do know, that when I flip a coin, the odds of it being heads or tails never change. So, one needs to determine if there are factors in place, that increase inevitability of a pandemic, with each passing day (or year). Does the appearance of a novel virus shoot the odds straight up? Or, is it simply a measure of how many humans get infected?

Certainly, advances in technology would lead most people to reasonably believe, that average time between pandemics could (and should) go up.

I doubt, during any of the pandemic periods you mention, did the massive culling take place, nor the increased vigilance in monitoring outbreaks. They had no idea what they were dealing with.

Here is some discussion right from this very site:

http://tinyurl.com/35uoll

Pandemics happen, I can see that. Guessing makes it interesting, but not any more sure.

MRK - 2/3 of the planets birds? Can you provide a link to that reference? It doesn't take a rocket scientist to figure out High Path is a bad thing. But again, guessing at how bad secondary things will become is no more scientific than guessing at virulence at this point.

I know, I'm paddlin' upstream here. And I don't see many people beside me. But thankfully, for the moment at least, there's still room for debate. Does anyone reading here have any optimism at all? Or am I literally the only one, who thinks it's POSSIBLE to avoid H5N1?

Patch.

You are presenting old arguments from two years ago...

...when the World Health Organization, in my opinion, concluded it wasn't going to happen and deliberately both misled the public and insulted the collective intelligence of the world scientific community with their 3-7 million total mortality estimate for the next pandemic...without qualification.

I have repeatedly heard this 50/50, flip a coin argument which is 'dead' wrong...and I use the term appropriately...

...it goes like this...In recorded history, pandemics occur every thirty years...therefore the odds are additive by 3% per year. So in year two the odds are 6%... year 29 the odds are 87%...Is the system perfect. No, this is a biological system with inherent error...however, you can assume that we are far more likely to have a pandemic today then in 1969...and the relative odds of this going much farther are becoming increasingly miniscule.

As far as technology goes, the number of pigs and poultry in China I think have almost doubled since 1997. The factory farms today are many times larger than the factory farms in 1990. Nipah virus is thought to have only emerged recently due to a threshold passed in realtive populations of factory farms, allowing sufficient generations of virus incubation which could not have occured in the past.

Vaccine on these factory farms has assisted selection and also assisted the further evolution and dissemination. Greed is a powerful accelerator of potentials and has been largely responsible both for the emergence and rapid geographical distribution.

All eradication and control measures have been a failure. If you don't want to take my word for it, ask Dr. Webster.

We will be lucky if we deal with this threat as well as our forefathers did in 1918.

Let me know when some effective technology comes along...so far H5N1 is laughing at us...

...and you should understand that the probability of a pandemic is actually unrelated to H5N1...because if it doesn't do it then H7 will...and if it doesn't then there are many others with the exact same potential.

You can dodge one bullet or maybe two bullets or even three bullets...but how many biological bullets can you dodge by pure luck only...before your luck runs out.

If you are happy with the status quo... good for you.

Some of us aren't very happy with the status quo and are doing our best to prevent reliance on technologies that don't and won't work and a creeping complacency that whether you want to believe it or not...is going to come back to bite us in the ass in the very near future.

Tom: We don't know the "hazard rate" for pandemics. It is almost certain this rate is not stationary but changes over time as population densities and the topology of contact networks change. Therefore there is no such thing as "overdue" for a pandemic. They don't happen at predicably regular intervals nor do we know the expected value of the interpandemic times nor its variance.

Patch, here is a recipe for you.

Pandemic Bird Flu Stew

Ingredients

1. One rapidly mutating bird flu.
2. A pinch of high and increasing virulence.
3. A smidge over 6.7 Billion people and growing.
4. Varying living standards - the vast majority of people living well below world poverty standards.
5. Many countries.
6. Hundreds of languages.
7. Thousands of dialects.
8. Hundreds of governments and economies (in various states of disrepair).
9. Thousands of local governments and economies (in various states of disrepair).
10. Thousands of education systems (in various states of disrepair).
11. Hundreds of religions and belief systems.
12. Thousands of health systems (in various states of disrepair).
13. Several concurrent wars and tribal spats.
14. Several concurrent famines and droughts.
15. The occasional earthquake.
16. The occasional tsunami.
17. The occasional hurricane/cyclone.
18. Global air travel.
19. World Pollution levels and C02 levels.
20. Global Warming.
21. One toothless tiger - the United Nations.
22. One highly unstable, highly volatile cup of Human Nature or the Human Condition.
23. It is been some time since the last Pandemic. Are we over due?

Instructions

Mix the above ingredients into a Morass.

Now establish a global system to stop the start of the pandemic. Do remember that the pandemic could conceivably start anywhere any time.

What are the odds???????????

Good Luck!!!!!!!

Revere. I completely disagree with you. If the longest recorded interpandemic period in history is 42 years...then that is a benchmark...and you conceptualize anyway you want...we are more likely (additively) to have a pandemic now then in 1968.

Your argument might stand if a pandemic occurred once or twice or three times in 2000 years but the fact is that pandemics are as periodic as seasonal influenza...it's just that natures time clock is perspectively different from ours.

The last significant Asian tsunami was in 1825...tsunami's also occured regularly through history...does that mean on Christmas Day 2004 that a tsunami was not overdue.

How about hurricaines in New Orleans...they kept missing hurricane after hurricane but hurricanes had occurred in the past there as well...

...or how about that heat wave in France that killed twenty thousand people.

Whether you like it or not...nature is regularly irregular with the emphasis on 'regularly'.

tom; You are making inferences with an n of 5. There are very good reasons to believe the R0 changes over time because R0 is not just the virus but the virus, the host and the environment, at least the latter two of which change. It is not enough to say you disagree with me. But you need to say why. We have great difficulty identifying pandemics before the 19th century so even if you figure R0 doesn't change (and you have to tell me why it doesn't) you don't have much evidence of the interpandemic periods.

Asteroids it the earth at irregular intervals. Are we overdue for an asteroid hit? Are we overdue for The Big One in California? Are we overdue for a revolution in the US? Are we overdue for the Cubs to win the pennant? Unless you can stipulate the mechanism that produces the periodicity or have a longer time series, your statements are just your guess.

I'm willing to engage in reasoned argument, here. So let's have some.

Hey, y'all can stand down now. The cavalry has arrived. Ms Rice and Mr Chertoff are in Ottawa, Canada, with the Canadian and Mexican collegues, discussing who is supply straw for the bricks,,, and pandemic preparedness.

Well then, Greg:

We're done for! We're Done for!!"

I notice in the maps and graphs above outbreaks are the unit of analysis. What is the definition of an outbreak? Is an outbreak a case here? Or is an outbreak a set of related cases? Just a clarification question. Thanks!

AGS: In this context, an outbreak is a case or multiple cases at the same place and same time.

Revere - EXACTLY! I'm not much with words, but you are finding the words, so elusive to me.

I don't disagree, that a pandemic is possible and inevitable. But I fail to see the logic in making predicitions based on historically eradic dormant periods. Throw in the changes in society and technology and it becomes even more muddy.

The focus has been on H5N1 and understandably so. Suggesting H7 or some other virus could be the villian is a good point, but I don't see H7 on the map or charts we are discussing. H5N1 has met some of the "pre-pandemic requirements" that we have identified. I thought that's why we were discussing it. We could throw any number of "world killers" into the mix if you want to start piling on the worry.

Pandemics do and will happen. However, I know of no scientific evidence which proves we are "overdue". And while H5N1 is still threatening, by the charts and maps above, it appears to have cooled from this time last year.

V - Your recipe is interesting, but depending on cooking method, could turn out to be meat....or cake. A vast majority of those ingredients have existed long before we started talking about H5N1 and I'm not sure (at this point anyway) that any of the H5N1 ingredients are unique enough to determine the final dish.

I'm still looking for SOMEBODY paddling along side me! :-) Thanks Revere, for at least waving!

Tom and V - No disrespect intended. I enjoy reading your thoughts.

"But I fail to see the logic in making predicitions based on historically eradic dormant periods."

Patch. This may be one of the great quotes of all time.

"We could throw any number of "world killers" into the mix if you want to start piling on the worry."...I really liked this one as well.

Thanks.

I do not have time to compose a complete response to at the moment but as soon as I can find the time...I will.

v. Interesting contribution to the debate. Thanks.

Okay Patch, once again here we are arguing for the sake of argument. Is it shittier now that it was sixty years ago? Or are we due for some cataclysmic pandemic? Are we statistically due for one, overdue for a moderate one, way big overdue for a superpandemic, an asteroid or hemmorhoids? STay tuned.

Here Patch-Go hit this link below and then roam around in this UN group that is called the "end of days section." Feel free to draw whatever conclusions you want... its all open to interpretation until the poo-pooh hits the rotary grinder. Then one side or the other will be right or mostly right and they get the bragging rights to stacked up bodies. Statistically speaking we are getting hammered as a species right now and the next big thing should be either famine, or a bug or both. It has happened each and every time the population has approached the level of the known food supply. It is also cyclical, it may be attributable to global warmiing in the middle of a climate change as it has about every thousand years or so. Milankovitch cycles? I dont know but we do know Greenland was farmed 1000 years ago, so will the surf go up? Will we all die in a "Day after Tommorow" scenario? Probably not. We have this damnable habit of surviving. How many will? I dont know and neither do they. Our Rosetta Stone of whats really going on isnt a crystal ball with the dialable information line. We can only look at the past, and try to determine if its prologue. Based on shitty data at best. Tip over in 30 years? Nope. It will just kill a shit load of people if it does. Reduction of pollution will only result in more people that will pollute on their own little scale. The Earth will wade in, kill a bunch and then will return to a state of equilibrium with or without humans based upon its own ecology at the time. Too dirty means dead humans. Screw Co2 levels. CO is far worse and it will smack us down sooner than Co2 will. Basic common denominator is the Earth and not the humans on it. It does what it does, and we do what we do. If we conflict, by default it wins automatically.

You arent convinced about bird flu.... Neither am I. But I am open minded to H5N1, SARS and even more so to starvation as being the big killers what beez coming and its only because they are on the radar right now. Or fair little planet has a skin disease and its sending a flu microphage out to remove it.
We are the skin disease.

Every pandemic has had some sort of herald wave, large or small. SARS? Hey now theres a happy little killer. BF is also very efficient at what it does so far 2 out of 3. Not bad. US military gets a 7.5 to 1 ratio now. Both are very good at what they do. So maybe even having a universal health care system would hasten our demise because more people would live and push us to the brink even faster.

My point? Something IS coming statistically speaking. Call it the big MOFO with the bigger MOJO and you'll have it. Why? Because their is no predictability to the absolutes in what Revere does other than very general stuff. The consensus is that we are in for it. Its based upon statistics and you can choose to ignore the numbers or not. Everyone I talk to in this field gets the feeling something is coming but they are scientists. When it comes they'll be trading notes as they go down too and we all will be saying "Aw shit" when it takes us Taking us apparently means taking a lot of us out this time around...Statisically speaking of course.

Catch this link http://www.unisdr.org/disaster-statistics/occurrence-trends-century.htm

See you in a couple of months. It will take you that long to read it all. Be sure to hit the home page afterwards. They love to hype up the G. Warming thing as "fact" because it fits their agenda. I personally wouldnt ignore it but simply say prove it. They cant and they know that to be a fact too. The associated papers with opposing views are there but are discounted, without recourse by their authors. So consensus of climate change is there, but not on global warming. Facts be known if they are wrong in 30 years we will be starting to freeze our asses off...again. That's if we are around.

Patch, I'm with you.
Clearly the risk exists and it's worth doing everything we can think of to mitigate it and prepare for it.
Beyond that, too many variables and not enough data.

Randy: Here's where we agree. Virtually every biological species we know about suffers a population crash when it becomes overcrowded and its wastes foul its own nest. This is true of both bacteria a voles.

Beyond that, I don't know what to draw from that. It is cedrtainly possible for humans, but it hasn't happened yet. Population crashes in the past -- if you want to call them that -- like the 30 Years War or the Black Death, were not from overcrowding. We are much more populous now than in the 14th century or the 17th. The 1918 pandemic was hardly a population crash in any meaningful sense of that term.

Moreover, while all biological populations naturally suffer population crashes, humans are the only one with one additional line of defense: technology and culture. It is arguable this would prevent a population crash by virtue of mitigating the things that can produce it. As income increases, birth rates decrease. In many places in the developed world populations are shrinking as result of births not replacing deaths. We are not increasing exponentially, a la Malthus.

Even if you believe something is inevitable (which I don't agree), there is not a thing that suggests the inevitable thing is influenza. We don't know what is going to happen with this virus biologically, much less what its effect would be on world population. I do not subscribe to the "overdue for a pandemic" theory. Our data on past pandemics is scanty and in any event they were taking place in a far different world than this one. Arguing historically one would not know we would have an HIV epidemic nor that we are not going to have a smallpox epidemic (unless the neocons have their way and cause or provoke one). We can look forward (plausibly) to eliminating both malaria and schistosomiasis, with time. Etc.

In other words, I am not a fatalist nor an apocalyptic, since I don't see either as forced on us by the natural world and the alternative is to give up.

Revere, again, you have said, what I have thought, but was unable to put into words. My compliments to your writing!

While it's not my itent to create division, I am interested in taking a pulse. Thanks Kevin.

MRK - I would encourage you to open your door and took a good look around. You may not realize it, but you've lost something: Hope. I highly recommend spending the effort in looking for it. It sure makes the future a better place to be.

Again Revere, I enjoyed reading your post. Thanks!

So we sit and wait. The governments of the world wont do anything more than they have except on a miniscule scale Revere. I dont disagree with you because I cant find anything scientifically wrong with what you say here on this. It is my assertion though that if it starts and its High Path and with all of the jets flying around this world that it would literally come so fast that overwhelm is not even a correct word for it.

IMO there is an acknowledgement of this by the DOC who went around the CDC and DHS and said stock up for a minimum of four months to the business planners. I bet there aint four months worth for even Queens in all of NYC. Sure we will save a few, but thats about it. They forage, they die. They go out, they get arrested and put into a pen and catch it for sure, they die.

I and family will be personally okay for more like six months but what do we all do if we are around after that. Those numbers, really those statistics going back all the way to the 10th century indicated that we are going to get by something. Inevitable? Only that something for sure is coming. Might not be bird flu.

Patch, thats 2/3rds of the countries on this planet have birds with it. Not necessarily high path at this time.

revere: do enjoy your blog, after I got over myself. Thanks. And yes, we are still contemplating moving to Odense.

MRK: to me you're the one with a more realistic viewpoint. Few people have the wherewithal to admit what is really on their mind.
Seeds, get seeds MRK, easy to plant and grow.

Patch: The future isn't here and it's best to not go looking for it. Live in the Now. And that Now indicates we're in for one heck of a ride. It's not a fatalistic viewpoint just a reasoned, cautious one.

Patch:-
Abandon ye who enter here'
Through me you pass into the city of woe:
Through me you pass into eternal pain:
Through me among the people lost for aye.

Justice the founder of my fabric mov'd:
To rear me was the task of power divine,
Supremest wisdom, and primeval love.

Before me things create were none, save things
Eternal, and eternal I endure.
All hope abandon ye who enter here.

Such characters in colour dim I mark'd
Over a portal's lofty arch inscrib'd:
Whereat I thus: Master, these words import.

Hiope? Shit son I have seen things that would scare a black man white. I have seen people literally squashed to death rather than shooting and not by US troops. I have seen nuns raped, I have seen priest killed. Hope? I have lots of hope. I just dont think its going to do much good and the only answer I can come up with based upon all the doom saying is that all ye should hunker down and let Mr. Scratch do his thing if we cant come up with something better than what we have now. I would have sworn that the Muslims would have gone for smallpox or something but they didnt. I keep on saying but I dobut if anyone is listening that preserving even one more life might be the tipping point for this planet. Not humanity, the earth. Its pissed and its going to get even. It likely will come up with something that we cant vaccinate for, produce an antibiotic for, something that kills cows and all things oxygen breathing. Generally speaking anything that we use to feed ourselves with high protein diets, and then we will go because of the lack of that protein. Finally, it will come with something that gets us and then when its at a considered state of equilibrium it will stop. I just HOPE its before it takes us completely out. Be it volcanic, or biological or whatever I personally believe that we are about to take a major hit. Dont tell me about hope. I even hope the libs make it.... thats a statement in itself.

I would expect anyone reading this blog to have more than a passing concern about BF. I'm not surprised to have bumped up against some deeply held beliefs.

Lea, I would argue that the "Now" does not indicate we are in for one heck of ride with any certainty. As it stands "Now", H5N1 is a relatively minor problem. Considering the amount of exposure, it rarely infects humans and appears to have extremely limited, if any, H2H capability. Right "Now" we are OK. I'm not sure you'll find any solid indications we are in for a heck of a ride. We COULD be in for a wild ride, but I don't think the Reveres are ready to say we ARE in for a wild ride.

I think a reasoned, cautious, viewpoint would also be one in which all possibilities are considered, rather than accepting the belief that all things are predetermined and inevitable. That, by definition, is fatalistic.

A realistic viewpoint isn't simply admitting what's on your mind. A realistic viewpoint is one which expresses things as they really are. If you take out the speculation about what COULD happen, what would be a realistic view of "Now" or H5N1?

I'm all for preparing. I'm all for keeping our eyes and ears open. But to make a difference, we have to think ahead carefully at more than one possibility.

The medical community has a huge task on it's hands. Let's help where we can.

I can't confirm or deny, that 2/3's of the earth has H5N1. But again, you throw LPAI in with HPAI. The map is showing HPAI and I thought that's what we were talking about. MRK, you make it difficult to debate, when you throw speculation into the mix so assuredly.

There have been 10 pandemics of influenza A in the past 300 years. A recent analysis showed that the pandemic of 1918 and 1919 killed 50 million to 100 million people,1 and although its severity is often considered anomalous, the pandemic of 1830 through 1832 was similarly severe.
Michael T. Osterholm New England Journal of Medicine Volume 352: 1939-42, May 5, 2005.

Flipping a coin is not an appropriate model to accurately determine the risk of a pandemic or any other biological natural event.

Nature is an ordered rather than chaotic system. It does not run on random chance alone and there are many shades of grey in its expressionsso at the very least, if the coin can not land on its edge in a measurable manner, than the analogy is not appropriate

the New Orleans Hurricane is one example of the orderedness of nature. There is an unknown number of factors that predetermine the track and ferocity of hurricanes and although time differentials might indicate that the incidence is random, it is not. If accurate historical records were available, the timing could probably be predicted very accuratelybut like influenza, records are incomplete. The same goes for all other biological systems as welljust because we cannot see the pattern does not mean that a pattern does not exist.

A more accurate way to describe the risk may be to use the multi-chambered gun analogy...

...The gun has 300 chambers with 290 blanks and ten live bullets. We have repeatedly raised the gun to our head and fired it now 38 times since 1968 and as a result, we know that there are now 10 live bullets in a gun with 262 chambers

however, we must also determine if the relative environmental pressures (risk) for the years 1669-1969 is equivalent to the environmental pressures that may or may not have an effect for the years 1969-2269. This includes human technology that may assist us in avoiding a pandemic vs. an assessment of population factors, human mobility and environmental events directly impacting on ezotic viral emergence etc.

Tom: You argue passionately and persistently for ... what? That a terrible pandemic is imminent? I'm not sure exactly, in so many words, what you are maintaining, so maybe you could spell it out. In the meantime, I'd like to address some of your points, in the spirit in which they were offered, a genuine engagement in the issues.

"Flipping a coin is not an appropriate model to accurately determine the risk of a pandemic or any other 'biological - natural' event."

I'm not sure what you are intending here. Flipping a coin is a metaphor for risk, the probability of an event occurring. Thus it is precisely analogous to the metaphor you use, Russian Roulette:

"...The gun has 300 chambers with 290 blanks and ten live bullets. We have repeatedly raised the gun to our head and fired it now 38 times since 1968 and as a result, we know that there are now 10 live bullets in a gun with 262 chambers"

Think of a coin with 300 sides and you will see that you also use a coin flip as a model, in technical terms, a probability model with a uniform density distribution.

That doesn't make it a good model, of course, and I would argue that if you are going to use a model like this you wouldn't use one that is, again in technical terms, "stationary." It is quite plausible to argue that the probability (the number of loaded versus unloaded chambers) changes over time. That is the case for most things in the real world, and since the probability of a pandemic depends on things that continually change, like contact networks, population densities, age structures, etc., the number of chambers and loaded bullets is changing, too. Your own coin flipping model doesn't take this into account. Nor does it take into account what is technically called serial autocorrelation, which just means that past events affect the probabilities of present ones.

You then go on to discuss the "orderliness" of nature, and say:

"Nature is an ordered rather than chaotic system. It does not run on random chance alone and there are many shades of grey in its expressions so at the very least, if the coin can not land on its edge in a measurable manner, than the analogy is not appropriate."

I will excuse you for your misuse of technical terms, but some precision is needed if we are to discuss this rationally. Chaotic systems do not depend on probability. In fact they are the opposite of probabilistic, they are strictly deterministic. Chaotic doesn't mean random, although they might look random if you didn't know the mechanism underlying them. Some deterministic systems -- i.e., systems that are orderly in the strictest sense that there is no possibility of randomness -- are chaotic, but most aren't. But they are all orderly.

Two characteristics of a chaotic system are sensitive dependence on initial conditions and aperiodic behavior (the third, topological transitivity needn't concern us here). Sensitive dependence means that extremely tiny changes in the determining conditions can make very large changes in result. The weather is widely considered to be a chaotic system in this sense, and it means that if it is, there is no possibility of long range prediction because we can never stipulate the initial conditions precisely enough, although the system remains strictly deterministic. Aperiodic behavior means the system never repeats itself. Both of these are pertinent to our conentions about epidemics and hurricanes. Whether these are chaotic systems or not, or whether they are sometimes and not others (different parameters can make qualitative changes in behavior and turn a non-chaotic system to a chaotic one and vice versa; this is called a bifurcation), we don't know. I have no position on the matter, but I wanted to signal to you that your statements get us all into very deep water, technically. It isn't just a question of whether this is like the flip of a coin (and you maintain it is with your Russian Roulette example, although you don't realize it). A good book about chaos is James Gleick's book of the same name. I recommend it.

But let's take you at your word. But what is your word? You say nature "doesn't run on random chance alone." Again, what do you mean by "alone"? That chance plays a part in nature (e.g., quantum mechanics) or it never does. And if it does, then your argument seems empty. Your reference to "shades of grey" is also puzzling. Do you mean some chance is involved? And what does that mean?

You finish up this way:

"however, we must also determine if the relative environmental pressures (risk) for the years 1669-1969 is equivalent to the environmental pressures that may or may not have an effect for the years 1969-2269. This includes human technology that may assist us in avoiding a pandemic vs. an assessment of population factors, human mobility and environmental events directly impacting on enzootic viral emergence etc."

This sounds like you are saying what I said at the outset, that arguing from the behavior of what happened 1669-1969, which is what you are doing, is not valid for 1969 - 2269 until we determine whether the factors that affect the emergence of pandemics in those two broad periods are the same.

You leave it as an open question. I would say the odds they are the same in the relevant sense are pretty small, but I could be wrong.

I'd be glad to take up the argument from here, either using the frame of reference I have set up or allow you to set one up of your own. I would only ask you to be precise enough that I know exactly what you are saying.

The particular aspect of Nature that we are discussing, is not chaotic or random...it is ordered and therefore, pure chance plays a role.

The fact is that all coins in history and all coins in the world today have two sides... while guns are multichambered. There is nothing that occurs in the world with a fifty/fifty chance other than flipping coins and therefore, the coin example is an over-used connatation...in my opinion.

The only way that you can determine probability in an ordered system (non random - non chaotic) is to use a historical perspective...

...Dr. Osterholm's excellent article in a peer-reviewed journal provides a snapshot of the last three hundred years...

...some may take comfort in the "10 live bullets in a gun with 262 chambers", some may not...but it is an accurate asessment of risk given the historical perspective provided by Dr. Osterholm.

The real issue in the discussion is how the circumstances of the last three hundred years have changed in the transition period of the last fifty or twenty or ten years...and how environmental pressures will accelerate or decelerate natures rthythms over the next 300 years...

...that in my opinion, is where the 'art' of science comes in...predicting on the basis of circumstancial evidence.

"The particular aspect of Nature that we are discussing, is not chaotic or random...it is ordered and therefore, pure chance plays a role."

Sorry, it should say that pure chance does not play a role.

Great discussion going on here, ideas coming from all angels. The biggest issue is no one knows for sure and that's what can drive a person insane.

MRK: I listen to what everyone says and then discard what doesn't work for me, just like everyone else does. I'm in total agreement with you when you say: that preserving even one more life might be the tipping point for this planet. Not humanity, the earth. Its pissed and its going to get even.
While this is true, unless the BF does hit, it's only going to intensify with sustaining the population being the new problem.

Patch: revere said: past events affect the probabilities of present ones.

Without getting off on a totally different vein of belief, basically as a society we are prone to deal with the effect, rather than the cause. When the cause creates enough effect, then we, and only then, start to go after the cause.
With all the energy and thought being given to the H5N1 the odds of it happening are greater than not.
If that doesn't answer your question I apologize.

Yikes! The first sentence should have said angles, not angels. As in look at it from this angle.

Revere, you are exactly correct. There is no such thing as "overdue" for a pandemic as time has no bearing on the odds. It is a red herring. A better way to look at is there is some chance that in any given year it could happen. For example if one were to assume that on any given year there is a 1/100 chance of a pandemic occurring it doesn't change to 1/99 if a year goes by without it occurring.

Shonda: That works only if the probabilities are independent. They aren't, of course, because there is always a space after pandemic when a large portion of the population is immune to that subtype. So on the host side there might be some periodicity. It is the virus and the environment that are the wild cards and don't allow easy predictions as to whether a pandemic will be soon or a long way off. Right now, soon seems more likely as there is a nasty virus bubbling away out there in birds that might pass over to humans. On the other hand it might find a better niche than us, too. We don't know.

Again Revere, excellent points!

Shonda, well put. That's what I was thinking. It doesn't matter if you flipped that coin 100 times and it's come up heads each and every time....the next flip is still 50/50. If it's not, then I need to let my wife play roulette more often!! :-)

Let's take weather...that's nature. Not just hurricanes. If the weatherman indicates that there is a 50% chance of rain tommorrow, does he base that estimate on past history or current weather conditions? Although it will inevitably rain again, because we are overdue for rain, does it mean it's coming in the next 3 days?

Patch: Actually, the best predictor of weather tomorrow is the weather today. That's because of serial autocorrelation. It doesn't mean that tomorrow's weather must be the same as today's, only that it is more likely to be like today's than some random weather day.

Patch: The idea of "overdue" is one of the primary reasons why casinos are so successful at getting your money. Many gamblers are blinded by the false hope of being overdue for a win in the face of losing their a**. Their decision is based on emotion rather than statistics. Of course the odds of a pandemic is a non-constant, meaning it changes from year to year based on many environmental/viral/host factors, but a simple time interval between events is no predictor.

-Cheers

Revere, thanks. You are correct. It probably wasn't a good example.

Thanks Shonda. You are right.

I initially posted here, with the intent of noting that compared to last year, the activity appears to have slowed. I simply found it noteworthy, not a predictor. I don't' want to put words in anybodies mouth, but I get the feeling that some people think that current conditions aren't particularly significant. Because H5N1 has met some prepandemic requirements and we are overdue, it's "Big Banana" time.

A H5N1 pandemic is not predetermined nor inevitable. I have found no solid evidence to contradict that.

Perhaps the real issue of this discussion is not the true nature of probability, nor the true nature of the world, but the nature of our perceptions of the world and probabilities.

Science demands repeatable experiments. Intelligence, even insect intelligence, functions largely through repeatable strings (and networks) of events/actions. Perhaps a great many misapprehensions are grounded in our primitive expectations/predictions failing to describe the world accurately. We might better avoid or recover from error, if we stay alert to the kinds of errors to which we are naturally prone.

Shonda-But you must admit that history hasnt borne out what you or Patch assert. Things happen damn regularly. Its not perfect in what it does each time, but when it does it generally kills people and a lot of them. Ethiopia is a good example. They know if they raise too many cows, they will have starvation because the grass is gone. But the number of cows is a matter of stature so they do it anyway. They are the polluters in their country if you will.

Kim Jong IL buys sports cars when there are no roads, and he builds nukes too. His people are starving. He knows that they will take him out sooner than later, but he does it anyway.

We all know we should prepare for pandemic... We have been warned. I bet less than 1 in 200 in the Tenn, Ark, Miss are prepared for it. We know something is going to happen. A quake is a real possiblity, possibly a bird bug or a tornado outbreak could also happen. But we still sit like lemmings waiting for the run to the sea and dont prepare, and dont make vaccines molecular or otherwise, and we dont build storm shelters.

So what are we really arguing here? Is panflu coming or is it something else? Does anyone want to really argue that we are overdue for something... History would prove them wrong. Its just what is it that is coming? No one knows. Most people have a bad feeling about where we are right now.

History does bear out what Tom and Lea have said. Revere is much more middle of the road on this. I fully agree it might not be H5N1 that comes, but my position is simple-something is coming. Chaos theory has a lot to do with it and normally the more chaotic it is, its easier to see that the randomness of primary, secondary and tertiary events become predictable. Is H5N1 a primary, secondary or a tertiary event of something that has yet to play out? I dont know and I dont care. I can see people building nukes in the Mid-East. Does that mean that I let them, or do I dust my shiny new F22's off and go for a short visit? Antibody rising to a threat? Call it what you will.

History is starting to repeat itself. 30 years War replaced with peace? Peace doesnt mean an absence of war. Peace means that neither have any hostile intent. BF is just that. We see a possible threat and we are doing absolutely nothing about it that is tangible or really more so credible except sending money to compensate for birds to be regrown at a later date. They use it to smuggle and they use it to build houses in Thailand. So if it comes, will we be overdue or will we really just be naturally selected for elimination because we were dumbed down for the lack of a better term.

I dont know and again all I care about is to make it.

MRK - Again you are making assumptions. You say:

"We know something is going to happen. A quake is a real possiblity, possibly a bird bug or a tornado outbreak could also happen."

How do we know something is going to happen? You've adopted teh fatalistic approach that I was talking about.

You talk about history bearing out what Tom and Lea have said, but again, the argument I am putting forward is that history is not enough to make predictions upon. You keep saying that epecting me to take that part of your argument for granted. I don't.

There will continue to be hurricanes, pandemics, fires, floods and so on, just as there has been throughout history. But odds of such events do not increase simply because they haven't happened for awhile. There must be other things in place. Forest fires don't start because "it's time". They need ignition, fuel and proper conditions.

Does H5N1 have the fuel and proper conditions? Maybe. But not because "it's time".

"Shonda-But you must admit that history hasnt borne out what you or Patch assert. Things happen damn regularly."

I do not agree with that and statistically my point stands; a simple time interval between events is not a predictor for the next event.

Does Nature Have Memory?

History suggests that while pandemics occur roughly 3 times a century, pandemics with CFR anywhere near H5N1's current lethality are extremely rare, if in fact they occur at all. Science ( refer to prior posts at this site ) suggests that trading lethality for contagion is not, in fact, a given. History, on the other hand, suggests otherwise. Now I take no position here other than "I don't know". I use the example to suggest that some of us are cherry picking from history to support a rather apocalyptic scenario.

Kevin,

You are missing the point. A pandemic with a CFR of the 1918 event would be catastrophic. In point of fact, a repeat of the 1968 event will cause havoc. We don't have the hospital capacity or supply chain resiliency that we had then.

Of course I am aware that of 1918 redux would be catastrophic, although not an apolcalyptic civilization ending event. My point was that those who cite history to claim a pandemic is overdue or immienent also tend to expect a much higher CFR than 1918 ( or any past pandemic ). It's the logic ( or illogic ) I critique.
I don't make any predictions. I don't know.

Patch and Shonda...Better to have a gun and not need it than to need it an not have it. Preparations are the gun. You should both sit back and do nothing based upon your beliefs. Watch out for the claymores in my front yard when you come looking for food.

Patch you are damned skippy I am making assumptions. We are on the brink of a possible nuke attack by Israel on Iran, we have 3 carrier battle groups on station in and around the Strait of Hormuz, we have Chinese subs surfacing in the middle of carrier battle groups in the Pacific, we have had SARS on the radar for several years, we have bird flu taking its time between infections from almost 28 days to just 5 and some change days, clusters have increased in size and geographical reach, medical types have gotten it.

Generally speaking this is known as the freight train in the distance. I dont go and put my head and ear on the rail to see how close (or far) it is. I take it for what its worth and stand off its path until its gone. Same thing here. I hope you understand that I believe that this or something like it is coming. I am not going to be standing around arguing clades and receptors when whatever it is comes. I am as I said going to be hangin with the homies, playing pool, eating regularly and when I do go out, I will get paid for it in astronomical sums if its high path with a high CFR. Sure money might become worthless and I am prepared to accept that. But if money goes bust so do all of us. We simply start over. Thats also when Dodge City comes into play. Me, I am ready for three scenarios. One is that it never comes, Second that it does and its mild. Third is the big banana as I put it and I deal with it as best I can when I can. Beyond that I move to defensible space and everyone who has kids can drop them off with me because they are the seed corn. I will turn everyone of them into Republicans much to the dismay of their parents and Revere.

See, now theres a reason to prepare. I also disagree with you Patch that simply because it hasnt happened that it doesnt mean it will. Its how you look at it. I believe that the longer something like this doesnt happen, we move closer to the time that it will. If you have visited the websites that I have posted and have the written info that is on there you can see that there is a propensity towards natural disasters, flood, earthquake, tornados and hurricanes in the last 30 years. There is also a move towards wars. There have been more in the last 25 years than the previous 100. GW? I doubt it. but indeed something is up. Argue the point all you want. Its folish I think to do so though.

Even in a tsunami its good to have a surfboard.

- Pandemics have occurred periodically for at least 2000 years.

- There have been ten pandemics in the past 300 years

- Three of the ten pandemics were of approx. equivalent lethality, 1830-1890-1918.

- H1N1 (1918) was a pure avian virus that adapted to humans without recombining-reassorting with seasonal human influenza viruses.

- Other high lethality pandemics (1830-1890) may also have resulted from pure avian viruses.

- The shortest interpandemic period was eleven years, the longest was 42 years

- In the last few decades there has been an increase in exotic viruses emerging to infect humans; at a rate of one new exotic disease per year.

- H5N1, a high virulence avian influenza virus, emerged in 1996 to infect humans. It is very similar morphologically to H1N1 (1918).

- Other high virulence viruses H7, H9 and H11 also emerged to infect humans in the same time period.

..

Even if you believe something is inevitable (which I don't agree), there is not a thing that suggests the inevitable thing is influenza. We don't know what is going to happen with this virus biologically, much less what its effect would be on world population. I do not subscribe to the "overdue for a pandemic" theory. Our data on past pandemics is scanty and in any event they were taking place in a far different world than this one. (Revere)

"But I fail to see the logic in making predicitions based on historically eradic dormant periods." (Patch)

"We could throw any number of "world killers" into the mix if you want to start piling on the worry." (Patch)

I fail to understand the logic.

Are you saying that the very clear scientific record is irrelevant?

Wish we heard more about this one on a state/local level, than the ones in my lifetime; since there is so much we don't know, we can't assume the best and not prepare for the worst:

..."The 1890 pandemic began in the late spring of 1889 and took several months to spread throughout the world, peaking in northern Europe and the United States late in 1889 or early 1890.

The second wave peaked in spring 1891 (over a year after the first wave)
and the third wave in early 1892 (Jordan, 1927).

As in 1918, subsequent waves seemed to produce more severe illness so that the peak mortality was reached in the third wave of the pandemic.

The three waves, however, were spread over more than 3 years,
in contrast to less than 1 year in 1918."...

"The Threat of Pandemic Influenza: Are We Ready? Workshop Summary (2005)Board on Global Health "

(Certainly population density and modes of travel today could maximize new pandemic strain survival and their compression in time; we could have overlapping waves.)