Bird flu. What? Me worry?

Speaking of reading sequences, it should be noted that in the Gharbiya cluster in Egypt in December, 2006 (which represents the largest cluster reported to date in Egypt), the sequences (which are public) show two HA changes in (V223I) or near (M230I) the receptor binding domain. These changes were also found in a February, 2007 isolate from a chicken from Gharbiya.

The V223I had been seen earlier in H5N1 from birds in Japan and southern China (Shantou), while the M230I had been seen in a Qinghai H5N1 isolate from a wild (but dead) eagle owl in Germany.

These changes are flying around and, as seen in the Gharbiya cluster, are finding their way into readily transmitted H5N1 in humans.

The changes have not gone away (media reports and official press releases, not withstanding).

Speaking of human and bird H5N1 sequences in Indonesia, the latest comments on bird H5N1 sequences in Indonesia looking more like human sequences matches an observation made in February, 2007

http://www.recombinomics.com/News/02120701/H5N1_Indo_Match.html

based on sequences released by the WHO affiliated H5 reference lab in Austrailia.

Previously, there had been concern about the failure of poultry H5N1 matches with human H5N1. Virtually all human H5N1 in Indonesia had the novel HA cleavage site of RESRRKKR. This sequence was also in a cat from Indramayu, in early 2006, but was rarely detected in poultry H5N1. This match failure was discussed at length in the WHO sponsored meeting in Jakarta last summer.

However, the recent poultry sequences did have the novel cleavage site, as well as several additional changes that had previously been largely limited to the human isolates.

Thus, the finding of more "human" Indonesian H5N1 (Clade 2.1) in poultry, has raised some concerns (and WHO is definitely aware of these changes, because it was the WHO H5 reference lab that generated the data and made it public in February, 2007).

that poll looks pretty pessimistic to me.
35% consider a flu-pandemic in the next few years as "very likely".
That's worse than anything I've seen so far.

Poll among European Physicians:
What is the probability of an influenza pandemic in the next few years?
Almost inevitable:9.3%
Very likely:35.4%
Possible:45.3%
Unlikely:7.5%
Very unlikely:2.5%

Keep it simple, stupid.

The reason 50% of peditricians aren't worried about bird flu, is because there have been 0 deaths attributed to bird flu in the US.

They probably aren't worried about lightning strikes, JAWS or the Yeti either:)

Sure, a bird flu epidemic would be a financial boon to public health officials (give them purpose in life), but, geez, look at the science squarely -- the risk of bird flu is trivial.

Ky, what part of low risk, high consequence is it that you don't get?

anon, Ky: These folks have no way to know if there is going to be a pandemic or not. There opinion is only valuable in terms of what they are or aren't doing about the possibility (nothing, probably, whichever way they believe). But Ky, since you have invoked science, I'm curious as to what you are using as your scientific evidence the risk is trivial?

But Ky, since you have invoked science, I'm curious as to what you are using as your scientific evidence the risk is trivial?

The fact that 0 deaths have occurred in USA (population 300 Million).

What could be more trivial than a risk of 0.

Of things to worry about (heart attack, regular flu, car accident, herpes, cancer), avian bird flu is not one of them.

In fact, talking about avian bird flu, probably causes stress to a few ditzy housewives in North Dakota, resulting in a few upset stomachs, which likely has a greater effect on public health than the actual bird flu itself.

Ky, I can't tell if you are pulling our legs or not. But I'll comment anyway.

You wrote: "The reason 50% of peditricians [sic] aren't worried about bird flu, is because there have been 0 deaths attributed to bird flu in the US."

The surveyed doctors were mostly European; 50% from the UK. See Revere's link to the coverage at the top of his post.

You are also using the term "bird flu" when I think you probably mean "pandemic flu." But I can't be sure. You wrote: "a bird flu epidemic would be a financial boon to public health officials."

That's laughable even if you meant "pandemic flu." Ask any public health officials you know if serious outbreaks help them earn more money.

But a "bird flu epidemic" -- technically, a "bird flu epizootic" -- would not be a financial boon for public health officials for other reasons as well: If HPAI H5N1 avian flu comes here, it would be primarily a problem for farmers and veterinarians and other animal health officials.

In any case, there is already a bird flu panzootic in the world, so it isn't the least bit hypothetical. Public health officials in first world countries with bird flu outbreaks mostly serve to screen and counsel humans who have been exposed to infected poultry -- and to try to help everyone else understand the hazards.

If you are interested enough to read "Effect Measure," perhaps you will try to learn something about bird flu and pandemic flu. Then, chances are, you will develop some interesting opinions or questions about the topics, like most of the posters on this site.

Ky. You are certainly entitled to your opinion...but here's the thing.

An influenza pandemic is the only pathogen and actually, the only threat of any kind that can kill 50-100 million people in 1918 in basically, 6 months.

H5N1 is currently more than 30 times as lethal as H1N1 was in 1918...and although I expect its mortality rate to fall precipitously as it gains in transmissibility, its normal is inherently higher than H1N1 (Low pathogenic strain) was in 1918.

In other words, in my opinion, it not only deserves the attention it has been given...but I would suggest that given the evidnce which is not good, that we should be on a war footing at the moment...

...because if it hits the way it looks, it is a matter of national security as well.

Thanks.

Tom DVM,

There should be a Godwin's law about invoking the 1918 flu pandemic, which conveniently happened in the middle of World War 1, when MILLIONS of people were, displaced, starved, sent overseas to foreign countries and killed.

Comparison:

1918 Flu Pandemic: Hurricane Katrina
2007 Avian Bird flu: Windy day in Chicago

Do you folks peddle facts or fear?

Ky. No problem...but it just happens that H5N1 is morphologically similar to only one other virus in history...H1N1(1918).

Two of the most knowledgable experts in the world (Dr's Webster and Osterhaus) about 15 months ago, within a week of each other, one on the record and the other off the record (later inadvertently placed on the record by a third party), stated that H5N1 was two mutations away from pandemic potential at the time...given the timing, I would assume that they had both been handed evidence indicating that H5N1 was actually two mutations away from pandemic potential.

But you are quite right. The reason we have a problem in translation is that authorities are speaking 'pig latin' instead of 'english'...and they aren't following scientific principles either, in my opinion...

...if they thought we could handle the truth, the whole truth and nothing but the truth, even if it hurts...then everyone would better be able to assess the risk for themselves...the 'real' information is in the hands of few while the rest of us scientists, must figure it out on our own from circumstancial evidence...

...and I would be more than happy to be wrong about the circumstancial evidence.

Thanks again.

Hi Tom,

"...stated that H5N1 was two mutations away from pandemic potential at the time .."

Well, we love scientific, testable, falsifiable predictions, but, in the avian bird flu arena, they just haven't panned out.

Time to pull the plug.

Thanks,

Ky

Ky,

You said "which conveniently happened in the middle of World War 1, when MILLIONS of people were, displaced, starved, sent overseas to foreign countries and killed."

Now we have Billions of more people on the planet, Aids ravaging many parts of the world, wars that have displaced millions, many more people crammed into tight living conditions, and airline travel which could take a mutated version of H5N1 from Indonesia and spread it to every corner of the globe in a matter of weeks.

Before you comment on a subject you should learn a little about it.

Tim B,

The primary thing one needs to know about avian bird flu is that it is purely a form of concocted scaremongering.

That's why 0 people in the US (pop 300 million) have died from it.

Of course, that doesn't stop idiots at ABC from producing a made-for-tv movie about it. Is that where you learn science?

Path Forward wrote:

You are also using the term "bird flu" when I think you probably mean "pandemic flu." But I can't be sure. You wrote: "a bird flu epidemic would be a financial boon to public health officials."

No, I mean bird flu. There isn't a pandemic flu. Go, look up the meaning of the word "pandemic"

That's laughable even if you meant "pandemic flu." Ask any public health officials you know if serious outbreaks help them earn more money.

From CNN last year -- $120 million already flowing to researchers to study a disease that has killed 0 Americans

The fact that 0 deaths have occurred in USA (population 300 Million). What could be more trivial than a risk of 0.

I'll have to forward this remarkable insight to the statisticians in my circle.

I used to know a guy who, despite the best efforts of friends and family to modify his behavior, insisted upon driving while inebriated, and not only that, driving at high speeds.

He, rather as does Ky here, defended the practice by saying that since nothing bad had happened in years of prior experience, he thus had conclusive proof that nothing bad would or could happen. Sigma, summa, QED.

Of course, he got his stupid ass killed in a crash on the proverbial dark and rainy night not long after having made that statement. Very fortunately not having killed anyone else into the bargain.

Further analogies involving Russian roulette, et al, are left as an exercise for the reader.

--

marquer and Ky: Here's a better manouver. There is a very tiny, almost vanishingly small, chance that there will a bomb on a plane. There is essentially no chance there will be two bombs on a plane. Therefore the best thing to do is carry a bomb on a plane you don't intend to detonate. I have also taken note there have been no terrorist attacks in North Dakota. Hence we should all move to North Dakota.

There is an interesting underlying statistical issue, here, however. If there are no occurrences of an event, how do you estimate the probability of it happening? The maximum likelihood estimator for space shuttle accidents before Challenger was zero, but we know this wasn't an accurate estimate -- it was biased in the statistical sense. There are a variety of other estimators that people have suggested for situations like this. However I don't think you were serious, Ky, in your example so I won't bother to parse the technical issues further.

So seriously, Ky -- although I don't know why I should be serious because I am beginning to think you are a troll -- many of us learned our science the hard way, by doing it. Seriously.

So, that's all you got? Ridiculous, inapt analogies to: (a) drunk driving (a documented fact that alcohol impairs judgment), (b) bombs on planes (See Shoebomber Richard Reid), (c) bombs in North Dakota?!!? and (d) the Space Shuttle explosion Challenger?

Analogies, but not data? This is pathetic.

BTW, regarding the Challenger, have you read Dr. Feynman's dissent from the Challenger investigation?

He noted that the risks, a priori, of a possible explosion were significant, but ignored.

Anyway, you guys are tying yourself up in knots, when the fact is NOT ONE OF 300 MILLION PEOPLE IN AMERCIA HAVE EVER CAUGHT THE AVIAN BIRD FLU AND DIED FROM IT.

Zero. Nada. Nothing.

You'd be better off worrying about Martian landings or Loch Ness monsters -- the same numbers of people have been hurt:)

I vote to not "feed the trolls!"

Michael,

That's good sense.

Michael, Melanie: Agreed.

Michael, Melanie, revere! Agree, agree.
Like my husband would say, Gads!

When public health is working nothing happens.

There's never been a nuclear terrorist attack. Therefore, our efforts to inspect cargo and control our borders are wasted. We ought to be guarding the former site of the Twin Towers quite well, since it was the target of two attacks.

Oh, boy.

You know Ky, I would never, ever call Revere or Melanie stupid. One rides the tide of H5N1 each and every day. In fact Revere has pretty much changed his opinion on bird flu. A full two years ago he said that he thought it might just be a splash in the pan. He isnt saying that now.

Statistically speaking Ky you are right. Aint one danged American had it that we are aware of. But on the other side of this planet in Indonesia it has a current and just posted 87% case fatality rate. Their head of flu preparedness and planning said that they believe its finally getting its legs and losing its wings. If that be the case and take it from a HARD core Republican that I personally believe we are flat screwed. It just will be in varying degrees. Start at death and work your way up from there. If you are still alive and complaining about the 120 million six months after it rolls in here, then well I just cant think of a thing to say.

I would jump and down and rant and scream and all sorts of stuff if I thought Revere was full of shit. Same with Henry Niman. Both are working towards the same end and they get into it a lot. Should have heard the noise when I suggested we use a couple of neutron weapons on Indonesia. But alas its too late now, its out and its running and the PLA in China has the information stream there. The lovely Auntie Margaret has WHO and Supari in Indonesia together and now we have something that we cant buy them off with. Vaccine being what it is, which is not here I suggest you pull up the clinical information about H5N1 and how it swacks you like a rock to the head in under 72 hours after you turn symptomatic.

How you can posture what you do is beyond me. Everyone here could cite websites, news articles, actual papers by some of the finest flu minds in the world and well, I guess you just need to back up what you are saying.

Me, I dont think we have a Jews chance in Teheran. We are going to be lucky if we get out of this alive most of us and most of all things that we know will end. Brave new world afterwards because cousin Ky, if it comes right now and it goes to just 1/2 of the Indonesians stuff its still a 40% fatality rate and thats going to take about 4.5 billion and change. So if you know something that I dont PLEASE by all means make my day and tell me what it is.

But on the other side of this planet in Indonesia it has a current and just posted 87% case fatality rate.

There have been report of 79 bird flu deaths in Indonesia

Indonesia has a population of 234 million people

79 out of 234 MILLION isn't a real robust risk, wouldn't you agree?

BTW, where do you get that 87% fatality rate from?

Bloomberg today Ky. And no I disagree, its a massively robust risk. Basically put, all those who get it die. Forturnately for the rest of the world and the detriment of the Indons who get it, they die too quickly to spread it much. That seems to be changing. I run a side statistics for a rolling one year average and I had it at 83% for about the last quarter world wide. But then again I didnt have all the poop from Indonesia because they were witholding.

Look Ky you could be right but the evidence says otherwise. All pandemics start off with herald waves. They are mild as a rule. Then blammo we get popped. Popped this time means that they would bury about half of the planet.

E.g. robbers used to come from behind the stacked bodies on the road to Cairo during the Black Death. We are massively overdue for a superpandemic statistically, Black Death, Smallpox, Swine Flu all got their little starts and went ballistic.

Not to be prepared for this one and that MEANS MONEY for everything including the kitchen sink equals dead people. A lot of them. I dont know how old you are but if you are less than 45 then you have about 1/2 of your body into a grave if we can find one for you if it comes. Its simple. This is pretty much a killing machine. You get it, you die and miserably at that. If you have never seen someone go from cancerous pneumonia then I would say its pretty much like that from personal experience. Seizures, urking green foam, urking bloody foam, more seizures, organ failure. For most its fairly quick. The unlucky ones get to cook in their own skin at 103.5 for about a week to ten days. Lack of oxygen does all sorts of things. Some even bleed from their nose, eyes, ears, and every thing down low.

So you dont feel that this is a big problem I guess? If not, please I am looking for volunteers that are comfortable working in a hazardous situation with no mask or other PPE. Add in the fact that some of the most imminent epidemiologists and communicable disease, and flu experts all say we are about to take a ride puts you at a disadvantage..... You have something to share that we dont know other than the whole of Indonesia doesnt have it just yet?

Randy I agree with the overall point of your comment, but your math is a little off... with roughly 6 billion people on the planet, if absolutely everyone caught a pandemic virus (100% attack rate), and the CFR were 40%, then 2.4 billion would die. (A 100% attack rate and an 80% CFR would kill 4.8 billion.)

The estimates of attack rate of a novel influenza virus that I've seen are more like 30-50%, or 1.8 to 3 billion sick. So at a 40% CFR, that would mean 720 million to 1.2 billion killed.

And I agree, any of these outcomes would be horrific and society-destroying, as are all scenarios where the CFR stays in the double digits.

No one knows if this flu can mutate. They say it needs two mutations, but no one says how likely those mutations are or how hard it would be for a virus to do that. Also when it mutates it could be much less lethal. In addition to that Relenza, Tamiflu, adjugvents, vaccines, and now blood from victims has been shown to be effective in tests, showing large survivial rates. The threat is very real. The scientists, countries and pharmacutical companies working on it are very real also. Also bear in mind that the people who are dying now, live with their chickens. Feces all over their homes. Their water is filthy, no running water let alone hot water and sanitizer. It is a real threat, that no one knows how serious it can become. The ones who say that half the world or eighty percent of the world will die are just as off and speculating as much as the one who says, nothing will happen. Aids is a virus also, it has been around for a long time, and can mutate, mutate to the point of being caught as easy as a common cold. Anything can happen. Prepare by getting extra meds, food, protection, water, you may want to join a site that specializes in preparedness then let it go and live your life. I have been waiting for three years, with people predicting the worst, I would have never guessed we would be here this long. It would appear it is harder for this virus to mutate then it was originally thought, I recall the dire predictions several years ago already. I also recall Swine flu which did not end up being much. A flu that many suspected was man made, as many suspect the WW1 Avain flu was bio weapons.

Yeah Deb, but Swine Flu in the 70's was a maybe with only a few soldiers that turned up with it. This is 300 plus cases now and they still havent accounted in China for the 6500 missing from a village that Boxun.com reported on. In addition what about that Ebola flu from July of 05?

Fact is that if it comes and just sickens us for a month or two at at time that alone will bring the system down if everyone gets it or even 1/3rd and no one dies. I am betting that it does and it has the adaptive mutation, and that it continues to mutate to infectious state and comes back for about five years.

Always assume the worst and then if it gets you well......

Caia you are right, it was the heat of the moment and yep I was thinking of my 83% rolling year average that I have been tracking on my Excel program. Either way, remember the tip over point is supposed to be at 8% if it all happens at once. We could withstand 8% if it happens slowly, which I doubt.

Look, remedial learning might be called for here. Some folk seem to have got the wrong end of the stick. Ky is just unzipping his (?) ignorance and waggling it about for all to see.

There's this thing called bird flu. It kill birds good, but who cares about birds? Fine. And we know that sometimes, rarely, it gets into humans. But again, the chances are small so who cares?

The problem is NOT the bird flu. The problem is that every time it gets into a human we have a chance that it has adapted or will adapt to become a HUMAN flu. That flu will spread through the human population as flu generally does, and this particular flu kills a LOT more than the usual type. Seriously, a possibly civilisation-threatening proportion (at least, threatening to those of us who rely on a vast and complex supply chain, as most of us do now days).

The argument that few have died so far just shows the speaker's ignorance. Of course only a few have died - the virus hasn't adapted yet! But we can see that it *can*, so doesn't it make sense to prepare? If you wait until it has adapted, then it's way too late to do anything.

Deb: I agree with most of what you say (except the implication that 1918 may have been a biotrror weapon; they didn't even know about viruses then). We just don't know. I also would have framed the prepping differently. The prospect of a devastating pandemic is a signal to get our communites in order to withstand whatever might come along. That means strenghtening public health and social services.

I won't address Ky's points. He is a troll and I don't think we should feed him.

Randy: Swine flu was a much more serious prospect. It spread through a couple of hundred soldiers quickly at Fort Dix and had all the earmarks of a pandemic taking off. If this happened with H5N1 now we'd all be heading for the hills. I also think the response to Swine Flu was sane, rational and commendable. I hope we'd do the same thing again, although do it better because we know more now (or know we know less). This was surely Gerald Ford's shining moment, for which he gets no credit. It was truly a Profile in Courage. Too bad he wasn't as good about other things.

Tom wrote: "H5N1 is currently more than 30 times as lethal as H1N1 was in 1918...and although I expect its mortality rate to fall precipitously as it gains in transmissibility, its normal is inherently higher than H1N1 (Low pathogenic strain) was in 1918."

Tom, where do you get that figure 30 times as lethal? haven't seen that in a journal. Based upon what I've read in the literature in the last year there is no good a priori reason to expect H5N1 mortality to drop if it were to become pandemic-capable. It might, but it might not.

Hi Marissa

Sorry if my math is off.

1918 was 2.5% CFR and Indonesia is H5N1 is about 70-80% CFR with intensive care avaliable.

2.5 times 30 = 75%

What is the CFR going to be with no healthcare and no pharmaceuticals including antibiotics due to demand outstipping unsustainable supplies and re-supply lines?

What is the collateral damage going to be?

It's worrisome.

I was referring to the dead ones Revere-7? For the kids in the group here is the link. Two hundred plus and it ran through them like crap in a goose. I mean a couple of DAYS....! For those of you who werent around then the country went onto a battle footing simply because of the speed with which it developed. These were well surveilled cases too. We dont have that capability in the countries that have H5N1 right now. We are also doing good to get them to acknowledge it. I hear things out of Myanmar Revere....nothing confirmed but its mostly troop type stuff, very interesting from our standpoint stuff about isolation zones

http://www.cdc.gov/ncidod/EID/vol12no01/05-0965.htm

Ky, how come internet is possible?! There was about five zillion years of internet. It shouldn't have happaned, should it?
;)

Ky, how come internet is possible?! There was about five zillion years without it. The internet shouldn't have happened, should it?
;)

Ky,

Re:"The reason 50% of peditricians [sic] aren't worried about bird flu, is because there have been 0 deaths attributed to bird flu in the US."

So please let us know just how many deaths from bird flu/pandemic flu must occur in the US (vs some other country) before it will become scientifically significant.

Are people taking into account the fact that Indonesians don't go to the hospital unless deadly sick? In other counties people have went to hospitals with mild cases, but almost every case in Indonesia people who are checked into the hospital are very sick and near death. So the mild cases are never tested because no one would test them as they would stay home in their village, and would not appear in the 80% figure.

Grace RN:

To your logical, non-confrontational question, I offer a logical, non-confrontational response:

1. According to the CDC, about 36,000 people die each year in the US from the Flu

2. Of course, these people tend to be older, frailer, even suffering from other immuno-compromised conditions. They are the most at risk.

3. The reason (2) is likely true, is because Millions of people get a bout of the flu each year -- and don't die. We just stay home for a few days with chicken soup and NyQuil.

4. Also, since the flu virus mutates regularly -- flu vaccines are always trying to play catch-up. We see new strains each year -- but the general health dynamics don't change.

5. So, why all the fuss about the avian bird flu -- with numbers so trivial, in lands thousands of miles away?

6. I submit it's a function of: (1) degraded scientific standards, (2) scaremongering, (3) politics, and (4) unending quest for gov't control and funding.

7. But, it certainly it isn't science of public health.

8. If the 36,000 yearly American death rate caused by flu, were to increase, say, 5% in a year (after factoring population growth rate), then I'd say that would become scientifically significant.

9. Raising the specter of 1918 WWI Flu pandemic is just hokum, though. Different era, different public health standards, different diet. Our sanitation, diets, immune systems and general health have gotten much better over the past 89 years (!), so that we can handle the flu, without all this ridiculous scaremongering.

Ky: Your objections have been discussed ad nauseam in the scientific arena by scientists. Apparently you aren't exactly au courant with the underlying concerns. As a physician I can tell you flu is a pretty bad disease, even when you get it when you have some immune response, as is the case with seasonal flu. While it is true that the flu changes genetically with alacrity, since it is the same three HA subtypes that are always involved there is also quite a lot of cross protection. The concern is for an HA subtype people have not seen before as the concern is there would be little cross protection. Thus H5 is a big deal.

As for an infectious disease thousands of miles away, the virus doesn't travel on air currents from the source, it travels on social networks. Thus by that metric , we are only as far as the nearest transportation hub. The epidemiology of flu is such that people who are infectious but not yet showing symptoms can travel virtually anywhere on earth.

The 1918 flu is just an example of what can happen with this disease. In fact, it can easily be far worse. We have no medical defenses against it because your local ICU is already at capacity. You won't be in it if you develop Acute Respiratory Distress Syndrome. You will be at home, without a ventilator and skilled nursing. Your immune system has never seen H5. There is no vaccine at the moment and likely won't be. There aren't enough antivirals and we don't even know if they work for H5 (they probably do, but you won't get them on time).

So that's what the fuss is about. Since you don't know any of this, I take your point about degraded scientific standards for the public. You are a case in point.

Ky,

I hope you are playing the Devil's Advocate here.

Why be concerned about a flu pandemic-whether the virus is H5N1 or not?

1. As an actively practicing RN for 35+ years, I can tell you, show you reports that the American Healthcare system is at a state of near collapse on any given day, flu season or not.

2. The annual flu is basically a 're-run' of prior years flu with some changes. Not a new never-seen-before-in-the-human-race flu virus.

3. Flu is an incredibly contagious virus, and a person can be contagious for days before they begin to feel ill.

4.Flu pandemics are recurrent events, averaging approx 3 per century. When the next one will occur,what virus will cause the next one is unknown.

5.H5N1 has already met 2 of the 3 criteria to become an official pandemic flu virus.

And re: "If the 36,000 yearly American death rate caused by flu, were to increase, say, 5% in a year (after factoring population growth rate), then I'd say that would become scientifically significant."

If a brand-spanking new flu virus that meets all 3 criteria for a pandemic virus breaks loose onto the human race, the annual flu death rate will rise exponentially.

Just think-how many 'medically frail' people do you know? People who are alive today only because of advanced technologies ie dialysis, venilators, blood transfusions, rapid access to advanced healthcare? Supply chain failures can kill them, whether or not they ever got any form of flu.

I have the impression that Ky has never had the opportunity to encounter the "genuine article." I had the utterly unique experience of personally encountering a distant relative of the 1918 H1N1 strain, while I was working as a patrol officer in an immigrant area of San Jose, California. The "beast" nearly killed me. I wrote about the encounter several months ago, in the
Flu Clinic at CurEvents.com; this was at the request of another member of the site. The title of the thread is "Pale Horse, Pale Rider;" it was an entirely honest effort to express what an encounter with this creature was like, and I believe that it is likely representative of what you can expect to experience, should you encounter this new "beast," and live to tell about it. This is the influenza that I sincerely believe you know very little about.

revere, have you ever heard of Wendy Orent? Wendy Orent is an Atlanta-based writer and author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease"
I just ran across it doing a search, which I really have little time to do searches but .... not knowing if you've ever heard of her I thought I'd ask. Or anyone else?

Ky: This is nothing against revere because he has my respect and attention on this matter.
I do understand where you are coming from though as our government is very corrupt now and really could manufacture more than we could imagine to keep the public "scared". But if that is what they're doing with the H5N1 scenario it isn't working because the percentage of people that don't believe in it happening are greater than those who do believe it will. ~~~ Mass Denial ~~~

Whether this virus goes ballistic or not it's still an excellent idea to stay abreast of it or any other "news" because in the end the individual will be the one that saves their own ass, not the community planning revere would like to see manifest.

Ky, what would you think to be the motivations behind this "scaremongering" and "politics" and "quest for gov't control and funding"?
Maybe the possession of the international jew of the dominion of the world? Or maybe the illuminati reign arising from the fear of the peoples of the world? ;)

Lea; I had multipel posts on Ms. Orent on the old site (at least half a dozen). She is a flu denier of the old school. Here is one: http://effectmeasure.blogspot.com/2005/10/dis-orent-ing.html

That was interesting and informative revere, thank you for once again taking the time to educate me. I wasn't around when you had the old site.
I won't waste anymore time thinking about her, "them", or trolls.

Ky, what would you think to be the motivations behind this "scaremongering" and "politics" and "quest for gov't control and funding"?
Maybe the possession of the international jew of the dominion of the world? Or maybe the illuminati reign arising from the fear of the peoples of the world

Nah. More gov't funding for mediocre scientists is probably the best explanation.

All: Ky is a troll. Please don't feed him/her/they/it. LIkely a highschool student trying to get a life. Trolls are not serious. They just like to get people riled up. Please don't oblige.

Grace RN:

As an actively practicing RN for 35+ years, I can tell you, show you reports that the American Healthcare system is at a state of near collapse on any given day, flu season or not.

Sadly, this is true. The reason, for it, though, is bad science and bad public policy, causing an overburdened system. Bird flu scaremongering contributes to this problem.

revere -

I really appreciate your posting about this. I hear very little about it and had the notion that it was pretty much dead in the water. I hope that it does die out, but it's nice to know that if it doesn't, there are folks like you to keep us updated.

Oh and, yes indeedy, Ky is a troll. I won't bother linking to other posts where I have seen him, honestly don't think he's worth it. But he has infested posts at Respectful Insolence and other sciblogs. He pretends he actually knows what he is talking about, trying to sound sciencey, as it were. All he really accomplishes is pissing people off and getting the attention he so strongly desires.

I think Ky, despite being somewhat obnoxious, has provided a valuable opposing view, supported by numbers.

Granted, it does no good to ignore health risks. But, it certainly does no good to exaggerate health risks, either.

From my extensive research into surveillance numbers, the top 3 health risks in the West are (a) heart attack, (b) cancer and (c) stroke.

Mike: No, it is not valuable in the least. He is ignorant about public health and has a history of making mischief. We entertain many opposing points of view here, as you will see if you go back over the two and half years of posts on this site. People can disagree and argue. That's encouraged. But Ky is not serious. He/she/it/they just want to get attention. Ky needs to get a life.

About your observation. We only have surveillance systems in the US for cancer (cancer registries) and many of those are not true surveillance systems (because they are not timely and are not used for surveillance. Surveillance is a special kind of public health data. It is not just vital records data. I am a chronic disease epidemiologist (cancer) and I use these data as part of my work, so the intricacies of terminology are important to me. I also have great respect for the three diseases you name, leading causes of death in the West. But they are not relevant to the threat of a pandemic any more than the Gross National Product or the price of soybeans is relevant.

revere,

I respectfully disagree. Perhaps, I have thicker skin than most.

There are scarce public health resources. This forces intelligent, concerned medical personnel (like yourself) to make proper allocations of time, money & energy. Think of it as triage on the macro scale.

To do this, we must accurately gauge and assess risks. Heart disease is the number 1 killer in America, followed by cancer. As for infectious disease, I suspect the major concern is pneumonia or the flu. Feel free to correct me, if I am wrong.

Yes, we should be mindful of the avian bird flu overseas, chart its course, attempt to preempt any form of outbreak.

But, No, we should not sensationalize it, produce movies about it, divert precious resources to it, if, indeed, its risk turned out to be lower than originally thought.

If I had Bill Gates' money, I would not be so penurious. But, I don't have it. I have obese people, still smoking cigarettes, leading sedentary lifestyles, depressed from failed marriages, dissappointed with under-achieving children, some who are between jobs, without insurance, half-way in the door of a lawyer's office, the minute a health expectation is not met. That's life, that's the landscape breeding illness in America.

In this context, Avian bird flu simply hasn't broken through any epidemiological threshhold, that I've seen.

Hi Mike P.

The difference between heart attack stroke and cancer and pandemic influenza is 'threat potential'.

If you examine the evidence objectively, and we have lots of evidence after ten years of it now...I believe you will conclude that this is a not a once in a lifetime threat potential but possibly a once in 2000 yr. threat potential or a once in 10,000 year threat potential...with the qualification that accurate pandemic influenza history is an oxymoron.

I do not think that H5N1 will fulfill its threat potential but I do believe H5N1 will be directly involved in the next pandemic, sooner than all of us would like it to.

The bottom line...this is and always was an issue of national security and should be treated that way.

I honestly don't see why we can't do two things or four things at the same time...the medical community in the first fifty years of the twentieth century didn't have these kinds of problems.

Thanks.

Probably not looking in the correct places.

If it broke through a "threshold" at this point, the only place to go is pandemic .

Then, everyone's preparation time just ended.

US Homeland Security said (since there is no prevention and no treatment/cure, no vax,) the public may be "directed to self-quarantine" (Officially Quarantining would require officials to meet people's needs) for up to 90 days each pandemic wave (and who knows if there will be gaps; could have co-circulating pandemic strains - look at how many subclades are out there. What if this is like a crop of green sunflowers; got started at different times but more than one may "bloom".)

No way to know what China has been doing to keep H5N1 in humans in check, but I wonder, if no tamiflu had been donated to Indonesia to give contacts and those inside zones, whether we'd already have been seeing cases here in the US and other nations; there is certainly airtravel to get it here. The people translating the Indonesian news and trying to keep track of names, ages, onset, locations, hospitals, deaths, (don't forget those 4 health care workers who fell ill after patient(s) died, and never were noticed in the news again) are seeing "disimprovement".

There is no way on earth to keep it from getting worse; in too many animal species, too many people would have to follow strict biosecurity practices they've never heard of and can't afford.
Every time a human gets infected, the virus gets to see which mutations thrive in humans.
Some day, someone infected but the day before they have any symptoms, or even at symptom onset, will get into a superspreader event. (That one person in Karo, sequences show infected 6 people, right?)

Perhaps a tourist/local worker bar sort of thing; tourist gets on a plane, infected passengers sow themselves broadcast on arrival, (meanwhile infected local worker's other causal contacts and other tourist contacts from other nations have dispersed, in different directions) - "as little as 21 days" from pandemic strain to global dispersal, experts informed Dr.Nabarro, at least a year and a half ago.

All the normal problems and causes people care about
will be like a knocked over chessboard;
look at what people's concerns were the month before the Tsunami, or Katrina. Wouldn't they have wanted to know, and adjust their resources and actions to be better prepared to survive as families, and be able to Recover as communities?

Diverting precious resources?? Hot air is in plentiful supply;
politicians and "leaders" have chances every day to tell the truth and educate people; if they'd talk, public would hear some hard facts; things would happen.
People waste money on whole sectors that are unnecessary or even harmful!
(Politicians mistake that for "an Economy"! And, they seem to think
The Economy can exist even if they let the population take a blindsided hit from a virus 30 times more virulent than 1918's was!)

The Gods of the Copybook Headings look down and laugh.

Ky,
Thanks for the display of sanity. It is refreshing indeed.

Who owns the world? Who benefit's from the world population not being aware of what's happening to the H5N1 thins?

i don't know who benefits from keeping h5n1 a secret but i damn well know that niman has his entire professional reputation staked on it becoming a human virus, which is why he is rarely accurate in his periodic summation of where things stand with regards to h5n1. does anyone remember the certainty in which he proclaim phase 6 in mid-2005? he lets his emotions cloud his judgement and the facts be damned. a poultry industry ceo has more credibility that henry niman with regards to h5n1.