Africa, flu and a meeting in three years

The Sharp Pointy Edge of the Issue.

By

Dr. Revere.

"With luck, there will be another one in three years. With luck. Three years is a long time for a virus that can make a millions of copies of itself on the scale of hours."

Comment: In the end, that is all this is...a mathematical probability...and at this point the probability is very very close to 100%...the politics aside of course.

"Comment: In the end, that is all this is...a mathematical probability...and at this point the probability is very very close to 100%.."

This is not a mathematical requirement. It depends on things we don't know at this point. It is certainly not true that the replication rate of this virus means a biologically relevant mutation to transmissibility is certain. The biological questions affect the transition probabilities, so it is not a question of mathematics but biology, biology we do not fully understand at the moment.

"The biological questions affect the transition probabilities, so it is not a question of mathematics but biology, biology we do not fully understand at the moment."

As I biologist of sorts, I will respectfully disagree. Nature is composed of overlapping irregularly, regular patterns...and therefore...essentially mathematical proability.

Tom: Your statement, regardless of its epistemiological import (which is outside both of our expertises as biologists) says nothing. You made a quantitative prediction and you didn't the support to make it. If you would like to tell me your assumptions we can discuss it further.

"You made a quantitative prediction and you didn't the support to make it. If you would like to tell me your assumptions we can discuss it further."

Sir: I have no idea what you just said. /:0)

However, let me put it this way. A serious earthquake occurs on the West Coast of North America every 700 years or so. A serious tsunami occurs in the Indian Ocean every 175 years or so...and a serious hurricaine occurs in New Orleans every 100 years or so.

There have been 10 pandemics in the last three hundred years...half of them with higher virulence comparable to 1918...with the provisial that accurate records in a crisis are an oxymoron...as rising estimates of mortality of the 'Spanish Flu' indicate.

We need to overlap this fact with the unprecedented emergence of 'exotic' diseases in the past 25 years including Nipah and chika-whatever.

and to overlap it with the unprecedented move of exotic subtypes influenza's into human populations in the past ten years...for the first time in history.

and to overlap it with the mutation to increase the virulence of existing viral diseases like that also occurred in 1918 (yellow fever).

Sorry, the last line should have read...the virulence of existing diseases like Dengue that also occurred in 1918. Yellow Fever is in brackets because that was another disease that also mutated to increase virulence in 1918.

Also, weather pattern disruptions occurred in the time period before 1918 and 1830 and I suspect the same will be the same around 1890.

Thanks as always.

In other words:

If you add up enough random coincidences...they are no longer random or coincidences...

Tom: The breeze from the handwaving almost knocked me over. Let's leave aside whether things are really random or deterministic. Operationally it doesn't matter because we don't have the information that allows us to make the kind of prediction you have made in either instance: that within three years a pandemic from H5N1 is certain. Even if the probability of a pandemic in each year were identically and independently distributed with a binomial probability of 50% (a pretty extreme case given the data), the probability it would occur within three years is not even 90% much less 100%. We know it isn't 50% per year because then we would have had many many pandemics, not just three in 100 years. But the virus isn't proceeding with a clock like that I'm quite sure. It is wandering in a genetic fitness landscape whose shape we don't know. It may have climbed to the top of a hill that is a local maximum and in order to get to the hill that is a human pandemic it has to retrace its steps back down the hill into a deep valley, which is very unfavorable from the fitness standpoint. I don't know. And I am quite sure you don't either.

Revere. I thin the problem is that you look at one probability in isolation...whether H5N1 will cause a pandemic...

to me the question is whether there will be a pandemic...and it could be just as easily Nipah and H5N1 or just as likely H3N3 as H5N1 or an H5N1-H7N7 reassortment for that matter...

...it doesn't matter to me because vaccine doesn't work...so at this point, if I was in charge, I would be researching vaccine like crazy but I wouldn't be making any...because it doesn't work.

The point is this is multi-factorial rather than a single probability...and if you start stacking up increasing probabilities one on top of another on top of another...they become a trend line...and eventually, you have a pandemic.

A pandemic is imminent...the point is that you and I and Mother Nature might have a different definition of imminent.

Tom: You gave us all your definition: less than three years. You want to throw all sorts of other pathogens into the pile. That's OK with me. But not all pathogens are the same, either in their potential for a pandemic, the ease with which they can be slowed or halted, our ability to treat them, their effect on society. We've just had a pandemic (AIDS) so maybe that's the one you were expecting? And some pandemics are still with us (TB, malaria, schisto). That's why I am trying to force you to operationalize this and make it more precise. Because in some sense you are already right and in others it is an empty statement and in still others, like the one you appeared to have made about H5N1, a very strong statement but without support.

Many people have the impression the bird flu menace has receded

A strawman statement right outta the box? Jeez, Revere, you can do much better than that.

Mant people have the impression that bird flu is and never was a menace.

1. In the US, there have been 0 deaths. (Pop. 300 Million)

2. In Indonesia -- ground central of the H5N1 epidemic -- there have been 80 deaths (Pop. 234 Million)

How can you call something so trivial, so hyped, so detached from common, ordinary public heath a "menace"?

There was and is no menace. It is only in the minds of hysterical, middling scientists and bureacratic, international health organizations struggling to find relevance.

The reason it is so dangerous, though, is that it diverts attention and resources away from things that do matter, ie, the Big 3: (1) clean water, (2) clean sanitation and (3) good food.

In the USA, you have a greater chance of being killed by a meteorite, than by bird flu. Don't worry about it.

Ky. You look after the clean water and the clean sanitation...I will help you with the food issue and I will look after the one we are currently talking about.

By the way...you are wrong about H5N1.

However, you are not alone. As a matter of fact, I belive that most regulators and Goverments are in complete agreement with you.

tom and others: Ky is a notorious troll, here and elsewhere. Ignore him. Don't feed him. This is how he amuses himself. When he graduates highschool maybe he will straighten out.

Tom, my conclusion may be wrong, how 'bout my facts?

1. In the US, there have been 0 deaths. (Pop. 300 Million)

2. In Indonesia -- ground central of the H5N1 epidemic -- there have been 80 deaths (Pop. 234 Million)

Another fact, that I should probably add.

The H5N1 scare emerged in 1997 in Hong Kong, when 6 people allegedly died from this massively, infectious microbe. (Hong Kong Pop. 7 million).

That makes it even worse! After 10 full years of this "epidemic," without a vaccine or treatment, we have a whopping total of 200 or so deaths in countries with billions of people.

More people have probably died by stress due to reports of this bird-flu, than by the bird-flu itself.

You can color me unimpressed, but make sure to color revere, a scientific "chicken-little."

Tom,

I needn't remind you, that you were predicting on Flu Wiki some time ago, that an H5N1 Pandemic would be upon us by March 2007. Thankfully, you were wrong.

Revere makes a good point. You can't categorize every threat to humanity as H5N1 related. Some of those threats are not only treatable, but avoidable. And some may be mitigated.

I'm not sure where you've gotten your information and you may well be right. But I question your statement that pre 1918 pandemics were more virulent. I'm not sure that any previous pandemic has been documented well enough to say that with certainty. Again, maybe it has. But we've never been through a pandemic with today's standards. While those standards won't prevent virulence, they may help prevention and treatment to at least some degree.

Unlike Ky, I fear H5N1's potential. But it only has potential. Not certainty. No matter how many facets you give it.

Patch,

According to the CDC, about 36,000 Americans die each year of ordinary flu.

As most folks know, the flu virus mutates each year.

So, why do you "fear" H5N1's potential, when after 10 years, nobody in the US has died from it?

Hi Patch Speaking of "today's standards...at 12:02 I should have added...

...I would be doing lots of research of antivirals as well...but I wouldn't be stockpiling any of the primitive ones currently avaliable including Tamiflu...because it also doesn't work.

What I would spend the savings on would be...

...networks of local farmers to provide food as well as antibiotics, prednisolone, acetominophen and oral electrolyte powder for home treatments...and telephone systems for consultation with medical professionals...and infrastructure redundencies.

I would also be trying to come up with a cost effective ventilator that could be used at home...they did a lot of this during the Second World War for example...there is no reason we couldn't do the same sort of thing today.

Ky. Next time someone gives you that 36,000 quote...ask them exactly it is based on.

I think they call this type of thing, an 'urban legend'.

Tom,

Nobody "gave" me that quote -- I cited the CDC (did you read the link?)

Are you saying it's too high or too low?

Airway tubes and hand held SPUR's in hand Tom, along with the requisite food, water, gasoline, alternate heating, cooking, Pedialyte and 10 cases of vodka for disinfection.....of my insides.

Ky-Come on. Did Hong Kong flu originate in the US. Nope. Just because it hasnt gone flamingly H2H doesnt mean that it wont, or will. What Tom I think is saying that unless you prepare the simple fact is that you will die of starvation, freezing, lack of water or actually the flu when you have to go out and forage for the needed items. From what I have seen across the last two years, getting certified to a NIMS-800 level by the feds is that the businesses will NOT be opening during a pandemic due to mostly the liabilities of doing so. You bring someone into work you have to provide equipment and training on biohazardous environments. One screw up and the employers will have to prove they didnt get it at work. Guilty until you prove yourself innocent in a lawsuit. Not a slam Ky but think, if it goes H2H in a hard and fast way and you are told you will need not the two weeks of food, but four months worth and 100 million heads of households go to the grocery, how long do you think it will last? Not likely more than a day or two. Think of the possibility of being shot on the street for being out. It could get that serious.

You must assume and prepare for the worst...just in case. Failure to do so will if it comes result simply in you or your family dying. Not a question but fact unless someone else intervene's along the way to save you. Think about the blizzard in Louisville from the 90's. No power, no heat, no water, no natural gas, no food and that only lasted for a week in most places. Dozens died.

Actually, it will take three years to recover from all of the handwaving. After listening to utter nonsense about a third wave (Fujian clade 2.3) when the second wave (Qinghai Clade 2.2) is the reported H5N1 in every country west of China, one participant finally stood up and said that calling constellations of genes a genotype was simply incorrect (since genotypes refer to genetic changes in gene sequences and the constellations of genes are base on reassortment, which by definition does NOT change the sequence of a gene).

The conference is painfully amusing and is mostly politics masquerading as science.

Kruger,

You will die of old age before your hysterical scenario plays out.

I have never seen so many fraidy cats running around on phantom issues in my life.

Have any of you ever been to a third world country or are you all theoretical desk jockeys?

There are several problems in the world (famine, hunger, lack of sanitation, lack of political stability, malaria, tuberculosis, etc, etc. The stupid bird flu ain't one of them.

Speaking of Africa, H5N1 is at a third location in Ghana and now appears to be in adjacent Togo on the border with Benin (prior to last month Ghana, Togo, and Benin had never reported H5N1).

H5N1 is evolving quite rapidly, no "mutations" required.

The conference is painfully amusing and is mostly politics masquerading as science

True, but understated.

The entire issue is painfully amusing and is mostly politics masquerading as science.

Some of you guys sound like the incompetents at the CIA who warned us that Saddam had a nuclear weapons program "scaring" us into action.

Ky,

I agree whole heartedly, with what you are saying. To date, H5N1 has been virtually irrelevant to human health (except for the 200 or so souls [and their families] you mentioned).

I fear H5N1 because of it's potential. 36,000 deaths could be mulitiplied many many times.

No one in my family has had skin cancer. Should I conclude, therefore, that no one in my family ever will? I've seen the destructive nature of skin cancer from people all over the world, so I take "SOME" precautions against it.

Now, people all over the world are NOT H5N1 infected, but could potentially be. And there are certainly some that have died from what appears to be highly virulent (nasty) bug. It's not your normal flu. From all accounts, it's a really crappy way to die. What we are saying here, is four ourselves and our family, that we must take some precautions and give it some thought.

Tom,

I agree, Tamiflu is no silver bullet. But it's a weapon. And there is evidence it has been an effective one until now when used properly. I agree that it could become useless.

You have some good ideas. Antibiotics could help with secondary infections (pneumonia), but too many people think they cure the flu!! A network of distribution is a good idea. And I'd like to hear more on the ventilator. But how long could one ventilate another manually?

But you said 100% certainity. That's where you went down the wrong path IMHO.

Speaking of the conference, it is ironic that western Europe was just said to be free of H5N1 by Ian Brown, who considers the new outbreaks this year to be re-emergence of earlier cases because of the conservation of region markers, and Ilaria Capua cited negative data to declared wild birds free of H5N1 (she also used slides by martin williams - no further comment required).

Meanwhile, while the conference shut down as participants headed for Niagara Falls, the Czech Republic is reporting bird flu (read H5N1) on a turkey farm (for the first time ever).

Stay tuned. Spontaneous generation is alive and well in Europe!

100% certain that govts can't stop a pandemic from occurring;
there are too many viruses in too many food and wild animals to even monitor them all, and, humans would have to do the right things all the time (and some can't, and some refuse to).
The virus is in places with human cases where they can't even monitor it (Africa) or wouldn't tell us if our lives depended on it (China)

- actually given that the US has not released the sequences of healthy children killed by atypical influenza this past season, (perhaps Americans died of H5N1? -without the sequences being made public - how would we know?) and, how out-of-the-public-thought they are trying to keep that we already have H5N1 here; in wild waterfowl, and, that most of the public still doesn't know we have a federal pandemic website saying "medical care, food, banking, work, transportation may be unavailable, so prepare",
nor heard that any state, community or citizen that fails to prepare assuming the govt will take care of them during pandemic "will be tragically wrong", -there will not be vaccine for the first wave of pandemic either-

and that the CDC failed totally to act in a timely manner with Mr XDR-TB, I don't see the US as better off than Africa or Asia, as far as leadership goes.

(1) clean water, (2) clean sanitation and (3) good food.

Those are exactly the systems that are so brittle even for Americans, and will fail during pandemic, and that would need to be solved nationally and right down to neighborhoods and households, to survive a panflu year.

Given that we now import too much of everything including food from China, and that they will sell poison as long as they make money, and they know the US doesn't inspect most of the food we import, immediate action needs to be taken to stop that, and educate consumers why Homeland Security means local food, and, deep pantries.

Patch. The 'if' is not in question...it is 100%.

...the tough one is 'when' and and thankfully, I was wrong in the prediction of Dec 2006-May 2007 made in Jan. 2005.

I wish that we could somehow avoid a pandemic but we won't...and this one is going to be one of the bad ones.

A very specific question for Tom DVM:

You state: "There have been 10 [influenza] pandemics in the last three hundred years...half of them with higher virulence comparable to 1918."

For years I have been trying to obtain peer-reviewed citations for the virulence of influenza pandemics prior to 1918.

Could you please post citations for the four other pandemics with virulence comparable to 1918, to which you refer?

Thanks!

Tom speaks of earthquakes and tsunamis as being mathematically probable events. That's not quite right, there are specific forcings (plate tectonic motions) that make earthquakes inevitable. Earthquake hazard analysis is based, in part, on statistics because we cannot completely characterize the heterogeneous Earth (yet) in models. Thus, while the chances of of a serious earthquake on the west coast are given in statistical terms, the forcing is not a random process. (you greatly underestimated the occurance Tom, there are several every century, on average,taking the whole west coast into account, and depending on what you consider 'serious') Tectonic earthquakes are inevitable, because the driving forces are persistent and relatively unchanging on human time scales, and unaffected by human actions.

I guess the big question with influenza, is can the same be said about pandemics?

Speaking of pandemics and the Options VI conference, most of the pandemic talk is on H5N1. However, in a late breaker talk on Monday, more details on the human H7N2 cases in England were released, and they are well into the cause for concern area.

Confirmed human cases were at THREE locations, and the hospitalized patients were fairly ill. Although most contacts with symptoms tested negative, the PCR testing is notoriously poor.

Follow-up serology on patients and contacts is ongoing and the number of infected humans may be higher than infected birds.

The efficienvy of transmission of H7 to humans is high, and the latest from the Czech Republic STRONGLY suggests H7N2 and H5N1 are co-circulating in Europe, providing the recombination opportunity of the H7 ease of transmission getting together with the H5N1 high CFR.

Preparing for the Next Pandemic

Michael T. Osterholm, Ph.D., M.P.H.

New England Journal of Medicine Volume 352: 1839-42 May 5, 2005.

"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 it simply occurred when the world's population was smaller. Today, with a world population of 6.5 billion more than three times that in 1918 even a relatively "mild" pandemic could kill many millions of people."

The Great Influenza John M Barry Page 261

"During and after the 1889-90 influenza pandemic-with the exception of 1918-19, the most seveer influenza pandemic in the three centuries..."

The third of the more serious pandemics was in the seventeen hundreds...I think 1745 but I do not have that reference at my fingertips.

...and by the way...Dr. Osterholms reference is from a peer reviewed journal.

Tom DVM,

In appears to me, you have misunderstood Dr. Osterholm's comments. Or maybe I am. But there is nothing in that quote, which suggests the VIRULENCE is higher. Only that the NUMBER of deaths will be higher. That stands to reason, given the larger population.

Your reasoning would suggest that seasonal influenza is becoming more virulent over the years simply because more people annually are dying (due to a larger population). You wouldn't expect the same number of seasonal influenza deaths in a town of 100, verses a town of 1 million, would you? The population has increased. The number of deaths by influenza a couple hundred years ago will not compare to those today, simple because there are more people.

You need to speak to percentages, rather than numbers. Show me a source that indicates a higher virulence through CFR, rather than sheer numbers. THAT is where I was coming from. Because again, I've found nothing to prove any past pandemic had a higher CFR (virulence) than 1918. There may have been, but I don't think you can say it definitively. Can you?

Ky-I can safely say that I have been to more third world nations than many could spell. I also have gotten bugs that I have trouble spelling myself, one or two still ride with me. Recurrent malaria being one of them and trench foot bacteria being the other. Its not a good feeling. Its been about six years since the last bout but its a build up of immunity against parasites for malaria. Primaquine also makes you puke constantly. Try it Ky, you'll like it.

I also hope that you dont hang your hat Ky on the fact that B. Flu hasnt come to visit. Remember SARS? The preps for B. Flu are the same as SARS, so name your poison. So I fail to understand your lack of respect of the situation in the face of whats been going on. There may have been as may as 7500 that died in China in July of 05. They sure cant account for them. Its almost like a bookeeping error with the Chinese and the PLA took over responsibility for distribution of information. Look it up under EBOLA Flu in a search. Again, the preps for Ebola are the same for SARS and Bird Flu. So we are statistically due for a pandemic. Which one would you like it to be?

The latest graphics reflect an ever increasing case fatality rate, the number of cases is increasing as well. So, hmm I dont get your suggestion that its not. If the surveillance were better we likely would show MORE cases than we actually have on the boards. Fedex, DHL, UPS, all the passenger airlines will spread this like wildfire if it goes H2H and I am waiting and watching for the "50 case cluster" in a city here or somewhere else in the world. Once that happens, its out, its running and very, very likely unstoppable at that point. They'll slow it and buy us or them some time, but it will come. It will likely take Tom the DVM too because its a get it and then figure out what you have after bug. Its not immediately sickening and you are shedding about 8 hours after infection. Pigs were the vector for H1N1 so vets are particularly at risk. And this little piggie went to Kentucky, and this one stayed at home. Oh yeah, H1N1 could recombine/reassort with this crap to make yet another whole strain and Tennessee is lousy with it on their pig farms. Kind of like seasonal pig flu for them.

Webster, Osterholm, Osterhaus, Fauci, Tang, Webby, Leneva and a crapload of Chinese doctors all think its going to happen and sooner than later. Webster issued a paper in 97 when the short scant information from the Chinese about that virus was put out and said it was novel, and presented a clear threat. Webster also proved that the pandemic flu's as a very young man were avian in nature about a year after I was born in the 50's mild pandemic. I got it then, I got the 68 and its one of the reasons I likely will survive this crap if it comes. I'll get sick, but probably not statistically die. Webster proved it. So when these gomers talk I listen.

We like the cites as Melanie is so quick to hammer me on when I say something, I want you to put something up that cites that its bullshit. I would like an opposing opinion from someone. Please! Even Revere two or three years ago said he though this might be a splash in the pan. I dont think he would say that now looking at the sequence information, how its adapting to human receptors as Niman and the Indonesians tout. We also know its in ferrets, ducks, dogs, cats and once it goes warm blooded even my simply educated mind gets the fact that its a VERY significant thing.

Its good stuff and you are right its not here yet. I hope to God it doesnt. Please drop your information off in the in basket. I will gleefully read it. I want to have a better feeling about this stuff but its gonna have to be some really hot info to make me and others change my mind.

revere said:
> so it is not a question of mathematics but biology, biology we do not fully understand at the moment.

what do we _ever_ understand fully ? Mathematics ?
Researchers in other areas do say the same, yet they give estimates.
When the biologists say "we don't know" , then what else
can we do than listen to the actuaries, who _do_ know ?

Tom DVM said:
>There have been 10 pandemics in the last three hundred years...half of them with higher
>virulence comparable to 1918...

since over a year you are spreading such things over several boards although you
had been corrected multiple times. What's the purpose ? Distract the people ?
How can we ever trust you, when you insist on such nonsense ?
You were wrong with March2007, you were wrong with 1890,1830 being more
severe than 1918, you are wrong with half of the last 10 pandemics being worse
than 1918, you are wrong with 100% for a pandemic in 3 years, you are wrong
with "not if, but when". Osterholm was _wrong_ in that peer reviewed paper,
(and elsewhere !) apparantly he hadn't checked the sources.
The sources which were given to you and ignored by you multiple times already.
You were wrong with Tamiflu,seasonal vaccine,prednisolene
and other things as well.

Anon-First Tom wasnt wrong. It just didnt run like a dog. We had higher cases during that period and the virus clearly separated into two clades. Niman posted it up on his website under the genetic tree. You sound like one of these people who are just going to be sitting around waiting for it to happen and if it doesnt come in and fuck 100% of the people as some predict you'll just say I told you so. Even if he gets it right by 1/2 of the current CFR it will level this planets carbon footprint for 10 generations or more.

Same with Revere and the numbers. 20 years ago they couldnt calculate it because the computers couldnt deal with the variable inputs and their interactions now we have computer after computer crunching it and it all comes up dead people. I dont understand why you are beating them up because they are partially wrong. Hell I am too, but to be even partially right on this one means a huge body count even at 5%. Maybe you arent reading the press, or watching the on the other side of the planet news. Tom and Revere disagree all the time, but I think they both agree that this is coming in some form and soon. If its highly pathogenic and has a high CFR what will you say then if you told people not to prepare? One thing is sure if they did prepare in the slightest it might give them one more day, one more week that they wouldnt have and they dont have to go out and die an absolutely miserable death. I am sure in his tenure Revere has seen the effects of pneumonia from lung cancer. Its a horrible way to die and it friggin' hurts.

When the entire planet is being told to prepare I think this is one thats left to the experts and that starts with the vets and ends with the human vets like Revere. He and I get into it all the time, BUT if he told me not to worry too much about it then I wouldnt. I would much rather be beating him up over UHC and Bush Bashing. His own posts indicate that this is yet another government muck up job and its planet wide this time around. All the conditions are set for a disaster, just add h2h and stir.

Randy: None of what you say makes sense. It has nothing to do with computers. It has to do with information being available. As for dying from pneumonia, Osler called pneumonia "the old man's friend" because it was a relativey peaceful way to die. If the death is from a cytokine storm, that is a different matter. That is not pneumonia. If you are so concerned about the quality of the medical data, then work for UHC. The lack of an integrated health care system is the main reason the US lags so far behind other countries and one of the main reasons or care is so unnecessarily expensive. That and the fact we put it in the hands of private health insurance companies, who are nothing but banks with a different name.

In 1917, H1N1 was a completely novel virus and a direct descendant of a pure avian virus. If you look at what happened after the 1918 pandemic, there was a series of significant epidemics through the 1920sthe outbreaks then slowly dwindled in size and frequency as the population reached a plateau-threshold of immunity

and then as if a last gaspit spun off two progressively milder pandemics through reassortmentone in 1957 and another in 1968the mildest being the last one, the Hong Kong Flu in 1968.

I have come to the conclusion that the 1968 Hong Kong outbreak was the exception to the ruleand in fact, half of recorded pandemics have virulence roughly comparable to the 1918 pandemic, rumoured to have killed up to 100 million people. I say rumoured because it is hard to manage data during any catastrophepast, present or future.

Well, for the better part of the twentieth century, the Spanish Flu was thought to have killed 8-20 million peopleand now, estimates are as high as 50-100 million.

It is understandable that a system under crisis, does not maintain very accurate records. The record pre-1918 is a void and therefore, we cannot say, with conviction, that a HPAI subtype has never caused a pandemic at any time in history...

I believe the fact is that H1N1 in 1918 was so overwhelming and dominant that it wiped out most if not all of the competition at the time, such that there was little genetic diversity left in the short termthen after 1968, we reach a threshold of quiescence where there is nothing genetically in the pipeline to take H1N1s place because it knocked out all of the other viruses of the time in 1918

In addition, an old strain of H1N1 escaped from a Soviet Laboratory in the 1970s. This event may have further suppressed natural competitionartificially extending the quiescent period until almost the end of the century.

If I had the opportunity to track all influenza outbreaks accurately over say the last two thousand years, I would expect to see the following

a dominant influenza virus emerging that would overwhelm and in effect, replace all circulating influenza viruses of the timeand then continue to dominate for a significant period of time. This would not happen each and every time there was a pandemic, but would happen at regularly, irregular intervals. An identical pattern seems to occur in all natural systems including tsunamis, earthquakes and hurricanesfloods and droughts.
The bottom line is that the virulence of the next pandemic may have already been pre-set by the overwhelming dominance in the twentieth century by H1N1 and its offspring, including the manmade re-release of H1N1 in the 1970s. However, as nature is always reflected in the scientist balancing and weighing many balls juggled at the same time, we must also balance the example of blackleg re-remerging simultaneously on all farms after 50 years or anthrax that can do the same after 100 yearsStrains and other subtypes are never knocked out completely by competition. If we think of the finite box for influenza viruses as a meadowthen there is only room for so many at any one given time. If one strain dominates then the other strains retract but never disappeareventually, when the strength of the dominating strain wanesthey will re-emerge in a rush of activityas we have just observed

If a long enough pandemic history could be studiedthe period of dominance of H1N1 and the period of quiescence would have been predictable and by extension, the period we are now in which is the transition to the next pandemic would also be predictable...and the virulence and frequency of future pandemics could be predicted by patterningat least in the short term of the next fifty years or so.

From: Risk Assessment-Is the writing on the wall?

Pandemic Flu Information Forum (PFI) Pge. 2

Author: /:0)

"Because again, I've found nothing to prove any past pandemic had a higher CFR (virulence) than 1918. There may have been, but I don't think you can say it definitively. Can you?"

Patch. At the end of the 1918 Spanish Flu Pandemic, they estimated that 8 million persons worldwide had died...why were they out by potential almost a factor of twelve times by today's estimates...because it is impossible nor does anybody care to keep records in the middle of a catastrophe when persons are often buried as quickly as possible in mass graves.

I believe if you examine the circumstancial evidence from the 1500's to 1918, you may see the same thing I did...taking into account the limited record keeping, about fifty percent of pandemics are comparable to 1918 in CFR.

"Your reasoning would suggest that seasonal influenza is becoming more virulent over the years simply because more people annually are dying"

Actually, I have come to the exact opposite conclusion...the 36,000 deaths per year from seasonal influenza in the United States, I believe is a gross exageration for understandable reasons which I get to in my paper...due to the way H1N1 set up the domination of the last century.

"Show me a source that indicates a higher virulence through CFR, rather than sheer numbers."

H5N1 is a high pathogenic (HPAI) subtype...and supposedly, this is the first time that a HPAI has repeatedly infected humans.

Now, I am pretty sure that is untrue...but remember, H1N1 (1918) was a LPAI- low pathogenic subtype which did not kill birds and when it reverted to its norm, the unusual virulence abated reasonably quickly.

H5N1 has shown more than 300 times and probably many more times than that...that it has the ability to infect humans...

...if it becomes a pandemic and reverts to its norm...which has occurred in all other pandemics...that means a norm of at least 60% CFR.

That is why I have come to the conclusion that this is a one in two thousand year virus (or had some human help advertently or inadvertently along the way...

...This thing is a monster...it is out of its cage and there is no way to get it back in...

...we have no control...so I don't feel real comfortable at the moment.

Also, check the news threads from last year at this time...there is a lot more noise now then then.

Also...it should be kept in mind that unlike seasonal influenza's, the more severe pandemics often start in the summertime.

Anyway, I have reached my conclusions...I am not trying to convince anyone of anything...and I will respect all other contrary conclusions and opinions.

Thanks for the interesting conversation.

gs. If you want to debate the issues with me...do it on PFI please.

Revere-sure it makes sense. The countries that are getting it are throwing everything they have and some of ours at it. The outcomes so far from those efforts have resulted in about the same CFR's as those that basically just put them into a room to recover or die. Bolstering the system might be a good idea, but not with UHC. Thats a different issue. Again, so far having another ventilator just means you get to hook another person up to it, the outcomes are the same. Tamiflu the same. Can anyone attribute anything related to treatment with a favorable outcome. Four months in the hospital for many, 320,000 for one guy in USD. If BF comes it wont matter anyway. It reminds me of the people standing on the beach at Banda Aceh watching the wave roll in.

As for the private insurance companies there is one point I want to make about them being banks with a different name and that ist that its elective to participate in a private insurance operation. It wont be with the great bank of the US. Big difference and private banks are just that, private. If everyone is covered then thats a good thing? Maybe not. It could destroy the existing and granted screwed up and expensive health care system we do have. Implosion.

We don't know what the CFR is, even now. It is 50% in Egypt and Vietnam, 80% in Indon. The virus or medical care or diagnosis? Who knows?

Well done Tom. It repeats almost to a letter a training gig I went to about the CFR's and that being that we could see this for years. Niman asserts pretty much the same thing as he and others believe recombination with other existing viruses out there will come on by and visit. Good years, bad years and each year taking a few more carbon footprints out of here.

Interesting that Tom posits about the super-pandemics. We have had hard and mild but few of the super ones. History though does account for two or three super ones. Black Plague one very likely killed many more in Asia than it did in Europe. 150 million but the records there are very poor.

Our ability to track has increased tremendously but we cant even get China and others to tell us what is going on, much less how many have died or became sick. So the numbers (computer variables) if applied are all ambiguous for anything about CFR's and correlation to the past. They could be skewed plus or minus. They know a lot of people died is about all.

But as stated by everyone, we are in a pickle if it does come. Ten miles of bad road.

MRK. Can I let you in on a little secret?

Nobody knows. And some even disagree.

Better safe than sorry,
and better preparing than "tragically wrong".

crf: Unfortunately that is just a slogan. It could easily be applied to XDR TB, an asteriod strike, terrorism, Ebola, a military coup or an arbitrarily large number of other things. It is not an answer to the question of how you prepare or how much you spend on it.

There are only two potential scenarios of equal import to the human race...a large asteroid and a pandemic with H5N1 over 5% CFR.

I believe that Nipah is a larger threat than Ebola. Terrorism and Military coups are limited by geography...and we dealt with untreatable TB for a few centuries (before the development of antibiotics) and it is limited by infectiveness.

Patch. Nobody knows so don't talk about the potential? That approach could apply to any threat in human history...
and probably lead to a few preventable catastrophe's.

At the end of the day...crfullmoon has it exactly right...but it is not and never was human nature to do so...so it probably won't happen this time either.

We will do a lot of talking and little else...unfortunately.

The a real growth industry for meeting-conference planners and government and agency consultants though

Tom,

I never said:

Nobody knows so don't talk about the potential?"

In fact, just the opposite. I said:

"Unlike Ky, I fear H5N1's potential. But it only has potential. Not certainty."

And also to Ky, I said:

"What we are saying here, is four (sic, my bad) ourselves and our family, that we must take some precautions and give it some thought.

I wouldn't be here, if I didn't think discussion was a good thing. But we need to keep in mind it's a discussion. I'm bothered by people who understand the subject well, but propose possibilities as fact. My point to Kruger was exactly that. Nobody knows and some disagree.

I've tried to gain a better understanding of BF and I'm not against prepping. I have, to some degree prepped. But I started almost 3 years ago now. Some of the purchases have surpassed expiration dates. I find it very difficult (and depressing) to treat prepping as a hobby. Because it is has to be treated that way, to properly rotate preps. And I'm becoming increasingly defensive of people insinuating that I'm a poor family head for not living a life of prepping. I seem to get it form both sides...people that say I'm a kook for worrying and people like you that say I'm not worrying enough.

I'm trying to become informed. And I'm also trying to raise concern, without impersonating chicken little. I sincerely beleive, that anyone who proposes possibilities as facts does more harm than good. I think, that many scientists understand that.

Thanks Patch.

The future...all future...is 'speculation'

I think that is a given...

...and I would respectfully, remind you that all science is based on informed-speculation.

I dont prep just for the flu Patch. I am sitting on the mother of all seismic faults and just yesterday (reason for the late post times) we were whizwheeling into the night the what ifs in an exercise. If it happens it will basically level everything along the Miss.River from just south of Chicago to Jackson Ms 7.7 mag. quake dropping 80% of the bridge structure for 400 miles N and S. along the Miss. River. We are only 45 miles from the suspected epicenters. The initial will set off other faults and the megaquake will be on, lasting for as long as 3 minutes.

The preps are the exactly the same for flu as disaster in the great part. If you dont use it, someone else will. No expiry dates here. Its rotated on penalty of going hungry per instructions of The Almighty Zod-(me). None of this get it out of the back stuff. I am what you would say way overkill on it but my house is a backup area command center having been built to the California 2000 quake standards and then some. Comm gear, power, fuel, water, solar, food. It is as I said a situation where I might not make it because I have to go into the night if flu or anything comes. The family will have a very good chance and likely a good chunk of the streets around me of making it. Flu or a disaster has a way of humbling people and that includes me. It could catch me, but its going to have to mightily slick to do so.

The simple point Patch is that I am not fearful when I am sitting on what I and others would and will need. If everyone did the same then there is no general reason to get sick. Indeed with proper preparations only a small percentage would and that came up last night that at the simulated 10 day mark we would be losing as many to dehydration as we did in the inital hit (80,000). There is a difference in pandemic planning though and actually being able to do something about it. We have no vaccine and Revere has brought up something about statins recently that I sent on to the next door neighbor Majority Leader in the state the day it came out. They are being pushed by pharma reps for purchases of Tamiflu and since the state medical people cant say for sure that it will work, they are holding their butter for what may be a better slice of bread. Ky S.'s reference that it might not happen doesnt escape anyone and the glass is half full as well as your positions to that. Sheyit, no one wants it more than I do not to happen but err on the side of caution. It takes one step forward, we should take two back.

This is the reason EM works so well. Get pissed off, rant, flame about a subject but it takes a lot of heat to make steel. They are now asking the questions about it to the medical types. Seems that perhaps they may have been caught up in the Tamiflu rush too. The data is beginning to indicate that it might not work so hot or make you nuts. The statin thing got their attention though. Availability for one seems to be very high. Good!

On the other hand and Revere and Tom may or may not bear this out is that in the big scheme of things its apparent to me that natural selection is starting to take hold on the planet. Seems that no matter what we do people are starting to go in larger and larger numbers. Some would say "Will of God." Due to lack of science in that I go with the natural dieback of a species in an environment due to lack of resources or introduction of a pathogen into it. Or that we have in a military term "crapped in our mess kit." Its a good analogy either way and the plain fact is that the EM-DAT indicates that we are on a major upswing for all things that whack humans.

http://www.em-dat.net/who.htm

This process seems to have happened all thru history as Tom DVM posits regarding pandemics. Is it happening? I dont know. Every day it doesnt happen is a good day and buys us time. Time though looking at todays graphics post from WHO just doesnt seem to be on our time.

http://www.wpro.who.int/sites/csr/data/data_Graphs.htm

MRK - Point taken.

But do you really think things are that much worse than they ever have been? Or are we just hearing more about it? I submit the latter.

However, I readily admit that the development of an easily transmissible H5N1 (with current virulence) could definitely be worse than we've ever had.

It's obvious that you have devoted your life to survivalism. But honestly....I'd suggest you get out a little more :-)

The site that I cited EM-DAT if you plug into the 2006 numbers tracks back for the last 30 years. The graphics are not in dispute. It shows a HUGE increase in natural disasters. On other pages if you want to get into it deeply navigating their available information and using the last couple hundred years and only where they were able to verify the information shows a quake, a bug, a tornado, hurricane, wars e.g. WWI and II, Korea and Vietnam. Believe it or not with as many people who were zapped by WWII its not much of a blip in the trend lines. 50 and 60's flu were mild but they in their own line follow the natural disasters line and the wars line pretty closely. Then 1975 came along and the whole damned thing went up on all lines. Wars, disasters, famines, floods, tsunami's, quakes all taking a ballistic ride north and all individually on their own lines. Some I am sure are sympathetic to the others. For example if you have a quake that kills a bunch of people thats one thing. If the quake generates a tsunami thats another. If a war breaks out because the land is there for the taking afterwards because everyone is weakened or dead is yet another.

Do I think that things are worse than ever before. Only by the number of people that are available for the "worst disaster" in human history if and when it happens. I dont know that its worse than ever before, only that it could be and in a rapidly spreading fashion. TB is a slow killer but its there. Ebola never turned pandemic, mostly because it kills the host so quickly. Smallpox is out there in the graves of the dead and it only takes one infection to spread around the world....again. Flu though comes in some form every year, and as Tom and others posit it takes a few. But Avian Flu goes transgenic as Webster proved in the 50's every two dozen years or so. I havent seen anything yet to say we ever had a pandemic of seasonal flu, but is it pandemic when bunches of people get it? Its in every country every year so thats more a Revere type of question.

I fear what likley will happen in short order in some form. That form hasnt manifested itself and I base myself on the "most likely" scenario. Since TB is out there along with SARS I watch them, but there isnt a daily briefing being sent out for either only an occurence data sheet. So "most likely" for me right now is pandemic flu and a quake in or around the New Madrid Seismic Zone. If either happen it will finish my town, maybe me and make this country more vulnerable than it has been since its inception. You can negotiate with the British but not with a killer virus.