The war in Iraq has been going on in earnest since March of 2003, which is about how long the war on bird flu has been going on. Yes, there were some preliminary skirmishes in the bird flu war in 1997, but it wasn't until it burst out of southern China with a vengeance that full scale hostilities started. In both wars there have been a lot of innocent bystanders. In neither are seeing a lot of progress, despite claims to the contrary. The war in Iraq, at least, is susceptible to human control. The war against H5N1 doesn't seem to be. The number of human casualties in the bird flu war is dwarfed by the carnage in Iraq, but so is the expenditure to fight it. In the bird flu war the potential remains for something much worse. Meanwhile, it keeps bubbling away in the manner of low intensity conflicts everywhere. This week it hit the melancholy milestone of 200 deaths with the demise of a 33 year old Indonesian man. Indonesia has now become the epicenter of avian influenza in the world.
If you think bird flu has gone away because it is no longer on the front page, just take a look at the epidemic curve over the last four years:
This year is the rightmost set of bars. It looks slightly better than last year but that is not the right way to think about this. Case fatality ratio (the curve) hasn't budged in the last year and a half. The H5N1 situation is definitely not getting better. It is displaying the typical pattern of an endemic disease that tends to fluctuate moderately from year to year. Last year was a mild West Nile virus season in the US but this year is shaping up to be the worst yet. That is typical of endemic infectious diseases. With H5N1, this year is better than last year but worse than the year before. But not by much in either case. This disease is out there an bubbling away, just as before. It isn't gone and despite some Herculean efforts we haven't made much of a dent in it, if we have made any.
The best we can hope for is that it will just keep bubbling away at this intensity. But infectious diseases often don't care what we hope for. They making sudden and unexpected bursts, just as H5N1 did in 2003 when it burst out of southern China to southeast Asia, the Middle East and Africa.
Very few think it has emptied its bag of tricks.
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Interesting how it clusters around Jan/Feb. Could be worth separating out the hemispheres to deteremine if it's the same for both or different.
".......This disease is out there an bubbling away, just as before. It isn't gone and despite some Herculean efforts we haven't made much of a dent in it, if we have made any.....
Revere, I agree with what you are saying. We haven't been able to make much of a dent. However it is possible, as some have suggested, that we have "dodged a bullet" more than once. Perhaps our efforts have at least bought us some time. We haven't put out the fire, but we may have had some success in keeping it contained. Maybe.
Your thoughts about moderate fluctuations of endemic diseases are sobering. The chart would suggest that as difficult as it is to control H5N1, it's nearly as difficult for H5N1 to make the jump. But you remind us that this pattern is nothing new.
Would you agree that moderate fluctuations at this level of infection while significant, are dwarfed by other health concerns? It still does not mean that H5N1 can find the key, right? But it does mean it gets more chances....I understand that.
Patch: Yes, you read me correctly. Your emphasis might be slightly different but not out of line with the facts. We are walking on (chicken) egg shells. Maybe we will get away with it. Maybe. But I should would like to be ready in case a lot of eggs get broken.
".....But I should would like to be ready in case a lot of eggs get broken....."
You and me both. I admire your efforts in the public health care sector toward that goal. I am convinced, that the only way TO "be ready" is an organized public effort. We can't go at it alone. Every man for himself gets ugly and there are many who will need help, regardless of preparation (or lack there of).
There are those that are still not convinced that H5N1 can find the key. I don't think it's "inevitable" as I've argued before. But this disease needs to be given attention. And preparation is not out of line.
As can happen, I hope the graph goes down, rather than up. I don't want to think our efforts to stop this disease are futile. I don't believe they are.
The chart is good as far as it goes, Revere, but both you and I know that the number of reported cases of illness--and likely of deaths--is inaccurate. Indo is under-reporting, and don't even talk about China. Plus, the use of Tamiflu has expanded dramatically in the past year, likely resulting in an artificial deflation of the numbers. I do believe that Tamiflu is buying us time, and I am grateful for that. But the little Dutch boy can only keep his finger in the hole in the dam for so long.
Edna: You are right that no one thinks the chart is exactly accurate and under reporting is more than likely. But if we assume that undereporting has not changed much (one could argue it either way), the shape of the curves remains the same and isn't surprising. It is an indication of what is going on qualitatively, not quantitatively. As for your opinion about Tamiflu, maybe, maybe not. No one has the data. At least with the curves we have data, imperfect as it is.
Revere. Again...a beautiful piece of writing...it was a pleasure to read...Thanks!!
"There are those that are still not convinced that H5N1 can find the key."
Where are they Patch?
...haven't heard any comments to that effect since Dr. Webster and Dr. Osterhaus (through Dr. Nabarro)stated concurrently that H5N1 would only require two mutations to achieve pandemic potential.
I wish they would explain there conclusion in a scientific paper.
You got me Tom. Nice catch. Let me restate.
"There are those that are still not convinced that H5N1 WILL find the key."
I know of very few experts that are "CONVINCED" of this. Except maybe you and a handful of others.
Maybe it's just unbiased writing, but I'm under the impression Revere is not "convinced". Perhaps I'm wrong, but I don't believe any of the experts you mentioned have publicly stated they are CERTAIN that H5N1 will become pandemic. Even you quoted them as saying "pandemic potential".
There is a distinction between WILL and COULD. I failed to make the distinction in my statement and I stand corrected. I think others should acknowledge the distinction as well.
Patch.
As I am sure you know...nothing is science and nature, and pathogens, medicine and public health...is 100%.
That is where miracles come in...
...and if you have one up your sleeve, it would definitely be a good time to play it in relation to the steadily worsening storm cloud (H5N1) now on the 'near' horizon...
...otherwise...pray!!
Oops!!
There was supposed to be a.../:0)... at the end.
No miracles up my sleeve.
And I do pray, almost every night, for "protection from the things that frighten us and comfort when He can't".
I'm not sure Tom that the H5N1 cloud is any nearer on the horizon than it was, or has been. You could make the argument that it is...I know that. But if you have an open mind, you could make an argument that it has not. Looking strictly at the graph provided here, a couple things are clear. The number of cases hasn't increased significantly over the last few years and CFR has leveled. Revere's point that CFR isn't decreasing is well taken (and unnerving). But the point must also be made that in terms of number of infections, not much as changed either. So I'm not sure you can say we are any closer. To do so, you make the assumption that the virus has a "goal" or an "intellect" to figure out how to infect our species. As far as we know, it's a matter of chance, literally by making mistakes in replicating itself. The virus has no intellect and is left to random mutations to find the key to the human race. Is it possible? Most definitely. Is it likely? Debateable. Is it certain? No. That's it. You said it...nothing is 100%.
And in terms of the graph, strictly speaking, little has changed. However, again, Revere's point is well taken, that moderate fluctuations are to be expected and it would not be a surprise to see increased number of infections (could be lower too). But has long as the virus is replicating it has a chance to "make the correct mistake" and adapt to humans. That's why I'll keep praying.
Hey Patch, Auntie Margaret at the WHO said what? 3 Days ago that the next pandemic flu will be caused by H5N1. Personally I have to take the honcho at the top at their word when they are first compromised by someone like Supari. Second when the Indons I think have something to hide e.g. I dont think its about vaccine at all any longer. I think its about money and support of their economy that will be shattered the second that they say "H2H" on their side of the fence.
That computer model announcement about 2005 H2H was VEHEMENTLY denied by Supari within I think looking at the time line that she could have heard about it in under 30 minutes. That I think that speaks for itself. Then the WHO came out and said the next day that it was in their opinion H2H. I can only say that I hope you are right but I am betting you are wrong.
Tom and Revere/Niman I think can bear this out but I think just about every "A" type virus has alwasy mutated to some sort of human infectious state. I think I did read that somewhere. All were not though some novel virus, some were.
I have been posting those graphics for over two years on the side to a lot of people and some are in government. Its better info than what government is giving them and it varies state to state.
It occurs to me that H5N1 may "go away" eventually, and hopefully without sparking a pandemic among humans.
My reasoning is that the cases we are seeing come from birds. The pandemic will eventually (I presume) so diminish the population of birds vulnerable to infection that the pandemic will end. (There are uncertainties of course, since immunity developed by the parent presumably is not transmitted through the egg, and "Typhoid Mary" carriers may be possible.
To that end, I would like to know if anybody knows the quantum of infection in the general bird population. It is my suspicion that the quantum of pandemic among birds in close contact with humans would be closely reflected in the "case count" of human infection in the graph above.
Another thought, there are peaks of infection (as pointed out by Marissa). Might those peaks be in some way related to the breeding cycle in domesticated birds?
MRK -
As to your first point, you seem to find "Auntie Margaret" credible only when she supports your argument. That's pretty convenient. I have not seen any coverage of her statement, if that is in fact, what she said (verbatim).
I'm not sure where you are going with your second point. Are you saying that Indonesia is covering up H2H transmission, so it has a chance to "sell" their samples for economic gain? I know that Indonesia isn't playing well with others. But it seems to me, that they would want to tell anyone who would listen, that there has been H2H transmission, to make the sequences even MORE valuable. What reason do they have to cover up H2H transmission?
And as far as type A viruses adapting to human transmission, I can't argue that. I'm not really sure of the history of type A viruses. I do know that H5N1 HAS done that. But we are talking pandemic here. Just because there is limited transmission of a type A virus doesn't mean the sky is falling. The Swine Flu should remind us of that! So I'm not sure what your point is there. But that's not unusual for me, I guess.
Bar - I've argued that more people are infected, only because more chickens are infected. Not necessarily because the virus is becoming more transmissable. It would be interesting to compare a chart of human infections with avian infections. As the chart above shows, there hasn't been that much change in infection rates. And yes...I realize that could change. And as long as the virus is infecting hosts, it has the opportunity to make a mistake and mutate into a humanly transmissible form. But at this point, you are as right as anyone, in your statement.
"Intent" is not at all synonymous with "motive." And intent can very easily be severed from intellection. It is the "intent," for example, of the Universe to expand outward until its material content becomes essentially undifferentiated from that of the "void;" complete entropy. It is the intent, in my opinion, of H5N1 to become the dominant "species" of influenza "A" virus on the entire planet. To achieve that end it has to expand -- from very meager beginnings -- to a point where it can contend with, and ultimately defeat, all of the other various influenza "A" viruses that might wish to marshal their substantial forces against it, and stake out the same territory that it seeks to dominate. There are no indications, to date, that it is taking any "brides," in this pursuit; that would be the easy route. That would be the trail that was blazed by H2N2, and H3N2; H5N1, instead, appears to be a dedicated "maverick;" much like its renowned predecessor, H1N1.
We don't really understand the nature of that which we simply characterize as "thought;" and we are only willing to accede to the existence of that nebulous quality in those creatures that most closely resemble ourselves, with respect to the constitution of their particular neural networks. That is a serious, and dangerous, conceit on our part, in my opinion. Nature spawned us...we ought to be very careful in our assessment of our position in this particular relationship...in the general scheme of things; especially when we so readily succumb to our innate hubris, in our cavalier assessment of so many of Nature's other children. Assuming that "evolution" necessarily implies a progressive, obligatory and linear hierarchy is a fundamentally flawed perception. It does not. I suspect that the greatest degree of complex organization of "life" resides at the cellular and sub-cellular level, and not at the macro level of beings such as ourselves. We're the "easy," and less interesting part, in my mind. We are no "end product," here. There is no special dispensation. We're simply another one of "Nature's" myriad experiments. Most of these have already been conducted, with the results subsequently, and summarily, discarded. And I am fully persuaded that our time will come, in this succession of experiments, too. That's just what the biological history -- incontestably -- has to say about the matter.
A little "poetic license," here. Twenty years ago I had an encounter with a distant cousin of the H1N1 virus that devastated the planet in 1918; I barely survived to tell the tale. It was a very, very narrow escape. This creature was very "smart". And it was very, very dangerous.
Patch-If they announce they have H2H then their second biggest money cow behind oil dies. Indeed, what reason could they possibly have? It buys them time to piss and moan about the system that has no viable vaccine, that likely could only be made from some poor Indon. And the most important part? They keep on rolling them Aussie and EU people in there spending money. It would total their economy in a head on and then the UN Security Council gets involved. They lie to their own people all the time, so why not us.
Re: Swine flu, A type viruses. 1998 case. Revere, you may want to review to see if it might have been misdiagnosed as H1N1 when it was H5N1. This womans lungs look just like anyone else who is going from pneumonia but she sure sounds like the same symptoms as BF. Again, as best I have been able to pull up nearly all or all type A's have mutated into some form of human infectious capability. Most LP some High Path.
http://www.mayoclinicproceedings.com/inside.asp?AID=2874&UID=
Revere it also notes a hemophagocytic syndrome. Elaborate a bit if you will as to what that is please.
Bar we used to think that the peaks of probability for pandemic coincided with lomg-distance migration of birds, but the recent evidence suggests that is not the case. In fact, the case has been made that the virus is spread regionally by birds, but that intercontinental spread is not. However, smuggling activities involving birds might be a different matter. We also have to factor in season (UV intensity vs. temp for the virus) and the social contact factor.
OK MRK. After reading your post 3 or 4 times, I think I've interpreted you to say that Indonesia isn't disclosing (or acknowledging) H2H transmission so that their tourism revenue remains stable. OK, I can buy that. They are, after all, the epicenter of the storm right now.
So you are suggesting that H2H transmission is occurring in Indonesia and perhaps at a higher rate than they are disclosing? Or were you simply debating the authenticity of the Minister of Health's comments? Because in the first case I don't believe that's possible, at least for any length of time. If you think the Minister of Health is blowing some smoke to save their tourism economy, you are probably right.
But let me say this...The Minister of Health's comments are a mirror image of some of the outlandish stuff I've heard in flu-blogia. Which one hurts us (or the cause) more?
I don't think your point about type A viruses carries much weight in this discussion. If only in the fact that even if it finds it's way into the human population, we don't know what the virus will look like. My point on Swine Flu was not that people could or could not become infected, but that it closely resembles the H5N1 situation. I believe Swine Flu was a type A virus that was able to infect humans, but didn't become the pandemic we feared. I'm not sure what your point was.
Dylan - Good piece of writing. But I'm still not convinced that H5N1 has "intent" even. H1N1 dangerous? Yes. But smart? How smart is it to nearly kill your host? If it was smart, it would develop a symbiotic relationship, wouldn't it? By the way, do you write owner manuals for a living? You are a very technical writer.
Watching H5N1 over the years reminds me of sitting on the beach and watching the water-will those waves out far continue to beach as ripples or will a rogue come like a tsunami?
>By the way, do you write owner manuals for a living? You are a very technical writer.< - Patch
No.
I'm a retired cop.
I view myself as an artist, essentially. Mostly verbal. But not entirely.
I do photography, too. Representational, and deeply abstract, also. The abstract is the most important medium, for me.
If you would like to access the verbal component, which is a "non-technical" presentation, then you might visit www.CurEvents.com, and look at "Pale Horse, Pale Rider."
It details a journey through a very long...and very dark night.
Abstract is difficult for most to catch as the "concrete" is all they entertain.
You did a terrific job Dylan and having learned abstract writing in college it was a welcomed read. A great deal of truth exists in the abstract.
>Watching H5N1 over the years reminds me of sitting on the beach and watching the water-will those waves out far continue to beach as ripples or will a rogue come like a tsunami?< - Grace RN
That is precisely what happened in 1918. A viral tsunami arose...directly from the depths of Hell, and washed over every continent. Complacency, now, will account for a huge number of casualties, when this creature does materialize...again. When the "thing," from 1918 revisits the "human community."
And it will.
It could not possibly be more "real." And more threatening.
When it ultimately rushes out from the blackness (which it will), it will "seek" to catch us all reclined, self-absorbed, and utterly unaware. Comfortably serene, in our collective ignorance. It did so in 1918. We are engaged with something very ancient, and very destructive, here. And it is remarkably formidable. And an immensely powerful foe.
We take it lightly, at our peril.
I felt this way -- without reservation -- when I first encountered it.
I feel no different, today.
"When it ultimately rushes out from the blackness (which it will), it will "seek" to catch us all reclined, self-absorbed, and utterly unaware." - Dylan (the King of Doomers)
King of Doom, No. Realistic, aware, awake, ready? Yes
Complacency will account for a huge number of casualties,...
That covers about 90% of the population right there.
>Dylan (the King of Doomers)< - Steely
I don't recall any coronation ceremony. This is clearly meant to be pejorative, and demeaning, on your part. I am not nearly as visceral, and obsessive on this issue as some others are. I've had a personal, and profoundly disturbing, ineradicable encounter with one of these "creatures;" have you? It left an unutterably indelible impression on the deepest, least accessible recesses of my being. If you had been there, and observed it face-to-face, believe me...you would know.
"Google" the two words "history H5N1," if you would. I am not a "hysteria monger, or fear merchant," here; I am much closer to being a level-headed scholar...rather than simply being a raving lunatic. I was there long before many of the contemporary, putative "experts" ultimately materialized, stepped forward, and finally acknowledged what is almost certainly coming. I didn't, somehow, just seize on "it,"..."it" seized on me. Now many of them, the "exalted" ones, who reside at the very highest levels -- collectively spouting very sober terms, in support of their "analysis," in fact -- are, like clouds in a gathering storm, menacingly articulating exactly what I had to say, nearly three years ago. And I wasn't the only one, of course. Not by a long shot.
Isn't that strange?
And you?
Patch.
As I am sure you know...nothing is science and nature, and pathogens, medicine and public health...is 100%.
That is where miracles come in...
...and if you have one up your sleeve, it would definitely be a good time to play it in relation to the steadily worsening storm cloud (H5N1) now on the 'near' horizon...
...otherwise...pray!!