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sarongsong
2005-Feb-22, 12:32 AM
"Avian flu poses the single biggest threat to the world right now...The "high season" for the avian flu was just starting in Asia...The U.S. government contracted with two companies...to make an avian flu vaccine, which will begin testing in people later this year..."
Reuters (http://reuters.myway.com/article/20050221/2005-02-21T190756Z_01_N21463384_RTRIDST_0_NEWS-HEALTH-FLU-DC.html)

beskeptical
2005-Feb-22, 02:14 AM
Told ya so. :P Warning, don't read my post if you are the worrying type.



















Actually you don't have to lock the doors yet but it wouldn't hurt to check those food supplies should you decide to hold up inside while it rages around the community.

Think I'm making fun of woowoos? I'm not.

Here's a fun fact that wasn't in the news summaries. The European vaccine manufacturers met last year to assess the WORLD capacity to make flu vaccine should a new deadly strain emerge. They calculated there is capacity to make enough vaccine for only 5% of the world's population and even that might be 2-3 years from now.

Past flu pandemics have tended to emerge rather suddenly so even though we are closely monitoring the situation, from detection of the start of human to human sustained transmission until it was out of control and worldwide could be as short as only a few months.

Just last month two cases of fatal H5N1 flu, (the bad one we are watching), were found in two kids who died of brain infections, not respiratory infections. They were siblings so it isn't yet known if the virus was the reason or the kids' genetics were the reason their disease was different. And, it isn't yet known how many, if any, other previously unrecognized cases there might be since no one was looking for flu in non-respiratory infection fatalities.

So what do you all think? Should we join the woowoos this time?

I'm also curious how GLPers are discussing this flu. Do you think they are going to miss the real hazard while they are busy watching the imagined ones?

W.F. Tomba
2005-Feb-22, 02:41 AM
I wonder how our government would respond if it were announced that a deadly strain of avian flu was spreading rapidly from person to person in Asia. On Sept. 11, 2001 we discovered that there were dangerous, stealthy killers on the loose who could wipe out large numbers of people in our country, and who were probably coming by airplane. So all flights to anywhere in the U.S. were grounded. This was a sensible measure given the threat. A new catastrophic flu would be a dangerous, stealthy killer capable of wiping out even more people in our country, and which would probably come by airplane, ship, car, and foot. Closing our borders altogether would therefore be a sensible measure. Do you think they would do it?

sarongsong
2005-Feb-22, 08:07 AM
Told ya so. :P Yes, beskeptical; I nearly put you in the opening
...Just last month two cases of fatal H5N1 flu, (the bad one we are watching)..."...Scientists now know that the H5N1 virus had been undergoing rapid evolution during the [Hong Kong 1997] incident...in 2001, Yoshihi Kawaoko discovered that a single chemical base change in the PB2 gene permitted the virus to infect people...in a pandemic, public health officials may need to turn to manufacturing systems that don't depend on eggs---cultivating the suspect virus in tissues or using recombinant DNA techniques, which replace lethal stretches of the genome with benign parts..."
Secret Agents: The Menace of Emerging Infections (http://www.nap.edu/catalog/10232.html), Chapter 5---Madeline Drexler

Candy
2005-Feb-22, 08:13 AM
Dumb question, what are the symptoms?

I haven't been sick for 4 years, and I got a whammy this last week.
Chills, fever, chills, fever, stuffy nose.

beskeptical
2005-Feb-22, 08:41 AM
I wonder how our government would respond if it were announced that a deadly strain of avian flu was spreading rapidly from person to person in Asia. On Sept. 11, 2001 we discovered that there were dangerous, stealthy killers on the loose who could wipe out large numbers of people in our country, and who were probably coming by airplane. So all flights to anywhere in the U.S. were grounded. This was a sensible measure given the threat. A new catastrophic flu would be a dangerous, stealthy killer capable of wiping out even more people in our country, and which would probably come by airplane, ship, car, and foot. Closing our borders altogether would therefore be a sensible measure. Do you think they would do it?Unlikely scenario since it will be here before it's bad enough for the non-medical government agents to realize how bad it is. IE CDC knows but Congress and the Pres won't get the seriousness of it until the epidemic is quite far along.

Candy
2005-Feb-22, 08:47 AM
I wonder how our government would respond if it were announced that a deadly strain of avian flu was spreading rapidly from person to person in Asia. On Sept. 11, 2001 we discovered that there were dangerous, stealthy killers on the loose who could wipe out large numbers of people in our country, and who were probably coming by airplane. So all flights to anywhere in the U.S. were grounded. This was a sensible measure given the threat. A new catastrophic flu would be a dangerous, stealthy killer capable of wiping out even more people in our country, and which would probably come by airplane, ship, car, and foot. Closing our borders altogether would therefore be a sensible measure. Do you think they would do it?Unlikely scenario since it will be here before it's bad enough for the non-medical government agents to realize how bad it is. IE CDC knows but Congress and the Pres won't get the seriousness of it until the epidemic is quite far along.
So chances of US citizens getting it? The doctor kept asking me if I had traveled lately. I had a double whammy rash, too. I figured out the rash... rosea... ????

beskeptical
2005-Feb-22, 08:48 AM
Told ya so. :P Yes, beskeptical; I nearly put you in the opening
...Just last month two cases of fatal H5N1 flu, (the bad one we are watching)..."...Scientists now know that the H5N1 virus had been undergoing rapid evolution during the [Hong Kong 1997] incident...in 2001, Yoshihi Kawaoko discovered that a single chemical base change in the PB2 gene permitted the virus to infect people...in a pandemic, public health officials may need to turn to manufacturing systems that don't depend on eggs---cultivating the suspect virus in tissues or using recombinant DNA techniques, which replace lethal stretches of the genome with benign parts..."
Secret Agents: The Menace of Emerging Infections (http://www.nap.edu/catalog/10232.html), Chapter 5---Madeline DrexlerThe WHO has already sent vaccine virus 'stocks' to the vaccine companies to make vaccine for human trials. They are hoping the viruses they have chosen will be protective but they can't be sure what the pandemic virus will actually end up as. I believe they are using vaccine virus that does match part of the new virus but isn't lethal to the chicken eggs. So the plan is to use existing vaccine production methods.

Any new vaccine production method such as recombinant vaccine is several years away at the earliest and there is no capacity in place for mass production.

beskeptical
2005-Feb-22, 09:06 AM
So chances of US citizens getting it? The doctor kept asking me if I had traveled lately. I had a double whammy rash, too. I figured out the rash... rosea... ????Unless you've been eating raw duck blood or handling live chickens in Asia you don't have it.

We have been on alert for both Avian flu and SARS since the SARS outbreak. It means you have a good doctor if they are asking for travel history.

There's no rash associated with this.

Symptoms of influenza:

Fairly sudden onset, fever >101 F , muscle aches, general malaise, no appetite. By day two you have coughing and the usual but severe respiratory symptoms.

But don't get too worried if you have these symptoms, the flu is peaking right now in the US and Europe and there is a lot of it going around. It isn't the bad one.

You will know there is a problem within days of it breaking out in Asia so there is nothing to worry about as far as if you are sick now. Think of the lottery, someone has to be first but there's no way it's going to be one of us. The WHO is actually doing an incredible job monitoring the situation considering the part of the world they are dealing with.

Rosea? Did you mean Pityriasis Rosea? (http://www.nlm.nih.gov/medlineplus/ency/article/000871.htm) That's a pretty harmless disease.

mickal555
2005-Feb-22, 09:07 AM
UH no.... Asia is just below us.... I hope I don't get this :(

W.F. Tomba
2005-Feb-22, 09:18 AM
I wonder how our government would respond if it were announced that a deadly strain of avian flu was spreading rapidly from person to person in Asia. On Sept. 11, 2001 we discovered that there were dangerous, stealthy killers on the loose who could wipe out large numbers of people in our country, and who were probably coming by airplane. So all flights to anywhere in the U.S. were grounded. This was a sensible measure given the threat. A new catastrophic flu would be a dangerous, stealthy killer capable of wiping out even more people in our country, and which would probably come by airplane, ship, car, and foot. Closing our borders altogether would therefore be a sensible measure. Do you think they would do it?Unlikely scenario since it will be here before it's bad enough for the non-medical government agents to realize how bad it is. IE CDC knows but Congress and the Pres won't get the seriousness of it until the epidemic is quite far along.
Yeah, I was afraid you'd say that. I'd say the same. But that really bothers me. If you and I understand how serious this is before it's even happened, and the health officials have been raising the alarm for quite a while now, why can't the message get through to Washington? Why aren't these things seen as a security issue? Personally, I am far more worried about being attacked by a virus than by another human being.

Candy
2005-Feb-22, 09:21 AM
Rosea? Did you mean Pityriasis Rosea? (http://www.nlm.nih.gov/medlineplus/ency/article/000871.htm) That's a pretty harmless disease.
Yeah, freaky rash to get, though. I hear it's not common. :o

beskeptical
2005-Feb-22, 09:28 AM
UH no.... Asia is just below us.... I hope I don't get this :(It won't matter where you are, if it's bad it will be worldwide in weeks.

In 1918, there was a wave of disease that sort of died out then resurfaced as a major outbreak that circled the globe in 4 months.

This disease first surfaced in 1997. It's the same disease labeled Hong Kong Avian flu back then if you recall they had to kill all or practically all the chickens in Hong Kong. Well they just didn't quite snuff it out and it really flared up last year and is still getting worse. But it isn't a danger to humans just yet and no one is absolutely positive it will ever be one. It does though sure look like it's heading that way.

The bottom line is start thinking about it but don't start worrying yet. Just watch the news for changes in the situation.

It's expensive but you can buy a few months worth of Tamiflu. For the moment it is the only drug that works for this virus. You need a prescription but most doctors would write one if you asked. Problem is 3 months worth for one person is $400 in Canada and twice that in the US. There will be some of this drug available and if we use it wisely it will save a lot of people. Problem is stock piles of Tamiflu won't be enough either. Canada recently decided or is thinking about buying 25 million dollars worth of Tamiflu to be prepared. My HMO has so far decided not to get extra but they are getting my feedback. I am keeping my doctor up to date on the situation and he in turn is in touch with their infectious disease department head. I hope to convince them to spend at least some dollars on the drug.

beskeptical
2005-Feb-22, 09:31 AM
Rosea? Did you mean Pityriasis Rosea? (http://www.nlm.nih.gov/medlineplus/ency/article/000871.htm) That's a pretty harmless disease.
Yeah, freaky rash to get, though. I hear it's not common. :oActually it is pretty common, for you young college kids. :wink:

I had it. Some of my friends have had it. I've seen lots of cases.

beskeptical
2005-Feb-22, 09:35 AM
Yeah, I was afraid you'd say that. I'd say the same. But that really bothers me. If you and I understand how serious this is before it's even happened, and the health officials have been raising the alarm for quite a while now, why can't the message get through to Washington? Why aren't these things seen as a security issue? Personally, I am far more worried about being attacked by a virus than by another human being.Well 1918 was long enough ago people just think it can't happen today. They have this impression modern medicine has infectious disease under control.

mickal555
2005-Feb-22, 09:36 AM
beskeptical,

You are the calmest person in the world.... if you are telling me to stock up on really expensive stuff- ........ -

beskeptical
2005-Feb-22, 09:54 AM
beskeptical,

You are the calmest person in the world.... if you are telling me to stock up on really expensive stuff- ........ -I debated if I should have said it because there really is no medical standard to recommend such a thing. Truth is though, I bought what I hope is enough for me and my son. I figured it cost me the same as 1&1/2 months of health insurance.

Unfortunately I have this picture of that twilight zone show where the family goes in their bomb shelter and the neighbors freak out trying to get in then it turns out to be a false alarm. 8-[

The flu vaccine shortage this year was an eye opener. Even though I got my vaccine supply before the problems started, for those who hadn't got theirs the public health took the rest to control who got it and also mandated by law who we could vaccinate. I don't want to have no control over whether or not I can get a life saving drug. I also asked my HMO if they had a plan on how to allocate such drugs should a worse case scenario occur and they essentially said they had their head in the sand. They just plan to defer to the public health to tell them how to allocate it.

Well the public health is a bit of an unwieldy agency. They go by the book. Should the flu start killing young people, the PHD conceivable could use the same vaccine allocation plan, people >65 etc., until some major time consuming re-evaluation and decision making process takes place.

I can't really recommend anyone buy an expensive drug for a hazard that hasn't really manifested itself yet. But I don't want to deny the fact I bought some.

mickal555
2005-Feb-22, 09:57 AM
OK..... I was more worried than anything as I don't want to die of the cold

W.F. Tomba
2005-Feb-22, 10:00 AM
I can't really recommend anyone buy an expensive drug for a hazard that hasn't really manifested itself yet. But I don't want to deny the fact I bought some.
What's the shelf life on that stuff?

beskeptical
2005-Feb-22, 10:03 AM
There is a compromise here on the Tamiflu. You really only need 10 which is about $45 in Canada and 70 something here.

The PHD currently recommends not taking it daily which is the preventative dose, but rather taking it if you are exposed or actually get infected. The tricky part is, you have to take it on day one of your symptoms. By the second or third day it isn't going to work. It means you have to know the difference between the flu and other illnesses, but that is manageable.

jofg
2005-Feb-22, 01:55 PM
This is one of the more realistic - and I think scarier - woowoo-type possibilities out there!

Are there any good, informative sites out there where I could go to track this and stay up-to-dated? I'd hate to be "behind the curve" on this one if it happens to gets bad. But i also don't want to have to track it on GLP :o

Swift
2005-Feb-22, 03:21 PM
Yeah, I was afraid you'd say that. I'd say the same. But that really bothers me. If you and I understand how serious this is before it's even happened, and the health officials have been raising the alarm for quite a while now, why can't the message get through to Washington? Why aren't these things seen as a security issue? Personally, I am far more worried about being attacked by a virus than by another human being.Well 1918 was long enough ago people just think it can't happen today. They have this impression modern medicine has infectious disease under control.
Just to make 1918 a little more current, my grandmother (my father's mother) died in 1918 when my dad was three; we suspect it was from the flu (my dad wasn't sure and there are no living relatives to get details from).

American Scientist had an interesting piece about the bird flu about a year ago. Here (http://www.americanscientist.org/template/AssetDetail/assetid/17221;jsessionid=baa83k-mYdbss1) is a link to the article, but it is for subscribers only. Here is the abstract

In 1997 the world came perilously close to a global epidemic of the "flu." If this particular virus had attained the ability to spread from person to person, the pandemic might have taken the lives of a third of the human population. As it was, only six people died—and all of them had contracted the virus from chickens sold in Hong Kong poultry markets. The only thing that saved us was the quick thinking of scientists who convinced health authorities to slaughter more than a million domesticated fowl in the city's markets. The avian virus turned out to be a new strain—one that the human population had never seen before. Webster, one of the scientists who consulted Hong Kong authorities in 1997, and Walker tell a horrific tale: These new, deadly strains arise a few times every century, and the next one is around the corner.
It was the March/April 2003 issue.

TriangleMan
2005-Feb-22, 04:39 PM
Hopefully the SARS problem in 2002-2003 has led to some changes in detection and quarantine procedures (as well as increased funding) to help stop the spread of potentially epidemic disease. Unfortunately with air travel it would not take much to spread a contagious disease world-wide in a matter of weeks.

If Bird Flu has found a way to mutate such that it can easily travel from person to person it will be a real crisis. I remember back in the 80s one doctor was grateful that AIDS couldn't spread easily, noting that if it could spread as easily as a cold it would be "goodbye human race".

mike alexander
2005-Feb-22, 08:23 PM
Scientific American recently had an article on the 1918 influenza (sorry, can't give the exact issue, but it was the last few months) that is a very helpful introduction to the subject.

Hutch
2005-Feb-22, 08:32 PM
I can heartily recommend The Great Influenza, by John M. Barry. http://www.amazon.com/exec/obidos/ASIN/0670894737/103-0036051-4857476

Compelling read, how medical science tried to fight it, and just how frightenly fast in moved...and killed.

And like the book says, we can vaccinate against flu these days..but we still cannot cure it.

W.F. Tomba
2005-Feb-22, 09:08 PM
The H5N1 flu is showing extremely high death rates, but isn't it very possible that there are a lot of milder, unrecognized cases? Given the type of communities this thing is spreading in, it seems unlikely that everyone who gets it will go to a doctor if they're not extremely sick.

:( I just keep thinking of ways we could be doing much, much more to stop this problem. For example, what if the First World nations got together and agreed to compensate the Asian poultry farmers for the slaughter of all the poultry in the affected areas? Sure, it would cost a lot of money, but more than being hit with a major flu pandemic?

It's excusable to be caught off guard by something that really is a surprise, like a tsunami or an asteroid impact. But how can we be so unprepared for a threat that prompted emergency action in 1997? Forgive me for adapting a tired old cliche, but if we could get men to the moon in ten years, why can't we ramp up vaccine production in seven?

How can we just stand by and put millions of lives at risk through inaction?

Doodler
2005-Feb-22, 09:33 PM
And like the book says, we can vaccinate against flu these days..but we still cannot cure it.

Same with any virus, unfortunately.

TriangleMan
2005-Feb-22, 09:33 PM
It's not just chickens though. I believe turkeys, ducks and other waterfowl can have it as well. I'm not sure whether other Avians can harbour the virus, if so then we'd need to eliminate other birds as well.

W.F. Tomba
2005-Feb-22, 09:39 PM
It's not just chickens though. I believe turkeys, ducks and other waterfowl can have it as well. I'm not sure whether other Avians can harbour the virus, if so then we'd need to eliminate other birds as well.
I meant poultry in the sense of all domesticated fowl. The purpose wouldn't be to wipe out the virus entirely, but to destroy its path from birds to humans. I realize it would be only a temporary fix to buy time. I guess that would only be valuable if we used the time well, though. #-o

Edit: Another idea---if we can make a vaccine, why can't we make one to use on birds?

beskeptical
2005-Feb-22, 09:49 PM
This is one of the more realistic - and I think scarier - woowoo-type possibilities out there!

Are there any good, informative sites out there where I could go to track this and stay up-to-dated? I'd hate to be "behind the curve" on this one if it happens to gets bad. But i also don't want to have to track it on GLP :oMain Pro Med (http://www.promedmail.org/pls/askus/f?p=2400:1000) is the best site for daily reports of outbreaks of animal and human infectious diseases around the world.

Couple of cautions, don't get alarmed about any of the reports when they say "unknown cause" or things like that. This site monitors news sources and prints the story as is. Often there is a very rational comment about the article added by the moderator.

An example was a recent article of 25 pigs a day dying of "pig flu" in a town in India. Of course the first thought is H5N1 has spread but the moderator adds,
[Infectious diseases, particularly zoonoses, should be ruled out. In
case an investigation takes place, we shall be grateful for an
update. - Mod.AS] IE calm down folks we get these reports all the time and shouldn't jump to conclusions.

And it is true, only a few of the reports end up about real problems like SARS. I will say though, SARS was reported on here long before any agency started to notice. If you go back through the SARS archives it is a very interesting chronology of reports.

The second caution is don't sign up for the list serve. Their mailing list has been infected with viruses more times than I can count. I e-mailed them several; times asking them to post something about it but they never have. For an infectious disease site, oh the irony of it. :roll:

They have posted 2 of my e-mails though. If you have an important point it gets noticed. There is no chit chat nor "gee that's interesting" so e-mails have to be specifically about monitoring outbreaks. They do an excellent job of keeping to that in a strict way.


For general information about flu and avian flu go to CDC flu page (http://www.cdc.gov/flu/) and WHO home page (http://www.who.int/en/) sites. CDC has an Emerging Infectious Disease Journal. (http://www.cdc.gov/ncidod/EID/index.htm) It is very technical and not a daily report but there are plenty of interesting articles. It's a monthly publication and there is no subscription needed. WHO also has daily reports on worldwide outbreaks. The WHO site on flu is good but they changes their flu monitoring report site and it is confusing to navigate now.

Thyla
2005-Feb-23, 01:16 AM
I work in healthcare. That scares me the most. If something is up we are the people that are going to be exposed first. I see so many people sick, I will never know if it's a flu, bird flu, or whatever. Once doctors and nurses start dying off we will be in trouble. :(

W.F. Tomba
2005-Feb-23, 01:22 AM
I work in healthcare. That scares me the most. If something is up we are the people that are going to be exposed first. I see so many people sick, I will never know if it's a flu, bird flu, or whatever. Once doctors and nurses start dying off we will be in trouble. :(
Health workers will probably be high on the list for vaccinations, though.

mike alexander
2005-Feb-23, 02:52 AM
Has anyone noticed the irony in the response to a possible influenza outbreak of this possible magnitude vs. the response to a couple of cases of bovine spongiform encephalopathy in cattle in the US/Canada?

Not to say that BSE is anything to chuckle about, but in terms of probabilities the odds of contracting it are pretty much nil. Yet the entire cross-border beef industry was shut down.

My own guess is that despite everything, slow brain rot just has a high shudder factor, even if under the worst circumstances it could never pose the pandemic threat influenza could. Flu is cured with Alka-Seltzer; it just doesn't scare people. Anyone remember the Swine Flu jokes? Even the press went into sarcasm mode on that one. Gee, there was no epidemic, and Swine Flu sounds funny.

W.F. Tomba
2005-Feb-23, 03:15 AM
Has anyone noticed the irony in the response to a possible influenza outbreak of this possible magnitude vs. the response to a couple of cases of bovine spongiform encephalopathy in cattle in the US/Canada?

Not to say that BSE is anything to chuckle about, but in terms of probabilities the odds of contracting it are pretty much nil. Yet the entire cross-border beef industry was shut down.

My own guess is that despite everything, slow brain rot just has a high shudder factor, even if under the worst circumstances it could never pose the pandemic threat influenza could. Flu is cured with Alka-Seltzer; it just doesn't scare people. Anyone remember the Swine Flu jokes? Even the press went into sarcasm mode on that one. Gee, there was no epidemic, and Swine Flu sounds funny.
With BSE, there's also the fact that the disease (or at least the epidemic in Britain) was caused by human agricultural practices. Flu, despite killing thousands of people every year, is considered a "natural" threat and therefore somehow more benign.

(In fact, the word influenza actually comes from Italian and means influence, because it used to be thought that these seasonal epidemics were due to celestial influence!)

Jpax2003
2005-Feb-23, 08:30 AM
They think cats are getting the avian flu now.
CNN story (http://www.cnn.com/2005/HEALTH/conditions/02/22/bird.flu.ap/index.html)

Dr. Julie L. Gerberding, head of the Centers for Disease Control and Prevention, said Monday that scientists believe it is highly likely that the virus that has swept through bird populations in Asia will evolve into a pathogen deadly for humans.
...
Study already has shown that the virus can infect cats who can then infect other cats, which Gerberding said was "another harbinger" of the possibility of a human pandemic.I remember hearing a statistic on the news this morning unrelated to the flu: 1 in 3 american homes has a cat or dog. Maybe Nancy Leider's pet euthanasia idea wasn't so radical after all...

beskeptical
2005-Feb-23, 08:33 AM
Has anyone noticed the irony in the response to a possible influenza outbreak of this possible magnitude vs. the response to a couple of cases of bovine spongiform encephalopathy in cattle in the US/Canada?

Not to say that BSE is anything to chuckle about, but in terms of probabilities the odds of contracting it are pretty much nil. Yet the entire cross-border beef industry was shut down.

My own guess is that despite everything, slow brain rot just has a high shudder factor, even if under the worst circumstances it could never pose the pandemic threat influenza could. Flu is cured with Alka-Seltzer; it just doesn't scare people. Anyone remember the Swine Flu jokes? Even the press went into sarcasm mode on that one. Gee, there was no epidemic, and Swine Flu sounds funny.
With BSE, there's also the fact that the disease (or at least the epidemic in Britain) was caused by human agricultural practices. Flu, despite killing thousands of people every year, is considered a "natural" threat and therefore somehow more benign.

(In fact, the word influenza actually comes from Italian and means influence, because it used to be thought that these seasonal epidemics were due to celestial influence!)I don't think that has anything to do with people's reactions. If you think you are going to die why would you care whether the threat was natural or unnatural?

The perception of risk is affected by many factors, one of them being how exotic it is. Flu is not exotic, BSE is. Another is how bad it seems. Dying of slow brain rot is scarier than dying of flu. And finally, it depends on how lethal you perceive it, thus if you think I've had flu, it didn't kill me then you have less fear. BSE is 100% fatal.

Risk perception is very often unrelated to actual risk. Peter Sandman (http://www.psandman.com/articles/cma-appc.htm) has done some good work in this field.

beskeptical
2005-Feb-23, 08:49 AM
The H5N1 flu is showing extremely high death rates, but isn't it very possible that there are a lot of milder, unrecognized cases? Given the type of communities this thing is spreading in, it seems unlikely that everyone who gets it will go to a doctor if they're not extremely sick.The death rate is almost certainly less than 70% but it is still extremely high.

SARS actually had a death rate almost as high as it appeared. There were very few unrecognized cases as was confirmed by the fact silent transmitters played almost no role. Antibody studies in the area of China where SARS emerged did find some additional cases of past infection. Those studies have not yet been done for H5N1 flu to my knowledge. They did look at hospital workers and found no cases but the goal was to see if transmission was occurring from person to person, not to see if less lethal cases were occurring.


:( I just keep thinking of ways we could be doing much, much more to stop this problem. For example, what if the First World nations got together and agreed to compensate the Asian poultry farmers for the slaughter of all the poultry in the affected areas? Sure, it would cost a lot of money, but more than being hit with a major flu pandemic?

It's excusable to be caught off guard by something that really is a surprise, like a tsunami or an asteroid impact. But how can we be so unprepared for a threat that prompted emergency action in 1997? Forgive me for adapting a tired old cliche, but if we could get men to the moon in ten years, why can't we ramp up vaccine production in seven?

How can we just stand by and put millions of lives at risk through inaction?Actually a lot is being done, even in the poorer Asian countries. The problem is this disease is now established in wild water birds that migrate. It is not going to be stopped at this point. The best we can hope for is to slow it down until we can get vaccines ready.

But whether or not this disaster or that one should receive prevention financing, I could give you a list much longer than flu. And I don't think the tsunami was unanticipated. And neither is the next big quake along any fault line known to be active, any volcano that could produce the next big mudslide, the next big flood, the next hurricane and on and on and on.

Then there are the individual failures, not wearing seat belts, not having a working smoke alarm, and so on and so on. We just don't do so well as a society in preventing even the most easily preventable disasters.

beskeptical
2005-Feb-23, 08:55 AM
And like the book says, we can vaccinate against flu these days..but we still cannot cure it.

Same with any virus, unfortunately.Not true. Antivirals can cure varicella virus when it emerges as zoster, some hep C cases, and a few others. It is true many other viruses are suppressed rather than cured but if they never recur, they are for all intents and purposes cured.

Progress in antiviral medications is advancing fairly rapidly.

beskeptical
2005-Feb-23, 09:06 AM
It's not just chickens though. I believe turkeys, ducks and other waterfowl can have it as well. I'm not sure whether other Avians can harbour the virus, if so then we'd need to eliminate other birds as well.I think it's been found in pigeons. It has been found in some kind of herons, some birds that were being smuggled somewhere, and a couple other species. If I find the specific information I'll post it.

beskeptical
2005-Feb-23, 09:11 AM
It's not just chickens though. I believe turkeys, ducks and other waterfowl can have it as well. I'm not sure whether other Avians can harbour the virus, if so then we'd need to eliminate other birds as well.
I meant poultry in the sense of all domesticated fowl. The purpose wouldn't be to wipe out the virus entirely, but to destroy its path from birds to humans. I realize it would be only a temporary fix to buy time. I guess that would only be valuable if we used the time well, though. #-o

Edit: Another idea---if we can make a vaccine, why can't we make one to use on birds?These measures are already being done. They are slaughtering all infected flocks all over Asia. And there is a bird vaccine.

At first the vaccine wasn't used for fear it would mask outbreaks without stopping them. But Viet Nam is about to use a new bird vaccine. I don't know whether it is the right thing to do or not. Time will tell.

beskeptical
2005-Feb-23, 09:14 AM
I work in healthcare. That scares me the most. If something is up we are the people that are going to be exposed first. I see so many people sick, I will never know if it's a flu, bird flu, or whatever. Once doctors and nurses start dying off we will be in trouble. :( SARS was the worst thing I've ever seen for health care workers. Hundreds of them died. At least with flu you'll probably be first on the vaccine and/or Tamiflu list.

beskeptical
2005-Feb-23, 09:18 AM
They think cats are getting the avian flu now.
CNN story (http://www.cnn.com/2005/HEALTH/conditions/02/22/bird.flu.ap/index.html)

Dr. Julie L. Gerberding, head of the Centers for Disease Control and Prevention, said Monday that scientists believe it is highly likely that the virus that has swept through bird populations in Asia will evolve into a pathogen deadly for humans.
...
Study already has shown that the virus can infect cats who can then infect other cats, which Gerberding said was "another harbinger" of the possibility of a human pandemic.I remember hearing a statistic on the news this morning unrelated to the flu: 1 in 3 american homes has a cat or dog. Maybe Nancy Leider's pet euthanasia idea wasn't so radical after all...Domestic cats were infected to see if they were susceptible I think. It isn't that lots of cats in Asia are carriers. There was also a bunch of tigers that died in a zoo from eating slaughtered raw chickens. And there was believed to be some cat to cat transmission.

Messenger
2005-Feb-23, 02:39 PM
SARS was a great learning experience for North America. I live close to Toronto, and I pulled both my kids out of school when the death toll started climbing rapidly, and the infection rate multiplied exponentially. We had a daily radio report at 3pm that gave the number of dead/number of infected. People thought I was overreacting; I thought I would rather be wrong than dead.

What I noticed: Although they did checks at the airport, the checks were not as effective as people hoped, and later review showed that people who were in fact ill, albeit with other sorts of flu, did get through the checks. Handwashing is still the best way to protect yourself against viral infection, and people started carrying hand sanitizer with them; if you go out to the mall, or grocery shopping, you can reduce your contact with viruses a great deal by just remembering to use hand sanitizer before you get into your car. Wiping down the door handles on your car & house periodically doesn't hurt, either. If you think you're likely to be exposed, create a staging area in your garage with water and bleach where you can change your clothing & disinfect your shoes, so that your clothing goes straight into a plastic bag and from there into the washer. Gloves are enjoying a rise in popularity, and are very effective; people understood this in the pre-antibiotic era. Finally, for the really worried, don't bother buying one of those masks you can get at the paint store; you will need something alot more serious. If you're stocking up on Tamiflu, you should use all these steps first.

Although airborne infection is very dangerous, it can be fought. If we can control our points of physical contact with the public (and there are more than you think), we can control our exposure. People in Toronto were disbelieving, and then quite worried. There wasn't panic, but public gatherings stopped. The grocery stores were weirdly empty. I know that an epidemic is probably coming, but it's not this kind that worries me; retroviruses are what scare me.

beskeptical
2005-Feb-23, 07:45 PM
SARS was a great learning experience for North America. I live close to Toronto, and I pulled both my kids out of school when the death toll started climbing rapidly, and the infection rate multiplied exponentially. We had a daily radio report at 3pm that gave the number of dead/number of infected. People thought I was overreacting; I thought I would rather be wrong than dead.

What I noticed: Although they did checks at the airport, the checks were not as effective as people hoped, and later review showed that people who were in fact ill, albeit with other sorts of flu, did get through the checks. Hand washing is still the best way to protect yourself against viral infection, and people started carrying hand sanitizer with them; if you go out to the mall, or grocery shopping, you can reduce your contact with viruses a great deal by just remembering to use hand sanitizer before you get into your car. Wiping down the door handles on your car & house periodically doesn't hurt, either. If you think you're likely to be exposed, create a staging area in your garage with water and bleach where you can change your clothing & disinfect your shoes, so that your clothing goes straight into a plastic bag and from there into the washer. Gloves are enjoying a rise in popularity, and are very effective; people understood this in the pre-antibiotic era. Finally, for the really worried, don't bother buying one of those masks you can get at the paint store; you will need something alot more serious. If you're stocking up on Tamiflu, you should use all these steps first.

Although airborne infection is very dangerous, it can be fought. If we can control our points of physical contact with the public (and there are more than you think), we can control our exposure. People in Toronto were disbelieving, and then quite worried. There wasn't panic, but public gatherings stopped. The grocery stores were weirdly empty. I know that an epidemic is probably coming, but it's not this kind that worries me; retroviruses are what scare me.There are some very good points here but a few things need to be said.

The hand sanitizers and hand washing - great idea.

Staging area in garage - also good idea during a pandemic of such proportions as the flu or something as bad but unknown as SARS. About the bleach though, be sure to use it properly as it damages a lot of surfaces. Don't use it on anything it isn't intended to be used on like skin, even diluted to 10%. And diluted solutions lose strength with time as the chlorine readily evaporates, so mix a fresh batch after 24 hours.

Taking the kids out of school until more is known - great idea but be ready to put them back in when it's shown the risk is not in the schools. I think caution until more was known about SARS was indeed the way to proceed.

The masks from the paint or hardware store are useful, just not for airborne viruses. SARS was droplet spread, (and probably also some fecal oral). Droplets are more like splashes, they will go about 3 feet or so from one person to another with coughing and talking. They don't stay in the air and float great distances. (Not to be confused with "droplet nuclei" of TB which are airborne.) Droplets can be prevented from entering your eyes, nose, and mouth with a mask and eye protection. It doesn't have to be a special mask, though N95 masks can also be purchased in hardware stores and are a little better.

You have to be careful because you can contaminate your hands removing the mask and goggles.

We don't have a mask that can truly keep flu virus out but despite that CDC is telling health care workers to use N95s. :evil: :evil: I am disgusted they are being disingenuous in that they are leaving out the caveat that the masks have not been tested to see if they prevent flu. The masks did play an important role in preventing SARS transmission.

The news media misinformed people when they said SARS was not as contagious as flu because flu was airborne and SARS wasn't. The route or means of transmission is a separate issue from the level of contagiousness. TB, as an example, is airborne but not very contagious. SARS was droplet spread but extremely contagious.

Also, you have to take into account multiple means of transmission. Both flu and SARS can contaminate a surface, get on a hand, and then be transmitted to the mouth nose or eye. TB, on the other hand cannot infect you in this way. It has to be inhaled into the lung. (Not to be confused with bovine TB which is a bacteria transmitted in unpasteurized milk.)

So for each infectious agent, you have to look at the whole spectrum of transmission if you want to prevent its spread.

With flu, Tamiflu may be the only means of control short of isolation. That's why I say make sure you have supplies to stay at home if need be. The other measures will prevent many cases of flu transmission, but they won't be absolute.

PS: I don't know which retroviruses you are 'scared' of but your experience with SARS may have lulled you into a false sense of security about flu. They are two different beasts. It is flu you should be worried about. I presume you all have seen today's headlines about flu.

Messenger
2005-Feb-24, 05:06 AM
Thanks for the response, beskeptical. After I posted, I wondered if people would think I was a bit looney. It seems like alot, until you have to live through an epidemic. I know pulling the kids out of school sounds extreme; however, several schools closed midway through the epidemic. My concern was that at that time, we had a public health officer who was less than proactive in dealing with the issue. Vancouver's public health officer was quite a bit more on the ball, and so Vancouver didn't go through the experience Toronto did, although both cities have a large Asian population, and both cities had early outbreaks of SARS. We have a new public health officer now. In any case, I didn't want to have my children infected and have the health department saying "well, in hindsight..." My kids were able to do their school work at home.

However, I do stand by my coment on the masks, based on what happened in Toronto. Many people started using the simple masks that pinch across the bridge of the nose. The city Health Department informed us that the "paint store" masks were not effective. What was needed was something with a seal. By the end of the epidemic, to their consternation, investigators were finding health professionals being infected even with gowns, face shields, good masks, and gloves. Everyone uses moon suits now. I don't think that masks are necessary, unless you know you are going into an area where exposure is likely, like a hospital waiting room.

I'm afraid of any virus that has a long latency period in which the victim is largely or completely symptom-free, yet contagious. I am not living in any state of security about viruses; I believe that they are the inevitable consequence of our high population density. I just don't see how we can duck an epidemic of some kind. I worry, however, not about the bold enemy that announces itself -- like SARS, or the flu -- but about the one that may arrive more stealthily, and be well-entrenched in the population before we even know it's there.

beskeptical
2005-Feb-24, 09:36 AM
However, I do stand by my coment on the masks, based on what happened in Toronto. Many people started using the simple masks that pinch across the bridge of the nose. The city Health Department informed us that the "paint store" masks were not effective. What was needed was something with a seal. By the end of the epidemic, to their consternation, investigators were finding health professionals being infected even with gowns, face shields, good masks, and gloves. Everyone uses moon suits now. I don't think that masks are necessary, unless you know you are going into an area where exposure is likely, like a hospital waiting room. Actually, face shields turned out to be the preventing factor, once it was determined how SARS was being spread. I'd always take a tight fit over a loose one but when there was a shortage of N95s the other masks could still protect people if used properly. What you have to keep in mind is when infection control fails, was it one thing or two or many? In the case of the gowns, just reusing cloth gowns was enough to spread SARS. What was learned was we can't put on and take off those gowns, gloves, face shields, etc as casually as we have become accustomed to. You had to avoid contaminating things from the surfaces of the protective equipment.

SARS was droplet spread. Unless you are very near a coughing patient, you are unlikely to inhale the droplets since they do not stay airborne. A tight fitting face mask is to prevent inhaling particulates the size of bacteria. Viruses go right through the mask filter anyway so the tight fit is a false sense of security. The following should give you an idea of what the masks are actually doing.dust mask- not NIOSH approved for recognized health hazards, OK for nuisance materials.
N95 - filters 95% of 1-5 micron size particulates. Requires fit testing to assure proper fit and training to assure proper fitting at time of use.
N100 - same as 95 but filters 99.7% of particulates.
N category masks are strictly mechanical filters.
P and R category masks, also come in 95 and 100, filter the above respectively but add certain absorbent materials to filter additional hazardous fumes.
TB bacteria are ~2 microns.
Anthrax spores are ~1 micron.
Typical viruses are all smaller than 1 micron.
Droplet spread organisms are stopped with a mere barrier over the face.
Airborne organisms are stopped by a respiratory filter.The important thing is to not assume one set of guidelines automatically fits all diseases and/or all situations. And, it isn't just if someone recommends something, it's best to know the principle behind the recommendation. Infection control you use in a hospital where you expect close patient contact may not be the same as what you need for more casual contact outside the hospital. If there is no better mask, a dust mask is certainly better than no mask.


I'm afraid of any virus that has a long latency period in which the victim is largely or completely symptom-free, yet contagious. I am not living in any state of security about viruses; I believe that they are the inevitable consequence of our high population density. I just don't see how we can duck an epidemic of some kind. I worry, however, not about the bold enemy that announces itself -- like SARS, or the flu -- but about the one that may arrive more stealthily, and be well-entrenched in the population before we even know it's there.By principle you would be correct. The reason we were able to stop SARS was because all cases were so sick they were easily recognized and we were able to isolate them. But what you are leaving out of the equation is the long latency principle is only one piece of the infection risk assessment. History tells us flu has caused the most deadly pandemics we are aware of. It has caused more deaths than the plague did in the 1400s. While the HIV epidemic is still growing and we don't know where it will eventually lead, flu has killed more humans by far. In 1918 it was somewhere between 20 to 40 million. The same pandemic today could be 10 times that. No one knows for sure if this is it or if it will be that bad, but we do know what the potential is.

sarongsong
2005-Feb-25, 04:03 AM
25/02/2005 (http://abc.net.au/ra/news/stories/s1310939.htm)
"A Vietnamese man has tested positive for bird flu, becoming the first human case identified in the country in more than three weeks...outbreaks of bird flu have killed 33 people in Vietnam since late 2003. Another 12 have died in Thailand..."

Thyla
2005-Feb-25, 10:17 AM
Personally I'm afraid to take a vaccination.

I always wonder what happened to SARS. Did it mutate to something more mild and just die out? It could have mutated into something more sinister I suppose, and we are lucky it didnt. I have no doubt that this flu will most likely become a human to human transmission virus. But I am not so worried as I believe that people are watching it so closely, it won't just blow up kill millions like the 1918 flu did. We have so much more knowledge and communication to stop this before it gets out of hand.

My only concerns are incubation periods. Whether the flu is transmitted during illness or during a two week non symptomatic period. I mean it takes a while for a virus to take over your system and wreak havoc. That is the crucial period to containing the infected people. If you were to have first wave of people who were infected fly out to different areas of the world and spread the virus unknowningly to others while not showing symptoms, that is when it gets a bit scary. Once people get ill they can be isolated. But if I am working beside someone who is infected and they are not ill, but coughing on doorknobs I am touching, and I wash my hands alot but I'm not perfect, what do I do? I don't want to be paranoid... lol. I don't think the other people at work would appreciate me in a full body moon suit running around with a windex bottle of bleach spritzing myself every five minutes...

I'm from Canada, and during the SARS scare, we had many bright colored photocopied sheets taped to entrances of our facility and on walls asking people to leave if they had traveled to the east, had a fever, or felt any general malaise. That summer we lost alot of patients to a really bad "flu" that went around (they had immune comprimised systems already), and I really believe it was a mild version of SARS. I could be wrong but it was very odd to have such a vicious respitory infection hit us in the middle of summer. Our flu season is usually from Nov - March.

Nonetheless, I don't think it's the end of humanity if a flu starts. It may reach pandemic status. And I'm not sure about the death rate, not saying that the people who have been struck already haven't received the best medical care, but we don't exactly know how they live and what types of care they were able to recieve, how far along they were in their illness before they were able to seek any medical intervention, and what their original health status was. If under 50 people have caught the virus and 70% have died, who is to say that would happen to everyone. The flu kills many many people a year. Will this flu attack the young and healthy? or the older and immune comprimised? I don't think we have enough information on the signature of the virus to even begin to make assumptions on it's death rate. It might just be a nasty flu that will kill, but won't be anything apocolyptic. Or it might be a super de duper killer flu and wipe out 3/4 of humanity. Who is to say?

Nonetheless. If it hits my hometown I will most likely stay home with my children. If a high deathrate is a determined fact , then we will take as many precautions as we can. You don't need to catch this. I have gone several years in a row not catching colds or flus and unless this thing is of the sci-fi variety, I don't think I will catch it.

All the above hints and tips for avoiding germs are excellent. Remember bleach is the best for killing viruses and bacteria. Never be too confident that you are immune to anything and you will fare well. Wash your hands after being in public places (or use anti bacterial gel) and never touch your eyes, nose or mouth or other entry into your body until you have made sure your hands are clean. Now if I could just get my kids to quit sucking on crap they pick up off the ground, life would be perfect..

That is all.
:)

W.F. Tomba
2005-Feb-25, 05:53 PM
I have a question for anyone who knows about these things. If this becomes a major pandemic that spreads at a high rate, will that also cause mutations in the virus to happen at a high rate? My reasoning is that if mutations are caused by "mistakes" that occur while the virus is being replicated in infected cells, then the faster a virus spreads, the faster it will mutate. Am I right about this?

beskeptical
2005-Feb-25, 08:49 PM
I have a question for anyone who knows about these things. If this becomes a major pandemic that spreads at a high rate, will that also cause mutations in the virus to happen at a high rate? My reasoning is that if mutations are caused by "mistakes" that occur while the virus is being replicated in infected cells, then the faster a virus spreads, the faster it will mutate. Am I right about this?The more virus replication, the more mutation. But mutation is always frequent in flu. It isn't going to change anything in the historical pattern.

Also, we aren't necessarily going to have that many more cases, just more deaths in the same number of cases.

sarongsong
2005-Mar-04, 07:18 AM
"...If Henry Niman's theory (http://www.wired.com/news/medtech/0,1286,66752,00.html?tw=wn_tophead_1) [that avian flu genes are swapping pieces in a predictable way] is correct, it would mean that scientists can predict avian flu's future iterations. And that would be handy for engineering vaccines that will work a year or two after they're manufactured..."

beskeptical
2005-Mar-04, 07:53 AM
"...If Henry Niman's theory (http://www.wired.com/news/medtech/0,1286,66752,00.html?tw=wn_tophead_1) [that avian flu genes are swapping pieces in a predictable way] is correct, it would mean that scientists can predict avian flu's future iterations. And that would be handy for engineering vaccines that will work a year or two after they're manufactured..."I can't quite follow the difference between reassortment vs recombination. And I can't see that either offers significant predictability in terms of timing or pathogenicity of any virus that will emerge in the future.

If the guy is saying we can predict which strains to use in matching vaccine production, perhaps he has something to add to the models. WHO has a vaccine virus already chosen to match the H5N1 avian strain but they are not stating with any certainty they have chosen the correct match.

sarongsong
2005-Apr-25, 05:47 AM
April 23 (http://washingtontimes.com/upi-breaking/20050423-072843-3205r.htm)
"Public health officials in Vietnam fear the South Asian outbreak of bird flu is becoming less virulent and, thus, more likely to spawn a pandemic...the 1918 Spanish flu pandemic...had a 5 percent mortality rate. The comparable rate for bird flu has fallen from nearly 70 percent to 35 percent this year..."

sarongsong
2005-May-15, 04:56 AM
May 14, 2005 (http://www.foxnews.com/story/0,2933,156527,00.html)
"Indonesian researchers have found a strain of bird flu in pigs on the densely populated island of Java, raising fears the virus could more easily spread to humans in the country...identified the strain found in the pigs as H5N1, which has jumped from chickens to humans elsewhere in Southeast Asia, killing 36 in Vietnam, 12 in Thailand and four from Cambodia..."

beskeptical
2005-May-15, 07:25 PM
From my Promed site:
Nidom said the samples were taken from pigs living 100 yards away from a chicken farm on Java island that was struck by bird flu during 2004. None of the pigs showed any signs of illnesses, he said. "I was just curious to see how far this virus could go," said Nidom, who works at a state-run university in the Javanese city of Surabaya.

New cases of H5N1 have re-emerged on a relatively small scale in some parts of Indonesia since it was 1st found in late 2003. A total of 281 730 fowl either died from the virus or were culled in the January-March [2005] period, latest government data show. Since late 2003, Indonesia has lost around 8.9 million fowl.

Specimens from Indonesian poultry workers have been sent for tests in Hong Kong as a precaution, officials said.And the site's editorial response:
the said newswire includes data regarding the (non-) occurrence of clinical symptoms in the infected pigs. Serological surveillance in exposed humans might provide additional information of significant epidemiological value. - Mod.ASEarlier notes, I think, said something to the effect the story was odd in that it claimed there were no dead chickens in the proximal flocks which suggested the story was incomplete.

I like the Promed site since it often cites where we should be cautious re these news reports. They don't say the report is false, only that there are inconsistencies. Now it seems the lab results have been confirmed and I see a report of chicken deaths in the country after all.

On another note:
This Google ad (http://www.truthpublishing.com/survivinginfluenza.html) at the end of that news article above is the typical fraudulent stuff that will have many folks thinking vitamins and whatever other herbal treatments being scammed offer protection. Sadly, there is no evidence supporting said claims.

The typical nonsense that drug companies don't want you to know because they can't make money ignores the obvious that these folks are the real bad guys making money off the public's ignorance.

beskeptical
2005-May-15, 07:59 PM
BTW, how can you protect yourself from Avian Flu should we have a pandemic before adequate vaccines and medications are available which probably is likely to occur? Being 'healthy' and/or taking this or that supplement is not going to protect you. That is the equivalent of expecting magic spells or potions to work.

In order of general effectiveness but we really need all measures combined:

Hand washing, & avoid touching your face with potentially contaminated hands
Avoiding crowded places
All persons with respiratory illnesses and their contacts need to stay home during potentially infectious times (sadly, many folks will just refuse to do this as was shown with the SARS outbreaks)
Face masks on all persons with respiratory illnesses when out of their homes
Face shields with a tight fitting face mask when in contact with potentially contagious persons

*face mask covers your nose and mouth, face shield covers your eyes as well

We know how the flu is spread so we can prevent it. The flu is ~90% droplet spread and maybe ~10% airborne. The CDC says droplet spread but they ignore some of the research indicating airborne spread so I made up the 90-10 numbers. Droplets are large aerosols that on average go about 3 feet from the source while airborne particles are much smaller and remain aloft longer and travel longer distances.

The bottom line? Infectious particles are going to be airborne near sick people and on surfaces everywhere. So if you stay away from the persons who are sick or recently exposed and if you are meticulous about not letting contamination get from a surface into your eye, nose or mouth, you can avoid infection.

People who are well but contagious just before symptom onset can spread 'droplets' to your face by talking so just don't let anyone's face directly in your face, especially when talking. This can be accomplished by just not letting said contact occur, or with a face shield. It may look very weird to use a face shield, (goggles and a face mask will also work), and it may be rude to avoid getting close to people, but in a pandemic, it will be more acceptable. Just remember those face masks that don't cover your eyes from droplets are inadequate. Viruses travel down one's tear ducts to the spot in the back of your throat where conditions are lovely for them to replicate.

jofg
2005-May-16, 12:17 PM
Pardon me for hijacking this thread, but you mentioned SARS and that brought to mind a question. I read recently that there were no signs of SARS this past "flu season". Is this common - having a virus like this disappear? Did it mutate itself out of existence? Has this happened before?

For such a potentially serious virus, going from the scare of 2003/2004 to completely gone in 2005 seems very unusual.

beskeptical
2005-May-17, 04:05 PM
Pardon me for hijacking this thread, but you mentioned SARS and that brought to mind a question. I read recently that there were no signs of SARS this past "flu season". Is this common - having a virus like this disappear? Did it mutate itself out of existence? Has this happened before?

For such a potentially serious virus, going from the scare of 2003/2004 to completely gone in 2005 seems very unusual.SARS was eliminated from the human population for now but almost certainly exists in animal 'reservoirs' in China.

Epidemics of infectious disease have a number of different patterns.

Smallpox...no animal reservoir. Every last case was tracked down and all contacts vaccinated until there were no human cases left so no reservoir except labs.

SARS...all or at least almost all human cases were very severe so they were also all tracked down and contacts isolated until no new human cases occurred. The couple of subsequent cases have all been tracked to lab accidents. But there is still the original source, thought to be wild and farmed civet cats in China which probably still carry the virus. The future is unknown.

1918 flu virus....probably mutated into milder disease. The sickest people die without spreading the virus as far. Those with milder disease infect more people. Both mild and severe infection confer immunity. The initial outbreak is widespread because everyone is a potential infection. Subsequent outbreaks have fewer cases and person to person spread interrupted. At the same time, selection pressures favor milder disease. In 1919 a second less severe wave of the pandemic occurred and after that the death rate from annual flu cases returned to baseline.

sarongsong
2005-May-23, 04:27 PM
May 23 (http://reuters.myway.com/article/20050523/2005-05-23T135229Z_01_PEK366200_RTRIDST_0_NEWS-BIRDFLU-CHINA-DC.html)
"China has sealed off nature reserves and rushed more than 3 million doses of bird flu vaccine to a remote western province after migratory birds were found dead from the H5N1 strain...domestic poultry in China, the world's number two producer after the United States, could also be at risk..."

Maha Vailo
2005-May-24, 09:58 AM
OK, suppose there was a flu pandemic going around right now. How long would I have to remain indoors and away from crowds? How would I get my food and other supplies? Where can I buy face masks and face shields that won't blow my budget? How many should I get? I want to be prepared for this. I don't want to die.

- Maha Vailo

sarongsong
2005-May-25, 07:04 PM
May 25 (http://starbulletin.com/2005/05/25/news/) (left column)
"As nations prepare for a possible avian flu virus pandemic, state and federal health officials are working on a proposal to screen travelers who arrive at Honolulu Airport with influenza-like illness...The system was in place when severe acute respiratory syndrome, or SARS, emerged as a threat in 2003..."

beskeptical
2005-May-26, 06:41 PM
May 25 (http://starbulletin.com/2005/05/25/news/) (left column)
"As nations prepare for a possible avian flu virus pandemic, state and federal health officials are working on a proposal to screen travelers who arrive at Honolulu Airport with influenza-like illness...The system was in place when severe acute respiratory syndrome, or SARS, emerged as a threat in 2003..."Not new. WA state has the same policy. Trouble is the health department thinks the airport does it and the airport thinks the health department will come do it if needed. :P

Most states with international ports at least have plans on the books to do this. What's missing is the hard part of the pandemic planning, that which requires money. US has enough meds for 1% of the population. Britain for example is stockpiling enough for 25%. Canada as well is stockpiling some.

Want to read something scary, read this. (http://www.promedmail.org/pls/askus/f?p=2400:1001:3824766470672399599::NO::F2400_P1001 _BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,29040) Of course it is a rumor at this point which often turn out to be incorrect. I'll let you all know if it gets confirmed or refuted. Either way the bug marches on. :o

Parrothead
2005-May-26, 09:51 PM
May 25 (http://starbulletin.com/2005/05/25/news/) (left column)
"As nations prepare for a possible avian flu virus pandemic, state and federal health officials are working on a proposal to screen travelers who arrive at Honolulu Airport with influenza-like illness...The system was in place when severe acute respiratory syndrome, or SARS, emerged as a threat in 2003..."

I trust Honolulu airport actually uses the machines. During the SARS outbreak/scare here in Toronto, the feds had a great photo-op with the scanner, which ended up back in its crate, as it couldn't be decided how or where to use the scanner. It was also stated that there wasn't any training or software for the scanner at the airport :roll:

beskeptical
2005-May-27, 07:07 PM
OK, suppose there was a flu pandemic going around right now. How long would I have to remain indoors and away from crowds? How would I get my food and other supplies? Where can I buy face masks and face shields that won't blow my budget? How many should I get? I want to be prepared for this. I don't want to die.

- Maha VailoYou can get inexpensive disposable masks at most health care supply places. Some of them have walk in stores but there is no reason anyone couldn't order on line. Some places require DEA numbers but those really only apply to prescription supplies. Google for N95 disposable masks. Don't forget some kind of eye protection like goggles.

The CDC is claiming we only need to worry about "droplet" spread. That means if you stay > 3 feet away (maybe further if someone is coughing in your direction) AND wash your hands and don't touch your eyes, nose, or mouth with unwashed hands you should be 90% safe. Stock up on those waterless alcohol based hand cleaners. They are going to become very popular.

If people are dying in the streets, stay home until things settle down. That is a very worse case scenario. I recommend you have a few weeks of food stocked up but you can plan on your water service probably working unless the employees don't go in or something very very extreme. The chance of things getting this bad are extremely small but they certainly did occur in 1918.

But don't worry. That doesn't help at all. And right now, the risk is not 100% of a 1918 recurrence. The risk is probably is 100% of a looming flu pandemic. But we have had many 'bad' flu pandemics without 1918 severity. IE the odds are greater for a less spectacular pandemic.

sarongsong
2005-Aug-05, 06:18 AM
August 4, 2005 (http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=358143&in_page_id=17 74)
"...Two separate teams of scientists [UK and USA] investigated the worst case scenario for bird flu and came to similar conclusions. Both models focused on Thailand, one of the places at highest risk..."

Sammy
2005-Aug-08, 04:46 PM
Maybe good news!



Avian Flu Vaccine Ready for Mass Production
By DAVID PACE, AP

WASHINGTON (AP) - Mass production of a new vaccine that scientists believe can protect against an avian flu outbreak could begin as early as mid-September, the director of the National Institute of Allergy and Infectious Diseases said Sunday.

Dr. Anthony S. Fauci said the government is ready to move ahead with ordering significantly more than the 2 million doses it acquired from a French vaccine maker before testing began earlier this year to jump start the U.S. vaccine stockpile in case the tests were successful.

Additional tests of the vaccine are being conducted on the elderly and children.

The initial tests of the 450 healthy adults found that higher doses than normally given in the seasonal flu vaccine were needed to produce the required immune response. Even larger doses likely would be needed to induce a similar immune response in the elderly.

Fauci said more testing is needed to determine the optimal dosage level. Until that is done, the 2 million doses already purchased by the government in bulk form cannot be repackaged for use if there is an emergency.

Health and Human Services Secretary Mike Leavitt said last week the government wants to stockpile 20 million doses of the new vaccine. He estimated that it would take four to six months to mass produce the vaccine.

More at http://aolsvc.news.aol.com/news/article.adp?id=20050807135509990005

sarongsong
2005-Aug-16, 04:34 PM
August 16, 2005 (http://www.washingtonpost.com/wp-dyn/content/article/2005/08/16/AR2005081600103_pf.html)
"Russia said on Tuesday an outbreak of bird flu in Chelyabinsk was dangerous to humans...no cases among humans have been confirmed in Russia...has killed more than 11,000 birds countrywide and could spread westwards to Europe, the Middle East and Africa...Neighbouring Kazakhstan and Mongolia have also reported outbreaks...Vlasov said there was no way to block the migration routes...as tens of millions of birds continue their migration to warmer climates from next month ahead of Russia's harsh winter."
Shades of Alfred Hitchcock!

sarongsong
2005-Sep-17, 12:18 AM
September 15, 2005 (http://abcnews.go.com/Primetime/Investigation/story?id=1130392&page=1)
"This week, the U.S. government agreed to stockpile $100 million worth of a still-experimental vaccine..."Right now in human beings, it [the H5N1 virus] kills 55 percent of the people it infects...the most lethal flu we know of that has ever been on planet Earth affecting human beings", says Laurie Garrett, a senior fellow on global health policy at the Council on Foreign Relations..."

TriangleMan
2005-Sep-30, 03:34 PM
The WHO is still greatly concerned about a pandemic, recent statements from the WHO indicate that if the virus can undergo human-human transmission we could be in danger of a pandemic that will kill millions of people. :sad:

From a 2005 WHO report (http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_05_8-EN.pdf)


In view of the immediacy of the threat, WHO recommends that all countries undertake urgent action to prepare for a pandemic.
Please take time to read WHO documentation and/or other health information on how to prevent the spread of flu. Things like washing your hands frequently should become a habit!

TriangleMan
2005-Sep-30, 04:18 PM
The potential pandemic from H5N1 is the cover story in this month's National Geographic (http://www7.nationalgeographic.com/ngm/0510/feature1/multimedia.html). NG's estimates of the death toll if the pandemic occurs range from 7.4 to 360 million.

sarongsong
2005-Oct-05, 01:21 AM
October 4, 2005 (http://news.yahoo.com/s/nm/20051004/ts_nm/bush_birdflu_dc)
"President George W. Bush asked Congress on Tuesday to consider giving him powers to use the military to enforce quarantines in case of an avian influenza epidemic..."

beskeptical
2005-Oct-05, 06:53 AM
I am so uncomfortable thinking the current administration is focusing on military enforcement of quarantine. That is so unnecessary and unhelpful. I suppose we aren't supposed to get into politics on this board as we didn't on Phil's but I'm sorry, in this case, that is the issue.

I can't help thinking the current administration is so far removed from science that they have the movie picture of how a pandemic will unfold instead of a picture based on history and the science of epidemics for which we have a current wealth of information.

We have so much data from the SARS epidemic. Taiwan may have locked folks in a hospital but Toronto certainly didn't need to. It makes me so upset thinking about another major disaster with the current incompetent administration in charge I can't even begin to discuss it.

Archer17
2005-Oct-05, 08:18 AM
I am so uncomfortable thinking the current administration is focusing on military enforcement of quarantine. That is so unnecessary and unhelpful. I suppose we aren't supposed to get into politics on this board as we didn't on Phil's but I'm sorry, in this case, that is the issue.

I can't help thinking the current administration is so far removed from science that they have the movie picture of how a pandemic will unfold instead of a picture based on history and the science of epidemics for which we have a current wealth of information.

We have so much data from the SARS epidemic. Taiwan may have locked folks in a hospital but Toronto certainly didn't need to. It makes me so upset thinking about another major disaster with the current incompetent administration in charge I can't even begin to discuss it.Spare me. Politics has nothing to do with this. If this "flu" ever reaches our shore it's an infectious disease problem, not a political problem. You of all people should know that.

sarongsong
2005-Oct-05, 06:11 PM
As you are on the frontlines of this threat, beskeptical, your views are appreciated. Any thoughts on Tamiflu, regarded by some as our current 'best' medication for this?

Archer17
2005-Oct-05, 06:50 PM
As you are on the frontlines of this threat, beskeptical, your views are appreciated..I concur .. as long as she leaves political rants out of it.

Halcyon Dayz
2005-Oct-05, 10:11 PM
Wouldn't the administration just be following the advice of the CDC?
At least one would hope so.

And proper policy would very much depend on the scale of the outbreak.

sarongsong
2005-Oct-05, 10:37 PM
Rant? Sounds like an astute observation to me; the history of FEMA's leadership, e.g., and I've not heard a peep from our Surgeon General on the subject, not even a word on his website (http://www.surgeongeneral.gov/):
"...America's chief health educator, giving Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury...".

Blob
2005-Oct-05, 11:07 PM
Hum,
it seems the 1918-19 Spanish flu virus was probably a strain that originated in birds.

Sam5
2005-Oct-06, 02:31 AM
If people are dying in the streets, stay home until things settle down.

That sounds like good advice.

beskeptical
2005-Oct-06, 06:07 AM
I concur .. as long as she leaves political rants out of it.
Archer, you're missing the point of my post. And I hardly would call my post a 'rant'.

I meant it in all seriousness. Do you think we need the military to enforce quarantine if people are dying in large numbers? Most people will stay home willingly. AND, one doesn't spread the influenza by walking down the street. One spreads it by being close to other people and via contaminated surfaces. The surfaces and one's hands can be washed and you won't need any military to get people to avoid contact with other people if we have a pandemic.

My point was, such a public announcement and even thinking that such a Presidential action was necessary at this time, let alone important enough to occupy a high priority in the disaster planning shows the administration is not using scientific advisers but rather the inner circle mentality this administration has used since it came to power. I could go on with examples but clearly that bothers you and would detract from my point rather than further explain it.

I am on the front lines of pandemic flu. Not only is my specialty infectious diseases but I have been in on the planning of pandemic flu preparedness for about 20 fire and 10 police departments to varying degrees for many years. I will be meeting with one of those fire departments and the public health department tomorrow for a regional planning meeting specifically focused on pandemic flu. We are taking it very seriously here on the Pacific Rim.

If the 'big one' arrives anytime in the next year I can tell you with confidence our federal government is out of touch with the science and completely unprepared. The CDC has been warning the country for years and was only taken seriously by more than a few folks in Congress in the last couple of months.

And like it or not, my opinion of the declaration the military will potentially be brought in to enforce some quarantine is that will make things many times worse, not better. Ask people to stay home and the vast majority will readily comply. You can then cope with the small contingent of dumb people that don't comply with local enforcement.

Threaten people with military enforcement of a quarantine and you will have people so upset they hide, lie and fight back rather than cooperate. It frightens them and they lose all trust that it is for their own good to be locked up. Think about it.

But rather than speculate, look back at epidemics in recent history and you'll see plenty of evidence such movie plot actions are not only unnecessary, they are not the best approach at all.

We did have institutions for TB disease and Leprosy isolation in the past and people were required to go there. The military was not called in to enforce such measures. Almost everyone just went if they had to. Was the military called in to isolate people in 1918? Of course not! Did they need the cops, let alone the military in Toronto during the SARS outbreak? I don't think so.

The only places I have ever seen or read about such nonsense as military enforcement of quarantine during epidemics are in countries where the military is the government and the population still hasn't bought into the germ theory.

In Taiwan during SARS they locked the staff and patients into one hospital. Most disease experts would tell you there probably were batter ways to have handled that situation.

In Kinshasha during one Ebola outbreak people fled to neighboring towns instead of staying put as they were asked. During a flu pandemic either you will have a small number of cases contained or it will be everywhere anyway. It will not be like Ebola in Kinshasha.

So cite me some examples in history, Archer, where we needed the military to intervene in a pandemic. I've only seen such nonsense in the movies and in the flu docudrama that was on TV last year. And that docudrama had so much crap that was unrealistic, it wasn't a docudrama it was pure fiction. It was the movie version of what people think a pandemic will be like. It isn't what it will be like at all.

I'll go through the WHO and CDC's planning for flu pandemics and see if there is any call for the government to grant itself emergency powers to send troops in to force people into where ever they think they are going to send those people. It's stupid. The last thing you want is for people to be in mass congregations or institutional settings. You want people to stay home in their houses away from large gatherings. You won't need any military to enforce that!

Maybe the police will need a little help from the military with civil disorder when Congress decides to give itself scarce flu vaccine like they did last year during the vaccine shortage. The criteria was not "people who might be exposed to lots of people" but that was the criteria Dr Frist claimed when he obtained some for himself and his friends. They set a great example for the rest of the country then. Showed their great leadership, yep. Followed scientific guidelines for who should get the flu vaccine, yes sir. (Now that last paragraph is a rant!)

Philip A
2005-Oct-07, 03:17 AM
CDC in Atlanta have reproduced the 1918 virus. They found it share some of the same mutations as H5N1.

http://news.bbc.co.uk/1/hi/health/4308872.stm

Philip A
2005-Oct-07, 03:20 AM
Oh, and I do feel there is a role for the military to enforce quarantines - sensible people will quarantine themselves, but how many people will be tempted to travel (eg to get home to their families)? Public transport will need to be shut down, especially international. Air travel is not our friend in pandemic times.

Fingers crossed!

beskeptical
2005-Oct-07, 06:01 AM
Oh, and I do feel there is a role for the military to enforce quarantines - sensible people will quarantine themselves, but how many people will be tempted to travel (eg to get home to their families)? Public transport will need to be shut down, especially international. Air travel is not our friend in pandemic times.

Fingers crossed!Well for starters, there is absolutely no role for any military enforcement of a quarantine if we should have a pandemic.

I went to the planning meeting today. It was attended by a diverse room full of folks from city human resources people to medics to public health to hospital administrators. There were many more people than I had imagined would be there.

So let me address the quarantine issue for starters. Someone asked the public health presenter the very question we are discussing here. The questioner noted hearing the President's step taken and asked how it would fit in. The presenter smiled in an eye rolling way and said it, "wasn't part of the public health's recommendations for the response" and that they saw no place it would be used. Why? Because it's a PANDEMIC! Who on Earth are you going to isolate from whom? Every region will be affected. Like I said, you won't have some disease carrying folks running away from Kinshasha. You will have disease in every corner of the country and the world in a very short amount of time.

Get the TV/movie version of a pandemic out of your head for a minute, (if you are inclined to agree with the idea we need the military and enforced quarantine), and look at the historical facts instead. Nine people rode in one elevator and took SARS around the world overnight via air travel. Thousands were infected and hundreds died. That might have come close to your movie scenario except for one thing. No one needed the military to contain any out break. The public health and the medical community did just fine without such measures, thank you.

Now take that same scenario and change one factor. In the SARS outbreak everyone was extremely ill and easily identified. In a flu pandemic as many as 40% of the infected persons who could also transmit disease will not have any symptoms or their symptoms will be so mild as to be indistinguishable from the 200 other known respiratory illnesses that plague the world's population at any one time. Just who would you quarantine and what good would it do?

In 1918 the first wave of infections spread around the entire planet in only 4 months and that was before air travel! Do you really see our government initiating and conducting an effective quarantine in that amount of time? Are you dreaming?

You don't call on the military and the President to quarantine anyone. That is just silly. It may sound good to pass such a law which by the way has always been on the books anyway. The public health has the authority to order enforced quarantine of persons who might spread serious infections. I'm not sure when the first such laws were passed but they were used to lock up "Typhoid Mary" and they have been used to put people with TB and Leprosy in institutions for many many years. But I digress. For Bush to call for such an order in preparation for pandemic flu just shows how removed he is from the actual planning for this disaster.

So what do you do? You close the schools, theaters, malls and so on. You start now teaching everyone how to wash their hands and cover their coughs and to stay home when they are sick. You teach doctors that Tamiflu only works if started on the first day of symptoms so they don't waste it trying to treat patients who have progressed to severe symptoms after the first 48 hours since it would just be wasting the scarce drug. You identify essential services such as medical care, police and fire and plan for how you will manage severe staffing shortages in those areas as well as how you will manage a huge overload of need in health care services. You cross train as many people as possible so when those needs arrive there might be folks who aren't needed in non-essential services that can take up positions that are essential. You get everyone on the same page so there isn't a breakdown in authority where no one knows who is in charge.

Those are some examples of the plan. Military quarantine has absolutely no place in the plan for dealing with pandemic flu and Bush's call for such powers shows me he hasn't bothered to ask the experts or if he asked, he didn't listen to the answers.

sarongsong
2005-Oct-07, 06:33 AM
...So what do you do?...You teach doctors that Tamiflu only works if started on the first day of symptoms so they don't waste it trying to treat patients who have progressed to severe symptoms after the first 48 hours since it would just be wasting the scarce drug...Wow!---had not heard this before---what a challenge to meet. What precautions will health-care professionals themselves be taking to prevent infection when encountering/treating definitely infected patients?

beskeptical
2005-Oct-07, 07:16 AM
Wow!---had not heard this before---what a challenge to meet. What precautions will health-care professionals themselves be taking to prevent infection when encountering/treating definitely infected patients?The key is containing contamination and preventing it from reaching your eye/nose/or mouth.

The majority of flu is spread by droplets that only reach about 3 feet from a person coughing before settling to the ground. But these same droplets go from hand to surfaces to the next hand then to one's face. Particulate respirators, hand washing and the rest of the basics of contact isolation will prevent much transmission.

Worrisome though is one of the discoveries reported on by the researchers that reconstructed and studied the 1918 flu strain was they found it had the ability to create massive viral shedding in infected mice. That may be one of the reasons the 1918 strain spread so fast.

How much true airborne spread may occur is one of the unknowns. Particulate respirators filter out droplets but not single viral particles should those be floating free. Still, there is a limit on distance airborne particles can travel before they are too diluted to cause infection. We learned from SARS that meticulous contact isolation did prevent spread. Now we just need to get the message out to health care workers what meticulous means because it isn't the isolation procedures they are used to.

beskeptical
2005-Oct-07, 07:23 AM
CDC in Atlanta have reproduced the 1918 virus. They found it share some of the same mutations as H5N1.

http://news.bbc.co.uk/1/hi/health/4308872.stmThis was particularly bad news. There are some researchers that are convinced H5 will never be a major human disease. The 1918 strain was H1. But to me the other findings sort of overshadowed the H5 issue.

Maha Vailo
2005-Oct-07, 10:21 AM
Just out of curisity, if this thing becomes pandemic and there is a quarantine, how long would it last? What is life like in a city under quarantine, and how to survive it?

Also, what are the first signs of a flu infection? I've never had a severe case, so....

- Maha Vailo

Gillianren
2005-Oct-07, 06:24 PM
. . . and to stay home when they are sick.

okay, then the first step should be keeping people from getting fired if they do. I've worked in jobs where, if you were sick more than a few days, you were pretty much out of luck. for a while, they accepted receipts for cold meds as evidence that you were actually sick and not, say, gallivanting with friends. for a while longer, they accepted doctors' notes, not that most of the people working there could afford to go to a doctor every time they were sick. (nor, in my opinion, should they have had to--what's a doctor going to do? tell you that you have a cold and you should stay in bed and drink plenty of fluids.)

I knew a girl who nearly got fired over a case of laryngitis--we were doing phone work, and if you couldn't talk, you had to go home, but you lost points anyway. (you got a total of sixteen points for every six-month period, and if you missed a day, you lost five. if you were late, you lost one. if they sent you home because you were sick, I think it was two.) a lot of us wanted to stay home when we were sick, but we couldn't afford to lose our jobs over a cold.

beskeptical
2005-Oct-07, 06:50 PM
Just out of curisity, if this thing becomes pandemic and there is a quarantine, how long would it last? What is life like in a city under quarantine, and how to survive it?

Also, what are the first signs of a flu infection? I've never had a severe case, so....

- Maha VailoHave you read nothing I wrote????? Services will be shut down like schools but there will be NO QUARANTINE short of one or two cases and their family members or close contacts with the first few cases that come BEFORE the pandemic. After that there will be no one to isolate from anyone since everyone will be exposed to everyone all over the world in a very short amount of time.

If history is out guide, it will likely be several months then return in shorter waves.

beskeptical
2005-Oct-07, 06:52 PM
okay, then the first step should be keeping people from getting fired if they do. ......That is absolutely one of the goals both for pandemic flu and for public health in general. Educate employers to not only encourage people who are sick to stay home but to plan for major staffing shortages by identifying critical jobs and cross training workers to increase flexibility with the limited staff you will have.

sarongsong
2005-Oct-08, 08:18 AM
...You get everyone on the same page so there isn't a breakdown in authority where no one knows who is in charge...Bush Plan (http://www.nytimes.com/2005/10/08/politics/08flu.html?ei=5090&en=fe3a7bec6c129653&ex=1286424000&partner=rssuserland&emc=rss&pagewanted=print)---NY Times-October 8
..."The real shortcoming of the plan [to be released soon] is that it doesn't say who's in charge," said a top health official who provided the plan to The Times....a spokeswoman for Health and Human Services Secretary...emphasized that the plan given to The Times was a draft and had not been finalized...A key point of contention if an epidemic strikes is who will get vaccines first. The administration's plan suggests a triage distribution for these essential medicines...the plan has the feel of a television movie-of-the-week when it describes a possible pandemic situation...

JohnD
2005-Oct-08, 04:43 PM
Above posters and BeSkeptical point out that few of us have any experience of epidemics, let alone pandemics.

To read what it was like working in the SARS epidemic go to the website of the Association of Anaesthetists of Great Britain and Ireland and their "Anaesthesia News" pages. There, in a series of seven articles entitled "Smile and retain smile", Dr.Anna Xi Zhao describes the experience that she, her colleagues and patients underwent at her Beijing hospital in April 2003.

Goto http://www.aagbi.org/pdf/A_News_Oct03.pdf for the first installment.
John

beskeptical
2005-Oct-08, 08:55 PM
Love your post Sarongsong. Much to Archer's dismay, this is about incompetence in leadership. Just as I'm sure global warming discussions on the board cannot stay completely politically free, neither can a pandemic flu discussion.

Our community is planning to be prepared without federal level involvement. That's what we all need to be doing now. Contact your own local officials and ask what they are doing to plan for this. Prepare yourself and your household. Don't expect the federal government to handle it well. My concern in bringing up Bush's call for armed forces was that it showed how poorly he was communicating with and listening to the health experts and the science.


On another note, the cultures are not in re: the outbreak among turkeys in Turkey and ducks in Romania. Wait and see before assuming it is H5N1 and not other bird flu strains we are less worried about. If it does turn out to be H5N1 that is a bad sign in how fast it is spreading, especially since human flu strain infections will be peaking in a couple of months.

sarongsong
2005-Oct-08, 10:00 PM
Your alerting us to what is/is not going on almost leads me to believe you're a NY Times stringer!

genebujold
2005-Oct-10, 12:23 AM
Some time in the last year, I posted news about a looming pandemic. I believe it was around this time last year.

Here's an update: http://www.cnn.com/2005/HEALTH/10/08/flu.pandemic.ap/index.html

sarongsong
2005-Oct-10, 04:06 AM
...The government has on hand enough of the anti-flu drug Tamiflu to treat 4.3 million people. Manufacturing of $100 million worth of a bird flu vaccine just began...A couple of interesting reflections on 1918's Spanish flu:
"...Spain, neutral in the war, writes about the powerful flu, which is thereafter called the Spanish Flu..."
http://home.swipnet.se/roland/flu.html
"In the late Summer 1998 issue (http://www.altheal.org/continuum/Vol5no4.pdf) (.pdf), Greg Bunker, in his article Lust for Life, comments on the disease epidemics that follow world wars and refers to the Spanish Flu disaster after WWI...The real killer was typhoid vaccine..."
http://www.whale.to/vaccines/spanish_flu.html

beskeptical
2005-Oct-10, 06:30 AM
A couple of interesting reflections on 1918's Spanish flu:
"...Spain, neutral in the war, writes about the powerful flu, which is thereafter called the Spanish Flu..."
http://home.swipnet.se/roland/flu.html
"In the late Summer 1998 issue (http://www.altheal.org/continuum/Vol5no4.pdf) (.pdf), Greg Bunker, in his article Lust for Life, comments on the disease epidemics that follow world wars and refers to the Spanish Flu disaster after WWI...The real killer was typhoid vaccine..."
http://www.whale.to/vaccines/spanish_flu.htmlSarongsong the typhoid article is nonsense. Don't tell me you find any credibility there!

Hey, it wasn't typhoid vaccine, it was space aliens because I said so.

VTBoy
2005-Oct-10, 07:04 AM
The virus could be adapting to tamiflu, this could be a major problem. All of those dosages of tamiflu goverments around the world have been ordering might be for nothing if this virus reaches pandemic level and tamiflu ends up having little effect on it.

beskeptical
2005-Oct-11, 07:38 AM
The virus could be adapting to tamiflu, this could be a major problem. All of those dosages of tamiflu governments around the world have been ordering might be for nothing if this virus reaches pandemic level and tamiflu ends up having little effect on it."Could be a major problem"? As if there isn't already one? Just how much of this drug do you figure is stockpiled relative to the world population?

The fact there isn't enough Tamiflu is a much bigger problem right now than drug resistance. While one strain did show some resistance the researcher talking to the media was misquoted. He said resistance was expected and they printed resistance had arrived. I can't find the citation but I read it a day or so ago.

I have been following the drug resistance issue and Tamiflu still works against the current circulating strain.

You must take Tamiflu within the first 48 hours of symptoms or it is too late to change the disease outcome. This also makes using the drug difficult because you need diagnosis and access to the drug as soon as you are sick. I can manage that for me and my son but how is JQ Public supposed to know the difference between a cold vs flu and then get their drug? And we certainly don't have enough drug for people to waste it on the 200 other organisms that cause respiratory infections. So it won't be practical to dole it out for home use. Our health care system isn't geared for how you have to use Tamiflu.

And don't forget, we are coming upon the regular flu season. If you have a high risk patient with flu now, they really should be getting Tamiflu if possible. No one would advocate saving it for the 'big one' if your patient really needs it today. Supply is the problem now, not resistance. Resistance will be the next problem.

Maha Vailo
2005-Oct-11, 10:46 AM
So then, what distinguishes the flu from other illnesses, initial-symptom-wise? I've never had a bad case of it, so I'd really like to know.

- Maha Vailo

soylentgreen
2005-Oct-11, 06:20 PM
Bush Plan---NY Times-October 8

Interesting...well, downright scary, actually! Not that I needed more confirmation that the word "preparedness" is not in the pocket dictionaries of anyone in the current administration.

I guess the best plan is to get out your old copies of "The Stand" and brush up on doomsday etiquette.

I'll being seeing you all(well some of you at least ;) ) in Boulder!

beskeptical
2005-Oct-11, 08:11 PM
So then, what distinguishes the flu from other illnesses, initial-symptom-wise? I've never had a bad case of it, so I'd really like to know.

- Maha Vailo
First, flu is not vomiting and diarrhea as many people believe. Influenza is a severe respiratory infection.

It tends to start rather quickly with fever > 101 F in adults*, headache and severe muscle aches. By the second day the person experiences more respiratory symptoms and coughing. A sore throat will be there but it probably won't be like some viruses that start with a sore throat for a day or two before the rest of the symptoms. In addition people usually have no desire to eat and may have nausea but the disease is respiratory, not GI.

One reason influenza is typically more severe than other respiratory viruses is that it often infects the middle airway rather than just the upper airway. Flu invades the cilia in your trachea. Other viruses tend to be in one's throat rather than in one's airway. It is not uncommon for influenza viruses to spread to the lungs and cause a viral pneumonia. Flu leaves the body vulnerable to secondary bacterial infections as well.


*Fever is not as predictive in young children as they get high fevers with milder viruses and in the elderly you may not see a strong febrile response to infection.

beskeptical
2005-Oct-11, 08:13 PM
Interesting...well, downright scary, actually! Not that I needed more confirmation that the word "preparedness" is not in the pocket dictionaries of anyone in the current administration.

I guess the best plan is to get out your old copies of "The Stand" and brush up on doomsday etiquette.

I'll being seeing you all(well some of you at least ;) ) in Boulder!It won't be doomsday nor like Outbreak nor The Stand. Very serious, yes, like the movie versions, no.

BTW, you forgot The Omega Virus, the classic fantasy version of this type of thing. ;)

Sam5
2005-Oct-11, 08:50 PM
How about wearing surgical masks in public? Would that help?

I remember seeing a lot of film from China, back when Nixon was there in the early '70s, and it showed a lot of Chinese people on the streets, riding their bicycles, and many of them were wearing surgical masks. News reports said that was part of a public health project in China that was designed to help cut down on the spread of flu and colds among the general population.

Every November and December, when all the local stores where I live are filled with sneezing people, I would like to wear a surgical mask, but no one else is wearing one, and I don't want to be the only guy in the store wearing one.

Any advice here from our Board Doctors?

sarongsong
2005-Oct-12, 12:29 AM
October 9, 2005 (http://news.yahoo.com/s/ap/20051009/ap_on_he_me/flu_pandemic)
"...health workers would need to wear special masks, known as N-95 masks (http://www.magellans.com/store/Health___Hygiene___SanitationIF115?Args=), to prevent infection while treating patients. Two U.S. companies produce 90 percent of the world's supply and "we'll run out overnight," Osterholm [University of Minnesota government adviser] said..."
These don't seem to provide eye protection, tho:

...The key is containing contamination and preventing it from reaching your eye/nose/or mouth...

Sam5
2005-Oct-12, 12:41 AM
I don't see doctors using eye protection.

TriangleMan
2005-Oct-12, 10:54 AM
I remember seeing a lot of film from China, back when Nixon was there in the early '70s, and it showed a lot of Chinese people on the streets, riding their bicycles, and many of them were wearing surgical masks. News reports said that was part of a public health project in China that was designed to help cut down on the spread of flu and colds among the general population.

It is also common in Japan for people who have a cold to wear a surgical mask when walking around. It might be something that is done throughout East Asia.

beskeptical
2005-Oct-12, 05:48 PM
Anyone with a cough or cold symptoms should wear a mask. If we changed our culture to make that more acceptable we'd be better off.

Health care workers will be using N95 or N100 particulate respirators, (masks), when in close contact with infected patients. The public will not find the masks offer any better protection than merely staying away from crowds and ill persons.

Yes, health care workers need to cover their eyes, nose and mouth, not just nose and mouth.

Influenza is mostly droplet spread but with some potential to also be airborne. Droplets are big and fall to the ground at about 3 feet or less from the patient. Surfaces your hands touch are a common source of transmission.

Airborne spread means the droplets coughed and breathed out by the infectious patient are small enough to remain airborne and travel longer distances. But keep in mind, the amount of this virus traveling in the air also has to remain concentrated enough to be an infectious dose. Some organisms are infectious with just a few reaching the new subject. Many, however, take a larger amount to cause disease. Think of it like a fire. You can light a fire but without enough flame and kindling not everything actually catches fire. It can just fizzle out, or it can burn down a building or forest.

We have no way of knowing at this point if the next flu pandemic virus is going to be highly infectious, nor do we know what virus quantity the infected persons are going shed from their throats.

If the virus is highly infectious and ill persons or even as is most likely, some persons infected but with no symptoms, shed large quantities of virus, then particulate respirators will be proportionately less effective. They happen to filter out bacteria size particles but viruses actually go right through the masks as do air molecules. Unless you have a contained air respirator, there is no filter mask that will leave you completely safe. If a filter mask were good enough to block airborne viruses, you couldn't breathe through it.

The idea of health care workers using particulate respirators is to block droplets. Viruses may also become trapped in the mask material despite fitting between the gaps just as water soaks into a sponge. But no tests have been done to my knowledge that confirm the respirators will be effective against influenza. The masks are only approved officially for TB. This fact is being politically ignored by the public health in their recommendations for isolation technique for health care workers taking care of influenza infected patients.

If you read the guideline rationale you will find conclusions, (assumptions?), that flu is droplet spread and that research to the contrary is sort of ignored. If it weren't political you find a discussion of the controversy. Instead the controversy is conveniently ignored. I think it is because we don't have better options so why point that out.

beskeptical
2005-Oct-12, 06:00 PM
Any advice here from our Board Doctors?What, a nurse practitioner who has specialized in this field for 15 years isn't good enough for you? I get calls from many doctors to ask for my advice. And, in addition, in this country, nurses not doctors have always been on the forefront of prevention of the spread of infectious disease. Only public health doctors work on this side of the equation. Infectious disease doctors treat sick people. They have little to do with prevention.


Every November and December, when all the local stores where I live are filled with sneezing people, I would like to wear a surgical mask, but no one else is wearing one, and I don't want to be the only guy in the store wearing one.Why not? Someone has to start the trend.

People actually appreciate ill persons wearing masks so there is no reason not to.

And I forgot to point out in my post above that a surgical mask on a coughing patient is more efficient at stopping viruses from filling the air than is a surgical mask being worn by the well person effective in preventing inhaling those viruses.

beskeptical
2005-Oct-12, 06:03 PM
http://www.ph.ucla.edu/epi/bioter/n95masks.html

Article about mask hype.

beskeptical
2005-Oct-12, 06:12 PM
Actually there are more than 2 manufacturers listed by NIOSH as having approval for the respirators they make. Whether 2 companies have 90% of the market share (I don't know if that is true or not but it sounds plausible), doesn't mean they have 90% of the capacity to manufacture the masks. But we will run out over night. SARS showed us that. And I'm not sure if anyone in the Bush government is putting money into mask manufacturing. The health care industry which does need the masks does not have anything close to enough.

N95 http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html
N99 http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n99list1.html
N100 http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n100list1.html

TriangleMan
2005-Oct-12, 07:33 PM
What, a nurse practitioner who has specialized in this field for 15 years isn't good enough for you? I get calls from many doctors to ask for my advice. And, in addition, in this country, nurses not doctors have always been on the forefront of prevention of the spread of infectious disease.
In all fairness to Sam5 I doubt he said "doctors" as a deliberate snide to you. Most posters here probably assume that you are a doctor, especially those who rarely post outside of ATM and General Astronomy Forums, like Sam5.

Sam5
2005-Oct-12, 10:35 PM
What, a nurse practitioner who has specialized in this field for 15 years isn't good enough for you? I get calls from many doctors to ask for my advice. And, in addition, in this country, nurses not doctors have always been on the forefront of prevention of the spread of infectious disease. Only public health doctors work on this side of the equation. Infectious disease doctors treat sick people. They have little to do with prevention.




My humble apologies. I didn’t know you were a nurse.

JohnD
2005-Oct-12, 11:00 PM
All,
Are you niot interested in first hand accounts of epidemic experience?

BeSkeptical will be aware of the Toronto SARS outbreak. You may like to read the experience of the Anaesthesia and ICU teams at Toronto in 2003: http://bja.oxfordjournals.org/cgi/content/full/90/6/715

D*mn right you don't see doctors using eye protection, Sam5. Note the first para line in the above editorial, "Over half of those infected [267] have been frontline healthcare workers, including three anaesthetists and one intensivist."

Note also the Toronto recommendations for self protection from a severely ill SARS patient: "Apply N95 mask, goggles, disposable protective footwear, gown and gloves. Put on the belt-mounted AirMateTM and attach the respirator tubing and Tyvek® head cover [filtered air supply bto enclosed helmet]. Then apply extra gown and gloves."


John

tbm
2005-Oct-12, 11:06 PM
Dumb question, what are the symptoms?

I haven't been sick for 4 years, and I got a whammy this last week.
Chills, fever, chills, fever, stuffy nose.


Add death to that symptom list and you've got the A/F.


tbm

Gillianren
2005-Oct-13, 02:08 AM
Hey, Beskeptical, I was telling my boyfriend's mom about this thread, and she said that she thought you seemed like an intelligent, reasonable person with your head screwed on straight. I told her you were. You're one of the people I consider to be among the most practical-minded on the board.

Sam5
2005-Oct-13, 05:32 PM
Above posters and BeSkeptical point out that few of us have any experience of epidemics, let alone pandemics.

To read what it was like working in the SARS epidemic go to the website of the Association of Anaesthetists of Great Britain and Ireland and their "Anaesthesia News" pages. There, in a series of seven articles entitled "Smile and retain smile", Dr.Anna Xi Zhao describes the experience that she, her colleagues and patients underwent at her Beijing hospital in April 2003.

Goto http://www.aagbi.org/pdf/A_News_Oct03.pdf for the first installment.
John

I and all my friends and relatives survived the Hong Kong flu and the Asian Flu. I don't think I want the government involved in putting troops on the ground trying to "manage" a flu attack. People die in this country every year of "the flu". I don't think need troops getting involved with this, or FEMA.

---------------

“By December 1957, the worst seemed to be over. However, during January and February 1958, there was another wave of illness among the elderly. This is an example of the potential "second wave" of infections that can develop during a pandemic. The disease infects one group of people first, infections appear to decrease and then infections increase in a different part of the population. Although the Asian flu pandemic was not as devastating as the Spanish flu, about 69,800 people in the U.S. died.

1968: Hong Kong Flu
In early 1968, the Hong Kong influenza pandemic was first detected in Hong Kong. The first cases in the U.S. were detected as early as September of that year, but illness did not become widespread in the U.S. until December. Deaths from this virus peaked in December 1968 and January 1969. Those over the age of 65 were most likely to die. The same virus returned in 1970 and 1972. The number of deaths between September 1968 and March 1969 for this pandemic was 33,800, making it the mildest pandemic in the 20th century.”

http://www.hhs.gov/nvpo/pandemics/flu3.htm

beskeptical
2005-Oct-14, 05:27 AM
In all fairness to Sam5 I doubt he said "doctors" as a deliberate snide to you. Most posters here probably assume that you are a doctor, especially those who rarely post outside of ATM and General Astronomy Forums, like Sam5.It's hard to convey a smile when posting. I wasn't really upset, just wanted to tease a bit about the subtle prejudice that nurses only follow medical commands.

Even though I am a practitioner and can diagnose and prescribe, I have a rich background in nursing science. I see both worlds and they are very different. But each, nursing and medicine, are practices in themselves. Determining what is wrong and what to do about it is typically medicine. Figuring out how to do that 'what' and how to live with that disease is typically nursing.

In the case of infectious disease, preventing the spread has always been more in the nursing field while treating the infection has been more in the medical field.

beskeptical
2005-Oct-14, 05:30 AM
Hey, Beskeptical, I was telling my boyfriend's mom about this thread, and she said that she thought you seemed like an intelligent, reasonable person with your head screwed on straight. I told her you were. You're one of the people I consider to be among the most practical-minded on the board.What a nice thing to say. Thank you very much for the compliment.

beskeptical
2005-Oct-14, 05:50 AM
I and all my friends and relatives survived the Hong Kong flu and the Asian Flu. I don't think I want the government involved in putting troops on the ground trying to "manage" a flu attack. People die in this country every year of "the flu". I don't think need troops getting involved with this, or FEMA.
....I don't think we have to worry about this. I heard quite a few news stories take off on this topic with the 'analysis and what if' that they so often report in lieu of real news. At first I wanted to write letters to the editors then the more I thought it through, it just won't happen. Not because the government isn't stupid enough to do it, but because there just isn't going to be the scenario these fools are picturing when they imagine the military sealing off a town. Isolated cases here and there will not require large scale intervention. And by the time flu has broken out into a pandemic, it will likely be more practical to isolate the towns that aren't affected rather than the towns that are.

Even a disease like SARS that might have needed even more serious isolation than it did would have spread beyond any single city long before such measures would have been called for. In other words, in the movie version, an outbreak spreads around the city. In the real life version, an outbreak spreads all over many cities at the same time.

Look at the SARS cases. It smoldered in a small area of China then soon after it started showing up in lots of places about the same time. A single person spread the virus to 9 people who all left to other parts of the world at the same time. By the time it was recognized as a serious threat, the cases had already started to appear in many countries.

While we will probably know when the H5N1 starts to spread among people if it does, there will be several weeks delay from the time it starts until it is recognized. That is more than enough time for the virus to have spread far and wide.

I don't say this to make the pandemic seem impossible to deal with because we do have the science to protect ourselves. I say it because the idea people in the government, the news media, and lots of the public have of how a pandemic unfolds is just not valid.

And as I said before, the fact the government wants the authority to use the military isn't the problem. The problem is such actions indicate that once again, these guys are not listening to the science.

TriangleMan
2005-Oct-14, 10:56 AM
It's hard to convey a smile when posting. I wasn't really upset, just wanted to tease a bit about the subtle prejudice that nurses only follow medical commands.

Oh. I saw the :mad: smilie and assumed you were serious.

TriangleMan
2005-Oct-14, 11:00 AM
Bird flu H5N1 has now been found in poultry in Turkey (http://news.yahoo.com/s/nm/20051009/hl_nm/birdflu_dc), and it might be in Romania as well, although I've read a news report that so far has not found evidence that the H5N1 was in Romania. No reports of people infected, just poultry.

Disinfo Agent
2005-Oct-15, 10:07 PM
Most posters here probably assume that you are a doctor, especially those who rarely post outside of ATM and General Astronomy Forums, like Sam5.I did, until now.

beskeptical
2005-Oct-15, 10:13 PM
Bird flu H5N1 has now been found in poultry in Turkey (http://news.yahoo.com/s/nm/20051009/hl_nm/birdflu_dc), and it might be in Romania as well, although I've read a news report that so far has not found evidence that the H5N1 was in Romania. No reports of people infected, just poultry.
While a news report came out saying the tests were negative, the official site where countries report animal disease outbreaks (OIE) confirmed the birds in Romania did indeed have H5N1.

Sam5
2005-Oct-15, 11:30 PM
While a news report came out saying the tests were negative, the official site where countries report animal disease outbreaks (OIE) confirmed the birds in Romania did indeed have H5N1.

How does this flu differ from the 1957 Asian flu (H2N2), and the 1968 Hong Kong flu (H3N2)?

I don't remember the Presidents talking about calling out the military during those flu attacks.

beskeptical
2005-Oct-16, 07:03 AM
How does this flu differ from the 1957 Asian flu (H2N2), and the 1968 Hong Kong flu (H3N2)?

I don't remember the Presidents talking about calling out the military during those flu attacks.For one, we have more monitoring going on. We have more news sources and the media always picks up on a disaster the public shows interest in.

I don't know what the news was during those epidemics but I would bet there wasn't a 50% mortality rate making headlines months before the event.

There were headlines and fear about 'the big one' in 1976 when a healthy soldier at Fort Dix suddenly died from flu. That led to the flu shot for everyone campaign that then led to the waaaay overblown Guillian-Barre' scare which then led to people being needlessly afraid of the flu vaccine ever since.

sarongsong
2005-Oct-16, 07:27 AM
Can you tell us yet anything about this year's 'regular' flu vaccine and how effective it is against what is actually showing up so far?

Sam5
2005-Oct-16, 07:57 AM
I don't know what the news was during those epidemics but I would bet there wasn't a 50% mortality rate making headlines months before the event.


Are you saying that 50% of the people who catch this current bird flu, die?

We've got a disease out West here that kills people at about a 90% rate. It's called hantavirus, spread by mice. I think it is killing people back East too because of the symptoms I've heard about in other people. 1) sick with flu symptoms one day, 2) in hospital the next day, 3) dead the next day. My girlfriend's mother died of these same symptoms. She lived back East. No tests were done to find out exactly what she died of. It was diagnosed simply as a "viral pneumonia", but her doctors never tried to find out what caused it.

beskeptical
2005-Oct-17, 06:21 AM
Are you saying that 50% of the people who catch this current bird flu, die?So far a little over 50% of the known cases died. We have no idea what the actual case fatality rate is until more research is done examining the % of the population that have antibodies to H5N1. Right now all we know is what happens to those cases brought into hospitals. There could be very few or many more cases unknown to the researchers.


We've got a disease out West here that kills people at about a 90% rate. It's called hantavirus, spread by mice.The rate is not 90%. Here is some more accurate information:
http://www.cdc.gov/ncidod/diseases/hanta/hps/noframes/caseinfo.htm

Through July 6, 2005, a total of 396 cases of hantavirus pulmonary syndrome have been reported in the United States. The case count started when the disease was first recognized in May 1993. Thirty-six percent of all reported cases have resulted in death.
AND:
http://www.cdc.gov/ncidod/diseases/hanta/hps/noframes/phys/q-a/satconfq_a.htm

Why is HPS uncommon in children in the United States?

Answer: As of June 1, 1999, 217 cases of HPS have been reported in the United States. Thirteen (6%) were 16 years of age or younger, although this age group represents 24.2% of the US population. The youngest reported patient was 10 years of age.

Two or more factors may explain the relative scarcity of HPS cases among children. The first is that children may be less likely to get infected because they do not perform the activities that would put them at risk for infection, such as cleaning in enclosed spaces. Even if they perform these types of activities or have their noses closer to the ground, their total lung exposure to virus may be less than an adult's; despite the fact that children breathe faster than adults, their minute volume is less. Alternatively, they may just be less likely to get infected due to nonspecific immune mechanisms. The second possibility is that children are as likely to get infected as adults, but less likely to develop HPS, the severest manifestation of infection. We would not generally know of these mild infections, but are aware of a 4-year-old boy who had a very mild illness and did not develop the severe cardiac and pulmonary syndrome. We know that HPS is a disease that reflects your immune response to the virus, so it is possible that children respond differently than adults.

The total picture of HPS infection among children is further complicated by studies in South America. There appear to be proportionately more children infected, more children with asymptomatic or mild infections, and children with hemorrhagic manifestations after infections. Some data suggest hantavirus transmission via breast-milk. Further research will help answer this question and provide us a clue to the immunology that underlines infection and disease development.
Dr. Ali Khan, Special Pathogens Branch, CDC.

For further information, see:
Pini NC, Resa A, Laime GDJ, Lecot G, Ksiazek TG, Levis S, et al. Hantavirus Infection in Children in Argentina. Emerg Infect Dis 1998;4(1):85-7.


What percent of the population in disease-endemic areas have HPS antibody but have not presented with symptoms of disease?

Answer: Studies in the United States suggest that most people who are infected with Sin Nombre virus (SNV) develop HPS. The prevalence of antibody to SNV among healthy people residing in the disease-endemic area is extremely low (0.3%). On the other hand, the prevalence of antibodies to South American hantaviruses among health populations in disease-endemic areas of South America may be considerably higher, suggesting that there are inapparent infections or that the disease is mild and unrecognized following infection with some hantaviruses.
Dr. James Olson, Special Pathogens Branch, CDC.

For further information, see:

Williams RJ, Bryan RT, Mills JN, Palma E, Vera I, de Velasquez F, et al. An outbreak of hantavirus pulmonary syndrome in western Paraguay. Am J Trop Med Hyg 1997;57:274-82.


I think it is killing people back East too because of the symptoms I've heard about in other people. 1) sick with flu symptoms one day, 2) in hospital the next day, 3) dead the next day. My girlfriend's mother died of these same symptoms. She lived back East. No tests were done to find out exactly what she died of. It was diagnosed simply as a "viral pneumonia", but her doctors never tried to find out what caused it.There are many infectious organisms out there and there's no way to guess from mere similar symptoms what the people you are referring to had. You need a lot more information.

Tell me a little more about your girlfriend's mother. When did it happen, where did she live, what time of year, what was her health and age at the time?

Hanta virus infections are generally associated with sweeping or vacuuming up mouse nests. Legionnaire's has often gone undiagnosed unless there is a cluster. Influenza kills 20,000 - 40,000 people every winter in this country alone.

No matter what the infection was, it's terrible to lose someone suddenly to an infection. We are lucky to live in this era of antibiotics and good medical science but every now and then we are reminded of the serious potential of infectious diseases.

beskeptical
2005-Oct-17, 06:43 AM
Can you tell us yet anything about this year's 'regular' flu vaccine and how effective it is against what is actually showing up so far?While there have been a few cases of flu in the USA so far, the actual flu season is winter, not fall.

current flu activity in the USA
http://www.cdc.gov/flu/weekly/weeklyarchives2005-2006/weekly40.htm

last year's flu activity in the USA
http://www.cdc.gov/flu/weekly/weeklyarchives2004-2005/04-05summary.htm

http://www.influenzacentre.org/index.htm

Comment on Influenza Vaccine Strain Match (26.11.04)

In September WHO recommended an update of the influenza A(H3N2) vaccine component for the next Southern Hemisphere winter to an A/Wellington/1/2004-like strain due to some recent antigenic drift in virus isolates of this subtype. This has resulted in some concerns that vaccines containing an A/Fujian/411/2002-like virus, currently in use in the Northern Hemisphere, may fail to protect. It is important to note that the formulation of influenza vaccines is reviewed by WHO on a six monthly basis, in order to keep vaccines for use in the two hemispheres as close as possible to the circulating viruses. The ongoing antigenic drift in influenza together with the 4 - 6 month lead-time for vaccine manufacture often results in a vaccine with updated formulation being released in one hemisphere as the vaccination program with vaccines containing an earlier strain are commencing in the other hemisphere. It is against this background that influenza vaccine effectiveness against laboratory-confirmed illness in healthy adults <65 years has been shown to be in the range 70-90%. The antigenic change from A/Fujian/411/2002 to A/Wellington/1/2004 is a relatively modest one, however, even when more significant antigenic differences are seen between vaccine strain and circulating viruses such as occurred in the 2003-4 Northern Hemisphere season (1), it has been demonstrated that the vaccines continue to provide valuable protection against morbidity, severe disease and mortality (1-6)

sarongsong
2005-Oct-17, 07:00 AM
Thanks, beskeptical; bookmarkable links, indeed.
Nice 8-page article in November's [print-edition of] Vanity Fair (http://www.vanityfair.com/magazine/currentissue/):
"THE WAITING PLAGUE...Epidemiologists warn of a potential natural disaster...Tracking the deadly avian flu across Asia, William Prochnau and Laura Parker find a handful of doctors, officials, and health workers who are struggling to confront the danger...A virus is a strange critter...some scientists seriously debate whether it is a life-form at all. It doesn't need oxygen, has no sex, and can't reproduce without parasitically invading a cell..."

VTBoy
2005-Oct-17, 07:49 AM
I read that a small percentage of the people who have died from H5N1 suffered Hemorrhaging in the lungs. Does someone know the exact percentage of people infected that will suffer Hemorrhaging and what percentage of those who die had hemorrhaging in the lungs as a symptom.

Sam5
2005-Oct-17, 01:02 PM
The rate is not 90%. Here is some more accurate information:
http://www.cdc.gov/ncidod/diseases/hanta/hps/noframes/caseinfo.htm

I'm talking about the hantavirus cases out here in the Southwest. The local hospitals report the cases to the news, and the news people report the cases to the public. The cases are rare, but most people who get the disease out here die from it. The reason being, most people get it and they don't go to a doctor or a hospital fast enough. The disease kills people in 3 days. If the victims don't get to a hospital on the first or second day, they usually die.

The only reason more people don't die from it is because it seems to require the inhaling of a lot of storeroom dust that contains the virus, and most people out here now try to avoid storeroom dust. Many companies out here buy "hantavirus kits" which contain face masks and disinfectants that kill the virus. Several years ago, before the virus was identified, people would clean out their store rooms and garages and they would inhale the virus in dust, they would get sick, and then die a few days later. This apparently went on for years until several people in one area died on an Indian reservation within a few months, and then the feds came in to study the cases. That's when they identified hantavirus.

Maha Vailo
2005-Oct-17, 01:04 PM
Since so many lethal diseases feel like the flu initially, does this mean I should take myself to the hospital as soon as I develop flu-like symptoms? Or when should I go?

- Maha Vailo

Sam5
2005-Oct-17, 01:09 PM
Tell me a little more about your girlfriend's mother. When did it happen, where did she live, what time of year, what was her health and age at the time?

Hanta virus infections are generally associated with sweeping or vacuuming up mouse nests.

It happened in the early '90s. Lived in the SE US. She was about 65, in good health. She had been rummaging around in a rural storeroom that had mice in it. The room was very dusty. She got sick after that. She was ok on Sunday, first flu symptoms on Monday, put in a hospital on Tuesday, died on Wednesday. This is typical of hantavirus cases out here in the Southwest.

Gillianren
2005-Oct-17, 07:27 PM
The local hospitals report the cases to the news, and the news people report the cases to the public.

That seems wrong to me. It seems to me that the local hospitals should report the cases to, oh, the CDC. Certainly I think those patients have a right to not having their cases reported on the news, especially if (as it sounds) they aren't passing the disease on to other people.

beskeptical
2005-Oct-17, 09:20 PM
I'm talking about the hantavirus cases out here in the Southwest. The local hospitals report the cases to the news, and the news people report the cases to the public. The cases are rare, but most people who get the disease out here die from it. The reason being, most people get it and they don't go to a doctor or a hospital fast enough. The disease kills people in 3 days. If the victims don't get to a hospital on the first or second day, they usually die.

The only reason more people don't die from it is because it seems to require the inhaling of a lot of storeroom dust that contains the virus, and most people out here now try to avoid storeroom dust. Many companies out here buy "hantavirus kits" which contain face masks and disinfectants that kill the virus. Several years ago, before the virus was identified, people would clean out their store rooms and garages and they would inhale the virus in dust, they would get sick, and then die a few days later. This apparently went on for years until several people in one area died on an Indian reservation within a few months, and then the feds came in to study the cases. That's when they identified hantavirus.
Sorry Sam, but your facts are wrong. The disease is the same, Southwest or not. There are a number of viruses in the Hanta virus family but my numbers were from the same Hanta virus that struck the Four Corners which you are describing.

Your problem is getting info from secondary sources. Try the primary sources. You can go to the same CDC site in my link above and probably find a breakdown of the numbers by state. I don't have time. If you find certain states had a higher fatality rate, I'd be interested in reading it.

It isn't just sweeping store rooms, it is sweeping or vacuuming dust from dried mouse urine and droppings in those store rooms. Cleaning up mouse infestations needs to be done with water or disinfectant to prevent aerosolizing the virus.

It is speculated that there had been previous outbreaks, particularly in Indian folklore of the area. And there would have been cases before it was identified. That was true of Legionnaire's as well. But at the same time, every similar death was not necessarily Hanta virus.

beskeptical
2005-Oct-17, 09:22 PM
Since so many lethal diseases feel like the flu initially, does this mean I should take myself to the hospital as soon as I develop flu-like symptoms? Or when should I go?

- Maha Vailo
Right now there is no bird flu. When the pandemic hits there won't be any hospital beds!

Going to the hospital early in the course of current flu strains is not helpful. Call your doctor for advice instead.

beskeptical
2005-Oct-17, 09:30 PM
That seems wrong to me. It seems to me that the local hospitals should report the cases to, oh, the CDC. Certainly I think those patients have a right to not having their cases reported on the news, especially if (as it sounds) they aren't passing the disease on to other people.The hospitals do report Hanta virus to the local public health which then passes the data on to the federal level CDC. Sam is not correct that his information from news sources is accurate.

On the other hand, during an outbreak, some information needs to get to the public and the news is an efficient way to communicate it. The trick is getting the correct information out like, "Stop sweeping storerooms and houses that have mice droppings. Mop instead," while not getting the incorrect information out such as, "Don't allow the local grade school band to travel to California because they might be carrying it." Something like that happened though I'm not sure of the details or whether the news media made it worse with false information.

beskeptical
2005-Oct-17, 09:36 PM
It happened in the early '90s. Lived in the SE US. She was about 65, in good health. She had been rummaging around in a rural storeroom that had mice in it. The room was very dusty. She got sick after that. She was ok on Sunday, first flu symptoms on Monday, put in a hospital on Tuesday, died on Wednesday. This is typical of hantavirus cases out here in the Southwest.
That does sound like Hanta virus would have been high on the differential list. Not all infections are cultured because the cost and difficulty of recovering the organism is not always justified. In the case of a single death, knowing the exact organism after the fact might not have helped anyone except maybe the family's desire to know. That is important but can't always be accommodated. I'm sorry her family was never able to know exactly what happened.

When there is a cluster, or an ongoing outbreak, then the health department gets involved and gets the tests done. Also there are certain diseases that are reportable because the public health needs to check if anyone has been exposed.

beskeptical
2005-Oct-17, 09:48 PM
Since so many lethal diseases feel like the flu initially, does this mean I should take myself to the hospital as soon as I develop flu-like symptoms? Or when should I go?

- Maha VailoForgot to add, take a broader perspective when it comes to worrying about what's out there that can kill you. Do you wear your seatbelt? Do you have a working smoke alarm and do you check the battery in it ever?

There is no reason to fret about bird flu, only reason to learn a bit about it and start thinking about preparing.

Titana
2005-Oct-18, 02:39 PM
I have been following this thread and decided to do a little investigation myself. As i was investigating, i was amazed to know that a flu virus spreads so easily via tiny droplets that 30 million to 60 million Americans catch it each year. Also it is knowned to mutate so fast that no one ever becomes fully immune and a new vaccine has to made each year.

One reason why a person can generally get over a flu is that your immune system has seen it before and knows how to respond. Although the next time you are infected it wont be a carbon copy of the last one (because the virus mutates constantly) but it will look similar enough that your body can almost always control it (thats ordinary flu).

But, every so often something new comes along from the animal world a vast preserve of type A flu viruses, the ones that that cause the most serious illness in humans (like the H5N1).

As i was further investigating i came across an article that mentioned a vaccine that has been tested and aproved to be effective against the H5N1 virus. The US government already ordered two million dosis, that would protect a country of nearly 300 million. Our next worry is, no one knows wheather the next H5N1 pandemic strain (if it ever merges) will be similar to the virus actually affecting Asia for this vaccine to offer full protection.


Titana...............

beskeptical
2005-Oct-18, 05:04 PM
...
As i was further investigating i came across an article that mentioned a vaccine that has been tested and aproved to be effective against the H5N1 virus. The US government already ordered two million dosis, that would protect a country of nearly 300 million. Our next worry is, ......The government doesn't have 2 million doses ordered, they have a certain volume ordered without knowing how much will be needed for an individual dose. In addition, it appears 2 doses are needed. No sense worrying about whether or not the vaccine will work against a mutation of the current flu until you solve the problem of producing enough to do anyone any good other than the government officials and their own friends and family.

Sam5
2005-Oct-18, 07:14 PM
That does sound like Hanta virus would have been high on the differential list. Not all infections are cultured because the cost and difficulty of recovering the organism is not always justified. In the case of a single death, knowing the exact organism after the fact might not have helped anyone except maybe the family's desire to know. That is important but can't always be accommodated. I'm sorry her family was never able to know exactly what happened.

When there is a cluster, or an ongoing outbreak, then the health department gets involved and gets the tests done. Also there are certain diseases that are reportable because the public health needs to check if anyone has been exposed.

Ok, I see. So you think that a single isolated case would not alert the doctors enough to order specific tests, but an outbreak of several of the same types of deaths in the same hospital in a short amount of time would alert them and the federal health people to conduct such tests?

ZaphodBeeblebrox
2005-Oct-18, 07:20 PM
Forgot to add, take a broader perspective when it comes to worrying about what's out there that can kill you. Do you wear your seatbelt? Do you have a working smoke alarm and do you check the battery in it ever?

There is no reason to fret about bird flu, only reason to learn a bit about it and start thinking about preparing.
ALWAYS, On The Seatbelt!!

As For, The Smoke Detector:

Found Out, It Worked, Thursday Night, While I Was Cooking!!!

Titana
2005-Oct-19, 12:39 AM
The government doesn't have 2 million doses ordered, they have a certain volume ordered without knowing how much will be needed for an individual dose. In addition, it appears 2 doses are needed. No sense worrying about whether or not the vaccine will work against a mutation of the current flu until you solve the problem of producing enough to do anyone any good other than the government officials and their own friends and family.


http://www.allamericanpatriots.com/m-news+article+storyid-3417.html

At this site you can find a comment on the 2 million dosis i mentioned and also mentions that the new vaccine would be used to protect laboratory workers, public health personel and.....the general public.

Gillianren
2005-Oct-19, 12:54 AM
www.allamericanpatriots.com/m-news+article+storyid-3417.html

At this site you can find a comment on the 2 millon dosis i mentioned and also mentions that the new vaccine would be used to protect laboratory workers, public health personel and.....the general public.

2 million doses, assuming it is 2 million doses and that only one dose is needed, would provide protection for the city of Washington, DC just under four times--or Seattle, which was the first city I looked up. It would not provide protection for Los Angeles or New York. How do you decided who "the general public" is that would receive those doses?

paulie jay
2005-Oct-19, 02:00 AM
The Australian govenrment is creating a large stockpile of Tamiflu and another drug (which I can't remember the name of) which we are producing locally. The Health Minister (Tony Abbott) says that 90% of it will be going directly to "essential service" workers, while the remaining 10% is earmarked for the general public. It's made a lot of people start to ask the question "am I included in the realm of essential services?".

beskeptical
2005-Oct-19, 05:58 AM
Ok, I see. So you think that a single isolated case would not alert the doctors enough to order specific tests, but an outbreak of several of the same types of deaths in the same hospital in a short amount of time would alert them and the federal health people to conduct such tests?
Yes, that's the usual protocol.

If a patient is being treated sometimes extensive tests are done to try to pin down the cause and treat it more accurately. And when certain diseases are suspected follow up tests after death might be done such as with Rabies. The reason being that exposed persons could need preventative treatment. When Legionnaires Disease is suspected, tests are done, for example, because the source needs to be looked for and disinfected before more cases occur. So there are a number of reasons to try to do difficult cultures and organism identification. But it isn't done for all infections, even fatal ones.

beskeptical
2005-Oct-19, 07:57 AM
http://www.allamericanpatriots.com/m-news+article+storyid-3417.html

At this site you can find a comment on the 2 million dosis i mentioned and also mentions that the new vaccine would be used to protect laboratory workers, public health personel and.....the general public.That site makes it sound like the government has everything in order and under control. Peachy Keen!

I didn't doubt that you read it in a news source. But that particular rosey version doesn't even mention that 2 million doses isn't close to the 20 million the CDC plan calls for at a minimum, let alone if 2 million doses were the actual amount.

I have no doubt health care workers will need the vaccine first but last year when the shortage of vaccine led to restrictions, certain members of Congress admittedly flaunted those restrictions and took the vaccine regardless. I'm sure they'll be the first to label themselves essential.

beskeptical
2005-Oct-19, 08:06 AM
The Australian govenrment is creating a large stockpile of Tamiflu and another drug (which I can't remember the name of) which we are producing locally. The Health Minister (Tony Abbott) says that 90% of it will be going directly to "essential service" workers, while the remaining 10% is earmarked for the general public. It's made a lot of people start to ask the question "am I included in the realm of essential services?".The other drug is Relenza unless they are referring to vaccine.

Essential services are police, fire, hospital workers and perhaps utility workers. The vaccine is the most useful for those people. The drugs only work if taken in the first 48 hours of infection since we don't have enough to give people daily preventative doses. Much of the doses are now being bought up into individuals' hands and much of that will be wasted if they don't know when to take it. I expect doctors to also waste it by giving it to critical patients starting after the 48 hours.

Everyone's best bet is to learn how to wash one's hands and keep your hands away from your face. It isn't magic, just basic infection control.

Titana
2005-Oct-19, 06:06 PM
That site makes it sound like the government has everything in order and under control. Peachy Keen!

I didn't doubt that you read it in a news source. But that particular rosey version doesn't even mention that 2 million doses isn't close to the 20 million the CDC plan calls for at a minimum, let alone if 2 million doses were the actual amount.

I have no doubt health care workers will need the vaccine first but last year when the shortage of vaccine led to restrictions, certain members of Congress admittedly flaunted those restrictions and took the vaccine regardless. I'm sure they'll be the first to label themselves essential.

What i think is that the 2 million is to have in stock just as precaution and yes, i do recall coming across an article that mentioned that the goal was 20 million.



Titana...........

The Supreme Canuck
2005-Oct-19, 06:36 PM
Stupid question: if it takes more than one dose to be effective, and if the goal is only 20 million doses, how is that anywhere near enough?

ZaphodBeeblebrox
2005-Oct-19, 06:46 PM
Stupid question: if it takes more than one dose to be effective, and if the goal is only 20 million doses, how is that anywhere near enough?
Government Math?

I Know ...

OXYMORON!!!

:wall:

Sam5
2005-Oct-20, 02:01 AM
Stupid question: if it takes more than one dose to be effective, and if the goal is only 20 million doses, how is that anywhere near enough?

Well, it should be enough to go around for all government employees.

Gillianren
2005-Oct-20, 02:29 AM
Well, it should be enough to go around for all government employees.

I'm not so sure of that, especially if you count the military as government employees, which they certainly are.

paulie jay
2005-Oct-20, 05:20 AM
The other drug is Relenza unless they are referring to vaccine.
Ah thankyou! That is the name I was after! Apparently there is a potential vaccine in the wind which Mr Abbott is keeping a keen eye on which could be effective provided the flu plays ball and doesn't mutate.

beskeptical
2005-Oct-20, 05:49 AM
Re the 20 million doses of Tamiflu and 20 million doses of H5N1 vaccine, here's my skeptic take on the matter.

The CDC knows it can't get enough of either drug quickly even if Congress directed them to and approved the funds, which they haven't done anyway.

What do you do? Announce that the current administration is wholly unprepared and risk backlash including being accused of exaggerating the hazard should it not appear?

Or do you announce the more politically correct statement that you want a little of this and a little of that but that your plan does not depend on the drugs? Instead, the public health plan depends on 'containment' even though it is clear, 'containment' is not a realistic goal should the worst case scenario occur. For that, we are to prepare to deal with it. Expect the worse, do the best you can.

In a way, the public health plan is the most realistic way to prepare. The government likes to put on a show of tidy preparedness. But then when the events unfold, like Katrina, it becomes clear the tidy plan was not so tidy after all. The public health is admitting the plan isn't tidy but instead of complaining, they are suggesting we deal with it since that's what is going to happen. All that planning isn't going to make the hospitals bigger nor will it make more health care workers nor the vaccine supply bigger. So why put 300 million vaccine doses in the plan? You just won't have them this year.

The Supreme Canuck
2005-Oct-20, 03:50 PM
I just read in the Toronto Star today that Ontario has a stockpile of over 12 million doses of Tamiflu, and the government has committed itself to obtaining over 14 million doses in total before its term runs out. And that's for a population of only 12.5 million.

They're still saying that it isn't enough.

So, with only 20 million doses for a population of 300 million...

I think you guys may be in trouble.

The Supreme Canuck
2005-Oct-23, 01:22 AM
New outbreak in Russia, virus found in Croatia.

http://www.washingtonpost.com/wp-dyn/content/article/2005/10/22/AR2005102200384.html

Avian Flu found in quarantined parrot in UK.

http://www.timesonline.co.uk/article/0,,13509-1837865,00.html

And maybe even in Canada:


Well the Labor leader's comments have added to a war of words between Canada and Australia over testing regimes after Australian quarantine officials discovered Avian flu antibodies in three pigeons imported from Canada.

http://www.abc.net.au/worldtoday/content/2005/s1487547.htm

beskeptical
2005-Oct-23, 07:59 PM
While the H5N1 strain will eventually make it to every continent, all the current reports of bird flu are not going to be H5N1.

The parrot in England had H5 but the N is not yet known. That one does seem the most ominous since it was exposed to a shipment of birds in quarantine in Suriname, SA. Those birds were destroyed but who knows if other imported birds have not already been released to their owners.

One thing that is disturbing to me is many of the reports of H5N1 in Eastern Europe are about birds that were tested way back in July. There is just no doubt the cat left the bag too long ago to have any hope of getting it back in. The H5N1 is now in the wild bird populations and will never be eradicated by humans. It may evolve itself into something else but it will not be stopped now.

As to the Canadian bird flu, I doubt that will be H5N1 yet. There are many other strains of bird flu just as there are many strains of all flu.

The Supreme Canuck
2005-Oct-23, 08:21 PM
As to the Canadian bird flu, I doubt that will be H5N1 yet. There are many other strains of bird flu just as there are many strains of all flu.

I figured as much. What worries me, though, is that it can go undetected for so long.

beskeptical
2005-Oct-23, 08:31 PM
Well the H5N1 has been confirmed in the parrot according to the latest news.

Titana
2005-Oct-24, 04:42 AM
Thats right, it has been confirmed.

http://news.yahoo.com/s/ap/20051024/ap_on_he_me/bird_flu


Titana..............

beskeptical
2005-Oct-24, 06:47 AM
This is very interesting re the British parrot import from my Infectious Disease Society daily updates:

The parrot died more than 30 days after arrival; the incubation of
avian influenza is considered to be not longer than 7 days. It is
thus unlikely that it came to the UK infected. We are looking forward
to the outcome of the UK investigation into the origin of infection
in this case.

sarongsong
2005-Oct-24, 07:05 AM
Do vaccine-takers become 'carriers' initially; is isolation required for x amount of time after administration?

zwat
2005-Oct-24, 07:13 AM
Well the H5N1 has been confirmed in the parrot according to the latest news.

He's only pining for the fjords.

The Supreme Canuck
2005-Oct-24, 06:58 PM
Do vaccine-takers become 'carriers' initially; is isolation required for x amount of time after administration?

I shouldn't think so. That's only possible if it's a live virus vaccine, and I don't think that's a case. Besides, I doubt you can be a carrier of avian flu like you can be of TB.

sarongsong
2005-Oct-26, 01:01 AM
Okay, see what you make of this newsletter excerpt:
"...the government is also funding MedImmune as they work with NIH to develop a nasally administered Avian Flu Vaccine (http://www.washingtonpost.com/wp-dyn/content/article/2005/09/28/AR2005092802197.html). Sanofi Pasteur is also working with NIH to create an injectable vaccine (http://www.sciencedaily.com/releases/2005/03/050325100848.htm)...just like MedImmune's existing "Flu Mist" vaccine, the nasally administered Avian Flu Vaccine would have a 21 day shedding period during which people who have been given this vaccine can TRANSMIT the Avian Flu (which they'll GET from the vaccine) to people around them..."

Meanwhile:
October 25 2005 (http://news.ft.com/cms/s/bcea3836-4578-11da-981b-00000e2511c8.html)
"Europeans should avoid eating raw eggs and cook chicken carefully to cut down any risk of contracting bird flu, according to an advisory note expected on Wednesday from the European food safety authority (Efsa)..."

beskeptical
2005-Oct-26, 07:46 AM
Re live vaccines and "carrier state":

First, 'carrier' usually refers to a permanent condition, not a temporary infectious period.

Viral shedding from the live intranasal Flu Mist is only a problem for immunocompromised persons the vacinee might infect. The vaccine strain is attenuated. It isn't the disease. Most of the time it is asymptomatic.

For measles and chicken pox vaccines, some persons develop a rash but they don't get ill like the illness one is preventing. A few persons getting rubella vaccine might have temporary joint pain.

The vaccine we have had the most trouble with viral shedding has been the live polio vaccine. Generally the person vaccinated has no illness. But one infected after the vaccine virus has been shed in the stool could rarely, get actual polio. As long as there was a significant amount of polio in a community, the live vaccine was safer than the disease and having the vaccine be oral made more people get vaccinated. So the risk of the disease outweighed the risk of the vaccine. Once the number of cases of polio dropped, the live vaccine has been discontinued here in the USA and kids today have to get the three shot series of the killed vaccine instead.

I don't know why your news letter would claim the live avian flu vaccine would give anyone avian flu. That's just plain silly. Why would you get the disease to prevent the disease? Just how stupid do you think people and vaccine manufacturers are?

By the way, Sarong, why is there no link to the news letter? I only find the links to the news sources but no where in those links is the quote in your post.

sarongsong
2005-Oct-28, 01:44 AM
Because it's a newsletter, without an Internet link, from http://www.iahf.com/ , and I wanted to get your take on his version of shedding. Thanks!

jora
2005-Oct-29, 07:49 PM
Well Bird flu is virus disease so it spreads through virus. For its recovery needs to be very large amount of drugs. Most of the countries are doing this as You give the example of US government.Relenza is the medication which is mostly used in this disorder. It has very less side effects so this is prefferd.Asia is facing this problem now a days.

Please see the page for more informations.

http://www.drugdelivery.ca/s33713-s-RELENZA.aspx

sarongsong
2005-Oct-29, 09:34 PM
October 29, 2005 (http://www.breitbart.com/news/2005/10/29/D8DHOP580.html)
"...Bush on Tuesday is visiting the National Institutes of Health to announce his administration's strategy on how to prepare for the next flu pandemic, whether it's caused by the bird flu in Asia or some other super strain of influenza..."

beskeptical
2005-Nov-01, 12:11 AM
Well Bird flu is virus disease so it spreads through virus. For its recovery needs to be very large amount of drugs. Most of the countries are doing this as You give the example of US government.Relenza is the medication which is mostly used in this disorder. It has very less side effects so this is prefferd.Asia is facing this problem now a days.

Please see the page for more informations.

http://www.drugdelivery.ca/s33713-s-RELENZA.aspxPreferred by whom? Actually, Relenza and Tamiflu have similar bioactivity. Tamiflu is a pill so easier to take. Relenza is a cap that you puncture and inhale the contents because it is not well absorbed in the stomach. Neither works if not started within 48 and preferably 24 hours of symptom onset.

The preferred drug is the vaccine.

We don't have nearly enough of any of the three.

The Supreme Canuck
2005-Nov-01, 03:00 PM
Perhaps jora comes from a country that was only able to get ahold of Relenza and not Tamiflu (Germany comes to mind). Tamiflu is actually the preferred of the two, simply because it is a lot easier to take.

sarongsong
2005-Nov-02, 05:54 AM
October 23, 2005 (http://observer.guardian.co.uk/business/story/0,6903,1598455,00.html)
"Roche has been accused of serious failings in the manufacture of Tamiflu...Gilead Sciences (http://www.gilead.com/wt/sec/pr_933190157/), the American biotech company which invented the drug and licensed it to Roche (http://www.roche.com/home.html), has identified a number of incidents over the past three years which required Roche to issue product recalls...is demanding termination of its licence agreement..."

beskeptical
2005-Nov-02, 06:49 AM
October 23, 2005 (http://observer.guardian.co.uk/business/story/0,6903,1598455,00.html)
"Roche has been accused of serious failings in the manufacture of Tamiflu...Gilead Sciences (http://www.gilead.com/wt/sec/pr_933190157/), the American biotech company which invented the drug and licensed it to Roche (http://www.roche.com/home.html), has identified a number of incidents over the past three years which required Roche to issue product recalls...is demanding termination of its licence agreement..."If that source is accurate, (I can't be sure because the title doesn't have correct facts, Tamiflu is not a vaccine), it looks to me like the company that sold the license to manufacture wants to re-negotiate because of unexpected profits. I'd bet the original license underestimated the value of the drug.

sarongsong
2005-Nov-06, 05:32 AM
Another possible contender:
...The sour-cabbage craze (http://starbulletin.com/2005/11/05/news/story01.html) (scroll down) was triggered by news reports that Seoul National University scientists in Korea used "kim chee sauerkraut" successfully to treat chickens infected with avian flu...Having sampled kim chee in Hawaii, can only say it's definitely an, um, acquired taste---much more intense than regular saurkraut.

beskeptical
2005-Nov-06, 06:23 AM
Another possible contender:Having sampled kim chee in Hawaii, can only say it's definitely an, um, acquired taste---much more intense than regular saurkraut.During the SARS outbreak the Chinese thought spraying vinegar steam in the air was a disinfectant. I was a bit surprised at the belief coming from their 'official' health sources.

Vinegar is not much of a disinfectant and it is impossible to disinfect air under any but the most extreme circumstances. You might be able to seal a room and fill it with some kind of toxic fumes, but otherwise any attempt to disinfect air would be futile. The disinfectant would have to come in contact with every organism you wished to kill and do so in sufficient quantity. It just isn't going to happen.

My point is if even the health officials have the science wrong, just because someone claims something cures bird flu in birds, doesn't mean it does. On a scale of 1 to 10 with 10 being likely, I'd say the story has about a -20 chance of being anything but pure garbage.

Are you suggesting, sarong, that you think there is any credibility there just because someone claims it is so? Or was the post just for curiosity's sake?

beskeptical
2005-Nov-06, 07:34 AM
Getting back OT...talk about scary I think it will start out like this:
Date: 5 Nov 2005
From: ProMED Russian correspondent<promed@promedmail.org>
Source: Russian information agency "Novosti" [edited]
<http://www.rian.ru/society/health_services/20051105/41995771.html>

A pneumonia outbreak has been detected in the city of Borodino
(Krasnoyarsk region), announced Nina Bogalej, manager of the
pediatrics department of a local hospital. In the last several days,
over 60 inhabitants of Borodino have sought medical treatment, mainly
children 2-13 years of age. Approximately half the patients had
fevers of up to 40 degrees Celsius [104 Fahrenheit].

Bogalej also said that physicians in that small city that "this viral
illness is being transmitted mainly by the aerial [aerosol? airborne?
- Mod.LM] route." She also noted that schoolmates and relatives of
those who have fallen ill previously are now seeking medical
treatment, including many adults.

Though containment measures have appreciably limited the spread of
the illness, in order to determine the source of the outbreak,
doctors in Borodino have asked the help of their colleagues in
Krasnoyarsk, who have the necessary equipment for research.
Of course, this kind of report comes out all the time with a little note of calm:

--
ProMED-mail
<promed@promedmail.org>

[Speculation as to the etiology of the acute respiratory illness
would include respiratory viral pathogens such as RSV, influenza,
adenoviruses, human metapneumovirus, and parainfluenza. Few clues
are given as to the clinical illness and any further information
would be appreciated. - Mod.LM]

[Borodino is a small city in the Krasnoyarsk region with 19 200
inhabitants. The Krasnoyarsk region occupies the center of the Asian
part of Russia between 51 and 81 degrees of northern latitude and 78
and 113 degrees of east longitude. In the southeast and the south
Krasnoyarsk borders the Tyvoj Republic, in the south the Altai
region, in the southwest the Kemerovo region, in the west the Tomsk
region, in the west and northwest the Tyumen region, in the northeast
and the east the Republic of Saha, and in the east and southeast the
Irkutsk region - ProMED Russian Correspondent]
................pg/lmI'll keep you all posted. ;)

sarongsong
2005-Nov-06, 09:04 AM
Thanks for the update!

...My point is if even the health officials have the science wrong, just because someone claims something cures bird flu in birds, doesn't mean it does..."Someone", in this instance, is among the world's top universities,
Prof. Kang Sa-ouk of Biological Sciences (http://www.snu.ac.kr:6060/snulife/Calendar/1184639_3523.html) has found Kimchi lacticacidbacteria called “Leuconostoc Kimchii” to be effective against bird flu...and certainly seems worthy of further investigation.

beskeptical
2005-Nov-06, 09:29 PM
Thanks for the update!
"Someone", in this instance, is among the world's top universities,and certainly seems worthy of further investigation.I can't read the page on the University to verify how 'top' it is. There is no information on the research itself in your link.

On the other hand, it looks very interesting and I await more scientific trials of the substance.

sarongsong
2005-Nov-06, 09:54 PM
Page 4 of World University Rankings (http://www.mba-scm.org/fileadmin/Dateien/Documents/world-rankings-16pages_Nov_04.pdf) (.pdf, 329 KB) shows SNU tied with [U.S.] Virginia University at #118. Haven't found the professor's paper yet, either.
Did find mention of saurkraut/cabbage brine here (http://www.mtt.fi/met/pdf/met43.pdf) (.pdf again).

sarongsong
2005-Nov-07, 06:57 AM
First H5N1 photos (http://www.dn.se/DNet/jsp/polopoly.jsp?d=597&a=483764) (Swedish site)

Halcyon Dayz
2005-Nov-07, 10:57 AM
"It is a strange fate that we should suffer so much fear and
doubt over so small a thing. Such a little thing."

Argos
2005-Nov-07, 04:03 PM
WHO deems avian flu pandemics "inevitable" (http://www.cnn.com/2005/HEALTH/conditions/11/07/bird.flu.who.ap/index.html)

beskeptical
2005-Nov-07, 11:01 PM
WHO deems avian flu pandemics "inevitable" (http://www.cnn.com/2005/HEALTH/conditions/11/07/bird.flu.who.ap/index.html)It is inevitable. The only problem is will it be H5N1 or another flu virus and when.

I will say however, while it may take a bit longer, this one has escaped from the bottle and can't be put back in now under any practical circumstances.

beskeptical
2005-Nov-07, 11:05 PM
Page 4 of World University Rankings (http://www.mba-scm.org/fileadmin/Dateien/Documents/world-rankings-16pages_Nov_04.pdf) (.pdf, 329 KB) shows SNU tied with [U.S.] Virginia University at #118. Haven't found the professor's paper yet, either.
Did find mention of saurkraut/cabbage brine here (http://www.mtt.fi/met/pdf/met43.pdf) (.pdf again).Keep in mind that while sauerkraut may be cheap and harmless so no harm in taking it, the guy fed the stuff to chickens not people. Influenza infection in chickens is in the gut while in humans it is in the respiratory tract. That's a big difference.

sarongsong
2005-Nov-08, 12:31 AM
...Influenza infection in chickens is in the gut while in humans it is in the respiratory tract. That's a big difference.You may have something there (great info!); went to look up Korea's (where kim chee is widely consumed) past influenza experiences
...From September 1986 through February 1987, influenza A(H1N1) viruses predominated and, in most countries, were the only type of influenza virus isolated. As in previous epidemics since 1977, influenza A(H1N1) outbreaks occurred mainly among children and young adults...In Asia, widespread outbreak activity was reported in the Democratic People's Republic of Korea during October and November and in Japan during November and December...CDC (http://www.cdc.gov/mmwr/preview/mmwrhtml/00000899.htm)Does consumption of infected fowl or eggs equate to human infection?

beskeptical
2005-Nov-08, 07:45 AM
You may have something there (great info!); went to look up Korea's (where kim chee is widely consumed) past influenza experiencesDoes consumption of infected fowl or eggs equate to human infection?Are you asking if one can get infected from eggs or chicken? Yes. Some have been infected from eating uncooked or undercooked chicken and ducks. In addition, the shells of eggs from infected chickens have recoverable virus on them. The jury is still out whether the egg inside can have the virus. Some of the eggs tested did not have virus but that is no guarantee that all eggs are virus free. It's best to cook eggs thoroughly anyway. This is just one more reason to do so.

The eggs we buy in the USA are cleaned and if the chickens become infected they won't likely go unnoticed. But those that have a few chickens in the yard might want to keep a close eye on the wild bird monitoring and have a plan to move your birds indoors when the time comes.

Also you duck hunters will soon need to be very careful slaughtering those ducks.

Archer17
2005-Nov-09, 03:19 AM
Love your post Sarongsong. Much to Archer's dismay, this is about incompetence in leadership. Just as I'm sure global warming discussions on the board cannot stay completely politically free, neither can a pandemic flu discussion.

Our community is planning to be prepared without federal level involvement. That's what we all need to be doing now. Contact your own local officials and ask what they are doing to plan for this. Prepare yourself and your household. Don't expect the federal government to handle it well. My concern in bringing up Bush's call for armed forces was that it showed how poorly he was communicating with and listening to the health experts and the science.


On another note, the cultures are not in re: the outbreak among turkeys in Turkey and ducks in Romania. Wait and see before assuming it is H5N1 and not other bird flu strains we are less worried about. If it does turn out to be H5N1 that is a bad sign in how fast it is spreading, especially since human flu strain infections will be peaking in a couple of months.Been away for awhile but bird flu,much to your dismay .. doesn't follow political affiliations. To presume otherwise is assinine. Now tell me .. has this "bird flu" mutated yet? If you say yes .. give me some citations. I'm only aware of 1 "possible" example of human-to-human transmission. Is there more? Is the "1" verified? Were they Republican? ;)

Hate to break this to you but if - and that's a big if- a pandemic was to happen and the government didn't get involved we'd hear the "Katrina" thing. If they did we'd hear the Beskeptical "sour grapes" whine no matter what they did. Fact of the matter is quarantine is a viable option for a pandemic if it would happen and, BTW, the bird blue is not SARs .. capice?

Global warming .. that's for another thread - although I'd advise you to do your homework before parroting spurious claims.

Sammy
2005-Nov-09, 07:20 AM
I never needed an excuse to feast on Korean food, but now I can say it's preventitive medicine. I won't wait for double-blind studies, either.

My favorite place has the unlikely name of "The Sushi Chalet," and serves a great sushi bar and korean buffet. The kimchi is always well loaded with garlic and red pepper.

sarongsong
2005-Nov-09, 07:33 AM
No wonder you don't need no supplements!---that is powerful stuff.

...Also you duck hunters will soon need to be very careful slaughtering those ducks.Report: Bird flu on migration path (http://edition.cnn.com/2005/HEALTH/conditions/11/06/bird.flu.ap/) - CNN

Archer17
2005-Nov-09, 07:39 AM
Are you hiding yet? :)

sarongsong
2005-Nov-09, 08:07 AM
No need---silver shields up!

ZaphodBeeblebrox
2005-Nov-09, 09:16 PM
No need---silver shields up!
Turning Grey, yet?

;)

beskeptical
2005-Nov-10, 01:06 AM
Been away for awhile but bird flu,much to your dismay .. doesn't follow political affiliations. To presume otherwise is assinine. Now tell me .. has this "bird flu" mutated yet? If you say yes .. give me some citations. I'm only aware of 1 "possible" example of human-to-human transmission. Is there more? Is the "1" verified? Were they Republican? ;)

Hate to break this to you but if - and that's a big if- a pandemic was to happen and the government didn't get involved we'd hear the "Katrina" thing. If they did we'd hear the Beskeptical "sour grapes" whine no matter what they did. Fact of the matter is quarantine is a viable option for a pandemic if it would happen and, BTW, the bird blue is not SARs .. capice?

Global warming .. that's for another thread - although I'd advise you to do your homework before parroting spurious claims.Archer, I don't have a clue what your issue is here.

If you don't think influenza has the potential to kill, I'd recommend a bit of history review.

As far as quarantine goes, you won't find the need for military imposed quarantine in either the CDC or the WHO's pandemic flu plan. I think the only Bush bashing I posted was a statement that Bush's plan to impose military quarantine showed he wasn't in touch with the experts and such a quarantine was from the movie version of a pandemic or "outbreak" not the real world version. In the case of a flu pandemic, early quarantine would only involve individual cases and their contacts. Later quarantine would be futile. Instead you would tell everyone to stay home as much as possible. You might be able to quarantine a town that didn't have any cases, but there wouldn't be any single location you could send the troops in to surround.

I don't know where in any of my posts I said H5N1 had begun human to human spread.

Archer17
2005-Nov-11, 04:44 AM
Archer, I don't have a clue what your issue is here.Easy, keep inappropriate poltical rants off the board.
If you don't think influenza has the potential to kill, I'd recommend a bit of history review.I never said influenza doesn't have the potential to kill. I'd recommend a history review of my posts if you think otherwise.
As far as quarantine goes, you won't find the need for military imposed quarantine in either the CDC or the WHO's pandemic flu plan. I think the only Bush bashing I posted was a statement that Bush's plan to impose military quarantine showed he wasn't in touch with the experts and such a quarantine was from the movie version of a pandemic or "outbreak" not the real world version. In the case of a flu pandemic, early quarantine would only involve individual cases and their contacts. Later quarantine would be futile. Instead you would tell everyone to stay home as much as possible. You might be able to quarantine a town that didn't have any cases, but there wouldn't be any single location you could send the troops in to surround.There's no excuse to involve politics regarding something that hasn't even happened at this point, that's my point. There's no waiver for violating the taboo on political rants here.
I don't know where in any of my posts I said H5N1 had begun human to human spread.Then why whine about what Bush might do if does become a pandemic via human-human transmission? :think:

Bottom line: keep politics off the board.

beskeptical
2005-Nov-11, 07:17 AM
Archer, the reason for the comment was Bush made an announcement that he was initiating a plan to be able to use the military to enforce a mass quarantine should he need to during a flu pandemic. It wasn't a political rant as you call it. I was pointing out there was no place in a pandemic response for such a quarantine. And, such a mass quarantine measure wasn't in the CDC plan either. We need science to respond to a pandemic. If our government leaders ignore the science I do think it is worth discussing as long as we keep it to very specific science issues. This was a very specific issue.

Archer17
2005-Nov-11, 07:44 AM
Archer, the reason for the comment was Bush made an announcement that he was initiating a plan to be able to use the military to enforce a mass quarantine should he need to during a flu pandemic. It wasn't a political rant as you call it. I was pointing out there was no place in a pandemic response for such a quarantine. And, such a mass quarantine measure wasn't in the CDC plan either. We need science to respond to a pandemic. If our government leaders ignore the science I do think it is worth discussing as long as we keep it to very specific science issues. This was a very specific issue.heh .. if you say so. Look, beskeptical, I frown on your political spoutings but I won't question, nor dispute, your area of expertise. I'm against political rants, nothing else. I happen to think that if the worst happens and this turns into a pandemic the PTW will suffer along with the rest of us. Trashing a hypothetical plan involving a hypothetical scenario is premature, even if such a thing was allowed here. I frown on Bush-bashing for the same reason I would frown on Kerry-bashing if he'd won. No good comes from it.

Color me an optimist .. I think that if the strain mutates we will get a handle on it. By "we" I mean someone on this globe. It has to mutate first (you know that).

SpockJim
2005-Nov-11, 07:49 AM
Wow! I actually stumbled upon a great thread here! I have not been too concerned about this avien flu but now I am getting concerned. My Dad has been talking about it and so have others. I do realize that people would like the government to step in and do something to stop it but how can you phyisically stop bacterium like this? You can't depend on vaccinations because over time baterium will become resiliant to that vaccine correct?

general 95% of people out there never think about how proned we really are to infectious diseases. One simple bacterium like this avien flu may cause a pandemic. It can't be stopped or can it? How can you stop it once it has been discovered or spreads throughout the world?

Sure, The goverment could issue a huge ration of vaccines for the flu but by the time everyone was vaccinated for it there would be a new stronger strain that would develop.

Archer17
2005-Nov-11, 08:05 AM
I think if this avian thing mutates, it's up to the people that work on infectious stuff to stop it, not politicians. That's why I've been giving beskeptical grief over this. If it turns into a global pandemic .. obviously nothing works to contain it.

On a positive note: It hasn't happened yet..

sarongsong
2005-Nov-11, 10:43 AM
...One simple bacterium like this avien flu...A virus is way much smaller than a bacterium.

ToSeek
2005-Nov-11, 04:27 PM
I was called upon to look at this thread as a moderator.

I don't see beskeptical's informed opinion of Bush's plan to use the military for quarantine as a "political rant". So far as I can tell, she's largely focused on the plan, not the politician. That seems legitimate to me, except for the line, "Much to Archer's dismay, this is about incompetence in leadership," which was pushing it, as is Archer17's ensuing accusations of "political rants." So, please, everyone take a deep breath before we have to close this thread or start issuing warnings. Thanks.

Archer17
2005-Nov-12, 02:53 AM
I was called upon to look at this thread as a moderator.

I don't see beskeptical's informed opinion of Bush's plan to use the military for quarantine as a "political rant". So far as I can tell, she's largely focused on the plan, not the politician. That seems legitimate to me, except for the line, "Much to Archer's dismay, this is about incompetence in leadership," which was pushing it, as is Archer17's ensuing accusations of "political rants." So, please, everyone take a deep breath before we have to close this thread or start issuing warnings. Thanks.No need ToSeek. While I disagree with your analysis, you are a moderator and I'll respect that. I do think avian flu, while not the "end of the world," is worthy of a thread. I'll leave it at that ..

beskeptical
2005-Nov-12, 08:07 AM
I was called upon to look at this thread as a moderator.

I don't see beskeptical's informed opinion of Bush's plan to use the military for quarantine as a "political rant". So far as I can tell, she's largely focused on the plan, not the politician. That seems legitimate to me, except for the line, "Much to Archer's dismay, this is about incompetence in leadership," which was pushing it, as is Archer17's ensuing accusations of "political rants." ...I appreciate the input. And I agree in reviewing my posts that I stated more about the politics than perhaps the science discussion should have allowed. So at the risk of making things worse, but making my point more succinct here are some links to the initial news release on the Bush quarantine statements that led me to make my comments.

Bush military bird flu role slammed (http://www.cnn.com/2005/POLITICS/10/05/bush.reax/)
WASHINGTON (CNN) -- A call by President George W. Bush for Congress to give him the power to use the military in law enforcement roles in the event of a bird flu pandemic has been criticized as akin to introducing martial law.

Bush said aggressive action would be needed to prevent a potentially disastrous U.S. outbreak of the disease that is sweeping through Asian poultry and which experts fear could mutate to pass between humans.

But Dr. Irwin Redlener, associate dean of Columbia University's Mailman School of Public Health and director of its National Center for Disaster Preparedness, told The Associated Press the president's suggestion was dangerous.

Bush wants authority to order military quarantine of Americans (http://www.unknownnews.org/0510071005militaryquarantine.html)
WASHINGTON -- President Bush, increasingly concerned about a possible avian flu pandemic, revealed yesterday that any part of the country where the virus breaks out could likely be quarantined and that he is considering using the military to enforce it.

"The best way to deal with a pandemic is to isolate it and keep it isolated in the region in which it begins," he said during a wide-ranging Rose Garden news conference....
Mr. Bush made clear that the potential for an outbreak of avian flu is much on his mind, and has had him talking with "as many [world] leaders as I could find," consulting a book he read about the 1918 Spanish flu pandemic that killed 40 million and meeting with staff and experts. "I have thought through the scenarios of what an avian flu outbreak could mean," he said.

He acknowledged that a quarantine -- an idea sure to alarm many in the public -- is no small thing for the government to undertake and that enforcing it would be tricky. "It's one thing to shut down airplanes," Mr. Bush said. "It's another thing to prevent people from coming in to get exposed to the avian flu."

Bush Call to Expand Military Powers at Home Seen as Unnecessary, Political (http://www.commondreams.org/headlines05/1008-02.htm)
"I cannot imagine U.S. troops surrounding a town where avian flu has broken out with fixed bayonets to prevent people from getting out of the town--that's just nuts," says retired army Lieutenant General, Robert G. Gard.

U.S. may use military quarantine to contain flu (http://www.msnbc.msn.com/id/9589897/)
WASHINGTON - President Bush, increasingly concerned about a possible avian flu pandemic, revealed Tuesday that any part of the country where the virus breaks out could likely be quarantined and that he is considering using the military to enforce it.

Critics hit Bush call for military role against bird flu (http://www.feedsfarm.com/article/6aec01c342a5b5e7dc2dc55e859bb635281f81f3.html)

From the October 2005 Idaho Observer: (http://proliberty.com/observer/20051009.htm)
The president’s talk of deploying troops to enforce quarantines has no precedent as a public health measure in the U.S. Historically, quarantines have been applied against individuals and families diagnosed with an infectious disease, or used in extreme circumstances to prevent the congregation of large groups of people in areas where a disease is spreading. But sealing off whole regions of the country by military force and preventing anyone from entering or leaving them has more in common with civil war measures than preventive health care.

It is not clear why the military would be needed for such an operation, unless it would be to set up roadblocks and shoot down anyone attempting to escape a region placed under quarantine.

Even public health professionals blasted the proposal, warning that the president’s remarks were indicative of his administration’s failure to prepare for the looming flu threat.

Here is what the WHO and our own Department of Health and Human Services has to say about the use of large area quarantine.
WHO's Responding to the avian influenza pandemic threat Recommended strategic actions (http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_05_8-EN.pdf)
intervention depends on several assumptions: (1) the first viruses that show an ability to sustain transmission among humans will not yet be highly transmissible; (2) the emergence of such viruses will be geographically circumscribed; (3) the first clusters of human cases caused by the virus will be rapidly detected and reported, and the viruses will be rapidly identified and characterized; (4) antiviral drugs will be rapidly mobilized from the stockpile, made available to the affected population, and administered to sufficiently large numbers of people; and (5) movement of people in and out of the area will be effectively restricted.This part of the plan is referring to the very first cases of person to person transmission which is in no way expected to occur in the USA. That is the only time a geographic area might be considered for quarantine.

Excerpt from the US Department of Health and Human Services Plan: HHS Pandemic Influenza Plan (http://www.hhs.gov/pandemicflu/plan/pdf/S08.pdf)
Containment measures applied to individuals (e.g., isolation and quarantine) may have limited impact in preventing the transmission of pandemic influenza, due to the short incubation period of the illness, the ability of persons with asymptomatic infection to transmit virus, and the possibility that early symptoms among persons infected with a novel influenza strain may be non-specific, delaying recognition and implementation of containment. Nevertheless, during the Pandemic Alert Period with a less efficiently transmitted virus, these measures may have great effectiveness, slowing disease spread and allowing time for targeted use of medical interventions. In addition, implementing these measures early in a pandemic when disease is first introduced into the U.S. and when the scope of the outbreak is focal and limited may slow geographical spread and increase time for vaccine production and implementation of other pandemic response activities. Later, when disease transmission is occurring in communities around the U.S., individual quarantine is much less likely to have an impact and likely would not be feasible to implement. Thus, community-based containment measures (e.g., closing schools or restricting public gatherings) and emphasizing what individuals can do to reduce their risk of infection (e.g., hand hygiene and cough etiquette) may be more effective disease control tools.In other words you would quarantine the first cases and their contacts but by the time you would need the military to carry out the quarantine it would no longer be of any use.

beskeptical
2005-Nov-12, 08:10 AM
There also seemed to be some comments about the fact a lot of the discussion was regarding a threat that wasn't real. Here is what the WHO summarizes about pandemic flu.

Ten things you need to know about pandemic influenza (http://www.who.int/csr/disease/influenza/pandemic10things/en/index.html)
14 October 2005

1. Pandemic influenza is different from avian influenza.

Avian influenza refers to a large group of different influenza viruses that primarily affect birds. On rare occasions, these bird viruses can infect other species, including pigs and humans. The vast majority of avian influenza viruses do not infect humans. An influenza pandemic happens when a new subtype emerges that has not previously circulated in humans.

For this reason, avian H5N1 is a strain with pandemic potential, since it might ultimately adapt into a strain that is contagious among humans. Once this adaptation occurs, it will no longer be a bird virus--it will be a human influenza virus. Influenza pandemics are caused by new influenza viruses that have adapted to humans.

2. Influenza pandemics are recurring events.

An influenza pandemic is a rare but recurrent event. Three pandemics occurred in the previous century: “Spanish influenza” in 1918, “Asian influenza” in 1957, and “Hong Kong influenza” in 1968. The 1918 pandemic killed an estimated 40–50 million people worldwide. That pandemic, which was exceptional, is considered one of the deadliest disease events in human history. Subsequent pandemics were much milder, with an estimated 2 million deaths in 1957 and 1 million deaths in 1968.

A pandemic occurs when a new influenza virus emerges and starts spreading as easily as normal influenza – by coughing and sneezing. Because the virus is new, the human immune system will have no pre-existing immunity. This makes it likely that people who contract pandemic influenza will experience more serious disease than that caused by normal influenza.

3. The world may be on the brink of another pandemic.

Health experts have been monitoring a new and extremely severe influenza virus – the H5N1 strain – for almost eight years. The H5N1 strain first infected humans in Hong Kong in 1997, causing 18 cases, including six deaths. Since mid-2003, this virus has caused the largest and most severe outbreaks in poultry on record. In December 2003, infections in people exposed to sick birds were identified.

Since then, over 100 human cases have been laboratory confirmed in four Asian countries (Cambodia, Indonesia, Thailand, and Viet Nam), and more than half of these people have died. Most cases have occurred in previously healthy children and young adults. Fortunately, the virus does not jump easily from birds to humans or spread readily and sustainably among humans. Should H5N1 evolve to a form as contagious as normal influenza, a pandemic could begin.

4. All countries will be affected.

Once a fully contagious virus emerges, its global spread is considered inevitable. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it. The pandemics of the previous century encircled the globe in 6 to 9 months, even when most international travel was by ship. Given the speed and volume of international air travel today, the virus could spread more rapidly, possibly reaching all continents in less than 3 months.

5. Widespread illness will occur.

Because most people will have no immunity to the pandemic virus, infection and illness rates are expected to be higher than during seasonal epidemics of normal influenza. Current projections for the next pandemic estimate that a substantial percentage of the world’s population will require some form of medical care. Few countries have the staff, facilities, equipment, and hospital beds needed to cope with large numbers of people who suddenly fall ill.

6. Medical supplies will be inadequate.

Supplies of vaccines and antiviral drugs – the two most important medical interventions for reducing illness and deaths during a pandemic – will be inadequate in all countries at the start of a pandemic and for many months thereafter. Inadequate supplies of vaccines are of particular concern, as vaccines are considered the first line of defence for protecting populations. On present trends, many developing countries will have no access to vaccines throughout the duration of a pandemic.

7. Large numbers of deaths will occur.

Historically, the number of deaths during a pandemic has varied greatly. Death rates are largely determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations, and the effectiveness of preventive measures. Accurate predictions of mortality cannot be made before the pandemic virus emerges and begins to spread. All estimates of the number of deaths are purely speculative.

WHO has used a relatively conservative estimate – from 2 million to 7.4 million deaths – because it provides a useful and plausible planning target. This estimate is based on the comparatively mild 1957 pandemic. Estimates based on a more virulent virus, closer to the one seen in 1918, have been made and are much higher. However, the 1918 pandemic was considered exceptional.

8. Economic and social disruption will be great.

High rates of illness and worker absenteeism are expected, and these will contribute to social and economic disruption. Past pandemics have spread globally in two and sometimes three waves. Not all parts of the world or of a single country are expected to be severely affected at the same time. Social and economic disruptions could be temporary, but may be amplified in today’s closely interrelated and interdependent systems of trade and commerce. Social disruption may be greatest when rates of absenteeism impair essential services, such as power, transportation, and communications.

9. Every country must be prepared.

WHO has issued a series of recommended strategic actions for responding to the influenza pandemic threat. The actions are designed to provide different layers of defence that reflect the complexity of the evolving situation. Recommended actions are different for the present phase of pandemic alert, the emergence of a pandemic virus, and the declaration of a pandemic and its subsequent international spread.

10. WHO will alert the world when the pandemic threat increases.

WHO works closely with ministries of health and various public health organizations to support countries' surveillance of circulating influenza strains. A sensitive surveillance system that can detect emerging influenza strains is essential for the rapid detection of a pandemic virus.

Six distinct phases have been defined to facilitate pandemic preparedness planning, with roles defined for governments, industry, and WHO. The present situation is categorized as phase 3: a virus new to humans is causing infections, but does not spread easily from one person to another.

Archer17
2005-Nov-12, 09:06 AM
You should have dropped it beskeptical. There's no justification for administration-bashing regarding the avian flu. So you don't agree with the administration. Big deal! Is this about the avian flu or what? If this becomes a human-to-human transmitted pandemic AND WE ARE ALL GOING TO DIE!! .. should we blame Bush? Kinda polemic, ain't it? What excuse do those unfortunate foreigners have? You know .. the rest of the world?!? Surely our administration isn't to blame there, right?

You prattle on about how the administration would drop the ball regarding the proper way to handle a global pandemic based on a sarongsong link, but you waste too much time decrying a hypothetical administration response on something that, if it reached here in it's terrible mutation, would be the issue itself. If no one else stopped it, what's that tell you? If it becomes a global pandemic impervious to drugs, despite your links and rhetoric, Bush wouldn't be the story .. the mutated H5N1 virus would be the issue.

Regarding the potential of this flu turning pandemic (ie mutating), yes, the threat is there but, it's premature to panic and irresponsible to post emotional rhetoric based on political affiliations. As I've said more than once, this H5N1 doesn't play politics.

beskeptical, you could contribute alot here if you focused on the issue. Stick to the thread topic. Can you do that? .. or are we just going to see you make excuses for why you don't?

sarongsong
2005-Nov-12, 06:38 PM
So who gets the U.S.'s $7 billion flu 'war-chest'?

beskeptical
2005-Nov-13, 07:08 AM
You should have dropped it beskeptical. There's no justification for administration-bashing regarding the avian flu. So you don't agree with the administration. Big deal! Is this about the avian flu or what? If this becomes a human-to-human transmitted pandemic AND WE ARE ALL GOING TO DIE!! .. should we blame Bush? Kinda polemic, ain't it? What excuse do those unfortunate foreigners have? You know .. the rest of the world?!? Surely our administration isn't to blame there, right?

You prattle on about how the administration would drop the ball regarding the proper way to handle a global pandemic based on a sarongsong link, but you waste too much time decrying a hypothetical administration response on something that, if it reached here in it's terrible mutation, would be the issue itself. If no one else stopped it, what's that tell you? If it becomes a global pandemic impervious to drugs, despite your links and rhetoric, Bush wouldn't be the story .. the mutated H5N1 virus would be the issue.

Regarding the potential of this flu turning pandemic (ie mutating), yes, the threat is there but, it's premature to panic and irresponsible to post emotional rhetoric based on political affiliations. As I've said more than once, this H5N1 doesn't play politics.

beskeptical, you could contribute alot here if you focused on the issue. Stick to the thread topic. Can you do that? .. or are we just going to see you make excuses for why you don't?
I'm sorry you don't get the point, Archer, but from this post you are missing it. What panic are you referring to? And, I believe handwashing and proper isolation technique will save anyone who figures that out.

That last paragraph doesn't warrant a response.

beskeptical
2005-Nov-13, 07:10 AM
So who gets the U.S.'s $7 billion flu 'war-chest'?This is one case where an investment in vaccine development and production is a good thing.

sarongsong
2005-Nov-14, 05:36 PM
November 14, 2005 (http://reuters.myway.com/article/20051114/2005-11-14T130049Z_01_RID434598_RTRIDST_0_NEWS-BIRDFLU-DC.html)
"...researchers in Vietnam say the H5N1 avian flu virus has mutated allowing it to replicate more easily inside humans and other mammals. Taiwan said it had detected another bird flu strain that can infect people...Like H5N1, the H7N3 strain can infect humans, said an official at the Council of Agriculture..."

SpockJim
2005-Nov-15, 07:06 AM
Interesting article there sarongsong!

It has mutated folks.

Eoanthropus Dawsoni
2005-Nov-15, 07:17 AM
But those that have a few chickens in the yard might want to keep a close eye on the wild bird monitoring and have a plan to move your birds indoors when the time comes.

Also you duck hunters will soon need to be very careful slaughtering those ducks.

I was a bit concerned earlier this year when my ducks and chickens started dying. I am still not sure of the cause, but I don't think it was flu.

Nevertheless, I am sure it will not be too long before this version of H5N1 appears in North America. The fall migration is underway and some of the geese and other waterfowl heading south do summer in northeastern Asia.

beskeptical
2005-Nov-15, 07:59 AM
I was a bit concerned earlier this year when my ducks and chickens started dying. I am still not sure of the cause, but I don't think it was flu.

Nevertheless, I am sure it will not be too long before this version of H5N1 appears in North America. The fall migration is underway and some of the geese and other waterfowl heading south do summer in northeastern Asia.Definitely do not assume anything is bird flu unless there is reason to suspect it. It is very easy to start seeing the bogyman behind every bush if one doesn't stick to a rational approach.

On the other hand, any unusual deaths of animals might be worth reporting to the health department. Are you in the USA? Newcastle disease and psiticosis are two concerns and toxins might be a third thing to consider.

beskeptical
2005-Nov-15, 08:44 AM
November 14, 2005 (http://reuters.myway.com/article/20051114/2005-11-14T130049Z_01_RID434598_RTRIDST_0_NEWS-BIRDFLU-DC.html)
"...researchers in Vietnam say the H5N1 avian flu virus has mutated allowing it to replicate more easily inside humans and other mammals. Taiwan said it had detected another bird flu strain that can infect people...Like H5N1, the H7N3 strain can infect humans, said an official at the Council of Agriculture..."Everything in the article has not yet been confirmed. That doesn't mean it is false, just that some of it may be premature conclusions. The idea the genetic changes have been detected is unconfirmed according to my infectious disease site. I tried to find more on the www.pasteur-hcm.org.vn website yesterday but the pages took so long to load I gave up. The info on their genetic analysis wasn't easy to find. But the Jakarta Pasteur site seems legit. They list a number of tests they perform as if they are a commercial lab. I'm waiting for follow up information.

There are certainly more and more human cases occurring. The odds of species jump increases with each new infection.

beskeptical
2005-Nov-16, 09:29 PM
November 14, 2005 (http://reuters.myway.com/article/20051114/2005-11-14T130049Z_01_RID434598_RTRIDST_0_NEWS-BIRDFLU-DC.html)
"...researchers in Vietnam say the H5N1 avian flu virus has mutated allowing it to replicate more easily inside humans and other mammals. Taiwan said it had detected another bird flu strain that can infect people...Like H5N1, the H7N3 strain can infect humans, said an official at the Council of Agriculture..."Got this comment today on my ID site re some of the above news story content I commented on earlier.

The Ho Chi Minh Pasteur Institute said its decoding of 24 samples of the
H5N1 virus taken from poultry and humans showed a significant variation of
antigen [presumably the surface proteins of the virus, HA and NA]. "The
H5N1 type that infected people and waterfowl in early 2005 has several
mutations focusing in the important functional parts of the surface
proteins," the institute said on its website <http://www.pasteur-hcm.org.vn>.

"There has been a mutation allowing the virus to breed effectively on
mammal tissue and become highly virulent," it said. The study also found a
mutation of the PB2 gene in a virus sample from a patient who died in the
southern Dong Thap province earlier this year [2005]. The finding showed
the virus had been combining changes to adapt to new hosts, Sunday's [13
Nov 2005] Quan Doi Nhan Dan newspaper quoted Cao Bao Van, head of the
Molecule Biology Department, as saying.

.....

[The evidence relating these particular mutations in the HA, NA and PB2
genes of H5N1 avian influenza to the host range phenotype of the virus is
not stated and must await critical evaluation when the data are published
in the scientific literature. - Mod.CP]Things are looking worse day by day.

Dragon Star
2005-Nov-16, 10:51 PM
<<Killed Dead Link>>

sarongsong
2005-Nov-17, 05:09 AM
Here's the plan, Stan:
House Hearing on Prevention of the Avian Flu (http://www.c-span.org/Search/advanced.asp?AdvancedQueryText=ron+dehaven&StartDateMonth=11&StartDateYear=2005&EndDateMonth=12&EndDateYear=2005&Series=&ProgramIssue=&QueryType=&QueryTextOptions=&ResultCount=10&SortBy=bestmatch) (loads directly)

Chairman Representative Bob Goodlatte (R-VA) and witness W. Ron DeHaven,
Administrator of the Animal and Plant Health Inspection Service at the Agriculture Department, hold a hearing on "Prevention, Detection, and Eradication of Avian Flu."
11/16/2005: WASHINGTON, DC: 1 hr. 45 min.
Note: Most events will remain in the archive for 15 days or less.
DeHaven shines with well-reasoned complete answers and elaborations to the Representatives' concerns...oh, and just for Sammy---a Representative from Minnesota's selenium comments.

Disinfo Agent
2005-Nov-19, 04:53 PM
This was posted on the Snopes Message Board (http://msgboard.snopes.com/message/ultimatebb.php?/ubb/get_topic/f/53/t/002703/p/1.html#000000):


The drug's Japanese distributor, Chugai Pharmaceutical, issued a report to the health ministry after the first incident saying a link between taking the drug and the odd behaviour that led to the death cannot be ruled out, the Mainichi said.

The ministry is aware of one of the cases and is warning that taking the drug may lead to abnormal behaviour and accidental death, Kyodo News agency said, citing an unidentified ministry official.

While Tamiflu carries a label in Japan warning of such side effects as "abnormal behaviour" and "hallucinations", the cases are the country's first in which strange behaviour linked to the drug has resulted in deaths, the Mainichi said.

source (http://www.cbc.ca/story/science/national/2005/11/17/Tamiflu-051117.html)Eventually 12 deaths in 13 months were identified as being possibly linked to the Tamiflu.

The 12 deaths in the past 13 months included one suicide, four cases of sudden death and four heart attacks. Other deaths involved asphyxiation, pneumonia and acute pancreatitis.

There have also been 32 cases of psychiatric abnormalities, including delusions, hallucinations and delirium, reported in children who had taken Tamiflu. Thirty-one of the cases involving psychiatric episodes occurred in Japan.

source (http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20051118-16483300-bc-us-fluwrap-1stld.xml)
On the other hand, the FDA sees no direct evidence so they don't have a problem.

"The committee does not think, based on the data presented, that there's any evidence Tamiflu played a role in the deaths," panel chair Robert Nelson said Friday.

snip

Japanese regulators reported reactions including skin conditions, heart problems and psychiatric effects such as confusion, anxiety and hallucinations. Tamiflu is widely prescribed during the regular flu season in Japan.

Panelists recommended changing Tamiflu's label to add information about serious skin reactions. The FDA is not required to follow the recommendations but usually does.

source (http://www.cbc.ca/story/science/national/2005/11/18/Tamiflu-051118.html)

Sammy
2005-Nov-19, 05:48 PM
I didn't go back to the sources, so I don't know if the provided info on the number of people treated with Tamiflu. All drugs have some side effects, ranging from negligible to frequent occurance. If the base od treate individuals is very large, the number of incidents cited, tho of concern, is hardly a big red flag..

sarongsong
2005-Nov-20, 06:55 AM
From Disinfo Agent's Snopes quote:
"...Tamiflu carries a label in Japan warning of such side effects as "abnormal behaviour" and "hallucinations"..."
Just wondering what might be hallucinogenic/behavior-altering here:
"...If you are allergic to anything that is listed below for your form of Tamiflu..." Medguide (http://medguides.medicines.org.uk/displaypage.aspx?t=medicine&i=61#ingredients)

beskeptical
2005-Nov-20, 09:04 PM
ID Society update (http://www.promedmail.org/pls/askus/f?p=2400:1001:118795033376963078::NO::F2400_P1001_ BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,31127)
The submission from Hoffman La-Roche -- Roche's US division -- to the FDA
states that the adverse events reported could be the result of influenza
itself. Neurological complications are not uncommon during influenza
infections, the symptoms of which occur concurrently with the usage of
Tamiflu, making any causal relationship of these events to Tamiflu
difficult to assess in the absence of a controlled trial.

The FDA notes that the evidence that influenza can cause brain
inflammation, or encephalitis, was first reported by Japanese
paediatricians in the 1990s, and the increased awareness of this rare flu
complication may mean that Japanese doctors are more likely to report it
than elsewhere. Japan also uses the majority of the world's Tamiflu supply
for seasonal influenza. It has used 24 million prescriptions -- 4 times
more than the US, says Hoffman La-Roche. The country has also had intensive
monitoring of the drug in its first 6 months after launch and again in the
very active flu season of 2004 to 2005.

The FDA said on Thu 17 Nov 2005 that it anticipated it would continue
monitoring adverse events linked with Tamiflu and report back to its
paediatric advisory committee within 2 years.While no one is ruling out the potential for side effects including death from Tamiflu, the flu also kills. No matter what drug one takes for any illness, you evaluate risk vs benefit. It's nothing new. How many parents would tell their health care provider not to give their kids Tamiflu if children were dying from flu?

Cylinder
2005-Nov-23, 01:33 AM
From the CDC press release (http://www.cdc.gov/od/oc/media/pressrel/r051122.htm):


The Centers for Disease Control and Prevention (CDC) today proposed critical updates to existing regulations that will allow the agency to move more swiftly to control a potential outbreak of disease that may result when a sick passenger arrives in the United States via commercial airline or ship. The new proposed regulations are being published in the Federal Register for public comment.

“CDC is committed to protecting health by preventing the introduction of communicable diseases into the United States,” said CDC Director Dr. Julie Gerberding. “These updated regulations are necessary to expedite and improve CDC operations by facilitating contact tracing and prompting immediate medical follow up of potentially infected passengers and their contacts.”

The changes are designed to ensure that CDC has the tools in place to respond to any public health threat that may emerge. Key updates to existing regulations include:


Expanded reporting of ill passengers on board interstate flights as well as airline flights and ships arriving from foreign countries,
Requirements that ships and airline flights arriving from foreign countries and certain interstate flights maintain passenger and crew lists and submit lists electronically to CDC upon request,
Explicit due process provisions for persons subject to quarantine.


Most public health actions are voluntary because ill and infected travelers often understand the importance of keeping themselves separated from others and remaining in a safe location where they receive care. CDC’s quarantine authority generally would only be used if someone posed a threat to public health and refused to cooperate with a voluntary request.

[snip]

The Public Health Service Act authorizes HHS to make regulations to prevent the introduction, transmission, and spread of communicable diseases into the United States and from one state or possession into any other state or possession. A communicable disease is one that can pass from a person or animal to another person. CDC protects Americans’ health by contacting individuals who may have been exposed to a communicable disease and recommending appropriate treatments, or through public health actions including isolation and quarantine

A list of the CDC-proposed legislation can be found here (http://www.cdc.gov/ncidod/dq/).


From the CDC Quarantine Fact Sheet:


Quarantine refers to the separation and restriction of movement of persons who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious. Quarantine of exposed persons is a public health strategy, like isolation, that is intended to stop the spread of infectious disease. Quarantine is medically very effective in protecting the public from disease.
States generally have authority to declare and enforce quarantine within their borders. This authority varies widely from state to state, depending on state laws. The Centers for Disease Control and Prevention (CDC), through its Division of Global Migration and Quarantine, also is empowered to detain, medically examine, or conditionally release persons suspected of carrying certain communicable diseases.

beskeptical
2005-Nov-23, 07:36 AM
The main accomplishment of the new Public Health rule is to be able to contact air passengers if they may have been exposed to an ill person who wasn't detected until after they have disembarked. That wasn't easy in the past and with SARS there were serious problems.

The airport here, (SEATAC International), didn't have their quarantine capability up and running when SARS occurred. They were supposed to have the ability and the rules were in place but there were no designated staff, no one to ID who might need to be quarantined, and I think the room they would need to use wasn't even set up. They probably still don't have everything ready but I haven't checked recently. It's amazing how unprepared we are for this kind of thing.

beskeptical
2005-Nov-23, 07:47 AM
From From my IDS site (http://www.promedmail.org/pls/askus/f?p=2400:1001:16502093324956223641::NO::F2400_P100 1_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,31154) re the Tamiflu neurological events:
The FDA revealed yesterday that a legally required safety review for pediatric
drugs had identified the deaths in Japanese children taking oseltamivir. The
advisory committee discussed the report at a meeting today. In a statement on
its Web site, the FDA said the children's deaths appear to be part of a wave
of influenza-related encephalitis and encephalopathy cases in Japanese
children that began in the mid-1990s, before oseltamivir was approved. "Based
on the information available to us, we cannot conclude that there is a causal
relationship between Tamiflu and the reported pediatric deaths," the statement
said.

The safety review identified neurologic and psychiatric problems such as
delirium, hallucinations, abnormal behavior, convulsions, and encephalitis,
nearly all of them (and all 12 deaths) in Japanese children. "In many of these
cases, a relationship to Tamiflu was difficult to assess because of the use of
other medications, presence of other medical conditions, and/or lack of
adequate detail in the reports," the FDA said. The agency said that since the
mid-1990s there have been many reports of flu-associated encephalitis or
encephalopathy in children: "These reports originated primarily from Japan
where pediatricians described a pattern of rapid onset of fever, accompanied
by convulsions and altered level of consciousness, progressing to coma within
a few days of the onset of flu symptoms. This syndrome frequently resulted in
death or significant neurologic sequelae."

[The FDA Panel statement provides a convenient point to disconnect this thread
until the Panel provides their update in one year's time and a full report 2
years from now. However, in the interim, it would be interesting to learn why
the Japanese children's deaths appeared to be part of a wave of influenza-
related encephalitis and encephalopathy cases that began in the mid-1990s,
before oseltamivir was approved. - Mod.CP]There was one bird flu case that was encephalitis and surprised everyone a few months ago. I can't remember why they tested this particular person though it may have been on autopsy. At the time the concern was how many cases of atypical bird flu were being missed.

Also, after the 1918 pandemic, there was an associated outbreak of brain disease. It's a famous case. The victims remained catatonic. Then someone tried a particular drug and they all woke up. Sadly, the treatment was temporary and they all lapsed back into their catatonic state. I believe flu was suspected but perhaps not proved to be the cause.

I wrote this to see how well I have remembered the facts. Now I'm going to look it up and see how well or poorly I remembered things.

beskeptical
2005-Nov-23, 08:04 AM
I found this book summary of the incident. (http://www.amazon.com/gp/product/0804511764/104-8141972-1800724?v=glance&n=283155&v=glance)
This book details the experiments with L-Dopa that Dr. Oliver Sacks put some special patients through at the Mt. Carmel Hospital in New York. These patients had been infected with encephalitis lethargica some 40 years earlier. One of the after effects of encephalitis lethargica (a disease which appeared mysteriously in 1916 and disappeared just as mysteriously in 1926) is manifestation of the symptoms of severe Parkinson's Disease. The patients had tremors, and they just seemed to freeze up, unable to move, walk, talk, or even swallow, in some cases. This left the patients in a catatonic state, and when their relatives were unable to care for them any longer at home, they were institutionalized at the hospital, together with patients suffering from dementia and other mental illnesses. Dr. Sacks, a neurologist, began working at Mt. Carmel in 1966. About that time, researchers working on Parkinson's began touting the wonders of L-Dopa, a drug that seemed to provide some relief from the Parkinsons' symptoms.

In the summer of 1969, Sacks began to administer L-Dopa to the encephalitis lethargica patients to see if it would also relieve their symptoms. The results were miraculous-at first. Patients were suddenly able to move their muscles again, and they stood up from their wheelchairs and began walking around for the first time in 20-40 years. They laughed, talked, sang and wrote about their experiences both before their illness, and during their long stay at the hospital. Unfortunately, however, the euphoria was short-lived for all, as ticks, psychoses, and other mental disorders began to set in, often after a period of a few weeks or even just a few days of relative health.

In this book, Sacks describes encephalitis lethargica, then he provides a selection of case histories, detailing patients' lives before L-Dopa, during the euphoric state of health, and the later stages, in which nearly every patient developed extreme psychological disorders that necessitated stopping the L-Dopa treatments. In the conclusion of the book, Sacks analyzes what went wrong, and generally ascribes it to the underlying mental state of the patients. He suggests that once their initial euphoria over re-joining the world wore off, weak personalities, compounded with poor relationships with family members and mistreatment over the years at the hospital came together and allowed simmering psychoses and other mental problems to bubble to the surface and drag the patients back down to their illness once again. "Love is the alpha and the omega," he states, suggesting that if these patients were more capable of loving and being loved, they could have maintained their healthy state brought on by L-Dopa. It doesn't mention the flu as the cause but I know that was suspected.

Titana
2005-Nov-27, 06:57 PM
More news.....



http://news.yahoo.com/s/ap/20051127/ap_on_re_as/vietnam_bird_flu

beskeptical
2005-Nov-27, 08:41 PM
On my public radio station I heard part of a news program saying India had their first human case and there was a new wild bird outbreak somewhere north of the current limits. I only caught a piece of it. I don't know if it was NPR or a local news show. I searched both NPR and the station for the piece but couldn't find any mention of it via their search engines. And, I searched Google News and found no record of either event.

Did anyone else hear anything like this yesterday or the day before possibly?

ADDED: Seems the India bird flu has hit the news wires today. Antibodies in 3 well workers and a lot of speculation and complaints about poor monitoring.

sarongsong
2005-Nov-28, 06:56 PM
November 28, 2005 (http://www.breitbart.com/news/2005/11/28/051128144954.1qt0p6wv.html)
"...In China's human cases, the virus has mutated "to a certain degree," health ministry spokesman Mao Qun'an was quoted as saying. "But the mutation cannot cause human-to-human transmission of the avian flu," he noted..."

beskeptical
2005-Nov-28, 08:55 PM
November 28, 2005 (http://www.breitbart.com/news/2005/11/28/051128144954.1qt0p6wv.html)
"...In China's human cases, the virus has mutated "to a certain degree," health ministry spokesman Mao Qun'an was quoted as saying. "But the mutation cannot cause human-to-human transmission of the avian flu," he noted..."This is a good example of how mutations accumulate in viruses and bacteria.

You start with a billion organisms. One mutates and is still viable. Soon that mutated organism multiplies into a billion organisms with the mutation. One of those mutates and is still viable. Soon the organism with two changes from the original multiplies into a billion organisms with two mutations. This process goes on and on.

It is no wonder the H5N1 is evolving differently in one geographic area from another distant one.

The example illustrates how many chances this thing is going to have to become dangerous to people.

In addition, once you get a strain that is genetically close to the one that will be transmissible from person to person, you will have billions of viruses that are close to the one that will be transmissible from person to person. The final mutation will likely occur more than once.

When I say final mutation, I mean that only as an illustration. In reality, the virus may accumulate more infectiousness after it becomes transmissible between people.

It is possible it will acquire the needed trait and be highly infectious immediately. It depends on exactly what needs to change to make the jump. Single mutations can have large results. We don't know enough yet about the genetic changes that allow transmission in this case.

The Supreme Canuck
2005-Nov-28, 10:18 PM
Hm. Well this is interesting:

Ethics in a pandemic. (http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&call_pageid=971358637177&c=Article&cid=1133133016571)


In the event a bird-flu pandemic hits the human population, should we force doctors and nurses to stand on the front lines and fight the disease, or let them seek safer ground?

Who should we treat with available medicines and who should do without?

Who should we quarantine, ban, turn away or jail?

Who should we save and who let die?

The first thing that came to mind is: What safer ground? What good would a quarantine do? Jail?

My next thought was: I hope it's just the paper getting it a bit wrong...

beskeptical
2005-Nov-29, 12:27 AM
Hm. Well this is interesting:

Ethics in a pandemic. (http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&call_pageid=971358637177&c=Article&cid=1133133016571)



The first thing that came to mind is: What safer ground? What good would a quarantine do? Jail?

My next thought was: I hope it's just the paper getting it a bit wrong...Well some of these questions really do need careful thought before the time comes and the decisions need to be rushed.

No one can nor should force anyone to risk their lives. You might be fired for deserting your post but if the employer can't provide protection for you as a worker then it's the employer's (or society's) problem not the workers'.

You have to ration vaccine and drugs. There might not be any other options. Better to have a plan than a free for all.

Safer ground is home. The virus isn't really going to 'in flew enza' through your open window.

Quarantine has some use especially early on in a pandemic. It is voluntary 99% of the time. We currently jail some people with certain contagious diseases that won't abide by isolation recommendations. You have to be pretty bad and you get lots of chances but at some point if you put others in danger, the public health officer (here in the USA) can order your detention in a jail infirmary.

Gillianren
2005-Nov-29, 12:47 AM
Just like good ol' Typhoid Mary, who persisted in working as a cook even after it was scientifically proven she was spreading typhus by doing so. (While arguments have been put forward that she didn't understand what was going on, I've always felt the danger to those for whom she cooked justified what it took to keep her from cooking for people.)

The Supreme Canuck
2005-Nov-29, 12:51 AM
Safer ground is home. The virus isn't really going to 'in flew enza' through your open window.

Quarantine has some use especially early on in a pandemic. It is voluntary 99% of the time. We currently jail some people with certain contagious diseases that won't abide by isolation recommendations. You have to be pretty bad and you get lots of chances but at some point if you put others in danger, the public health officer (here in the USA) can order your detention in a jail infirmary.

Huh. I really only had issue with these two points in the article. I read "safer ground" as meaning going somewhere else. Doesn't really work in a pandemic. I didn't think the health workers point was too big of an issue anyway. Absolutely we need to keep them safe. But we don't need to force them to work. The good ones will do that voluntarily. They're there to help. That's what they want to do.

As for quarantine and jailing, how does that do any good in a pandemic? It doesn't stop anything; too many people are already infected.

beskeptical
2005-Nov-29, 09:02 AM
Huh. I really only had issue with these two points in the article. I read "safer ground" as meaning going somewhere else. Doesn't really work in a pandemic. I didn't think the health workers point was too big of an issue anyway. Absolutely we need to keep them safe. But we don't need to force them to work. The good ones will do that voluntarily. They're there to help. That's what they want to do.

As for quarantine and jailing, how does that do any good in a pandemic? It doesn't stop anything; too many people are already infected.During the SARS outbreak, not many health care workers skipped work. And they were indeed catching it and dying.

Quarantine takes many forms. The plan during a flu pandemic would be to use individual and contact isolation at home or in the hospital depending on how sick one was in the beginning when only a few cases were in the country. Once you get beyond that stage, you close schools and other non-essential public gatherings and encourage people to stay home for the most part. Only essential workers with no symptoms will go to work.

The only time you would use police force to isolate someone, would be events such as a plane arrives with a sick person on board and the passengers balk at being told they cannot leave the airport isolation area. That would only happen very early in a pandemic and only extremely rarely.

The more likely scenario would be all the passengers would be advised to go home and stay home until the incubation period was over. If they weren't ill or if they were cleared by a public health visit, the quarantine would be over. If such a person went home but then refused to stay there, there might be a case or two where the person was arrested and held in quarantine briefly.

I already said rather vehemently that the President's order granting himself the power to have the military enforce an area quarantine was nonsense. Such a scenario is from the movies, not from any real experience nor public health pandemic flu plan. There will not be some local outbreak affecting only one major city for example. You'll either have a few cases in which the military would never be needed, or you'll have a nationwide outbreak where there will be no one to quarantine since there'll be no boundaries.

That's when people can just stay home and they will essentially be isolated. You will then see a lower infection rate in 1st world countries because we live in houses. Countries where people live in much more crowded conditions won't be as fortunate.

The Supreme Canuck
2005-Nov-29, 01:29 PM
Ah, thanks for explaining that. One question: was the military quarantine idea specifically for avian flu, or is it just a general power that could be applied in case of a local outbreak? If that's the case, it might have limited use if a town is infected with, er, something and they (for some strange reason) refuse to cooperate with the public health. Never, never going to happen, but it pays to be prepared. Or have I missed some big medical truth?

beskeptical
2005-Nov-30, 09:59 AM
Ah, thanks for explaining that. One question: was the military quarantine idea specifically for avian flu, or is it just a general power that could be applied in case of a local outbreak? If that's the case, it might have limited use if a town is infected with, er, something and they (for some strange reason) refuse to cooperate with the public health. Never, never going to happen, but it pays to be prepared. Or have I missed some big medical truth?If this was Kikwit, Democratic Republic of the Congo, you might need the military to stop uneducated poverty stricken people fleeing on foot to nearby towns in fear of Ebola. If this were Taiwan, you might need the military to lock down the local hospital where SARS cases were spreading, letting no one in or out. If this were the movies you might want the military surrounding a town and threatening to shoot anyone who tries to leave for dramatic effect. If this were a fake documentary put together by poorly informed writers with no public health background you might put a scene in where people were rounded up from perfectly good isolation in their homes and taken to a crowded location supposedly to stop an epidemic.

In modern Western countries with average or better public health systems, there isn't any scenario I can think of that would ever warrant the use of the military to stop a pandemic. It is totally absurd. Even a smallpox outbreak wouldn't warrant such a response.

Think about it. You're on a plane and a passenger has smallpox which is either diagnosed at the time or shortly after. The public health department contacts you and tells you that you've been exposed. What would 99% of the people you know do? Whatever the health department told them to, of course!

Maybe there'd be the one idiot who insists on ignoring the recommendations. That would hardly call for more than one or two police officers to convince the person to cooperate.

Even if hundreds or thousands of people were exposed to something, you wouldn't seal off an area. What would be the point? By that time, there wouldn't be one area affected. It would already be widespread. We are a very mobile society.

We aren't a bunch of ignorant frightened Kikwitis who believe Ebola is an evil curse. If the medical community tells you there is a disease spread by contact with body fluids you avoid contact with people's body fluids. If you've been exposed, you want medical care, you don't want to flee into the hills.

If there is an airborne disease, you want people to stay home. You don't want to put anyone in a crowded building.

There are a few scenarios we think of as what would happen merely because we've seen the scenario played out over and over in novels, in movies, and in other fictional accounts. Like the supposed panic people will go into if the government tells them there are UFOs. Maybe with a drama like War of the Worlds you have some people panicking. But that was because people thought there were invincible Martians coming toward them with frightening weapons, burning the countryside as they went, not because ETs were shown to exist. I'd think most of us on this BB know the movie cliche of government UFO cover ups to keep people from panicking is complete fiction. I always wonder just what these panicking people are supposedly going to do?

Well it's the same with the fictional account of the military moving in to surround the town to isolate some disease. It is purely 100% some figment of fictional writers' imaginations. It's a story that once it was written has been repeated in subsequent works of fiction as if it would actually occur.

Just as some revelation that a UFO landed in Roswell will not send the world into a panic, neither is there any infectious disease that were there to be an outbreak, would require any military intervention in the modern world. In countries where there is a role for the military in controlling the population anyway, such as China, you might see soldiers used, like the hospital in Taiwan. But that's because they use the military for all sorts of crowd control reasons, outbreak or not. We have a public health system here. People trust the hospitals and the medical community to help them. People mostly follow quarantine requests voluntarily here.

As I write this I did think of one scenario, and it isn't for quarantining anyone. When people are dying and they can't get scarce drugs or vaccine, you could have pharmacies and hospitals mobbed by desperate people. If the police were not enough, that's the only thing I can think of where military assistance would possibly be used.

And, getting back to Bush declaring Influenza be added to "the list" of diseases that he could order quarantine for, those laws are already on the books in every state I've lived in and presumably all the states I've not lived in as well. Your local public health generally has some law allowing any action necessary to protect the public health.

That law was used here last year because our county had a particularly serious flu vaccine shortage. An order was issued for all health care workers in the county to restrict who they gave flu shots to. I bought my vaccine supply. I am not part of the public medical community. But I was restricted in who I could sell vaccine doses to. That's what public health departments do. And, they have the authority to do so without any Federal intervention.

I think Bush was either grandstanding, or has the same misconceptions as many people and thought he may need to send in the troops to aim their weapons at fleeing citizens who would want to get out of town as people fell ill around them.

People will go home. That's all. No panicked flight. Maybe the tourists would stay away (like Toronto with SARS cases), or someone would cancel a visit by the high school band coming from the affected town, (like during the Haanta virus outbreak in the Four Corners area), but no military needed there.

The Supreme Canuck
2005-Nov-30, 08:20 PM
Right, pretty much what I thought. People would obey health recommendations. It's in their best interests. I did think of a scenario where the military would be useful, though. Probably more useful in Canada than the US: the military has resources that the public health doesn't. So if a remote community gets some sort of infection, the military can go in and fix it. This happened recently with tainted water on a reserve in northern Ontario. The army went in with water purifiers, and fixed the problem. They'd also probably be the first to be called if, say, there was some sort of biological agent released somewhere. Either way, not a quarantine, but a use.

beskeptical
2005-Nov-30, 09:59 PM
Right, pretty much what I thought. People would obey health recommendations. It's in their best interests. I did think of a scenario where the military would be useful, though. Probably more useful in Canada than the US: the military has resources that the public health doesn't. So if a remote community gets some sort of infection, the military can go in and fix it. This happened recently with tainted water on a reserve in northern Ontario. The army went in with water purifiers, and fixed the problem. They'd also probably be the first to be called if, say, there was some sort of biological agent released somewhere. Either way, not a quarantine, but a use.The military here has the mobile level 4 isolation unit. There was much discussion during the SARS outbreak and the anthrax release as to just how the health department was going to interact with the military. One would think it was an easy task but there is no formal relationship between the two departments.

There were also issues mobilizing the military to assist in New Orleans. They supposedly didn't have the jurisdiction to be involved. They especially aren't allowed to act as any kind of police force.

I would think the National Guard would have been more appropriate had they not been deployed to do the military work that we can't discuss here.

But I agree there is plenty of work the military could be doing during a major disease pandemic. It just won't involve surrounding a town and threatening to shoot civilians on site should they try to leave.

The Supreme Canuck
2005-Nov-30, 11:57 PM
We're agreed on that. ;)

Anyway, I find it kind of interesting that there's problems getting the US military to help. In the incident I mentioned, the army just got a call, and went in.

sarongsong
2005-Dec-01, 08:30 PM
December 1, 2005 (http://cbs2.com/topstories/local_story_333212149.html)
Weak strain of avian flu found in Southern California...

beskeptical
2005-Dec-01, 09:33 PM
December 1, 2005 (http://cbs2.com/topstories/local_story_333212149.html)
Weak strain of avian flu found in Southern California...Sarong, this is not new news. It's only the media paying attention to reports that would have otherwise been ignored and more thorough surveillance of wild birds. Avian flu, just like human flu and swine flu and equine flu and so on are natural diseases that will always be found in these populations. Even LPAI, low pathogenic avian influenza, H5N1 has been circulating in birds for many years (probably thousands of years or more).

The current concern is only about the HPAI, highly pathogenic avian influenza, H5N1 which emerged as a new mutation from the existing strains in 1997.

sarongsong
2005-Dec-02, 12:19 AM
Thanks for the clarification; funny how the media left that part out.

The Supreme Canuck
2005-Dec-02, 01:42 AM
They didn't here. They've been finding low-pathogenic H5N1 in BC for a while now. In every article I've read, there's been a statement to the effect of, "It's not that H5N1!"

beskeptical
2005-Dec-02, 10:34 AM
Thanks for the clarification; funny how the media left that part out.They are rather annoying aren't they? :)

sarongsong
2005-Dec-11, 12:33 AM
???
December 10. 2005 (http://reuters.myway.com/article/20051210/2005-12-10T200755Z_01_RID567810_RTRIDST_0_NEWS-BIRDFLU-USA-DC.html)
"...the White House on Saturday conducted a test of its readiness for a feared bird flu pandemic...top officials took part in the four-hour tabletop drill...officials said afterward that it was clear that state and local governments would have to assume a leading role..."

Sammy
2005-Dec-11, 09:09 PM
???
December 10. 2005 (http://reuters.myway.com/article/20051210/2005-12-10T200755Z_01_RID567810_RTRIDST_0_NEWS-BIRDFLU-USA-DC.html)
"...the White House on Saturday conducted a test of its readiness for a feared bird flu pandemic...top officials took part in the four-hour tabletop drill...officials said afterward that it was clear that state and local governments would have to assume a leading role..."

How many top officials can fit on a tabletop?

(Sorry, but I just couldn't resist ....)

beskeptical
2005-Dec-11, 09:32 PM
???
December 10. 2005 (http://reuters.myway.com/article/20051210/2005-12-10T200755Z_01_RID567810_RTRIDST_0_NEWS-BIRDFLU-USA-DC.html)
"...the White House on Saturday conducted a test of its readiness for a feared bird flu pandemic...top officials took part in the four-hour tabletop drill...officials said afterward that it was clear that state and local governments would have to assume a leading role..."
Not to get too political here but isn't that what they said with the Katrina response?

My point is everyone will have a role when the next major flu pandemic occurs.

The public can wash their hands, cover their coughs, stay home when sick, and stay away from crowded places.

Employers can be planning for staff shortages and alternative ways for employees to work from home. They can keep surfaces clean with disinfectant wipes and provide places and time for employees and customers to also keep hands clean.

Health care and public health agencies are already mostly getting ready.

But the federal government shouldn't be just concluding that everyone else needs to do most of the work. The feds need to get their own act together. They're going to be in charge of the borders, the air and sea ports, trade and economic issues, interstate transportation, and national preparedness like our national vaccine and anti-viral medication supply and distribution.

The military can add to the absent workforce and there is the military medical system. The feds need to get the mechanisms in place for the military public interface. (No armed soldiers sealing off towns needed, than you.)

Right now, we don't have a national vaccine distribution plan, except the Vaccines for Children Program. Vaccines and Tamiflu are in private hands. Distribution of vaccines and drugs are via private providers. There aren't enough public health providers to distribute vaccines to the nation's health care workers who will supposedly be first in line.

(It isn't as simple as, "Can't the nurses just give the shots?" There are the problems of delivering supplies, refrigerating vaccines, coordinating who, when and where and so on. While that seems simple, it is, except it doesn't just occur without setting it up. It took the public health 3 months to plan and distribute flu vaccine during last year's shortage. The result was vaccine went unused because it wasn't distributed until January.)

From the article:
"This is not going to be a federal answer to the problem," she said. "The federal government has got a support role to play. But frankly, I think, really very important is the state and local efforts."I think every role will be critical, not merely support.


Leavitt said officials discussed at length how they would deal with limited U.S. supplies of antiviral and vaccines.Of which we don't have any federal stockpiles of now nor has the purchase been funded.


"..the United States also needed a surveillance system to detect the virus before it spreads.That we have, I believe.


The plan calls for building stockpiles of influenza drugs, which would not provide a cure but which might help make the most vulnerable patients less ill.Here the reporter or someone has their facts confused. Everyone with flu will either die or be 'cured'. The infection is self limiting. What is a 'cure' if you don't have a disease? Tamiflu shortens and modifies symptoms if given in the first 24 hours of symptom onset. That's what a 'cure' does, it shortens and modifies the infection. Sometimes 'cures' shorten infection times more dramatically, but not always. And if given after an exposure, T. can prevent infection.

I don't feel very confident after this news account that the drill was as successful as claimed. But staying out of the politics of it and trying to keep to the science, I wonder who from CDC was there?
Cabinet secretaries, military leaders and other top officials took part...I think I'll check into that and get back here.





Well, this doesn't look like science was well represented, emphasis mine:
Bloomberg news (http://www.bloomberg.com/apps/news?pid=10000087&sid=a6ZH_uWsYuy8&refer=top_world_news)
``The federal government has got a support role to play,'' in preparing for a potential outbreak, said Fran Townsend, President George W. Bush's top homeland security adviser, following the four-hour meeting. She said there ``is not going to be a federal answer to the problem.''

U.S. Homeland Security Secretary Michael Chertoff, Treasury Secretary John Snow, Federal Reserve Chairman-designate Ben Bernanke, who is currently head of the White House Council of Economic Advisors, and more than a dozen cabinet officers and military generals participated in today's exercise, which focused on the federal government's response to a potential outbreak.

``The most important part of that strategy will be vaccines and anti-virals,'' said Townsend, following today's so-called table-top exercise. ``You might think about getting your annual flu shot.''CDC doesn't have vaccines and anti-virals at the top of their response list because we won't have enough for years.

And the "not going to be a federal answer" is too political to discuss here.

mugaliens
2005-Dec-11, 10:00 PM
Stay healthy, exercise, take your vitamins, eat right, practice good sanitation - best prophalaxis (sp?) against disease!