[Ought Six]

WHO: Flu Pandemic Inevitable, Plans Needed Urgently (http://story.news.yahoo.com/news?tmpl=story&cid=570&ncid=753&e=2&u=/nm/20041126/sc_nm/birdflu_dc)


By Vissuta Pothong
Reuters, via Yahoo! News
Fri Nov 26

BANGKOK (Reuters) - Every country in the world must come up with a plan urgently to deal with an inevitable influenza pandemic likely to be triggered by the bird flu virus that hit Asia this year, a top global health expert said on Friday.

"I believe we are closer now to a pandemic than at any time in recent years," said Shigeru Omi, regional director for the Western Region of the World Health Organization (WHO).

"No country will be spared once it becomes pandemic," he told a news conference.

"History has taught us that influenza pandemics occur on a regular cycle, with one appearing every 20 to 30 years. On this basis, the next one is overdue.

"We believe a pandemic is highly likely unless intensified international efforts are made to take control of the situation," he said of the H5N1 avian flu virus, which has defied efforts to eradicate it in several Asian countries, most notably in Thailand.

The world would have to cooperate closely to stave off a pandemic by sharing information promptly and openly on the virus -- such as how it spreads, why it hits children more easily than adults and how quickly it is mutating, Omi said.

"There is no single solution to solve this disease, you have to do many things," he said.

"Vaccine will protect you from the disease and reduce the impact individually. But vaccination alone will not prevent this outbreak," he said.

"Each country has to come up with a plan because, as I said, a pandemic, it will happen."

HUGE HUMAN TOLL

The WHO fears the next flu pandemic could infect 25 to 30 percent of the world's more than 6 billion people and kill up to 7 million of them.

Two U.S. firms are working on a vaccine, but neither is likely to have one ready until March, well after the cooler Asian season in which the virus thrives best.

The H5N1 virus, which has already killed 20 Vietnamese and 12 Thais, arrived in Asia about a year ago, probably spread by migrating birds, especially wild fowl heading to warmer climes at the onset of the northern winter.

Governments have slaughtered tens of millions of poultry in a bid to eradicate it, but WHO experts say it is now probably a permanent fixture.

The wild birds that can carry the virus without falling ill are returning to Asia for the northern winter and, in an alarming development, domesticated ducks are showing they too can have the virus without showing it, Omi said.

Experts say a pandemic will emerge from an animal, most probably a pig, which can harbor both flu viruses that affect humans and the avian flu variety.

The two would mate and produce a virus to which people have no immunity, they say.

That has not happened yet, but Omi said the geographical spread and the impact of the H5N1 virus was unprecedented and had struck animals such as tigers and domesticated cats not previously known to be susceptible to avian flu viruses.

"We have found that the virus is resilient, very, very versatile," Omi said.

[goatlady]

This is the second news release this week concerning this pandemic potential. The first came from the head virologist at the Russian virology institute and he said he was expecting it this year!!! Things are getting very interesting on this front

[CanadaSue]

And increasingly, with reason. When H5N1 first struck humans in Hong Kong in 1997, the flu world was stunned; not so much because humans had become infected - although that was cause for alarm on its own - but more so because no intermediary species had been found. Flu 'collective wisdom' generally has it that avian strains FIRST jump to mammals, usually swine, THEN humans. In the case of H5N1, it was direct. Worse, 6 or 18 patients died.

Earlier this year, H5N1 broke in domestic poultry in a major way across significant parts of south east Asia. Then humans started becoming ill & here's a short description of symptoms in the first 5 confirmed human cases in Thailand:

***Despite the antigenic and genetic differences in the H5N1 viruses causing the current Asian outbreaks, certain clinical features of the five human cases described in this report are similar to those of severely affected patients from the 1997 outbreak in Hong Kong (3). In all five cases, disease was severe, with pneumonia progressing to respiratory failure and death. Early distinguishing features included fever, sore throat, cough, and lymphopenia. Other organ involvement included mild-to-moderate hepatitis and later cardiac and renal impairment. In contrast with the cases reported from Hong Kong, gastrointestinal symptoms were not prominent features.***

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a2.htm

Note, genetic sequencing showed this strain of H5N1 was a bit different from the 1 which hit HK in '97. Same or different, the more serious symptoms, (which significantly increase the risk of death), involve heavy duty intervention in patients. Later human cases apparently also showed some of these more serious symptoms. Somewhere I have fairly detailed case descriptions of more early cases - must find.

H5N1 has now been present in parts of south east Asia for abou a year & while the outbreaks do not remain at a consistently high level, it's pretty much been admitted that they can't get rid of it. The countries involved are poor & have lousy surveillence & health care infrastructures. Compensation for culled flocks is iffy at besat & many desperately poor poultry farmers hide any poultry they feel are NOT infected. As well, the virus can survive at least 10 days in the environment under the right conditions.

Depending on who's doing the counting, anywhere from 68 - 71% of human cases have died. I personally like to THINK many cases never become ill enough to seek what medical care is available. I hope so. If that's NOT the case, then the case fatality rate is in the 'oh sh*t' range for sure. If it's lower.... how much lower?

Look, we don't know what's going to happen with H5N1. Chances are it WILL muate to become easily transmissible to humans, then from human to human. THe $64k question is... once it does that, what happens to the fatality rate? Of 100 people exposed, how many would catch it? Spansih Flu had a case fatality rate of roughly 2.4% - we'll never know for sure & that may not sound like much but given that flu is well adapted to human transmission - it adds up to a lot of cases.

Take a transmission rate of 25% - 1.5 billion humans could potentially contract this one. Even a 'lowered' death rate of 10% leaves us with 150 million dead. Play with transmission rates & case fatality rates any way you like - those are ugly numbers. It's TYPICAL for emerging human infections to initially have high complication/fatality rates then over time, they affect humans less severely. That's no real comfort when thinking of H5N1 flu. As we have seen, flu seasons can strike in pretty compressed fashion where it seems everybody & his neighbour are sick at once.

An airborne illness can seed itself quite thoroughly around the world in about 6 weeks - which might be the time needed to know what we're dealing with in any case. Okay, so it gets out there & you figure out what it is - what the heck do you do then? Currently - not a whole lot. We have no vax for H5N1 - og there are experimental trial vaaxes but for a strain of H5N1 we KNOW isn't human to human. By the time we started producing significant amounts of any pandemic strain flu vax, we're looking at 4-6 months by which point, it's pretty well everywhere & most will already have been exposed. Say: "Good night, Gracie..."

With a high potential for many cases to occur at once, don't even dream of counting on health care - they'll be over burdened within a week or so. You'll have to see to yourself & your loved ones. Start learning how - it's never too soon to think it through & figure out how you can cope under different personal circumstances.

This probably would occur in waves & as a completely new subtype in humans, the potential for further muation is high. BY the time we get a working vax for the first wave virus, it may have mutated enough so that THAT vax won't work. You could even get it again - a new strain... and so on.

Secondary infections will be a huge problem. Even if folks are struck with bacteria treatable with antibiotics - how long will those last? NOt very, when you consider this will be a global problem. Heck, there would only be enough vax for about 5% of the population anyway.

It's coming, we just don't know when or where it will start. The latter hardly matters. Start thinking about how it might affect you, your loved ones, (directly), as well as how it will impact on other aspects of your life. You can do a considerable amount to help get you & yours through it.

[revtaz]

So what preps would one start to make now in light of health care being overwhelmed?

[CanadaSue]

I'll put some stuff up in small chunks over the weekend.

[shalym]

Sue--

What ever happened to the possible case of human-to-human transmission a few months ago? I've been trying to find anything about it, and I can't seem to. All of the articles I've found just reference it as a possible and don't give any info on whether or not it was confirmed.

Shari

[CanadaSue]

They can't be sure none of the parties involved had zero exposure to chickens & recently it became clear that domestic DUCKS can harbour & transmit high levels of H5N1 - were the women & girl exposed that way?

It's probable it was human to human - a few such isolated cases occured in HK97, but these have been rare. I suspect there have been a few other human to human cases but nothing publicly acknowledged. To be fiar, no one may be aware of them - I just suspect, don't know nuttin'.

[shalym]

Thanks for the reply, and thanks also for the time you spend researching and (especially) explaining all of this stuff!

Shari

[EdPPCLI]

I have some questions about Flu in general and HN51 in particular.
1) Most of the Spanish Flu (1918) numbers are from American data. But we know alot of the Americans that initially contracted it were returning servicemen. Did cramped conditions, war wounds (minor gas exposure even) and the general lack of 21st century health standards skew the fatality numbers?
2)The majority of HN51 deaths have been third world farmer types. These have notoriously poor diets, could the high death count be due to underlying health conditions or even lack of dietary vitamins.
3)Losing 10% of your country's population is horrific but are not the majority of flu victims the very old and the very young, not the main workers of a country?
Thanks
Ed

[CanadaSue]

Just finishing a few other things first - here & in real life.

[Martin]

Viet Nam attends ASEAN+3 health ministers' meeting to fight bird flu
11/26/2004 -- 21:34(GMT+7)


Bangkok (VNA) - Viet Nam joined nine other ASEAN member countries and three partners, China, Japan and the Republic of Korea, at an ASEAN Public Health Ministers' Meeting to combat bird flu in Bangkok, Thailand, on Friday.




The Vietnamese delegation to the ASEAN+3 Public Health Ministers' Meeting was led by Deputy Health Minister Tran Tri Liem.



Participants discussed the building of a plan to cope with the disease and enhance supervision and preventive measures. They dealt with the capability of researching and applying vaccines against the epidemic, as well as the promotion of cooperation, food security and quarantine.



The participants pointed to the need to build a regional monitoring system, mobilise the necessary resources for disease prevention, enhance international cooperation, raise public awareness and exchange information on the disease.



Speaking to a Bangkok-based Viet Nam News Agency correspondent, Deputy Minister Liem praised the good results of the meeting. He spoke about Viet Nam's plan to develop livestock breeding areas and disseminate technical knowledge on animal husbandry.



The Vietnamese Deputy Minister stressed the need to discover symptoms of the disease and invest in developing labs to research and identify the causes of the disease.



Representatives of the United Nations' Food and Agriculture Organisation (FAO), the European Union Committee and the World Health Organisation (WHO) also attended the meeting.-Enditem


http://www.vnagency.com.vn/newsA.asp?LANGUAGE_ID=2&CATEGORY_ID=29&NEWS_ID=128735

[Ought Six]

r:"So what preps would one start to make now in light of health care being overwhelmed?"I have latex gloves, disposable masks, eucalyptus oil and cayenne pepper.

The gloves & masks are obvious. Get the fluid-resistant type of mask, in case someone sneezes in your face. You will need these not only in case you must go out, but also in case you must care for an infected family member.

The eucalyptus oil is a strong antiviral. I put it in my nostrils before going out during the flu season. In a pandemic, I would put some on the mask as well. It can also be used in a vaporizer in rooms where infected people are being nursed, both to help their breathing and kill airborne viruses.

I have cured every flu I have gotten recently in a couple hours by drinking a heaping tablespoon full of fresh-ground cayenne mixed into a glass of hot water. You can get cayenne in the bulk section at health food markets and some mega supermarkets.

Another important thing is to make sure you have lots of disinfectants; bleach, disinfectant wipes to clean surfaces, baby wipes to clean up people experiencing vomiting and dihorrea, and a disinfectant floor cleaner like Lysol. Stock up on paper towels and toliet paper. I also keep adult diapers around. If you have ever had a bad stomach flu, you know why.

You should have lots of extra bedding and towels. They do not have to be pretty, so garage sales and flea markets are good places to find them cheaply. Plastic mattress covers and pillow covers are also needed.

In addition to all that, you should have all your standard preps in order. The best way to survive an pandemic is to lock yourself in for a couple months until it is over.

[Martin]

Mass culling given the chop

Agriculture Minister Cees Veerman has announced a major change in the way his officials will deal with any future outbreak of an infectious disease among livestock in the Netherlands. Mass culling has been carried out in recent years following outbreaks of avian flu on chicken farms and foot-and-mouth disease in cattle. But Veerman said that culling in future would be restricted to the animals directly affected or in the vicinity of the outbreak. He also said healthy animals would be inoculated to protect them from the infection.

http://www.expatica.com/source/site_article.asp?subchannel_id=1&story_id=14410&name=Dutch+news+in+brief,+26+November+2004

[helen]

Do the math before you get worried.

6 billion people on the planet.

30% upper range of infection rate -- heck, let's call it 1 out of every 3 people.

That means 2 billion people get the pandemic flu.

Of those only 7 million die.

What do you bet most of the 7 million deaths take place in Asia and Africa?

It is not time to panic. However, anyone requiring practice prepping for Panic Sex is allowed to do so. Except for Brihard.

[CanadaSue]

They're confusing me. Annually, roughly 550k to 2 million people die of flu. Most as you've indicated, are from third world countries. 7 million dead would be case fatality rate a slight snitch over 'normal' death rates.

Here's the problem. H5N1 has shown anywhere from a 33% CFR to 71%. I simply can't imagine it staying that high - no way. However a 'reduction' to a 'mere' 10% case fatality rate gives us 300 million dead.

In truth nobody. NOBODY has a clue what will happen with H5N1.

Ideally it, it would jump to humans, make a lot of us ill but stick to the 'usual' death rate for flu among humans. Not that we're talking anything wonderful, but it beats the alternatives.

[helen]

300,000,000/6,000,000,000 = 300/6000 = 3/60 = 1/20

One flu death per 20 people worldwide.

I don't think it's going to be a problem for most of us. Famous last words. cough ...

[CanadaSue]

what you were saying about

if sick: "TAKE TO YOUR BED!!!"?

You're right.

I'm just trying to find some non-convoluted way to explain why - over the weekend.

Right now some non-convoluted fried mushrooms & onions are waiting.

Oh yeah, could you... WOULD you explain that once flu symptoms begin - 'take to your bed' does NOT involve panic sex?

There are specific parameters for that but initial stages of flu ain't part of them.

[helen]

CS ...

I think you're just arousing panic. Arousing panic has been very lucrative for me, of course, but there is only so much market for it and you're stepping into mine.

Your suggestion that taking to one's bed should not include Panic Sex for health reasons is unfounded and potentially party-pooping.

I say if you're going to die anyway, die in post-orgasmic bliss. And be sure you don't die wishing you'd had more icecream as well.

[CanadaSue]

I thought we were friends. I was sharing some beverages with your agent who shall remain nameless. Said agent boozily revealed that your latest opus was going to deal with the physical benefits of panic sex: specifically peri-pandemic panic sex.

I was just trying to help your...

bottom line.

Seriously 1 in 20 means most of us wouldn't have to worry & DO realize that to my mind, that's beyond worst case potential. Even if we were looking at such drastic numbers yes, the third world would be disproportionately represented in final death tolls.

Few pandemics have ever caused such devestation. The Black Death it's true caused some significant social & cultural changes & various epidemics of smallpox have changed the course of history. The same may be said for The Spanish Flu but we must remember such events are extremely rare.

Just as well - a pandemic of flu which is new to us WILL be tough to deal with. The last thing we needed is an extreme death rate.

[fruit loop]

CanadaSue, please don't take this personally. My oh, please attitude is not direct at you.

WHO has been issuing Dire Warnings Of Dire Flu Pandemic for years now. Whoopee.

There have been other flu pandemics before. A nasty form, the A-Beijing, circulated in the 90s. The Hong Kong flu of the 60s. And, yes, of course, that baddie in 1918.

Frankly, I'm not worried about the flu.

Yeah, yeah, yeah, the 1918 epidemic killed 20 million people worldwide in three years. BUT! Remember that people lived in much closer quarters and in much poorer sanitary conditions back then.

This virus spread so quickly because the soldiers from World War II returned home with it.

Flu itself does not kill. Death occurs from secondary infections such as pneumonia and bronchitis in a patient already weakened.

The flu is nasty, can last two weeks, and leaves you feeling like you've been run over by a truck. This makes you a sitting duck for a more serious infection. The elderly, small children, and people with compromised immune systems are especially vulnerable.

Remember that in 1918 we didn't have the anti-bacterial agents that we do now. There were no antibiotics to treat the secondary infections. The modern fever-reducing drugs didn't exist (although aspirin did).

I don't think this flu would spread so fast today or that the death count would be so high.

While there are accounts of people "drowning in their own blood" or dropping dead in the evening, we don't REALLY know how long they'd been sick. One can have the flu and think it's just a little cold. remember also that people didn't have sick leave or sick pay and someone desperate to make a living might well try to hide their illness so they could keep working for as long as possible.

Yes, an epidemic would tax the health care system. Antibiotics might become scarce, but remember again that not everyone would NEED the antibiotics. Only the people with bronchitis or pneumonia!

It's entirely possible to survive the harshest flu. Treat the symptoms. Most people won't die, only wish they would.

I'm not afraid of a flu pandemic.

I'm MUCH more frightened of diseases like smallpox (since I'm one of the people who absolutely cannot be vaxed for it), Ebola, etc.

Black Death? I'm not worried. The medieval outbreaks stemmed from poor sanitation and the rampant infestations of rodents and fleas. EASILY preventable.

[CanadaSue]

The points you raise are valid & I wish the WHO & other health alphabets tempered warnings & statements in a more measured fashion. Let's look at the points you raise - some I agree with, some I don't, others... I figure we don't know enough.

I think fear of the unknown is part of the reason the WHO is so dire with their warnings. 1918 was an anomoly as far as we know & if there's 1 thing most medical types don't like, it's the aabsence of fact, of hard knowledge. Therre remain a major number of unknowns surrounding Spanish Flu.

You're right about the 1957 & 1968 pandemics not being THAT dire. Heck, technically, EVERY year is a pandemic year for flu. They should be more clear about that & state it's more extreme pandemics they're concerned with.

In many ways, I think conditions today mirror those in 1918. Much of the world still lives in crowded, filthy conditions - certainly plenty of people enjoy poor health so would likely be much more susceptible to flu & its complications.

Air travel. It's estimated an airborne, easily transmissible, new or emerging pathogen would seed itself throughout the world within 6 weeks. Look back & see how easily SARS broke out of China & that one is NOT easy to catch. A brand new subtype of highly infectious flu would be everywhere within short order.

We wouldn't lose as many in the west - I understand your point about most of us being in better health than third worlders but we're also dealing with many more elderly with complex medical conditions, increasing levels of immunocompromised - well you pointed those out. I'm just wondering if we'd have enough antibiotics. And what of resistent bacterial infections? They're doing nothing but increasing & would have a field day in a serious flu pandemic.

Excellent points about not knowing how long many had really been sick before they dropped. Back then, folks simply didn't complain the way we're accustomed to & without sick leave, with higher levels of poverty, you worked or starved.

I think the health care system would be screwed. We're used to 'consulting' for everything. Get word out of a pandemic & people start racing in for the every system, or they phone. 'White medical noise' & there's never a shortage of that. Trouble is, many WOULD be ill & many doctors are increasingly loathe to trust their own judgement in regards to who has pneumonia or other complications. They want lab tests to back them up & the labs will rapdily become too busy to do that. So who gets increasingly scarce antibiotics?

Flu is certainly survivable for most at any time; certainly most of us here. H5N1 is still a wild card - what IS the REAL death rate? We'd be a while sorting that out but even a high one means most people survive.

Yes, treat the symptoms as is advisable, rest & simply wait it out.

Ed, your answers coming today.