[Arubi]

Bird flu changes herald pandemic preparations in Canada

Last Updated Wed, 08 Dec 2004 09:35:51 EST

MONTREAL - Public health officials are planning for a flu pandemic that they say could kill up to 58,000 people in Canada.

Immunology experts from across the country are meeting in Montreal this week. The worst-case scenario for a flu pandemic is one of the hot topics.


The federal government aims to have enough flu vaccine for every Canadian in case of a pandemic.


RELATED STORY: 1.2 million flu shots will stay in Canada after all

"It is possible that 11,000 to 58,000 deaths could occur in Canada," said Dr. Teresa Tam, who is in charge of pandemic preparations at the Public Health Agency of Canada.

Scientists say the H5N1 type of avian flu is the strain that is most likely to mutate and cause a worldwide health emergency. So far, 44 people in Asia have come down with the virus after coming into contact with infected fowl.

Deaths occurred in more than 70 per cent of the cases, most of which occurred in young, healthy children and adults.

The deaths are potential signals of the beginning of a pandemic, said Tam.

The rush is on to have a vaccine ready. The federal government has a deal with ID Biomedical to make 32 million doses, enough for every Canadian, in case of a pandemic.

If a pandemic were declared tomorrow, the company would switch its production to a pandemic vaccine, said Dr. Anthony Holler of ID Biomedical.

"Basically, what that would involve is using our egg-based production method to manufacture that vaccine," said Holler. "Within a couple of months, we would be in a position to have all Canadians receive vaccine."



FROM NOV. 9, 2004: WHO aims to fill world demand for pandemic flu shots

Before manufacturing can begin, scientists need a genetic fingerprint of the virus. Until then, researchers are working with a mock vaccine that could be tested ahead of time, Tam said.

The advance testing won't happen until the federal government pays about $15 million. Holler said he thinks the company will hear from federal officials soon.

Written by CBC News Online staff

http://www.cbc.ca/story/science/national/2004/12/07/flu-pandemic041207.html

[CanadaSue]

Well it sounds good, doesn't it? Let's look at numbers first:

***Every year, up to 1,500 Canadians, mostly seniors, die from influenza-related pneumonia and many others die from other influenza related complications such as an aggravation of underlying chronic heart and lung disease.***

http://www.canadian-health-network.ca/servlet/ContentServer?cid=1065630278792&pagename=CHN-RCS/CHNResource/CHNResourcePageTemplate&c=CHNResource&lang-En

The anticipated range of flu deaths means roughly 8 to 38 times the usual number of flu deaths could, stress - COULD be expected. If we want to stay with KNOWN pandemic worst case death rates of 2.4% that implies that 2.3 million Canadians might become ill. Frankly, that's far less then generally contract flu yearly which can range from 5 to 10 million dpending how severe strains are.

Naturally if you want to 'worst case' this puppy - go with a 50% attack rate & 'drop' the H5N1 KNOWN death rate to 25% for a total # of deaths of 4.125 million. Now THAT is in the catastrophic range as it implies 16.5 million become ill. But that's the trouble. You can scare yourself to death using high end variables of reduce the risk to something close to what we face yearly with a somewhat higher death rate.

Let's be cold, hard & nasty. If a pandemic strain kills the elderly & weak - those who usually succumb to flu & its complications, we're looking at a lot of personal tragedies. We're also looking at people who have lived their lives or who frankly, didn't stand much of a chance of getting to be much older than their current age. It's when we get into the higher range of sick & dead & combine that with healthy adults & older kids becoming victims that it REALLY starts to hurt on a national level.

The other big unknown factor is timing. Does this hit during our winter, where demands on infrastructure maintenence/repair are already heavy; when roads & rail lines MUST remain open for essential goods to be transported? Canada has 1 main rail line, much of it is double tracked but 1 good train wreck in the wrong place... And if winter storms are severe & block roads & few are there to clear the roads & keep them open, traffic of goods slows & may stall completely. That's one aspect of timing. The other is how quickly the flu spreads. If everyone gets sick 'at once' - yeah we've got problems.

We could make 32 million doses of vaccine - given about 18 months at current production rates. And that assumes, staffing, no production problems, enough eggs... I don't think so. Nice to hear that a company could switch to pandemic vaccine tomorrow except that's a load of crock. They need the seed strain first & may take weeks to obtain.

Look, I'm not trying to be a prophet of doom here, but we need to be realistic. We can't do it - it's no more complicated than that.

[Shadowfane]

The only PROVEN arrow in the quiver is isolation and quarantine.

tamoxifen and the other 2 are gonna be HELPERS for when the People decide that the quarantine orders are bunk and that they NEED to go out ANYWAY to get food etc.....

but you are correct. this is a battle we can't win. Barring Divine Intervention in the MindSet of the People.

[SmartAZ]

Random reactions:

These are big numbers. Just disposing of the bodies would be quite a chore, even if they are all people of no emotional importance.

I heard about an epidemic in Holland (oh, say, a few centuries ago) where anybody who got sick was nailed into their house. If they were still alive a few months later, fine. If not, the house was burned.

Making X doses of vaccine in a hurry sounds heroic, but then there are the stories about people who die from the vaccine. Is there any way to avoid this, or do they just accept or reject the juice and hope for the best?

It's hard to quarantine the sick, but there is also the possibility to quarantine the healthy. Families may be able to shutter their homes until the emergency passes. But if even a small number of people do this, expect to hear horror stories about barricaded neighborhoods and swift action against percieved threats, real or imagined.

[CanadaSue]

quarantine/isolation.

A number, (in total several thousand I believe), in Toronto were asked to voluntarily enter quarantine after suspected/confirmed exposure to SARS. I'd have to dig up the reports & will soon - trying to mass produce holiday baking here...

Folks found it VERY tough. They felt isolated & often neglected. After their quarantine period ended, many continued to be shunned out of fear. Many claimed they'd been damaged psychologically by the process & fears involved in quarantine. I can certainly accept it's frightening & lonely & those quarantined early may well have been terrified. We didn't know how easily it could be caught & we already knew that some cases had the ability to infect a dozen or more fairly easily.

I'm not sure how most Canadians would respond to a request to self isolate in the event of pandemic flu. Certainly people might WANT to - the less you're in contact with others, the less your personal risk. However, who is PREPARED to isolate themselves? We're looking at a bare, (skip some safety protocols), 4 months to get the first vax out. Who can remain at home, working with what they have for 4 months? Few indeed. Food, water, normal prescription meds, many need regular medical visits & those are just the normal, every day - everybody reasons to leave home for most.

Such isolation/quarantine means no school for the kids, no shopping & for a great many whose jobs may not be considered essential - no work. With restaurants, cinemas & other public entertainment venues closed - no work. In cities or suburban areas, no walks, not even for the dog. No visiting friends or family.

Phone lines, cells, sat phones & the net would be jammed & I would expect frequent breakdowns of those systems as use is maxed & maintenence may be hard to come by in timely fashion. Media could play a valuable role - information, entertainmanet & even 'classes' for kids in school. These things take time to set up not to mention interest - we can't count on those.

We can't begin to assure quarantine, even at gunpoint. Not enough people. Not enough guns. Fear may well keep people home at first, not to mention a feeling of 'pulling together' & for some a feeling of drama - they're in some way participating in a seminal, history making event. The novelty will wear off all too fast & like a dry drunk looking for a reason to drink, all sorts of excuses to break quarantine will begin sounding more & more reasonable.

Certainly not every break in quarantine will lead to more cases of flu but it's a certainty that some will. Someone will catch it having gone out & a ripple effect in their community can't be avoided. Family, neighbours, passersby who passed by at the wrong time will catch it. Local authorities will use each such example as a reason NOT to break quarantine & people might 'behave' again for a while but if/when they percieve the risk is decreasing so will their caution.

I'm not counting on Tamiflu or related antivirals. SOME is available but what does it do? It MIGHT prevent flu if you take it early enough. If not, it may shorten the duration by a few days & make it less severe. If you're immune compromised, a lessening of severity may be academic.

And it works now. Why assume the flu virus won't adapt around it? Antivirals have no inherent qualities making them forever effective against any strain of flu. Yet it's all we have from the pharmas & there's not enough of it & you & me won't be getting it without a superb reason. Personally I don't have one.

At best, we'll slow this sucker down some until SOME vax gets to SOME people. Then perhaps, we can crank it up a notch & genuinely start worrying about 'beating' the pandemic. Beating it isn't even in the picture for a long time though. Getting through it, surviving it, is what we'll be doing.

And yes as modern as we are - that's the best we can do for the first of many, long months.

[CanadaSue]

Back to answer in a bit - got to go shower off the bits, pieces & grease involved in churning out 20 dozen cookies...burp!

[EdPPCLI]

Some great insights on this thread. I definitely agree that in Urban areas any kind of voluntary quarantine will be a joke. The majority of people don't have more than 3 days worth of food and how many work paycheck to paycheck (they will have to leave the house to earn the family income). My office for example doesn't offer paid sick days and so you see people glassy eyed with fever dragging themselves in to work in order to cover the mortgage.

[CanadaSue]

You know just how far, (not) your former brigade group could stretch in even trying to THINK about coping with something like this if folks decided not to co-operate. Even if every nominal reserve unit was called in, every newly retired former member... uh uh.

I live cheque to check with little in reserve save some essential supplies. What I'd have to do is haul DH out & we'd have to agree to max out credit available stocking up. Many can't do that. We're lucky we can.

And yup, you will have employers, (especially the nauseating ones who haven't had even a cold in 15 years), who insist illness is a 'weakness', that anyone trying to call in sick is a slacker or coward. Easy in theory to tell people to offer bosses like that a 1 fingered salute but when it's your paycheque & the rent is due... many won't/don't have a choice. I've worked sick - not to have done so would have 'looked bad'. I've grown smarter in my old age.

Now it's all well & good to order people to go home & stay home. But then you have to set up some kind of human infrastructure to deliver food & other needed supplies. Just dealing adequately with peoples' regular pharmacy needs will be a nightmare. Pharmacies have to be reminded of renewals, fill them & they have to be delivered - who does that? How do you deliver food? By truck - one family at a time coming out of their house - well, 1 family member? How does anyone know the food bags/boxes haven't somehow picked up flu virus? HOw do you keep track of who gets what, who has special needs - insane.

The practical considerations of mass quarantine are staggeringly difficult even if everyone chooses to co-operate. Voluntary quarantine BEFORE illness strikes is what all are referring to here, SA - it's the only way to stop this sucker.

Yes, body disposal will be a chore if people die in large numbers & close together. We're essentially talking mass graves & I hope at least, WHO the dead are is recorded.

The epidemic you're referring to SA is, I THINK, bubonic plague.

Few die of flu vax but considering they're going to be cranking it out as quickly as is humanly possible, I fully expect some production runs would end up contaminated in some way. I can only hope they check that before they start giving it. Put it this way - in some countries they will, in others they won't.

Yes, there may be some ugly cases where those suspected of being ill are harmed or driven out of their homes. That of course, simply spreads the virus.