It’s important to keep in mind that the bird flu now has an enormous reservoir in the wild, and as such, will evolve along many different paths simulataneously. There are posts that, rightly, identify particular strains of avian flu as being resistant to Tamiflu and/or other antivirals — but we need to realize that other strains will develop further down the road that will vary, both toward being more and less resistant. Because the bug mutates so rapidly, we will continue to read conflicting reports about virulence, attack rates, case fatality rates, symptoms, sensitivities, etc. through the entire course of a pandemic. So, uncertainty will be the rule in terms of the microbiology and the havoc it plays with the population. In Turkey, some infected children are dying while others are showing no signs of illness. Other than host variables, which are significant, the extreme ability of H5N1 to mutate into different forms — even in ways that seem nearly insignificant on the DNA level — could account for these broad inconsistencies. I would expect that, even in the middle of a pandemic, Toledo could experience a very different flu from Milwaukie — both of them H5N1.
Yes, even Person A in Toledo could have a different flu than Person B - I think it was John Barry’s book where I read the concept of the all the copies of one virion in an organism being demonstrably different from each other (because of the sloppy no-checking RNA copying) - they used the phrase “a mutant swarm”.
That also explains the massive increase in number of deaths during the second wave of the 1918 flu.
I still get tired of hearing the massive deaths in 1918.
Look at the medical knowledge and ability back then! $hit it was also a World War!!
Antiboitics?? Nope, Ventalators? Nope.
Geeze wiz!!
bbbb: got news for ya pal- antibiotics will not help with the flu (secondary infections, yes-if you can get them in time) and vents do not save everyone now with ARDS or respiratory failure and a patient on a vent requires a HUGE amount of educated support people….oh yes-and a vent………
bbbb, you counted the ventilators in your nearest hospital lately? And are they all currently in use?
Do the math: if 1 of every 4 people in your region all get sick the same week, how many people would that be?
How crowded are the ER and hospital floors right now?
Oh, and zero immunity to H5N1 means 1-in-4 of the medical personnel you seem to be counting on will get sick too, or may have to stay home to care for sick family members.
World population has tripled since 1918, too. See what happened to the US Gulf Coast after Rita and Katrina? No infectious, deadly, pandemic involved there, and see how smoothly aid and communication and public behavior went?
What if the whole country is affected at the same time? pan-demic.
bbbb, look at all the stuff people have forgotten how to do since the 1918 people, who about 50% were living rural, not in cities; they were growing food, canning it, more knew how to tend sickbeds, ect.
The virus is mutating/evolving so much, as you said, California, so, we really don’t know how many waves nor what they will look like.
The different communities may also have different experiences depending on what measures they manage to take, too; when they cancel public gatherings, and which people also have HIV, or other health conditions that change their experience with the virus, which places are isolated, which have high travel volumes.
Will testing and identifying strains be kept up during a pandemic? Will it become more important to do other things, and just try and test later to see what went where? Are there facilities/staff enough to even do all that?
bbbb, every medical person who has reviewed the situation notes that the surge capacity to take care of ‘extra’ patients beyond the usual during a pandemic doesn’t exist. Check the Trust For America report in the Links section of the wiki. It’s under ‘reports’.
If there’s no room in your ICU, what good is the ICU? And whereas H5N1 may not have a 50% mortality, the ICU version is still deadly even in modern ICUs.
……..Should H5N1 become the next pandemic strain, the resultant morbidity and mortality could rival those of 1918, when more than half the deaths occurred among largely healthy people between 18 and 40 years of age and were caused by a virus-induced cytokine storm (see diagram) that led to the acute respiratory distress syndrome (ARDS).4 The ARDS-related morbidity and mortality in the pandemic of 1918 was on a different scale from those of 1957 and 1968 — a fact that highlights the importance of the virulence of the virus subtype or genotype. Clinical, epidemiologic, and laboratory evidence suggests that a pandemic caused by the current H5N1 strain would be more likely to mimic the 1918 pandemic than those that occurred more recently. If we translate the rate of death associated with the 1918 influenzavirus to that in the current population, there could be 1.7 million deaths in the United States and 180 million to 360 million deaths globally. We have an extremely limited armamentarium with which to handle millions of cases of ARDS — one not much different from that available to the front-line medical corps in 1918. ….
bbbb- please believe us. I am a RN who works in a univeristy medical center on the east coast..we had no beds available this morning; and we have no seasonal flu in our area yet! from chaper one of the book “‘Flu’‘The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It’
by Gina Kolata “It may take a few days, it may take a few hours, but there is nothing that can stop the disease’s progress. Doctors and nurses have learned to spot the signs. Your face turns a dark brownish purple. You start to cough up blood. Your feet turn black. Finally, as the end nears, you frantically gasp for breath. A blood-tinged saliva bubbles out of your mouth. You die — by drowning, actually — as your lungs fill with a reddish fluid.”
This is real and it is U-G-L-Y and it could be coming to a town near you soon…why take the chance? do what you can to prepare for the inevitable shortages a pandemic would cause, self-educate, monitor and help others to become educated and start planning. We are all in this together; none of us is immune.
Yea , I understand.
How about a vaccine??
oops the government we have elected over and over again has dropped the ball.
Look maybe we like disaters, not me. There is a book I forgot what the name is but it talks about how fear is the greatest problem in 2006!!
Look at the darn weather channel, a new series IT COULD HAPPEN TOMORROW!!
Yes and a terrorist could get a nuke into a western city and if you are there and it goes off well you are toast.
I wonder why I post here.
??
Grace
My wife is an ICU nurse, I know the deal.
America has closed hospital beds Managed care.
Insurance companies.
PROFIT!!!
Bottom line, yep If it becomes a bad deal. oh well we will survive somehow.
By the way the WHO says preliminary findings are that the virus HAS NOT MUTATED and in fact look at my other thread there maybe a WEAKER strain of H5N1 and maybe if it does mutate we all will not die.
We can’t make the vacinne until the true pandemic form ie easily transmitted human to human is seen and that will take 6 months minimum. I can prepare-minimally- for a nuke event of any causes. I can prepare more for a potential pandemic. Why do you post here if you are not willing to even read the available literature online here?
Grace
I just want to bring a different persective on preparation.
Sometimes there really is not much you can do, lord knows the government will be useless.
Katrina.. Rita..
bbbb…you’re sure right about the government; that’s why I make my own plans, as do most of us who blog here. After Katrina I swore I would not let myself or my family get caught like those folks in NO. So I started looking over general disaster planning for my geographical area. I have a 72 hour pick up and run backpack with stuff and info to help get me and mine to safety and possibly set up in a new place in a hurry; and made one for everyone of my kids. Do I want to use it-never! Let them bury me with it I hope. Same for this-I have seen lotsa people die over the past 34 years of being a nurse-I’m 54 now. I never want to see a potential pandemic hurt my family, so I do what I do mostly for them. And me a little bit.
bbbb - read everything here on Flu Wiki or go read the excellant Bird Flu summary over on www.arielco.us They post and link some stuff on people who were working in the trenches during the Spanish Flu. (It’s probably here on Flu Wiki too but it will take days to read everything here.)
If H5N1 becomes person-person contagious and if it hits in your area even with, WE HOPE, much less of a mortality rate than it currently has, you can forget the medical establishment (unless you happen to be very rich or a privleged politician) - you are on you own and what you may learn here may save you and/or your family’s life.
The bottom line is that most people will not recieve professional medical care in a Pandemic. Hospitals will be in lockdown, local officials will have confiscated supplies, and your doctor’s emergency number will have a recording.
The medical care you or your family does receive will come from someone who was simply “Prepared”.
viralprotein
Yep,
Gonna hide inside for how long??
Please, lockdown yadayadayada, 1968 I got the flu got sick felt like crap and got better. It was a Pandemic.
Again are americans so darn scared witless from 9/11?? Katrina??
What has changed??
I am a health teacher, wife ICU nurse, if we get sick hope we don’t die.
Whatya gonna do??
We sure are not gonna put 3 months of food in the bunker. Probably have enough stuff down there anyway for a bunch of weeks, how many cans of tuna do we have????
We will probably do a george w bush, BRING IT ON!!
bbbb, you talk but you don’t listen. You’ve said your piece. Enough.
I’m afraid there are a lot of people who think like bbbb. They think “I got the flu one time and I did not die. What’s the big deal?” So bbbb got the flu in 1968 and it was a pandemic and he got better. Was it an avian flu pandemic? (Maybe someone can answer for us.) Was that one as lethal as the Spanish flu or H5N1?
This one could be a doozy, bbbb. Grace RN above quotes a description of what it was like in 1918. I’ve had “the flu” before too and I did NOT have what she describes. Don’t be a worry wort, but be aware.
No bbbb is saying no big deal, he just is not a worry wart.
He is a realist, one who understands that the internet has turned many into zombies who stay on forums and debate and blog day after day.
I am very aware that the avian pandemic might be a doozy, whadya gonna do?
Have some faith and get off the computer, like I am now, been here cause I am bored and ran across this site and sure enough it is like the others Panic central..
Hope we all Survive, if not oh well, it has been a good run.
bbbb - Do you have kids? Frankly I might have the same attitude as you if I didn’t. However it seems prudent to me to get educated and prepare for potential shortages so I can take care of my daughter during a moderate to severe pandemic as much as would be possible. There are some things you can do. Our government just recently came out endorsing the idea of preparedness.
I do understand your point of view but know I would kick myself if we have a problem and something happens to my daughter and I hadn’t made any effort. That little effort might make all of the difference. I think the idea of protecting family and others is very present here. It’s not all self centered. Panic on these types of forums? Yeah, a little. If you’re not the panicing type just ignore that and use it as a resource. This site is filled with good suggestions.
Hmmmm he’s a teacher - now where have we heard that recently?
Yes, we’re all zombies here. None of us has ever seen the light of day. RAAAAAAAAAAAAAH.
DemFromCT had it right: bbbb wants to talk, but refuses to listen.
Carolina Girl…could it be our precious mewja, back for more?
<i>DemFromCT had it right: bbbb wants to talk, but refuses to listen.</i> It almost feels like an anger reaction on the part of bbbb. Okay, I can understand that, but as D from C says, enough is enough. I’d also like to say that I’m relatively new here and I appreciate this website and Dem’s posts. Grace RN and Eccles also stand out as very helpful. So thanks.
To sum it up this is really scary,i read over your letters and only think,how many people know nothing,that are just doing the daily thing,work,sleep and weekend.I would like to ask all of you what are your friends and family saying when you mention h5N1,do people take you seriously? do they think your worried about nothing,has anyone paid attention to your beliefs this will be a world catasphrope
I’m also a recent visitor and agree with with TJC. Thank you to those people who he mentions. I had that ‘68 bug. It was Hong Kong B and I don’t think I’ve ever been that sick. I was 13 or 14. My interest in influenza lies in my grandmother’s experience in 1918. She volunteered with other young women to nurse people on Idaho’s Camas Prairie. Many people of Nordic descent on the Prairie were hard hit. Some of the girls who went with her died. She never got it. My dad always said that was amazing. Thanks for your info and suggestions.
Stella, the people I try to talk to fall into some curious groups: 1) That just affects birds, not that many people have caught it, so why should I worry 2) It’s just the flu 3) Huh? and my favorite 4) It’s just a bunch of hype by Bush and Cheney to make money for their friends in the pharmacutical industry
My husband of 34 years thinks killer bees are a bigger risk, my youngest daughter, 25, calls me day after Tomorrow (old post-nuke in NYC film). My oldest daughter age 33 and my 3 sisters after alot of emails are now starting to plan. My 29 year oldson thinks I am a bona fide nut case. Kids! A good perspective to give people is this- we pay alot of money for life, homeowners, car insurance etc, and what do we get back at the end of the year for it? This is a kind of..disaster/layoff/job loss/case flow shortage insurance…and if there is no disaster, you can eat it and save on your food bills for a while!
My neighbor said “technology will save us” and “how long has it been around without being a pandemic, huh, huh, how long” I have a co-worker I love who says, “I don’t believe it will happen.” I say I hope it doesn’t happen but I am ready for whatever emergency life throws at me from ice storms to an earthquake to a pandemic.
I am ready also, with that full liquor cabinet.
I bought some Cabo Wabo tequila and a big bottle of Glenlivet this weekend along with 10 more gallons of water.
Is that good??
10 gallons of water sounds like a good start. My kids are some of those who say this whole scare was cooked up by Bush, like the terrorism, etc. I tell them that no, Bush was actually reluctant to talk about bird flu until he had no way out of it. His supporters may profit, but they can profit from anything. It doesn’t mean they created the problem.
I was thinking, may be crazy, but maybe the birds are getting so sick partly from the huge climate instabilities. Imagine if you have always migrated in a certain direction, and now it’s not a friendly climate anymore, but you just can’t change migration patterns in one year. You get too cold or hot, immune system breaks down, and catch a bad virus. At this point it doesn’t matter though, not much we can do to bring back the usual weather patterns. Poor birds, poor people.
So, water, food, blankets.
Forgive my rudeness in interrupting this tangent, but I’m really interested in the original topic of this thread and California’s offerings re what is known about the evolution of this virus.
As a lay person, I’ve been trying to get a better grasp on the nature of the evolutionary process and would appreciate further input. Seems to me many people think about “the virus” like it’s something fixed, when in fact the virus that infects me may be different than the one I pass on to the next guy (?) or that someone else nearby picks up from my source tomorrow. Is it indeed thought to be this variable as the “swarm of viruses” desciption suggests?
And what are the implications of having mild/asymptomatic cases? Can these people actually pose a greater danger by being silent carriers?
We also seem to be hearing suggestions today that there may be worrying mutations in Turkey — anyone have any thoughts or more to add on this?
Also, I keep worrying that mortality rates would also rise in a pandemic because people would be unable to get the sort of attention they’re now getting. Is that a valid concern?
PS, I’ve suggested before a separate “skeptics” thread where we can refer these discussions that keep coming up and hijacking other topics, as we seem to keep having the same discussion over & over? Does anyone else support this?
Is it indeed thought to be this variable as the “swarm of viruses” desciption suggests?
yes, the well adapted mutants will thrive and survive. They may be milder, or they may be more severe, or they may make no difference to their host, but something about the mutations may make them replicate better.
Can they spread it? Once it’s adapted to H2H, yes. Right now, they serve only as a marker of being infected because H2H is difficult, but that could change.
Are there worrying mutations? Anything that suggests easier B2H is worrying. Anything that, for example, looks more like a 1918 or a 1957 hemeagglutinin gene than it did before is worrying. Hopefully, WHO will be more specific about exactly what they mean.
The mortality would be affected in multiple and perhaps opposite ways. Milder illness means a drop. Overwhelming of medical care could mean a rise. it depends on what the denominator is (i.e., how many people are sick at one time). Trust for America’s Health, for example, has tried to look at that.
sure, re skeptics and separate threads, but that requires ‘their’ cooperation, too ;−0
Dem, if folks are carrying the milder strain, and the virus continues to mutate, does that mean they would be immune from further mutations? Could the folks who survived the first wave in 1918 have been hit harder by what came afterwards?
Thanks Dem. I see we have a new thread re today’s announcement re this new mutation, so will skip over & follow from there.
closed for volume issues. Note date of last post.