Forum: 2006 Mild Bird Flu Only Kills 75 Percent

With all this talk about how H5N1 is evolving into a mild disease, I thought I’d check the fatality rate for 2006. According to the WHO, there have been 8 confirmed cases in 2006 thus far and 6 of them have died. That translates into a 75% fatality rate. Phew, what a relief. I tell you, I was scared before, but now that I know its dropped from 43% fatality rate in 2005 to a 75% fatality rate in 2006, I can relax. Did I say drop? Oh yeah, I guess it didn’t drop so much as rise. Paging Maria Cheng. I need some WHO magic mumbo jumbo words to make these bad numbers go away.

Add to that 14 of 17 cases in Indonesia have been fatal since December.

tjclaw1: You’re not supposed to notice that. Keep your eyes on the confirmed, unconfirmed, mild but deadly Turkish cases that haven’t been confirmed officially yet.

Look guys if you are going to be rational and look for facts, I am going to another site!

I thought, that the idea that H5N1 may be becoming less lethal was tied to the study being done by testing people in Asia, specifically Japan, if I remember right (Turkey too maybe) for H5N1 infection and they were finding evidence of H5N1 antibodies. Since these people had no symptoms, they were assuming that they had H5N1, but had mild symptoms, if any. I didn’t pay strict attention to the study results and methods, but that’s what I remember.

The hospitalized cases are the only tested (and therefore confirmed) cases and by the time they get to the hospital, their chance of recovery was poor. That’s why it appears so lethal, if you go only by the confirmed cases.

But maybe I’m wrong.

But as the current drill, to keep the appearance of H5N1 prevalence down to trivial numbers, there are only two classes:

1) Confirmed by positive test 2) it never happened.

By applying those rules, the case fatality rate is what this item represents it to be. Change the rules and you may see a lower case Fatality Rate. of course, then you’ll also have to admit that it is more prevalent than previously admitted.

Check this out for Seroprevalence info?.

When can we expect China to finally come clean with real numbers? This lifetime?

April - Not likely.

Actually I think those numbers may be off. I believe that the fatality rate is dropping when you add in Turkey. But if H5N1 is going to be a human pandemic that is what usually occurs. Becomes less lethal but transmits easier. The 1918 flu had a 2.5 to 5.0% fatality rate and it was horrible. It doesn’t make me rest any easier to know that this is becoming less lethal. To me, it just means less time to prepare.

Boneman: We have no idea what the final numbers in Turkey will be. The current “official” numbers for Turkey are 4 cases and 2 of these have died. We may find that some of the “recoveries” never had it. Unfortunately, some of those currently in ICU may not recover. I suspect the apparent variation in mortality rates between countries may have more to do with the promptness and quality of care patients receive than any difference in the virus. In a pandemic, mass distribution of tamiflu and ICU’s will not be available.

The idea that the virus “must” decrease its kill rate before it goes pandemic represents magical, wishful thinking to me. Its often repeated by health authorities, but with absolutely no scientific basis that I can see. No mechanism is presented for this to occur. Viral evolution does NOT require this. The virus may come under selection and therefore decrease its virulence AFTER it has passed through the human population at least once, but not before. It would be a mistake to assume that 1918 is the worst case scenario. Its not. H5N1 is nasty. Perhaps much nastier than the 1918 strain.

Monotreme - “The idea that the virus “must” decrease its kill rate before it goes pandemic represents magical, wishful thinking to me. Its often repeated by health authorities, but with absolutely no scientific basis that I can see. No mechanism is presented for this to occur. Viral evolution does NOT require this. The virus may come under selection and therefore decrease its virulence AFTER it has passed through the human population at least once, but not before. It would be a mistake to assume that 1918 is the worst case scenario. Its not. H5N1 is nasty. Perhaps much nastier than the 1918 strain.”

Bravo! Well said!

Thanks NumbersGal. I don’t really want to be the resident pessimist, but I suppose I am. Sigh.

I think the origin of the “must reduce in severity” thinking is based on the idea of natural selection. If we assume that the virus is perfectly efficient at killing its host population in the first pass, there will be no hosts left and it will die. Thus, when you are dealing with isolated population pools from which infected but still living individuals must leave to spread the disease to other population pools, this may make some sense.

On the other hand, we humans move around the planet so fast now, that this natural selection is not necessary to support wide dissemination of the virus. It can go planet wide before people even realize its loose. So, if there is no biological mandate that H2H requires decreased virulence, I see no reason to assume we will see decreased virulence. Especially since all of the virologist stuff I readimplies that the current H5N1 is a real monster in the world of influenzas.

Oh well then maybe that is what happened to the dinosaurs..

Could we be next?

Actually, the current thinking of what happened to the dinosaurs is that an asteroid struck the earth somewhere East of the Yucatan peninsula. The resulting dust cloud enveloped the earth for several years setting solar illumination way down, hampering vegetative growth and lowering the average temperature of the earth. The cold blooded dinosaurs could not deal with both low temperatures and drastically reduced fod supply. The little ignominious furry mammals that were never in real competition with them suddenly had an open playing field.

And interestingly enough, that was not the only Garnd Extinction which exists in the fossil record during the existence of life on earth.

I think that THIS may be why about 70,000 years ago it seems that the human race went through a very narrow funnel and everyone around today is descended from a very very few individuals.

Yes that DNA mapping that is being done is interesting. I think I heard that some big % of males are related to Ghenghis Khan. It is a “small world” in a sci-tec way.

“….Its often repeated by health authorities, but with absolutely no scientific basis that I can see…..”

I would think that Darwinism has a scientific basis and the virus will thrive if it does not kill the host.

Docwatgone-I started working toward my degree in anthroplogy in 2004. I don’t wna’t to become fossilized before I have a chance to dig one up…:((

Krunchie - In order for Darwinian selection to be effective, the virus must cycle through the host population a few times. As one of the target hosts, I’ll tell you that I don’t give a rip if the virus fails to succeed because it killed all available hosts the first time. This virus will be aided and abetted by the airplanes and motor vehicles that we have populated the world with. If it then runs out of hosts, there will be no one left to keep score.

“some big % of males are related to Ghenghis Khan”

What I read was that every night he would sleep with one, perhaps more, of the women from conquered tribes, thus fathering huge numbers of offspring. The figure I remember is that about 8% of people in that part of Asia are descended from him. I think it was Mel Brooks said, “It’s good to be king.” Don’t try this trick at home, though, kids. The child support payments can be murder.

it’s over people.

Eccles,

Professor Stanley H. Ambrose an anthropologist, University Of Illinois says that the Mitochondrial bottleneck was caused by the Toba Supervolcano ~71,000 years ago. Pyroclastic ash fall from Toba has created a layer of ash in central India 6 m (20 ft) deep (ref. Acharyya S.K. et al., 1993). In addition, a staggering amount, 1010 metric tons of H2SO4 (sulphuric acid, was blown into the atmosphere by the event (Huang et al. 2001).

These are a couple of link’s to some of Stanley’s papers. http://www.bradshawfoundation.com/evolution/ http://www.wac.uct.ac.za/wac4/symposia/papers/S017rmp1.pdf

The major problem going forward is that the largest of these Supervolcanos is under Yellowstone National Park. And when IT goes it will turn most of the US in to an archeological site. The rest of the planet of course, will be trying to survive a nuclear winter and the start of the next great Ice Age.

Some comparisons http://volcano.und.nodak.edu/vwdocs/volc_images/southeast_asia/indonesia/toba.html http://www.andaman.org/book/app-r/textr.htm

viralprotein

Well, as Rosanne Rosanadana used to say, “Its always something”

“I would think that Darwinism has a scientific basis and the virus will thrive if it does not kill the host.” As Eccles points out, evolution does not require that the H5N1 virus lower its lethality. The core of evolution is random mutation which provides variation. Natural selection acts on this variation. The virus doesn’t “want” to survive nor is it evolution’s job to help it survive. 99.999% (add as many 9s after the decimal point as you wish) of all species that have ever existed on this planet are currently extinct. Bad evolution, bad, bad. H5N1 will be extinct one day as will we. The only question is when. Very bad things do occasionally, but inevitably, occur. See above for some colorful examples.

“As Eccles points out, evolution does not require that the H5N1 virus lower its lethality.”

In reference to the 50% mortality of H5N1: John Oxford, a virologist at Queen Mary’s School of Medicine in London: “No virus under the sun would be able to spread with that kind of mortality.”

“On the surface, H5N1 sounds more dangerous (than the 1918 pandemic). But that is not the case, according to virologists, who explain that by killing off hosts quickly and in great numbers, the momentum of any H5N1-inspired plague necessarily would falter.”

krunchie: In reference to the 50% mortality of H5N1: John Oxford, a virologist at Queen Mary’s School of Medicine in London: “No virus under the sun would be able to spread with that kind of mortality.”

Gosh, I hate to disagree with such an eminent scientist, but H5N1 seems to spread quite efficiently among birds and has a nearly 100% lethality rate in chickens.

Here is my thinking. When an influenza virus enters a host, it is doomed. Either the host will die, killing any virus with it, or the host will recover and the host’s immune system will kill it, usually within a few days. The only way a virus can persist is to infect new hosts. Influenza, devil virus that it is, can spread to new hosts before its original host shows any symptoms. This is why it is impossible to stop it with normal screening and contact tracing. So, once H5N1 acquires the ability to spread through respiratory droplets, it will spread from hosts while they are healthy to new hosts. What happens to virus that is left behind in the original host is irrelevant to the spread of the virus. Assuming that some hosts survive initial infection, their immune system now has a “memory” of H5N1 and develops an army of cells specifically capable of attacking it. The next time that host is attacked the virus is under selection. One of the viral genes, polymerase, is responsible for viral replication. When not under selection, ie, the first wave, this enzyme works very well and makes lots of virus very quickly before the host can mount an effective immune response. This will make the host very sick or even kill the host. But, when the virus infects the host the second time, assuming the host survived the first infection, there are antibodies that can recognize the polymerase enzyme. The virus is now under selection. Viruses that have polymerase enzymes that the host immune system doesn’t recognize will have a selective advantage. However, these variants don’t work as well as the original polymerase and hence the virus replicates more slowly. This is one proposed mechanism for the evolution of a virus from a highly lethal to a much less lethal version. The key point though, is that selection doesn’t start until the second wave. I would be interested in any counterarguments you or Dr. Oxford would have. BTW, I want to be wrong and will acknowledge it as soon as somebody gives me a specific mechanism.

Ref

Krunchie - I think you are being hypnotized by the difference between weather and climate. In this case, the weather (instantaneous virulence of the virus) need not adhere to any particular model of preservation of the host population. For a climate of long term survival, then the host population needs to be spared. But in the current case, the pertinent points are:

1) There is no functional linkage between the Case Fatality Rate and the viability of the organism. It could have 100% Case Fatality rate and the organism would still be perfectly viable.

2) While a naturally evolving organism would need to spare some of the host population to insure long term success, we are not interested in the long term success of H5N1.

3) the fact that it is communicable for days before the appearance of symptoms means that given a human host population, and given 21st century culture and transportation, then there will be sufficinet opportunity for the organism to spread widely throughout a candidate host population.

In the long run, if H5N1 killed a substantial portion of its host population, it would turn out to be unsuccessful. But in that long term the human host population would end up severely depleted.

unless John Oxford has more to offer than opinion, it is of little consequence to H5N1. it is not interested in his opinion. If, on the other hand, you can propose a limiting mechanism, then lets hear it.

“…unless John Oxford has more to offer than opinion, it is of little consequence to H5N1”

I guess in light of your disagreement with him, we’ll have to defer to your opinion as I’m sure your expertise on the matter are vastly superior to his. BTW, comparing chickens and humans as hosts is like comparing apples and oranges.

krunchie: Appeal to authority won’t cut it here. You don’t seem to have any kind of specific or detailed rebuttal. BTW, there have also been studies with monkeys and cats?.

Monotreme, look at Turkey to evaluate the validity of Dr. Oxford’s position. I think we can all agree that H5N1 has shown some signs of mutating to a form slightly more favorable to humans. With these changes we’ve seen a measurable decrease in the CFR (compared to the advertised ~50% mortality the media keeps reporting). Please don’t use the WHO stats on Turkey to show that the mortality rate hasn’t changed. We all know that their “official” numbers are bunk.

Yersinia pestis otherwise known as the Black Death had a mortality rate of 40%−70%

--
From Lonnie King’s Presentation at the University of Michigan

viralprotein

krunchie: “Please don’t use the WHO stats on Turkey to show that the mortality rate hasn’t changed. We all know that their “official” numbers are bunk.”

I agree. But see my analysis of the Turkey numbers at at 08:20.

And what about Indonesia? See tjclaw1 – at 23:30.

In reference to the 50% mortality of H5N1: John Oxford, a virologist at Queen Mary’s School of Medicine in London: “No virus under the sun would be able to spread with that kind of mortality.”

An idea:

One could argue that the mortality rate is not important whether the virus spreads or not.

An infected host will either die, or recover and have immunity from being infected again. Either way, it can’t infect any more hosts. What is important is that it infects other hosts prior to dying or recovering. A long incubation period and how infectious the virus is, determines how effectively the virus spreads.

Per krunchie 1/25/06:

“Monotreme, look at Turkey to evaluate the validity of Dr. Oxford’s position. I think we can all agree that H5N1 has shown some signs of mutating to a form slightly more favorable to humans. With these changes we’ve seen a measurable decrease in the CFR (compared to the advertised ~50% mortality the media keeps reporting). Please don’t use the WHO stats on Turkey to show that the mortality rate hasn’t changed. We all know that their “official” numbers are bunk.”

Per Dr. Dimitris Trichopoulos, Leading Greek epidemiologist 1/26/06:

“In Turkey, we have seen people more easily infected by birds because over a short period of time more cases were found than in Southeast Asian countries. However, we are looking at an epidemic which is not so deadly. Out of the 18 cases there have been three deaths. If there are 30 or more cases, as has been estimated, the mortality rate is 10 percent or less, compared to 65–70 percent in the beginning.

We are already talking about asymptomatic cases… This mutation of the virus is likely to mean that it is more infectious but that the disease it causes is not as serious. So I don’t think the nightmare scenario of the entire population of the earth getting sick and half of us dying will ever come about.”

IMHO we’ll begin to see more experts (like Oxford, Trichopoulos, Butcher, Segal, etc..) distancing themselves from the propaganda campaign of fear regarding H5N1.

krunchie: This is still a viral “comet” coming our way, and even the experts admit a profound ignorance and lack of tools (sophisticated algorithms, etc.) for really determining the trajectory of this event. What we are hearing from all are guesses based on the angle of the comet’s tail at any given moment. Trust your fear, but don’t let it dominate you.

-IMHO we’ll begin to see more experts (like Oxford, Trichopoulos, Butcher, Segal, etc..) distancing themselves from the propaganda campaign of fear regarding H5N1.-

Can’t say that I totally disagree with you.

krunchie: I think you missed the point of this thread. The first post was *satire*. I was making fun of the fact that the WHO was downplaying the severity of the virus at the same time their “official” numbers seemed to show a screamingly high mortality rate in 2006.

As I said before, I for one will not be persuaded by appeals to authority. You seem unwilling or unable to respond to my detailed explanations for my opinion. I do agree that there will be more and more health officials trying to soft pedal a pandemic. The same thing happened in 1918 and resulted in many unnecessary deaths. The basic idea is that, from the position of some politicians, the disruption to social order would be so damaging if people knew how bad the pandemic was, that its better to lie to them so that they continue to work and society functions normally. Read John Barry’s “The Great Influenza” for many examples of this. Unfortuantely, this strategy fails once people realize that they have been lied to. Then the real panic starts.

As far as the “real” case fatality rate, I don’t know what that is. I said on another thread that based on the animal studies that have been done it is likely at least 10%. But it scarcely matters whether its 10% or 75%. The pragmatic steps one needs to consider are the same. Isolation, social distancing and use of personal protective equipment until a vaccine is ready. Are you against these precautions?

“I do agree that there will be more and more health officials trying to soft pedal a pandemic. The same thing happened in 1918 and resulted in many unnecessary deaths.”

I guess you’ve missed my entire point as well. My central theme is that H5N1 has been overhyped from the beginning in order to generate $$. Just think about how everyone that’s pushing the doomsday scenerio, generally has something to gain by it. As it becomes more obvious that H5N1 is not the bogeyman that it’s been made out to be, you’ll see more and more experts start to distance themselves from the central theme as to protect their reputation.

One last point. If H5N1 was truly the potential killer that many have made it out to be and human civilization is hanging in the balance, wouldn’t you expect drastic efforts to have been made to complete basic seroprevalence studies? Additionally, wouldn’t you expect these to have been published?? Damn, this is pretty basic stuff for the greatest threat to mankind dontcha think??

Damn! Guess I’ll just have to move my pandemic supply stuff over to my earthquake preparedness shelf, or maybe to my terrorist threat corner, or maybe to my upwind release of God-knows-what from the chemical depot stash, or….

“If H5N1 was truly the potential killer that many have made it out to be and human civilization is hanging in the balance, wouldn’t you expect drastic efforts to have been made to complete basic seroprevalence studies?”

krunchie- please don’t underestimate the cumulative effect of politics, avarice and stupidity.

krunchie: Haven’t you figured it out by now? Humans are the biggest screw-ups to ever hit the species pool. And you will see the “Coming Attractions”. That I can guarantee you.

krunchie: “If H5N1 was truly the potential killer that many have made it out to be and human civilization is hanging in the balance, wouldn’t you expect drastic efforts to have been made to complete basic seroprevalence studies?”

You bet I do. You can read about our discussion of Seroprevalence studies here?.

The 7th level of hell is reserved for people who try to make a buck of the pandemic, IMO.

“krunchie- please don’t underestimate the cumulative effect of politics, avarice and stupidity.”

Please don’t underestimate the cumulative effect of clever propaganda. There’s nothing more powerful in provoking irrational actions, just ask the Jewish survivors of Nazi Germany.

I read from the Jan 19 Nature article that the latest mutation found at position 153 of the haemagglutinin gene causes the virus to favor binding to the nasal mucosa cells than the lower respiratory tract. If that is the case, then it would favor spread over lethality.

krunchie: Do you know how many scientists, including the ones you cite, would have to be in on the conspiracy you suggest? Pretty much every epidemiologist and virologist in the world. Not credible.

“The 7th level of hell is reserved for people who try to make a buck of the pandemic, IMO.”

I completely agree and would add “those who try to make a buck off the non-pandemic by convincing those that H5N1 is it”.

Monotreme, where did I state “conspiracy”? What I really said was propaganda. It’s not even close to being the same thing.

krunchie: But virtually every reputable virologist and epidemiologist in the world says that H5N1 influenza is a serious threat and that we should prepare for it. If they are all lying for the sake of propaganda, wouldn’t that require a conspiracy? Or did they all decide to somehow participate in the “propaganda” at the same time?

No-one is saying the pandemic has begun, yet. Or even that we are certain H5N1 will cause a pandemic. We are simply saying that risk and the potential harm are sufficient that we should plan and prepare now. If is doesn’t happen, no-one will be happier than me.

anon_22: Could you elaborate on the significance of the mutation found at position 153 of the haemagglutinin gene? I haven’t read the article in sufficient detail yet.

Monotreme - “I suspect the apparent variation in mortality rates between countries may have more to do with the promptness and quality of care patients receive than any difference in the virus. In a pandemic, mass distribution of tamiflu and ICU’s will not be available.”

I completely agree with this statement. I suspect that one reason the CFR (perhaps) went down in Turkey is because they were unprepared for the first onslaught of patients. When the second and third (and so on) waves of people (the lucky ones) got sick, the authorities were prepared. These pts got treated early with ventilators and with Tamiflu and so they did much better.

If this is the case, TPTB sure as hell don’t want the news to get out. How much of the world’s population are there vents and Tamiflu for? There would be chaos. And danger.

Monotreme - “This is one proposed mechanism for the evolution of a virus from a highly lethal to a much less lethal version. The key point though, is that selection doesn’t start until the second wave.”

Maybe I’m confused here. But the above quote seems to contradict the 1918 flu statistics where the second wave was most lethal.

Scaredy Cat: Agree completely with your analysis of the Turkish situation. I think its also possible that family members of infected patients were given Tamiflu prophalactically. Although they may have been infected prior to receiving Tamilfu (as a result of limited human to human transmission) getting the Tamiflu early may have prevented more severe symptoms and death. Still waiting on WHO for the results. Tap, tap, tap.

I am also concerned that the fatality rate would be higher without tamiflu or vents. More reasons to encourage as many people as possible to prepare for isolation. This will be our only hope until vaccine is ready.

“If they are all lying for the sake of propaganda, wouldn’t that require a conspiracy? Or did they all decide to somehow participate in the “propaganda” at the same time?”

You are kidding right? If you really believe that propanda requires conspiracy then you should go read up on subject. The only thread (ie connection) between those pushing the propanda is $$.

To illustrate, let’s take a look at global warming (I’m not taking sides on this debate). If you have an environmental group a pollution reducing equipment supplier and an alternative fuel company all pushing “global warming” and using fear to promote it, they are all using propaganda without conspiring. Get it? The media can also participate by selling the gloom and doom story…again without conspiring.

krunchie - “To illustrate, let’s take a look at global warming (I’m not taking sides on this debate). If you have an environmental group a pollution reducing equipment supplier and an alternative fuel company all pushing “global warming” and using fear to promote it, they are all using propaganda without conspiring. Get it? The media can also participate by selling the gloom and doom story…again without conspiring.”

If you’re not taking sides on this debate, then why did you not give an example of an oil company, making soft, warm, fuzzy, kind to puppies and kittens and all living things above all the planet commercials, encouraging reliance on fossil fuels, from which they, the oil companies, profit fabulously?

And as far as I know, most environmental groups are not in it for the profit.

krunchie: So what you’re suggesting is that every scientist who takes H5N1 seriously and advocates preparing for it is trying to make a buck? Not credible. But I don’t think there’s anything I can say that would convince you that you are wrong.

Scaredy Cat: I just read an article that addresses alot of the issues we have been discussing.

Avian influenza. Amid mayhem in Turkey, experts see new chances for research. Science. Jan 20, 2005. Vol . 311, 314–315.

I can’t put the whole text here, but the bottomline is some of the mild cases may be due to false positives and/or due to the wall to wall coverage in the Turkish media which prompted parents to bring in children to the hospital earlier and put on tamiflu. Consider yourself vindicated, at least for now.

I’ve put a short excerpt up on the seroprevalence page?.

Thanks Monotreme. Wish they made these articles easier to access.

“So what you’re suggesting is that every scientist who takes H5N1 seriously and advocates preparing for it is trying to make a buck? “

Again, you’ve mischaracterized what I said. I’ve never said that H5N1 should be ignored, I’ve said that it’s simply not the bogeyman that we’ve being led to believe. ‘Overhyped’ probably best describes my point.

There was an article today that had bird flu in the title along with the Black Death of the 1300′s. I guess the 1918 pandemic comparison is losing it’s sting. If you don’t think this exemplifies my point about propaganda, fear-mongering, and overhyping, then I give up….

Krunchie - Even if there is a very low probability that H5N1 turns rogue and begins to run, what harm is there to advocate prudent preparedness?

Preparation for a low probability but high impact event is still warranted, prudent and called for. Just look at the results of the last hurricane season in 4 Gulf Coast states. Do you have some personal belief structure that requires that you dissuade people from provisioning their families for whatever potential hard times are out there?

krunchie - “There was an article today that had bird flu in the title along with the Black Death of the 1300?s. I guess the 1918 pandemic comparison is losing it’s sting. If you don’t think this exemplifies my point about propaganda, fear-mongering, and overhyping, then I give up….”

Unfortunately, thus far, the CFR is showing signs of approximating more the Black Death statistics than those of 1918, thereby making “fear-mongering” completely appropriate (and potentially life-saving), and quite apart from any “propaganda.”

I hope you’re right though. But in case you’re not, I suggest you stock up on lots of granola.

Monotreme,

“anon_22: Could you elaborate on the significance of the mutation found at position 153 of the haemagglutinin gene? I haven’t read the article in sufficient detail yet.”

Sorry, I meant the mutation at position 223, not 153.

In any case, it is still referring to the same thing, that there is a (possible) selective preference for nasal rather than pulmonary mucosal cells. However, I haven’t been able to verify this with a second source so this is according to Alan Hays as quoted by Declan Butler. But it is interesting none the less.

“The Turkey strains are the first in which the polymerase and receptor-binding mutations have been found together. They could make it easier for humans to catch the virus from poultry. But they might also favour human-to-human transmission. This is because the polymerase change helps the virus to survive in the cooler nasal regions of the respiratory tract, and the haemoagglutinin mutation encourages the virus to target receptors in the nose and throat, rather than lower down in the lungs. The virus is thought to be more likely to spread through droplets coughed from the nose and throat than from infections lower down.”

http://www.nature.com/news/2006/060116/full/439248a.html

anon_22: I understand how the mutation might increase human to human transmission. But I don’t see why this requires that it become less lethal. Could you explain that part?

Maybe, upper respiratory infections are less lethal than lower, in general? However, hasn’t H5N1 been shown to infect and damage cells in many organs and that is what ultimately makes it a killer?

In 1918 the second wave was more virulent than the first so I am not sure that we can make any judgments about its lethality.

Monotreme,

Here’s the problem. So many experts have said that for a pandemic to occur, the mortality rate has to be lowered. But I have not been able to find any science that explains the mechanism by which this happens. Some say that it needs to have more survivors to spread the virus, but given the high contagion of this virus, it really doesn’t need a very low fatality to spread widely. The other problem with this hypothesis is that it almost presupposes a level of consciousness that directs the virus to behave a certain way, and the agonistic me finds that a little hard to swallow without protest. I have a feeling that you are probably the same. :-)

What I have been looking for is some sort of mechanism inherent in the behavior of the nucleotides and proteins that triggers a lower mortality at the same time as a more efficient spread. If this particular mutation really does give selective binding to nasal rather than lung mucosa, one would imagine it would result in higher degree of virus shedding (and therefore more efficient spread) while at the same time a lower viral load in the lungs might reduce the severity of pulmonary complications.

Again as I said this is just my conjecture from one source. Anyone who can enlighten me will be greatly appreciated.

Monotreme, bumped for your attention.

Thanks anon_22. I agree with your first paragraph. The need to believe that CFR *must* go down is strong. The evidence that it must go down is nonexistent.

The hypothesis you present in your second paragraph has the great advantage that it is mechanistic, rather than faith-based. I’m not sure that the virus has to choose between nasal and lung mucosa, but maybe it does. We need a flu pathologist’s opinion. I’m also wondering how much of a lung infection is needed to trigger a cytokine storm which apparently could be quite lethal itself. One of the unusual features of H5N1 is the wide variety of tissues it can infect. See this paper for further info.

In any case, before I am persuaded that a lower fatality rate in Turkey is due to changes in the virus itself, rather than extrinisic factors such as tamiflu administration, I would like to see animal studies comparing the “Turkey” strain with a “Southeast Asian” strain. This is the only way to control extrinsic variables.

Well. even if the mechanism (of this mutation) is valid as a hypothesis, it still doesn’t PROVE that it has to be so.

Sorry if this question has been asked or the answer is obvious (to all but me) but I’ve heard that the CFR must go down or the bug will be too lethal and not have time to spread (dead people don’t spread disease). But doesn’t a lot depend upon the incubation period? In other words if something was 100% fatal and took 1 month to manifest itself and was highly contagiuous wouldn’t we ALL be dead in a month? There has been some discussion that some strains of H5N1 might have a longer incubation period in which case it would have time to spread regardless of its lethality. Probably a dumb comment but that hasn’t stopped me before.

True. But its refreshing to be discussing possible biological mechanisms rather wading through faith-based quotes from “experts”.

I wonder if SARS has any lessons? SARS caused severe damage to the lungs of its victims. SARS is about the same size as influenza and is also spread by droplets. In fact, the recommendations for PPE for H5N1 are based on the SARS experience for this reason. SARS had a 15% CFR. However, it never developed into a pandemic, presumably due to contact tracing and the eventual use of proper PPE in hospitals. My understanding is that the reason these measures worked is because people did not shed virus until they were already ill. As we all know, influenza can spread when people are feeling quite fine. So, it would seem possible that H5N1 could eventually cause severe lung damage and still spread via droplets resulting in a pandemic with a high CFR. Based on the SARS experience, a CFR of at least 15% should be possible.

NW: Your question is not dumb at all. The hypothetical virus you describe would indeed have the unfortunate effects you suggest. The key issue is how long does the host shed virus before they become too ill to be out and about infecting others? With influenza, that time is at least one day and possibly more. The ultimate lethality of the virus is irrelevant, a fact which many people don’t understand. One day is plenty of time for an efficiently transmitted virus to jump to other hosts. How many? This number is expressed by the famous R0 variable. If each patient, on average, infects at least one person before they become too ill to move, a pandemic begins. This has not happened yet. But there is no evidence to suggest that H5N1 cannot keep its current high fatality rate and acquire the ability to be efficiently transmitted.

That doesn’t mean the final CFR will really be 50%, rather that given our current understanding, there is no reason why this couldn’t happen.

Transportation efficiency and dense pack society allow the more deadly to spread without selection for lower kill rate.

NW, there are no dumb comments on the Wikie, only TROLLS that we kick out :-)

You made a very valid observation. I might add that long incubation period does not necessarily mean a long period for virus shedding. You could have a 1 month incubation but the person does not shed virus at all until the start of symptoms, as in SARS, or the person sheds virus from 2 days before symptoms, as in the current H5N1. In both examples, the long incubation would give public health officials time to do thorough contact tracing and quarantine or prophylactic treatment, which will limit its spread. Whatever the case, these numbers do not tell us about the CFR, which is the percentage of symptomatic cases that die.

It might help clarify thinking to make these distinctions:

Incubation period = time from exposure to symptoms Period of contagion = time when virus is shed Transmissibility = the number of cases in the next generation infected by one case Pathogenicity = the ability to cause clinical disease in those infected Virulence = the severity of the disease caused Lethality = the virus’s killing power measured by the CFR

Corky52: True. In some chicken coops, the kill rate was 100%.

OK, that didn’t work.

Incubation period = time from exposure to symptoms

Period of contagion = time when virus is shed

Transmissibility = the number of cases in the next generation infected by one case

Pathogenicity = the ability to cause clinical disease in those infected

Virulence = the severity of the disease caused

Lethality = the virus’s killing power measured by the CFR

Monotreme, if the CFR can really stay 50% ± with efficient transmission, why would the virus not burn itself out like other deadly viruses (ebola)? We’ve never really seen a such virulent virus go to pandemic level so what makes you so sure it could happen now? It is assumed that during previous pandemics, where the death rate is very high, the vast majority of deaths are actually from secondary infections so this would have nothing to do with the virulence of the virus itself.

Ebola is not spread by respiratory droplets. Its R0 is therefore much lower.

Plus the kill rate has to be much closer to 100% for it to burn itself out.

How do we know that the kill rate must be closer to 100%? I don’t think we’ve ever seen any highly transmittible virus that kills even close to 50%, not counting secondard infections, have we?? If it hasn’t happened before wouldn’t it suggest that it can’t?

Ditto, what anon_22 said.

Also, the available pathology suggests that most people dying from H5N1 are dying of viral pneumonia and cytokine storm. Antibiotics have been tried. They are useless.

Larry, the higher the transmissibility R0, the less likely that the virus will burn itself out. The higher the kill rate, the more likely that that will happen. Compared to influenza, Ebola has a lower R0 but a much higher CFR, therefore it is easier to control until it burns itself out. With a much higher R0 than Ebola the flu virus will have to have an extremely high CFR to burn itself out.

Thanks for your comments.

So is it just an accident that we’ve never seen such a highly lethal pandemic strain or is the virus truly limited by it’s lethalness and we are just assuming it’s not too lethal to spread efficiently??? LOL..what a question huh?

Larry F: “If it hasn’t happened before wouldn’t it suggest that it can’t?”

• We don’t know whether its happened before. Pandemics occur at rare intervals. Our data is incomplete, to say the least.
• It has been suggested that a vaccine was used in China in chickens that did not result in sterilizing immunity. This might result in a very unusual selective pressure on the virus. Certainly, the high population of both chickens and humans in Asia is unprecedented. This alone provides much greater chance s for “unusual” viruses to evolve.
• Rare, bad things do happen. Just ask the dinosaurs

Yes, those poor dinosaurs.

I wonder if in later millenia they will have human skeletons in museums?

Yes. and gaggles of giant, superintelligent cockroach children will try to scare each other by pretending to be humans.

Having lived in student housing with a bunch of cockroaches, it is quite likely to imagine them as the last species standing. They are admirably equippped to deal with most any situation, despite being viscerally abhorrent to our own kind. Their track record on this planet is quite impressive.

The smaller the better.Didn’t mammals survive in part due to their small size? Just in my generation it seems I see taller and taller young men. The japanese I have heard have gained height, and due to fast American food, some chinese children have gained breadth. Perhaps not as dramatic as mutation, but change nonetheless.

in later millenia there will still be humans - but they are kept in labs by robots for experiments. No museums are required, all data are stored on media for easy exchange. And no, cockroaches didn’t make it to the 22nd century. Humans killed them using viruses.

Impossible GS. A computor can only do what you want it to do. Kill its power source, silence the human activating it and you have nothing. Zilch. Ditto with Robots. Why would robots propogate robots., unless hormones and whatever caused desire can be wired in.

Another example of propaganda? How do we know (scientifically) the lethality of H5N1 without seroprevalance studies? It seems a bit presumptuous to complete a study to determine what makes the virus is so deadly without first scientifically establishing that it is really deadly! Of course without the study we are expected to assume that H5N1 kills ~50%.

Again think about an earlier question I raised. If H5N1 was truly the potential killer that many have made it out to be and human civilization is hanging in the balance, wouldn’t you expect drastic efforts to have been made to complete basic seroprevalence studies? These studies are standard protocol. They were among the first things done when West Nile virus and SARS emerged and we are continually being told that the bird flu is a greater threat than either.

Genetic code offers clue to why bird-flu strain is deadly

WASHINGTON - Scientists who have unraveled the genetic code of bird-flu viruses have found a new clue that may help explain why the H5N1 strain is so deadly. St. Jude Children’s Research Hospital in Memphis is home to a remarkable viral library, samples of about 11,000 influenza viruses that Dr. Robert Webster has gathered from around the world since 1976. They are not just flu viruses that have infected people over the years, but ones from pigs and other animals - including about 7,000 bird-flu viruses gathered from poultry, ducks, gulls and other flocks.

St. Jude researchers reported yesterday in the journal Science that they had completed the first large genetic analysis of more than 300 of these bird-flu viruses. They identified 2,196 bird-flu genes and 160 complete genomes, doubling the amount of genetic information available for scientists to study how these viruses evolve and spread. Simply having that new trove of information - posted in a public genetic database so that any scientist can mine it - in itself is a huge step, said Dr. Maria Giovanni of the National Institutes of Health, which has launched a major project to map influenza genomes and helped fund the St. Jude’s work. So far, most of the complete influenza genomes available are from human viruses.

Until now, scientists trying to decode flu genetics have mostly focused on specific genes involved in making flu vaccines, such as hemagglutinin - the H in H5N1 - on the virus’ surface that triggers the immune system to mount an attack. When it encounters a brand new hemagglutinin variation, like when H5 strains first infected people in 1997, the body doesn’t know how to defend itself.

But unique hemagglutinin alone doesn’t explain why H5N1 is so dangerous to people. Decoding all the influenza genes instead of select ones will help scientists learn how these constantly evolving viruses change and spread, and why some are so much more virulent than others.

Enter the new clue, a protein called NS1 produced inside flu-infected cells. In bird flus, the NS1 protein harbors a molecular feature that seems to help the virus latch onto and disrupt certain important cellular processes - a feature that influenza strains common in humans don’t seem to have, the researchers concluded

http://www.siliconvalley.com/mld/philly/living/health/13722003.htm?source=rss&channel=philly_health

Are you one of those that needs absolute proof to beleive anything? The absolute proof will only be the dead.

Lily I would think that for something this “important”, scientific facts would trump hyperbole! We’ve got governments pledging billions (with a B) to fight this. Don’t you think that decisions should be guided by scientific fact?

I once read that Einstein did not think in words as such. He had a thought and then found the words to express how he thought. Noone needs to convince you of anything. Whatever is being done by governments is sub rosa. New Zealand certainly is taking this seriously. When I speak of Einstein I am saying that most people here on this particular wiki are taking this very seriously. Most of the experts are taking this very seriously. If the general public prefers to be ignorant that can’t be changed. I go around my daily life without a thought of bird flu most of the time. But I feel very strongly that this is no false alarm. I am a layperson with some background in medicine, not much to be sure. I have always gone by gut feelings, I always pay attention to my intuition, and guite frankly, intuition sometimes trumps everything in my life. I beleive. Sorry. Civilization won’t crumble, Countries will function, and quarrel as they always have. But we will possibly have millions dying in horrendous ways. I don’t want to be one of them.

krunchie: “How do we know (scientifically) the lethality of H5N1 without seroprevalance studies?”

Absolutely correct. Please see the Flu Wiki Seroprevalence page? for more information. However, animal studies also provide clues to lethality. See the Flu Wiki animal studies page? for more information.

Krunchie,

The following forum thread might also provide some answers to your questions (here goes nothing with the link):

AShockingLackOfSeroprevalenceStudies?

Krunchie - First, let me assure you that I am well trained in the scientific method, and use it as part of what I do for a living. That said, if you allow the awe of “SCIENCE” to cloud your thinking, you are in deep trouble.

I have always taught my students that if you ever hear the opening of a statement begin “There is no scientific proof that…..” then you should immediately place your hand on your wallet because the party uttering that line is out to swindle you. The scientific method is a methodology of sieving through information and attempting to extract the correct answer. It does not replace any other methodologies of wisdom that exist in the world. Reliance on position is a clear give-away that you are not thinking for yourself, instead allowing some high priest to do it for you. If you want to believe that so-and-so is true because the Great professor So-and-SO has said it, then please realize that you are engaging in religion, not science.

There are some things that do not need the scientific method applied to them before you engage your common sense. If you believe that “scientific fact” (i.e. scientific methods of proof have been applied) is necessary before you consider something reasonable to act on, then you will not live long under rapidly developing conditions, as it appears we are seeing in the case of H5N1.

IN the mean time, please ponder that:

‘’‘There is no scientific proof that jumping from an airplane in flight without a parachute or other arresting gear will result in your death.

There is no scientific proof that standing in front of a major cattle stampede with your hand held aloft as a signal to stop will result in serious injury or death.

There is no scientific proof that placing the muzzle of a Charter Arms .44 caliber pistol in your mouth and discharging the weapon will result in your death.

There is no scientific proof that rolling around in intimate contact with H5N1 infected chickens will cause you disease.’‘’

Not everything is amenable to, nor requires proof by the scientific method. You are surrounded on this Wikie by a large number of professionals, all trained in the scientific method, and yet you seem to think that by invoking it as a magic talisman, we will all bow to your superior intellect and abandon perfectly reasonable positions.

Think again. There is no scientific proof that we shall do so.

“However, animal studies also provide clues to lethality.”

Monotreme, I again point to the article I referenced. The study was to determine why H5N1 was so lethal to HUMANS. I am scientifically trained and I know you can’t skip step 1 (scientifically establishing the lethality to humans) before proceding to step 2 (why). The fact that they are doing it and not being called on it just adds to the growing pile of propaganda evidence. Don’t confuse propaganda with conspiracy (which is not required). The fact is that St. Jude Children’s Research Hospital in Memphis likely got grant money for this study, and the newpaper got money for selling the story…. All of this without any scientific basis for the study being real (H5N1 being deadly)!

“There are some things that do not need the scientific method applied to them before you engage your common sense.”

Eccles, in reference to seroprevalance

“They were among the first things done when West Nile virus and SARS emerged. Yet they have not been done in a big way among poultry workers in Asia — the most likely people exposed to bird flu.

“I’m frankly a bit bamboozled by all that. I can’t understand why that hasn’t been done extensively,” Schaffner said.

Without serosurvey information, the apparent human death rate for H5N1 infection of about 50 percent may be erroneous, said Craig Pringle, a viral diseases moderator for ProMed-mail, a blog operated by the International Society for Infectious Diseases. He’s also a retired professor at the University of Warwick in England”

Krunchi. You are a stubborn man or woman. Beleive whatever you want to beleive. Just one thing. Noone on this forum is a propagandist. If some have a private agenda it is obvious to the rest of us, but tolerable. Some here are grasshoppers by nature, I am one. Most are ants, and very industrious ants to be sure. I doubt that anyone is changing their minds, anymore than you will change yours. Good Luck, you’ll need it.

krunchie: Please read my post at at 13:12 and go to the Flu Wiki Serorprevalence page and actually read it. Its hard to argue with you if won’t take the trouble to read the available information.

Lily, I never accused you of being a propagandist. I’m actually stating the opposite, which is that we are being fed propaganda in giant spoon fulls and we need to just be willing to accept the fact that things are not always what they seem. I’m sorry if this makes me “a stubborn man or woman”. Would someone making these same arguments regarding the swing flu in 1976, or Y2K, or SARS be equally stubborn?

-Have a great weekend

I like many on this site simply googled up Avian Flu and got this site (1st try beside WHO) I felt comfortable and stayed, as many here do. If you notice noone here is saying you must beleive as they do.If anything I think there hasn’t been any attempt at propoganda by authorities. Its the opposite, I wish we could be like New Zealand and handle it with the intelligence shown there. Somewhere Eccles posted the newspaper article about body bag. coffins and funeral preps being instigated in New Zealand. Just in case. If Eccles would be kind enough to find it, please read it and shudder.

Lily -

So let it be written, so let it be done.

This is the link

Thank you Eccles. I hope if Krunchi logs in again he or she will read the WHO pandemic influenza draft protocal and listed under the thread WHO Draft Protocol. I was so disgusted with WHO . Thanks tjclaw1 I was driving elsewhere and decided to check in before I gave up Bird Flu for the day.I don’t really care what Krunchi thinks, but every one who posts here gets their moment.

Lily, from your article: “New Zealand does not have enough freezing capacity to deal with a projected 33,000 deaths”

What do they base the 33,000 on? Is it from seroprevalance studies, or is this just another opinion? Seems like a little science might be in order here don’t your think? Either way, it seems they’ve distanced themselves from the advertised 50% mortality rate…

Krunchie, you’ll have to ask the New Zealand government who handles these projections. Have you read the WHO pandemic influenza draft. More propoganda?

“Have you read the WHO pandemic influenza draft. More propoganda?”

Lily, you’ll have to answer that yourself. If you trust the UN-WHO, then more power to you. I’ve seem more compaints on Flu Wikie about WHO than any other organization. If you want to use them to defend your position, it’s your call.

PS - This thread was started as satire, because of WHO’s own statistics.

The Swine flu, 1 person died in one location, and they panicked before an election.

H5N1 is in many countries and spreading, and more, not fewer, people are getting sick and dying, as time goes on.

Y2K was if anything a mechanical glitch created by humans, seen years ahead and understood by business and government as a concern, and fixed before its set timetimes came up.

Pandemic Influenza is a natural disaster, highly infectious, not going to give a launch date, and can mutuate and have waves of killing for over a year. (With all related consequences.)

SARS is less easily transmitted than influenza, has a longer time (about 3 times as much?) between “generations” of new cases, not contagious before symptoms, and was only controlled by extreme effort by the cities and countries involved. The economic costs just by unaffected areas taking precautions, or, misdirected fears, were enormous.

H5N1 is much more virulent than seasonal influenza, and, may cause cytokine storm and death in the healthy such as 20-to-40 year olds. It is contagious before fever or symptoms appear. (The costs would be higher than next week’s US deficit!) Seriously, global recession for at least a couple years has been thought likely.

Suggest finding and reading the book “1491″ to think more about what totally new viruses can do to populations with no previous immunity.

This is what is scary: “3) the fact that it is communicable for days before the appearance of symptoms means that given a human host population, and given 21st century culture and transportation, then there will be sufficinet opportunity for the organism to spread widely throughout a candidate host population. “

and just because all the governments and leaders aren’t seeing that pandemic suddenly appearing everywhere within a week of a strain finding the right mutation, is a threat, and not doing all the right things, says more about human nature’s capacity for denial, status quo, greed, personal political or portfolio gain, or its lack of basic scientific education and common sense, than it says about the threat level of H5N1 going pandemic, or anything else ever going pandemic in our futures.

The WHO saying they are going to do the response actions

without raising the alert level

has made most places action plans useless now, if they keep them pegged to what the WHO says, not to what it is needing to do to respond to H5N1.

http://www.who.int/csr/disease/avian_influenza/guidelines/RapidResponse_27%2001.pdf (6. on page 13, though, bottom of page 12: the circumstances under which they won’t try a containment, even if the virus met the human-to human transmission paramaters, are worth reading, as in, if the area is too large and there are more people who need anti-virals or vaccines than there are available supplies, or, if it has already gone on for 6 weeks from the index case. !

It’s not my position. Duel with the smarter members of the wiki. I, as I stated feel my gut instincts trump official statements. I’ve lived all my life trusting intuition. What you need to do, is say to yourself, perhaps this isn’t propogands, perhaps simple prepping isn’t a bad idea. What does it cost you, a few hours of shopping and filling up the pantry. Then, sit back and watch it unfold.I find that contrary to my nature, but I am doing it. Ten cans of soup here, ten cans of tuna there, a bit of grape juice, some cranberry juice, some spring water. Is that so hard? You”ll consume it anyway.Or as we all say,contribute it to the food pantry in your town if everything fizzles out. Its something devoutly to be wished for, and one position often stated. Unfortunatly most of us feel it is very possibly unstoppable, since people are people, and screwup.

All your points are valid. The problem is that your using hindsight. At the time all of those things (swine flu, SARS, Y2K, etc) were advertised as big threats and many people were genuinely panicing. Only after the propaganda died and the smoke cleared was the truth unveiled.

Again I’ve never stated that H5N1 is no threat. In fact preparing for any natural disaster is a good idea, and yes I’m prepared for anything that might come my way. All I’ve stated is that based on what we “know”, this doesn’t deserve to be front page news every day with the continual disclaimers of million could die, H2H, etc… and comparisons to 1918, the Black Death, etc…

It isn’t front page news. It isn’t on T.V. very often. An occassional magazine article. The average American doesn’t even beleive it.

Well its time to sign off, pleasant chatting with you Krunchie. Hope you make yourself comfortable at the wiki. Good people reside here.

from Rense.com about mysterious deaths of scientists and microbiologist. even if it is half true, the list might suggest a larger order of cover up to protect military and national secrets.

http://www.rense.com/general62/list.htm

Rense is never even half true. Put that on your list of ‘never to be believed’ sites. Sorry. i understand even a stopped clock is right twice a day, but…

Thats funny. Its like a blind squirrel finds a nut sometimes. good one.

Monotreme – at 22:27 Thanks anon_22. I agree with your first paragraph. The need to believe that CFR *must* go down is strong. The evidence that it must go down is nonexistent.

In reference to the 50% mortality of H5N1: John Oxford, a virologist at Queen Mary’s School of Medicine in London: “No virus under the sun would be able to spread with that kind of mortality.”

anon_22 – at 08:45 Monotreme,

Here’s the problem. So many experts have said that for a pandemic to occur, the mortality rate has to be lowered. But I have not been able to find any science that explains the mechanism by which this happens.

?? I see none of that.

There is no believe that the virus or any virus “needs” a certain lower mortality to spread amongst HUMANS or cause a HUMAN pandemic - in the scientific community.

There is: - the observation that flu viruses - over time - show a lower mortality when circulating amongst humans (e.g. 1918 and other examples) - there is the observation (in some examples) and the logic that a very lethal (high mortality)virus burns itself out faster IF and thats important: virus shedding and being too ill to be a walking/flying whatever around is closely related (same time span). See HIV - it is still incurable so does have directly or indirectly a mortality rate closer to 100 than 50 %. And infecting others is possible for more than a decade. Whats missing here for a devastating effect on humanity (its bad enough, but not as bad as it could be)? Easy transmission via droplet infection by very casual contact.

Flu: in the few days that a person infected is still feeling well the person does indeed infect a huge number of people. And for a pandemic thats the only thing that counts, how easy is the transmission - and for how long can someone go around infecting without anyone noticing the sick person. The mortality rate /CFR only comes into the picture later. It might indeed stop spread when the mortality is very high - but not for biological/statistical reasons (as it would be in an animal situation out there - next host far away kind of thing and thats what some of the experts are thinking of) rather for social reasons = unless forced people would instantly stop any social contact and disruption of transport would be complete. that does not lower mortality but does indirectly slow the process of spread (but not the dying of starvation and other secondary effects that come with it).

Anyhow, back to the qoutes: “So many experts have said that for a pandemic to occur, the mortality rate has to be lowered.” I have not heard a single expert stating that. I have heard experts expecting the mortality rate to drop (slow or faster) when a pandemic occurs, when meaning during a pandemic.

“The evidence that it must go down is nonexistent. “ Agreed for human pandemic and flu. The reasoning behind that idea comes from other sources and circumstances, it would be too time consuming to elaborate on that.

“No virus under the sun would be able to spread with that kind of mortality.” That must be taken out of some context. Whatever he has in mind its not biological reasons, its host closeness, time to move while infective and things like that, not any “virus” genes that determine that.

the virus must mutate to become h2h. If this mutation occurs by recombination of large parts or reassortment then we would probably get a completely different virus and thus also the mortality could be completely different. If the existing H5N1 slowly changes by a few point-mutations to become h2h, then we won’t expect a dramatic change in transmissability and we might only get a local outbreak and enough time to develope a vaccine. Interesting the Oxford-quote ! Compare with what anon_22 reported about Oxford’s perceived change in “pamflu-mood” in another thread here.

non-english. The above is a clear, concise and beautifully written analysis. Please, stick around.

The fear of a thing is often worse than the thing itself, but history is replete with examples of when we did not fear enough. Very smart people have made some very bad decisions. Consider the insurance companies that pushed life insurance during the early stages of the 1918 pandemic. In my mind, I can see some very bright boys with some very compelling actuary tables persuading their bosses that this was a golden opportunity to capitalize on the fear and hype prevalent at the time in the unsophisticated herd of humanity. Once the pandemic was over, I suspect that those bright young men, who were not dead, found themselves banished to the mail room.

As a species we appear to react to fear in one of three ways: we freeze, we flee, or we fight. I suspect our take on the pending pandemic is hard wired into our brains. That hard wiring will compel us to forever talk past each other.

As for me, I am too hyper to freeze. I have nowhere to flee. So, I am going to fight. To my mind, imagining the unimaginable is the first step in fighting that fight.

Tom DVM – at 09:20 thanks a lot for your kind words

anonymous – at 03:20 “the virus must mutate to become h2h. If this mutation occurs by recombination of large parts or reassortment then we would probably get a completely different virus and thus also the mortality could be completely different. “ The experts are still throwing out the educated guesses, for now it stand as - it might be H5N1 - it might be any other one - it might be via reassortment - it might be via mutation, independendt of any other host, directly -…..(and many more)

The whole excitement stems from the asumption that it might indeed not be a completely different virus and thus might have a high mortality.

anonymous – at 03:20 “and we might only get a local outbreak and enough time to develope a vaccine.” A local outbrake is an epidemic. By definition pandemic is worldwide. The whole conversation here is about pandemic, epidemics, we have plenty of them, thats not really frightening for the developed world. Unless: - the Belgium/US vaccine is successfully further developed which might take a few more years and thus enabeling us to vaccinate for many plus future strains of the virus there is no hope to stop any pandemic with a vaccine. It simply does not work because of the time needed (6 month to get to the first batch of the new vaccine). By the time you have a tiny fraction produced to vaccinate, you are well into the second wave (Nabarro´s words - more or less (rather less ???)- word by word November 2005, House of Lords). And the vaccine production capacity at the moment is 1% of worldwide population. And it cannot be increased unless they start doing it and have years to do it (just production facitlities, let alone the rest of the problems) so unless thats happening, there is little hope. Forget the vaccine for at least a few more years.

I sincerely hope: - we do have years - we are just lucky with the pandemic strain if it arrives before we solved the vaccination problem

AND: I do hope they start including likely strains in the yearly vaccine. I have not heard of it, but I am confident some are thinking along theses lines and will finally do it. Because thats one do-able way to try to lessen the impact.

Cloud9 – at 10:33 “we freeze, we flee, or we fight.” There is no way a person can prepare for the unimaginable or even imagining it. Fortunately. If you are able to do that, normal life cannot continue. From a psychological perspective, all that freeze, flee fight can happen and change during the course. Wether imagined or real. Step by step preparing does include more of the figthing attitude.

Cloud9 – at 10:33 “That hard wiring will compel us to forever talk past each other.” Many talk past each other, not all. Doe not matter for the end result. Its nice to meet someone on the same wavelength from time to time. But talking is pretty useless for fighing the pandemic unless its your job (or you try to alarm others). So all the dicussion about the “speculative” temperature towards pandemic flu is interesting, but has no impact on reality and zero result for personal survival (unless its about concrete survival tips).

Thats just some of my “few cents”

non-english – at 03:22


yes, but H5N1 can also be epidemic first(or not ?). Then we can use that strain for vaccine. So we are prepared in case the epidemic strain continues to improve in infectivity (years later). I feel that a pandemic would be a big change (reassortment in 1957,1968) and that H5N1 evolves slowly.

anonymous – at 04:05

interesting idea behind that. You are assuming that infectivity changes slowly (as a possibility). For the moment that cannot be ruled out by the knowledge today. I do not lean towards that idea, but thats just my guts feeling and hopefully wrong.

We can use one strain for vaccine right now. We would still need years (!!!) to produce and vaccinate the worlds population. Keep that in mind please. We simply do not have the production capacity and have not started to increase that. And that increase takes years.

But it is not the “ruling” theory, which assumes/fears rather a certain SHIFT (as opposed to slow drift) for efficient H2H “infectivity”. Thats the main cause for a pandemic, more or less we have epidemics of “normal” flu every year, thats the “slow” version (the drift). Science has no complete understanding, if we have enough time (years) we will be a lot smarter and better prepared. The idea for the moment is, yes, there is hope to contain even a starting pandemic, but thats a slim hope. To watch multiple smaller epidemics evolve over years into a pandemic is hoping for quite a bit. So far, H5N1 has offered more than enough nasty surprises and was always faster than expected (in the animal world. Slow evolving? Might be before, since one year its going mighty fast around the world.

propaganda, conspiracy and the end of the world… how are these related? they are all propagated by people with large imaginations and few facts…

Old thread - Closed to increase Forum speed.