Forum: A Current Threat Assessment

4. Possible Scenarios (2006 and beyond): a. My expectation (JFTHOISTGYT*) - 33% of population infected, 50% mortality of those infected (or, 66% of population infected, 25% mortality of those infected): i. Worldwide Infection - 2.2 billion (6.6 billion x 33%); ii. Worldwide Deaths - 1.1 billion (2.2 billion x 50%) or 16.67% of the total world population; iii. U.S. Infection - 99 million (300 million x 33%); iv. U.S. Deaths - 49.5 million (99 million x 50%); v. Washington State Infection - 2.1 million (6.4 million x 33%); vi. Washington State Deaths - 1 million (2.1 million x 50%); vii. Spokane County Infection - 148,500 (450,000 x 33%); viii. Spokane County Deaths - 74,250 (148,500 x 50%); ix. Spokane City Infection - 65,000 (196,000 x 33%); x. Spokane City Deaths - 32,125 (65,000 x 50%). b. Other estimates from “experts” range from “it’s a hoax” or “it’s controllable” (there will always be those oddballs) to worldwide deaths totaling insignificant / negligible numbers (very few) to a few million (many) to tens of millions (most) to hundreds of millions (some) to 2 billion (one Russian prediction). Expect the estimates from most “experts” to noticeably change as the pandemic evolves. This is predictable, since the “experts” must maintain their perceived status as such.

reference here http://www.fluwikie.com/pmwiki.php?n=Opinion.SurfersViews

I believe

Moeb.

1) 10% CFR

2) the equivalent of 10% CFR due to collateral damage (lost infrastructure)

3) 10% of those recovered with quality of life altering chronic sequelae (permanent direct viral lung damage - emphysema etc).

CFR = Chance for Recovery? What does this acronym stand for on this forum? Thanks.

Case Fatality Rate.

lurker57 - “Case Fatality Rate” = percentage of those who get it, die from it. The current CFR of 55% means that over half the people who come down with it have died.

Ironic, huh?! Lurker@1200 sees the glass as half full…only to find out it’s empty…I know it wasn’t meant to be poignant, but the contrast is glaring.

Incidentally, there’s a Glossary page on the wiki that includes translations for a lot of the acronyms and shorthand used on the forum.

Thanks for your predictions! I too instinctively believe it will be horrible. However, as I told my worried girlfriend yesterday, If ANYTHING goes right then the outcome will be better than she and I expect. So it can’t possibly be as bad as we fear.

Worried in the City. The approach that I have taken is that if you have a complete understanding of your enemy and its behaviors, then I get myself in a postion to respect but not fear it.

When you respect H5N1, it means by definition, that there are steps that can be taken to minimize the chance that you will be seriously affected…and I strongly believe that is entirely possible.

And if you take 1918 for example, even in that scenario, your odds of recovering from an H5N1 infection and living a completely normal life afterwords, albeit a life changing event, are excellent (approxa 96%).

So the thing is to not get depressed or at some point out of the depression will come anger that becomes stubborness and determination…that is where you want to be!!

Wow TomDMV - you took the words right out of my mouth. You really do need to take the position of respecting it. It is a deadly enemy - and I am determined to try to keep one step ahead!!!

Tom DVM at 12:44: That was a great post! And that is what fluwikie is about. It is like the old saying “Know your enemy”. And even though it may seem esoteric and maybe, in the end, a moot endeavor, that is why we want the sequences released. Anything we can glean about the “enemy” could be of value. We just don’t know.

We at fluwikie are honing ourselves into the best trench fighters that panflu will encounter. We will be a worthy opponent even though it (panflu) won’t give a damn. But our families will “give a damn” as will all of our possible descendants on into the future.

Not to get the “proof” thing exasperated again, but I am trying to figure out how to take the current, known figures and extrapolate them into some kind of prediction.

And I know this has been covered befoer as well. I guess I’m waiting for the CFR to come down from 50+% to match everyone’s lower predictions. Is it some historical perspective that I’m missing? Hopeful thinking? Wild hare prediction? <grin>

Seriously, I don’t mean to be inflammatory … just trying to figure it out.

Kathy in Fl. You do identify a problem. We don’t have a lot of history with analyzing outbreaks with influenza, in fact I don’t think we knew what influenza (the virus) was until the 1930′s.

There is one thing we know for sure. The virus we see today will be different than a pandemic strain of the future. The theory, which I believe, is that there is a trade-off between virulence and transmissibility…to become more transmissible virus strain virulence must fall…hopefully preciptiously.

I have done quite a bit of thinking about it and I believe it will come in around ten percent, which if you take revised figures into account may be where the 1918 outbreak ended up as well.

In total, I think the relative mortality will be approx. one million in Canada and ten million in the United States (population ten times that of Canada)…

…and of course I hope that I am ‘out to lunch’.

However, if you compare numbers, ten million out of a population of more than 200 million would mean less than a five percent chance of dying…not saying that is a good risk but probably is a managable risk.

Kathy in FL – at 13:23

The only reason that my estimates of the CFR of an H5N1 pandemic are lower than the current 50+% is that I am unable to comprehend the aftermath if it doesn’t decrease. No proof at all, just wishful thinking.

Medical Maven, Commonground Thanks!!

Thanks Tom. Another thing that may happen I suppose if is that everyone is totally freaked out and moving around so much that they can’t be tracked effectively. Add to that a possible communications problem.

What we might wind up with an initially out of proportion CFR that comes down after time. Similar to 911 and NOLA. Initially the death toll was in the tens of thousands … but the final death toll was no where near the initial estimation. I know that isn’t the greatest comparison but it would fit with our current shock media tendencies.

Hi Kathy I wouldn’t necessarily disagree with you. As you probably know, the second wave in 1918 was the worst. For those that said the end of World War one was critical and essential, they should keep this in mind.

Just because it was the second wave that was the most virulent in 1918, I agree with you. I have had a bit of a hunch for some time that the first wave this time, might be the most virulent…I’m not sure why except although history repeats itself, Nature always switches things up a bit to ‘keep you on your toes’.

Tom:

What do you think is the infectious state timeframe from known data. I’ve read 3–14 days and I was wondering what you think?

Tom DVM -

Can you help me understand these terms being used related to infection rates and mortality rates, especially as they relate to prior pandemics?

For example, I have seen the term “clinical infection rate” used, and then you apply the CFR to that to understand or estimate mortality. But do we really know what the infection rates have been in prior pandemics, or for that matter the current outbreak of H5N1?

Or, to bring the question closer to home, we know by experience that the US suffers some 35K to 40K deaths per year due to seasonal influenza. But what is the infection rate? And how do we know? We can sometimes get a figure from clinicians reporting their cases, but what about all those others out there that come down with the flu, but never even call a doctor, much less go in for a visit.

The reason I find this important from the corporate viewpoint is that we are a critical infrastructure entity and are attempting to estimate absenteeism due to the illness itself. We have run numerous scenarios, but I am not yet completely comfortable with the assumptions due to the lack of clarity about infection rates, “clinical” or otherwise.

Any guidance out there?

Funny how things change over time. I once posted 12.5% CFR for the United States and went on a tropical vaction from all the hot air being blown in my direction from all the dissenters who thought I was much too high. Now, I feel that my figure is hopelessly optimistic. I am sticking with it only because I share some thoughts with others that lethality over time will decrease.

Confused - we are all a bit confused on this one. Problem is there just aren’t enough instances of pandemic anything with accurate data collection to give us a more defintive picture. Some of the problems in accuracy include: 1) innacurate/incomplete data collection in 1918 (too busy to collect numbers) 2) many got sick but never sought medical treatment, so no accurate # for survived 3) many died from 2ndary infections, primarily pneumonia and weren’t recorded as “flu” 4) no testing to see how many in the total popluation were exposed but never became ill.

The 1958 and 1967 outbreaks were quite mild (we can only wish this is what happens if H5N1 goes H2H). H5N1 in its current form is much more virulent. But that isn’t to say it wont decrease for all the reasons stated above by others. Even if it dropped to 30% CFR we are still in a heap of trouble. I think the US gov’t rates of 2million dead are optimisitc and based on 1918 estimates. I am hopeful that is all the worst it will be. But we won’t know until are deep into it.

Likely our best bet is to simply run best/middle/worst case scenarios. Simple enough to set up on an excel spreadshhet. Sorry I wish had a crystal ball….

Leo7. Excellent question.

I’d rather know what you think…but we have a lot of data on seasonal flu’s for the last fifty years. If we check the variability in incubation period for seasonal flu then we would know how variable it actually is…My bet is that it does not vary from 1–5 days and therefore, H5N1 should have the same incubation rate.

I think their use of longer incubation periods was a way to get around having to admit that many cases did not come directly from live poultry…in other words from a scientific perspective, it was bull-****…and they followed that time tested solution when you are in a scientific corner…bull-**** baffles brains!!

Confused Exec. I competely agree with you…I have also been confused by all of this in attempting to come down to a firm estimate of the damage.

For instance, Case Fatality Rate…it’s a great term but of course that depends on what percentage of the population becomes ill with influenza in the first place.

If every human on earth has an immune system that is virgin as to H5N1 then does that not mean that eventually, every human on earth will contact H5N1 and get sick. If this is the case then how do they explain their estimate that only thirty percent of the population will get sick…it doesn’t make sense.

I think this is where your frustration is and I don’t have a solution for it. I spent nine years in university and I find the terms just as confusing as you and everyone else does.

If you break my figures down, I am saying that half of the population will get sick and ten percent will die as a result of the infection…that an equivalent number will die from infrastructure problems (unable to retain essential services and an equal number will have chronic sequelae.

I often find a common pattern of equal deaths to chronic sequelae in animals other than humans…and I don’t think it would be out of the way for equivalent numbers due to infrastruture when you think of its many effects including no surgeries and drug shortages (ie insulin).

Would the bird flu kill the Internet, too? Computerworld http://www.newsnow.co.uk/cgi/NGoto/148991147?-13907

<snip>

Actually, if any of the other predictions that arose from the Davos simulation bear out, the fate of the Internet may be the least of anyone’s worries. The war game indicated that by the 28th day of a pandemic, the social infrastructure would have disappeared and governments would have to declare martial law to maintain basic services. To that end, they would probably end up conscripting those who had caught the flu and survived, since those people would continue to be around.

<end snip>

(coughs) it looks to me like, if you are part of a company that wishes to survive a pandemic you stock what you can for your employees… tell them that if they survive to come together in a “tribe” format around whichever authority figure in the company survives and hope said survivors are not conscripted into service to a higher authority

So when you see data and concepts that do not make sense to you…it is not that you don’t understand or are missing something…it’s just that the data and concepts make no sense to anyone.!!

This is a common state of affairs in science and medicine.

And, of course, you always have to factor in that critical tippiing point in which the CFR gets high enough to partially crash “the system”, and then you have an avalanche of collateral deaths. Let us hope we stay just under that (or well under!).

Wonder what that “tipping point” CFR is? It would probably differ from country to country, locality to locality. And then how many “tipped” localitys would it take to crash the country? And what would those critical localities be for each country that would have the most effect in crashing any given country? The variables are mind-boggling, and it all might come down to the season and the particular weather in which the first wave lets loose.

If what small pox did to Americas native population is any measure of this viruses potential or what the Bubonic plague did to Europe in the 16th century we have a real problem on our doorstep. On the ohter hand in 1918 the last really BIG Flu pandemic medicine was still primitive and no anti-V’s or VAX possibility even existed. Society just kept on going. Got up dusted itself off and 88 yrs. later 6.6 billion people are on earth. So, the Virus has already lost in it’s battle to kill us all off. That aside it’s still going to be really ugly even if only 2% CFR happens. I’m not as concerned about massive death due to infrastructure collapse however. It’s a possibility but I think the probability is lo for that happening. People are resilent and they will make do. My biggest worry in that area is power. If the lights go off and stay off in large areas of the planet then the stage will be set for real trouble.

lauraB - at 14:25

Thanks a bunch for that insight. And your note about the mildness of the 1957–8 pandemic, really hits to the issue with which I’m grappling. The Asian Flu has been called mild, presumably because the US deaths were around the 70K mark, or about twice the current seasonal flu deaths. However in our scenarios, we are using 25% infection rates from that pandemic, very close to the advertised rates of 1918.

Now, I wish I could recall precisely from where we drew that statistic for the Asian Flu, because I would like anyone out there to challenge that with better sources if they are handy. I have visited with retired corporate executives to see if they recall the 1957 outbreak, and all have said they do not remember it having any unusual affects on absenteeism. Now, I don’t know if that is because the infection rates were much closer to seasonal flu (say 5% to 10%), or perhaps because the infection rate was close to 25% but it actually hit school age kids more than the working age population.

In any event, being able to get a quick read on H5N1 if it becomes effecient H2H is an absolute must if our industry has any hope of implementing the appropriate response activities to keep America’s infrastructure intact and operating close to normal. Goes back to another thread - who can we count on to get us detailed information about this bug when it hits and begins to reveal its pathogenicity? WHO? CDC? The new ECDC?

Again, thanks for sharing your thoughts. Every new piece of information helps in our corporate preps.

briefly touching on Tom’s idea of a 10% CFR, I understand the thought process behind that, but find the argument similar to the one that says Bird Flu won’t go pandemic because it’s had ten years to do so and hasn’t. I see very little scientific data that says it will lower from it’s current 55%+ CFR. After all it kills 99.999% of chickens it infects. It didn’t need to mutate down to a lesser CFR in order to survive and thrive.

So currently I still believe “Surfers” numbers are more accurate. ack ack! NEWBIES.. this means 50,000,000 dead Americans.

On that note… many won’t say it, many won’t acknowledge it but that’s what the current data really says. No sane person wants it… only a fool would revel in the sensationalism of it. It’s scary… it may be hell pending. but it will pass, humanity will definitely keep on ticking

Moeb. You’ve got more guts then me!!

I can’t go there…my mind won’t register on those figures…because that means it is a civilzation buster and there will be nothing we can do other than be overwhelmed with a tsunami.

Mother Nature can seem like your worst enemy at times but I promise, she will never be that bad…a wake-up call will be the worse we will get.

moeb- I think we all know that possiblity is out there. But the implications are so frightening that I think many (okay, I know I do) push those aside because it is too overwhelming to think about. Yes, it could be that bad. It could be much “better” (better than 55% CFR that is). At least many of us prepping at lease acknowldege the possiblity. Too many will be side-swiped by reality if it goes H2H with high CFR. I think a big reason people aren’t prepping is when they hear 2m dead, they run the numbers and odds through their heads and say, “that isn’t so bad. I’ll take those odds.” Of course, there are other reason people don’t prep, but the US gov’t in its desire to not freak people out did a great dis-service by not freaking people out.

crap Tom, I was hoping you’d throw some scientific data in my face…. (smiles, it’ll be okay. brave new world and all that)

Confused Exec: If the corporation you work for is waiting to see “the whites of Panflu’s eyes” before it takes meaningful material action, then the game is up already, and you might as well fold your tent.

Also, throw away the mild scenarios akin to 1957 and 1968.

For Two Reasons:

There was no worldwide phenomenon like “H5N1” prior to either of those milder pandemics. And the recent scientific literature has pointed towards similarities between H5N1 and H1N1 (1918).

Being part of the critical infrastructure you can not err and underprepare. You have to prepare now for at least a “1918″ event. For your company to do otherwise would be foolish and irresponsible.

laura… you, I and all of the rest of the fluwikians will help build the new world as we’ll be amongst the survivors. 10%, 55% or even 78% CFR (Indonesia), there is probably less of a difference to the outcome between these numbers than we suspect. I am more comfortable with an infection rate of 30% (although this is also questionable).

that means a WHOLE LOTTA people surviving. so we have a 70% chance of not getting it under normal circumstances and if we do perhaps a 50/50 chance of surviving.

we also know the answer is to be activist now and prepare to hibernate for 18 months. we will be amongst the survivors

MM - at 15:02

I understand your point. Well taken.

I can assure you that our company is not prepared for a pandemic, and we have been working on detailed response activities for a very long time. Our departments have detailed plans assuming 50% absenteeism, but that doesn’t mean that there aren’t nuances within those plans that should not be considered given the potential nature of the virus. So, we are working the system from every angle to make this preparation as robust as possible across a number of reasonable scenarios. But even after that excercise, it still doesn’t mean that we are prepared for a pandemic.

But for me to carry out my responsibilities to the corporation, the communities we serve and all the many stakeholders that look to us for leadership, I need to fully understand the possibilities, judge the various options that may be available to deal with this mess, and therfore have some comfort that we have all done our homework. I hope moeb is completely wrong with respect to his/her assumptions, because I have no plan for that scenario, even though our policy is to “hope for the best, but prepare for the worst”. Those are now sounding words, but in reality, we plan around many likely possibilities and attempt to taylor our responses to fit the situation that develops.

Also MM, I note you are worried about H5N1. Do you have any opinions that you are willing to share about the potential for H5N2? It’s already here in the US, Mexico and Canada.

actually if I ponder the worst case scenario, it’d be…. we become the chickens and it really does take ten years to come up with an effective vaccine http://tinyurl.com/zf77q

moeb -

I don’t know about other companies, but our planning for absenteeism assumes NO availability to our personnel of either vaccines or antiviral medications. Even though we are critical infrastructure, and likely to be high on the priority list after health care workers, police, and other important governmental workers, we just don’t believe that these medications will be available in sufficient quantities, or that they will be all that helpful in arresting the spread of the virus.

The information out of Paris would also suggest that not much would be there to help with the second and third waves of the pandemic either.

Thanks anyway, moeb, for the news lead. Interesting information.

Just recieved an email, and at the conference in Paris on the Avian Flu, information has come out that NO VACCINE will be avaiable for about 10 years for the Avain Flu….Now that is not good news, also recieved an email that WHO is stating an uptick in the virus spread this fall and spring of 2007. Again being forewarned is being forearmed and time is precious to get prepared as best as possible.

Confused Exec – at 15:27

H5N2

Most trends are pointing toward H5N1 being the next pandemic strain, but its not definite by any means, just most likely right now by a wide margin.

A set of reassortment changes could drive us toward another subtype. My personal belief is that H5N1 is the most likely PanFlu variant to come next, thus the nomenklatura of PF51.

Gary Near Death Valley @ 16:39 -

Uptick in the virus spread?

I can’t dispute that. But I also wonder how they can state that? Given it’s history, it would seem quite plausible, yes. But there is no guarantee of anything. Is there?

No vaccine for 10 years?

I was under the impression there is little question, SOME (LIMITED) vaccine can be manufactured in about 6 months. You said NO VACCINE for 10 years. Who was that email from??

Your post is quite blunt, with undertones of inevitability. Not sure that is the case.

Who was that email from? Someone “in the know”?

Dont know how to shorten the address so here it is: http://news.bbc.co.uk/2/hi/science/nature/5132910.stm

And here is the address for the “uptick” in the spread: link

Gary,

The directions for making a link are at the bottom of each page.

Oh thank you Melanie,,,,will do that next time. ON a learning curve here and sometimes I go in the ditch.

Roche has been urging individual companies to order tamiflu even though there is supposedly a backorder problem due to government orders. I gather either Roche feels they may have time to deliver, they wish to make good PR and/or it makes good business sense to keep on pushing the product. I would think it’s a safe recommendation for you to make (order it) who knows maybe you can trade an order in the pipeline for product on hand (as an infrastructure company)

Gary,

We’ve all been newbies! The mark-up is pretty easy and I say that as someone who is utterly code-phobic.

Confused Exec: My take on the possibility of any other panflu candidates out there is that if you prepare for a “1918″ event then you are prepared for them all (short of the viral asteroid). And that you prepare for the panflu that seems to be nearest and most threatening (H5N1).

I also assume that since you are task-oriented that your question on H5N2 was to further build a brief for your corporate heads of a need for action regardless of whether H5N1 further evolves into panflu. That is a question that somebodyelse can handle better.

But another thing to consider that is a bit more nebulous is the upcoming Solar Maximum in 2012. The “experts” expect it to be 40 to 50 per cent stronger than the last one that we had,, and it will be the strongest since 1957 (pandemic year). Some researchers in Canada found a very high correlation between Solar Maximums and pandemic onsets. Temperature increases worldwide correlate with Solar Maximums. Also, solar magnetic storms are thought by some researchers to affect bodily processes causing worldwide spikes in the incidence of strokes. I am giving this information to you just as background. Even with the studies I would not bring this into the boardroom. But the point here is that the upcoming few years are fraught with danger. The length of time since our last pandemic and all of the environmental factors coming togther---global warming, pollution, environmental stresses, higher numbers of hosts/incubators (both human and animal),etc.

So if H5N1 fizzles, I fully expect another virus to make the grade. This is just too potent a situation to ignore. I know I am preaching to the choir here, but sometimes it is good to just lay it out one more time.

blinks…. damn those Mayans

meanwhile…. possession of tamiflu by a company could instill confidence, loyalty and be extremely persuasive when judging “live at work” options or similar

Confused - the fact that your company is taking action and developing strategies and tactics to deal with different scenarios puts you way ahead of the curve vs many other companies. So many are ignoring it, as is the general population.

Don’t forget to take what you are learning for work home with you - this is the one time that’s okay! Prepping your family is just as, if not more so, important than work.

Medical Maven. I agree completely with what you said. I have seen studies going back twenty-years that correlated specific viral mutation patterns and rates with solar flares.

I know you and I have discussed this before in other threads but I didn’t see it specifically mentioned above.Unfortunately, at the time, I did not expect to be here, so I did not save the resources; just read them with interest.

I have following an odd pattern of increased rates of viral mutation for quite a few years now (at least five). The funny thing is that it is not only viruses but bacteria and parasites as well.

Like you just said, we must observe H5N1 with the underlying comprehension that it is being pushed by factors that we do not fully understand…increasing the likelyhood even further that a pandemic is imminent.

I also see a pattern of increasing hype from agencies…I think that is a pretty good indication that they have come to the same conclusions.

OK -

If I read correctly, the article says up to 100 million doses could be made in 6 months. That is LIMITED…but that’s what I said. The article (and you) steer towards NO VACCINE. I’ll agree, with 6 Billion people…that is essentially no vaccine. But that means 200 million doses a year X 10 years…that’s 2 billion doses in 10 years…right?

This thing will primarily be over with in 2, by all accounts. In 10, vaccine production or even the need will likely be vastly different.

If using a little reasoning…this article appears to have some “hype” and worries me, as it turns people off to good information.

“But that means 200 million doses a year X 10 years…that’s 2 billion doses in 10 years…right?”

Anonymous Theoretically correct…but keep in mind a relatively short shelf-life…months.

it does raise the interesting question… will there really ever be a vaccine for you and I, in time?

(assuming we’d fall within the 30% of the population likely to become infected)

True Tom….and the strains are usually as short lived.

I just don’t like the 10 year thing…it’s got too many caveats.

if 30% of the population is infected and 30% is out taking care of the infected, can 40% of the population of earth keep things ticking? This is with use of curfews, national guard, militias and conscription of flu survivors

anonymous. We all know that if we don’t have a pandmeic within three years, everyone will go back to sleep; which means there will be no vaccine in ten years, one way or another.

moeb: It could be the biggest drama ever. The “battle” for world civilization (as it now exists) could be so close it could come down to one commander saying “my kingdom for a horse”.

It’s even worse. Remember this hits the young 15–40 and healthy. That’s the people who keep it all running. Those of us over 50 are already half dead and won’t be of much help in picking up the pieces. Those under 15 aren’t worth much either. Society will have the stuffing knocked out of it for many years. If you want to see what this kind of effect can do to a country forget the world look at France after WW1. It lost almost an entire generation of young men and some say it hasn’t recovered yet. The US suffered a similar calamity after the Civil War. This time it will be even worse because the women die off as well so you can’t breed your way back as easily. I hate even thinking about it. It reminds me of what Nikita K. the dead ex. leader of the dead nation The Soviet Union once said. When asked about what life would be like after a nuclear war he said, “The living will envy the dead.” Get the picture? I think his quote may apply equally as well to this calamity if it ever happens.

glennk Well Said!!

smiles.. and a horse for a nail, seems I heard the opening act to this story. local carnage, problems everywhere, but civilization will not get hurled back to….? what the seventeenth century? will we loose infrastructure? knowledge? will libraries, both real and digital… burn? I don’t think so.. (shakes head chuckling)

it’s far far more likely the event will last 18 months it will shake the foundations of the financial world hard, but commerce will survive. democracy will survive. there will be no new order as the old order will survive. 70% of you will not get it. I think you’ll work and carryon, not stay hidden at home. (probably because yer not prepared for that)

(my opinion anyway)

glennk you slipped your post in there… it certainly took my smile away. “the living will envy the dead” hmmmmm

glennk: There are some thoughts that maybe the CFR spread might change once it goes panflu, but, regardless, The First World industrialized societies are already topheavy with seniors. Look at the just released statistics on Japan and Italy. We can’t afford to lose proportionally more of that 15–40 age bracket no mattter how small. Demographically, we are in a downward spiral as it is.

glennk,

Hey, those of us over 50 are just coming into our “wisdom years.” I think that’s worth a lot.

Wisdom is fine if there is someone left to impart it to. My guess is if thing kills the young many of the older generation will die from grief or worse. The thought of a grandma grandpa society trying to raise an generation that loses it’s parents is sobering to say the least.

“70% of you will not get it. I think you’ll work and carryon, not stay hidden at home. (probably because yer not prepared for that)”

Moeb. You have raised an essential point.

I need someone to give me an understandable scientific explanation of why 70% of the world’s population is going to escape being infected by H5N1, a virus for which human’s have no inherent immunity.

To me the bottom line of the article, states to me,,,,at the new age of 60 years of age,,that I most likely would not get a vaccine anyway,,,,and the best thing for me and mine is to prepare in place and continue to spread the word to friends and relatives about the importantance of taking care of ourselves first,,,,,again not relying on magic wands or help from places that most likely won’t be able to help much. To speculate on the total percentage to me is not the point,,,the point is to get as prepared as BEST as possible, and to maintain a clear head what is going on in the world.

best as I understand it Tom is H5N1 is a flu virus, the vast majority of flu viruses of all types have historically only infected approx 30%.

I did read a news article about six to eight weeks ago whereas a high muckity muck think tank group with some well known names… suggested the infection rate could go as high as 78%

Hi Moeb. Here’s the thing.

Two years ago the highest mortality I saw for 1918 was 20 million people. Since it has been raised to between 50–100 million and I have seen more experts say 100 million.

Two years ago re-assortment with coinfections in Pigs was essential to a pandemic…an event probability that was thought to be remote. Last fall, we find out that avian influenza’s can mutate and jump causing a pandemic without intervening steps.

Fact is…they don’ know ‘squat’.

I think the 30% infection rate is an urban legend and like all urban legends, if it sticks around long enough, even the authorities are saying it.

You state that other experts are saying 78% infections. Okay, but what is the reason that the other 22% are not infected…it’s not due to immunity…they don’t live on the moon…influenza viruses are best known to spread everywhere so they will contact it at some point.

The point is the days when authorities can make blanket statements that are not scientifically sound, without questioning and further explanation are over.

However, I am sure they are very uncomfortable and concerned at the moment in fear of how they will be percieved by the general public if and when the pandemic starts.

moeb – at 14:36

Funny that. My husband was just thinking the other day that we can’t run our property management business without a certain amount of “farming out” the work orders. There are some things he is simply unable to do, or that might require a license and permit.

He was saying that after we have our family as set as can be reasonably arranged for “x” amount of time that he is going to invest in some items to give his workers that continue to work with him. A couple of these guys we’ve known for going on 10 years now. They only do day labor … aren’t able to or interested in regular employment … and therefore have few to nothing for reserves. I’m not sure how much good it might do, but it might be a way for us to maintain some help if things get bad. This would work with them even if things don’t get even half as bad as I’ve seen predicted on this thread.

Tom, whatever the percentage cited for ‘clinical attack rate’ that is the rate of people who will get SYMPTOMATIC. It is generally thought that there would be an equal number of people who are asymptomatic, or have such mild symptoms that they never suspected they had caught the virus. So a clinical attack rate of 30%, you might expect something in the range of 60% being infected, half of them with symptoms.

On top of that, even though we talk about immunological naievete, ie nobody has immunity, I believe that there is no definitive data that tells us that 100% of the people would have no resistance to a new strain. I suspect there is a certain percentage of people who are immune either from cross immunity from prior infection with other flu strains (this question of cross immunity being one of those non-Holy Grails of influenza, wherein everyone says something which no one actually ever proved, I think) or from some genetic host response that produces immunity to a novel virus. We just don’t know. We also don’t know how many of those who might supposedly be immune end up in the group which gets seroconversion, ie infected, no symptoms, gets antibodies.

Then you have those who truely did not get exposed, either out of luck or whatever.

Medical Maven – at 14:38

Wow. That’s a round table discussion in and of itself. Probably wouldn’t take much to “tip” a large urban area that had pre-existing problems.

It probably wouldn’t take much even in areas where the mean age was quite a bit higher than the current at risk population … because it would still be that population that supplies the labor in said area.

So, even in areas where you wouldn’t normally consider there to be a problem, even a small fraction of movement in the CFR could have disastrously cascading effects.

Tom DVM – at 19:18

What is your view as to why the 1918 Spanish Flu held to under 30% infection rates on average in the US? There was no known immunity to H1N1 was there?

Also, does the genetic disposition of the host have a role to play, despite immunity? In other words H5N1 seems to be fairly efficient within bloodlines, but not as much outside, with the caveat that we really have a very small sample to study at the moment.

Birdman,

I think my post above might have answered your question

Funny how I got it in one minute before yours. :-)

Kathy,

“So, even in areas where you wouldn’t normally consider there to be a problem, even a small fraction of movement in the CFR could have disastrously cascading effects.”

Yes, that’s true. On the other hand, the upside is that whatever we can do to improve the CFR even by a small fraction will translate to many many lives saved.

The use of statins comes to mind as one of the most promising possibilities that the world has not factored in yet.

Yes, anon_22, it is a mystery how Mother Nature fools us all from time to time. I agree, we just don’t know.

Tom, do you have some info that makes a good case for really high infection rates? It would be nice if we had more seroprevalance data from Thailand, Indonesia, China and Viet Nam.

anon_22 - at 19:38

I see where statins might help to mitigate cytokine and chemokine storms, but do you know if it has any affect on infection rates? As someone who has to plan around work place absenteeism, I am also interested in CIR, as well as CFR.

Birdman. I am no expert…but then again the experts didn’t turn out to know much either…so I guess you and I and everyone else on flu wiki are as much experts as the experts…confusing I know but true.

I guess the explanation could be that the virus is working under a quota system. All over the world, when it infects the case representing 70 % of the population it can’t infect any more.

It just doesn’t make any scientific sense. If it is in fact true, someone has to come up with a reasonable, understandable explanation.

The point is I think they were so overwhelmed that no one went around after the fact to determine how many people were infected. They were probably following the same urban myth that came before 1918 that said in the 1888 pandemic that thirty percent of the population was affected.

Does the genetic disposition of the host have a role to play? I don’t think so but what do you think? It seems to me that if your breath enough of an absolutely novel influenza virus into your respiratory tract, you are ‘virus toast’….no if’s and’s or but’s.

I suppose if someones family have smaller noses or very cold internal body temperatures, then there might be a degree of resistance but it would be a pretty inconsequential number in any population.

One thing to consider though. Even with epidemics of smallpox, a population is never wiped out by infection. Extinctions do not occur by infection. Nature always seems to leave a small percentage of any animal population to survive and rebuild…for some unknown reason.

Jeepers. I write one and you guys post ten. GREAT!! The wheels are spinning tonight.

moeb – at 17:45

Could 40% of the population kept things ticking along? Sure. Given the current rate of mechanization and the fact that for most (not all) 2 income homes … if folks would give up the luxuries and stop trying to live like the Joneses … they could survive on 1 income with the other partner either taking care of the kids or ill relatives, neighbors, etc.

That would mean a pretty good restructuring of how households are currently run with an interesting and partial return to “old fashioned” structures.

I’m not being sexist … just thinking out loud. Reverting to “old fashioned” or modified versions of the “old-fashioned” way of doing things would certainly be one way to address the issue.

In the just released WHO analysis of confirmed human cases, they state the following:

“Asymptomatic cases, confirmed retrospectively by testing serum samples during contact-tracing studies, were excluded.”

Does anyone have a clue how many of these studies may have been done, or how many people were tested? And what did they find? If they tested a large number of neighbors in the villages where these deaths occured, and found very few with antibodies, WOW! In other words, the data might or might not speak volumes about CIR and CFR.

Birdman. I only spent nine years in university. I would probably need another nine to understand the WHO statement you just quoted.

Do you know what this gloop means?

We can know one thing for sure. If they had in their little hands, something they thought was good news…heaven or hell or confidentiality agreements would’nt stop it from being released at this point.

Tom DVM – at 19:44

Good point Tom. In the middle of a major crisis, who keeps tract of much of anything? Could have been a lot of infections never recorded, just as I suspect there is today with seasonal flu. Who really knows what the CIR of seasonal flu is?

And your raise an interesting point about body tempretures. I recently read that perhaps one of the reasons that the H5N1 CFR is so shockingly high in school age kids is that their body tempretures are different from adults, and this virus thrives on that.

But, you know, I agree 100% as to the idea that if a chicken or a human is really, really sick, anyone with much contact stands a fairly good opportunity of getting sick as well.

Concerned Exec-

These questions are being discussed by TPTB. The Red Cross is also discussing and debating these questions at very high levels. We really have no hard data I am aware of on the relative infection rates for either seasonal or the H1N1 1918 pandemic, although there are lots of educated guesses. I have heard Red Cross senior officials state that they do not expect to have either vaccine or anti-viral drugs available to support any Red Cross operations

However, I do have some advice for you-

There are really two questions to answer-

One is how bad could it get and what do you as an individual need to prepare for. My personal worst case scenario is 50% infection rate and 50% CFR for a net of 25% fatalities in the USA from the flu. I suspect third world countries may see higher death rates overall, but that is my “worst case”.

Since I expect that this kind of overall death rate will trigger a collapse of civilization, regardless of how vital the infrastructure is that you support, it will become irrelevant after such a pandemic. There is a point beyond which vertical integration is not economically feasible without the technological base to support it.

Which brings me to the second question:

How bad a pandemic does it make sense for a corporation to prepare for? 75% infection rate over 3 waves in 12 months (30%, 25%, 20%) and 4% CFR are probably as bad as it could get with the social structure still remaining intact. Even that may be more than this civilization can take.

Tom DVM – at 19:56

Regarding the WHO seroprevalance studies: my sense of the results is as you state: if they had promising news, they would have likely put it on the air. Maybe they are having some real difficulties doing these studies, and just don’t have a lot of data to share. Some of these villagers hide from strangers and think that it is black magic at work. Many don’t desire anyone taking a blood sample from them.

But, again, my sense from the available data is that if you get this particular bug, you have a fair chance of not coming out alive. These poor folks die of massive organ failure and pulminary edema, all signs of pervasive chemokine storm reactions. Wouldn’t it be great if we could treat them will both Tamiflu and the statins to see how many could be saved?

Birdman,

“Wouldn’t it be great if we could treat them will both Tamiflu and the statins to see how many could be saved?”

I would vote YAY to that!

You know…I haven’t been around that long on this earth but I have read a lot of science and have had a lot of scientific discussion of one sort or another.

…and I am absolutely dumb-struck…amazed by the quality and tone of debate on flu wiki…

…I honestly don’t think if you went around the world and hand-picked a team of researchers in desperate times, you could come up with an any better group of minds.

I also honestly believe if this team was given the authority and a little money, some remarkable things could be done in advance of the coming pandemic.

I would take my hat off to all of you if I had one to take off.

All I can say is you continue to astound me and Thanks!!

Tom DVM

We don’t call it “the hive mind” for nuthin’

Birdman, I haven’t come across anything that might suggest a reduction in infection rates with the use of statins.

Thanks anon, and “bon chance” in the city of lights.

Somewhere — this thread or a similar one — someone asked what might have happened in the late ‘50′s or ‘60′s that could be related to the fact older people are not getting the flu. Now, bear in mind that my background is law not science, however I remember getting the flu during the big epidemic in the late ‘50′s when I was at a boarding school in Iowa. I was raising young children in the late ‘60s and frankly don’t remember the flu epidemic/pandemic at that time. And yet this thought crossed my mind — If those prior epidemics were world-wide, could those who did get the flu in either or both of the periods have retained some sort of immunity that is protecting them from getting H5N1-? Even if that “immunity” was limited so that those who did get sick in either the 50′s or 60′s become less seriously ill or asymptomatic this time around? Of course that sets up tons of questions, such as did the countries where we are now seeing human cases indeed experience the prior epidemics? If so, and if they were exposed at a young age, and are now in their 50′s and beyond, is this a possibile answer? Very young children that are nursed by their mothers, as is most often the case in many of the countries where there has been outbreaks of H5N1, may have gotten immunity through the milk that is serving them today.

Again, perhaps there are a thousand scientific reasons why this explanation is not viable. I’m just brainstorming.

MA (Hi, neighbor),

All epidemics are local. The effects vary widely from one local to another. The 1957–8 pandemic was really severe in the city of Liverpool, for example, but not so much here in the states (though I got sick.)

Tom,

“I also honestly believe if this team was given the authority and a little money, some remarkable things could be done in advance of the coming pandemic.”

I have very recently as you know been ‘outing’ myself :-) and telling people about fluwiki. And I can tell you that those who work with panflu and know about us already think we are pretty remarkable.

We just need to keep getting better, IMHO. :-)

Tom,

We can’t do much about the authority, but I’m working on the money.

You know folks, if we have a problem wrapping a big CFR around around our brains, imagine the people who don’t think H5N1 is an issue trying to deal with it…..

I love the sound of the hive at work….

Grace,

Bzzzzzzzzz

I think we may be making a wrong assumption comparing the Spanish Flu with H5N1 as they relate to younger people getting sick or dying, at least in one respect.

We know that a large percentage that died from the Spanish Flu were young adults, but wasn’t the infection/age ratio across the board for all ages?

We know for H5N1 the numbers overwhelmingly point to younger people getting sick and dying (as with the Spanish Flu), but the infection per older adults seems to be very different from what we saw with Spanish Flu. If I remember correctly, most of the older adults in the family clusters did not even show symptoms at all.

I think that in both cases (1918 and today) older people likely had some type of prior exposure to low pathoginic avian flu viruses and a multitude of human flu viruses. For the Spanish Flu it wasn’t enough to keep them from getting it (the virus had changed to a human flu) but it was enough to keep them from dying from it. In todays world, in countries where H5N1 is circulating, the older folks who have been around poultry all their lives, are getting sick much less or not at all.

The point I am making is that if/when H5N1 turns pandemic in nature will it necessarily effect young people the worst in developed countries, or will it effect old and young alike, because they have not had a lifetime of exposure to poultry (and their viruses) as people did back in 1918 or in Indonisia today.

Since, I think a CFR of 50% or higher is a distinct possibility, I should point out that I do not think this would necessarily result in the collapse of civilisation. There are two variables that are relevant, the attack rate (how many people get infected) and the fatality rate (how many of the people who are infected die). There will be little we can do about the latter. But there is a lot we can do about the former. As I have said many times, if you don’t get infected you, you won’t die. This is obvious, of course, but these discussions seem to assume that there is nothing we can do about the attack rate, which I don’t think is true.

In addition, civilisation is dependent only on certain individuals, not everyone. If Britney Spears goes to a party during a pandemic and get’s panflu, well, I think civilisation will survive her loss. We can save the essential workers. And if we save them, civilisation will go on.

Another thread on this subject:

A Pandemic with a High Case Fatality Rate is Not the End of the World

My mom has told me this story several times over the years. She got a really bad flu I think in 67 and could barely move from her bed for days. I was the baby and everyone else was in school and dad was at work. She said I played quitely on the floor or crawled into bed with her. Everyone in the family ended up sick but me with it. Was there a bad flu going around at that time?

I think I’m glad I was on the sidelines the last couple of days. Being more concerned about loosing my job than the state of the world had me refocus a bit toward personal capacities before saving the world. Now, I’m free to go looking for a spot to use the varied experience, skills and eduction I’ve amassed in some way to help out on this upcoming pestilence.

In some ways, I was prepared to see the WHO information begin to “mutate” toward realistic acknowledgement of the CFR and the likelihood of H5N1 “breaking out” in under a year. I have personally felt that a 2.5% CFR was a fairy tale from the start. This bug is far too mean to be that gentle. Will it be a civilization buster? No, unless it reduces us to about 25% of the present population it cannot do that to us. It cannot destroy the infrastructure proper, only the operators and the consumers. Psychologically it can put us into a (human) racial state of depression and shock for some number of years, but we can recover with what will be left.

Economies will have to be reconfigured drastically with anything over 10% CFR. No company will come out anything like what it is presently (or even plans to be) with that large of a hit. A 10% CFR in the prime demographic is going to eat about a quarter of the workforce either by death, disability, psychological impairment, and family readjustments. Single parent families that were previously dual wage earners result in either less ability to work due to childcare problems or such lower incomes. The surviving markets will not support all the businesses based upon disposable income. Your company won’t survive if it’s customers can’t afford the products. Foreclosures and unpaid insurance benefits will rob huge numbers of people of the “cushions” that they think can hold them together and have paid into in unprecedented rates the last two decades.

This is the soft underbelly we are not considering in most projections I have seen. I keep seeing posters proclaim the inability of the elders to help restart things, but (like it or not) a lot of the elders - down-sized, outsourced, or “bought out” by employers to cut costs earlier - may be the only capacity to get things running again and re-train the surviving younger generation how to keep things going. In a way it does return us to a tribe structure like the stone age elders teaching children around the fire. With thousands dying and sick around them, employees aren’t going to being showing up when called out to work while a child or spouse is dying at home. I caution that expecting people to rally around their employers for anything other than a lynching in that environment is going to take huge PR campaigns starting yesterday and lots of cash or goods. That type of loyalty and credibility died a decade ago, and governmental trust after Katrina is imaginary to most middle-class and working-poor that do the work that our society relies upon.

I’m in the damnable position of being 50, having 2 children under 10, and being out of work - yet I see this as a reason to make a move to “put my money and my butt where my electronic mouth is”. Starting Monday morning my efforts will be focused upon finding a new spot somewhere to work preparing forward-thinking businesses or governmental bodies to find ways to survive and reshape themselves during and after this pandemic hits. It CAN be done, if we choose not to think ourselves and our society dead before this happens - and actually believe it can happen and do our best to prepare to save all we can.

Melanie, we need to chat off line. I think you could point me to places I can help, and I’m willing to make some hard choices now to be around when this is over.

The “hive mind” is well at work, and that slow period we bemoaned a couple of days ago seem to be at an end, even without new clusters. This just became very real. It is much like getting word that a newly discovered comet will impact Earth - it may seem unreal, but it can happen, it has happened before, and will happen again. Maybe by turning to some of the brainstorming already done on those scenarios we can find things to apply to this threat.

Like Tom DVM said, I’m not going to go down without a fight on this one. Not on my watch, not on my ship, not on my species! We (humans) survived ice ages, volcanic winters, even a few planetary impacts, and mankind keeps getting back up. I’m just of the opinion we can do better than ever before because we have the warning and the collective intelligence here to use what we have in ways we have not considered before - if we are willing and brave enough to try despite the lethargy of the status quo.

Kim T, 1968, Hong Kong Flu.

TRay75 -

I’m sorry to hear about your job troubles.

Perhaps it is a blessing in disguise? Meant to be? It’ll be people like you that makes a difference in this battle.

(Still doesn’t make it any easier to go through your uncertain employment times. I hope things work out for you.)

You know, after sitting here for a couple of hours thinking hard about what TomDVM said earlier I keep coming up with a question for myself.

Seeing how it isn’t really necessary to invision a low or high CFR in order to prep, and that constructively a low or high CFR prediction really doesn’t change the amount of personal prepping we do … at least it shouldn’t … why do we continue to hypothesize?

If we all intend to survive and thus are prepping to SIP … or whatever our choice is … does the CFR really matter to our immediate, personal prepping?

I can see it as a possible … not necessarily probable … tool in shock value to get others to prep. I can also see it as a hypothetical tool for TPTB for economic planning and such. But on a personal level, if we are planning on surviving does the CFR really matter?

Probably too late and I’ve been listening to a houseful of teenage girls partying their heads off so my brain may be on the numb side. In fact, I’m off to bed so that I can partially recover by tomorrow. <grin>

But really, beyond academic speculation, does hypothesizing on the CFR really gain us that much on a personal level … except as a vindication, rationalization, justification, etc. for our own prepping?

I mean, to my own thinking, even with a low CFR I’d prep the same amount because the number of people in my home isn’t going to change. Our physical needs aren’t going to change. So, low or high, I have to stock the same amount. I’m chosing to SIP to lower the exposure risk to my household. The exposure risk doesn’t change with the CFR does it? I mean, isn’t exposure different from fatality?

Wouldn’t the infection rate be more important to figure out than the CFR? Or is my terminology wrong?

Thanks Heather. I’m pretty burned out tonight, and a good night’s sleep is in order. We can’t slay dragons without our rest, or build Emerald Cities with sand unless we dare to dream. See y’all tomorrow.

Kathy in FL:

It’s at least as important, anyway. The number of cases in a demographic group is usually referred to as the “attack rate” (the total number of people infected is the “gross attack rate”). A lot of people confuse the case fatality rate with the mortality rate. To get that, you multiply the gross attack rate by the case fatality rate. So if thirty percent are infected and half of them die, that’s only fifteen percent of the population. A ghastly prospect, without a doubt — but then, a CFR of fifty percent is higher than anything ever seen before in an influenza pandemic by more than a factor of ten. Seasonal flu epidemics frequently feature attack rates over fifteen percent, and most pandemic models assume an attack rate of thirty or thirty-five percent, because that’s what it’s been in previous pandemics (which is based on estimates, yes, but it’s not like the numbers were just pulled out of thin air).

I think you make an excellent point regarding the implications of CFR as far as prepping goes. Seems like the potential for social disruption could be worse with a higher attack rate even if the CFR is a lot lower than it is now. The wheels will grind to a halt if enough people are calling in sick; they don’t have to call in dead.

Despite all the discussion about herbal remedies, antivirals, steroids, etc, I have serious doubts about whether there is realistically going to be much we can do to lower case fatality rates. Attack rates are another matter. I’m betting it all on my ability to lower that number, at least among members of the demographic group represented by my household, and if prepping were widespread policy, who knows? (Like that’s gonna happen.)

CFR 50%? - OK i buy that (79% indonesia - 100% cambodia/Iraq) as long as you have a hospital with ventilators and tamiflu and all that other modern medical life saving stuff. - Lets try close to 100% fatality rate - just like the chickens who dont go to hospitals and get tamiflu.

I see no reason for the fatality rate to go down. I see most people NOT going to the hospital.

I do not buy that for the virus to become more effiecient CFR has to go down.

If H5N1 goes pandemic - “we are screwed” Period.

CFR 50%? - OK i buy that (79% indonesia - 100% cambodia/Iraq) as long as you have a hospital with ventilators and tamiflu and all that other modern medical life saving stuff. - Lets try close to 100% fatality rate - just like the chickens who dont go to hospitals and get tamiflu.

I see no reason for the fatality rate to go down. I see most people NOT going to the hospital.

I do not buy that for the virus to become more effiecient CFR has to go down.

If H5N1 goes pandemic - “we are screwed” Period.

sorry for dbl post

Bottomline,

While I’m all in favor of preparing for the worst and hoping for the best, we just have no freakin’ idea of what the CFR for a bug like this can be. I have to put your post in the “speculation” file.

“COLLAPSE OF CILIZATION”… “CIVILIZATION BUSTER”

These terms are interesting, frightening but what do they mean? I would love to hear from people on what is their vision if this were to happen.

Are we talking total breakdown a la mad max? Might it be more like a loss of the economic infrastructure resulting in more localized economies? Does this become a country of “tribes” banded together for protection, survival, growing their own food? Are we talking about the world going through a period of time of massive starvation for a year or two until systems get going again for growing food and transporting it?

I would start a new thread to discuss this, but I don’t know how to do that, but I do think, if we are talking about this collapse as a possibility, let us try to mentally prepare for what that might be.

earlier Tom asked me some provoking thoughts on the infection rate of an H5N1 pandemic. 30% to 78% or what… the premise being that we have very little scientific fact to base a decision on. the most relevant being that historically (my perspective), flu viruses have only infected approx 30% of the population as they spread.

In declaring that the facts as they exist point to a CFR of at least 55% (with subsequent loss of life in the millions), I can’t say with any authority that the CIR will be any higher than 30% because we have no facts… no data upon which to base a higher CIR. It would be correct to speculate it could be higher but what little information we have doesn’t allow us much more than speculation.

We are told that H5N1 is endemic in migratory birds; they are its “main squeeze” and humans (well mammals really) are just extra, the sprinkles on top. It seems to me that the only relationship in which virulence would be of concern to the continued existence of the virus is virulence in the migratory birds. The birds are its home. Therefore I can’t see why its virulence in humans must necessarily decrease. Our survival is of no consequence to the virus, it can do quite well without us, thank you very much. Unless of course its mutations lead it down a path of specialization within mammals making it imppossible for the virus to return to birds, a “reverse” species barrier. I sure hope I’m wrong in this line of thought.

Moeb-

I agree with your assessment, as do many others in various other posts. We do not have solid data.

Given that to be the case, what reasonable maximum CIR can be assumed/expected? What maximum CFR can be expected?

CIR has been debated, will continue to be debated, and won’t be resolved until detailed statistically significant seroprevalence studies have been completed all over the world in infected areas. Given that, we make a SWAG. My SWAG is 50–75% CIR.

The “tipping point” for civilization is whether or not we can keep the power grid working. So many things depend upon electrical power that without it this civilization cannot function. Critical nexii, like hospitals and blood banks, have generators, but after a few days, the people that work in the hospital and run the blood bank cannot function without power as they do now; they will spend increasing amounts of time taking care of their families.

No power means no broadcast media, no internet, no cable, no transportation system (if you cannot pump fuel you aren’t going anywhere) and no way to keep the population distracted from sheer terror and panic. Most of the people in this country do not understand the basic science of epidemiology, and when those around them start dropping, they are going to be terrified.

If we lose power to the cities, they will have no food, no water, no communication, and the cities will come totally unwrapped. People will flee the cities. if the CIR is 75% then the sick and dying will be scattered in the areas around the cities. Starvation, other diseases, violence, and weather will kill most of those who used to live in the cities, and some of those who don’t. Most of those people are the ones that possess the specialized skills we need to operate this complex civilization we have now.

Since 90% of the US population lives in cities presently, my expectation that the overall death rate in the event of a civilization collapse will be about 90% (may range from ~60% to as high as 95%, depends on the severity of the epidemic and the time of year); many of those will die not from the flu but from the lack of civilization and the inability to function under those circumstances. Most of those presently dependent upon medical technology and government largesse will not survive.

The power grid is a large and complex entity; it is difficult to take the whole grid down with a point source attack; the only one I am aware of that could do the job is a continental EMP attack. However, if we lose 30% of the untility workers, pwoer plant workers, coal train operators, coal company excavators, nuclear plant workers, hydropower plant operators, etc, etc. it will be VERY difficult to keep the power on in the cities.

ColdClimatePrepper, Mad Max World exists right now, in Darfur and other regions. A severe pandemic will push additional regions into Mad Msx World. The shock will be when chaos breaks out in First World cities. I don’t think Civilsation as a whole will break-down. I do think that if you live in certain cities it will feel like civilisation has broken down. Think Sarajevo during the war.

My bottom-line is that results will vary. Areas that are close to food production will do better. Cities that have planned extensively will do better.

I have been reading the plans for all the US states and checking on local planning. There is tremendous variability in how much prepping is suggested and how much is being done. Texas and Florida are doing alot. New York is doing very little. We’ll see what the results are.

Knowledge is fragile; civilization is fragile. Our civilization has evolved several stages past the subsistance stage, and the technology for the intermediate stages is largely lost. How many piston steam engine manufacturers and mechanics are there, for example? How many small foundries are there within 50 miles of you are there? (0) How many vacuum tube manufacturers are there? how many machine shops are there in your neighborhood?

If we lose the knowledge in major cities, even if the economic system recovers, will we still have the knowledge needed to rebuild?

Looks like I went to bed too early last night.

So, let me get this straight … terminology, terminology. <grin>

The CFR and the Infection rate do not really have that much to do with one another. The CFR percentage is based on the percentage of infected, but could grossly make the number of deaths worldwide appear worse than it was. What I mean is that That even with a CFR of 50 - 100%, if only 3% of the overall world population gets infected … the virus will only be bad for those that catch it. Am I completely off base?

So, “the world as we know it and how it functions” may actually be based more on the infection rate because people don’t have to die to be absent from work and cause cascading shortages.

And I guess further we have to factor in that even with an infection rate of 30% or more, realistically speaking it is unlikely that all 30% of those infected will get sick at the same time.

So, would it be possible that the sick get to “rotate” in and out of their jobs and you wouldn’t necessarily have 30% or more absent at any one time due to illness?

Of course, I guess that problem would be compounded … as we’ve discussed previously … by adults who have to leave the work force not out of their own illness, but due to a family member’s illness. But again, it wouldn’t happen all at one time.

I think even with a bad infection rate, if there is enough balance in the “waves” … again a hypothetical phenomena … and/or enough time between waves, that any disruptions are surmountable. What do you all think?

OnandAnon – at 09:47

The knowledge of the past, the time between “horse and buggy” days and the 1950′s, is a critical set of information that has been lost. If we do not have a severe panflu, then we can just pickup where we left off. If it IS a severe pandemic though, we will be put back into the horse and buggy times, minus the critical knowledge needed (blacksmithing anyone?) to function.

A fear I have is that we as a civilization will be knocked on our keester, and lose much of the knowledge and skills to come back. If we lose a lot of people, the survivors will simply gather up what they left and use it for a generation, versus manufacturing or building anything. In other words, it will be a scavenger generation. The following generation will not know how to build, manufacture or create anything. Then comes the long slow slide into darkness (the Second Dark Ages).

Some of the information that I have been gathering up is how things were made back in the 1800′s. This knowledge needs to be preserved because it may ultimately have to be utilized once more.

Re: Horse and buggy times.

Suddenly feeling a new level of happiness that I live near Amish and Old Order Mennonite country. I know two blacksmiths within a half-hour driving range (but that’s driving by car).

OnandAnon at 9:47: We have talked about this aspect before. If it is not a viral asteroid, but just short of it, it could be a Pyrrhic victory for the human race. Several decades of slow, uneven rebuilding marked by worldwide economic depression and numerous small wars would be the likely scenario. In other words, the same thing that happened after The Black Death in Europe would be our fate.

The viral asteroid scenario would indeed take out 90 per cent of the human race, most of us from collateral damage. Several of us have independently come to that conclusion. God knows what the likely follow-up to that scenario would be. It is not beyond the imagination, but the permutations are just too numerous.

Hi everyone. Two years ago, it was thought than 1918 resulted in 10–20 million deaths. In the last few years, that number has been raised to 50–100 million deaths with some researchers stating that it may have been even more than this.

We have pretty much come to a unanimous conclusion about where we are going…the problem is that we don’t have the accurate data to indicate where we are going…

…and that makes sense given the anarchy of widespread disease.

Maybe, we should be collecting sources of deaths from all diseases including small pox and influenza, too settle in our minds what the worse case scenario might be and then work backwards.

I personally don’t buy the 15–30% infection rate…it doesn’t make scientific sense to me when talking about a novel and therefore ‘freak’ virus that comes along once in a hundred years at this virulence.

Monotreme. I don’t know how much we can lower this Case Infection Rate (CFR). We are but one grain of sand in the world’s dirt pile…western civilization doesn’t care and eastern civilization doesn’t have the resources anyway…

…I’m sure the battle field of history is littered with the bodies of authorities who were blind to the obvious and ultimatly paid the same price as those they were supposed to be helping.

One one hand, I worry because history repeats itself. Mostly. And when you look closely at nature, you’ll see it’s made up almost entirely of circles and waves (I think of waves as open-ended circles). Except for the oddity that either fades or grows into another evolutionary step, natural law is largely reliable. And from within that natural law -where we humans exist- it’s difficult to change it’s rhythm. Though I guess we’re just at the beginning of changing that now with things like stem cell research and GMO’s. So, I’m feeling pretty confident that another pandemic is on it’s way, and likely a lot of social disruption as well.

On the other hand, the one I try to look at just as often so I don’t get the blues too bad, is that humans and society has always recovered. Sure we’ve had our “Dark” ages, our ups and downs, but we have always recovered. And I think that overall we’ve improved. We can talk about Darfur or Baghdad or Somalia, but I think that those are carrying more weight exactly because they are the exception, not the rule. There was a time, not too long ago, when many places in the world were like that. Now, I really believe there’s more peace and stability in the world than before. And that means a lot as far as what people will strive to return to once this next period of ugliness is over. Children who have grown up with war tend to grow into warring adults. Because it’s what they know, of course. But now, I think there are more children who are living in environments of stability and health than not. Remember, I’m talking about the overall. Believe me, I know there are a lot of children out there who are living in difficulty. But how many more today have vaccinations that didn’t even exist 50 years ago. And the very idea that children can learn and should be treated with respect wasn’t around until the past few hundred years. For a long time, children were only seen and not heard. Just the idea of the importance of physical and mental health for children has made a huge difference, I think. And so I think this is what our kids will strive to return the world to. It may be bumpy for a while, and no one reading this thread may be around to see it, but things will get back on track. I just don’t see “civilization” going down the tubes. H5N1 may be a worthy foe, but it’s got nothing on the persitence of humanity. Now please someone take this soapbox out from under me.

Kathy, you are right. It is possible for the impact of a pandemic to be mild enough for civilization to survive; we have a lot of examples of this over the last 500 or so years. However, consider this-

H. sap has been around in present form for several tens of thousands of years at least. Influenza has been around a lot longer than that, living in birds, etc.

• THE FOLLOWING IS PURE SPECULATION*

Our present civilization has evolved over the last say 4000 years to it’s present form. If H. Sap. has been around for say at least 36,000 years before that, why didn’t we create a civilization before that?

Maybe there was one. And maybe they weren’t any better virologists than we are. And maybe they got hit, purely by random chance, with a *bad* flu bug, the kind that only happens every 5000 years or so.

It does not seem likely, somehow, that this is the very first civilization our species has created. Lots of things could fracture a civilization; asteroidal impact, WMD wars, even foolish economic policy could do it. But so could a particularly bad influenza virus……..and we know they’re out there. I sometimes have the most unpleasant ideas……

Kathy in Fl at 10:02: It all depends on how the waves hit in addtion to the CIR and CFR. A swirling, random chaotic process is determining the future of civilization as we speak. If this phenomenon doesn’t get you closer to God, nothing will.

On the subject of older tech and the history of technology, I am a fanatic on the subject, and my place will eventually be a small manufactury for wood and metal. I am toying with starting a glassmaking operation and bricks too.

And I am an amateur blacksmith, too.

an interesting point kathy. we know the speed of progression in bird flu and when we talk of waves not only are we speaking of a pandemic arriving in two or three waves, we are also speaking of each wave starting out in smaller numbers (of those infected) and a subsequent build of the numbers throughout the days the wave exists within the community infected.

so of our hypothetical 30% infected in the population, what percentage is actually infected at any given time within a wave lasting 6 to 8 weeks. or a pandemic of 9 to 18 months

of that percent… we may expect up to 45% surviving. of those we can expect trauma and health problems with what percentage? we then quickly have a traumatized but usable percentage of people to put into high risk (to infection) areas of need.

meanwhile we have an alarmed but mostly uninfected population. a population mostly unprepped facing a 3 in 10 chance of getting infected and a about a 2 in 10 chance of dying. (as of the moment they become aware it’s all very real)

so what do they do? what would you do if you suddenly became aware that you have a 2 in 10 chance of dying within the next 18 months if you simply go about your normal activities?

electricity probably stays on.. security on an overall level exist.. you need money ergo you must work.. you need food and supplies ergo you must buy.

consider it the virus war lasting 18 months, I guess that’d be war on our on turf

Okieman – at 10:04

There is a pretty good size “homesteading” movement … returning to more simple lifestyles … that you might be interested in. There are several large homesteading lists on Yahoo alone. There is also a “urban homesteading” movement that has suggestions on how to “homestead” in an urban and/or suburban setting.

Moeb. Good points…but remember that there will be probably some very sick survivors probably equal to the number of mortalities that are going to require ongoing care and a lot of services.

moeb – at 10:32

And on top of that, there is that idea that people won’t become aware of enlightened about what they are facing all at once. Just like on FW … there are always new posters or people who’ve said they just became of H5N1 as a personal threat.

If the first “wave” is a relatively mild one with a low infection rate the majority of people may just moan, groan, and complain about any resulting inconveniences, but the vast majority isn’t going to freak out and suddenly go out and start prepping from what is available.

Think about the effect that Katrina and NOLA had on all those folks that really should prep for hurricanes. <snort> The vast majority of people still don’t do any kind of REAL prepping until they are staring down the barrel of a Cat 5 hurricane … and even then will make excuses why they don’t, won’t, or can’t.

Perception will have as much to do with how things turn out as with actual and factual statistics. Isn’t that why there are Spin Doctors anyway? <tongue in cheek>

ColdClimatePrepper – at 07:42

and for anyone interested, there are imagined, speculative scenarios stored on the wiki.

Kathy in Fl. Your last paragraph…you nailed it…dead on.

I sorry but I can’t see how the first wave can be anything but nasty and devastating. as we tumble down this path many of the scenario’s spoken of here could happen. if not on our shores then on someone else’s. I fully expect to see panic buying and shrill headlines. I also expect that somewhere in the world, criminals, rebels, terrorists and dictators will attempt to take full advantage if they can.

but in no way would I expect our respective locations to spontaneously break out in riots and looting with subsequent downfall and/or setback of civilization. that’s probably why we won’t see it happen at all

moeb: In the 1960s I remember multiple, spontaneous riots on the mere reporting of the Dr. King assassination. I assume you are saying these things and preparing for a higher level of disorder. Highly urban populations have a fuse that is set very low. Sometimes the slightest vibration can set off an orgy of mayhem. Now what happens, if a viral earthquake is reported?

when the laughing and evasions turn into stark terror then we are in big trouble. Fear can be managed. Stark raw panicked terror is another matter; when the lizard brain starts issuing orders then the cerebellum gets ignored.

Moeb, I hope you are right, and we don’t see that; as I said before I’m basically a lazy man. I am surprised that anyone who saw the King riots in LA or any of a number of similar events could think that a pandemic couldn’t start a breakdown of order.

However, my sober assessment is that if we see a “quick start” pandemic, when we see tens of thousands of cases almost immediately , and shortly after that the MSM start with a news blackout, and meanwhile more and more people are dropping, the hospitals aren’t taking any patients and THEN the lights go out, there isn’t any more water, and then the fires start, and the looting, and nobody shows up to deal with it….and then the foreign banks foreclose on our debt….

The cities will collapse and burn

I’ve been thinking about things and I’ve come to the conclusion that the disease is a lot easier to track and predict then the consequences of infrastructure breakdown. Shortages of food and electricity are my greatest fears.

Given that the disease itself is easier to track and predict then infrastructure loss and given the fact that treatments will have to be given at home and probably not alter the course of infection very much…I have come to the conclusion that if I was in a postion of authority at the moment I would have to ensure that infrastructures were in place first and then treatments and healthcare in place afterwards.

If there is to be a civilization buster…it will be not due to disease but due to loss of all critical infrastructure and the cascading effects that result.

We may have to write off the losses due to disease to in fact save the civilization if financial resources can’t cover both…an amazing potential paradox!!

Tom:

We don’t need scientific sense to know that no contact means no transmission; common sense tells us that, and that some who avoided infection during previous pandemics must have done so by virtue of not having come in contact with anyone who was infected. Even if half or three quarters or nine tenths of a population become infected during the course of a pandemic, they can’t all be infectious at once; it takes time to pass the virus from one individual to another, and there is an incubation period. So probabilistically, we would expect some who — despite being susceptible — were lucky enough not to come into contact with any infected individuals, perhaps a few who weren’t even being all that careful. But, “no contact means no transmission” doesn’t invert to “contact means transmission”, either; so there will also be those who are susceptible and who do have contact and yet do not become infected as a result of what is referred to scientifically as: “dumb luck”.

I think it may be easy to get so fixated on virulence as to overlook the fact that virulence has a minimal impact on attack rate. The observation (made by Bottomline above) that the virus causes mortality rates approaching one hundred percent in some poultry populations ignores the fact that in some species of wild birds, the carriers are largely asymptomatic. To explain this, we could apply scientific sense (“common sense, with notes”), and begin by looking at “effective contacts”, defined as “any kind of contact between two individuals such that, if one individual is infectious and the other susceptible, then the first individual infects the second”. This is going to be pretty high in a flock of chickens all bred from the same stock and confined to a pen — but even then, not every contact is going to result in an infection.

We would not expect such a tricky affair as viral replication to play out the same way in every host. We don’t all have the same degree of tolerance for glucose, lactose, or rap music, and there doesn’t seem to be any reason to suppose that we would all share the same degree of susceptibility to a virus. By the time we add to the “not exposed” group the “exposed but not infected”, we already have some percentage of the population spared infection, and we haven’t even counted the “not susceptible”.

This thing is exciting enough without turning it into a Stephen King script for a made-for-TV movie.

Another way to imagine our problem is that the world is now a very crowded theater with only a couple of exits. And from the time that mankind has attained this state of “closeness and interdependedness” we have been very lucky that nobody or no thing has had the capability and desire to yell “FIRE”. I think we are near that real world experiment when everybody everywhere hears the same thing at the same time-loud, clear, and terrifying.

Racter. I think you and I probably agree on pretty much everything so, in a sense, I am dancing on the head of a pin here.

There may be a miniscule porportion of the population that due to unknown genetic expression, is by luck immune to a novel ‘freak’ virus that the human immune system has not encountered before.

Cross-immunity is speculative but probable. As with everything else there are too many unknowns with H5N1…

…but here is the basis of my argument. H1N1 was a novel virus. Many were affected in 1918, many were affected in waves with supposed significant virulence in the 1920′s and the virus has been making people more or less sick ever since…

…so you see from my angle there is no way to avoid this infection…the only question is the virulence of the particular strain you end up encountering.

If we could infect everyone with an attentuated but not killed virus that we would give everyone artificially a very mild case of flu that lasted a few days, we wouldn’t have a problem here (assuming we had enough control to prevent further mutations of course).

Of the millions of people who contacted H1N1 over three waves in eighteen months for instance…many or actually most would have contacted the mild strain…

…however, the virulent strain knocked out the numbers reported probably in six weeks before it mutated itself out of business for whatever reason.

Therefore, I don’t think avoidance is in the equation…I think the best we can do is hope to pick up the infection when its virulence is low.

What do you think?

Medical Maven. As I’m sure you probably know, the corrective process for which the human race is headed, if not by infectious reason then crop disease or food shortage or asteroid etc, is an established process in all of nature’s population systems.

All animals humans included overpopulate until they have expanded outside the capability of environment they live in. The same thing will happen to us that happens to rabbit populations on a regular basis.

Another way to look at it…is that if Mother Nature put the earth in place not as a playground for mankind but as a playground for all living things, plants and animals, then where and how does mankind fit in importance in this system.

If pankton is removed from the sea, all life forms who depend on plankton fail. Mankind is at the top of the food chain. If mankind is removed who losses? What other living forms depend on mankind for survival…none.

Man could be defined as a parasite. Eventually, we will be dealt a severe blow by Mother Nature. We will probably survive as a race but there is no gaurantee in my mind….In my opinion, we are actually much weaker as a species then we were in 1918 when the last significant pandemic occured.

You know this may sound incredibly stupid but here’s something to think about … and respond to if you chose.

Back in earlier times most people didn’t not have a lot of “extra.” Extra anything really … fat on their body, health reserves, etc.

In most first world countries people now do have “extra.”

I know that when I’m sick and have a significant fever I lose weight very quickly. My body expends a large amount of energy “fighting” and calories spent far outweigh caloric intake. If there is vomiting and/or diarrhea, the “fighting” is even greater.

But I have enough “extra” to withstand such an onslaught by a viral attack. I’m far enough away from a physical “tipping point” in my body that I have enough “extra” to give my body time to build a defense and heal itself.

If I were a woman in earlier decades this would probably not have been true and I would have died in childhood or childbirth. I didn’t make it out of the 70′s unscathed as it was. I was perpetually “skinny” because I was constantly expending calories “fighting” off the latest infection.

Is it possible that this might prove helpful in developed countries so that even with a high infection rate, the CFR may be signficantly lower than should be expected?

Thus far, we’ve seen most of the fatalities in countries that are not considered “first world.” The people there that have been infected with H5N1 didn’t have a lot of “extra” for their bodies to do battle with.

I know that the cyto and chemo storms have a play in this but as a generalization, how far off base am I?

Kathy in Fl: NS1 would have a good answer for you. And Tom DVM alluded to that strain of thought that either he or others should flesh out.

Are we looking at The Stephen King nightmare story called “THE STAND?” I remember seeing the TV Movie and laughing at the prospect of such a scenario. I’m not laughing anymore. The BF might not kill us all but who knows what other forces it might let loose on this planet? When you have millions hungry, sick, in deep depression and grief God only knows what might happen? It’s a disaster of biblical porportions in the making. I expect some leaders to make their move against their enemies real or imagined. If those enemies have their own WMD OUCH!

Tom DVM- The difference between people and rabbits is that we are consciously capable of understanding what could happen and take some steps to avoid that.

Potential does not translate into actually doing something about it.

And that is what is so sad about this situation. TheTPTB around the world have it within their capability to at least try to mentally prepare their populations so as to avoid the “shock and awe” knock-off effects that can cause as much grief as the viral infection itself. They are just not going to go “full bore” on this aspect of preparation. And it is the easiest and cheapest remedy that they could apply.

Kathy You raise excellent and relevant questions…and it is just from this sort of cirucular thinking that real innovatons and advances result. Often with specialist, you get tunnel vision which I guess is an extention of the term specialization.

Lets deal with a few of the issues. There are proabably too many to handle all at once.

Children died in early childhood because of infections. That is why the development of antibiotics in the early twentieth century (remember penicillin was first used during the second world war) was the single most important scientific study in the history of mankind. Other things that helped were clean water systems, a recognition of the need to control sewage, rats etc. and basic cleanliness increased at the same time.

Women died primarily because of complications of childbirth and no antibiotics to treat infections.

Therefore, women and children did not die in the past because they were too thin, in fact if you look at pictures from the time period, heavier body images were more accepted.

Secondly, there has been a correlation made between body fat and immune function. I am not sure I buy it but researcher have determined that excess body fat directly decreases the functioning of the immune system. Therefore, in a sense, that body fat is working against you when it comes to infections…like I said, I doubt this is true quite as reported.

Thirdly, we must keep in mind that the virus we are talking about has little relation to other viruses other than H1N1 (1918)…

…There have been viruses in the past, small pox and measles being the best examples, that have the ability to completely overwhelm the immune system for one reason or another…

…Influenza viruses seem to have the additional ability to, in a sense, harness the immune system itself to kill us. Influenza viruses are the most successful viral parasite in history.

In my experience, the infection completely overwhelms our systems and our back up systems and our back up systems for the back up systems that body fat will probably no play a role because we will die long before it could have an effect.

But we must keep things in perspective. Say the Case Fatality Rate is 10%. That means that you probably have an 80% chance to get the disease and walk away with no after-effects…

…… a 4/5 chance to be unaffected…

…THOSE ARE EXCELLENT AND MANAGEABLE ODDS, although I would rather not have to play the game in the first place, if you know what I mean.

“The difference between people and rabbits is that we are consciously capable of understanding what could happen and take some steps to avoid that.”

LMWatBullRun. LMW, I know that you and I probably agree but I will explain myself a little more for others that might be interested.

Rabbits are a pretty good model to follow because their breeding potential increases the rate at which the pattern develops.

Rabbits breed and overpopulate a fixed area rather quickly, a number of things happen as an end result.

1) the increase in population density causes infectious disease outbreaks.

2) they starve to death due to foods running out.

3) natural predators (wolves foxes etc) that depend on rabbits for food, become more successful and their populations increase as well so more raabbits die from increased predation.

There is a book written by Ronald Wright called ‘A Short History of Civilization’.

In it he describes something he calls ‘progress traps’ I believe…been a while since I read it.

Anyway, it would make good summer reading for those who have time, because he describes how all human civilizations have fallen basically in the same way rabbit populations fluctuate in a meadow.

I don’t believe being conciously aware, but too stupid and stubborn and ignorant to do anything to avoid it…changes very much!!

Tom DVM – at 13:04

OK … so you are saying that first world residence may not have a leg up on a pandemic even with “extra” but it doesn’t seem to hurt either.

I’m thinking in terms of the fever factor. If the fever component overwhelms our ability to “fight” in a health sense, then we lose. I’d much rather see my body using fat reserves during a fever battle than resorting to muscle loss.

And if the infection overwhelms the body that quickly, it doesn’t seem that any type of medical intervention could be taken quickly enough to be effective. You are back to treating the symptoms … fever, conjestion, vomiting, diarrhea, etc. … which would make you think that having physical reserves would be a good thing.

Virus are not affected by antibiotics, correct? Only potential secondary infections caused by the virus. Still, unless I am missing something, wouldn’t it be better to start off with reserves or “extra” than not?

a little personal. Yes, you are absolutely right…and I have always kind of believed that the spare tire that we seemingly can’t avoid, is an evolutionary advantage provided by Mother Nature to do just as you say…allow us to survive prolonged illnesses…

…and I really have trouble buying the increased fat, decreased immune functioning argument.

The problem with influenza specifically, is I believe the damage will be done very quicly…within the first 24–48 hour time period.

You are right about antibiotics having no effect on viruses…but in a good percentage of milder cases, secondary bacterial pneumonias will be a significant risk, prevented by prophylactic antibiotics.

Tom … 24 to 48 hours from symptom onset or from actual infection?

If it is from the point of infection, could that be why tamiflu and the like are less effective with H5N1 than with other flus?

Knowing what your looking at with this infection will be 50% of the battle if you have Tamiflu or Relenza or both. Taking both or either at the right time and dosage then will be the next call. Of course the big ? is will either work when the time comes?

glennk – at 13:30

That’ll be a moot question for my family. We are unable to acquire the amount needed for a family of seven … no prescription, and an inability to afford the amount needed by non-prescription methods.

I suspect that most families will be in the same boat when all is said and done.

Tom DVM: Moderation in all things, fat included. The studies I have seen reconfirmed over the years is that obesity, (and I believe a third of American are obese or near it these days), decreases insulin resistance which sets you up for increased, generalized inflammation in the body. That extra fat pumps out cortisol, an excess of which decreases insulin resistance and makes it more likely that your arteries will collect plaque. In other words, your body is not operating in the efficient, healthy manner that it was designed to.

Fat was designed for survival in lean times, not for a modern industrialized society in which there are no lean times, (at least not yet).

Kathy. You hit the nail on the head again…damage is done before the drug hits effective blood concentrations…

…However there is a second complicating factor…drug doesn’t seem to work…

…and a third complicating factor…I don’t like the list of side-effects specifically for overworked, panicked and stressed out healthcare workers who may be on the antivirals for a completely untested period of time as prophylactics.

Glennk. I am talking about the worst cases leading to death but I am not sure that you could take it soon enough to make a difference…

…and it should be said that the majority of doctors are on the other side of the argument…saying it will work.

To be honest, I should tell both of you that while I could get these drugs, I won’t…neither myself or my family will be getting them…

…one reason is they do not fulfill the first precept of medicine…’Do No Harm’.

Medical Maven. The cortisol would also, in high enough concentration, decrease immune system functioning. Your points are well taken!!

Tom:

I agree that we mostly agree, though I think I am a somewhat stronger advocate of the genetic susceptibility hypothesis.

The word: “immunity” may confuse things here; if some are “less attractive targets” in the first place, their immune systems may not have to fight the thing at all.

Here, I think we do disagree. If we accept the neighborhood of thirty percent as a reasonable estimate of the gross attack rate, then once the pandemic is split into (say) three waves, you have roughly ten percent of the population infected in each wave, and since the waves last longer than the contagious phase of each individual case, an even smaller number in any given geographic area who are contagious at any given time. It also seems reasonable to expect that many people will make at least some effort to practice social distancing and to isolate sypmtomatic patients, lowering the opportunities for transmission even further. If the CFR is high in a pandemic strain, there will be even more motivation to isolate, hence (from my angle), a higher CFR should result in a lower attack rate.

At some point, the odds of avoiding exposure don’t look all that bad to me — especially for those who are reasonably well prepared.

Well, I can see MedicalMaven’s point … too much isn’t any better than too little.

But I was thinking more of the “average.” I’m talking about people that are perhaps on the upper end of their height to weight ratio, or maybe a little over but who don’t qualify as medically obese. By insurance industry standards I am overweight and freely admit it … but I also run, play hard, work hard, and now am rarely ill compared to when I was a “healthier sized” teenager and child. In other words, I’m bigger … and healthier for it compared to when I “fit” the mold.

And that is with greater exposure potential as I have five kids who could potentially be bringing home every bug under the sun, plus being around a lot of our tenants that don’t lead the healthiest lifestyles.

With the stomach flu that just went around out house … the first time ever that we’ve all been sick at the same time … I was actually the first one recovered despite being the one that lost the most weight. I had it to lose, the kids and hubby, who did not, were a lot longer getting back on their feet. I wasn’t the “index case” nor was I the last to get it, yet I was the first to recover. I’m just trying to use that as an example to extrapolate from.

I suppose some of the “common sense” approaches that are normally true will have to be put aside for this bug.

I was thinking that people in less developed countries would have bodies under much more stress - due to nutrition, environment, etc. - than say a developed country like the USA. The difference would be in the little “extra” or the physical reserves that we had. And that the reserves/extras might be what “tips” the odds back in our favor away from succumbing to H5N1.

“At some point, the odds of avoiding exposure don’t look all that bad to me — especially for those who are reasonably well prepared.”

Racter I agree but our band of merry men/women does not account for a significant porportion of the world’s population…the rest don’t care.

If we look at the history of H1N1 and the fact that not only did it cause a pandemic but probably waves of epidemics over decades and is still influencing viruses today…

…then if thirty percent of the world’s population is infected in three waves…

…what is the reason the other 70 % will not get H5N1 assuming it becomes a full pandemic strain with relative transmissiblities?

Ten to fifteen pounds overweight with average height for a man or woman probably isn’t going to make a dime’s worth of difference either way. Your genome will tell the tale, if exposed and infected..

Medical Maven – at 14:13

Humph … well just bust my bubble why don’t you. <grin>

I don’t know if genetics tells the whole tale to be honest. I was a terribly ill child and teenager. Every few weeks I would get something. Might have actually started in ‘68 from the Hong Kong flu that turned into double bronchial pneumonia. But wouldn’t have only been that, even if it was true. My eardrums, tonsils, adnoids, and sinus cavity are all “abnormal” which caused me to catch everything under the sun. The only “cure” back then was breaking facial bones and reshaping everything which was an “if-y” proposition that my parents passed on. At 40 I still have my tonsils and adnoids and they no longer are problematical since about the time I turned 21.

None of my kids inherited any of my problems … thank goodness they take after their dad in that respect.

Just makes you really think about how your family, individually, will be affected by the pandemic regardless of what the infection rate and CFR are. I mean, if you lose someone you aren’t going to care what the percentages are, you are only going to see the impact on your family.

Tom:

Not susceptible, not exposed, or just lucky. The chances of remaining uninfected over decades gets a lot better as soon as a highly effective vaccine is developed, but we have to wait till a pandemic strain sticks its head up before we can get a shot at it.

Racter

“Not susceptible, not exposed, or just lucky.”

Hope you’re right…70% seems a little high for this to me. I don’t think that many could be that lucky over extended periods of time.

glennk - at 18:01

Ok, now I’m REALLY depressed.

A few pounds overweight won’t make a difference to a virus, it’s true. But it will only be irrelvant during the pandemic. Right now it’s very important. If your body is going to have to fight for its life it had better be in shape when it enters the ring. That means getting your body ready today. I think of my health and fitness level as part of my preps. Mental state, too. All of it will have a cumulative effect that could make a difference when you’re lying there in bed. Yes, susceptibility may be genetic, but I think your ability to survive will depend on your health in a broader sense.

Regarding susceptibility: The pH of nasal secretions are affected by stress and the foods that you eat. We had one whole thread devoted to this topic. The nose is a major pathway to being infected by panflu. The more acidic those nasal secretions the more likely you will contract the flu. Garlic, fruits, fruit juices, vegetables and their juices are all conducive to maintaining a healthy pH in those nasal membranes.

As far as mental stress is concerned I would say you could keep it within bounds by having a good plan, implementing that plan, being well-supplied, having those you love close at hand, and makiing sure none of those that you love gets sick. That is a lot. And one more thing-have faith in a higher being, not just a facile faith, but one that reaches to your very core.

Nasal saline solutions are helpful in cutting down on ordinary colds, flus and sinus infections and may be useful for preventing H5N1 infections.

Regarding infection rate —

The other possibility is multiple strains developing, via recombination or whatever, some more serious than others. Infection with a minor strain may be no more serious than ordinary influenza, and confer some immunity to the “bad strains.”

However, I would imagine that a seriously virulent strain of H5N1 that hits hard and replicates like mad might have a higher rate of spread — the patients would be shedding more virus before the showed symptoms and need more nursing care (and have more opportunity to infect others) after they came down sick.

The other possibility I’ve heard is that infection with H1N1 (or vaccination or exposure to) may confer some level of immunity to H5N1 because of the “N1″ … interesting theory, anyway. (In a perfect world, they’d check the neighbors of the big clusters for antibodies H1N1, and maybe do some animal studies. Can a pig immune to H1N1 catch H5N1?)

Tom:

I can see some possible basis for questioning whether H5N1 will follow patterns observed in past pandemics, but I don’t understand your basis for questioning the reliability of data from those events. If 1918 seems too far back to be a reliable source of data, what about 1957, or 1968? These pandemics have been studied extensively, and while estimates of attack rates, case fatality rates, and mortality rates are just that — estimates — challenging them seems to call for something stronger than personal incredulity. Epidemiologists have some pretty nifty computer programs that permit them to play around with the variables and see what happens. The “mean infectious period”, for example, is one that can make quite a difference; if it’s closer to two days than to four, it can impact the r-nought considerably.

It’s really not a matter of mere luck. The virus faces stringent time constraints in aquiring new hosts, and the behavior of those hosts is as important as anything. By preparing to isolate, we are making our own luck.

I wish I believe isolation was going to work for most of us but I don’t. For those in here that still have a farm with a well and live 10 miles from the nearest neighbor like Gary in Death (sic) Valley it might be an option. For the rest of us it’s not. Staying home will be ok for a few weeks but if the water systems fail and the power goes off it will be all over for most people. I don’t think we can run from this nor do I think we can hide for very long. In fact the opposite. Those that show immunity and those who survive are going to be tasked immediately with keeping things going on top of caring for masses of sick and dying people. Their skills and courage will either save the day for millions or the opposite. I prefer to be an optimist and believe this will bring out the best in enough of us to get through this. If I’m wrong then this will play out like a “Mad Max” epic only worse. I think I’d prefer to check out permanently instead of living in such a world.

How many mothers have had to nurse sick kids; willed themself not to catch the bug; and didn’t get it? What’s driving that?

glennk,

“I wish I believe isolation was going to work for most of us but I don’t.”

With this virus, everything that we do, we are looking for only small returns. And one has to look at it both from the personal view and the collective view. Thus, isolation may give each person only a slightly better chance of not getting infected, but when you look at it as communities or even countries, then advocating isolation to reduce the incidence or speed of transmission makes a lot more sense. So in order to protect yourself, it may be time for us to go out and advocate social isolation as a general policy rather than individual choice.

Stress! Stress works! Somehow I have always managed to get through the “crisis” only to get sick when things calm down.

Didn’t alot of people die in 1918 from secondary infections i.e. bacterial pneumonia? If so, why isn’t the pneumovax vaccination being suggested as a precaution?

Has anyone else read Jared Diamond’s book COLLAPSE?

It is an extremely interesting study of various societies and what they did which resulted in either survival, or the collapse of their society. He looks at Easter Island, the Anasazi, Greenland, New Guinea and other places.

As someone said up thread, at some point our species will encounter a population correction. If you’ve seen a graph of human population growth you know it is an exponential curve, in other words it starts out going up slowly, then goes up at a steeper and steeper rate. We, just like all other organisms, will reach carrying capacity of the planet.

Something has got to stop us. In biology we divide those population control factors into two categories “density dependent” and “density independent”. Density dependent limiting factors are things that get worse the more crowded a population is: such as shortage of food, presence of parasites or diseases. Density independent limiting factors are things that happen regardless of how crowded or uncrowded a population is: such as droughts, hurricanes, floods etc. Seems to me we are headed for both these types of problems.

We THINK we are safe from nature’s laws because we have big SUV’s and feel invincible, but the truth is we are more vulnerable now than ever before. Most of us in the developed world have so few survival skills beyond being able to drive to the market and work the self - pay checkout line. Ugh.

The earlier discussion about whether or not the pandemic will be so severe that society crumbles reminded me of a “History of Emerging Pathogens” list I read last night in The Eleventh Plague, a thriller by John S. Marr, M.D., and John Baldwin. (Dr. Marr is an epidemiologist and has been director of the New York City Department of Health.)

  A lecturer listed the centuries from the 11th to the 20th, with their society-changing illnesses.  

11th-ergotism/ 12th-smallpox/ 13th-leprosy/ 14th-plague/ 15th-syphilis 16th-dysentery/ 17th-tuberculosis/ 18th-typhus/ 19th-cholera/ 20th-HIV/AIDS/

The point was made that some of these illnesses had a different form or consequences back then. “Every civilization has its encounter, almost all have tried and failed to predict it, to outwit disease, going as far back as the Romans. Or the Egyptians and the Greeks.” (page 190)

On the pessimistic side, maybe keeping a diary would be of interest to future citizens.

I hope our libraries stay safe from riots and out-of-control fires. Maybe we should check out some how-to books when the pandemic starts, for preservation (if the location of the library is iffy)? LMWatBullRun is an inspiration.

I can only commend to your attention the great grand mammy of pandemic books, Laurie Garrett’s phenomenal The Coming Plague. This is a doorstop of a book, but I read it in one sitting and got my pandemic chops from the reading. I was also so chilled by the reading that I didn’t need the air conditioning on that July weekend. She’s a writer first and a science writer second and the book is utterly compelling.

Melanie: Yes The Coming Plague is a tome in our science department. Good stuff, and unfortunately, I think she is soon to be proven correct in her concerns and predictions.

Irene: I have been questioning why the health profession is not pushing the pneumonia vaccine also? Maybe we will see them doing so in conjunction with the next round of flu shots this fall/winter.

I can tell you that I and my family members have gotten ours. When I told the doctors why I wanted the vaccine, I got blank stares. They did not have a clue about what I was talking about.

My feeling is that the vaccine might greatly reduce the amount of deaths though it will not prevent you from getting the flu.

Garrett’s book should be on your shelf next to Barry’s and Crosby’s. If you want to understand what we are up against, having the perspective of history is simple wisdom.

I’ve got Barry’s book on order. I’ll check out Crosby’s too.

Thanks for the suggestions.

Thought ColdClimatePrepper – at 07:42 had a good suggestion about starting a new thread about “rebuilding after the flu”. We live in Florida, and the worst case scenario for us to have the double whammie - the avian flu followed by a devastating hurricane. Nix the electricity, nix the internat, nix cellular much less regular phone lines, nix public health care and then start playing out the scenario.

We are fairly well prepared. We will be frugal about our daily consumption (because we really won’t know how long our supplies will have to last). We will continue to listen to any radio broadcast that might surface using our solar-powered radio. We will cleanse our water from our lake. But we will continue to wonder when it’s safe to “come out”. Will a radio announcement be our only signal? What if that doesn’t come? When will we venture back into civilization to see what’s happening? And when driving into town (of course wearing all of our PPI), what specifically would we look for as an indicator? Do we drive to the county commission office? Red Cross? Dept of Health? Fire Department?

I believe that while many of our key people may be MIA (either because of death, illness, illness of a loved one, or simply fearful of being contaminated), there will be those whose depth of character and innate leadership qualities will inspire them to step up to the plate, recognize that someone needs to lead the march toward in an effort to reorganize their community, and respond to that call. Each community will have a different set of priorities, casualties, and resources. And I agree that we will indeed see “shades of the past”…where community gardens will become essential, where the barter system will prevail, where neighbors will embrace their neighborhoods, and slowly but surely some of the current technology will find its way back into our future. Farmers…who may now be barely making a living…may prove to be the highest paid. Our “currency” will change drastically.

We will have to help one another through the depression that will accompany this tragedy, but perhaps…just perhaps…we will find our new set of values to be more relevant that the ones our society seems to currently embrace. Fancy cars and expensive homes will pale in comparison to health and food supply. What family and friends that remain will be more precious than ever. The devastating part is this: not all of us have the luxury of being fully prepared, and for that, I am truly saddened. But I do my part by passing out a small business card that simply says. Prepare Yourself - Read up on the Bird Flu - visit www.fluwikie.com

PS - Plan to post this same copy on a new thread to get some conversation going…”Rebuilding after the flu”

Hi Racter. I am from a profession (specifically farm animal veterinarians) that is required to do a lot of things through intuition alone…and it kind of gets to be a habit after a while…and you either learn to trust your intuition or forget it altogether.

Speculation is just that, speculation. No one knows anything about this virus and the track record of experts reflects the fact.

Some of the things we have been discussing don’t make sense to me based on my intuition and training but that does not mean that their incorrect.

I don’t believe genetics can fully explain the cluster in Karo and elsewhere based on my genetics training but the alternative I came up with has too many hoops to jump through to be true either…so at the moment we do not know. It also does not make sense to me that 70 % of the world’s population can escape this virus…a lower percentage may escape the first three waves but may not escape the waves of aftershocks (epidemics) that will occur…it’s just not the way nature works based on my experience with nature.

As far as the computer modelling goes, the fact that I am not a big fan would probably not surprise you. I will take a human brain over a computer anyday…or better, a hive of minds as Melanie says!!

The bottom line is we are quickly reaching the spot where the rubber hits the road and we will know some answers one way or another…because my experience is that you make hypotheses and then with nature you always find out if you were right…

…I will be more than happy to be wrong in this instance.

I have really enjoyed our conversations.

disruptive comment removed

Thread was getting long anyway.

Continued {http://www.fluwikie2.com/pmwiki.php?n=Forum.ACurrentThreatAssessmentII|here]].

Now how did that happen???