I have 1/2 hour to make a few brief posts, so these are raw, unfiltered, titbits and highlights. No links or references just yet.
We have data for use of tamiflu in Turkey. 10 patients were treated with standard dose of 75mg twice daily. Those who died (4) started tamiflu on 8.5d from onset. 6 survived and their mean time from onset to start of tamiflu was 3.6 days.
Tamiflu resistance, large scale study for seasonal flu. adult 0.32%, children 4.1%. Commenting on the 18% resistance in children from one Japan study, apparently that was because initial recommended doses for children were weight based, which gave the younger childre far too low doses. The current recommended doses from the manufacturer are now ‘unit based’.
The other problem with Japan is that they treatment for seasonal flu tends to be geared towards resolution of fever, with the result that too often the drug is stopped too soon, thereby promoting resistance
Reasons for resistance in children:
WHO will be releasing recommended doses for H5N1 treatment in the next couple of weeks.
John Oxford related a story of cases of fatal chest infections in army camps in Europe in 1916. At that point there were 100+ deaths from several hundred cases. His point was that if someone at that point were to say let’s prepare for a pandemic that is going to kill 50 million people, they would all say he’s nuts.
I like this story.
anon_22 -
Thanks for the info. I am not surprised about the lag in time to start Tamiflu and the higher death rate.
I will be interested to see the recommendation from WHO re Tamiflu. I am betting they state it should be used for 14 - 15 days for treatment, and maybe a higher dose too.
Martin Meltzer, health economist from the CDC, gave probably one of the most impactful presentations so far. Rather than just giving you numbers for economic impact, the message came through loud and clear: plan, prepare, practice.
A couple of messages he repeated:
There is no healthcare system anywhere in the world that can cope with even a 1968 type pandemic.
You can have all the numbers you want and plan and prepare and all that, but I guarantee you (his words) when the pandemic occur, what you have done will not be enough.
Yi Guan’s study on the multiple sublineages of H5N1 showed that these all developed from original parents strains arising out of south China. Those subtypes in Vietnam and Indonesia etc are fairly stable once they emerged. Even the ones derived from Qinghai.
But in South China, new subtypes are being formed all the time. That’s where the natural reservoir for H5tN1 is.
Actually I didn’t have 1/2 hour :-(
More later.
From Singapore (populations 4.4 million), impact on healthcare from SARS experience:
For a total of 13 SARS patients, they used 419,480 N95 masks at USD$0.74 each, total of $310,400, and 60,290 disposable gowns at $1.41 each, total of $85,000.
I guess Dem is right. Show me the money
“I guess Dem is right. Show me the money”
And show ME the production capacity. And gloves?
I have read that a 600 bed hospital would go through over a million masks in six months of a pandemic. France has ordered 685 000 000 masks. Obviously insufficient. Hopefully the US is ordering in the BILLIONS? I mean, 3 billion would be ONLY ten per capita…. And ONE vaccine plant in the US? That must be a goof on my part—can’t be true.
Not in the America that produced over 50 000 aircraft A YEAR during World War II!
There was an Business Week article a few weeks ago that most of the US mask manufacturers are not ready to produce the quantities needed - even if the gov’t were ordering the right amount. Many have stopped producetion/scaled back because of previous litigation relating to asbestos. Another one of those “private sectors” that the gov’t assumes will”step up to the plate.”
The Turkey Tamiflu data is encouraging in some respects - if you can get it early enough it seems to make a difference. Problem is getting it.
Any comments on H5N1 in swine (new sequences at GenBank from Guangdong and Anhui)? These sequences led to wild bird H5N1 sequences in Jiangxi and Qinghai (as well as ducks in Guangxi).
Any comments on origin of PB2 E627K?
bumped…. anon_22 is reporting important data, and hopefully can report on niman’s question.
Production capacity???? The US has shipped almost all of their production capacity overseas thanks in no small part to NAFTA, GATT, etc. There just aren’t a lot of products manufactured in the US anymore. We no longer have the plants or the machines to make much of anything. At the beginning of the Iraq conflict it was a real struggle for the military even to procure enough ammunition, because almost all of the production capabilities were gone. It’s very sad and very scary.
The press does Martin Meltzer. A ‘short, sharp hit’.
I would like to express my gratitude to anon_22 for the very important information that has been post.
I have post the information at Flu Trackers,with theref and credits, if she/he feel annoyed or it is against the policy to reprint those, please stated it here. I have taken the initiative to repost it for the Professionals that I am refering there.
Again thank you very much for this up-date, we are lucky to have such informations ahead of time, it gives us, in Public Health a lead time.
Snowy Owl - we operate under GNU. Steal what you want, and give credit.
Thanks to all of you, that makes a difference
Snowy Owl for reference purposes, Anon-22 is female. Another win for the female of the species.
some comments on the news thread re webster
Snowy, ditto to Dem’s comments.
Bump (Thanks Anon_22)
anon_22, thanks very much for this report. Very informative. Your first post confirms something we have been speculating, that Tamiflu can make a difference in survival if it’s given soon enough. Good news, especially since there are new methods to make it rapidly and cheaply. This also suggests that the lower fatality rate observed in Turkey may be because of rapid access to Tamiflu.
Also, a completely off-the-record discussion with some clinicians of one Asian country that had been treating H5 patients revealed that they have a internal consensus for tamiflu dosage that is 4x the recommended dose. ie 300mg twice daily for adults, taken minimum 10–14 days.
WARNING: This is NOT tested, not officially sanctioned, there are no safety profiles, so please apply all health and professional disclaimers that you (or lawyers!) can possibly think of.
anon_22,
When you get home, I’ll be awaiting your seasoned judgement of what you learned. My experience of conferences is that they can be very exciting, but I need to get home for a few days to absorb what I think I learned and judge the quality of the material. It usually takes me a couple of days to make any sense of it.
Malik Pereis, quoting De Jong (no reference yet):
The viral load (total amount of virus in patient) in seasonal flu rises sharply after infection, peaks at around 48 hours, then delines steadily.
For H5N1, there is a scattered range of peak viral load which is later than the 48 hour for seasonal flu, to about Day 5. This means that the window for treatment with oseltamivir is wider.
Data from ?Thailand, also discussed by Pereis, gave the median date of start of treatment with tamiflu for survivors as 4.5d and for fatal cases as 9 days.
There is therefore sufficient ground to give tamiflu even if the drug is started after the first 48 hours.
Of course, results are better the sooner you start. The viral load profile also warns against stopping too soon.
Melanie, thanks. That’s why I’m saving some of the other stuff except for these few simple yes/no type of information.
anon_22,
Carry on, and I’ll await the other stuff later.
anon_22 at 02:20 re: “There is no healthcare system anywhere in the world that can cope with even a 1968 type pandemic.”
Very disheartening, and may I say frightening, but not unexpected. It confirms my private fears.
bump
wow, it is great having real access to developing scientific information.. too bad we didn’t have reporters at more of these conferences!!)
Richard Horton, Editor of Lancet, gave a fine short inspiring speech at the end. I cannot reproduce the whole speech, but portions captured by my notes (with the rest paraphrased from memory), are here, Bold type = my emphasis
This virus has been neglected and misunderstood. We all agree that there is lack of info, rsponse plans have holes.
Post-sars, some policymakers are over confident. They say we’ve got it figured out. Well, they haven’t.
WHO has a role in holding others up to accountability. It is not good enough to say countries have their problems etc.
We have to help the WHO.
Pandemic flu should be #1 in G8 summit agenda (coming up soon).
Private sector has shown extraordinary agility, but that is not enough.
We all seem to agree we do not have effective national plans, regional plans, resources, vaccines, anti-virals, surveillance,
We all know that this is the single biggest challenge humanity has faced, will face, for generations. It’s not enough to agree in this room.
We need to go out of this room and say it outside, loud and clear. None of us are saying this loudly enough.
Need to follow through – non-pharmaceutical interventions, social distancing, closing schools, who will get the vaccines first.
These need to be debated in the media right now.
We may have only 12–18 months at most.
It is not just a challenge, it is an predicament of extra-ordinary proportions
We hope that our worst fears won’t be realised, now we must go home and make sure that they won’t.
anon_22 went to Atlanta and live-blogged the Emerging Infectious Disease conference, and there was also a live blogging of a Webcast by Dr. Arnold Monto (Mich SPH), a flu expert. Both threads were in the old Forum and are now archived, as the data has been reported elsewhere.
Way back in Sept, someone sent in notes from the Deutchbank conference, and when conferences put their info on line, we put it here.
uhh, sounds really bad. He seems to estimate more than 50% that the pandemic will start in the next 12–18 months !!
I missed that… where does it say that?
> We may have only 12–18 months at most.
where do you get the 50% out of that sentence?
now I understand how you think :-)
> We may have only 12–18 months at most.
Or longer. Or shorter.
Heck, I could have a piano drop on me tomorrow. Plan for the worst, hope for the best! I doubt a virus will abide by our timelines anyway :)
Dem,
> We may have only 12–18 months at most.
Or longer. Or shorter.
Although John Oxford also said max 18 months.
http://www.24dash.com/content/news/viewNews.php?navID=47&newsID=3243
John Oxford, Professor of Virology at Barts, claims the likelihood of a human avian flu pandemic was “high and within a span of, say, 18 months”.
“high” seems to be 70% or more. But maybe not if it was only 10% before, then 20% would already be considered high “high and within a span of 18 months” is it the same as “high in a span of 18 months”. A number for the likelyhood of a human avian flu pandemic within the next 18 months, please.
OK, someone explain to me what has occured to have these experts give estimates of the arrival of a H5N1 pandemic? And I am assuming they mean H5N1.
This thread is the first I’ve heard of a solid “prediction”.
I agree Grace. They seemed to have, as a herd of sheep, turned a month or so ago to downplay the risk…’H5N1 has a barrier preventing it from becoming pandemic’ to today where they, for no apparent reason, have turned left again like drunks swerving from one side of the road to the other. Like you said…….Reasons Please?
I beleive a clue may lie in Websters presentation.
All mutations required have occurred but not in the same virus. The next few months will see a convergence of birds from across the world at Quinghai. The opportunities for cross infection amongst returning birds must be great, and must increase the risks.
If a similar pattern as seen in the last 6 months occurs once migratory season arises, the risk of a human transmissible form, evolved within birds must be greater. I am not a statistician, but one may be able to calculate probabilities, if we assume that all reuired mutations presently exist amongst wild birds.
flumonitor – at 13:52
OK; it’s a though all the winning cards needed have been dealt, but not yet held by one person?
And when that one person/virus holds all the cards/mutations, then TSHTF.
Am I correct?
I’m not sure, but I think “the mutations are out there” might not mean in strains of H5N1 - might, e.g., mean that they’re available in other flu viruses for reassortment or recombination.
flumonitor. Dr. Webster has been entirely consistent in his message. I agree with you assessment but it seems there must be more to get all the other participants in the ‘dance of a thousand veils’ changing at the same time: first away from the H5N1 risk a month ago to where we’re at now…or maybe there isn’t a rational explanation which wouldn’t surprise me either given what I have observed in the last 16 months.
It seems to me that you might want to mislead when you can determine the outcome…but in this case if you mislead what is your downstream plan to control the blow-back when you can’t and couldn’t control the eventualities… do they think people will just forgive them…don’t think so.
The 10 mutations have been seen in isolates in the past. The only one that is currently circulating widely is PB2 E627K which has become fixed in the Qinghai strain of H5N1.
Tom DVM, Mathematician, Grace
I am just guessing, but logically, if all the mutations required exist within H5N1 itself, and birds mix and match from Asia, Europe etc, again logically, it would be easier for recombinants to occur as gene sequences would match easily. I guess that even if this event DOES occur, you would need a human host to be exposed to that particular bird for a pandemic virus to take hold. The problem would then be if an h2h virus became fixed in the birds, who would then spread back across the migratory routes. This is speculative on my part, and I do not have the data to comment further. However I expect Webster et al do have this data, hence my wondering if this might be behind the see saw of opinion.
Again, perhaps a statistician can run the probabilities. I would be surprised if the experts have not done this already.
flumonitor. I am a generalist and not an expert on mutations; if there are any in a science which appears to know very little to nothing about the field.
Many have been circling the question of one, two, ten etc. required mutations when the answer is no one knows.
From my experience, I believe that nature has not read the book and doesn’t always follow linear progressive pathways. Therefore, I believe evolution can occur in leaps…all required mutations of indeterminate numbers…all in…at the same time. Using this approach there is no need for minutiae…
..stay calm…be brave…wait for the signs.
Sorry, should have read…’appears to know very little to nothing about the field of study’.
Is the time period dependent on bird migrations?
Migratory birds comming back to their place of “origin” bringing some undefined quantity of mutations with them from other places, and thereby stiring the pot.
Thank you, anon_22 !
Thanks anon_22. Was there anyone at the conference, that cared to speculate on a more optimistic scenerio? And if so, were any reasons given?
Thanks!
I’ll add my thanks as well :-)
Thanks!
And I’ll add mine. Did amantadine treatment come up, btw? It’s being discussed on the Webster thread.
hey guys, just walked in the door from the airport and guess what’s the first thing I do? Yep, check out what y’all been saying :-)
Dem, I didn’t manage to stay awake throughout the whole conference so if someone else mentioned amantadine, I’ll have to look up the notes.
Anyhow, Webster appears very encouraged and is very emphatic that we need to do studies asap on combination treatment. We don’t know if it will work, but we have to be careful not to get fixated on one or two headline-catching treatments and forget there are lots that needs research (and research $$$). We may not have a pandemic for another five years, and in five years time we may have far better treatment opions if we keep doing everything.
<note to self: go take a shower>
anon_22 - Thanks for all the great info.
Anon_22,
Welcome home. Go get that shower and a nap. Your reporting was heroic and very helpful to those us who couldn’t attend. Thank you for sharing it with us.
Anon_22 - Thank you.
Patch,
“Was there anyone at the conference, that cared to speculate on a more optimistic scenerio? And if so, were any reasons given?”
Unfortunately, no.
In comparison to when I met them in January, a couple of them seem more convinced/resigned that this is going to happen.
John Oxford in January was far more jolly and saying well, we don’t know if it’s going to happen and treating the whole (Jan) conference more like an academic topic, more like let’s discuss virology rather than what are we going to do. Now it’s more like a cause, like he is trying to galvanise people to go out and convince others. It’s very subtle and if you are not a fellow Brit you probably wouldn’t notice. But I do.
The other one who I met a couple of times since January was Martin Meltzer. I was quite surprised at the extent to which he is now telling people to prepare, because that wasn’t my impression even a couple of months ago, where again he was more professorial and talked about statistics(!) and policymaking in general, and wasn’t as animated when I asked about pandemic preparedness. Now there seems to be a tinge of heaviness, sort of feeling the weight of the responsibility, if you know what I mean.
In his presentation, the sentences I quoted before were repeated clearly and emphatically. And his last slide says:
anon_22. Thanks for these insights regarding the change in attitudes of Drs. Oxford and Meltzer. You’ll recall that we discussed a similar change in Dr. Taubenberger’s attitude. I wonder what prompted this change. Is it an overall synthesis of all the available information, or one specific piece of data?
and if that’s the opinion of Oxford, Meltzer, Webster, (…) -
then why are they only telling it in private talks to anon_22
and others instead of expressing it to the politicians or to
the public ?
Why isn’t there some sort of communique, signed by scientists
(as many as possible !) and addressed to the politicians ?
We still have the Paleses,Butchers,Siegels, who are sceptic.
We have the recent soothing statements from Gerberding,Peiris,Fauci.
And the turning to a “no one knows” -strategy by Webster after
his scary interview in March.
Also anon_22 has a history here of concentrating on the frightening
aspects while leaving out the positive aspects.
So, there might have been positives on the conference too, but anon_22
ignored them or just didn’t pay attention or just doesn’t report
them here. Who knows ?
I didn’t notice the change in Taubenberger’s attitude. Is there a referrence ? Taubenberger is always very careful and indifferent, you can hardly elicit a prediction from him.
Monotreme, I think its an overall thing. Do you not feel that yourself? That the more you think about it the less you can convince yourself that it’s going to be ook?
“anon_22 has a history here of concentrating on the frightening aspects while leaving out the positive aspects.”
WHAT? I’ve just been trashed for 2 solid days for ignoring high CFR???
You win…
:-)
anon_22, I had a bad feeling about H5N1 from the beginning. But it was initially based on just a few facts. The high apparent mortality rate in humans and the decimation of chicken flocks. However, over the past year, a number of papers have been published that provide more details about H5N1, the 1918 virus and how influenza viruses evolve in general. None of these are reassuring. The geographic spread is also bad news. I keep looking for “loopholes” whereby we escape a severe pandemic, and there are some, but there are fewer and fewer of them.
petition is the right word above, rather than communique.
I don’t know “ook”, nor do I understand what you want to say at 9:41.
The last “trend” that I felt were the defrightening attempts by
Webster,Gerberding,Peiris,Fauci,Palese. Also the decreasing number of cases and fewer reports the last weeks.
I’ve developed a high appreciation for anon_22′s comments, pretty much soundly presented. thank you
you’re welcome :-)
ook = ok
yes, I don’t feel it’s going to be be ok. Sometimes I find myself running the floor up and down and saying to myself: “it won’t work, it won’t work.”
Dem at 09:37, May 4 - Did Martin Meltzer of CDC (health economist) really say the economic effects of pandemic would be mainly on the tourist industry and a rebound would occur in 1 or 2 quarters, (so most people don’t have any worries??) We have anon_22 quoting him saying plan, prepare, practice, you can’t do enough. Is this a pat on the head, keep spending, type of story for the public while in private the big boys sweat? Or what?
Jane. It is just my opinion…but there are several on flu wiki who have come to the crystal clear conclusion over the past few months that a pandemic is imminent. What I have found in my professional life is that when an independent scientist reads this in the ‘tea leaves’…there is always many regulators who come to the same conclusion at roughly the same time.
I believe that is why you are reading a great deal of confusion from the public stance of these regulators and scientists which of course would be nuanced from their private opinions. They were feeling pretty confident and cocky a few months ago but things have changed since.
Jane – at 11:54
anon_22 heard him, and I presented what the news reporters were saying. That’s all I can tell you.
Tom DVM – at 12:05
I think anon_22 has it right in the sense that many of these authorities are realizing what it means for them to have every word they say so carefully scrutinized. And you can’t get body language, as you have noted, from a news article, which are professionallly ‘scrubbed’ from emotion. So unless they speciaically say, “I’ve changed my thinking”, there’ll be continued uncertainly about what they really mean.
>there are several on flu wiki who have come to the crystal clear >conclusion over the past few months that a pandemic is imminent
who ? where ? And isn’t this happening permanently on these forums ? If you had joined in fall last year, you’d probably noticed the same.
>there’ll be continued uncertainly about what they really mean.
and is this wanted ? Why don’t they express themselves clearly ? They are scientists, they are writing papers, they should know how to express themselves without resorting to body-language. So, why are they being unclear about their opinions ?
From a complete nonexpert who has followed this since last fall (we keep chickens): It is the increasing roar that is shaping my level of concern — not the “made for TV movie” but the bits and pieces about where H5N1 shows up, incidents as in Azerbijan that indicate some H2H, the steady addition of human cases here and there — I feel like I’m biking toward the ocean. I hear the surf, quietly at first, then stronger at intervals and then we turn the corner and I am seeing something so huge that my mind can’t comprehend the vastness of it all.
Okay gs…stop screwing around and use your real name.
Olymom. I agree and that was a really good analogy. Can I use it?
and is this wanted ? Why don’t they express themselves clearly ? They are scientists, they are writing papers, they should know how to express themselves without resorting to body-language. So, why are they being unclear about their opinions ?
No, it’s not wanted. But if you’ve ever given an interview in your local paper about smaller issues, you know that what you say and what appears in print aren’t always the same. Nor do they have the same media training as a Mike Leavitt or a Tony Fauci.
I’ve spoken to people who spent a half day with the media to get a 45 second sound byte aired - and not on the topic most interesting to the interviewee, either.
And neither the media nor we deal well with “I don’t know”. So you make it sound easy when it’s not. But, in the end, the accumulation of info will tell us something.
Dem, just a number instead of an ever increasing variety of probability or opinion - “descriptions”. It’s easy. It’s not a question of being difficult, the problem is, that they don’t want to do it. You know that. Not in public at least, but privately. When they are afraid, the press gets it wrongly, then they can just upload a copy to their homepage. They could even provide discussion and comments and clarifications/modifications/updates there.
Jane,
“Did Martin Meltzer of CDC (health economist) really say the economic effects of pandemic would be mainly on the tourist industry and a rebound would occur in 1 or 2 quarters, (so most people don’t have any worries??)”
Dem is right in that everyone hears/remembers whatever it is that they want to hear. Or what they think they are able to understand.
No, he didn’t say the economic effects of pandemic would be mainly on the tourist industry.
There was a slide from ‘Citibank: Global Portfolio Strategist: Avian Flu, Nov 2005′ which was apparently an investment analyst presenting risks to their clients. It basically showed ‘buy’ ‘sell’ recommendation columns eg on the ‘buy’ list internet commerce, freight delivery, etc and on the ‘sell’ list air travel, malls, tourism etc. It was one of several used to demonstrate overly simplistic assessments of macro-economic impact and how they carry little correlation between numbers ill, death, and econ impact, because these models do not take into account epidemiology.
On the slide Meltzer had circled the word ‘tourism’ and put in stars and ‘Why?’, as part of the discussion of his point. Whoever reported it must have taken a look at the whole set of slides, found the only one that looked vaguely similar to other ‘economic impact’ reports that you see from ‘economists’, and decided that was the theme of the presentation. Forgetting to report, of course, that the slide was clearly labelled Citibank, and not CDC Meltzer.
Here’s a lesson if we ever need one of being very careful with stuff that you read.
“It’s not a question of being difficult, the problem is, that they don’t want to do it. “
It’s that they really, really don’t know. and pushing them to guess anyway makes them uncomfortable. See, you don’t accept “I don’t know’ either. ;-)
PS give yourself a name. It’s easy.
“Okay gs…stop screwing around and use your real name. “
How many different people are currently using the non-id ‘anonymous’? That makes it very difficult to follow some of these threads.
Meltzer demonstrated how economic impact can/should be approached from many different angles, none of which carry straight-forward answers:
In other words, what answer you get depends on what questions you ask. Asking a well-constructed question gives you slightly more useful answers. Some questions give you completely useless (or unusable) answers.
Oh, and the ‘rebound would occur in 1 or 2 quarter’ thing?
I found it.
2 slides from ADB (Asian Development Bank) estimated reduction in GDP. On the side there is a remark which says ‘Assumed: 2 quarters of economic contraction’.
As in, ‘these numbers are based on the assumption that there will be 2 quarters of economic contraction’. Not ‘the market will rebound after 1 or 2 quarters’.
Duh!
Anybody still have confidence in the finance pages in the papers please raise their hands?
Thx anon22. Your remarks have been reproduced over in flutrackers.com for those there by me and snowy owl.
anon_22-re: “As in, ‘these numbers are based on the assumption that there will be 2 quarters of economic contraction’. Not ‘the market will rebound after 1 or 2 quarters’.”
Another assumtion that is a work of fantasy.
For Tom DVM, Sure, use my analogy any time you think it might help open some eyes. I quote you and the other Wikiens constantly, so I’d be flattered. (Flattered today, flattened tomorrow, I am afraid . . .) Onward through the fog!
olymom-re: “I feel like I’m biking toward the ocean. I hear the surf, quietly at first, then stronger at intervals and then we turn the corner and I am seeing something so huge that my mind can’t comprehend the vastness of it all.”
It’s like they’re warning us of a high tide,but knowing it could be a tsunami.
Yep. And a can of tuna under the bed is about as helpful as a fishing bobber as a flotation device.
Grace,
“‘these numbers are based on the assumption that there will be 2 quarters of economic contraction’”
“Another assumtion that is a work of fantasy.”
No, what it meant was that the assumption used for calculation to arrive at these figures. It was not meant as an opinion on how long the economic contraction might last, just as an explanation of the context. So if the economic contraction lasts longer, the numbers would be different.
Just to clarify in case others have the same question.
Ways of dealing with the “I don’t know”:
What would be the strategies in all 4 “corners” of the “problem space”? Looks like we could create a wikiproper page at some point in time. We need to share the load and make people aware of the complexity of this issue.
lugon,
I think everyone should do their own 4 “corners” or “quadrants” of the problem to discover the most critical components relevant to planning. You can’t plan for all of them, but you can use them to find the gaps in your thinking.
Meltzer’s remarks reported by Reuter’s
TomDVM at 12:05:
‘’there are several on flu wiki who have come to the crystal
clear conclusion over the past few months that a pandemic is imminent’‘
I didn’t see any such crystal clear conclusion on this forum.
Is there anyone here who identifies himself with
the above statement ?
I think what Tom is referring to is the fact that it has been and remains clear that so many unreported cases/deaths are out there and the lack of governments worldwide to respond to this coming pandemic with anything but a feel good version of the evidence make the history on the way crystal clear. I, for one, believe this is a much bigger picture. If you did’nt see it-keep looking.
I keep seeing this here, as long as the fluwiki exists. So, why in particularly, now ?
>>it is not a question of being difficult, the problem is, >>that they do not want to do it. >It is that they really, really do not know. and pushing >them to guess anyway makes them uncomfortable.
what a nonsense. They do not really,really know their own estimate (probability number)? Although they speak about these estimates in interviews ? (after converting the numbers into unclear wordings) And although they give exactly these numbers in private talks to friends ? (but not to public)
>See, you do not accept _I do not know_ either. ;-)
you can always say _I do not know_ (exactly) because you are never 100% sure. Just give your estimate when you are not sure. When you refuse to talk about events which you are only -say- <99% and >1% certain about, then you restrict yourself to a very small area of events, of science, of life. This is not very useful.
>PS give yourself a name. It is easy.
why ? So you can attack me for my supposed “trolling behaviour” in other threads or other boards rather than for my arguments here ? (as was done in the past) So you can create a cookie on my HD with that name and collect data and identify me, report my online times, check my logon-IDs and report them to the forum ? (as was done in the past) Check your privacy politics. Check your own name. Check your public interview and your own statements about privacy and anonymity. Check what happened with curevents vs. flutrackers.
Concentrate on the arguments, not the behaviour in other threads or other boards which apparantly you think is in conflict with your (local) culture, your ethics. Concentrate on the _logics of the issue_ instead of just marking the _behaviour_ as “trolling” or such and putting it to public vote.
Florida1 – at 20:55, the quote´d article is about Meltzer’s views, but it starts (as sort of a headline) with a statement given by “a senior economist”. It is apparant, that they want the reader to associate it to Meltzer. Also, they don’t mention that most (all?) of Meltzer’s simulations assume a CFR of 2% or less. “normal growth rates” is not, what I would call a “great rebound”
anonymous – at 02:34
Wow. You are attacking where no attack has been made. You are accusatory where no accusation is justified. Pick a random name that has nothing to do with any other board and isn’t your real one. I don’t know who you are and I don’t care. We don’t trace you. and you certainly don’t have to justify pseudonymous postings to me! ;-)
And I could care less what happens on other boards to you or anyone else. This is Flu Wiki; I’m a mod here, not anywhere else.
But I’m afraid that your lack of factual content in that last post is undermining your presentation. Back up and reconsider. You have things entirely backwards. where are you being attacked as a troll on this thread or in this forum?
anon_22: added a page with the 4 quadrants for planning. The 4 sets of strategies might be discussed at the Forum.FluwikianStrategies? place.
Thanks, lugon, that is useful.
Thanks for reviving this thread. The other thing that always stuck with me was Meltzer’s quote: “You can have all the numbers you want and plan and prepare and all that, but I guarantee you (his words) when the pandemic occur, what you have done will not be enough.”
that doesn’t mean a lot. “enough” is not exactly defined. If you spend X on prepping, then we could always ask: “why didn’t you spend 2*X” ?
anon,
“If you spend X on prepping, then we could always ask: “why didn’t you spend 2*X” ?”
Well, that’s always the problem, isn’t it? We tend to always think we should have done more.
But I think Meltzer meant more than that, that chances are the pandemic will have consequences that are far beyond what you can imagine today, and we won’t find out till we get there.
WHO said very early on to countries to “do everything that you can do NOW. Don’t just plan it and think you are going to do such and such when the pandemic has started. Cos when the pandemic arrives, there will be many new problems that you cannot think of right now”
(This is not an exact quote, but a paraphrase, even though I put them in quotes for ease of understanding.)
OK, so what does Meltzer think is a suitable/optimal amount for X ?
_That_ would be useful information.
Increasing X is not just some financial sacifice but in some countries
will directly kill people due to reduced support for other things.
Also, WHO can’t be serious when they say “everything”. This sort of
agenda just reduces their credibility (further).
The point is, you need some sort of probability estimates and
estimates for the expected impact of a pandemic.
As long as you don’t talk about this as well, any request for spending
money on panflu preparedness is rather meaningless.
Meltzer at CDC said what Leavitt at HHS says at each of the state forums: Before the pandemic, (whatever we do) people will say we did too much. After the pandemic, (whatever we do) people will say we did too little (paraphrasing). It’s a boilerplate talking point.
Anonymous, you bring up a stubbornly familiar pont.
but stubbornly familiar point which is valid (by logic !)
and which is being ignored stubbornly.
Before the pandemic, (whatever we do) people will say we did too much
no wonder, when Meltzer and co. refuse to say how big they
really think the threat is.
After the pandemic, (whatever we do) people will say we did too little (paraphrasing)
…
and ? didn’t you left out something ?
What will poeple say, when there will have been no pandemic ?
I didn’t leave it out, Leavitt did. But yes, 1976 is certainly on their minds (swine flu experience).
However, they realize there will be a pandemic eventually (90% certainly that a pandemic will happen in their own, their children’s, or their grandchildren’s lifetime).
that’s more than 100 years and could be a 1957,1968-like pandemic.
Nothing to really worry about.And IMO it’s less than 90%, maybe 80%.
Where did you see 90% ?
1976 in their minds could indeed be a problem. Do you think, that’s the
reason for the small attention in the media ? But it’s still much more
than in Europe, and Europe has no swine flu memory.
Meltzer also left it out. Or quoted without recognizing this, if you prefer. This reduces his credibility (a bit).
Question: Is there anything at all about the way H5N1 is playing out that looks more like ‘57, ‘68, or ‘76 rather than 1918?
Closed to increase Forum speed.