tamiflu for prophylaxis - dilemmas
tamiflu for treatment - dilemmas
Does anyone know of documentation that explains the case fatality rate for those without antivirals?
I’ve seen something somewhere, but I don’t remember exactly what I was looking at.
I’ve asked that question before…wondering what CFR would be with no medical intervention.
From the little reading I’ve done on the subject, there have been relatively few who presented as “mild”. I’m guessing that most, if not all, were given antivirals at some point. But I could be wrong on that.
Antivirals would presumable be given to all presenting symptoms at the time they seek medical care (or are surveyed/screened).
Since antivirals are limited in availability at this point, the greater question (at least to me), seems to be what the CFR would be with NO advanced medical care. Which is the boat most of us would find ourselves in, should this go crazy.
I thought that at least in Turkey, those that died were given Tamiful late - likely because they didn’t know what they were dealing with initially - and those who got bf later were given Tamiful quickly and survived. The whole efficacy of the drug is that you have to take it within 48 hours of first symptoms. Many others who have died may have received it but it was too late.
There is also uncertainty as to dosage - it may take much more than the current recommnded doseage.
I do not know if it helps or not, but I DID ask my GP for a prescription for Tamiflu. I got some flak for mentioning it here as I was told I had to be under a doctor’s care to take it. However, I feel that I am capable of determining if I, or my loved ones, need it. Will it work? Dunno. But I got it and if things go south, I will be able to use it.
I highly recommend that anyone concerned about it go and ask their doctor about a prescription. I had no problem, but then, I talked, I think, with him and articulated my concerns (not to mention loaning him the ‘Great Influenza’ book). Give it a try.
There are no scientific studies which would give us a window into the efficacy of Tamiflu in the outbreaks we’ve seen so far. Remember that in places like Indonesia, record keeping and surveillance are primitive to non-existent.
Thanks Melanie…better you say it then me.
The picture is further, and enormously, obscured by the fact that those (on the records) who received Tamiflu did so in hospital settings.
We are therefore talking not about Tamiflu alone, but Tamiflu with supply of antibiotics to fight any secondary infections, very adequate hydration, and above all, use of ventilators if needed! Plus round-the-clock personal care and monitoring, lab work, etc etc.
Myself, I would rather have such hospital care as that and do without the Tamiflu, then have a kilogram of it at home alone.
<Antiviral sceptic! Shame on me!>
To address Nickolai’s point first: yes, those who received it, most did so in hospital settings. But you also have to think that most who died died in hospital settings with icu and antibiotics and everything, some with tamiflu and some not. It would still be accurate to say that tamiflu makes the biggest difference to survival even with the best care provided in most places, and the timing and secondly the dosage and/or duration are most important considerations.
LauraB is correct in that in Turkey, the average time of starting treatment with tamiflu (standard dose) was 3.6 days for survivors and 8.5d for fatal cases. For ?Thailand, the figures (median) are 4.5d vs 9d. Assuming no problems with availability and delivery etc, it would be almost criminal not to give tamiflu in light of such data, IMHO.
We do not have figures for those who survived without tamiflu, because we don’t know how many of the milder cases did not receive it. I suspect from around late 2005, very few of them would NOT have been given tamiflu, if only to reduce virus shedding to reduce the risk of transmission.
The current best practice, almost-official, certainly used as standard by some countries that I know of, is twice the normal dose (ie 2 tablets or 300mg twice daily) for 10–14 days.
Melanie,
“There are no scientific studies which would give us a window into the efficacy of Tamiflu in the outbreaks we’ve seen so far.” Yes, there is now, see my post above.
Nicholai,
“<Antiviral sceptic! Shame on me!>”
For your own benefit, I would suggest you reassess your thinking to determine how much of it is rational and how much ideological.
anon_22,
Do you have links to those studies? I haven’t seen them referenced anywhere in the literature yet.
Patch,
“I’ve asked that question before…wondering what CFR would be with no medical intervention.”
You can get a sense of that by considering the seroprevalence data that we have so far: Cambodia, 0%, Vietnam 2.4%, Indonesia 2/400+ or <0.5%. That is, there were very few (or none) mild or asymptomatic cases, and the ones included in the official CFR of around 55% is illustrative of the situation.
Melanie, they are presented in conference at the moment. They are not enough as formal efficacy studies, but certainly enough for your ‘window into the efficacy of tamiflu’, IMO.
CORRECTION to 21:49 post:
the 2.4% for Vietnam was not seroprevalence, it was the percentage of asymptomatic cases of all confirmed H5N1 cases.
anon-22,
I’ll take your judgement on it and expect that since the scientists got on this so quickly we’ll have a stream of papers to study soon.
I’m just glad to hear that the docs are on this so fast.
Proper efficacy will have to wait for the NIH proposed study on the NEXT 300 H5N1 cases in Asia. Personally, I hope they never get that data!
When I say mild…I don’t necessarily mean asymptomatic….
I recall there were H5N1 patients who had milder symptoms, who were in the hopital under observation.
Patch, I don’t have exact numbers, but I think most if not all of them by late 2005 were put on tamiflu.
Roche’s Tamiflu suppresses Vietnam avian flu-study
Mon Jul 18, 4:47 PM ET
WASHINGTON (Reuters) - Roche’s influenza drug Tamiflu suppresses the often deadly avian flu strain seen in Vietnam, which experts fear will soon cause a human pandemic, U.S. researchers said on Monday.
They said tests in mice showed the drug, licensed for use against influenza in general, could suppress the newest strain of H5N1 virus that is sweeping though flocks of poultry in Vietnam, Cambodia, China and elsewhere in Asia.
Public health experts say the avian flu virus is mutating and fear it could develop the ability to spread easily from person to person and kill millions in a flu pandemic.
The H5N1 strain has killed more than 50 people in Asia since 2003. More than 140 million chickens have been killed in the region in a bid to halt the disease.
“We need to know whether antiviral drugs can prevent and treat avian flu, because in the early stages of a global outbreak, most people would be unvaccinated,” said Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, which funded the study.
“If a pandemic occurs, it will take months to manufacture and distribute a vaccine to all who need it.”
The team at St. Jude Children’s Research Hospital in Memphis, Tennessee, tested 80 mice with the drug, known generically as oseltamivir.
None of the mice that got a placebo and then were infected with the Vietnam strain of H5N1 survived. Five of 10 mice given the highest daily dose of oseltamivir for five days survived.
But writing in the “Journal of Infectious Diseases,” the researchers said eight of 10 mice given the drug for eight days lived.
This will help experts decide how much drug to use and how long to treat people should the virus begin to spread among humans.
The researchers found the new Vietnam strain is much more virulent than a 1997 variant of H5N1 that killed six people in Hong Kong.
“The H5N1 avian flu viruses are in a process of rapid evolution. We were surprised at the tenacity of this new variant,” said St. Jude researcher Elena Govorkova.
“Our results provide baseline information that will be needed for further studies on preventing and treating avian flu with antiviral drugs.”
Governments are buying and stockpiling doses of Tamiflu to use in case of an avian flu pandemic, but experts say they will need many more than the few million doses now on hand.
It’s an old article, and it’s on mice.
There probably won’t be any mice left in the cities for the starving to eat.
I sent the following commentary to a friend July 18, 2005. I think I used the worst case mortality of the country with the highest fatality rate at the time.
The team at St. Jude Children’s Research Hospital in Memphis, Tennessee, tested 80 mice with the drug, known generically as oseltamivir.
— The number tested seems small, I don’t know how accurate the percentages can be.
None of the mice that got a placebo and then were infected with the Vietnam strain of H5N1 survived.
— 100 percent mortality untreated
Five of 10 mice given the highest daily dose of oseltamivir for five days survived.
— 50 percent mortality
But writing in the “Journal of Infectious Diseases,” the researchers said eight of 10 mice given the drug for eight days lived.
— 20 percent mortality
— The article didn’t list treatments of longer than 8 days. — This goes with what I’ve read on the human cases; It kills in 9 days — I guess at this point you have either survived or are dead. — 20 percent looks to be the best we can do. (if we had enough meds, which we don’t)
— The 1918–1919 Pandemic — Infected approx. 20 percent of the world population - hard to know for sure — Infected approx. 28 percent of americans - number is fairly reliable — Killed 20 to 40 million world wide
— World population at that time was approx. 1.85 billion or 1850 million — 20 percent of pop. is 370 million infected — 20–40 million deaths gives a 9.25 to 18.5 percent mortality rate — 28 percent of pop. is 518 million infected — mortality rate is 12.95 to 25.9 percent — Ergo, the 1918 pandemic had a mortality rate of 9.25 to 25.9 percent
— Hurrah for modern tracking numbers.
— World population hit 6 billion in the year 2000, I’m not sure what it is now but based on recent growth it is approx 6.5 billion or 3.5 times as large
— Bird flu has a human track record of 62 to 75 percent mortality depending on the strain.
— So best case 20 pecent - worst case 75 percent - though could mutate into deadlier strain.
— best case 54 million dead — worst case 1135 million or 1.14 billion
Oremus, CIDRAP reports on a more recent version of the study, with results on ferrets. Ferrets being better models for human flu than mice
“best case 54 million dead — worst case 1135 million or 1.14 billion”
Actually, you cannot extrapolate the CFR in this way and get a meaninful figure. It depends on the epidemiology of the virus versus the demographics of each country/region eg age, sex, occupation, pre-existing conditions, availability of healthcare, awareness of the disease, sanitation, and so on. The proportion of these groups or the prevailing conditions in different populations vary widely. Certainly the current H5N1 cohort of patients are seriously biased towards younger ages, for example. So the overall CFR per population in any location could be a lot less, extending those numbers to cover the whole world irrespective of these considerations would give numbers that are not very useful for planning or prediction purposes.
I am not a doctor, nor do I play one on TV. I always differ to those that know more. The purpose of my numbers were to try to alert my friend to the possible seriousness of the situation so she would become more informed. Accuracy is somewhere between 0 and 100 percent.
anon_22 Thanks for the CIDRAP link.
“Accuracy is somewhere between 0 and 100 percent.”
Ditto here….
lol
anon_22, In the ferret study, the control group also had a 100 percent mortality. Would we expect humans that received no treatment to have similar mortality? How effective would self treatment be for those that can’t receive hospital treatment due to the hospitals being overwhelmed in a pandemic?
Oremus, that is the $$$$$$$$ question, isn’t it? The biggest difference I suspect is not hospital vs non-hospital treatment, but tamiflu vs no tamiflu. Again this is only my best guess at the moment but I think tamiflu given early enough with supportive care of the kind that is possible at home, eg fluid replacement and symptomatic relief, you stand a good chance of surviving. But that all depends on your ability to get those things in place now.
ACtually, backtracking a bit, this thread shows a real concern that has not been addressed properly even here on fluwiki, that is the percentage of population with access to antivirals would be marginal in a pandemic, whereas current worst case predictions are all still based on patients WITH access to antivirals in the vast majority of cases.
This is where even I want to go into denial…..
Wake me up when we’re all done with pandemics <sigh>
Also depends on the virus becomming tamiflu resistant e.g. the Viet Nam cases.
Actually, I am not too worried about tamiflu resistance at this point. The (limited) knowledge we have so far shows that those strains with mutations that will confer NI resistance have low fitness for transmission. In a pandemic, it would have to compete against the prevalent strain and would lose out. EXCEPT in a containment situation where 100% of the population exposed are already taking tamiflu and therefore will not get infected by the original strain, then there is a chance that the selective advantage will go to the mutant resistant strain.
The key to reducing the possibility of mutant strain is to give adequate doses for a long enough duration. The standard dose of 1 tab twice daily for 5 days will not be enough for that.
anon_22 – at 01:31 The key to reducing the possibility of mutant strain is to give adequate doses for a long enough duration. The standard dose of 1 tab twice daily for 5 days will not be enough for that.
I agree; in the mice study, the 8 day treatment showed significant improvement over the 5 day treatment. Do you know what the durations were in the ferret study?
8 days
Sorry, a longer answer is that when they measured the viral titre, for those that stopped treatment at 5 days, the virus came back, but not for those on 8 days.
Thanks. Good to know.
anon-22 at 21:41 says
“The current best practice, almost-official, certainly used as standard by some countries that I know of, is twice the normal dose (ie 2 tablets or 300mg twice daily) for 10–14 days.”
That is FOUR tabs a day for 10–14 days, or from FORTY TABS to FIFTY-SIX TABS for the treatment course. That is ranging from FOUR TIMES the dose on the package of ten up to ALMOST SIX TIMES the initial recommendation!
My very dated impressions come from early studies that used the original levels and observed an average 1.5 days cut in symptomatic duration merely. Also my ‘ridiculous’ thinking was coloured by reports of Tamiflu resistance, especially out of Japan.
Thank you sincerely, anon_22 for your advice at 21:43 that “For your own benefit, I would suggest you reassess your thinking to determine how much of it is rational and how much ideological.”
Clearly, my foolish ideology developed from what was at the time ‘the best scientific knowledge and practice’.
I stand humbled at being so behindhand in my knowledge, but I gently remind others, not you anon_22, that today’s best and most ‘expert’ advice may not be cut in granite either…
When—pardon, IF—Tamiflu becomes available to me, I shall get all I possibly can, thanks to your guidance.
One tab, twice a day for five days = 10 tabs. But above the
Last line ‘hid’ at the bottom when I edited in additional. Please ignore.
I know. It’s a real dilemma, availability vs efficacy, and what is the most ethical way to use tamiflu.
Given that as far as I know governments have NO VIABLE plans for distribution to sick people in the event of a pandemic, I would still say personal stockpiling would not be unethical in this regard.
We should be cautious about citing “studies” regarding treatment, as there have been very few. Observations made do indicate that Tamiflu might be efficacious, but these are just observations in poorly controlled conditions. The Turkey cases also included other early interventions. Limited controls and too many variables. And a hugh problem is, other than the SE Asia cases, nobody is sharing data. This is just as bad as the Wormbank issue regarding genetic information that is being hoarded. The resistance rule is that if you attenuate 9 strains with Tamiflu, the one with resistance mutation will be the sole survivor and will carry on. We must anticipate resistance at some point and the longer this percolates in humans, the greater the chance.
rrteacher,
While I agree that these are not studies, our current problem is we cannot wait for studies. As I said, the NIH study will take the next 300 cases, which is all well and good, except that we need to prepare for a pandemic that might happen before we have those 300 cases, with data analysed and published etc.
Also, the Turkey data was presented at 1st Bird Flu Summit at Washington DC in February 2006 by Dr. Huseyin Avni Sahin, Chief Physician, Van Yuzuncu Yil Research Hopital, Turkey. Follow this link scroll down to find his name on list of speakers. This was quoted by Haydn at the Lancet Forum in Sinagapore. So I wouldn’t say that we only have SE Asia cases.
Is this good enough as reference? Certainly not. Do we have anything more to work on? I wish there were, but there aren’t.
I would personally warn against being too cautious in recommendations to laymen at the current time given the potentially fatal consequences to a lot of young people if a pandemic happen soon. I feel very strongly about this as an ethical issue. A lot of people are working as hard and as fast as they can. We must make use of the results of their efforts and modify them if necessary, instead of waiting for formal publication of studies.
More data will be posted as and when available.
Also, there are serious ethical problems with ‘controlled’ trials with H5N1 with the current CFR.
anon_22,
would you say more about the “ethical problems” please?
Agreed and conceed. I’m certainly not suggesting double blind crossovers. The point is that they have the data now that could be loosly used for a best guess. For $685 or a ticket to the Summit in six weeks, you can get the deluxe version. Case reports in any form would be helpful. I tried contacting this guy Sahin in January through Zkurmus @ CE, (she lives in Istanbul), and he would not respond, (due to fear of government reprisals, I’m told). Whatever the reasons, the clinical data needs to flow more freely.
We’ll you can’t give placebo Tamiflu to a patient who might die without it as a control. You can, however, make an observational study if you at least monitor and compare the other variables. Ventilator, CXR, Lung Mechanics, ABGs, etc.
I’m sure they did this. It is a teaching hospital. But is sucks to have to wait for a “conference” to get it.
I will say that the arguing factions (me is one) petitioning CDC/HHS for increases in ventilator stockpiles are betting on specifications that are based on what we think will work. Their successes and failures in this area would be helpful.
(microrant)
Just a tiny question troubling me. I’m sure any of several well-informed folk will be able to clear it up.
If, as anon_22 has established, and I fully accept: “The current best practice, almost-official, certainly used as standard by some countries that I know of, is twice the normal dose (ie 2 tablets or 300mg twice daily) for 10–14 days.”
Which I have to accept, of course, and go on to quantify:
That is FOUR tabs a day for 10–14 days, or from FORTY TABS to FIFTY-SIX TABS for the treatment course. That is ranging from FOUR TIMES the dose on the package of ten up to ALMOST SIX TIMES the initial recommendation!
Then what about side effects observed when Tamiflu was used prophylactically? If it requires a vastly enhanced dose to be effective after infection, surely it must require a proportionately higher dose to protect.
For essential HCW and utilities suppliers to feel assured of protection, it is proposed to give them the antiviral…for the period of an eight-week wave.
But at a dosage commensurate with the above agreed dosages? Is there, perhaps, more than some small danger in that?
‘If a little bit is good, more must be better…and most is best of all’ may not strictly apply here.
Perhaps I am being irrational and ideological again, but I would feel easier if this were debunked for me.
Thanks!
While I am no meidcal testing expert, I was a statistician/researcher for coproartions BK (before kids). Unfortuantely, what evidence we have about the effectiveness of Tamiful is limited, albeit promising. There are a few issues to say definitively if Tamiful will work:
1) small samle sizes of those who have received it. Even if all 200+ knowm BF victims received it (which doesn’t appear to be the case), 200 is a small sample for medical testing.
2) many received it too late - although the Turkey results indicate that early dosage can help
3) uncertainty over the dosage - again, has not been well tested
4) whatever mutated viral strain causes H5N1 to go H2H could react very differently to Tamiflu vs the B2H the 200+ patients have had
5) if people start taking Tamiful preventatively we could easily devleop a Tamiflu-resistant strain, in which case it does no good to anyone.
6) outside variables such as treatment received is inconsistent country to country and can greatly impact patient’s outcome. Again, wider scale testing with far more patients would be needed to be able to remove outside fators, along with age, etc.
Oh yea. Then, of course, not enough people can get it.
In a nut shell - yes Tamiflu MIGHT help, especially if taken early enough. I think if you have some, great. If you don’t, don’t panic. It’s certainly not a sure bet, there are lots of fakes out there, and given limited supplies my HO is medical personnel, etc. should get it first. I can’t get any and am not willing to try for potential fakes, etc. Maybe this thing will take long enough to H2H that there will be enough. In the meantime, keep prepping.
There is no cure for highly pathogenic H5N1 period.
Unwanted ‘primary’ effects of prophylactic dosages of antivirals include hallucinations and erratic to violent behaviour.
In the absence of a post-event solution, prevent the event.
As part of your preparations, take steps to make your body work properly now, so that the virus cannot effectively colonise your cells when you are exposed.
rrteacher,
“But is sucks to have to wait for a “conference” to get it.”
I agree. But it is still faster than peer-reviewed journals.
And Haydn was kind enough to relay it.
And then of course I posted here ASAP.
So just hope I get more chance/time/stamina to go to conferences like that.
There are no easy answers to the question of use for prophylaxis. Especially in the context of essential workers rather than post-exposure. Problems/potential problems include:
The tamiflu dilemma in the context of treating patients in a pandemic by H5N1 in its current form goes like this:
So if a government eg UK says it will have enough to cover 25% of the population (which would have been everyone who gets sick assuming clinical attack rate of 25%), that only means the standard dose of 1 tab twice daily for 5 days (=i packet). Doubling the dose for treatment and doubling the duration for 10 days means that you only have enough to treat 6.25% of the population, (or 1 in 4 of those who get sick).
And that’s not counting what you need for post-exposure prophylaxis, currently set at 1 tablet daily for 10 days. If each infected person has 4 family members (and this is grossly underestimating the no of contacts) then you need a minimum of 8 packets per patient to include treatment and prophylaxis to save lives and to stop people running around infecting everyone else. That means there is enough for 3.125% of the population, or 1 in 8 of those who get sick.
The other 7 will do ….what?
And we haven’t started counting prophylaxis for essential workers and healthcare workers.
And that’s for countries that have or will have a ‘25% stockpile’. That’s not the US, folks, in case you are wondering.
And again we haven’t figured out delivery.
Prioritizing scarce resources will be the norm for a pandemic. These are life-and-death issues and IMO should be debated widely NOW. Societies need to arrive at some consensus, however painful, while cool heads still prevail. When people are dying, the time for consensus is gone.
Very scary anon_22.
I hope these numbers are made public, because we, or rather the authorities, need to rethink a lot about what people are to do during a pandemic.
Is there any possible way of having successful isolation or selfquaranteen in place? That would mean either prepping or arranged food-distribution with procedures for handing over food etc.
NS1 – at 06:20 - “In the absence of a post-event solution, prevent the event.”
I agree that helping yourself (and family) by preparing to “take steps to make your body work properly now” makes a tremendous amount of sense. If/when we are faced with infection on a worldwide scale our individual chances of obtaining Tamiflu are very likely negligible.
“Prevent The Event” and for all of the reasons in NS1’s brief post above, in my view, is as important a preparation as storing enough water.
“Prevent the event” (my new mantra) is almost as catchy as “if they do not fit you must acquit!” ;-)
Excellent NS1!
“I hope these numbers are made public”
That’s what I am doing here, NOW.
Please feel free to use what I have posted, but please remember to check back from time to time in case new data becomes available. And also I think you need to include as far as possible the logic of the dilemma rather than just numbers, to have the desired effect IMO.
Thanks anon_22
:-)
mmmelody47 – at 07:18
Please remember though
Oops, there I go again?
I’m very concerned about the masses relying on denial first and then the hope of anti-virals to carry them thru this potential PF51 crisis. As Anon_22 has so carefully stated, we do not know if our best case scenario counts of anti-virals will have even a minor overall effect on public health against this viral strain. The reproductive number on efficient and sustained H2H HP H5N1 is going to create an exponentiation of needs and we have a finite stockpile.
the new study on Tamiflu resistance had a few possible mutations which they say would not reduce the transmissability of the virus. Once panflu has reached USA or Europe it might quite well be resistant. And then in one other study resistance developed in the infected person himself in 3 (or 2?) from 8 cases. So, I don’t think we have a better chance than 50% that Tamiflu will work in a pandemic.
After those numbers, it becomes even more obvious that delivery of drugs will be a nightmare. Even assuming that there is no infrastructure breakdown and you’ve got the manpower (which is highly unlikely) and you are able to get the stuff to the right patient within the timeframe (which is even more unlikely), to the extent that fully 7/8 of infected patients will not be the target of such deliveries, what is to stop whoever is doing the delivery or in charge of the stockpile to divert the drugs to their private use? Or to the blackmarket?
If most of the dying patients are young people, what do you think desperate parents will do to get their hands on the drugs?
What do you think then that parents whose kids are not yet infected will do as they watch supplies rapidly disappearing?
anon_22 - are you keeping a personal stock of tamiflu to your recommendation?
NS1 – at 07:30 - I just read your profile. Those few words say much of who you are. Nice “talking” to you.
Parents are strange creatures at times.
I’m sure in the US that we’ll see supply and distribution “disruptions” due to parental influence via the black market or personal direct action.
All for a drug not even rated against H5N1 and failing in most cases to offer protection.
The reason why I am not focusing on tamiflu resistance at the moment is that we truly won’t know till it happens, and I am not willing to divert very precious mental energy on that unless it becomes a high probability.
“anon_22 - are you keeping a personal stock of tamiflu to your recommendation?”
Yes, for a total of 10 young people in mine and my immediate extended family. Not enough for anyone over the age of 30.
mmmelody47 – at 07:52
The profile was very hard for me to post, as I am a very private person with a very public work.
Just trying like all the others here to make a difference where I can.
Nice talking to you too.
The Final Nail? We count on antivirals ‘to hold the line’as we struggle to create and manufacture vaccines…
A parallel note of unparalleled consequence:
Copy the following to a piece of paper, tape it to the edge of your monitor, then re-read ALL the above posts.
THERE CAN BE NO EFFECTIVE VACCINE FOR SOME TIME AFTER THE EMERGENCE OF THE INITIAL PANDEMIC STRAIN AND THEN PRODUCTION TO ANY MEANINGFUL LEVEL WILL ENTAIL FURTHER MONTHS UNDER THE DURESS OF SUPPLY AND PERSONNEL DISRUPTIONS BEFORE EVEN SOME DISTRIBUTION CAN BEGIN IN A THEN POSSIBLY RAVAGED SOCIETY. WHILE EVENTS BECOME MORE CHAOTIC, THE VIRUS CAN MUTATE AS DID THE 1918–19 SECOND WAVE INTO AN EVEN MORE DEADLY STRAIN AND ONE POSSIBLY REQUIRING A QUITE DIFFERENT VACCINE…
Does anyone else see writing on the wall, or are my old eyes playing tricks on my elderly mind?
Let me go now and write that on the wall, Nikolai!
Nikolai, my young-ish eyes see the same thing.
The other half of the ‘twin pillars’ against a pandemic (antivirals and vaccines), is being discussed on a new ‘vaccinations strategies’ thread. I’m afraid, Nicholai, that it is not more encouraging than here. Sorry.
We can only produce vaccine for a fixed target safely.
And I can very wholesomely question the safety even with current production methods. Seeking untested solutions when under the gun of impending pandemic may reduce the accuracy another few notches?
That would leave the last line of defense. Supportive care. Plan for the best, expect the worst, as it were.
And the first line of defense:
A properly working immune system behind social distancing.
Include in your food and material preparations some activities that will prepare your immune system for the various onslaughts of H5N1 and subsequent bacterial and fungal secondary infections that are sure to spread as well.
If my family stays isolated won’t we be OK? If we stay in our house and accept no visitors, won’t we be OK? If someone comes to our door and we talk to them through a closed window, will we be OK? Should I be more focused on being able to stay away from people?
I spent $500 on Online Tamiflu and it looks OK but maybe the $500 would have been better spent on more food to be isolated longer.
Many of the doctors I know feel that way, Watch Dog.
Just remember, after an H5N1 pandemic, the virus will likely replace H3N2 as our annual flu. You will have to eventually get vaccinated, even if virulence is attenuated over time.
If we have great than 10% of the population infected and more than one wave, it is probable that you will be exposed in some form and some dosage.
The key is to reduce the amount of exposure, but you won’t likely get to zero exposure even upon your best efforts.
Anon_22
Did you say that Dr. Sahin has published clinical data somewhere, and could you provide a link?
Thanks,
Richard
rrteacher at 19:31
There is no requirement for influenza vaccination for most of the population.
The difference in a High-Path H5N1 vaccination and a future seasonal low-path H5N1 is exactly the same difference between today’s High-Path H5N1 and today’s seasonal influenza.
There’s just no comparison because they are entirely different genetic organisms with entirely different vaccination risk factors.
rrteacher,
“Did you say that Dr. Sahin has published clinical data somewhere, and could you provide a link?”
Not that I know of. Only what I got from Haydn see my post at 03:14.
Thank you everyone for the input. I was thinking about coming out of isolation when there was a vaccine available or some form of life saving treatment.
Hopefully I will have enough supplies to last till then.
Watch Dog. I think our only choice is to learn to live with this virus…and I think it is possible to do just that even though it will take some effort.
Self-quarantine is a good concept in theory but I believe impossible in practise. Forget one little thing and you will have to break it…A family member or neighbour phones desperate for some help and I think it will be in our nature to help them…the good side of human nature.
Lets hope H5N1 just disappears…if we have learned to expect he unexpected from it, that would be the most unexpected turn of events right now.
If we do get the pandemic, there will be no vaccine for the masses. This can be predetermined by the evidence that is currently avaliable.
Antivirals. I have my doubts.
The good news will be that 50 to 80% of the population will either not get sick at all or get sick and recover with no long-term effects…
…but believe me when I say that no matter what, this is going to be a very difficult journey, no matter the overall survivability.
I’m also convinced that we will be living with some pandemic strain in the next 2 years.
NS1. Two years would be better than my intuition of less than 12 months.
anon_22 @ 03:14
“Also, the Turkey data was presented at 1st Bird Flu Summit at Washington DC in February 2006 by Dr. Huseyin Avni Sahin, Chief Physician, Van Yuzuncu Yil Research Hopital, Turkey.”
If he presented data, is there a transcript or printed version of his presentation?
Too Many Secrets!!
Two year old case presentations from SE Asia are the best we can get? There seems to have been a significant change in pathologies and outcomes since Viet/Thai cases. This is very important. I have a lot of people looking and so far , zippo.
I agree with what everyone is saying. I feel like I’m out of time. I know that isolation will fail at some point. I would like to make it past the panic.
I’d like to come out when there is order again. I hope by the time my family gets sick that there is help again. After the worst is over, don’t you think the world will have a chanch to re-group and re-organize efforts to provide supplies/meds again?
Won’t the goverment show up way too late with their help? I’ll come out then. How long will I have to wait for them?
Watch Dog. I think you have hit on the point exactly. It makes complete sense to maintain isolation for a short period of time until the initial panic is over…this is a workable and attainable.
As always however, there is a problem and that is not to start the isolation too soon…ie before the pandemic actually threatens your area. This is also a problem with limited drug supplies etc….start too soon and supplies will be exhausted when you need them.
I would ask one question to all who plan to self isolate. If your best friend or favorite relative phoned and requested that you break your isolation, one way or another, do you really think you could refuse?
I know I couldn’t and that is why isolation for me is not an option.
12 months is most likely Tom IMO.
NS1 — 01:16
“12 months is most likely Tom IMO.”
I feel like the novice I am, sitting at a high-stakes game in Las Vegas and nervously fiddling with my little stack of chips—sixteen weeks of preps, 16 white ones—while I glance around the table at others with stacks of reds and blues, of generators and firearms, solar power installations and their own wells! People I know are veteran and skilled players. People I admire—and envy.
And the Grim Dealer is shuffling the cards and glaring at me from under his green visor…watching me squirm.
But what is the poker term, having no more space or money, I just have to declare “I’m potted” now.
Dont underestimate yourself Nikolai. I suspect others may do so at their peril.
Nik-
You are far ahead of the rest of the world because you have a clear view of what’s coming and the sagacity to make sense of it all.
You’re not “potted” at all. You’re just measuring with the wrong stick.
rrteacher,
“If he presented data, is there a transcript or printed version of his presentation?
Too Many Secrets!!
Two year old case presentations from SE Asia are the best we can get? There seems to have been a significant change in pathologies and outcomes since Viet/Thai cases. This is very important. I have a lot of people looking and so far , zippo.”
No, only what Haydn said, no slide. Let me repeat in case this is confusing, what I got was what Haydn said he got from the Bird Flu conference in Washington in February. That’s it. If Haydn had any copies of slides, he would not have been able to present them without permission.
But to be fair, this is not 2 year old case presentations, we are talking about cases in Turkey, Jan and Feb 06. This is May 06, so it’s actually not bad as far as raw data go.
Also, if the Turkish authorities are unwilling to share data the whole times, there’s not much Sahin or anyone else can do. This might be as far as they can comment publicly without crossing their government, so let’s not pin our frustrations on what may be innocent parties.
If you want to discuss in more detail the clinical aspects, you can email me, (see my profile). I do not know much beyond what I am posting but I’ll have a go at your questions.
W\tch Dog,
“After the worst is over, don’t you think the world will have a chanch to re-group and re-organize efforts to provide supplies/meds again?”
Yes, there are a lot of mostly mid-level people working very hard on this, even though TPTB may not have the right policies to make things happen. I have recently been touched by some very dedicated souls who will always remain invisible to the public, but I do feel encouraged that with so much brain power and will, it won’t be complete apocalypse, at least not permanently or persistently.
Then there is the discouraging “What’s the Fatality Rate without Ventilator Support” - (“with” ain’t so hot, either).
-Not getting the pandemic virus, if it’s anything like the current H5N1, seems to be the first plan.
For even “social distancing” let alone “self-quarantine” to work takes education and preparations now.
Thank you anon
anon_22
To be fair to the good Dr.,(actually I believe he was a subordinate of Sahin), my contact made several “quiet” attempts to introduce me. She elaborated about the pressure the hospital was under and I can’t fault the medical staff for not wanting to go to a Turkish Prison. nasty places I’m told.
In 1918–19, Barry’s book suggests that the political and professional walls of competition didn’t really start to come down till lots of people were dying. There was Woodrow Caesar’s Law to be fearful of besides. We may need to develop a branch of the AMA just for medical espionage.
In the mid 1980s I was working with ID at the University of Oklahoma in developing pentamidine aerosol for PCP prophylaxis and treatment in HIV cases. Bruce Montgomery and Kevin Corkery at SF General had just published their work on it. In several phone calls and a letter, I was able to get as much information as I needed to tweak our program, some of which they hadn’t yet published. Not prudent perhaps, but it worked and we say a big decrease in out PCP/ARDS cases.
Thanks for moderating,….but it sucks just the same.
Old thread - Closed to increase Forum speed.