Continued from here
FrenchieGirl – at 13:23
LMWatBullRun – at 13:38 — As discussed elsewhere, I think the tipping point for significant collateral damage will be more related to how many people get sick at a given time. If 25% of the people in this country became ill in a couple of weeks, almost regardless of the CFR, I think that might be enough to set off a cascading system failure.
INFOMASS – at 14:03 — LMWatBullRun: Do we have any analogous experience in which large fractions of the work force were unable to come to work in the past fifty years?
I was in London (UK) during a winter in the early nineties when a particular bad seasonal flu hit the population. It was said that 40% of the workforce was sick. In Greenwich District Hospital (South-East London), in my area, they did not have enough staff, were putting ill people in corridors. I had some difficulty in getting my normal shopping as deliveries weren’t regular and a number of shelves were bare for days. However what was missing in some shops was generally to be had, sometimes with another label, at another. I remember queuing for a while at petrol stations because some had run out. I do not remember any power cut, save trains were late or cancelled (which would have happened with British Rail anyway for a number of reasons other than this). I did not use the bus, only car, train, tube. I do not recall anything special with the tube, save the usual bomb alerts. This state of things lasted about 10–15 days, after which everything came back to normal. However, I never forgot. You may want to ask Anon_22 if she remembers when it was exactly.
Oremus – at 14:16
If you look at some of the hospital stays of bird flu survivors (sometimes 30 to 40 days), the number of people sick at any one time will be high.
JWB – at 15:31
Olymom – at 11:40 (yesterday) You can hide your own Easter eggs! I like that one!
FrenchieGirl at 1323
re:”I was in London (UK) during a winter in the early nineties when a particular bad seasonal flu hit the population. It was said that 40% of the workforce was sick…”
I think you have related a perfectly clear prequel to a pandemic.
The severity of what we now consider to be a “bad” case of seasonal flu would pale next to the severity of a pandemic strain. People were months recovering from H1N1 in 1918……
…and the few known survivors of H5N1 in 2005–2006 are no different. Months to recover, with serious complications…
Yep, I can hide my own Easter Eggs. And we have learned that it is FAR better to hide chocolate eggs instead of hard boiled real ones because finding an old chocolate egg is DEFINITELY better than an, ahem, “mature” egg.
There is an excellent movie, “Awakenings” about a patient who is brought out of a coma after about 3 decades in a coma. I believe the patient had been a healthy young man until he got a violent case of flu (perhaps the 1918 flu?). This movie is based on the real life experiences of a doctor in New York City. (Oliver Sacks? Can’t remember . . .oh yeah, that’s what started this posting . . . can’t remember . . .)
Anyway, just because there isn’t a death, doesn’t mean a life isn’t ruined.
“I think you have related a perfectly clear prequel to a pandemic.”
Grace. I think this time it may be those pigs in China that are the prequel to a pandemic.
“…and the few known survivors of H5N1 in 2005–2006 are no different. Months to recover, with serious complications…”…Exactly!!
Even with hospitals most die…and if you live…you may wish that you died…like SARS.
The Coup in Bangkok is worrying, any thoughts.?
Red Aleart in Africa XDR TB goes airborn.
Don’t get caught looking the other way.
ah the good old (very bad), threat assessment. I don’t know about TB in Africa but there are those two clusters in Indonesia… that country still with the exceedingly high CFR (death rate derived from clinical cases of H5N1) if we aren’t at level 4 for a pandemic alert we should be and I believe we will be very very soon
Moeb - at 05:19
In July I sent an email to WHO regarding the current alert level, questioning the fact that it should be at a 4 and not 3. Received a response from Donna Eberwine-Villagrán, Editor, Public Information, Pan American Health Organization/, World Health Organization with a bunch of mumbo jumbo as to why they are currently at level 3. Interestingly enough, I received an email from her yesterday. Going to cut & paste it here, please tell me what you think.
The subject box read “FYI”
Dear Sabby34,
You might find this interesting. http://mediresource.sympatico.ca/health_news_detail.asp?channel_id=131&news_id=10765
Best, Donna
Donna Eberwine-Villagrán
Editor, Public Information
Pan American Health Organization/
World Health Organization
525 23rd Street N.W.
Washington, D.C. 20037
Tel. (202) 974–3122
Fax (202) 974–3143
Here is the link she attached. http://mediresource.sympatico.ca/health_news_detail.asp?channel_id=131&news_id=10765
oops….did not mean to double post the link
it was good news, the appointment of a special advisory board on the threat level at WHO. we of course know that level 4 has not been announced (to date) but heavily discussed. I think WHO has painted itself into a corner in this regard. Once it goes level 4 under current rules many countries must kick in actions that have serious ramifications.
they will have to overcome that reluctance and this advisory board is probably aimed at that.
More information about the panel is now on the WHO website:
http://www.who.int/mediacentre/news/notes/2006/np28/en/index.html
Because I am currently imobilized due to a nasty case of strep throat, I took the time to follow the links mentioned (and to the subsequent links mentioned) to read further details about this panel as they set them forth in the May, 2005, meeting. It was interesting reading, for anyone who wants to do similar wading through pages of legalese.
from link at 9:48
The final decision on whether to move up - or down - the pandemic alert ladder rests with the director general.
—Will the panel announce/leak their recommendation to increase the level if the director general decides not to?
I think the Director General has already decided to raise the alert level.
And I think the 20 member ad hoc committee that has been convened (ahead of schedule - was due to be convened next May) is chartered with gathering and presenting the rationale, and getting agreement from all the U.N. member states.
Not holding my breath, BUT if they do, will be surprised….but still nothing on the news or other places yet.
Swell.
Did WHO finally get around to appointing a Director General ?
Indonesia should rate a Level 4.
Period.
What do you think would happen if they did announce a level 4 ? close the country ?, stop trade ?, would it start a chain of events here?
I think that those that keep track on the various flu blogs and news sites, would begin to prep alittle more,,,try to convince their friends and relatives alittle more,,,try to get those preps that they are short of alittle more,,,and pay attention to the news alittle more.
DennisC – at 23:46
Speculation
Member states agree on and are ready with common course of action before WHO announces phase 4.
1. increased production of Tamiflu
2. government and public stockpiling for 2 weeks
3. activate training and recruitment of volunteers
4. change in employment, disability, maternity leave regulations
5. education campaign on social distancing
I was looking over the WHO pandemic plan:
http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5.pdf
on page 15: item 1 is to start a panel of experts (they did that last week). Now the interesting thing is that the action is for interpandemic phase 1
I just looked. Isn’t that normal? The document is long but I will get through it. Thanks for sharing. Phase 4/5 Question: It mentions larger clusters are an indication. What is the largest cluster of humans we have seen…reported? It’s not like we have seen half of a village hit. It tends to be the individuals that handle birds.
According to the WHO plan - governments are only required to notify the public about the likelihood of shortages of ‘basic commodities’ when we reach PHASE 5!!! That will be kinda late for the non-wikians who have not yet prepped!!
I want to note for all of us that it is a lot easier to criticize something that somebody else has already drafted rather than try to think of all the angles when you are drafting from scratch. But couldnt we somehow let them know that there are some serious problems with ‘the plan’ - i.e. they are just so focussed on the medical aspects that they have completely ignored the rest of the issues, like food water fuel economy - I wonder why these things are not addressed?? Is there anything we can do about it?? The written equivalent of ‘hey you have a run in your stocking’ - any ideas of how we could accomplish that??
gharris: Awareness Week. Reach out. To the max.
And we SHOULD also create a summary of “neglected issues in pandemic preparedness”. As a way to help. With alternatives as to what to do, specifically: stock up, save, localize etc.
bump
I am speculating that the decision to appoint a panel was triggered by 2 events 1) the disagreement between the UN and WHO a while back about raising the pandemic alert, and 2) the vaccuum at the top of the WHO right now. Even after election, it will take a little time for the new DG to establish his/her authority. More importantly, the fight between countries about who should hold the DG job will be less ferocious because of the panel, which in effect reduces the power of the DG. I think its a good idea.
DennisC - at 00:01: There is more info on the setting up of the panel in the 2006 World Health Assembly Resolution and specifically the International Health Regulations 2005 (IHR) which come into force June 15, 2007 (at which time the panel formulation and purpose changes). Wading through the PDF’s, look for Article 48 which has the most detail on the panel and other similar issues.
Pixie – at 18:24 thank you
Question (suggested by anon_22 a few weeks ago): is “possibly secondary cases / all cases” ratio increasing?
Sources:
Limitations of the sources:
Method:
Please check my figures but I get the following:
Looking at 2006 in 3-month periods:
Interpretations:
Conclusion:
I don’t want to say I’m sure about all this. Please review and comment. Thanks!
Lugon-I’m reading this, but I feel that I don’t know enough about R-naught to make an intelligent comment.
Limitations of the sources:
We may have enough information to build up a case to “here’s the data, make up your own mind” to the public, or at least to the more educated part of the public (or to those who, like us, are doing their best to catch up as fast as possible). It certainly looks like things are getting slowly worse, and certainly not better.
Green Mom - R-naught is defined as the average number of secondary cases. In past pandemics I think it was between 1.8 and 2.1. It has to be higher than 1 to start an epidemic, otherwise it “dies off” because each case yields less than one new case.
I read somewhere that WHO pandemic stages 4 and 5 would correlate with R-naught lower than .5 and lower than 1.0 respectively. These would be averages and there would be other factors to take into account, sure.
Here’s my shakey conclusion (please prove me wrong!): The proportion of cases that are compatible with H2H transmission is growing as time goes on. The same fact could be explained by a more efficient B2H transmission. The first case would be uglier than the other but I don’t like any of these interpretations.
lugon. We need to chase Monotreme around and get him to comment on this data. Thanks for all of your hard work.
Yep, and Monotreme once told me this was more someone else’s business. We’ll find out and get in touch.
Thanks for your encouragement!
Lugon, are there other specific “signposts” you are looking for to solidify the conern your formula raises? If so, please let us know so we can all be looking for it too.
Lugon-I have (reluctantly) learned what R-naught is (Sort of)and what you say makes sense to me, but I just don’t have the depth of knowledge here to refute you. It does seem to me, as a lay person who is somewhat knowledgable about this, but by no means an expert, that we should be at a level four, as far as the R-naught factor and other medical/epidemiological evidence indicates, though I also know that there is a political/economical factor to be considered. What I’m wondering is-what would a level four alert mean-to the average person? Will certain plans go into effect, quarantine measures, for example? I know theres an epidemilogical difference between levels 3 and 4, but what would a change in levels mean socially/politically/economically? I thought I read somewhere that certain goverment/corperate plans were keyed to the WHO pandemic levels.
Heres a scenario:I know that if WHO goes to a 4 everyone here on the WIKI will be excited (NOT PANICKED!!!!) because we know what that means in terms of pandemic spread. But if I go out and tell, say, my dentist?- “WHOS pandemic scale has just gone up to four!” She would look at me and say “So?” Whats the short answer I can respond with? Will borders close? Will school shut down? Will food prices skyrocket? Will anyone outside the flu community even notice? Does anyone know?
The big hole (okay, a gapping, glaring, crater) is how many people (if any at all) either had mild symptoms or none at all? It may be doing more H2H transmissions than we know about because people don’t get that sick. However, in the absence of that data, it does seem that there is a clear rise in the number of what I call “almost clsuters” - cases where there may have been H2H (turkey, Indo) or cases where people in nearby areas are coming down with the same things (certain parts of Indo recently). The other key fact for me: >60% die. Unfortuantely that fact has not changed much over time.
Green mom - just tell them TS is close HTF and they better get to Costco real soon.
Appologies if this is somewhere else, but do we know what the R factor was for SARS? Or better yet, other viruses that behave like influenza in that people are infecting others more often BEFORE they know they are sick vs AFTER (eg SARS, Ebola). I’m just curious what theose figures look like and how health officials reacted to them.
As Greenmom suggests, we should try to think of other explanations for Lugon’s logical and well presented results. One is more sick domestic birds living close to humans. Another is a mammalian source for which the efficiency of transmission (and maybe proximity to people?) is higher. A third (least desirable) is that the virus is “evolving” towards an R0 higher than 1.0. Note that all three could be happening together. Greenmom, tell the dentist that if it goes to 5, he may want to shut down his practice for a while. If it goes to 6, he may not want to leave his house much. Lugon, I do not know how you could squeeze much more out of the data. If you didn’t torture them, they certainly were roughly (but fairly) handled.
Green Mom at 12:59 -
You asked the question that if WHO goes to 4, “ Will borders close? Will school shut down? Will food prices skyrocket? Will anyone outside the flu community even notice?”
When everyone on Fluwiki was wondering a week or so ago about whether WHO had, or was planning, to go to level 4, I asked this question to someone at a high level of planning/knowledge. The response I got was no, and, if or when they do go to 4, “…there will be blood on the floors of stock markets around the world.”
I do not personally know that will be the situation, and others here can debate it. But, if that is true, then yes, people outside the “flu community” will notice.
Lugon:
Your premise is sound, but as LauraB points out there could be mild cases changing the numbers. Also, I don’t know how but with the recent info of a Tamiflu blanket used in India, and the thousands of dengue cases, it’s possible the numbers are really higher,but we can’t prove them.
LauraB-at 13:17,The question about mild or asympomatic infections was addressed by Dr Osterholm last April.He said that there were six studies involving over 5,000 people from Indonesia,Vietnam,and Hong Kong who had close contacts with H5N1 victums.Less than one in a thousand had evidence of a mild infection.Dr Osterholm said he was confident that the real mortality rates are close to those reported based on this.The huge CFR`s are a very big graveyard to try and whistle past.
I just watched a webcast of a Grand Rounds presentation by Dr. Darell Trampel, Extension Poultry Veterinarian and Poultry Diagnostician in the Iowa State University Veterinary Diagnostic Laboratory given through www.prepareiowa.com. His slides were available at the course website, though it is necessary to be registered (free) for the course. [Their live webcast courses are usually available by video streaming shortly after the webcast.]
Dr. Trampel gave a detailed presentation on flu science, the history of H5N1, etc. At the end of the presentation, someone asked when the virus is likely to arrive in the U.S. He responded that “it is still IF not WHEN”. He said that a migratory bird virus is slow to be transferred between Eastern and Western hemispheres.
I’m a dyed-in-the-wool pessimist, so I failed to be cheered by his optimism. However, there was much interesting information in his talk, e.g., longer survival of the virus in colder than in temperate water, survival in frozen poultry products (some of which are smuggled into the U.S.), fecal dust on feathers (at least once the cause of a human death), transport of “vagrant”, not migratory, birds from West Africa to Western hemisphere by tropical storms. Some of this country’s trading partners, notably Mexico, have already banned the import of U.S. poultry because of the low path H5N1 found in wildfowl.
LauraB – at 13:17
The big hole (okay, a gapping, glaring, crater) is how many people (if any at all) either had mild symptoms or none at all? It may be doing more H2H transmissions than we know about because people don’t get that sick. However, in the absence of that data, it does seem that there is a clear rise in the number of what I call “almost clsuters” - cases where there may have been H2H (turkey, Indo) or cases where people in nearby areas are coming down with the same things (certain parts of Indo recently).
I thought that hole was plugged in Turkey when the results came back as NO asymptomatic carriers ?
I’ll have to dig back for a URL, but I remember it clearly.
stillwaggon - at 15:52, I posted this in yesterday’s news thread. AnnieB included it in today’s summary:
Migration and spread of H5N1 virus (link http://tinyurl.com/ylw2x8)
I noticed that the clusters Lugon used are all through WHO. We have some that never got to WHO. Wouldn’t call them clusters, but cases within a geographical area in Indonesia. That is the change we are seeing. It’s not like the Karo cluster. More spread out now.
Moeb posted an article in the news thread a doctor in Vietnam is interviewed. He said they wonder about the poultry workers, why didn’t they show symptoms? After they found the antibodies in the blood of the recovered victims they did animal tests and the antibodies were protective. Now, they want to test the blood of the poultry workers to see if the antibodies are present. So, I think now that they know what to look for they will perform more of these type tests trying to determine the percentage of mild or non—symptomatic flu. To be honest, I’ve always believed there had to be a mild or asymptomatic sub group. If they don’t test, we’ll never know.
JV 13:58 With that kind of immoral thinking, what impetus will spur WHO to ever post stage 4? I guess I first see a complete breakdown of society and its structures, then WHO will feel comfortable upping it to a 4. With the economy at the top of the list, they have got everything to lose and nothing to gain by ever posting 4, right?
Hi everyone. In a sense it is bad news both ways. However, I believe the news is far worse if we start to see identified asymptomatic infections. Asymptomatic infections allow many passages through humans and the more passages the greater chance of selective adaption and mutation. There is nothing good about this.
At the moment, H5N1 has a very high kill rate but still must be acknowledged as a foreign virus poorly acclimated to humans.
Either way, I believe all required mutations are going to occur at once (astounding the experts one last time) and the pandemic virus is going to pop up…either scenario above would be a factor in respect to timing, with widespread asymptomatic infections pointing to a pandemic far sooner in my opinion.
Tink – at 16:26 JV 13:58 With that kind of immoral thinking, what impetus will spur WHO to ever post stage 4? I guess I first see a complete breakdown of society and its structures, then WHO will feel comfortable upping it to a 4. With the economy at the top of the list, they have got everything to lose and nothing to gain by ever posting 4, right?
Correct, Tink. The world economy will shudder very meaningfully when phase 4 is announced. Whether it recovers from shudder or proceeds on to crash will depend on how quickly we move from phase 4 to 5 and then 6. It is possible that phase 4 could last long enough to allow markets to adjust to the “new normal.” However, given the fact that we should already be at phase 4, I am skeptical that H5N1 will grant us much of a furlough between phase changes.
Tom - are you watching the five thousand plus cases under surveillance in Thailand? AnnieB posted a story in yesterday’s news thread. I just checked the Ministry of Public Health site for Thailand and there is not an update for today yet. This, combined with the Reuters story about the Fujian strain of H5N1, which mentions cases in Thailand, has certainly gotten my attention today. I would appreciate your opinion on this:)
Tink at 16:26 -
Re WHO:
“With the economy at the top of the list, they have got everything to lose and nothing to gain by ever posting 4, right?”
That may be exactly their problem!
jeez puppies eat alot A WHOLE LOT! meanwhile I don’t believe there are any significant quantity of asymptomatic infections, since this is a holy grail in regards to H5N1. If they existed they’d have been found by now.
what? that defies expectations? a lot of things about H5N1 defy expectations. lately I’m wondering if there will be time for members here to come together in various groups. or will it be, that the idea will take too long in the forming then moving to action and pandemic will be upon us?
lugon – at 08:17
It appears you did a lot of work figuring that out. I do not have time to look at this right now, but maybe I can help…
Go to the large file commincation project and download the excel document I made when I was doing research for individuals (and clusters). The name of the file is “Individuals info for graphs” or something like that.
It has several pages of information, and should be relatively easy for you to figure out. I think you are frustrated like I was in the fact that the WHO data is not complete. This is one reason why I did the individuals like I did. I will be updating the cluster page in November when I have more time.
I have listed the source for the individual, the onset date of Symptoms, (& other dates). I have also listed comments to the very right of the row, if I found something that didn’t fit. It is also color coded by month. and color coded by cluster…. I should add the colors are there only to highlight and to separate…. no other reason. I may have a later version, but it does not have many differences, but I will be happy to ask dude to post it if you wish. Sometimes, the onset date of symptoms was not known, but I used the WHO methodology to determine an onset date. (These are listed in orange font).
The entire methodology is also listed at the top of the pages….
Some information was taken from studies, promed, and other sources, but they are clearly identified. I am quite sure, if I had more time, I would have located more cases, from more sources that could be validated.
Let me know if you have any questions….
lugon, TomDVM and Infomass,
Here’s what I think, fwiw. Some people get infected directly by birds which has a very low R0, say .1. However, other people get infected from a mammal with a much higer R0 say, 0.5. There are many infected birds but a relatively small number of infected mammals. The bird form is very difficult to get in spite of close and repeated contact. Poultry workers have been examined. They are almost never infected. Meanwhile, many people with only very limited exposure to birds have been infected. My subjective impression is that the mammalian form is still under selection and actively evolving for more efficient transmission. Humans are mammals and are hence more susceptible to this form than the avian form. However, it may be that efficient transmission in the mammalian reservoir, whatever that is, may still not result in a R0 greater than 1 in humans, at least not until the winter. And this is the other issue that is not often appreciated. R0 doesn’t just depend on the genetics of the virus. It also depends on the environment. It’s possible that an H5N1 strain that is capable of efficient and sustained H2H already exists, but will not become apparent until the right environmental conditions occur, ie, winter. Perhaps a strain with a current R0 of .5 will jump to 1.1 under winter conditions. After that is acheived, H5N1 will come under full selection in humans and we can expect the R0 to increase further.
We don’t know whether a strain of H5N1 already exists that has the ability to cause a pandemic in the winter, but it’s possible. If so, there is no reason to expect a decrease in CFR from it’s current level. On the contrary, I would expect the CFR to go up, not down. There is no reason for the CFR to drop until after the first or second waves have worked their way through the human population.
wild but I also think the CFR could go up when the pandemic hits
A further thought. Perhaps we should regard the conditions that led to the Karo cluster as an artificial winter. People were in close contact in a small room with poor ventiliation. Perhaps this facilitated H2H transmission which in turn facilitated rapid evolution of the virus to a more easily transmitted form. Fortunately, it was summer and the specific conditions that occurred during most of the transmissions in the Karo cluster did not occur more widely. In addition, it is possible that the Tamiflu blanket was also helpful. If this is the case, then an efficiently transmitted virus strain already exists, just waiting for the right conditions to occur again, ie, winter.
Perhaps this is what Dr. Nabarro meant by “God’s time”.
moeb – at 21:20
Not wild at all. This is standard viral evolution. Most viruses become more lethal to their victims as they become better adapted, not less. The statement that H5N1 *must* decrease it’s lethality as it adapts to humans is sheer balderdash. I don’t know of any precedent for this strange statement, other than wishful thinking.
Here is experimental proof that flu A becomes more lethal as it adapts to a new host:
The genetic basis for virulence in influenza virus is largely unknown. To explore the mutational basis for increased virulence in the lung, the H3N2 prototype clinical isolate, A/HK/1/68, was adapted to the mouse. Genomic sequencing provided the first demonstration, to our knowledge, that a group of 11 mutations can convert an avirulent virus to a virulent variant that can kill at a minimal dose. Thirteen of the 14 amino acid substitutions (93%) detected among clonal isolates were likely instrumental in adaptation because of their positive selection, location in functional regions, and/or independent occurrence in other virulent influenza viruses. Mutations in virulent variants repeatedly involved nuclear localization signals and sites of protein and RNA interaction, implicating them as novel modulators of virulence. Mouse-adapted variants with the same hemagglutinin mutations possessed different pH optima of fusion, indicating that fusion activity of hemagglutinin can be modulated by other viral genes. Experimental adaptation resulted in the selection of three mutations that were in common with the virulent human H5N1 isolate A/HK/156/97 and that may be instrumental in its extreme virulence. Analysis of viral adaptation by serial passage appears to provide the identification of biologically relevant mutations.
and
Adaptation of human influenza virus to mice by serial passage results in the selection of highly virulent variants that have acquired mutations in multiple genes
From:
The fact that H5N1 is already highly lethal to humans is proof that it is already largely adpated to humans, not the converse as the soothers would say. I have come to the conclusion that the soothers are largely innocent of any knowledge of virology whatsoever.
they of course hang there hope on natural selection and the idea that the virus will die off it kills it’s hosts to quickly. you know
any thoughts on less lethality over time (once it’s become adapted)?
I am tempted to read the link since you suggest that increase in virulence is a given in test after test using H3N2 and point out the resemblance in H5N1. I gather I base my supposition on what it does to chickens. It kills em all and keeps on ticking. I don’t see yet, why it won’t do that in us.
where do you stand on forming groups? are you going to SIP solo (with family) or do you see a local group forming?
monotreme, if H5N1 reassorts with H3N2 then there is reason to assume that the CFR would go down. And the CFR also went down during the 2nd wave in 1918. Even Osterholm assumes that the CFR would go down in a pandemic. No flu-pandemic in human history is known with a CFR as high as actually. How can H5N1 be highly adapted to humans, when it always dies after a few generations of human infection ? The changes can only be conserved, when they are transmitted to other hosts.
moeb – at 21:44
they of course hang there hope on natural selection and the idea that the virus will die off it kills it’s hosts to quickly.
And I know you know that this demonstrates a shocking ignorance of natural selection and flu biology. For those who haven’t heard the obvious response to this point, here it is: Flu viruses are transmitted before patients become sick. Even H5N1 patients who are doomed to gruesome death are out and about spreading virus for days before their symptoms impair their mobility. Hence there is no selective pressure for the virus to decrease it’s lethality. The ultimate fate of the original host has no effect on the spread of flu.
any thoughts on less lethality over time (once it’s become adapted)?
I used to think this was a sure thing. After the first or second wave, attempts to evade the human immune system have resulted in milder strains of flu in the past. This is because the polymerase genes which are responsible for viral replication can be recognized by the immune system of someone who was infected before. Immune system evasion is now under intense selection. The result seems to be a polymerase that is not recognized by the immune system but which does not work as well resulting in slower replication, lower viral load, and lower pathogenicity.
However, there is evidence that multiple genetic strains of H5N1 are evolving in China. I don’t what the heck is going on over there, but the Chinese are doing *something* that is causing unprecedented, incredibly rapid proliferation of novel viruses. It is now possible that even if you survive one strain of H5N1 another may come along in 2 years which your immune system does not recognize putting you at the same risk as someone who was never exposed to any H5N1 strains. This would be the true worst case scenario, which even I have not dared contemplate for very long.
References
Pandemic Influenza: Risk of Multiple Introductions and the Need to Prepare for Them
anonymous.
“No flu-pandemic in human history is known with a CFR as high as actually” We have a very small data set. The CFR estimates etc. for 1918 have fluctuated what best could be described as widely. We know little about 1890 and 1830 other than they were similar in virulence to the 1918 strain. The only pandemics that we have reasonable numbers for are 1957 and 1968. I do not believe you can make the conclusion you do in the statement.
‘ if H5N1 reassorts with H3N2 then there is reason to assume that the CFR would go down’ This could very well be true but why would a ‘kissing cousin’ of 1918 bother to reassort when it is perfectly capable of doing it by mutation directly…and maintain present CFR’s or according to Monotreme, possibly increase CFR. The only way your above scenario works is if we have multiple pandemics in the next fifteen years which I think is most likely anyway.
The CFR in 1918 was artificially low because the first wave provided partial immunity to the second wave…and the first and second waves provided partial immunity to the third wave etc. If the first wave of the imminent pandemic is virulent, all bets are off as to CFR’s.
‘The changes can only be conserved, when they are transmitted to other hosts.’ Not according to Dr. Taubunburgher…the avian virus did it unaided.
‘How can H5N1 be highly adapted to humans, when it always dies after a few generations of human infection ?’ Past performance is not a measure of future behavior in a fast mutating, fast evolving influenza’s.
The problem is that influenza A has the rather nasty tendency to shed virus for several days even before the infected person falls seriously ill, and for several days afterwards. It’s ultimate lethality matters little once the virus has spread. Over the short term. Longer term, lethality may decrease and morbidity may increase, assuming that there are still hosts…
This is some bug.
I think any fool could see the Chinese thing coming… you mask a problem you shouldn’t be surprised if it keeps bubbling underneath. What comes at me out of it all is that first and foremost… no vaccine for six months (nothing new there) but with subsequent vaccine production combining yet new variants. Much like today but with severe consequences due to CFR.
in a nut shell we’re worse off and all the vaccine work to date is mostly beneficial from an infrastructure and experimentation basis only
moeb – at 21:53
I gather I base my supposition on what it does to chickens. It kills em all and keeps on ticking. I don’t see yet, why it won’t do that in us.
Yep.
where do you stand on forming groups? are you going to SIP solo (with family) or do you see a local group forming?
My state/city seems to be taking prepping pretty seriously. Unusual, I know. It also has alot of geographical advantages. However, I am working on an alternative location in case I decide the planning is not sufficient for the challenge. I haven’t decided where yet, though I have some candidates. Based on Jumping Jack Flash’s suggestions, I’m looking at small towns with hydroelectric power plants located nearby. Google search “hydroelectric” plus GoogleMaps are useful tools.
“I don’t what the heck is going on over there, but the Chinese are doing *something* that is causing unprecedented, incredibly rapid proliferation of novel viruses.” Monotreme
Recipe: take HUGE numbers of poultry + HUGE numbers of pigs + HUGE numbers of humans…pile them one on top of another at the interface between domestic animals and wild animals…let them incubate for a while…
…then add antivirals to the animal feeds and vaccinate only a portion of the poultry flocks and pigs…
…end result - China Flu.
on high CFR- remember that smallpox (virus but not flu) had a CFR of 25% up to 80% when it was first introducted to the Aztecs and Incas-
“1521…smallpox devastated the Aztec population. It killed most of the Aztec army, the emperor, and 25% of the overall population…….. The Spaniards said that they could not walk through the streets without stepping on the bodies of smallpox victims….
Within a few years smallpox claimed between 60% and 90% of the Inca population, ….”
http://en.wikipedia.org/wiki/Smallpox
The point being- viruses can have a high CFR within a given population.
I have a theory: if you follow this problem enough certain things become obvious as you move along. Grouping is coming.
I would have named my two new puppies “pan” and “demic” but I would have never wanted to call them to come’r
Dennis C. I would also say that if this virus is only going to affect 25% of the population then a pharmaceutical company must have come up with a recipe for ‘fairy dust’ that protects the rest.
Smallpox demonstrated that the attack rate without immunity was between 85–95%.
The funny thing is that that my friends at the WHO quote these figures but then do not follow up with an understandable ethical scientific explanation…
…a wonderful combination…acting with impunity and immune from prosecution.
as I understand it there are now three distinct strains of H5N1? with several sub clades? (if you can’t tell by now I only pretend to be really really smart)
Thanks to all to what I have been personally struggling to articulate.
The CFR means nothing to the virus. I see viruses in the same context of a chemical reaction, similiar to fire. A fire doesn’t know or care what it’s doing, and it doesn’t have any kind of ‘communication’ with another fire.
What is key, or rather what is unique in our present society is our travel/interactions to each other. Yes, in 1918 a R0 factor is key. You can contain it or it will burn out out. That doesn’t apply IMHO today.
When this gets legs it will explode.
(sorry for no spell check,l I’m tired in in a hurry)
Small pox is what I thought of when I first started considering the possible calamity produced by the China flu. I think all of our planning is for naught. There are too many things working against us. The unwillingness to come clean by the Who and others, the use of less than adequate vaccines in China and our lack of foresight in ensuring adequate vaccine production. I’m starting to lose hope.
moeb – at 22:25
I have a theory: if you follow this problem enough certain things become obvious as you move along. Grouping is coming.
Well, if there was time, we could found a new town - “Flubiobia”. The city would get power from hydro or wind farms, every house would be have as much solar collecting power as possible. It would be located near a source of fresh water and good arable land and not near any megacities. The citizery would be flubies and sustainable living advocates. It would be structured like Main Street USA (in Walt Disney World) - a diverse group of shops with apartments above them for young adults and empty nesters. Family homes would be within walking/biking distance. The homes would have big front porches and wide sidewalks to encourage social interactions between neighbors. There would be a small but good library, a small community center and perhaps even a bandstand.
Yeah, I’ve been day-dreaming too much.
Tom DVM
WHO has selective memory and has been saying things like there could never be a pandemic with a CFR as high as 60%. But history shows that it is very possible. I don’t know why they don’t admit it.
I would be thankful if it does drop to 25% CFR. When I run my numbers I usually pick 30–35% “out of the hat”. I think we were lucky in Turkey, but it did show what is possible.
Did you notice the list of birds in the “new strain report”?-
to wit:”Most isolates are from ducks and geese, but many wild birds from Hong Kong (common magpie, crow, large-billed crow, white-backed munia, munia, Japanese white-eye, little egret, crested myna, and robin).”
those with Sparrows,ducks, chickens, geese,… are becoming a big list.
Notice the robin.
Monotreme – at 22:47 “we could found a new town “
did you live in a commune in the 60′s?
What a dork!! That’s toooo funny :)
Sorry…I meant that for Moeb’s comments about the dogs…I read slower than the rest of you I guess
Stephen Hawking had it right when he said that we should be putting research into colonizing space. We seem to have run our course on planet earth…at least in this phase. After reading the rumors thread, I’m in a state of depression that’s just not healthy. It’s like I’m leading parallel lives here. I see what’s coming and yet everyone around me seems oblivious.
DennisC – at 22:50
did you live in a commune in the 60′s?
Nope. And I’m well aware that almost all attempts at communal living have failed. The only such experiment that ever succeeded, for a time, was the Shakers. Unfortunately, they prohibited procreation which tended to slow down additions to their communities ;-)
Although my daydream does not require communal living, it is probably not practical because it would take very few non-conformists to ruin my sustainable living paradise. Sometimes hippies give birth to cigar-chomping, red meat eating, Humvee driving, bambi shooting, uh, non-sustainable living advocates. And what are you going to do with them, run them out of town when they turn 18?
Monotreme, I LOVE the sound of your “make believe” town. It’s just the kind to suite me!
Monotreme..run them out of town
it sounds good but….what do we do to the ducks on the pond, the robins and sparrows in the yard, the cats and dogs,… and do we keep the schools open? :)
Can’t I go away for almost two days without hearing about the HuChina Flu. My solar plexus started bothering me around 2:30 central time but I wasn’t able to get on until after 9.
Monotreme – at 22:47 I like your vision!
In my fantasy town, I’d get to pick the personalities (kids too) — had one of our offspring attend an alternative school for two years (second and third grade — a fabulous alternative to ritalin for a boy who just needed a little more time) — anyway, everybody there wanted the best for the kids — but “best” meant long discussions on whether raisins were a good snack or did they have to be organic raisins to qualify as “good” (God forbid a kid ever injest a HoHo) — it was a bit much a times.
Wonderer – at 22:55
Welcome aboard !
dork? I resemble that remark
JWB, I’ve been around a while. I read a lot and post a little. The news of the last few days has me a bit down. The news about the new strain out of China was the real kicker.
Wonderer – at 22:55
It’s like I’m leading parallel lives here. I see what’s coming and yet everyone around me seems oblivious.
You have lots of company. It’s amazing.
DennisC – at 23:05
it sounds good but….what do we do to the ducks on the pond, the robins and sparrows in the yard, the cats and dogs,… and do we keep the schools open? :)
Well, in my fantasy, we would teach kids not touch birds. We might have to ban cats for a while, sorry. Dogs, gotta find some way to keep them ;-). The town scientists would also be working on safe and effective vaccines :)
Of course we would all agree to close schools and SIP, if necessary, but this would be an “escape” community, so no human sources of infection would be possible. It would be as hard to find as Shangri-La, (and probably as realistic).
Flu sleuths:
I hope that the picture being painted is wrong. You’re discussing Darwinian survival here at the gene pool level not the prep level. Pandemic after pandemic there will be no health care let alone health care workers left. Basically, if you’re going to let it hang out-then hang it. People with chronic health problems are goners as much as young kids or teens and tweens. If you can’t walk a mile without getting out of breath—same thing. The viral wave being projected will drown everybody. What have I left out?
Oh-If there have been mild cases, then the antibodies produced might save us from cursing our long dead ancestors. I see mild cases as providing the first gate response.
“Monotreme – at 21:15
lugon, TomDVM and Infomass,
Here’s what I think, fwiw. Some people get infected directly by birds which has a very low R0, say .1. However, other people get infected from a mammal with a much higer R0 say, 0.5. There are many infected birds but a relatively small number of infected mammals. The bird form is very difficult to get in spite of close and repeated contact. Poultry workers have been examined. They are almost never infected. ____
Except that the polybasic cleavage site is DIFFERENT between the chickens and the people. The poultry workers are not infected because people aren’t getting it from poultry anymore. The human strains are pretty much all alike, and have the Qinghai cleavage, and this is NOT what the birds have. This whole line of reasoning needs to be coordinated with the actual DATA.
Leo7 – at 23:42
“If there have been mild cases, then the antibodies produced might save us “
remember the news back in mid Sept:
“S. Korea confirms additional human bird flu contamination SEOUL, Sept. 15 (Yonhap) — South Korea’s disease control agency confirmed Friday that five people have developed antibodies to the lethal H5N1 strain of bird flu after taking part in the slaughtering and disposal of infected chickens and ducks.
The five people tested positive for bird flu antibodies, but none of them have shown symptoms of the disease as defined by the World Health Organization (WHO), the Korea Center for Disease Control and Prevention (KCDC) said. “
Monotreme- a BIG library- “A Great City deserves a great library”
Wonderer-don’t lose hope- its pretty grim, I know, and I’m probably not sleeping tonight (again!) Theres this-I saw a program on Discovery Health Channel tonight on the Black Plague-a little light entertainment to cheer myself up. I had read this before, but it was kinda neat seeing it on tv-anyway, the plague was devistating but it didn’t kill as many people as it “Should” of-why? Viriologists and historians suspect that some people have genes that made them immune to plague, and not only that, but plague survivers decendants who carry those cenes seem to be immune to HIV/AIDS. Nature has all kinds of surprises-some particuarly nasty, but others astonishing. We just don’t know.
Moeb…I use the word “dork” to describe people who are funny and whom I like (I fancy myself a dork)…I just want to make sure you know it’s a good “word” in my vocab. I know that’s odd, but I am odd, I guess. And I love it when I get a good laugh on here. Kind of takes some of the tension off.
yes Betty (gives you a stern look) the term for you would be dorkette (smiles)
one of these days, I’m afraid my humor will need to dry up and I’ll have to act deadly serious, damn it anyway
With reference to my post at the top of the thread FrenchieGirl – at 13:23 I was in London (UK) during a winter in the early nineties when a particular bad seasonal flu hit the population….
Eurosurveillance has just published (October 2006) a report entitled: “Surveillance of influenza-like illness in England and Wales during 1966–2006″ which confirms what I was saying above: the winter flu season 1989–1990 was particularly bad then, with the worst peak in infuenza-like-illness (ILI) in the previous 13 seasons. In the discussion part of this report, I quote the following:
Reconscout….That info is contained in this article:<p><a href=http://citypages.com/databank/27/1320/article14219.asp> This Thing Just Continues To March</a>
Closed for length and continued here
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Frenchiegirl refers to http://www.eurosurveillance.org/em/v11n10/1110-224.asp
This should be “readable” by public health officers, no?