From Flu Wiki 2

Forum: Posts for Posterity

21 October 2006

Average Concerned Mom – at 13:39

Some posts are so thought provoking they must not be missed.

However they may be too long for the quotes thread, so place them here.

It would be helpful if you could indicate which thread they came from (and the time), so anyone wishing to see the context of the post could easily do so.

A link would be even better.

I hope in this way, even those who are short on time could quickly read through this thread and find the latest “deep thoughts” of the dau or week!

(You’re welcome, Tom) (-:

Average Concerned Mom – at 13:40

aw crud, deep thoughts of the DAY.

I really did try to proofread, too.

Tom DVM – at 13:45

Wow!! You’re psychic too.

Tom DVM – at 13:48

I dont mean to be harsh, but I see a lot of people ignoring reality here. In a severe pandemic, reality will be extremely harsh, and wont care what the paper says.

Harsh reality is that in the event of even a mild pandemic, you will not have either the beds available or the staff available to provide care to present standards.

Lets take a hypothetical hospital I know about, Hooville Hospital. It has about 565 beds, and presently averages 81% fill rate for those beds. It has about 700 doctors and 1600 nurses. Its located in Hoo County, which is around a hundred miles from a very large metro area (5 million people) and about 60 miles from a large metro area (1 million people).

Hoo county has about 90,000 permanent residents, and houses about 25,000 students at HooU, and is the health care service hub for the surrounding counties which have about another 160,000 people in the surrounding area.

Assume that all students are immediately sent home at the start of the pandemic so that the 10,000 beds of student housing are made available for flu patients.

Assuming only a 1918 level pandemic, at the end of week 1, Hooville Hospital will have seen at least 4500 patients. of those, at least 2250 will require admission; 450 will require ICU level care with ventilators. Assuming all the current patients are discharged immediately and that less ill patients will be discharged to make room for the more severly ill, there will be room for the 450 critical patients and 115 of the rest. Average stay for these patients is 24 weeks.

Assume all deaths occur only in critical patients. Of these critical patients, 225 will die, many quickly, some slowly. Assume half die quickly, and the rest die within 4 weeks; other patients will be admitted as soon as beds are cleansed and cycled.

At the end of week 1, the hospital will have 338 critical patients, 227 less severely ill patients, only 630 doctors left, and only 1440 nurses. It will also have 113 dead bodies to dispose of, and the morgue facility has space for only 24. Local funeral parlors have space for about 25. The local ice skating rink can stockpile as many as 600 bodies, however. The student dorms are now housing around 4000 very ill flu patients.

At the end of week 2, the hospital will have 565 critically ill patients. Some critically ill patients will not be seen at the hospital, all others will not be seen, and the docs will be down to 560, assuming all show up. Nurses will be down to 1300 or less. The dorms will be about full, with 8000 patients. (Who feeds these people or changes the linens?) This assumes that there is no civil disturbance, and that no locals insist with use of force, that their relatives be seen, a considerable assumption.

Q- how many nurses are required per day to support one ICU patient? 2? 3?

Q- How many ventilators are required (565)? How many does Hooville Hospital have? 25?

Q- Where are all the bodies going to go?

Q-What about all the people from the outlying counties, the other 160,000 of them? Where do they get medical care? There is another smaller hospital in town with a couple hundred beds, but theyll be overrun too.

Q- Who takes care of those in the dorms?

Q- What happens if the large cities to the north and east collapse?

So, 2 weeks into the pandemic we see that the health care system in one real hospital, in one real town, is overwhelmed in less than 2 weeks, and in many ways this is much better than can be expected in most locations in the US.

My point is, that if we are to be serious about trying to plan for an emergency, that we have to start with what the reality is now, and the reality is that we have NOWHERE NEAR the capacity required to deal with a pandemic using present protocols.

We have no antivirals. We will have no vaccine. we will have a tiny fraction of the ventilators needed. We will have a small fraction of the professional HCW needed.

Therefore, it is simply absurd to state that we will be able to care for the pandemic victims under these circumstances. Realistic plans for such an event will have to be based on telling people to stay home if they have the flu, on providing expedited burial services, and trying to prevent collateral damage. We will need docs and nurses after the pandemic to treat bacterial pneumonia. Panflu is a viral tidal wave. Killing our HCWs trying to stop it is like trying to stop a tsunami by lying down on the beach.

We WILL need HCW skills to treat those who survive the virus; not only is that a situation where trained HCWs could make a difference, but we will need plasma from the survivors to transfuse the newly ill and save lives. IMO, the only thing to do at the start of a pandemic is to close the hospitals, send everyone home, and tell everyone that they are on their own. alternately, you might set up a screening and triage station outside the facility, or several of them. There you could screen everyone, give them the knowledge they need to care for the sick, admit no-one with the flu, and send them all home.

This location, btw, is Charlottesville Virginia.

LMWatBullRun.

AnnieBat 15:20

I have mentioned this on some threads some time ago. I have given up using deaths as a ‘persuader’ for people to do something. I use the numbers to ask “how will you keep business, industry and support services operating?”

The NZ pandemic plan has some profound numbers. We have a population of just over 4 million people spread across the entire country. Assuming an attack rate of 40%, and a ‘downtime’ of 2 weeks with the illness, this means 1.6 million people will be sick AT THE SAME TIME. (In the Plan, they talk about the ‘peak’ of illness being in weeks 3–5 of the waves, so using a 2 week ‘downtime’ is still meaningful.)

That puts tremendous stress on all healthcare systems and makes an enormous hole in the workforce. Further, others will remain home from work to care for sick family members - even allowing that just 20% of those ill remove a carer from the workforce that is another 320,000 people not working.

Okay, now take your city or county or community that you live in. Apply the same attack rate percentage etc to your local populace then go ask your community leaders how they intend to maintain even the most basic services during that period.

26 October 2006

Tom DVM – at 11:38

I caught the end of the GSK ad on Discovery Health channel last night. Isnt this the vaccine with the proprietary adjuvantan oil-emulsion adjuvant, or closely related to the MF59 adjuvant that has caused so much concern as highlighted by anon_22 on a different thread? Has the proprietary GSK adjuvant been approved yet by the FDA for use in vaccines in the U.S.? If there is truly an oil emulsion adjuvant in this new vaccine they are already advertising, and it has not been approved yetwhats going on? Is this an effort to build early public support, without the public knowing whats in the vaccine, and cant find out due to proprietary status?

For the record, I do not always take an anti-vaccine stance; but I am in favor of full testing, full disclosure, and informed consent. Sometimes the testing of biological products is not thorough; and the current level of knowledge about interactions in molecular biology is not as complete, or has not penetrated as thoroughly, as we would like to think. We are not God, yetif everand there is need to behave in the professional world with great respect. Hopefully the public will demand full disclosure, and will be cautious about what they allow themselves to believe.

Words of Wisdom…Beehiver

tjclaw1 – at 11:49

I need some help figuring out a hypothetical for my county in the event of a 1918-type pandemic like you’ve done above - how many people will be sick, require hospitalization, die, etc.

County population: 36,000 Hospital beds: 60

beehiver – at 11:55

Tom DVM, thanks.

I am very upset by all this vaccine stuff this morning. I am, thank God, at the beach…and need to go for a walk, get my feet on a small place between the earth and the ocean for awhile. What a h^&* of a position to be in, that we might have to choose between being ill with this virus, or possibly life-long illness from vaccine side effects. I am tired of the deception and the secrecy.

I appreciate the connection, Tom.

27 October 2006

Tom DVM – at 12:37

Ants, were all ants running around on the surface of this planet in order to generate wealth. What is wealth? Food, shelter, goods, medical care, entertainment, etc. What activity is necessary for a nation as rich as ours to survive for six months with nobody going to work unless you are part of that minimal, absolutely necessary activity to keep us alive. I personally believe we can muster the resources to feed, house, and keep some of the lights on for long enough during this 6 mo. for most of us to survive, if we jut suspend the stupid economy that is not necessary. Bill me. I will agree to work off the effect on the Gross Domestic Product. So, just figure out who is necessary and shelter them at the place of work and figure out how to keep the water, lights and food coming. Let that be the only essential activity. Now, we can think of lots of creative ways to stop a few essential workers from spreading the flu when they do things and move about. We might have enough n95 masks, PPE, and pre-flu vaccines with some protection to get just that job done. And if we pass national legislation that suspends all contractual obligations without interest for the duration of the emergency and pay those who are involved in essential services a bonus for the risk (bill me for that too) then we may just save almost everyone and come out with our infrastructure and workforce in tack and rested from a home vacation with family and or friends. So, we are not capable of planning that? Give me a break. Stockpile everything you can think that we would need to do this (oh, bill me for that too). I dont give a damn about the economy, I care about the people. Let us see the models of that.

Dude.

Reconscout – at 13:27

I fully agree with you Tom.Another thing which is being ignored is the desparate necessity to build up food reserves for when the system tanks.Right now there is only a two month inventory.Years ago when we had subsidies for grain farmers(admittedly a pork barrel)the US had grain reserves for nearly two years.If we had legislation now to insure heavier than normal planting in the spring we might make it if the pandemic holds off until next flu season.You can bill me for that one.

Tom DVM – at 17:02

The Doctor at 22:46: Dr. Grattan, while I deeply respect your input and concern on medical issues, there is no way for you to know what path will be the best one to take for families to survive, based on the fact that we dont know yet what the landscape will look like.

You assume a CFR somewhere between 2% and 8%. What if it is much higher than that? What if our points of sale and distribution systems shut down for longer than 3 months? What then? How long do you really think our meager yet efficient stockpiles will last for just our families alone? The point is, your suggestions may work under one scenario, but they certainly cannot work under all scenarios. In other words, I feel a plan must be more fluid, more flexible.

You mention that it is within mans nature to band together in the face of calamity, and that each member of the group will add his or her skill to the common good. That may work for other parts of the world, but will it really work in most of the developed countries? It seems aside from just-in-time deliveries, we are also a vulnerable society in that many of the old useful skills and arts have been greatly diminished, if not extinguished. Look at the medical profession for example. How many doctors make house calls today? How many could go back to making house calls if they wanted to? Put another way, how many doctors are so specialized in what they do that they can no longer provide an adequate level of patient care regardless of the cause of illness? I would submit to you that not many could. How many blacksmiths do you know? How many people know how to make their own clothes, let alone wash them without a washing machine? Take a good, hard look around you. Most of your neighbors are accountants, administrators, yes, even lawyers. I dont mean to disparage these groups, especially since Im in one of them, but how many of these folks have useful skill sets in a pandemic setting?

The Romans used to say, never judge a mans life until you see the way he dies. Its obvious that we are all going to die someday. However, I surely dont want to die the way I have read about in John Barrys book. I dont want my family to go out that way, either. Im pretty sure everyone feels the same way. That means that when faced with that kind of horrible death, most folks would do anything they could to protect themselves and their families from it, at all costs. If another family knew what kind of medicines you had, and they feared they were afflicted or about to become afflicted with bird flu, do you really think they would defer to the greater good of the community? The same goes with food and starving to death. Neither picture is very pretty, and the Romans would probably agree that a man, woman or child who suffered that kind of death did not live a good life.

Furthermore, I dont believe anyone would stop and think what the legal ramifications would be if they or their family was subjected to loss of life or limb due to anarchy. Historically, there have been common law defenses to an otherwise criminal act where the person found himself or herself in such a situation. A look at the definition to necessity under Blacks Law Dictionary reads:

A person is excused from criminal liability if he acts under a duress of circumstances to protect life or limb or health in a reasonable manner and with no other acceptable choice.

I would think if a mans life were threatened by his neighbors, he would not be contemplating whether he should protect himself or not due to what the law may or may not do to him afterward. Remember, it is better to be judged by twelve than be carried by six. And if he is in the position of being judged by twelve, remember, those twelve would have managed to survive the pandemic somehow. I think those prospective jurors would be more or less sympathetic with their fellow survivors.

By your most recent comments (above), you seem to be arguing almost the opposite point of view, or Necessitas publica major est quam privata (Public necessity is greater than the private). But isnt this the same kind of argument that doctors are now using in order to deny requests for Tamiflu scripts? Arent they saying, in effect, I cant take care of you, an individual (even though you are my patient), when we might need these scarce resources in the event of a pandemic.? Or are you saying that the synergistic benefits of belonging to the group would outweigh each lone individuals achievements? But I dont believe that for my reasons stated above. Moreover, I just dont see the group reward is worth the risk in an infectious disease situation.

Although I cant readily agree with your suggestions on the PSG, they are thought-provoking. Moreover, it is conceivable that a situation would arise where a PSG would be preferable (low infection rate, low CFR, etc.) I appreciate your taking the time to further explain your position.

De jure

Tom DVM – at 17:06

PSG = Pandemic Survivors Group…a group of citizens that band together to as a group face a pandemic…rather than as a family or individual.

29 October 2006

Tom DVM – at 20:08

Itfs funny how some are so quick to brush aside gold and silver yet historically if you look practically anywhere in the world with basic civilization and trade you could get along quite well with plenty of silver or gold.

Now I grant that if you are expecting a loss of 95% of humans on the planet and going back to a caveman like way of life gold and silve my not do you much good while you are out hunting down the bear for dinner. I on the other and donft expect things to sink to that level. As long as there is basic trade, basic government or basic civilization silver and gold will do you well. Whether you are looking at the situation in Zimbabwe today where they they are better off using their $500 bills instead of toilet paper because one sheet of tp is worth more than the bill, Argentina in the 90s, Mexico or Brazil in the 80s, Germany in the 20s where people loaded up their wheelbarrow with printed money to go buy one loaf of bread, the US in the depresion, Holland during itfs Tulip mania, or the Roman Empire you will have done fine economicly with silver or gold.

Granted two hours after the 9.0 earthquake or the day after a EMP blast takes out all electronics in the country it is not the time to try to survive using your silver or gold. This is where your other preps come into the picture. Still, at some point, whether is it days, weeks or months after the event your silver and gold will have value. For some reason civilization goes back 100 years, guess what - silver and gold were valuable then; civilization goes back to colonial levels, guess what - silver and gold were valuable then; civilization goes back to medieval levels, guess what - gold and silver were valuable, civilization goes back to ancient (Roman, Egyptian, Persian) levels, guess what - silver and gold were valuable. In short ANYWHERE there is basic trade, government or civilization silver and gold will be valuable. That is, unless you are planning on being the only person within 200 miles living in a cave hunting that bear down for dinner that I mentioned.

Yes, other preps are vital. You need food clothing and shelter after whatever the event is. Do NOT think you can survive with just silver or gold. The day after your silver or gold may not buy you a piece or bread, this is the time your need your food, water, lighting, etc. preps, but at some point at a minimum basic trade and barter will start again (even if it is only on a Medievel level) then your silver and gold will make you very glad you were smart enough to have it.

RepoMadMan

30 October 2006

Tom DVM – at 21:10

Here is my interpretation, FWIW.

The Chinese government does not want phase 4 declared until the pandemic has started. The reason is that this will trigger travel restrictions to affected areas which would obviously include mainland China. This would decimate their economy. It would also have ripple effects on other economies, most notably the US. What would the value of factory be in country with a big biohazard mark on it be? What would happen to the value of the companies that depend on cheap labor in China?

China has controlled the message coming out the WHO via its control of Margaret Chan, the panflu czar. The untimely death of the former Director-General now allows for the installation of Margaret Chan as DG - the only person who can declare phase 4. Im sure China, and perhaps other countries as well, have made it clear that they do not want phase 4 declared until there is a new DG - a convenient pause. Once installed as DG, Margaret Chan will make the usual polite noises about preparedness, but if anything thinks she will apply pressure on China, the source of newly evolving strains of H5N1, to be transparent, well, Ive got some extra special bottled water from Harbin to sell you.

The American CDC is has very close ties to the WHO. For whatever reason, they have agreed to de-emphasize the threat of a pandemic as much as possible. They have deliberately sought to undermine preparedness in US states by claiming that .25% CFR is the worst case scenario. Further, Nancy Cox, et al., published a study that had been done years ago showing that old strains of H5N1 did not form highly infectious viruses when artificially re-assorted with H3N2. The publication of this negative, and largely meaningless, data seems calculated to provide an excuse to de-emphasize preparedness despite the fact that newer strains of H5N1 were not studied and the fact that the 1918 strain, which H5N1 most closely resembles, did not evolve by reassortment but rather by direct adaptation to humans, which H5N1 shows every sign of doing.

The net effect of WHO and CDC propaganda has been to confuse public health officials and slow down preparedness. I dont think everyone at the WHO or CDC has bought into this. Middle level scientists may realize that something is rotten, but they feel there is little they can do. They are also probably being kept in the dark regarding some of the data. Countries and US states that rely on the WHO and CDC for information are completely unprepared for a severe pandemic. However, there is another source of information. The US deparment of Homeland Security and some people in Secretary Leavitts group are much more concerned about the possibility of a severe pandemic. Their message is much more serious and focused than that coming from the CDC and WHO. States that listen to them have mounted very serious preps.

I also agree that there is bottom-up effort on the part of a number of scientists to alert the world. They are meeting considerable resistance from the WHO and CDC in getting their message out. Some of them are so frightened now that they are prepared to risk their careers to warn the world. We need to support them whenever possible.

Monotreme

Tom DVM – at 21:59

Heres 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 doesnt just depend on the genetics of the virus. It also depends on the environment. Its 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 dont know whether a strain of H5N1 already exists that has the ability to cause a pandemic in the winter, but its possible. If so, there is no reason to expect a decrease in CFR from its 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.

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 Gods time.

Monotreme

Tom DVM – at 22:27

they of course hang there hope on natural selection and the idea that the virus will die off it kills its hosts to quickly.

And I know you know that this demonstrates a shocking ignorance of natural selection and flu biology. For those who havent 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 its lethality. The ultimate fate of the original host has no effect on the spread of flu.

any thoughts on less lethality over time (once its 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 dont 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.

Monotreme

31 October 2006

crfullmoon – at 22:54

not written by a fluwikian, but…

James Wilson, 1788 …”Why may we not hope that,… our councils will be directed to the encouragement, and our strength will be exerted in the cultivation of all the arts of peace?

Of these, the first is Agriculture. This is true in all countries. In the United States its truth is of peculiar importance. The subsistence of man, the materials of manufactures, the articles of commerce - all spring originally from the soil. On agriculture, therefore, the wealth of nations is founded. Whether we consult the observations that reason will suggest, or attend to the information that history will give, we shall, in each case, be satisfied of the influence of government, good or bad, upon the state of agriculture.

In a government, whose maxims are those of oppression, property is insecure. It is given, it is taken away, by caprice. Where there is no security for property, there is no encouragement for industry. Without industry, the richer the soil the more it abounds with weeds. The evidence of history warrants the truth of these general remarks…

But is agriculture the only art, which feels the influence of government? Over Manufactures and Commerce its power is equally prevalent. There the same causes operate; and there they produce the same effects. The industrious village, the busy city, the crowded port - all these are the gifts of liberty; and without a good government liberty cannot exist. These are advantages, but these are not all the advantages that result from a system of good government. Agriculture, manufactures and commerce will ensure to us plenty, convenience and elegance. But is there not something still wanting to finish the men? Are internal virtues and accomplishments less estimable or less attracting than external arts and ornaments? Is the operation of government less powerful upon the former than upon the latter? By no means.

Upon this, as upon a preceding topic, reason and history will concur in their information and advice. In a serene mind the sciences and the virtues love to dwell. But can the mind of a man be serene, when the property, liberty and subsistence of himself, and of those, for whom he feels more than he feels for himself, depends on a tyrant’s nod? If the dispirited subject of oppression can, with difficulty, exert his enfeebled faculties, so far as to provide, on the incessant demands of nature, food just enough to lengthen out his wretched existence; can it be expected that, in such a state, he will experience those fine and vigorous movements of the soul, without the full and free exercise of which science and virtue will never flourish?

Look around you to the nations that now exist. View, in historic retrospect, the nations that have heretofore existed. The collected result will be an entire conviction of these all-interesting truths. Where tyranny reigns, there is the country of ignorance and vice. Where good government prevails, there is the country of science and virtue. Under a good government, therefore, we must look for the accomplished man.”…

If we would be happy; we must be active. The Constitution and our manners must mutually support and be supported. Even on the Festivity, it will not be disagreeable or incongruous to review the virtues and manners that both justify and adorn it.

Frugality and temperance first attract our attention. These simple but powerful virtues are the sole foundation, on which a good government can rest with security. They were the virtues which nursed and educated infant Rome, and prepared her for all her greatness. But in the giddy hour of her prosperity, she spurned from her the obscure instruments, by which it was procured; and in their place substituted luxury and dissipation. The consequence was such as might have been expected. She preserved, for some time, a gay and flourishing appearance; but the internal health and soundness of her constitution were gone. At last she fell, a victim to the poisonous draughts, which were administered by her perfidious favorites. The fate of Rome, both in her rising and in her falling state, will be the fate of every other nation that shall follow both parts of her example.

Industry appears next among the virtues of a good citizen. Idleness is the nurse of villains. The industrious alone constitute a nation’s strength. I will not expatiate on this fruitful subject. Let one animating reflection suffice. In a well constituted commonwealth, the industry of every citizen extends beyond himself. A common interest pervades the society. Each gains from all, and all gain from each.

It has often been observed that the sciences flourish all together. The remark applies equally to the arts. Your patriot feelings attest the truth of what I say, when, among the virtues necessary to merit and preserve the advantages of a good government, I number a warm and uniform attachment to liberty, and to the Constitution. The enemies of liberty are artful and insidious. A counterfeit steals her dress, imitates her manner, forges her signature, assumes her name. But the real name of the deceiver is Licentiousness. … With the giddy and undiscerning, on whom a deeper impression is made by dauntless impudence than by modest merit, her pretensions are often successful. She receives the honors of liberty, and liberty herself is treated as a traitor and an usurper.

Generally, however, this bold impostor acts only a secondary part. Though she alone appear, upon the stage, her motions are regulated by dark ambition, who sits concealed behind the curtain, and who knows that despotism his other favorite, can always follow the success of licentiousness. Against these enemies of liberty, who act in concert, though they appear on opposite sides, the patriot citizen will keep a watchful guard. A good constitution is the greatest blessing, which a society can enjoy. Need I infer, that it is the duty of every citizen to use his best and most unremitting endeavours for preserving it pure, healthful and vigorous? For the accomplishment of this great purpose, the exertions of no one citizen are unimportant. Let no one, therefore, harbour, for a moment, the mean idea, that he is and can be of no value to his country. Let the contrary manly impression animate his soul. Every one can, at many times, perform to the state, useful services; and he, who steadily pursues the road of patriotism, has the most inviting prospect of being able, at some times, to perform eminent ones.

Allow me to direct your attention, in a very particular manner, to a momentous part, which, by this Constitution, every citizen will frequently be called to act. All those in places of power and trust will be elected either immediately by the people; or in such a manner that their appointment will depend ultimately on such immediate election. All the derivative movements of government must spring from the original movement of the people at large. If, to this they give a sufficient force and a just direction, all the others will be governed by its controlling power.

To speak without a metaphor; if the people, at their elections, take care to choose none but representatives that are wise and good; their representatives will take care, in their turn, to choose or appoint none but such as are wise and good also. The remark applies to every succeeding election and appointment. Thus the characters proper for public officers will be diffused from the immediate elections of the people over the remotest parts of administration. Of what immense consequence is it, then, that this primary duty should be faithfully and skillfully discharged? On the faithful and skillful discharge of it the public happiness or infelicity, under this and every other constitution, must, in a very great measure, depend. For, believe me, no government, even the best, can be happily administered by ignorant or vicious men.

You will forgive me, I am sure, for endeavouring to impress upon your minds, in the strongest manner, the importance of this great duty. It is the first concoction in politics; and if an error is committed here, it can never be corrected in any subsequent process. The certain consequence must be disease. Let no one say, that he is but a single citizen; and that his ticket will be but one in the box. That one ticket may turn the election. In battle, every soldier should consider the public safety as depending on his single arm. At an election, every citizen should consider the public happiness as depending on his single vote.

A progressive state is necessary to the happiness and perfection of Man. Whatever attainments are already reached, attainments still higher should be pursued. Let us, therefore, strive with noble emulation. Let us suppose we have done nothing while any thing yet remains to be done…”

02 November 2006

Tom DVM – at 09:04

Old news - The New Straits Times, March 31, 1999

Singapore - Another eleven abattoir workers in Singapore have been tested positive for a newly-detected virus, one of the two which has killed 71 people in Malaysia. A government statement said the Hendra-like virus was detected in blood samples of the victims sent to the Atlanta-based Centres for Disease Control and Prevention (CDC) for testing. The abattoir workers were earlier suspected of being infected with Japanese encephalitis (JE). One of them have since died while six of the 11 remain in hospital, one of them in serious condition. http://tinyurl.com/ydfg4v ____________________________________________________

I posted this because I wonder if there is a trend in these old news stories - Japanese Encephalitis confused with hendra-like virus and mystery illness similar to that in Nepal?? The animals killed in the abbattoir possibly a mammalian vector for it??

gharris at 01:19 Hendra virus (formerly called equine morbillivirus) is a member of the family Paramyxoviridae. The virus was first isolated in 1994 from specimens obtained during an outbreak of respiratory and neurologic disease in horses and humans in Hendra, a suburb of Brisbane, Australia. Nipah virus, also a member of the family Paramyxoviridae, is related but not identical to Hendra virus. Nipah virus was initially isolated in 1999 upon examining samples from an outbreak of encephalitis and respiratory illness among adult men in Malaysia and Singapore.

gharris at 01:21 The natural reservoir for Hendra virus is thought to be flying foxes (bats of the genus Pteropus) found in Australia. The natural reservoir for Nipah virus is still under investigation, but preliminary data suggest that bats of the genus Pteropus are also the reservoirs for Nipah virus in Malaysia. Where are the diseases found?

Hendra virus caused disease in horses in Australia, and the human infections there were due to direct exposure to tissues and secretions from infected horses. Nipah virus caused a relatively mild disease in pigs in Malaysia and Singapore. Nipah virus was transmitted to humans, cats, and dogs through close contact with infected pigs.

How are Hendra and Nipah viruses transmitted to humans?

Pig farm in Malaysia, 1999. In Australia, humans became ill after exposure to body fluids and excretions of horses infected with Hendra virus. In Malaysia and Singapore, humans were infected with Nipah virus through close contact with infected pigs.

gharris at 01:26 Only three human cases of Hendra virus disease have been recognized. Two of the three individuals known to be infected had a respiratory illness with severe flu-like signs and symptoms. Infection with Nipah virus was associated with an encephalitis (inflammation of the brain) characterized by fever and drowsiness and more serious central nervous system disease, such as coma, seizures, and inability to maintain breathing.

Illness with Nipah virus begins with 314 days of fever and headache. This is followed by drowsiness and disorientation characterized by mental confusion. These signs and symptoms can progress to coma within 2448 hours. Some patients have had a respiratory illness during the early part of their infections.

Tom DVM – at 09:04

Sorry, I forgot to put at the bottom that this series of excellent posts were from gharris.

03 November 2006

Tom DVM – at 16:19

Ahhheemmm.

Im going to step in & mention something to the great minds at work here. This week is the national championship for the PBR (Professional Bull Riders). I love to watch bull riding. Ive never come close to actually being near a bull.but that doesnt mean that I cant appreciate the power and the danger they represent and I wouldnt stand outside the pen yelling at the big beasts just because they might not be able to get to me to retaliate. Id be afraid that Id make em mad and theyd take it out on the next brave bull rider that strapped himself on his back for the longest 8 second ride in his life.

My point is, to use a bull riders vocabulary, were here to git our bulls rode. Yes, for those who dont read cowboy, thats bad English, but by golly it gets the point across.

Weve each got our bull (our passion, our politics or whatever) that we feel we need to challenge and conquer proudly and were not going to be able to do it in 8 seconds. Weve got a LOT of bulls to ride in this flu competition before we can get to the finals & running off other bull riders isnt gonna help because the final score is based on what WE do with ourselves and our talent for other people around the world, separate and apart from our race or our politics.

In all the time Ive watched bull riders, they NEVER have done anything to endanger another bull riders life, but instead theyve done everything they could to support and encourage other riders. Even though theyre competing against each other, their attitude and their approach is to be inclusive to the benefit of all, not to be exclusive because they have the right to make that choice.

Boys and Girls, git your bulls rode safely enough that we ALL benefit, even if it means shuttin yer mouth a little bit and considering the other guy.

Ill return you to your discussion now.

I’m Workin’ on it.

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