Forum: Efficacy of Social Distancing Measures

As we get closer to a possible pandemic, governments should be looking at what measures would make the biggest difference to the outcome. This thread is for the purpose of discussing the relative effectiveness of different non-medical measures such as social distancing and travel restrictions. Most of us here already intuitively think that social distancing will make a difference, but precisely by how much and which policies might be effective and what outcome parameters we are looking for are important.

Because this kind of information will invariably have to involve numbers, whether actual or estimates, which may be challenging for some folks, it is even more important to stay on topic.

This is intended as an educational tool to understand the pros and cons of different measures in principle, and not as a judgement of whatever actual policy decisions that have already been made by different governments. Only when we have gotten a better understanding can we begin to have opinions, so please do not use this thread for attacks on current policies or governments etc.

The following is part of a table from the supplementary material of Ferguson’s paper in Nature Strategies for mitigating an influenza pandemic showing how various policies might affect outcomes.

The first row (Policy Number 1) gives you the parameters for no intervention. Let’s skip for now how they arrived at these numbers. The cumulative clinical attack rates (which is the total % of population infected and showing symptoms during the first wave) given for 2 different scenarios (high and moderate transmissibility) are 34 and 27% respectively. These give peak (daily) clinical attack rates of 1.9% and 1.2% respectively.

Now, I’m looking at Policy Number 4, which includes:

• Household quarantine with 50% compliance
• Reactive school closure
• Reactive workplace closure of 10%

If I only take the high transmissibility R0=2 scenario, the cumulative clinical attack rate is reduced to 29%, which is a reduction of (34–29)/34 x 100% = 14.7% which doesn’t seem like a lot.

But if you look at the peak clinical attack rate, it is reduced by (1.9–1.2)/1.9 x 100% = 36.8% which is a very significant reduction and will relieve the stress on the health system significantly.

It might also make the biggest critical difference to whether society continues to run relatively smoothly and calmly.

The delay in peak of 13 days may not be a lot, but in a disaster response scenario, this might again just be enough to make a critical difference.

Notice that adding 99% border closure to the above (Policy #7) does not affect the cumulative clinical attack rate for the high transmission scenario, and only lowers it for the moderate transmission scenario by a small margin (comparing row #4 to row #7) of (21–20)/21 x 100% = 5%.

Again, this still reduces the peak clinical rate by a margin of (1.2–1.0)/1.2 x 100% = 16.7% for the severe scenario and an even better margin of (0.7–0.5)/0.7 x 100% = 28.5% for the moderate scenario.

I’m going to pause here for comments.

Isn’t a great deal of this moot, because various jurisdictions have said they will not do widespread quarantine or school closures ?

That alone, spread across a couple of jurisdictions nationwide, would completely implode this model.

Comments ?

Let’s not get into whether they will or will not use these measures just yet, but only evaluate the relative effectiveness.

Now if you compare Policy #10 and #11, the difference between the 2 being 20 km quarantine (ie you are free to travel within the 20km zone, but not to other zones, which is assumed to reduce by 90% travel between areas) and a blanket tranvel restriction (ie everyone told to stop travelling unless absolutely necessary, but with no boundaries imposed, which the study assumes will result in 90% reduction of any travel over 50km).

On the surface, one would intuitively think the second measure #11 is more draconian, but it is less effective than the first #10.

The reason why I started this thread and pointed out these different numbers is to help start informed debates at the local level as to which measures are relatively effective in relation to the social and other costs. Otherwise, we will end up with haphazardly imposed policies that are useless, difficult to enforce, and unco-ordinated with neighbouring jurisdictions.

Another paper looks at it from a different angle, and comes to the same conclusion that non-medical measures can substantially mitigate the effects of a pandemic.

This paper is published online ahead of the Sep PLOS issue.

Reducing the Impact of the Next Influenza Pandemic Using Household-Based Public Health Interventions

I want to highlight some interesting relationships between R0, attack rate, and social measures.

The above graphs show various things. The first thing is the relationship between the Basic Reproductive Number R0 and the Infection Attack Rate IAR. (where IAR = 1 means 100% infection rate of the population).

At the beginning of a pandemic, the R0 is likely to be lower (since the virus has to mutate from inefficient to efficient h2h). With subsequent mutations and with no interventions, R0 rises such that IAR can approach 1, ie everyone infected.

The charts A and B show the effect of quarantine and quarantine + isolation on the infection rate, in relation to different R0.

The easiest way of understanding this is to look at the separation (the white space) between the bunches of blue and black dots in A. This shows the reduction in attack rate using quarantine alone. Similarly, the white space in B shows the effect of quarantine + isolation.

Notice how the biggest gap (largest white space) is achieved on the lower end of R0. That is, quarantine and isolation will make the biggest difference at the very beginning of the outbreak arriving at a community. As the R0 increases, these measures are far less effective.

I cut out a portion of the charts for clarity, but a couple of labels are missing for the last 2 charts:

D - Quarantine, isolation, and anti-virals

E - Quarantine, isolation, anti-virals, and contact tracing

Notice how little difference there is between B, C, and D.

It is only when you get to E, ie with the addition of contact tracing, that more reduction in infection rate is achieved.

PreparationNotPanic – at 10:55

“Isn’t a great deal of this moot, because various jurisdictions have said they will not do widespread quarantine or school closures ?

That alone, spread across a couple of jurisdictions nationwide, would completely implode this model.

Comments ?”

True. The reality is always going to be different from what you get in models. However, I have a sense that officials are just beginning to really grapple with this d***ed business, and its a real big learning curve for them.

Hence the purpose of this thread. :-)

anon_22 11:36 Is that because, as Tom believes, people will be unable to maintain complete isolation as time goes on?

What he knew in 1918 could save millions of lives

07/08/2006

St.Ltoday.com

“In 1918, nobody had a flu vaccine that worked. If avian flu strikes now, nobody will have a flu vaccine for the first six to eight months. Until that vaccine gets into doctors’ hands, public health workers are going to have to rely on what worked in 1918.

What worked then in St. Louis was stern “social distancing” - the medical bureaucrat’s term for quarantining the sick and keeping everybody else as isolated as possible, all to check the spread of the disease through coughing and sneezing.

‘’‘That “social distancing” of 1918 was the brainchild of the city’s health commissioner, Dr. Max C. Starkloff. Working with Mayor Henry Kiel, Starkloff closed schools, barred public gatherings and shut or limited businesses.

As a result, the city’s flu death rate for each 1,000 residents was 3.0 - the lowest big-city figure. Philadelphia’s rate was 7.3, and that was only third-worst among big cities. San Francisco’s rate ran to 7.6. In Pittsburgh, the figure hit 8.0.’‘’

Starkloff’s approach worked back then, and some experts think it could well work again.” (excerpt)

http://tinyurl.com/zf4lv

seacoast – at 11:53 “anon_22 11:36 Is that because, as Tom believes, people will be unable to maintain complete isolation as time goes on?”

No, the chart is not a function of infection rate against time, but infection rate against R0. ie at whatever point in time in a pandemic, the higher the R0, the less effective these measures are. But since R0 is likely to be lower at the beginning, we can expect to make the biggest difference by imposing policies very early on.

A lot of people tend to think of R0 as a fixed number depending only on the properties of the virus. In reality, it is affected significantly by host biological factors, behavioral changes, policy measures, etc.

Klatu,

Yes, I agree. The excess mortality figures for 1918 vary a lot between countries and also between cities. This variation cannot be fully accounted for by virulence alone, IMO. I suspect St Louis was not the only place where some quick thinking by leaders saved a lot of lives.

This thread is appearing as a side-scroll.

Really? I’m not getting side-scroll here. Anyone else?

Side scroll- Just a little here. Can’t get the discussion and the margin both, but it is OK.

Is there a list of the St. Louis “rules” all in one place? How did they do groceries and supplies?

No side scroll here, I’m on Dsl.

A little side-scroll, but it does fit between the margins. If it bothers you, go to the top of the page and click on “print”“

A little side-scroll here. I’m on Amaretto di Sarona <grin>.

anon_22,

Your charts broke my browser frame. I have side scroll.

I just resized everything. Try it again now.

I can put in on a different page, but it’s easier to follow the numbers if its the same page.

Problems is it not showing as sidescroll for me, so I have to depend on you folks telling me it its ok. :-)

I’m wondering if the higher flu rates of Pittburgh, San Francisco, and Philadelphia might be due to lack of sunlight/UV due to cloudy- foggy colder conditions, and St. Louis being warmer and possibly more sunny? In the advice to poulty farmers for avoiding regular type Avian flu (not the H2H current strain) they emphasize keeping clean dry sunny and well ventilated coops to avoid infection. Cloudy, cold, wet undersunned winter northern hemisphere may be more of a problem.

  Is there any data on Los Angeles? 

Anon_22- I am very interested in the topic and will be following closely. However, I just can’t get past your first words “As we get closer to a possible pandemic…” Are you reflecting on the clusters of the last few days? or is this just a more general statement?

Yes I have some side scroll for me … but it isn’t a problem.

But one note … I know that I’m missing some of the scientific point to this exercise; however, based on my experience in other areas it is only “common sense” that social distancing have an affect against getting a viral or bacterial infection. If someone has a cold, staying away from them and things that have their germs on it means that you are less likely to get their cold. If you find out that a friend of one of your children has chicken pox or measels, you don’t send your kid over there to play unless you want them to come down with it as well. If you child is sick, you don’t send them to school or other extracurricular activities to spread their germs, as a point of consideration for other parents if nothing else.

In the event of a pandemic it would seem that the efficacy effect would be along the same lines. The question should be how efficacious is it, not whether it is efficacious? How long does this effect last? As long as social distancing is maintained or is there a “viral load in the community” that once it is reached, social distancing becomes moot?

Then there is the environmental questions that go beyond social distancing such as social distancing with “x” type of weather or social distancing with “x” level of preparation for nutrition.

Lauralou – at 13:37

“Anon_22- I am very interested in the topic and will be following closely. However, I just can’t get past your first words “As we get closer to a possible pandemic…” Are you reflecting on the clusters of the last few days? or is this just a more general statement?”

No, it’s a general statement.

The US Navy had an island base in California in 1918 that kept very strict quarantine and did not have one flu case. Supplies were dropped off and anyone coming on island had to be isolated and wear a mask with a germ killing solution for three days. For all of the Navy, about 30% of personnel got the flu and 3–4% died. If only on-shore (not on-ship) personnel are considered, the infection rate was closer to 50% and the Case Fatality Rate at 3.6%, if I recall correctly. The difference between on-shore and on-ship infection rates suggests social distancing is partly effective, let alone the example of the island.

Kathy,

“But one note … I know that I’m missing some of the scientific point to this exercise; however, based on my experience in other areas it is only “common sense” that social distancing have an affect against getting a viral or bacterial infection. If someone has a cold, staying away from them and things that have their germs on it means that you are less likely to get their cold. If you find out that a friend of one of your children has chicken pox or measels, you don’t send your kid over there to play unless you want them to come down with it as well. If you child is sick, you don’t send them to school or other extracurricular activities to spread their germs, as a point of consideration for other parents if nothing else.

There is a difference between ‘common sense’ decisions made by individual parents (some of whom btw will NOT have the same level of common sense as others) and policies for pandemic mitigation that governments, whether local or nationsl, have to make.

Knowing one should keep a child with chickenpox from school as a parent is not the same thing as being the official in charge of deciding whether they should make it mandatory for parents to keep their children at home if they have chickenpox. To make such a policy mandatory, they would need a lot more than common sense; they would need credible data. That is when these modelling data come in useful: they help officials choose between various options.

In the event of a pandemic it would seem that the efficacy effect would be along the same lines. The question should be how efficacious is it, not whether it is efficacious?

Yes and No. There are many things that are efficacious. Again as private individuals, you have the luxury of taking as many or as few precautions as you want, and bearing the consequences. Policymaking involves trying to decide for others and using resources that are limited on a good day, but will be stretched thin in any disaster. So knowing the relative difference in efficacy between different policies becomes important.

How long does this effect last? As long as social distancing is maintained or is there a “viral load in the community” that once it is reached, social distancing becomes moot?

These are questions that need to be answered, as far as possible, bearing in mind that all models are speculative and understanding the limitations and variables. Educating themselves about all of these now will allow officials to make better plans ahead of time, and to respond more appropriately as conditions change.

Then there is the environmental questions that go beyond social distancing such as social distancing with “x” type of weather or social distancing with “x” level of preparation for nutrition.

This is an interesting question. Weather or nutrition are factors that are far less quantifiable or even predictable. For example, you might say cold weather might impair our resistance and therefore more people will get infected, but cold weather may also mean more people staying indoors which then reduces transmission. It becomes a lot harder to try and ‘model’ what the effect of weather on viral transmission is.

I am of course only using your question as illustration for how to help your community leaders make reasonably sensible plans.

I applaud your efforts.

Interesting model.

However ( you knew that was coming next ) in my experience with public officials, especially elected ones like mayors that may have difficulty tying their shoelaces without assistance, your model needs to be GREATLY simplified to be understood.

You may be able to sell it to the city attorney and city managers, but the politico’s will need it presented in a way they can understand.

My $0.02

Keep up the good work.

PreparationNotPanic – at 14:29 “I applaud your efforts.

Interesting model.

However ( you knew that was coming next ) in my experience with public officials, especially elected ones like mayors that may have difficulty tying their shoelaces without assistance, your model needs to be GREATLY simplified to be understood.”

Thanks,

However (you knew I would have an however ) what I am hoping to do is to educate an army of Fluwkians who will then go and sit in on townhall meetings and challenge policies that are stupid and support officials who are genuinely trying to do a good job.

Anyone who has been able to understand this thread so far is miles more clued up than many officials at the moment, so it will be up to you what you do with the knowledge.

Never has there been a higher need for exercising your civic responsibilities.

Back to the data - here are a couple of excerpts from the second paper:

“Wherever in the world the novel strain evolves, with modern news services and electronic communication, there will be a period of time during which the disease is not present in some large populations but is known to be spreading in other more remote locations. This presents a window of opportunity for implementing interventions to reduce R0 prior to the introduction of the pandemic strain from those remote populations. Although R0 is sometimes considered to be intrinsic to a pathogen, it is also dependent on the behavior of the host population and can vary across time.”

This one from the editors:

“Using this model, the authors predicted that even if only half of the population were to comply with public health interventions, the proportion infected during the first year of an influenza pandemic could be substantially reduced by a combination of household-based quarantine, isolation of actively infected individuals in a location outside the household, and targeted prophylactic treatment of exposed individuals with anti-viral drugs. Based on an influenza-associated mortality rate of 0.5% (as has been estimated for New York City in the 1918–1919 pandemic), the magnitude of the predicted benefit of these interventions is a reduction from 49% to 27% in the proportion of the population who become ill in the first year of the pandemic, which would correspond to 16,000 fewer deaths in a city the size of Hong Kong (6.8 million people).”

anon_22: great work, thanks - a number of people will be reading this sooner or later so let’s keep it as good as it is and then better.

I personally buy into seeing less people die.

lugon gets ready for local battle soon

This is importantly about sharpening the very best knives in the field. We’ll parallelly want to look for unprotected flesh to dig them into.

I’ve been away and will still be away for some time - I hope someone is keeping the candle lit at the simple masks thread. I don’t recall numbers regarding degree of protection with the masks AND other meassures combined. I also need to see how well hand washing works - simple stuff, so we might want to buy lots of soap for Africans - it’s my guess that if some are better off, all are better off.

View is much-improved now, thanks. All the text fits within the margins now. Interesting topic. The very obvious difference between personal, in-home countermeasures and those mandated by policy just zipped right by me until now.

Now let’s get away from modelling for a minute and look at some ‘real’ data, to see what effect population wide behavior changes might have on transmission of respiratory viruses.

This is a study of Respiratory Infections during SARS Outbreak, Hong Kong, 2003.

“Severe acute respiratory syndrome (SARS) is an infection caused by a novel coronavirus that is transmitted primarily through direct mucous membrane contact with infectious respiratory droplets and through exposure to fomites. In 2003, Hong Kong reported SARS cases from March 11 to June 2.

During the height of the outbreak, schools were suspended, social activities were curtailed with the closure of various public places, and the community was engaged in a sustained and intense hygiene campaign (1–3). Population education on personal hygienic measures was spearheaded by the government with concerted efforts from various organizations and the community.

Surveys conducted in April and May 2003 showed that most of the population

• wore a face mask (76%),
• washed their hands after contact with potentially contaminated objects (65%),
• used soap when washing hands (75%),
• covered their mouths when sneezing or coughing (78%),
• and used diluted bleach for household cleaning (>50%).

Another survey on health-seeking behavioral traits conducted in June 2003 showed that >70% of respondents practiced some of these hygienic measures more frequently during the SARS outbreak than during the pre-SARS period (6).”

The authors of the study investigated whether these measures would have any effect on the incidence of common respiratory diseases.

“The study period was January 1, 1998, to December 31, 2003. Data were obtained from the Government Virus Unit (GVU), a public health and diagnostic virology laboratory serving public and private hospitals and outpatient clinics in Hong Kong.

“For each month of the study period, we obtained the number of respiratory virus isolates as a proportion of the total number of respiratory specimens processed by GVU. We computed the percentage change in the proportion of positive specimens (PPS) for each virus between each month of 2003 and the mean PPS in the same month of the preceding 5 years (1998–2002), which served as the reference period.

“For comparison purposes, we obtained the monthly number of positive tests for immunoglobulin M (IgM) antibody against hepatitis B core antigen (anti-HBc) and the corresponding total number of tests performed in the study period.”

The results are shown on this chart:

Notice the very significant reduction of positive tests for all 4 respiratory viruses during the period March - June/July, with no reduction for Hepatitis B.

The rebound in respiratory infections in August is also interesting because it verifies that the reduction of transmission during the preceding months was a real result of changes in behavior and not a lower prevalence of those infections for that year, and that the accumulated non-immune population promptly became infected as soon as respiratory precautions were stopped.

BTW if anyone (eg penny-pinching officials) try to tell you that masks don’t work, take out this chart and show them.

Granted they didn’t just use masks, but on the other hand, it would be harder for them to say “there is no evidence that masks make any difference”

anon_22 good discussion, but coming from a very layperson perspective, I would need to find a way to break this discussion back down into 2 penny words before I was able to effectively communicate the ideas in a community meeting type setting.

I suppose it is fairly easy to use this stuff to communicate risk and possible mitigating policies to lawyers and other people familiary with science-speak <grin>; however, talking like this to the average Joe that appears at our local community meetings would get me boo-ed and ignored by the audience.

Its a fine line to walk … sounding “intelligent enough” so that the muckety-mucks listen to you but not sounding “too academic” so that the regular Joes in the audience don’t tune you out due to suspicion.

For the average Joe, the message can be very simple:

1. pandemics kill a lot of people
2. because too many people get very sick at the same time, healthcare services won’t be able to take care of everyone
3. therefore, it’s important to try and reduce the ‘explosive’ spread as much as possible
4. data from 1918, from SARS, and from scientists’ calculations all suggest that social distancing and personal hygiene are effective
5. they are most effective when started at the very beginning, BEFORE society becomes so stressed that everything gets paralysed
6. getting these plans together and making sure people know what to do require both time and a calm, responsive public
7. therefore the time for governments to lay out detailed plans and educate the public is NOW
8. NOW is also the time to put aside provisions that people need in order to comply with social distancing ie families and communities must stockpile essential items in anticipation of the necessity to ‘shelter in place’ at short notice

anon_22 – at 19:23

Yep, fairly easy to communicate that. Now we just need to find a way to communicate the risk in such a way as to influence the community to actually accept any austere restrictions. Unfortunately, our area has a significant portion of the population that wants to have their cake and eat it too. <shaking head at the absurdity>

I like how you are laying out concrete statistics that we can cite. Now to find a way to get beyond the “that was then, this is now” mentality by drawing on pandemics that have occurred later in the 20th century. For some, 1918 is ancient history. Is there data for some of the African epidemics … perhaps even for some of those epidemics that traveled to the US and/or popped up here due to animal/environment issues? Legionnaires is airborn, correct? Wasn’t there a type of plague that was in the US southwest that became airborne that was initially from some type of vermin entering homes? The details escape me, as I have a wiggly 2 year old in my lap.

Perhaps something can be extrapolated from those examples as well … at least as far as the hygiene and quarantine aspects. Especially as these were highly contagious outbreaks, even if they were limited in scope.

Here’s an abstract of an NCBI paper on the 1968 pandemic.

Kathy,

Influenza is really a completely different kind of ‘beast’. The numbers are incomparable to other outbreaks. Its best to stick with numbers from flu pandemics.

The Ferguson paper took much of its data from previous pandemics and so on. Even though I disagree with his conclusions about containment, the data and calculations are sound, as far as I can tell.

It’s late here and I have to pack for tomorrow, but if you have specific questions, you can post them here and everyone can work on them together.

I am travelling tomorrow and will be occupied for the next couple of days, but I will certainly check back and follow up on them when I can.

Thanks, anon-22 for the thread. I think what Fluwikians with school age children can do is focus on #5 from your post at 19:23. We can work to educate other parents and school board members and district superintendants that EARLY school closure is acceptable and desireable. This is in contrast to how closures due to weather are done — usually school officials wait until it’s quite clear than roads are going to be dangerous before closure is announced (because we parents howl when school is out for a dusting of snow).

Although I enjoy reading the model papers and playing with the modeling software, it really has very little value in considering what would happen with a pandemic strain with a 50% kill rate. The reason? Psychology. No model can possibly predict human behaviour if a virus is unleashed with the ability to wipe out 25% of the human population (assuming a 50% attack rate).

Humans are hard to predict under any circumstances, and under highly stressful conditions, they are impossible to predict. So, I would suggest, the models are only of value if the kill rate drops precipitously. Otherwise, they will be worthless once people understand the situation.

Any attempts to control or manage the population will fail unless those doing so can guarantee the safety of the people they are trying to control. And we all know there aren’t enough resources to do that - for everyone.

If a panflu evolves with a kill rate of 50%, social distancing will consist of targeted resources for saveable cities at least 200 miles from the chaos that will envelope the megacities.

If you want a model for that, better email Steven King.

anon_22 – at 11:06

20km restricted travel zone, or about 12 miles (right?)--- hmmmmmmm. That would get me … next to nowhere… and better… get nobody near me!! Hope they do that! :)

bump

Wow! Monotreme, you are saying it like it is (applauds)

Thanks moeb.

I just don’t understand why we are pussy-footing around. A pandemic may not happen. Or it may be mild. But there is very good reason to believe it will happen and that it will have a very high CFR. It irks me that no-one is telling people what the real worst case scenario is.

“I just don’t understand why we are pussy-footing around.”

/:0)

I understand… perhaps in keeping with the idea this thread promotes, there should be a recommendation to civic leaders facing a CFR of 50%

make two lane highways one way leading out of town?

station police (preselected and confirmed to show up) at gas stations?

arrange gas tankers and tow trucks to stand by for assistance and delivery?

prepare the stoplights to all go green?

prioritize patients to be admitted to medical care or shunted to alternative locations?

it boggles the mind

moeb at 10:36: “prepare the stoplights to all go greeen”

No, if Monotreme’s suspicions are correct the stoplights would be calibrated to create gridlock in the megacities with just enough “seeming” functionality to get the motorists to go along with the ruse.

If a panflu evolves with a kill rate of 50%, social distancing will consist of targeted resources for saveable cities at least 200 miles from the chaos that will envelope the megacities.


what does this mean ? Some cities are savable ? But only when they are not megacities and at least 200 miles away from megacities ? How can social distancing consist of targeted resources ? Please explain.

I don’t want to commit thread hyjacking, but my idea of social distancing will be not to be any where near a megacity.

The only way social distancing will work in a megacity is if emergency food stockpiles are prepositioned near them, right now. National Guard could deliver the supplies to apartment blocks. Perhaps appoint one or two trustworthy people within each apartment building to break the boxes down and put supplies outside the door of each apartment.

I see no evidence that any planning of this sort is occuring, but hope springs eternal.

Monotreme. For a long-time, it was pretty obvious by their statements and their actions that they thought ‘hell would freeze over’ before we got a pandemic (completely ignoring history of course)…

…then came the tsunami (last one 1830 with 25,00 deaths - second last significant pandemic in 1810 as well) and Katrina.

Now reluctantly admitting to the possibility they think they have ALL THE TIME IN THE WORLD…many years or decades or even better the pandemic will occur when they are no longer in a position of authority.

Sorry, should have read second last significant pandemic in 1830 as well.

Well, officials have to do what they have to do. If they are going to make policy anyway, IMO there is a case for trying to get the best or least worse policy out there.

Plus the Hong Kong experience with SARS shows that these measures work to a certain degree.

We mustn’t be too cynical. That won’t help anyone.

My 0.02 before I rush off. :-)

Monotreme, please calm down, there are security measures that have been adopted more than 3 years ago, and freaking out in writing, at this time, do not help.

I understand your feelings, but it appears that you do have some credibility among Flu Wikians, therefore you have more responsability.

Please stop inflaming.

Yes, the pressure is rising, but we are not near the ‘Lets panic mode’.

And please remember

A truly good book teaches me better than to read it. I must soon lay it down, and commence living on its hint. What I began by reading, I must finish by acting. (Henry David Thoreau)

“Cure rarely, Comfort mostly, but Console always’‘.Hippocrates

Snowy- Please provide a link for “security measures that have been adopted more than 3 years ago.”

Thanks!

I would suggest that you go to your national pandemic preparedness plan, security part.

Security measures for what ? What planning ? What practice to execute these security plans ?

“No plan survives first contact with the eneny” - Murphy.

The police in the local big city here can’t even handle a normal Saturday night without running out of resources.

BTW, I don’t see anybody freaking out in writing here at all. Just calling it as it probably will be.

You see inflammation, I see reality based upon governmental past performance.

The government is going to have to practice triage. Not every city will be salvageable. That’s just a fact of life.

Brutal, but none the less, it must be incorporated as part of political policy decisions and the expectations communicated to the electorate.

Bird Guano,

I will bear with Fukuda statements done last year, Quarantine measures could be good in some cases.

The CDC had update this element yesterday

Quarantine and Avian Influenza Preparedness Topic: Quarantine and Avian Influenza Preparedness

Speakers: Dr. Michael Doney, MD, MPH, MS

LCDR Michael Doney, USPHS is a medical officer at the CDC Washington Quarantine Station. He serves on several working groups in collaboration with the Department of Homeland Security to develop border health screening protocols in the setting of an influenza pandemic. He assists in the development of communicable disease response plans at ports of entry in the quarantine station jurisdiction which includes Maryland, Virginia, Washington, DC, and West Virginia and collaborates with state and local public health authorities to monitor the health of arriving international travelers. He is also a staff physician in emergency medicine at the National Naval Medical Center in Bethesda, Maryland.

Date: August 21, 2006

Time: 1:00–2:00 p.m. ET

Dial-in Number: 888–889–4431

Passcode: Quarantine

Objectives for this call are to:

Discuss the role of the CDC Division of Global Migration and Quarantine and the CDC Quarantine Stations Discuss community-based nonpharmaceutical public health interventions and their rationale for use during an influenza pandemic Discuss a strategy and implementation rationale for using nonpharmaceutical public health interventions in the setting of an influenza pandemic Slides Available for this Call: Power Point Slides (3,058 kb/64 pages)

http://www.bt.cdc.gov/coca/ppt/COCA_…es_Pan_Flu.ppt

    * August 8: Pandemic Flu Preparedness
      Instant replay for Pandemic Flu call - 888–568–0032
      Audio Presentation: N/A
      Slides Available for this Call:Power Point Slides (461 KB/29 pages)
      Summary: N/A

    * July 24: Recent Mumps Outbreak and Update
      Audio Presentation: Listen Now (6.36 MB/MP3)
      Slides Available for this Call:Power Point Slides (569 KB/36 pages)
      Summary: Available Now

    * June 22: Avian Influenza Surveillance and Update on Current Situation
      Audio Presentation: Listen Now (11.2 MB/MP3)
      Slides Available for this Call:
      PDF (3.01 MB/16 pages) PDF (3.02 MB//32 pages)
      Summary: Available Now

    * May 2: Crisis & Emergency Risk Communication
      Audio Presentation: Listen Now (6.9 MB/MP3)
      Slides Available for this Call: PowerPoint Slides (810 KB/14 pages)
      Summary: Available Now

    * March 28: CDC Operations and Natural Disasters
      Audio Presentation: Listen Now (3.1 MB/MP3)
      Slides Available for this Call: PowerPoint Slides (12.5 MB/43 pages)
      Summary: Available Now

    * February 7: Quarantine
      Audio Presentation: Listen Now (3.5 MB/MP3)
      Slides Available for this Call: PowerPoint Slides (2.18 MB/54 pages)

Objectives for this call are to:

1. Discuss the role of the CDC Division of Global Migration and Quarantine and the CDC Quarantine Stations
2. Discuss community-based nonpharmaceutical public health interventions and their rationale for use during an influenza pandemic
3. Discuss a strategy and implementation rationale for using nonpharmaceutical public health interventions in the setting of an influenza pandemic

Slides Available for this Call: Power Point Slides (3,058 kb/64 pages)

it is strange, we dance to a funny little tune of 1918 statistics when it’s plain that, that is very unlikely to be the case. so suppose we know better yet follow the party line… later after it’s over we may be left saying “I should have spoken up, lives could have been saved”

I think this is what drove dr. webster to speak up, who can stand the thought of thousands of people dead (if not millions) because we didn’t speak up?

moeb. Who was it who said…’records are meant to be broken’.

You are right Moeb, I have relay Dr Webster comments as Dr Osterholm and others for years now.

But lets not behave like wild Lemmings, lets keep cold blood and walk the talk without hysteria, paranoia, it cannot lead to the good Trail.

Snowy Owl – at 12:48 Snowy I have to agree with you. I am getting the feeling of panic starting to set in on the boards (almost all of them) Now is not the time for that. We can not “catch the falling knife”. We on all of the Flu Boards are truly the only ones who know what is coming and what is going on. We above all others must keep a cool head and do everything we can to hold it together for ourselves. We in the end will be the ones who will be able to to the greatest good if we work as a group to help our less that knowledgable neighbors.

lordy lordy lordie (all spelled wrong) okay we’re all wise beyond our public facade. and we all say stupid things in here now and then. we are after all human.

shrugs… I saw no hysteria and remember the last time I suggested there was I was called on the rug by concerned mom

sometimes I would like to stand up and shout NO MORE LIES! I’d like to take an oath to tell the truth, not sugar coated daydreams.. (finds himself babbling on a soapbox and gets off it)

sighs. whatever it will be, it will be. surely more than 100,000 people are prepping. if it comes I and you may survive, we do what we can.

I find myself drifting off to the New York Times piece glorifying nimen while pointing out he’s basically an unemployed guy who hasn’t earn anything in some time.. it intimated that all of us flu forum people were anti social misfits attempting to somehow solve the bird flu problem by participating in a feeding frenzy on any tidbit of flu news toggletexted to feed our insatiable need to know

see there’s a stupid thing to say.. yet it’s very true

moeb – at 13:08,

attempting to somehow solve the bird flu problem by participating in a feeding frenzy on any tidbit of flu news toggletexted to feed our insatiable need to know

Okay, there may be a grain of truth in that statement!

smiles.. chuckles.. all that stuff, hey it’s saturday morning and I’m a little crazy. I hope nobody here takes themselves too seriously. certainly the public doesn’t

have a good week end

Snowy Owl,

What are your assumptions regarding the kill rate of H5N1 if it goes pandemic? If you think it will drop from over 50% to less than 5%, please provide a mechanism. If you think it is impossible to go pandemic at its current kill rate, please explain why.

Please provide evidence that there are any plans whatsoever to provide food for the megacities. Where will this food come from? Please provide evidence of stockpiles.

I am quite certain that no information regarding panflu prep is being given to HCWs in New York City. Don’t you think it should be?

There is a difference between telling the truth and being inflammatory. When I go hiking, sometimes I see signs telling me that there are bears about and I should take that into account. This is helpful information, not inflammatory. Maybe I won’t I see a bear on a particular hike, but I’m grateful for the warning.

There is ample evidence to suggest that H5N1 may go pandemic with a very high kill rate. There is no evidence that the megacities are prepared to deal with this. Two simple facts.

Sorry (not really), but I really, really do NOT see panic here.

I see frustration, a lot of animated discussion, and a longing for things to be better, but the one thing I do NOT see here is rising panic.

I’m amused that others do from simple one-paragraph postings on a wiki.

Strange indeed.

I’ve been dealing with public officials in a safety capacity for 30 years.

Call me cynical, but I have YET to see them “get it right” on any subject of importance.

<sighs>

Time for some weekend fun outside

Monotreme,

I have been watching you post since about four days. I do understand your perceptions of risk heightened. I wanted to highligted that since you do have some credibility, your posts have more impacts than people with less credibility.

Therefore, if, like some of us your priority is to reduce morbidity and mortality in the event of a pandemic, your comments must reflect that.

Some Public Health Officers are, hum, opportunists, if I can say, and it is wise sometimes.

For instance, the new regulations for flights towards the US & Canada, is reducing the travelling pace, it give more time to custom officers to get some infos on travellers, and more time to noticed of any of the symptoms that they have lately taken knowledge of.

Yes the dropping & distribution point for food has been identified, yes there are stockpiles of the basics, yes the North Continent of America has done a lot in the last 3 to 4 years. No it is not perfect, no, do not rely and be dependant upon the cavalry, because on many things, if not the most we will be on our own.

But no, do not magnified the social unrest or fears, this is as you know contagious.

Step back for a sec, do you honestly believe that the imperative of security amidst a crisis will let diffusion of statements that rise the fears and social unrest.

You can be sure that they will pull the plug off of those diffusers in few seconds.

À bon entendeur

I once started a thread here: A Simple Plan. Can anyone point to a link to it? I assumed a very high CFR at that time. I laid out my suggestions in detail about PPE, spray bottles of bleach, food storage, social distancing, government legislative issues, SIP, Shelter in workplace, only required essential workers allowed to be out, no enforcement for those that choose to move and die, stoppage of the economy, necessary costs deferred and payed by tax dollars etc. I remember ending up talking to myself (people voted with their feet) and just drifting away from our exercise. A few branded me as a “Utopian Idealist” and “unrealistic.” Maybe what we need to do now, very soon, is to create a wiki page that can reflect what a community (local/national) could do based on a simple morality and action plan for life i.e. If I take my action and generalize it to everyone, what is the result? In a pandemic, if I can obtain everything I need for a year shelter in place and then generalize that to everyone what will be the result? What stops this? Bills. Food. Medicine. Keeping power on. Fixing things. Water. Critical and emergency health care. Nobody with flu symptoms should go to a hospital. Each patient that needs medical care for another reason gets a pickup and a decontamination and gets taken to a hospital. No visits. We treat AF with such available care as can be done in the home or a large facility in the community.

Snowy Owl – at 13:44 “À bon entendeur”, “Salut”. Actually Snowy Owl, this expression could be extremely badly interpreted by French ears. I sure hope it has some other more gentle meaning where you hail from.

I beg to differ from your statement: “Step back for a sec, do you honestly believe that the imperative of security amidst a crisis will let diffusion of statements that rise the fears and social unrest. … You can be sure that they will pull the plug off of those diffusers in few seconds.”

If there are any fear-mongerers in the world, it will not be FluWiki and its FluWikians, they will be the MSM. I am quite determined, despite my nervousness at the prospect of SHTF, to remain as calm and collected as I possibly can, and I firmly intend giving voice to reason on this Forum. Just as I am sure all other FluWikians here will behave as I shall, amongst them Monotreme. Henceforth, if we all adopt this attitude, I view the likelihood of TPTB shutting down our collective, reasoned, voice as improbable.

The truth is that we are debating whether social distancing is likely to be helpful or not, and there are divided opinions on this subject. I do not think it inflammatory to debate the pros and cons of a subject; that’s what we were taught at school when we turned 16 years old, in order for us to understand life better by unravelling fallacies. The hive mind of the FluWiki allows just that where it is not necessarily favoured elsewhere. I visit this place, and a few others, exactly where I am at freedom to express myself, an important area of my life, which I shall never cease to try and protect. In this quest, I should afford others to be able to do so, among whom, Monotreme and other FluWikians.

[end of rant]

I’d like to see that thread.

Before my time here I guess.

A bit Utopian.. ya, sounds like it.

Politics, money, power, trump common sense most every time unfortunately.

Snowy Owl – at 13:44,

you do have some credibility

Thanks!

As regards travel regulations, sorry, I don’t think these are of any value whatsoever. As I’m sure you know, people infected with influenza can infect others before they show symptoms. The only way to stop spread of a pandemic via the airlines is to shut down the airports.

Yes the dropping & distribution point for food has been identified, yes there are stockpiles of the basics,

What is the basis for these statements? Links please. I can find no evidence of this. And please don’t suggest that you have inside information indicating that this has been done. It would be impossible to hide the stockpiling of enough food for the megacities. And I have my sources as well.

do not magnified the social unrest or fears

I’m not trying to magnify fears, I’m trying to convey straight-forward information. If that information is scary, well, sorry, but I assume the people reading my posts are intelligent adults who are capable of making their own decisions about what to do with it. I’m one voice. There are plenty of others saying “Don’t worry, just buy some rice and beans and we’ll get through this.”

do you honestly believe that the imperative of security amidst a crisis will let diffusion of statements that rise the fears and social unrest. You can be sure that they will pull the plug off of those diffusers in few seconds.

I agree. That’s why I’m warning people now.

Monotreme, can you describe what you think the megacities are? I know that NY City and Los Angeles are probably megacities, but would Wash, DC or Houston be a megacity? I was talking with a friend a few years ago who stated that when they lived near a large city, it was discussed by their governing council (those closed sessions) that if there was a nuclear blast or other issues in this larger (maybe not quite a mega), city, that their solution in the smaller city would be to close the road and bridges so that millions of evacuees would not overwhelm “things”. At the time, I thought surely, she was mistaken, but it happened during Katrina, I believe.

Also, do you have any information on the history of the 1830 pandemic. I am just curious if anyone knows much about it, or should I start a separate thread?

PS (always appreciate reading the info and expertise you share)

Dude at 14:17, is this it? http://tinyurl.com/g68ot

“The US has nine cities with populations topping one million. New York City, with more than eight million residents, is by far the largest US city.

Los Angeles, in second place, has a population of just below four million people.

Both Chicago and Houston have populations of more than two million.

Other cities with more than one million citizens include Philadelphia, Phoenix and San Diego.

San Antonio has leapfrogged Dallas to become the eighth-largest US city.”

Source: http://www.citymayors.com/gratis/us-census2000.html

Dude, I like your plan, but there is no way there will be enough food for everyone in a pandemic with a very high CFR without massive involvement of the federal government. There is no evidence that they are doing any planning at all for a very high CFR. This is why I think the real plan will be to triage the cities.

FrenchieGirl – at 14:23

Thanks for your comments. I hope your right about honest information being dessiminated after a pandemic begins. It didn’t happen in 1918, but maybe this time will be different.

Ange D – at 14:29

Thanks for your information regarding the plans to block the roads from the megacities in case of disaster. I have seen this option mentioned several times. Even if the Feds didn’t do it, locals would. As they did in China during SARS.

BirdGuano – at 14:38

Thanks for the list of megacities in the US. Needless to say, the situation will be even worse in 3rd world megacities.

Dude at 14:17- I used the search function here for “ A Simple Plan” and found your thread- “A Simple Prevention Plan”. Wasn’t hard at all to find…<grin> Be well!

Here is a post from Dr. Joe Thornton from our forum that is very informative.

As we consider the potential psychosocial consequences of pandemic influenza the scenarios can quickly overwhelm. The published plans from WHO, Federal and state officials break down the tasks nicely but the plans are estranged from the range of human behavior. We are not even sure if the plans have goals that are supported by the community. For example is the goal to save my life, the greatest number of lives, to save society or to save a society of souls.

A book on problem solving (?Turing) suggests looking at how other people solve similar problems.

Here I suggest that smallpox and SARS are similar problems. The Univ Pittsburgh Center for Biosecurity has an online scenario for a developing smallpox pandemic called “Atlantic Storm” http://www.upmc-biosecurity.org/ I highly recommend a review of that slide show and if we can dig it out to look at the Dark Winter exercise from 2001.

In Aug 2002 I participated in a 5 day multidjurisdictional exercise on smallpox called “Pale Horse.” I presented on the MH aspects in March 2003 to Disaster Psychiatry Outreach. We saw many of the issues acted out during the 2003 SARS outbreak but we also saw many very successful and clever adaptations to the outbreak.

The key issues are risk communication and demand management. There is plenty of room for important positive contributions from nonofficial forums.

In the light of the published smallpox scenarios and actual experience with SARS, we can consider what we actually need to do as members of a community to support the social infrastructure.

For example, when the headlines read that WHO has announced the world is entering a phase of pandemic influenza, do we believe that citizens will look at the published plans and then try to go buy 4 weeks of supplies? What will happen at the stores? How will people react? How do we diffuse the pressure and still meet the peoples needs? How do we get people to show up for work inside closed institutions like nursing homes, prisons or forensic mental health facilities? Is it important?

How do we advise others on how to balance personal needs for perceived safety versus the need for society to continue? What is the point of personal survival if society is catastrophically changed? Can a sufficient number of people develop a social contract with each other dedicated to the survival of society? Would such a strategy increase the survival probability for more people?

Everyone has the opportunity to help build resiliency. Those of us who are concerned can reach out to each other and define an environment that will help direct policy decisions. Dr. Stephen Southwick of Yale University has described a 12 Step program for building resiliency. These steps are not a direct path to recovery but serve as tools for the journey.

1.Support spirituality of the population a. connect with churches b. provide training for church volunteers on disasters and mental health c. promote the participation of churches in coordinated community response. d. build strength in diversity 2.Support peer communication for social support a. provide access to phones b. provide access to internet c. support dedicated local talk radio and cable access TV 3.Support constructive actions for the impacted persons by establishing natural mentors and role models a. a buddy system of volunteers with evacuees can be helpful to get through the multiple “little” hassles that wear people down. b. the buddy can help persist with calling numbers that are busy or voice message only or refer to multitude of other numbers c. the buddy can help problem solve the “assistance burden,” where the person receiving assistance must jump through hoops that do not provide the needed services 4.Support regular exercise, physical training and recreational activities 5.Support disaster recovery training for volunteers, a. channel the altruism of the population towards planned constructive action. 6.Enlist the children in activities, a. the children could organize color coded handouts that are distributed for information b. the children’s world view can help the adults with perspective c. the children help promote a sense of the future and recovery 7.Enlist all impacted persons in the problem solving to develop an active coping skills 8.Keep a goal in the grieving process towards acceptance a. The shock of multiple losses is accompanied by a natural grieving process. b. Many including the decision makers will need support towards accepting the magnitude of changes that are in store. 9.Assist the process of stress inoculation a. No matter how competent and caring the support communities, there are going to continue to be hassles and obstacles along the way to recovery b. Build on the survival so far to instill confidence in the ability to continue to meet the challenges with assistance 10.Leadership, operational personnel and all those affected will need assistance to develop cognitive flexibility. 11.Permit humor a. Humor can be one of the most developed coping strategies b. Distinguish between bitter cynicism and sweet irony 12.Instill optimism – things were bad, they are tough now, but by our actions they will get better

We can promote these skills now and apply them now to pandemic preparations. cr

Top world cities. Same source:

Rank City Country Population

SEOUL South Korea 10,231,000

São Paulo Brazil 10,009,000

Bombay India 9,925,000

JAKARTA Indonesia 9,373,000

Karachi Pakistan 9,339,000

MOSKVA (Moscow) Russia 8,297,000

Istanbul Turkey 8,260,000

MEXICO (Mexico City) Mexico 8,235,000

Shanghai China 8,214,000

TOKYO Japan 8,130,000

New York (NY) USA 8,008,000

BANGKOK Thailand 7,506,700

BEIJING China 7,362,000

Delhi India 7,206,000

LONDON UK 7,074,000

HongKong China 6,843,000

CAIRO Egypt 6,800,000

TEHRAN Iran 6,758,000

BOGOTA Colombia 6,422,000

Bandung Indonesia 5,919,000

Tianjin China 5,855,000

LIMA Peru 5,681,000

Rio de Janeiro Brazil 5,613,000

Lahore Pakistan 5,143,000

Bogor Indonesia 5,000,000

SANTIAGO Chile 4,788,000

St Petersburg Russia 4,678,000

Shenyang China 4,669,000

Calcutta India 4,399,000

Wuhan China 4,040,000

Sydney Australia 4,031,000

Guangzhou China 3,935,000

SINGAPORE Singapore 3,894,000

Madras India 3,841,000

BAGHDAD Iraq 3,841,000

Pusan South Korea 3,814,000

Los Angeles (CA) USA 3,694,000

Yokohama Japan 3,426,000

DHAKA Bangladesh 3,397,000

BERLIN Germany 3,386,000

Alexandria Egypt 3,339,000

Bangalore India 3,302,000

Malang Indonesia 3,173,000

Hyderabad India 3,145,000

Chongqing China 3,127,000

Ho Chi Minh City Vietnam 3,015,000

Haerbin China 2,990,000

ANKARA Turkey 2,984,000

Chengdu China 2,954,000

Ahmedabad India 2,954,000

Casablanca Morocco 2,943,000 Chicago (IL) USA 2,896,000

Xian China 2,872,000

MADRID Spain 2,823,000

Surabaya Indonesia 2,801,000

PYONGYANG NorthKorea 2,741,000

Nanjing China 2,678,000

KINSHASA Congo (Zaire) 2,664,000

ROMA Italy 2,648,000

Taipei China 2,640,000

Osaka Japan 2,598,000

KIEV Ukraine 2,589,000

YANGON Myanmar 2,513,000

Toronto Canada 2,500,000

Zibo China 2,484,000

Dalian China 2,483,000

Taegu South Korea 2,449,000

ADDIS ABABA Ethopia 2,424,000

Jinan China 2,403,000

Salvador Brazil 2,331,000

Inchon South Korea 2,308,000

Semarang Indonesia 2,221,000

Giza Egypt 2,221,000

Changchun China 2,192,000

Havanna Cuba 2,192,000

Nagoya Japan 2,171,000

Belo Horizonte Brazil 2,154,000

PARIS France 2,152,000

The inner belt of Paris is 2 million. If you include the outer belt, it’s close to 9 million.

These are ALL way beyond carrying capacity if you have a Just-in-time supply breakdown.

How are you going to shelter in place 10 million people and keep them supplied for a couple of flu waves?

How will you enforce quarantine and movement restrictions ?

It’s just NOT going to happen.

A thought about social distancing on a somewhat macro scale.

If quarantine of towns and cities were to be tried, (and I think they will), then it will be approached somewhat from a military mindset. Let me explain. The folks that will map out and enforce the quarantine procedures will in all likelyhood be the military. I personally have no problem with that because I do not believe it will be a “cordon solitaire” (sp). I think it will be an attempt to slow the movement of people, not a total prohibition of movement which is probably impossible without shooting violators. I do not believe the military or our government will even attempt such an act. They will only try to restrict the movement of people.

The military mindset I mentioned earlier will be one similar to that of a war of defence: identify defensable locations where you are able to restrict movement of the enemy and stop it’s advance. (The people are not the enemy, but rather potenial carriers of the enemy.) This will not be within cities, but rather between cities and states utilizing natural geographical features: rivers, mountains, deserts/plains, lakes/bays. I can see the Red River between Oklahoma and Texas being one of these features, and the bridges crossing the river the restriction points. I can also see the highways through the Rocky Mountains or the Appalachians being restriction points. The military would coordinate the process and provide some of the manpower, but the bulk of the personnel would come from state and local law-enforcement. The quarantine would not be fullproof, nor would it be intended to be so.

If these measures were put in place in the early stages of a pandemic in the US they would probably buy parts of the country several weeks to take preparatory measures. It would not stop the pandemic, but it would surely save some lives.

Think about where you live and where those restriction points would likely be located. I can think of several within 100 miles of my home. I can also see a pandemic playing out similar to a reargaurd battle with the lines of battle (not the “troops”) steadily moving as the enemy penetrates the line. In its final stages it would be similar to a guerilla war with small pockets isolated from all contact from the outside but providing material and technical support. It will be during this period between “initial contact with the enemy” and the “guerilla war” stage that movement of supplies, materials, and food will take place, but with steadily deminishing frequency as the “battle” progresses. During the stage where the enemy is virtually everywhere it will be every man for himself until the smoke has cleared. Then it will be time to pick up the pieces, bury the dead,…and prepare for the next wave.

Snowy Owl – at 13:44

“Monotreme,

I have been watching you post since about four days. I do understand your perceptions of risk heightened. I wanted to highligted that since you do have some credibility, your posts have more impacts than people with less credibility. …

But no, do not magnified the social unrest or fears, this is as you know contagious.

You can be sure that they will pull the plug off of those diffusers in few seconds.”

I am not agreeing with everything Monotreme states, but at least he doesn’t call it DATA. Since you let Niman on your own forum unchecked with speculation quoted as DATA all the time, I cannot believe you have an interest in finding the truth. Talk about fear mongering.

You have vested interest in your own forum, and on your own forum you play moderator which the public can evaluate.

Scaring people the feds might pull the plug on this forum? This is not the first time we see your thinly veiled attempts to undermine us here. I think it’s enough. You are insulting the intelligence of viewers of this forum.

Okieman – at 15:26

Basically, I agree with your scenario. Bridges and tunnels will be the restriction points.

Now might be a good time to get a backroads Atlas if you are planning on bugging out. However, I wouldn’t be surprised if there were lots of “informal” checkpoints and blockades.

Frankly, I wouldn’t bet much on anyone’s ability to bug out in time if there really are plans to restrict travel.

ANON-YYZ – at 17:30

You are in the ditch, and please let me explain.

I have embraced 3 1/2 yrs ago to reduce morbidity and mortality, I have kept the same moniker, I have been constant with Fukuda, Webster, Niman and up to the genocidary laxism of Reveres.

I happened to have contributed to the traffic of Flu Wikie very intensively at its announcement up to few months ago.

Flu Wiki has been cited in MSN, it is weel indexed in search engines, and with a lot of work from Revere, Dem from CT and Melanie blogs.

You hide again behind a moniker Lisa the GP, cut it out once and for all, you are a pain…

The reason I came in today, is simple, a lot of work, not what you are doing, wich is overwhelmingly bashing, a lot of work as been done here by generous members.

You do not have a hint of how FW members becomes nervous and insecure when you are out.

It is because of people like you, that resentment take a lot of space here now.

Move along, I am here because I want FW to hold the road, but maybe it is not your purpose Milady…

I have known Monotreme since CE and Diseases Outbreaks, pressure is rising up, I ask him to cool down for the sake of FW. ..too fast on the gun as they say in US.

As for our site, please notice that we are autonomous and have our own Mission.

The Intelligence of FW knows this.

As for you, well take some pills.

Caracterial nevrosis is tough I know, but please go take a walk, do not bring down this site like you did at CE.

Thank you

Thank You

Snowy Owl – at 17:44

“You hide again behind a moniker Lisa the GP, cut it out once and for all, you are a pain… “

First of all, I am not Lisa the GP. You stated that as your cover knowing that I have no way of proving one way or another. May be the mods could help me here. You are trying to put me on trial to deflect exposure of your intentions.

Yes, only those Witch Doctors, Fortune Tellers and Alchemists will consider me a pain. I am interested in seeking the truth, and charlatans can’t fool all of the people all of the time. You can shut me up, but I won’t be the last one you need to stop.

I trust most viewers of this forum who have read my posts can tell from my writings I am not a doctor.

You may have some history with whoever Lisa the GP is, but you should know that what you have done earlier today is so blatant and obvious that someone will expose you.

You are again suggesting that this site might be brought down, again trying to scare people so they start going to yours. Your not so honorable intentions are obvious. Yelling and name calling doesn’t do anything, desperation notwithstanding.

Ok nuff said, I have did what I truly believe what has to be done

Please read a post from Dr. Joe Thornton from our forum that is very informative.

As we consider the potential psychosocial consequences of pandemic influenza the scenarios can quickly overwhelm. The published plans from WHO, Federal and state officials break down the tasks nicely but the plans are estranged from the range of human behavior. We are not even sure if the plans have goals that are supported by the community. For example is the goal to save my life, the greatest number of lives, to save society or to save a society of souls.

A book on problem solving (?Turing) suggests looking at how other people solve similar problems.

Here I suggest that smallpox and SARS are similar problems. The Univ Pittsburgh Center for Biosecurity has an online scenario for a developing smallpox pandemic called “Atlantic Storm” http://www.upmc-biosecurity.org/ I highly recommend a review of that slide show and if we can dig it out to look at the Dark Winter exercise from 2001.

In Aug 2002 I participated in a 5 day multidjurisdictional exercise on smallpox called “Pale Horse.” I presented on the MH aspects in March 2003 to Disaster Psychiatry Outreach. We saw many of the issues acted out during the 2003 SARS outbreak but we also saw many very successful and clever adaptations to the outbreak.

The key issues are risk communication and demand management. There is plenty of room for important positive contributions from nonofficial forums.

In the light of the published smallpox scenarios and actual experience with SARS, we can consider what we actually need to do as members of a community to support the social infrastructure.

For example, when the headlines read that WHO has announced the world is entering a phase of pandemic influenza, do we believe that citizens will look at the published plans and then try to go buy 4 weeks of supplies? What will happen at the stores? How will people react? How do we diffuse the pressure and still meet the peoples needs? How do we get people to show up for work inside closed institutions like nursing homes, prisons or forensic mental health facilities? Is it important?

How do we advise others on how to balance personal needs for perceived safety versus the need for society to continue? What is the point of personal survival if society is catastrophically changed? Can a sufficient number of people develop a social contract with each other dedicated to the survival of society? Would such a strategy increase the survival probability for more people?

Everyone has the opportunity to help build resiliency. Those of us who are concerned can reach out to each other and define an environment that will help direct policy decisions. Dr. Stephen Southwick of Yale University has described a 12 Step program for building resiliency. These steps are not a direct path to recovery but serve as tools for the journey.

1.Support spirituality of the population a. connect with churches b. provide training for church volunteers on disasters and mental health c. promote the participation of churches in coordinated community response. d. build strength in diversity 2.Support peer communication for social support a. provide access to phones b. provide access to internet c. support dedicated local talk radio and cable access TV 3.Support constructive actions for the impacted persons by establishing natural mentors and role models a. a buddy system of volunteers with evacuees can be helpful to get through the multiple “little” hassles that wear people down. b. the buddy can help persist with calling numbers that are busy or voice message only or refer to multitude of other numbers c. the buddy can help problem solve the “assistance burden,” where the person receiving assistance must jump through hoops that do not provide the needed services 4.Support regular exercise, physical training and recreational activities 5.Support disaster recovery training for volunteers, a. channel the altruism of the population towards planned constructive action. 6.Enlist the children in activities, a. the children could organize color coded handouts that are distributed for information b. the children’s world view can help the adults with perspective c. the children help promote a sense of the future and recovery 7.Enlist all impacted persons in the problem solving to develop an active coping skills 8.Keep a goal in the grieving process towards acceptance a. The shock of multiple losses is accompanied by a natural grieving process. b. Many including the decision makers will need support towards accepting the magnitude of changes that are in store. 9.Assist the process of stress inoculation a. No matter how competent and caring the support communities, there are going to continue to be hassles and obstacles along the way to recovery b. Build on the survival so far to instill confidence in the ability to continue to meet the challenges with assistance 10.Leadership, operational personnel and all those affected will need assistance to develop cognitive flexibility. 11.Permit humor a. Humor can be one of the most developed coping strategies b. Distinguish between bitter cynicism and sweet irony 12.Instill optimism – things were bad, they are tough now, but by our actions they will get better

We can promote these skills now and apply them now to pandemic preparations. cr

Snowy Owl – at 18:11

“Please read a post from Dr. Joe Thornton from our forum that is very informative. “

You don’t even try to hide it any more. Still desperate for traffic?

Saying it nicely, some nice people on this forum may help you. No need to beat other people up, and try to shut down this forum. Censorship doesn’t work.

An appeal to the mods,

Please do not publish dates when you won’t be available. Every time you guys do that, we run the risk of bad people coming to disrupt us …

So, Snowy Owl and ANON-YYZ, you guys are probably not really flaming each other right? You are demonstrating how the EFFICACY OF SOCIAL DISTANCING MEASURES can be utilized by unnecessary verbal onslaughts which cause everyone to flee this thread? I wonder why the rest of us did not think of this ingenious method? Wonder if it can be applied in a pandemic?

Snowy, please cut out the name calling and bashing Lisa the GP. People seeking information about pandemics and wishing to establish themselves in an online community in the event of a disaster don’t want to see name calling and verbal wars. They go elsewhere. Please be true to the person in you who seeks to be honorable and help others. Rise to a greater level in yourself. That one who seeks to make the world a better place!

We may all be going down a difficult road soon if things in Indonesia escalate. You have knowlege that may need to be shared. Don’t ruin your ability to be useful with attracting unnecessary negativity. Be peaceful.

Bird Guano, thank you so very, very, very much for taking the time to look up all of that information. It was VERY helpful. :-)

Ange D – at 18:53

Sorry…

Snowy Owl, ANON-YYZ is not Lisa the GP. And in any case, s/he was merely objecting to your attempts at censorship and not even necesarily disagreeing with your point of view. I suspect ANON-YYZ does not have nearly as dire a view as I do.

Florida1 has already posted the very lengthy advice column you post.

I think the bottom-line is that the people who post and lurk on FW are intelligent adults who are able to judge the merit of differing opinions for themselves. One thing that irks me is patronizing putative authority figures. I am not one of them.

(((((ANON-YYZ))))

:-)

Here we go again . . . weren’t there similar fireworks a few months ago along similar lines?

What the heck…? If there’s going to be a quarrel, at least let it be something that the rest of us can follow! I have no idea what this is all about - it isn’t following the line of the thread. What’s “CE”? Who’s “Lisa the GP”? What’s Snowy Owl’s “own forum”?

There is not even one post on the entire thread from ANON-YYZ and then bam! there’s ANON-YYZ upset and rude. What’s up?

ANON-YYZ – at 18:25 “Saying it nicely, some nice people on this forum may help you. No need to beat other people up, and try to shut down this forum. Censorship doesn’t work.” And then, “An appeal to the mods, Please do not publish dates when you won’t be available. Every time you guys do that, we run the risk of bad people coming to disrupt us …”

What’s this all about? What just happened? When did Snowy Owl beat other people up and try to shut down the forum? What “censorship”? I haven’t seen any moderators publish their schedules? (And I’m thinking they can if they want…) And wouldn’t bad people come here anyway?

I don’t get it…

Snowy Owl – at 17:44

“the genocidary laxism of Reveres”

Wow.

Snowy Owl – at 17:44

“the genocidary laxism of Reveres”

Wow.

Getting back to social distancing, it appears to have some positive impact, though it might break down if the infection and CFR are high. I have a question. Has there EVER been a pandemic with a 30%+ infection rate that had a CFR of over 50%? I know the black plague wiped out a third or so of Europe over many years, but that was when cities had little or no clean water and sanitation. While some people do not trust history as a guide, and it is always possible for something badly novel to appear, the odds of getting something worse than our worst previous pandemic are low, though not zero. Are there any pandemic historians out there? (I assume we are not dealing with terrorism/biowarfare -could be wrong.)

This thread is getting long, so I’ll split it off into Part 2, found here

Last post copied to new thread

I was wondering the same question, INFOMASS. I did a little reading lately of some of the plagues but it seems that they were of the kind spread by fleas. (Bubonic?) Such as the one written about in “Journal of a Plague Year” by Daniel Dafoe. Also, the Black Death in whenever that was — 1400s? — was spread by fleas, i.e. (I think) not contagious person to person? I presume that means it spread whn the rats carrying the fleas moved from house to house, or perhaps the fleas spread from person to person.

If all this is correct, it makes sense that a highly fatal disease could spread and kill so many people, becuase as people dies out, the disease vector remained.

But, has there ever been a highly fatal CFR 50%+, easily spreadable, INFLUENZA epidemic? It seems so unlikley — it seems eventually it would just have to die out for lack of people able to spread it.