note, please feel free to print out or link to this post
A Severe Pandemic is Likely, Part 6
In reviewing the US State Plans, I have come to the conclusion that there are many, including public health officials, who are apparently unaware of the facts pertaining to the risk of a severe pandemic.. Since planning is heavily dependent on the assumptions made, it’s important that decision-makers, which includes the general public, understand why a severe pandemic is likely.
Definitions
I am defining a severe pandemic as a case fatality rate of at least 2%. I use the term very severe to mean a case fatality rate of at least 5%. I am only referring to virus, not to effect of the pandemic on society. I believe it is possible for society to survive a very severe pandemic, if adequate planning is done.
Clusters are becoming more frequent and larger.
Although we don’t know what the kill rate of a pandemic strain of H5N1 will be, there is no reason to think that it will be less than the 1918 pandemic strain and many reasons to think that it will be worse, much worse. Historical arguments are non-scientific and ignore basic virology. Risk assessments of the likely severity of an H5N1 pandemic should be based on the very substantial data that has been collected on this virus and not based on what has happened in previous pandemics with different viruses.
Given the available facts, failing to prepare for a severe pandemic is irresponsible and likely to result in the deaths of hundreds of millions of people.
Additional References
Evolution and adaptation of H5N1 influenza virus in avian and human hosts in Indonesia and Vietnam
The viral polymerase mediates adaptation of an avian influenza virus to a mammalian host
Structure and receptor specificity of the hemagglutinin from an H5N1 influenza virus
JWB – at 20:06
The graphs are great! No. Awesome!!!
Goju – at 20:07
The WHO graphs are the exact ones I have been showing to Town officials and Media. They work!
NO one can walk away saying
1 - its going away 2 - Its not getting worse. 3 - i dont care that it is killing the kids 4 - if this comes here my kids will be safe. 5 - i shouldnt do anything about it like preparing to SIP
Dude – at 21:18
The reason that we chose the layout of the cluster graphs that we did is that the human mind can see trends and interpret data better than we can articulate it. The WHO data actually shows the increase in cases, but does not show the distribution of these cases in any clear way. Only when you seperate the data by year and put them in visual alignment can you really see the trends. The next graph is more ambitious and will show the yearly distribution of all cases by case onset date. If you have any data on the case onset dates please contact me at dudeatsingtomeohmusedotcom. This is for the period of 2003–2006. We are looking for the areas in green on the word document on muse entitled individual cases by month [1][1].plus cluster info. So put your snoop hats on and let us know if you find this information anywhere. If we don’t have data we will make some assumptions that we hope will be as valid as they can be. Thanks.
crfullmoon – at 21:39
…”send these graphs to the WHO, CDC, etc”? Nah; send them to media, community organization leaders, power/fuel workers, grocery managers, morticians, teachers, other essential, or influential people…
Medical Maven: “Hasn’t mankind always reacted after the fact, after the “sucker punch”?
No reason not to do the right thing for once! Listen to scientific warnings.
No excuse for not informing the public; telling them it is important to prep. No good reason for so many families with children to not be told to get ready by school systems nor their physicians, who know. I also don’t believe the, “If it doesn’t happen right away, the public will never listen to us again” is true. People don’t all listen about not drinking and driving, or not smoking, or not polluting the environment, or about evacution warnings, but that is no reason not to educate and warn them. (Certainly hasn’t been another large terrorist attack on US soil lately, yet the country seems to listen and obey no matter how much money or rights it costs. How about the public hears “Prepare for pandemic” only just half as many times politicians have said anything about terrorism? That would be an improvement. Give it equal billing as a clear and present danger, though it has been the top one on my list for years.)
ColdClimatePrepper – at 21:46
OK, it seems like we all are a bit freaked out here right now. Is is possible we are all just building on each other… the echo chamber affect? I mean, we have all been waiting/watching for this pandemic for quite a while. You see what you look for if you know what I mean.
Can anyone out there offer some yin for all this yang? I mean, I’m getting a bit alarmed here. I guess tomorrow is another box store day, at the rate you all are predicting the time until pandemic!
I’m sure hoping all this is unecessary panic and it turns out we all laugh at ourselves later. Please?
ColdClimatePrepper – at 21:46
I’m not sure anyone is predicting a particular time point for pandemic onset. However, if the apparent multiple clusters in Indonesia hold up, we will be in a new grey zone. What I mean by that is that it will be very difficult to exclude the possibility that the pandemic has begun. Note, we could be in that grey zone for a year, which will not be good for our nerves, but would beat the alternative.
So was MadamSpinner “spinning” us a few days back about her son in Indonesia and his dire reports? Or was that legit?
Medical Maven – at 22:15
Beats me. Even without any super-secret information from the “inside”, I’d say the situation is dire. If the situation was actually worse than we think based on the excellent work being done on the Indonesia thread, hospitals would be going down, IMO. And I think that would be very hard to hide.
Medical Maven and Monotreme.
You don’t have to have the inside information to know how serious the situation is…
…you just have to read those that have the inside information.
Momotreme at 22:03-I read her post again. It was 6:02 on Sept. 25th on this thread. It was her nephew. And rereading it I tend to think it was genuine. Her nephew had a government job and said cases were being suppressed. I could believe that would be the case, and still without the hospitals going down. How many people have access to the hospitals anyway, and how many would want to go?
I’ve looked for Madame Spinner’s post but can’t find it. Anybody got a link to it?
Wonderer – at 23:47
It is on the Indonesia thread. Either the current one or the previous one.
http://www.fluwikie2.com/pmwiki.php?n=Forum.IndonesiaOutbreakX
Madamspinner – at 06:02 and at at 14:56
Here is the link. Scary to read. I hadnt read that before.
I found it. I still can’t believe the main stream media isn’t putting more up about this. I really don’t get it.
ColdClimatePrepper - some softness…
The pandemic of highly effecient and sustained Panflu has probably not started yet. There is still time.
We need to find that balance that moves people from lack of knowledge, and understanding the threat, and the freakout moment when their faces turn ashen and panic seizes their soul, and realizing there is something that can be done, and preparing their home for SIP to duck under the wave and spare their children to actually DOING IT.
Gov workers and media workers are just people like you and me. And when they have reached that dark place in the back of their mind and see the potential horror as we have all seen, they will use their positions to make a change and help others prepare.
I have witnessed it. Several times in the past 2 weeks.
I wanted to add a thought. Indonesia has a large number of cases that have clinical symptoms, but never seem to come up with a resolution of the case either positive/negative etc. These cases appear as numbers in the charts for August and September. The same is true for the large numbers from Thailand. I know that a number of cases can get a Tamiflu prophylaxis dose or treatment before verification of BF and that this may in fact mask the results. Now if a country were looking for funding and wanted to exaggerate the risk, would they in fact take seasonal flu cases (as opposed to bf cases) and just give them Tamiflu and up their numbers for more money from the world bank. That was the thought for Thailand too. I just don’t like unresolved cases over long periods of time. It may just be masked sysmptoms due to the decrease in virus particles, or it may be greed. I remember reading that the major reservation of the world bank about financial aid to Indonesia is corruption.
Dude, I think the commercial down side of having BF cases hugely outweigh any upside on the aid front. Don’t forget that often officials also control big commercial interests.
I would just remind those on this thread that recent high-level information from an Indonesian government minister to a close friend confirmed that the response to avian flu was inadequate and poorly organized and funded; that getting emergency-level actions would require more deaths; and that the situation was worse than reported. I agree with Goju that R0 must be low for H to H (or pig to H??) and that there is still time, which is why the hospitals have not collapsed yet.
INFOMASS – at 15:39
which is why the hospitals have not collapsed yet.
You may be more right than you realize. One of the first signs of a pandemic may be news of hospital closures in outbreak areas.
I should have added - not just because of the large number of patients, but more importantly because of the realization that they are seeing nosocomial infections - infections transmitted inside healthcare settings.
anon_22 – at 15:29 Yes, I agree. My point was not that. I feel that the real case numbers are bad enough, but that to inflate them might bring in even more money. The economic downside is also as infomass says a political football that can be used by any side not in power. It still does not preclude graft and greed. The data here for me is the standing number of cases that do not get resolved. Oh, and do you have mail anon22?
MEDICAL MAVIN— “So was MadamSpinner “spinning” us a few days back about her son in Indonesia and his dire reports? Or was that legit?”
I’m still here. This was my nephew that is in Indonesia. I haven’t heard anything new from him directly, but talked to his wife ( who finally got back to the USA with the girls ) .. she said even tho the native people in the cities ARE educated; compared to the rural people…who aren’t…. the majority are FINALLY believing what they’re being told…and NOW they are just flat scared.
Before people were hiding their birds, and not letting the authorities cull them; but now they are CALLING the authorities to come back and cull their birds. Gina said when she left to come home, they were starting to see city people, literally moving out of Surabuya…back into the mountains. Their “secured” household help, quit and disappeared several weeks ago.
Someone strongly suggested to me on the other list that I post my information on the Rumors list, because it couldn’t be verified.
Well, I’m sorry, people; but with my nephew doing the “certain” job he’s doing over there….it is NOT safe for him to come forward to “verify” anything. In reality, he “IS” the USA government source for the ( our ) truth over there…he just can’t come forward into the “light”.
Those who chose to treat any info I pass along as a rumor, are certainly free to do so. But as for me, & mine; I’ll take his word as the bottom-line truth; because he is there. And it’s one of his responsibilities to know what’s going on, in several areas.
Madamspinner: On the PPF thread, you said you were at a 7 (not a 9.9999), so can you tell us anything about your nephew’s feeling about when/if he thinks this may be out of control? If it were out of control or were soon to be (in his opinion), wouldn’t you be at 9.99999 rather than 7? Just curious. Thanks!
Well, the bird-to-human has been out of control for awhile; we already knew that. It’s the human-to-human rate of infection we don’t know the true numbers, due to any number of factors. They are finding that in almost every h-h-h case —that with each human jump, the virus is mutating within each person…now into WHAT ? is the 64 billion dollar question. Say you have a h-h-h cluster of 4…the virus seems to be making 4 mutations before that cluster is stopped.
Seems to me, that it’s trying to mutate into a fast moving, easily spreading, lethal, monster. But I’m just a layman.
He has no idea of “when’ well, that may not be so; but if he does, he’s not saying just yet. The Indonesians have no control of the spread…they need MORE people, more education, and more money to do the job; and it’s just not there. There was a late start to bird control;…well, more like a late “acceptance” of the reality, I think.
Honestly, IF I sat down and THOUGHT about his messages to family….my PPF would be wayyy above a 10. But I have a heart problem…so I absorb what I can; and as much as I can deal with. I have a very limited income; but I have managed to do just about all I can do;…and that keeps the PPF down to a dull roar…because I know I can only do so much.
Now the nephew can get out of the country whenever he needs to; but he’s one to stay longer then most people would; simply to “get the job done”. THAT makes my “other” PPF go above a 10 for sure.
Madamspinner-Sorry I doubted your original post, but it was accompanied by another new poster nearby that seemed “out there”. I have no doubt that you are genuine and heartfelt in your concern. (Also a surfeit of anons has jaded me) : )
Best of luck with your nephew.
I’ve looked at the text below the cluster charts, and I think it would be more digestible if we rewrite it in chunks and sort the chunks differently. What I suggest below is exactly the same text, but with said changes (and a bit more):
hth (=“hope this helps”)
It might end up looking like this (with titles like this):
Maybe “2 or more persons who had contact with each other where at least one has been tested and returned positive for H5N1” between quotes.
This starts to look good - now, I suggested some “devil’s advocate” comments in some previous comments. I’ll re-collect them and post them here in order to see if there needs to be any more information or comments in the page where the charts are. Anticipate attacks and disbelief, as this is really crucial!
part 5:
lugon – at 16:49
Ok, so let’s look at other possible explanations (not that I share them!):
Any other alternative explanations? Ways to prove or disprove either? Data needed and wanted and kindly requested from those who may (or may not) have it?
Skeptics will say interesting hypothesis so let’s move past that.
Thanks - the charts look - frightening.
Now, some people may challenge the origin of the data. Is the data collection method replicable by other teams?
I think we’re almost done with this, and some text should go with the charts. In a paper we’d end up writing there’s strong evidence to suggest that ….
You are the authors. Please finish it off.
Madamspinner – at 06:02 thank you for posting……most of the news reports are ‘over my head’ because I’ve not been tracking this as long as the others here have, but I understood your message.
I have a couple of questions. You said that your Neice in law & the children were back in the states — are they here to stay or do they have plans to return to Indonesia? I would assume they’re here to stay so my second question is are THEY prepping?
I understand that your heart condition keeps you from an all-out assault on the stores for prep supplies and I’m not sure which probably hurts you more, the concern about your own health or the concern that your sister who, having medical training, should know better but is denying what seems obvious to those of us here. It must make you feel very frustrated & alone in a lot of ways. I’m glad you’re posting because you’re among friends and can consider us a part of your extended family who IS PREPPING! :-)
Madamspinner – at 01:45
I was the person who suggested you post your report on the Rumor thread. And I still think you should do so. Please don’t take this as an insult. It doesn’t mean we think what you are saying is not true. It only means we don’t have independent confirmation. The WHO (and the CDC, I think) have peole whose sole job it is to exmanine rumors to see if they are true. They have found that a significant portion of them are true. Thus, rumors are considered very valuable sources of information.
The rumor thread provides one stop shopping for people who are looking for information that may be worth following up. In addition, by posting your report on the rumor thread other Fluwikians with connections to Indonesia may be prompted to make enquiries of their sources.
Monotreme, I know you’re busy as we all are. If/when you look at my suggestions above, I think the “clusters chart” page can be made into an even more powerful way to communicate what’s going on.
I’m starting to believe it really lets us do without WHO’s “stages” (your “grey zone”).
I think the page could look even better with the charts (one for each year) in a sequence (from top to bottom), and some text like in formal scientific papers. (In fact, would it hurt if someone could re-do the job and publish it officially? Not that I personally care, but if it travels faster and further, then so be it.)
At least, it lets us do without stages 3 and 4.
And maybe we just need recognition from “peers” (in the scientific journal’s papers), maybe just reprinting it, or citing it as a source in a letter to the editor, or whatever.
What are your ideas regarding this?
I think everything that the World Health Organization states should immediately go to the rumour thread until the information can be confirmed by an independent scientist.
It takes an imagination to come up with some of the stuff they have tried to pass off as ‘science’…and a greatly inflated imagination to come up with reasons to explain away the fact that they have been acting in collusion with the Government of China etc. to block the release of scientific information to said independent scientists.
tosses a ball against the wall while pondering this tidbit of information. it would be nice to have an inside “on the ground” source of information direct out of Indonesia.
then again as we see with the mous~s, anyone can pretty much create any type of image they wish to sell us and manage to foster that crap on us as the truth. (I’ll rant later about the weak who follow the weird)
meanwhile I never read the rumors thread
If the WHO wants to maintain that it is not H2H, then they should at least say that it is quite easy to get it from birds. A dead or sick bird within 100 yards of you seems to be all that’s needed.
I dunno - I think that rather it is pretty hard to get from birds, but rather easy to get from a human in one’s own household if they become infected from some means.
Indonesia has seen infections in something like 80% of the country now. That means that sick birds are endemic, whether symptomatic or unsymptomatic (they’ve found both).
The good news is that so far it appears that the first people who become infected from the index case do not seem to transmit at a high level to the
Madamespinner, I am going to trust my instincts here. I believe you. I’m getting ready as fast as I can, but your report lends my preps new urgency. Please continue to post any news you hear. The rumors thread was closed because it was getting too long but it is easy to start a new thread. I can’t remember what number it would be. Shoot, I’ll look it up and start one myself. When you want to post a new report just look it up.
Rumors has been one of the most popular threads here as far as I know. In my opinion, your report was also suited to the Indonesia outbreaks thread, too. But that is just my opinion. You have clearly identified this as a personal source and whether others are prepared to believe you or not is a personal choice. My instincts have proved right too many times for me to ignore them. Please keep posting someplace here.
Moeb, maybe you better start reading the rumors thread. It’s a lot of fun. Remember? LOL Sorry I didn’t realize you weren’t joking that time. I enjoy all your posts
sorry - to the next level of individuals. I am surprised, with all the birds infected in Indonesia with H5N1, that we are not seeing more B2H infections, but it is good news that we are not.
Monotreme beat me to it. He already started New Rumors V yesterday. It was just far enough down the list when I checked each time yesterday that I didn’t see it. Thanks, Monotreme.
bgw in MT at 14:17 Moeb, maybe you better start reading the rumors thread. It’s a lot of fun. Remember? LOL Sorry I didn’t realize you weren’t joking that time. I enjoy all your posts.
I guess the above proves my instincts aren’t always 100%, but the percentage is high enough that I trust them anyway.
the truth is, we tend to take all poster’s text at face value until proven differently. I avoid the rumors page because all the weird stuff…(thinks a minute), well most of the weird stuff gets put there
Heck, I’d like to see Madamspinner start her own thread… I’m sure I’d read it :-) or definitely post to the Indonesian thread before you consign it to just rumors
I’d like to see Madamspinner start her own thread too. She could bookmark it so that she would be able to find it easily when she had something to add to it.
I’m-working-on-it — “‘over my head’, but I understood your message. “
I’m having the same trouble and I have a medical background in Orthpediacs…I wish when translators; translated…they would also include a short version in PLAIN ENGLISH for us laymen.
On your questions: My Niece-in-law & the girls ARE back stateside to stay. Nephew moved them back with all their household belongings.( So he can’t ?? be far behind ??)
:-S Gulp !
And a BIG YES—to their prepping ! They are getting a late start, I think, on the prepping; but they have loads of bucks; so they can get caught up in a matter of days and a bunch of phone calls ( deliveries) if they need to. They have 2 places of residence here in the states; 1 in St Louis, 1 , a farm in Illinois.
I understand that your heart condition keeps you from an all-out assault on the stores for prep supplies and I’m not sure which probably hurts you more, the concern about your own health or the concern that your sister who, having medical training, should know better but is denying what seems obvious to those of us here. It must make you feel very frustrated & alone in a lot of ways. I’m glad you’re posting because you’re among friends and can consider us a part of your extended family who IS PREPPING! :-)
I-m-working-on-it —
Nuts to fast posting…I screw things up every time . LOL !
On your last paragraph; It used to upset me that my sister, the nurse, wasn’t/isn’t prepping; but I have come to the conclusion, she’s an Ostrich, with her head in the sand. They have a farm at the top of a hill; perfect for defending, etc. They are not doing a thing. ( sigh…)
It’s not that she believes Uncle Sam will come to the rescue;( Katrina proved that ) but that she simply either doesn’t believe this will happen, won’t happen as bad as we KNOW it will; or that she is just ignoring it…and it will go away. I finally had to quit trying; but I did tell her that when TSHTF; I will meet her, ASAP; halfway from my house to hers( 1/2 is 125 miles ) , to pick up her 9 yr old son. I also told her that she will have 1 chance and ONE CHANCE ONLY, to get him to me. If it soaked in; only God knows.
“”I understand that your heart condition keeps you from an all-out assault on the stores for prep supplies “”
I have taken months to get to where I am now; slowing bringing things in. Because of the idiot neighbors, I’ve brought everything inside at 3 AM…when nobody’s awake, ( I’m a night owl; if you look at most of my posts).
I know we can never have enough, but My teeny apt is literally stacked to the ceiling in 2 rooms; but you know, I don’t care ! I am willing to turn sideways to get thru the rooms; if it will see me thru to the other side; because altho I am not panicing (yet); I AM scared spitless.
I have a 74 yr old disabled mother to take care of, also; and I don’t know if I can do it alone. I don’t have a “nursing bone” in my body; and if she gets sick…I don’t know if I can go to her apt ( here) to take care of her…and that bothers me. But in the end, the survivial instinct will overtake US ALL. So who knows.
As far as starting a “Madamspinner: thread; I don’t really hear from the nephew often enough to make that work. “”“I wish I did”“”….but he is busy with what he’s doing…hazard pay wouldn’t even begin to cover what his work is worth to the US citizens…if I could only tell “all” I know…. However, in regards to the BF, whenever I hear anything, I will post it.
All things considered, I know when he says he’s coming stateside; it’s time to “slam” the door. But in the meantime, if I see a bird falling dead from the sky, I’ll have the door locked before he hits the ground. No joke, on that one.
I can’t do a thing on gas for the cars; but we won’t be going anywhere anyway..( need fuel stabilizer for the gas tank once we SIP ! )
I have a few vital things left to get; a crank radio, and more cooking fuel, a collar for an oil lamp, try to weasle some more scripts from the dr; then I’ll start all over on the food. I know I need more fruits. I have a giant freezer, but I have been canning the meats from it, in case the power goes off. Making alot of soup, for when we might be sick… reviving my sourdough culture for breads…
Should I start a thread ? I’m not “tooting my own horn”, but I have alot of knowledge in many areas that could help some… Just wish my heart would let me do the physical part easier…..
I would love it if you started your own thread. It would be so much easier to find you then. I am a night owl too and can so identify.
Spirit in the wind
lugon – at 09:22
I’m just a facilitator on the Clusters chart. The lead people are FloridaGirl and Dude. They are continuing to refine the message and I expect more from them soon. You may want to contact them via email.
Monotreme - at 23:34: Yes, please. lugon at singtomeetc
I have been giving the numbers that I have worked out some additional thought, and I have run some additional numbers. What I have found is that an individual who remains infectious for 3 days and has an R0 of 0.9275, then a Pandemic with the possible world wide infection would happen. At 0.9 then the spread of infection would start to collapse at 154 cases. At 0.75 it would start the collapse at 5 cases. (What we saw in the Karo Cluster).
So what are we looking for?
I truly do not know.
My best GUESS is that we would need to see a cluster that has grown to 155 cases or more in a 20 day time period. Individual clusters would not count unless they can be tied into each other. Any thing less than that and the spread will collapse.
With that said I now understand the concern with using Tami Flu in that it may be masking the growth rate but at the same time saving lives. (A real Catch-22)
What I now believe happened in 1918 is that the first wave had an RO of about 0.92. It did spread but was in the process of collapse when it mutated into the more virulent form. For a short while, its R0 was about 1.1 and then lost its ability to transmit and dropped to a level of about 0.91 (still spreading but collapsing). Then over succeeding years it keeps the 0.92 – 0.93 level but lost virulence and as more people had the disease, susceptibility fell.
If we assume that the annual flu is a mutation of the H3N2 virus which changes each year (hence the need for flu shot each year). Then the R0 should be in the 0.92 to 1.0 range which would account for the slower infection rate during the “flu season”
As to Dr Webster’s contention that the current flu shot will provide some protection from the H5N1, I have a hard time with that claim. While he knows his business and I do not, the mere fact that you have to have the flu shot annually is an indicator that the effectiveness would be remote. I do believe that it may help keep the seasonal flu down during a time when the fewer normal flu cases the better and would help keep the H5N1 from mixing with another flu virus.
I am now convinced that the local out breaks we are seeing are H2H, however the R0 rate is so low that it collapses before too many are infected. We could see this continue for a very long time and it may never find the right key for the correct R0 rate, or it could find the key tomorrow and we would be off to the races.
In short if H5N1 hits the right R0 rate then it goes pandemic, all of the pieces are in place except one and that seems to be the hardest piece to get. Additional, it may find the right key and lose it in the process, causing it to collapse and we would not know it until it was almost gone.
The more I look at the numbers and put it all together the more I understand why no one will commit to a firm time frame, how long it would last or even if it would happen.
Need to get a bottle of RWFK my pipe and a good dog and go sit on the river bank and think about this a bit.
Anon_451 – at 16:01
Excellent assessment. Thank you.
anon at 16:08-Were you the anon just on the PPF thread? Trying to build a profile on you so that I can hold you to task, if I see some inconsistencies show up later. But if you were not that anon, what was your previous submission recently? Or are you totally new to this site, and the above is your first submission? Or are you the old “gs” with a better accent? (An inside joke if you are a new anon, a recent anon, or an anon with a poor memory, or an anon who just skims and does not take in detail well.
Bump
Anon_451: Is there any reason to think that the virus has to have a single R0? While a flu virus can normally be said to have “an” R0 of 0.92 or 1.0, as per your example, does this number “have” to remain consistent from generation to generation?
Additionally, Tamiflu seems to affect the transmisibility as well as the severity of the virus. Are there any published studies that discuss what, exactly, Tamiflu’s effect is on the R0?
Pixie – at 20:08 I was hopping some of our medical types would join in on this as that is one of the questions that has troubled me. While I can work the math and understand the way it would spread, The mutation side of the house leaves me a bit befuddled.
Short answer I Just do not know. But with mother nature anything is possible.
Pixie,
Additionally, Tamiflu seems to affect the transmisibility as well as the severity of the virus.
It may be more accurate to say that tamiflu reduces virus shedding significantly, thereby reducing the chance of transmission to contacts.
Are there any published studies that discuss what, exactly, Tamiflu’s effect is on the R0?
Antivirals for influenza in healthy adults: systematic review, Lancet “Oseltamivir in a post-exposure prophylaxis role has a protective efficacy of 58·5% (15·6–79·6) for households and from 68% (34·9–84·2) to 89% (67–97) in contacts of index cases.”
Now this does not address whether treating infected patients will reduce the R0. But generally any measure that reduces transmission especially early on will reduce the rate of increase of R0. That’s assuming that all infected patients are consistently treated. Giving tamiflu to contacts is the basis behind the whole containment exercise, as discussed here.
anon_22 – at 21:10 Left untreated, would the RO stay the same in individuals or would it decrease over time. (Barry’s book lead me to believe that it would decrease) As I have said I can do the math part, it is the unknown medical part that has me troubled and sipping RWFK. (Just opened a second bottle to share with DW <Grin>)
Anon 451.
When it comes to nature and pathogens…expect the unexpected.
If we want to know how well prophylactics or treatments work…we will unfortunately have to wait for the post-pandemic analysis.
Anon_451 – at 16:01
Excellent analysis. This is what I have been thinking too. We are seeing multiple clusters with R0 less than 1. I would add that FloridaGirl and Dude’s chart indicate that the clusters may be trending larger which may mean that that R0 is evolving in the direction of a larger value. I can’t think of how this could be unless it is under selection in a mammal. And if it’s under selection in a mammal, I can’t think of why R0 won’t continue to increase. If this is true, the clusters should keep getting bigger, but spontaneously extinguishing, until R0 is greater than 1. At that point the pandemic would have begun but numbers would take time to build. In addition, once the number is over 1, I would think selection for higher R0′s would kick in. So, R0 would be a dynamic number influenced heavily by selection. Getting to 1 will be the hard part for the virus, after that higher numbers should get easier.
Of course, it’s possible that there is some barrier that will prevent H5N1 from ever getting to R0 = 1, but at this point I don’t know what it would be. Transmissibility is the key scientific issue to resolve at this point, IMO.
Absolutely agree with Monotreme’s analysis on R0.
Monotreme,
Of course, it’s possible that there is some barrier that will prevent H5N1 from ever getting to R0 = 1, but at this point I don’t know what it would be.
That’s what we all want to know. This is one of my posts from the JKT thread:
I said if a pandemic was to break out say in the next 12 months, and we only have limited time for research, what is the one question that you want to find the answer to?
And he said it would be host gene response, or more specifically how exactly does the virus cross into a new host, what are the virus-host interactions necessary for that to happen.
Anon_451: ========== As to Dr Webster’s contention that the current flu shot will provide some protection from the H5N1, I have a hard time with that claim. While he knows his business and I do not, the mere fact that you have to have the flu shot annually is an indicator that the effectiveness would be remote. I do believe that it may help keep the seasonal flu down during a time when the fewer normal flu cases the better and would help keep the H5N1 from mixing with another flu virus. ================== That isn’t what he is saying, I think. What he’s talking about is preventing cytokine storm, not just the flu. The people who have the worst cases are mainly people who have never had the flu in any form at all before: the immunologically naive. They are hit by a bad strain on _first_ exposure, and their immune sytem goes ballistic. Now take that same person and give them a flu shot, any flu shot. Now their system has been primed for the _idea_ of influenza. The next time they encounter it, they are far less likely to have an out-of-control response.
Don’t confuse the two things. There is great value in partial immunity, if it means you can avoid cytokine storm. So effctiveness doesn’t mean you don’t get the flu, it means you are less likely to die of it.
Hi everyone.
Between 1950 and 1997, as I understand it, there were two identified cases of avian influenza in humans.
Some unknown force snapped the string of convention in 1996…
…so as far as humans go the species barrier has been crossed several hundred times now…the jump has already occurred.
Secondly, I have studied pathogens in books and I have studied pathogens and their interactions in the field…and I can say without reservation, that I have never observed or could have concieved of a virus that could cross so many species barriers, with relative ease, at the same time.
bottom line…H5N1 is a monster of unprecedented abilities. ……………………………………………………………..
The era of procrastination, of half-measures, of soothing and baffling expedients, of delays, is coming to it’s close. In its place we are entering a period of consequences.
Winston Churchill (1936)
Thanks snowhound 1
anon_22: Thank you - those are the kinds of numbers I was looking for. Of course, one thing we have learned is that all infected patients are not consistently treated, nor are neighborhoods which (may?) have been given Tamiflu prophylacticly. The blanket is really just a crazy quilt, and the WHO containment plan does not really have any contingencies for that eventuality built into it.
Monotreme - at 22:13: “..the clusters should keep getting bigger, but spontaneously extinguishing, until R0 is greater than 1. At that point the pandemic would have begun but numbers would take time to build.”
In Indonesia, given that the chickens are not going to go away, we will see more clusters, that is clear. But WHY should they keep getting bigger? What is the mechanism behind that?
(Knock on wood that they continue to spontaneously extinguish, but let’s leave that for later)
Anon 451 I am going to several school boards in the upcoming two weeks in an effort to educate and encourage an early closure of schools. Should I say “look for 155 cases or more over a twenty day span” as an early signal? How did you get to that case number/ day number? Help, please, because that’s exactly the kind of thing that would raise the comfort level of a school board member about closing schools (an exact thing to look for).
Olymom - i have been trying to get through to my schoolboard… no response yet.
Pixie – at 22:36
In Indonesia, given that the chickens are not going to go away, we will see more clusters, that is clear. But WHY should they keep getting bigger? What is the mechanism behind that?
We will seem them get bigger if transmission between mammals is under selection. The chickens aren’t part of this. I am assuming that there is a hidden mammalian reservoir. In fact, it is the clusters that caused me to hypothesize this a while back. If the clusters have been getting bigger, and it appears that they are, then mammal to mammal transmission must be under positive selection, IMO. This is because each cluster is itself an evolutionary dead end. If the clusters are getting bigger, transmission has to be ongoing in something that facilitates H2H transmission.
Monotreme - at 22:13: “..the clusters should keep getting bigger, but spontaneously extinguishing, until R0 is greater than 1. At that point the pandemic would have begun but numbers would take time to build.”=========== It’s not clear from the sequences that the clusters are, in fact, extinguishing. The sequences, specifically, the cleavage site, clearly shows that chickens are not the source of the human infections. The human sequences are all pretty much the same, and the chicken sequences are pretty much the same, and they are different from each other. Either a miraculous series of identical mutations is taking place in each and every human infection, or there is a mammalian, probably human, reservoir of the virus. The existing sequence data show that these are not independently generated clusters. This makes a big differenc in how you calculate Ro, because for there to be a human reservoir, there have to be mild infections occurring.
Pixie – at 22:36
But WHY should they keep getting bigger? What is the mechanism behind that?
Good question! This has been a matter of some very thorough discussions on this series of threads started by Monotreme Final Adaptation Of H5N1 To Humans Role OfMammalian Reservoirs
My input on that subject was posted later on in the series here
In this double act, Monotreme and myself both came to certain conclusions about this WHY question…..
Just after I posted above, another thought occured to me. Suppose H5N1 is richocheting across more than one mammalian species? Flu viruses can be transmitted from humans to pigs. Suppose people get infected from whatever, they infect pigs, pigs infect cats, cats infect people, for example. The virus would bounce from mammal to mammal never having a chance to become perfectly adapted to any particular species but would continue to be under selection for mammal to mammal adaptation. This would explain why virus isolated from mammals doesn’t match virus isolated from birds.
If true, this would not give me a warm feeling.
Monotreme - at 22:55 - “I am assuming that there is a hidden mammalian reservoir.”
Isn’t it possible that the humans are the mamalian reservoir?
You are assuming, then, that the humans are coming in contact with an unknkown (four-legged) mammal. So far we are still seeing linkage to chicken deaths in most of the cases. Is it possible that the chickens are providing the initial viral material, and then selection is taking place within the humans? Or, are you removing the chickens from the equation at this point.
One thing that makes me disbelieve that we are seeing infections coming from both chickens and four-legged mammals is that, if the virus is changing in one of those carriers - most likely the mammals - we are still not seeing external evidence that would indicate two different types of H5N1 infections in Indonesia. I would think that we would at least start to see this happen regionally, if it were a case of chickens in one place, and a mammalian reservoir that was feeding the infections in another. So far, though, all the cases and the subsequent generations of cases seem to be proceeding in a remarkably similar way, and clusters seem to be fairly evenly distributed.
Which leads me back to that question about whether humans can be the hidden mamalian reservoir in which H5N1 is doing its work.
disgruntled – at 22:57
See my post at 23:00. Also recall that the virus isolated from a cat was similar to that isolated from humans.
I don’t think there is a human reservoir, at least not in Indonesia. Although we need more seroprevalence data, I don’t think there is a huge pool of mild infections.
But your example doesn’t explain why the human sequences from the ‘different’ clusters are pretty much the same. You’d expect more differences if there was a lot of crossing of species. Occam’s razor and all that, the simplest explanation is that the reservoir is human, and we just aren’t seeing it. They’ve swabbed more duck butts in Alaska than they’ve tested humans in Indonesia, and all they got is one hit.
Pixie – at 23:05
The sizes of the clusters do vary. The sequences from different clusters do vary. The viruses isolated from mammals are different than the viruses isolated from birds, but similar to each other.
Dont forget the WHO has said that H5N1 is developing resistance to tamiflu. The only way this can ocur is by repeated H2H. Or are the natives giving the FREE tamiflu to their chickens?
disgruntled – at 23:08
But your example doesn’t explain why the human sequences from the ‘different’ clusters are pretty much the same.
I don’t think that’s true. Are you sure that differences between different human clusters in any less than the differences between the sequences from humans and the cat?
I’ll check on this later.
DARWIN – at 23:11 Dont forget the WHO has said that H5N1 is developing resistance to tamiflu
The tamiflu resistance is not recent news, is it??
Could you please explain to us non-scientific types what RO is? Ive gone back through the posts and cant find it-I must have missed it somhow….. Thanks
Monotreme & disgruntled: Both of you have said that the sequences from the clusters are pretty much the same or do differ. Has anyone been able to see these cluster sequences? I thought part of our problem was that we are kind of flying blind here, and Indonesia has not been too terribly forthcoming with human sequence information.
The sizes of the clusters may vary, but only a bit - maybe not enough to be statistically significant because the variance is small and the numbers of clusters is small to begin with. The epidemiological presentation and outcome (based very much on when the case was discovered) is pretty standard, though, across the board. There just seem to be more similarities between cases/clusters than dismililarities.
anon_22, Monotreme, disgruntled: A hearty thanks for answering these questions.
DARWIN – at 23:11
No doubt H5N1 goes H2H, but it doens’t have to go too many generations before it becomes resistant. In fact, cases have been reported after a single generation. Selection is powerful.
Green Mom – at 23:16
R0 is the average number of people infected by one infected person. A pandemic begins when one infected person infects one other person (R0 = 0). This person will then infect one other person, and so on. This creates a sustainable chain of infections. If R0 = 2, each infected person infects 2 new people and so on. The higher R0, the faster the virus will spread.
Oops, that should have been R0 = 1, not R0= 0 above.
annon_22 at 23:13 Last thursday, September 28th was when the tamiflu resistance was first reported in the media.
Some additional news reports appeared today refering to it.
Monotreme- thanks for the explanation. Could you please tell me what the R means and what the O means? Thanks again
Monotreme – at 23:21 No doubt H5N1 goes H2H, but it doens’t have to go too many generations before it becomes resistant. In fact, cases have been reported after a single generation. Selection is powerful.
I know I know. Selection IS VERY powerful. If it wasnt we wouldnt be woried about H5N1 going pandemic would we ?
Thats why I have Relenza & Statins.
Pixe and Disgruntled,
I know have a partial and preliminary answer to your questions. I just BLASTed a cat Sequence from Indonesia, A/Feline/Indonesia/CDC1/2006. The most similar sequence was a human sequence A/Indonesia/CDC326N2/2006, not a chicken sequence. If I blast this human sequence, the most similar sequences are four human sequences, followed by the cat sequence listed above. Then comes a long list of human sequences which are more dissimilar to A/Indonesia/CDC326N2/2006 than the cat sequence. My guess is that the similar human sequences form a cluster (although I haven’t verified this yet).
All the sequences are from Indonesia.
The viruses that infected the group of 5 humans and the cat are more similar to each other than the viruses that infected other humans. I can think of only one way to interpet this - mammalian transmission and mammalian reservoir(s).
Olymom – at 22:38 DO NOT USE That number as Gospel. What you have been seen from the Medical Professionals was the reason I needed the bottle of wine and my dog. From a pure math standard. It is a good number. But Mother Nature does what she wants when she wants and how she wants. That was why I said
“The more I look at the numbers and put it all together the more I understand why no one will commit to a firm time frame, how long it would last or even if it would happen.”
DARWIN, do you have a link to the tamiflu resistance report? Thanks!
From the Flu Wiki Science Glossary
R0 aka R naught: The other “number” that is frequently mentioned in the influenza case and infectious disease epidemiology is called the Basic Reproductive Number, usually designated by the symbol R0 (pronounced ‘R naught”). It is the expected (average) number of new infectious cases in a completely susceptible population produced by a single case during its entire period of infectiousness. Like transmission probability, this simple definition hides some subtleties. See Disease Transmission Primer.
anon_22 – at 23:41 DARWIN, do you have a link to the tamiflu resistance report? Thanks!
Your wish is my command. Most recent referal. World Health Organization (WHO) announcement that the two most prevalent anti-viral drugs are losing their effectiveness against the avian flu, pandemic response plans must be reviewed and updated.”
The german cat matched the buzzard and the swan. ===================== Cat HA sequence is virtually identical to swan sequence from Germany and Buzard sequence from Denmark. Cleavage site is GERRRKKR.
Unique polymorphism is A356G, which has the following travel log that includes tree sparrows and other wild birds (in bold)
DQ356886 A/chicken/Anhui/M HA (4) 1038 H5N1 DQ643982 A/cat/Germany/606/2006 HA (4) 1779 2006 H5N1 ==================== I don’t find anything on the similarity of the german cat to the Turkey outbreak in humans. ==================
The Jakarta cat sequence predates the August-October outbreak in humans: -=========== (quoting Niman)====== The cat has a number of polymorphisms that are in almost all of the human cases, but this thread will focus on a subset that include the cat polymorphisms.
I believe the human sequences will be patients that were idetified in late 2005 or early 2006 and the cat H5N1 was isolated in early 2006,
Thus, this thread will identify what was “going around” Jakarta in early 2006 … =============== As I recall, the cleavage site in the swine was different, so that rules out swine as an intermediate vector, although there are no data from this year.
Monotreme - at 23:36: Thank you. Ok, so we have discrete groups of humans, humans + cat, and then other humans. How do we account for the chickens, then? (I am not being argumentative - that is a real question).
I think we have to somehow account for the chickens in the equation (who would have ever thought that I would write such a sentence?!).
Each time we find an infection/cluster, there are rumors of, or evidence of, dead/infected chickens nearby. One question that has not been answered, I think, is:
Are there chickens dying, maybe lots of chickens dying, of H5N1, and this is happening WITHOUT the people nearby falling ill?
At this point, are cases of chickens dying so prevalent that they are just not reported unless humans nearby happen to fall ill too? We know H5N1 is endemic in the chickens in Indonesia, but we are not hearing about a lot of chicken deaths/culling - we hear nothing at all about chicken deaths unless there is a human H5N1 infection nearby. It is possible that the chicken and the egg have nothing to do with each other at this point? From your analysis of the human infections, that would appear to be potentially so.
anon_22 – at 23:41 DARWIN, do you have a link to the tamiflu resistance report? Thanks!
Another referance from last week.
GENEVA (AP) - The deadly H5N1 strain of bird flu which has killed at least 148 people is showing signs of being able to mutate and develop resistance to the most effective anti-viral drugs and any possible vaccines yet to be produced, a WHO scientist said Thursday.
What is an RO ?
R0 aka R naught: The other “number” that is frequently mentioned in the influenza case and infectious disease epidemiology is called the Basic Reproductive Number, usually designated by the symbol R0 (pronounced ‘R naught”). It is the expected (average) number of new infectious cases in a completely susceptible population produced by a single case during its entire period of infectiousness. Like transmission probability, this simple definition hides some subtleties. See Disease Transmission Primer.
DARWIN,
Thank you. It looks like he could be talking generically, rather than there being new drug resistance data. Still I’ll keep an eye out for it.
Monotreme - at 23:00: “Suppose H5N1 is richocheting across more than one mammalian species? … Suppose people get infected from whatever, they infect pigs, pigs infect cats, cats infect people, for example.”
That’s the most logical explanation I’ve heard so far for the dispersion of the H5N1 virus with mammalian markers all over that huge Indonesian archipeligo. If it’s not the bird sequences that are spreading in mammals, well pigs don’t fly and even cats would have a very hard time spreading the virus throughout nearly every corner of Indonesia on their own. The kind of mammalian synergy would certainly give the job a hand.
Anon451 at 23:39 — no, I’m kinda shy about quoting “a dude on the internet” as gospel : ) — but I could say something like “one mathmatical model suggests that a point of concern would be 155 cases over twenty days” — would that be on the right track? I have to say that I like that — sounds scientific enough — keep in mind here, we’ve got a medium-fat housewife (GRRR — ok, blood pressure under control) trying to convince 5 people (school board) that they want to be aggressive on an action that sounds anywhere from inconvenient to down right scary. I’ll take some of the charts Goju’s charts and I am developing a list of about 10 specific actions I’d like to see taken by the school board. Some are not scary, but I think I could get them to go along “Appoint a staff member to check the CDC reports daily” — “identify pregnant staff and plan for early notification/approval to stay home” — but we’ve all seen these cases pop up and peter out month after month, it would be helpful to have some things to be specific heartbeat raisers for the school board.
Also, we keep hearing about “mammalian reservoirs” — is anyone looking for H5N1 in roof rats, ground mice, fruit bats, etc? I have yet to read any reports of researchers doing this. Seems like a natural PhD project for somebody. . .
Olymom – at 01:00 - “Also, we keep hearing about “mammalian reservoirs” — is anyone looking for H5N1 in roof rats, ground mice, fruit bats, etc? I have yet to read any reports of researchers doing this. Seems like a natural PhD project for somebody. . .”
When we last tuned in to Indonesia, Dr. Nidom was having a heck of a time wresting permission to do research on the infected cats from Dr. Cissy, who was demanding that he fill out the proper paperwork and research proposal. Let’s just say that research in H5N1 ridden Indonesia does not seem to be going at a terribly speedy rate, impending pandemic or no pandemic. Stay tuned for more episodes of “As Indonesia Turns…”
Someone ought to murmur “there maybe a Nobel prize in this” in Dr. Cissy’s (or the Indonesian Prime Minister’s) ear. Are there no university mammalogists who have specimens, blood samples from assorted local species? I know Jared Diamond did a lot of birding in Papua New Guinea. Surely there are some mammalogists running around somewhere (I’m married to one who looked at anoa in Sulawesi, but that was a couple decades ago) — who’s out and about who can bring back cold blood samples?
it could still be birds without other mammals. Just one species which doesn’t mix so much with the other birds but does mix with its own species. And with
humans through some environmental storing
of the virus
Lugon, others,
Yes, I think we could make an 8.5 X 11 trifold sheet of paper printed on both sides with the wiki graphs and some summary information like what Monotreme has at the beginning of this thread. It would make a great handout. That is the only kind of publication I think this merits. It is an original piece of work by FloridaGirl stemming from her question to me about what I wanted to see in a graph. It belongs to the wiki. Do whatever you want with it. Let us also wait for the next graph that will show all cases before we jump any gun. I like all of your ideas about the fixing of the text…anything that helps people understand.
OK, I googled a bit. Lance Durden, Asst. professor at Georgia Southern Univeristy. Did work for Smithsonian, National Geographic and NIH 1985: Grant award from the National Geographic Society to study mammals, their ectoparasites and potential disease relationships in Sulawesi, Indonesia. Research interest in Emerging diseases/zoonoses
Anybody know this guy? I will try and contact him tomorrow. But somebody like this may have some answers in their departmental freezer.
anonymous—Think about what you just said. Birds mainly spread it by oral/fecal route, and the pond/paddy/village system of farming is where the human/bird interface is. How do you segregate a bird population from this mess? And your idea has to at least not contradict the sequence data, which shows that the wild and domestic birds have a different strain thatn the humans. So, are you suggesting a reservoir in a kind of bird that has never been tested, and does not share territory with the pond/paddy/village system, and yet mixes with humans? I can’t visualize this.
Madamespinner: Thank You So Very Much for your reply to my question about your PPF! That does make much more sense. Maybe you can relate to your nephew that it would do your heart good, literally, if he got himself back home before things got really, really, really bad over there. It sounds as thought things are really to really, really bad already…sad for the entire planet.
disgruntled, yes. It could be IMO. Those birds (special ducks ? quails ? won’t poop virus into the ponds but spread the virus to other birds of the same species by another route.There are various possibilities. Humans could get it by the poops or by some intermediate animal eating the eggs, but the reservoir where the virus evolves would still be those special birds. It could even be non-deadly in these birds and they recover. E.g. the ducks give it to doves and other ducks, evolution happens only in the ducks while the doves are a dead end, they poop into the towns, some humans are infected but the virus finally dies. When these ducks have little contact with poultry, the virus could be missed.
(just an example)
Dude – at 01:20
Thanks! It would really be a great hand-out. I even thought about creating a t-shirt with the charts; if someone does that please take a picture and share that!
The hand-out will not be ready for PFAW, I would guess, but that doesn’t matter (hopefully).
A PDF going around through email networks - that would do.
Memetic war at work.
Thanks!
I copy this from another thread:
http://www.fluwikie.com/pmwiki.php?n=Science.GraphOfClusterSizeAndFrequencyOverTime
WHO’s pandemic stages would suggest reality is “either white or black” (stage 3 is different from stage 4), and that’s what made many of us uncomfortable. This chart portrays reality as “grey and getting darker”, so it makes better sense, explains things better, feels more real to many of us.
Maybe if we tell this to the press they will realise we’re in what Monotreme calls “a grey zone”, and people should use their own judgment regarding stock-up etc. This might mean stock-up would be gradual, maybe.
60 stages instead of 6. Then we are at 38, maybe.
lugon and everyone else - thank you so much for keeping on top of this critical topic. Everytime I read this thread I get knots in my stomach because the whole things seems ready to explode. Too many people, including my own loved ones (despite my pleadings) are unprepared and that scares that cr** out of me.
Also, I think you are right. Not all MSM here would pay attention to what is happening in Indo, but if you got one or two big papers to cover it it may take off. Also, the BBC was the first to carry info on the May cluster, long before US press did. Anyone have any contacts there?
Keep up the great work!
Closed and continued here.