New thread; old thread here.

Testing 1, 2, 3.

Up until about 6 weeks ago, I didn’t think this day would ever come. Puts just a bit of a twist in the tummie…

What time does this chapter end? (EST)

It already has. This is one of the two active threads.

The conversation continues here.

Once upon a time, on a world, far, far away, there was a very enchanted era. If ever there was a planet more overflowing with magical life, it was there. I know. My vast extended family and I called it home.

This is a short story, of the rise and fall of one of the most remarkable life forms in the universe. My life form. A life form, that by all comparisons was extremely unique. Eventually we came close to dominating this bluish marble wonder, blissfully sailing through space and time.

We fought through the ages to submit all other life forms to our will. To be our slaves, for our consumption and entertainment. But alas, another life form, explicitly complicated, finally destroyed us. It wiped out our offspring, our cousins, our brothers and sisters. It had something we simply could not comprehend. Thus we met our end.

What? What do ask? What was this attribute that this amazing life form possessed that destroyed our quest for dominance? I know not of it’s meaning or capabilities.

It is simply known as the human spirit.

Regards,

H5N1

eek, sidescroll

sidescroll on Circumventing the System

Fixed. Thanks.

Sidescroll at A Severe Pandemic is Likely

(thanks, pogge)

-oh! - here also (how much sidescroll is there?):

Must a Pandemic Strain of Influenza decrease in lethality?

Both fixed.

Tip of the Week-Archive- in the wiki side (right sidebar, at the bottom) is a cool feature. I clicked on A Knight at the Oprah, expecting to see Oprah’s show with Osterholm, but it was a current website, so the clue to click on Tues. gave me this Tues. with Mary Blige and other music guests. That can’t be right.

Here’s a bit about the pandemic show.

short clip from Osterholm on Oprah

slide show

the threads “chances for a pandemic” and follow-ups back in May/June, were they removed from the archive ?

Is it OK to post a copy ?

pogge, is it OK to download all the fluwikie threads here now, that the forum is closed and there are no more bandwidth problems ? You may tell me a time, when it’s appropriate. Will take some hours, I assume.

Author — 17 January 2007, 03:56 --- Is this the thread you’re looking for?

http://www.fluwikie2.com/pmwiki.php?n=Forum.ChancesOfAPandemicLike1918

no. “Chances for a Pandemic” with followups 2,3,… started on May 25, 2006

is it OK to download all the fluwikie threads here now

How is it you propose to do this? There are tools out there that, if used inappropriately, can still crash the server even if our traffic is relatively lower than it was.

“Chances for a Pandemic” with followups 2,3,… started on May 25, 2006

Four threads altogether. Restored.

Can threads be copied and pasted into TextEdit one by one (whew!)? Or is there a way to get them into a flashdrive?

Is there another way? That won’t hurt the server?

thanks for restoring. Could there be many other threads missing ? I plan to use “wget”, download the list of titles, create URLs from it, put it into a big file and run wget on it. First I test with a smaller list, whether it works well. I’ll make the whole archive available with a tool to extract single threads from it. I’ll use the print-versions. Maybe I’ll offer it to fredness from CE, who sends CDs with such Infos, when you are content.

Jane, on the upper right here, there is a “print” button which might make it easier. I hope my archive will also do it.

OK, I’m ready. I have 1900 threads, each one takes some seconds, so 1–2 hours in total. Do you still have some webspace, where it can be uploaded as 1.) one big .htm file, all threads in one file and /or 2.) the same converted to a textfile for keyword search 3.) a file with all the outgoing links 4.) a file with the contents of all the linked files (if that’s OK with copyright)

Re: wget. Here’s what you need to stay away from:

Recursive Download

I’m not going to volunteer to host whatever you produce at this point. We haven’t discussed long term plans at length yet. We have several thousand threads archived, i.e. not currently online, that need to be reviewed. The management and I need to discuss what we’re going to do with that material and that may involve experimenting here to see how much of it we can have online at any one time with the site (basically) read-only. We need to get that sorted out before we talk about hosting anything else.

Copyright shouldn’t be an issue for most applications. Everything on this site is published under the GNU Free Documentation License. As long as you abide by that, you’re fine.

Here is the link to the New Forum Diary, News Reports For January 12, which includes the summary for Jan.11

http://www.newfluwiki2.com/showDiary.do?diaryId=658

Here is the link to the New Forum Diary, News Reports For January 13, which includes the summary for Jan.12

http://www.newfluwiki2.com/showDiary.do?diaryId=670

Here is the link to the New Forum Diary, News Reports For January 14, which includes the summary for Jan.13

http://www.newfluwiki2.com/showDiary.do?diaryId=678

Here is the link to the New Forum Diary, News Reports For January 15, which includes the summary for Jan.14

http://www.newfluwiki2.com/showDiary.do?diaryId=685

Here is the link to the New Forum Diary, News Reports For January 16, which includes the summary for Jan.15

http://www.newfluwiki2.com/showDiary.do?diaryId=692

Thanks!

Here is the link to the New Forum Diary, News Reports For January 17, which includes the summary for Jan.16

http://www.newfluwiki2.com/showDiary.do?diaryId=700

oh, and you’re welcome I’m-workin’-on-it!

Here is the link to the New Forum Diary, News Reports For January 18, which includes the summary for Jan.17

http://www.newfluwiki2.com/showDiary.do?diaryId=711

Continuatino of previous thread

I have faced catastrophe all of my life. Although I have personally been spared, many others have died in sudden, unspeakably violent and horrifying circumstances. They usually had little warning because it is nearly impossible to predict the cause of their demise with certainty. Even so, because of the risk to human life, there is an enormous scientific effort made to predict the phenomena and warn the public. These predictions are based upon vague, imperfect and often misinterpreted data. They are often wrong. The best that science can do is provide general advice and imprecise warnings.

I live in Tornado Alley. I have been through many many “tornado warnings” but I have never even seen a tornado. The National Weather Service (NWS) monitors every severe thunderstorm in CONUS 24/7/365. They more or less understand the physics of a tornado. NWS constantly collects and analyzes enormous amounts of precise raw atmospheric data in near real time. This data is fed into sophisticated atmospheric computer models.

Even so, the science of predicting tornados is, to say the least, imperfect. For instance, today there is roughly a 60% chance that a tornado will form within the boundaries of any particular tornado watch. This is a great improvement from 1970, when it was only 31%.

But tornado watches cover about 25,000 square miles each. Your individual chances of being at risk from a tornado in a tornado watch area are miniscule. Even when a tornado warning is issued, the odds of actually being struck by the tornado are very small.

But despite the shortcomings, improvements in the accuracy of forecasting have been made. And lives have been saved as a result. While imprecise, it is not a futile exercise.

Perhaps the science of pandemic prediction will see the same progression as that of tornado forecasting. There was once a time when there were no tornado warnings. In fact, the forecasting of tornadoes was officially banned. According to the Storm Prediction Center (a division of NOAA), “Before 1950, at various stages of development of the Weather Bureau, the use of the word “tornado” in forecasts was at times strongly discouraged and at other times forbidden, because of a fear that predicting tornadoes may cause panic.” link This ban was revoked in 1950

Fear of causing panic. This is often the excuse for withholding information. But perhaps the real fear isn’t of panic but reflects the insecurity of those who are supposed to have the answers. Meteorologists are expected to be able to forecast severe weather. Repeatedly issuing wildly inaccurate forecasts for tornados wouldn’t have spoken well of their skills. The ban on tornado forecasting is reminiscent of Abraham Lincoln’s advice, “’Tis better to be silent and be thought a fool, than to speak and remove all doubt.”

Today, we have changing WHO pandemic alert scales and debates about whether it is possible to predict a pandemic. Some are indignant and demand a direct prediction of when the next pandemic will emerge. Others decry the lack of reliable data and insist that it can’t be done. One thing is certain; science, at the current time, has no definitive answers.

It seems quaint and anachronistic to believe that tornado forecasting should be discouraged because of a fear that it could cause panic. Perhaps as scientific knowledge increases, pandemic forecasting will likewise mature and this debate will someday seem similarly odd. One day, we may say, “Of course we can and should provide pandemic forecasts—why wouldn’t we?” Pandemic forecasts will probably never be perfect, but perfection can be the enemy of the good.

Many noble scientific advances have been motivated by a desperate problem which begs for a novel and useful (if not perfect) remedy. These are desperate times.

this thread continues the discussion from
http://www.fluwikie2.com/pmwiki.php?n=Forum.ChancesForAPandemic
and
http://www.fluwikie2.com/pmwiki.php?n=Forum.ChanceForAPandemic2
and
http://www.fluwikie2.com/pmwiki.php?n=Forum.ChanceForAPandemic3

yes, the WHO pandemic alert scales ! When you resort to a “no data”, “no prediction is possible” kind of argument, then, how do you justify the existence of the WHO-scales ? Don’t they qualify as data ? How can you even say things like : “the pandemic threat is larger now than it was in 1985″ when you completely deny the predictability and usefulness of probability estimation of the pandemic threat ? It’s inconsistent and contradictory.


I predict this will be recognized as one of the major faults in pandemic preparation and awareness in the aftermath of the next pandemic. How can it be, that common folks and flu-forum posters have estimates which differ so much ? While the experts don’t give numbers but do give unclear and probably deliberately ambiguous statements like “not if,but when” - but when being asked then they specify that they meant any pandemic not only H5N1 and without time-frame.

Still, I have problems with assigning numbers to it. Even recognising a number would be valuable if we had it. Hey, maybe a silly number (explained as such) is better than no number?

From the older threads, if we ever do ask for 500 somewhat qualified opinions and produce a chart with their estimates, what would that chart look like? We don’t know unless we try, so do try.

Questions:

• what would the questions be? Hammer that out in full view, here.
• who would you ask, how would you frame the query, and what would be the rules of the game (anonymity, etc)?
• what would the output be? A small anonymised database? A set of charts? How do we represent central points and spread and felt uncertainty?
• what would be the guidelines in interpreting such “data” (data about hunches)?

How to move onwards:

• discuss these (and other) items here, one by one. Charts can be described with words, or examples can be linked to, or ascii-art’ed, etc.
• create a wiki page summarising the state of the art, the points “for and against” (if there’s such a thing), a link to “the number’s game” and other related sources, etc
• write a definite proposal for the scientific (etc) community

We will be treating this as a part-time exercise anyway: those who feel it’s futile will give it zero time, and others will give it some minutes (and some energy) a week.

If anyone feels it’s dangerous to try, please say so.

Of course, anonymous posters can’t create wikipages on fluwikie.com. :)

This is ironic. Sometimes (more often than not, in chaotic times?) outliers are right. (And look at how the author of the article is identified as a film director in his signature, even though he insists he’s not and wikipedia is wrong about him.)

lugon, a number is here only a way to improve your communication and to express more clearly what you think. \\\We have some charts from the fluwiki survey or the curevents poll. The deviation (spread) of the estimates was quite large although still better than just randomly picking a number. Expert numbers should be better.

Questions: what’s your estimate of the probability that there will be a pandemic starting within the next 1 (2,3) years ? What’s your expectation value of the number of H5N1 deaths in the next 1 (2,3,) years ?

experts can remain anonymous, we would have only the numbers and the experts but not who gave which number. But I hope that some experts will stand to their numbers and justify them and discuss them in public and with other experts.

“Should” and “better” are value-heavy words. You mean you personally expect a narrower spread of the estimates? If that’s the case, why do you expect that?

Your short replies (05:13 and 05:17) answer most (but not all) of the detailed questions I posed at 04:17. Now, how do you suggest the practical problem of “getting it done” could be aproached? Who poses the questions, to whom exactly, and how is data collected?

What you want to ask starts to look like the following. See if you agree or if you would change it. And tell us about the practicalities.

Dear Expert,

Opinions are being collected about the following questions.

Opinions will be anonymised, so that your response will not be linked to your name in any case, unless you personally want to speak publicly about it.

Your participation will not be published unless you explicitly let us (now or later).

Thank you.

• ( ) Yes, I want you to include my name in the list of “people asked to provide their opinions”.
• ( ) No, I don’t want that to happen.
• ( ) I will tell you after I see the results (before the public does).
• What’s your estimate of the probability that there will be a pandemic starting within the next 12 months? ( )%
• Same for 24 months? ( )%
• Same for 36 months? ( )%
• What’s your expectation value of the number of H5N1 deaths in the next 12 months (in number of individuals, millions, or whatever figure is apropriate - please specify)?
• Same for 24 months?
• Same for 36 months?
• Further comments:

 >Should and better are value-heavy words. You mean you personally
 >expect a narrower spread of the estimates?

yes

 >If that’s the case, why do you expect that? 

experts are more competent ;-) They have more common sources. As I said, when there is enough discussion I expect they would all finally agree. But that “enough” could be too much to be practicable. But now that you ask, I looked at the Tufts data again and I am becoming skeptical.

 >Your short replies (05:13 and 05:17) answer most (but not all) 
 >of the detailed questions I posed at 04:17. 

so many posts…

 >Now, how do you suggest the practical problem of getting it done
 >could be aproached? Who poses the questions, to whom exactly, 
 >and how is data collected? 

we could ask experts by email, but they usually refuse to give numbers. We could send a request to CDC,WHO and ask to form the panels as they did in 1976. Or we could get a magazine or such to host the story.Maybe they can even periodically update it. E.g. once a week if it’s a weekly magazine. Or a student or scientist or journalist who wants to publish a paper on it. Like the Tufts,Fischhoff,Brilliant’s initiative. That would also be more reliable if they officially guarantee the anonymity of the experts.

 >What you want to ask starts to look like the following. 
 >See if you agree or if you would change it. And tell us 
 >about the practicalities. 
 >
 >
 >
 >Dear Expert, 
 >Opinions are being collected about the following questions. 
 >Opinions will be anonymised, so that your response will not 
 >be linked to your name in any case, unless you personally 
 >want to speak publicly about it. 
 >Your participation will not be published unless you explicitly
 >let us (now or later). 
 >Thank you. 
 >
 >
 >
 >( ) Yes, I want you to include my name in the list of people 
 >    asked to provide their opinions. 

that list could be published without their consent. We still won’t know which of those finally agreed to paticipate.

 >( ) No, I do not want that to happen. 
 >( ) I will tell you after I see the results (before the public does).
 >What is your estimate of the probability that there will be a pandemic
 >   starting within the next 12 months? ( )% 
 >Same for 24 months? ( )% 
 >Same for 36 months? ( )% 
 >What is your expectation value of the number of H5N1 deaths in the
 >next 12 months (in number of individuals, millions, or whatever figure is apropriate - please specify)? 

expectation value is clearly defined mathematically, but I’m not sure whether virologists,epidemiologists, other experts know about this. Suggestions how to better formulate it ?

 >Same for 24 months? 
 >Same for 36 months? 
 >Further comments: 

OK.

I have seen gs and now ‘anonymous’ ask this question over and over again over many months. Two things strike me when I read the responses:

1) I have yet seen another person on the forum persuaded to take up the banner to the same degree (of obsessiveness) as anonymous/gs. Clearly you are NOT persuading anyone. And clearly this discussion is not going anywhere.

2) The people who have participated vigorously in this discussion (and previous ones) have managed to settle on a unsatisfactory but reasonably comfortable relationship with uncertainty, and have moved on to other more important things like preps or helping others.

I would suggest you do the same.

Anon_22- Many, many months ago I suggested that a diagnosis of OCD would be in order. I stand by my previous opinion.

“perhaps the real fear isn’t of panic but reflects the insecurity of those who are supposed to have the answers.”

People like having what seem like solid answers, more than such are physically possible, given the size and complexity of the world.

anon_22,Melanie,Eccles : just typical Anglo-American behaviour to attack the author instead of the arguments. I am still waiting for a fruitful discussion contribution from you. You rarely ever address my arguments and replies. instead I keep hearing:
“no data” - me:here is the data,(link,link,..) - “no data, period.”
It’s boring to argue with that.


some people were persuaded : monotreme,lugon(?),LIP,Bo,cilibrar,StLBill. Scientists like Fischhoff,Neustadt,Fineberg,May,Alexander, share my position. I’m not aware of any mathematician or logician or statician who opposes as you do here. How could they ? It’s simple logics. I have a statistics, that i.e. the females oppose. Whether it’s important - time will tell. How are you going to convince intelligent,logical people about the pandemic thread without having expert estimates ? BTW. what’s your IQ, what’s your expertise in math or statistics ? Why do you consider yourself competent to take such a strong position, without even entering a discussion about the arguments ?

hey, wasn’t there a poster called “mathematician” here ? Where are they when you need them ?

So, “Anonymous”…WHAT is the answer? You seem to know that everybody here is wrong, in which case you know the correct answer. How’s about sharing it with us?

BroncoBill, the answer is: expert probability estimates should be given and discussed and are useful

I’ve devoted maybe .0001% of my “flu time” to gs’ and later anonymous’ “persistent query”. Here’s my assessment:

• I’m not a psychiatrist, so I’m not sure “people living with OCD” behave like gs and later anonymous do. It could be just an obsessive trait that might serve us well if successful. Most people here are “different” anyway! :)
• Having that survey done may stir up things a bit, maybe even more than proportional to the investment made. It might be a teachable moment to some, if their final conclusion is “we don’t know but pandemics happen and it looks like there’s one waiting to boil over, so we’d better prepare”. Things are not linear (something probabilities don’t handle well), and this is true in preparedness too, so maybe this “probability” thing would be the final straw on some people’s backs. :-?
• OTOH, such a survey might also turn people off. We just don’t know.
• Then there’s the final question? Will it get done? I very much doubt it.

Hmm - I guess I’ve used up my .0001%. Bye and good luck!

I was writing while there was this “ad hominem” thing. Useless stuff if you ask me.

gs, I suggest you create a wikipage that will get more exposure. Maybe someone will take up the challenge.

And yes, you will need a username to edit the wikipage.

You only need to present the best possible case to persuade those who will run the survey. You know what’s needed: the questionaire, people who are trusted with keeping the anonymity of others, and a little time in their hands.

lugon amicably wonders if anonymous will feel empty after that

assuming that lugon just only spent 10 minutes on this, I calculate that his/her “flu time” amounts to more than 19 years of 24h days.

precise numbers don’t matter all that much, really ;)

Consider Indonesia alone. The first case was part of a cluster of 3. Now we have clusters of 8. The flu went from one double to 3 doubles in cluster size in 9 months.

There are people who believe that there are now 3 strains circulating there now. This is one double in the number of strains in about 9 months.

At what point will they loose control?

There are computer models which predict the spread of a pandemic strain. Those are, of course, mathmatically based.

The models must have some initial input parameter assumptions. Why can’t the experts take those assumptions and run the model backwards? If a Pandemic looks like “x” after “t” months, what does it look like if you use -t.

I imagine the model will not like that very much and may require some tweaking, but it’s a start, isn’t it?

Torange – at 10:21

This is exactly my pause at accepting any generated “likelihood numbers”

There is just too much information popping up that surprises folks in the field and on this site.

If this were to be a quasi-trusted number - I’d ask to remove the human component and model this bad boy in a grid network… or some chartered super computer.

Alas, there is still the specter of understanding HOW this virus works… everyone has been gosh darn sure it’s the migratory birds transmitting the virus - but now that “sure” fact is in dispute.

So even if it were possible to model this event and make predictions - ones made last week would now be useless (and the folks that followed it - potentially underprepared) because they followed predictions based on imperfect information.

I agree that stages are the best system (given the alternates) - if we were to start using % numbers - there’s always the fact you run into a “grading error” where you start saying, “Oh, I’m not prepping till it hits 40% likelyhood in 6 months.” But the problemn there is, actual risk is not calculated… so even though it never may hit 40% - The risk is huge because despite the % only hitting 39% IF it did hit - the costs are huge.

I’d much rather leave the stages broad and have folks prepare based on associated reasonable risk than have them follow a naked number that is interpretted as differently as the methods for generating it.

Just thought of an issue here:

“So even if it were possible to model this event and make predictions - ones made last week would now be useless (and the folks that followed it - potentially underprepared) because they followed predictions based on imperfect information. “

Not to say prediction efforts are not worthwhile in development - I just think, given my comment above that there is a responsibility issue here as well.

Unless you can say the prediction model is far more likely to produce false positives than false negatives - I think there is an inherent danger in publicly persuing this endeavor.

Not that anyone would mean to - but what if the model failed completely? Though you got it to work in “post-predicting” the 1918 pandemic - it failed completely by greatly underestimating the threat potential?

How does that possibility register? What variance is acceptable when millions of lives are on the line?

I think that is an important point to consider.

Power hungry- It is not usually of much value to run models backwards. Let us take a simplistic example- Suppose after 3 months of running a model determined that everyone, everywhere was dead. Starting from this end point, there would be an infinite number of paths to get back to the beginning point where everyone was alive and a few were sick.

Torange. I agree.

Eccles, Quartsman, Power Hungry. Why use a model when we have the real thing working right in front of out eyes. Sometimes, I think models are used so that we don’t have to think and that statement is not said to reflect on the good analysis the three of you have been doing here. It was meant more for the agencies that run these models.

One thing is sure. This ongoing adaption and evolution of H5N1 should, in the future, provide all the needed data to make their computer modelling progrms work much better…problem is that for the first time in recent history, we are now the guinea pigs.

anonymous. You have given two predictions in respect to H5N1…the first was a probability of 1% per month and the second was a 50% chance in the next ten years. It appears to me that at a rate of 1% per month the probability would be 96% in 8 years which does not correlate with your second estimate….please explain the difference.

Everyone here brings something different and special to the Flu Wiki table and I appreciate what anonymous is trying to do and think it potentially has a great deal of merit.

At some level probablility estimates are made by everyone who is aware of the threat of H5N1. I don’t put a number on my estimate, but whatever my number might be, it is high enough to motivate me to spend a significant amount of money, time and effort in preparation. Businesses, too, must have some fuzzy number they come up with to decide if they are going to ignore this thing, hope it just goes away, or spend a significant amount of money, time and effort in preparation. Same with communities, states, nations, the WHO.

So I don’t think asking for an actual number is all that outrageous. Problematic and imperfect, yes; outrageous no. In fact, more I think about it, more I think it sounds reasonable. The U.S. must have based their decision to stage Tamiflu in the vicinity of Indonesia on some mathematical calculation that took into account what data there exists from past pandemics and what is currently happening in Asia, including any insider knowledge they have of viral sequences that we lesser mortals are not privy to.

But what are those numbers? What is that number? To get experts to give numbers would be very interesting, if nothing else. But maybe they don’t want to because of the panic that might ensue.

Anyway, thank you anonymous for your contributions to Flu Wiki. At first I didn’t think you were credible; I do now. And I admire your courage and tenacity in pursuing this issue in the face of such vehement criticism.

Tom DVM- This encounter might provide future generations with more data to help understand the situation, provided that the data was actually being taken, was placed into the public record, and then was not subsequently altered in an attempt to render a revisionist history of what happened and why we didn’t see it coming.

Note this comment by Sandman and Lanard in their latest article:

I thought of it as I read this post. We really are a sane pragmatic lot.

I think I understand anonymous. There are reasons for his monomania, and it has a value. It has been presented to the forum in varying ways, if it didn’t resonate at all those threads would have died long ago. I have no trouble with the uncertainties of this problem. Others for business reasons, and some for guidance want numbers.

“provided that the data was actually being taken, was placed into the public record, and then was not subsequently altered in an attempt to render a revisionist history of what happened and why we didn’t see it coming.”

I’m not betting on that happening.

You know Eccles you are absolutely right.

I have been doing a lot of thinking about this and I am convinced that they have been gambling that a pandemic was not going to happen.

In January 2005, they were shooting more **** then today. If you think of what was going on then vs now, the data set has been steadily getting worse for their opening position…but instead of changing, they are doggedly holding on to it. That level of rigidity requires them to conveniently (only becaue they can) start covering up scientific data that doesn’t agree with their opening position; a little at first, followed by a requirement to cover up more and more data. At each step along the way, they are trapped by their previously adjustment of the truth.

For those on flu wiki that think I am being to harsh with the WHO, I am going to refer them to you, because even I would not have thought of this angle…keep up the good work. /:-)

Tom DVM: I pray that you are wrong, but something in my instincts tells me that you are dead on.

…”they have been gambling that a pandemic was not going to happen.”..

I would basically swear this was the local officials’ position as late as last Oct. (possibly Dec.) -maybe some even now. De Nile pretty wide this year, still.

When the pandemic starts you won’t see this thread anymore so I love seeing it at the top of the page.

All comment that follow are IMHO - Models are primarily for board level executive summaries because chaos enters any equation based upon natural events, and policy makers like to appear to be in control and intelligent in the choices history records them making.

And everything in this situation is dynamic. It could be that the one person harboring the one mutated virus that can cause the pandemic will be hit by a truck and never spread the mutation - or that the mutations spontaneously occur in multiple hosts in the same time period in different locations and nothing stops the pandemic.

There are as many “ifs” as there are combinations of precursor events times the interaction of those precursor events with each other in raw reality. Lightning “should” strike a lightning rod instead of the roof of a building, but variability creeps into the situation some days and the building burns down around the lightning rod. Most of life is made up of making choices that seem the best at the moment, even for the WHO, CDC, USDA, Enron, or Florida Board of Elections. Usually we can live with the circumstances of being wrong.

Provided enough people survive being wrong this will be entertaining academic banter for future generations on when the virus became human vectored. For others, it will hopefully at least leave headstones. It just depends upon the level of compassion and action generated by the argument as to whether we are actually making a difference or just tuning up our fiddles while the flames advance on Rome.

If this turns into a pandemic, the next generations will bury all this data. What happened after 1918, the roaring 20′s. It would only resurface in the face of a similar threat, because the human race never seems to learn very much from the past.

We know that the bird flu is an exponential function but it is a fractal version of an exponential function. The rate of increase is not a smooth line but is very bumpy. The big picture from the trends is that the pandemic will start soon. When you have exponential increase in cluster sizes on top of exponential increases in the number of strains on top of exponential number of individual cases on top of exponential cases in animals in nature, things can move fast. We are in trouble and there is no obvious solution. We may have reached the crook in the hockey stick. Good luck and may God be with us.

Don’t take my observations as indications to give up by any means, just realize I don’t need a executive decree to decide not to tap dance in a mine field. Thanks to the wikie I have been warned. What I do with my knowledge is now my responsibility and up to my experience and decision making capacity. Most of the western world has never faced a true life-threatening situation with foreknowledge. That is why we watch Discovery adn History Channels on cable TV, and wonder how people survive the disasters we see there. This may be another learning moment.

As I have stated elsewhere, the WHO and similar national organizations have a great deal to lose professionally by predicting an epidemic if one does not happen. They have very little to lose by NOT predicting an epidemic if one happens. There is a systematic bias in favor of under-reporting and underplaying the legitimate level of concern. This situation would obtain even if the threat were not as highly variable and stochastic, even chaotic, as influenza in fact is. This highly variable threat makes the situation even worse.

Given the prediliction for under-reporting and underestimation of the real threat, cautious prudence suggests that this bias be recognized and allowed for. Simple epdemiological models are relatively easy to construct using Excel spreadsheets; more sophisticated models can be written in C++ in a day or so.

Sophisticated stochastic models are a lot more complex, but for the purposes of preparation and illustration, assume that one airliner (747)arrives in LAX with half of the passengers nonsymptomatic but infectious. Assume further that no infections occur in the LAX terminal building and that half of those infected travel separately to only 12 other airports and then ride public transit to the final destination. You will be amazed at how quickly the flu will infect 10% of the US population; it’s days, not weeks.

Scaredy Cat – at 12:15

“Anyway, thank you anonymous for your contributions to Flu Wiki. At first I didn’t think you were credible; I do now. And I admire your courage and tenacity in pursuing this issue in the face of such vehement criticism.”

:)

I didn’t think I’m being vehement - but I admit to being opininated and apologize if that’s raised anyone’s heart rate.

On another note, I must also admit I’ve shifted a bit from my original denial of the value in developing this info… But I still (obviously) have my reservations. ;)

For sure, I’d be last in arguing this topic shouldn’t be discussed (or argued). And I greatly appreciate the maturity of the discussion despite the clear differences in opinion.

In my mind, Anonymous has a worthy goal and I can respect our differences because they are so vital to keep near. Also, who knows? It may turn out, in the midst of chaos, Anonymous finds a jewel of life-saving info. So I can’t discourage his efforts - just express my thoughts for what ever value they hold. I think we all can agree with that…

I second Melanie’s observation of our sanity and pragmatism… and add the lowest common denominator of everyone visiting FluWikie (trolls aside) is a person sincerely concerned for human lives.

A community worth visiting regardless of our threat’s outcome.

Tray75 at 12:47: The journal article that was presented some time back that dealt with the likelihood of smothering an incipient pandemic with Tamiflu assumed that any initial success would be leavened by the certainty that if H5N1 made “the leap” once it would certainly do it again. In other words, we are only buying time. So let us say we get very lucky in Indonesia and snuff it out before it gets going. We have only bought time. And the authors of the study thought that the time bought would be at most, months. As Torange has ably elaborated on our current situation, we are in dire straits. Believe what you see (and what you don’t see) should be our mantra.

anonymous. You have given two predictions in respect to H5N1…the first was a probability of 1% per month and the second was a 50% chance in the next ten years. It appears to me that at a rate of 1% per month the probability would be 96% in 8 years which does not correlate with your second estimate….please explain the difference.


that’s because the probability per month goes down later. When it won’t come in the next 5 years, then it is becoming more likely that it “burns out” somehow, as in Vietnam. Or it causes some epidemics like normal flu but doesn’t go pandemic. We have seen some changes the last 12 months, I don’t expect H5N1 can hold this speed. There is a chance that there just is no pandemic strain in the genetic neighborhood of actual H5N1. But if there is one, then it should have enough opportunity to show up in the next few years. Another argument for lower probabilities in later years are advancements in research, antivirals, vaccines, understanding how it spreads, which might prevent a pandemic.

And the earthquake, and Mt. Meriap with the possible erruption impending. Perhaps nature is taking a quantum leap in other ways also.

I see some people switching sides… but strangely not for the reason I had expected, which is the swine-flu analysis by Neustadt+Fineberg,Neustadt+May which still hasn’t been addressed. Is someone interested in some links ?

Medical Maven – at 13:35
we will learn from that outbreak. We will improve our strategy to recognize and contain later outbreaks. We will start making vaccine. We will speed up our research. We will increase our investments in panflu prevention and preparing.

Anonymous at 14:01 - Hogwash! your post sounds like the old And Then a Miracle Occurs term in some of the poorly constructed proofs I have analyzed in my day.

anonymous, at 08:45

“anon_22,Melanie,Eccles : just typical Anglo-American behaviour to attack the author instead of the arguments.”

FYI I am neither Anglo nor American.

Shows how assumptions based on limited data can be so far off the mark.

You need a futures market.

Lily ¨C at 12:54: If this turns into a pandemic, the next generations will bury all this data. What happened after 1918, the roaring 20¡äs. It would only resurface in the face of a similar threat, because the human race never seems to learn very much from the past.

Can’t say I agree with this, Lily. We have had some incredible medical advances thanks to horrible diseases (i.e. AIDS) and horrible events (wars).

I recently did some consulting for the VA Administration and they had, on site, a museum that showed the medical advances due to Civil War, Korean War, World War 1, World War II and the Vietnam War - everything from x-ray machines to medivac - all based on what went wrong and why alot of soldiers died during the various wars.

We know the same is true of the AIDS virus. There is alot of good medicine out there now that helps boost ones immune system that is not only used in AIDS but in various cancers and a wide assortment of other diseases. My mother was the recipient of one such drug.

So, my rebuttal would be that we, as a human race, just don’t BURY bad events and not learn from them. I think we learn a tremendous amount - I think we learned a whole hell of a lot from Katrina and 9/11 and already see some of the new advances that came about because of these horrible events (Homeland Security, etc.) Doesn’t mean we won’t continue to make bad mistakes and bad choices, but I think humans have a tendency not to get burned twice.

I would expect the same after a more current pandemic.

who is a political organisation,expect political behavior. media is corporate,expect a corresponding spin. as to whether or not who took a chance when deciding that h5n1 wouldn’t go pandemic;didn’t the current u.s. administration take the same approach with hurricane safety in n.o. to save money,only to get busted by katrina? you pays your money,you takes your chances. logic tells me to distrust power and do my own homework.

Lets do an expert prediction to see if it is useful. We will assume a semi traditional family: two boys and a girl, ages 15, 16, and 17. This seems appropriate for anonymous to understand. Now I want to predict if the children’s mother will yell at them on Saturday. The children are experts on their mother’s behavior. They have been living with her for a total of 48 years and they have closely observed her behavior. Therefore, as experts, we can ask each to predict her yelling at a family member on Saturday. The predictions are 90%, 70% and 50% the average prediction = 90+70+50 /3 = 70%. How useful is this prediction?
Well we have some problems don’t we. Mom may not be home. Perhaps she yells at one person more than another and the predictions are biased by different types of experiences with Mom. Perhaps the one who was going to be yelled at is not at home on Sat. Perhaps no one does anything that requires Mom to yell and on and on and on.
None-the-less these are experts and we demand a prediction. After all serious damage could results from Mon’s yelling.
Well my young ignorant acquaintance, does that help you in your infinite wisdom to see the problem of expert predictions? Demand all you want and receive and answer. Is the answer useful?

It was pointed out above that the odds of a particular house being hit by a tornado, even when you are in a tornado watch zone, are infintisimal. True. OTOH, four years ago I was in a tornado watch zone and my house was destroyed by a tornado and my wife was injured. So, what have I learned? S--- happens and it is smart to buy insurance and be prepared. If nothing happens you are not out much, but if it should happen it can mean the difference between surviving or not surviving. However, I have found that friends and family want some idea of what the risk is. So, to help sell preparing to them I DO use a figure of 15% as the liklihood of a pandemic occuring and a CFR of 1–2%. These number don’t have much, if any, scientific basis but I use them as a shorthand way of indicating that a pandemic is not necessarily a sure event but that it isn’t about as likely as winning the lottery either. I tell them that this is a heck of a lot higher than my chances of being wiped out by a tornado in 2002 was. I tell them that it is “a low probability event with such potentially terrible outcome” that being prepared just “makes sense” (just like buying wind insurance for your house made sense for me, despite the very low risk). I tell them that, while noone can say that H5N1 will go pandemic, there are some “clues” out there that should make you sit up and take notice, and maybe be pretty worried too. I have had the swine flu thrown up at me and I have responded by throwing Katrina back at them. People in New Orleans were warned about the risk of a hurricane wiping out their city—the N. O. Times Picayune ran just such a series on the risk a year or two prior to Katrina. There were some who paid attention and got “out of Dodge” when warned and others who ignored it and died (or sat for days in the sun on a freeway, or in feces and urine at the Convention Center)--I would rather be the former. John-Ohio (still can’t get my handle to post where it is supposed to)

anonymous too – at 16:02 - I see your point. Just don’t let this get personal. We are all stuck on the same rock (except 2 people currently in orbit) and some people hold science and math as dearly as religious conviction. You have a great way of expressing the uselessness of data, and a creative one. If I were to ask “What Are the Chances of an Asteroid Striking the Earth” science and math would come up with 100%. The “When” of the strike would be the variable? So it is with a pandemic even amongst the most critical of H5N1 watchers. The unknown driving us all nuts is the “When”.

Tray75. Exactly.

There was nothing personal. To be you and ignorant is part of life. To be stupid, a variable I did not discuss, that is another matter.

anonymous too – at 16:36

Now that’s just uncalled for…

:(

We can be above insults - it doesn’t make your point more valid and only lowers the opportunity for compromise or understanding.

anonymous too.

Your comments were uncalled for.

We consider all arguments for discussion here including yours…and we do it with mutual respect.

for goodness sake please pick a ‘handle’ for yourselves instead of having a host of anonymouses. It doesn’t have to be fancy or ‘deep’ call yourself peanut or 28 or marbles- whatever, anything.

It does nothing to promote understanding to have multiple anonymous postings from many people.

I would rather be insulted by someone with a handle than an anon.

Janet, I agree with you entirely, except I meant something different.

Actually something seems to be amiss, might be one of those low tolerance days today. The moon was merely a sliver last night so its not a full moon.

Lily at 17:04, :-)

anonymous too – at 16:36 - Everyone has an opinion. A truly wise man can even learn from one thought a fool. Insult me if it makes you better able to handle the stress. I had my breakdown here a few weeks ago, and found support and comfort, so I’m not going anywhere. I probably won’t live through a pandemic, but my point in being here is to give what I can so that others may. And I see that same support still exists. I may not agree with the way you say things, but you have every right to say them if it is to help prepare or cope.

In defense of gs (aka “anonymous”, etc.), I can honestly say he has always created some thought-provoking posts, and IMHO has never tried to mislead anyone. In fact, I was most impressed by his virus-sequencing posts on previous threads. He obviously knows something about tracking the changes in this particular virus. Maybe there is someone out there that can answer his queries on probabilities. For my part, I continue to look at this virus as a low probability high impact sort of occurence. I can’t put numbers to it, but I believe the chances of a H5N1 pandemic happening are higher than my house burning down (although the more gas I store in anticipation of a pandemic, the higher my chances are of my house burning down! Not to worry though, I’m not storing it IN my house). What I’ve always felt is that I want to protect my wife, children and myself from dying the kind of horrible death that the avian flu would bring. So perhaps I am motivated by emotions much more than rational thinking in this case. I believe that there are times when emotions are better at telling you what to do than reason. These emotions are nature’s “short-hand” for elaborate instructions. You can either read the short-hand or ignore it and pursue more elaborate instructions (based on mathematics, perhaps) on what to do. Of course, you need more time to pursue the more elaborate instructions. Everything has its price. Still, I enjoy reading gs’s “quest” for the perfect probabilities. May he and all others who need them find them in time.

The reference to young and ignorant was to anonymous. But with regard to ignorance, note that everyone is ignorant, just on different topics. Insult implied or otherwise and simple obstinance are part of anonymous’s posts. Reap what you sow.

anonymous too – at 17:30 - thanks for clearing up the “anonymous” mix up. Keeping track of all the anon’s is going to require we hand out numbers soon! And that, for the moment, I will accept as my ignorance in not knowing the difference.

I dearly hope the next forum, no matter its form, eliminates all these anonymous posters. How many of them are there? On occasion I can see posting something under ‘anonymous’ for something particularily revealing. And yes, mistakes happen and people on occasion forget to type in their name (I have), but if you are a regular poster here, in my opinion, its rather rude to not give yourself a name or number to make the conversations less confusing.

Hi All,

In manufacturing, substitute measures are used for control\ charts where the gathering of data for the activity is not\ viable. This may be as simple as validating the effect of an\ action.

In the absence of sufficient or precise data to predict the\ probability of a pandemic and with the given that it is designed\ to influence a change in behaviour (be prepared) could one\ substitute with the trend in opinion of a sufficient body of\ experts?

For instance:#. Compared with your assessment at October 2005 do you now\ believe a pandemic is less likely (0) or more likely (1)in 3\ years, 5 years?

1. . Same as 1. but based on a comparison with your assessment at\ March 2006

Ah but who remembers. I don’t.

Yes I do. Less likely soon. More likely later.

gs, please move on to do something practical with the questions … unless Quartzman is right in saying this: Unless you can say the prediction model is far more likely to produce false positives than false negatives - I think there is an inherent danger in publicly persuing this endeavor.

It’s something I had thought of, myself. Not that I’m sure. But, you know, before looking at probabilities you have to look at possibilities. Just an example: throw a dice and you have 6 possibilities. Presumably with equal probabilities so it’s one sixth for each. Now, throw an irregular object, and you have many more possibilities - and only after you have the possibilities can you start to think about probabilities.

Of course, your questions are worded so that they have definite (and comparable) answers. Which is good in a way.

Now, I also noticed you suggested 1, 2 and 3 years. Why not further than that? Possibly because in 3 years we might have a new invention that makes “vaccines for all, in a week” real? Just around the corner, and the future (our image of it) changes dramatically.

Trouble is, the future might not be linear at all, starting today (and not just in 3 years time).

I have a problem with the future. In my mind there are at least three kinds of future:

• a bird poops and faeces fall more or less linearly.
• a bird’s feather falls to the left, then to the right, and eventually reaches the ground in an unpredictable place.
• the bird flies - where the heck will it go?

I’m not sure what kind of future is H5N1’s future. And it might help in thinking about possibilities, probabilities, etc. Any ideas?

I can understand the want/need/desire to have numbers attached to the potential of our experiencing a panflu at a certain time. I also would be interested in seeing the odds. But, I live in a state in which I can gamble in the lottery, and I only risk one dollar when the pot reaches $30 million or greater…so you see how bad MY odds are…but alas, I am a first-born child and have great need for control and/or the illusion of such.

I am sure “experts” are currently working on so many possibilities and probabilities that the stats are confounding. I would have every grad student working on every potential variable. And I would expect that many are glued to their keyboards “working the numbers.”

It just might not be so useful to publically announce their results. I’m not sure we have enough firm data to do so yet. Perhaps revealing the unknown sequences would be a good first step. To use an analogy, we seem to have a systemic “macular degeneration” which has left us with a huge blind spot right in the middle of our vision. Restricted vision results in a major handicap. How do you make accurate predictions with antiquated data? And I would assume in virology, antiquated data is anything greater than a few hours old. Some of our last sequences are years old.

I can see an inherent danger in publishing predictions based on a multitude of variables. I was taught to publish information for general consumption with the assumption that the highest educational level was 4th grade. I would assume that those of us on the wiki generally have a bit more education than that and we would perhaps welcome a thought-provoking prediction.

But those who may take such information literally or concretely may indeed panic. I’m not sure of the statistics, nor do I necessarily equate education with intelligence, but I would surely think that there would be more people with less education than more. Would a large scale panic benefit anyone?

The difference today vs. 1918 is the ability to transmit information (accurate or INaccurate) in seconds. Panic is an emotional response; it follows no logic. It is already difficult to stop false rumors re: panflu. IMO, publish the facts. But don’t hide them either. And that seems to be our problem.

a’Akova – at 15:20
You need a futures market.


yes !
And high volume betting markets.
And insurances, who insure companies against panflu loss.

concerning the anonymous names and handles. I assume this is the result of people’s behaviour including moderators in earlier threads. Gs has been marked as troll, insulted, thrown to dungeon, they started a thread: “is gs a 12 year old sociopath” at curevents. Maybe this thread hadn’t been started without being able to use ananymous as handle. Imagine gs starting to contact CDC,WHO or magazines to start the probability estimates project. If they find those threads, won’t they be worried about their own image ? They would just see the posts and insults, they have not the time to figure out whether they are justified. There is clearly a reason why most people here, even those who are running this site are staying anonymous. And one can only advice everyone to do the same.

anonymous at 20:27,

It would be useful if you would choose a handle, too, please.

gs is an old contributor to this site and we are all familiar with his work and his questions. He is not without insight.

anonymous. First of all, our mutual friend gs chose to use his real name. Maybe wasn’t a good idea but in the large scheme of things it doesn’t change anything…nobody remembers names in a short period of time.

It doesn’t matter what happened on current events, gs is held in great affection on flu wiki as the comments indicate.

Time to pick an anonymous name…I would suggest Mr. Spock because he was a bear for detail as well.

Maybe our mutual friends can suggest other names for this anonymouse.

All he is is a mathemetician. He has his own way of looking at matters, and that is all there is to it.

Gs has been marked as troll, insulted, thrown to dungeon, they started a thread: “is gs a 12 year old sociopath” at curevents.

This isn’t curevents and people have debated with gs (and each other too BTW) on a variety of issues. I don’t consider him a troll and have enjoyed both agreeing and disagreeing with him at various times, he has never been banned here.

A handle like mine and many others is anonymous while being distinctive from the rest of the posters, that’s the point really.

A question, is it reasonable to expect experts to give probabilities based on incomplete (IMO) data under their true name with their professional reputations at stake when the person asking the questions won’t even reveal his/her true name? Think about it.

I’d like to add that disagreeing with someone’s opinion on a particular subject does not = a lack of respect. It’s just a simple difference of opinion.

Excellent point MaMa as always.

Something that suits, like data bank, or his favorite character or personage in history, or in mathematics.

I think the problem why most people oppose that idea is that they don’t realize that probabilities are only, well, probabilities. Assigning numbers to them -no matter how many decimals that number has- won’t change that. In practice a probability of 10% or 10.231% is hardly a difference, while on the other hand 0.001 or 0.00001 is very much different. When you say an event has 80% probability, then it may not happen with 20% and if so people will notice and might question that previous estimate. On the other hand when the expected happens then they won’t take much notice. That’s the reason why people usually overestimate the chances of outsider wins and lottery-wins. Losing a bet or being wrong occasionally with a probability estimate is normal and no sign of incompetency, except when you are wrong lots of times. We all should use probability estimates more often in normal conversation. It clarifies what we mean. It doesn’t imply that we have some advanced knowledge and put lots of thought in it. Just a language tool to express ourseves instead of using unclear words like : maybe, probably, we cannot exclude that,it may happen,…. Lots of expressions had been invented to describe probability estimates without having to assign numbers. But numbers are more suitable to communicate your thoughts to others.

Only if you have a mathematical bent, and most people don’t.

Thanks Tom DVM.

anonymous, when you say ‘We all should use probability estimates more often in normal conversation. It clarifies what we mean. It doesn’t imply that we have some advanced knowledge and put lots of thought in it. Just a language tool to express ourseves instead of using unclear words like : maybe, probably, we cannot exclude that,it may happen,…. Lots of expressions had been invented to describe probability estimates without having to assign numbers. But numbers are more suitable to communicate your thoughts to others.’

you’re doing the same thing, you just feel more comfortable thinking of things and expressing them in terms of numbers, that’s what works for you. Language is what a higher proportion of the population responds to though. To me, if it’s got numbers it MUST be a measurable thing- my mind doesn’t deal well with uncertainties in numbers. IMO alot of people have trouble with the idea that a probability doesn’t have a particular certainty of outcome. It’s not right or wrong either way, just a difference in wiring.

I respectfully suggest ‘Master of Probabilities’ as a handle, though Lily’s suggestions are great as well.

Dear friends, gs/anonymous will not take up a new handle precisely because you are asking him to. He’s flipping the bird and smiling every time one of our esteemed colleagues like Tom DVM suggests a name like Spock - good one Tom!

I too, feel that gs is far from being a troll. Argumentative, bright? Sure. I really think he occasionally enjoys sticking his finger in the eye of those he feels deserve it.

“enjoys sticking his finger in the eye of those he feels deserve it”

Who doesn’t? I’ve done it a thousand times.

The problem is that such conduct is usually not conducive to a productive dialogue. Short term satisfaction. Long term frustration.

Is there any probability that this thread will discuss the header topic?

Interested in an approach that will assist with focusing ‘Joe Public’ on the pandemic issue and preparing to survive.

MaMa – at 21:11

“It’s not right or wrong either way, just a difference in wiring.”

Who are you?!? :-) That is an observation so obvious it was begging to be said.

Thank you!

So really, that makes sense because there isn’t much else that can explain why we can’t reach some middle ground.

And as an ENFP - (only 2% of the US is like me - or I’m only like 2%… you get the idea..) - I can appreciate that this may be more than a perspective difference.

So please, let’s just let Anonymous work this out. I still feel it should be handled carefully, but the argument can’t be “won” on either side. :)

KevinNZ – at 21:38
yes. The thread was about how they handled this in the swine-flu affaire and its later analysis and conclusions and what we can learn from it for the actual situation with H5N1.

mmmmelody. Thanks on the ‘Spock’ thing but it was not my idea. I believe someone mentioned it last night on this thread but I can’t find who to attribute it to.

This is unlike me, but I suggest that this thread be ignored, rather than closed. Attention seems to fuel gs’s engines and we should cut off his supply. Nothing productive has emerged from his prevocations and it is unlikely that this will, either. Nothing to see here, move along.

Melanie is calling to ignore the claim and trying to disturb the thread and then she complains that “nothing productive has emerged”. The one who was most unproductive here was her. Just crying “no data” but never seriously arguing or answering. I’m still wondering what’s the real reason that she doen’t want expert probability estimates. Would that detract attention from fluwiki ? Could the estimates be too low, so people would no longer be interested to prep ? So far expert estimates were lower than estimates of fluwiki members in the fluwiki-survey.

Quartzman, I’m just an INFP chick who finally saw the light:-)

anonymous, I have a suggestion. Maybe you should consider formulating a set of questions that you feel would be useful and presenting a questionnaire to some of the experts relevant to the study of H5N1. From the completed questionnaires you could figure out the probabilities and present them to us here on the forum. Then we could discuss what our thoughts were on the results. What do you think?

I for one am always interested in a probability estimate. I would want to fully understand how the numbers came about. It most likely will not change my mind overall unless there where different sources to back it up, but it would be apart of my planning if I found the data sound. I am data orientated and would not take any prediction serious without data.

MaMa, it won’t work. Experts won’t answer. We need the panels as in 1976 or some magazine or research-group like Tuft’s working on it. We need more people to ask these questions to experts, people who require politicians and journalists to ask these questions to experts. Write to your representatives as with the sequences-withholding-thing. This one is even more important. It was done and recommended in 1976. We are being kept in the dark about the likelyhood of that pandemic.

Nldaho,have you ever tried to ask an expert this question ? Please do it. Not that I expect they would give a number, they will likely use unclear wordings, if they answer at all. But it shows public interest to get those numbers and if enough people ask, they will have to think about it. You will easily find the email-addresses of most experts.

Maybe we should put a bug in the ear of some different magazines, to organize a poll.

If the experts truly won’t answer then I don’t know what else you could try.

I’m off to bed, g’night all…

you could offer them money. You could allow them to stay anonymous. You could urge them by public or government pressure. You could form the panels as in 1976. That they truly don’t want to answer could be some political directive, some temporary style. They did answer in 1976. If public really wants the answer then it could get it.We first have to rise the general panflu-probability-awareness-level. Some discussion about the problem in newspapers and journals like the Fischhoff-report might help. (I hope) We have the poll from the 565 US-physicians, from the fluwiki-survey, from curevents and these numbers differ a lot. I.e. people here and at Curevents are much more pessimistic than the US-physicians. Don’t you want to see the same poll with H5N1-experts ?

And in 1976 they were wrong.

guenther,

the chance of a pandemic is greater than zero. That is the only number we have.

Melanie-

Don’t you believe that the GBS-inducing swine flu vaccine also prevented the tremendous death toll of the 1976 pandemic influenza?

NS1,

I’m not a scientist, I’m a writer, and I have no idea. What I’m marking out here at Flu Wiki is the human cost of the failure to understand pandemic and to help others to plan.

Anonymous, you have a problem. You solve it.

Melany, It’s not clear whether they were wrong in 1976. Maybe the decision to vaccinate was correct and reasonable given their knowledge at that time. But if it was wrong, we could still learn from it. And that is what the analysis of Neustadt+Fineberg is about. And that is why the CDC still refers to even that analysis in their smallpox vaccinating directive.


Also we do have some more numbers already. The fluwiki-survey, the physicians-poll, the Fischhoff-paper, the Webster interview were already mentioned. Among others.
And I’m not “guenther”. Name calling won’t help you here anyway. You are wrong. There is some data, we do have numbers other than zero. But we urgently need more.

lugon, the whole world has a (pandemic) problem. Let’s cooperate to reduce its expected impact.

Anonymous, you have a problem. The problem is, in my respectful opinion, “how can I move from asking people to do things to doing them myself?”

Your “let’s cooperate”, when turned into actions, appears to mean “I ask that others move this forward”. It really does look like you feel you’re weaker than everyone else. I tend to call this “complain mode”. You’re not moving forward much, really.

You might go to an internet cafe and choose a handle so that you can create a wikipage on fluwikie.com and write your proposal in full, taking all things into consideration, acknowledging that you have listened to other people (that way people may be more prone to see your point, which is not the only way to look at things), and then create noise as apropriate.

You want to stay anonymous? Is that the problem, really? Use stuff written by other people, not your own words.

You really have an interesting problem in your hands. You’ll have to solve it directly or indirectly, but I honestly don’t know how. Good luck!

lugon, many people can achieve more than one.
It’s not a problem which I ask you to solve for my pleasure.
It’s a problem that gs (and probably others) figured out is an
important one to be attacked in these prepandemic times.
He volunteers his time to help you (us all) and not vice versa.
Gs did ask many experts already without much success.
When you say “you are not moving forward” you could as well
say “we are not moving forward”. What’s your contribution here ?
Was it successful ? I can send a long list of gs-activities and
hundredth of hours spent without payment.

The anonymous posting is to reduce debate about
personal issues as sadly happened before and is
still happening here despite my attempt to keep it out.
What do you think would have happened if gs had posted this
thread ? The Melanies and Anon_22s and female catlovers
here would have thrown it to dungeon immediately. Just
from the history of gs posts and behaviour before,
which for some reason they don’t like.

Creating a wikipage could be an idea, but then why not
post it to the forum so it can be commented and discussed ?
People are not walking through wikipages and then find stuff
occasionally. They follow links or search for keywords
and this can be done with the forum as well.
Still better would be sending copies to CDC,HHS,WHO,…
but we know, they tend to ignore emails.
However someone said they were monitoring the fluwiki forum
frequently…

Your final “good luck” sounds like “goodbye, you are on your own”

There’s the physical possibility, for anyone with internet access, to create the suggested wiki page at http://www.fluwikie.com - full with the compiled summary and a growable list of surveyable people, maybe even with replies as you or someone else receives them. There’s the possibility to link to that wikipage from here, and keep it active (and visible) by telling the world about every step and who reacts or who doesn’t.

OK. Nobody wanted to know about the 1976 data, so here it is ;-)


http://www.fluwikie.com/pmwiki.php?n=Science.LessonsFromTheSwineFlu1976

Anon, here in the U.S. kids in supermarkets can’t even figure out your change in a purchase. They depend on the machine, don’t calculate in their heads at all, the way we that are older do. But most of us, and I think the majority of females are not mathematically inclined, and thinking mathematically as is normal for you, is just not our bag, no matter how important it might be in your analysis of the situation. Therefor, while you are comfortable with this manner of thinking, we are not, and are extremely resistant to any prodding.

Lily,then why do they oppose to the subject when they feel incompetent ? They can say that they don’t like my behaviour or language style or whatever. No problem. Just they shouldn’t interrupt the threads with ridiculous arguing and requiring them to be closed or ignored or sent to dungeon.

People want probibilities so-

Unless the trends in Indonesia are reversed the probibility is 100%.

The probibility for pandemic in 2006 is less than 100%

You have to ask them. Curevents is curevents, Flu wiki is flu wiki. People just like to jump in with their views. You think like you do obviously with mathematical projections. They can’t possibly understand how you think. Best not to argue, just barge ahead. Those of us who have been here a long time do understand even if we give you backtalk. Obviously Dem from Ct. understands.It hurts, but if you believe what you are about, thats all that counts.

Melanie – at 04:12

I was just making a light joke.

Of course, the decision makers missed the mark in 1976 and produced a vaccine that permanently damaged a portion of the population.

a very small portion, if any. Do you think the decision was wrong ?

lugon and all,
see this page:
http://www.fluwikie.com/pmwiki.php?n=Science.EstimatesAboutAFluPandemic
please comment. You can edit and improve the wording. The recent success with getting sequence data gives new hope that some experts might finally also give probability estimates !

It would be useful if some reknowned person would host the project, (not much work) whom the experts can trust with the anonymity issue. I think, it’s important to offer them the option to stay anonymous.

Known people? Declan Butler? Can anyone contact him? Reveres? Other bloggers?

statistics will be displayed once there are at least 5 expert estimates. Asuming no-one’s behind is left uncovered (i.e. if there are five replies, four with level 1 and one with level 2, then that means level 2 is a level 1 in practice) :)

Re estimating the odds: does that mean the panels of experts were in fact created in 1976? Where are those documents? Could it be (tin-foil hat) that those comitees are in fact active now and there’s a number (or a set of numbers) which are being hidden?

It looks like “the number” is just a way to start the conversation regarding “why different numbers? what do we assume?”. Is that it? Because I know I wouldn’t trust the number itself. But the conversation around it would be useful.

Just like when planners say “the value is in the planning process, not in the actual plan document”.

 >Known people? Declan Butler? Can anyone contact him? Reveres? 
 >Other bloggers? 

yes. gs also mailed to numbers guy from wall street journal, no answer yet. Or the fluwiki (Melanie ? ;-) or flutracker, or CDC,WHO,HHS,CIDRAP,ECDC,… Our favourite would have been Dr.Alexander, alas he died some months ago.

 >statistics will be displayed once there are at least 5 expert
 >estimates. Asuming no-ones behind is left uncovered (i.e. if 
 >there are five replies, four with level 1 and one with level 2,
 >then that means level 2 is a level 1 in practice) :) 

yes, I hope it is unlikely. We could say: at least 3 with level >=2

 >Re estimating the odds: does that mean the panels of experts were
 >in fact created in 1976? Where are those documents? 

yes, that is one of the reasons why I started this thread. We added the URL now to the wiki. What was good in 1976 can’t be bad now ?!

 >Could it be (tin-foil hat) that those comitees are in fact
 >active now and there is a number (or a set of numbers) which
 >are being hidden? 

quite possible. Not the same committee and the same people, though. And not only in USA. Not also, that experts occasinally give numbers privately (Garcia Sastre,Osterhaus) but not in public. However once it is common to give estimates and discuss them, there is no more reason to stand aside and keep your estimates secret.

 >It looks like -the number- is just a way to start the conversation 
 >regarding -why different numbers? what do we assume?-. Is that it? 

yes, I hope some discussion like that will evolve

 >Because I know I would not trust the number itself. But the 
 >conversation around it would be useful. 
 >Just like when planners say the value is in the planning process, 
 >not in the actual plan document.

In theory they should finally agree on one number. I hope the deviation at least would go down.

would a public list of “contactables” do any good? there are people who go to scientific meetings and so on …

maybe even suggest that they do it among themselves and give them the tools to do it?

Perhaps you could go for a trusted agency instead of a ‘known trusted person’to gather and analyse the probability data from “the panel”.

For instance, there are several agencies that run ‘internal customer’ questionnaires for departments like IT and Finance. The responders are all anonymous to the department/organisation being surveyed. The survey agency may also be useful in framing the questions.

yes. Or there should be one online-agency from Microsoft or Yahoo or google or such, which automatically collects the data, checks the email, and displays the statistics according to the anonymity level. A list of emails is entered beforehand and only estimates from these emails are accepted. But we would still need some pressure or incentive for experts to participate. And an attached forum to discuss the estimates. Or better 2 forums, one for experts only and one for everyone.

Closed due to length. Conversation is continued here.

Closed due to length. Conversation is continued here.

Then Hannity asked about chances for a pandemic. Gerberding said it is unpredictible


“chances” are always predictable. Keeping the CDC predictions secret is irresponsable. This is not a secret agency. How can they call to prepare for an event when they can’t predict the chance that it will occur ? In 1976 after the first swine-flu deaths CDC formed two panels to independently predict the chances of a swine-flu-pandemic. One panel came up with 10–25%, the other one with 40%. President Ford decided to vaccinate the entire US-population. Let’s call CDC (and others) to form two panels now to predict the chances for a H5N1-pandemic !

Before the rush with fifty personal responses, please let each consider the boundaries that are necessary to make an answer such as “Thirty-seven percent” somewhat meaningful.

Just from my amateurish standpoint, I see a need to consider: 37% in what time frame? 37% with what lethality (CFR)? 37% with what infectivity, (what R sub-o)? 37% with what degree of vaccination effectiveness? Vaccine supply time line expectations? 37% with what background of antiviral supply and effectiveness?

Just some preliminary thoughts, off the top. Others will be able to improve on my rough guidelines.

Just for the exercise, let me put my own head on the chopping block!

Fifty percent probability within the next 12 months. CFR 40%. R sub-o of 2.3. Ineffective vaccination and negligible supply for first six months after onset; 10% effect second six months, due to mutations, supply and distribution bars. Antivirals little or no effect first six months, partly due to minimal availability. Second six months of pandemic no meaningful effect, 10%, partly due to resistance developing and mutations.

< Nikolai realises his folly not stocking BB’s flu killer >

I fled the internet when I realised the folly of so exposing myself to ridicule in above posts. The consideration shown me in not flaming that impudence is truly touching but I fear may in part be scorn for my obviously developing senility!

Regardless, thanks!

< Be good, Nikolai. Just read quietly or go to bed >

Ah Nikolai! No-one would flame you for voicing your thoughts. They are all valid points.

I don’t know… all I can argue is Mother Nature does her thing and we do ours.

In that line:

Sometimes what may happen - happens with no input from us,

sometimes our actions to avoid something cause that which we are avoiding,

and sometimes we manage to manage a situation enough to avoid it completely.

So…

I offer up 1–99% possibility this flu will be nothing or complete havoc.

Given the uncertainty of nature - it will just come down to who was prepared for the event and who wasn’t. For all we know, the day before the pandemic begins a comet swings in from the Southern sky and obliterates everything. Atleast the fellows on the ISS will have a few weeks to contemplate humanity.

:)

I have followed these boards with intense interest since Turkey, posting only twice. As an intuitive kind of thinker (INFP, for those who know Myers-Briggs)I have depended on the rocky combination of hard science and human intuition that has married here for the purposes of giving us some sense control and knowledge over how this might unfold. It has been a fascinating journey and I thank you all for the wisdom, insight and knowledge that has kept us collectively steady and, at the same time, moving forward in understanding without undue panic.

I have counted on all of you (particularly the more conservative, Melanie :))to help determine my own sense of the nearness of this. I believe Dr. Niman and believe he has been basically right about this all along and have been subject to bouts of panic as a result. I appreciate, in particular, the balance of the threads which help one regain steadiness amidst both dire information and the lack of true knowledge.

That said, my intuition tells me we are close to a revolutionary change in the human condition. As a closet academic and theologian I have learned, of course, how the human response to adversity determines the perspective of God, community and self. As one who lives in the United States, I recognize that our collective sense of entitlement and righteousness has reached appalling levels. One can’t help but imagine a kind of relative “good” that can come out of a “falling apart”.

I can’t do predictions but I can say within the study of human history we witness the fight against essential finiteness and frailty. I see this board as an extention of my existential dread and the struggle to gain some sense of control and determination over and against what will inevitably be or not be.

I appreciate the call to prepare and will continue to do so. If individual intuition counts for anything, I am haunted by the sense that life as we have known it (rich in creature comforts) may soon be suspended and although I cannot consciously imagine it, we will be in a fight for our lives.

Out of this we may find a richer definition of community, although it won’t be nearly as neat and pretty as the one we have now. Freud found us to be driven by our neurotic fear of death. All the manicured structure around us now reflects that truth. We will be left to face our collective neurosis and struggle to find meaning therein. All the food preps in the world won’t prepare us for the internal struggle, should this break out. How not to lose hope, how to find peace in the midst of, how to lose those we love and still believe in the essential goodness of existence….these are what I worry about. Our stockpiles will become an important provision but the rest of what will be needed we can’t possibly prepare for.

I am just grateful to all of you in giving me the chance to begin getting my head around this. We cannot know what this means yet but we can know that there has been a warning shot and we need to begin to “suit up”. We have determinately foiled the element of surprise which decidedly effects the psychological impact of what this may be. That is what makes me most worried about how the WHO is playing this publically. People need that warning shot. I work with folks in traumatic grief and what most hurts and complicates their grief is A. lack of honest information at the time of the loss and B. appeasement on the part of those who accompany them. False hope. Let’s not fear the impact of this on each other and trust our natural resiliance.

Take care, I will be following along beside you….

Hello flufriend

As one who has experienced (within the past year) the kind of ‘traumatic grief’ you probably have helped others with, I thank you for your post. In my case it was the witnessing of a sudden and unexpected and freakish auto accident that lead to the death of my mother and I can definitely say from unwished-for personal experience that the delays in truthfulness and the feelings that one needs to behave in certain ways to accommodate the feelings of others makes grieving tough.

Since I presume you have experience in grief counseling, your thoughts on how we will all cope with something like a pandemic are most eagerly welcomed.

Oh and the only tangible things I can think of from our stockpiles that might begin to help us are extra tissues for the tears and items that divert us and allow us to feel good, simple things like a good book, bubble bath, and the comfort foods and drink of one’s choice. These ‘luxuries’ will be necessities for the soul.

Anon- I extend deep sympathy to you on the death of your mother. You will know as well as anyone who has suffered deep loss what we need to muddle through life and all of its attending pain.

Flufriend

Flufriend, I am like you in that I am a pattern seeker, constantly taking in information, sorting through it, evaluating, and learning every step of the way. I’ve been with the wiki for six months now, and have watched an amazing community form here, which is as important for the emotional and psychological support that it lends as the breaking news, scientific insights, and practical helpfulness that also streams by. From the patterns, I also try to project the ballistic trends of the situation, and I would agree with you that we are headed into an unimaginable time of change, and very possibly an abbreviated human history. I had always hoped for the age of Aquarius, when my hair was long, but now wonder about our brave new world, just ahead. I have felt this coming in my bones for a long time; now the storm is on the horizon. Chances of a pandemic? Any day now, or any month now; those who are connected to their surrounding must feel the electricity in the air, as just before a summer storm. I’m ready. Find your peace in the spark of light in the chickadee’s eye.

Here’s the way I see it.

H5N1 has been around for more than ten years and isn’t going away. This virus continues to spread to more and more species. It also continues to spread in an ever larger geographic area. H5N1 is infecting a growing number of humans at a faster pace. The virus is now being passed from human to human. There are multiple strains of H5N1 infecting more and more species. There’s no way of stopping what’s happening and no sign that the virus’ progress will cease.

So, it’s like watching a very large boulder coming down a mountainside gaining size and speed. Will it stop or change direction? Why should it? No, it’ll continue coming and contiue doing what it has been doing in the past, in my view. And sooner probably rather than latter H5N1 will become a human pandemic. It just seems logical. Don’t like it, but there it is.

Thank you, Brock. Well put. I played with numbers, above, but my heart is with your first paragraph, in particular.

These are useless posts. No one knows.

As far as survivability, I figure nothing is as good as we hope or as bad as we fear.

As far as when/if it’ll happen soon? Well, if you see the guys from the bomb squad running, you should try to keep up. Public health officials are prepping , so I am too.

anonymous — at 12:22 cuts:

“These are useless posts. No one knows.”

Anonymous, life is a useless post. Everyone knows. But you?

<The thread asked for personal opinions, not ultimate truths>

Yes, but don’t miss the positives. It’s typical but unlogical that people either gather only negatives or only positives.
It has stopped in Vietnam. It needn’t change direction nor stop, just for a pandemic it has to gain a lot of speed. Only H1,H2,H3 are known to be able to cause pandemics and these are rare. Why didn’t a H5N1 pandemic happen earlier ? With that high CFR we would have noticed. Wouldn’t it be a strange coincident if our generation should be the first to experience this since thousands of years ? H5N1 didn’t make much progress to infect humans efficiently, although it had had 9 years of time and many different strains, none of which succeeded to go h2h efficiently. When we have some more years, we might learn how to avoid infection and how to contain it.Research might find better vaccines and antivirals.


On the other hand it did succeed to spread geographically and gained diversity. It does survive in blood and survives long in the environment.

But anonymous! Look at the BRIGHT side of my 03:40 post! I said there is a fifty percent chance of NO PANDEMIC in the next twelve months! I estimated sixty percent of those infected would SURVIVE! And so on!

Don’t be so NEGATIVE! As you said in your first sentence: Don’t miss the positives! Well, then…DON’T!

In many sciences, ‘predictions’ are made, or ‘chances’ are computed, by creating, at first, simple models with only a 1 or two variables, and then by ever increasing the complexity of the model until the scientists feel some measure of confidence that they have accounted for the major forcings, with appropriate fudge factors for chaos and random action.

Not being a biologist or epidemioligst myself, i can only hazard a guess that in this situation, there are so many variables to consider, some of which we may not even know are important, that it is impossible for the WHO to come up with a model that can give meaningful ‘chances’ of an epidemic arising, to any level of confidence (pick a sigma, any sigma).

Add to that the sad fact that the general public doesn’t really understand statistics and probability, and I can see why it’s difficult for the WHO, or any official organization, to make a statement like you want. If a scientist or an organization predicts a 50% chance of X happeing this year, and it doesn’t- then people think they were ‘wrong’, actually, they were ‘right’ because they also predicted a 50% chance that it wouldn’t happen. A large portion of the American public doesn’t understand that. Just look at the statistics for San Francisco- apparently only 6% of the city’s population an earthquake preparedness kit or made preparations, and that is a situation where they have published ‘chances’ of earthquakes coming out of their wahzoo. If an elevated risk of a large EQ occurs, when it’s announced, and it doesn’t happen, people see the forecast as having been ‘wrong’ and prediction fatigue sets in.

As I see it, the WHO is between a rock a hard place trying to make meaningful statements that will lead to the desired result, of getting people to be watchful and aware, but not seeing the announcements as just an endless series of ‘crying wolf’

in 1976 the CDC-panels estimated 10–25% and 40%. Each member of the decisive meeting also made a secret estimate. Ranges were from 2%−20%. The predicted pandemic was expected to be of 1957 or 1968-type. That was enough to go for vaccination, and later this was considered a mistake. The members of the committee never discussed their estimates with the other members nor in public. Later they said that this was a serious mistake. Forcing experts to make public statements were one of the best methods to find weaknesses in their arguments… (Neustadt and May, “thinking in time..”,1986,p.152)

Anonymous 1 or 2 or whatever. (Frightened, are you?)

Just an amateur in anything at all sophisticated, but I’d hate to cross a street in busy traffic while the ‘experts’ calculated the complex set of differential equations involved in the cross traffic and my possible timing and path.

I just do it. Same for my inspired post of 03:40. I got over.

Nikolai-Sydney, I appreciate your estimate, but you are not an expert. Support the idea to force the experts to make estimates and to discuss the estimates and find weaknesses in other expert’s arguments !


It often helps to split the one big estimate into smaller subproblems. In the poll among physicians they asked for the chances of a pandemic within 1,2,3,4 years - so the physicians were forced to check whether there was enough probability left for the other years :
http://www.hcdhealth.com/ViewPress.cfm?ID=23
but these were only normal physicians, not experts who had read the papers on the subject and followed the discussion.

anonymous,

what data do you need to make a proper prediction? Guesses from a number of people here won’t do as the data will not be of good enough quality. I am asking because everybody, that includes me btw, would like to have a nice, good and reliable prediction (of course within the limitations of what a prediction / probability number can really tell).

What we are reading here are guesses. The data don’t exist to create a prediction.

Melanie – at 13:09,

I know :-)

Hi Anonymous. I’m glad you are back. I was starting to get a little worried about you.

Given the re-emergence at Q. Lake, the ongoing secrecy in China and Guandong in particular and the recent events in Indonesa…I have changed my asessment of the probability of a pandemic to 100% within 5 years, 99.9999% in two years and 99% within one year.

Ask yourself some questions:

Is bird flu picking up speed? Are there more outbreaks? Are more people getting sick? Is it spreading faster and faster?

It’s not fading away and it’s not slowing down. I would love to see it fizzle out but it’s just not doing that right now. It’s on a run and until someone stops it, it’s heading my way.

Tom DVM at 13:30

So, what was your probability assessment before those events you cite?

Tom DVM re: “I have changed my asessment of the probability of a pandemic to 100% within 5 years, 99.9999% in two years and 99% within one year.”

So, don’t hold back; tell us exactly what you think the chances are, no hedging… ;)

My feelings; plan for the worst occur sooner than later, hope for the best.

Grace.

There is something I have wanted to say for a while…so I will insert it here.

I have really enjoyed corresponding with all on flu wiki but to me, there are three that are absolutely essential…Grace RN, Medical Maven and Scaredy Cat. If I am going to hang in here, you three can’t go anywhere.

The reason is your philosophical approach to things…the three of you have a way of bringing all of us, theoretical scientists, back to reality with a few well placed words…when I am getting really, really frustrated your words comfort and refresh…and I don’t think flu wiki would be a very interesting place without you…the three musketeers!!!

anonymous. I like you but I don’t understand your question.

Sorry, anonymous I still like you and I just figured out what you were asking…my problem not yours.

My previous estimates I think were 99% within 10 years…75% within 5 years…and 50 % within two years.

The previous estimate was made in January 2005.

Tom DVM- I am deeply honored to have your trust and to be in the company of such esteemed others. I don’t have a degree-yet- (98.6 on a good day)-old work horse diploma hospital school of nursing grad since 1972. I deeply respect and need the comments/opinions of such well-educated people such as yourself and the others.

Not going anywhere in the foreseeable future. I have become a fluwikie2 junkie of sorts- need it to start and finish each day.

I am a older women of american Indian tribe. I was raised very simple. was taught and leaned to listen to mother earth and God thru Birds, the earth and animals including people. I live very very simple. I feel the earth on my bare feet and listen closely to all the birds and animals during each passing season.. I know the birds and animals in my area. I know who returns to lay her eggs, I know who does not return. I know the animals, I know who makes it or not each follow spring. I watch and I liston to every change. I have lots of time because I don’t work full time. I just work when I need to. I am not lazy by all means. I just don’t need much to live, just basic. I am well educated and do not gain anything from the goverment by being who I am. I am free to live how I choose. The only modern thing I own is this computer that my children set up for me. I was taught that women has a basic deep instinct and even more when she becomes a mother to children. So we women are basicly like mother earth that yeilds us her fruit to eat and live. A mother knows when her children need her, she knows when something is up because of this instinct, she knows when to prepare for her family. There is wisom in motherhood. Mother earth is like us women, she tries to tell us when things are not just right. In a mordern day world filled with people that are concerned with luxuries, we don’t hear nor do we watch as each year passes to understand her language. we soon lose ourselves from the connection we have to the earth and God by our wants. Women have a connection to mother earth and we know when something just isn’t right, we will know by our instinct when to move and when to prepare. I have noticed a anxiety in the last two springs and never before have I stored food other than winter. Something is in the air and I began feeling it two springs ago, something is changing, thru this I have began to store food for my family, at any given time I am prepared to pull my children and grandchildren beneath my wings for protection. To what is ever coming about I give it a 60/40 chance in happening. Women listen to your deep voice of instinct.

• Nikolai---Sydney – at 12:33

anonymous — at 12:22 cuts: “These are useless posts. No one knows.” *

Where have I heard this theme before - Shaw, Wilde, Hemmingway, Yeats…Ovid? ….darn, I’ll think of it. (Thinking through movies….For Whom the Bell Tolls? Casablanca?…it’s just early afternoon, night fever hasn’t kicked in yet.)

I too spend a lot more time here than is apparent. Lots of lurking. I am guessing at 70–80% within 1 year. I am personally prepared about as well as I am going to get. I continue to work on my Hospital. More than one department manager feels that it is important to get our plan out( we have actually started implimentation of parts of it ) before this fall.

The big hang up is medical staff( they see a problem but are too busy to help us ) and administration( we are in the mist of an expansion and they see nothing but construction). But administration has released some funds so we have been moving ahead. I am now on both Bioethics and Diasasters Committees. Disasters( Bioterror ) has some funds! I have recently polled some staff and find some prepping, so it does not look quite as bleak as it did a couple of months ago.

I have no illusions, anything we do will most likely not be enough. That is not good rational not to try. Kelly

This is what I was thinking of!

“Integrity without knowledge is weak and useless, and knowledge without integrity is dangerous and dreadful. “

Samuel Johnson (1709 - 1784)

Tom DVM at15:25

I guess your January 2006 estimates were low in retrospect - I mean China’s secrecy is nothing new - Indonesia isn’t that much different then Turkey is it? Q lake is troubling - but certainly not surprising.

Mind you - I don’t disagree much with your current assessment - I just don’t think much has changed since January.

Melanie,European: you are in contradiction to the members of the 2 CDC-panels and the members of the committee in 1976 who did give estimates. You are in contradiction to the analysis of Neustadt and Fineberg 1983 and Neustadt and May 1986 who concluded as I wrote above and this was also the later agreement of the committee members. You are in contradiction with Webster,Monotreme, the Tuft’s participants, the 656 physicians from the opinion poll and other polls. If these estimates had no base then why were they made ? You see frequent statements by experts and politicians estimating the pandemic risk using unexact words, so there is some data. “The data don’t exist to create a prediction” well, what’s a “prediction” ? Clearly we can make a subjective estimate of the “chances” or probability. This is done frequently with sport events and other events which I consider even less “predictable”. It can be done and it is done. How reliable it is and whether people agree on the estimate is another question. Stop this “chances are unpredictable” - nonsense. It’s just unlogical.

anonymous. the estimate I listed was in January 2005.

GooseBumps If you could, your quote would go well on the H-H-H thread as their is a bit of a debate going on with respect to the ethics and integrity of the WHO.

Did Turkey have witch doctors too?

Thanks Tom DVM, sorry!- Misjudgement on my part. I will post it in H_H-H-.

INDIAN: re: “Something is in the air and I began feeling it two springs ago, something is changing”

Thank you-our senses are the most important guide we will ever have in our lives. I respect yours to the utmost, and your eloquent statements.

Tom DVM
“I have changed my asessment of the probability of a pandemic to 100% within 5 years, 99.9999% in two years and 99% within one year’‘
You can’t be serious here. You’d bet $100000 against $1 that it would happen within 2 years ??

‘’My previous estimates I think were 99% within 10 years…75% within 5 years…and 50 % within two years. ‘’


think again. That would mean, that it’s 50% in 2006–2007 , 50% in 2008–2010 and 96% in 2011–2016

Tom DVM - at 16:23

Whoops my bad - 2005 / 2006 they all blend in….

Just for kicks - what would you have said the probabilities were if asked in January 2006?

The often repeated line attributed to the scientific community “not if, but when” comes to mind in this discussion. We seem to be edging closer to critical mass, the “when” moment speeding up. Between this fall and next spring is my best guess for the efficient transmission level. Maybe we’ll be lucky. Maybe we’ll be lucky and the “when” will be postponed to another time.

Anonymous at 16:20,

I am however in complete agreement with nearly all of the flu scientists in North America. These are guesses. The data don’t exist, period, for anything other than guesses.

INDIAN at 15:39 -

I support what you say. I ahve been the family prepper and fluwikie participant for a long time. My wife has been supportive of my efforts to a point, but didn’t want me obsessing over this Bird Flu stuff. She still doesn’t. But lately, for whatever reason, she has started coming home with major amounts of food during her shoipping expeditions to add to our stockpile, and has been cruising the web and looking at water filters, solar heaters, stoves and power accessories.

She is usually insightful to the point of sometimes being psychic. She is very aware of the nature and birds around us and sometimes has discussions and even arguments with them in their own language.

I am not ignoring the message of what I see there.

pre-HIV: population experts regarded growth estimates for Africa as highly uncertain — but they made estimates! important and meaningful estimates, in context, based primarily on historical population patterns… but they made very clear that these estimates were (again) _highly uncertain_.

well, after the emergence of HIV (w/ particularly catastrophic impact in Africa) it became popular to profess (often very extreme, to both ends of spectrum) population projections with certainty!

But, now there was a new and powerful and largely unknown and unpredictable actor: HIV.

So, before FWians get too much further with tenured armchair professorial predictions of the probability of a pandemic:

maybe take a look at past flu epidemics and pandemics;

hmmm there were 3 pandemics (or 4 if you count 1977) in my grandmothers life time… and there’s been 1 (or 2 if you count 1977) in mine… so maybe there will be two more before I die (if I’m lucky enough to live as long as she).

That’s a prediction (my prediction), based on some evidence — there will be 2–3 more influenza pandemics in the next 60 years.

So, FWians can aso demand that flu experts start talking publicly bout such informed expert opnions/estimates (they can use all kinds of data other than my grandma’s exerpeicen…).

Demand that US (and world) governments act with same energy as 1976 (at least).

1976 panels made public estimates… 1976 they also had a vaccine… 1976 no pandemic happened… 1976 probability of a pandemic was almost certainly < 2006 probability…

even a 1% chnace of a 1918-like pandemic should muster billions and billions more toward vax and antivirals then we currently see.

Its just so hard to say. I thought 50/50 within the next year until the recent outbreaks, now I lean closer to 60/40 in the next year. I base my guess largely on input from friends who know much more than I do; one being an epidemiologist, 2 being docs and several nurses. I completely agree with GraceRN at 15:09, plan for the worst sooner than later and hope for the best. I have definately felt an urge, instinct, spidey-sense, something telling me to get my preps completed.

NYCfluy: I agree completely that fluwikians should demand answers but how to go about the demanding part? letters to our congressman might or might not have much effect. Im at a loss as to what else to do. Ideas?

Maybe we could look at the chances from a slightly different angle:

Do we have any recorded data on any flu virus, that has infected as many people as the H5N1 currently has, of dying off on its own? Is this a possiblity based on past history with a similar virus?

If the answer is no - no virus has ever reached this level that has died off - then I would give the chances of this virus going away on its own a 0%.

To me (no mathmetician here) that would mean that we have a 100% chance of this thing continuing in that there is no chance that it will just go away.

So, that still leaves us with when (anyone’s guess) and how lethal it will be. There is a large chance, from what I understand from experts, that if it went pandemic it could weaken seriously in its ability to kill. I guess the question to this is also: Do we have any data on a virus that has erupted in a pandemic and what was the level of death as it progressed. Did it decrease from the time it was appearing in just smaller clusters, etc?

Viruses are like hurricanes and other natural disasters. There is some reasoning and patterns that should be suggested. So far the only thing I have seen comparable to this virus is the Spanish Flu. If that is the case, and we have never had a flu that has just died down that has reached the current level, then my bet would be to use a computer model to determine where the Spanish Flu was at this point; how long it took to go pandemic and how lethal was it along the way.

I know that information was not readily available in 1918, but God we aren’t talking that many years ago. I would just hope that alot of research is being done on how the Spanish Flu behaved in order to establish some guidelines of what to expect. We all know from Katrina that it could be a lot worse, but can’t they give some indication of how long it takes to go pandemic from the cluster stage (Stage 3 - 6) and what is the mortality rate early into the pandemic and what is it as it moves along.

If this information is already out there, please forgive me. However, I have been following this flu for six months and have never seen a straight-forward chart that compares 1918 to now. Whatever information they could “unearth” would be really helpful. I am sure that the Spanish Flu was researcher in the early days after it hit - it was a major event in the lives of that time. We have to have more information than we currently see. All we see now is, it is a cousin to the Spanish Flu and the Spanish Flu lasted so many months and killed so many people. I want to know how did it unfold…what are the facts and how is this comparing to this flu.

I don’t get to watch to much TV only when I am at someone house that has one. For some reason I began to go to stores in search of canned items that I could not can enough of. I began a storage of items for a family of 15. My husband could not understand this nor neither could I. It seems all the sudden my mind and spirit has no other thoughts of anything but prepare. Prepare for what, I do not know. I was at a friend house and she was watching the news when I noticed words going across the bottom of the news and there it was BIRD FLU. I had never heard of it and ask the eldery lady what it was, she had no idea! I have been storing for about three months before I seen this. I came home and for days wonder this around in my mind. I finally looked it up on the computer and found this sight. This is my first post ever. I try to throw this from my mind by thinking it is unreasonable but I can’t shake the idea that something is about to happen. This is by far one of the prettist spings I have ever seen. As far as the colors of the leaves, flowers and the birds are so deeply colored in my area like never before. Their songs are so clear and beautiful, but there is a uneasy feeling in the air. It is so uneasy that prompt me to began storage of foods for my family. My thoughts of all the stories from the bible of the foolish without the lamp oil, that went to find more and lost out on the wedding. I think about Joesph and his storage of wheat. I can not began to tell you this over concern I have. I keep telling myself that I am getting to old to trust myself with instinct. I am preparing for winter for something to happen. It may be bird flu, it may be something else that I must endure in my life only. But in all my life I have had this uneasy feeling several times and each time I was prepared..

Janet, Thank you for putting that question into words! Has there ever been a virus that reached this level that just faded away. Who knows the answer to this?

I feel the opposite. I think it is stranger than strange. So many people exposed to sick birds, culling them by the millions with no protection, and yet merely a few hundred getting it. It’s seems weird to me. I’m prepping very slowly, have very much a wait and see attitude. I just can’t feel it breathing down my neck quite yet. I’ll be one surprised cookie one of these days, though I take it very seriously. Might be just that I always think that things will work out,and my temperment is fooling with my rational mind.

INDIAN at 15:39

Thank you so much! For about two years I have noticed there has been a calling. Not urgently at first, yet it’s palitable lately. There is starting to be a sense of urgency in the human consciousness. Being the gnostic that I am, I put it to the turn of a new age. This a good time to live. This perhaps the reason we signed up to come down to this earth plane at this time. Our purpose to help in the coming change. I am a dyed in the wool lurker, but your comments touched the spirit in me and I had to echo your call.

(WooWoo Mystic goes back to her lurking)

Melanie, I particularily like this “period” - argument ;-) You’d better look for scientists in logics,philosophy or mathematics. The question whether chances are unpredictable is not flu-specific, you won’t learn it in medical classes. Flu-scientists are biased here.They don’t _want_ to give numbers and that’s the only reason why they say it “can’t” be done or “no one knows” Their numbers would be discussed and disputed, they don’t like that. Although, once everyone else gives numbers too this would no longer be a problem.


Rosie,Janet,Tom, you might compare with the poll among physicians which is the best what we actually have http://www.hcdhealth.com/ViewPress.cfm?ID=23 less than 20% think that a pandemic within 1 year is likely. The mood in these forums is generally scary. All the news and speculations. So people in forums tend to overestimate , compared with experts.


Indian, if you were not afraid of bird-flu, you would never have found us. So, for us it’s not a surprise that people who are irregular visitors here are more concerned than average - for whatever reason.

I strongly think it is a genetic anomoly at present. And only some people will get it, and most with the same exposure won’t. When it find its final mutation to fit us all, then I will sit up and feel fearful. I compared it to a jackpot at a slot machine, all the reels falling into the proper sequence. The odds are still in our favor. Its the virus that has to get the right code.I call it the Bird Flu Code in my mind.Of course I am completely ignorant in virology, and my opinion counts as nothing.

Has there ever been a virus that reached this level that just faded away. Who knows the answer to this?


no such virus is known. But it likely happened before in the million years of human evolution. Another question: if there had had been many H5N1-like victims before in a pandemic or epidemic or epizootic, could archaeologists find hints for this ? Where/what should they search ?

I am constantly enthralled by the need (?) for people to have experts tell them the actual chance of this H5N1 going pandemic. Is this part of the “needing some reality around this” thinking or what? (I am sorry, I cannot seem to get the words for this at present, I’ll keep trying.)

We do know that we have influenza pandemics on a reasonably regular basis - 3–4 times per century. We do know we are “due” for one. We have a virus circulating that is of the influenza type to which we humans have no immunity. We have a chance to observe and prepare. What are the odds that H5N1 will be the source of our next pandemic? I don’t know. What are the chances that something else will hit us from left field and be our next pandemic? I don’t know.

What I do know is that I need to be prepared for an influenza pandemic some time in the (near?) future. What I do know is that there are people out there watching for signs of a possible cause so we have a chance to be forewarned (if possible) that pandemic conditions are now prevalent.

Pandemics and tsunamis have a lot in common - in the (not too distant) past we didn’t know they were happening until they actually happened. Now we have a chance to be warned they are happening. It doesn’t stop them happening, it just gives us a chance to prepare and ‘lessen the damage’.

All this aside, I do enjoy the discussion about chances and odds. I see them as curious and incidental ‘chit-chat’ which satisfies my analytical right-side brain.

anonymous at 18:18, Thanks for that link, its reassuring. You’re right that we here will precict higher if only because we think aout it more than others. Ive also noticed that while my family practitioner is not worried at all about it, a friend who is an epidemiologist is MUCH more concerned. Lily at 18:19 The genetic factor seems significant, I hope we find out more regarding this soon. How would that be dealt with? Wouldnt it be nice if it was as simple as something that showed up in a physical trait so we could put our efforts into protecting the few at risk? But I guess the continued mutation would always be a factor. Like you I am completely ignorant in virology and Im just spouting off the top of my head.

anonymous at 18:18,

The scientists don’t want to give guesses because they have no data on which to base such a guess and they know it. On the list of possibilities, as the reveres reminded me on the phone t’other day, is that nothing will happen.

Dr. Bob’s rough actuarial estimates

http://tinyurl.com/fe37t

Here’s Dr. Bob’s commentary:

‘’ We are looking at a process, not an event. And the process will continue until we have a pandemic or the virus disappears of its own accord.

If we have a pandemic—still very much an “if”, and by no means a certainty—the virus will cause through multiple clusters, until it “learns” how to efficiently transmit from human to human. Yes, H5N1 is an influenza virus capable of causing a pandemic, but no we are not here — yet.’‘

These are wise words.

Melanie, Thats the one Im hoping for.

Janet. I would encourage you the read the book, The Great Influenza, by Barry. This book gives alot of information about how the 1918 virus erupted, spread, and how the scientists attempted to learn about and treat the virus. It is a very interesting book and it’s almost like reading about what is happening today. Of course, health care back then was different, but we are more of a global society. If you haven’t read it, please do and let me know what you think about it. Some of it is kind of tedious, but push yourself through it, and some of your questions will be answered.

Indian. It’s funny how you put it. You don’t know where it came from but all of a sudden you prepared. That is what I did. Now that I think of it. I have no idea how I first read about bird flu. I do know that my two brothers started preparing in the seventies. They said be prepared. Be ready to survive. That only the strong will survive. I thought at first this to be strange. But I followed them in their quest. Both have since passed a way and now I feel it is my duty to protect my familys. My sister and her children. My own family. One thing I do know is that I am a decendent of the Pa nobescot Indians in Maine. My father, and two brothers and sister. Use to follow the customs of the Panobscotts. I find that I have a second intution on things. That I see things other don’t see. I am one with the earth. Changes are noticable to me.

My neice was reading a book a indian woman wrote about the changes to come in the future. And I am shocked at the truths in it.

I feel the pandemic is around the corner in the not to far further. This is just my gut feeling. I just came back from buying more supplies. Two more boxes of face mask. And I have the uncontrollable urge to go grocery shopping. But my husband thinks i am nuts. So much of what I am buying is being stored as if I never bought it. I told my mother inlaw that she would be thanking me. Because I am preparing. And those who didnt at least in my family will survive cause of my actions.

My doctor is one of the Infectious Disease Specialists for Mexico who is part of group of Doctors who deal with flu determinations for Mexico. He predicted two years to go pandemic and that was before Indonesia.

Melanie, you just keep repeating this “no data”-nonsense again and again without ever addressing any counter-arguments or doing any specification. That’s no useful discussion. Who do you want to convince this way ? Is there also “no data” in predicting chances for the outcome of a football-match ? Also “no data” in predicting probabilities for weather, elections, cosmic events, scientific theories ? “no data” and flu-scientists still have no problem to make predictions … as long as they are worded unclear enough.

Yes, nothing may happen. Of course. But how likely is it ?

AnnieB, we are not due to another pandemic. That theory had been rejected. Pandemics don’t come in cycles.

I would say there is a 100% chance of a pandemic flu not happening last year.

Everything that can happen will happen. You just can’t know precisely when. Volcanoes, tsunamis, earthquakes, plagues, wars and depressions all occur. Some are shockers, some are mild. We even get hit by asteroids! You all really want to know when and how severe. You can see by the spread of H5N1 that it will be soon and by its Indonesian fatality rate that it will be bad. All you can do is prepare for isolation in the short term and work out a better way to live on this planet for the longer term. And help each other with your great ideas and support. I ‘hope’ we get another 2 years, minimum, before it creates havoc.

NewGuy: you mean the whole thread is nonsense and we could as well talk about whether 1+1=2 ? Or what ?


RA:not everything that can happen will happen.I have some counterexamples. You can give your prediction, but don’t you want to see, what the experts predict ?

I Have no medical degree I do not know how the sequences work, and most of you in here are brighter than I. From the small amount of data I have collected from other sources, I think that TPTB expect this to break by November 2006 with a 40 to 50 percent infection rate in the US and a 25 to 34 percent CFR in those infected. Duration of no more than 6 months first wave a slight break and 5 more months for wave 2 CFR on second wave in the 70′s unclear on wave 3. TPTB are really in full panic mode.

I can make a statistics that it’s i.e. the females who don’t like these probability estimates. There must be a genetic factor.

MajDad,who is TPTB ? Why do you conclude this ? I can’t see it. Can you give a referrence ?

Or the discomforting realization that we are the caretakers. And will be caring for our darlings without the prospect of a vaccine!

anonymous….

Nothing so profound. I just recognize that it is easier to predict the past than to predict the future.

I am predicting there will be no significant BF news in the next four days since my fourteen-year-old son just lectured me on staying off the laptop for the family camping trip. It will ruin the experience he says. He’s right but dang, will I be edgy not being able to get on. Maybe in the middle of the night…

Tom DVM,

Re your 15:20 post, I, I’m absolutely speechless (although perhaps not for long) - blown away, actually. I have the utmost respect for you - for your intelligence, your integrity and your willingness to lay it all out there, to not mince words, to not shrink back from expressing righteous outrage. I am hono(u)red by your words. And here I thought I was just an irritant.

Anyway, I am not going anywhere. As long as H5N1’s a threat, I’ll be following Flu Wiki. God willing, that is (God being God or a metaphor for whatever the mysterious life-giving force). And I hope you don’t go anywhere either.

As far as the thread topic goes, I personally could not give a number (and since I’m no expert, the mathematician formerly known as gs wouldn’t care anyway). Some days, some moments, a pandemic seems too ridiculous to believe. Other times I can see it. I can just see it.

Last week, my very best friend of all time came out for a visit from Indiana. Although she lived in California for a time many years ago, she had never been to Yosemite. (I myself hadn’t been there for almost 10 years, back when a gigantic landslide let loose on top of Happy Isles and missed my family by a day). Well, I took my friend to Yosemite last week. And it was absolutely holy. Maybe holy’s the wrong word; perhaps sacred would be better. I don’t know. But the waterfalls were fuller than I’ve ever seen; the Merced River was nearly overflowing. It was cool, it was warm, it was green, it was misty. It was a time and place of absolute wonder.

We only had 3 days, my friend and I, but in those 3 days we hiked the Mist Trail to the top of Vernal Falls (scarier than hell); we walked to Mirror Lake; we picnicked by the river, at trailside, and even took a couple of meals in the Camp Curry Cafeteria (well, it used to be a cafeteria, now it’s a buffet (thumbs down)), where we had the (temporary) smallness of spirit to bitch about the surly attitude of the staff and the shortage of shuttle bus service in the park; we saw Half Dome at its most magical - in the hour before sunset - and on our last day, on our way out of the park, we visited the Ansel Adams gallery, we watched teeny-tiny mountain climbers dangling from the face of El Capitan, we stopped at Yosemite Falls, and then Bridalveil Falls - where the volume and power of water (and the fact we had left our ponchos in the car) precluded us from getting too close - and we walked through the Mariposa Grove of ancient redwoods.

And I’m not sure why I’m sharing all this, except finally to say - at the risk of sounding melodramatic - that when our visit came to an end, when last Saturday I had to say good-bye to my friend, the parting was particularly painful because I couldn’t help but wonder if I was hugging my dear friend for the very last time. And that’s been on my mind ever since.

anonymous at 18:30 — Recent genetic reseach shows humankind has indeed come close to extinction before, for unknown reasons, about 75,000 years ago. We were down to as few as 1,000 souls. It’s called “The Great Bottleneck” and explains why humans are so genetically similar, much moreso than would be expected. Despite surface differences, we are more genetically similar to the remotest African Bushman than than any two chimpanzees are to each other — within the same troop! Volcanic eruptions causing climate change around the time of the die-off has been suggested as the cause…I’ve always considered that an incomplete answer as other, similar species (such as chimps) did not also die off. Epidemic? It’s possible.

Anonymous at 02:28 I can give no referance nor explain the TPTB. Just that is the way I am reading the tea leaves. I could be so far off that In 6 months you will all have a good laugh at me. Or.

Anonymous,

Unlike you, I put my name and my reputation on my posts. What I mean is that you can’t put odds on a pandemic the same way that you can on a sporting event. Odds are based on the past performance of the teams involved.

You can’t do the same thing with a novel infectious disease virus. We have no information which could guide us in making such a prediction.

Tom DVM: Regarding your “too kind” post-I just engage in random acts of posting. : )

And rather than chop my prediction up I will say what I have before—If a pandemic has not occurred by late Fall 2007 (or the clear runup to one in progresss, Stage 5, etc.) then I will begin to have a little confidence that maybe this virus won’t be the one. But right now, that confidence is skyhigh, and I believe that it could happen anytime. Indonesia has tipped me to sooner rather than later.

Melanie at 08:10: “You can’t do the same thing with a novel infectious disease virus. We have no information which could guide us in making such a prediction.” Melanie, I think this gets right to the heart of the matter, at least for me. This H5N1 is not like West Nile virus, smallpox, or whatever the “scare du jour” (as one self-proclaimed “expert” puts it) happens to be. This is new territory. It’s like that old Sesame Street song, “One of these things is not like the other…” H5N1 isn’t, according to everything I’ve read here, like “the others”: it survives in the blood, it jumps from species to species with relative ease, and most importantly, it makes “liars out of the experts”, as oft repeated by our resident vet expert (Tom DVM). Hopefully, it will make a liar out of his prediction that there will be a pandemic within the next 12 months (although he’s been unnervingly correct on almost everything else so far). There is no way we can predict what this virus will do because it is, as you said, a “novel infectious disease virus”. I couldn’t agree with you more. I feel that its unpredictability is what scares everyone the most.

Anonymous at 02:28 Perhaps I do need to clarify what tea leaves that I am reading. Understand that everything is speculation on my part and I can not give any insight that you your self could not find.

First: This has been cooking for a while now. The US is way behind the power curve on this as compared to the EU. What is important to note is that the entire EU is prepared for this and many of those nations (the Swiss and the Dana’s) do not spend money on something that may or may not happen. The response of the Romanian government appears to be over kill, yet that were not letting up. That they have eased back a bit is a direct reflection of the EU telling them that they are scaring the heck out of the rest of the people. That the disease was able to be contained in Thailand and Vietnam tells me that the strain in Asia is not well developed yet.

This is what IN MY HUMBLE OPINION is happening.

The EU has clearly defined the H5N1 as a threat. That they expect it to infect the swine in Europe (which carries the H1N1) and that it will make the break out in Europe. They will have no warning. (Hence the Romanian response). The original break out in 1918 came from the US off of a remote farming community that most likely would have burned out in Kansas if not for WWI. With the globalization of the world economy’s, that break out will come from an Eastern European Country and the first wave will be the marriage of the H1N1 and H5N1 during the fall migration of the water fowl. (First Wave)

The second wave will come from Asia and it will be more H5N1 than the European strain. It is not fully cooked yet (many on this site acknowledge that) but the strain from Europe will cause the final leap in Asia and it will be more virulent and as such, more deadly than the first strain.

The unknown factor is what is happening in Africa. (Third wave???) We do not have enough information from that part of the world to know how much of a progression the disease has made there and if it will be the starting point or not. We all need to try and find that data out

Absorbing all the above posts and distilling, my final clear and firm conviction is: There is no way on Earth, absolutely no possibility, of our societies, nations or of individuals adequately preparing for the virulence, universality and long, long duration of this coming catastrophe. This has all the hallmarks of a civilisation-buster.

But, also, no more than that. It’s not the end of humankind. Merely a lapse back into something like the Dark Ages in Europe after the fall of Rome. And only for one or two brief centuries.

Then, the World Rennaisance arising first in … China? In South Asia? And so we go ‘round the mulberry bush.

< I am off to the seaside in the morning, for a few days of relaxation and reflection on the beauty of life today, >

We are still in what I call the limited Brushfire stage of virus spread. We have seen multiple hops in the spread between humans, but outside of close families we don’t see it spreading very well. That is because it is still a deep chest infection. When it gains the gene to be able to replicate in the inside skin tissue of the nose and throat, THEN it will become a pandemic strain.

To do so, it needs to recombine with a flu virus that already has that capacity. The likelyhood of that happening increases with a greater distribution of H3N1 or H1N1 or even H2N2 (if anybody can find it).

It is flu season south of the Equator right now, so if it becomes pandemic soon it will probably do so in southern Africa or South America (There is a far remote chance of Australia or New Zealand because of their low population.). As most of you know, I suspect that post Qinghai H5N1 is already in the Americas so we could see an outbreak in Argentina, Chili or Paraguay in the next few weeks.

I believe the greater likelyhood will be an outbreak contingent with the flu season in the northern hemisphere. In that case, it will probably mutate with greater likelyhood in November or December of this year.

For what it’s worth, I have a contact who said he was briefed that they were expecting something to happen this fall. Personally, I am skeptical of this information because I don’t know how they could possibly forecast that. There are so many unknowns right now. There is a growing sense of inevitability on the wiki and I think we need to step back and analyze why so many are assuming a pandemic is imminent. What data are we using to make this assumption? Are we going on a “gut” feeling? Sure, the worse case scenario could pan out. Or, H5N1 could burn itself out. We just don’t know. Accepting that uncertainity is difficult. However, I think it is more productive if we reign in our fears so we can examine the issue with a clear head. IMHO

The likelyhood of it burning itself out would be the same as the likelyhood of any human flu virus burning itself out. H1N1 is still here. It has been around for four generations now. H2N2 is still around, but is seldom found. H3N2 is coming around every year and is estimated to kill 30,000 Americans every year.

http://www.avianflutalk.com/forum_posts.asp?TID=2149

Melanie, attack the arguments rather than the name or reputation of the poster or the history of his/her behaviour. You’re still ignoring my points. It can’t depend on the level of uncertainety. Estimates had been given in similar situations. What when the football team is a newly formed team ? The virus is old ? They still give estimates. Where’s the threshold, since when you can estimate ? We will see the uncertainety in the distribution (deviation) of the estimates. When these are continuously distributed then indeed we can’t say much. But this is not expected. See the distribution from the 656 physicians, the percentages are not just random numbers. Some experts do give estimates, just rarely clear numbers instead ranges and we have to guess a bit on their definitions, but still useful. If we “had no information which could guide us in making such a prediction” then such unclear predictions were also impossible and all the statements and interviews were just nonsense.


dejure:H5N1 being different is not important. We still have data (e.g. we know it’s different). Experts are not liars, when their estimate is bad. It’s only an estimate.


majdad, the EU is way behind the US in community and individual preparing and awareness.


nicolai-sydney:it is possible to prepare and avoid H5N1, a high-security laboratory is clearly protected. Lower security is still helpfull but not so safe. Find your level and what you are willing to do.

Okay, H5N1 may simply not ever make the leap into humans in a sustained efficient way or it may evolve into a milder seasonal flu. I’m not saying these two options will occur or that they won’t because there just is no way to know.

Regarding making estimates, I think what we are making here are classified as SWAGs. Sophisticated wild-a** guesses. Nothing wrong with doing that as long as everyone understands that that is what is going on. It is the CERTAINTY of some of the posts which I find troubling. We just don’t have the data available to back up these predictions. TPTB don’t even have this data…Again, I have no problem with speculation but I believe that each of us has a certain responsibility to ensure that it is clear that our posts are speculation. If you have evidence to back up your claims, post it.

I assume that most of us here are rational in nature and do not necessarily need an ‘expert’ to tell us what is going on. While their opinions are influential, about all we can do is watch what goes on in the flu world and, using our own intuition, make our own plans. If no outbreak, what is the worst that happens to us? We have a lot of food and supplies on out hands. In many cases they can be used or consumed anyway. If there is an outbreak, we will be better off than those whose chose not to prepare.

There is no certainty to all this. Probabilities, yes, but they change from day to day. Again, it is up to each individual to decide how that change influences their daily life as regards to preparing for an uncertain future.

banshee – at 10:58 re: “For what it’s worth, I have a contact who said he was briefed that they were expecting something to happen this fall.”

Who is “they”?

Bird flu is picking up speed and spreading faster and faster so I think that is why many feel a pandemic is an inevitability

Anonymous at 11:12: “Experts are not liars, when their estimate is bad. It’s only an estimate.” I beg to disagree with you, sir. So-called experts ARE liars when they state with complete confidence that H5N1 will simply burn itself out, or when they say it will never be able to spread efficiently H2H because it has had plenty of time and opportunity and “hasn’t done so yet.” How many people rely on these so-called experts because they have a D-R in front of their name, or because they claim to know someone famous for their research in the medical community? Just take a look at the newspapers and see who the lazy reporters get to contribute to their articles. Their “small group of critics” are always made up of the usual list of suspects, who have no more knowledge about this particular virus than you or I do. Their irresponsible comments allow people who don’t believe they have the time or resources to worry about this to simply dismiss the H5N1 threat out of hand. Their “guestimates” do a disservice to their fellow man. Just how much of a disservice remains to be seen.

I’m getting to the point where I think anyone who uses “anonymous” without a further identifier (such as anon_22) should be automatically deleted. It’s just too confusing. I haven’t a clue as to people’s real names, but handles like Tom DVM or MajDad helps me understand what background they bring to the table. It helps me see thier viewpoint through their lens. When we get two (or more) “anonymous” es on it’s hard to keep straight who is saying what — because if you’ve seen a name on another thread you have an idea of what they already know or don’t know.

Please, people, don’t make all this even more confusing. Call yourself Einstein or Doofus or ANYTHING but Anonymous.

Will second that Olymom. Difficult for me to take someone posting as anonymous seriously and impossible to keep track of.

As a HCW I base my assumptions on the health of mankind—and it’s not so good. Weak host =strong bug. I can’t even go to the grocery store without hearing people coughing and hacking in aisles and its May! Our respiratory systems are weak—at least they seem to be judging from my co-workers and patients. Has anyone else noticed this?

The bottleneck 74,000 was probably caused by the eruption of Toba (Indonesia) BBC article The BBC article makes it sound like it’s a theory advanced by 1 scientist, but it’s propounded by many.

Melanie is right- there isn’t enough information out there to make a meaningful prediction. ‘Predictions’ are made, or ‘chances’ are computed, by creating, at first, simple models with only a 1 or two variables, and then by ever increasing the complexity of the model until the scientists feel some measure of confidence that they have accounted for the major forcings, with appropriate fudge factors for chaos and random action.

You can’t compare making odds on a football game with maybe 40 key persons and the weather to account for, with making a rigorous forecast of the evolution of this virus. To try to do something like that for this virus, you’d have so many variables to account for, so many unknowns that just aren’t known, that you’d end up with error bars on the numbers that it would negate the prediction. Like there’s a 50% chance, plus or minus 50%.

Olymom12:25 Thank you form the lurs.

Wasn’t sure where to post this but I suppose this is as good a place as any. Laidback Al over at FluTrackers posted this regarding the progression of clusters. (Laidback Al - hope you don’t mind my re-post.) Interesting way to take another look at the data. My only caveat is I am not sure which data they have based this on.

“So far we have been counting and watching the the number of individuals go up for each cluster. Going back through the cluster data gives the following:

Number of clusters per year

2003….3 2004….5 2005…13 2006…12 (to date through 5/2006, projected up to 30 by year end).

Without doubt we are seeing an increase in clusters.

we are also seeing an increase in the average number of individuals per cluster.

2003 …. 2.3 2004 …. 3.0 2005 …. 2.5 2006 …. 4.3

I don’t think we can predict when it break loose, unless there are some modeling statistics relating to cluster size and inability to contain through isolation and blanketing treatments.”

http://tinyurl.com/r4w7g

so if stock prices have risen for the last 10 years, they’ll probably rise for the next 10 years to? BUY BUY BUY if that was the case.

Anon_today, If you read my previous posts you’ll realize that I don’t think that a pandemic is imminent. Possible, yes. I simply think this is another interesting way to look at the data. However, your point is taken and it is a good one.

banshee, call it whatever you are comfortable with - it remains the same.


3L120:the amount of reasonable preparations depends on the probabilities. That’s why these are important.


dejure:you know that H5N1 will go pandemic, so you conclude those who don’t think so are liars. But then you also say, it’s unpredictable. Contradiction.


Olymom: apparantly you want to monitor behaviour rather than content to come up with your judgement. I can anticipate you referring to previous posts of the author showing behaviour which you think doesn’t match your local,religious,political ideals of behaviour and ethics.


Melanie,dejure: what’s with the analysis of Neustadt,Fineberg,May and the later conclusions of the members of the swine-flu committee ? Uncertainety in 1976 was as big as now. CDC has acknowledged their analysis in many papers and included it into its smallpox planning. The same CDC whose Gerberding now merely says: “chances can’t be predicted” !

Anon_today – at 13:10

Some people do make money in the stock market. And if bird flu was a stock, then people would be buying it right now. It is important to look at the trends and yes trends could and do change.

Anonymous, “…the amount of reasonable preparations depends on the probabilities. That’s why these are important.” I think for many this is the crux of the problem. We all know a pandemic is possible. But, how should we prepare? For 2 weeks, 3 months, 6 months? What would be prudent? If we had a reasonable probability to work with, we could adjust our preparation accordingly. 5% chance this year? Maybe I should put a few things away but I’m not going to get a bleeding ulcer over it. 85% chance? Well, of course I would dedicate all of my available resources to prepare. The problem with probabilities is how do we account for all the variables and unknowns in such a way that we feel comfortable in using the probability as a guide for our preparations? If we guess too low, we leave ourselves exposed. Guess too high, well, for some they could have placed themselves in financial hardship with their preparations or caused themselves some considerable angst and disruption of their personal lives. I think you will continue to see a lack of consensus on this board and you will even see people contradict themselves simply because this is an emerging situation and people will change and refine their views as the information changes.

banshee,

I wish I could say things as well as you do. Thank you for all of your input.

banshee

well put…this is all about allocation of one’s own resources over a given period of time.

By running QA simulation for opportunity cost, varying different probabilities for pandemic, there is no justification for “do nothing” approach. Adjustment of a life style (preparation) can save money and increase comfort of living in the long run.

The art of war teaches us to rely not on the likelihood of the enemy’s not coming, but on our own readiness to receive him; not on the chance of his not attacking, but rather on the fact that we have made our position unassailable. Sun Tzu

banshee at 13:36
that’s why the experts shall give their estimates and discuss it ! Shall they form two panels now as in 1976 to come up with probability estimates Their estimates should be better than the one which a normal citizen can make.

As a practicing therapist, I learned that people have an almost unbelievable intuitive ability. Patients would say they did not know if their husband was cheating, their son was an addict, or if they would get the needed raise at work. They would say that they had no way of knowing if their grandmother would die in the next month.

I would ask people to guess (not be right but simply guess) at what was going to happen and found over 25 years as a therapist that people know what is going on in their own life much more often than they think that they do.

I never tried it with a national disease such as AIDS but on an individual basis I found that people had an uncanny ability to “know” whether they that they had it or not. I have learned to trust others’ intuition more than they trust it themselves.

In our University cafeteria, there is a sign that states 5/4 people do not understand fractions. That would be probabilities too. Therefore, the heck with the numbers, scientific reports, expert opinion, etc, etc. What is you intuitive perception that within the next year you and your family are in for some very difficult times?

The amount of money, time and effort you have expended is one measure of your intuitive expectation.

In clinical work there is what I call scientific significance ( <.05, .01, .001 etc) then there is clinical significance; when the clinician has a hunch. No two variables reach significance by themselves but they way they go together lead to the conclusion that such and such is going to take place unless we get involved now. That is why it is called the “art and the science” of medicine.

I would suggest that most of you already know what will happen to you and your family. You already know who is most likely to bring it home, die, and who will survive.

Of course, we could also talk about the people who believe in little green men and their intuitions. However, these groups usually exhibit significantly (that science) more psychopathology than is seen around here.

Is it going to hit? What does your gut tell you? Mine says we are up for some difficult times.

And mine continues to say, watch, wait, watch, keep an ear and eye open, and continue to wait. Something will happen, but it may not be the pandemic. While I watch and wait, I don’t worry.Whatever happens, it is interesting, and I don’t consider it a curse to live in interesting times.

anonymous – at 11:12

majdad, the EU is way behind the US in community and individual preparing and awareness.

That may well be true on an individual level but not so on the national level. Remember that most EU countries are no larger that some of the larger State in the US and They as governments have been working this issue for a longer time. Further the EU countries have not just under gone a Katrina where their ability to act was truly tested. They still think that they can handle it on a national level.

Lily, I never cease to amaze at how similarly we view living at this time. I’m not worried…just watchful, expectant although I won’t be surprised if we see something other than a pandemic. There remains that overriding sense that “something” is coming. I don’t pretend to know what, but being with likeminded souls makes the time pass more peacefully. The intellect says pandemic is quite possible, but so are a variety of other situations. I told a friend the other day, it’s like watching a mystery novel write itself. The nuances fascinate and the characters are creating their plots.

Thanks for all the great reads, all. Wish I had more time to play.

if it looks like s**t,and smells like s**t,there is a better then average chance it is s**t.

Pandemics timeline

Major outbreaks of disease through history

Phil Hoad Wednesday April 2, 2003 http://www.guardian.co.uk/medicine/story/0,11381,928203,00.html

JoeW, great post - Thank you!

To answer the question my opinion is that H591 will break out either this year or next and I have planned accordingly. I began my prepping in January as I watched the Turkey clusters unfold and have been steadily planning and purchasing food, survival supplies and medications ever since. During the times where there was no new info regarding bird flu and it seemed to be simmering down I did step back and ask myself if I had gone overboard (basically wondering if I had lost my mind and had gone over the edge), but then as soon as I did that things would take off again. With this last Indonesian cluster I find it very difficult to believe that this virus could/would just up and disappear, especially since everything we have seen to date this year is that it is becoming more established verses less. This is all from a laywoman’s perpsective.

This is off topic, but JoeW, did you ever publish the results of your poll that you took back in March? The Wiki went down around the time you were going to publish and I never have been able to find it to read the results.

Thanks!

Let me elaborate on my original post of 8:24.

The would-be skeptics of the probability of this looming pandemic are ignoring significant, underlying, worldwide trends which have been mentioned in other threads over these many months. I will briefly reiterate them here:

Repeated studies have linked climate change (both warming and the resultant environmental stress) with increased mutation at the cellular level.

The Solar Maximum is approaching. There is a high correlation between the onset of pandemics and the Solar Maxima. Some have attributed the connection to the worldwide warming that Solar Maximas generate. But another recent study also found a connection between the incidences of stroke and Solar Maximas. One of the authors of the study conjectured that the solar magnetic storms affected the earth’s magnetic field which in turn upset electro-chemical mechanisms in the body.

The host levels, man and beast, are at levels much higher than the last time a pandemic occurred in 1968, (more “slot machines” for the virus to play).

Chemical and plastic pollution are at unprecedented levels worldwide. That pollution is working synergistically on our bodies and on ALL living organisms in unforeseen ways. Some of the deleterious effects of the physiological stress are being documented such as immuno-suppressed organisms and again increased cellular mutation.

We have been seeing an acceleration of viral mutation worldwide over the last few years. (It was just confirmed that the recent “crippling disease” outbreak in the Seychelles was much more deadly this time around because the virus had made a significant mutation).

All animals and humans are much more mobile worldwide since our last pandemic in 1968, (so not only more hosts but more vigorous mixing).

Despite statements by the many “odds masters” that frequent this site there has been an historical regularity to pandemics. Mathematics aside, we are OVERDUE.

So you meld all of the above with “what is on the surface”, and what should you reasonably conclude?

To use a less crude saying than “inthehills” used and a little more appropriate to the topic-If it looks like a duck, walks like a duck, and quacks like a duck, it probably is a duck.

You skeptics are not seeing, because you do not want to see. There is something inherent in your makeup or situation that cannot allow you to make that last step. It is not SCIENCE, it is STUBBORNNESS.

If it were SCIENCE, you would allow ourselves only a very slight possibility of avoiding this “viral asteroid”.

Medical Maven – at 19:15

Thank you for the post.

Isn’t the Solar Maximum six years away? When do you think the pandemic will hit?

I was confused.

Watch Dog: Global warming due to greenhouse gases and due to increased radiance of the Sun, (a 10,000 year peak currently) are already replicating the conditions that a Solar Maxima provides. I look upon the coming Solar Maxima (which by the way will be gearing up late this year or late next year and is forecast to be the strongest since 1957, another pandemic year) as the “fail-safe” mechanism for H5N1 to “make it over the hump”. This virus has so many things going for it. It is entrenched. Its timing is right. It is doing all the right things to get where it needs to go in order to become the next panflu.

I think the pandemic could happen at any time. I think it will certainly happen by late Fall 2007, and, if not, I give us a slight possibility of escaping this catastrophe. But, then again, H5N1 has all of the time in the world and the conditions just keep getting riper.

Hospitals “Full-Up”: The 1918 Influenza Pandemic

Short educational documentary

http://tinyurl.com/ng2ve

Medical Maven @19:15 Wow!! no really !!!!!

Medical Maven. It is hard to come up with the words to express just how good that piece of writing is…I guess the best I can do is clear, concise and complete.

JoeW, I’m disappointed. Now you want to decide this by the gut-feeling of the ordinary people here ? What do we have these experts for ? Shall they read the papers, analysize the data and discuss the probability estimates in public.


MedicalMaven, give a link, when you think there is a serious study about this. As far as I know these theories were discussed and refuted and most experts don’t believe in it. I think it will certainly happen by late Fall 2007, and, if not,… so, are you certain or not ?


I see this forum drifting away from statistics, science, like discussing the papers from medical journals, like analysing and comparing the news from several sources - towards telling personal stories, superstition, alarmism. “Arguments” are becoming less logical and more emotional.

Hi anonymous. I know you probably don’t want to hear this but all we have are unknowns. There are no knowns…

…and like you, I am getting damn tired of the so called authorities beating around the bush.

I don’t think Dr. Nabarro and Dr. Webster could be accused of beating around the bush.

I also don’t think Dr. Butcher could be accused of the same.

So there are a few that have stood up but not enough in my opinion.

I don’t think there have been any studies to refute Medical Maven’s text and it seems factual if one looks at the big picture and the big picture is that something is pushing overall mutation rates in all geographical locations around the world…and it is specifically this evolutionary pressure of unknown origin that is going to push H5N1 to a pandemic next fall or early winter in my estimation…so my studies correlate with Medical Maven’s opinion pretty much exactly.

Anonymous - at 22:38

Once upon a time, I was much like you. I required that … everything had to be proven scientifically. You can’t argue with the data…

There truly is nothing wrong with that, but now I look at everything in a different “light” these days.

If 100 people , from all walks of life/careers were to stand up and explain/justify their position on this subject, I would most likely pay the most attention to “INDIAN – at 15:39 “…

…Never… ever… ignore your Mother (Earth) when she’s trying to tell you something VERY important…

Live long and prosper… Mr. Spock

TomDVM, I don’t know what you mean with “unknowns”, “beating around the bush”, what’s the referrence ? You first need studies to support a theory, then these can be questioned you can’t refute such a theory per se. When mutations occur more frequently, I can’t see why this should be good for the virus.Its mutation-rate is adapted through evolution and we can expect it is almost optimal. I can’t see an evolutionary pressure of “unknown origin”. Where are “your studies” ? Who else thinks that next fall or winter is particularily likely ? Why is it ? Or is it just another “gut-feeling” ?

TC_in_CT, INDIAN: that’s nonsense. How can the animals in USA predict the mutations in Indonesia ??? And if, why should they be interested in _human_ pandemics ?

What I mean by unknowns is that there is no data upon which to make an indisputable prediction because by definition, a prediction is based on chance - probability.

I have looked at every shred of evidence about as many diseases as I could get my hands on. I have stuffed as many variables as possible into my memory banks…then I have taken twenty-years of experience with animal diseases, analyzed the data subconciously and out pops an answer…which is a pandemic in the next twelve months.

I really think you should consider Mr. Spock instead of anonymous…it’s kind of catchy.

anonymous. I don’t think you understand the term Indian. They are natives or aboriginals…not animals.

you doctors TomDVM,JoeW , please confirm that this INDIAN and MedicalMaven stuff is not accepted science.

TomDVM: INDIAN at 15:39 claims that she can draw concusions concerning the likelyhood of a pandemic from carefully watching the animals in her area.

anonymous The text by Indian is not driven by science but by nature and intuition. It doesn’t hurt anyone to have a little intuition in the discussion. I’ll bet you use intuition as well. Isn’t it what brought you here in the first place.

Medical Mavens text is science. What she said does have a scientific basis. I have known or sunspot activity and viral mutations for twenty-years. I didn’t really believe it until I saw a recurring pattern of viral and bacterial mutation. I originally put it down to global warming but it could just as easily be due to sun spots.

I know it’s morning where you are but I’ve got to go to bed…talk to you again.

TomDVM, what’s your background in virology and epidemiology ? Do you claim we should consider you an expert in pandemic-prediction ?

anonymous. You know exactly what I am and how I’ve described myself. I am a generalist and an intuitive thinker like Indian and Medical Maven. I think this happens when you are a disease fighter for twenty-years…when sometimes nature works with you and sometimes against you…and after a while you realize that nature is the real power.

I am not an expert in virology and epidemiology. What I am is an expert in phentotypic disease expression in nature…in other words what is in the textbook is not what’s in the field. I am an expert in interpreting how confusing text translates in nature.

Tom DVM: Thanks a bunch for your support. I was at a family dinner for the Memorial Day weekend.

anonymous: I hate to haul out another hoary old saying, but this following one certainly has you tagged---You can’t see the forest for the trees.

And that one won’t get through to you either because you arre truly lost in the thicket. You are not a “big picture” guy (or gal).

Medical Maven I’ve never seen you write as much as you did at 19:15. You really should do it more often.

It may not be science but it is knowledge of another kind. Science is only one way of coming to know. If your married, how did you make that decision? I’ll bet it wasn’t science.

Humans are finely tuned patteren recognition devices and I maintain that when they have taken in a great deal of data they often can recognize a pattern before some simple heuristic that in even multivariate studies can consider no more than 7–9 variables with any degree of precision.

Obviously, I would not ask a six year old to predict the likelihood of “bad things,” but an educated adult is a better predicting machine than even the individual thinks.

Ask someone who has been happily married for 50 years how they made the “right” choice. And of course the example also shows that some people are not very good at following their intuition.

It is interesting to note, in my prior work, how after the fact, and in a new marriage, the patient will say, ya know I knew from the start that he and I would probably never make it, but he was so much fun at first.

I would support anonymous’ implied and overt call for critical thinking. And I would support a bit more tolerance and less derisiveness from anonymous posters.

We all are at fault on this thread. We do not know the chances for a pandemic any more now than we did months ago when we had this discussion. We are still fans of ‘hope for the best, prepare for the worst’. For those who are not convinced we are about to see TSHTF (and I am one), we can call for critical thinking without calling the posters on the carpet. For those who are convinced otherwise, cool. State your reasons, proive your links and keep teaching each other.

That’s “teach”, not “convince”. That’s not why we are here.

Deb: search for “Flu Wiki Survey Summary” in the Forum and “Flu Wiki Survey” in the Wiki for the tables and numerical presentation. The results were interesting

Medical Maven/Tom- I would like some legitimate links or professional references for your broad statements that global warming can replicate the effects of the geomagnetic swarms of solar maxima, and for your statements about the effects of the solar maxima on terrestrial viral and bacterial mutation. thank you

The facts ae few and far between. We are long on speculation and short on facts. So what we wind up with is exploratory data analysis of data that are far too contaminated to derive any good hypotheses. In addition, to that we can’t test hypotheses anyway. So what is left — informed speculation and de-constructing every statement made by some politician who has received a summary from those who do the actual work. The whole thing is three times removed yet we seem to derive some pretty good insights in my opinion.

we seem to derive some pretty good insights in my opinion.

I agree. Still, nothing wrng with asking clarifiaction on what’s speculation and what’s not. We (on occasion) fall in the habit of stating/restating speculation as if it were fact because it’s been repeated often enough.

anonymous – at 23:13

The Japenese people have a term for “inner harmony” , I don’t know how to how to really spell it, but it’s “ WA “….

A little over a decade ago I was a ‘profession” sailboat racer, yup, I sailed with and against “the big boys”. Our crew rode on thousands of $$$ worth of state of the art equipment. We beat “the best of the best” occasionally. That only happened when we were “one with boat… AND the ocean/wind…

The earth has a “harmony” to itself that can not be scientically explained, but it is real.

Do you live anywhere near Hurricane Alley? If so pay attention to nature 4,3,2 days before a hurricane lands near you… When a storm is a thousand nautical miles away… The animals KNOW it’s coming… and a lot more accurratley then NOAA could ever predict in my life time.

“INDIAN” is using a “science” that is thousands of years old. My trouble with your LOGIC is that you can not comprehend that. When she states that Mmother Nature’s “wa” is not right, I beleive her…

The part of all this that you are neglecting to acknowledge is that Mother Earth has a harmony to herself, and that all of here creatures

anon: I don’t have time for these “vetting” games. The fluwikie archives have most of the links, and if you are as knowledgeable as you seem to be, none of these findings should come as a shock to you. Google the rest. Your specialty must be very demanding and limiting.

I am very careful about what I state as fact. More than several references have fixed those facts in my mind. And I will not be your factotum. I am going to bed.

MM, goodnight, perhaps tomorrow you will provide the reference. If you state that so and so is fact, the onus is on you to back it up. That’s only polite. But it is late, your probably tired and maybe tomorrow ??

Medical Maven – at 19:15

Thank you for your input. I thought the Solar Maximum was six years away. The Mayan Calendar ends Dec 2012 and I thought that was a year of solar maximum. Doesn’t this happen every 11 years?

JoeW, make a study to support your theory of “knowledge of another kind”, select a large enough sample and do the statistics. If it is significant, I predict you’ll get the Nobel-price. But I also predict that you will fail. When you only mean, people often have a good feeling about their body and condition often more than the physician who has all the test results and other data - OK, that might be. They have more information about their body which they can hardly all describe and express. But they have _not_ a “gut-feeling” about other areas like pandemic-prediction.

DemFromCT, I disagree.We should say what we think. This is not a coffee-klatsch, or an exercise in politeness behaviour. We are debating about millions of deaths.We do know the (subjective) chances of a pandemic and we do know it better than months ago. “hope for the best, prepare for the worst” is just nonsense. (think about it !) We are not really convinced either way by now. It could happen or not, we are just checking the likelyhood of these two.

this is not like a hurricane or a sailing tour or forecast of local nature events. It’s different. You can’t predict or analyse it with intuition.

anonymous – at 00:35

This thread has a lot of value for most of that spend time in this thread. Like you said, we are talking about millions of deaths. So with such an important topic why are you spending your time in a thread that makes no sense to you?

anonymous, I would say there is a 90% chance you were formerly known as gs or Guenter.

at 00:44, ‘this is not like a hurricane or a sailing tour or forecast of local nature events. It’s different. You can’t predict or analyse it with intuition.’

Maybe not, but you can’t predict or analyze it with the facts either. The experts don’t know enough to know exactly what or when it will happen. Noone does. An excerpt from an article today to illustrate :

…”How serious is the situation? The outlook is plagued with frustrating uncertainties for decision makers and forecasters alike. The final pre-condition for a pandemic - that the virus already proving lethal in birds mutates into a form that is easily transmitted between humans - has yet to be met. So far, there have been just 208 confirmed human cases and 115 deaths. As Martin Meltzer, an economist at the US Centres for Disease Control, puts it: “The crystal ball is not just foggy. it’s completely pitch black…”

more… http://tinyurl.com/ottdn

We here the same thing from scientists again and again ‘We don’t know….’

In the absence of pure knowledge what else is there to go on other than intuition?

the subject of the thread makes sense. Just some posts are drifting away from the problem, which is that experts refuse to give estimates. So we are on our own to predict the chances and that’s the ground for speculations like the above ones. Ask the experts for estimates ! Write to CDC and politicians to require the CDC-panels to be formed now as in 1976 !

I’m frustrated too! See everyone on Monday, I’m out

MaMa:I’m in close contact with “gs or Guenter” and I agree on his views. That includes the possibility that I “am” gs or am just forwarding his posts - I’m not going to tell you. Argue about the views presented instead about the person behind it.
I’m only asking for probabilities. They do exist. Don’t ask the virologists, whether probability estimates are possible or not or chances are predictable. Ask the logicians,philosophers,mathematicians.Health-experts did it in 1976 and later analysis showed that they should have intensified on this. When Meltzer’s crystal ball is completely black, then why does he claim that his work has any value ? Why do we follow the news and read the statements and papers at all when they are useless to improve our predictions ? I don’t think the crystal balls are darker here than on many other situations where predictions were given and experts didn’t have to hide behind black crystal-balls.

‘I’m in close contact with “gs or Guenter” and I agree on his views. That includes the possibility that I “am” gs or am just forwarding his posts - I’m not going to tell you. Argue about the views presented instead about the person behind it.’

Who you are doesn’t matter. I was merely stating a probability.

I know you’re asking for probabilities and wouldn’t it be lovely if we could have some idea of what was coming and when? The fact of the matter is that not enough is known about past pandemics and the behavior of this particular virus to have data on which to base the probabilities you’re looking for. We follow the news to have warning as soon as possible of something that cannot be predicted with any degree of accuracy. We follow the news to learn of developments on goverment and business preparedness, vaccine and treatments, etc.The only thing we do know is that it’s coming- not when or how severe. So we watch and prepare and affect positive change wherever we can.

If the numbers exist, whoever knows isn’t telling.

Interesting discussion. One side seems to be arguing for strict scientific facts/data/proofs, while the other is more open to information that might be classified as less tangible and intuitive. I feel like I’m watching a ping-pong game going between these opposites. Well, in My work, we have a saying “The impact of opposites is the same.” To understand this, one must put the emphasis on the word “impact.” The two sides are seemingly not the same, yet their impact is. And that is where the trouble comes in, because as I see it, the answer is not located at the extreme of either pole.

Nature supports this: we live in a dualistic world, male/female, day/night, cold/hot, a complete breath is in AND out, our heart beat and brain waves have both an “up” and a “down” side if they are working correctly. No up AND down and we are probably dead. Its common knowledge that we have two sides to our brain: the left/logical/scientific and the right/artistic/intuitive. So, to me, as I view parts of this discussion it would appear that some want to argue that only one side, or one WAY of gathering information can be correct. To me that compares to arguing for 1/2 of a breath, a brain wave or a heart beat.

There are benefits and strengths in BOTH sides. We need both and are severely weakened if only one side were the correct one. And, if memory serves, I believe there have been several scientific breakthroughs that were credited by the discoverer as being intuitive [wasn’t it the carbon ring that came in a dream?] Einstein was forever making statements that would place him squarly in the “right brained” group as well.

Now, I’ve said before I’m not a scientist, so I guess that puts me in the same “side” as Indian and JoeW [if they’ll have me.] Yet I work with lots of scientific types and I’m happy to have them in my life. You see, I train therapists, physicians and other healers how to use intuition in their work. BTW, I generally find that when they begin to use their intuition, if often feels to them as if the information is coming from their gut! Why? Haven’t a clue, but that is a very common experience. Also listen to very successful CEOs. When questioned about what they did what they did to become successful you’ll often hear them say. “I followed my gut.”

MaMa:suppose, we increase our knowledge, at what point exactly would you say that “enough” is known to base probabilities on ?
“cannot be predicted with any degree of accuracy” huh ? You mean: accuracy is low (uncertainety is high) and deviation of expected expert estimates is high ? But what’s the problem ? We will see how high the deviation is. And I predict it will be lower than with typical sport or economy predictions. Numbers do exist by axiomatic postulate. Everyone has his/her number for the pandemic-likelyhood. Some are more profound than others. Experts do withhold their numbers. They are not trying to discuss them and to discuss other expert’s numbers so to improve the estimates. Given enough discussion all experts should finally agree on the same number and deviation would go to zero. I do encourage to start this process now.

MAinVA, I can’t see how both views can have positives here. The positions are opposite. What you classify as “gut-feeling” , I interpret it as an abbreviation for “it’s too difficult to explain the pros and cons are difficult to express with language, it can be done but it’s a lot of effort”

Well, this anonymous is the smug one. Maybe I can figure out who is saying what by adding my own tag lines in my brain. Yeah, anonymous, I’m not that keen on your behavior. You seem to enjoy throwing out little “gotcha” speedbumps while some of the rest of us are trying to untangle all the bits and pieces of information.

“Given enought discussion all experts should finally agree on the same number” --- don’t think so. We can’t even get experts of the world to use the same measurement systems (such as temperatures in the same scale). Man, NONE of the scientific meetings I’ve ever attended ended with all the experts agreeing (well, maybe that the department should pick up the bar tab . . .)

anon — EXACTLY, the positions are opposite!! Got that right. Yet you seemed to have missed my point: We need both sides. One without the other is only 1/2 of the whole. I believe that the reason that the scientist made their “intuitive breakthroughts” was because they had gone as far as the left logical brain could take them. Yet, it was also in their working to collect data, make studies, etc that they then, in stepping away from the problem, had somehow earned the right to have the answer — the whole — come together in a flash. We have square off opposite each other or we can work together in a way that can move things forward.

When I train the physicians especially I tell them to use all their medical knowledge, do the tests, and if they are still stumped, then to step back and call in the intuition to put the left brained knowledge they have gathered together in a new way so that the answer that is eluding them can come in — generally in a flash of insight! Intuition

anon — EXACTLY, the positions are opposite!! Got that right. Yet you seemed to have missed my point: We need both sides. One without the other is only 1/2 of the whole. I believe that the reason that the scientist made their “intuitive breakthroughts” was because they had gone as far as the left logical brain could take them. Yet, it was also in their working to collect data, make studies, etc that they then, in stepping away from the problem, had somehow earned the right to have the answer — the whole — come together in a flash. We can continue to square off opposite each other or we can work together in a way that can move things forward. Using left brained numbers it would mean 1 + 1 = 100 instead of 1 - 1 = 0

When I train the physicians especially I tell them to use all their medical knowledge, do the tests, and if they are still stumped, then to step back and call in the intuition to put the left brained knowledge they have gathered together in a new way so that the answer that is eluding them can come in — generally in a flash of insight! Intuition

What are probabilities, predictions based on? Facts, numbers, right?

IMO not enough is known about past pandemics to provide a base to work from. Do we have information on the characteristics of pandemic causing influenza viruses from the past? How they behaved and spread in the months or years preceding the onset of pandemic? No. Do we know how many and the characteristics of viruses that have attained the geographical spread and the amount of infection in humans but died out anyway in the past? No. We have never had the technology before to track and learn these things. H5N1 is a unique virus, the world today is different than it was 50 or 100 or 500 years ago in ways too numerous to count.

Anybody can make a prediction, based on what little they know or their ‘feeling’. How accurate is is or isn’t would be known in time. I would like to know the true probabilities too, but wishing and hoping doesn’t change the fact that probabilities based on thin air are really just a guess.

Sorry for the double post — the second is the corrected one.

MAinVA, opposite was not the right word. I mean contrary, mutually contradicting each other. The question is not which data should be included or how it should be interpreted. The question is whether expert probability estimates of a pandemic are useless (“impossible”)or not.


MaMa, even if nothing were known about previous pandemics we could make estimates. When you say :”do we know..no.”, we know a lot to estimate these things. We are not 100% certain, but maybe 90%. And even if we knew everything about past pandemics, you would still find an excuse like the world being different today. You didn’t answer whether there is any situation where you think that estimates are possible and where you want to put the threshold here. How much info is required for an estimate being possible ? When we study H5N1 for 10 more years, would that suffice ? Strangely enough the less informed people _can_ give estimates and do so in polls but the experts “can’t” (don’t want to).

MaMa at 02:09 has effectively summed up this whole thread. If you want a scientific expert to give you a prediction, or a probability, they will only do so if they feel they can give a number that has some validity. If it is just intuition or guesswork they’ll keep mum, because that is not their job, and don’t fault them for that. There’s a saying about scientific models and programs— garbage in, garbage out—. If there isn’t enough background information (and just how long have been able to study viruses and outbreaks in such detail?) or process knowledge, it would be as MaMa said, basing a probability on this air. I heard a major city official quote a 50% probability in 5 years, but it was in a very informal setting, although still in an official capacity, and I felt he was overstepping his bounds because he was not a virologist and he even admitted he was only basing it on what he could gleam from various publications and webpages.

I think the idea that we’ll get honest predictions is only true up to a point. H5N1 will probably not mutate into a godawful pandemic strain, but the possibility exists. As long as the mortality and infection rates don’t skyrocket, which they probably won’t, we’ll get reasonably honest answers from the powers that be. If the thing does explode, which is kind of what all the fuss is about, the truth will be in short supply. Fictional pandemics like The Stand (King) and Full Circle (Boyle) paint a grim but probably realistic portrait of the coverage such a thing would receive while it’s in progress.

Anon_today at 2:27
and why was it different in 1976 when experts _did_ make probability estimates ? Why did later analysis recommend that this should even have been done more extensively by answering hypothetical questions like :”what new data might make us change our mind” ? And why do people keep ignoring this point in this thread ? Estimates were being made and are being made. Just recently not by those who should be considered most competent.


Remo at 02:47:
I won’t rely on reasonably honest answers from TPTB, when the experts have none. TPTB usually say, what they want you to believe and not what they really think.

I am still unclear why numerical predications are necessary . Stuff happens. Some of it can be really bad stuff. We can either be prepared to take care of ourselves or we can be victims (or, maybe someone else will bail us out). It helps to have an idea of what particular stuff is on the horizon, but its not necessary. The more we learn, the better chance we have of adapting.

As far as intuition goes- good grief! If we had to stop and look at/verbalize every bit of data that goes into our brains, gets sorted around and comes out as good knowledge, we’d be paralyzed! Some people are better at putting it all together than others. That doesn’t mean we rely on it to decide when/if BF gets here this year or next. It does make me pay attention when things don’t feel right. I pay even MORE attention when a lot of people think things don’t feel right.

kc_quiet at 03:11
numerical predictions are especially important for the communities and states and nations to base their preparations upon.

Well, that makes sense- thanks. (although it wouldn’t hurt them (us) all to be a little more prepared for a variety of things, at least as far as planning goes. )

Just a reminder: we have no data and everything which is stated here is speculation, guesses. Perhaps informed guesses, but without data, we have no idea how informed.

Dem and I attended a flu conference last fall with all of the leading scientists in the flu fight. We spent an entire session on statistics and probabilities and the one thing that was drilled over and over is that putting a number on this is something that no sane statistician would do because we have no data. Anyone who does is just plucking a number out of the ether.

For those of you who know set theory, let me state it for you in those terms: the set which is relevant for this discussion includes zero% and 100%. Find your way through that.

Melanie, how often have you just repeated this without ever addressing the counterarguments ? That’s not a useful discussion. There is lots of data and it has been done. 656 US-physicians,2 CDC-panels,1 committee,Webster,etc., CDC-recommendation is to intensify assigning probabilities. Many experts assign ranges instead of numbers or give unclear statements giving room for speculating about their numbers. At what point do you think there is enough data ? Give an example. Address my points.

you can’t decide a statistical,logical,philosophical issue by letting flu-scientists vote on it. They are biased. They can give numbers but don’t want to.

anonymous, if you think a prediction can be made then you too must think it can be based on something. What are the relevent data points for a prediction? Should the prediction take into consideration prior probabilities and what would these prior statistics be.

You advocate for a prediction but you do not state on what the prediction should be based.

Hi everyone. anonymous, my friend, I’m sure you are trying to get a point across but I don’t understand the point you are trying to make.

You want everyone to stand up, be counted, and make a prediction. I agree, knowing that there is no evidence other than intuition upon which to make the prediction…but that is exactly what I want. JoeW has a lifetime of experience in psychology…

…believe me, I want to suck the intuition out of his brain like a mosquito…psychology is important and will be especially with the life-altering shock of a pandemic (immediate post traumatic stress for us who have been watching and waiting and warning).

There are a lot of what I would call experts at life on flu wiki. I would like to gather and learn everything I can from them so that my life is richer for it.

I want the opposite to you. I am specifically asking for intuition based on fact…I want what their life-time of experience is telling them will happen.

I spent too many years reading dry information in text-books only to realize that the text-books correlate with little that goes on outside of the university grounds.

So bring it on…everyones opinion on flu wiki is important…you don’t have to have degrees…the best information in fact has not come from people with degrees…let us harness humanity on this forum to benefit humanity and if we fail to prevent things then it will not have been for lack of trying.

In fact, I know that we are leading the field in some of the things that we have been able to extrapolate and predict from the minimal information that has been released.

Mr. Spock, you are an important component in this process.

Remember those old 1960′s movies of the Gods sitting around a table moving “World event chess players” This dreaded event here….this army there…millions of people dead with another move of the player… Well, I feel like I’m in one of those old movies right now!!!

The world has been corrupted and made vulnerable by a “just-in-time” culture. Many here and around the world want a “just-in-time” pandemic so they can adjust their supplies, attitudes, mindsets, and say their goodbyes at the last opportune minute. It doesn’t work like that.

There are no absolute certainties. There are probable certainties.

It is a probable certainty that the sun will rise tomorrow. It is also a probable certainty that we will experience another pandemic.

What are the surface and underlying trends telling you about the timing of the next pandemic, a probable certainty?

Go out and get really drunk, wipe the slate clean with a little temporary oblivion. Then look anew with fresh but bleary eyes at all that has transpired these last few years, like you have just dropped in from Mars. What would your “gut” tell you as to the near-term likelihood of a pandemic?

Many of us have been immersed in this for so long that we are like the frog that is being slowly boiled in the pot, and the frog thinks that everything is okay because the escalation in temperature is only gradual and only mildly discomforting. But soon the boiling point will be reached, and that probable certainty will have arrived.

JoeW at 08:39
the predictions should be based on all available data, of course.

>Tom DVM at 09:16
>Hi everyone. anonymous, my friend, I am sure you are trying to get
>a point across but I do not understand the point you are trying to make.

which of my points exactly did you fail to understand ?

>You want everyone to stand up, be counted, and make a prediction.

not everyone, just the experts and they need not stand up.

>I agree, knowing that there is no evidence other than
>intuition upon which to make the prediction but that
>is exactly what I want.

with whom do you agree here ?

>JoeW has a lifetime of experience in psychology believe me,
>I want to suck the intuition out of his brain like a mosquito

if he does not want to give us his number, we should not
hurt him

>psychology is important and will be especially with the
>life-altering shock of a pandemic (immediate post traumatic
>stress for us who have been watching and waiting and warning).

yes, but that’s another subject

>There are a lot of what I would call experts at life on flu wiki.
>I would like to gather and learn everything I can from them so
>that my life is richer for it. I want the opposite to you.

you don’t want me to gather and learn or you don’t want to gather
and learn with me ?

>I am specifically asking for intuition based on fact I want what
>their life-time of experience is telling them will happen.

name it intuition based on fact (just another expression)

>I spent too many years reading dry information in text-books
>only to realize that the text-books correlate with little
>that goes on outside of the university grounds.

apparantly you read the wrong books

>So bring it on everyones opinion on flu wiki is important
>you do not have to have degrees the best information in fact
>has not come from people with degrees let us harness
>humanity on this forum to benefit humanity and if we fail to
>prevent things then it will not have been for lack of trying.

what exactly do you suggest to try here ?

>In fact, I know that we are leading the field in some of the
>things that we have been able to extrapolate and predict from
>the minimal information that has been released.
>Mr. Spock, you are an important component in this process.

sorry, this is all difficult to understand for me, what you mean.
You did not address the points from my previous posts.

>><<

And who said these threads are all the same?

anonymous. On your first point, there is no evidence other than that from the last ten years. H5N1 is one of those rare occurences where there is no evidence and little history…so spell out for me what exact evidence you think anyone could present.

I agree with you that those asked should make the prediction requested to the best of their ability…

…by the way, I would like to request your predictions…as many as you can present…you can sit down however while you give them!!

As far as JoeW, I will try and leave enough blood for him to live.

You want facts, I am more interested in intuition. I want you to give me your intuition.

I read the required textbooks for my profession and found them largely useless when dealing with the expression of diseases in the field.

I said bring it on because I have found that the key piece of evidence that often decodes the puzzle come from the most unlikely of sources…to hear it you must hear all sources.

I think I did comment on all your points from previous posts.

anonymous, you’re spoiling for a fight, as usual, with those who don’t see the world the way you do. Chill. Most don’t.

If the virologists and epidemiologists don’t agree with you, they’re ‘biased’. If you don’t agree with why you’re not given estimates , you’re getting ‘platitudes’. If you’re asked to tone it down, you claim the right to be rude because ‘millions of lives are at stake’. If you’re paraphrased, you’ll claim to be misquoted.

You’re more than welcome here, (you always have been) and I agree with those who find your POV refreshing and necessary. But respect, more than politeness, to your fellow posters and their disparate opinions is a requirement, and not an optional attitude. Consider that a fair warning.

Joe W, Tom DVM: Both of you, thank you for contributing.I have been very interested in your thoughts. Like both of you, I am keeping a finger to the wind of intuition, both mine and of others. Our collective “sense” of the patterns in the noise may well be all we have to go on. So far as preps go, tuna under the bed is easy but I think the real rubber-meeting-the-road intuition is what we do with our money. In that light, here is where my intuition has led me to stand, as of now:

Have identified assets that can be liquified quickly and lined them up, but have not done so yet.

Have looked at converting assets into rural properties, have toured several, but have not yet purchased.

Other actions in process:

Had until recently, never touched a gun before or considered buying one. Have recently begun researching purchases and have actually gone out to a gun range for a “ladies day” training session. This is HUGE for me. To my surprise, I am a good shot.

Even though my husband and are economical people, we have purchased and expensive All-American (worth it!) canner and have been putting up food. Our children have food issues due to severe food allergy; “survival rations” would probably be fatal for them.

I began prepping seriously since, hmmm, about October — maybe earlier. I have never prepped before and was prepping for months before I found the Fluwiki and discovered, amazed, other people were doing so as well. I am a flu-watcher, have been watching this one since ‘97. My husband considers me *very* intuitive; he was giving me the hairy eyeball about prep food but one very short conversation about it got him on board. It must not have been what I said but how I said it — he just gave me a funny look and he was a convert.

I have mentioned bird flu to few people — friends and family — but almost all have taken me very seriously and are now prepping.

I was coasting for a while, but have now begun stepping up the prepping again with the news out of Indonesia.

So several of my “tipping points” have been passed yet there are others — and I won’t know where they are until I pass them — that have not yet been reached. But I feel they are closer.

OK, now for the pure guesswork: when I ask my intuition “when?” the only answer I get is “cold… cold, so very cold.”

So I am guessing, winter.

 TomDVM, you write:
 >On your first point, there is no evidence other than that from
 >the last ten years. 

we can use all archeological data available about possible previous
pandemics as well. We can use all research done ever on flu- or other viruses.

 >H5N1 is one of those rare occurences

not so rare. Similar things happen frequently. Just this got our
attention because of the possible dramatic consequences

 >where there is no evidence and little history 

quite some evidence and long history back to 1918 at least.

 >so spell out for me what exact evidence you think anyone could present. 

all the data in the fluwiki, in the medical books and papers.
Data about previous pandemics, virus evolution, receptors,
antigens,antivirals,vaccine etc.etc. tons of data.
The more you have read the better your estimate should be.

 >I agree with you that those asked should make the prediction
 >requested to the best of their ability

good ! And then let’s discuss and compare their estimates
and hope that they will more and more agree upon one value.

 >by the way, I would like to request your predictions 
 >as many as you can present you can sit down however 
 >while you give them!! 

1% probability for a pandemic per month. 

 >As far as JoeW, I will try and leave enough blood for him to live.

?

 >You want facts, 

here in this thread I want estimates

 >I am more interested in intuition. I want you to give me your intuition.

is it different from what I want ? What do you mean with intuition ?

 >I read the required textbooks for my profession and found them
 >largely useless when dealing with the expression of diseases
 >in the field. 
 >I said bring it on because I have found that the key piece of
 >evidence that often decodes the puzzle come from the most 
 >unlikely of sources to hear it you must hear all sources. 

I have no special sources here but let me repeat the analysis
of Neustadt+Fineberg, Neustadt+May and their suggestions how
to achieve good estimates.

 >I think I did comment on all your points from previous posts.

why doesn’t CDC form panels to make probability estimates
as they did in 1976 and according to their own guidelines ?
Why do so many people think this shouldn’t be done
despite the importance of the decisions to be made ?
Why do people ask for chances and don’t insist on answers
(see Gerberding, first post in this thread, many other
examples) ?
Why can physicians and experts in 1976 make estimates 
but not experts in 2006 ?
Why should uncertainety be bigger now than it was e.g. in 1976,
although we did lots of research in the meantime ?

Because we know more about what we don’t know. if people don’t think they can make an accurate estimate, they won’t make an estimate.

Why is that such a difficult concept for you to grasp? You’ve been rejecting it for months.

This was a fun thread before it turned into a flame war. :(

anonymous. Your estimate was intriguing. We live in a world of uncertainties at the moment. That may be the best we can do.

I believe that we have covered the issues as completely as possible in the last three months and now it seems we are going over ploughed fields…not that that’s a problem…

…and I think that conclusions reached here have been quite accurate over the time period…and more accurate then most of the supposed experts.

FACT A: Seasonal flu is transmitted by coughing and the resultant hand-to-hand-to mouth/nose/eyes route.

FACT B: Flu transmission by coughing defines “easily” transmissible flu.

FACT C: WHO says that coughing was the likely route for this H5N1 transmission.

So, If A = coughing spreads flu, B = easily transmissible flu and C = H5N1 flu, this is what we know: A=B and A=C.

What we can conclude, then, is B=C. Easy transmissible flu = H5N1 flu.

Help me out: I seem to remember this principle from Algebra I in high school and/or Logic 101 in college. Did everyone at WHO cut class that day?

I think that conclusions reached here have been quite accurate over the time period…

One example is Flu Wiki and the other flu blogs and BBs picking up on H2H well before WHO was ready to say so. We went rather quickly from “no comment” to, “well, it’s common ehough and it’s happened before”.

AVanarts – at 10:42

My apologies. I should know better. I get torqued at seeing the same argument month after month by the same people.

SoCal – at 10:49

That’s the worry, but data doesn’t support that. No one outside the cluster is coming down with it. it is transmissible, but not easily transmissible.

Dem, that comment wasn’t aimed at you, but at the general direction that this thread had taken.

 >DemFromCT at 10:14 
 >anonymous, you are spoiling for a fight, as usual, 

not true. It’s relevant discussion. Just that I disagree
with you and others doesn’t mean I’m spoiling for a fight.
Be more specific, if you think I just bring this up
for the sake of arguing or “fighting”. Don’t you agree
that this is important and _should_ be discussed since
apparantly many people here disagree ?
The fact that only gs and me brought this up so far
here is a shame for fluwiki IMO.

 >with those who do not see the world the way you do. 

it’s not about a general philosophy on how to see the world.
It’s about giving probability estimates for a possibly life-changing
event. It’s one of the main reasons why we are here and following
the news, so I don’t know why you are trying to denigrate it
as a personal problem.

 >Chill. Most do not. 

I claim that most who have expertise in decision making and
statistics do. Neustadt+Fineberg+May+CDC apparantly do.
It seems just to be some cultural problem with people here.
And maybe some genetic factor with the prevalent females here.

 >If the virologists and epidemiologists do not agree with you,
 >they are biased.

they are biased because they do not want to give estimates.
They are afraid of their estimates being discussed and possibly
questioned in public. It happened with the early 2–7million deaths
estimate of WHO. Clearly experts avoided to give estimates
since then. See also the well known Webster-estimate and how
he retracted to a “no one knows”-strategy after being critisised.
They avoid the subject. They do not argue why they can’t
give estimates. Why others can give estimates but experts can’t.

 >If you do not agree with why you are not given estimates , 
 >you are getting platitudes.

other than you, I’m trying to discuss the reasons and figure out
the truth. Give an example, what you mean with platitudes.

 >If you are asked to tone it down, you claim the right
 >to be rude

give an example where I was rude or where I claim the right to be rude.
I’m trying to avoid it.

 >because millions of lives are at stake.

do you disagree here ? I mean, we should be allowed to discuss this
controversy , as BTW. is quite custom in other places in internet.
It’s not useful to avoid important subjects just because there
is disagreement and engaged arguing.

 >If you are paraphrased, you will claim to be misquoted. 

again, give an example here. BTW. it’s hard to read these posts
when you write them in one piece without the refering
quotes, as I do here and as proved useful in decades of
usenet-debates.

 >You are more than welcome here, (you always have been) 
 >and I agree with those who find your POV refreshing and
 >necessary. But respect, more than politeness, to your 
 >fellow posters and their disparate opinions is a requirement,

you have to question when you disagree, how else can you
start the discussion ? It’s not “respectless” in general
only about the special argument.

 >and not an optional attitude. Consider that a fair warning. 

I’m missing your desire here to figure out the truth and the
possible implications for panflu-preparing and information.
It’s not just talking about _something_ and figuring out who
is right or who shows what you think is the best behaviour
and ethics.
It’s important to get experts giving estimates
so I tolerate people marking me of bad behaviour or such.
Sorry, I have to continue. You’ll have to ban me if you 
think there is reason.

Is this thread serving any useful purpose at this point?

You’ll have to ban me if you think there is reason.

You haven’t given me reason, though I suspect it’s happened to you before elsewhere. Look, we are all on the same page about wanting data, but if it’s not there, it’s not there. You’ve tried to obtain it. If you had it, you’d post it.

And obviously, it’s not a universally accepted truth that it’s important to get experts to give estimates. Being expert in a certain field doesn’t make you especially qualified to give accurate estimates in the sense that you mean. That’s one reason why you don’t have what you’re asking for. It’s not a conspiracy to withhold information.

I’ve discussed this with risk managers tasked with telling their employers the risk of a pandemic. They all want the answer we don’t have. They’re as frustrated as you are. The rest of us don’t need a number to proceed.

I will politely and respectfully wait for your response.

Paralegal, our unnamed friend is reflecting frustration that is shared by the ‘numbers’ people, as I mentioned in my post above. I am sympathetic. I do think it’s important to understand and have that POV reflected on the wiki.

In fact, I would love to have anonymous or anyone else get that elsewhere and bring it back here if it exists. It’s not to be found here.

BTW, anyone interested should go here. These are the best numbers we have, albeit a tad dated.

 >DemFromCT at 10:36 
 >Because we know more about what we do not know. 

but then we do know, or not ?

 >if people do not think they can make an accurate estimate, 

what’ an “accurate” estimate anyway ?

 >they will not make an estimate. 

they will also do this, when they think an estimate is bad for
their career or makes them look silly. I know, that you know
that experts easier do make estimates when they can remain anonymous.
That pretty much proves, that the real reason is not that
they think they can’t make an “accurate” estimate

 >Why is that such a difficult concept for you to grasp? 

it’s unlogical and just doesn’t make sense.

 >You have been rejecting it for months. 

I have been disproving it for months. You have been ignoring those
disproofs for months. Noone ever questioned or argued about
these disproofs.

 >AVanarts – at 10:42 
 >This was a fun thread before it turned into a flame war. :( 

not a flame war. Just arguing. Goto usenet if you want to
see real flame wars ;-)

 >Tom DVM – at 10:43 
 >anonymous. Your estimate was intriguing. We live in a world
 >of uncertainties at the moment. That may be the best we can do. 
 >I believe that we have covered the issues as completely as
 >possible in the last three months

but we don’t yet agree

 >and now it seems we are going over ploughed fields not that thats
 >a problem and I think that conclusions reached here have been
 >quite accurate over the time period and more accurate then most
 >of the supposed experts. 

which conclusions do you mean ?

 >SoCal – at 10:49 
 >FACT A: Seasonal flu is transmitted by coughing and the 
 >resultant hand-to-hand-to mouth/nose/eyes route. 
 >FACT B: Flu transmission by coughing defines “easily� 
 >transmissible flu. 
 >FACT C: WHO says that coughing was the likely route for this
 >H5N1 transmission. 
 >So, If A = coughing spreads flu, B = easily transmissible flu
 >and C = H5N1 flu, this is what we know: A=B and A=C. 
 >What we can conclude, then, is B=C. Easy transmissible flu = H5N1 flu. 
 >Help me out: I seem to remember this principle from Algebra I in 
 >high school and/or Logic 101 in college. Did everyone at WHO cut 
 >class that day? 
 >DemFromCT – at 10:50 
 >> I think that conclusions reached here have been quite accurate
 >> over the time period… 
 >One example is Flu Wiki and the other flu blogs and BBs picking 
 >up on H2H well before WHO was ready to say so. We went rather 
 >quickly from no comment to, well, it is common ehough and it is
 >happened before.
 >DemFromCT – at 10:53 
 >AVanarts – at 10:42 
 >My apologies. I should know better. I get torqued at seeing the
 >same argument month after month by the same people. 

there is something new here. The reference to 1976 , the CDC-panels,
the committee, the Neustadt+Fineberg+May - analysis.
Noone commented on this yet.

 >DemFromCT – at 10:55 
 >SoCal – at 10:49 
 >That’s the worry, but data doesn’t support that. No one outside
 >the cluster is coming down with it. it is transmissible, but not 
 >easily transmissible. 
 >AVanarts – at 11:26 
 >Dem, that comment wasn’t aimed at you, but at the general direction
 >that this thread had taken. 

don’t end your posts with a double slash. screws up the formatting. ;-)

anon,

you are running around asking for data that doesn’t really exist. We are dealing with far too many unpredictable and unknown items here. There are no hostorical statisics (not history) that we can use either. The scenario is actually extremely fuzzy in terms of predictablity.

What we know today is that this virus kills and kills very efficiently at that, once it infects a host. We do not even know if the virus will ever develop the capability of infecting easily and uniformly across the human population. There are not enough knowledge around to even make valid guesses about its future capabilities. It continues to surprise us. Even if all available data had been in the public domain I assume we wouldn’t have had much more success in making predictions about its future. I believe this is because it is a biological entity, and we do not know enough about how they evolve to make such predictions.

What we can say on the other hand is that if so and so happens, then we would expect to see the following, etc. In my book that is guesswork, not valid predictions. These guesses are useful for contingency planning, but they do not give me a prediction that I would put my name under. They would be based on a lot of preconditions, most of them unstated, like how much Tamiflu is available, the time to manufacture vaccines, population mobility, population density, the effectiveness of the precaution people take, the length of the pandemic, general availability of food, drugs, and other goods, etc., etc. Basically far too many datapoints to make them useful for anything. They remain guesses and speculations.

When experts answers enquettes about a subject they will most probably tend to answer based on personal outlook and experience. If they on the other hand were asked to write a formal paper on the same subject the answer would be completely different. The data would be backed up by sources and reasoning. The methods they employed to get to their answer would be described etc. Repeatability of the procedure is the important factor. An enquette is nowhere near that. To use data collected by enquettes is a bit like trying to predict the stock market based on registerred stock transactions - very, very difficult ;-).

thread closed for length.

DemFromCT, I am in complete agreement that all points of view should be welcomed. However, a discussion conducted solely for the purpose of being argumentative (not you) seems pointless. I’m probably missing the entire point of the exchange (I can be a little dim sometimes!).

 >Paralegal – at 11:32 
 >Is this thread serving any useful purpose at this point? 

the purpose is to get experts to give probability for a pandemic
and expectation values for the number of deaths.
And to discuss whether it’s reasonable to ask them for
estimates or to form panels to give these estimates
as was done in 1976 with the swineflu-pandemic threat.

 >DemFromCT – at 11:40 
 >> You will have to ban me if you think there is reason. 
 >You have not given me reason, though I suspect it has happened
 >to you before elsewhere.

… the thread at curevent was thrown to dungeon although
it had stayed within the site-constitution as the moderator
had admitted.

 >Look, we are all on the same page about wanting data,
 >but if it is not there, it is not there.

And if it is there, then it is there ;-)
I’m repeating myself, but the data is there in books and medical papers
in libraries and internet.
What particular data do you have in mind ? Sorry to repeat myself
again, but what hypothetical data , if it existed, would make
you change your mind ?

 >You have tried to obtain it. If you had it, you’d post it. 
 >And obviously, it is not a universally accepted truth that
 >it is important to get experts to give estimates. 

again, it is generally accepted in other branches of science
and economics and betting markets. It was the conclusion
in the NFM analysis after the swine-flu-affair in 1976.
Apparantly it was accepted truth in 1976 and even more
in its aftermath.

 >Being expert in a certain field does not make you especially 
 >qualified to give accurate estimates in the sense that you mean.

I’m wondering what sense you mean, that I mean.
I never used the attribut “accurate”. What’s the purpose
of accurate ? “about 30%” is almost as good as “9*pi” or such.
Since people rarely give accurate estimates apparantly
you imply here that the whole thing is uncommon and useless.

 >That is one reason why you do not have what you are asking for.

I think, it’s just a temporary stream of style, which makes
it nonfashionable in 2006 to give estimates.

 >It is not a conspiracy to withhold information. 

proof it ! I think there is reason to believe that some scientists
did receive directives to not give their estimates estimates to public.

 >I have discussed this with risk managers tasked with telling 
 >their employers the risk of a pandemic. They all want the answer
 >we do not have. They are as frustrated as you are. 

… and they are all wrong in that they expect such an estimate
could be useful ? Isn’t it more reasonable to assume that scientists
have these estimates but keep them secret ?
You know, that sometimes scientists do give their estimates
in private talks but not in public. This has been mentioned before
and is documented. People here are ignoring it.

 >The rest of us do not need a number to proceed. 

you can’t speak for the rest. And just wait how many will require these
numbers when the thread is finished. And you yourself did acknowledge
earlier here that getting these estimates would be useful.
“we should push gs” or such were your words…

 >I will politely and respectfully wait for your response. 

no problem with your politeness. That’s all perfectly OK.
I hope you have no problem with mine.
Only that I disagree.

 >DemFromCT – at 11:43 
 >Paralegal, our unnamed friend is reflecting frustration
 >that is shared by the ‘numbers’ people, as I mentioned 
 >in my post above. I am sympathetic. I do think it’s important
 >to understand and have that POV reflected on the wiki. 
 >In fact, I would love to have anonymous or anyone else get 
 >that elsewhere and bring it back here if it exists. 
 >It is not to be found here. 

we must ask the experts. We must ask the CDC to form the panels.
We must write letters to the politicians as with the
withholding of sequences and patient-data.
It’s even more important that these estimates are released IMO.

 >DemFromCT – at 11:46 
 >BTW, anyone interested should go here. These are the best 
 >numbers we have, albeit a tad dated. 

see also 
here
>><<

Must a Pandemic Strain of Influenza decrease in lethality?

This is a question that has been addressed several times on this forum, but new data prompts me to consider the question once again. We now know that H5N1 truly is a highly lethal virus in humans. The recent release of seroprevalence data has established this as fact. The arugment that a flu virus must avoid killing its host has been discussed extensively. My conclusion is that this is not true because virus is shed before the host becomes ill, so there is no selective pressure to spare the host. Additional recent evidence, and a rethinking of the genomic structure of influenza viruses provides additional reasons to think that H5N1 may be able to retain a very high level of lethality when/if it becomes a pandemic strain.

Influenza is an unusual virus in that its genes are separated into 8 distinct segments. The hemagluttin gene (HA) is responsible for entry of the virus into the host cell. It is also likely that this gene is important for initiating a pandemic as it must acquire the ability to infect the upper respiratory system in order to be transmitted efficiently between humans in respiratory droplets.

Viruses evolve via 3 mechanisms - random mutation, reassortment and recombination. Reassortment involves exchange of entire viral genomic segments while recombination involves exchange of subsegments. However, regardless of how H5N1 evolves, because of its segmented genome, HAs can change independently of other H5N1 genes. Recent studies demonstrate that this viral gene swapping occurs much more often in influenza viruses than was previously thought. Thus, H5N1 could acquire an HA adapted for efficient spread of virus without affecting the other genes in its genome. Thus, the question of which genes contribute to its virulence become key in understanding its potential lethality as a pandemic strain.

Both the polymerase gene complex and NS1 are thought to be major contributors to the high lethality of H5N1. They are not on the same genomic segment as HA. So, there is no reason to think that a change in the HA gene that permitted efficient human to human spread would affect the lethality of the virus, at least that part of the lethality that is due to genes other than HA.

There is still much we don’t understand about influenza viruses, so there may constraints in its behaviour that put an upper limit on its lethality in pandemic strains. But if so, we have no evidence of them that I am aware of. We have concrete reasons to think that the virus may be much more lethal than the 1918 virus. Yet, all our official planning is based on the assumption that a 2.5% fatality rate is the maximum. I would argue that, based on the available evidence, not only is a much higher fatality rate the true worst case scenario, it’s the most likely scenario if H5N1 becomes a panflu.

References

The polymerase complex genes contribute to the high virulence of the human H5N1 influenza virus isolate A/Vietnam/1203/04

Pathogenesis of Hong Kong H5N1 influenza virus NS gene reassortants in mice: the role of cytokines and B- and T-cell responses

The NS1 gene of H5N1 influenza viruses circumvents the host anti-viral cytokine responses

Whole-Genome Analysis of Human Influenza A Virus Reveals Multiple Persistent Lineages and Reassortment among Recent H3N2 Viruses

Absolutely irrefutable, M. Those are among the cards in the big deck. And these are the cards we’re only too apt to be dealt.

‘Read ‘em and weep’ as they say at the poker table.

Thank you for your time, effort and courage.

Monotreme:

Since your weighty post, the silence has been deafening… The title, plus your credibility, guarantee many have read this post. The final paragraph should be engraved on walls.

May I ask, in due time, your observations on the impact of this, and the spreading strains of H5N1, on Panflu51 VACCINE(-s) development?

Clearly, the more lethal the virus, the more vital effective vaccination protection. High lethality agents are possible civilisation busters…

H5N1 keeping its’ current mortality rate during panflu would make the clips that I have seen from the ABC movie airing on the 9th, a little less dramatic fiction and a little more dramatic reality. Very scary, clearly an all bets are off scenario. Great post, Monotreme, scary but great….in my town, you’re talking over 10,000 dead….

Monotreme: Thanks for another penetrating post.

As a practical matter, probably but not necessarily.

- Monotreme

I have read your post, and right after, Revere’s comment on H7 in UK.

I have just been shell-shocked. Both of you have brought home to me just how bad, really bad, it’s going to be if/when…

My deafening silence is going to be converted into extra energy geared towards even more thorough prepping.

FrenchieGirl. I certainly share your feelings on the subject. Part of the reasoning is on the current thread ‘H5N1 spreads more efficiently H-H than B-H’.

However, something we should keep in the back of our minds, is that there is another group of scientists, with reasonable arguments, that state there is a barrier and it will never happen.

The truth is…no one knows. We have the evidence of past pandemics and of H5N1 and H7 viruses of the past ten years but little else. One of the greatest surprises to me has been just how little we know. This area of research must have been almost completely ignored for a very long time. I know of no equivalence from the field of Veterinary Medicine. I don’t know how the determined researchers managed to continue…thank god they did or we would know even less.

So as we continue to observe, we should all remember anything can happen including a rapid disappearence of H5N1. I personally don’t think so but we must acknowledge the possibility.

Monotreme Speaking to those folks who have shown an interest in attempts to educate them about the Pandemic possibility, have always noted that there was a good chance there was about a 1 out of 3 probability of something similar to 1918. If mentioned at all I would say there was a very slight chance of something worse. Your post is certainly sobering to say the least.

Let’s hope that this worse case scenario does not come about. Reading info on H7 certainly does not offer encouragement.

Thank you for sharing your insight with our community.

I’m just bumping this up as I think everyone should read Monotreme’s analysis.

Thanks everyone for your kind comments. I’m still hoping, however, that someone will find a flaw in my logic. Tom DVM is right that it is possible that H5N1 will just fade away, but that seems unlikely at this point. Recall that with SARs that we had hard time finding an animal reservoir. Same thing with Ebola. Not so with H5N1. We will all be able to find animal reservoirs in our backyards soon. My last reference also increased my personal estimate that H5N1 would become a panflu. The recent release of large numbers of H3N2 virus sequences from the NIH has changed peoples ideas of how often influenza viruses exchange genes. This makes it more likely that H5N1 will acquire an “humanized” HA gene at some point, IMO.

Nikolai---Sydney, “civilisation buster” is an apt phrase. To me, the only comparable threat was all out nuclear war between the US and the Soviet Union during the cold war. That didn’t happen, but it was close. Here in the US, no expense was spared in contingency planning and preparation. Unfortunately, the decision makers in most countries don’t seem to understand that we face a similar scale threat with H5N1. I’m not sure how, but we have to convey to them the seriousness of the threat.

Monotreme: That “last reference” was a hard read for me, but I agree with your conclusion. And if you pair that information with Dr. Niman’s suppositions, it seems we have two equal chances of being “knocked-out” by H5N1--a reassortment “right hook” or a recombinant “left hook”.

Tom DVM,

This thread is H2H vs B2H. I’ll expand on why I was shocked, but I may find it difficult to put into words, bear with me please.

Some days ago, I read an abstract on PubMed

QUOTE “Quail carry sialic acid receptors compatible with binding of avian and human influenza viruses.” UNQUOTE

This abstract essentially says that quail carry both types of receptors, sialic acid alpha2,3-galactose (SAalpha2,3-gal) linked receptors, and abundant sialic acid alpha2,6-galactose (SAalpha2,6-gal). The conclusion being QUOTE “these results are consistent with the notion that quail could provide an environment for the spread of reassortants between avian and human influenza viruses, thus acting as a potential intermediate host. UNQUOTE

I read further litterature on why H5N1 should attach/not attach to human lungs owing to the various locations of these receptors in the human respiratory system. And all sorts of scientific arguments on why H5N1 will/will not reassort/recombine, etc.

Then I read Monotreme’s extreme logic.

Then I read Revere’s blog on the subject of these human receptors being used by H7N7 and H7N3 and ALSO that these two “mild” flu candidates share some common features with HPAI H5N1.

Many farms breed not just chickens or turkeys, but also quails, at least in France where I live now.

I hope I got my scientific reasoning wrong, but what happens if a mild H7N7 or H7N3 meets not just chickens, but quails, and then humans, and by nasty occurrence, there’s a few swans/geese also carrying H5N1 either bred on this farm or wild landing for some food on these farms? Isn’t that just what we are fearing?

In addition to realising that there must be something terribly wrong with the UK system of testing - Remember they tested thousands of birds a few weeks ago and did not find ANY avian flu except the “Scottish Illegal Immigrant Swan” whereas bird flus ARE common in birds and they should have found x% of some (mild) avian flu in the thousands of birds. Not to mention some authorities questioned their way of keeping swabs. Plus Revere’s remark about false negatives.

I am not enough of a scientist to jugdge, but that’s what gave me the shivers.

PubMed ref: http://tinyurl.com/q2w86 Revere ref: http://tinyurl.com/jdnmb

Monotreme - The one question I have about your last post regards the animal reservoir. Is there any reason to assume (or not to, for that matter) that a human adapted avian flu would become endemic in birds or mammalian wildlife such that we would be “surrounded” by vectors, no matter which way we turned?

If this were the case, then we would either need to find a vaccine right soon, or else all become vegetarians eating only from our own hermetic greenhouses. And this assumes no insect vectors.

Monotreme, thank you for all you do. (Wish you lived in my town)

I remeber that the 1918 flue got more and more deadly till it couldn’t spread faster then it killed. Some variations of it were extremely deadly.

The possiblity of 50% is certainly out there. I think those of us who are better educated w/BF and have been tracking it likely agree. It’s another huge unknown that will imapct all of us yet, yet we have no control over it. Most mainstream media coverage uses 1918 as a reference point (for lack of anything better to use). I think people hear “less than one million dead from 1918 in the U.S., that’s not so bad.” Nobody wants to concede the fact that it could horrifically worse. So bad that ignoring it is better than facing the possibility.

Polymerase Chain Reaction - Xeroxing DNA National Center for Human Genome Research, National Institutes of Health. “New Tools for Tomorrow’s Health Research.” Bethesda, MD: Department of Health and Human Services, 1992.

Who would have thought a bacterium hanging out in a hot spring in Yellowstone National Park would spark a revolutionary new laboratory technique? The polymerase chain reaction, now widely used in research laboratories and doctor’s offices, relies on the ability of DNA-copying enzymes to remain stable at high temperatures. No problem for Thermus aquaticus, the sultry bacterium from Yellowstone that now helps scientists produce millions of copies of a single DNA segment in a matter of hours…

more at: http://www.accessexcellence.org/RC/AB/IE/PCR_Xeroxing_DNA.html

I wonder if we could see a reassortment of H5N1 into a quasi-‘58/’68 strain, (through a co-infection with an H7 or other virus) while the global resevoir continues to recombine into a quasi-1918 strain.

I wonder if the reassortment event would provide a primer, or natural vaccine of sorts to the human population? If it preceded the H2H recombination of the ‘other’ virus significantly that is….

A reassortment event would give us a novel potentially pandemic strain, but it would not stamp out the currently evolving ‘thread’, would it?

Comments?

IIRC, the deadliest, percentage-wise, plague to hit Europe was about 35% fatal. While European diseases which came to the New World were closer to 70% fatal. Does that sound right? If so, then the potential for the same percentages in this pandemic could be that high. Someone better have all their ducks in order for vacceine R&D if and when it does go h2h.

3L120 immediately,(and all above):

The worse a prospective pandemic may turn out to be, the more vital it is that societal disruptions be minimised, as they can magnify the final death toll dramatically.

Some have pointed out that fewer survivors means less drain on resources, which may be true. But it also means fewer human resources, especially technically able, to encounter the challenges.

The urban infrastructure must not be allowed to completely collapse or even come very close. Whatever draconian laws and policies, the vital workers, and their families, MUST be protected—but also COMPELLED to keep electricity and water, at least, ongoing.

Think about that—and pray your government is also.

AJ: We have batted around the idea of the possible benefits of a “primer” pandemic from time to time. Some have even suggested to create one, but nobody has taken that seriously. The timing and the nature of the reassortments and/or recombinants and their respective waves (or lack thereof) will probably determine whether we are layed low or totally crushed. Too much luck in life, that’s for sure.

Monotreme,

“I’m still hoping, however, that someone will find a flaw in my logic.”

I’m working on it…

I am in a strange country and lost the use of my laptop. Now I’m borrowing someone else’s much slower machine with no access to my file :-(

I hope I DO find some flaw in your logic, for once.

Vaccine development

Several have raised this issue. I think the expansion of conventional vaccine production plus acceleration of new more rapid methods should be of the highest priority. We are in an arms race with influenza and other viruses and we are losing.

Societal disruption

Oft discussed on flu sites, but it really hasn’t sunk in yet among TPTB. Despite Katrina. Amazing, simply amazing. I suspect the ABC tv movie on the subject won’t even come close to depicting how bad it could really be. And you just know it’s going to have a happy ending. A flu pandemic with 30% CFR isn’t going to have a happy ending for anyone, unless we get our act together.

Monotreme. With a 30% CFR, it isn’t going to have a happy ending even if we get our **** together.

Tom DVM, not for the 3rd or 4th world. That’s for sure. But for the developed countries, I’m not so sure. As Osterholm and Senator Frist have suggested we need a Manhattan project for pandemic prep.

One rosy scenario, panflu holds off for 2 years, DNA vaccines are intensively researched and turn out to work, massive food and medical supplies are stockpiled near every major population center, redundancy is built into every mission critical societal function, detailed contingency plans are developed as well.

See,it could have a happy ending. For gs, the probability of all of the above happening is .000001%.

Just as the human race gets too big for its’ britches, Mother Nature reminds us again who is really in charge. And it ain’t us!

crfullmoon, thanks and good luck to us all.

anon_22, your computer may be slow, but I your brain is still fast.

One possible mechanism for decreased lethality would be if the current high lethality were due to the alpha 2,3 affinity of H5N1. Perhaps a switch to alpha 2,6 would somehow decrease lethality. I’m not very optimistic about this, but perhaps you can make a better case for this than I could.

AJ raises an interesting issue regarding re-assortment. If H5N1 reassorted with H3N2 and became an H3N1 pandemic strain, would those of us who had infection-acquired or vaccine-acquired immunity to H3N2 be protected against the pandemic reassorted virus? Even if this did offer some protection, most children have no immunity to H3N2. This is one reason I made sure my family and friends got vaccinated last year. It’s a small hope, but one worth pursuing I think.

Of course, if H5N1 evolves into a pandemic strain by random mutation or recombination, this small hope is gone.

Monotreme. My probabilities demonstrate that the first world is going to be hit far worse than the third. They have food in their backyards, we have none…They don’t have hydro, we can’t live without it…they know what it is to not have healthcare, we don’t…they know what it is to do without, we don’t…they know what it is like to lose children periodically to disease, we have no idea. We are nieve, idealists and superiorists at the same time…bad combination.

Human nature says that we will not respond until it is too late. There will be no Manhattan project for H5N1.

Questions: Does this lethality present a range of figures for the case fatality rate of 40% to 50%? What would be a best fit estimate of the clinical attack rate? I wish to revise my projections made in another thread of total deaths in the United states. I don’t want data from 1918. I have already calculated those figures and projected their consequences for the current United states population. I am looking for best guess based on a realistic appraisal of current information. It is my contention and has been for many months, that we are underestimating the task we face. The only way to make good decisions is to have an idea of what we face. Thank you Monotreme - you have just become one of my heroes no matter what happens. You have courage and intelligence. Grin, I am not worthy and your head is too big for your body.

Sounds like you and Robert Webster are on the same page.

Tom DVM, your portrait of the third world applies to rural areas with intact social systems. I agree that those areas have the advantages you mention. Isolated villages may do quite well. Although, no guarantee of that. Very isolated villages in Alaska lost almost their entire population to the 1918 flu.

However, there has been a transformation of the third world in the last 20 years that has involved mass migration from rural areas to megacities and an erosion of traditional societal ties. I’m thinking of shanty towns in Mexico City, Lagos, Mumbai, and many other places. Many areas of Africa are totally dependent on foreign aid for food and basic medical care. What happens when all aid and infrastructure collapses in these overcrowded death traps? Sorry, but I think they will suffer much worse losses than the first world.

I agree that we will probably not respond adequately in time. Sigh.

Thanks Dude. Yeah, a lot of people say my head is too big ;-)

Regarding fatality rates, they vary from country to country. The low is about 30% for Turkey to a high of 100% for Cambodia. There are several ways to reconcile these differences, but I think it comes down to supportive care. 30% CFR with prompt administration of Tamiflu to all contacts of the index case, ventilators, round the clock nursing, state of the art ICU, etc. Take these things away and you’re looking at a nearly 100% mortality rate. During a pandemic, we will all live in Cambodia. Hate to say this, but a 30% CFR may turn out to be a best case scenario, and perhaps unrealistic during a pandemic.

anon_22, fix your computer and stop me before I depress myself any further.

Monotreme. There are a couple of arguments that I have had trouble with the more I think about them. 1) We are healthier than 1918…don’t think so. 2) We have effective treatments they didn’t have…don’t think so. 4) We have better healthcare systems…don’t think so 3) Our advanced systems would prevent a societal collapse…don’t think so. etc. etc. etc.

When I look at the first world today, I see a population spoiled by success and infrastructures that will fall like a ‘house of cards’. Their technological quick fixes that were to save us 12 months ago, now appear largely useless.

However, I have great hope in individuals and individuals within communities. They have saved us in the past and I hope they will limit the damage in the future…and I hope we are wrong and this virus goes away but I don’t think so.

So, a person to person clinical attack rate for a novel virus - pandemic? You agree with 50% or higher?

Tom DVM hits the nail on its unfortunate head. And I’m hearing a lot of this happy talk in the “secular” (that word means non-professional) press.

Tom DVM, I think it’s a mixed bag. We do live longer now than in 1918. The elderly, especially, are in better shape now than at any time in the past. Infant mortality is greatly reduced compared to 1918. Hygeine, for most people in the first world, is much better than in 1918. On the other hand, our current health care system is strained to the limit and will collapse under the weight of a pandemic in short order. And everyone who needs health care to live, will die, as the diabetics did at the Convention center in New Orleans.

I think our advanced systems could ameliorate the damage of a pandemic, but I’m not optimistic that they will be used for this purpose.

I agree, community is the key. We will live or die as communities.

As a computer tech, former radar repairman, and general nerd, I think society is in big trouble. There are very few people at any given moment that are “up” on what it takes to keep this together. We better have rush plans for cross training of critical services!

Dude, the recent Seroprevalence data suggests the observed attack rate is the clinical attack rate, few to none subclinical cases were found.

The attack rate will vary depending on the area. It will be very high in shanty towns and very low among Flu Wikians ;-). So it’s hard to come up with a projected world-wide number. I do think that in the first world, we have a chance to keep this number down, with adequate planning. All this being said, I have seen models that project attack rates between 30–50%. So, Webster’s extreme statement may not far off the mark, unfortunately.

Melanie, send those happy talkers to this thread. I’d like to hear their logic.

AF may just be the trigger of the disease cascade. Here in San Diego, I expect to see Cholera in short order and god knows what else as systems break down and the work of surviving gets hard. How long will people boil water for everything, I’d say maybe a week for many, then the work will be just to much. Beyond the AF how many will die from things we have forgotten about?

US Population in 2006 = 296, 500,000 Cases in the United States (based on 50% infection) = 148,250,000 30% and 50% = case fatality rate (infected who die) Fatality Rate X Clinical Cases = Dead on/about 2006–7 30% X 148,250,000 = 44,475,000 dead in USA on/about 2006–7 or 50% X 148,250,000 = 74,125,000 dead in the USA on/about 2006–7 You can estimate that roughly one fourth of the world population will die based on a 50% clinical attack rate. With that figure you get 1.625 billion people.

I was pretty young, admittedly. But I don’t think the hospitals were that great 30 years ago. My sister died about 43 years ago, to a disease that is easily treatable today. I keep hearing that hospitals are in such bad shape, but are they truly any worse than they were 100 years ago? Certainly our health care system was strained back then. Come on!

When my mom gave birth to me some 40 years ago, we stayed in the hospital for several days. OTH, when my youngest was born 9 years ago, they sent us home the next day. Hospitals and the care received there is much better than it was even a half a century ago.

A failure of the health care system is inevitable in a worst case scenerio. I can not argue that. But in comparison, the health care system is much better off than it was in 1918.

When we make these arguments, especially in trying to convince people of the seriousness of the situation, we need to be realistic. Is making comparisons to the 1918 health care system and concluding we are worse off realistic?

Dude – at 00:44

Those are sobering numbers, in a worse case (and that is worse case).

Remember though….here is certainty…6 times that many will die in the next 100 years, including me and you.

No problem.

Dude4-−00:44

“You can estimate that roughly one fourth of the world population will die based on a 50% clinical attack rate. With that figure you get 1.625 billion people.”

I agree these figures are altogether possible, highly so. Please don’t think I’m trying to be ‘cute’ with words though, if I remind us of the ‘glass’ analogy.

We ‘get’ in the sense the figures come up with, but we actually LOSE 1.625 billion people. Our ‘glass’ is then one-quarter empty, compared to today.

At those grim figures, we have left, just approximately, 5.7 billions. Our depleted ‘glass’ is still three-quarters full. Earth’s population a relative few years ago!

Next, at our human reproduction rate in the handicapped regions of this planet, the population will be back to the present, earth-resources-devouring, level in a scant ‘few years’, biologically speaking….

And we think viruses replicate fast! Like we don’t?

Just some off the top thoughts I may instantly regret after posting!

Monotreme : your reasoning is logical, I accept it in full. Whatever mechanism would produce an efficient H2H strain of H5N1 will have to happen though. AFAIK, these gene jumbles happen haphazardly and more than one coincidence has to occur for a pandemic to take off. Estimating that probability is impossible, with some experts saying 10%, others predicting 30%, some say 100%. To conclude that it is going to be bad, very bad, catastrophic, incites panic in some people and laughs in others.

I noticed that the threat is taken a bit more seriously now than a couple of months back. where I live, some Embassies and big private companies have already stashed Tamiflu for their staff and families. One Embassy has advised its staff to prep…. for five days ! I have told them to make that three months at the very least but don’t know yet if the message got through.

Mono-I agree as well. Look at where and when pandemic flu, or any lethal virus perhaps, shows up. If the heard encroaches on new turf, over-crowding/population, weakened species imunity. Just a thought, that besides replicating, these “organisms” seem to be the cullers of heards. Of all the candidates for the job, some are too weak, (rhinovirus, etc) and some are too hasty, (perhaps Marburg, Ebola), but influenza may have the right resume. Not a scientific speculation, but it seems that killing the host (or hosts) in this case is the primary job.

Patch - I agree that in many ways hospitals are not much better than years ago. However, Americans have come to expect that medince will save them. All the press on new technologies, new medicines, etc. that have eliminated incurable diseaes, saved or improved people’s lives. And dont forget the E.R. factor - people assume you go to the hospital there will be heroic measures taken to save everyone and a few charges to the chest will do it. But it’s not that simple. There are fewer hospitals and fewer beds today than many years ago. There aren’t enough nurses. Too many doctors are specialists and ill trained to handle infectious diseases. The doctors and nurses will be sick also. Many have lost the dedication to the profession seen years ago and will simply walk away to protect themselves or their families. There aren’t enough respirators, which are about the only thing that can help someone in severe respiratory distress. And with supply disruptions there may not be enough critical meds like antibiotics to fight secondary infections, one of the leading killers in 1918.

(I remember this monthy-python(ish) movie about the Atlantis inhabitants who sang while their island was sinking.)

Monotreme, I’ll try and find flaws in your logic, too. So far I can’t find any. Sorry.

There’s something I noticed in a hurry, and that is speed and number of case-generations. Maybe if we manage to slow it down (simple masks or whatever) then we will select the less deadly strain? Or is this just wishful thinking as the more deadly strains selected themselves somehow in 1918?

I like your “rosy picture”. We need to work on that. We’re just a few here so we need to:

1. be more efficient and focused
2. reach out to others who have invented the wheel before us (I’m thinking square-foot gardens and such)
3. see how fast we can go from design to implementation, from how-tos to practical innovation

We need to think strategically, on a high level: Just How Do We Organise Our Abilities?

Fast cross-training of essencial services is a must. We need to tell them to create the apropriate templates to be copied fast and wide in an emergency. Again, emergency learning.

Surge capacity means planed-for priorization: just stop moving furniture around, and move food around. No gadgets for a while, just antibiotics and insuline. This needs planning and an open conversation? Ok.

On-the-fly prioritization will need electricity and water. You (meaning Monotreme) worked on water supply. Electricity has lagged behind. Emergency communications is somewhere in resilience technologies.

We will have no Manhattan project, but we can create a grassroots coalition, of which we (fluwikians) are one important member.

Now we know it can be really bad (or maybe not, depending on Nature, who is really in charge). Let’s not over-predict, and instead get going as fast as we can.

lugon hides behind a rock, scared as a mouse

I hardly speculate any longer. Just prepping as best I can on minimal finances, in a large city, in a small flat…

All my speculation is overshadowed by one major unknown, even bigger than transmissibility, or lethality, or governmental preparedness…

Is the ‘Ultimate Variable’ TIME? Is my situation analogous to a movie script where the crowd is fleeing the irresistable menace, the nuclear bomb about to explode, and TIME is all that will affect the outcome? Will there be time for them to flee far enough to achieve safety?

Concretely, will it start this October-November? Or will I have until October of 2007? 2008?

If it comes in say six months, I feel as Melanie quotes… Osterholm was it? Or Webster? “We’re screwed.”

Putting it in another light: What should we do with 1 month? With 6 months? With a year?

Or, once you have 1 month of food (or whatever): What should you do next?

Anyone cares to create a list or outline or wikipage with the options?

Interesting first comments from the Singapore meeting on AI

http://tinyurl.com/kexy7

QUOTE

By Tan Ee Lyn

SINGAPORE (Reuters) - Leading influenza experts urged nations not to lower their guard against the deadly and hardy H5N1 virus, saying it now survives longer in higher temperatures and in wet and moist conditions.

[…]”When we tested the virus in Hong Kong from 1997, the virus was killed at 37 degrees Celsius (98 Fahrenheit) in two days. The current H5N1 is still viable for six days at 37,” said Webster, from St Jude Children’s Research Hospital in the U.S. city Memphis.

“H5N1 at room temperatures can stay (alive) for at least a week in wet conditions,” Webster told Reuters on the eve of a bird flu conference organized by the Lancet medical journal in Singapore.

[…]Webster said heat-stable strains of H5N1 were already circulating in ducks in Vietnam, Indonesia, China in 2004 and 2005 and experts would have to test if this trait was in the variants now circulating in India, Africa, Europe and parts of the Middle East.

[…]The virus’s growing adaptability to water has ominous implications because it means untreated water might no longer be safe, Webster said, and it was important to drink boiled water.

“This means that water supplies for feeding chickens, or water supplies where people are swimming and water supplies for villages have got to be treated,” he said.

UNQUOTE

Not just Webster being quoted in this article, but also John Oxford, Kennedy Shortridge

So even if the virus was going to become less lethal, we would be liable to catch it during a period three times longer, assuming we do not handle the job of disinfection perfectly…

Now, is there anyone of us who is capable of disinfecting, and repeating all the gestures to disinfect for days on end, every single teeny-weeny speck on: clothing, hard surfaces, moist surfaces, soft surfaces, furnishings, shoes, containers, baths, showers, door handles, stray hair, etc., do a perfect job of this during 6 days after a (supposed or real) contact with the virus?

What if the house next to yours is upwind from you with ill people in it, the sick are burning with fever, it’s summer, weather hot and humid, they open the windows, the wind blows towards your house with your own windows open - how do you disinfect your windows, blinds, curtains, etc. and again and again and again during six days, and then repeat the whole process at every opportunity the virus might have to get deposited in your home? Are you going to live quarantined with all windows and doors locked shut in stiffling heat, possibly with no air conditioning, in darkness??? We don’t just need months of food, we need tons of disinfectants and cleaning agents

Even if the virus becomes less lethal, it won’t matter if it can live longer outside a warm blooded-living creatures, we’ll be no better off.

Hi everyone. Dude…thanks for the spelling advice the other day.

I believe our regulators self-comparisons to 1918 have bred complacency so I thought I would bring up a few points about that.

In 1918, a large majority of North Americans lived on farms. They produced all of their food supplies, heating supplies, were not reliant on hydro, could and did self-isolate. These people were totally self-reliant that would make any survivalist today blush.

They had experience with all manners of tragedies including repeated experiences with localized epidemics (ex. cholera) that left large numbers of children etc. dead. They were also ‘battle-hardened’ from four years of world war. They were tough!!!

The advance in life expectancy in the twentieth century has been the result of markedly decreasing childhood mortality (antibiotics) and loss of women in childbirth. I you walk through a cemetery from that time period, you will notice, other than the deaths I just mentioned, how many persons lived into their late 80′s or 90′s.

Today, we are living in a era of rapidly deteriorating health whether you look at asthma, food allergies, auto-immune disease, cancers, tuberculosis, malaria and other infectious diseases of public health significance.

Our immune systems are not better prepared to withstand a pathogenic insult. The evidence clearly indicates that immune sytems in 1918 were much stronger and better prepared.

There was a functioning healthcare system in 1918. It appears that there will not be one in 2006 if a pandemic occurs. Therefore, the 1918 healthcare system was, in effect, better prepared.

A wonderful job on many fronts was done in the 1918 pandemic…we should be so lucky.

Eccles – at 11:16 Is there any reason to assume (or not to, for that matter) that a human adapted avian flu would become endemic in birds or mammalian wildlife such that we would be “surrounded” by vectors, no matter which way we turned?

Eccles’ point goes right to the issue of the probability of a pandemic occuring. There is little doubt in my mind that H5N1 will become endemic almost everywhere in the world. The geographic spread is inexorable. Further, many more mammalian carnivores will be infected. We don’t know how many more changes are necessary in the HA sequence to become a human adapted strain, but it may be as little as 2. I can think of no biological or physical law that would make these changes impossible. Anyone who can, please let me know what they are. If these changes are not impossible, then it is simply a matter of probability. I acknowledge the probability is likely quite low, yet the opportunities for the virus to acquire these changes are endless. Unless H5N1 fades away for evolutionary reasons, ie, it is displaced by a more fit virus, I think it is inevitable that a human adapted strain will emmerge. When? That’s what we don’t know.

Montoreme. In my opinion, for what its worth, within twelve months from today.

Monotreme. With the latest information from Egypt, 4 of 12 died, does this not mimic the findings in Turkey and Azerbizan. I think the reason you have not seen the Turkey and Iraqi sequences is because your intuition was right.

We have a unique strain demonstrating increased transmissibility and decreased virulence.

Tom DVM, I have been wondering about whether there is a new strain that began in Turkey. There were large clusters there and in Azerbaijan. Not sure about Egypt. The US Navy did deposit a sequence from Iraq, but there were no surprises there. Also, no clusters, and the death rate was high there.

As to the 30% death rate in Turkey, Azerbaijan and Egypt,I don’t know if this is because of a new strain or because of the quality of medical care. Hard to know without animal studies comparing the different strains.

Monotreme. Vietnam, from what I observed in a documentary, had Western equivalent in terms of care. I don’t think better healthcare is the reason because of the pathogenicity of H5N1.In most cases the damage would be done (cytokine storm) before you could realize that you had H5N1.

This has to be an adapted strain. Have we seen any sequences from Turkey etc?

I agree with Monotreme that H5N1 will be growing in the wildlife population year by year, due to it’s strong traits of fast replicating, pervasive species adaptability, and hardiness in the environment. Although bird virus have rarely crossed from Euro-Asia, it has happened in the past, and if any virus can cross with migration, this one can. It may be hard to find the first year, but year by year, the problem will be growing. We have many subsistence lifestyle people in Mexico, Central America, and South America, who depend on their backyard poultry. The bird flu virus will be more than a nuisance eventually for them too.

In birds, the virus has so far shown that it can keep it’s virulency without a continuous close quarters infection process. The deadly outbreaks can be spread apart in time and location. The wildfowl carriers who are not as susceptible to the illness, have not caused H5N1 to wimp down. The idea of moving to a normal level of pathogen-icy, is not occurring as a matter of course. What may often happen is not perhaps to be considered a “rule”.

If the close quarters of the World War I trenches are believed necessary to fuel the 1918 pandemic lethality, the world has many times more soldiers today, including militia in poor countries with low health care standards. But the density of populations in large urban slums give an even greater tinder box condition, that makes invalid the argument that we can’t have a virus as bad or worse than 1918. Far worse than developed nation slums are the third world slums. There are 1 billion slum dwellers, according to UN-Habitat. Comprehend these population densities-

Dharavi (Mumbai) –571,000 per km.sq.

Delhi (India) – 300,000 per km. sq.

Kibera (Nairobi) – 200,000 per km. sq.

Cite-Soleil (Port-au-Prince) – 180,000 per km. sq.

City of the Dead (Cairo) – 116,000 per km. sq.

-and so on, for many third world countries. For a basis of comparison, Manhattan and Tokyo are 13,400 per km. sq. Try to imagine how much denser the populations must be in these other slums, than our skyscraper cities. Tell me this isn’t a much worse fuel potential than what existed in 1918. Consider ourselves very, very lucky if the next new flu strain that crosses to humans, is a mild pandemic.

Monotreme,

Thanks for another one of your stimulating well thought out posts. After wasting a whole day my laptop is finally up and running, and that’s just after one moment of spilt drink! Perhaps illustrative of the consequences of our dependence on technology, as Dude so aptly said at 23:55 “As a computer tech, former radar repairman, and general nerd, I think society is in big trouble. There are very few people at any given moment that are “up” on what it takes to keep this together.”

The upside was I got some unexpected downtime waiting for my number to be called at the repair center; occasionally an enforced time away from the keyboard brings up some interesting thoughts, so I hope this is useful.

I would agree with your broad hypothesis, suitably with a ? at the end. There really is no automatic rule that says a pandemic strain has to correspond to a decrease in lethality. But that’s not what you want to hear. So let me give you some counterarguments and some counter-counter-arguments if you know what I mean.

“So, there is no reason to think that a change in the HA gene that permitted efficient human to human spread would affect the lethality of the virus”

On the other hand, there is no reason to believe a change in HA receptor binding is the necessary and SUFFICIENT condition for efficient h2h. Because receptor binding is not the same as transmission. There may be (in fact, likely to be) additional factors eg the way that the virus is shed, or how long the virus can remain viable in the environment, or how likely is it to be airborne, that determine whether a virus can cause a pandemic. If virulence hinging on PB2 or PB1, for example, or virus-host interactions based on NS1, also affect transmissibility due to an unknown factor x like the above, or multiple factors x1, x2, x3, and so on, then a mutation in PB2 causing an increase in transmissibility contributing to a pandemic could at the same time have an effect on virulence. This effect could be positively correlated to virulence (which would really suck and we can all go home) or it could be negatively correlated, resulting in a reduction in lethality and an increase in transmission.

I am using this hypothetical x factor(s) to show how little we know. Yes, Webster et al’s various papers are brilliant and demonstrate how these different proteins MIGHT work, but these are extremely simplified models and they are by no means close to demonstrating EVERYTHING about these proteins, their mechanisms of action, and their genetic requirements. If we think of cytokine storm for example, this is a clear example of a complex interacting cascade of events individual components of which may have either inhibitory or facilitatory effects on every other component. As with cytokine storm, so can viral protein mechanisms be just as complex. In fact, they are far more likely to be so than not, especially with H5N1.

“There is still much we don’t understand about influenza viruses”

Yes, we only know what we know, or what we think we know; we have some vague notions that there are gaps in our knowledge, but it is possible that we don’t even know in which universe those gaps lie, let alone whether that has to do with HA or polymerase. And therein lies the problem of trying to extrapolate and make predictions from limited laboratory results obtained in circumscribed artificial environments.

“One possible mechanism for decreased lethality would be if the current high lethality were due to the alpha 2,3 affinity of H5N1.”

Yes, one could hypothesize that a change in affinity would reduce the viral dose at the cellular level in the lungs. Since lethality is mostly dose-dependent, one might think reduced binding > reduced cell entry > reduced lethality. However, I could also argue (here’s my counter-counter-argument) that the affinity of the virus for the upper respiratory tract may not be so benign, since there you also have entry into cells and viral replication. If, as appears to be the case, HA does not change viral replication per se, then the virus can just as easily multiply in the cells of the upper respiratory tract to the same degree (not directly causing ARDS but maybe cell necrosis and other kinds of tissue damage), and then shedding the virus in huge quantities some of which will end up in the lungs. (I know this really sucks, I’m sorry.) In which case the ARDS type illness might be slower in developing but may not be milder, still that would buy a little more time for antivirals to work.

Now as to Nikolai---Sydney’s , ‘civilisation buster’.

There may be some comfort in knowing that these happen extremely rarely, in the order of thousands or tens of thousands or more years. And if flu is such a common occurrence, variations in seasonal strains happen yearly, pandemics happen several times per century, the incidences of each of these decreasing by several orders of magnitude, so ‘civilization busters’ (to the extent that they are so rare) must require an extremely high level of complexity or combinations and/or sequentialness of mutations plus environmental and human conditions that the chance of a civilization buster would be several orders of magnitudes lower than a regular pandemic

You can think of this schematically as the observed incidence (past) or probability (future) over time of the following happening (brackets my rough estimates for illustrative purpose only):

People catching influenza (millions per year) > seasonal ‘epidemics’ due to small mutations within circulating strains (1–3 per year) > pandemic (3 per century) > ‘civilisation buster’ (ask the dinosaurs?)

I do not agree with the comparison with nuclear war. During the cold war, there were long periods where everything was in place for that to happen except for the decision in the minds of a handful of people. The mechanism to trigger it was clear-cut and ready to go. Without orders from these leaders, none of the other components necessary for a war could be changed significantly, ie these conditions were static, stable, and present, which is hardly the case with a virus. In that sense, there was always more chance of a nuclear war than a pandemic of a ‘civilisation busting’ degree.

“Take these things away and you’re looking at a nearly 100% mortality rate.” “anon_22, fix your computer and stop me before I depress myself any further.”

The way to stop depressing yourself is to stop thinking of 100% mortality, or 50% or even 20%.

I started off a while back thinking of 2.5% as worst case scenario, then I got really freaked out thinking that might be the best case scenario. Now I still think that it is possible and maybe likely enough to be threatening to have a 50% CFR. But I’ve come to a point where I realized I needed a cut-off point in my thinking. I needed it for several reasons, not just for my sanity, but mainly because preparing for a 2.5% CFR is going to take so much of our energy which as a society or globally we are so far behind that to consider anything beyond that will significantly take away our energy and willpower and material resources and ability to persuade others that it is currently counterproductive to go there.

If you can get yourself prepared to ride out a pandemic with 2.5% CFR, and succeed in helping everyone else in your community achieve that, and able to persuade all governments of every country to prepare for that, it will take everything that you’ve got for the next several years assuming that you do not take breaks, indeed do not sleep, eat or whatever, and you will still be lucky to achieve it.

This is not science, it is personal philosophy and choice.

Plus it is extremely hard to prepare for scenarios again several orders of magnitude removed from the current situation because it is likely that conditions will be so different from what we anticipated sitting in front of our PC today that all those efforts will be wasted.

“There is little doubt in my mind that H5N1 will become endemic almost everywhere in the world.”

Because of the frequency of multiple sublineages, instead of ‘civilisation buster’, it is likely that we may see multiple pandemics of varying lethality over an extended period, eg 5 years instead of 18 months. One strain may cause a pandemic, but instead of producing enough immunity after several waves to subside into background levels of prevalence and severity, another strain that arose from a different sublineage can cause another one because of insufficient immunity, and so on, depending on how much diversity is obtained in the avian pools. That’s why the multiple sublineage paper is worrying, not because it implies higher chance of having one pandemic strain (although it does that too due to increased participation at any one time of candidate strains) but because it implies more chance of causing MANY pandemic strains over the medium term.

THAT is my worst case scenario, for planning purposes.

bump for comments please

Hi Anon-22, Tom, and Monotreme!

Thanks for all you do for us!

Dumb Mom questions…

If the virus mautated and began to infect Alpha 2,6 instead of Alpha 2,3, do you think Relinza would have a better chance of working, since perhaps the medication could directly reach the initial infection receptors?

Is it possible the mortality rates were lower in Turkey and Egypt, because of better communication within the general public? Could people have panicked and run in to be evaluated, giving those with very early infection, a chance to be positively screened and treated earlier? Some countries have much better (or worse) public communication and I’ve read over and over again, that in many impoverished countries, even many of the poultry farmers still don’t know about bird flu.

Tonight I am going to the first ANYTHING our county has had. It is a pandemic summit. It is actually for business and civic leaders and they have had a poor response getting many to commit to come. I was asked by someone at our local health dept. to come. Don’t know what help I’ll be, am really afraid to disclose what lengths I’ve gone to, to prepare for my chicks, but then want others to see what they can do. Mostly I just want to tell people this…”Look inside your circle of life and use everything possible in it to prepare. Be creative! Do you have land to garden, an abandoned well, a little extra change saved up, a dusty, forgotten canner? Use what is in your life now….Then think outside of the circle. I think there are things we can do, that would shock even docs., but we can do them. I have had several chidlren sent home with feeding tubes. This isn’t an especially fun thing to do for your child, insert a tube down the back of their throat, but it also isn’t hard. That is if you are properly trained. My plan is to insert one down any of my young chick’s, as soon as I would suspect they have H5. Maybe they would have a fighting chance, if they don’t become dehydrated. We can also learn to give injections and maybe vaccinate our own or even those incapable of doing this for their own families…. when the time comes, that vaccine is available. We can teach each other food preservation and canning…But the clincher is that we need to be sharing this training NOW! Not when a pandemic breaks out. We need changes in laws and waivers allowing laymen the chance to learn some of these medical techniques. The thing is, when the insurance now says, go home, you are taught all kinds of things, mighty fast! Why can’t we just learn them ahead of time to save our families ?

I’ve also suggested that we start a food bank for a disaster, of any sort. We could keep the site of storage hidden. When we donate something to the regular food pantries, we could bring along an extra can or two and donate to the disaster storage. Extra medical supplies could be donated as well. When my parents died, we had a difficult time finding places to donate any leftover supplies. We could encourage our hospital and doc. offices to keep extra supplies of antibiotics etc.

I suggested that we have volunteers, set up central websites, where community memebers could report signs of illness. We could have volunteer citizens monitor these sites and report where there was severe illness and make sure medical, food, and other supplies could be delivered to the home. This would insure that families with sick members would be taken care of and also limit infection, by carriers, as they left their homes seeking help etc.

Now these are my mom ideas…do those of you with the science background have any suggestions I could pass along? Please make them simple, my brain isn’t as large as yours! Thanks!

You are well come Tom DVM. Anon_22 glad your puter is back up. May I suggest a rugged notebook, that can take a spill of a fine wine served in crystal and a drop. They cost about 150–200 more. All my life I have struggled to be a realist. I know that the mind numbing projections of a pandemic “civilization buster” are going to inhibit discussion because many of our homeostatic tendencies will not be able to deal with those implications. The key is to first figure out as best as we can, where the truth is at a given point in time. We NEED to give honest projections, or I can not figure out the scope of the problem. It may be well and good to offer up some more obtainable and manageable scenarios and work with those. That has efficacy, but the plans themselves MAY be affected by what we project. If we think that all we are capable of is survival in a 2% situation, then it may be a self fulfilling prophecy. It is never my job in life to walk in another person’s shoes, but it is my personal objective to seek the truth in every discussion. The trick is to accept what life gives you and move on to the next moment. I will never be a deer frozen in the headlights as death approaches. I know nobody is suggesting that, but just for illustration….

So, if anon_22 @15:17 is right and I have the highest respect for him based on my constant lurking and thinking and cross checking, we have to develop plans to live in a hostile environment for much too long. How can that be done? Dry homes, wet suits, spray with bleach, ultraviolet light chamber, swimmer goggles, N95 masks stored in black boxes with salt and glass tops kept in the sun for 5 days and reused after a rotation with time in a above/below UV chamber, hepa filters on our air supply. You see we can start a discussion of some plan, but we must know the extent and what is coming.

Tom DVM.

Agree with you that our health care system will be inadequate within a very short period if the Big One comes down on us. Even my Doctor agreed with me there.

Does anyone know what the ratio of population to hospital beds was back in 1918? Because as we all know, many, many hospitals have closed in recent years. I would hazard a guess that there were more back then, although there would be better care overall. Today I spent much of the day in a local regional hospital with an elderly relative, who hopefully will be fine. They have recently expanded and modernized their emergency department, have improved their handling and reduced time spent in the admitting process. They provided wonderful care to her, but I was struck by the fact that I only saw, for example, one negative pressure room in Emergency, and also that although it was a light day for them, almost every room there in the Emergency ward was occupied.. Scares me to think what it would be like if hundreds of Pandemic victims arrived within a few days after an outbreak.

Many thanks to all who contribute. Let’s hope that it will not happen, at least in our lifetime, although that sounds like a hopeless wish.

anon_22 is a she, just soes y’all know.

NauticalMan,

A lot of the discussion on the end of this thread is so theoretical as to be nearly meaningless. Our city EDs are already routinely on diversion on Friday and Saturday nights. The EDs and the hospitals will be overwhelmed within hours of the infection moving into a local area. The hospitals and what is laughingly called our “health care system” are not going to be players in a flu pandemic. We handle this on our own or we don’t handle it at all.

NauticalMan. In 1918, most medicine was done at home by doctors on housecalls. In the country, deaths were also handled in the parlour of the home. These were tough, self-reliant people who did not have the social protections we have today. They were conditions to many types of tragedies including the expected deaths of a percentage of children born as well as deaths of women in childbirth. They had hospitals but were not as quick to use them as we have grown accustomed to today. I know how good a job they did in 1918 and I have an immense amount of respect for their stoicism.

What really bugs me is the re-invention of history when it serves the interest of regulators and governments which in effect are their own interest group.

1) We are healthier now…nope…look at cancer, asthma, food allergies, auto-immune diseases, rates of heart and lung disease etc. etc. etc.

2) Our modern healthcare system, we have technologies that were not avaliable to them:

a) Antibiotics are the single most important invention in our history but they will not stop the majority of flu pandemic deaths from the ‘cytokine storm’. It occurs because of direct viral damage (antibiotics have no effect on viruses) and the bodies immune response to the presence of massive numbers of viruses.

b) Just because you make a vaccine does not mean it will work. Flu viruses mutate away from vaccine strains too quickly for them to have much effect. INFLUENZA VACCINES DO NOT WORK. (sorry).

c) The primitive anti-virals presently avaliable will not work either and they have been found, in their limited use, to have the potential for serious, life-altering side-effects.

d) ventillators, intensive care, hospitals…there will be no one to run them.

3) Our infrastructure is better…This is not worthy of a response.

I could go on but my post is already too long.

anon_22, thanks for your response. I agree with much of what you say, but disagree on philosophical issues.

HA and efficient H2H

It’s possible that changes in other genes are also necessary, but I don’t think so. The polymerase complex of H5N1 works quite well right now, and it is correlated with virulence, regrettably. The virus has no problems replicating in humans or other mammals. Both pathology in humans and animal experiments support this. Once it get’s into us, it also has no problems infecting multiple organs, including the brain. These multi-organ infections cannot be due to an initial loading dose, they must be due to very efficient replication in many cell types. I could be wrong, but I do think the only left on H5N1’s list is alpha 2,6. In any case no concrete arguments against this, we just have to hope that something else is necessary.

Unknown mechanisms

Hard to argue against these. Kinda like proving God doesn’t exist. Of course, there really might be unknown mechanisms that block H5N1 from becoming a pandemic strain, or at least one with a high fatality rate. I hope so, but we can’t plan based on this. (Of course you know this).

Multiple pandemics for 5 years

I have been thinking this too. Let’s hope DNA vaccines can be made to work. The only hope under these circumstances, I think.

Civilisation buster

I don’t buy the argument that such a rare event is unlikely to happen in our lives. Most civilisations have already died, and natural events like weather and plagues have been implicated in their demise. Ask the Babylonians.

The cold war analogy leaves a lot to be desired, but I was searching for some other event of similar probability and destructive capability. In the later stages of the cold war, the greatest danger was a random mistake, miscommunication, a la “Fail-Safe”, or computer error etc, not deliberate armageddon. I do think almost everything is in place for H5N1 to cause a horrific pandemic and only a few random events, which may or may not happen, separate us from disaster.

I understand your decision about using 2.5% as a cutoff, but I’m with Dude in wanting to know the truth, no matter how bad. People work in BSL4 facilities every day with the most dangerous microbes one could imagine. They know if they make a mistake, they will die. But, this is their job. No matter how dangerous H5N1 turns out to be, there will be ways to lessen the risk of infection. If a high CFR turns out to be the most likely possibility, then mission critical workers need to be told this now. And they need to be told how to protect themselves. They know if they don’t do their work civilisation will crumble and their families will suffer along with everyone else’s. Let’s tell them the truth, and help them prepare for the worst. The real worst.

Monotreme and Annon. Hope you don’t mind if I take a little run at the issue you two have raised. I look at things this way.

When Nabarro came out and gave the two mutations comments, Dr. Osterhaus came out to qualify because his opinion was meant to be an ‘off the record’ comment. He did not deny saying it. I believe Dr. Webster also made a similar if not the exact same comment about two mutations. These are the two most renowned and experienced virologists in the world. What I conclude from their unanimity is that the virus is in fact one or two mutations from pandemic potential and our discussions on flu wiki since it came back have also hypothetically proven the same fact…and now we have an area of the world that is consistently demonstrating an increase in transmissibility combined with a mortality rate which has dropped to 33% from over 50 %….the virus continues its linear adaption to humans and I believe it will be pandemic if not this fall before this time next year.

The second issue was the eventual CFR or mortality rate of the pandemic virus. As kids, we all had lots of experience with hills. If we conceptualize a long hill, H1N1 in 1918 started from say half way down…it had lower mortality probably because it was from a low pathogenicity subtype as demonstrated by no bird die-offs in the preliminary stages.

H5N1, on the other hand, starts at the top of the hill…it is the first example of a high pathogenicity subtype affecting humans. Therefore, it can afford to fall a lot farther and still be a killer…if it loses 50% lethality, it still will be 10 times as lethal as the 1918 pandemic…and so on and so on.

They can speculate all they want, we have as close to absolute as possible in the lack of solid knowledge about any influenza’s let alone this ‘freak of nature’. We must do this from circumstancial evidence. The circumstancial evidence is crystal clear…all the other stuff is clouding the issue…forest for the trees…Thanks.

Monotreme and Annon. First, the ‘they’ I used in the last paragraph did not apply to either of you.

Secondly, I estimate that there will be a 10 % mortality rate and a 10% chronic sequelae rate and a loss of 10 % due to collateral damage (infrastructure).

Tom DVM, of course you, and anyone else is welcome to comment on this thread.

I think the idea that we may be only two mutations away from a pandemic has alot of support. It’s possible that more mutations may be required, but 2 is definitely within the realm of possibility.

I can’t say I know what the final CFR will be, but I do think the available data suggests a very high CFR is very possible, if not probable.

If this is the consensus, and it seems to be, it seems to me that we have a moral responsibility to warn workers who will be deemed essential that may be facing a very lethal virus and to help them prepare. If that means buying them all moon suits and teaching them how to use them, then let’s get on with it.

Monotreme. There is very little that the three of us disagree on…in fact our frequency on flu wiki indicates that we have reasonably patient partners and really don’t have a life…just kidding.

Dr. Osterhaus and Dr. Webster clearly said it…they didn’t retract…end of story.

Secondly, Dr. Webster has not retracted his comments of a month ago…he may be frustrated with the way they were presented but he has not publically retracted them…end of story.

I think we are discussing on this thread what we clearly proved with avaliable circumstancial evidence on the other thread. I was convinced 16 months ago, I was convinced before we had that conversation, and I am more convinced now then ever.

My question is why are they downplaying the risk now. Things aren’t looking better, they are looking worse?

You and I and our colleagues on flu wiki are powerless to change this spin…but watch for Dr. Osterhaus and Dr. Webster and their comments in the near future…they don’t tend to beat around the bush.

Tom DVM, part of the problem is just plain stupidity, exhibit A, Dr. Gerberding, and the other part is ignorance, exhibit B, almost all politicians. I do think there are individuals within various agencies who are fighting to get the word out. Dr. Nabarro is the best example of this, IMO. We need to support these people as much as possible.

Monotreme. Exactly, the evidence would be ‘a lot less circumstancial’ if all of the information from Turkey re: strain, seroprevalence and cluster data was freely disclosed as is required under the first precept of scientific principles, we would already have the evidence…and could move on.

Of all the times to start downplaying and spinning the issues, this is not the time. If there was ever a time for openness it is now. If there was ever a time to grab every avaliable mind and turn it to solutions it is now…and what are they doing…spinning everything and even managing to convince a few on flu wiki that the threat is over…

…they will be lucky if they are not lynched in the end.

Sorry, They are standing on the head of a pin and stating more or less categorically that there is a barrier and H5N1 is not going to go to pandemic potential.

Their margin of error is not great…once again they have proven to be poor probability theorists.

I susptect many are under political pressure not to “panic” populations and that is why they are retreating a bit. The White House doesn’t want to come out with it’s “worst case scenario” (which is a joke anyway) then be refuted by people at the CDC.

I just got back from this. Two things come to mind that are related to this topic:

1 M Peiris on Pathogenesis of human H5N1 diseases, asked exactly this question: “Will adaptation of H5N1 virus to efficient h2h attenuate its virulence for humans?” The short answer was that previous models on pandemic causation focussed a lot on reassortment, so if a reassortment occurs and the virus acquires a whole segment from a non-virulent human flu strain, its lethality may decrease due to the removal of some of the avian genome which could be contributing to high virulence. However, if there is no reassortment, and mutations cause a pandemic strain to form which is of purely avian origin, then the lethality may not decrease.

2 Fouchier, in his discussion on H7N7 outbreak in Netherlands 2003 and the difference between the one fatal case and the other non-fatal conjunctivitis cases, compared the sequence and found a lot of changes in PB2, and noted that E627K was found only in the lethal human case but not in other non-lethal cases. He said, “We understand determinants of virulence; we do not understand determinants of h2h transmission.”

Ok, then - strategies time:

• Get the word out. Support those who are saying a really bad scenario is possible and even, to some unknown extent, likely.
• Reach out to groups and businesses that work on resilience, sustainability, you name it.
• Prepare locally and help others prepare locally. Help them link to each other so they are not afraid of talking.
• Create the blueprints for action: that’s the wiki-proper, as DemFromCT will be glad to see mentioned.

Now, imagine we have 2 months and we want to get the most important and effective stuff done in that time. What do we do?

If someone wants to start a Fluwikians Job Strategy thread, or use some other name, then that’s fine.

The main idea is we are a number of determined people. By “we” I mean frequent posters, not so frequent posters, lurkers, and those “touched by us” (think Revere’s blog’s readership).

What to do, what to do, what to do - the outlook was decidedly blue (As sung by Ella Fitzgerald.)

Ok, I’ll start it as Fluwikie Strategy - just a minute …

here

The apropriate wikipage here

Tom and lauraB, and even Monotreme :-)

I think the theoretical construct that Monotreme proposed at the beginning of this thread needs to be debated as theoretical constructs. We were invited to comment on Monotreme’s thinking, brave soul that he is :-). This is a pure epistemological problem that needs to be worked through, and not to be mixed up with our opinions and what we suspect is happening with the CDC or WHO or Turkey. (These are also important but they are not the primary purpose of this inquiry.)

So Monotreme, when I say your supposition is not necessarily right, it doesn’t mean that it is not. It only means that as a thought process there appears to be some serious problems present. Consider the following:

“It’s possible that changes in other genes are also necessary, but I don’t think so. The polymerase complex of H5N1 works quite well right now, and it is correlated with virulence, regrettably. The virus has no problems replicating in humans or other mammals. Both pathology in humans and animal experiments support this. Once it get�fs into us, it also has no problems infecting multiple organs, including the brain. These multi-organ infections cannot be due to an initial loading dose, they must be due to very efficient replication in many cell types. I could be wrong, but I do think the only left on H5N1�Œs list is alpha 2,6. In any case no concrete arguments against this, we just have to hope that something else is necessary.

There is a subtext in this paragraph implying some kind of logic that goes like this: �git�es doing very well, why should it need anything more? Therefore I don�ft think it needs anything more. Therefore it must only need one more mutation.�h I am grossly simplifying, of course, but you get the drift :-) In this instance, you are in danger of falling into a kind of circular logic where you convince yourself by your own logic which is in turn based on your own opinions or assumptions.

“These multi-organ infections cannot be due to an initial loading dose, they must be due to very efficient replication in many cell types.” The multi-organ infections are not of course due to initial loading dose, they are most likely due to increased tissue tropisms plus efficient replication. My reference to initial loading dose was the hypothetical one examining whether there might be a case to support some people�fs suggestion that a change in receptor affinity might reduce the lethality. In any event, if you follow my logic on that to its completion, you will find that I do not support that notion. (Notice however it doesn�ft mean that I support the opposite notion either.)

Meanwhile, lugon has gotten a worthwhile effort going. :-)

It may appear that I am engaging in drivel in comparison. But getting our thinking straight is very important precisely because we may be challenged with TEOCASKI. If things are as bad as described on this thread, we will all be thrown into situations that bear no relationship to our normal life, and our ability to rise to the occasion will depend heavily on our ability to (ruthlessly) examine our own thinking and tease out all the blind spots, pseudo-logic, wishful thinking or fixation and obsession disguised as conviction, and so on.

anon_22 I have a question for you. I took a look at the conference you are attending. Will a summary document be provided at the end and will it be available on the web? I want to read about each session. It seems that this is what I do with my spare time now. <g>

Dude, I don’t know if there will be a summary. I intend to post tomorrow the most significant points that I gathered. I don’t want to post today as some of the thoughts will be continued tomorrow. I will certainly post a link if there is one at the end of it.

Monotreme, sorry, I missed an important point with the last post.

Receptor binding is not transmission.

It was one of the first points but I accidentally deleted it, now I can’t be bothered to re-write the whole paragraph, so I will leave you to ponder it.

Blame it on the UK-US-UK-HK-Singapore-in-6-weeks kind of jet-lag..

ZZZZ,,…ZZZ..

No, BBB, it wasn’t drool that ruined my keyboard… Cross my heart, honest… <g>

Regarding a vaccine, I was reading the announcements that the company called Vical had successfully tested an H5N1 vaccine against mice and ferrets. One of the more detailed articles is here: http://tinyurl.com/juz9u

The study tested two vaccines: one was against NP (nucleoprotein) and M2 (transmembrane protein from matrix gene), which are considered to be conserved proteins; and the second vaccine included H5, NP, and M2. The news article indicates the first vaccine provided “significant” protection, the second “complete” protection when the animals were challenged with Vietnam/1203/2004 H5N1 virus. And that the NP/M2 version also provided “significant” protection against other strains of human influenza virus.

Now if the NP/M2 vaccine were eventually proven to show efficacy in humans, that would be a definite step ahead. But there is a question nagging in my mind about this. If the highly-conserved NP/M2 antibodies are proposed to be effective against multiple strains of human infl A, why wouldn’t we all have some degree of resistance against multiple strains once we’ve suffered through a session of influenza A, due to presence of NP and M2 antibodies?

Mice and ferrets have shorter life spans than humans, so raising the production of NP/M2 antibodies via a vaccine would give them a “fresh” supply. The implication here might be than once humans have had influenza A, the presence of these conserved antibodies wane as years pass. Some people seem more prone to getting influenza than others, why these antibodies would not protect them more thoroughly is puzzling. Perhaps it is a balance of antibodies and immune system response.

Perhaps this is heresy to say on this group, but I am reluctant to jump on the vaccine bandwagon, and agree with Tom DVM at 20:46 (yesterday) than influenza vaccines don’t work well. If something were found to be effective against this looming H5N1 cloud, that would be wonderful. But I would want to be thoroughly informed about it, including the adjuvants and how it is prepared. Not to detract from the current discussion, but current influenza vaccines do contain thimerosal as a preservative. Sorry, but there is significant indication there are genetic sensitivities in some animals (and people) to mercury levels in the body. Additionally, influenza vaccines are grown on chicken eggs, and I have significant concern about indigenous retroviruses present in chickens, some of which are strongly related to cancer-causing viruses…not to mention other possible pathogenic contaminants which can be present in vaccines. So, while a reliable and safe H5N1 vaccine would certainly be welcome, I would need to be convinced it is indeed effective, reliable and safe, and would want some science behind such statements.

Tom, thanks for posting about the hardiness of people living in 1918. I do a bit of genealogy work, and yes so many people from that era were farmers. Even my grandmother who lived in the downtown part of a city, told stories of how she had to tend the ducks in her backyard. Having poultry living nearby has been a part of much of human civilization for a long time, and no matter what the danger of H5N1, is not to be easily changed, especially in what we call “third world” countries.

I remember the day looking through some church death records, and being shocked that 7 children in 3 related families living near each other (the children were all first cousins), all died within a period of 3 weeks due to a diphtheria epidemic. Childhood mortality was a reality of life - and this was only a bit more than 100 years ago. My attitudes have been humbled.

Monotreme et al. I have just been re-reading the thread because once again Monotreme has re-focused debate on key issues: is H5N1 going to initiate the next pandemic: if so, is there a potential for the morality rate to exceed the 2.5 % CFR of 1918: and most importantly, how far down the human adaption trail have we gone…when will the pandemic begin?

One interesting aspect has been the genotypic vs phenotypic discussion. I understand that phenotypic expression can not occur without genotypic analysis, it’s just that I get totally lost when Monotreme, Annon 22, gs, NSI and others begin to discuss segments.

I believe you can most often extrapolate answers by examining existing avaliable evidence of the phenotypic expression of H5N1 and after ten years there is quite a bit of this evidence avaliable.

In comments today, Dr. Shortridge who was involved in the 1997 eradication effort in Hong Kong, states that he believes that it was one or two mutations from a pandemic in 1997. Once again we here the same comments as that from Dr. Osterhaus and Dr. Webster.

How has the virus changed since 1997.

1) Dr. Webster states that although the 1997 virus was killed within two days in an environment of 37 C, today it lives more than six days at this temperature and lives more than a week on moist surfaces. To me, this is clear evidence of significant environmental adaption.

2) Several distinct strains with individual phenotypic expressions have been identified. All known strains have maintained mortality rates greater than 50%.

3) Turkey etc. A strain that has not been released to independent scientists clearly indicates increased transmissibility and decreased mortality. This indicates that in an effort to adapt the virus decreased its mortality to 33% from 50% and it is not fully adapted yet.

4) The virus can enter through by respiratory, oral and gastri-intestinal routes. In addition, it can infect tissues considered atypical for other influenza’s excepth the 1918 subtype.

5) The virus is adapted to a wide variety of mammals and birds, both symptomatically and asymptomatically, a feat that would have been thought impossible a few years ago.

All of this since Dr. Shortridge considered the virus one of two mutations away in 1997.

Concerning Monotremes concern about mortality rates, the existing evidence indicates that the mortality rate will decrease before pandemic potential will be reached but probability strongly suggests that since H5N1 mortality rates had so much farther to fall then those of H1N1 in 1918, the final mortality rates will be multiples of the 1918 rate of 2.5%.

When? The evidence indicates to me that it will be within the next twelve months but this estimate would be the weakest to be arrived at from pre-existing phentoypic evidence.

My question to Monotreme et al would be what are the possibilities of more than one pandemic virus at the same time. The possibility of this situation seems to be growing although again the linkage to existing evidence would be considered weak.

Monotreme Annon 22 et al.

Thought you might be interested in this.

“If this virus becomes a pandemic, will it attenuate its virulence in humans? I think that would be a rather optimistic assumption to make.”

                                  Mallik Peiris   Univ. Hong Kong.

Tom DVM: Do you have the article from which that statement was reported?

As an aside, even though the evolution of H5N1 seems to have temporarily slowed down (or maybe not) I am no less unsettled. In fact, I am making major life decisions based on the likelihood of this beast rearing its head within the next couple of years. So it is not only time and money that I am putting up front. I am putting the rest of my life on the line, and I don’t feel like I have “fallen down the rabbit hole”. Just logic at work here, and also a somewhat “out of body” overview of how events are playing out.

Hi Medical Maven. As you may know, I am computer disabled…If you go to the current week on crofsblog H5N1, the second story is: ‘Singapore: Nearly 150 types of bird flu pose threat.’ The quote is from that story.

Tom DVM: Thanks, good enough.

Monotreme, you wrote: We now know that H5N1 truly is a highly lethal virus in humans. The recent release of seroprevalence data has established this as fact.

May I ask what “recent release of seroprevalence data” are you referring to. This area is one which I try to follow closely (and haven’t had the time lately).

I would appreciate a hint, link, or description. I assume these seroprevalence studies show what all the rest have shown.

Thanks much….

anon_22, I appreciate your concerns regarding language, but I don’t want to get bogged down in semantics. So, let me review my position.

• The original question was “Must a Pandemic Strain of Influenza Decrease In Lethality”? I believe the answer is no.

As you and Tom DVM point out, Dr. Malik Peiris has also answered this question no. As has Robert Webster. As has Michael Osterholm. I see no reason to assume 2.5% is the worst case scenario. Magical thinking is required to believe this. That doesn’t mean that a pandemic with a 30% CFR will happen, but it’s certainly in the realm of possibilities.

• What should our assumptions be for planning purposes? The current range for mortality rates with H5N1 is 30–100%. Since I believe it is possible that the virus could become a pandemic strain without losing any further virulence, the possibility of a very lethal pandemic strain should be included for planning purposes. Under a true worst case scenario, absenteeism will much higher than 40% unless steps are taken ahead of time to prepare essential workers.
• A worst case scenario in terms of fatality rate does *not* have to be a civilisation buster. I think we have to face the possibility of a very high fatality rate, but that does not lead me to throw my hands up in despair. There are ways to avoid infection. Yes, each method has its weaknesses, but that doesn’t mean we shouldn’t try them. N100s and gloves won’t be 100% effective, neither will Tamiflu or even vaccines. But if we use all the methods at our disposal, we can keep essential services running. But we must be honest with essential workers and get them involved in the planning process. I’m with lugon on this one.

FloridaGirl, here is the Seroprevalence information.

As they said in the movie, “I’m with you fellas.” I think we must have an idea of what to do in true “worst case” situations. Look, think of the dynamic…a panflu starts…people get infected…it spreads…lots of people get infected…it spreads…Can we tell the Attack rate or the case fatality rate? No. All we will know is that lots of people are sick and lots of people are dead. What matters is that we keep essential services functional. We can’t do that if we do not plan for the worst. Why? There won’t be time if we have made an assumption that 40% of the workforce will be absent from work for two weeks at a time…(pardon me I don’t swear at all,) but in this case, that is bullshit. We must plan for this before the fact. I see no other alternative. I personally think that Monotreme is right. Yet, I am very comfortable that we could also only end up with a common cold from this.

As always it would be difficult to argue with the common sense of Monotreme, anon 22, Dude, Medical Maven FloridaGirl and everyone else.

Monotreme. How do we warn people given the current downplaying of the risk…’its only a bird disease’. Human nature is such that if the message is not 100% consistent as in …we are all going to die, no one will do anything…we will be ignored.

They didn’t believe us in the past, they don’t believe us now and they’re not going to believe us in the future. That’s the problem with human nature. The only thing they will believe is when the Koffi Annan goes on television to tell the world…’whoops it was out of control before we identified it and by the way…we’re screwed’.

We are a few water beetles swimming against a tidal wave of denial.

Tom DVM… Maybe some good news. After the U.S. Presidentcial Flu Plan was released today, our local television station did pick up on three things the public need to do. The need to prep was one. With all digits crossed, maybe all is nt lost. gina

Tom DVM, see my poorly written attempt at fiction on the Essential Workers to get my take on two possible scenarios. The key, IMO, is opinion leaders. There are some people whose opinions we respect more than most. These are the people we need to persuade. If we can convince these people, they will help us convince everyone else. Now, how to identify them and get our message to them…

Hurricane Alley RN. Thanks. I am impressed by the increasing trend of complete honesty with US regulators. I am from Canada…our message…nothing to worry about, we’re the best and we are going to look after you…and the losses would be 2–7 million worldwide in a pandemic anyway.

We are but a few water beetles swimming against a tidal wave of denial. I do not believe we will get enough attention to be able to change things given the current environment (as I believe we are less than a year from a pandemic).

Monotreme. I read your scenario but there was only one. Is there a second installement coming.

I have total belief in the eventual success in getting the information released because they read this site and we will shame and embarass them into acting.

I fear that this second one has little hope of success because the message would have to be consistent across the board…and we know they are downplaying the risk…its a disease of birds…they have their walking papers and their ‘talking points’ and these are not going to change until the corpses are piling up at their office doors.

Why would the general public believe us when it is only a disease of birds.

I think we should organize a wiki panflu demonstration in washington DC to get the attention of the media. Ask everyone to demonstrate, have good speakers, music, and a spin team for press releases so the press knows what to write about. Have it on CDs in word format so they can cut and paste. Have some video ready to show them. Have some street theatre. Call it a national day of concern. Create some momentum.

MOnotreme,

My posts on this thread were all attempts to suggest counter-arguments. I could have called it nit-picking by invitation. We can get out of that now if you prefer. :-)

As I said, I do broadly agree with you, with the caveat that “we really won’t know the answer till at least 2–3 weeks into a pandemic” (Roy Andersen, at the Lancet Asia Forum today). If that is the case, the next question is how does one prepare for this, how do communities, government, etc cope.

Because this issue is so big, consequences so severe, politicians and people so not prepared, we, (yes you and I and fellow fluwikians who know quite a bit more than them and had gone through the shock and despair somewhat) may need to do our own triage initially as to what and how to communicate risk.

As with all triage, there are some difficult decisions and choices, and we all have to make them for ourselves. I have tentatively chosen the straight forward way of using the worst case scenario that the world has seen so far ie 1918, as a reference point. I know full well that far worse can happen, but at this point, the political climate is not ready for that, and anyone going beyond that is likely to get shot down before you can achieve anything.

Also, as I said earlier, the gap between our current capacity in anything, eg healthcare, infrastructure, and what is needed to cope with a pandemic is so big that to go beyond a 1918 scenario will be counter-productive in terms of return for time/resources spent.

If I think of the near term, then I would say let’s get them to prepare for a 1968 scenario first. To quote another speaker from the Lancet forum, Martin Meltzer, economist, CDC “there is no healthcare system in the world that can cope with the surge in demand even with a 1968 scenario.”

The outcome is to achieve a balance between seeking the truth and coming up with pragmatic strategies.

Tom DVM… When it comes down to the when this flu goes H2H, I think you are 100% correct in you guesstimation. Less than a year or sooner… you bet. This influenza has it’s own time schedule and that doesn’t mean ours. I plan on contacting the t.v. station in the morning. Now is not the time to become complacent. It’s time to grab the bull by the horns. No pun intended. gina

the fatal 2003 H7N7 case in NL had a lot of mutations. More than 20, AFAIR while the other human cases had very few mutations. I don’t understand this. Was there any other similar thing ever observed ? Not with H5N1 or H3N2 or H1N1 as far as I know (AFAIK).

It could be that one mutation S227N in the Qinghai strain is sufficient for a pandemic and it did already occur. (Add/replace to this G228S+Q226L or G228S alone.) When it occurs again under other conditions - in a school or such - it might be enough to start an epidemic or even a pandemic.I don’t consider this very likely, though.

This Qinghai strain is not included in the actual US-vaccine BTW. while the Indonesian strain is. If there were secret Turkey mutations which were considered dangerous, wouldn’t they include it into the vaccine ?

There is no significant evolution of H5N1 in humans yet. The evolution and the changes which lead to different strains took place in birds. The potential of H5N1 in birds has already been tested by nature quite a lot and we don’t expect that H5N1 might wipe out 10% of all birds or such. But we consider the pandemic in humans that is threatening as different from the pandemic in birds that is taking place here in this thread. Is it reasonable ? 1918 H1N1 was quite different with respect to contagiousness, why should H5N1 suddenly become as contagious as 1918 H1N1 ? It seems more likely to me that it would slowly become more contagious, if at all. That would maybe leave us some time to develope vaccines for the dominant strains. We don’t really know, how suddenly H1 in 1918 became more contagious. H2 in 1957 and H3 in 1968 apparantly reassorted. H5N1 isn’t really reassorting actually. But I think, we should test its reassorting+recombining potential in a lab. With mice or ferrets or chicken or maybe even cats or pigs … until some moderator closes the discussion for ethical reasons , as politicians closed/discouraged

pandemic plans with high CFR. Yes, I also think that these “worst case” scenarios or the CFR’s assumed in most of these pandemic plannings are just not very interesting or realistic. I think, they just _do not want_ to plan with any worse scenarios. The consequences would somehow touch their ethics and they just don’t find appropriate words to describe it without people getting uncomfortable, or just refutative for ethical reasons, not logical reasons. Also they want to avoid panicing.

So more severe scenarios are just not to be discussed in public (too much).

Dude, I do not think, speakers,music,street theatre in Washington would be the appropriate envelope to increase pandemic awareness. You can sell anything with enough advertisement, but panflu is a matter of life and logic and scientific analysis rather than just advertisement. What we need to convince the politicians and the public are serious probability estimates by the experts and engaged+controversy discussion about these. The current discussion is just too hypothetical, everyone has too much room to interpret the statements just as he wants.

The fatal case of H7N7 crucially had E637K mutation, which was not found in the other cases nor in the avian isolates available. However, virus samples gathered at the farm from which this vet was supposed to have contracted the virus for some reason have stil not been sequenced (Fouchier, oral commumication, Lancet Asia forum, May 3, 2006) I don’t know why, perhaps somebody thought they didn’t have samples and then discovered them recently? Anyhow, the important question is did this mutation happen in the bird or in the human? We should keep an eye out for this information when it comes out.

We are all making guesses about what mutations are needed. The most detailed data so far is still this study. It would appear that it is not just what mutations, but also the configuration/orientation of both the receptor and the virus antigen that might determine binding affinity.

Re anonymous at 03:57:

I see your points on difficulty of getting through to others. Also agree strongly that “The current discussion is just too hypothetical, everyone has too much room to interpret the statements just as he wants.”

That is true, and will remain exactly that way until history in the fullness of time, instructs us further.

How can a discussion be anything BUT extremely hypothetical when we don’t KNOW 1)if it will mutate, 2)when a pandemic will commence, 3)what pattern of waves 4) what additional strains may occur, 5)how deadly it may be, 6)how well will it communicate, 7)How effective our antivirals would prove,

 8)How effective vaccines would be,  9)How effective production and distribution of vaccines,  10)How disruptive

to social order the pandemic may prove to be, adding to the death toll of the pandemic proper… Etc, etc…

This discussion, and any other, is structurally confined to a series of hypotheses. Statistical likelihood of ANY expert or organisation hitting All of them is astronomically beyond any rational expectation.

AND if anyone DID unlock this complex sequence, HOW WOULD WE RECOGNISE IT as the valid, correct scenario?

Like the medieval monks who argued ‘how man angels can dance on the head of a pin?’ we, ourselves, with all intelligence and knowledge and sincerity, are likely to only appear to TPTB and the public as…pinheads?

Tragic. I could weep in frustration.

Fat head/fingers, read ‘How MANY angels… BTW, this is an historical fact. The argument was about whether spiritual beings have dimension, and was pointedly illustrated in that analogy…

“I have tentatively chosen the straight forward way of using the worst case scenario that the world has seen so far ie 1918, as a reference point.”

Annon_22- the thing about 1918 flu is that it depends completely on your point of view 86 years ago. If you were white American, your chance of dying was say 1 in 100. If you were Western Samoan, your chance was 25 in 100. If you were an Inuit, your chance could have been something like 60 in 100.

I suspect that you are going to go on and say- “1918, 2% CFR”- You might as well say “Nobody died in 1918 from the flu, because I am using the CFR from American Samoa which had no flu cases in 1918″.

Using a 2% CFR as a worst case is wrong. I am sick of white Americans extrapolating their personal experience to the entire world. If the CFR in white USA had been 18% in 1918, even if the worldwide CFR had been 2%, then 18% would be touted (by Americans) as the worst case scenario.

It is a very big world out here and the USA is just a little, but noisy, part of it.

And another thing! Everytime I read anything about 1918, there is a different death toll. Everything from 15,000,000 dead to 100,000,000 dead world wide. So if there is a 700% disparity on the total death toll- It is reasonable to deduce that there would be a 700% disparity in the possible world wide CFR from 1918. In other words, the CFR from 1918 could have been as high as 15%−20%, if you include all the millions and millions of nameless people living in tiny little remote places- or giant 2nd and 3rd world cities- In which nobody was counting the numbers of people sick, or the numbers of people who died. They just disappeared.

Does anybody have any idea where this 2.5% CFR from 1918 come from? It is just a random, unsubstantiated number. Probably somebody’s (an American newspaper reporter?) hunch at the time. Then repeated in the papers. It is extremely dangerous to all of us, because if we are basing our worst case scenario planning on a number that has no basis in fact………………………..well ….

Clark:

Steady, lad. Steady, now. Manners, please. Don’t break the keyboard now.

The posters on this wiki are predominately Americans for the simple reason of its origins. And it is statistically likely 80% are European-Americans, based on USA demographics.

You and I have come into this wiki as guests. We were not forced to and are not coerced to stay. Even with my modest intellect, I very early on realised this was an American based site, and could take it or leave it at that.

I have been treated with patience and courtesy, even when I have skirted the edges, and in turn I have tried to not be aggressive about attitudes and emphases that, for me, are a bit parochial.

As if our Australian site isn’t parochial! Or the ‘private’ thread “Australia and New Zealand #X”

To be meaningful and relevant and to communicate, the wikians here need to use an American Dialect spelling, weights and measures, the milieu of US culture—strengths and problems. They should be free to ‘see things through their own eyes’ without criticism.

If you or I don’t like it, I suggest we set up our own site and Modferate it to OUR ‘superior’ standards.

Are you quieter now. I speak to you as an elder brother, a visitor to a largely alien land here, and one who also has been a little irritated once or twice. The perils of the traveller, to India, France or…Australia!

Cheers!

clark

I am not white American,

AND quit the racist talk.

I will respond to the rest later.

Nikolai- the wiki is not in America- it isn’t anywhere. It only exists because people come here and communicate. I am not here to insult.

This wiki is full of rascism- But no one minds as long as it is directed towards the 3rd world or the USA poor.

The rascism I am pointing out is in the numbers- what numbers are reported- what numbers are ignored. In 1918, soldiers of the Indian army had a CFR of 22%, (wikipedia). 17,000,000 Indians are reported to have died.

Why is this not important information in 2006 as we face a flu virus that is very similar to the virus that killed so many Indians? Why didn’t John Barry mention India, or New Zealand or China or Indonesia or Korea or Samoa or Iceland or Norway or Nigeria or hundreds of other countries in his Great Influenza Book? Don’t we exist? Why is the May 9 flu movie set in New York, even though it was filmed in New Zealand?

If we are going to use numbers, lets use real numbers- and accurately define them. Picking a number because you are comfortable with it is a good stategy for lotto or the horse races. It is not a good stategy if you are a scientist of Flu Policy person.

It freaks me. I see it everywhere, everyday. “I am not comfortable with that number, so I’ll just pick this number”. “Oh, and we will plan our World’s, Nation’s, State’s, City’s, neiborhood’s, company’s, family’s flu prep on this random number”….. and hope for the best………

For what its worth, I don’t like the use of the terms ‘racist or racism’. These terms are very much in the eye of the beholder. There are racists in the world but there are no racists on flu wiki.

Each of us brings a particular skill to the table. I see Clark as flu wiki’s resident historian on past infectious disease outbreaks, epidemics and pandemics. He makes facts that I would never have thought, more than relevant to the discussion.

He was a little frustrated earlier…we have all been frustrated at one time or another in the few months I’ve been here. That doesn’t make him a racist.

I would suggest we all re-read his posts because his arguments are sound in logic and sound from all the historical evidence that I have read but could not have put as succinctly.

Clark’s facts are absolutely essential if we are ever to see the full picture of 1918 and use the information to help us going ahead. Thanks.

Clark: A bit ethnocentric perhaps, but not at all racist. We colonials usually see the world from our slightly different, but English-European roots. The ABC film actually starts in Asia, (highly probable) and wings its way to NY, (highly probably). Made by an American network for Americans. J. Barry is from New Orleans, but focused his book in Philly. It was about flu, but more about science and politics and the struggles of a nation. If you want to hawk about racism, find a Border Security thread. This is a species thing.

Monotreme and others,

Thanks for the great discussion. Like many others I think this is an important thread.

My current concern is the possibility of H5N1 and an H7 virus acquiring characteristics from each other to improve human to human transmissibility, particularly by a reassortment/recombination event occurring between the two viruses.

My own personal view is that it may be possible to maintain the current fatality rate of H5N1 with increased human to human transmission, although making any predictions as to what may need to be exchanged between the two viruses is impossible.

However, one of the central questions for me is whether the ability of an influenza virus to induce ARDS in humans [acute respiratory distress syndrome (ARDS)] will always be necessarily associated with lower human to human transmission rates. ARDS is one of the features of H5N1 infection in humans and appears to be one of the major factors responsible for its high fatality rate.

In the case of the 1918 pandemic, this influenza appears to have only caused ARDS in a proportion of cases (when it did, these cases were often fatal). The 1918 influenza had reasonable rates of human to human transmission and a lethality rate significantly lower than H5N1.

Although, this whole question may be seen as a re-phrasing of the debate that bird viruses infect cells of the lower respiratory tract and that human viruses infect cells of the upper respiratory tract, I think that this issue goes further than this.

ARDS is a complex clinical presentation. As discussed previously on the Wiki and lately in this thread, the ability of influenza virus to produce ARDS may also be dependent upon mutations in genes such as PB2 for efficient replication, and mutations in NS1 being able to induce prolonged virema and inhibit interferons in a subject.

The 2003 H7N7 outbreak in the Netherlands is interesting in this regard. It appears that this outbreak had the ability to transmit readily efficiently between humans (see Revere’s comments). The majority of individuals infected in that outbreak had only symptoms of conjunctivitis, indicating that the virus did not replicate well in the respiratory tract.

In the cases of human to human transmission that were sequenced, these cases did not show any changes in the HA gene, indicating that the virus already had acquired the necessary characteristics for relatively efficient human to human transmission.

As discussed above, there was also one fatal infection in a veterinarian, who showed acute respiratory distress syndrome (ARDS). The sequence of the viral isolates from this individual showed amino acid substitutions over that found for the milder cases in a number of genes, including HA, NA, NS1 and PB2 (one of which was the E627K mutation). This data suggests that at least some of the amino acid substitutions outside HA may have been responsible for this ability to induce ARDS.

As far as I can tell, there were no cases of reported human to human transmission from the veterinarian, so the jury is out.

The crux of all the above is that we just don’t know what’s going on. However, and playing devil’s advocate, it may be that the changes in a virus that are responsible for ARDS (and hence high lethality) are generally associated with lower human to human transmission. For example, changes in the NA gene that might be required for ARDS to occur in cells deep in the respiratory tract (say by prolonging viral presence in the cells) are also associated with altered or reduced viral escape from cells of the upper respiratory tract, leading to reduced transmissibilty.

Prepper A- My thinking is that if the virus is predominantly in the lung parenchyma, (terminal bronchioles and alveoli), whether from siliac acid receptor preference or not, it can not easily be expelled out through the conducting airways. It typically takes an invasive procedure to recover material from alveoli. A virus that infects and sheds from bronchial smooth muscle airway, however, can easily be expelled in droplets or as airborne particles. The defences of the lung would prohibit droplets from reaching the alveoli, so infection is probably a two step process, where more typical flu symptoms create a bronchorrhea drainage that usually causes a lobar or focal pneumonia (alveoli filling) setting up the alveolar attack. The insult in any one location of lung tissue can cause ARDS

Clark - John Barry did mention many countries and I found his reporting very helpful in making the same point you are trying to make. He no doubt was limited in research to what can be found or translated. Wikipedia may have used the info from his book. From “The Great Influenza”, not quotes, as that would take pages, but some of the numbers.

Yes, included is Western Somoa - 22% mortality of the entire population. Strict quaranting of American Samoa a few miles away, saved them from having any deaths.

Frankfort- 27% mortality of those hospitalized with the flu.

Paris - 10% of mortality of victims.

Cape Town - 4% of the entire population in the first four weeks of reported cases. (note “entire” is not just the CFR of cases)

Gambia - 8% of Europeans but whole villages wiped out.

Guam- 10% of the entire native population.

Fiji- 14% of entire population.

Chiapas, Mexico- 10% of the entire population.

Russia and Iran - 7% of the entire population.

Labrador- 33% of entire population.

India - troops 21.69% CFR. Further studies keep pushing the total up to 20 million deaths in India alone.

Huge unknown numbers in China, decimated Inuits, Eskimos, Pacific Islanders, Africans.

John Barry also mentions higher world totals from different studies. In 1940 Nobel laureate Macfarlane Burnet estimated 50–100 million. This was reaffirmed by a 2002 study that reviewed the data. Given the world population of 1.8 billion app. in 1918, that would be a mortality rate of 5% of the “entire” population (the CFR of cases would be much than 5%)

It is not accurate to claim 2.5 or whatever, as the CFR of 1918. The expolating that is being used as a worse case scenario is underestimated.

NJ. Preppie. The evidence as provided is crystal clear. The 2.5% CFR is wrong. I think was the point that Clark was trying to make.

Your well-presented information raises several issues and inconsistencies that are going to take some time to fully absorb.

Thanks.

To all. IN the pandemic of 1918 did the moryality rate take into account those who died from starvation or other causes or were all causes of death classified as flu? gina

clark,

AND EVERYONE ELSE PLEASE READ

This thread was about whether the current estimates might be too optimistic, and (as far as my post 01:58 that triggered your diatribe was concerned) how might one approach this problem from the point of view of risk communication.

If you want to discuss whether the numbers for 1918 was wrong and/or ethnocentric, feel free to start a different thread, with supporting sources if possible. Or even just discuss it, as NJ Preppie is doing!

YOU HAVE NO WAY OF KNOWING WHAT I WAS GOING TO SAY, WHO I AM, WHAT I THINK, and why I use certain numbers (which btw I hadn’t even mentioned, the 2.5% was started by yourself) except what I choose to post here.

To suggest that you know what I think and then make inferences based on WHAT YOU THINK I THINK, ie like a white American who ignores the experience of other ethnic groups or races, which btw is an accusation that is extremely racist in and of itself, is the height of arrogance.

As I said, I am neither white nor American. I grew up in the Third World. If you have a gripe against white Americans, you are barking up the wrong tree.

SHOVE IT OR TAKE IT SOMEWHERE ELSE!

For everyone else, I don’t think the wiki is racist, at least not any more than any other community where a majority of the group shares a common background. Opinions can sometimes be limited by the experiences of participants. For my views on American or western-centric worldviews, Read my post on the b2h/h2h thread at April 26 05:17

And Tom, Whether the 2.5% CFR was wrong or not does not give clark the right to make his point in the way that he did.

anon_22, calm down. You’re overreacting. Better concentrate on H5N1.

anonymous,

When someone makes statements like this (clark 07:45) “This wiki is full of rascism- But no one minds as long as it is directed towards the 3rd world or the USA poor.” there is a need to respond and set the record straight.

Let’s not be anonymous. I appreciate letting a fine mind speak their mind. I can’t believe how racism gets used for everything, and the 1918 CFR isn’t American and no journalist made it up. WHO and all the international groups, experts, all err on the extreme low estimate side, as if everyone can’t stand to err on the high side. Fearmongering is a scientific deadly sin. Why do the experts always damp down what the CFR rate could be for H2H - Are we nuts to believe how bad it could be- that’s what this thread subject is debating.

Well said, NJ, the way it should be said.

You all dance around the real question, will the death toll be high enough to break down social cohesion and the working of society? The number of deaths may be quite different in different groups and in different areas, but the real question still remains, will society continue to function and on what level.

anon_22, you are an excellent choice to moderate. Thank you. (BTW I am Canadian and many ethnic derivations, by and large everyone here is about as neutral in attitude as you can get in that regard- let’s not forget what we’re really here for)

We know that the World population was about 1.8 billion people in 1918. The most recent estimates of world wide death from the flu in 1918 are 50,000,000 to 100,000,000. The most recent estimates of the attack rate of the 1918 flu are 20% to 30%. These are the estimated percentages of the World’s population who became sick with the flu.

Therefore, based on these numbers, the Case Fatality Rate (CFR) in 1918 was between 9.3% and 28%.

The average of those two extremes is 18.65%- an estimated CFR for the 1918 flu as experienced by the entire World.

I think Clark brings up some very legitimate points. While no posters to this thread have ever made any overtly racist comments, there certainly have been such comments made - by others - on other threads.

But much racism and/or nationalism is more insidious than that, and I do think the CFR commonly used for 1918 could be an example of that (although Anon_22, even having mentioned 2.5% earlier in the thread, is certainly not to be blamed for its widespread usage). And if 2.5% was the CFR for only the U.S., then gratitude for the wiki should not preclude anyone from bringing it up.

2.5–5% is the consensus world wide average. Locally, conditions were all over the map. For example, the 1957–58 pandemic was considered a “mild” one in the US, but it was devestating for the city of Liverpool.

Although I disagree with how clark expressed himself, I agree with the substance of his remarks regarding a CFR of 2.5% for 1918. The .5% implies a false precision that cannot possibly be supported by the data. Ridiculous really, when you think about it. If the death toll really was 100 million, there is no way you can get that with a 30% attack rate and a 2.5% CFR, not even close. Further, there were cases where more than 50% of the members of a community died, so we know that one number cannot express what happened. I suspect that both the attack rate and the CFR varied depending on a number of variables: hygeine, density of population, general health, access to supportive care, etc. Given that the 2.5% number has no rational basis, I think we should stop using it. Let’s simply tell people the truth, the current death rate from H5N1 is 50%, on average, and this number may or may not decline if H5N1 becomes a pandemic strain. We don’t know how many people will die in a pandemic, but we do have ways to decrease the attack rate and improve the survival rate. Let’s trust people with the facts and concentrate on getting them prepared.

Hear, Hear Monotreme.

Almost exactly what I was going to say.

<crawls back to bed>

Thanks anon_22. Hope you feel better soon.

Well, it’s nice to know that our passion for the subject(s) is still intact after many months of debating and discussing the issue.

   “But much racism and/or nationalism is more insidious than that…”

                            Scaredy Cat (May 2006)

I was going to put it slightly different…one man’s patriot is another man’s racist.

We sit at our keyboards, slapping off posts without the opportunity of sober second thought or editing for that matter.

This was not a racist issue but an ethnocentric one with qualifications. I do not think that the intention was to insult: it was to inform. We have all said things we regret on flu wiki or wish we could take back. I hope the next time I do it, you will understand and visa versa.

anon_22, what I was saying was not directed towards you specifically, but towards experts in general. I have been going on about this “invisability” of other people’s 1918 experience for nearly as long as I have been posting on the wiki. It is one of my memes. Honestly, I did not mean to offend you. If I did, I appologize with no reservations. You are one of the good guys.

Every time you read about how banks (power, phone, water, police, garbage disposal, internet) are planning to stay open because they are relying on 33% of their staff showing up (33% are sick and 33% are looking after them)- you know that their Flu Policy Analysis is betting the farm that 2% CFR is as bad as it can get.

clark, “Every time you read about how banks (power, phone, water, police, garbage disposal, internet) are planning to stay open because they are relying on 33% of their staff showing up (33% are sick and 33% are looking after them)- you know that their Flu Policy Analysis is betting the farm that 2% CFR is as bad as it can get.”

Exactly right. We need to kill this urban myth and get them to prepare for a more challenging possibility.

clark,

Apology accepted. Also point accepted.

Monotreme’s post reflects what I think about how to approach this issue of numbers.

Martin Meltzer of the CDC and I have had several long discussions about the use of numbers. Even though he is an economist(think ‘number cruncher’) and policymakers hound him for numbers, his point of view, and I concur, is that straight numbers are meaningless and misleading without accompanying understanding of how one arrived at them, what are the confidence limits, the context in which these data was collected, sensitivity analysis, and so on. What you get depends as much on what questions you asked and how you asked them as the data that you collect.

In other words, Garbage in, Garbage out.

If I look at 1918 and ask those same questions, immediately what comes up for me is that the degree of accuracy varied widely all over the world. Where does one start? Sure, you can start with China or Gambon, but let’s say I’m kinda lazy (or my research grant is running out soon) and just want to start with what appears to be relatively accurate for a first assessment, I would start with data from US or British cities. It doesn’t mean that I ignore Gambon, but I am hypothesizing that the accuracy for Gambon would be a lot less than US, and that gives me an index or reference point to work from.

Let’s say some of the mortality figures were taken from health department records because doctors were required by law to report flu cases. Since CFR = no of deaths/no of clinical cases, the accuracy or confidence with which you can declare your CFR accurate depends on many things. To name just a few:

Other issues include distortions by: demographics, urban vs rural, people movements in or out of the affected area, loss/damage of records over time, etc.

Whatever number you are getting carries with it a configence limit, or a range best expressed for laymen as x(± y)%.

For 1918, attempting to get an ‘accurate’ average worldwide CFR would leave you with results where y is likely to be >>> x.

(I learnt this using the example of one study to assess effectiveness of vaccinating every child for measles in stopping an epidemic, measured as the % fall of cases over time, which sounds like an uncomplicated study where one would expect high accuracy, but where a 20% (x) fall in number of cases which sounded reasonbly good became meaningless because when you add up all the confounding factors, any one of which on its own sounded trivial, y became > 20. Hat-tip to Meltzer.)

Garbage in, garbage out.

Racism is not the issue of those who frequent this wikie. A horrific potential Pandemic is. I am sorry if I have given offense and I also feel sorry for those who perceive offense when none is in fact there. Racism is not what I am about at this moment. (FYI I have Native American ancestors, I don’t even wish to go where the discussion of racism and the dominant American culture has been with respect to that.) I have come to respect the regulars on this thread. I have not forgotten who I am when I do that. In my not so humble opinion, racism discussions really belong somewhere else. They are a distraction. They have great import to me, but not here, not now. We have a more pressing monster to contend with.

Since there is little accuracy or hard science to fall back on, how you communicate becomes a matter of personal choice. And some people are more pragmatic than others.

For me, I would try to assess whether someone:
→1 have close to zero idea of what a pandemic is and what is H5N1
→2 have little time, patience, tolerance for complexity
→3 have a vested interest or resistance to preparing
→4 demands a quick answer by way of probability or percentage
→5 requires those numbers to convince their boss, spouse, the finance department, their subordinates
→6 needs to be motivated by fear
→7 goes into denial or complete paralysis and unable to take action if there is too much fear
→8 is likely to shoot the messenger

and use whatever method that is going to get them to do ‘the right thing’. But then frequently because of limitation of resources the gap between current status and ‘the right thing’ is so big, and the danger of yourself being discredited is so extremely high currently, that I choose to err on the conservative side in risk communication, knowing that even the ‘conservative’ and ‘expert’ estimate of 2 or 2.5% will require far more than any of these folks are likely or able to commit to doing.

Rather than freak them out and have the door shut in your face.

It’s a personal choice.

A thought occur to me: were doctors licensed in 1918? Does anyone know? It’s in John Barry’s book, I think.

“Since there is little accuracy or hard science to fall back on”. anon_22

The population of 1.8 billion in 1918 is an accurate number. The world wide attack rate of 20%−30% is a conservative estimate. This includes everybody on Earth.

The 50,000,000- 100,000,000 estimated deaths in 1918 from the flu are numbers that I believe have been arrived at by scholorly analysis and recently corroborated. Saying that these numbers are inacurrate (meaningless) because they don’t fit with your world view is not very rigorous.

“his point of view, and I concur, is that straight numbers are meaningless and misleading without accompanying understanding of how one arrived at them, what are the confidence limits, the context in which these data was collected, sensitivity analysis, and so on” anon_22

As Mark Twain said “There are lies, damned lies and statistics”….

If you have to resort to statistics to support your point of view, well, IMO, you are on thin ice.

“The population of 1.8 billion in 1918 is an accurate number.”

Really?

How did you arrive at that?

Do you have peer-reviewed sources that carry that consensus, that 1.8 billion in 1918 is an accurate number?

“If you have to resort to statistics to support your point of view, well, IMO, you are on thin ice.”

What is my point of view? Which part, and in what context? Do you really know enough to make that judgement?

If you are saying is the current CFR very high and is a pandemic with H5N1 likely to be devastating, the answer is Yes. (btw, Monotreme and I were the lone voice for a long time about a very high CFR.)

If you are saying that suggestions that CFR must fall are not supported by hard science and CFR may not fall, or may not fall a lot, therefore let’s not be complacent, then Yes.

If you are saying that the CFR for H5N1 pandemic in 2006 has to be very high, I would disagree.

If you ask me to give an educated guess, gut feeling, place a bet as if I am in a casino, I would say it could be anything between 2–50%, with a median of approximately 30%, based on my limited understanding of virology and epidemiology, as of now. But that could change as information becomes available.

If you are saying do I think the CFR for 1918 was 2.5% or was it higher, I would say, a rough overall guess is that it was higher. But there were local variations due to many factors, just as there will be if we have a pandemic in 2006, so one must be careful how you interprete such numbers.

If you ask me how much higher, I would ask you a question back and say for what purpose are you asking this question? If it was for intellectual curiosity, then good for you, please go and do more research and share the information, but remember to also share all the limitations of the data. Remembering that all data has limitations.

BTW, notice I carefully choose not to condemn people who disagree, whereas you have no qualms in doing so persistently, as in “As Mark Twain said “There are lies, damned lies and statistics”….”

If you want more exact estimates to prove a point, I would say what point? To prove people are liars? Then what?

To prove you are right? Then what?

If your point, which by now I am very sceptical about, is to facilitate pandemic preparedness in communities or governments, then I would say use whatever number works for you. Just don’t tell me that I lie because I use it differently.

And THAT is not even close to the sum total of my point of view.

For everyone else,

This conversation between clark and myself is NOT a vendetta or whatever. There are important issues being thrashed out, including science, communication, ethics, personal prejudeices, to name a few.

If we have a pandemic, ALL of these and more will come up for resolution for a lot of people.

BTW how is 1.8 billion population in 1918 not statistics????????

 >Martin Meltzer of the CDC and I have had several long discussions//
 >about the use of numbers.//

// looks like some philosophy of math,logics,set-theory…// //

 >Even though he is an economist(think //
 >number cruncher) and policymakers hound him for numbers, //
 >his point of view, and I concur, is that straight numbers are//
 >meaningless and misleading //

// what are “straight” numbers ?// //

 >without accompanying understanding//
 >of how one arrived at them,//

// that holds maybe for a teacher who has to decide whether the// student does understand the approach.// It doesn’t hold, when it’s clear that the approach is understood// and tested, e.g. an established computer program.// //

 >what are the confidence limits, //
 >the context in which these data was collected, sensitivity //
 >analysis, and so on.//

// it’s up to the operator to decide this, and the other experts // to check it. But don’t bother the average reader with the details,// how the result was achieved.// //

 >What you get depends as much on what questions you asked //
 >and how you asked them as the data that you collect. //

// sure. Proper interpretation is important.// //

 >In other words, Garbage in, Garbage out. //

// Meltzer is one of those who even early in 2004 worked on// models to predict the likelyhood and impact of a pandemic.// But he did _not_ answer a clear formulated question about// his subjective probability estimate.// (what’s your subjective estimate of the probability that// there will be more than 1e8 panflu deaths in the next 10 years)// Now what he is trying here to explain to you looks just// like an excuse, why he does not _want_ to give his estimates.// Clear question in, void out.// You must question the whole sense of the analysis, when the// decisive conclusions are withhold.// //

 >If I look at 1918 and ask those same questions, immediately //
 >what comes up for me is that the degree of accuracy varied //
 >widely all over the world. Where does one start? Sure, you //
 >can start with China or Gambon, but let us say I am kinda //
 >lazy (or my research grant is running out soon) and just want//
 >to start with what appears to be relatively accurate for a //
 >first assessment, I would start with data from US or British//
 >cities. It does not mean that I ignore Gambon, but I am //
 >hypothesizing that the accuracy for Gambon would be a lot//
 >less than US, and that gives me an index or reference point//
 >to work from. //

// so what ? Of course you should use the best data available// and make the estimate as good as you can.// Others will use the same data and give their own estimates,// based on their interpretation and experience.// Some other person might start with Gambon.// Some third person might read both approaches and find an even// better estimate etc.// //

 >Let us say some of the mortality figures were taken from health//
 >department records because doctors were required by law to report//
 >flu cases. Since CFR = no of deaths/no of clinical cases, the//
 >accuracy or confidence with which you can declare your CFR //
 >accurate depends on many things. To name just a few: //
 >…//

// not necessary. However long that list is, it can be extended.// It’s not necessary for the reader to dig into the details. // The question is clearly formulated.// Let’s just compare the answers. You don’t want every reader to// elaborate on it, that’s what we have the experts for.// The differences in the answers depending on these “things”// is not very big anyway. It gives some uncertainety, but the// estimate is still useful.// //

 >Garbage in, garbage out.//

// it’s not important what happens on “Garbage in”.// It’s important what happens when the input obeys to // the rules and can be processed. Some programs even then// produce garbage.// // // //

 >anon_22 at 00:36 //
 >Since there is little accuracy or hard science to fall back on, //
 >how you communicate becomes a matter of personal choice. //

// but some choice it better than the other// //

 >And some people are more pragmatic than others. //
 >For me, I would try to assess whether someone://
 >1 have close to zero idea of what a pandemic is and what is H5N1//
 >2 have little time, patience, tolerance for complexity//
 >3 have a vested interest or resistance to preparing//
 >4 demands a quick answer by way of probability or percentage//
 >5 requires those numbers to convince their boss, spouse, //
 >  the finance department, their subordinates//
 >6 needs to be motivated by fear//
 >7 goes into denial or complete paralysis and unable to take//
 >  action if there is too much fear//
 >8 is likely to shoot the messenger //
 >9 is likely to be shot by others for being the messenger //
 >and so on. //

// so, you assume being asked by someone. And then you select your// answer depending on the personality of the questioner rather than// the scientific truth ? The same question produces different answers// depending on _who_ asks ?// //

 >and use whatever method that is going to get them to do //
 >the right thing. But then frequently because of limitation//
 >of resources the gap between current status and the right thing//
 >is so big, and the danger of yourself being discredited is so //
 >extremely high currently, //

// when there is chance of discredit, there is equal chance// of credit. Avoid speaking/writing altogether when you’re// afraid of discredit.// //

 >that I choose to err on the conservative side in risk communication, //
 >knowing that even the conservative and expert estimate of 2 or 2.5% //
 >will require far more than any of these folks are likely or able//
 >to commit to doing. //
 >Rather than freak them out and have the door shut in your face. //
 >It is a personal choice. //

// we want scientific fact here, it is important.// Not just fine smalltalk and nice behavious.// //

 >anon_22 at 00:47 //
 >A thought occur to me: were doctors licensed in 1918? //
 >Does anyone know? It is in John Barrys book, I think. //

// sort of licence. But he complained about the standards.// And in the pandemic they took almost anyone.// // // //

 >clark at 01:12 //

// yes there are 2 papers about these estimates.// I found a reference in the CIDRAP-guide// //

 >As Mark Twain said There are lies, damned lies and statistics.//

// is Mark Twain a scientist ?// //

 >If you have to resort to statistics to support your point of view,//
 >well, IMO, you are on thin ice.//

// if you have no statistics to support your point of view,// well, IMO, you are on thin ice.// anon_22 at 01:53// //

 >> The population of 1.8 billion in 1918 is an accurate number.//
 > Really? How did you arrive at that? //

// it is pretty exact. No one really doubts it. It could be 1.6 or 2.0,// but that is within the margins of the other uncertaineties.// //

 >a pandemic with H5N1 likely to be devastating, the answer is Yes.//

// that is much more debatable// //

 >(btw, Monotreme and I were the lone voice for a long time about//
 > a very high CFR.) //
 >If you are saying that suggestions that CFR must fall are not //
 >supported by hard science and CFR may not fall, or may not fall//
 >a lot, therefore let us not be complacent, then Yes. //

// it may fall. We must try to estimate how likely it is and how much// it might fall. Just saying : it need not fall is not enough.// //

 >If you are saying that the CFR for H5N1 pandemic in 2006 has//
 >to be very high, I would disagree. //
 >If you ask me to give an educated guess, gut feeling, place //
 >a bet as if I am in a casino,//

// no need to go to a casino. We bet all the day intuitively on all// sorts of things. Guesses and gut fellings as you call it are// very common in science. Rarely (never) are you 100% certain.// //

 >I would say it could be anything between 2 - 50%, with a median //
 >of approximately 30%, based on my limited understanding of virology //
 >and epidemiology, as of now. But that could change as information //
 >becomes available. //

// yes, thanks for the estimate of 30% . Don’t know what you mean with// median here. I think, it’s lower , say 10%. And I assume you agree,// that most expert’s anticipated estimates are closer to my 10% ?!// //

 >If you are saying do I think the CFR for 1918 was 2.5% or was//
 >it higher, I would say, a rough overall guess is that it was higher.//

// yes.// //

 >But there were local variations due to many factors, just as there//
 >will be if we have a pandemic in 2006, so one must be careful how //
 >you interprete such numbers. //

// of course. It’s the global CFR.// //

 >If you ask me how much higher, I would ask you a question back //
 >and say for what purpose are you asking this question? //

// the true answer of that question cannot depend on the purpose.// It seems that you are trying to give deliberately a wrong answer// if it serves a certain purpose.// //

 >If it was for intellectual curiosity, then good for you, please//
 >go and do more research and share the information, but remember//
 >to also share all the limitations of the data. Remembering that//
 >all data has limitations. //
 >BTW, notice I carefully choose not to condemn people who disagree,//
 >whereas you have no qualms in doing so persistently, as in //
 >As Mark Twain said: There are lies, damned lies and statistics//
 >If you want more exact estimates to prove a point, I would say//
 >what point? To prove people are liars? Then what? //
 >To prove you are right? Then what? //
 >If your point, which by now I am very sceptical about, is to //
 >facilitate pandemic preparedness in communities or governments,//
 >then I would say use whatever number works for you. //

// that is not what the government pays the scientists for.// //

 >Just do not tell me that I lie because I use it differently. //

// he cannot know whether you lie. It is an estimate.// Just if you are permanently wrong with your estimates,// that reduces your credences of a good estimator and people// might start weighting your estimates lower and concentrate// more on other people’s estimates.// //

 >And THAT is not even close to the sum total of my point of view.//

// of course not. You still gave no estimate about the threatening// H5N1-pandemic.// //

 >anon_22 at 01:57 //
 >For everyone else, //
 >This conversation between clark and myself is NOT a vendetta //
 >or whatever. There are important issues being thrashed out, //
 >including science, communication, ethics, personal prejudeices,//
 >to name a few. //
 >If we have a pandemic, ALL of these and more will come up for//
 >resolution for a lot of people.//

// very good. Not so long ago you attacked me for repeatedly // asking these questions here.//

sorry for the formatting. I hope this is better:

 >Martin Meltzer of the CDC and I have had several long discussions
 >about the use of numbers.

looks like some philosophy of math,logics,set-theory…

 >Even though he is an economist(think 
 >number cruncher) and policymakers hound him for numbers, 
 >his point of view, and I concur, is that straight numbers are
 >meaningless and misleading 

what are “straight” numbers ?

 >without accompanying understanding
 >of how one arrived at them,

that holds maybe for a teacher who has to decide whether the
student does understand the approach.
It doesn’t hold, when it’s clear that the approach is understood
and tested, e.g. an established computer program.

 >what are the confidence limits, 
 >the context in which these data was collected, sensitivity 
 >analysis, and so on.

it’s up to the operator to decide this, and the other experts 
to check it. But don’t bother the average reader with the details,
how the result was achieved.

 >What you get depends as much on what questions you asked 
 >and how you asked them as the data that you collect. 

sure. Proper interpretation is important.

 >In other words, Garbage in, Garbage out. 

Meltzer is one of those who even early in 2004 worked on
models to predict the likelyhood and impact of a pandemic.
But he did _not_ answer a clear formulated question about
his subjective probability estimate.
(what’s your subjective estimate of the probability that
there will be more than 1e8 panflu deaths in the next 10 years)
Now what he is trying here to explain to you looks just
like an excuse, why he does not _want_ to give his estimates.
Clear question in, void out.
You must question the whole sense of the analysis, when the
decisive conclusions are withhold.

 >If I look at 1918 and ask those same questions, immediately 
 >what comes up for me is that the degree of accuracy varied 
 >widely all over the world. Where does one start? Sure, you 
 >can start with China or Gambon, but let us say I am kinda 
 >lazy (or my research grant is running out soon) and just want
 >to start with what appears to be relatively accurate for a 
 >first assessment, I would start with data from US or British
 >cities. It does not mean that I ignore Gambon, but I am 
 >hypothesizing that the accuracy for Gambon would be a lot
 >less than US, and that gives me an index or reference point
 >to work from. 

so what ? Of course you should use the best data available
and make the estimate as good as you can.
Others will use the same data and give their own estimates,
based on their interpretation and experience.
Some other person might start with Gambon.
Some third person might read both approaches and find an even
better estimate etc.

 >Let us say some of the mortality figures were taken from health
 >department records because doctors were required by law to report
 >flu cases. Since CFR = no of deaths/no of clinical cases, the
 >accuracy or confidence with which you can declare your CFR 
 >accurate depends on many things. To name just a few: 
 >…

not necessary. However long that list is, it can be extended.
It’s not necessary for the reader to dig into the details. 
The question is clearly formulated.
Let’s just compare the answers. You don’t want every reader to
elaborate on it, that’s what we have the experts for.
The differences in the answers depending on these “things”
is not very big anyway. It gives some uncertainety, but the
estimate is still useful.

 >Garbage in, garbage out.

it’s not important what happens on “Garbage in”.
It’s important what happens when the input obeys to 
the rules and can be processed. Some programs even then
produce garbage.



 >anon_22 at 00:36 
 >Since there is little accuracy or hard science to fall back on, 
 >how you communicate becomes a matter of personal choice. 

but some choice it better than the other

 >And some people are more pragmatic than others. 
 >For me, I would try to assess whether someone:
 >1 have close to zero idea of what a pandemic is and what is H5N1
 >2 have little time, patience, tolerance for complexity
 >3 have a vested interest or resistance to preparing
 >4 demands a quick answer by way of probability or percentage
 >5 requires those numbers to convince their boss, spouse, 
 >  the finance department, their subordinates
 >6 needs to be motivated by fear
 >7 goes into denial or complete paralysis and unable to take
 >  action if there is too much fear
 >8 is likely to shoot the messenger 
 >9 is likely to be shot by others for being the messenger 
 >and so on. 

so, you assume being asked by someone. And then you select your
answer depending on the personality of the questioner rather than
the scientific truth ? The same question produces different answers
depending on _who_ asks ?

 >and use whatever method that is going to get them to do 
 >the right thing. But then frequently because of limitation
 >of resources the gap between current status and the right thing
 >is so big, and the danger of yourself being discredited is so 
 >extremely high currently, 

when there is chance of discredit, there is equal chance
of credit. Avoid speaking/writing altogether when you’re
afraid of discredit.

 >that I choose to err on the conservative side in risk communication, 
 >knowing that even the conservative and expert estimate of 2 or 2.5% 
 >will require far more than any of these folks are likely or able
 >to commit to doing. 
 >Rather than freak them out and have the door shut in your face. 
 >It is a personal choice. 

we want scientific fact here, it is important.
Not just fine smalltalk and nice behavious.

 >anon_22 at 00:47 
 >A thought occur to me: were doctors licensed in 1918? 
 >Does anyone know? It is in John Barrys book, I think. 

sort of licence. But he complained about the standards.
And in the pandemic they took almost anyone.



 >clark at 01:12 

yes there are 2 papers about these estimates.
I found a reference in the CIDRAP-guide

 >As Mark Twain said There are lies, damned lies and statistics.

is Mark Twain a scientist ?

 >If you have to resort to statistics to support your point of view,
 >well, IMO, you are on thin ice.

if you have no statistics to support your point of view,
well, IMO, you are on thin ice.
anon_22 at 01:53

 >> The population of 1.8 billion in 1918 is an accurate number.
 > Really? How did you arrive at that? 

it is pretty exact. No one really doubts it. It could be 1.6 or 2.0,
but that is within the margins of the other uncertaineties.

 >a pandemic with H5N1 likely to be devastating, the answer is Yes.

that is much more debatable

 >(btw, Monotreme and I were the lone voice for a long time about
 > a very high CFR.) 
 >If you are saying that suggestions that CFR must fall are not 
 >supported by hard science and CFR may not fall, or may not fall
 >a lot, therefore let us not be complacent, then Yes. 

it may fall. We must try to estimate how likely it is and how much
it might fall. Just saying : it need not fall is not enough.

 >If you are saying that the CFR for H5N1 pandemic in 2006 has
 >to be very high, I would disagree. 
 >If you ask me to give an educated guess, gut feeling, place 
 >a bet as if I am in a casino,

no need to go to a casino. We bet all the day intuitively on all
sorts of things. Guesses and gut fellings as you call it are
very common in science. Rarely (never) are you 100% certain.

 >I would say it could be anything between 2 - 50%, with a median 
 >of approximately 30%, based on my limited understanding of virology 
 >and epidemiology, as of now. But that could change as information 
 >becomes available. 

yes, thanks for the estimate of 30% . Don’t know what you mean with
median here. I think, it’s lower , say 10%. And I assume you agree,
that most expert’s anticipated estimates are closer to my 10% ?!

 >If you are saying do I think the CFR for 1918 was 2.5% or was
 >it higher, I would say, a rough overall guess is that it was higher.

yes.

 >But there were local variations due to many factors, just as there
 >will be if we have a pandemic in 2006, so one must be careful how 
 >you interprete such numbers. 

of course. It’s the global CFR.

 >If you ask me how much higher, I would ask you a question back 
 >and say for what purpose are you asking this question? 

the true answer of that question cannot depend on the purpose.
It seems that you are trying to give deliberately a wrong answer
if it serves a certain purpose.

 >If it was for intellectual curiosity, then good for you, please
 >go and do more research and share the information, but remember
 >to also share all the limitations of the data. Remembering that
 >all data has limitations. 
 >BTW, notice I carefully choose not to condemn people who disagree,
 >whereas you have no qualms in doing so persistently, as in 
 >As Mark Twain said: There are lies, damned lies and statistics
 >If you want more exact estimates to prove a point, I would say
 >what point? To prove people are liars? Then what? 
 >To prove you are right? Then what? 
 >If your point, which by now I am very sceptical about, is to 
 >facilitate pandemic preparedness in communities or governments,
 >then I would say use whatever number works for you. 

that is not what the government pays the scientists for.

 >Just do not tell me that I lie because I use it differently. 

he cannot know whether you lie. It is an estimate.
Just if you are permanently wrong with your estimates,
that reduces your credences of a good estimator and people
might start weighting your estimates lower and concentrate
more on other people’s estimates.

 >And THAT is not even close to the sum total of my point of view.

of course not. You still gave no estimate about the threatening
H5N1-pandemic.

 >anon_22 at 01:57 
 >For everyone else, 
 >This conversation between clark and myself is NOT a vendetta 
 >or whatever. There are important issues being thrashed out, 
 >including science, communication, ethics, personal prejudeices,
 >to name a few. 
 >If we have a pandemic, ALL of these and more will come up for
 >resolution for a lot of people.

very good. Not so long ago you attacked me for repeatedly 
asking these questions here.
>><<

Corky52,

“You all dance around the real question, will the death toll be high enough to break down social cohesion and the working of society?”

I quote Guiliani, the then NY mayor, spoken on 9/11/2001. “The numbers will be more than any one of us can bear.”

anon_22, you are just thrashing around, muddying the waters. All I am talking about is the worldwide average CFR from 1918 and how that simple range of percentages (say 9% to 28%) could influence planners when they decide to stock up tamiflu for the guys and gals who put chlorine in the City water supply.- or who are going to decide whether to buy good masks for the police force. Or decide how much food to stockpile down at the phone exchange in case they all have to quarentine. Should we get a good stock of fuel for the power station. The potential lethality of the bug will help planners, plan. There seems to be a consensus that 1918 is the Worst Case Scenario. OK

You are taking this too personally. You are anonymous#22- no name, no body. None of what I am saying is about you personally.

Incidently, I am at a University and work with statisticians quite regularly. The Mark Twain quote is about the use of statistics. My statistician says it all the time.

anonymous,

(I and probably a lot of people reading this would prefer that you are not anonymous, but we respect your choice.)

Thanks for your long comments. I am going to be offline soon so I haven’t read all of it. I will give a brief big picture view.

I think it is healthy to have debate, we need it. Really I do, otherwise I would not have spent so much time doing this (and I have a flight to catch.)

It is also healthy to understand and respect that people have different learning styles, different communication styles, live in different communities/countries where conditions vary.

It’s called diversity.

I think it is also important to separate debate and accusations and innuendos and attacks on people’s integrity, without justification.

clark in his posts on this thread has twice stepped over that line, first by implying racist attitudes where none existed, and second, implying lying where none happened.

THAT is not acceptable.

If anyone else think my approach as described above 00:36 constitute lying, please re-read every word that I have written on this subject, and if you still think so please say it and explain.

I choose the way I think. I choose the way I approach life. I clearly and freely declare that this is my personal choice. You don’t have to agree.

I am clear on my own integrity.

I will not bow to half-truths and pseudo-logic.

anon_22,

What a cop out! 2 million deaths will mean one thing, 20 million another and 100 million yet another! Death will happen and we will have only two choices, bear it and go on or give up and die. Cold blooded and subhuman as I am, I’m far more interested in the possible outer limits of what I’ll have to cope with than political platitudes.

anon_22 at 02:43

 >I quote Guiliani, the then NY mayor, spoken on 9/11/2001.
 >The numbers will be more than any one of us can bear.

Just rhetorics. For some (religious,ethical) reason US-people like to hear such things. He was clearly wrong with that.

 >clark at 02:47 
 >anon_22, you are just thrashing around, muddying the waters.
 >All I am talking about is the worldwide average CFR from 1918
 >and how that simple range of percentages (say 9% to 28%) could
 >influence planners when they decide to stock up tamiflu for
 >the guys and gals who put chlorine in the City water supply.
 >- or who are going to decide whether to buy good masks for 
 >the police force. Or decide how much food to stockpile down
 >at the phone exchange in case they all have to quarentine. 
 >Should we get a good stock of fuel for the power station. 
 >The potential lethality of the bug will help planners, plan.
 >There seems to be a consensus that 1918 is the Worst Case 
 >Scenario. OK 

yes, but don’t you agree that this reliance on 1918-data is very unsatisfactory anyway , no matter what CFR you assume ? Take actual H5N1-expert-estimates instead. Average over all expert-estimates available. Hey, that’s their task to work out estimates where the communities should base their preparations upon !

 >You are taking this too personally. You are anonymous#22- 
 >no name, no body. None of what I am saying is about you personally. 
 >Incidently, I am at a University and work with statisticians quite 
 >regularly. The Mark Twain quote is about the use of statistics. 
 >My statistician says it all the time.

sort of humor, I assume.

anon_22 at 03:03

 >anonymous, 
 >(I and probably a lot of people reading this would prefer that
 >you are not anonymous, but we respect your choice.) 

you know who I am and most others too. I’m one of the few non-anonymous here with email, homepage, profile, 9 years of active internet posting history available at deja.com and as many posts here as you, #22.

 >Thanks for your long comments. I am going to be offline soon
 >so I have not read all of it. I will give a brief big picture view. 

OK.

 >I think it is healthy to have debate, we need it. Really I do, 
 >otherwise I would not have spent so much time doing this (and I
 >have a flight to catch.) 
 >It is also healthy to understand and respect that people have 
 >different learning styles, different communication styles, 
 >live in different communities/countries where conditions vary. 
 >It is called diversity. 
 >I think it is also important to separate debate and accusations
 >and innuendos and attacks on peoples integrity, without justification. 
 >clark in his posts on this thread has twice stepped over that line,
 >first by implying racist attitudes where none existed, and second, 
 >implying lying where none happened. 
 >THAT is not acceptable. 

even if true, he clarified and I see not so much a problem here. There is no real disagreement about the 1918 figures or racism, right ?

 >If anyone else think my approach as described above 00:36 
 >constitute lying, please re-read every word that I have 
 >written on this subject, and if you still think so please
 >say it and explain. 
 >I choose the way I think. I choose the way I approach life.
 >I clearly and freely declare that this is my personal choice.
 >You do not have to agree. 
 >I am clear on my own integrity. 
 >I will not bow to half-truths and pseudo-logic.

no problem with your integrity and personal choice. But this debate is about what estimates the panflu preparings should be based upon and the difference easily is worth thousands of lifes and billions of $. So it is not just a matter of personal choice or approaching life.

oops, sorry. Formatting again. You have to include double slash-backs after each line. Let me try again:


anon_22 at 02:43

>I quote Guiliani, the then NY mayor, spoken on 9/11/2001.
>The numbers will be more than any one of us can bear.

Just rhetorics. For some (religious,ethical) reason US-people
like to hear such things.
He was clearly wrong with that.


>clark at 02:47
>anon_22, you are just thrashing around, muddying the waters.
>All I am talking about is the worldwide average CFR from 1918
>and how that simple range of percentages (say 9% to 28%) could
>influence planners when they decide to stock up tamiflu for
>the guys and gals who put chlorine in the City water supply.
>- or who are going to decide whether to buy good masks for
>the police force. Or decide how much food to stockpile down
>at the phone exchange in case they all have to quarentine.
>Should we get a good stock of fuel for the power station.
>The potential lethality of the bug will help planners, plan.
>There seems to be a consensus that 1918 is the Worst Case
>Scenario. OK

yes, but don’t you agree that this reliance on 1918-data
is very unsatisfactory anyway , no matter what CFR you assume ?
Take actual H5N1-expert-estimates instead.
Average over all expert-estimates available.
Hey, that’s their task to work out estimates where the
communities should base their preparations upon !

>You are taking this too personally. You are anonymous#22-
>no name, no body. None of what I am saying is about you personally.
>Incidently, I am at a University and work with statisticians quite
>regularly. The Mark Twain quote is about the use of statistics.
>My statistician says it all the time.

sort of humor, I assume.





anon_22 at 03:03

>anonymous,
>(I and probably a lot of people reading this would prefer that
>you are not anonymous, but we respect your choice.)

you know who I am and most others too. I’m one of the few non-anonymous
here with email, homepage, profile, 9 years of active internet
posting history available at deja.com and as many posts here as you, #22.

>Thanks for your long comments. I am going to be offline soon
>so I have not read all of it. I will give a brief big picture view.

OK.

>I think it is healthy to have debate, we need it. Really I do,
>otherwise I would not have spent so much time doing this (and I
>have a flight to catch.)
>It is also healthy to understand and respect that people have
>different learning styles, different communication styles,
>live in different communities/countries where conditions vary.
>It is called diversity.
>I think it is also important to separate debate and accusations
>and innuendos and attacks on peoples integrity, without justification.
>clark in his posts on this thread has twice stepped over that line,
>first by implying racist attitudes where none existed, and second,
>implying lying where none happened.
>THAT is not acceptable.

even if true, he clarified and I see not so much a problem here.
There is no real disagreement about the 1918 figures
or racism, right ?

>If anyone else think my approach as described above 00:36
>constitute lying, please re-read every word that I have
>written on this subject, and if you still think so please
>say it and explain.
>I choose the way I think. I choose the way I approach life.
>I clearly and freely declare that this is my personal choice.
>You do not have to agree.
>I am clear on my own integrity.
>I will not bow to half-truths and pseudo-logic.

no problem with your integrity and personal choice.
But this debate is about what estimates the panflu
preparings should be based upon and the difference
easily is worth thousands of lifes and billions of $.
So it is not just a matter of personal choice or
approaching life.
>><<

I understand people’s desire to get certainty by those numbers.

But consider this: At the current time, there is no community, hospital, country that is fully prepared for a pandemic even with a 0.5% CFR. What is the chance of them being prepared for a 2.5% CFR in the immediate future, say 6 months? With all the goodwill in the world (and you may not have that, especially if you get the door shut in your face for scaremongering), starting immediately today, most communities and governments will still not be able to achieve that.

Unless and until they have adequately prepared for a pandemic with a 2.5% CFR, for example, it may be counter-productive to push beyond that AT THE PRESENT TIME.

Recommendations based on (currently) unreachable goals have a high chance of being rejected, together with whatever wonderful ideas that you may have.

We can discuss 1918 or 2006 CFR here, that’s fine. We all have our opinions.

The problem is that there is only 24 hours a day, and so much to be done. We all have to choose how we spend our time.

I am interested in the easiest, shortest, path to achieving an important (albeit insufficient) goal: to get communities & countries prepared as best they can for a pandemic of 1968 severity first, then for 1918 type severity if resources allow, knowing that whatever they or I do, a lot of people will still die and there will still be a lot of heartache. Knowing full well that with all the goodwill in the world, there will be things that you cannot prepare for because they are unexpected, because the solution is beyond your/their capability, because your numbers were wrong, or simply because at a moment of weakness, you gave up.

But you still do it anyway.

At the end of the day, it may be more important to focus on what we can do than whether we are right.

anon_22.

I think that is what we are all passionate about here: to save lives.

there are important nuances of uncertainety, best expressed by numbers for probabilities. It’s not just hospitals. It’s quarantine, protect essential workers, coordination with other departments elections, treaties, war, civil war,etc. For privates it’s not just getting food, it’s moving, getting financial plans, jobs, preparing for school, studies, job-education… At some probability level your whole future planning might dramatically change.

Anything beyond 2.5, we’re screwed anyway.

You can only prepare up to a certain point, beyond that it is a case of diminishing returns.

I wonder what Sandman and Lanard have to say about all this.

My own (shaky as gelly) position, right after reviewing this thread:

• We don’t know, so we should say so to start with. My own estimates change several times a day. A picture taken by someone with a bad case of tremor.
• We must use our own best judgement as to how to communicate risk to others, balancing “truth” and “guess” and “need for action”. This “must” is not an ethical thing: it’s simply that we have nothing better to rely on. Each of us is as alone as can be on this. Yes, we can comment on this forum, ask for comments etc. But when confronted with some other individual or group, we have no choice but to follow our instinct.
• I’d rather see some preparation going on, rather than no preparation at all. (We’re together in this. Let’s share how we think this could be done.)
• Looking at things from the other person’s point of view:
  • I believe there’s a feed-backed loop between preparation and awareness: first you’re a little concerned, then you prep a little, then you become even more concerned, and so on. So it may not be a one-off sort of thing.
  • If we’re lucky, we’re starting a conversation with the other person. We don’t want to shut communication off. Maybe we should focus not so much in How we speak but also on How we listen? Would that make us more effective in getting people to prep (prep a little, then prep some more)? What are our experiences regarding this?
  • That other person receives other inputs and not just our own. So it’s a cummulative thing.
  • If we’re really lucky, those we speak with will in turn speak with others. It’s the only way a wide-enough preparation will happen, I think.

Strange little cells, we are. I’m curious as to how we’ll help the body to prep.

yes, when death is certain you can do what you want. But even in the Webster-scenario 50% will survive. When we can make it 60%, that’s worth some billion $ !

“When we can make it 60%, that’s worth some billion $ !”

What is that supposed to mean?

10% more survivors , the effect of preparaction (measured in $) even increases when the expected number of deaths increases. 2% or 3% CFR is not so big a difference than 50% vs. 40%. Of course you can say 40% CFR is too bad to even think at - people won’t accept any preparation for that. For the hospitals it won’t matter. But maybe for quarantine, social order maintaining, organizing of infrastructure.

only if you think they can improve their non-existent preparations from 40% mortality to even better preparations for 50% mortality.

Think global act local is as poignant today as it was 20 years ago as a green slogan. Survival begins and ends at home

It’s a matter of politics. You would change laws. You would have martial law. I think, with 40% mortality any of the quarantines considered useless in the MIDAS studies are starting to make sense. These studies assume 2% CFR , and then a complete quarantine is considered too expensive. But I wonder what the calculations are with 40% CFR. You’d also buy better protective cloths for the workers with 40% CFR. You won’t treat normal cases in hospital then, maybe even close the whole hospital. There might be strict curfew and people will be forced to work. These things might be overreacted with 2% CFR but make sense with 40% CFR.

I wonder if TPTB have fallen victim to their own internal propaganda.

What if people at the very highest level of govt consider that the publication of the prospect of a CFR greater than 1918 is too hard for people to stomach and accept, and act on. Therefore they focus on what may be considered more acceptable i.e a 2.5% CFR as a worst case. This is then the formal pandemic ‘position’ at highish, medium and lower levels of govt; all departments, those in a positition to plan, act, etc take this literally. This then feeds back up to the decision making levels (via their plan conclusions etc) as the worst case scenario and decisions are made accordingly.

Thus planning becomes sub optimal.

It doesn’t matter what number gets pulled out of the hat, as a possible threat, if the seriousness does not get communicated to the population. How many people are going to know to read the government web site? The media covers a few headlines, “someone else died”, with a final closer of “experts fear the virus may mutate into…”. That’s as far as most people know about bird flu. Individual self sufficiency would have the biggest effect in preserving lives and social order. The Federal Government can not solve the problems without the people and communities totally preparing, for what a pandemic can do.

anonymous in the middle of your 4:25 post- “you know who I am and most others too. I’m one of the few non-anonymous here ..” I give up! Can anybody clue me in on who this is? You appear to be a new but knowledgeable poster, unfamiliar with the formatting surprises, and a distinctive style of slicing and dicing up other people’s posts. The last records I saw of this site show “anonymous” with 1447 posts. I believe you would not want to be credited with the quality of most of those posts. Can you distinquish yourself somehow by capitalizing all the letters? Any nickname will still be just as anonymous, and some people switch names for a new personna.

Put very simply, the CFR (case fatality rate), is your chance of dying if you get sick. It is a very very important number for people to come to grips with- because it is the single numbers (the odds) that you will use to make decisions. We know that cancer has a high CFR- so we give up smoking. We know that AIDS has a high CFR, so we don’t engage in dangerous practices. Chickenpox has a low CFR, so it doesn’t much affect our behavior. The CFR dramatically effects the way the community behaves.

In most peoples minds, the Flu has a low CFR, so in the case of a pandemic, they will wash their hands more often, take Vitamin C in the morning, send the kids off to school and head off to work. They are acting on the CFR data that is common knowledge about the annual flu.

If you thought your chance of dying if you got sick was one in a thousnad, or one in a hundred- you would modify your behavior. If you thought your chance of dying was one in ten or one in five or even one in 3 or 2- you would act differently again.

People have got to know the odds. Not to tell them is (“unethical” is not the word- I won’t even try and use a word for this-).

Anonymous at 9.09 is right on the button.

Clark,

In good conscience, we can’t tell them any CFR. We don’t know what it will be when it eventually becomes efficiently transmissible between people. Any number given would be nothing more than a guess.

I decided sometime back to base my decision to work/not on CFR. As I work in a hospital, that may not last long in any case. BUT, ther will still be places to go to get care; community centers, MASH units clinics. People will continue to crash cars, have heart attachs, ect. At what CFR will I just go home and stay for awhile? At this point I do not know.

clark – at 16:35 “People have got to know the odds. Not to tell them is (“unethical” is not the word- I won’t even try and use a word for this-).

I agree. But I am unsure just what most people will do with this information. I do not assume that they would use it as I do. Education, education. Most people are not concerned. I have come to believe, like some others here, that most will not pay attention until people they know start dieing. Kelly

clark at 16:35 - it sounds as though you think normal flu has a CFR of less than 1 in 1000. Not so. (0.35% is what’s usually quoted, I think, i.e. 3.5 per 1000).

We tend to underestimate many of the risks of everyday life. I was shocked to find that today, in developed countries, around 1% of babies die around the time of birth, for example. (And it makes sense: when I think about it, I know of two among the children of my friends, which is about right - but I thought I was unlucky to know that many, rather that about average.)

Melanie, don’t we have to give some sort of worse-CFR-than-you-expect-for-seasonal-influenza-and-your-demographic-group ?

- also because a new, pandemic, strain will have a relatively high attack rate, and even if you might not die if you were the only case in your hospital, you certainly might die from lack of proper care just because so many, including medical and support personal may be ill too, and supplies used up when no supply chain functioning.

The excuse for not telling the public I have heard is that, “they are foolish and don’t listen; see how many still smoke and still have unprotected sex?”

But, the public would listen, if they knew pandemic influenza, unlike cancer or HIV, could have them or their children dead in a week or two.

Things that affect their health years down the road should not be classed with their interest to take action against a deadly disease we have no protection or cure for currently. (Then, the public official line flops to “We can’t tell them that, or they’ll ‘Panic’ !”)

Certainly we have to say a pandemic could be worse than they expect, and, systems will surely collapse as soon as it starts if we don’t make better contigency plans and preparations now. We are all unused to emergencies that last months, or when we cannot rely on mutual aid/outside resources to come help. (Not to mention not used to having many young healthy people die from disease in the US.)

With people contagious before they feel sick, our hyper-travelling world, and, the fact the virus doesn’t have to drop the virulence segment to grab the very-contagious segment (unlike a toddler with a toy in each hand who is eyeing a cookie) I am afraid the mortality rate does not have to drop as low as we’d need it to to keep functioning the way some assumptions/current plans paint as possible.

Public education needs a fuller explanation, even 2.5 is a dangerous rate, but it means nothing without the public understanding it. The government doesn’t seem to want the public to be motivated to do much of any preparing. Why?..I do not see what harm could come,to calmly explain the need for storage of food,(more than a week),water, and alternatives to no power. Instead, the government, not the poultry industry, is paying for commercials, with our tax dollars, to encourage us to keep eating chickens!!- http://tinyurl.com/m3c8t

That makes me clucking mad!! They obviously have no intention to put anything into preparedness communication - one of their three big pillars.

Well, we know what a 3-legged stool with 2 legs does.

“He’s no fun; he fell right over!”

You’re right, NJPreppie; the public is not ready -even if 30% to 50% got ill and didn’t die, the supply chain, power grid, medical care, security, ect, would collapse, as things are right now.

crfullmoon. I have a bit of a problem with Governments and Regulators (WHO) from a philosophical, ethical and functional approach to the issue.

The way I see it, a pandemic is imminent, within twelve months from today, and very well could start in the fall of 2006.

Okay, we all agree that 2.5 % is unrealistic and the probable CFR is potentially much higher. This has also been confirmed by many experts in the field of animal-human virology.

So we have higher CFR’s (mortality)which do not include survivors with serious quality of life issues, which does not include deaths and injury from collateral damage, loss of infrastructure.

The point is…what is the point of avoiding the relative potentials now to deal with them for real in a very short period of time.

If it breaks in the fall, what exactly is their plan at that point.

The point is if you spin long enough…you start to smoke the very dope you’re supposed to be selling…I think they have forgotten the truth and are buying their own spin…This is the most dangerous situation a regulator can be in because they are in charge of preparing the Governments of the world (remember that 2–7 million worldwide estimate one year ago).

The way I see it, a pandemic is imminent, within twelve months from today


what do you base this upon ? Is it just only your (unsubstantiated ?) prediction or are there also experts who give similar predictions ?

“People are, smart. Yhey can handle it” J

“A person is smart. People are stupid, panicky animals, and you know it” K

The process is slow but dropping “death odds” on people who are not somewhat knowledgable will probably not yield a good reaction.

The Innorant and Incorrect can be worked on. CFR as it relates to 2 million or 5 million doesn’t really change anything. A number we can confirm after the fact but useless to argue about now. How many dead? “Like the stars”

Too many is a good number for me.

rrteacher, now go to the local pandemic preparing officials and tell them that. What rational should they base their spendings on ? They could as well prepare for earthquakes,meteorites,revolution, measles,rain,smog,narrow streets, … anything. They must somehow select priorities, so they need numbers.


How can you best invest the $xxx which you have to safe the most expected lifes possible ?

rrteacher,

There are no data upon which to make any predictions. None.

anonymous,

chose a handle so we can get to know you.

People understand odds. They know that if they get drunk and drive, bad things can happen. They know about the odds with illegal drugs. They know about the odds with mountain climbing. We take risks all the time.

Telling people what the CFR was worked with AIDS and cigarette smoking (cancer). If someone continues to smoke and then gets lung cancer- we are sorry, but they were given fair warning. Not so in the 30s and 40s when people were told that smoking was good for their lungs!

People need to be told the truth about the 1918 world wide CFR figures (>10%) and the truth about what we know about H5N1 (>50%) so far. What people do with the information is their responsibility.

One of the anonymous’ made a great point. A CFR of 2% makes it too expensive to close boarders. A CFR of 15% (I am just making up numbers here) makes it too expensive to keep boarders open.

A 2% CFR pandemic- it makes sense to spend $10 billion on tamiflu, hospitals and gowns.

A 15% CFR pandemic, it makes more sense to spend the $10 billion on rice, milk powder and beans for the population sheltering at home-and on space suits, rations and positive pressure accomodation for water, electricity, refuse, police and mortuary workers. Forget about the hospitals

A very high CFR means that you do not want to get sick- the way you do not get sick is to not be exposed to the virus- everybody just quarentines. Those that do not, must face the consequences. (If you are afraid of getting sunburn- do not go sunbathing- it is simple)

My understanding is that simple quarentine is the single most effective way to deal with a high CFR infectious disease. The interesting thing is that is not that expensive- Money that was to be spent on a couple of courses of Tamiflu could buy alot of rice and beans.

The thing about quarentine to be effective- people have to be willing to give up their important lives for 3 months or whatever- BEFORE the pandemic takes hold. Once every family has at least one family member infected with the virus- whether from working at the hospital, or regular work or kids from school or their school friends- then we are in trouble - because it is then endemic. This is all conjecture- I am making this up.

We have to be willing to stop everything for awhile- if the shit hits the fan and we have a high CFR flu pandemic

I only have my small part to do. Working in healthcare, I have carried the message to a few and now to many. For us, it will be in the details. What do we do and how do we do it? Need more data? Yes. But we already know a lot. We are anticipating effects of the virus on people and on health care processes. We have enough experience and knowledge to predict what actions to take. We are addressing problems one at a time. It’s work in progress. I have sent this document to most of the 50 states and Canada, to RTs and disaster people. I have sent it to HHS leaders and academics working on Panflu. Its merit is not in the answers but in the questions is asks. I have only been around for abour 8 months on this problem, but in that time, I have seen a lot of people change. I just can’t think and scream at the same time.

Dem has been nice enough to post our early work here. Here is a link to our post. http://tinyurl.com/gznsl

Melanie, lots of data. Lots. No handle, no cookie. Argue about the arguments themselves without discrediting the arguer.


Clark, agreed. The thing about self-quarantine and how well it works should be examined in a study. The MIDAS-computer simulations seem to indicate that it won’t help a lot. But they might have made unrealistic assumptions. There is no official study how to make a lodgement panflu-isolation-proof. Whether and how long people can isolate, how to handle and protect essential workers etc. Probably because the models assume a small CFR and strict isolation doesn’t make too much sense. But with high CFR it makes a lot of sense. This has to be examined ! Only planning for small CFR is insufficient.

anonymous at 3.33 is the anonymous I referenced at 3.07.

On strategic risk communication and the use of numbers:

If I want to get an interview with a senior official, for example, you think I can just turn up and talk to them? Everyday they have people knocking on their doors, people who are passionate about all sorts of pet causes, probably half of them nutcases giving some sort of doomsday warning if the government does not do X.

No, they have ‘gate-keepers’, mid-level Harvard/Oxford graduate types who will look at your brief and decide whether you should be one of the lucky few who will get through the door. So you give them your brief, what’s the first thing they ask? You bet it’s going to be something along the lines of “Where did you get the data?” or “Who says? What does (name of expert) say about this?” (BTW chances are they have done more calculus than you and have more names in their book to throw around than you.) If you keep in mind that their job is to NOT let you in, why should they go out of their way to help you unless what you are presenting is irrefutable, undeniable, water tight, AND the consequences of not letting you in is far worse?

Say I get through the door.

If I get a 30min interview, I want to spend 5 min explaining pandemic and CFR and 25 min on what to do about it. You think that will happen if I use figures that speak of apocalypse but are not solidly backed by heavyweight references or official agencies?

I give way on a minor point to gain a bigger point. It is about being UNDENIABLE.

So then, what do you think their reaction will be if you give them apocalyptic estimates?

They will either buy it or they won’t.

Those who don’t will kick you out.

Those who do, there is an additional danger: them freaking out so much that they decide to quit, either physically or mentally abandoning the responsibilities or their post.

I don’t want policymakers to get so freaked out that all they can think of is whether they or their family are going to die; they won’t hear anything else I have to say. Those who have their hands on the check books or who will sign the laws need to be steered towards playing win-win. They need to believe that their personal risk is moderate but the systemic risk is high, or that their family are more likely to die from consequences of systemic breakdown than from the virus. Otherwise they will either quit or there will be a big scramble to get their hands on whatever they think will save their lives. I don’t want public resources siphoned off to build bunkers for leaders and their families.

I want a number that will get me through the door and get something going. If you succeed in doing that, there will be time to explain the complexities and consequences and all the rest of it. And to recommend strategies for a higher CFR.

But you gotta get through the door first….

I agree with clark – at 03:07.

anon_22, I understand the problems in getting through to the bureuacracy, but why not start with the current fatality rate of H5N1? This is backed by the WHO. There are now numerous seroprevalence studies indicating that H5N1 truly is a highly lethal disease. I don’t think this is seriously disputed by any credible scientist. Let this be the default position. You can say that we hope that fatality rate will decline if a pandemic strain of H5N1 emmerges, but that this is a hope, not something we can count on. The burden of proof is on the people who claim that the CFR will decline.

As far as adjustment reactions go, it is difficult for me to judge. I went through mine a long time ago, so it’s hard for me to argue what’s the best approach. I accepted that a pandemic might have a very high CFR right from the beginning, but I realize that some people are slowly edging upwards in their estimation of the worst case scenario. It’s like getting into a cold lake. Do you just jump right in or slowly edge in?

Monotreme, Of course I start with the current CFR.

Here’s what I would say: There’s a chance that H5N1 is going to cause a pandemic (blah, blah, blah). We don’t know how many people are going to die. Currently the CFR (of course adapted to laymen terms etc and explained) is at >50%. If a pandemic happens, some scientists hope this number may go down, but there is no solid science to say that is a given. Just to give an idea of the impact of a CFR of say, 20% might mean, there were 3 pandemics in the 20th century, of which 1918 was the most severe. Estimates of worldwide mortality ranges from 20–50 million, but there are indications that it could have been more. The CFR for that is estimated by experts to be 2.5%. So if we have a pandemic with H5N1 as we currently know it, the CFR has an awful long way to drop before we even match 1918, and we know that today the world being so interconnected (etc etc) the chance not just of any individual dying but of catastrophic systemic breakdown is quite high.

anon_22, Your approach (at 09:34) seems reasonable. Do they let you through the door?

anonymous – at 01:40, there is by now, because of the spread across nationsand continents, no way to prevent all contact between humans and species infected with the current H5N1, nor is there any way to know about, test, treat isolate, monitor and report on each human case. Parts of African nations, and other places too, have zero health infrastructure, and people die and get buried every day who were never even known to their governments.

H5N1 has been “unprecedented” in many ways, and it now is so widespread and has access to so many species (list is in the Wiki somewhere) the virus is sort of rolling dice, and rolling dice, in thousands and millions of creatures. Lots of chances to interact with other influenza viruses in wild and domestic birds and mammals too. Humans do not have the money, scope, materials, nor science understanding and motivation among the populace nor the governments to drop everything and stop H5N1 from being a pandemic threat. Impossible.

So, for the first time we have forewarning of an influenza pandemic, but can only watch it happen. We have no way to stop it and no real way to even know if it has started; it may be out and about before it is noticed, verified, and who knows if governments will choose to announce it? Too many past officials in history chose “preventing panic” over telling the public what was known and what was unknown, and having a helpful, co-ordinated response was not possible then, and doesn’t seem very possible now.

H5N1 has only seemed to be going farther down the path to a pandemic; nothing in its behavior so far has made it look like it is stopping or moving away from the possibility of pandemic.

I have no credentials that could get me past gatekeepers. Maybe we have all been just lucky that it hasn’t started already. I haven’t learned anything reading the scientists discussing H5N1 and pandemic viruses that would say we couldn’t have more than one strain go pandemic, or more than one strain in a wave at a time.

Perhaps they should all just drop the numbers and say, anything that will impact our children and our vigorous and healthy reproductive and working-age population, like pandemic influenza (looking at 1918 and, H5N1,) is going to overhwelm the unprepared on all levels, and then, the unprepared also overwhelm the few currently preparing.

“Anything we say before a pandemic happens feels alarmist. Anything that we have done once a pandemic starts seems inadequate. We’re at a greater risk of a pandemic than at any time in decades. We are overdue. And we’re under prepared.” ~”Secretary of Health and Human Services Mike Leavitt, the man charged with preparing America for the next pandemic.

The ones who don’t want to do anything until they know with certainty that pandemic is occurring just haven’t grasped the concept. Preparations, building buildings stronger in better locations,contingency planning, education of the public can’t start when the mega-quake does, nor when a tsunami wave is actually sighted… Pandemic Influenza would be worse natural disaster;it lasts longer and everyone is affected. Wish the officials would see grassroots education as a good use of their time and money too.

 >Here is what I would say: There is a chance that H5N1 is going 
 >to cause a pandemic (blah, blah, blah).

sure, but how big is the chance ?

 >We do not know how many people are going to die. 

sure, but what’s the best prediction ?

 >Currently the CFR (of course adapted to laymen terms etc and explained) 
 >is at >50%. If a pandemic happens, some scientists hope

only some ? We all _hope_ that. But how many scientist do predict it would go down and how much in average ?

 >this number may go down, but there is no solid
 >science to say that is a given.

sure, (almost) nothing is a “given” in pandemics prognosis.

 >Just to give an idea of the impact of a CFR of say, 20% might mean,

why ? They can do the calculation by themselves.

 >there were 3 pandemics in the 20th century, of which 1918 was the
 >most severe. Estimates of worldwide mortality ranges from 20–50 million, 
 >but there are indications that it could have been more. 

best current estimate is 80million deaths (see Woodson in the other thread)

 >The CFR for that is estimated by experts to be 2.5%. 
 >So if we have a pandemic with H5N1 as we 
 >currently know it, the CFR has an awful long way to drop before
 >we even match 1918, and we know that today the world being so 
 >interconnected (etc etc) the chance not just of any individual
 >dying but of catastrophic systemic breakdown is quite high.

“awful long”, “quite high” is not what they need. Give numbers. Unbiased averaged expert estimates.

Hi everyone Intersting discussion. The point I was trying to make was… if it is assumed that we will be in the middle of a pandemic in less than twelve months…what is the point of hiding things now when they are going to hit the listener on the head later…better to have a controlled panic now then a vindictive panic later.

Big enough chance we should prepare. Governments certainly prepare on national and local levels for much less likely events.

Since the US hospital/ER system, (and, most first responder departments) are stretched to the breaking point now, anything at all extra is going to be too much.

People like “gs” wanted accurate estimates and probabilities, but, humans are imperfect and limited in resources, and do not have the data to make accurate estimates. But we can see when things are spun way too low, for reassurance purposes.

And Leavitt saying, no vaccine ammounts for the public for 3 to 5 years from now, no pandemic vaccine until after the first wave and then not enough even for first responders,

and the US CBO expecting each wave to be in an area 3 to 5 months,

and, the federal and state governments telling communities Don’t Plan on us Being Able to Help You

should be enough, no matter what the CFR turns out to be, for communities to be having public meetings of all community “stakeholders”, and, households changing priorities enough to make preparations.

crfullmoon. If I haven’t said it before, you’ve made perfect sense in the past and I hope you continue to make perfect sense in the future.

Yeah, Tom_DVM at 10:45, and I don’t call shoppers emptying shelves now, when supply chains work, “panic” (unless anyone gets injured).

I don’t call people saying, “What do you mean we might die?!” “panic” even if public health and local government officials don’t want to hear public’s adjustment reactions,

nor all the “How will we pay our bills/taxes if we can’t work during a pandemic or the economy goes into a Depression?” questions that there are no good answers for.

Problem is, too many assume we can’t have a pandemic, or that the WHO says we’re only at Level 3 therefore, we must have long stages between all those numbers up to 6:Pandemic.

Or, it is too terrible to think about, so, they want to do nothing, and figure ‘no planning would have helped anyway if it will be that bad’, so, they plan to fail. They still expect the military to save them or something. I think there is much that can be done and should be done anyway, if only in the mass casualty management, (and that will be needed if they aren’t going to do anything else!).

Tom DVM – at 10:45


a “controlled panic now” has unwanted economic and political consequences. People are moving, suspending/modifying their jobs, their treaties, their future planing, their career-planing, their education. Insurance policies were modified or cancelled, people would stop saving for pensions, would stop taking care for health etc. When you have a good chance to die and another good chance for political or economical instability you will concentrate on short-term planning rather than long-term (decades). The government itself might be at risk - they were not elected for pandemics, pandemics were no subject in the last election campaign, so it could be argued that they have no legitimation in a severe pandemic and new elections are required.

etc….

nobody ever said this was going to be easy.

Controlled panic is the lesser of many evils.

crfullmoon at 10:48, “accurate estimate” is a strange expression. An estimate needn’t be very accurate and when there are different estimates you typically take the average and you have a deviation, so this isn’t accurate. There is no point in refusing an estimate just by claiming it weren’t “accurate” and others might differ. But yes, most of the estimates I’ve seen do indeed indicate that current planning and preparing levels should be increased.

Tom DVM at 10:51, thanks, (and I hadn’t realised SARS was the coronavirus-equivalent of the Rock of Gibralter falling into the sea), and I sure wish you could come up and we’d both go around here, because, I don’t seem to be accomplishing much.)

Monotreme, I read your post again and think that maybe you didn’t realize what the big fight here was about. It was about whether it was appropriate for me to act as if the CFR for 1918 was 2.5% and not try to seek or present a higher number. Now do you get my point? That one doesn’t always have to harp on the most awful figures to present a good case.

crfullmoon. Mantra to live by…

   ….Stay calm…be brave…wait for the signs. 

                             (Tom King: Canadian Native Author)

anon_22, I try not to get involved big fights ;-)

However, I basically agree with clark. I don’t think we should mention 2.5% for 1918. There is no scientific basis for this number. All we can say for sure is that alot of people died back then.

ahh, “ a lot” is very inexact. 10–15% worldwide or 2–3% for USA looks justified and is certainly more informative.

Please, anonymous, give us your own summarized estimate. What exactly would you say? Can you write the sentence without the numbers? What numbers would you provide? Would you provide the names of the scientists or just a number of scientists or what?

What you say may be felt as irritating by a number of people - I find it interesting, and I’m not sure about the value of it all. If your position really represents the position of many decision-makers, then we should adapt to that and see what we should do.

We might get scientific about it: try all aproaches and see which one works better? Of course we feel we don’t have time. Or we have lost lots of time already.

My take on this:

• There have been pandemics so it’s a safe bet to say there will be another one.
• The factors are there, with only easy h2h missing, so the next one might come anytime.
• We don’t know the probability but in all likelyhood two of the factors (or indicators) are the extension of birdflu (3 continents) and the number of human cases (which has been doubling every year: 45 in 2004, twice as many in 2005, and it looks like twice as many again in 2006).
• The costs of not doing anything are high in any case: even a mild pandemic would put our healthcare system belly-up. Simulations using a relatively low number of deaths show disruption would be major.
• We can’t say “we’re not prepared” as “prepared” is not a yes-or-no thing. A perfect preparation would include a way to shut down all of humanity in self-sufficient villages for as long as needed to make the apropriate vaccines. It might also be a good thing to have a way to create vaccines for 20% of human beings every ten days. We’re quite far from that. Let’s say we’re “somewhere below 50% prepared”.
• We need to move upward from that. We need to do what we can, starting today. We can go from there tomorrow. (We hope.)

In short, we need both their adjustment reaction and their action. We want them to keep talking to us. We want them to talk to others.

We can make several assumptions, ranging from sooner to later, ranging from mild to worst. That “surface” has some areas - I have not looked deeply into this, just making it up as I type - and I’m sure all areas have something in common: resistance to action. If we have some available time, we’re going to have to use some of it upping their adjustment reaction.

Sincerely, I don’t know what’s the best course of action.

I think I’d rather tell the whole truth, ignorance included.

In short: we don’t really know what to do to get the world to prepare effectively and quickly.

This “what to do” plan should take into account several factors:

• my own emotions are important for my action.
• we’re all influenced by other people’s emotions, and our predictions about their emotions.
• the balance “perceived danger vs perceived hassle of carrying out a plan” is important.
• what other factors are there?

So far we have tried some strategies and we know their success or lack of it:

• saying we don’t know.
• saying 2.5% is worst case.
• what other things have we tried?

The anonymous person previously known as you-know-who suggests we should try harder to come up with a few numbers. Then what? We would have to tell something to agree publicly with them, in order to get the ball rolling.

Let’s treat this as an unsolved and important problem - which it is.

All suggestions from ‘The anonymous person previously known as you-know-who’ appear to never go far beyond trying to get more numbers…

:-)

jokes aside, lugon, I think we should try everything. Whatever works, whatever we think might work, whatever seems harmless though off-the-wall, whatever people are willing to engage in, etc…

And then those who have done something that works or seems to work please report here.

How about that?

Do you think that this whole discussion is itself part of a larger adjustment reaction? That is, one where you see one reality but everyone disagrees with you, and how do you get them to see what you see?

As for my own adjustment reactions, I’m starting to feel bad, maybe guilty for harping on the flu the way I have been to some people. I feel like I’m just focusing on the negative and who wants to be around someone like that. Moreover, focusing on the positive might actually make it happen.

Anyone else feel guilty telling people about the flu? Maybe it’s just the way I do it. Maybe I haven’t mastered “risk communication” properly yet. I think I have used mild-moderate scare tactics, stating the blunt facts and risks, rahter than this moderate/mediated/”make up your own mind” type tactic.

So I oscillate between needing to give more info as it unfolds (since no one here has done anything about it yet) vs. deciding OK, that’s it, I’m shutting up about it now….

I am reposting Dr Woodson’s post from the “CFR was 19% during 1918 flu epidemic” thread.

http://tinyurl.com/zpu9o

“The case fatality rate during the Spanish Flu is unknown. Neither this data nor the clinical attack rate for the pandemic was accurately recorded for the Great Influenza except in a few places like Boston, MA USA.

I have been working with a simple model that included variables for these data, the world population in 1918, and the most up-to-date estimate of the number of deaths during the Spanish Flu using modern epidemiological techniques. This range of deaths is between 60 million and 100 million people worldwide. The midpoint of this range is 80 million deaths. Accepting this figure as a reasonable estimate of the death number during the Great Influenza together with the known population size of 1.6 billion, various combinations of clinical attack rate and case fatality rate for the event can be projected.

Having run the numbers, the most likely combination of estimates consistent with the facts are a worldwide clinical attack rate of 40% and a case fatality rate of 12.5% during the 1918 pandemic. When these estimates are applied to a world population of 1.6 billion, the death number of 80 million is derived. While this projection is just a guess, I think these estimates contain some insight into the possible shape a severe Great Bird Flu Pandemic might take today.

The effect of a pandemic occurring now in the developed nations would probably be reduced somewhat by our healthcare resources. A reasonable adjustment would be a reduction in the case fatality rate by one third to 8% in the developed nations compared with a 12.5% rate in the third world. The US Dept of Health and Human Services has a more sanguine assessment of our fate during a 1918-like event. It projects a case fatality rate of no higher than 2%. Let us hope they are correct.”

Grattan Woodson, MD, FACP

Clark. As you know, I have equal respect for every one of our colleagues on flu wiki, and the family has just grown by one.

However, I respectfully disagree with one of Dr. Woodson’s statements.

“A reasonable adjustment would be a reduction in the case fatality rate by one third to 8% in the developed nations compared with a 12.5% rate in the third world”.

This may have been true in the 1960′s and 70′s but is not true today, in my opinion. There may be a good chance with our fragile infrastructure that our overall mortality rates, from all related causes, may be greater than the third world.

My worry is that planners are using “The impact on the economy” as the filter through which they run all of their figures and make all of their plans. As anon_22 has stated “Garbage in, garbage out”. In other words, if the numbers or estimates you start with to make your calculations are wrong, then the conclusions will be wrong. The conclusions can be catastrophically wrong- think of the space shuttle blowing up.

In our experience, the 1918 virus is the best metaphor we have for H5N1 virus. Nobody can argue a world wide CFR of 2.5% with the data (concensus estimates) that we have right now. I know that any figure is going to be an estimate. I am happy to go with Dr. Woodson’s estimate of 12.5%.

If planners, who are using the 1918 experience as their worst case scenario, use 12.5%CFR as the worst case scenario for a present day pandemic- or even as a likely CFR for a present day pandemic- Then I think we will see a completely different type of planning.

Our ancestors got through it and so will we. The economy will be the least of our worries- and planning should reflect that (if TSHTF).

Tom DVM – at 16:55 I agree. As a society, we are in the “I’ll Sue McDonalds if I scald my tongue” frame of mind. We are not mentally prepared for a pandemic. I am 55 years old, and really, my life has been a breeze- nothing but coffee and donuts -with a few scalded tongues now and then.

I really hope that I am up to the challenge if a pandemic shows up. My forebears were- God bless everyone one of them.

There are four types of economy (I once heard): the transfer of goods and services itself, the transfer of money that represents (or remembers) the transfer of goods and services, the Wall Street economy (which is related to rumors, expectations etc), and I don’t remember what else. So if Wall Street goes down, and if normal money is scarce, I still want to see food and water running around.

WHO summed it up well: “buy time, keep basic things running”.

I think we might give it a shot at thinking of 4 scenarios and giving our best advice for each: soon+mild, soon+bad, later+mild, later+bad. It looks like some countries are are planning for later+mild, and most are not planning at all.

Ok, maybe there’s no real “mild”, but rather a “mostly disruption” pandemic versus a “deaths and disruption” pandemic. And “soon” or “later” is whatever we want to call it.

So we’re seeing plans for “less than mild + very much later”, if we agree?

At what stage can we expect working vaccines to be available to fight this, and enough for a reasonable portion of the worlds population. Or put in another way, for how long must live on a prayer?

Use egg-based vaccine cultivation, it will take a year following the emergence of the pandemic strain before sufficient vaccine to be available to confer even a modicum of herd immunity. Cell culture technology is 8–10 years down the road.

But a year is not enough time to produce enough vaccine for the world, even if every single vaccine factory in the world produces the new vaccine (AFAIK). My question was really how many years do we have before we can feel “safe”?

This is a relevant question. If technology makes it so that, say 20 years later, there’s the capability to create all the needed doses in 2 weeks, then we would only have to worry for 20 years.

lugon at 15:01

IMHO, I think too many choices will make people scratch their heads and move on. However, I honestly do not know what format ie mild-moderate-severe context to pose the question to others.

At this time, I plan to:

1.) Remind people for the immediate and long-term screw-up that Katrina brought to the residents of the Gulf, with all levels of government seemingly unable to work together. Do you want yourself and your family to be in that situation?

2.) Show them, or tell them about the last paragraph on page 9 of the newly released National Strategy for Pandemic Influenza Stategy Plan under “Federal Government response to a Pandemic”.

snip

“The center of gravity of the pandemic response,however will be in communities..local community will have to address medical and nonmedical effects of the pandemic with available resources. This means it is essential for communities…to support the full spectrum of their needs over the course of weeks or months…”

For once, no double-speak. We are being told NOW, that each little hamlet in America is going to be on their own when TSHTF. To me, this means plan for yourself, try to get your neighborhood and community to plan, but count on no one except yourself.

Grace:

This is not happening in Europe. At all.

And our anonymous friend’s fixation on probabilities (if we could only have what he or she suggests) would make for a powerful way to convey your very message to many more people. 50% people prepping is better than .5% people prepping.

Regarding vaccine. DNA vaccine technology is here today. It is scalable. It could easily produce enough vaccine for the whole world in a few weeks. Only two problems. We don’t know if it’s safe. We don’t know if it’s effective. I really think we should make finding the answer to those two questions a priority.

Europepanflu, European,

Check out my new thread European Policy

Richard Adams, in his book, “On Watership Down”, told a story about a society of rabbits and other creatures. Social, but not terribly bright, rabbits could count up to four. Anything more was ‘thousands’.

It is probably important that we get close with an predicted CFR so we can better prepare all the logistical and resource needs. Food, fuel, medical supplies, body bags, etc. Like anon_22 says, the credibility is in the facts.

Most of the HCWs I have spoken with believe the CFR will be one, or not, at a time. Anything more is thousands. You don’t have to get the significant digits to get it. Someone said “more than we can bear”. Close enough.

rrteacher.

Would that be a philosopher in a scientist’s clothing…or a a scientist in a philopsopher’s clothing.

Either way, I like you approach to things.

“Vaffie” posted this over at CE yesterday. I think that it speaks directly to the subject of this very long thread.

http://www.curevents.com/vb/showthread.php?t=47519

“the population dynamic of the world is very different now than it was in 1918. For instance, the population of the US was about 106 million, and now it’s about 250 million. But not only that, but in 1920, there were 54 million urbanites in the US (or about 50%). Now there are about 188 million (75%). This is similar all over the world now. Thus, though the population has increased 135%, the urban population has increased 240%. It is this number that should be considered more important than just the population, because city-folk are far more susceptible to spreading an H2H infection rapidly, as was seen in 1918 too. But it doesn’t work linearly however. Mere common sense would tell you that if you triple the number of moving balls in a gymnasium suddenly, the chance that you are going to get hit in the next minute increases by much more than 3 times. In the same way, a dense population will propagate any virus far more than you would predict linearly, and so the percent affected may also be much higher. On a global level, the change has even been more dramatic, going from 14% in 1920 to >50% in 2005. This translates to an increase in the world’s urban population of 13–14 times—creating an unprecedented ability for an epidemic to affect almost everyone instantly.”

Ok, lets produce a newsletter with a summary on the subject of Bird Flu that we can have everyone e-mail to their address book. Let’s make it good enough and clear enough to really communicate. Remember our audience is at the average of the Bell shaped curve.

Clark @20:11 I did the math long ago on this forum in the thread, “H5N1 DEATHS IN THE UNITED STATES.” I extrapolated the data from 1918 and applied it to our current situation. One problem with thread formats is that we go over the same territory again. We need to summarize and synthesize and then design the communication tool for general consumption.

In my day we published our own newspaper and started our own news service to get our information out. Today, I would let the internet forward the information (short and to the point) from person to person. We could put it in a focused one topic newsletter format.

Yep- Dude - you are so right.

I sent Woodson’s Pandemic guide to everyone in my email mailing list. Most would have been binned- but some people saved and read. I would do that again-

If you send via your mailing list, it gets past alot of spam filters.

Tom DVM —

Someone else asked , and I too am curious…

Why/What makes you think this fall? …or within a year?? (gut feeling??)

tc in CT. Thanks for the question…yes, it is all intuition…and there are so many variables and factors in coming to a solid personal decision that I’m probably a little too tired at the moment to be able to describe them all.

In a communication to the Canadian Government in Jan. 2005, I predicted that the pandemic would start in the Fall of 2006. I didn’t know about flu wiki or crofsblog etc. The only reason my family had the internet was because I had a daughter in high school, she just finished second year university…I didn’t want the internet…but lately my family has been a little angry with me for the time I spend on it.

All of the information I have learned since Jan 2005 has re-inforced my opinion.

I collect patterns in nature not from the center of things where everyone concentrates their attention but on the periphery of things where nobody looks. Also, my patients can’t talk to me and Farm Veterinarians spend all their time preventing hopefully or treating localised epidemics on intuition alone…so I’ve had quite a bit of practise over the years.

All of my senses point to 2006 as the year…but I could be completely wrong and maybe I can give you a more complete description at a later date.

I am tired of scientists and politicians hedging all their statements. It does no one any good and everyone including many on flu wiki just end up being confused…so I decided to stop beating around the bush.

Tom DVM—

Thanks for the answer.

Every now and then I’ve read postings that make “just so much sense…” You mentioned that buying rice and beans for the multitudes makes better sense then on Tamiflu.

Like DUH!

MHO now… nobody knows if it’ll (Tamiflu) work (partly because you have to TIME it right), or for how long it’ll be useful before a resistant strain may emerge, so it just might be a total waste of precious funds…

Preparing so that there will be food on everyone’s table is IMO, brilliant…

anonymous – at 02:48 there is a common argument that the CFR (case fatality rate) will decrease in a pandemic. The virus can better spread when the host lives. This is a common observation with other viruses. It was clearly observed in the 1918 pandemics.

However, H5N1 could be different. We didn’t so far observe any decrease in CFR, neither in chickens nor in humans. We do have asymptomatic ducks, and less severe desease in some animals, though. But when H5N1 goes efficient h2h, can we assume that selection would favour less lethal strains and mutations ? Will people who recover spread more virus to others than people who die ?

lugon – at 04:26 This has been dealt with at Forum.MustAPanFluDecreaseInLethality.

Short answer: no, CFR doesn’t have to decrease. It might, and we all wish it would.

If selection does favour less lethal strains, then that’s one more reason to buy time and try to make it happen in slow motion - or at least in a slower motion - in order to let the not-so-evil strains advance faster than the really evil ones. If we can.

Please go to that other thread. Admins, could we close this one? Thanks!

anonymous – at 04:56 yes, it has been discussed before. But I am missing arguments why H5N1-survivors are more likely to spread virus to others than non-survivors. Are we more likely to isolate (handle,bury) non-survivors more carefully than survivors ? What’s the difference here between 1918 H1N1 and possible 2006 H5N1 ? Also, many experts still argue that H5N1 would go down in lethality when it goes pandemic. So this is controversy. You can’t just say : “short answer is:no , now close the thread”

anonymous – at 05:08 lugon, that thread is long and not very much on topic. I can’t follow monotreme’s argument in the first post. It seems valid for 1918 H1N1 too, yet the lethality did decrease. I’m not so much interested in whether it “must” decrease, (of course it needn’t) but how likely it will decrease. Yes, virus is shed before infection, but also later. How much more virus is shed by survivors ? That’s the critical question.

lugon – at 05:39 I was suggesting to close this thread, and only to avoid duplication. We can of course continue here, and close the other (or at least redirect new posters to this one).

There is controversy. But there wasn’t much of it before, at least not that I was aware of. In my opinion, before it was more or less blindly accepted that lethality must come down. Now we (or at least I) are not so sure. So yes, the possibility space has widened.

And the probability space is as muddled as it was before. My personal opinion is we must act on possibilities, and looking for probabilities takes away energy I need for other tasks.

The possibility space includes:

a hard pandemic soon a mild pandemic soon a hard pandemic later a mild pandemic later

I believe even “a mild pandemic later” (say lethality 0.3%) would be highly disruptive in a globalised world that depends on travel. I would be surprised, gladly surprised, if it were different. Call it a 95% or higher if you like.

I believe a highly lethal, highly disruptive, “sooner rather than later” pandemic is possible. I don’t know how likely. If it is 10% this year (and I don’t know) then that’s enough. 5% is still enough. 1% is still enough.

Give me a limit where it’s not enough. Then ask that question.

Sorry if I sound upset. I am, at times. I reply because I feel your arguments are valid, but I don’t see how we could move forward from this “probabilities? I don’t know! but how come? I don’t know” loop.

I feel we can make a strong case for preparation without probabilities. See this thread.

How much more virus is shed by survivors? I don’t know what will happen when there’s a pandemic. I would guess non-symptomatic carriers (before falling ill or those who don’t fall ill at all) shed less but for a longer time. I don’t know what the net (pun implied) effect would be. (Any expert in simulations here?) Social distance and so on do make sense in any case. To what degree? We’ll have to find out as we go along, if we can.

anonymous – at 06:03 you address the individual preparations done here, not the important decisions on government basis. When it comes to billions of $, you definitely want some numbers to justify your decisions.

To compare the R_0 of H5N1-survivors in a pandemic with that of H5N1-deaths, it’s easier to think about the differences from 1918. What’s the infection-time, the estimated number of people infected before onset of symptoms , defore death, after death, before recovery, after recovery. What can we do to improve these numbers ? (only ethical suggestions) Clearly, the more severe an illness is, the more we should avoid infection. Not only for our own immediate health but also for disruption of the spread of the dangerous strain. Should we go so far to “support” mild strains in a pandemic ?

lugon – at 06:37 I wrote: Give me a limit where it’s not enough. Then ask that question.

Anonymous wrote: you address the individual preparations done here, not the important decisions on government basis. When it comes to billions of $, you definitely want some numbers to justify your decisions.

Yes, some numbers: a 1% possibility of a civilization breaker. A 5% possibility of major disruption. A 20% possibility of major health-care disruption.

Do you really think they are not paying attention? It’s just that they don’t know what to do.

Or maybe numbers would bring people on board faster?

Please, do create a page on the wiki titled “the numbers game”, outline why this is so crucial, what you’ve understood about what others say about this, your summary of who has said what regarding numbers, and what we should be doing next.

It’s not that I dismiss your work in this area. It’s just that I find it terribly frustrating. I feel it doesn’t take us any further, at all! An important, yet impossible question.

I suggest you settle it as best you can. I’m moving on to other things. Thank you.

lugon – at 06:39 My numbers are not official: just a way to say “if it’s this or higher, then it’s worth the investment; and it is this or higher”.

Most of the investment would not be monetary, by the way: just plain old talking about it, organising around it, planing for it.

Nikolai---Sydney – at 06:42

And I, too, feel this has been fine-combed on the previously

cited thread. There is no question in anyone’s postings but

that this is a vital question, but there is question as to

whether we need or even wish to rehash it.

anonymous – at 07:36 the old thread is lengthy and the subject of the thread was missed in most of its posts. Alas, the same is happening here already. If lugon and nikolay-sidney don’t like the discussion, they can just skip it. No need to close the thread. Even if it were discussed before, which I can’t see, there are lots of examples in the archive where repitition was no reason to close a thread.

anon_22 – at 08:18 anon,

Go and post your questions on that thread. For the benefit of everyone, it is better for threads of EXACTLY the same question to stay in one place.

lugon – at 08:38 I repeat: I was suggesting to close this thread, and only to avoid duplication. We can of course continue here, and close the other (or at least redirect new posters to this one).

Anonymous - at 07:36 wrote: the subject of the thread was missed in most of its posts. Alas, the same is happening here already. So here’s the subject again: But when H5N1 goes efficient h2h, can we assume that selection would favour less lethal strains and mutations? Will people who recover spread more virus to others than people who die?

My answer to the three questions (well, actually, one assumtion and two questions):

We don’t know if H5N1 will go efficient h2h or not. We don’t know if it will happen, when, or how would the resulting pandemic virus (which H5N1 currently isn’t) behave. If someone asks about probabilities, I will skip it because I badly want to use my limitted time working on something which, in my mind, will be more useful. I think selection favours less lethal strains and mutations … in the long run. But that doesn’t necessarily happen short term. Sometimes it happens, sometimes it doesn’t. The deeper mechanisms escape me: I’d sincerely like to know more about how “selective pressure” works. But the practical conclusion, for me at this stage, is another “I don’t know”. Will people who recover spread more virus to others than people who die? Let me see …

Three groups of people here:

People who will die have a more severe form of the disease than those who will recover. More severe may or may not mean more virions inside the patient, and likewise for shedding. More severe may mean more contacts with care-givers, or less time to contact anyone, or contact with protected care-givers. People who will recover will have a less severe form. They may shed less virions, but for a longer time, and maybe to care-givers who are less protected. Some may even go to work even when ill, at least in the last days of disease when they are a bit better. People with little or no symptoms. They probably shed a small amount of virions, to anyone who is around.

I guess the factors are:

amount of shedding per time-unit number of time-units the patient is alive number of people who are around the case degree of protection by those who are around the case

What info do we have on each? What would happen in a pandemic?

How all of this adds up I don’t know.

THIS THREAD IS SO LONG IT SLOWS THE ENTIRE WIKI.

I RESPECTFULLY SUGGEST WE GO ON TO A NEW THREAD

Don’t know either; so many unknowns.

People who die may not have had a worse form of virus; they may have had no caregiver preventing dehydration, ect.

And, dead from many causes not the virus itself, will add to the “surge” of bodies to be buried. Don’t see places buying enough PPE now for surge mortuary needs (and I think places will need to bypass the funeral industry somehow, to get all the extra losses buried. But, live infected people spread virus more than dead ones, who may need contact precautions, (and I’m not sure about surface water contamination - get cemetery departments planning and stocking up at home now, so bodies are getting buried promptly -and with id/paperwork done- but aren’t getting buried where/how they shouldn’t be).

What is anyplace’s HIV rate? This is not even known for sure, because so many don’t get tested. But they and others with low immune systems, (probably can get numbers of transplant or cancer treatments) if they survive, may shed virus for longer, and be more likely to give time for more strain mutations?

Getting people prepared, and, officials able to tolerate erring on the side of caution; don’t tell people not to wear masks, don’t be in a hurry to tell them a wave is over and to stop taking distancing/infection control precautions, ect, might help, but, we need to educate and prepare now.

Having recovering/recovered people still try and take precautions, in case they do shed, is not unreasonable.

We (and tptb) can’t prove pandemic won’t happen, and we can’t prove it won’t drop in lethality, so, better to get preparing.

With being able to spread the virus before one feels ill, and airflight criss-crossing people ‘round the globe every hour of the day and night, a virus could do great damage even if its host dropped in its tracks, as long as it had a few days to spread without symptoms first; it wouldn’t burn itself out to fast not to give it a try. It doesn’t have to make sense long-term -its a virus, and evolution tries everything, for as long or short as possible.

closing this thread. Will open part 2.

A Severe Pandemic is Likely

This thread is a re-statement of what is obvious to people who have been following the H5N1 story. However, 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. 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.

• The H5N1 virus that originated in China in the 1990′s has novel properties.
  • It has already killed millions of birds and many different mammals.
  • It has crossed the species-barrier and killed over 140 humans.
  • It has killed over 50% of the people it has infected, even with advanced medical care.
  • It preferentially kills school-age children and young adults.
  • It kills in a similar way to the severe pandemic of 1918 - cytokine dysregulation
• H5N1 is widely dispersed
  • It has been found in animals in countries all over the world.
  • People in in many countries have been infected and killed by the virus
  • It is very unlikely that H5N1 will be eradicated in the foreseeable future
  • It is likely that H5N1 will continue to spread by migratory birds and other means to nearly every country in the world.
  • It is likely that hundreds of millions, and possibly billions, of animals will be infected.
  • Close association of hundreds of millions of people with hundreds of millions of infected animals provides many opportunities for adaptation of the virus to humans
• H5N1 has already partially adapted to humans, the precursor to pandemic onset.
  • Many clusters of human cases indicating human to human spread of H5N1 spread have been observed.
  • Human to Human to Human spread of H5N1 was observed in Karo, Indonesia, earlier this year.
  • Serial passage of the virus between humans selects for human adaptation
  • This adaptation has already occurred for the polymerase complex - H5N1 was recently shown to replicate at high levels in humans.
  • Sustained transmission of H5N1 between humans is the only barrier left to pandemic onset. Given that H5N1 is already partially adapted to humans and the many opportunities it will have to finish it’s adaptation in the coming flu season, the risk that a pandemic will begin within the year is very high.

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.

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

Monotreme-Do you have the full study on that last recent reference (April 2006)? I tried to access it through the link, but could not find “the key”. I missed that study, if you have previously presented it. It seemed like very bad news, a likely avenue for panflu, even one that we can see with our “blurred vision”. This just keeps getting…..I can’t say it again.

Thank you Monotreme;

I can think of many officials, politicians, (and news outlets!) that need to get sent the Print version of this summary. Assumptions based on on “best-case pandemic” just are wasting time and effort.

Time for the public to know their preparation is needed; no top-down solution possible.

Medical Maven,

Here is a better link:

Structure and Receptor Specificity of the Hemagglutinin from an H5N1 Influenza Virus

This was discussed previously in this thread:

H5N1 Evolving Towards Pandemic Strain.

It was bad news. The polymerase adaptation is also bad news. There is no good news. H5N1 is under positive selection in mammals. This is published. This means an H5N1 pandemic is inevitable, IMO. It is highly likely to be severe and quite possibly catastrophic.

I disagree with some of the above conclusions, as I usually do. Monotreme has made a compelling case that the H5N1 virus is established and has become endemic.

That is not the same thing as establishing that

• it will be the pandemic virus
• a severe pandemic is likely

A severe pandemic is certainly possible. More than that we don’t know. Stating otherwise is dogma, not fact.

crfullmoon – at 18:49

You’re welcome. I started this thread to because I think there are many public health officials who have no idea how bad the situation is. We also need to get this information to decision-makers so that they can urgently ramp their preparations to meet the likely threat. Too many are either not preparing at all or preaparing for a mild to moderate pandemic.

Monotreme,

I have borrowed this and the link to post to my community blog. Thank you.

I am trying a new approach - if my town leaders won’t come to me, i will have to go to the townspeople!

Now, that’s a conclusion I don’t disagree with. Because a severe pandemic is possible, it must be included in all decision-making processes by the states. The lack of significant emphasis in the state plans is a failure of imagination, but also a failure to listen.

DemFromCT – at 18:55

The reason I use the term likely is because H5N1 is under positive selection to adapt to mammals. This is published. It has already partially adapted to mammals. This is published. What would the mechanism be that would stop it mid-adaptation? Serial passage of viruses in a novel host is well-known to result adaptation to that host. Some unknown and bizarre mechanism would have to be invoked to conclude that H5N1 will stop mid-adaptation. The only way to stop the adaptation is to stop human exposure. Want to take odds on that?

Birdie Kate – at 18:58. You’re welcome

DemFromCT – at 18:59. My goal is to get every state to plan for at least a 1918 style pandemic. They won’t do this if they think a severe pandemic is unlikely. The term “possible” includes everything from a 1% to a 99% probability. Based on my understanding of viral adaptation and the widespread distribution of H5N1, I think the probability that H5N1 will become a pandemic strain is well above 50%, hence my use of the term “likely”.

DemFromCt -

Can you update us on your personal feelings on where we are right now and if we are indeed in a countdown? I am assuming that you are not at the same level of concern that Mono, Tom, MM and others are presently at, but since we are your guests and we go way back, could you give us your current take on the situation?

Monotreme at 18:53-I even participated in the thread discussion!! So much water under the bridge it is hard to retain it all. Anyway, in seeing the study and its summary again, I know a “bell tolling” when I hear one. And for the second time.

Medical Maven – at 19:12

I have the same problem remembering all the various bits of information. The summary in my first post was for myself as well. Sometimes the pattern is not clear until all the pieces are put together in one place. There was reason to be concerned in April. There is much more reason to be concerned today.

seacoast – at 19:10

Mildly alarmed. Not willing to sit back and do nothing. Concerned about apathy. Not assuming it’s this year. Worried about indonesia and this fall-winter in southern China. Worried that overhyping will reduce the ability to get states to move. Anyone who ignores H5N1 is nuts, in my opinion, but so is anyone who insists they know what happens next (too many unknown unknowns). Concerned that governments will never get thir act together.

In short, about where i always am. ;-)

What would the mechanism be that would stop it mid-adaptation? Serial passage of viruses in a novel host is well-known to result adaptation to that host. Some unknown and bizarre mechanism would have to be invoked to conclude that H5N1 will stop mid-adaptation.

nonetheless, I’m glad Monotreme put this together… I should have included that.

Monotreme wrote:

‘’‘A Severe Pandemic is Likely This thread is a re-statement of what is obvious to people who have been following the H5N1 story.’‘’


no. It is not obvious to most people who have been following this. You will always hear : “no one knows how bad the next pandemic will be”. A mild next pandemic is still considered more likely by most experts.

Your list of points does apply to other diseases as well and yet they don’t go pandemic. Where in your list appears that we have influenza A here ? We would not be concerned about all this, it it weren’t influenza A, which has a history of pandemics. This is the main point.

Oops, that was me. I hit post before I was done. Sorry.

anonymous – at 19:17 Montotreme: “What would the mechanism be that would stop it mid-adaptation? Serial passage of viruses in a novel host is well-known to result adaptation to that host. Some unknown and bizarre mechanism would have to be invoked to conclude that H5N1 will stop mid-adaptation.”

I think this is key. Statistically, I think you are, sadly, correct. I hope you are wrong.

Dem- Thank you for your comments, I am sure that there are many of us out there in wiki land who do not have a full scientific backgrounds and need help with this complicated “stuff” and the thoughts on both sides helps us fill in the gaps so that we can decide what we think and how we are going to proceed.

I really appreciate all of you, I have grown as a person because I was taught here to think beyond my family, friends and students, but to think that I can help save lives if I get off my arse and become involved in my town and county.

seacoast – at 19:31

we know more together than we know alone. Really, I appreciate Monotreme’s exploring in depth the State plans and updating the wiki on them. He actually read some of them… that’s what, I think, got him going on this. ;-)

When you read what the states say in some of those plans, it’s like “But, have you learned nothing? Have you heard nothing?” he’s absolutely tright about that.

But you must appreciate also that many of the state folks in charge are old enough to remember swine flu in 1976 - the severe pandemic that never happened. It affects their attitude 30 years later; don’t underestimate that.

Monotreme,

As my own understanding of the situation evolves, I keep re-evaluating my own risk perception. The 2 biggest changes in my thinking (and they are still changing) are that:

1. I am less and less certain of whether we can compare H5N1 to anything, and so less able to extrapolate and predict.
2. But IF our current extrapolations are valid, which is a very big IF, then a pandemic happening in the near future looks so hellish I have a hard time finding the right words to describe it.

Which lead us (me) to precisely nowhere.

The only thing that I do know is that our very limited state of knowledge tells us that to assume that a 1918 scenario is the worst case AND an unlikely scenario, and make plans based on that, is highly irresponsible coming from those who should know. Since most officials still don’t really know what they are talking about in terms of pandemic risk, I charge leaders at the highest level, particularly the scientists who advise them, with carrying the responsibility to communicate this accurately and honestly.

See outline summary has “Pandemic risk”: “possibilities”, “probabilities” and “impact”. The outline is not intended to settle the issue, but merely to bring all the positions together. Or maybe we’ll be able to settle on some things.

It’s a tool to talk around. A conversation igniter, maybe.

Dem at 19:43: Dem, are there any studies that demonstrate what effects the mass vaccination program in the U.S. had on the spread of the swine flu in ‘76? In other words, do we know one way or the other whether this strain would have gone pandemic without the mass vaccinations, notwithstanding their side effects?

anon_22 – at 20:10 I charge leaders at the highest level, particularly the scientists who advise them, with carrying the responsibility to communicate this accurately and honestly.

Well Said!!!!

In my Very Humble Opinion, I believe that the world should prep for a 1918 level event AT THE BARE MINIMUM. This will set them up for a very effective All Hazards Preperation.

And I fully agree with anon_22: my perception included 1918 as an extreme. Not so now.

And my updated perception tints a 1968-like pandemic as a highly disruptive one, maybe.

Not getting ready for disruption is silly. More so, when part of that “getting ready” doesn’t mean spending money - it’s about talking openly, planning/organising, cross-training. Things that make sense in any case.

I’m very much concerned about the “talking openly” part.

De jure, there was no ‘spread of swine flu in ‘76′, cos there was no swine flu outbreak (in humans) after the first cluster of cases in a military base.

De jure, there was no ‘spread of swine flu in ‘76′, cos there was no swine flu outbreak (in humans) after the first cluster of cases in a military base.

anon_22 is correct; there was no swine flu outbreak, and not because of vaccination. The authorities did what they did based on what they knew at the time. But based on the flak they got, they’ll not easily pull the trigger again.

See wiki links.

Not preparing for at least a 1918 event, would be like the U. S. Armed Forces not preparing for two simultaneous wars. It would be the height of irresponsibility not to do so. This is national security (for all nations) that we are talking about. The first task of every responsible government is to provide for the common defense of its people. All that is different is that the foe here is Panflu, a faceless enemy that says nothing, threatens nothing, and then is on top of you.

I agree that the swine flu debacle is one reason for the hesitation on the part of some public health authorities in asking for resources. However, from a scientific perspective I don’t think swine flu and H5N1 are in any way comparable. A single individual died from swine flu. There was no world-wide animal reservoir of the virus that killed that individual. Hence, the risk level is much, much higher with H5N1 than it ever was with swine flu. And the risk of swine flu was considered enough to launch a massive pandemic flu vaccination program. The current lethargy on the part of many public health officials is, I am convinced, based on a combination of concern for their careers and ignorance.

As I sit and read about the problem with China, I am worrying about the 2008 Olympics. Families, fans and athletes from all over the world, confined to a relatively small area for a few weeks and then going back to every corner of the world. Could the perfect storm be brewing?

anonymous – at 19:20

You will always hear : “no one knows how bad the next pandemic will be”. A mild next pandemic is still considered more likely by most experts.

It depends on who you consider experts. Drs. Webster, Osterholm and Nabarro? I don’t think they are expecting a mild pandemic.

Your list of points does apply to other diseases as well and yet they don’t go pandemic. Where in your list appears that we have influenza A here ? We would not be concerned about all this, it it weren’t influenza A, which has a history of pandemics. This is the main point.

If I understand your point, you’re correct. Influenza A is different because of it’s rapid mutation rate. This guarantees that will be a huge substrate of variations for evolution to act on. Evolution is important in understanding the risk. This is why I went to great pains to explain the conventional scientific view on random mutation and why I also explained positive selection in other threads.

I still don’t think I have succeeded in communicating how powerful selection can be. In my own laboratory, we set up conditions for positive selection to occur. I can guarantee that it will occur given the knowledge of certain values, the most important being mutation rate and number of individual organisms. If you set up conditions to select for a certain mutation and you have an appropriate number of individuals given the mutation rate, you will get exactly the phenotype you are selecting for. Virologists use this technique to adapt a virus to a particular host. Once the virus is partially adapted, you can be pretty sure that you will get a strain that is fully adapted.

H5N1 already is partially adapted to humans. This is a matter of record. It replicates very well in our cells, today. Its high mutation rate is a matter of record. Its widespread geographic distribution is a matter of record. Its ability to spread human-to-human-to-human is a matter of record. These facts are relevant to the probability that H5N1 will become a pandemic strain.

As I have said before, I am not a virologist. It would be interesting to get a virologist to comment on the likelihood that H5N1 will become a pandemic strain based on the currently available information.

For the statistically inclined, I recommend the following link:

Selection Operating on Quasispecies

Some prefer numbers to words.

worried in NJ – at 21:28 As I sit and read about the problem with China, I am worrying about the 2008 Olympics. Families, fans and athletes from all over the world, confined to a relatively small area for a few weeks and then going back to every corner of the world. Could the perfect storm be brewing?

Worried in NJ, I was thinking that myself after seeing a news story about the US athletes possibly not participating (a political group is pushing for this; can’t remember why as my mind immediately was distracted by implications of Olympics on pandemic). It would be the perfect storm. Since it would be something straight out of B-rated movie, my skeptical side says, “Nah.” Only time will tell.

Hi all — last night I was listening to the American Asian program on NPR and they had a section about China, the incredible availability of transplant organs (you can have exactly the organ you want “installed,” so to speak, , with matching blood types and other factors, within hours of your inquiry.)

To be brief, they believe that prisoners are typed, and held until there is a need, and then sent to a hospital for execution and removal of organs.

They believe that unethical means are used, many non-criminal innocent people who have run up against TPTB have disappeared in this way, and they want to have this exposed before the Olympics.

I was shocked, could not believe my ears, and hope this wouldn’t be true, but gee, it was NPR ----

Hello again — if you are interested, here is a reference url for “Pacific Time” and there is a synopsis half way down the page about Canadian politician David Kilgoren’s assertions. If this is true, maybe the Olympics will find another venue?

heddiecalifornia – at 23:03

We’re getting a wee bit off topic, but it’s true that people who are executed in China are used as transplant donors. They are typed before execution and an ambulance is on stand-by ready to take the organs to their new recipients. The type of tissue desired influences the means of execution. The Chinese government would say: “Waste not, want not.”

Whether all of the people executed are what we would consider criminals is another matter.

Monotreme at 19:07, My goal is to get every state to plan for at least a 1918 style pandemic. They won’t do this if they think a severe pandemic is unlikely.


why not ? They will do it when the risk is high enough. Nuclear war was also unlikely but possible in the 60s and they did prepare. Same with earthquakes,hurricanes, etc. Is it ethical to lie to them ,or use tricky wordings, and paint the picture darker than you think it is ?

Monotreme, please change the title of the thread, when you think we should only say this to the state-planners , while you are thinking something else.

DemFromCT at 18:55

As usual, thank you for being a voice of reason here.

anonymous – at 23:18

Is it ethical to lie to them ,or use tricky wordings, and paint the picture darker than you think it is ?

I believe everything I write here and have acted accordingly in my private life. I say the same things in public forums. I think my words are pretty straight-forward. I think a severe pandemic is likely. Not sure why you think I don’t really believe that.

My comment regarding the state planners was in regard to the fact that they seem to be ignorant of the available data. I assume that most people at FluWiki are familiar the data I presented in the first post. I was apologizing for presenting information that I though was obvious to people here. Clearly I was mistaken in that belief.

Drs. Webster, Osterholm and Nabarro? I don’t think they are expecting a mild pandemic.

I think, they still consider this more likely than a severe one. Osterholm is arguing that even a mild pandemic would be bad, he talks about a severe pandemic (let’s say severe = 1918-type or worse) and a very severe pandemic , but said that he didn’t expect very severe. He doesn’t say about severe. He’s a bit like you, exaggerating so to get people preparing. He often points out this “not if, but when”, however that refers to an average pandemic and average pandemics were 10 times less severe than 1918. Webster says : “no one knows”, so what ?

Influenza A is dangerous not because of its high mutation rates, but because of the pandemic history. No other virus could cause these pandemics with infecting 20% or more of people worldwide. It is unclear what it is that makes it so contagious, the mutation rate might contribute but’s not the whole story.

Even when H5N1 is fully adapted, it might still be incapable of going pandemic. Rarely a virus is that much contagious. It could be, we have the similarities with other flu-A but who knows whether any pandemic virus is in genetical neighborhood of actual viruses ? If it is, then it will probably be “found” earlier or later.

I am not a virologist. It would be interesting to get a virologist to comment on the likelihood that H5N1 will become a pandemic strain based on the currently available information.
me too. me too. me too.

My bet is that in the backrooms of agencies and Governments and universities around the world, there are alot of dire predictions being made at the moment…

…don’t forget they read the same information we do…they observe what we observe…they have the same fears that we do…and I know they are coming to similar conclusions because you don’t have to be one of the top ten influenza scientists in the world to see things clearly.

I might have misinterpreted your statement at 19:07 then. It sounded as if the (only) motivation to say this were that the state planners had to be convinced, no matter how.

My own personal take on it (having been in the emergency service, also working with various governmental agencies), that the bottom line, not alot will get done, maybe some on paper, but when the rubber meets the road,,,,will be a total diaster in the making,,,and again like fed gov told the states, you are on your own. Which means to me,,,we as individuals are on our own,,,and we are the ones that will be helping out. I do not expect much from any government level.

anonymous – at 23:18

Monotreme at 19:07, My goal is to get every state to plan for at least a 1918 style pandemic. They won’t do this if they think a severe pandemic is unlikely.

why not ? They will do it when the risk is high enough. Nuclear war was also unlikely but possible in the 60s and they did prepare. Same with earthquakes,hurricanes, etc. Is it ethical to lie to them ,or use tricky wordings, and paint the picture darker than you think it is ?

They prepared for a Nuclear war because they were able to see what the A and H Bombs could do with their own eyes. They could “SEE” the threat. No one in power today has “SEEN” the threat so they can not get their minds around it. Hence the threat is not real because they can not “see” it.

I have been on my college debate team, received advanced placement in public speaking, was a toastmaster at 16, I am a trained discussion leader who specialized in small group dynamics and the recognition of blockers and those with agendas that do not fit with the group purpose. I say all this so my words to anonymous at 23:18 will ring loud and clear. You sir, have established no credible evidence to backup your assertions and your assertions have nothing to do with the facts of the discussion. You behave in this case as a blocker. You project lies when none are presented. You use the techniques that you accuse others of using. It is you who are lying when you say others are lying. You can behave better than that, I have seen it.

I have come to the conclusion that 1918 was the ‘rule’…

…and 1968 was the ‘exception to the rule’.

Anon_451 – at 00:06 Your are correct, and that is why the disaster in New Orleans was so great,,,,,it never happened before, not in any of their lifetimes, and this situation is just like that. Has not happened in our lifetime, so wont prepare like they should, UNTIL it happens, they the gov agencies will plan like crazy for the next one. That is if many are left from this one.

Yo, Dude! Stick around — we NEED that kind of analysis here. (and I do get grumped at all the “anonymous - i” — it does get confusing when two or more start posting).

One challenge we all have is that the facts don’t all support strong action. There have been, what, 135 deaths from H5N1 ?(documented). There are probably that many deaths in the US in one weekend from drunk driving. I know, I know, the challenge is that the virus will bust out of the box in a violent and widespread way, but getting local heart rates up over 135 deaths that occurred over months in lands far away is, unfortunately, a challenge.

Gary Near Death Valley – at 00:10 Please know that I have some very good friends in Gov who are trying their level best to get the politicians off their hands. A lot of the career civil servants “See” what is coming but have their collective hands tied by elected morons from both parties.

I can tell you that the Red Cross is (slowly) thanks to the efforts of the NHQ medical director’s office, attempting to come to grips with this with respect to both general relief and blood banking. I can also tell you that their “worst case” is considerably worse than 1918. I posted that the CFR posited was 20% with 50% CAR; I got another look at the document in question and the CFR was 10%, not 20%. My error. Regrettably, these documents are not public, but I can assure you that Red Cross is looking hard at this issue, and lots of resources are being mobilized. The question is whether H5N1 will make this attempt moot or not.

My personal estimate of the situation is that we are more likely than not to see a pandemic this winter in the US. While nobody *knows* what will happen, my assessment is that this will be at least as bad as 1918 and could be a good deal worse. I am planning for 50% CAR and 25% CFR, which is likely to be catastrophic. I am planning as best I can for that, too.

As far as the USG preparing for a nuclear war, they prepared to preserve essential portions of the government from the effects of a nuclear war, but the average Joe was, and is, on his own. I do agree with the essence of the comment above, however, in that it’s difficult for decision makers to realize on a gut level how bad this could be.

Yes I know how gov works, having been in it and worked with it. It is usually the lower level ones that better understand the real world

Monteme: I counted 34 clusters in the reference you gave above. I remember reading that the total clusters were closer to 50. I wish I could pin down the source of my information. I am curious to know what the definition of a cluster hinges on. Is it disease onset date? Does it also require the absence of an animal vector beyond the first case? What is the major element of this definition or is it all factors taken together? It seems that the adaptation to humans is one central tenant of this discussion and I think a very tight definition is in order to prove the point. I recognize the trend in the number of cases has increased, but that may be more bird to human transmission due to the increase in the number of infected birds. The study in ProMed is a source of great concern for me and makes your case much stronger in my opinion.

Anon_451 – at 00:25 I agree that politicians seem to be sitting on their hands - nobody has publically spoken on BF in a year. I have a good friend who is a staffer for a U.S. Senator and I’ve been trying to thing of a way to push this issue without seeming like a kook. I know my message will be conveyed, but am waiting for the opportune time. In my view, our politicians have a responsibility to speak out.

If I understand the adaptation argument correctly, the polymerase issue revolves around the study of unrelated strains of HPH5N1 and each of these separate strains showed that when there are repeated infections in mammals they tend to have convergent evolution toward more virulence and an easier ability to infect mammals (humans). This study does not state how large the N was. Nor do I find a reference to the specific areas of concern in the sequences. I gather that the argument hinges on the ability of this virus to do point mutations that tend to cluster it in a general direction. Is this correct?

tjclaw1 – at 00:44 you are correct that politicians have a responsibility to speak out,,,,,and I wish and hope they would, but seems the message is lost amid the clutter of everything that is going on in the world, even though this should be at the TOP of every politic agenda everywhere. As it is not, shows me, that 1) They have no clue 2) They know and do not want to frighten the herd before the storm as the storm they know is coming and cannot be stopped.

I really hope they get going on this as I am thinking that Dr. Osterholm and others are getting more tired and frustrated with each passing week. To have the avian flu not on the front burner shows me,,,,,,,,well,,,,the country is screwed ,,,,,,,,,,again.

Dude, This may help explain…

http://tinyurl.com/n6v5m

Two clusters of human infection with influenza A/H5N1 virus in the Republic of Azerbaijan, February–March 2006

Following the appearance of influenza A/H5 virus infection in several wild and domestic bird species in the Republic of Azerbaijan in February 2006, two clusters of potential human avian influenza due to A/H5N1 (HAI) cases were detected and reported by the Ministry of Health (MoH) to the World Health Organization (WHO) Regional Office for Europe during the first two weeks of March 2006. On 15 March 2006, WHO led an international team, including infection control, clinical management, epidemiology, laboratory, and communications experts, to support the MoH in investigation and response activities.

As a result of active surveillance, 22 individuals, including six deaths, were evaluated for HAI and associated risk infections in six districts. The investigations revealed eight cases with influenza A/H5N1 virus infection confirmed by a WHO Collaborating Centre for Influenza and one probable case for which samples were not available. The cases were in two unrelated clusters in Salyan (seven laboratory confirmed cases, including four deaths) and Tarter districts (one confirmed case and one probable case, both fatal).

Close contact with and de-feathering of infected wild swans was considered to be the most plausible source of exposure to influenza A/H5N1 virus in the Salyan cluster, although difficulties in eliciting information were encountered during the investigation, because of the illegality of some of the activities that might have led to the exposures (hunting and trading in wild birds and their products). These cases constitute the first outbreak worldwide where wild birds were the most likely source of influenza A/H5N1 virus infection in humans.

The rapid mobilisation of resources to contain the spread of influenza A/H5 in the two districts was achieved through collaboration between the MoH, WHO and its international partners. Control activities were supported by the establishment of a field laboratory with real-time polymerase chain reaction (RT-PCR) capacity to detect influenza A/H5 virus. Daily door-to-door surveillance undertaken in the two affected districts made it unlikely that human cases of influenza A/H5N1 virus infection remained undetected.

<snip>

Possible case • any individual with unexplained axillary temperature ?38 °C; • AND one or more of the following symptoms: cough, sore throat, shortness of breath; • AND resident in an area where influenza A/H5 virus infection has been suspected (i.e. undiagnosed mass poultry die-offs, dead wild birds seen or probable/confirmed human cases from the area).

Probable case a possible case AND that had, within 7 days prior to the onset of symptoms, one or more of the following: • close contact (within 1 metre) with a probable or confirmed case; • close contact with sick or dead poultry or with areas heavily contaminated by their droppings; • close contact with wild birds or with areas heavily contaminated by their droppings; • consumption of undercooked bird meat or eggs; • worked in laboratory processing samples (human or animal) suspected of containing influenza A/H5 influenza virus.

Confirmed case • a probable case for whom a specimen tested positive for influenza A/H5 virus infection by PCR.

tjclaw1 – at 00:44 I’ve been trying to thing of a way to push this issue without seeming like a kook.

Print out a copy of the Indo Maps from the great Indo Group. Include a copy of the box score. Add in a couple of the reference’s from Monotreme all hard copy.

In your cover note, just say that you have found some information that the Senator may find useful. Something he/she can use to question DHS HHS and DOD on to insure that they are “protecting” the American people. You may also want to insure that the State Government is meeting this head on and ask them “at the local level” what can the Federal Government do to help now before we are no longer able to help due to the volume of needs once this starts.

Hope that helps. I know that the maps and box scores made a big difference with some folks I spoke with.

Shoot,

Dude, I meant to add the parts about disease onset date…

Epidemiology

Cluster 1 Daikyand is a rural, relatively poor village in Salyan district, with around 4800 inhabitants in 800 households. The village is divided in three settlements: Seydler, Daikyand and Salvan [FIGURE].

Influenza A/H5 infection was laboratory confirmed in samples from seven residents of Daikyand settlement. Six were from the same family and one from a neighbouring family, and became ill over a two week period, with dates of onset from 15 February to 4 March 2006. Four of the seven cases died, and this figure is compatible with the case fatality rate observed elsewhere [5]. The median interval between onset of symptoms and death was 9 days (mean: 11.2 days; range: 8–19 days).

Patients’ ages ranged from 10 to 20 years (mean: 16 years; median: 17 years); five of the seven cases were females aged 15– 20 years.

<snip>

Dude,

That is why the Powerpoint I sent you, the Genogram of Clusters (in Indonesia) is important to see (make) in order to see at a glance the disease onset dates, hospitalization dates, dates of death, possible exposure / (or relationship) to confirmed cases / chickens….

It gives you a good grasp on what is going on even when some tests are returned as negative. (such as the person who tested positive twice, but the third time the test was negative.

Trying to establish attack rates and CFRs and use those in discussions I have found ‘fruitless’. What I have found effective is to give actual numbers in your community (city) that WILL BE SICK AT THE SAME TIME. If you take a city of 5 million people, with little or no immunity to any virus, assume that only 40% will become ill in the first 3–5 weeks, that is 2 Million people sick at the same time - now keep your city operating …

Grin, FloridaGirl, I accept the reasoning that disease onset dates are a critical factor in the determination of a cluster that involves H-H transfer. I can see that the data in you example supports that. The epidemiological factors presented establish a correlation, but unless the sequences are also analyzed and can show the relationship it is not proof of the point. Too often we must infer in the absence of data. I think those inferences are correct, but when I make the case to the people I know, I want to be sure. It seems we have most of the argument correct. I am just looking for the details that will convince people who can understand the argument. Do we have data or a graph that shows the size of the clusters increasing in frequency and size over time? I am slowly getting caught up with all of you, due to other pressures…forgive my inability to review the Power Point presentation. I will, I respect your work. Thank you.

anon_22 – at 20:10

But IF our current extrapolations are valid, which is a very big IF, then a pandemic happening in the near future looks so hellish I have a hard time finding the right words to describe it.

Yes.

In between the chatty posts about chocolate and useful tips for just about everything, there is that.

“to insure that they are “protecting” the American people.”

How many pandemic plans have we see where protecting people is the goal ? How many where the goal is “continuity of government” is the goal ?

Since we don’t know how virulent this will turn out to be, we can only look at the CFR to date. In the 1997 Hong Kong episode it was 6 out of 18 or 33%. Now nine years later based on the latest WHO data, with 247 confirmed cases and 144 deaths the CFR is about 58%. Based on this data it seems unreasonable to expect the only outcome must be a match for the averaged 1918 figure of 2.5% or less.

TPTB are calling a CFR of 2.5% a worst case scenario. It could easily be ten times that severe with a CFR of 25%. Even at that rate the current CFR would have to be cut by over half. What evidence exists to make that a reasonable probability?

Monotreme, great summary. Thank you for being a voice that tends to balance the large number of public reports that represent a worst case scenario as being like the 1918 pandemic. Considering other possibilities is essntial for full spectrum planning.

“Severe” may mean “big disruption”. People have a hard time imagining that.

I’ll have a look at “selection”. It’s not in the “outline”. Where would it go?

Tom DVM – at 00:10 :
I have come to the conclusion that 1918 was the ‘rule’ …and 1968 was the ‘exception to the rule’.


is there anyone else, who came to the same conclusion ? I can give you lots of referrences, who say 1918 was the exception. The links to the historical data had been given to you here several times. You seem to dismiss it. Why ?

Not as a scientist, but working in the “social” fields, I am adding my 2 cents worth of observation. First of all, the government knows that the government is in control of whatever vacine (remember, Bush told the pharmaceutical companies to start working on it a year ago, even if it’s generic, they surely do have something) and anti-virals we have. That is the first problem. They do not worry about access to medicine for themselves, they have control of it. Why would they want to panic our pretty little heads and possibly take that control away from them? Of course they are going to say that it’s not likely to be severe or that we don’t want another 1976 false scare or whatever reason they give out. Now they want you to believe that it’s coming and be prepared, people are the number one resource in America. But they, just the same, want you to think that they have perfect control over it so you will not question their actual control over it. The second part about this is - why do they? The medical professionals should have that control to say who gets what, but they do not. The government will be giving them enough to protect themselves and after that doctors will be told who they can and cannot give anti-virals to. It’s not going to be done by democratic means either, this will be dictatorship control. Now the doctors may protest, but after all is said and done, who will they be facing? The government. Our government has made extreme strategic plans to survive and they will. Have you noticed Bush’s attitude change from last fall to this fall? Last fall he was very concerned about it, but now he rarely mentions it. Why isn’t our president, our leader, standing up in front of America telling us to stockpile a little food and water in our homes? Come on now…when the threat was Iraq, he was out there everyday telling us about WMDs. It’s because he is not worried about his own butt anymore. As many here have said, we are on our own. Monotreme, I adore your scientific approach and logical attitude. I have always laughed at the contradiction of “political science”. Political psychosis would be a better description. You can say that the general public is part of the decision makers but that is severe contradition to what actually is. Your facts are awesome and I believe you are right. It’s just that facts don’t pile up to a hill of beans against politics.

I’m not saying give up, please don’t. I’ll vote for you if you run for president, Monotreme. Every ray of hope is light in the right direction.

See Jerry Pournelles Iron Law of bureacracy-

“Pournelle’s Iron Law of Bureaucracy states that in any bureaucratic organization there will be two kinds of people: those who work to further the actual goals of the organization, and those who work for the organization itself. Examples in education would be teachers who work and sacrifice to teach children, vs. union representative who work to protect any teacher including the most incompetent. The Iron Law states that in all cases, the second type of person will always gain control of the organization, and will always write the rules under which the organization functions.”

It does not matter which political party supposedly controls the administration: the Iron Law states that the unelected bureaucrats will control and make decisions designed to protect the bureaucracy.

Whatever strategy you adopt to effect change must take this law into account or you are doomed to failure.

I also strongly suggest that those reading this also read Rudyard Kipling’s “The Gods of the copybook headings”. I have found this to be an effective poem to get people to set their prejudices aside and look at the facts, both present day and historical.

http://www.kipling.org.uk/poems_copybook.htm

Sorry, I have no poetry to offer.

In cruising the net yesterday, I discovered that the Workplace Hazardous Materiels Data Sheet for handling influenza virus has been removed from the Public Health Agency of Canada website. I think this reflects confusion. If they post that airborne precautions should be in place, then this will have a trickle-down effect, and all the masks stocked by the hospitals will not meet specs….and people will refuse to work until they have better equipment.

Everytime I try to post the link, this site becomes “non-responsive”.

One indicator that an H5N1 pandemic would not be mild is the study done with the ferrets… Inthat study they showed that it is unlikely for H5N1 to reasort with a current human virus… 1957 & 1968 were reasortant viruses & they were mild… 1918 did not reasort & was severe.

anonymous 6:28. I LIKE YOU…PICK A NAME!!!!!!!!!!!

I don’t remember seeing your references…if they are at hand could you give them to me again…if you have to search for them don’t worry about it.

I can explain how I came to this conclusion. There is very little known about the disease influenza or about historical outbreaks. We have reasonably good information on 1957 and 1968 and as far as 1918 goes their mortality estimates have been out more or less by a factor of 5 times. The information from the nineteenth century is spotty and information before that is like a black hole. Clarke has been repeatedly telling us that some of the plagues in the Middle Ages have to have been influenza’s and I tend to agree with his conclusion.

Okay, if we look at the last two centuries We have an exceptionally mild one…1968, a mild one 1957 and one that was reported as a ‘freak’ in 1918 that was a one-off never to happen again…

…well, it turns out that this couldn’t be further from the truth. I believe there were either three pandemics in the nineteenth century. The pandemic in 1830 was the equivalent to 1918 (Osterholm May 2005 New England Journal of Medicine) and 1890 which was classified as the worst pandemic in 300 years at the time (400yrs. then if you count the twentieth century) (The Great Influenza - John M. Barry).

Therefore, if we take our last two centuries as sample size, we had six pandemics…three were equivalent to 1918 or worse, two were milder than 1918 and one was exceptionally mild (1968)…

…Therefore my statement…

“I have come to the conclusion that 1918 was the ‘rule’…and 1968 was the ‘exception to the rule’.”

so you think, that study was bad news ? Well, maybe it was. Maybe a mild, reassorted pandemic would be good now. It could make us somehow immune against a more severe one, although not very likely considering the large diversity. And then, we could as well take that prepandemic vaccine. Maybe we should….

Don’t overestimate this study. They just tested a few of the existing strains and a few of the combinations and only in ferrets. They also stated that we shouldn’t too much rely on that study. My guess is, that it reduced my likelyhood of reassortment by 20% so it’s still 80% of what it was before. OTOH there seems to be little reassortment lately in the strains which infect humans. Although, we don’t really know what’s going on in China

WildBill – at 09:50

“In that study they showed that it is unlikely for H5N1 to reasort with a current human virus”

I think they only tested something like 3 out of 50 possibilities. And because it didn’t reasort in the 3 tests, they concluded that it would be unlikely, even though 47 more tests needed to be done. I remember thinking that they had some nerve to use the word unlikely without the testing being complete. Maybe someone has a better memory of this?

anonymous. Unfortunately, here is how I see it…We have a lot of unstable genetic diversity floating around at the moment…including other diseases and we must not forget about our old friend SARS…it also could mutate to increase transmissibility…the only thing that saved us from a full-blown pandemic last time around in 2003.

In respect to influenza alone, we have H3N8, H7N7…1…3…4, H5N1, and a couple of other high pathogenic ones H9 I think and one other.

For want of a better word, I would call this a ‘mutant tsunami’…I don’t think we can count on a one-off pandemic, there are too many possibilities…I think we are in for several pandemics in the next twenty to thirty years…and these pandemics have the potential to overlap because during a pandemic we should be more susceptible to other viruses and as food supplies drop we too may be eating diseased animals.

If we dodge one bullet…we should not on one hand be self-congratulatory and on the other hand be complacent…we are facing a machine gun!!

Monotreme. Thank you for your opening post. I’ll add it to my awareness arsenal.

It’s a numbers game. I’ll lead as many horses to water as I can. The ones that don’t drink I can no longer be concerned about. We are rapidily running out of time.

TonDVM, again you ignore the best source which is available online:
http://www.blackwell-synergy.com/doi/full/10.1046/j.1365-2672.2001.01492.x
Osterholm is not very credible here. He gives no source. He is an alarmist. Clarke’s theory is not commonly accepted and he didn’t mention 1830,1890 AFAIR. Numbers for 1890 are partially available, it was much less severe than 1918. So the Barry reference just shows that 1830 was less severe than 1890. Barry most certainly didn’t say that either 1830 or 1890 was more severe than 1918.

TomDVM, sorry I misinterpreted “references”. Just looked up the Barry quote, he says 1890 was worst in the last 3 centuries (from now?) _except_ 1918.

What would the past pandemics look like with todays air travel? Should we use past pandemics as argueing points? The world has changed so much.

anon at 10:38-“1830 or 1890 or 1918″---Any one of these pandemics would throw our CURRENT civilzation into a tailspin. And do you really really believe in your heart of hearts based on all of the current data (and I know you like statistics and can tally them in your sleep) THAT we will get by with a “1968 or 1957″ next time out of the chute? So what are we arguing here? Is it whether the rubble is going to be bounced once or twice or thrice?

anonymous. Thanks…I am currently re-reading Barrry at ‘warp speed’…could you give me the page number of that quote.

TomDVM, the other flus, why should they be more dangerous now than decades before ?
Well, they might provide a source of reassortment for H5N1, but that’s not new either. They also were that source for H1N1,H2N2. But, when H5N1 goes pandemic, then the risk of reassortment with other flus, shouldn’t it increase dramatically compared with now ? I never read about this, but maybe one pandemic induces another one, not just a 2nd wave. ?!?

page 261

Thanks.

now ,im anonymous

NOW, I AM anonymous…..drumroll please.

Maybe we all should be anonymous. /:0)

Now Tom, somebody might get an alternate view of the world from the other side of the table, if that were to happen. And we wouldn’t want that to happen. Would we? huh, huh?

I could well imagine that H5N1 might cause an epidemic without going globally. We have antivirals,vaccine, desinfectants,masks,better communication now. And the more severe it is, the more effort will be done to reduce its spread. The pan-virus needn’t be as contagious as 1918. Although - no historic example for a contained new fla-A virus so far. Air travel ? We can always close it or quarantine, if we want.

11:06, what you mean ?

anonymous 11:12

What who mean? Which of us at what time?

That there anonymous a couple (or more) posts above me talking about containing H5N1. In your dreams, baby, in your dreams.

here they say that 1889–1895 was much milder than 1918 in Switzerland.


Überall in der Welt lag 1918/19 die Zahl der Erkrankungen und der Todesfälle höher als bei früheren Epidemien, doch schwankte sie von Gegend zu Gegend. Das war nichts Neues. Schon für die letzte vorangegangene – weit mildere – Grippewelle von 1889 bis 1895


another source said that 40%(!) were infected in 1889ff (forgot the referrence)

I have given up re-reading Barry’s book…anonymous thanks for 261…here are the statements.

An influenza pandemic has always been a great global infectious-disease threat. There have been 10 pandemics of influenza A in the past 300 years. A recent analysis showed that the pandemic of 1918 and 1919 killed 50 million to 100 million people,1 and although its severity is often considered anomalous, the pandemic of 1830 through 1832 was similarly severe — it simply occurred when the world’s population was smaller. Today, with a world population of 6.5 billion — more than three times that in 1918 — even a relatively “mild” pandemic could kill many millions of people.

Preparing for the Next Pandemic Osterholm Volume 352: 1839–42 May 2003 ……………………………………………………………..

“During and after the 1889–90 influenza pandemic - with the exception of 1918–19, the most severe influenza pandemic in the last three centuries - he (Dr. Richard Pfeiffer) had searched for the cause.

The Great Influenza, John M. Barry page 261.

anonymous. You are indeed right…I stand corrected…their were other statements that I put together to extrapolate my conclusion but I did not save the evidence…so to speak.

If you compare the two above statements…you will see that Dr. Osterholm states 1830 was as bad as 1918…John Barry states 1890 was the worst pandemic in 300 years…and the statement pertaining to Dr. Pfeiffer was made in the context of the initial stages of 1918 when he (Pfeiffer) could not conclude that 1918 was more severe than 1890…

…but I do acknowlege that different literatures have listed vastly different assessments of these pandemics which indicates to me again…poor record keeping during the panic of a pandemic.

Anyway, on the basis of the page 261 quote alone…I stand corrected.

Thanks.

I want to be anonymous too.

minime anon (without the German accent) does not take on faith data offered in a foreign language by an anonymous poster. Just my bias. Now if he/she had a handle..

here they say, that 1890f was dramatic and 40% worldwide “seized”. But 1918 was the most devastating of all epidemics (probably in the context of influenza ?)

Als dramatischer erwies sich bereits 1890/91 eine Grippeepidemie, die etwa 40 Prozent der Weltbevölkerung erfasst haben dürfte. Der verheerendste aller Seuchenzüge verlief 1918/19 in mehreren Wellen und forderte seine Opfer

I have a handle.

It’s the other anonymous that doesn’t.

Oops, deleted my cookie, the above was me.

Awards go to my alteregos at 11:32 and 11;34

Is than you gs?

Likely - 40%

Okay, let me try that again…is that you gs?

I think if he can be anonymous ,i can too.You see,anonymous,we have handles out of respect and to keep posters in order so we know who the hell we are talking to.Get a handle…

Sorry, Is that you gs?

anonymous – at 11:37

I agree with you.

Or was that me.

anonymous gs, I just tried to read your reference at 6:28 but I am uni-lingual…I can only read Canadian…so it would be really nice if you could give a more expanded description of your references…I admire your command of probably several languages. /:0) Whoops…slipped!!:)

Can the Chinese Government come and get you if you are anonymous?

gs has been resurrected. He is there in the ether. TPTB won’t let him go. One lonely anonymous only has to reach out, and he/she will BE again.

anonymous – at 11:41

Oops, the above was me, as I tire of this.

But anonymous is right. My mind envisions a poster when I see a handle. With anonymous I don’t know which anonymous to envision, the one on the news thread, the one on the Flu Prep thread, the one on the………

I *was* ROTFLMAO… but this is really aggravating. We need the new format requiring registration. Now!

anonymous – at 11:46

was me.

There, I’ve restored my cookie.

God, how does he stand it! Game’s over for me.

Hey this is fun I can talk to my self this way and answer my own questions and argue with my self. I could be a troll and no one will ever know.

here you can read:
In 1918, the cause of human influenza and its links to avian and swine influenza were unknown. Despite clinical and epidemiologic similarities to influenza pandemics of 1889, 1847, and even earlier, many questioned whether such an explosively fatal disease could be influenza at all


so, apparantly it was much more severe than earlier.

see alone the headline:
1918 Influenza: the Mother of All Pandemics


reicht das jetzt ?

(try google for “influenza deaths” +1890)

Anon_22 said: I am less and less certain of whether we can compare H5N1 to anything, and so less able to extrapolate and predict.

I agree. I think we should just be looking at the current data, the current behavior of H5N1, and that tells us all we need to know.

When the idea of a pandemic was brand new to all of us Baby Boom and later kids, there was a need to educate the public about the basics of what a pandemic looks like since none of us had ever spent a minute thinking about the subject, nor had any of us experienced one. At best, the pandemic of 1918 was a footnote in a few history texts. Barry’s book, the bad tv movies, the state pandemic conferences, Osterholm on Oprah, all that has raised awareness of what a pandemic is about in the public’s mind.

But now, the most basic education accomplished, I think that we should not be extrapolating and predicting any future pandemic on the basis of 1918, 1968, etc. They really are not useful and relevant to what is happening today beyond being illustrations of pandemics in general.

Like Anon_22, I have grown uncomfortable with trying to hammer a square peg into a round hole. We need to be focused on what is happening in front of us, what the data from the current situation tells us, and screen out the tales of past histories (which are really distractions now) to formulate policy on how to handle this one. I think we do a great disservice if we use figures like 1918′s 2.5% CFR when the H5N1’s CFR has grown from 50% to 70% this year. (And I don’t think we saw any parallels to that in 1918 anyway). We don’t know if the 1918 virus was seeded around the world by birds, but we know that this current situation has become dangerous because of the speed (in evolutionary time, a flash) that the virus has been seeded around the planet. We know enough about viruses to understand that it is changing, better adapting to humans and other mammals, and I doubt any policy leaders can answer Anonymous’ (yes, please get a name)excellently posed question as to “What would the mechanism be that would stop it mid-adaptation?”

When dealing with policy makers, I would give up all attempts to compare and contrast this possible upcoming pandemic with anything in the past. I would just put the current data in front of them, and return them to the present data whenever their attention wanders. The data in front of us tells us quite a lot if we look at it, in fact it speaks volumes. The only thing it cannot tell us is “when.” Beyond that, policy makers have to be encouraged to take a good hard look at what is happening, real-time, no fudging the data - just look at what is there. We are looking at high fatality rates. And both in terms of the virus’ habits and our own lifestyles we are looking at speed. (And does anybody else think that this current e-coli outbreak in spinach is an object lesson in speed? From 9 CA farms to 25 states in mere days. We are one zippy society). The policy makers need to be focused specifically on what is happening, today’s data, no distractions. Thanks Monotreme for a very sucinct summary up there.

Barry writes: “The great influenza” (title)
The Epic Story of the deadliest plague in history. So we would hardly expect 1890 or 1830 were even remotely as severe as 1918

pixie, H5N1 is influenza A. That’s the only known virus which went pandemic in the past. And there were many such examples. And that makes it so worrysome. Else we could just compare it with Ebola or such. And the other pandemics _were_ 1918,1957,1968…etc. And the virus _did_ reassort with other flu-viruses. And so did H5N1. So it’s not so far fetched to compare it with earlier (flu-)pandemics.

Not me at: 06:28 10:23 10:38 10:48 10:55 10:56 10:58 11:01 11:06 11:09 11:12 11:16 11:22 11:23 11:29 11:37 11:41 11:44 11:45 11:47 11:50

Great post, Pixie. But as others have said, if there isn’t a recent (or fairly recent) history of such an event the bureaucrats harbor that disabling doubt in their minds about the need for preemptive action. The old pols just can’t get themselves out of that “box”, and they worry that they will get themselves out on a limb and somebody will saw it off.

but I also see, that H5N1 is quite different from H1N1,H2N2,H3N2. It’s very prevalent in birds and evolves much faster than earlier flus. Also much more virulent, survives in blood. But could still reassort with other flusA and thus become more contagious.

anon0628. I would appreciate your intuition based on your study of the subject pertaining to:

Is a pandemic going to happen…when will it happen…where will it start…will it be a mild one and which previous pandemic would you expect it will be similar to…what will be the attack rate and the CFR.

I would be very interested in your opinion. Thanks.

Closed and continued here.

Medical Maven, point well taken about the pols not wanting to crawl out on a branch. But we also face the risk that if they do take action of some kind, they will utilize old and worn out models that just do not apply (i.e. those state pandemic plans). In the military they call that “fighting the last war.” We’ve done that lately too. Rolling into Baghdad was not met with the same response that rolling into Tokyo and Berlin was met with in ‘45, but that’s because some really key points of present reality were probably left out of the strategic assessment. If we talk about 1918 and 2.5% and having months to prepare a community, we are likely to find out quickly that this new war against H5N1 bears little resemblence to the past influenza wars too. So beyond the broader educational possibilities of describing past influenza pandemics, I’d still stick to the evidence of what is happening now in front of us as the action model for any pols who do want to move towards the end of that branch. It’s a harsh enough reality on its own, and it leads to the conclusion (even apart from any historical models) that they should taking action, even if no pandemic had ever happened in 1918.

Sometimes I think that the comparison to 1918 makes it all look too mild, makes the pols even more complacent. If we were talking about a 2.5% death rate in Indonesia, maybe that complacency would be warranted.

I for one have been frustrated with TPTB. I have felt that Im banging my head against a brick wall. All the while the clock is ticking. So what about going straight to the people instead. Im going to start hitting area churches.I will be making appt. with the pastors and presenting some of the facts regarding H5, I will leave some reading material with my phone number and an offer to address the church about the threat and what can be done to prepare and motivate local officials to act. Anyone have any other ideas, places, or groups that might be receptive? Your collective thoughts would be welcomed

Local clubs are always looking for “speakers”. Check with the extension homemakers, PTA/PTO, scouting - be prepared, Lions, Rotary, Professional Women’s Association, Local political women’s group, check your local paper and see if it has a calendar of local events - and call those sources, historical club, genealogical society - tie it in with 1918, support groups - folks with special needs that need to be getting ready, Salvation Army?, food pantry, rescue missions, etc. Local university/college professors of history/public health/continuing ed for their classes. Local health food stores to have a ‘workshop’, local grocery stores for a prep promotion, drugstores the same.

janetn – at 23:14

Good for you!

Just one word of caution. If this is the first time you are publicly doing this in a systematic way, it may be useful to ‘practise’ what you are going to say first, to get the best effect. This kind of information is not easy to understand nor easy to accept.

Probably most important to get 2 things right

1) the amount of information or level of complexity - it may be useful to write out a ‘chain of logic’ to build your case towards your outcome, then make a simplified version of what you’ve written so you have 2 different levels of details to give depending on who you talk to and what they are interested in.

2) the balance between being assertive and being permissive - push them too hard, people abreact. Just give them the information without telling them what to do, most people won’t do anything. You need to offer solutions so people don’t feel helpless, but the solutions should have enough flexibility that they don’t feel being walked over either, IMO.

I would also recommend saying that this is an evolving situation and you would keep them informed of developments. This will give you the opportunity to do that as well as re-visit what you have said the first time. Do not be surprised or upset if you find that they have missed quite a lot of what you said the next time round.

I read a survey once that said most people questioned immediately after leaving a doctor’s office retain only 40% of what they have been told.

Good luck.

janetn

Your goal is admirable. However, you may want to consider remaining annonymous. When this stuff hits - and the folks are dropping dead or starving - if your contactees know that you have goodies, they will come for them. Pastor, congregation, and all.

Consider this: Annonymous email to those in the community that you think may have some influence. Point them to this site (including the forum) and other sites. They then become responsible for their own destiny, and you don’t reveal your identity.

janetn – at 23:14

That is a great idea. And it what i have done.

My recommendation… Set up an appointment with someone in your health department for a meeting. Tell them you want to show them the material you are going to be presenting to various groups. Your reasoning is to make sure you are giving the same information. They may share with you some of their plans… It does work. I now am part of the committee.

But, things to think about. Power Points work well, but use them as a visual only. Talk to the slide’s contents. Use pictures of the 1918 pandemic… Those slides are a good place to talk about things like… The medical care available then… and the medicare available now… and the CFR is still > 50%.

use the most current info… Inform them that there are official sites that have info… i.e pandemicflu.gov, cdc who, CIDRAP, Pro Med, etc…. and unofficial but very informative in all aspects. i.e. fluwiki.

Don’t stay anonymous… people don’t know where you live. If people do not begin to get out there and be seen, then others will not either. Set the stage….

The issue of anonymity is very important. There’s a case for it both ways. On a local level, Surfer’s concern is genuine. OTOH, it is very hard to be convincing if you are anonymous. Perhaps one way is to work on a bigger piece of ‘localness’ eg county level rather than town level, and not give out your real address except to 1 or 2 people.

I myself have chosen for now to work more at the national or international level, and not just cos of this. I have only spoken to one person locally, someone that I picked very carefully based on many considerations, and this person has not responded at all. I have a suspicion that he has taken my advice and started to prep but chose to keep quiet about it. In a way I don’t blame him, as trust is not easy to find in this town where I live!

As Melanie kept reminding me, coming out of anonymity is easy. Taking it back is impossible.

There might be a network so that I talk in your place and you talk in mine. If such a “couple” is formed, please tell us how it works.

lugon – at 05:49

There might be a network so that I talk in your place and you talk in mine. If such a “couple” is formed, please tell us how it works.

OMG that’s such a good idea! You want to start a thread for that. Yes, you do. :-)

anon-22 - How is Melanie doing? Any word on when she’s coming back?

The anonymous thing would not work for me in any fashion. My county is too small. Everyone already knows me, my family, etc. But, what I bring with the familarity is credibility.

But,summer of 2005, I did pick and choose who to talk to. This summer and fall, there is more of a sense of urgency. I am talking to larger groups. I know people are listening, I know people believe… I just do not know if they really understand and are prepping to any extent.

I am now beginning to talk to teenagers. I am telling them how to talk to each other, their parents, etc. Most important… get the facts right.

don’t forget the federal checklist for churches at pandemicflu.gov, and, anything useful you can find from your state’s pandemic summit

;-) (if you’re not from the US, feel free to borrow anything - go find that retracted Nov 3rd “12-week” advisory for Americans in HK)

“Faith-based and community organizations will play an integral role in the event of a pandemic. Health and Human Services (HHS) and Center for Disease Control (CDC) have developed a checklist to assist community organizations with their pandemic planning” (also available En Español )

http://pandemicflu.gov/plan/community/index.html

Same page, I would also print out the Medical Reserve Corps guidelines, or, just their Assumptions about what a pandemic will be like, since seems like places are trying to get people to volunteer without knowing what a pandemic really is, or just want to talk about the vaccine distribution part, not the getting community ready for “two or three quarters of a year catching pandemic and coping with disruptions part” … which certainly seems like should happen first, in case this breaks out next month…

I also wonder if local papers or free, advertising-papers, could find something to object to in being asked to run snippets as filler/PSAs; the short Definitions of Seasonal, Avian, and Pandemic influenzas, and say it is “from the US pandemiflu.gov” for instance.

;-) HHS Sec. Leavitt’s MN pandemic summit quote:

Any state, any community, or for that matter any citizen that failed to prepare - assuming that the federal government could take care of them during a pandemic - would be tragically wrong,

Or the pandemicflu.gov intro for individuals the parts that say, during an influenza pandemic, Social Disruption May Be Widespread, Being Able to Work May Be Difficult or Impossible, Schools May Be Closed for an Extended Period of Time, Transportation Services May Be Disrupted, People Will Need Advice and Help at Work and Home, Be Prepared, Stay Healthy, Get Informed see http://pandemicflu.gov/plan/individual/index.html

“from the US pandemicflu.gov” (darn, knew I missed a typo somewhere)

Try the Men’s fellowship groups—they are always looking for speakers. Keep it short only 20 minutes and have handouts with additional information and web sites. Most churches also have women’s missionary groups that may be willing to have a speaker, If you are a male you would probably want to ask your wife to make the contacts and accompany you. Use the Biblical angle and women want to hear how they can protect their “cubs”. Different strokes for different folks, know your audience and what they want to learn about. You might want to feel out the heads of these groups first—if you can get leaders behind you the rest of the group will probably listen. Try writing articles in the newspaper and offer to speak to local groups.

(You mean an angle such as the “during 7 good years; stock up for coming 7 bad years” story?)

lugon wrote: There might be a network so that I talk in your place and you talk in mine. If such a “couple” is formed, please tell us how it works.

anon_22 wrote: OMG that’s such a good idea! You want to start a thread for that. Yes, you do. :-)

I see just one problem with that idea: the name and location have to be Joe Nobody or they may print it electronically and you’d be found out locally anyway.

But I’ll start the thread and see what happens. Here it is!

You folks are to be commended for your your concern. However, there is no need to put your life on the line needlessly. Yes, warn your family and friends. Most will ignore you. Be sure that they understand that they will not be invited to share in your assets and provisions (if you have enough) unless they agree to specific rules and compensation for your effort to save their lives. Be firm. Don’t let their ignorance soften your stand and be transformed into guilt.

As for the community, you will have a bullseye on your forehead if you reveal your preparations. Maintain your annonimity, but get the word out. It is not your fault if your community ignores your warning, just as it not your fault if they ignore the smoke alarms in their homes when they are on fire and burning to the ground.

Your priority is to protect your family.

So, about that fluwikian relocation program…

Don’t know who bumped this at 06:37, but I happened to spy it. The following is my one page letter that I am shooting out today. Perhaps it can be of use to others.

November 17, 2006 Dear Friend,

I’ve been sending out warnings regarding this subject since January 2006 (contact being made personally, by mail, telephone, fax, or e-mail). To my knowledge, almost one year later, not one recipient has prepared. Shocking. Amazingly, except for four individuals, folks did not even have the courtesy to acknowledge receipt of my messages. It is disappointing, yet revealing.

This letter is an effort to inform those of you that I have not previously informed of this dynamic situation. Perhaps you “new” folks will understand the severity of the circumstances - none of the previous recipients apparently did. I hope all of you do.

This condition is rapidly approaching critical mass. New information released this past week by institutional and government sources is compelling and urgent. Wake up, look up, and wise up. Previous recipients - this is a courtesy notice. You are only being copied. You were warned. You did not respond. I hope that you now “get it.”

Based on past experience, I don’t expect most or even any of you to act. But I am extending this warning to you as a “heads up” because I am personally acquainted with each of you, and I would not feel comfortable if I did not pass this information on to you. At the risk of being scorned, I have now warned you. And glad to do it. It is now up to you to act - or not.

Bottom Line: If you don’t act soon, it will be too late for you to do so. Believe it. In the U.S. Armed Forces, this is referred to as a “no shitter.” Rephrased, that means that “if you don’t get your ass in gear right now, you ain’t gonna make it.”

Believe me. I’ve spent well over 1,000 hours researching this subject. I’ve devoted at least three times that amount of time preparing. I am convinced that it will arrive - and soon. You can prepare in much less time. I can show you how. Just ask.

The threat is from pandemic H5N1 “Bird Flu.” H5N1 is here. It will kill you either by direct virus contact or collateral damage to our infrastructure. The pandemic has yet to arrive, but it is very, very close. It will be devastating. Prepare accordingly.

Visit (www.fluwikie.com) for basic information. To see my posted opinion, scroll down the left column (gold colored) to the “Opinion” category. Click it. On that page, scroll down to “Surfer’s Introduction and Views.” Click it. Read all of ‘em.

To view the opinions of others, visit (www.fluwikie2.com). It is important that you do this! The opinions and facts expressed on this forum range from those of the new and uninitiated to “in the know” scientists, doctors, researchers, health care workers, and government employees. The opinions and news arrives from around the world - 24/7/365. Yes, there are some folks that post seemingly stupid opinions on some threads. Those opinions may indeed be stupid. Who knows? But don’t let that distract you. Sort them out, and ignore the rubbish. Look at the big picture. Read the (www.newsnow.co.uk) website (hot topics, bird flu) and the (www.fluwikie2.com) forum daily. Bookmark them. Lots of good gouge. You don’t have much time left. Check Six. Pass it on. Best Wishes. Surfer.

I just found this thread. Umm been there done that. Let me save you the trouble. You will find that no one is interested in what you have to say, they will look at you like your a nut even when you have legit scientific data to back it up. You will quickly find people are just too stupid to comprehend what is going to happen and you will get frustrated and mad at them. The people that can understand what your saying already know whats up. Plus looking at the news of the last 2 days it might already be too late. Even going full bore you cant prep in a few weeks. The average person does not have that kind of cash reserve to do it even if they wanted. Personally I have a maxed out amex card to show for my prep efforts. I dont mean to really discourage you, by all means if you think you can make a difference go for it. But speaking from personal experience your wasting your time. If you think Im wrong try a couple meetings and speaking engagements and you see very quickly what I am talking about.

I’m curious, with all these problems in your surroundings…
has noone ever considered to move away ???


Let’s create flubieland and give us our own constitution ! And yes, let’s prepare to take over the world when panflu hits badly and revolutions start elsewhere… That’s the sort of preparation which makes people listen. Some union of states like the EU, but worldwide, finally a world government. This is needed anyway earlier or later

Annoyed at 09:55

I’ve been there and done that as well. Re-read the first paragraph of my post. See also my posts on the opinion section on the main wiki. Not one has prepared. I’m simply sharing the message with others that I have not yet contacted. If just one of those prepares, then perhaps I will have saved at least one life (maybe many if one includes the family of the newly contacted recipient).

E-mails are easy. If recipients don’t respond, no harm - no foul. I’ve done my job, my conscious is clear. I’m not going to force them to do the right thing at knife point.

As for speaking in public, see my post on 10 November on this thread. I won’t do it.