Let's start with this...

I'm not close to finishing my 'package' but here's what I have posted elsewhere so far - a review of what influenzxa is & how it works. That's going to segue into H5N1, pandemic potentials from a medical point of view, then the whole spectrum of socio/economic/political factors whaih are going to mess us up big time when this hits:

***WHY H5N1 is leading to pandemic worries

--------------------------------------------------------------------------------

I see a lot of 'pandemic fatigue' expressed in a lot of places. People are thoroughly fed up with annual warnings that pandemic flu may be just around the corner, we need to be prepared, we need more money, vaccines, blah, blah, blah.... yaaaaaaaawn!

Okay, fair enough. After all we see new strains of flu every year. Most of the more serious ones are covered in flu shots for those who choose that route & for the majority who don't, IF they get flu it's a matter of several days of miserable inconvenience followed by a complete recovery. Yet almost as an annual ritual we get these warnings & since the advent of widespread H5N1 avian flu last year, they've really taken on an urgency not previously seen.

So what's up with that? We're not living in 1918-19 when Spanish flu killed up to 40 million of the world's then 2 billion or so population. WE live in a developed part of the world. We have excellent medical available to most of us at levels which are the envy of the rest of the world. We have outstanding specialists in every field, a broad spectrum of preventatives & treatments & a pretty good surveillence system for most worrisome things.

But there is a threat - a clear & present danger that IS mostly closely exemplified by H5N1 & it's not at all far from us in any practical sense. I'd like to try & explain why. Because I'm prone to nauseatingly long explanations with all sorts of side tracks, I'll break it up into sections. I'd better review the purely medical aspects of it first - WHY this particular type of flu represents such a looming danger.

Planning for & responding to pandemic threats involves a great many factors - it's a real headache making exercise at all levels. In terms of pandemic flu - which is what I'm addressing here - the medical considerations alone are a nightmare. They are only one of several crucial factors that much be examined, managed, prioritized & 'blended' in an attempt to benefit the greatest number of people possible. These other factors include economic considerations - macro & micro, politics & social/human factors. In the end, no matter how well prepared a plan is, no matter how thoughtfully executed in the beginning, the very nature of these factors at play over a global scale almost guarantee significant failures.

So let's go - section by section starting with the medical explanation...***

The basics of influenza

Let's start simply...


There are fifteen TYPES of A strain flu, which is the strain which causes the most problems for us. These are the 'H' designation in the flu names. All types of flu live naturally in migratory waterfowl, (ducks & such) & until very recently didn't make them sick. They contracted the virus soon after they hatched & lived with it all their lives with no problems. We had the odd problem when virus excreted in duck doo somehow ended up infecting domestic poultry - chickens, quail, geese & such. In THESE birds the one we're worried about is invariably fatal & in a very rapid & nasty way.

Until recently only 3 'H' types infected humans, H1 through 3. It's when they first 'jumped' from birds to humans that they proved to be real bears. H1 showed up in large scale as the 1918-19 Spanish Flu. H2 first appeared in 1957 & H3 in 1968. The latter 2 weren't as severe & we have yet to figure out why H1 in 1918 was so hard on humans.

Flu mutates quickly & every year we see 'modified versions' of the H1, H2 & H3 types which we're used to. When the mutations are large enough, they tend to make more people sick than in 'normal' years & those people often became sicker. We saw that last year with A/Fujian - that's an H3 & it was different enough so that very young kids especially, were vulnerable.

We old farts have been exposed to lots of different mutations of H1, H2 & H3 in our lives so we have a degree of protection already in our immune systems. Some immune factors react against most versions of any of these individual types. If you had A/Saigon - an H2, (which I'm making up here), when your body is exposed to A/Wisconsin - (another made up H2), you have a lower risk of getting sick or if you do, won't get as sick. Now if there's been no H2 in your neck of the woods for a number of years, you're still going to be okay but the youngest members of the population have NO expsoure & no immunities. Guess who'll catch A/Wisconsin first & get the sickest? That's what happened with A/Fujian - it was different enough from the H3s that have been around over the past 5-10 years so that they had little protection. The very smalls got very sick & some died.

Back to H5. It's beginning to 'learn' how to infect humans. Save for a few cases here & there, relatively speaking no human population has any 'immune experience' with H5 strain flus. That makes us ALL vulnerable to this type of flu. When large segments of the world's population have never been exposed to something, that's when it tends to hit the hardest. Historically we see that with native North Americans who'd never had exposure to certain European diseases. It killed them like flies when to Europeans, these were literally childhood diseases with low fatality rates - measles etc. killed up to 50% of natives when they were first exposed to it.

This is currently the major concern with H5N1 but let me end this part here. I have a tendency to ramble on & too much info in one post is mind numbing...

Next...

--------------------------------------------------------------------------------

H5 is a strain which is new in humans & has yet to develop the ability to EASILY infect people - as far as we know. Without getting into the biochemistry & microbiology of how flu virus infects, let's simply say that if the H5N1 virus is a key, the human cell that's the 'lock' it's trying to open isn't a match for the key. Either it's brute forcing the lock or getting in some other way & it's been successful very few times that we're aware of.

Flu viruses for a couple of reasons, mutate very easily. Luckily most mutations don't hold up to 'hard use'. Either they don't offer any advantage to the virus or they work against it & the viral line with these mutations quickly peters out. Most years, enough mutations accumulate in named flu strains so as to cause them to DRIFT away from the parent strain - genetically they're different enough to get their own name. Last year's A/Fujian genetically drifted away enough for a new named strain A/California to emerge. Most often these drifts away from the 'original' still mean it's close enough to be considered almost a sibling. It's not really going to have much effect on the number or severity of flu cases.

Every few years, the drift is a bit more serious & a new named strain can be quite different from it's 'parent'. In these cases, we'll often see more people become ill & of those more will have a more serious bout of illness. Again - A/Fujian was an example of that. These drifts happen because flu viruses are prone to many copying errors & the virus doesn't have a built in correction function. Often the errors simply consist of a few bits of genetic material lining up wrong, going missing or shuffling around a bit in order - no biggie but over time enough of these errors accumulate to lead to a new named strain. This year, it's A/California that's accomplished this in North America.

A more major change in genetics is known as SHIFT. That's when a really major change occurs in the flu gene of any type. That can happen several ways. One way is that the genes in a virus are shuffled around like a deck of cards - sometimes they shuffle in such a way as to have the same genetic material but as in real estate, location is everything. A string of genetic material in one spot can result in one thing where in another it can do something completely different.

The more dangerous changes for us occur when 2 different flu viruses literally swap genetic material. 2 flu virus particles, completely unrelated to each other can be in the same host cell at once. While they're reproducing, there is a short period of time where the genetic material is 'migrating' to a part of the host cell - lining up to form into a new virus particle. If 2 such movements are occuring close to each other, the 'wrong' genetic material can match up & you end up with TWO completely new viruses. That happens fairly often, it's theroized & most of the time there's no visible result. I would think most of these mistakes are big enough so as to render the resulting viruses unable to act as flu viruses - they fizzle.

The risk is when by accident a relatively harmless flu virus to humans picks up genes which turn it into a potential killer. There are 2 main ways this happens with different results - that's next.

CS, I am so happy to see you here. I do hope you'll stay.

How's H5N1 getting into humans?

More H5N1 considerations

--------------------------------------------------------------------------------

I mentioned locks & keys wherein the human cells a flu virus infects can be considered to have a lock which much be opened & part of the flu virus can be considered the key. The key in a flu virus is the 'H' designation in the name. Right now it doesn't fit the lock in human respiratory tissue cells that flu virus usually infect. I'm still not sure how the virus is managing to get in - hoping one of our colleagues here with virology education & experience can explain how H5 is doing that.

In birds, H5N1 gets in through DIGESTIVE system cells which have molecular characteristics our respiratory cells don't have. Symptoms in poultry tend to be digestive in nature to begin with - not respiratory. That's been 'saving our bacon' so far. Now let's imagine a scenario where H5N1 DOES get into a human - as we know has been happening in several Asian countries - most notably Vietnam. At the same time a HUMAN flu strain is also inside that patient - in the same respiratory tissue cell. Both the viruses - the H5N1 & say... an H3N2 are replicating, (reproducing) & they swap some genes. The H5N2 COULD pick up enough HUMAN strain flu genetic material to gain the ability to easily infect people - changes to the 'key' to it more easily fits the human 'lock'. Or the H3N2 COULD pick up some of the characteristics of H5N1 that makes this subtype of flu really nasty with people. Maybe both - although statistically that's really pushing it to think both new viruses could be that awful.

Our patient may or may not live but while they're sick, they pass on the new 'improved' strain to a family member or member of the health care team. Because it's gained the ability to more easily infect people, someone gets sick... & passes it on. THAT is how a pandemic would theoretically start in a very real way... a new strain that can easily infect people due to genetic changes that also retains the ability to make people extremely ill.

Until now, that doesn't appear to have happened - no new strain has developed in such a manner AND managed to infect people AND spread. I'm not saying those genetic changes haven't happened at all. Maybe they have & the person within who the changes happened died or recovered without passing on the virus. That new line of virus died out with no further harm being done. We have no way of knowing if this happens & if so, how often.

The World Health Organization last year worked out a case definition of H5N1 infection in humans & passed that out to health authorities everywhere - especially in southeast Asia. It let them know what to look for & when they should suspect possible H5N1 infections so they could take appropriate safety measures. Primarily, they asked doctors & other health care workers to look for the usual flu symptoms which progress very rapidly to severe illness AND exposure to poultry, exposure to KNOWN human H5N1 cases and/or travel to affected countries. These symptoms all revolved around respiratory symptoms - coughing, shortness of breath, pneumonia, as well as fever, severe achiness & the miserable stuff we associate with flu.

Things may have just changed in a very unwelcome way & I'll do that next - later this evening. I might first explain why flu, in spite of modern medicine, vaccines etc is tough to control at the best of times.

Why we can't control flu

Why we can't 'control' flu


Humans contract influenza viruses most often by inhaling them. Touching virus then either touching your eyes, nose or mouth can also give you a case of influenza. The virus is capable of surviving up to a few days in the environment under the right conditions & you can safely assume that if you have someone in your home suffering from flu, there's virus everywhere & you're stuck with it until 2-3 days after your sickie is better & has stopped shedding virus.

Usually within 48 hours of inhaling or otherwise taking in enough individual flu virions, (virion = singular of the plural virus), you come down with flu. That can vary - generally by a day or to on the longer end of the incubation period. Here's one reason this illness is so hard to control. 24 hours BEFORE someone starts feeling lousy, before they start thinking they may be sick with something - they're transmitting the virus. If they cough or sneeze - they expel virus. If you're sleeping with your spouse who's expelling virus with every breath, you have a good chance of waking up with flu yourself 48 -96 hours later.

So... you have a virus that is easily caught by humans, is transmitted through the air & by touch, can live in the environment for a while & can be passed on before the first person even knows they have it.

And while we frequently hear of people REALLY sick with it - some literally wake up in the middle of the night feeling as though they want to die after going to bed feeling fine, many don't get that sick. Initially, they may simply think they're overtired, have a cold... it can take a few hours before symptoms get bad enough, (if they do), for them to realize they've got flu. They may go to school or work, run errands... & pass it on to others who may get far more ill.

Most years however, that's not a problem. H1, H2 & H3 types have been with us for decades & while they can & do mutate over time to become more virulent, (sick making), some years, for the most part the older you get the more exposure you've had to similar types & the less likely you are to catch them or if you do, you generally "just" suffer through a few days of misery. Periodically the changes are large enough so that those without much exposure to a certain type, (usually young children), are going to get sick with flu more often & may be sicker with it. A/Fujian was a prime example of that last flu season & it hit early & hard. We probably all remember the news film from nightly news. This year's season has been fairly average this year but is heating up & that's being blamed on a 'cousin' of A/Fujian - a new named subtype of flu named A/California. It was first spotted in September & really seems to be taking off now. Watch... most who get it & suffer the worst complications will be children.

Last year A/Fujian was no stranger to the WHO or CDC when they looked at the composition of flu vaccine for that season. The problem was they simply couldn't grow it out & had to reluctantly leave it out of the vax formulation. The result was a hard & early hitting season - tons of sick kids. This year, they found a very similar subtype & have successfully used it in the flu vax. A/California is different enough from A/Fujian to mean no protection from A/California can be gained by a vax including A/Fujian. So they've decided to include A/California in next year's vax - replacing the A/Fujian part of the vax.

One little problem - it's hitting now. Another problem - A/Wellington - another type similar to A/Fujian but different enough so A/Fujian vax component doesn't work was the dominant strain in the southern hemisphere last spring/summer. It was been chosen for THEIR vax for this coming season. I've not seen reports of A/Wellington on this side of the ocean so far this season. It wouldn't be 'covered' by the A/California part of the vax. Yup - this was a gamble - A/Wellington which hasn't been seen here yet? Or A/California which is here NOW? What if yet ANOTHER named one of that subtype surfaces? Norway is starting to report something they're calling A/Norway - a relative of California,Fujian & Wellington. What if something completely different, as yet unidentified appears between now & next flu season? We're pretty much already committed to the formulation as it's been set now - only about 6 weeks left to change it if necessary.

These concerns can make for some interesting flu seasons & when you get a few in a row with assorted problems - health authorities get twitchy. Is it coincidence? Is the viral type or subtype undergoing a series of rapid genetic mutations leading to profound changes? An older strain of flu can have faded to 'deep background' for decades - barely being seen anywhere, then after a few mutations can roar back to life. While it's been rarely seen however, lots of people have been born who may never have had exposure to that type of flu or anything closely related. This can lead to outbreaks of middling to severe disease in areas where these particular flus have not been seen.

Now all the above & a bit more which will come later - is about strictly HUMAN flu. The problems or potential problems with H5N1 AVIAN flu encompass these issues & other more worrying ones.

Flu vax - what's up with that?

--------------------------------------------------------------------------------

First - what exactly is it?

The annual flu vaccine offered to just about anyone who wants it, (when they have enough), consists of an injection or nasal mist which contains 3 different flu strains/subtypes judged most likely to cause serious illness in a flu season. While B strain flu tends to be mildest it can hit kids hard so the B strain known to be circulating is included. 2 types of A strain are also included & which is chosen also depends on what ones are thought to pose the most risk. This year A/Fujian, (H3N2) & A/New Caledonia, (H1N1), are included in the vaccine.

Picking which 3 are going in to any season's shot is always a gamble. Dozens of different named subtypes are identified each year so the WHO does their best to pick the ones which cause the most serious illness or which are new, have the potential to cause serious illness & which are 'on the rise'. Usually they get it right but some years, they're surprised. Why only 3? Making the vax can be fairly complex & realistically more than 3 strains would mean slowdowns in production as well as result in even larger volume injections.

How is it made?

When the formulation is decided, selected labs grow out in chicken eggs which are as close to sterile as possible, 'seed strain' of the candidate strains. Those are then tested to make sure they haven't picked up any kind of impurity & the seed strain is sent to the companies who make flu vax.

Virus is injected into chicken eggs which are laid at poultry farms which are contracted to provide such superclean eggs. One egg will grow enough of 1 of the 3 viral strains to make enough for ONE vaccine dose. Only 1 viral strain will be grown in each each so if a company wishes to make 100 million doses of flu vax, they need to have 300 million of these eggs. Yup - takes time.

Once a company has all the virus needed, it's killed, cleaned to make sure there are no impurities & the virus 'broken up' - that's an attempt to guarantee there's no way the virus used in vax production can CAUSE an influenza infection. The 3 different flu viruses are combined into 1 vaccine formulation & other stuff is added. Thimerosal or other preservatives are added so the vax has a longer 'best by' date. Small amounts of antibiotics are added in case the vax gets contaminated at any stage of the delivery, preparation for injection & injection itself. Small amounts of other stabilizers are added.

Before the vax is licenced to be shipped anywhere it undergoes testing to make sure they got it right. Is it contaminated? If so, it has to be disposed of - look at Chiron this year. Is it formulated properly to form antibodies - lab testing clears that up. Is the amount of the various ingredients correct? Too much or too little of some of the ingredients may mess it up.

Only once all that is done & the vax licenced for human use can it be shipped out to distributers or directly to consumers. Each country using flu vax has its own regulations about plant sterility & safety, composition of the vax & specific testing requirements. They can't be strict enough in my book. "First, so no harm". All of this can take upwards of 8-9 months, which is why we are NOW picking the formulation for next fall's vax.

I said earlier, that can be a gamble. The southern hemisphere replaced A/Fujian with A/Wellington as a component as they've seen a lot of this new named subtype this year. For the northern hemisphere, it seems A/California may be the biggie next season. This leads to the interesting potential scenario that the south might see A/California, we might see A/Wellington... & both have the wrong formulations. Because our seasons differ, we can't swap vaxes - ours wouldn't be ready for their use & theirs would be used up.

So does flu vax work?

Does flu vax work?

--------------------------------------------------------------------------------

The answer depends what is meant by the question.

The vax formulation does indeed produce antibodies to the strains it includes within people - that is regularly tested. I was part of one such study years ago - not a large scale one but did get to see my results. That formulation that year gave me a nice level of antibodies a month later. Retesting after 6 months however showed they were dropping already & the last test, after a year indicated only tiny remnants of antibodies to those strains in my blood serum.

That's the exasperating part of this - the antibodies last at best, a year & in those populations we'd most like to see vaxed - the elderly & ill, sometimes only a few months protection can be obtained. I don't know enough to understand all the mechanisms behind this but I think age, pre-existing conditions & slowly metabolic responses may act in combination. Face it when you're elderly, your body is slowing down & eventually, breaking down.

Does flu vax, if there's a high rate of uptake, lower the incidence & severity of flu in a community? Logically yes - but we can't prove it. Flu is not a reportable disease & even if it were, how many people coming in with flu like symptoms are ever tested specifically for flu? Not many or else labs would be flooded with flu samples & wouldn't get those much less anything else, done. So many respiratory illnesses mimic flu you'd end up testing up to half a nation's population every flu season. Impossible & expensive.

But knowing that vax reduces illness & severity - as shown in testing in 'closed' environments such as nursing homes where flu shots are sometimes mandatory, can help people decide if it's for them. Vax has been shown to reduce outbreaks in long term care facilities if most patients AND staff are vaxed. Yet even with high rates of coverage, you still get outbreaks. The vax doesn't induce an immune response in everyone, especially the elderly & often when it does, it's only partial.

The reasoning goes that some is better than none & if we have a vax that appears to be reasonably safe, why not use it? It's a call I feel everyone should have to make for themselves, considering their own health, the health of those they live with & to some degree those people they work with. If I choose to live in a small hospital that cares only for HIV/AIDS patients, it would be damned irresponsible for me NOT to get vaxed. Same holds if anyone in my family has serious health issues.

We're hearing now 2 messages that some find confusing. We know the current human flu vaxes offer no protection against H5N1 avian flu, yet are urged to get that vax anyone in order to 'prevent a pandemic strain' emerging. That reflects the ability I explained before of 2 entirely different strains of flu recombining within you to form an even more dangerous strain. The reasoning goes if I'm infected with H5N1, (maybe mildly) & have the vax against an H3N2 named subtype, there's no risk of those 2 strains brewing a monster I might pass on.

This neglects the fact that only 3 of often many circulating strains can be prevented from recombining this way but with flu, we're stuck using what little we have as best we can. We're trying to hold back the tide knowing the tide is coming anyway.

It's worth the time to mention that in any given year, few countries have enough flu vax available to vax more than a percentage of their population. In most cases they have more than enough to meet demand. Most people don't get annual flu vaccines & most people don't get flu every year. Of those who do get flu, the vast majority make uncomplicated recoveries. The current 'H' types making the rounds have been circulating in humans for a great many years & while they change to some degree yearly, most of us have had enough exposure to them to prevent illness that completely overwhelms our body. If we get ill with flu we're more likely to suffer several uncomfortable days & possibly a few weeks after that where we feel more tired than usual. We may miss some work or school. The overwhelming majority of flu related deaths happen in those population groups already vulnerable to most infectious illnesses - the very old & very young, the immune compromised & those with pre-existing medical conditions. Most hospitals occur among these same groups.

Should H5N1 develop into a form which will cause a human pandemic - we're going to see a completely different picture.

Back to H5N1

--------------------------------------------------------------------------------

We 'know' of less than 100 confirmed cases of human H5N1 illness world wide since 1997. I think that's way off, that there may be thousands out there who've been exposed & have developed antibodies without having been ill or who had mild illness. Nevertheless compared to a world population of 6 billion+ - that represents almost nobody being exposed to H5N1 - ever. So WHEN H5N1 jumps with both feet into the human population, it is going to have a pool of 6+ billion people vulnerable because almost none of these people have had any exposure & thus immune systems will have no specific antibodies to combat this form of flu.

In terms of the signs leading up to pandemic & the severity of illness, right now this is running frighteningly close to what happened before & during 1918-19. We think - we can't KNOW for sure because we don't have good samples from back then we can test. After all, we're talking 85 years ago. They didn't even know about viruses back then, never mind how to preserve samples over the very long term. So we have to examine what incomplete samples we DO have & look at historical & privatew accounts of what happened back then & from that, try & determine what MIGHT happen here with H5N1.

Human flu normally has a death rate of .04% & those deaths occur among those who for various reasons can't handle a heavy duty respiratory infection or the complications that can result from one. The very old & very young babies. Anybody who's immune compromised, anybody with certain & fairly significant pre-existing medical conditions. Those high risk groups will grow after pandemic starts, but that's something for later. Spanish Flu saw a death rate of 2.4% - not even close to frighteningly high but when you consider that at least half the world's population caught it over the 2 years it was making it's rounds, that adds up to a lot of deaths.

H5N1 is currently running a death rate of well over 70%. I still think that's WAY off, far too high but even if we can drop it as low as Spanish Flu in terms of death rate, it may still mean a lot of dead. The world's population in 1918 was 1,864,154,000 - slightly less than 2 billion & a bit less than a third of what it is today. By extrapolation then & depending if you use the lowball 20 million dead or go as high as 40 million for Spansih Flu - accurate counts are impossible, we could be looking at 60 to 120 million dead. I suspect even that is lowball but later on that & the reasons why I'm thinking that way.

Demographically, that may be considered 'chump change'. The population in 1919 ROSE by 14 million & that 14 million per year rise held for quite a few years even with pandemic flu about:

http://www.neopage.com/know/worldpop.htm

Today, that number of deaths, even on the high end, wouldn't cause a drop in world population is the flu itself is the only consideration - it won't be but that we can't predict in terms of other effects leading to death; not accurately.

Spanish Flu started showing signs it was coming about a decade before it went postal. Ferocious & small scale outbreaks of odd respiratory illnesses were reported in humans in various parts of the world. Coming closer to 1918, many occured in, at or close to military installations & thus, no special importance was placed upon them. War & infectious disease go hand in hand & in every war at least as many die of disease & infection as they do directly of battlefield wounds. Back then there were no antibiotics, the trenches were hell & so particularily nasty forms of flu, pneumonia & similar illnesses were seen as consequences of war.

But even animals started suffering of unusual respiratory illnesses. A large region of France lost most of their horses. Some primate species contracted killer flus. MOOSE in Canada did & Lord knows what else. I'd need a month or 2 with a pile of books, no responsabilities & somebody shovelling food at me a few times a day to get through the background reading I'm still lacking to really 'find' all the precursors. I've picked up enough to see though, that we seem to be heading down the same payth with H5N1.

One problem when examining the precursors back then is... were all these outbreaks due to the SAME subtype of flu - the Pandemic H1N1 we know caused Spanish Flu? Or were other avian strains popping up in humans, then fading to background? The latter is being seen now with H7N7, H9N2 - they're infecting humans but not making them that sick. They're also jumping into other animal/avian species, as is H5N1 & that we have recorded & analysed.

So what if we're seeing the same signs of impending pandemic as were retrospecitively noted in the decade prior to the Spanish Flu? What are we facing considering the changes that 85 or so years have brought out world?

I'll look at what we know & are learning about H5N1 next & see if that gives us the clues we need.

Yes, this is eventually leading to prep stuff.

Pandemic H5N1 - what would happen?

--------------------------------------------------------------------------------

Usual disclaimer time... I'm a rank amateur unfit to sterilize used agar plates. I'm a pretender, a jealous wanna be in these very precise & educated fields. But I love it & TRY to follow as best I can & put together bits & pieces garnered from the science, the politics, economics, sociology & my own warped musings. In other words, I AM SPECULATING & like all speculations, I'm wrong most often than right. Don't know my batting average, probably not even close enough to get me to first year university - lol.

I report the science, the knowledge as I find it. When I prattle on about pandemic planning - that's the guess work, so don't assume I have any special knowledge here - just a keen amateur interest. Okay, now that we have that out of the way...

As previously stated, when a new 'H' jumps into a virgin population in terms of immunities, everybody is susceptible. we have NO immunities that will help against an 'H' brand new to the human population. This is the case with H5N1. A possible several thousand or even tens of thousands exposed are as nothing against a world population of 6+ billion. When H5N1 gains the ability to easily jump into humans, (& I think it's there) AND can easily transmit from human to human - that's the last bit missing - I suspect 50% of the world's population will become ill with it. They won't all get sick on the third Friday of April. It would probably take a few months for the entire world to be exposed. Possibly MOST of the world would actually be exposed enough to either get sick or not get sick but develop antibodies - hardly likely to see a scenario where retroactively we test everyone in the world. We wouldn't have to.

Once we begin hearing of rapid spreading flu which is making a significant proportion of people VERY ill, once we have that & several positive tests for H5N1, we're off to the races with pandemic. I suspect we'd go from hearing of a few cases in a few cities to "oh shit!" within a week. With an incubation range of 2-6 days - figure on an average time of 2-3 days, simply because most human strain flus act that rapidly. Without detailed case reports though - we can't be sure. Currently cases are presenting in a country where you get help when you're really at you wit's end - hard to know the time lapse between exposure & first symptoms.

Not half the people you expose are going to get it that first exposure - if you're the one doing the transmitting. It will depend how much time you spent with them, how close you were to them, what shape they're in to start with etc. Spanish Flu had 'waves'. The first wave made a lot of folks pretty darned sick but the death rate wasn't alarming. What was worrisome was how sick people felt & how long they took to recover - weeks & months. Some relapsed. We've seen that with H5N1 - even as early as Hong Kong, some relapsed a few times & even if they lived, (2/3 did), recovery took a long, long time.

The second wave really took the world by storm. It hit more people & killed more. It continued, (as in the first wave), to hit primarily young healthy adults, (between 15 - 50 would count) & just wouldn't quit. The third wave was worse than the first but not nearly as bad as the second. The three waves played out over roughly 18-20 months - close enough.

It wasn't really noticed at first - news was censored because of the war & war news was predominant anyway. War & disease go together anyway & considering the toll Spanish Flu took, it's remarkable that even today history of the WW1 era frequently doesn't mention Spanish Flu or gives it barely a footnote. Yet it delayed campaigns, messed up recruitment & training & troop movements as well as refugee travel greatly enhanced the spread of this.

The vastly increased shipping due to war allowed Spanish Flu to spread with what was breath taking speed at that time. Outbreaks occurred spontaneously in widely separated regions of the world as troops & supply ships docked. From the docksides & troop billets, it spread into surrounding communities. Most had no idea what was coming or what hit them when it did.

Are we going to be able to do any better? I don't really think so...

Hi (((CS)))
This has hit the local news in the Cinci area big time!
Thx for posting!!!
l, hippie

WHY - can't we do better than 1918?

Okay, let's say tomorrow we wake up to the news, (CDC press conference), that 5 cases of H5N1 have been lab confirmed in the US. Let's make this 'fun' - 2 cases in Boston, 1 in Chicago, 2 in Atlanta & 1 in Salt Lake City. Dr. Gerbeding is at her most reassuring. 1 case in Boston came from Thailand & passed it to her father. The 1 in Chicago flew in from Hanoi via Hong Kong. Both cases in Atlanta also flew in from southeast Asia. They're still trying to figure out where the Salt Lake City case came from - patient is too sick to ask but sh's sure they'll find a link to one of the other 4 cases.

In the meantime, these patients are getting the best of care in complete isolation, (to the point of lockdown), staff caring for them are limited & receiving Tamiflu. So are family members & other close contacts. They're all really sick in critical condition, on ventilators & we're 'not to be surprised if some die' - she won't answer how many even when pressed later during the press scrum. She won't answer anything about when they flew home, when they became ill, if they have symptoms other than respiratory - citing confidentiality & a large helping of 'we don't know'. Fair enough - they don't know but will be busting their butts finding out.

She'll say they're trying to confirm the flight numbers & connecting flights & expect that news to be released in a few hours. In the meantime if you've just come from Asia & feel icky, stay home, take your temp, call your health care provider... if she's more a doc than a politician, she's firmly urge people NOT to GO to the doc's office or the emergency room - call & get advice first. Whether or not that's ever stated in the early stages of pandemic, that's MY personal recommendation. If you don't have it before going to emerg, you most likely will coming out on top of your cold.

The announcement is short, just long enough for the networks to call their flu 'rent an experts' & get them into the studio for hours of commentary, some more practical than alarmist. Some will be really alarmist. Trouble is - it might be right. There will be lists of signs & symptoms & smart state & city public health depts. will get right on it & give out 'dial a medic' type phone numbers, stressing they don't want to see you in emerg for very good reasons.

Thursday morning breakfast news, every small town tv station has a reporter at the hospital - outside the emergency room & they're either looking excited or solemn. You can tell they're just dying to see ambulances screaming up to the doors - idiots. That will hit soon enough. Network news states 1 of the 5 has died & a dozen more patients are in isolation with suspected H5N1 - lab results pending. The nerves are ratcheting up in the medical world & behind the scenes, beds & staff are being counted. Won't be nearly enough anyway, but nice to know what you can start with. Holidays are cancelled for medical types. Elective admissions are cancelled & patient discharged are planned - even if some are a bit early.

Friday - over 60 confirmed cases & in spite of flight details having been given Wednesday afternoon - it's all over transport corridors - impossible to avoid that. Most cases are surrounding main transport hubs - NYC, Chicago, Atlanta, LA, DFW... Toronto, etc. Any network bright enough to go visual with maps clearly shows over the next few hours, spread between air travel hubs & slow spread outwards from those hubs.

By Monday, all manner of hells are breaking loose. People are dying - upwards of 50, hundreds are confirmed ill & thousands are suspected of having H5N1. Most present with severe respiratory symptoms but other are coming in primarily with meningitis/encephalitis & rampaging runs - a few were tested & yeah it's H5N1. At this point, testing everybody makes no sense - too much needs to be done. The presumption, for those coming in with certain symptoms, contacts etc, is that they have H5N1 flu.

Schools are closed & there are rumours that non-essential workplaces may be closed. Workers who don't consider their pay cheques non-essential are screaming foul. The decision is held off 'for a few more days'. Medical supplies the public can buy are about to be rationed. It's 'recommended' that those owning public venues shut them down. They don't, not at first, then do when they find their staff is too nervous to come in & the public not attending anyway.

The public over the weekend, hearing of more & more cases stops going out 'unless they have to'. Some are transmitting it, others catching it. But damn it - they needed groceries or gas or to rent DVDs & - pick a reason. The 'it won't happen to me' mentality can stick - until you wake up with a fever & feeling like death warmed over.

Governments & their agencies respond in mixed ways. Some smaller communities have their stuff together far better than huge cities with diverse populations & interest groups. Overall though, it's a huge mess & I'll later look at the different factors involved there - there are quite a few.

No, I don't think we're going to do better. Next - I'll explain first what cases will look like medically - how they're likely to present.

Sick with H5N1

--------------------------------------------------------------------------------

This part has been the most frustrating to try & nail down. Plenty of ominous hints that H5N1 is right nasty in patients, some early case descriptions from the WHO from last year in Thailand & Vietnam & an appalling lack of information from cases in the last few months. Because of that, please understand I've had to make some assumptions about how this will present, incubation times & such. I honestly wish I didn't have to do it this way but the information is being held as if it were the Third Secret of Fatima.

I'm utterly & completely opposed to this approach. I don't care how frightening the information might be, I simply fail to see HOW any individual, community or nation can adequately plan with such basic information. We can guess, speculate, etc., but without as many details as possible 'out there', the guessing may be inaccurate.

What I'm going to do here is try to 'mid range' this. Best case & worst case hopelessly melt down under the rigours of reality. Mid range is scary enough & I'm really trying to not be too extremist & trying to keep the speculative stuff tempered with what we know about influenza in general. Okay, let me give this a shot.

Assume it's just gone human to human - the first warnings may have been given but no confirmed cases are noted yet in the US. Sunday you go to a basketball game & are exposed. Tuesday night, you go to bed early - you don't feel sick but you're more tired than you should be. You shrug it off - it happens & 2 extra hours of sleep should set you right. You're in bed by nine thirty & snoring by ten...

At three in the morning you wake up & start looking around for the truck that just ran you over. You've got a pretty foul headache, your body feels as though you slept in a really squished position - you're stiff & achy & you are HOT. You curse - the last teen to bed forgot to turn down the heat - AGAIN! Stupid twit must have turned it up after you were in bed - these drama queens never hear of sweaters?

You sit up - in preparation for grabbing your robe - gotta check the heat & grab a few Tylenols or maybe ibuprofens. Yeah, the second might help more with the throbbing aspect of the headache & the achiness. Man - sitting up makes your head whirl & your head REALLY pounds. Crap! You really need to be at work tomorrow - big meeting at nine. You stay seated, cursing. You're wondering if getting up is going to be possible. You manage but man, you feel weak. Slowly you make your way to the bathroom - might as well go while you're there & that's where the meds are.

You turn on the light, look at yourself in the mirror & wish you hadn't bothered looking. How can you be that pale, yet flushed at the same time. Your eyes are glassy. The light does NOT help the throbbing headache. You grab one, no two ibuprofen & a glass of water. Man - you didn't realize your throat was that scratchy. They're tough to get down. You go out to the front room - hey, the heat IS lowered - must be the cold making you feel so hot. You stagger back to bed & manage to wake up your wife stumbling back in.

She asks what's wrong & is startled at how warm you feel. She insists on getting the thermometer & some ice water. You tell her not to bother - you just want to lie still in silence & hope the ibuprofen takes effect soon. She's not paying any attention & is not happy to find you're temperature is 102.4. She forces you to down a glass & a half of ice water. It DOES feel good on the throat. She tells you you're not going to work tomorrow. You're too tired to argue & tell her 'you'll see' in the morning.

The rest of the night isn't much better. You sleep in short bits but it seems every time you move, you wake yourself up. You're feeling hotter, stiffer & the headache seems to be getting worse. Your wife is awakened just before six - one of the kids had a nightmare again. She settles her down & checks you again. Fever's up to 102.8 & she is NOT happy. She urges you to drink more. You do but your throat is really sore by this point & you've started coughing. She's up now anyway she says, she'll get ready for work & get the kids up & off to school. YOU are going nowhere. By this point, you're relieved to hear her TELL you what you will or won't do. You feel like sh*t. You're almost too tired to feel guilty about missing work & not helping with what's usually a very busy morning routine at your house. You fade in & out of half sleep as the morning routine progresses. The kids are being mercifully quiet - she must have threatened them with a fate worse than death - no TV or dessert or something.

Before heading out she comes up, helps you to the bathroom & does a lightning bed change, telling you she's phoned work to tell them you're in no shape for any meeting. She passes on the message that the boss hopes you feel better & not to worry - your meeting presentation will be covered by someone else & as all your notes were on the boss's desk anyway, it's no biggie. She makes sure you have a pitcher of ice water & plastic glass already filled, tissues, ibuprofen handy & tells you she mixed up some of your favorite butterscotch pudding & 2 flavours of jello - the jello should be set in a few hours. A bowl of chicken noodle soup is in the microwave with the time set - all you have to do is push start when you're ready to eat. Rest, sleep - she'll call at lunch the phone is right beside the bed.

Blessed silence after they all leave. You force a glass of water down & try going to the bathroom - no joy. You crawl back into bed & take your temperature again - 103. You think of turning on the TV but your head hurts too much. You close your eyes & pray you'll fall asleep. Being awake is just too miserable. The morning passes - somehow. You manage to get another glass of water down & get to the bathroom once. That turns into a seriously frightening event as you have trouble keeping your balance. You can't remember feeling this weak since that last massive college hangover years ago.

Your wife calls at noon - not too thrilled with what you tell her. Not that you've told her much but she's not stupid & you don't imagine your voice indicates any improvement. You're coughing more & nothing is coming up. No you haven't eaten, not hungry. The truth there is you're not sure you can manage to get to the kitchen heat the soup & sit up long enough to get it down. You drift off again & wake at some point FREEZING! You're shivering uncontrollably & your teeth are chattering so loudly you fear breaking or chipping them. That passes after about half an hour, leaving you feeling hotter than before. You don't bother taking your temperature - too much work. You shove off everything but one thin sheet & try to sleep. Can't - you're really hurting.

You're wakened again by the sounds of your 2 oldest coming back from school. Your oldest daughter eventually wanders up & asks how you're doing. Even she can see you're not doing well. You tell her to stay out of your room & keep her brother out & please get her little sister off the bus which is due shortly. No, you're not hungry & not to worry, mom will be home soon. If she doesn't have too much homework - how about starting supper. For once, she doesn't argue.

Your wife arrives shortly before six to find you shivering uncontrollably again. Your temperature is up to 103 & she phones your doctor - can't get through. When she finally does, the doctor says it sounds like flu, stay in bed, drink what you can, take acetaminophen or ibuprofen & try to sleep. It will pass but will take some miserable days to do so. If the coughing gets really bad, call back. Are you having trouble breathing? You are a bit actually but put it down to feeling so stiff & sore & having been flat on your butt in bad so tell him no, not really. He tells you if you are, to call back.

The evening passes in a blur. You're alternating between bouts of shivering, then massive & smelly sweats. You're really aching now & the headache is atrocious. The coughing is becoming really annoying. It's exhausting & after every bout, you're breathless for a few minutes. You wife announces she's already called you in sick for the next few days. You're not inclined to disagree. Even sipping water is a chore, tiring you out.

You have a wretched, rotten, achy, cough filled night. You've sent your wife to the spare room as you're too restless for her to get any sleep. You're popping ibuprofen & acetaminophen like candy hoping one or the other will kick in at some point. They don't. You wish you still had some pain meds from when you had those three wisdom teeth dealt with a few months ago. Breathing is a little harder & you wonder if maybe you shouldn't call back the doctor?

Tuesday - more of the same. The wife & kids head off to work & school. You've managed to get 1 bowl of soup down & water & that's it. The coughing fits are getting longer & tougher now - they HURT. And now you ARE finding it tough to breathe but you're fine as long as you're lying down - which is about the best you can manage anyway. You desperately need a shower but can barely manage to go to the bathroom & when you do, you have to sit. Your urine is dark & looking pretty foul. No wonder, fever & not enough fluids will do that. You have the TV on at some point but more for a bit of company - you've got the volume off as your head is still pounding.

By the time everyone is home Tuesday evening, you want to die. You can't remember hurting this much or everything being so much effort. Your wife cleans you up - in bed - as best she can. If this isn't better to some degree by morning she threatens, the doc is being called & she's going to want something done - NOW. That would be good you think - how about a bullet to the head?

By now, your temp hasn't dropped below 102 for over 36 hours. You're having trouble thinking & the coughing is exhausting. Sitting up for more than a few minutes is exhausting, yet you can't sleep. Drinking is a real chore & increasingly, you need help with that. You're becoming frightened.


Okay, this is what a severe case of human strain flu feels like. I may be a little fast on the progrssion & severity of symptoms but I don't think so. Some would progress more slowly & others faster. Bearing in mind that this is an H5N1 infection, our mythical case's problems are only just beginning. I just need to figure out 'where to take him' from here or more accurately, how it's going to go all wrong - there are several possibilities with H5N1. I might stick to 'classic' severe respiratory.

This is as far as I've gotten for now

Back to work for a few hours before I have to head out for the eveing.

Essentially I'll finish detailing what an 'ordinary' case of H5N1 MIGHT look like, then guess wildly on what other ways it might show up. We've always known complications can take interesting forms with flu - digestive problems & rare neurological problems. It's beginning to look though as though these might be PRIMARY influenza manifestations with H5N1. In English - the virus iteslef may cause these presentations in the absence of any other secondary infection.

Secondaries, by the times the strains really get lethally efficient in humans might not even be a huge factor. Too early to call & I don't have nearly enough information. Too much info is starting to burst out into the public & it's 'all over the place'.

The WHO will be changing their case definition of flu - I hope that will be presented this week at the conference currently underway in Vietnam & frankly I'm thinking their pandemic prep level is off by at least 1 level. The Canadian federal budget comes down in a few hours. Fopr the first time \ever, SPECIFIC pandemic prep money is being detailed. Locally, they've really ramped up planning & prep activities.

Lovely...

welcome home sue! good to have your insight here again.

I think Sue deserves a standing ovation for her work thus far.

Thank you CS!

Thanks Sue. Good to see you !

I think CS deserves a standing ovation just for coming back here. The fact that she did shows me how serious she thinks the threat of pandemic must be, CS you make me proud. old bear.

Thank you so much for this. You have a gift for simpliifying the explanation so that anyone can understand.

Now what?

Wednesday noon & this is not even close to hinting at getting better. Your wife is home today as is your 15 year old daughter. She woke up feeling headachy & has a fever of just over 100. Your wife took the other 2 to school & informed the school she'd be available at home today - any problems with the kids, just call.

Your fever dipped to 101.8 for a very short period but has been hanging in the 103 range. You can't remember ever feeling so weak & you don't care. Some part of your brain worries about this 'not caring' part but it's too tiring to think about. Your ribs are killing you from the coughing & the humidifier in the room since last night seems to be doing no more than creating mildew streaks on the wall. You ARE having trouble breathing now - you feel as though you've just finished a 3 mile run. You can breathe but don't feel you're getting quite enough air. When you try to breathe deeply, another paroxysm of coughing results. You're desperate to avoid those. Standing is out of the question & your wife emptied out a wide necked juice bottle as a urinal. Not that you've used it much. Even taking sips of water is exhausting & you just want to be left alone - to SLEEP if you can.

You're alert enough mid-afternoon to ask about your daughter. She's in bed, sleeping thank God but your wife thinks she's in for a rough time too. When she's not upstairs, it's fairly quiet in the bedroom & you can hear the front room TV softly in the background - not what the news is saying but you know it's the news & that's odd - your wife usually catched only the late news before bed. You remind yourself to ask her about that - have we invaded Iran or something? You should care but... you really don't. It seems as though whatever is left of your brain, (not much you think), is focused on every throb of your headache, your increasingly sore body & the fever. The afternoon drags on...

Shortly after the supper hour, your wife comes back upstairs with an old school friend of hers, a licenced practical nurse who wants to take a look at you. You remember her - sort of - & wonder why she's got a mask & gloves on & is looking strained? She does the usual nurse crap - temperature, breathing, pulse, respiration, then she & your wife heave you up to a sitting position & she pulls out a stethoscope & listens to your lungs - or tries to. The deep breathing the medical nerds always ask you to do simply result in more coughing & by this point the pain of that is almost enough to make your eyes water. She listens anyway, putting the stethoscope everywhere she can reach. When she's finished, she suggests to your wife you'd be best sitting up - at least partially. Between the 2 of them & 7 pillows, they manage to prop you up to a point where you feel you won't tip over.

After haranguing you into getting down a half glass of water, (an exhausting process), they leave you in blessed peace. You assume they're checking your daughter. Nope. The LPN is telling your wife you need to go to hospital - unless she's way off & she doesn't think so, your lungs are rapidly filling - pneumonia. She's hearing rattling, crackling, bubbling - call it what you will - this is NOT what healthy lungs sound like. Your pulse is too fast - another sign you're not getting enough air & you're very pale, especially considering your temperature is now at 103.2. Your breathing rate is way too high for her liking & as for that fever... definitely time for some high priced help, if it's to be had.

What your wife hasn't been telling you is that H5N1 is here, in your community, in your nation & spreading fast. How fast? They're not sure yet but the computer models don't make for pleasant reading. You - so far are showing respiratory symptoms. This morning's news reported a cluster of what appears to be meningitis in Davenport - 11 people suspected to have it & the main part of that news story was the scramble they had to undergo to find hospital beds for them. Half are kids, half are adults & it's just... weird. Several gastro outbreaks are reported near Atlanta & New York City - they're not hue but patients are really quite ill. There seems to be no common food link & everybody is getting really twitchy. Increasingly, people are being told to NOT go to doctors' offices, clinics or emergency rooms unless they're REALLY ill or injured. Health types urgently encourage people to PHONE first. Doctors' offices, clinics, hospital switchboards... all are frantically scrambling to set up extra phone lines & as soon as a new number is announced - it's swamped. Getting qualified people to answer the phones is taking precious resources away from patient care. (I've got an idea for that - later & if I forget over the next few days, could somebody remind me? Thanx).

Your wife calls the hospital after not being able to get through to the doctor. They're concerned & especially so when she mentions your daughter is ill & progressing as you did - although not as quickly. They're already almost full & beds are less available by the hour - it's a real dilemma. What they're going to do is send an assessment team of paramedics, (another idea of mine although the pros have probably developed that - but I will later), who will more thoroughly check your husband, consult the hospital & decide based on what they observe.

They show up late evening & yup you're one sick puppy but... not sick enough to be admitted. Your wife is in tears. She's tired, terrified & isn't sure she can cope. The senior paramedic is blunt. For now, she's going to have to cope. They start an iv - one that can safely stay in for days to give you fluids. They show her how to change the bags & explain every 9 hours or so, she'll have to change one. They leave her a dozen bags of saline & 5% dextrose - she's to alternate. This is also given to her in writing & the sheet tells her what to do if the iv blows out. Easy enough but when you've never done it. Her friend has stayed & offers to help as best she can until your wife feels more confident. You feel guilty - when you can summon the energy to feel anything but half dead. The paramedics also authorize home oxygen, make the necessary calls & say a local medical oxygen company will be along when they can to set you up with a mask & oxygen tanks - they'll explain all that to your wife.

Pain meds are out of the question. WHY??? Because they depress breathing & coughing & as much as the coughing hurts, the best thing at this point is to begin to cough out what's in your lungs. NO, no antibiotics although your wife is shrilly insistent by this time. They won't work & may be needed later, if not for you, then for others. They do leave 10 days worth of Tamiflu for your wife but none for the kids. Your wife has to be kept on her feet. You're sick, your daughter is sick & the younger kids may become ill. At this point, she should be lucky there's any to give her. They're about to stop doing even that - they're sorry, but...

They leave & your wife bursts into tears. This is AMERICA! It's not supposed to be this way, what the HELL is she supposed to do? Her friend lets her wail for a while, explaining to the kids that mom is just tired. They creep away scared & put themselves to bed. Once your wife is a bit calmer, her friend has a blunt & short conversation with her. She's damned lucky anybody came. She's damned lucky she got some iv fluids & a promise of a home oxygen setup. Her friend is betting even that level of home support is about to dry up. Cases are being reported everywhere, many communities simply have no hospital beds left & are actively opening alternative beds - flu hospitals - in hotels, whatever they can get.

This is just beginning. You probably don't know any of this - your wife is reacting in another room. Frankly at this point if you did know, you probably couldn't summon up much energy to care.

YOU FEEL LIKE CRAP.

You have no idea how much worse this is going to get.

aaahhhhww sue, there goes the ink cartridge...23 pages

so great to have you back!

EXCELLENT-THANKS!

WOW.

CS, you have a way with explaining things..............almost looks like the Book of Revelations is ready to kick in........

Canada Sue! Thank you for all your effort in puting this together for our benefit! I so fear another pandemic flu outbreak.

Loretta V.

Someone always has to go and interject religion in a perfectly good thread.

Let's start with this. . .

Whoa, Sue, this sure makes us sit up and think! Good to have you back! (I think)

inspirations

Meatworld time...

--------------------------------------------------------------------------------

This is Pathogen Pit night & I'm not sure I have time to come back with more on this before 0130 or so. Irks me to no end that I have to be away all tomorrow morning & possibly Friday morning. I may pull some semi-all nighters as this is getting almost dire.

Reality mirroring what I write. I was 'happily' posting about our mythical poor sick puppy when Brian staggered out of bed complaining of a 'size 9 brain in a size 7 head. Eyes watering his sinuses are so messed up & he aches. Sore throat. No fever, no coughing. But naturally, knowing he spent the weekend in transient barracks, did a course Monday & Tuesday & some general duties on base yesterday, I squirmed. He's got a bad head cold with sinus involvement - that's all. And I cheerfully repeat that to myself every 3 minutes - lol.

Look, I'm trying to put a whole bunch of differently sourced stuff together as thoroughly yet simply as I can manage. Seems I have something half prepared & new info comes in - maddening.

Suffice it to say for now, all indications I'm getting is that various levels of health care & government are no longer assuming pandemic is 'later' - they're preparing for 'maybe tomorrow?' The virus is now mutating at a ferocious rate, infecting mind boggling species & doing interesting new things in people.

Oh, I can't help it - gotta do one of my infamous analogies.

Picture 2 dams... both are in poor shape. These dams are the barriers against pandemic. The water is H5N1. With the first dam, small leaks are happening & they're slowly getting worse. There's time to warn the complaining public, to close roads & evacuate neighbourhoods. People resist evacuation big time until spectacular news clips shows houses washing away, cutting away to shots of more leaks in the dam - dam is holding but it's not looking promising. Once some person who wouldn't leave gets killed by some flooding, EVERYBODY co-operates. It's a scramble but authorities are able to manage. They can't prevent the water escaping but by making sure as few as possible are in the way, human damage is limited.

Dam #2. Engineers are emphatically stating it's gonna go. The spillways being non-functional doesn't help - the water is piling up. Think of the water as genetic changes now accumulating in H5N1. We know they're there - they know the water is there & getting higher. People are warned & urged to evacuate but the local/state government doesn't want to freak people out so thew warnings aren't urgent enough. Nope - what threat? We'll stay & keep on keeping on. The dam looks fine. Until the day it bursts & everyone/everything downstream save a few very lucky people with more fortune than brains. The death toll is far higher than it should have been.

Right now, most governments are operating under a 'dam #2' scenario. This to put it mildly, is an appalling way to treat your constituents. It's not pleasant to have to admit that under a pandemic scenario there's not much the governments can realistically do - I'll explain that within the next few days. But they can't & that means it's up to the individual.

Right now, work on collecting a month's worth of N-95 masks for everyone in the family - if you can. I'll explain how they can be disinfected for reuse later. Get those, latex gloves & a dozen or gallons of bleach & get them soon. Stock up on your favorite OTCs, including expectorants, electrolyte replacements, a few thermometers, a urinal or 2, bedpan...

Yeah, I think we're that close.

Gonna try & pull a few all nighters between now & Monday. GOT to finish putting all of this together...

Here's one of the reasons in black & white:

***If a pandemic emerges, it will be impossible to prepare a special bird flu vaccine, said Gerberding.***

http://www.cbc.ca/story/science/national/2005/02/21/bird-flu050221.html

Later...

It is better to be prepared and nothing happen than the other way around.
We have most of the things CS mentioned, but a lot of our bleach is so old that it has lost most of it's usefullness. We are thinking of getting some of the stuff they use for swimming pool "shock". Which is a powdered form of bleach and it should store better.

Also, it is hard to really be "over prepared" for something like this IMHO.

Right before I sat down at the computer I saw a news teaser about this. It basically said they expect to see this breakout of Thialand and kill 100 million world wide. They were saying that this should be treated as the gravest threat to the world right now.

Funny I was wondering where is CanadaSue when you need her, signed on and there she is. Thankyou for updating us. I hope you can continue, you have been missed.

Hey CSue, glad to see you back in here.

Good stuff as always.

Bobga

Okay after reading this first I went and spoke withour Infection control nurse.She had no info on this on hand only what we could pull up fro the CDC website. My next questions are where is the best online source of N95's, and Does anyone have ideas on how to approach your family doc seeking tamiflu to have on hand in case? We had a SARS scare at my facility a few months back so I figured they would be better prepared by now but they ain't.

What herbals might help? I know what expectrant to buy so I ain't worried about that. Is pure old aspirn still the best for fever aches and pains? CS how about a prepper's Bird flu first aid kit contents guide with meds, herbs, equipment listings based on 1 person so I can figure out how much to buy for my family.(The burden will be on me as Y2K soured them on preps beyond the basic 3 day kit type stuff.)

Anyone ever seen the Vincent Price movie about the plague that kills almost everone in the word?The Charlton Heston movie Omega man was based on it.


Edited for stupid spelling errors. Please forgive me I am not really illiterate, I just play that role on the internet.

a BIG thank you neighbor to the north.

It would be truly ironic if a strand of RNA did us in. Guns, thugs, JBT'S, nukes even chemicals - don't much worry me. A 72% mortality rate bug -- does. So ....

I wonder what sort of time frame we are looking at? A month? Three months? [Not until its over .... but rather, until we begin to see the full lfedged pandemic.]

Perhaps I'll hold off on buying things I don't really need. Like more land; a new house, etc.

Shades of "The Stand" come to mind; minus the supernatural elements King used to make a rather stupid thriller.

TP....I got packs of 10x N95's at Home Depot a while back, 10 bucks IIRC, in the paint section near the sanding stuff. They have a section of face masks in another place that are a lot priceier, and only 2 N95's for 5 bucks, so try and get the 10 pack.

Sue, thanks for the education. Know what to do, to make sure we have a "flu" kit ready to pick up in a minute's notice.

suzy

truthseeker said:

Right before I sat down at the computer I saw a news teaser about this. It basically said they expect to see this breakout of Thialand and kill 100 million world wide. They were saying that this should be treated as the gravest threat to the world right now.

Funny I was wondering where is CanadaSue when you need her, signed on and there she is. Thankyou for updating us. I hope you can continue, you have been missed.

Click to expand...

Do you remember where you saw that?

THanks

Maybe this:

http://www.abc.net.au/pm/content/2004/s1254963.htm

rryan said:

Do you remember where you saw that?

THanks

Maybe this:

http://www.abc.net.au/pm/content/2004/s1254963.htm

Click to expand...

I wasn't able to open that link, but here's another similar story:

http://news.yahoo.com/news?tmpl=story&u=/ap/20050223/ap_on_he_me/bird_flu_20

Incidentally, out of curiousity, I clicked on the link for the Yahoo message board about this story. I didn't read any of the messages, but I did notice that many of them had titles like "another scare tactic."

So chances are, most sheeple will probably continue going to work, etc. I suppose that's good news and bad news. The good news is that they will keep providing essential services, such as heat and light, video rental, etc. The bad news is that you can assume most other humans have had contact with numerous other humans, meaning that they are much more likely contagious.

Does anyone have ideas on how to approach your family doc seeking tamiflu to have on hand in case?


Tamiflu is used for treating and preventing the flu. I've gone into the doctor with a story like "I work in a school and am around all these sick kids and I really don't want to catch the flu." It has worked every time. We have several walk-in clinics that tend to write prescriptions more frequently than our local family doctor.
I now have a ten day supply of tamiflu for each member of my family but it's taken a couple of years. Tamiflu is expensive, about $10.00 per pill. You take two a day for 5 days for treatment and one a day for 10 days if used for prevention. I've also found that insurance won't cover the costs if it's for prevention, only for treatment.

Tamiflu info...

--------------------------------------------------------------------------------

***Usual amateur disclaimer about me not being trained, educated, experienced or knowledgable in this stuff - just a jealous wanna be who likes to read this stuff & think about it. My opinions may disagree wildly with those of people who actually know what they're talking about.***


I've been wading through some fine print type literature on Tamiflu. I'd been puzzling how a pandemic outbreak of flu might be handled using Tamiflu as a treatment or prophylaxis as suggested. Most of what I obtained I got through the company site:

http://www.rocheusa.com/products/tamiflu/pi.pdf

and confirmed elsewhere.

In short, this is going to be a huge problem. First, it helps to know exactly how Tamiflu works.

It can only work to PREVENT or TREAT flu, (the latter is obvious), in the PRESENCE of the flu virus. It is NOT like a vax in which a layer of protection, (antibodies), are created & remain behind in case the virus shows up. Tamiflu acts by interfering with the neuraminidase gene in flu. It just doesn't let it 'work right' as the main effect & neuraminidase is crucial to newly generated flu viruses being able to leave the cell in which they were replicated & being able to infect other cells or be 'coughed out' to potentially infect others.

As well, when the new viral genes are formed, they have to line up in organized groups within the host cell, migrate towards that cell wall, 'borrow' some of that cell wall as a viral coat & then "Ciao dude!" out they go from the host cell to do their dirty work eslewhere. Think of the genes as a group of nursery school kids you're trying to herd to one place - they're all holding on to a rope. The Tamiflu 'makes that rope disappear' & the kids scatter. You may end up with the wrong kids in the wrong groups. Tamiflu may result in virus with duplicate genes & completely missing other genes - utter dead ends.

None of this can happen without the virus being present.

In terms of treatment, the best studies have shown, is that flu symptoms are somewhat moderated, (you don't feel QUITE so deathly) & the duration of the flu is shortened by 1.3 days. Big whooping deal. It does NOT reduce the incidence of flu complications. Bearing that in mind & considering how limited world wide supplies of Tamiflu are, I'd be loathe to use any on treatment.

Prophylaxis - the problem there again is that if you take it in the absence of flu virus - it's tantamount of wasting precious drug. However in the case of health care workers & first responders - whern you KNOW there's an outbreak - give it to them. They may be exposed at any point of time without knowing it. The dose for treatment is two 75 mg. tablets twice a day for 5 days. For prophylaxis, that drops to one such tablet - same dose & this have been safely given as long as 42 days - 6 weeks.

Here's where it gets interesting. The stuff is very limited in supply. We have no way of knowing how long a pandemic would continue. What if pandemic flu is in your city 13 weeks? How do you pick the 6 weeks? Can you afford it? 6 weeks of prophylaxis with Tamiflu equates to 2 courses of treatment for 2 people - can be a tough choice in some places depending on who the sick person/people are.

In any case, I think it's academic. Pick a hospital that is full of flu patients & is staffed by 500 nurses/docs/associated techs/support staff - all of whom have daily contact with flu patients. That's 21 thousand tablets of Tamiflu alone - ONE hospital - ONE 6 week period of time.

Then there is resistence. Tamiflu did showe in Roche's own testing resistence developing in lab testing alone. This was clearly demonstrated in NH1, N2 & N9 strains of flu. Heck, they even pinpointed the exact location of the genetic changes that conferred resistence.

The decisions on the judicious use of Tamiflu during a severe outbreak or pandemic are going to be crucial & at best, they will slow down the progression. I don't think there's enough Tamiflu available to really halt an outbreak in ONE city, never mind trying to halt one nation wide.