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See excellent post by DarkSyde, interviewing Dr. Tara Smith. This Science Friday follow-up expands on some of her points about H5N1.

Did you know that flu experts met in Washington this week and took stock of the situation? The conclusion, after evaluating what's going on here and abroad, is that we're not ready if it should ever get here.

U.S. experts expect to be overwhelmed by bird flu

WASHINGTON, Feb 2 (Reuters) - U.S. flu experts are resigned to being
overwhelmed by an avian flu pandemic, saying hospitals, schools,
businesses and the general public are nowhere near ready to cope.
Money, equipment and staff are lacking and few states have even the
most basic plans in place for dealing with an epidemic of any disease,
let alone the possibly imminent pandemic of H5N1 avian influenza, they
told a meeting on Thursday. While a federal plan has been out
for several weeks, it lacks essential details such as guidance on when
hospitals should start to turn away all but the sickest patients and
when schools should close, the experts complained.

The Feds agree. HHS Secretary Mike Leavitt is touring the country (he was in CT yesterday), explaining about the disastous 1918 flu and warning that if (and when) a pandemic strikes the US, and you're not prepared, there's no cavalry coming from DC.

Rell and Leavitt signed a resolution at Thursday's event to affirm the
state and federal governments' commitment to work together on pandemic
planning. Local officials who attended the conference also were
directed use its lessons as they create or revamp their own
municipalities' preparedness plans.

But the details include a $1 million grant to prepare all of CT. That works out to be around $32,000 per CT's acute care hospital, and  if you think that's enough to solve this problem (if nothing else, that'll buy enough tamiflu to treat 10,000 of CT's 3.5 million citizens), I've got a bridge in Brooklyn to sell you. The Feds know this, and that's why they're warning citizens to consider stockpiling food and water in the event services are disrupted.

Why would services be disrupted? Well, the planning assumptions are that 40% of the workforce would be ill, and half of those would seek hospital care. That means a big hit to our just-in-time economy, which is not designed for such an event. The workers who maintain infrastructure for water treatment plants and bring and distribute food into cities might be affected. Cities typically have a weeks worth of chlorine and a week's worth of food on supermarket shelves. what happens if they can't be replenished?

But isn't that just "fearmongering"? That's a term some of the skeptics like to use, and there are skeptics. However, even the skeptics agree on several points: some day there will be a pandemic, they just don't this it's the current H5N1 that'll be the problem. And they also agree, for the most part that pandemic praparation is a good thing. What they emphasize is that the H5N1 virus in the news is a difficult virus for humans to catch in its current form, and that it needs to go through some significant mutations in order to move from an avian flu to a pandemic flu. Their focus is on vigilence in the hen house, by making sure the poultry that can get H5N1 are monitored, vaccinated (there are bird vaccines) and (if necessary) culled.

But even that is a big deal. H5N1 in CT would cost the state $193 million in lost commerce if the largest egg producer were shut down by culling chickens. And the cost to developing countries where poultry has to be culled now (Turkey, SE Asia and Iraq) is enormous, a cost they can't afford.

Something else has been happening as well. The virus has continued to mutate, picking up abilities that make it ever so slightly easier to infect humans. The assertion by the skeptics that 'it just won't happen' is nonetheless being challenged by virologists, epidemiologists and public health docs all over the world. It may, indeed, not happen but that's an unknown and not a fact. In the meantime, new cases are reported every week, and the Iraq cases have to give one pause. It's a war zone. Imagine if the next international WHO team sent in to asess, treat and control an outbreak is either kidnapped or blown up. Is that 'fearmongering'? Ask the ABC News team.

Back home, as the prep message makes its way from Leavitt to state leaderts to local leaders, the message is heard, but heeding it is difficult.

County health officer Ulder Tillman discussed local efforts, which
include a disease hot line and quarantine orders in case of a flu
pandemic.

The county is also planning a session with area businesses to establish
crisis plans in the event that a pandemic affects a large number of
workers.

Council President George L. Leventhal took issue with Tillman's
recommendations that residents stockpile up to 30 days of food and
water in case of a flu quarantine.

``I have half an acre of land that I live on. Where am I going to put
all these gallons of water?" said Leventhal (D-At large) of Takoma
Park. ``I don't think it's reasonable to ask people to give up a
portion of their living space when they have no room."

Asked by Councilman Michael L. Subin (D-At large) of Gaithersburg
whether any county building or agency had taken the same precautions,
Tillman said no.

In the end, we have a situation just like pre-Katrina. Something might happen and we don't know when. if it does happen, we need to be prepared, not just now but 10 years from now. And if you're going to prepare, best plan for a cat 5 storm, not a cat 3. And just because you can't remember such an event in your lifetime doesn't mean it hasn't happened, or that it won't happen again. So you'd best get used to calm, rational planning. Don't call it 'fearmongering'. Call it experience.

Crossposted to The Next Hurrah

Originally posted to Daily Kos on Fri Feb 03, 2006 at 05:32 AM PST.

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Comment Preferences

  •  The Hospital I work in (none)
    won't know whether to shit or shine our shoes.  We're too busy with the bottom line & such.  Not even a drill, I'm tellin' ya.

    The future ain't what it used to be. Yogi Berra

    by x on Fri Feb 03, 2006 at 05:40:49 AM PST

    •  I hear ya. (4.00)
      But when Leavitt visits your state, your hospital CEO, COO and CFO will be told to get his/her head out of his ass and start planning.

      Davos heard the same thing.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 05:44:43 AM PST

      [ Parent ]

      •  DS - question for you (none)
        Did you hear anything about the administration coming out with some kind of legal talk, executive order or legislation that basically put the emergency and financial components of an emergency back on the states?  

        I know I heard it, but can't find it on google.  That means they're doing the CYA so they don't have another Katrina boo boo.  That's scary because they must know something is going to happen... any thoughts?

        •  Look, I'm only gonna say this once (4.00)
          This administration, and many members of congress, DON'T WANT GOVERNMENT TO BE PREPARED OR EFFICIENT in dealing with crises, because what would that do to their argument that the public sector cannot be trusted with anything?

          Imagine what would happen to the lobbyists and the corporate collaborators and the whole greedy pro-business-is-best brigade's insistence on privatizing everything from national parks to federal lands to the postal service, if it turned out that the government, any government, whether fed or local, actually did a GOOD JOB!!

          Imagine how hard it would be to blame government for every single little ill in people's lives, and to continue braying about how tax-and-spend Democrats are good for nothing except robbing your hard-earned money out of your paycheck?  If, in fact, government conducted an effective, well-planned, thought out and properly financed public health (or natural disaster protection and relief) effort, that vast middle class of America may suddenly get snapped out of its anti-government stupor and say:  "hang on - government does all right by me, and I don't mind paying taxes knowing that they've got my back in a crisis."  

          When Bush said, "Brownie, you've done a heckuva job" we all groaned and shook our heads in amazement and made him the butt of late night jokes.  But do you think the anti-government, pro-privatization folks were reacting the same way?  Hell no!  I'm guessing they were breaking out the champers and fighting to be first in line to award Brownie the "anti-government hero of the decade medal of honor," because not in their wildest dreams had they imagined such a complete and utter government f-up ever being so successfully mounted.  Not even if they had actually sat down over a three-martini lunch and PLANNED it!  

          If we want a government that is prepared, responsible, efficient and competent, we aren't gonna get it from any of these CEO-hugging sycophants in Congress or in the WH, who seem to think you can run a country of 300 million people based on a 2-year MBA.  

           

          Reality addict - can't get enough of seeing it all clearly

          by writeout on Fri Feb 03, 2006 at 08:47:28 AM PST

          [ Parent ]

  •  Just how effective (none)
    will tamiflu be once the virus mutates to the point of human=>human transferal ?

    Methinks it will have to re-engineered and re-issued once we reach that point. No one State is truly prepared for a pandemic. None, zero, nada. At best, some States have prepared to minimize the number of casualties.

    Again : see Balckwater & Co.

    visit my blog and blister: Music & More

    by rossini on Fri Feb 03, 2006 at 05:41:41 AM PST

    •  not clear (3.66)
      some Vietnamese strain have been partially resistant (but less virulent).

      Newer drugs like IV peramivir might be needed.

      But tamiflu in combo with relenza or the older drugs migth help. early use, effective supportive care and good nursing will make a difference... until the hospitals are overloaded and you're doing it at home.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 05:46:32 AM PST

      [ Parent ]

    •  We have ONE (none)
      negative pressure room out of 24 beds on our unit.  That's for TB patients, & it may be 50% of hospital wide neg pressure rooms in the entire 250 bed hospital!  Our medical system is not prepared for any serious emergency.  Half the staff will drop dead from bird flu before the 100th infected patient is wheeled in.

      If this becomes a pandemic, We Are Screwed.

      The future ain't what it used to be. Yogi Berra

      by x on Fri Feb 03, 2006 at 05:48:45 AM PST

      [ Parent ]

      •  negative pressure not needed (4.00)
        Influenza is spread by contact and respiratory droplets that only travel a limited distance before gravity takes over and they fall to the ground.  Negative pressure isolation rooms are needed for airborne spread pathogens such as TB, measles, chickenpox.  Negative pressure rooms aren't necessary for the isolation of patients with influenza.

        Please ask your hospital administrators and your hospital infection control department if they are formulating a specific pandemic influenza plan to deal with the high census that would be expected.

        2,243 wrongs don't make a right.

        by desertbug on Fri Feb 03, 2006 at 06:09:31 AM PST

        [ Parent ]

        •  Luckily, in our case (4.00)
          most of our rooms are private, single patient.

          Thanks for clearing that up.  We are still not prepared for a major pandemic.  Any major disaster will be an exhausting chaos.  But we do chaos twice a week.  We're good at that.

          The future ain't what it used to be. Yogi Berra

          by x on Fri Feb 03, 2006 at 06:15:00 AM PST

          [ Parent ]

      •  Ventilators (none)
        We don't have nearly enough ventilators to deal with a large number of bird flu patients.  Patients seriously ill with bird flu to date have presented with severe lung problems.  I don't know if this is solvable as I don't see how we could possibly have enough reserve ventilator capacity to deal with a problem the size of a pandemic.

        "All right, then, I'll go to hell." Huck Finn

        by karin on Fri Feb 03, 2006 at 09:40:18 AM PST

        [ Parent ]

        •  we can't and we don't (none)
          many hospitals are stocking up on portable oxygen-driven ventilators, and planning on moving from standard of care to sufficiency of care. but it still won't be enough.

          The, we get to decide who gets ventilated. Wouldn't that be best done in advance? see, that's why planning is so important.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Fri Feb 03, 2006 at 10:19:18 AM PST

          [ Parent ]

        •  we don't and we won't (none)
          have enough reserve ventilator capacity to deal with a bird flu pandemic.  That is part of the popular misbelief that "Oh, it won't be like 1918, because they didn't have ventilators or ICU's or anything like that".  We only have ventilators and ICU beds until the last one is plugged in and the last one is filled.  After that, we aren't a whole lot beyond 1918.  There is precious little room for extra "ICU-sick" patients in our modern health care system.

          2,243 wrongs don't make a right.

          by desertbug on Fri Feb 03, 2006 at 02:18:04 PM PST

          [ Parent ]

    •  Do we even know Tamiflu works? (none)
      People, don't be naive. Think like a scientist for a moment: does Tamiflu even work to prevent extreme symptoms of this strain of bird flu virus?

      It's just a guess right now, and Hoffman LaRoche is making huge money on this assupmtion.

      Don't cling to straws, they break easily . . .

      OOOOOMMMMM . . . . .

      by MarkosNYC on Fri Feb 03, 2006 at 06:07:25 AM PST

      [ Parent ]

      •  think like a scientist (none)
        and read the literature.

        Roche is ineed making a fortune. Welcome to capitalism. But tamiflu will still have an important role, even though you're right to suggest we not rely on iy alone.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Fri Feb 03, 2006 at 06:12:43 AM PST

        [ Parent ]

        •  Reports from Hong Kong and Vietnam (none)
          last fall while I was trying to find my daughter who fled NOLA before Katrina.---that's a partial excuse for not having cites---

          There were reports from both places of Tamiflu's not being effective in treating birdflu.  The suggestion was that it might be partly because chickens were being given Tamiflu.  ???

          But of course Rummy would have made sure we knew something like that.

          Being liberal means one is for civil liberties, equality, social justice, fairness. ... How can someone be too liberal? Dr. P.Z. Myers

          by maybeeso in michigan on Fri Feb 03, 2006 at 06:20:08 AM PST

          [ Parent ]

          •  amantadine - a different drug - was given to (none)
            chickens in china as part of their feed.

            There were reports of partial resistance to tamiflu in vietnam, but most of the isolates from SE and Turkey have been sensitive up until now.

            That can change, but it's something to be watched.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Fri Feb 03, 2006 at 06:24:29 AM PST

            [ Parent ]

          •  Oooops DemFromCT (none)
            I just saw your comment way up.  

            We should be fine for supplies if (when?) it gets bad.  Short a bit on water and powdered milk and my people will wind up eating some things they will hate, but OK.  Even if I get 4-5 more family moving in.

            Taking it seriously---you betcha.

            Being liberal means one is for civil liberties, equality, social justice, fairness. ... How can someone be too liberal? Dr. P.Z. Myers

            by maybeeso in michigan on Fri Feb 03, 2006 at 06:28:33 AM PST

            [ Parent ]

            •  So what are we talking? I have my earthquake (none)
              wheeled storage box with water, food, medical supplies, flashlight, transistor radio, batteries, etc..

              Is there anything I should add for pandemic prep?  

              Nothing short of an aroused public can change things, nothing less than democracy is at stake- Bill Moyers

              by maggiemae on Fri Feb 03, 2006 at 07:53:34 AM PST

              [ Parent ]

              •  no you're good to go (none)
                just think maybe 3 weeks, not one.

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Fri Feb 03, 2006 at 08:00:03 AM PST

                [ Parent ]

                •  Thanks! Someone down thread (none)
                  mentioned elderberries.....does elderberry wine count? May not be as effective, but I'll be lowering my stress levels. LOL!

                  Nothing short of an aroused public can change things, nothing less than democracy is at stake- Bill Moyers

                  by maggiemae on Fri Feb 03, 2006 at 08:13:45 AM PST

                  [ Parent ]

                  •  sambucol and elderberry (4.00)
                    have been cited in literature as helping with decrewasing flu replication, but it may increase cytokinme storm. It's never been tried in humans with H5N1 so don't count on it.

                    Flu Wiki has a CAM page if you want to explore iot.

                    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                    by Greg Dworkin on Fri Feb 03, 2006 at 08:57:34 AM PST

                    [ Parent ]

                •  a few other items to consider (none)
                  I think a month's disruption of movement of goods is optimistic--people will panic and we have to expect some violence. In 1918 people were still, to a certain extent, self-sufficient--much greater than today.  And more civil in many ways. So, I worry.

                  Do you have pets?

                  I've got a shower bag you can hang in a tree; a few rainbarrels (you can't just turn water treatment plants on and off--think Katrina sized disruption); a portable propane stove and I keep my spare BBQ tanks full; couple bags of charcoal in the garage; some inflatable matresses (as I expect family will bug out to where we live); and I try to keep 20-30 gallons of gas on hand (we cycle it through our cars on a regular basis--a real pain, but we live a bit remotely); a shotgun and some ammo. batteries and a hand-crank radio; 100 lbs of dogfood and 50 of catfood. Oh, and TP and super thick plastic garbage bags (trust me, you'll need these two items more than you want to know); my laundry room is never without extra soap and lots of extra bleach (extraordinarily useful).

                  It seems like a lot, but I've bought it slowly over the years, taken advantage of sales, and tried to imagine what I would want most NOT to do without (so yeah, I keep LOTS of coffee and spirits). I'm sort of a packrat, so I keep an inventory and cycle through things. We have power outages here pretty often, so I keep plenty of candles, flashlights, and batteries.

                  I'm like a little cassandra in my family--and everyone indulges me. It comes in handy to have some of this stuff in the house

                  One more thing--learn how to season and cook dry beans, rice, cowboy coffee, and make a flavorful soup stock.  

    •  33% resistance rate. (none)

      ...if I recall the statistics correctly.  That means it might be useful for controlling sporadic outbreaks, but useless for an epidimic.


      Some people, however, feel that Tamiflu will be noticably more effective than its standard resistance rate would indicate.

  •  Think NOLA (4.00)
    Given how well the DC calvary did in LA and MS, it's probably a good thing the DC calvalry isn't coming.   Even if this flu pandemic doesn't happen, it'll be a good excercise for local hospitals, etc. in being prepared for some sort of pandemic or disaster.  If it does happen....well we best all be prepared.  Time to stock up on ibuprofen and water.

    Oh yeah... and TP too. ;)

    •  I agree (none)
      It's the least our medical community can do, but are we going to build and maintain 1000's of extra hospital facilities and just wait for a pandemic? What kind of public (now of course, privatized) commitment of tax dollars is that going to take just for a supposed epidemic?

      Is this because our "high standards of care" in the U.S. means a bed in a ward for each infected patient? What's that, another 50 million beds? Let's see . . .  500 beds per new "epidemic" hospital -- divide 50 million by 500 = 100,000 new hospitals. Ok, that's 100,000 real estate deals, 100,000 construction deals, untold millions of contracts to buy equipment, train and hire staff, etc, etc.

      What do you think this is going to cost, folks? THINK ABOUT IT. You think the Republican controlled country, the one-party totalitarian drive in our country will pay for even 10 hospitals?

      Uh Uh.

      IF there's a pandemic, we'll all be dying in droves. Oh well, Mother Nature has taken Her course many many times before in human history, and she will again. It's valiant and right to prepare and try to save as many lives as possible, but let's not take flights of imagination so far. Nothing in global history suggests humans will rally in such numbers ($$$) to save the hoi polloi.

      OOOOOMMMMM . . . . .

      by MarkosNYC on Fri Feb 03, 2006 at 06:18:23 AM PST

      [ Parent ]

      •  hospitals will need to be creative (none)
        Many people may need little more than fluids.  They don't need an ICU bed for that.  They may be fine in a cot in a large "flu ward" with oral rehydration solution such as used in underdeveloped countries.  They may need some supplemental oxygen for a while, but that can also be delivered in something far short of a new ICU bed.

        Regulations on bed capacity will need to be relaxed in such a setting and hospitals will need to shift their mindset to something like "If I didn't have to worry about every little letter of the law, how many patients could I safely take care of and how would I do that?"  

        There will be a massive tug of war between physicians who want to make plans for their hospitals to do this and the hospital's risk management people who will oppose it because it is outside of the "standard of care" or the "JCAHO standard"

        2,243 wrongs don't make a right.

        by desertbug on Fri Feb 03, 2006 at 02:25:19 PM PST

        [ Parent ]

        •  in a crisis one moves from (none)
          'standard of care' to 'sufficiency of care'. it meands using the local school instead of the hospital for the O2 and fluid cases.

          many of the state and international pandemic plans include just that way of thinking. local communities should be identifying such 'alternate care' sites, so as not to think something already designated as an emergecy shelter, for example, would be available for hospital-type care. That's the kind of thing that should be decided in advance.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Fri Feb 03, 2006 at 02:31:34 PM PST

          [ Parent ]

    •  The problem with the DC cavaly is (none)
      that money gets skimmed off on at least two crony levels before it gets to where it should be.

      The evacuation buses for instance.....

      Being liberal means one is for civil liberties, equality, social justice, fairness. ... How can someone be too liberal? Dr. P.Z. Myers

      by maybeeso in michigan on Fri Feb 03, 2006 at 06:30:31 AM PST

      [ Parent ]

    •  They'll come (none)
      but it'll be martial law.

      Unitary Executive is just a nice way of saying Dictatorship.

      by voltayre on Fri Feb 03, 2006 at 10:14:10 AM PST

      [ Parent ]

  •  ..just a nit.. (none)
    ..there's no cavalry coming from the feds, not calvary. thx
  •  Not to minimize the risk (none)
    There's no question we need to be prepared for a pandemic, because sooner or later there will be one.

    However, one fact seems to get lost in the fear over this particular potential pandemic:

    Bird flu may not be anywhere near as dangerous as we've been led to believe.

    One study published about a month ago (I wish I could give an exact reference -- perhaps I'll search for it an post it later) indicates that the mortality rate from bird flu is actually no worse than any of the other strains of flu that have circulated recently.

    There are indications that most people who contract it simply experience mild flu-like symptoms then get better.

    Most of the people who have contracted it so far have not sought medical attention. It's only the severe cases that have been counted.

    I'm not making this up, I swear. It was a CDC study that got very little attention probably in mid-December. (I swear I'll look it up.)

    That's not to say that there won't be a severe flu pandemic someday. We should certainly be prepared.

    But I wonder if bird flu isn't being turned into the next big scare to keep people afraid and voting Republican.

    Republicans are men of narrow vision, who are afraid of the future. -- Jimmy Carter

    by elsaf on Fri Feb 03, 2006 at 05:48:14 AM PST

    •  Here's a reference (none)
      This is not the exact one I'm thinking of, but it's as close as I can come with the time I have right now:

      http://www.cdc.gov/...

      How does H5N1 virus differ from seasonal influenza viruses that infect humans?
      Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 virus has caused the largest number of reported cases of severe disease and death in humans. In the current situation in Asia, more than half of the people infected with the virus have died. Most cases have occurred in previously healthy children and young adults. However, it is possible that the only cases currently being reported are those in the most severely ill people and that the full range of illness caused by the H5N1 virus has not yet been defined.

      Emphasis added.

      Republicans are men of narrow vision, who are afraid of the future. -- Jimmy Carter

      by elsaf on Fri Feb 03, 2006 at 05:54:47 AM PST

      [ Parent ]

      •  Please don't try to dispell the flu danger (none)
        It'll just make it that much harder for our OverLords to enact Martial Law when the first few smattering of cases hit.

        And, more importantly, it might suppress the value of Mr. Rumsfeld's Tamiflu stocks.

        . . . OK, done channeling Karl Rove . . .

        •  In contrast with 1918, when public meetings (4.00)
          were declared illegal in order to prevent the flu's spread, at least we'll all be able to communicate with each other on the internet.

          Economic Left/Right: -6.63 Social Libertarian/Authoritarian: -5.85 That makes me more Gandhi than Stalin

          by TomDuncombe on Fri Feb 03, 2006 at 06:00:42 AM PST

          [ Parent ]

          •  Umm, I don't think so (none)
            I've heard rumors that the internet can become infected with viruses . . . I suspect that the really really scary avian flu virus could easily mutate to gain this ability, too . . .
            •  Ever think about (4.00)
              the people who make the internet and keep it up and running ? We're human too ! If we get the flu, the net could go down in many areas......as a matter of eventuality.

              Just consider what will happen when office rats get the flu. Offices close. Trains run late, etc. etc.

              T R O U B L E big time.

              visit my blog and blister: Music & More

              by rossini on Fri Feb 03, 2006 at 06:13:03 AM PST

              [ Parent ]

      •  Please provide the link later... (none)
        Elsaf, I think the mortality rate is the issue.  Please provide the link to the study you are talking about at a later time.  I'll check back here if no one else provides the link.
      •  Don't forget... (4.00)
        ...that the first wave of the 1918 flu was "mild".  There were pockets of cases where it exhibited extreme virulence, but the majority of people who caught the 1918 flu when it first jumped to humans had either a fairly mild case, or got sick but didn't die.  It wasn't until the second "wave" (it never really stopped between "waves") that it hit people like a hammer.  We don't know what the current bird flu will do, but don't think that because it may be mild now that it won't mutate into an extremely virulent virus.

        I think the term is "passage".  A virus can get more virulent as it passes from one host with no immunity to another before either burning itself out of leveling off.  There was a medical researcher (I forget who) at the turn of the century who discovered that the amount of a virus needed to kill his lab animals decreased significantly as it passed from one animal to the next one.  I forget the details (what kind of animal he tested, what virus), but basically, he had to give on animal a large amount of the pathogen before the animal died...he took blood from the first animal and injected it into a second, but it took much less blood before the second died...he then took blood from the second and injected it into a third and, again, it took much, much less...  Well, you get the picture, and it was theorized then that that was why the 1918 flu started out without killing people who got sick and then went into this phase where it was shockingly deadly.  And although the virus remailed deadly for a while, there was this point at the beginning of the second wave where it was just extremely so.  Although the overal mortality rate was, what 2%, in the U.S, the cities that caught the virus first (say, October) were usually hit much harder than cities and town (sometimes nearby) that didn't experience an outbreak until more time had passed (say, January).

        The history of the 1918 flu, and epidemiology in general, is fascinating stuff.

      •  Don't forget... (none)
        ...that the first wave of the 1918 flu was "mild".  There were pockets of cases where it exhibited extreme virulence, but the majority of people who caught the 1918 flu when it first jumped to humans had either a fairly mild case, or got sick but didn't die.  It wasn't until the second "wave" (it never really stopped between "waves") that it hit people like a hammer.  We don't know what the current bird flu will do, but don't think that because it may be mild now that it won't mutate into an extremely virulent virus.

        I think the term is "passage".  A virus can get more virulent as it passes from one host with no immunity to another before either burning itself out of leveling off.  There was a medical researcher (I forget who) at the turn of the century who discovered that the amount of a virus needed to kill his lab animals decreased significantly as it passed from one animal to the next one.  I forget the details (what kind of animal he tested, what virus), but basically, he had to give on animal a large amount of the pathogen before the animal died...he took blood from the first animal and injected it into a second, but it took much less blood before the second died...he then took blood from the second and injected it into a third and, again, it took much, much less...  Well, you get the picture, and it was theorized then that that was why the 1918 flu started out without killing people who got sick and then went into this phase where it was shockingly deadly.  And although the virus remailed deadly for a while, there was this point at the beginning of the second wave where it was just extremely so.  Although the overal mortality rate was, what 2%, in the U.S, the cities that caught the virus first (say, October) were usually hit much harder than cities and town (sometimes nearby) that didn't experience an outbreak until more time had passed (say, January).

        The history of the 1918 flu, and epidemiology in general, is fascinating stuff.

    •  After Katrina (4.00)
      anyone who votes Repub is on their own & a fool.  

      The future ain't what it used to be. Yogi Berra

      by x on Fri Feb 03, 2006 at 05:56:38 AM PST

      [ Parent ]

    •  actually , i need to take mild issue with you (none)
      you are referring to astudy by Thorson that states that in vietnam when asked about a flu-like illness, many who worked with sick birds can recall one. There was no seroprevalence done (checking blood for antibodies to prove exposure).

      However, we have actually gathered all the seroprevalence stidues we can find, publsihed and unpublished, and mild infection being common is not supported by the data. it certainly happens, but it is not common.

      what we need is seroprevalence in Turkey, with the latest iteration of the virus.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 06:07:41 AM PST

      [ Parent ]

    •  Agree (none)
      We "need to be prepared" without doubt.  However, we know we're NOT, and we better not depend on the fools in the White House.
  •  During the last serious flu pandemic (1918) (4.00)
    About 40 million people died worldwide, and the entire world was exposed with the exception of some people in the Pacific islands who had no contact with the outside world for 2 years.

    Nothing worked. Of course there were no antiviral meds, but the much-vaunted quarantine--which is part of the government's plan for dealing with Bird Flu--didn't work either.

    Economic Left/Right: -6.63 Social Libertarian/Authoritarian: -5.85 That makes me more Gandhi than Stalin

    by TomDuncombe on Fri Feb 03, 2006 at 05:51:17 AM PST

    •  this is a race between a good vaccine (none)
      and a bad virus. Hope the good guys win.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 05:52:22 AM PST

      [ Parent ]

      •  Even if a vaccine is invented (4.00)
        and it happens to work, there will only be enough vaccine available in the short run to vaccinate something like 20 million out of 275 ot 290 million people.

        Who would get vaccinated under those circumstances?
        Don't tell me that it won't be business leaders, Republican government officials and their families, etc.

        Economic Left/Right: -6.63 Social Libertarian/Authoritarian: -5.85 That makes me more Gandhi than Stalin

        by TomDuncombe on Fri Feb 03, 2006 at 05:55:56 AM PST

        [ Parent ]

        •  that's the current vaccine that takes 6 months to (4.00)
          the newer techniques, not perfected, use cell culture, not eggs and can be made in a month. We're not ready here either, but it's a very promising area of research.

          IOW, mass vaccination capability would be a reality 3-4 years from now, not today. That's why it's a race.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Fri Feb 03, 2006 at 06:09:52 AM PST

          [ Parent ]

          •  there is a vaccine (4.00)
            There's a vaccine being worked on at Univ Pittsurgh that's been 100% effective in (small) tests in mice and chickens.  More encouraging, they were able to make it in 36 days instead of the six months for the old process.

            The vaccine uses an adenovirus vector containing genes from H5N1, a process that's also being used for experimental HIV vaccines.  A link to the study is here on PubMed and another article here.

            The question of mass vaccination, and who decides it's worth the risk and who gets it and when - now that, I don't know...

            •  Human Vaccine? (none)
              Immunizing fowl with that HA/adenovirus looks very effective. What about immunizing humans, so we don't have to worry about quality control on the global factory farms, and less competent family farms, that so often incubate diseases?

              Innoculating fowl populations incubating the epidemic is clearly necessary for the world's safety. But my own selfish desire for personal safety won't be satisfied unless I'm personally protected, as well as the people I care about - like the people running my water system.

        •  You would NEVER want to vaccinate everybody (4.00)
          Vaccines of almost every type--flu, Hepatitis B, Hepatitis R, MMR, and others--produce severe and sometimes permanent fatal reactions in a significant proportion of the population. Most widely known is the Guillain-Barre syndrome, which can paralyze its victims, render them unable to breathe or produce excruciatingly painful neuropathies and other neurological disorders. While the reported incidence of GBS is small, it is known to be vastly underreported, either because it doctors fail to recognize it or fail to report it to VAERS, the Vaccine Adverse Event Reporting System. In addition to GBS, vaccine injections have been linked with CIDP (a lifelong version of GBS), multiple sclerosis, lupus and other diseases thought to be caused by an immune system confused by vaccines into attacking bodily tissues. Incidence of ADHD, autism and other neurologically related childhood disorders has exploded in direct proportion to the number of vaccines American children now receive.

          Inoculating the entire country would create millions of cases of these diseases. Victims with autonomic forms of GBS often need to be placed on respirators to survive; in a mass vaccination program, most would be left untreated and die.

          If a vaccine is needed, the proper strategy is to immunize vectors like healthcare workers, the families of sick peoplep and populations around outbreaks--not everybody.

          •  you've brought up an issue well familiar (4.00)
            to eveyone, but the majority of scientific opinion is that the benefit outweighs the risk - by far.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Fri Feb 03, 2006 at 08:03:00 AM PST

            [ Parent ]

            •  It is hardly familiar to everyone (none)
              or even to doctors, who often fail to recognize even a syndrome as obvious as "classical" GBS.

              Nor is scientific consensus remotely as you describe. In fact, those most familiar with the actual data are proscribed from releasing it to the public, both at the FDA and their European counterparts. Even vaccine manufacturers themselves have admitted that none of their safety studies follow up with patients for the minimum 90-day period required to pick up even a fraction of severe adverse events. Hepatitis B is contracted mostly through sex and IV drug use, yet the vaccine is routinely given to preschool children--without a single study indicating that the immunity it confers will last the decade or more until they become sexually active.

              The regular flu vaccine has no known correlation with any positive outcome except one: a reduction in the number of sick days among vaccinated populations, which may be an artifact of the fact that people who get vaccines are generally more attentive to their health care anyway. Proponents of the vaccine use highly dubious statistics in their arguments. No one actually knows the incidence of flu deaths; seropositivity is never tested by doctors, and many people who have the "flu" actually have a rhinovirus, pneumonia or some other respiratory infection. And no evidence shows any decrease in mortality among the elderly, who are most often browbeaten into getting the injections.

              While some would like to believe that flu shots are just sweet little sugar pills without serious risk of side effects, their risk is actually significant and serious, including paralysis, lifelong disability, irreversible neurological damage, and death.

    •  Quarantines can work (none)
      on a local level.

      There are several examples from Alaska (Fairbanks for one) of towns that threw up strict quarantines and survived the virulent fall onslought of the 1918 flu.  Fairbanks posted marshals on all roads and trails leading into town, and didn't get the flu until spring, when its virulence was diminished.

      One village on the Seward Peninsula had an effective quarantine between the upper village and the lower village, though they were only separated by 100 yards.  The lower village had over 50% mortality.  The upper, 0.

  •  Invasion from Mars (none)
    OMG ... we are not prepared for an invasion from Mars.  I saw the movie.  We are dooomed

    And the plant revolution.  We must put all plants under watch ... you can never be too careful.

    And are we really prepared for the "Big Strike".  You know the meteor that's out there headed for the US.

    We should bankrupt our country to alleviate our trivial fears ... like instead of just seeking therapy to accept that RISK happens and that's life.

    American Engineer :== loser!

    by jnmorgan on Fri Feb 03, 2006 at 05:53:46 AM PST

    •  I can tell you failed history. n/t (none)

      Economic Left/Right: -6.63 Social Libertarian/Authoritarian: -5.85 That makes me more Gandhi than Stalin

      by TomDuncombe on Fri Feb 03, 2006 at 05:57:45 AM PST

      [ Parent ]

      •  Risk Assessment (none)
        What is the real risk vs what is the real cost?

        This is fear mongering!

        I too saw a report that shows this strain has been monitored since the 60's and has killed 60/80 people/year.  The strain's rate of death of humans is based only on people that were sick enough to seek medical assistance.  

        Most people experienced a cold/flu like symptoms.

        American Engineer :== loser!

        by jnmorgan on Fri Feb 03, 2006 at 06:04:06 AM PST

        [ Parent ]

        •  We're overdue for a true pandemic (4.00)
          That's not fear-mongering to state.

          I believe the figure I've seen quoted for the 1918 flu pandemic, American casualties, was something like 200,000 dead. And that was among a much smaller population.

          If the deaths of 3000 people on 9/11 permanently traumatized us and changed the nature of our government forever, what would happen to our social fabric with 200,000 dead in a single month?

          Economic Left/Right: -6.63 Social Libertarian/Authoritarian: -5.85 That makes me more Gandhi than Stalin

          by TomDuncombe on Fri Feb 03, 2006 at 06:07:59 AM PST

          [ Parent ]

          •  675,000 dead in a population (4.00)
            1/3 today's size.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Fri Feb 03, 2006 at 06:14:22 AM PST

            [ Parent ]

          •  I agree planning for a pandemic (none)
            is a good thing and something that the federal government (CDC) should have damned well have done in the past.

            But spending billions of dollars guessing that this is the strain is foolish.  

            When the strain mutates it's a different strain

            So as in all fault tolerance/avoidance scenarios think FDAIR Fault Detection, Assessment, Isolation and Recovery: expand on that thought and you have done all you can til it shows up.

            American Engineer :== loser!

            by jnmorgan on Fri Feb 03, 2006 at 07:19:56 AM PST

            [ Parent ]

            •  prepshould be fotr all or any strain (none)
              but you wouldn't really do it diferent based on what you've said.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Fri Feb 03, 2006 at 08:03:53 AM PST

              [ Parent ]

        •  If you don't believe it, don't prepare for the flu (4.00)
          - but if others choose to put food and water in their basements, why are you being condescending towards them, comparing this to Martians invading? It is their decision.

          Just don't then go grubbing for food from them if it happens.

          Republicans to Americans: "Are there no prisons?...And the Union workhouses?...Are they still in operation?"

          by adigal on Fri Feb 03, 2006 at 08:32:57 AM PST

          [ Parent ]

  •  What would be helpful (4.00)
    Would be for Sec. Leavitt to start acting like a responsible Federal public health executive and deliver his own plan that would detail in writing what he expects Local and State officials to deliver.

    I'm sick and fucking tired of Federal officials holding press conferences and pointing at the locals. And I don't need Mike Leavitt telling me how bad the flu of 1918 was - it killed a good deal of my kin, working as nurses to the sick.  So Mike, give me a detailed written response plan with defined responsibilities or shut-the-fuck-up.

  •  Honestly it is hard for me to get (none)
    excited about Bird Flu.  I know we should be but it just isn't that exciting.  There are many more people who will die from car accidents, smoking, overeating, RSV, etc.
    •  2 to 7.4 million deaths, predicts the WHO n/t (none)

      Economic Left/Right: -6.63 Social Libertarian/Authoritarian: -5.85 That makes me more Gandhi than Stalin

      by TomDuncombe on Fri Feb 03, 2006 at 05:59:06 AM PST

      [ Parent ]

    •  yeah (4.00)
      that's what they said in New Orleans in July.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 06:15:07 AM PST

      [ Parent ]

      •  ...and said in DC... (none)
        ...about New Orleans in August, September, October, Novemeber, December, January, February...

        But...I'm sure than some Republicronies will get contracts to "recover" the bodies, bury the dead, and clear-up the estates.

        Anyone wanna speculate on whether bird flu will disproportionately effect the poor?

  •  Underestimate it (none)
    if wish. Me ? I've already begun increasing my daily intake of good old Vitamin C. Not that it will make much of a difference, but if I can keep my immune system up, I should be okay. If not, see ya next time around.

    The avaian flu works so friggin fast, it makes HepC look like a snapshot of a virus.

    visit my blog and blister: Music & More

    by rossini on Fri Feb 03, 2006 at 06:02:14 AM PST

    •  The 1918 flu virus killed the strongest (4.00)
      in the population--it had a death rate much higher among 20-40 year olds than would be expected otherwise. Scientists think that the virus learned how to turn people's strong immune systems AGAINST them--I think the word that was used was a "cytokine storm," something like that.

      So that the death curve for the 1918 was W-shaped instead of the normal V-shape (hitting young, old, and middle-aged instead of just infants and old people).

      Economic Left/Right: -6.63 Social Libertarian/Authoritarian: -5.85 That makes me more Gandhi than Stalin

      by TomDuncombe on Fri Feb 03, 2006 at 06:05:54 AM PST

      [ Parent ]

  •  Duct tape (4.00)
    Ok, I don't want to minimize the risk here.  It's important to be prepared for any potential epidemic.  But I'm getting a graduate degree in exactly this field, and so I always kind of cringe when the "OMFG" flag goes up and the media starts panicking.  This isn't nuclear war or some Andromeda Strain killer virus, it's a pathogen that we kind of understand and that we have some idea how to treat.

    Stockpiling food and water like this is some post-apocalyptic scenario is unlikely to be useful.  The nation kept its basic infrastructure functioning even through the 1918 flu, despite the enormous death toll it was causing and the fact that there was a large overseas war being fought at the time.  In addition, pretty much everything you read about a human H5N1 pandemic is hypothetical.  This is currently a bird disease which has only infected a few humans, and then only those with prolonged direct contact to birds. So far there's no hard evidence that the disease can transmit from person to person, we've only theorized that it potentially could.

    What IS useful?  Well, number one IF, the virus evolves in a way that it passes from person to person, we need to have strong epidemiology studying every factor of this disease.  Who's at risk, what promotes or prevents the transmission of the disease, how lethal is it?  To some extent, we have this already because of the extensive work done on "normal" influenza.  I guarantee you that CDC will be deploying tons of personnel to the site of the first confirmed P2P transmission to collect this data.  They'll make recommendations about who should or shouldn't seek treatment based on that hard data, and members of the media NEED to report that information instead of sowing hysteria.  The reason is that epidemics have a tendency of turning out millions of people who are not at-risk-- the "worried well" phenomenon.  That can completely overrun the capabilities of hospitals, and it provides a huge concentration of people in a place where there are ALWAYS pathogens lurking around: kind of like a viral buffet.

    Also, local communities need to have an incident command system plan for this event.  We need to detail who's responsible for every part of the response, and how they're going to take safety precautions.  Some communities already started working on this when bioterrorism preparedness became a big issue, and there is a national plan, but local agencies need to make this a priority.  Throwing tamiflu around won't necessary solve the problem (I don't think we even know if it works prophylactically, and using too much of it too early could potentially breed resistance).  We need to make sure we're only treating those cases that need to be treated, and keeping everyone else AWAY FROM THE HOSPITALS.  Also, we need to come up with ways to establish isolation procedures in the field for contagious patients-- we'll need to designate some place as ad hoc influenza wards (say gyms or convention centers), and we have to figure out ways to modify the ventilation systems to prevent transmission to healthcare workers.

    We can manage a flu epidemic, and we've done so in the past.  However, the single biggest factor in our success will be planning from the federal level down.  Make sure we have contingency plans and established protocols for every type of infrastructure.  However, the US has been doing that since the era when Atomic Fire Raining Down From the Sky was a serious concern.  I would LOVE to see bird flu become a reason to significantly improve the nation's public health apparatus (we absolutely NEED some big improvements).  But the apocalyptic rhetoric is stupid and overblown, and should really be viewed in the same category as the government's recommendations to buy duct tape after 9/11.  My guess is that these are political appointees at the top who are playing into Bush's "be afraid all the time!" strategy.

    Oh well a young man ain't got nothin' in the world these days-- Mose Allison

    by ChicagoDem on Fri Feb 03, 2006 at 06:10:06 AM PST

    •  exactly right (4.00)
      this isn't an OMG diary... I've been writing on this here for over a year and i'm reporting what the experts are saying. But if someone doesn't get a fire lit under their butt, nothing gets done.

      That's reality. Risk assessment, meet risk communication. On'e useless without the other, but they're not the same thing.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 06:17:31 AM PST

      [ Parent ]

      •  Oh yeah (none)
        Don't get me wrong, my annoyance was more with the Federal officials actually calling for stockpiling than with your diary.  Bird flu is definitely something we need to think about, but it's often misunderstood.  Totally agree about risk communication though.

        Sorry about the lack of precision, my earlier post was written pre-coffee.

        Oh well a young man ain't got nothin' in the world these days-- Mose Allison

        by ChicagoDem on Fri Feb 03, 2006 at 10:03:03 AM PST

        [ Parent ]

        •  like that's never happened to me ;-) (none)
          but as I said, I agree. The mixed messages are astounding from the feds. It's important, but we'll bury the message on a still obscure web site.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Fri Feb 03, 2006 at 10:15:48 AM PST

          [ Parent ]

    •  On the other hand... (4.00)
      Any American who can afford to stockpile at least a week's worth of food and water and who doesn't do so is a fool.

      That's good to have for ANY reason. It lets you and your family remain civilized citizens for the duration of any interruption of services due to disaters, not hungry, helpless refugees.

      You ought to expect the government to rescue you if your house is coming apart in a flood, or to provide shelter if it's destroyed.

      You should NOT expect the government to put food in your mouth, like a baby bird, one day after the power goes out.

      "When fascism comes to America, it will be wrapped in the flag and carrying the cross" - Sinclair Lewis

      by Loboguara on Fri Feb 03, 2006 at 06:36:46 AM PST

      [ Parent ]

    •  What you might remember (4.00)
      Is that in 1918 a much larger percentage of the population was self-sufficient, lived in isolated rural communities and had little dependence on infrastructure (electricity, public water systems, trash pickup, restaurants, grocery stores, and public transportation).  

      The America of 2006 is a nation of people that wouldn't know how to feed or care for themselves if the shopping center closed up. And by-and-large we gather in tight clusters to do our jobs.

      •  Amen. n/t (none)

        In the practice of tolerance, one's enemy is the best teacher. Dalai Lama

        by leolabeth on Fri Feb 03, 2006 at 09:33:57 AM PST

        [ Parent ]

      •  I dunno (none)
        Even in 1918, there were major population centers, and these weren't running out of food and water.  You also didn't have the luxury of helicopters, personal communications technology, and individual transportation.  There might be some limited danger of not being able to get food and water in a few geograhpically isolated communities, but for 99% of the country it's not a serious threat.

        I mean there were people blogging from New Orleans as it filled up with water.  If people are somehow starving to death because a town's cut off from food or water supplies, SOMEONE will hear about it.

        Oh well a young man ain't got nothin' in the world these days-- Mose Allison

        by ChicagoDem on Fri Feb 03, 2006 at 10:07:41 AM PST

        [ Parent ]

    •  I appreciate your analysis (none)
      and advice - but here's the worry for me.  

      However, the single biggest factor in our success will be planning from the federal level down.  Make sure we have contingency plans and established protocols for every type of infrastructure.

      If Clinton or Gore were president, I would not be so worried.  But in Bush, we have a president who strummed a guitar while a major American city drowned.  He has no plans.  They don't need no stinking plans.  These people do NOT know how to govern (see Paul Krugman's excellent NYTimes column today.)  We will see chaos, perhaps martial law, and no coordinated plan to deal with this.

      When the first human case hits the US, expect pandemonium.  I wish I had more faith in the administration and my fellow man, but I don't.

      Republicans to Americans: "Are there no prisons?...And the Union workhouses?...Are they still in operation?"

      by adigal on Fri Feb 03, 2006 at 08:40:59 AM PST

      [ Parent ]

      •  It is scary... (none)
        But if it makes you feel better, there's going to be intense international support and coverage on this issue.  CDC itself is not nearly as amenable to bullshit as FEMA, and it's got a ton of allies at pretty much every level of healthcare.  In addition, for better or worse, any bird flu epidemic will be MUCH wider spread and slower progressing than Katrina, meaning it will be harder for there to be point source fuck-ups like Mike Brown's little high-ground vigil outside New Orleans.  It will be harder for Bush to Cheney this up.

        Oh well a young man ain't got nothin' in the world these days-- Mose Allison

        by ChicagoDem on Fri Feb 03, 2006 at 10:12:22 AM PST

        [ Parent ]

        •  Yes, however (none)
          It sure would be nice to have a federal government which was helping the CDC do their job, not hindering it. I have no stats, but wonder how well they are funding this project.

          I think that public health in general is anathema to the right wing. It cuts against their ingrained belief in PERSONAL RESPONSIBILITY= EVERYONE FOR THEM SELVES.  

          If you die, it was all Gods plan, see. The rich who can buy their way out of a crisis are blessed. the rest are blamed.

          Coincidentally, I just finished an article on avian flu, from national geographic. They mentioned that the US was only stockpiling 2 million doses of tamiflu vs 15 million in the UK. That's cutting corners to save money, and playing fast and lose with our national safety.

          They bet the farm on their big gamble in Iraq and lost. So now we "cant afford" enough to do the maximum to protect ourselves from this.

  •  FluWikie (4.00)
    http://www.fluwikie.com/index.php?n=Consequences.PandemicPreparednessGuides This site: Fluwikie really got me up to speed and helped me feel less anxious about the whole thing. There will be ways to protect your family.
    •  I like that site ;-) (4.00)
      I forget why.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 06:18:09 AM PST

      [ Parent ]

      •  Parts of it remind me of civil defense literature (none)
        issued in the 1950s. Like the part wondering whether you should have guns in your house to shoot your neighbors should they come around wanting to share your food and water.

        Economic Left/Right: -6.63 Social Libertarian/Authoritarian: -5.85 That makes me more Gandhi than Stalin

        by TomDuncombe on Fri Feb 03, 2006 at 06:21:20 AM PST

        [ Parent ]

        •  it's a site like this (none)
          and everyone in the Forum has a different pov.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Fri Feb 03, 2006 at 06:25:38 AM PST

          [ Parent ]

          •  I saw your name there (none)
            What I liked was it reassured me that if we didn't get sick initially our best form of defense was to avoid strangers and just stay home and read books, watch tv, and play on the computer. The worst part would be having to put up with each other.
        •  Though the modern version... (none)
          ...with ample evidence in New Orleans, is that IF..and only IF you are willing to commit to training and safe storage of them, yes, it is a good idea to have some form of defense.

          People were truly and absolutely on their own in New Orleans, facing a destroyed city...with no help coming.

          Call the police from a wrecked neighborhood because a drug addict is trying to smash into your damaged house...and they can't come.

          That's America 2006. Back to the pioneer days where every family, no matter how nonviolent, peaceful farmers they might be, HAD to have a rifle of some sort, simply because authorities couldn't get to them in time.

          And if you believe differently, I'm sorry, but you're dreaming. The neocons have and are gutting first responder services under their idea of an "ownership society", which basically means...

          ...you're on your own.

          "When fascism comes to America, it will be wrapped in the flag and carrying the cross" - Sinclair Lewis

          by Loboguara on Fri Feb 03, 2006 at 06:41:08 AM PST

          [ Parent ]

      •  Just in case (none)
        You know, just in case there's nobody around to say it after you're proven right,  you all over there are owed an enormous debt of gratitude from the survivors.  You're doing important work, and it must feel like shouting at a brick wall sometimes.  Just know it's not completely unappreciated.  
  •  I have several cans of (none)
    saurkraut in my basement awaiting to be eaten when the flu apocalypse hits.  

    There won't be enough antibiodics.

    Sadly, in the US I am sure those doses won't go to crowded inner city neighborhoods. The ones getting treatment will be the government first, CEOs, military, police/fire, and then health workers.

     The rest of us are on our own. Gotta do something even if it may not work:

    http://www.waltonfeed.com/...

  •  Isn't the dirty little secret... (none)
    That if a pandemic occurred there wouldn't be a whole hell of a lot you could do.  It would be a trial by fire.  I think that's what has so many people wringing there hands.  Tamiflu stockpiling and the like is akin to the Homeland Security rainbow.  It's just there to cover someone's ass later.  I think it's really hard for most people to understand that beyond new breakthroughs in the production of a viable vaccine, nothing could stop this if it were to occur.... hence pandemic.  Also, it is just as propagandistic to act as though H5N1 will inevitably become a terrible human pandemic as DemFromCT repeatedly does.  It is right to assume that SOME kind of pandemic will eventually occur, but to keep pushing the fact that H5N1 is coming to get you, and soon is not very scientific.  We simply do not know that.

    Arrogance and stupidity: it's a winning combination.

    by MatthewBrown on Fri Feb 03, 2006 at 06:32:17 AM PST

    •  No, there's plenty you can do (4.00)
      There is a great deal that can be done to mitigate the consequences of a pandemic, no matter how severe or how mild. The Flu Wiki is based on the premise that by thinking ahead and being sufficiently well informed, we can prepare for the workarounds that would be needed if we were to suffer a 30% to 40% absenteeism for extended periods.

      Take one simple example. Today's pharmacies operate on "just in time inventory" systems so they don't have a big reserve stock. If supply lines were interrupted for even a week this might be a serious problem for those who depend on blood pressure or heart medications or insulin on a continuous basis. You can't change the just in time system overall, but for most things it doesn't matter. If they run out of Viagra or deodorant we'll all live. But we can think ahead about what are the dozen or so most frequent urgent meds and plan for alternative supply lines in the event of a supply chain interruption. Maybe it wouldn't get everyone's urgent medication but it could supply 90% of them. There are lots of other examples and the solutions can come from the ingenuity of the community. The Flu Wiki is a place to share them and educate ourselves as well.

      DemFromCT is not a doomsayer about bird flu. He is a reasonable person who is suggesting that by using a little foresight and by strengthening our social service and public health infrastructures we can make our communities more resilient to the shock a pandemic of any kind and from any source would cause.

      His posts and The Flu Wiki are real life examples of community mobilization and empowerment using the technology of the internet.

      •  revere's my coeditor (none)
        of Flu Wiki and a very smart guy, as well as a good judge of character. ;-)

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Fri Feb 03, 2006 at 08:05:33 AM PST

        [ Parent ]

      •  Bird Flu masks and goggles? (none)
        Revere, when, if at all, should an individual invest in a mask and goggles?  At the Senate hearing this week on Bird Flu preparations, didn't one of the HHS representatives say that the Federal Government was purchasing some masks?  Am I wrong in thinking that it was suggested that the supply of masks would be such that the public likely would not be able to purchase masks at the time of a pandemic? Am I correct on this?  Will any governmental or quasi-governmental body supply masks to the general public?  How about medical providers or insurance companies?  How should a citizen make a judgment on this issue?
        •  Masks and goggles (4.00)
          There seems to be little evidence masks or goggles will do much good. They may be useful for protecting other people from you, but the evidence for the other way around is scant. I don't have a mask and don't intend to get them.

          Here are the circumstances where I think a mask could be warranted: health care or other high risk workers who are around the sick frequently. Those masks need to be properly fitted, which is a problem. If you have a beard, forget it.  Conceivably for other caregivers, llike family members, when they enter the room where the sick person is. For people who are  coughing and sneezing to prevent them from exposing others. Probably a simple surgical mask will  work best. Respirators are too hard to breathe through for people who are already having trouble breathing.

          Not for the general public. If things get that bad you are  better off not congregating in crowds rather than doing it with a mask that may or probably won't work.

          My two cents.

          •  DarkSyde and I were going to address this (none)
            so just let me add my two cents on masks.  I agree with Revere, and wanted to add that it's possible they can give you a false sense of security.  Flu doesn't necessarily have to be breathed in--you can inoculate yourself also by having the virus on your hands, and rubbing your eye, for example.  Mask ain't gonna help you there, and wearing one might make you complacent about handwashing.  
            •  Look forward to reading your Diary... (none)
              Like all the rest of it, the issue of masks and goggles can be overwhelming.  I take it there are different types of masks for different types of potential users.  Look forward to your information.  Thanks in advance.
    •  I've got 6 months of food stored (none)
      When human to human transmissable bird flu is verified in North America, my family will not leave the house until it is gone.  (I'll live in my office).

      We'll disinfect mail and live off food storage.

      Quarantines can work well.

    •  What? Me worry? (none)
      ...SOME kind of pandemic will eventually occur, but to keep pushing the fact that H5N1 is coming to get you, and soon is not very scientific. We simply do not know that...

      Isn't that the same kind of argument the Repugs use about global warming?

  •  Caution against overreacting (none)
    A bird flu epidemic certainly sounds scary and there is every reason to be prepared but before we start panicking, let's consider what we're dealing with.  
    First, in order for the virus to jump species and become really virulent, there is going to have to be a LOT of contact between people and poultry.  The low number of infections so far doesn't sound like it has reached a critical mass by a long stretch.  
    Second, the death rate from infection from the Spanish Influenza wasn't that high.  Oh, yeah, millions of people dying worldwide certainly SOUNDS scary and there is no doubt that it will be more than we're used to but I've heard that the estimated death rate from infection, based on the Spanish Flu model is more like 5%.  It isn't going to be like the bubonic, pneumonic, septicemic plague of the middle ages where whole towns were abandoned.  
    Third, your body's natural immune system will successfully fight this infection, provided you don't succomb to the symptoms beforehand.  Modern medicine is much more sophisticated than it was in 1918.  
    Fourth, if you take normal precautions to avoid infection, like washing your hands and avoiding people who appear sick, your chances of being infected are a lot smaller.  
    Fifth, bird flu didn't materialize this year which gives vaccine manufacturer's a little more time to develop a vaccine against H1N5.  
    Anyway, to me, this is just another case of irrational versus rational fear.  The chances that I will contract and die of bird flu are not that high but I will follow normal precautions to protect myself anyway.  Meanwhile, life goes on and I will not become paralyzed from fear because the preznit and his minions are trying to scare me to death.  

    -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

    by goldberry on Fri Feb 03, 2006 at 06:33:58 AM PST

    •  Remember the Y2K Computer problem.....NOT! (none)
      The one that didn't happen?  You make a good point.
    •  Are you saying 5% mortality rate? (none)
      Goldberry, 5% sounds low.  Where did you get that number?
      •  Heard it on NPR (none)
        There was a report on it several weeks ago.  The mortality rate was estimated based on the 1918 flu model.  Now, we don't know if the bird flu is going to be worse but even if it is twice as bad, that's not the catastrophe we've been lead to believe.  It'll still be alarming but not apocalyptic.  
        Disclosure: I work for a big pharma company that has kept it's employees up to date with recent developments on this subject.  There is concern but not panic.  Follow normal precautions, get a regular flu shot, keep yourself healthy.  Most people will be just fine.  
        One final thing, if the country is saved by a H5N1 vaccine, it can thank the French.  I am just delighted at the irony of that.  :-)

        -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

        by goldberry on Fri Feb 03, 2006 at 07:15:43 AM PST

        [ Parent ]

    •  5% of Americans would be (none)
      15 million people.

      Sounds serious to me.

      The H5N1 strain has killed over half the people (50% mortality) who have contracted it, in spite of excellent medical care in many cases.  It will take relatively few mutations for the virus to become transmissable between humans.

      Bad things can happen.

    •  Caution against not reacting at all (4.00)
      Your first point is not correct. There is already a lot of human poultry contact all over the developing world and the mutations are random. They could happen with the first contact or only after millions. But there already have been millions, probably billions of contacts. And each virus makes about a billion experiments on its own when it replicates.

      Second point. The death rate in 1918 varied in locality from around 1% to 8 or 9% but most people take 2% as a good average. And this relatively low mortality wreaked havoc because 2% of a global population with a 40% infection rate is a lot of bodies to pile up in 6 weeks or so. More importantly, the very sick will overwhelm health care and social service facilities and just a fraction of that burden and a 30% to 40% absenteeism in a highly interconnected society with critical node points can create serious problems. Add to this the fact that in pandemics the age distribution shifts markedly to the young and in this virus the distribution is shifted to the left even more strongly than 1918 and there is a big problem. The over 65 age group will die at much the same rate as in a regular seasonal episode but the under 45s will die and sicken severely to a much greater extent.

      Third, the whole point of an H5 pandemic is that your body has never seen this antigen before so it is immunologically naive to it. You don't have immunity. Plus its virulence means it kills many quite quickly so you don't get an immune reaction (cell mediated immunity requires 5 to 7 days, humoral immunity 14 days or more). As for "modern medicine," the burden on the health care system will mean most people never get the benefit of it but even if they do, the danger is ARDS which has about the same case fatality today as it did in 1918. Antibiotics might help for some secondary infections but primary viral pneumonias still have no treatments. You will die much as they did in 1918.

      Fourth, about hygiene and handwashing. Always a good idea. But there is currently no evidence it will do that much to protect you. We still have many unknowns regarding influenza transmission, especially the role of fomites and droplet nuclei.

      Fifth, currently you have to wait for a pandemic strain to emerge before you can make a vaccine. So there will inevitably be a lag. We don't have the infrastructure to produce or distribute vaccine now and that is years away independently of any new vaccine technologies (which themselves are years away). The current adenovirus headliners have years of development and safety testing ahead of them, assuming they work at all in humans (and there are many vaccines that work in mice but not people).

      •  Shriek! Shriek! We're all gunna die! (none)
        Let's all concentrate on the worst possible scenario.  Let's run screaming to our savior Bush so he can declare martial law and impose an iron will on us.  
        There is no reason to panic.  Jeez, even if a pandemic happens, what are you going to do about it?  If the absolute worse case scenario happens, civilization will not come to an end.  We will cope.  The human race will survive.  We are mortal.  We all die.  We are no different than frogs or trees or potatoes that have unfortunate confrontations with pathogens.  My grandfather lost his mother in the aftermath of the 1918 flu.  She nursed her whole family back to health but eventually died herself when she succombed to TB, presumably due to a weakened immune system.  My grandfather's sister died of rabies.  My grandfather's first daughter died of Rocky Mountain Spotted Fever.  He'd seen enough death from infection to scar him for life but somehow, I never saw him panic over anything.  Learn to survive, be cautious, take care of yourself.  What good does panicking do?  Remember, if you are consumed by fear, it is harder to make rational decisions.  

        -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

        by goldberry on Fri Feb 03, 2006 at 07:36:23 AM PST

        [ Parent ]

        •  You're Joking, Right? (4.00)
          Goldberry,
          Where do you see anybody panicking?  Revere and others are providing info so we can better understand what's going on.

          Think how weird this statement sounds: "There is no reason to panic.  Jeez, even if a pandemic happens, what are you going to do about it?  If the absolute worse case scenario happens, civilization will not come to an end..."  

          So, don't take precautions because civilization will continue?  Concede hundreds of thousands of avoidable deaths because in the past potatoes and pumpkins and humans ultimately survived the plague, etc.?  Then belittle someone for trying to understand the situation better.  Ask someone in New Orleans whether or not the Bush Gov't should have factored in a worst-case scenario.

          "Revere" is completely rational in helping us understand what precautions can be taken.  

          "Don't look back... something might be gaining on you..." -Satchel Paige.

          by npb7768 on Fri Feb 03, 2006 at 08:09:29 AM PST

          [ Parent ]

          •  Hype (none)
            Panicking?  Maybe.  Hyping?  Definitely.  
            Don't get all self-righteous with me.  
            I have seen my own mother absolutley hysterical at the prospect of bird flu.  No matter how many times I tell her to get a grip, she won't stop hyperventilating about it.  I blame people who are hyping the worst case scenario.  And, no, I don't think we can prevent every epidemic, as hard as we might try.  There is some craziness in this society that believes that if you do everything just right, no harm will ever befall you.  Eat the right foods, until a new study tells you that overdosing on it may be harmful.  Don't let your children out of the house because predators may get them, but let them get fat and develop coronary artery disease from staying indoors all the time.  Scream that the governement is not protecting you from bird flu, even though the chances that you will die are very slim, even if the government did nothing.  
            What exactly do you propose we do about it?  And what makes you think for one minute that the Bushies are going to follow your advice?  You wanna ship all the sick people to some remote island?  Ok, so you may not die of bird flu from the afflicted but something else is going to get you in the end.  You can not prevent death.  Just repeat to yourself that your chances of dying from bird flu are remote.  
            This reminds me of the HIV panic of the 80s.  I can remember colleagues who should have known better wanting to shun people with AIDS and create special "colonies" for them.  It's just ridiculous.  
            It's a fricking FLU even if it turns out to be a particularly nasty one!  Use precautions against flu and reduce your chances of infection.  

            -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

            by goldberry on Fri Feb 03, 2006 at 08:37:45 AM PST

            [ Parent ]

            •  Take Sensible Precautions... (none)
              Panicking?  Maybe.  Hyping?  Definitely.  
              Don't get all self-righteous with me.  
              OKAY, MR WOUNDED BUFFALO...

              I have seen my own mother absolutley hysterical at the prospect of bird flu.  No matter how many times I tell her to get a grip, she won't stop hyperventilating about it.  
              JEEZ, SORRY ABOUT THAT.  

              I blame people who are hyping the worst case scenario.  
              (COUGH) NEW ORLEANS (COUGH).

              And, no, I don't think we can prevent every epidemic, as hard as we might try.  
              PREVENT? NO.  REDUCE THE AMOUNT OF AVOIDABLE DEATHS?  MAYBE, IF SIMPLE, SENSIBLE PRECAUTIONS ARE TAKEN, WHICH COMES FROM EDUCATING OURSELVES ON THE DISEASE.

              There is some craziness in this society that believes that if you do everything just right, no harm will ever befall you.  
              SEATBELTS DON'T PREVENT AUTO DEATHS, BUT THEY'RE UNDERSTOOD TO BE A SENSIBLE PRECAUTION THAT REDUCE FATALITIES.  SEE HOW IT WORKS?  

              Eat the right foods, until a new study tells you that overdosing on it may be harmful.  
              IS THAT YOU, ADMIRAL STOCKDALE?

               Don't let your children out of the house because predators may get them,
              I DON'T KNOW A SINGLE PERSON WHO SAYS THIS.  WHERE DO YOU LIVE, THE SERENGETI?

              but let them get fat and develop coronary artery disease from staying indoors all the time.
              TELL YOU WHAT-- WHY DON'T YOU SKYDIVE TO WORK EACH DAY.  NO??? THINK ABOUT IT, BECAUSE YOU MAY GET INTO A CAR ACCIDENT AND DIE ANYWAY.  OH, I SEE, THE PROBABILITIES OF A DEATH WILL DECREASE IF YOU DRIVE TO WORK AND WEAR YOUR SEATBELT.

              Scream that the governement is not protecting you from bird flu, even though the chances that you will die are very slim, even if the government did nothing.  
              DO YOU BRUSH YOUR TEETH?  WHY??? THEY'RE GONNA FALL OUT EVENTUALLY ANYWAY?  MY GRANDFATHER LOST HIS TEETH AND NEEDED DENTURES, AND MY GREAT AUNT HAD A ROOT CANAL, AND A SECOND-COUSIN OF MINE HAD SIX CAVITIES... SO WHY BOTHER BRUSHING???  AND DO YOU FLOSS?  YOU DO??? WHY ARE YOU PANICKING ABOUT YOUR TEETH?  SEE?  YOU'VE EDUCATED YOURSELF, AND YOU'RE USING SENSIBLE PRECAUTIONS FOR YOUR TEETH, TO YOU REDUCE THE RISK OF A CATASTROPHIC DENTAL CONDITION IN YOUR MOUTH...  YOU MAY STILL GET CAVITIES, BUT YOU'VE EDUCATED YOURSELF ON TEETH CLEANING, AND REDUCED THE RISK OF A PROBLEM TREMEDOUSLY.

              What exactly do you propose we do about it?
              I'M LOOKING INTO WHAT SENSIBLE PRECAUTIONS TO TAKE TO INCREASE OUR ODDS OF AVOIDING A PROBLEM, WHY?  

               And what makes you think for one minute that the Bushies are going to follow your advice?
              THEY'RE NOT.

              You wanna ship all the sick people to some remote island?  
              NO, I DON'T WANNA.

              Ok, so you may not die of bird flu from the afflicted but something else is going to get you in the end.  You can not prevent death.  
              A BUS COULD HIT ME AS I CROSS THE STREET.

              Just repeat to yourself that your chances of dying from bird flu are remote.  

              This reminds me of the HIV panic of the 80s.  
              NO, IT DOESN'T.  IT'S SIMILAR IN THAT BOTH DISEASES WERE, OR COULD BE, CATASTROPHES BECAUSE OF IDIOTS LIKE YOU DISMISSING THE SERIOUSNESS OF IT.   IT'S ALSO SIMILAR IN THAT THE PUBLIC WAS NOT PROPERLY EDUCATED ON THE DISEASE-- ON HOW IT SPREADS, SIMPLE SENSIBLE PRECAUTIONS TO TAKE, ETC., UNTIL TENS UPON TENS OF THOUSANDS WERE DEAD.

              I can remember colleagues who should have known better wanting to shun people with AIDS and create special "colonies" for them.  
              YOUR COLLEAGUES WERE SICKOES.

              It's just ridiculous.  IT IS.

              It's a fricking FLU even if it turns out to be a particularly nasty one!  Use precautions against flu and reduce your chances of infection.  
              THANKS FOR THIS MEANINGLESS LAST COMMENT.

              "Don't look back... something might be gaining on you..." -Satchel Paige.

              by npb7768 on Fri Feb 03, 2006 at 11:41:40 AM PST

              [ Parent ]

        •  Thank you (none)
          If we were prepared and prevented it we would have to find something else to be afraid of.

          Or we could just remain scared of the N5 strain since the "pandemic" did not show up ... and it's still out there.

          American Engineer :== loser!

          by jnmorgan on Fri Feb 03, 2006 at 08:11:37 AM PST

          [ Parent ]

    •  Thank you for saying what I was about to say (none)
      :)

      SecondPageMedia - What matters to you, what matters to us.

      by aerojad on Fri Feb 03, 2006 at 08:17:43 AM PST

      [ Parent ]

    •  I don't understand (4.00)
      where did anyone ask you to panic or fear anything? I didn't cite anything Bush said... who'd want to listen to him?

      Preparation. not panic. Foresight, not fear.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 09:04:17 AM PST

      [ Parent ]

      •  What's info to us,... (none)
        ...is panic to others.
        Personally, I think bird flu has gotten a disproportional amount of attention lately.  The fact that it is frontpaged is just another case of everyone worrying about a scenario that sounds a lot worse than it will actually be.  It does tend to panic people.  If you live in the suburbs with a lot of typical suburban moms, you know what I mean.  They go overboard with more than precaution.  I've been in school board meetings when they have demanded the school system gets shut down over a dozen cases of head lice.  
        And yes, I have seen family members absolutely stark raving scared to death over the comments posted here.  There is a certain level of urgency in the prose that is very fear provoking in the vulnerable.  
        So, all I'm asking is if your diary and the comments posted here are stirring the pot or calmly informing.  You can decide for yourself.  I see both and the pot stirring is very unhelpful.

        -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

        by goldberry on Fri Feb 03, 2006 at 09:36:31 AM PST

        [ Parent ]

        •  okay, i'll take you up on that (4.00)
          and i don't see panic or hype. i do see a phenominal amount of denial and ignorance on your part if you think a 5% mortality is nothing to sneeze at in a country of 300 million people, of whom 30% might come down with pandemic flu. "Just the flu" is what was said in 1918, btw.

          Let's be crystal clear, and I think we were. There is no current pandemic, we may not have a pandemic any time soon, but all the scientific evidence, andexperts on the topic (including skeptics) agree we will have another.

          It might not be H5N1, though this virus has broken enough rules and behaved in a way that scares everyone who knows somewthing about it. it's an unknown.

          Planning should be for any virus, every virus that can go pandemic, now and in the future. It might be H5N1 or some other. But there's no reason to avoid planning.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Fri Feb 03, 2006 at 10:31:58 AM PST

          [ Parent ]

  •  Something to note.... (none)

    "In the meantime, new cases are reported every week, and the Iraq cases have to give one pause. It's a war zone. Imagine if the next international WHO team sent in to asess, treat and control an outbreak is either kidnapped or blown up. Is that 'fearmongering'? Ask the ABC News team."

    Let us not forget that the last pandemic started just as WWI was ending, and that the military coming home just helped to spread it faster...

    •  You're forgetting... (none)
      ...that it doesn't spread via human contact.  Maybe the troops will bring chickens home with them from Iraq?

      Man will occasionally stumble over the truth, but most of the time he will pick himself up and continue on. --Winston Churchill

      by rmwarnick on Fri Feb 03, 2006 at 09:41:19 AM PST

      [ Parent ]

    •  This is important. (none)
      The international strategy in preventing a pandemic outbreak, as I understand it, is to carefully monitor human cases of disease.  If a pattern of disease cases arises such that it appears that the virus has mutated so that it can spread from human to human, immediate action is to be taken to prevent further spread from  this "ground zero".  

      If such an event were to happen in Iraq, I highly doubt we would be able to detect the initial infections given how difficult it is to collect news of any kind.  Even if detected, it would be difficult to implement the kind of measures that would be needed.

      "All right, then, I'll go to hell." Huck Finn

      by karin on Fri Feb 03, 2006 at 12:38:57 PM PST

      [ Parent ]

      •  that's exactly right (none)
        outbreaks in Iraq and N Korea, to name two examples, should scare anyone. The norms of civilized behavior don't apply and the 'plan' may not work.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Fri Feb 03, 2006 at 12:52:37 PM PST

        [ Parent ]

  •  I Make Instruments That Detect Pathogens (none)
    What do you think the government (DOD, HHS, DHS, DOA) is most worried about?

    Bird flu?

    Nah.

    Still obsessed with biothreat defense. This includes bad people trying to infect our food supply. And plague-ridden foreigners getting onto planes bound for America.

    Birds can fly right over our borders and land in our back yards.
    Or our chicken farms. You think they would worry about that, but like all-things-Bush, they can't figure out how to make money off bird flu so they don't care about it.

    Bush is the first President to admit to an impeachable offense. - John Dean

    by easong on Fri Feb 03, 2006 at 07:14:05 AM PST

  •  I Own Seven Hens. (none)
    I own seven barred-rock hens, on an acre of land in southern Rhode Island.  Great for eggs.  They're caged in 10 foot by 16 foot area.  No direct contact with any other animals.  What precautions should I take right now, and what should I do if the bird flu hits this continent?  

    "Don't look back... something might be gaining on you..." -Satchel Paige.

    by npb7768 on Fri Feb 03, 2006 at 07:23:04 AM PST

    •  Shoot em and burn the carcasses (none)
      OMG you have chickens.

      American Engineer :== loser!

      by jnmorgan on Fri Feb 03, 2006 at 07:38:56 AM PST

      [ Parent ]

      •  I'm Serious... (none)
        I'm serious.  I know nothing specific about how the disease is spread.  And I don't trust a gov't website for real information.

        "Don't look back... something might be gaining on you..." -Satchel Paige.

        by npb7768 on Fri Feb 03, 2006 at 07:51:08 AM PST

        [ Parent ]

        •  If the pandemic (none)
          occures then obviously it's not the chickens that are the source of the infection anymore...it's your neighbor.

          Otherwise, if your worried about the bird strain showing up here and infecting your chickens and then perhaps you ... well it's seven hens, get a cow and fear mad-cow disease (which is very real but covered up because of the Bush-Cattlemans connection.

          American Engineer :== loser!

          by jnmorgan on Fri Feb 03, 2006 at 08:21:28 AM PST

          [ Parent ]

    •  You're fine. (none)
      DemfromCT may add to this, but, as I understand it, your chickens can only catch this flu from other birds. This means NO birds (ducks and geese being the most likely carriers) can fly over the cage and contaminate it with feces. If you really have no contact; no worries. Keeping the roosting area and cage clean and dry is just a good idea anyway.

      Educating small farmers is another place where we might be dropping the ball. Friends who have chickens haven't seen anything about this either.

      In the practice of tolerance, one's enemy is the best teacher. Dalai Lama

      by leolabeth on Fri Feb 03, 2006 at 08:28:36 AM PST

      [ Parent ]

  •  "God's wrath" (none)
    Ask a random Bush supporter and they will likely tell you, as my cousin did, that there is nothing we can do about bird flu as it is God's punishment for our acceptance of...well, you all know the list: gays, abortion, evolution, fluoridated water, you name it.  The questions to my mind are will the CDC and scientists who know be willing to push forward a cogent plan that Leavitt seems incapable of providing, will there be any funding for them to have a platform, given the anti-science,pro-faith bias of the administration, and will anybody who can do anything listen?
    •  Killing for oil? (none)
      They always leave that one out.  I guess God said that's OK?

      anti-science, pro-faith you're absolutely right to assume that in the current political atmoshpere if God does not intervene we (the common mass) are pretty much had.

      American Engineer :== loser!

      by jnmorgan on Fri Feb 03, 2006 at 08:27:58 AM PST

      [ Parent ]

  •  Hate to say this... (none)
    but this is taking on the proportions of the Alar scare of 1989, where millions of people were scared needlessly into fearing something that eventually evaporated into the thin air of it's origin.
    READ REPORTS FROM THE CDC yourselves and judge how worried you need to be on your own.
    My own personal opinion is that autos and obesity are far greater threats as is the next round of ordinary flu that's making its way around the world already.
    There has been no index case of transfer from birds to humans, and even if there were, there's no knowing the virulence or its infectious rate and more importantly, there's no knowing the exact innoculant until it's been analyzed, and that takes weeks, maybe months of research.
    Better would be an overall 'generic' shot that would decrease symptoms from all influenzas, something that's being worked on very seriously in several labs.
    There's plenty of other things far more dangerous to worry about.
    David.sf
  •  Stockpiling seems to make good sense anyway, (none)
    but whether you need to store water depends on where your electricity comes from.

    Here in Maine most of our power comes from oil fired plants here in the state. The oil comes from tankers landing in Portland, our largest metro area. If Portland were to come under a quarantine, it's hard to say whether pilots could be taken to the tankers out in Casco Bay, or whether they would be allowed to land.

    No oil; no power.

    I pick up five gallons of water every few trips to the grocery store. We can use it this summer for camping trips if we don't use it sooner.

    In the practice of tolerance, one's enemy is the best teacher. Dalai Lama

    by leolabeth on Fri Feb 03, 2006 at 08:36:05 AM PST

  •  A Quite Different Perspective here: (none)
    on this recent Terry Gross segment by Dr. Marc Siegel: The Next Pandemic: Bird Flu, or Fear?

     Fear and paranoia often take hold when a disease threatens to become an epidemic. Dr. Marc K. Siegel is the author of the new book Bird Flu: Everything You Need to Know About the Next Pandemic.

    Bird Flu takes on the issues that are injected with a sense of panic and dread, as many parts of the world have grown to fear the spread of a deadly influenza outbreak in recent years. That outbreak, says Siegel, is a distinct possibility. But he urges those who may be at risk to trust in reason -- and ignore the hype -- in judging the risks.

    For those readers who still want to get  really scared and angry, but about something that is an undebatable  REAL fact, AND something you can take a proactive action on and not just quiver helplessly there, like wounded rabbits paralyzed with reason-robbing fear,  please read this important diary:

    MUST SEE!!! Downing Street Memo II BBC Video News Report

    and then contact and share it with your "Fighting Democratic" elected leaders, and press them to find out what they plan to do about it.

    •  I cited Siegel and Butcher (4.00)
      in my skeptic link. Dealt with above.

      You off-topic comment about what's relevant to you politically is irrelevant to this thread.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 09:09:03 AM PST

      [ Parent ]

      •  That (none)
        is your opinion.  

        Two back-to-back "Fear-The-Germ"  (over the top, imo) "panic" diaries jumping out on the front-page at the same time as the really big Bush/Blair 01/31/03 'pretexts for attacking Iraq' meeting/memo story is nowhere to be seen yet on the DKos frontpage, just really makes me go "Hmm"

        •  LOL - actually (none)
          you've been bitching about what's on the front page since 11/3/04, shumard. Thanks for speaking up (your right) but it doesn't sway me or anyone else (my right).

          Today's just a different day, same kvetching. Like there's nothing else on the FP by tonight.  ;-)

          Well, since this thread has over 100 comments, guess you're gonna have to live with it, as always.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Fri Feb 03, 2006 at 09:41:19 AM PST

          [ Parent ]

        •  Yeah (none)
          Two back-to-back "Fear-The-Germ"  (over the top, imo) "panic" diaries jumping out on the front-page at the same time as the really big Bush/Blair 01/31/03 'pretexts for attacking Iraq' meeting/memo story is nowhere to be seen yet on the DKos frontpage, just really makes me go "Hmm"

          I'm sure it's a grand conspiracy.
    •  Huh? (none)
      I have found myself able to read 2 (or 3 or 4 or more) diaries on different subjects without ill-effect. The DSM II diary is high on the rec list so is getting its fair share of notice. Why try to hi-jack this topic, which is also of interest to a number of people.

      Practice absurdus interruptus - Support ePluribus Media.

      by Catte Nappe on Fri Feb 03, 2006 at 09:57:45 AM PST

      [ Parent ]

  •  Like I have room in my FEMA (none)
    camper for 3 days of food and water, much less 30. Let's just forget the formalities, the pretensions, and tell it like it really is.

     We are on our own. The government isn't going to save you or your children,your parents, or your ass, no matter how many doses of vaccine they say they have, and the preparations are not going to help us regular folks one bit.

    This will be one more opportunity for this fat-cat government to save the connected, those who have cash, those who have clout, and put into place curfews, arbitrary economic manipulation, devalue the property of those effected, and basically relocate those segments of society most likely to suffer from widespread epidemic.

    We will be dependent upon each other, so if you trust FEMA, or any hter agency loaded with Bush appointees, you're living in lala land.

    We need OUR OWN LEADERS to set up a distribution system, a volunteer effort, not just for this, but for other potential disasters, for own survival, and for a framework of Democratic action.

  •  $1 for CT with 3.5m people? (4.00)
    That's absurd, I had no idea preparation was that bad over there.

    Don't mean to gloat, but I'm just glad I live in a country of a similar population (New Zealand, 4m) that has spent tens of millions stocking up Tamiflu, improving civil defence, preparing scenarios, and updating readiness of hospitals and essential services. $1 million wouldn't even cover the government ad campaign that's getting started.

    P.S. If you haven't already, check out kos user AlphaGeek's diaries. Best disaster preparation manual I've read.

    •  NZ has one of the best prep plans in the world (none)
      we Yanks are in catch-up mode. BTW, the NZ department of health regularly links to Flu Wiki.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 09:10:10 AM PST

      [ Parent ]

  •  I have to say... (4.00)
    ...that I'm a bit taken aback by the lack of understanding many have show wrt the possibility of a new pandemic.  Go reread both DemfromCT's and Revere's posts and realize (for at least Revere) that they are experts in public health  and they are NOT fearmongering here.  They are trying to get everyone to pay attention to a critical issue that is being conveniently ignored by those who should know better. (or it's being irresponsibly hyped by cable news outlets always eager to make a quick "crisis" buck)

    Here's the deal.  Let's assume, worst-case scenario a 2% mortality rate (like the 1918 influenza) with a reasonable infectivty rate of 40% (slightly higher than 1918, but well within pandemic flu expectations).

    There are 300 million people (approx.) in the US.  40% of that is 120 million.  Think of that number.  120 million sick to some degree or another with what is, under normal circumstances, certainly a debilitating enough illness to create significant worker productivity losses and absenteeism.  Now imagine a good number of that 120 million all being simultaneously sick, say just 75 million, even.  Could this country cope with a large percentage of its work force suddenly out of commission?

    But that's not all, 2% of that 120 million will die, and a good chunk of that 2% will be <45 years old, that is working adults and young adults.  You're looking at 2.4 million people dead, maybe a million of which were productive working people.  Think of that.  Can our just-in-time economy handle the permament loss of 1 million workers?  Who will replace them?  How much will it cost to train them?

    So, when you properly do the risk assessment for the pandemic, in reality, the mortality count is just the tip of the iceberg.  Yes maybe a few million will die, but think of all the lost productivity due to illness.  Think of the X factor of what quarantines will do to interstate commerce, i.e. even if the 60% or so who are not sick wanted to go to work, they couldn't due to quarantines.  What about those among the non-ill 60% who have chronic medical conditions like diabetes and require regular medical care?  Where will they turn to when their community hospitals are swamped with influenza patients?  How many will die or become seriously ill because they couldn't receive the prompt medical care they needed?

    My point is that, regardless of the mortality rate, ANY pandemic influenza strain can be a true national emergency.  Of course, the more seriously ill people are, the more of a strain it places on the national economy (hence the relative "non-stories" of the 1957 and 1968 pandemics.  But it's unlikely that H5N1 will be like those two, because, thus far it's not used the same adapt-to-humans strategy that they did with passage through a mammalian host (pig).  It's following what we believe to be the 1918 model (direct bird-to-human jump), and it may result in similar consequences.  Or it may fizzle out.  The point is, it is best to prepared and aware.  

    I think that Katrina is the perfect frame to think about the worst-case scenario here.  No one's going to liken an H5N1 pandemic to The Stand or The Day after Tomorrow, because truth is, no pathogen we know of kills 99% of its victims (if it did, it wouldn't be a very successful pathogen, evolution-wise).  But a pandemic may very well follow a Katrina-like scenario with an initial acute event that seems manageable at first, but which quickly resuslts in a number of systematic failures that end up putting a far larger population at risk than initially planned for.  And throw in the unknowable social dynamic that may ensue, and how much more morbidity and mortality will be attributable to preventable injury, violence and lack of clean water and food?

    Then imagine what would happen if Katrina happened in every big city simultanously.  Where would the "surge capacity" of necessary relief workers come from?  Who would be keeping the electricity going, the supply lines running, the oil pumping, the natural gas flowing, and the streets clear of refuse.  Who would ensure the public safety?  How will we educate the masses on disease prevention and the necessity for quarantine?  Who will enforce that?

    It's a complex system, and just a little push can throw the equilibrium out of whack.  We need to know the risks associate with that contingency and try, to our best ability, to plan ahead to mitigate those risks to ensure such doomsday scenarios don't play out.

    People should not be afraid of their governments. Governments should be afraid of their people.

    by viget on Fri Feb 03, 2006 at 09:10:37 AM PST

    •  thanks (none)
      see Chicago Dem's post above as well.

      There are issues here than can't be dismissed with the loathed term 'fearmongering'. And they won't go away because De Nile is a river in Egypt.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Fri Feb 03, 2006 at 09:19:25 AM PST

      [ Parent ]

  •  the idea that we can't get water is ridiculous (none)
    that will never happen in an epidemic. We are not talking about a high tech job. The day our water supplies cannot be maintained is the day pretty much everybody is dead.  That fearmongering has to be debunked.  I mean, worst case, even this is ridiculous, you can boil the water. A thirty days supply of water? gawd if this is the best  advice we get, we are all in a heap o trouble.

    An election does not make a democracy.

    by seesdifferent on Fri Feb 03, 2006 at 10:11:26 AM PST

  •  the Boy Scout Motto.... (none)
    is what ? Be prepared. Someone upstream mentioned that in this day and age we could at least continue to communicate with one another thanks to the interNet. I'll try again to get my point across as I see this as an important aspect only slightly touched upon here, with a few exceptions. Calm, rational planning for a major Telco, or Communications firm if you may, would / should include contingency plans to cope with a reduced workforce if bird flu hits any of the major nodes and especially those areas where the bulk of the brainwork is done. Not to forget the numerous transportation rooms. The interNet didn't just evolve and it's not self-sustaining. If I were senior manager of a small communications firm, I implement plans to equip a large number of my workforce with the means of remote access so they can work from home. Remember, a very large percent of communications work can be and is done remotely. Hands-on work in the various transport rooms is usually less critical and can be carried out by a skeleton crew. I see effective and flawless communication as one of THE most important weapons in combatting any sort of outbreak or pandemic. So why are being accused of crying "WOLF!" when all we really need to do is prepare for a worst case scenario ? The costs involved for such preperation are minimal. Smart firms have already implemented such plans. even smarter firms already have a large percentage of their workforce working via remote access ( RAS ). even in terms of a simple flu wave, forcing your employees to drag their tired and feverish butz to work so they can spread the virus is just downright irresponsible.

    Smart CEOs have already instructed Management to implement contingency plans for the worst-case scenario. Sadly, we're not talking about a majority here. the majority is continuing to scuff it all off as a scare and a hype. But what if worst comes to worst ? How long will we have the interNet to communicate with ? Will the US military revert to their contingency plans, and believe me, these do exist.......and simply take over the portions of the interNet they need to keep control of the situation ??

    Point to ponder from a telecommunications point of view.

    visit my blog and blister: Music & More

    by rossini on Fri Feb 03, 2006 at 10:14:12 AM PST

    •  ad libitum (4.00)
      I live & work in "old Europe". A few months ago, as the avian flu hit Romania (Vlad Dracula Land) I urged my neighbor to extend the roof on his chicken coop...just in case. Migratory birds will be returning from their mediterranean hideouts and with them comes the virus. Weather was permitting and the arguments outweighed any reason to thwart off preperations. The roof was extended and the chickens, an ample amount of laying hens to supply six households with A1 chicken eggs - hens willing - were locked inside prior to the issuance of orders to please do so by local Governments. It was at that point where I realized how important it is to voice one's concerns and how effective conversant argumentaion can be.

      Green Eggs & Ham......anyone ?

      visit my blog and blister: Music & More

      by rossini on Fri Feb 03, 2006 at 11:56:21 AM PST

      [ Parent ]

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