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Here's an interesting op-ed from the SF Chronicle:

The deadly terror lurking around the corner may not be such a big, ominous threat after all

Since James A. Lewis is director of the technology and public policy program for the Center for Strategic and International Studies in Washington, this sounded interesting. After all the smallpox vaccination program for civilian heath care workers was a complete failure (23 page .pdf):
Three key failures are responsible for the continuation of this serious gap in biodefense:

  • Sufficient resources were not allocated nor requested in time for public health agencies to properly implement the program, leaving state and local agencies without the funding to manage vaccinations without cutting other health services.
  • An adequate compensation plan to compensate volunteers who may suffer side effects from the vaccine was not in place when vaccinations began
  • Healthcare workers, first responders, and the public at large are not persuaded that smallpox is a serious threat that warrants participation in a limited vaccination program.

But I was rather surprised to find avian flu at the top of Lewis' hype list, even though homeland security issues fill the rest of the article (as they should), and avian flu is not amongst this fellow's expertise.

more below fold

From Lewis' editorial:
Americans receive a steady stream of warnings and alarms about new and horrific perils that await them. Pandemics, dirty bombs, cyber attacks, bioterror and other exotic threats are always on the verge of being unleashed onto a shamefully unprepared republic. Yet, judging from statistics on life expectancy, violent deaths and war, we live in much less perilous times than any generation before us.

Avian flu, for example. We are cautioned that a pandemic on the scale of the 1918 Spanish influenza outbreak, which cost hundreds of thousands of lives, is only months away. One World Health Organization estimate says 2 million to 7 million people will die in the next pandemic. But it is not 1918. The WHO reports that since 2003, there have been 152 cases of avian flu, resulting in 83 deaths. A flu pandemic has been regularly predicted since 1997 and (knock on wood) it has never arrived. (my bold)

It's true that it's not 1918. In fact, our just-in-time technology is far more vulnerable now than in 1918, and global travel is far swifter. These two factors alone increase pandemic consequences enormously, even for a mild pandemic. And our medical system can not cope with a pandemic because it would be overwhelmed with patients. Medical improvements compared to 1918 are irrelevant if there's no room at the hospital, and 30% less staff to care for you, or no gowns, gloves, and medicines.

So how to inform the public? Peter Sandman, an expert risk communicator, has some advice:

"There's no way to get people to take precautions without frightening them," Sandman said.

What is likely to lead to panic is giving false reassurance, he said. "When you mislead people, when you overreassure people, they feel abandoned--because they are," he said. That's what happened in the United States during the flu pandemic of 1918 and during the SARS (severe acute respiratory syndrome) outbreak in China in 2003, he added.

"People panicked because the government was telling them there was no SARS," he said.

"People are much better able to handle a crisis when they are told the truth" and "treated as adults."

Sandman goes on to say:
However, there is danger in overplaying a threat as well as in false reassurance, Sandman said. He zeroed in on the oft-repeated statement, "A pandemic is not a matter of if, it's a matter of when."

"That's true of a pandemic; it's not true of a severe 1918-like pandemic," he said. "In that case, it's if."

He added, "Just as overreassuring people backfires, alarming people in ways that won't last, that won't stand up to investigation, backfires. There's an unknown probability of a pandemic of very high magnitude."

Arnold Monto, a preeminent epidemiologist and flu expert at the University of Michigan School of Public Health puts it this way (from a webcast on 1/24):

"Most of us believe that the probability of an H5N1 pandemic is low but real and because it's real and would have enormous consequences, active and vigorous response is necessary".

H5N1 is one nasty virus that many people are tracking. But despite careful language, no matter what we say, any posting on H5N1 will attract posters levying the charge of 'fear mongering'. Or that Rumsfeld stands to make millions because of tamiflu investments (it's true, but irrelevant).

I think Sandman is right. Treat people like grown-ups and tell them the truth. Every expert who studies this virus is extremely concerned, and even those like Monto, or Peter Palese from Mount Sinai, or Ian Lipkin from Columbia, or Anne Moscona from Cornell, or Robert Webster from St. Jude (all eminent in their field) who think the chances of this virus going pandemic are low, also think (like Monto) the chances are also real and the consequences are enormous.

Now what would a grown-up do with that information? Not write articles like Lewis did, IMHO. The better way, the grown-up way, is to keep informed, and consider whether your own personal disaster preparedness plans are up to speed. And that's what we intend to do.

Originally posted to Greg Dworkin on Sun Feb 19, 2006 at 06:58 AM PST.

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Comment Preferences

  •  Toronto gets it (4.00)
    Are you one of those people who follows only the stuff at the beginning of a newscast or in the front pages of the newspaper?

    There are a lot of clues about what's developing on the back pages too. The headline on Page 27 of yesterday's Sun is an example: "Nigeria ignores flu advice."

    Don't forget, the first story in the Sun about Hurricane Katrina was a tiny one on Page 12. This story yesterday was about how people on the other side of the world decided to keep open their poultry markets -- despite warnings the latest strain of bird flu could mutate into a virus that could affect humans.

    Even though they are waiting to learn if some ill children were hit with the H5N1 strain of the flu, Nigerian agriculture ministry spokesman Tope Ajakaiye said, "We don't want to cause a situation where there will be much panic or alarm."

    Time will tell if this was a good decision, to prevent panic. One wonders if it's akin to the glass shaking on a table in the Jurassic Park -- as in, you have yet to see the vicious Tyrannosaurus rex who will try to kill you but you know he is coming. It's not a matter of if, but when. Screenwriters love to foreshadow. Problem is, this is real life.

    "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 Sun Feb 19, 2006 at 07:23:18 AM PST

  •  I'm recovering from ... (4.00)
    ... this year's garden variety flu. It really caught me unaware because I got it right after getting over an ear infection.

    And this year's flu is nasty enough without being avian flu. I  was unable to talk from Thursday night til this morning because it would set off coughing. Several times, I honestly thought I should just check myself into a hospital. I've been buried under three down comforters on the sofa or staring dumbly at the computer for days now because I've just been too sick to do anything else.

    I'm kicking myself I forgot to get a flu shot.

    My point is, this is the first time in years I've had the flu, and even I had become cavalier about how bad it can be.

    And the avian flu is even worse. The numbers of people actually getting it at this point may be low, but look at the percentage of people dying from it.

    That's scary. Had the flu I got been just a tad worse, I would have put myself in the hospital.

    Except --- except we had an ice storm and our roads are impassable.

    So there was no way I could have gotten to a hospital. Imagine that same scenario (which isn't uncommon out here) were bird flu to have taken hold out here.

    You know, the neighsayers really need to pull their heads out.

    •  Similar experience (4.00)
      In December 1999, there was a nasty, nasty flu making the rounds.

      I started feeling "off" one afternoon, a sore throat, tired.  I was talking to my karate teacher for a long time, plus a bunch of other karate students.

      I don't know who had it first, but within 24 hours, we had to close the dojo because EVERYONE was sick.  All of the instructors had the flu, plus almost all of our students did too.

      I was immobilized, and if my mom hadn't been visiting, it would have been impossible to do anything for myself (get food, etc.).

      My husband said he had the same thing (as did everyone he knew), at the same time of year in 1999.

      He was in Amsterdam.

      So if that flu kicked everyone's asses so badly, and it's mild relative to H5N1... well, you're right.  People need to pull their heads out.

      •  Late in 1968... (none)
        I got the Hong Kong Flu (Type A H3N2). One morning I felt fine and by that evening my temp shot to 103. I was young, strong, generally healthy and survived it. But the pandemic Hong Kong flu killed 34,000 people in the U.S. that year.

        "...and Robert called the judge." Sen. Edward Kennedy

        by Caldonia on Sun Feb 19, 2006 at 09:01:50 AM PST

        [ Parent ]

    •  Flu (none)
      I have only had a major influenza illness once in my life (many times people say they have the flu, and they don't...they have adenovirus, rhinovirus, or some other respiratory virus).  It knocked me on my ass for four days, and I felt horrible for days afterward.  I have never had fevers and the chills like that in my life.  I was so shocked at how ill I was. I rarely get sick, so it was a real wake up call. I couldn't imagine how a small child or elderly individual would deal with being that ill.  That next year I got the flu vaccine for the first time in my life.  

      Jesus H Christ: The H is for haploid.

      by Mote Dai on Sun Feb 19, 2006 at 08:00:03 AM PST

      [ Parent ]

  •  Risk Analysis (4.00)
    I happen to work for a Dept. of Defense program that is actively involved in the international avian influenza scene in Central Asia and the Caucuses.  When the government assesses "risk" it determines two variables: likelihood and consequences.  For avian influenza making the jump to humans, the likelihood is low or moderate, but the consequences are ENORMOUS, so the DoD sees this as a major risk to the United States.  And now that likelihood is actually rising quickly with the increased number of countries reporting H5N1.

    People with the US government are well aware of the issues, but are having problems getting organized.  Many agencies are unaware what others are doing, or just assume that another agency is doing something.  

    I would actually like to take a moment and highlight the Herculean efforts of one man that has probably done more in the avian influenza battle than any other person and is relatively unknown outside of a few offices.  His name is Major Sam Yingst (a fellow Hoosier!) and he runs the influenza program at the Naval Research Medical Unit-3 (NAMRU-3) in Cairo, Egypt.  Sam is a one man Army that flies all over Asia, Europe, and Africa collecting samples and establishing surveillance programs.  NAMRU-3 is one of the facilities that annually collects samples from around the globe and sends them to the CDC to help determine what should go into the vaccine for the next year.  With the rise of avian influenza, Sam has been the "go to guy" in the area.  He has been at the center of just about every outbreak in Asia, Central Asia, Caucuses, and parts of Europe.  I don't know when this man gets to must only be on planes coming and going.  He also brings scientists back to Cairo for training in his laboratory.

    Jesus H Christ: The H is for haploid.

    by Mote Dai on Sun Feb 19, 2006 at 07:55:56 AM PST

    •  thank you for this post (4.00)
      There are many unsung heroes in the public health world, uniformed and non-uniformed. The career people must go nuts with the political interference.

      whether it's the NDU or other uniformed health services, hats off to you.

      Here's a USA Today article about Dr. Yingst's work in Iraq. And since ~70% of emerging infectious diseases in humans come from animals, it makes sense Dr. Yingst is a veterinarian!

      Flu, especially, needs close coordination between the MDs the MPHs and the DVMs.

      "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 Sun Feb 19, 2006 at 08:03:44 AM PST

      [ Parent ]

    •  PS the fact that H5N1 hits the younger healthy (none)
      age groups has not escaped the military's notice. Or ours, for that matter.  ;-)

      "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 Sun Feb 19, 2006 at 08:07:02 AM PST

      [ Parent ]

    •  PPS (none)
      When Dr. Yingst retires,  does that make him a vet vet?

      "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 Sun Feb 19, 2006 at 08:08:42 AM PST

      [ Parent ]

      •  I think so! (none)
        He is an amazing guy, and luckily, a very young guy.  We have awhile before he becomes a vet vet.  The last time he came to Washington, everyone wanted a piece of his time.  I think he went from our office, to the Pentagon, to Congress...and he was supposed to be in here for a tropical medicine conference.  I don't know how much of the conference he actually attended that week!  I just wrote a proposal for a human and vet influenza surveillance program in Kazakhstan and Sam is one the major collaborators, so I am looking forward to working with him in the future.  I am trying to wrangle a trip to Cairo to see his lab and maybe do a little training myself!

        Jesus H Christ: The H is for haploid.

        by Mote Dai on Sun Feb 19, 2006 at 08:24:40 AM PST

        [ Parent ]

  •  I've been following the Avian Flu (none)
    for over a year now.  Long before it's reached such topical frenzy.  The one thing all researchers agree on is they don't know a damn thing about how this virus will mutate.  They can speculate till the cows come home but haven't a single clue on the nature of what needs to happen for it to take off.
    They scratch their heads and wonder why it hasn't mutated long ago as a human contagion.  It's been around for quite some time but doesn't seem to know how to make that leap.
    My point is that any who claim to reassure us that the risk is negligible and this is all hype are full of it.  THEY DON"T KNOW.  They won't admit they don't have a clue.  And this thing is spreading at an alarming rate.  Good diary. Recommend.

    "I'm an insect who dreamed he was a man and loved it. But now the dream is over..." - Charles E. Pogue, "The Fly".

    by edsdet on Sun Feb 19, 2006 at 08:44:26 AM PST

  •  You may wish to know (none)
    ... that the Flu Wiki made Kim Komando's daily newsletter today. She's a (pretty much nonpolitical) computer tips radio show host who sends out various newsletters, invariably useful and well-written, on Internet-related topics. She is at Oddly enough, Kim Komando is her real name, even though it sounds like something out of Saturday morning cartoons.
    •  thank you! (none)
      not on her website yet.

      "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 Mar 03, 2006 at 05:16:30 PM PST

      [ Parent ]

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