Skip to main content

So it's official as of this AM:

Officials confirmed Saturday that the H5N1 strain of bird flu had been found in turkeys on a commercial farm _ Britain's first mass outbreak of the disease that has ravaged Asia's poultry stocks and killed more than 160 people worldwide.

The virus strain that killed about 2,500 turkeys on the British poultry farm was identified as the highly pathogenic Asian strain, similar to a virus found in Hungary in January, the Department for Environment, Food and Rural Affairs said.

As i wrote on today's open thread, according to the BBC, Prof. John Oxford is speculating that perhaps a small bird came through a ventilation shaft. The extent of virus in the smaller bird population beyond ducks and geese is unknown. But the idea that poultry in developed countries can be infected remains relevant. BTW, cooking birds kills the virus, and the likelihood of a resultant human case is small. These birds were too young to get into the food supply in any case. Still, it's a problem that has not gone away (and because it's the UK there will be a flurry of news - it took them by surprise).

This all follows the release of the CDC's Community Mitigation Strategy on Thursday, which is a remarkable document that lays out a variable approach to pandemics based on severity. It treats pandemics like hurricanes, assigning a category score from 1-5. A cat 4/5 pandemic would require severe measures such as closing the schools for up to 3 months (the social disruption would be justified by the desire to save lives) whereas milder cat 1 or cat 2 pandemics would require simpler measures.

The idea of the more extreme social distancing measures would be to reduce the number of deaths and delay the onset of morbidity and mortality so as to better allow existing facilities (i.e., hospitals and health care workers) to cope.

While I have been critical of CDC in the past, I must give them credit for pulling together an extremely sophisticated plan while trying to coordinate the differing needs of a host of federal agencies from the Department of Education to the Department of Homeland Security. Even more remarkable is the level of consultation with various stakeholders, including the public, that took place prior to the release of these guidelines. But the difficult task of implementing these recommendations both at state and local level, figuring out how to even track unlicensed day care, work with colleges and health care workers, etc. has only begun.

As long as there's time, some or most of these measures can be implemented, and some or most of the hurdles can be surmounted. The unanswerable question is "how much time do we have?" That's where the UK story comes in to remind us that while there's no evidence of an imminent pandemic, the known unknowns and the unknown unknowns make any predictions extremely chancy. This H5N1 is one nasty virus and the work to implement the community mitigation strategies needs to be done in parallel with the work on a pandemic vaccine (and that's merely the complete rebuilding and restructuring of how vaccines are made, distributed and administered... all without knowing if H5N1 or some other virus is the pandemic strain). Hopefully, the vaccine work is completed before the non-pharmaceutical mitigation in necessary.

Pandemic interest by the public waxes and wanes. But rebuilding public health infrastructure is something that needs to be supported whether incidents like the UK H5N1 outbreak are in the news or not. If attention begets support, funds and political will, so be it. This outbreak in turkeys is going to cost the UK some dollar equivalents, but it's a wake-up call for the kind of work that needs to be done there and here.

Originally posted to Daily Kos on Sat Feb 03, 2007 at 07:14 PM PST.

EMAIL TO A FRIEND X
Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags

?

More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  Swell. One more thing for americans to panic (5+ / 0-)

    about.  Like we needed any excuse.  Would it help if I wrapped my house in plastic?

    Republican Debate Handbook: Obfuscate, misdirect, insert talking points here

    by bherner on Sat Feb 03, 2007 at 07:14:31 PM PST

    •  maybe if you just wrapped your head? (2+ / 0-)
      Recommended by:
      bherner, Rex Manning

      Just kidding. :)

      Although I saw a dress made out of saran wrap once.  It was quite interesting.

      You may say I'm a dreamer, but I'm not the only one. - John Lennon "Imagine"

      by a dumb dreamer on Sat Feb 03, 2007 at 07:20:15 PM PST

      [ Parent ]

    •  Read the Homeland Security Checklist! Buy plastic (1+ / 0-)
      Recommended by:
      JML9999

      and lots of duct tape. Will that help with H5N1?

      Recommended Items to Include in a Basic Emergency Supply Kit:

         * Water, one gallon of water per person per day for at least three days, for drinking and sanitation
         * Food, at least a three-day supply of non-perishable food
         * Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
         * Flashlight and extra batteries
         * First aid kit
         * Whistle to signal for help
         * Dust mask, to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
         * Moist towelettes, garbage bags and plastic ties for personal sanitation
         * Wrench or pliers to turn off utilities
         * Can opener for food (if kit contains canned food)
         * Local maps

      http://www.ready.gov/...

      "I belong to no organized party, I am a Democrat" Will Rogers

      by vassmer on Sat Feb 03, 2007 at 07:43:48 PM PST

      [ Parent ]

    •  No But what would help (0+ / 0-)

      If this becomes a pandemic on par with the 1918 Swine flu. Expect not to have essential services for 2-3 weeks.
      At a minimum

      1. Emergency Generator
      1. Bottled Water 1 Gallon Per Day Per Person
      1. Canned and Freeze dried meals

      Be carefull what you shoot at, most things in here don't react well to bullets-Sean Connery .... Captain Marko Ramius -Hunt For Red October

      by JML9999 on Sat Feb 03, 2007 at 08:13:43 PM PST

      [ Parent ]

      •  it turns out that 1918 was a bird to human flu, (3+ / 0-)
        Recommended by:
        splashy, tzt, JML9999

        most probably, and it likely never went through swine. That direct bird-to-human jump is what makes us nervous about H5N1 in 2007.

        "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 Sat Feb 03, 2007 at 08:45:50 PM PST

        [ Parent ]

    •  best is to have your (1+ / 0-)
      Recommended by:
      splashy

      "panic" (really, just an adjustment reaction) now, get over it, and get on with it.

      Do it in advance and you're better prepared for whatever comes later.

      By the way, people only panic when they're feeling they're not being told everything by paternalistic crisis managers who get the whole thing wrong by offering false reassurance or "no comment" responses. Otherwise, like on 9/11 in NYC, panic isn't all that widespread (it's been studied at UPMC and other places). New Yorkers behaved rather well during that crisis, and that's far more typical.

      "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 04, 2007 at 05:31:46 AM PST

      [ Parent ]

  •  I don't understand... (2+ / 0-)
    Recommended by:
    elveta, Rex Manning

    ...how closing schools is going to help a pandemic.

    It's hard enough for parents to find child care during parent/teacher conference days much less for up to 3 months at a time.  Most young children will go from being in school to being in daycare (another breeding ground for diseases) unless they're planning to shut down a lot more than just schools for up to 3 months.

    You may say I'm a dreamer, but I'm not the only one. - John Lennon "Imagine"

    by a dumb dreamer on Sat Feb 03, 2007 at 07:19:15 PM PST

    •  I suppose the theory is there are fewer kids (2+ / 0-)
      Recommended by:
      Ky DEM, Rex Manning

      at day care than the dozens or hundreds at your average school(?).

      Republican Debate Handbook: Obfuscate, misdirect, insert talking points here

      by bherner on Sat Feb 03, 2007 at 07:20:38 PM PST

      [ Parent ]

    •  schools and daycares both close (7+ / 0-)

      in this most extreme scenario, and so do the malls.

      Look at it this way: if it's that bad, parents are not sending their kids to school or day care and they're closing anyway.

      This doesn't stop a pandemic, it slows it down. Look at St. Louis vs Philadelphia in 1918 and guess which city closed schools.

      "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 Sat Feb 03, 2007 at 07:27:41 PM PST

      [ Parent ]

      •  Have you read The Great Influenza (John Barry) (2+ / 0-)
        Recommended by:
        tzt, vassmer

        about the 1918 flu?  I haven't yet, but liked his book about the Mississippi floods in the 20s.

        Republican Debate Handbook: Obfuscate, misdirect, insert talking points here

        by bherner on Sat Feb 03, 2007 at 07:30:36 PM PST

        [ Parent ]

        •  Has anybody else noticed how diseases become (1+ / 0-)
          Recommended by:
          Rex Manning

          hugely publicized and then just seem to disappear?  In the eighties (I think) we were all frantic about toxic shock syndrome.  Is there still toxic shock syndrome around?  How about SARS; is there still SARS?  I'm not minimizing the seriousness of pandemics, not at all, and I don't know anything about them, but I'm just wondering what happens to make certain diseases disappear from the public radar.  Okay, this is a little quirky, I admit.  Just got back from S.E. Asia and am feeling BAD--both stomach and regular flu-like symptoms so I'm trying to avoid thinking seriously about what I might have picked up!

          •  SARS is a coronavirus (4+ / 0-)
            Recommended by:
            splashy, sawgrass727, tzt, feelingsickinMN

            and is potentially still around. It never affected huge numbers of people, the way a flu epidemic or pandemic does. Knowing the source and instituting good handwashing and cough covering helped to control the last outbreak. 45% of the victims were health care workers, so it wasn't a community-acquired disease the way flu is.

            Sometimes a virus mutates its way off of the radar because it becomes more benign. Sometimes it's too lethal and kills the victims before it can be spread.

            John Barry's book is a great way to learn about 1918. Or, you can go here.

            "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 Sat Feb 03, 2007 at 07:43:52 PM PST

            [ Parent ]

          •  I thought TSS... (0+ / 0-)

            ...was from using tampons incorrectly.  Or am I mistaking it for another condition?   I remember hearing about it as a kid in sex ed but I didn't think it was a disease was it?

            diseases seem to have seasons.  They get really dangerous until public health are able to address them and then they taper off.

            Like west nile for example.  It was really bad in many states but then there were public efforts to kill mosquito larvae in standing pools of water and educate people on wearing insect repellant.

            That helped keep the infection rates down in later years.

            You may say I'm a dreamer, but I'm not the only one. - John Lennon "Imagine"

            by a dumb dreamer on Sat Feb 03, 2007 at 07:45:59 PM PST

            [ Parent ]

            •  Viruses are the ultimate parasites (0+ / 0-)

              Their "job" is to replicate their kind and one good way to do that is to not kill their host. Let's think about viruses that were pretty good at that: smallpox, killed only a small percentage; polio, the same; measles (several viruses) the same. Where WE run into trouble is when viruses jump species, and WE may have little innate immunity to check the replication level.

              We humans are not the only ones that have this difficulty, IIRC, seals died after being exposed to canine distemper virus. And dog parvovirus was more recently a cat virus that was much less severe in the felidae.

              With H5N1 influenza there are several problems: it is totally (this may not be a correct statement) lethal to farmed poultry. And it has the ability to infect humans who are exposed to the massive amount of viral particles produced from sick/dying/dead birds. There is not good research on what migratory species might be "at equilibrium" with the virus, meaning they don't die, merely shed virus in their poop that can infect susceptible species.

              There are human herpesviruses that kill monkeys. There are monkey herpesviruses that kill humans.

              So we have to deal with the fact that particles of nucleic acid and protein can eat us all, given the unfortunate chance. There is a good reason to be worried (to some extent) and watchful (to a greater extent) about any new, alarming diseases that look communicable. Don't freak out today, but consider that there is a good likelihood of another pandemic in our lifetime. For us, HIV is the known pandemic of our generation and was also a species jump.

              •  Wow, that's facinating. (0+ / 0-)

                I've heard it said that pigs are living, breathing biological weapons labs and that they have just the right physiology to combine differing viruses into all kinds of new buggies.  There was some speculation that is why pork is forbidden in many cultures.

                Is that true?  

                You may say I'm a dreamer, but I'm not the only one. - John Lennon "Imagine"

                by a dumb dreamer on Sat Feb 03, 2007 at 08:45:14 PM PST

                [ Parent ]

                •  probably more trichinosis than flu (1+ / 0-)
                  Recommended by:
                  tzt

                  but you're right about them being 'mixing vessels' for flu. However, it's now theorized that 1918 was a direct bird to human problem, so there's more than one way to get there.

                  "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 Sat Feb 03, 2007 at 08:47:21 PM PST

                  [ Parent ]

                  •  Wow. (0+ / 0-)

                    Ah well...you gotta die of something.

                    I'm no where near panicing.  Just gotta deal with what life gives you.  No sense getting all worried about it.  But always a good thing to stay informed.

                    Thank you,

                    You may say I'm a dreamer, but I'm not the only one. - John Lennon "Imagine"

                    by a dumb dreamer on Sat Feb 03, 2007 at 08:50:07 PM PST

                    [ Parent ]

                  •  And there is now some concern (0+ / 0-)

                    that cats can carry H5N1, and maybe infect their caregivers. But I suspect they were looked at because of the SARS connection, not because of any real epidemiology.

                    If the Red Cross looks for antibodies to West Nile Virus in US blood donors, and I suspect they don't, they do PCR for virus, there may be many of us who have "seen" the virus, in that it was replicating in our bodies enough to cause an immune response that led to antibodies being made.

                    DfCT, you would know better: are there any epidemiological studies about exposure to influenza H5N1 in poultry workers in areas that have had large bird epidemics? We all hear the "kill rate" in infected humans, but is there any evidence that some infections lead to mild disease? And if so, are there genetic tests being done to determine who might be so fortunate as to be relatively resistant to H5N1 as the various quasispecies exist now?

                    •  funny you should ask (2+ / 0-)
                      Recommended by:
                      tzt, HiBob

                      we maintain a seroprevalence page at the wiki.

                      Since the initial signs of human infection, scientists in Indonesia, Vietnam and Thailand have been studying those around the people who became infected, looking not only for signs of infection and increased transmissibility, but also for antibodies that could help to explain why some people became infected while others remained healthy.

                      "The evidence for widespread asymptomatic infections is just not there,’‘ said Michael Perdue, a World Health Organization scientist working on the global influenza program. "The (more recent) studies that have been done, one of the reasons frankly that I think they haven’t been followed up on, is they haven’t found many positives. You don’t get too excited about all negative serology (blood work)."

                      Dr. Scott Dowell, director of global disease detection and preparedness at the U.S. Centers for Disease Control in Atlanta, agrees: "If there was mild or asymptomatic H5 infection and that was relatively common and the severe cases we’re picking up were the tips of the iceberg, then if you look at family members or hospital contacts or cullers, you would expect to be seeing some of these.

                      "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 Sat Feb 03, 2007 at 09:11:46 PM PST

                      [ Parent ]

                    •  cats were looked at because of observations about (1+ / 0-)
                      Recommended by:
                      tzt

                      them eating chickens in the live bird markets in indonesia and because there were reports that 1 in 5 stray cats in these areas were infected and because tigers in a Thailand zoo were known to be infected (carnivores) and because the Dutch showed that cats could pass the virus to each other.

                      "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 Sat Feb 03, 2007 at 09:16:10 PM PST

                      [ Parent ]

          •  Human SARS appears to have disappeared (0+ / 0-)

            Lab outbreak caused the last cluster. No human cases at all since then...and no known animal cases either, but of course would be harder to track.

            Je suis Marxiste, tendence Groucho.

            by gracchus on Sat Feb 03, 2007 at 08:17:39 PM PST

            [ Parent ]

        •  I got the audio version. (0+ / 0-)

          Excellent. I highly recommend it. The reader is really good.

          Rex Manning, boy genius.

          by Rex Manning on Sat Feb 03, 2007 at 07:36:05 PM PST

          [ Parent ]

        •  yes, i have (2+ / 0-)
          Recommended by:
          tzt, bherner

          and it is a wonderfully written tale of government incompetence, dedicated public health workers, and the price of ignorance.

          1918 happened during WWI, and the 'need' for censorship and keeping morale up destroyed the ability of authorities to enact the measures needed to try and control the spread of virus. Nothing can stop a pandemic, but you can sure make it worse by refusing to cancel war bonds parades (Philadelphia was burying the dead in mass graves).

          "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 Sat Feb 03, 2007 at 07:38:47 PM PST

          [ Parent ]

        •  My great aunt spoke a lot about it... (3+ / 0-)
          Recommended by:
          monkeybiz, tzt, bherner

          I wrote an article about the flu and her experiences a few years back. She was a 22 year old seamstress in Chicago.

          Maybe I should diary it.

          I have skimmed through the book. Terrifying really.

          "I belong to no organized party, I am a Democrat" Will Rogers

          by vassmer on Sat Feb 03, 2007 at 07:40:01 PM PST

          [ Parent ]

          •  My great-great grandfather (1+ / 0-)
            Recommended by:
            vassmer

            died in it.

            I only know the bare details of the story, but it did -- at one point -- hit home in the worst way.

            •  One of the problems historians had (1+ / 0-)
              Recommended by:
              lemming22

              with "recording" the plague and how it played out in the daily lives of people, is it wasn't talked about.
              People lost their loved ones and wanted to move on. There was a silence about it. Many died and their stories were never told. People want to forget and then the people forget.

              I never heard my great-aunt talk about it until she was in her 80s. It was all to painful to talk about it when she was younger (she lost an eleven yr old brother.)
              I understand what you mean....

              "I belong to no organized party, I am a Democrat" Will Rogers

              by vassmer on Sat Feb 03, 2007 at 09:13:12 PM PST

              [ Parent ]

    •  btw, you've 'gotten' it... (5+ / 0-)
      Recommended by:
      monkeybiz, splashy, tzt, HiBob, Dianna

      this is extremely disruptive because everything closes, so if you have to deal with it, it really, really needs to be planned out. In advance.

      That's the whole point of bringing it up now.

      There's a list of things (including the production of vaccine) that may make it so it's unnecessary. But...

      "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 Sat Feb 03, 2007 at 07:33:27 PM PST

      [ Parent ]

      •  who's going to make that vaccine? (0+ / 0-)

        it's not very profitable (not to mention the most reliable) to make a vaccine for a disease that hasn't hit H2H transmission yet.

        But man, closing all that down would really bite.

        You may say I'm a dreamer, but I'm not the only one. - John Lennon "Imagine"

        by a dumb dreamer on Sat Feb 03, 2007 at 07:47:53 PM PST

        [ Parent ]

        •  Except there is a prebuilt market (0+ / 0-)

          Supposedly the government will keep 'X' amount of doses on hand - not enough for everyone, but for primary care people.  I may have even read it in DemfromCT's diaries! (Excellent work).

        •  yeah, it would (0+ / 0-)

          so it only happens if it's a bad pandemic (cat 4 or 5).

          The US government is investing billions of dollars of your money to rebuild a vaccine industry that didn't exist a few years ago. Research is going into new ways of making vaccines, novel methids are being funded.

          There's this new entity called BARDA. Google it.

          if a vaccine can be made, it's much better than non-pharmaceutical mitigation, which only delays and reduces the impact of a pandemic. A vaccine could, in theory, stop it cold. hence the investment.

          "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 Sat Feb 03, 2007 at 08:07:38 PM PST

          [ Parent ]

    •  If it's bad enough to shut down schools ... (3+ / 0-)
      Recommended by:
      splashy, HiBob, Diaries

      ... then it's bad enough that it's safer to keep kids home -- even on their own -- than to send them to day care.

  •  Bird flu; global warming (2+ / 0-)
    Recommended by:
    vcmvo2, Rex Manning

    Huge issues, capable of destroying the entire planet as we know it. One would thinkg that that  should bring the entire world together.  

    I do not know what weapons World War III will be fought with. World War IV will be fought with sticks and stones. -- Albert Einstein

    by elveta on Sat Feb 03, 2007 at 07:19:54 PM PST

  •  I am glad to see (2+ / 0-)
    Recommended by:
    sawgrass727, Rex Manning

    that they at least (the CDC) seem to have things organized. This is very important work- thanks Dem From CT!

    I'm going back to better absorb the Community Mitigation Standards. It is up to us to better understand this strain. God help us if it is left up to the Bush Administration...

    "Mankind must put an end to war before war puts an end to mankind." John F. Kennedy

    by vcmvo2 on Sat Feb 03, 2007 at 07:22:12 PM PST

  •  note the story in the Guardian (5+ / 0-)
    Recommended by:
    shermanesq, monkeybiz, splashy, tzt, maryru

    and note the flu wiki link at the bottom.

    "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 Sat Feb 03, 2007 at 07:24:15 PM PST

  •  Screw the birds (2+ / 0-)
    Recommended by:
    vassmer, Rex Manning

    Am I going to die?

    Seriously, this is freaking me out.

    Senator Feingold: American Hero.

    by Basil on Sat Feb 03, 2007 at 07:25:01 PM PST

    •  nope (6+ / 0-)

      this is a bird illness, not a human disease and will likely stay so. Many measures are being taken to keep it so.

      But better to get nervous now, and get over it. it's called an adjustment reaction, and better to just be done with it.

      The fact is that some time in the future, in a year or ten years, some virus will go pandemic. It's happened before. So, best to plan for it.

      "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 Sat Feb 03, 2007 at 07:30:20 PM PST

      [ Parent ]

    •  Might as well say, "Screw all of nature..." (2+ / 0-)
      Recommended by:
      Basil, Rex Manning

      This is evolution. This is life. And will always be this way. Not the birds' fault.

      Not being flippant, but there are more dangerous things to human life.

      If we didn't have these viruses we would not exist. Too bad, the viruses don't apppreciate us as much as some of us appreciate them.

      "I belong to no organized party, I am a Democrat" Will Rogers

      by vassmer on Sat Feb 03, 2007 at 07:35:48 PM PST

      [ Parent ]

  •  Public Health (2+ / 0-)
    Recommended by:
    goodasgold, Rex Manning

    Oh yes - somewhat forgotten as we've put all of our  money into Iraq and The Global War on Terrorism.

    Glad to read the CDC has put out the beginning of a plan.  They have the expertise to do really great work, if we could get the

  •  Japan also has an outbreak of bird flu (1+ / 0-)
    Recommended by:
    Rex Manning

    Japan Confirms Deadly Bird Flu Outbreak

    The Associated Press
    Saturday, February 3, 2007; 1:41 AM

    TOKYO -- Japanese authorities on Saturday confirmed the country's fourth outbreak of the virulent H5N1 strain of the bird flu virus at a poultry farm in the country's south.

    About two dozen chickens were found dead at the farm in Shintomi, southwestern Miyazaki state, last month. The birds had been infected with the H5N1 strain deadly to humans, the Agricultural Ministry said Saturday.

    The case marks Japan's fourth H5N1 outbreak incident this year and the third to hit poultry farms in Miyazaki, Japan's largest chicken-producing region.

  •  And this moral is the same whether the threat is (4+ / 0-)
    Recommended by:
    DemFromCT, splashy, maryru, Rex Manning

    a flu pandemic or a manmade threat:

    But rebuilding public health infrastructure is something that needs to be supported whether incidents like the UK H5N1 outbreak are in the news or not

    If the response to 9/11 had included beefing up public health facilities rather than invading an uninvolved country we'd have spent less and been better off.

  •  The invisible hand of the market will save all (1+ / 0-)
    Recommended by:
    Rex Manning

    For had a preaching session today.  Their little rountable was all worried that the Florida tornado would make people long for bigger government and more help (they see it as welfare).  They went on and on that we need to be steadfast in protecting the free market, and freedom on this country, that's what makes us strong, etc...better than any other country.

    They said the freemarket is at work in Katrina, for example.  Their reasoning was that half the population went to Texas and found better opportunity, moved my the magical hand of the market.  

    Nothing amazes me anymore.

  •  I realize this is a serious issue, (3+ / 0-)
    Recommended by:
    Plutonium Page, Rex Manning, Diaries

    but I didn't know they had turkeys in ENgland. I could not find for the life of me a turkey sandwich in London.

    ... we now know a lot of things, most of which, we already knew... (-dash888)

    by Tirge Caps on Sat Feb 03, 2007 at 07:40:07 PM PST

    •  Much longer than you think (0+ / 0-)

      Turkeys were sold in England very soon after the discovery of North America and there was a large industry in East Anglia, the region where this outbreak occurred. In fact the Pilgrim Fathers took turkeys with them and those originally eaten at Thanksgiving were probably the English domestic breed rather than the wild North American type. The first were introduced in the 1520s and soon became popular.

      According to Thomas Tusser's 1570 Five Hundred Points of Good Husbandry, turkey meat was now part and parcel of England's Christmas celebrations, at least for the well off. Such was the demand, that farmers from Norfolk, eighty or more miles distant, would drive their thousand-strong turkey flocks to market in London on foot, reportedly creating the first traffic jams on the streets of the English capital. According to local legend, each turkey wore custom-made leather booties to protect its feet on the long march south to the slaughter. It sounds too cute to be true.

      By 1541 eating turkey was so popular that when Thomas Cranmer, the Church of England's top archbishop, introduced a sumptuary law to restrict the consumption of meat dishes by his underlings, turkey was on the hit list. He said "of the greater fishes or fowles, there should be but one in a dish, as crane, swan, turkeycocke, haddocke, pyke, tench."

      http://www.history.org/...

      In fact the very name comes from England as the first birds were sold by foreign, eastern, salesmen and they were thought to come from Turkey.

      Kneejerk reactions do not come from knees.

      by londonbear on Sat Feb 03, 2007 at 11:18:37 PM PST

      [ Parent ]

      •  I'd sure have liked to have known where those (0+ / 0-)

        turkeys were last summer.

        ... we now know a lot of things, most of which, we already knew... (-dash888)

        by Tirge Caps on Sun Feb 04, 2007 at 12:01:27 AM PST

        [ Parent ]

        •  Bad reputation (0+ / 0-)

          The largest sales of birds are over Christmas and to a lesser extent Easter. The rest of the time Bernard Matthews (the very large company involved in the outbreak) market manufactured products. The icon of bad school dinners is the "turkey twizzler" which is a reconstituted shaped meat from turkeys and it gave the meat a bad name. Apart from cold luncheon meats made from turkey, their largest sales are formed "roasts" and burger type foods.

          Kneejerk reactions do not come from knees.

          by londonbear on Sun Feb 04, 2007 at 12:07:43 AM PST

          [ Parent ]

  •  Did they every find out.... (0+ / 0-)

    what happened to those birds in Texas and Australia--those ones that were just dropping dead one day recently?

  •  Aluminum hat time (0+ / 0-)

    Too easy to vaccinate people with funds.

    OKAY - I'm done.

    Two "markers" turn a flu-bug from pandemic into a sneeze that pisses menopausal the ofice manager off.

    Just sayin'.

    Platinum, gold-plated "nucular" knit cap?

    Now? When?? Why??? Because, Goddammit! Isn't that enough? -8.88 -5.08

    by SecondComing on Sat Feb 03, 2007 at 07:56:53 PM PST

  •  I am sorry but this question you put raise in (0+ / 0-)

    a rather "chicken little" style as usual:

    The unanswerable question is "how much time do we have?" That's where the UK story comes in to remind us that while there's no evidence of an imminent pandemic, the known unknowns and the unknown unknowns make any predictions extremely chancy.

    merits the same answer for every virus.  Al viri are "unkonws" because they mutate.  We don't know what we will be dealing with at all and it is possible that while the virus is deadly for birds, it won't be anywhere near as deadly as SARS or the Noro virus.  We don't know.  We will have NO time in that it will mutate into the human population and that is our first opportunity to study it in that form and start to defend against it.  Until then we wait and it is within the realm of possibility that it will never mutate to the deadly predator to the human population that people like to talk about.  

    Until (and IF) the virus jumps to humans we don't have a clue what vaccine to develop and then we have to hope that we can develop the human vaccine in time to stop widespread death IF IF IF IF that is how it actually mutates and it isn't impossible that it won't be much less devastating than all these predictions make it sound.

    I read your posts which were really scary for a long time and then I had a good long heart to heart with some of the people who are actually working on the vaccines (to the extent that they can at present) and concluded from their knowlegeable and forthcoming lectures that while Bird Flu is certainly something to watch carefully, the reality is that we are dealing with flu - influena - we are always at risk - and any of the others could mutate and become just as deadly for humans as any of us know who have worked in the infectious disease arena.  Bir Flu may never mutate.  I had a colleague who was so afraid of Bird Flu that when we were in Hong Kong a year ago and walking through a park - when he heard a bird he stopped and said, "It sounds healthy..."  Jesus people.  I am still alive and in the grand scheme of things this flu has killed a lot less people than the other big flu strains.  Just keep that in mind.  Thanks.

    •  no, i don't think so (2+ / 0-)
      Recommended by:
      splashy, tzt

      I just got back from meetings in Arlington with flu experts from all over the world. More details here. There is a lot of information in your post, but some of it is not quite right, so let's go over it.

      a rather "chicken little" style as usual

      How so? Only someone reading what I wrote with extreme prejudice would interpret "there's no evidence of an imminent pandemic" as chicken little. No one can predict when the next pandemic will happen. There's a reason that it is now being compared to hurricanes. No one can predict the next cat 5 hurricane either, but we know they happen. preparing for one so there's npot another Katrina is merely prudence.

      We don't know what we will be dealing with at all and it is possible that while the virus is deadly for birds, it won't be anywhere near as deadly as SARS or the Noro virus.

      That's so. OTOH, the case fatality rate right now in 2007 for humans is88%. The overall CFR is 61%. So, if you review current cases of H5N1, there's reason for concern if it's H5N1.

      It's also true it may not be H5N1, which I said in my post. But we do know that all flu pandemics are associated with fatalities far beyond norovirus (a GI bug), so it's an inapt analogy you cite. Even mild pandemics are deadly, and pandemics, like hurricanes, do happen.

      Until then we wait and it is within the realm of possibility that it will never mutate to the deadly predator to the human population that people like to talk about.

      Do you have life or car or home insurance? Why? Maybe nothing will happen. But so you understand more, I highly recommend John Barry's book The Great Infuenza, as others have done on this thread.

      As for vaccine production, with current vaccine capability, it'd be at least 5 months before you'd have one you can get, assuming you're not a health care worker. Not good odds.

      "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 Sat Feb 03, 2007 at 08:27:37 PM PST

      [ Parent ]

      •  But the risk is so low (0+ / 0-)

        We're not very good with assessing risk. Here we have a situation where the mortality rate is high but the risk is so low as to be negligible. Zero Americans have died from bird flu, yet 36,000 Americans die from regular flu. Which should we make sure we vaccinate for? Which should have long posts with 100s of comments?

        But this isn't about DemFromCT. Extreme reactions to tiny risks is what brought us the thinking behind the White House's The One Percent Doctrine.

        It's also what contributed to several thousand more people dying in vehicle accidents when they decided to drive instead of fly after 9/11. If you drive 12 miles to the airport to take a cross-continental flight, the most dangerous part of your journey is already over.

        We have to balance false worry with complacency I guess. The public feel that there is every likelihood of human-to-human transmission of avian flu (a study showed they estimated it at 60%) while experts think it more like 10% (source: the Time article).

        By the way, according to the CDC diagram we're already undergoing a Category One in the US (regular flu, and what is the lower limit here, it just says <90,000?)</p>

        Here are some other ways of dying we could worry about:

        Category One: Suicide (30,000 deaths annually)
        Category Two: Smoking (438,000 deaths annually)
        Category Three: Heart Disease (685,000 deaths annually)

        My issue with public health PSAs is that they can cause unnecessary worry for some and complacency in others. Remember how sickle cell anaemia is a "black" disease? Well it isn't; there's no biologically meaningful category of race, but if you're black you worry about this, while others, who may have sickled cells won't. Same with diabetes.

        Public health that doesn't look across the culture-nature spectrum is going to be incomplete.

        •  actually this is not a cat 1 (2+ / 0-)
          Recommended by:
          splashy, tzt

          cat 1 would be above and beyond the usual 36,000 annual deaths, although your point about how nasty seasonal flu can be is well taken. Some see seasonal->pandemic as a spectrum, hence the graded response.

          But it goes back to hurricane thinking. The flaw in your argument is in looking only at the risk as of this moment (miniscule) instead of understanding that this is a cumulative risk (which, over time, grows larger) and that the plans and concerns are for this year, next year and the next 10 years. Yet, the complexity of planning requires a multi-year milti-agency/stakeholder effort.

          Again, think of hurricanes. You can't say "well, more people die in motor vehicle accidents than cat 4 hurricanes, so why bother planning, especially since we didn't have a hurricane this year?" The result is Katrina-type aftermaths in a non-predictable but inevitable fashion, and that is simply not acceptable. Saving lives requires that we avoid a failure of imagination, as in "no one could have predicted..."

          Been there, done that.

          BTW, the cross-cultural need is well-taken and the point is important. We can't just help the internet-savvy. That's a flaw in pandemicflu.gov, and that's why we need PSAs.

          "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 04, 2007 at 06:43:47 AM PST

          [ Parent ]

          •  risk is relative... (0+ / 0-)

            Again, think of hurricanes. You can't say "well, more people die in motor vehicle accidents than cat 4 hurricanes, so why bother planning, especially since we didn't have a hurricane this year?" The result is Katrina-type aftermaths in a non-predictable but inevitable fashion, and that is simply not acceptable. Saving lives requires that we avoid a failure of imagination, as in "no one could have predicted..."

            I feel you're lurching between extremes. I did not suggest we "should not bother planning" for things that have a lower risk than others.

            My point was that we aren't very good (as a society) at assessing risk, and that the very mentality of risk is what gives us the one-percent doctrine in response to terrorism (a point you did not address). We often over-play things with minuscule risk (avian flu, homicide) and underplay things with known, high, risks (smoking, driving). I do this too, btw!

            Risk may or may not be cumulative. The risk of dying from last year's strain of flu is lower now than then.

            PS Re: PSAs. I didn't say we don't need them, rather that they can give misleading impressions, because in their attempt to get a clear message out they're not adequately describing a complex situation.

            This often leads to inappropriate responses by the public (eg., over-estimating the chance of sickle-cell anaemia or diabetes if you're black, even though there is no biological meaning to race). Corporations then profit from this, eg BiDil, the first FDA "race-based medicine". There's a website in Florida that sells race-based vitamins ("if you're Latino, click here"). Coincidence? Maybe, but I think it's because we're presented with race-based information so often.

            Risk assessment is a political act, as surely Katrina showed. Katrina was predictable in the same way that global climate change leads to predictable consequences.

            •  pandemics are in the category (0+ / 0-)

              of global climate change and Katrinas rather than 1% solutions. They are cumulatively higher probability,  although they are low probability, high risk for any given year.

              Sorry if I've misinterpreted what you are saying. I don't think a rational transparent data-driven approach to things like pandemics and hurricanes, with stakeholder input from the public, has much to do with political approaches to terrorism.

              Now, if you are saying you don't trust the government or this administration regardless, that's another issue altogether. I would point out that there's plenty of outside-the-government opinion supporting thhis pandemic approach, some of which I've quoted in the comments.

              "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 04, 2007 at 08:28:15 AM PST

              [ Parent ]

              •  Guess I wasn't clear... (0+ / 0-)

                Now, if you are saying you don't trust the government or this administration regardless, that's another issue altogether. I would point out that there's plenty of outside-the-government opinion supporting thhis pandemic approach, some of which I've quoted in the comments.

                No, I wasn't saying that. I'm saying let's put it in perspective! Killers such as malaria and AIDS have not disappeared. We've spent billions of dollars on developing millions of doses of anthrax and smallpox vaccines (most of which are thrown away), yet in 2003 Congress approved only half the $100 million requested to develop better flu vaccines.

                I was linking to the Time article about misperceptions of risk, which in turn is based on interesting work of people like Gerd Gigerenzer on "dread risk," and discussions about the whole way the risk-to-fear meme operates (hereand herefor example).

                One might also usefully read this book by an MD on the politics of fear: False Alarm. He usefully differentiates between potential risk and actual risk.

                And as he points out, one does not need to claim that there are no risks to understand that risk is not always correctly perceived by the public and the media, or that public authorities can exacerbate those misperceptions. For example, flu is likely to be more of a worry in developing countries where medical resources are stretched, rather than the USA.

                When parents of newborn babies won't let relatives visit in case of flu transmission, when there is panic about school closings, we might wonder how we got to that point.

                As Dr. Gerberding (Director of the CDC) has said:

                "for almost everyone, flu is not such a serious disease. We don't need to panic or assume that the worst-case scenario is going to happen to everyone. Most of us will get through this fine."

                Thanks for the conversation. I'm off to wash my hands!

                •  thank you! it is an interesting topic! (0+ / 0-)

                  I cringe when I see the word 'panic' used in relation to bird flu, because no one is panicking. Everyone who uses the term should be required to give two examples of actual panic over bird flu.

                  Instead, the assumption is made (and a faulty one, disputed by research and congressional testimony from communication experts) that "people will panic".That's wrong. The public will not panic. They will adjust. The problem is too little info, not too much. A background awareness needs to become the 'new normal' as risk communication expert peter sandman describes it. And the paternalistic attitude towards information only engenders distrust.

                  So, thanks for bringing up the topic. it is really interesting.

                  "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 04, 2007 at 06:51:57 PM PST

                  [ Parent ]

        •  PS this kind of thinking (0+ / 0-)

          may well lead to mandatory flu shots for health care workers.

          All health-care workers should be required to get a flu shot every year, unless they formally refuse in writing, the Infectious Diseases Society of America (IDSA) said today.

          The society called on the federal government to plug what it called a "critical weakness" in the nation's influenza preparedness by ensuring health-care workers are protected.

          "It's our professional duty to first do no harm," pronounced Andrew Pavia, M.D., chief of pediatric infectious diseases at the University of Utah and chair of the society's National and Global Public Health Committee.

          "Voluntary systems haven't brought immunization rates up far enough," Dr. Pavia said, calling for a regimen with "more teeth in it."

          It's not just business as usual.

          "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 04, 2007 at 06:47:22 AM PST

          [ Parent ]

  •  I joined (1+ / 0-)
    Recommended by:
    DemFromCT

    the Medical Reserve Corp, which is organized under the Department of Agriculture, last spring.  We would respond to sheltering needs etc. during evacuations as a consequence of weather, pandemic, or other national or regional displacement.  My group is also making provisional plans to shelter displaced or abandoned pets, and livestock.  Sign up...
    Contamination rates would be far greater than in 1918 because of increased population density and our mobility.  We will face a challenge that didn't have to be met in '18, which is the collapse of JIT (just in time) delivery.  Keep in mind, the milk you buy today belonged to a cow 48 hours ago, so buy a couple of big bags of rice and dry beans and vacuum seal them, JIC (just in case).
    The Federation of American Scientists has put up a great site, find it at http://www.fas.org/...

    What's so bad about the bird flu outbreak during cold and flu season is the considerable possibility of a mutated virus. If you have the flu and are exposed to bird flu a mutated strain can result, and would be case #1 of pandemic flu.

  •  fyi (0+ / 0-)

    WHEN SYNTHETIC BIOLOGY FALLS INTO THE WRONG HANDS
    Speaking at the World Social Forum in Nairobi this week, the ETC Group says abuses of synthetic biology have the potential to threaten humankind in just 5-10 years. Synthetic biology is the practice of building life from scratch. "Genetic engineering is passé," said Pat Mooney, Executive Director of ETC Group. "Today, scientists aren't just mapping genomes and manipulating genes, they're building life from scratch - and they're doing it in the absence of societal debate and regulatory oversight," said Mooney. With synthetic biology, just about anyone can have the ability to build dangerous viruses and pathogens from scratch. It's as simple as obtaining published gene sequence information on the internet and purchasing mail-order synthetic DNA. Scientists predict that within 2-5 years it will be possible to synthesize any virus.

    Learn more:
    http://www.organicc onsumers. org/articles/ article_3825. cfm

    "She's (Hillary) been consistently solid on the need to do the right thing on national defense." Newt Gingrich

    by mattes on Sat Feb 03, 2007 at 08:11:18 PM PST

  •  I know this is easy to be snarky about (7+ / 0-)

    but my dad works in public health (and has consulted with the CDC and the Pentagon) and is not a particularly paranoid person, and he has gallons of water stocked up in the basement and glowsticks and windup flashlights in case the electricity goes out because people stop going to work in case of an epidemic. My mom and I make fun of him for it all the time, but still.

    He's pretty convinced that there will be a breakout in the next 4-5 years, which is why he's working so adamantly to come up with IT solutions to help with the strain on health officials -- coming up with some kind of screening test to separate the hypochondriacs and people who are afraid and want to be tested from people who are actually sick and need to be seen by a doctor. It's really important that we have an infrastructure in place to support doctors, who will be in heavy demand in these circumstances.

    Trust me, the government does a lot of fearmongering, but this is real and should be taken seriously, especially because it managed to make it from China to the UK. I'm not saying we should all go out and duct tape our windows -- and I'm sure that many people will think that's the case and overreact to this news. But this is a much more likely threat than another terrorist attack, if you ask my dad.

  •  God work (0+ / 0-)

    Damn "Noro-Virus done kicked my proverbial butt this week though.

    Infuenza is too easy.

    Now? When?? Why??? Because, Goddammit! Isn't that enough? -8.88 -5.08

    by SecondComing on Sat Feb 03, 2007 at 08:14:40 PM PST

  •  DemFromCT, can you recommend (0+ / 0-)

    any particular discussions of the CDC's CMS?

  •  Are multinationals preparing? (0+ / 0-)

    Thanks for the diary and your informative replies.  

    I was a bit blithe about the issue until I recently spoke with a friend of mine. He's an executive with a multinational financial corporation (we're talking about a really, really big one) and he told me that they have been working on a risk and reaction plan to a pandemic. Closing offices, etc.

    Until his comment, I was on the fence about the threat. But when I learned this very responsible corporation was regarding the threat with a lot of concern, I began to pay much closer attention.  

    Are you aware whether there's a pervasive and proactive corporate concern on the matter?

  •  God help us if this happens in the next 2 years (0+ / 0-)

    After the fiascoes of Iraq and Katrina, I can only imagine how badly the Administration could screw this up as well.  

    Bush 41 to 43: "See, Son, your problem in Iraq is the same one I had with your mother: neither one of us pulled out in time."

    by mattinla on Sat Feb 03, 2007 at 08:47:23 PM PST

  •   Rumsfieldian "unknown unknowns" ? (0+ / 0-)

    DemFromCT,

    "[Known unknowns and the unknown unknowns"?

    Quoting Rumsfield?

    "Flu Stories: UK Deals With H5N1 Outbreak; US Plans For Graded Response"

    Why did you omit the victims, i.e. the turkeys?

    By chance, are you in the pharmaceutical industry?

    Why do you **never** state the hard cold facts about Avian flu not being transmittable  from human to human?

    Why do you **never** state that a pandemic strain of H5N1 has not been found and may never be found?

    Perhaps a small short paragraph regarding that could be included in what you write?

    •  no I am not in the pharmaceutical industryn? (3+ / 0-)
      Recommended by:
      rabel, tzt, HiBob

      Why do you **never** state the hard cold facts about Avian flu not being transmittable  from human to human?

      Becuasd it is not a fact. There are at least 3 documented cases, one involving a health care worker in Vietnam, a case of a daughter giving it to her mom in Thailand (both died), and a H2H2H case in Indonesia, which involved a family cluster of 8. There may have been others but it's tough to prove. The cited cases are recognized by WHO. But the concern is not about now, it's about the ptential risk if the virus mutates. As you must know, that's a known unknown.

      Quoting Rumsfield?

      It amuses me.

      By chance, are you in the pharmaceutical industry?

      Nope. I haven't discussed pharmaceuticals at all in this post. As amatter of fact, the CDC's plan is non-pharmaceutical intervention (NPI).

      Why do you **never** state that a pandemic strain of H5N1 has not been found and may never be found?

      Because it would be misleading to state that. In fact it would be rather presumptuous to state that because there's no pandemic strain now, there never will be one. They fact that there may never be one is married to the fact that there may be one. The first requires no preparation, the second one does.

      Why do you omit the victims and not talk about the turkeys?

      I don't think of them as victims. I eat turkeys. I smile when I do, and dare them to eat me back.

      "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 Sat Feb 03, 2007 at 09:33:34 PM PST

      [ Parent ]

  •  this is a bird illness, not a human disease (0+ / 0-)

    "[T]his is a bird illness, not a human disease and will likely stay so."

    Great!

    If I may, thus would be great to read in each of your posts.

    This is extremely important information.

    •  that's an 'as of this moment' concept (1+ / 0-)
      Recommended by:
      tzt

      right now H5N1 is a panzootic (pandemic in birds). it can pass to humans, and at the moment it's not a threat to you or me. At the moment. The UK poultry workers are at risk.

      Of course, you don't worry about hurricanes outside of hurricane season, but thank goodness others still plan, regardless.

      "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 Sat Feb 03, 2007 at 09:19:25 PM PST

      [ Parent ]

  •  stupid question? (0+ / 0-)

    I've been meaning to ask for a while if there are any issues about feeding the wild birds outside.    I'm on the north coast of California.

    •  no problem with feeding wild birds (0+ / 0-)

      they are not the enemy.  ;-)

      But wash your hands afterwards.

      "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 Sat Feb 03, 2007 at 09:20:16 PM PST

      [ Parent ]

  •  Not really useful (0+ / 0-)

    The approach summarized in the provided chart of the Pandemic Severity Index, has a basic limitation evident from that chart.  To assign a given epidemic to one of the categories, you have to know an illness rate (what % of the general population will become cases) and a case-fatality ratio (what percentage of cases will die).  We're never going to know either very well, especially not the illness rate, until we're already in the soup, well after it's too late to drop the hammer on the very costly Cat 4/5 preventive measures.

    Take avian flu for example.  It seems to have a high case-fatality ratio.  We need to be cautious about a testing bias, whereby only very serious unexplained illness is tested, but let's conceed a high case-fatality ratio.  Avian flu has not, hitherto, proven to be easily transmissable to or, especially, between humans, thus we do not now expect anywhere close to the 30% illness rate as per the chart, or even within two orders of magnitude thereof.  The concern is that this deadly disease will mutate to become easily transmissable, capable of pandemic rates of illness, without losing its high case-fatality ratio.  Why we should worry that this particular high fatality infectious disease will suddenly turn pandemic, rather than worry that other high case-fatality entities like Ebola, Marburg, Sin Nombre, etc., will do so, has never been clear to me, but let's conceed some special threat from avian flu for the sake of argument.  How will we know that avian flu has suddenly gone pandemic?  Or do we not wait, and close the schools right now, forever?  Probably not.  We could get lucky, and the bug could go pandemic first in some isolated corner of the world from which it wouldn't reach us until we had the warning of that corner's disastrous experience.  The problem, and this factor has fueled the growing concern over these high case-fatality infections, is that the world really doesn't have isolated corners anymore, and certainly not isolated corners where they monitor outbreaks closely enough to be good early warning for us that it was avian flu causing the locals to drop like flies.  We wouldn't know it was going to hit an illness rate of 30%, or 20%, or 10%, or 3%, or 0.3%, until it had already crossed those lines headed north, and crossing any of those lines would be no indiciation of what illness rate it would stop at in the end.  This sudden pandemicization of avian flu would be new behavior that we would have to observe first, before we knew it had happened.

    This is not to say that there's nothing to be done to mitigate possible future high case-fatality pandemics, simply that this PSI is eyewash.  It has a bell-the-cat problem, in that it describes a notionally useful process that unfortunately is inherently impracticable, and it does nothing to advance the practicability.  Of course it makes sense to grade our response, especially the all-important prevention measures, to the expected severity, but we have a huge problem getting reasonable estimates of what new, previously unobserved, behavior to expect from particular diseases.  The only headway we can make would come from deepening and broadening the epidemiologic surveillance.  Part of "broadening" would be to extend surveillance to those (relatively) isolated corners of the world, which mostly can't afford much public health infractructure on their own.  But mostly what I think this audience needs to hear in respect to the need to broaden surveillance, is that we need to get off the dime of worrying about any one candidate for the next high case-fatality pandemic.  Yes, avian flu has theoretical reasons to advance it as a candidate, but, in medicine, theories are like excuses, and therefore like a certain part of the anatomy, in that everyone's got one.  Or even worse, unlike that body part, every question in medicine has a whole cloud of theories surrounding it.  The more you know about a subject, the more of these theories you are aware of, so the more you tend to discount any one of them until the facts come in.  Facts first, and then build a solid theoretical structure based on those facts.  The theoretical framework to our understanding of what causes the different aspects of virulence, severity of effects and ease of transmission, is still so much in its infancy that we really won't know what agent will cause the next Cat 5 pandemic until we are in the middle of the fact of that pandemic.  Better surveillance, snooping out the facts even the little bit earlier that current methods will allow, is the best that we can do for now, but is still well worth doing.  

    The way up and the way down are one and the same.

    by gtomkins on Sat Feb 03, 2007 at 09:53:51 PM PST

    •  thank you for your thoughtful post (1+ / 0-)
      Recommended by:
      tzt

      I'm not certain what you are really suggesting, vs what you are analyzing.

      As for the analysis, the PSI is designed for influenza pandemics, though it might suit a new superbug as yet undescribed. That "undescribed superbug" is a much lower probability than flu pandemics, which are known to happen irregularly and unpredictably, but on average 3 times a century. Other viruses outside of influenza A don't do that... flu does, has, and will. We don't know which flu and we don't know when. H5N1 is a scary candidate, but it's not the only candidate. The timeline cannot be predicted.

      Nor is the PSI designed to be an avian flu algorithm; rather it's an "any flu" algorithm, with a graded response based on severity. The goal? Save lives, Mitigate disease. Bring the purple peak down, delay the peak and spread it out. Turn Philadelphia into St. Louis. Click for bigger pic.

      It's not designed to be triggered the moment something happens in Indonesia; triggering would happen closer to your community. The idea is to mitigate the consequences, not measure exactly where the CFR finally ends up. And, you have to make decisions based on an ongoing issue, not on the fly with no plan. That way lies chaos.

      The bottom line is:

      "No one's arguing that, by closing all the schools, you're going to prevent the spread," Markel added. "But if you can cut cases by 10 or 20 or 30 percent and it's your family that's spared, that's a big deal.

      Is it perfect? Nope. Lots of things to be worked out. What do colleges do? Don't families want to unite? What about unlicensed day care? There's always more to do.

      But this is a necessary and great start, being done openly and with community and science/medicine input. A rarity, but it should be acknowledged.

      "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 04, 2007 at 05:06:46 AM PST

      [ Parent ]

      •  The Department of Homeland Health Threats (0+ / 0-)

        What bothers me about the Pandemic Severity Index in particular is the strong resemblance to our counter-terrorism alert levels.  What bothers me about the hyping of the avian flu threat in general, is that it both draws from, and reinforces in its turn, the validity of the disastrous model of this administration's hyping of the terrorism threat.  

        The real world doesn't work like that TV show "24".  In the real world, there isn't some near-omniscient, and, of course, super-secret, govt agency that somehow knows that character X knows where in Manhattan al Qaeda has hidden the suitcase nuke, nor are there near-omniscient virologists who understand well enough how high case-fatality pandemics work to know, before we are actually in the middle of the next such pandemic, what extreme preventive measures which particular infectious agent should get before it's too late for them to work.  We know illness rates and case-fatality rates by observation, which can't happen and be collated until the pandemic has passed its peak.  The vague, unstated, notion that these empirical matters are somehow knowable from DNA or something, is magical thinking akin to that which has the neocons convinced that they know which countries are "evil" and need to be invaded now as a preventive measure.  No, the danger here is not that the "pre-emption" of avian flu will do the horrendous damage that this approach has wreaked in our foreign policy.  My concern is that we validate this "24" approach to reality in general, when we try to ape the failed approach of this administration to the hyped threat of terrorism, by hyping the threat of flu into something that would sell soap if it was the subject of a "24" episode.

        Gathering facts is not sexy or dramatic, and can't compete for public attention with groundless theorizing, which is free to latch onto dramatic scenarios.  The money being spent on dramatic avian flu war-games by the CDC, pursuing a model of responding to pandemics that is way too ambitious relative to our knowledge of the underlying facts, would be much better spent on researching those underlying facts.  We tend to only get interested in animal diseases after they start to affect humans, where they tend to high case-fatality because the virus hasn't adapted well enough to an unfamiliar host to avoid killing the goose that lays the golden eggs.  But if we had as good an overview of the total picture of infectious disease in animals as we do of those that affect humans, we would have a much better understanding of the relatively rare crossover events in which the animal disease starts spreading to and among humans.  We are worried about avian flu crossing over to humans, and carrying with it the high illness rate we often see with human flu, because its rare cases in humans have an apparently high case-fatality ratio.  But we would probably have a much better idea of how likely or unlikely such crossover would be, if we had taken advantage of the undoubtedly far more numerous cases of low-to-no fatality crossover events from birds to humans, but which we haven't studied, because we are only interested in the sex and violence of "The Coming Plague", or "The Hot Zone", or, in general, the breathlessly awaited next high case-fatality pandemic.  You can't work with an n of 1.  It is hard to imagine anything less interesting to the general public than the surveillance and cataloguing of diarrheal illnesses in chickens, but it is upon such an empirical  foundation that we must look to start down the long road of one day being able to catch at least some high fatality pandemics before they have already devastated us.  

        The way up and the way down are one and the same.

        by gtomkins on Sun Feb 04, 2007 at 10:30:08 AM PST

        [ Parent ]

        •  since I don't watch 24 I don't understand (0+ / 0-)

          half of what you said. But the basic research is ongoing, in terms of bird surveillance. Scientists over the last few years have catalogued over hundreds of different strains of h5N1, and the basic research into simple things like how flu is spread is ongoing as well. You'd think it had been done before, but better late than never.

          This isn't just about colored charts. I agree the basics are key.

          Thanks for posting.

          "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 04, 2007 at 07:00:41 PM PST

          [ Parent ]

    •  here's how the local folks (1+ / 0-)
      Recommended by:
      tzt

      (and they are the ones who wanted this guidance) are reacting:

      "This seems like a reasonable response," said Dr. David Pegues, a hospital epidemiologist who wrote UCLA Medical Center's pandemic flu plan. "There had not been a threshold in place for when to cancel a hockey game or a Lakers game."

      Local health officials would have the ultimate authority to implement the measures, but the CDC recommended that the first cluster of confirmed cases in a state or region trigger a quick reaction.

      The definition of a region is intentionally nebulous, said Dr. Marty Cetron, who helped develop the guidelines at the CDC.

      "L.A. may be more connected to Hong Kong than some suburban areas," he said. "If there's an epidemic in Hong Kong that feels like an immediate threat, then L.A. officials can consider that a trigger."

      Dr. Jonathan Fielding, Los Angeles County's public health director, said guidelines appeared to be appropriately measured.

      "We always want to err on the side of caution," he said. "This document, on first reading, appears to do that."

      But he said the restriction could cause some serious social and economic problems.

      A poll by the Harvard School of Public Health conducted in conjunction with the report found that 57% of people surveyed said they would have serious financial problems if they had to miss work for more than a month. About a third said they would ignore the restrictions if their employers asked them to come to work.

      Ninety-three percent of adults said that if schools and day cares closed for a month, they could arrange for child care, but about 60% said that at least one employed person would have to stay home to provide the care.

      Economic concerns led to the notable omission of travel restrictions, Cetron said.

      "The trucks that cart the chlorine we need to purify water may have to move across state lines," he said. "We want to preserve the functioning of civil society and work to the extent possible.... If we are in the setting of a Category 5, then we can reevaluate."

      it's a big deal, so pre-planning, public input and adjustment to necessity is key.

      "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 04, 2007 at 05:37:04 AM PST

      [ Parent ]

  •  Not first case in the UK (0+ / 0-)

    A swan was found dead of H5N1 in Scotland last year.
    http://news.bbc.co.uk/...

    This was the first case in a commercial unit and the company involved has a dubious reputation of treating its workers well. Having said that, these were large barn type units kept separate and the infection was only in one (so far found) The rest are being slaughtered and tested as part of the precautions and there are some fairly draconian restrictions on movement in force and all flocks within 2 Km have to be kept inside.

    Kneejerk reactions do not come from knees.

    by londonbear on Sat Feb 03, 2007 at 11:33:05 PM PST

    •  correct about the swan (0+ / 0-)

      though the swan was felt to be from Germany and died and was washed ashore. This is, indeed, the first in commercial poultry in the UK, with a very different population and ability to spread than the single swan.

      Because of the ability of the virus to spread (whether introduced by small wild bird or whether by poultry droppings/parts shipped from Hungary, where the virus has also been reported). It does not matter whether it's one of 4 sheds, etc. since if it got in, it could get out.

      Where it came from is going to be a matter of intense interest.

      "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 04, 2007 at 05:12:31 AM PST

      [ Parent ]

  •  I come home and see this and I have a question... (0+ / 0-)

    ...why are they assuming what, Greater Than or Equal Too a 2% mortality rate? Am I reading that right?

    So far mortality rate is somewhere around 55%! If it makes the jump to infecting humans regularly how likely is it to go down 10 times or more?

    So far nothing has dissuaded me that a full blown Avian Flu pandemic would kill off about 1/5th of the human race.

    There's something attractive about invincible ignorance... for the first 5 seconds.

    by MNPundit on Sat Feb 03, 2007 at 11:42:18 PM PST

    •  no assumptions made (1+ / 0-)
      Recommended by:
      tzt

      and for those who are aware of the current mortality rate of 61% (88% so far this year, small numbers), the plan basically says, look, we'll pull out all the guns at a CFR of 1% (cat 4) and treat that like the beginning of something much worse. Cat 5 is a range from 1918 2.5% to beyond.

      It does not assume that there's a difference in response by plan between 1%, 5% or 30%. It assumes 1% is devastating, do everything you can and do it early. That ends the argument about "what will the CFR be?" because we don't know in advance. But the response in fact will be very different, by necessity. For example, in a severe pandemic, the schools will close by parental choice, not education department or public health decision.

      If it appears to be an H2N2 or some other mild pandemic, otoh, none of the big guns like school closure apply.

      Kudos for that kind of thinking.

      "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 04, 2007 at 05:20:10 AM PST

      [ Parent ]

      •  Thanks that makes some sense... (0+ / 0-)

        For example, in a severe pandemic, the schools will close by parental choice, not education department or public health decision.

        The parents of the kids I went to school with 15 years ago, and that my sister goes to school with now (she's in 7th grade) have not shown that kind of sense in regard to illness from what I've seen. Of course who knows what can happen if enough kids start dying but a lot of people that I know in my acquaintance will have to learn the hard way.

        It's also a sobering reminder that if things get really bad there are limits to what we can do.

        There's something attractive about invincible ignorance... for the first 5 seconds.

        by MNPundit on Sun Feb 04, 2007 at 10:24:50 AM PST

        [ Parent ]

  •  "... but it's a wake-up call ..." (0+ / 0-)

    The wake up call is that animals in confinement/factory farms are populations that are ripe for epidemics that can spread to human populations.  Um... DUH. We don't need vaccines, we just need to get rid of CAFO's that, for so many reasons, are unhealthy for humans and animals, flu being just one of them.

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site