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This is crossposted from the HHS Pandemic Flu Leadership Blog, where I'll be posting for two more weeks. The Pandemic Flu Leadership Summit agenda is here. I will be on the panel from 11:15-12:15. I will also be presenting a round table on pandemic flu and preparations at Yearly Kos (more to come on that).

Update [2007-6-10 8:13:41 by DemFromCT]:

The importance of the grassroots/netroots is highlighted today by Nedra Weinreich.

That’s where the grassroots approach comes in. A vibrant and engaged  community of concerned citizens has developed over time in various places online, such as the Flu Wiki and the Pandemic Flu Information Forum. On their own, they have come together to share news and preparedness tips, and many participants have tasked themselves with educating their community leaders and neighbors.

While we're still in week 3, and looking at getting the job done there's an important piece of this we need to get out on the table, and very relevant for answering the question "What do I need to succeed in communicating the importance of preparing for a pandemic?" It's to take a look at the virus we know is out there, H5N1, and make sure it is central to our thinking.

This is a nasty, vicious killer of young people (90% of H5N1 deaths are less than 40 years old), and while we do not know that it is the next pandemic virus, no one can assure us that it is not. Mutations are a normal part of viral evolution, and the virus has changed since 1997 when it appeared, and 2003 when it reappeared, in Hong Kong. The next set of mutations can set off events we'd rather not think about, let alone experience. After all, the 1918 pandemic was bad enough with a 2.5% case fatality rate, but H5N1 has a 61% case fatality rate overall (80% in Indonesia). Those are staggering numbers to consider and comprehend.

Now, isn't that just an alarmist way of looking at current events? isn't it true that we don't know for a fact that H5N1 will be the next pandemic virus? Well, here's the thing. H5N1 is out there, and it is not going away because it's established itself in the bird and animal population (cats in Indonesia are not excluded from this virus, and there's speculation that they may have some undefined role in viral spread). Each human exposure is another chance for viral mutation. And we have an important precedent to look at, both from Hong Kong and Ontario. I am, of course, referring to SARS. And here, we have a blue ribbon review of what happened in Canada when SARS broke out, what was done, and what could have been done better.

The independent Commission to Investigate the Introduction and Spread of Severe Acute Respiratory Syndrome (SARS) was established by the Government of Ontario as an investigation under section 78 of the Health Protection and Promotion Act. Mr. Justice Archie Campbell of the Ontario Superior Court of Justice was appointed Commissioner.

The Commission investigated how the SARS virus came to the province, how the virus spread and how it was dealt with. Its final report was completed in December 2006 and made public on January 9, 2007. It was transmitted to the Minister of Health and long-Term Care on January 4, 2007.

Here's an excerpt:

SARS had Ontario’s health system on the edge of a complete breakdown. The wonder is not that the health system worked so badly during SARS, but that it worked at all. SARS also badly hurt Ontario’s international reputation, setting up an unfortunate link in the minds of many in other countries between Toronto and a mysterious deadly disease. Worst of all, SARS demonstrated how many earlier wake-up calls had been ignored, and how few of their warnings had been heeded...

We must remember SARS because it holds lessons we must learn to protect ourselves against future outbreaks, including a global influenza pandemic predicted by so many scientists. If we do not learn from SARS and we do not make the government fix the problems that remain, we will pay a terrible price in the next pandemic. (bolded mine).

There were some specifics from the report that need highlighting (vol 1, p.16):

Common problems and themes emerge from the stories of both [hospital] outbreaks. They reflect seven systemic problems that run like steel threads through all of SARS, through every hospital and every government agency.
• Communication
• Preparation, planning
• Accountability: who’s in charge, who does what?
• Worker safety
• Systems: infection control, surveillance, independent safety inspections
• Resources: people, systems, money, laboratories, infrastructure
Precautionary principle: action to reduce risk should not await scientific certainty

Here's more on the precautionary principle (page 10):

Perhaps the most important lesson of SARS is the importance of the precautionary principle. SARS demonstrated over and over the importance of the principle that we cannot wait for scientific certainty before we take reasonable steps to reduce risk. This principle should be adopted as a guiding principle throughout Ontario’s health, public health and worker safety systems.

H5N1 is a real threat. Robert Webster and Elena Govorkova , writing in the New England Journal of Medicine, said

Clearly, we must prepare for the possibility of an influenza pandemic. If H5N1 influenza achieves pandemic status in humans -- and we have no way to know whether it will -- the results could be catastrophic.

So, given what we know about the potential threat of H5N1 (which is considerable), and mindful of the precautionary principle, as well as the duty to inform, does it not make sense to prepare for worst case as well as mild case scenarios? It is in this context that discussion of how to stockpile (including suggestions of how long, and what, to stockpile, including medicines), and folding pandemic preparation into an all-hazards approach run into stormy weather. Planning for a worst case scenario ought to cover mild case scenarios and assist all-hazard preparation. Planning for a mild case scenario does no such thing. Mild scenarios do not consider loss of electricity, for one, or mass casualty events, nor do they consider the effect of illness on a vulnerable JIT economy. We will not be closing the schools for mild events (though they may close on their own when parents don't send their kids – and don't ever underestimate parents).

And while it is true that we can not predict the next pandemic, or whether H5N1 is the next pandemic virus, the precautionary principle suggests treating H5N1 as if it is. After all, that's why there's such interest in this topic in the first place. Let's acknowledge it and move forward with that in mind. After all, preparing for H5N1 prepares for any pandemic we get.

Originally posted to Daily Kos on Sat Jun 09, 2007 at 07:43 PM PDT.

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Comment Preferences

  •  previous flu stories can be found (13+ / 0-)

    by clicking my name or going here and 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 Jun 09, 2007 at 07:48:44 PM PDT

    •  I lurk over in FluWikie and a couple other sites. (5+ / 0-)

      A number of people have asked about government assurances that the government won't attempt to seize citizen stockpiles.  Why prep if the government is just going to seize it?

      This issue hasn't been raised on the HHS blog.  Not that they have much that's useful to say.  But I'd like to see them say - in writing - that if you spend the money and take the time to prep, that the government won't step in and take what you have.

      Can you raise the issue?

      •  yes I can (3+ / 0-)
        Recommended by:
        RunawayRose, bwren, Fabian

        I haven't seen it in writing, and i will ask at the conference but what's been written by public health is all voluntary. Voluntary quarantine, e.g.

        the best answer is they'll be too busy and/or too sick to worry about your and your preps.

        "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 Jun 09, 2007 at 08:56:56 PM PDT

        [ Parent ]

        •  I found out what the HHS site moderates out (0+ / 0-)

          I did finally post over there.  My second post was moderated out.

          All they want on their site is happy, happy, joy, joy.  If you don't meet that criteria, they moderate it out.

          I don't think they liked the issue I raised, either, because it's generating some comments...

          Here's the 2nd comment I attempted to post and they moderated out:

          "#36 - that’s what scares me. It won’t stop the unprepared from hunting down government officials to demand assistance. It won’t stop the unprepared from resorting to violence to get what they need.

          The worst case scenario I can envision is the government doing nothing to prepare Americans for a pandemic, a severe pandemic hits, and the government again does nothing. It’s a recipe for absolute social chaos and violent anarchy.

          Note that our government would be the only government in the world to do nothing in response to the pandemic in that instance. And we should trust them?"

          Here's the thread I attempted to post to:

          http://blog.pandemicflu.gov/...

          Pfft.  That's not a blog, it's government propaganda.  If they can't take the heat, they should stay out of the kitchen.  Since their current motto is "you're on your own," why do they bother with their blog when they intend to do nothing?

          •  Here's how I responded to that moderation: (0+ / 0-)

            "I cry foul on this blog.  You don't want to hear the actual issues that are being raised amongst the public about a government pandemic response - generally as a direct result of the terrible response to Katrina.  You don't want to be questioned, or hear that your last screw up made us wonder if we could trust you.  Is that a surprise, given the disaster you created out of the Katrina response?  So if we say that out loud - why should we trust the government in a disaster, our post gets dumped?

            Is it just happy, happy, joy, joy, or you don't get to post here?

            That's not a blog, that's communism."

          •  it's a moderated govt. blog (0+ / 0-)

            The 'hunting down govt. officials' might have been a bit strong for the venue. Well, anyway, thanks for posting. We are both interested in the response.  ;-)

            "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 Jun 10, 2007 at 01:53:18 PM PDT

            [ Parent ]

            •  Yes, but the hunting down government (0+ / 0-)

              officials was to demand assistance.  I wasn't implying anything else.

              I think they didn't like the fact that I said I don't trust them.

              After Katrina, who could blame me?

              But they want to dodge the issue of their incompetence, and the effect it has on public confidence.

              •  there's plenty of uncomplementary posts there (0+ / 0-)

                try this thread ;-0

                http://blog.pandemicflu.gov/...

                see also:

                KimT/CMT Says:

                Sick of It post #35 raises a REALLY Great question. I have had a number of people ask me about it too since they know I have neen following panflu data.

                What is the government going to do about it?

                Will the officials, troops be told to take supplies from citizens to be given to those that did not prepare?

                It did happen in Katrina.

                Until we receive an answer my advice to people is to use cash only for prep supplies.

                "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 Jun 10, 2007 at 02:48:29 PM PDT

                [ Parent ]

                •  I think they do intend to seize our preps (0+ / 0-)

                  So I don't think we'll get a response.

                  There's some grumbling in paradise about what's really going on with the government and various others here:

                  http://www.singtomeohmuse.com/...

                  It's ironic that I found this link at the HHS site, and one of the first threads I saw when visiting the site was the link above.

                  I'm not sure what to think about what's going on, but I've seen enough to have no confidence in what they're doing.  And to worry.  And to know that I'm not the only one who feels that way.

                  WRT hunting down government officials to demand assistance, that's exactly what will happen, IMO.

                  The truth hurts, but...

      •  actually, come to think of it (1+ / 0-)
        Recommended by:
        RunawayRose

        you can. Just post the exact same question there to Admiral Agwunobi. That's the point of the blog.

        "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 Jun 09, 2007 at 08:58:56 PM PDT

        [ Parent ]

  •  excellent diary, DemFromCT (4+ / 0-)

    And you end with a superb point:

    After all, preparing for H5N1 prepares for any pandemic we get.

    We won't be able to deal with even a more limited outbreak until we truly comprehend that it can happen.

  •  Don't underestimate the importance of this diary. (4+ / 0-)

    As was demonstrated in Katrina and other recent disasters, help from outside sources is unreliable at best.  Look carefully at what you have on hand. Start washing your hands much more often and longer than you do.  And, for Pete's sake, keep your hands away from your face, especially when in public places.  

    Health care for people, not for profit.

    by bloomer 101 on Sat Jun 09, 2007 at 07:58:32 PM PDT

  •  Great diary. (1+ / 0-)
    Recommended by:
    RunawayRose

    Thanks for a calling our attention to this very important topic.  I hope we prepare well, but I also hope and pray it doesn't happen.

  •  SARS Was Brutal (6+ / 0-)

    I talked to someone from the women's hospital that got hit hard. They said the x-rays were freaky - not congested, but the virus had just ripped big holes in the lungs. In those scenarios you hope that the virus "burns itself out" - that's it's so lethal that victims don't have time to spread it.

    •  The scary part is that H5N1 is worse. (5+ / 0-)

      Fatality rate in Indonesia is currently above 80%.

      SARS only hit 20%, I believe.

      If H5N1 goes pandemic with that kind of fatality rate, we're screwed.

      In that case, being prepared will mean the difference between life and death for you and your family.  Not optional.  Not a nice thing to do.  Necessary, essential, vital.

      The brainiacs in the government will probably run around trying to steal people's preps.  Worse, they might be trying to steal them for their cronies.

      What I saw after Katrina was extremely disturbing and I don't trust the government one bit to do the right thing - including letting people keep their own preps.

      •  The difference between life and death? (1+ / 0-)
        Recommended by:
        KiaRioGrl79

        Here's the scenario:

        You either are exposed
        OR
        You aren't exposed.  

        If you are exposed:
        You either become infected
        OR
        You don't become infected.

        If you do become infected
        You either develop life threatening complications
        OR
        You don't develop life threatening complications.

        If you do develop life threatening complications, only hospital level services can help you.

        The best way to win in a pandemic is to not play the game!  Preparations are good for keeping you safely at home away from the disease, so stock up on food, water and prescription meds.  And skip the TamiFlu unless you have money to burn.  TamiFlu doesn't do squat for respiratory distress and pnuemonia.  The virus doesn't kill you, the complications do.

        •  tamiflu remains controversial (2+ / 0-)
          Recommended by:
          Fabian, KiaRioGrl79

          it's got to be taken within 48 hours of symptoms, and maybe at a higher than normal dose. it has too few trials in H5N1, almost none controlled, to know. Most experts still recommend it because if you keep the viral pneumonia under control, you're less likely to get secondary infection with staph or something else.

          But you're right that non-pharmaceutical methods of avoidance will be needed. Plans for that need to be done in advance.

          There'll also not be a vaccine for 6-12 months after a pandemic starts. The currently licensed panflu vaccines are for emergency workers only, do not work well, and there's not enough to go around. We can start manufacturing vaccine 4-6 months after a pandemic starts, but it will take months to ramp up production after that.

          "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 Jun 10, 2007 at 04:31:43 AM PDT

          [ Parent ]

          •  I actually had really good luck with (1+ / 0-)
            Recommended by:
            Fabian

            Resveratrol and Oscillococcinum when I had the regular flu.

            OK, so I had to test them to see if they actually work.  I had tucked away a packet/bottle or two in my storage.

            For me, they worked better when I took both than when I only took one or the other.  And they worked far better than doing something like taking tylenol.

            Once the two took effect, my flu symptoms were entirely gone.  I had to take them faithfully for about 3 days, then I was OK.

            To be honest, I was quite shocked that they worked as well as they did.  I'd never taken homeopathic remedies before.

            My plan, rather than to feed the Tamiflu profit machine, is to use the natural remedies that have actually worked for me.

            I've never taken Tamiflu, so I don't know how quick it knocks down the symptoms and gets you better, but I was VERY impressed by the results of my own personal test of these two natural remedies.  Your own results may vary, and all that disclaimer stuff.

            From now on it's my treatment of choice for the flu, pandemic or no.

            My results were based on using them against the regular flu, to which I have immunity, but I figure if my options are limited to what I can get over the counter to care for myself in a Pandemic when hospitals and doctors are overwhelmed, then I need to get the best over the counter remedy I can find.  These two worked for me really well.

      •  SARS CFR was 9%. The scary part was its velocity (2+ / 0-)
        Recommended by:
        4jkb4ia, KiaRioGrl79

        The SARS CFR was just under 9.6%.  See the last WHO published stats on this, Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003.

        And the total number of cases was never all that frightening, taken as a global total over an interval of 9 months.  We probably lose more than 8096 people, plantwide, in any given nine months from falls downstairs and slipping in the bathtub.

        The things about SARS that were truly frightening, even considered 4 years after the fact, were as follows:

        • The way it made use of the technology of globalization to hop from continent to continent.
        • The speed with which it spread, when it was much less well adapted to "stealth" spreading than any seasonal airborne-H2H influenza is.

        On May 20, 2003, this little gem was published by the WHO: Severe acute respiratory syndrome (SARS): Status of the outbreak and lessons for the immediate future (PDF).

        I sat down a couple of years later and extracted a timeline from this document.  It makes very frightening reading.

        • February 21, 2003

          A 65-year-old medical doctor from Guangdong checks into the 9th floor of a Hong Kong hotel. He had treated patients with "atypical pneumonia"prior to departure and is symptomatic upon arrival in Hong Kong. He infects at least 12 other 9th floor guests and visitors.

        • February 26, 2003

          A 48-year-old Chinese-American businessman is admitted to the French Hospital in Hanoi with a 3-day history of respiratory symptoms. He had previously been in Hong Kong, where he visited an acquaintance staying on the 9th floor of the hotel where the Guangdong physician was a guest.

        • March 1, 2003

          A 26-year-old former flight attendant is admitted to a hospital in Singapore with respiratory symptoms. A resident of Singapore, she was a guest on the 9th floor of the Hong Kong hotel.

        • March 5, 2003

          In Hanoi, the Chinese-American businessman, in a stable but critical condition, is air evacuated to the Princess Margaret Hospital in Hong Kong. Seven health workers in Hanoi who had cared for him are ill.

          An elderly Toronto woman, who had been a guest on the 9th floor of the Hong Kong hotel, dies at Toronto's Scarborough Grace Hospital. Five members of her family are found to be infected and are admitted to the hospital.

          Dr. Carlo Urbani, a WHO official based in Viet Nam, continues to treat cases at the Hanoi French Hospital.

        • March 11, 2003

          Dr. Urbani departs for Bangkok, where he is scheduled to give a presentation on tropical diseases. He is ill upon arrival and is immediately hospitalized.

        • March 13, 2003

          Health authorities in Ontario, Canada take steps to alert doctors, hospitals, and public health units that there are 4 cases of atypical pneumonia in Toronto that have resulted in 2 deaths.

        • March 15, 2003

          WHO intervenes to have a Singaporean physician, who had treated patients with atypical pneumonia in that country, removed from a flight in Frankfurt, Germany, and immediately placed in isolation.

        Sweet!

        SARS hops a flight from Hong Kong to Hanoi and establishes itself there within five days of its first arrival in Hong Kong.

        In less than two weeks, it's killing people across the Pacific Ocean, in North America.

        Within 22 days, it's in Germany. It has now hopped two oceans.

        And in four calendar weeks, on March 21, where are we?

          Well, we're here.

          Cases are being reported in from Italy. Slovenia. Ireland. Spain. 15 countries in all.

        In just 28 days.

        Jesus.

        The increase of the SARS epidemic's geographic extent, measured in countries, now begins to slow, because by this time, the WHO has already caught wise to the fact that it is using commercial airliners as a vector.

        Everybody now knows.

        And SARS just isn't contagious enough to evade quarantines at all easily once the authorities are roused and warned, as all now are by the last week in March, 2003.

        But influenza is capable of managing that little trick, because a flu victim can be contagious for up to 48 hours before showing symptoms, if my memory serves me correctly.

        •  controversial (little proof) but (1+ / 0-)
          Recommended by:
          KiaRioGrl79

          likely 24 hours pre-symptoms. The biggest infectivity is 24-72h after getting sick. In 40 days flu can spread across the world.

          may I steal borrow your timeline?

          "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 Jun 10, 2007 at 05:41:57 AM PDT

          [ Parent ]

          •  Timeline (1+ / 0-)
            Recommended by:
            KiaRioGrl79

            By all means.

            I wrote that up to try to drive home the impact of passenger air travel on the velocity of a future pandemic.  The WHO was blindsided because this has never happened before.

            The virgin field pandemics that nearly slate-wiped the Native American population of two continents were carried by ship.  They took weeks to make a problematic passage, and months to years to get established.  And they trickled over here over the course of four centuries, more or less by accident.  Smallpox got here first because practically everybody in Europe was exposed to it.  But yersinia pestis didn't show up in North America until the incredibly late date of 1900.

            Four weeks from initial escape from the epicenter to global presence was unheard-of prior to 2003.

            If our luck runs out with H5N1, we can expect it to spread even more quickly than SARS did.  There simply won't be time to prepare much, once the thing goes airborne H2H.

            We'll have to face it with what we have on hand at that time.  Not with what we hope to cobble up at the 11'th hour; there won't be time.  We either make preparations prior to H5N1 becoming a threat-in-being, or we deal with the crisis with nada.

            I'd like this timeline spread far and wide, thank you very much.  It may give more people an idea of exactly what the new globalization-enabled pandemic threat environment is really like.

        •  Given the infectivity rates of flu, (1+ / 0-)
          Recommended by:
          KiaRioGrl79

          can you imagine the rate at which a full blown pandemic would propagate?  HHS says we'll have months of advance warning that a pandemic is coming.  I think they're high. I think once the thing starts transmitting human to human efficiently, it's going to be all over the world in the first month.

          Containing the thing would be a nightmare.

          I can only hope that the case fatality rate goes down.  If it doesn't, and it has standard flu transmittability, we're toast.

          I think the FIRST thing governments would do with that high a fatality rate and full blown transmissability is PANIC!  They'll be shutting down all transportation, quarantining the masses, and doing everything to try to contain the beast.  There will be a lot of panicked decision making in initial stages, and you know what those kinds of decisions are like.

          •  HHS is nuts. Yeah, they'll panic. (1+ / 0-)
            Recommended by:
            SecondComing

            HHS says we'll have months of advance warning that a pandemic is coming.

            Well, they have to studiously ignore the lessons of the SARS incident in order to believe that.  But then, the way Little Boots has hollowed out Federal agencies, I'd be surprised if there's anybody left there in charge past the usual Bushbot incompetents like Brownie, Chertikoff, Gerberding, etc., etc., ad nauseum.

            I think the FIRST thing governments would do with that high a fatality rate and full blown transmissability is PANIC!

            Everyone will panic.  That's what usually happens when people are confronted with a threat they are unfamiliar with and are completely unprepared for.

            Given preparation and a sufficient degree of familiarity, humans will do what they figure they must, KNOWING they won't survive.  In mute testimony, I give you just about every high-intensity battle in recorded history.  The Somme comes uppermost to mind.

            But hand them something out of the blue, and they will freak out.  Humans don't handle imponderables and complete unknowns very well at all.

            Add the perception of lies and breach of trust by the authorities, and all hell will break loose.  For evidence of that, I give you the Beijing Panic of April, 2003.  All those people knew was that the government was lying to them.  So they jammed into train stations in their thousands and paid scalpers rate for tickets to ANYWHERE, so long as it wasn't Beijing.

            Meanwhile, SARS never even managed to kill more than ten people per day on average, in the ENTIRETY OF CHINA, let alone Beijing, during the entire course of the epidemic.  It was so far down on the list of things you could die of, that it would have fallen off the bottom if it hadn't made the papers.  And if the government had told people the truth.

            They'll be shutting down all transportation, quarantining the masses ..

            Which won't work, of course.

            Even if they shut down mass transportation - the most important secondary vector will then be wildfowl.  Which will simply fly over any quarantine governments can erect.

  •  I agree that an ALL HAZARDS approach (1+ / 0-)
    Recommended by:
    KiaRioGrl79

    to preparation is the way to go.

    However, getting people PAST the notion that preparing for disaster is somehow "Wacky" or "Weird" or that those who prepare are "Survivalists" with all of the negative connotations that go with that, is going to be very, very hard to do.

    People have gotten the idea that being self-sufficient is somehow "wrong"....

    THIS is what we are up against when trying to get people to prepare for ANY disaster, let alone a pandemic of this potential magnitude.

    I could give you good examples of my neighbor's apathetic attitudes during severe weather events and power outages... They look at me like I have three heads when I urge them to fill their bathtubs with water or figure out what is the safest room in their house to shelter from storms....I can just imagine how they would react should I suggest they stockpile food and medications.

    •  it's true (3+ / 0-)
      Recommended by:
      KiaRioGrl79, SaraBeth, sillia

      and surveys supprt that. but if you can't get 44% of people to think about the futue, it means you CAN get 56%.

      Why Don't People Prep?

      Think of it as an election. You're never trying to convince everyone. Settle for a working majority, and that's progress. it eases the burden on everyone else.

      "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 Jun 10, 2007 at 05:46:04 AM PDT

      [ Parent ]

      •  Here is what I have run up against... (0+ / 0-)

        They may not really know what a public health crisis is, but they have experience with major storms and they readily accept that storms or other emergencies could cause disruptions in basic services such as electricity, water, transportation, and grocery and drug stores, leading to a public health crisis.

        They may "readily accept" that storms or other emergency could occur... they just don't seem to really care. "I'll deal with it if and when it happens." is the message I get from folks I talk to. "The weather man never gets it right." "Pandemic? Oh it's just to keep us afraid."

        Yes, education IS the key... but how...? "Public Service" messages on T.V. are already few and far between...the barest of minimums... We need an "Al Gore" kind of blitz. Hour long documentaries... In depth special reports from our news media...etc.

        "Think of it as an election. You're never trying to convince everyone. Settle for a working majority, and that's progress. it eases the burden on everyone else."

        I look at what happened in New Orleans... Those folks live with the threat of hurricanes every season... If THEY weren't prepared... sigh

        •  that's why we're giving this HHS blog a shot (0+ / 0-)

          I erm don't normally work with WH appointees. For this, i will.

          "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 Jun 10, 2007 at 06:47:33 AM PDT

          [ Parent ]

  •  Why Don't We Do In In Our Sleeves... (1+ / 0-)
    Recommended by:
    DemFromCT

    As someone who works in health care (IT Professional) we get bombarded by all sorts of stuff.  Soon you learn that the one of the best ways to stop infection is on a very personal basis.  It's up to all of us.

    So why not learn how to sneeze?  There is an excellent video that shows how to do it ... just click here.

    (-9.00, -8.92) Those Who Hear Not the Music, Think the Dancers Mad

    by craigb on Sun Jun 10, 2007 at 08:30:49 AM PDT

  •  What are the odds that H5N1 will become pandemic? (0+ / 0-)

    I'd really like to know the answer to that question.

    For the last few decades, centuries, etc, there must have be hundreds or thousands of viruses that have come into being.

    No?

    Of those, how many have become pandemic?

    So, again what are the odds that H5N1 will become pandemic?

    •  Of course, (0+ / 0-)

      no one knows. One thing we do know is; that a pandemic occurs at regular intervals throughout human history, and we are overdue.

      Also, consider recent human activity across our planet. We kick over every rock, interrupt every ecosystem. Then consider, our very human, conscious intent to do each other harm with bio-weapons. H5N1 may or may not be the next, but there will be a next.

      Sold in then sold out

      by Citizen80203 on Sun Jun 10, 2007 at 08:55:11 AM PDT

      [ Parent ]

    •  Imponderable (0+ / 0-)

      There is simply no way of assessing the odds.

      It won't take too many changes in the genome.  But viral genomes can change by -

      • Mutation: Random changes effected by the environment: ionizing radiation, chemical means, etc.,
      • Reassortment: Bulk exchange of genetic material between two similar but not identical virus strains co-infecting the same host, and
      • Recombination: Small-scale xchange of genetic material between two similar but not identical virus strains co-infecting the same host, and

      We don't know enough about any of these processes to make an assessment as to odds.  Recombination is still controversial.  And it isn't clear, AFAIK, the degree of genetic variation across which exchanges can be made.

      We also only have the smallest insight into which genetic changes could render H5N1 airborne H2H infectious.

      This makes ANY attempt to generate commitment to preparation immensely difficult.

      As anybody who has spent much time in corporate or government information security knows, it's stony hard to make a business case to effect management buy-in when you only have expected loss per incident without incident probability.  Even when management knows, up front, that absence of a comprehensive security program will open the door to system compromise.  Without hard numbers, it's just not "real" enough.

      This is worse, because we've never observed the evolution of a pandemic virus before it created a pandemic.

      If this were like an earthquake or seasonal hurricane, we'd have extensive history of observations to go on, and we could draw on this for estimates as to likelihood.  But 100 years ago, we didn't even know viruses existed.  The 1918 pandemic was laid to a bacterial root cause for decades before we learned better.

      In short, we just do not know enough.  The probability you want - and that I want, for that matter - isn't to be had.

    •  robert webster writing in EID (0+ / 0-)

      link

      Conventional wisdom about pandemic influenza holds that a pandemic is inevitable and that the only question remaining is "When?" The H5N1 virus continues to evolve and spread, with additional human infections occurring in Vietnam, Cambodia, Indonesia, China, and Thailand. If this virus acquires human-to-human transmissibility with its present fatality rate of 50%, the resulting pandemic would be akin to a global tsunami. If it killed those infected at even a fraction of this rate, the results would be catastrophic.

      and

      We cannot afford simply to hope that human-to-human spread of H5N1 will not happen and that, if it does, the pathogenicity of the virus will attenuate. Notably, the precursor of the severe acute respiratory syndrome (SARS)–associated coronavirus (31) repeatedly crossed species barriers, probably for many years, before it finally acquired the capacity for human-to-human transmission, and its pathogenicity to humans was not attenuated. We cannot wait and allow nature to take its course. SARS was interrupted by early case detection and isolation, but influenza is transmissible early in the course of the disease and cannot be controlled by similar means. Just 1 year before the catastrophic tsunami of December 2004, Asian leaders rejected a proposed tsunami warning system for the Indian Ocean because it was too expensive and the risk was too remote. This mistake must not be repeated in relation to an H5N1 avian influenza pandemic. We must use this window of opportunity to prepare and to begin prepandemic implementation of prevention and control measures.1

      This is why we evoke the precautionary principle.

      "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 Jun 10, 2007 at 01:56:44 PM PDT

      [ Parent ]

    •  the WHO working group (0+ / 0-)

      From WHO Working Group, 21-22 September 2006 (p. 15)
      http://tinyurl.com/...

      One especially important question that was discussed is whether the H5N1 virus is likely to retain its present high lethality should it acquire an ability to spread easily from person to person, and thus start a pandemic. Should the virus improve its transmissibility by acquiring, through a reassortment event, internal human genes, then the lethality of the virus would most likely be reduced. However, should the virus improve its transmissibility through adaptation as a wholly avian virus, then the present high lethality could be maintained during a pandemic.

      This is why we evoke the precautionary principle. it does not require knowing the odds to take steps to mitigate a real danger.

      "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 Jun 10, 2007 at 02:01:04 PM PDT

      [ Parent ]

    •  A reading list to answer your question (0+ / 0-)

      "Origin of Species" by a guy named Charles Darwin.

      Then get a first year statistics textbook.

      Combine the two. There is very very little chance this virus will become human transmissable.

      This is fearmongering. It is exactly what the right does with "terrarists are coming to eat your babies!". People pick their favorite fears..

      Tens of millions are dying as we speak of Aids. Millions will die in the near future from Hiv, Tuberculosis, Malaria, Measles etc etc and their side effects. Not to mention starvations, lack of health care, state sanctioned murder, et al...

      But those arent "sexy". And they happen to those brown people. And poor people. And it would require a drop in the bucket moneywise and that western governments act Morally in their foreign policy to stop. Much easier and more fun to panic over a micropercentage chance that evilscarydisease will come destroy our way of life follow us home make us all wear turbans launch a nuclear strike kill our helpless babies.

      Troll rate away true believers.

      "All you have to do to qualify for human rights is to be human" An 11yo Girl. Unbossed.com

      by cdreid on Sun Jun 10, 2007 at 03:18:54 PM PDT

      [ Parent ]

      •  And you somehow think that WHO would (0+ / 0-)

        sign up for this little plot?  As well as a lot of credentialed doctors?  They have an agenda to scare us all?

        You have evidence for this?

        Yes, read Darwin.  You might find survival of the fittest selects against you.

        •  Umm (0+ / 0-)
          most of the hysteria is coming from the net. The medical establishment simply refuses to get into the panic you wish them to. Note the above posts about likelihoods and potentials are very very very careful to avoid numbers. Numbers that probably could be estimated were it in the interests of those quoted to do so.

          Um.. if thats your best insult you should try harder. Really. Bird flu first has to become human to human transmissable. Small chance of  that happening. Then it has to become transmissable via cough (particular kinds oflung infection). Or via flea, et al as in the black plague. Or perhaps as ebola through body fluids after creating open wounds (pretty darn rare). The odds of that happening are probably along the lines of aids becoming airborne/aerobic. And it THAT happens (aerobic hiv) say bye bye to the human race.

          "All you have to do to qualify for human rights is to be human" An 11yo Girl. Unbossed.com

          by cdreid on Sun Jun 10, 2007 at 11:59:32 PM PDT

          [ Parent ]

          •  So it's hysteria to prep for a pandemic? (0+ / 0-)

            In your opinion, we shouldn't worry or prep until it goes pandemic?

            So, in the very brief window between viral change to allow efficient human-to-human transmission and resultant widespread cases the entire world is supposed to prep for a pandemic?

            Like trying to shop (or leave the city) on the eve of a Hurricaine?  Yeah, that worked out well for Katrina.

            That's one way to cull the herd.

            Like it or not, prepping for a pandemic isn't easy, nor can it be done overnight.  So while your approach might make you feel all warm and comfy, it doesn't do much for survivability if it does mutate to efficient human to human transmissibility.

            Hence, Darwin.

            •  No (0+ / 0-)

              So, in the very brief window between viral change to allow efficient human-to-human transmission and resultant widespread cases the entire world is supposed to prep for a pandemic?

              Origin of species is a good intro to evolution. There is no more guarantee it will become h2h than any of the other bajillion viruses that could have should have would have become  humanitykillers. For instance if AIDS becomes aerobic and airborne.. bye bye humanity. Or say bubonic plague becomes antibiotic resistant. Or  the us intelligence agencies produce another experiment like ebola (watch the documentary of the epidemic and deny that.. )

              There are a lot of killers out there. Tuberculosis, aids, etcetc etc.. but they arent "sexyscary!", profitable and a threat to wealthy white westerners.. so lets get our panties in a bunch about this phantom.. cuz phantoms is skeeery.

              "All you have to do to qualify for human rights is to be human" An 11yo Girl. Unbossed.com

              by cdreid on Mon Jun 18, 2007 at 02:00:14 PM PDT

              [ Parent ]

      •  hey cdreid (0+ / 0-)

        how ya been? ;-)

        the threat is real, it's always been real, and despite you saying so, it is going to be needing the attention of individuals. And since H5N1 and pandemics affect the poor far more than us, it's a big deal.

        Meantime, simultaneously, other things need attending to. Luckily for the world, we can multi-task.  But more about that tomorrow.

        Instead of being dismissive, spend more time learning about what you don't know (or what you think you do know).

        "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 Jun 10, 2007 at 03:43:53 PM PDT

        [ Parent ]

        •  As before dem (0+ / 0-)

          this potential threat needs the attention of the medical community. And it is a potentially huge threat. However it appears it is among some a "fear of the moment" to obsess over. Present company excluded. I simply believe we have much more important issues to invest in. In this particular area of healthcare even making standard vaccinations and things like base antibiotics available worldwide would save more lives than even "bird flu activists" worst nightmares could take.

          "All you have to do to qualify for human rights is to be human" An 11yo Girl. Unbossed.com

          by cdreid on Sun Jun 10, 2007 at 11:52:26 PM PDT

          [ Parent ]

          •  Do the math (0+ / 0-)

            Present estimate of attack rate: 0.25
            Present Case Fatality Rate: 0.6
            Population of the United States: 300,000,000.

            Multiply these three numbers together for a "worst case" scenario, specifically excluding fatalities due to civil disorder.

            Is your mind boggling yet?

            Could be worse.  Could be 1347 redux.  Which H5N1 promises to miss even if it does go airborne H2H.

            And that's just for the States alone.

            If we don't get this right, we lose the civil order piece too.

            How are you are chipping flints?

          •  investment in pandemic vaccine production (0+ / 0-)

            for worldwide use is investment in vaccine productiin for worldwide use... and so on.

            here's another tie in:

            http://blog.pandemicflu.gov/...

            "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 Mon Jun 11, 2007 at 07:40:37 AM PDT

            [ Parent ]

  •  Thanks Again DemFromCT (0+ / 0-)

    Every time you post about a possible pandemic, you open a new eye to this very real threat.

  •  Here's the thing: most people don't trust (0+ / 0-)

    our government to tell the truth.  About anything.  So when they hear about a potential pandemic, they don't believe it.  The government as a whole represents the boy who cried wolf.  Color-coded threat levels, impending doom from every angle, "mushroom cloud," etc.

    My feeling is that when people hear "pandemic," they remember the calls to stock up on plastic and duct tape.  Since no one is sick in the U.S. at the moment, the possibility of a flu pandemic simply doesn't register.

    Even after Katrina and its aftermath, I don't believe that most people can - or will allow - themselves to think in terms of huge natural disasters.  We all have a certain sense of "it won't happen here."

    How do you correct these types of group-think?  I have no idea, but I honestly believe that is the crux of the matter as it relates to people not preparing ahead of time.

    The Rapture is not an exit strategy. (-6.5/-7.33)

    by pidge not midge on Sun Jun 10, 2007 at 09:05:39 AM PDT

    •  Trust? (0+ / 0-)

      Why should be `trust' that H5N1 may become pandemic when we do not even know what percentage of viruses actually do become pandemic?

      I find great nearness between the elevating of the threat of H5N1 and the selling of H5N1 vaccine strange.

      H5N1 was around years ago too, prior to the Bush admin.

      In time, it just disappeared.

      Recently, with the Bush admin, it resurfaced as a potential menace.

      •  mistrust is no excuse for ignorance (1+ / 0-)
        Recommended by:
        Sick Of It

        this is an international issue, with international concerns that transcend this administration (which is why Obama and Reid were discussing it as far back as 2005).

        The vast majority of viruses don't become pandemics (3 per century, on average). What does that matter? The vast majority of lightning strikes don't hit you either. Are you suggesting that therefore they are not dangerous, and the odds are that you can play golf on a mountain in the midst of a thunderstorm and ignore the odds? The vast majority of cat 5 hurricanes don't hit New Orleans. Are you saying we don't need strengthened and repaired levees?

        In fact, the chances of a pandemic happening are 100%. No one knows the odds of a pandemic happening with H5N1 (I wish we did) and that's where the precautionary principle comes into play.

        it's really a simple concept and you should spend some time understanding 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 Sun Jun 10, 2007 at 11:00:01 AM PDT

        [ Parent ]

        •  The Truth about H5N1 (0+ / 0-)

          DemFromCT: that transcend this administration

          Actually, H5N1 precedes the Bush admin. It simply failed to take flight in the media a few years back.

          DemFromCT: The vast majority of viruses don't become pandemics (3 per century, on average).

          Thanks for admitting that.

          That would be a **great** statement you could include in all your posts in re to H5N1, no?

          With copy and paste, it would be very easy to do.

          E.g.:

          The vast majority of viruses don't become pandemics, so it is highly probable that H5N1 will not become pandemic just like the  vast majority of other viruses.

          That is the truth.

          DemFromCT: What does that matter?

          The truth matters a lot.

          Why should people not know the truth, i.e.  it is more probable that H5N1 will not become pandemic.

          A lot of people are actually scared to the extent of taking Tamiflu when it is highly probable that H5N1 will not become pandemic like the  vast majority of other viruses.

          DemFromCT:  The vast majority of lightning strikes don't hit you either.

          True, but not relevant.

          Why?

          The already present harmfulness of lightning is NOT analogous to the ***not yet** harmfulness of a pandemic H5N1.

          Unlike H5N1, lightning does not need to beat the odds and then to mutate into a form harmful to humans.

          Lightning already exists in a form that it is harmful to humans.

          All I am saying is that the truth should be stated with all posts in re to H5N1.

          I am not saying do not take precautions, etc.

          Let the truth be known!!

          The vast majority of viruses don't become pandemics, so it is highly probable that H5N1 will not become pandemic just like the  vast majority of other viruses.

          •  sorry, but you're completely misinformed (1+ / 0-)
            Recommended by:
            Sick Of It

            Your 'it's not analogous because lightning is dangerous and H5N1 is not' statement is unfounded. The truth is that H5N1 has a 61% case fatality rate and infects on average a person a week. The truth is that people educated and informed in virology, public health and medicine have a healthy respect for this virus, and fear it based on knowledge. British virologist John Oxford:

            Fortunately, the world has woken up to the threat of H5N1. The US government has thrown $9 billion at the problem, much more than against smallpox and polio combined. Every related research programme in the United States will benefit. The ripples have even reached Britain. There is now an axis of flu research, but will we join it? Yes please!

            However, the book fails to confront the question I am asked daily: "Why are you so worried about 151 deaths from H5N1?" Well, go back to 1916, to Etaples in northern France, where a form of flu causing heliotrope cyanosis (a characteristic lavender coloration of the face) with a case fatality of 60% was beginning to spread. There were 145 cases. At some point in the next two years it mutated to become more infectious and 30 times less virulent. Then it killed 50 million people. Doesn't this ring a nasty bell?

            I understand you want it to be a non-problem, but alas that's not the truth. The truth is that you dismiss all the facts and all the experts just so that you can be right in your own mind and feel better about the world.

            1. Influenza pandemics are recurring events.

            An influenza pandemic is a rare but recurrent event. Three pandemics occurred in the previous century: "Spanish influenza" in 1918, "Asian influenza" in 1957, and "Hong Kong influenza" in 1968. The 1918 pandemic killed an estimated 40–50 million people worldwide. That pandemic, which was exceptional, is considered one of the deadliest disease events in human history. Subsequent pandemics were much milder, with an estimated 2 million deaths in 1957 and 1 million deaths in 1968.

            A pandemic occurs when a new influenza virus emerges and starts spreading as easily as normal influenza – by coughing and sneezing. Because the virus is new, the human immune system will have no pre-existing immunity. This makes it likely that people who contract pandemic influenza will experience more serious disease than that caused by normal influenza.

            1. The world may be on the brink of another pandemic.

            Health experts have been monitoring a new and extremely severe influenza virus – the H5N1 strain – for almost eight years. The H5N1 strain first infected humans in Hong Kong in 1997, causing 18 cases, including six deaths. Since mid-2003, this virus has caused the largest and most severe outbreaks in poultry on record. In December 2003, infections in people exposed to sick birds were identified.

            Since then, over 100 human cases have been laboratory confirmed in four Asian countries (Cambodia, Indonesia, Thailand, and Viet Nam), and more than half of these people have died. Most cases have occurred in previously healthy children and young adults. Fortunately, the virus does not jump easily from birds to humans or spread readily and sustainably among humans. Should H5N1 evolve to a form as contagious as normal influenza, a pandemic could begin.

            That's the truth. What part of it are you having trouble with?

            "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 Jun 10, 2007 at 12:39:43 PM PDT

            [ Parent ]

            •  Foul! Inaccurate rewording!! Foul! (0+ / 0-)

              DemFromCT: Your 'it's not analogous because lightning is dangerous and H5N1 is not' statement is unfounded.

              Foul!!

              You are completely mis-representing my words.

              I am not at all saying that a pandemic H5N1 would not be dangerous.

              Here's what I wrote:

              The already present harmfulness of lightning is NOT analogous to the ***not yet** harmfulness of a pandemic H5N1.

              Unlike H5N1, lightning does not need to beat the odds and then to mutate into a form harmful to humans.

              Lightning already exists in a form that it is harmful to humans.

              So, again, I did not write that a pandemic H5N1 would not be dangerous.

              The TRUTH:

              The vast majority of viruses don't become pandemics, so it is highly probable that H5N1 will not become pandemic just like the  vast majority of other viruses.

          •  Here's truth (0+ / 0-)

            "Consider the concept of evacuating top executives and housing them in "safe havens," where they can be protected."

            < snip >

            "ISSUES TO CONSIDER

            • Shortages of critical supplies will necessitate security to protect critical assets.

            • Social disruption may occur, increasing the likelihood of public panic and disorder."

            http://www.kiplinger.com/...

            Do you REALLY think Kiplinger would be publishing these kinds of things for businesses if there were no risk?

            In addition:

            "Lightning already exists in a form that it is harmful to humans."

            H5N1 is also already harmful to humans, and since 2003 189 people have died.

            http://www.who.int/...

            Here's what the World Health Organization has to say about it:

            http://www.who.int/...

            Given the time compression between the day a virus becomes easily transmissible and the day the pandemic is in full blown outbreak and disruptions are already occurring, when would you propose we prepare?  When it's too late?

            How do you get people to prepare if you don't make them aware of the risks?

            Yes, H5N1 may not become a pandemic.  But what if it does, and people have listened to you and failed to prepare because you said it's not much of a risk?

            •  Vast majority of virsuses don't become pandemics (0+ / 0-)

              Sick Of It: Yes, H5N1 may not become a pandemic.  But what if it does, and people have listened to you and failed to prepare because you said it's not much of a risk?

              Again, all I am doing is bringing up the notion that people should be well informed of the fact that the vast majority of viruses don't become pandemics, so it is highly probable that H5N1 will not become pandemic just like the  vast majority of other viruses.

              What's wrong with including that fact?

              I am not saying a pandemic H5N1 would not be dangerous.

              I am not saying not be prepared.

              I am asking that the truth be told as a sort of standard disclaimer.

              That's all.

            •  Vast majority of viruses don't become pandemics (0+ / 0-)

              Sick Of It: Yes, H5N1 may not become a pandemic.

              May not become a pandemic?

              The vast majority of viruses ***don't*** become pandemics, so it is highly probable that H5N1 will not become pandemic just like the  vast majority of other viruses.

              A para like this should be part of every H5N1 post.

              To knowingly admit this HARD FACT is wrong.

              Why not include this?

              •  you meant, I think (0+ / 0-)

                "To knowingly omit this HARD FACT is wrong."

                You're right, I grant you that it is a hard fact that the vast majority of flu viruses do not become pandemics. The concern isn't about the many that don't, it's about the very few that do.

                The analogy to hurricanes remains apt. The vast majority of storms do not become cat 4 or 5 hurricanes. Disaster planning is for the few that do.

                "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 Jun 10, 2007 at 05:53:30 PM PDT

                [ Parent ]

  •  As someone from Toronto (1+ / 0-)
    Recommended by:
    infosec guy

    I'd say the biggest problem won't be the actual disease but the disruption that a North American outbreak will cause.

    Let's face it, if H5N1 lands in North America it will be the biggest story in the world for the MSM.  They'll go wild creating fearful stories of what's going to happen.  They'll create an absolute shitstorm of paranoia.

    The economy of where ever the breakout is will tank and spread to anywhere else there's a breakout or a connection can be made to the initial place.
    Anything or anyone that can be used to create a "profile" of a possible risk for flu will be.

    The media will pump out these stories 24/7 and damn the consequences if anyone gets hurt in the process.

    Here's what happened in Toronto.  My SIL in California wrote to warn us to stay away from Asians.  Chinese restaurants and the various Chinatowns of the GTA were deserted, because ignorant people thought it had something to with China so anything related was suspect.

    People who could made a killing snapping up bargains as businesses floundered.

    I only realized about the restaurants when we had a treat out at a place that was normally jammed and it was less than 1/4 full.

    Hotels lost bookings as conventions were too scared to come to the city.  Then hotels in other Canadian cities lost bookings because they were in Canada and that's where SARS was.

    Every business person I knew suffered in that time because of fear that their products or services were somehow tainted.

    Expand that by several orders of magnitude and it could get pretty close to anarchy.  Luckily Bush has thought of this and has procedures in place to take control of things.

    The Next Agenda "For Progressive Canadian Politics"

    by Bionic on Sun Jun 10, 2007 at 09:23:28 AM PDT

    •  Like he has control in Iraq? (0+ / 0-)

      In Bush's delusion, his wild ideas of granduer actually work.

      In reality, people are far harder to control than he realizes.

      •  No like a police state (0+ / 0-)

        There were a few diaries about his plans to suspend elections in the event that he determined that there were threats somewhere.

        The Next Agenda "For Progressive Canadian Politics"

        by Bionic on Sun Jun 10, 2007 at 10:51:23 AM PDT

        [ Parent ]

        •  I saw those (1+ / 0-)
          Recommended by:
          Bionic

          What Bush does gives me a lot of angst because I think he's delusional enough to think he might be successful with something like that.  But there are enough Americans who oppose him (75%!) that his delusions would turn to dust once reality set in.

          It's a lot easier to seize control than it is to keep it.

    •  Panic is ALWAYS worse than what triggers it (1+ / 0-)
      Recommended by:
      Bionic

      Thanks, Bionic.  I didn't know what the facts on the ground were in Toronto.  All I knew is that it managed to be the SARS magnet for the entire North American continent.

      Of course, people panicked.  When people are both frightened AND misinformed, that's what they'll do.

      The only cures for this are -

      • Utter transparency by the authorities and
      • the MSM shutting their traps until they actually have something to say.

      The shining example of a public health crisis done right was the almost-epidemic that happened when a car full of hemorrhagic smallpox victims (read "walking dead", because the hemorrhagic smallpox CFR is north of 95%) arrived in NYC from Mexico in 1947.

      In Metro Seattle in spring of 2003, it was all rumors, all the time.  From the way people talked, you'd think half the city was down with the SARS.  Instead of a grand total of 27 probable cases in the entire US, with exactly zero fatalities, which was what actually happened.

      You want my honest opinion?  Here it is.

      Even in the worst case: 45 million dead in America alone, it will still be a "recoverable" disaster if the country doesn't rip itself to pieces in the resulting panic(s).

      •  Not much hope then (0+ / 0-)

        The only cures for this are -

        Utter transparency by the authorities and
        the MSM shutting their traps until they actually have something to say.

        My sister is an infectious diseases specialist.  She told me that they suspect there were more SARS cases in the US, but the reporting procedures regarding iffy cases was different than in Canada.

        How's that for transparency?

        If we get H5N1, I don't think it will be as fatal as the 1918 flu, as we have better ways to treat the symptoms, and people generally practice better gygeine here now than then, but the panic will be absolutely insane.  I expect more people will die of panic related causes than flu.

        The panic will feed on itself because the media will love it.  The government will love it if it means it can tighten its grip on control.

        The Next Agenda "For Progressive Canadian Politics"

        by Bionic on Mon Jun 11, 2007 at 08:22:04 AM PDT

        [ Parent ]

        •  actually it's the opposite (0+ / 0-)

          people rarely panic (anthrax, 9/11) unless info is being withheld (that was the problem in 1918, btw - censorship) or false assurances issued (Toronto, SARS). You can always make them panic, of course, by telling them there's nothing to panic about. ;-P

          OTOH, H5N1 has anywhere between a 33% mortality (Egypt) to 80% (indonesia) at a time that few cases mean there's plenty of hospital beds. The 'better ways to treat' simply do not exist. There are some excellent elite hospitals with WHO support that show nearly a hundred per cent fatality if you are on a ventilator.

          However, in a real pandemic, even if the case fatality rate drops, there are already overcrowded hospitals and ERs. The American public health system cannot cope with a pandemic. That's why this is a big deal, even though it hasn't happened yet. Planning for it and fixing issues will take time and money.

          "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 Mon Jun 11, 2007 at 08:58:39 AM PDT

          [ Parent ]

          •  What false assurances? (0+ / 0-)

            IFAIK the assurances that were issued in Toronto were believed true at the time.  From what I have read they also feel they were unfairly treated because they were more upfront than the Americans in what they considerd to be possibly SARS.

            The better ways to treat are comparing 1918 treatments.

            There will be panic when everyone treats every little sniffle and cough as THE flu.  The tragedy of the masses will kick in and the media will bray it along to a firestorm.

            And I don't know how you can imply there was little panic in relation to anthrax and 911.  So people didn't run around in the streets screaming, but so much of what we are living is the result of deep and massive and manipulated panic.

            The Next Agenda "For Progressive Canadian Politics"

            by Bionic on Mon Jun 11, 2007 at 10:20:07 AM PDT

            [ Parent ]

            •  what happened in toronto (0+ / 0-)

              is that there was a biphasic response. a peak of illness, then assurance that it had died down and was over.. but it wasn't. They had no way to know it was, and said it anyway. That killed trust, and that's what I was referring to.

              And I don't know how you can imply there was little panic in relation to anthrax and 911.  So people didn't run around in the streets screaming, but so much of what we are living is the result of deep and massive and manipulated panic.

              Too big a topic to get into here. Different order of magnitude but manipulation doesn't equal panic.

              "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 Mon Jun 11, 2007 at 11:11:39 AM PDT

              [ Parent ]

  •  No one knows the stats on new pandemic viruses? (0+ / 0-)

    For the last couple hundred years, there have been  thousands of viruses.

    And yet no one knows what percentage of those viruses have become pandemic?

    I'd like to know of the FACTS.

    Do you not find it strange that H5N1 turned into such a potential menace right after Tamiflu came onto the market vis-a-vis Rumsfeld?

    What are the odds that H5N1 will become pandemic?

    •  Do you want to risk the consequences of not (0+ / 0-)

      preparing if a pandemic does come?

      Pandemics are a fact of life.  Even if H5N1 didn't turn into one, there are other diseases that can - like XDR tuberculosis, to point out recent public hysteria.

      While I'm the first to criticize Bush and accuse him of everything under the sun, I have a hard time believing he could get global cooperation in turning H5N1 into a boogey man so Rumsfeld could make money.

      China, for example, would never go for it.  Yet they're a hotbed for H5N1.  Indonesia, a largely muslim state, wouldn't give Bush the time of day if he suggested a little corruption for his cronies and only a few Indonesians would need to die.  Indonesia is a major point of infection for H5N1 and currently has the highest death rate.

      It isn't only the US who is saying H5N1 might go pandemic.  It's a whole lot of people, and a lot of those people aren't necessarily our best friends.

    •  No, it's not strange at all (0+ / 0-)

      The first outbreak of H5N1 that was "above the radar" was the one on Hong Kong in 1997.  That was an epidemic among domestic fowl, but what made it news was 9 human cases, of which (correct me if I'm wrong, DemFromCT) 6 were fatalities.

      This would not have happened without ominous changes in the H5N1 genome prior.

      But see my earlier comment: there is NO WAY we're going to get hard numbers for the odds, because we do not know enough about the underlying biology yet.

  •  Shame on Kos for plugging this pharma hype (0+ / 0-)

    I think the juxtaposition of the announcement of Al Gore's new book and it's theme of the disappearance of rationality from public discourse and yet another piece of avian flu propaganda from demfromct couldn't be more appropriate.

    At a time when there are real unmet health needs in the United States, such as the epidemics of juvenile diabetes, autism, pediatric nuerobiological disorders, asthma, pediatric autoimune disorders and others and the completely unjustifiable expenditures that are being squandered on this avian flu hoax is nothing shot of criminal.

    Avian flu has been hyped beyond any sense of proportion. Clearly this was a campaign to whip up a hysteria to justify huge transfers of money to the pharmaceutical industry and their client agencies.

    Correct me if I am wrong but to date not a single bird has died of avian flu on the North American continent yet we see the autism rate increasing at a rate of about 20% per year. In New Jersey now 1 out of 80 boys has autism. Twenty years abo autism affected about 1 or 2 out of 10,000 kids. But peanuts are spent on autism research.

    This is a pathetic example of health priorities being set by the marketing needs of pharma and not the real health needs of human beings.

    And Markos why you keep hyping this drivel is beyond my understanding. This is exactly what Karl Rove wants you to do.

    •  What is your evidence that H5N1 WON'T (0+ / 0-)

      become a pandemic?

      I'm interested.

    •  Actually Kos didn't write the article (1+ / 0-)
      Recommended by:
      Sick Of It

      I did. Pandemic preparedness doesn't replace other issues. But pandemics happen whether you're paying attention or not. Thank goodness many thousands of other people are.

      There is a duty to inform, and I am fulfilling that duty. it is a moral imperative. If you'd like to stick your head in the sand because only your issue matters, I'll buy you a shovel and then we can call it even.

      "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 Jun 10, 2007 at 11:05:16 AM PDT

      [ Parent ]

      •  Spreading Propaganda isn't a "moral imperative' (0+ / 0-)

        I brought up about half a dozen new epidemics plauging American children which you have chosen to disregard. Autism is just one of them. But unlike avian flu autism is a real epidemic with the number of affected people increasing by two orders of magnitude in twenty years.

        And it is obvious that Markos doesn't write your absurd posts. He just posts them prominently for some mystifying reason and actively serves the interests of one of the key pillars of the Bush administraition and GOP money mill: pharma.

        A lot of people are handsomely paid to exagerrate the threat on a variety of infectious diseases. The CDC goives seminars on how to do it every fall to get people hyperventilating about flu shots. The PowerPoints on this are right on their website.

        Who benefits from the insanely disproportionate investment made on the "pandemic flu" threat which in the past five or so years has killed about 150 people, if you believe the CDC? More people than that are killed by lightning in the US in a single year. The pharmaceutical industries and the public sector agencies that serve them are the only people getting anything out of this charade.

        Why don't you use your obvious talents and training to do something that will actually benefit people? You went to med school for this?

        •  I earned my front page posting position (0+ / 0-)

          before you registered here, as a point of information (given your high UID, you might not have known that).

          Since you don't know the difference between propaganda and the New England Journal of Medicine, the world health organization and Emerging Infectious Diseases, there's not much to discuss with you. my points about pandemic risk are all well grounded. read especially the provided links re SARS from Canada.

          But it would do you some good to read the provided links, and give yourself an attitude adjustment. People who refer to science peer-review journals as 'propaganda' generally don't convince people they know what they are talking about.

          "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 Jun 10, 2007 at 05:34:37 PM PDT

          [ Parent ]

          •  Why are you refusing to address the issues? (0+ / 0-)

            In an era of increasingly scarce health resources how do you justify spending billions on a health risk that is speculative at best, when they are immense unmet confirmed needs?

            And you aren't addressing my points, you are simply creating strawmen and avoiding the significant political and policy issues at play here.

            And as far as peer-reviewed journals, you know as well as I that there is a huge and growing credibility problem with many journals due to the influence of advertisers, again pharma. Marcia Angell, MD, former editor of the NEJM wrote a book about the undue influence pahrma's are now exerting on journals. She's teaching at Harvard now. You should read her book, "The Truth about the Drug Companies."

            •  well, actually (0+ / 0-)

              you haven't made any points to address. You don't like pharma, think peer review journals are biased, even when the articles have nothing whatever to do with pharmaceuticals and are not sponsored by drug companies, criticized Kos for something or other (though it was unclear to me what), and in general seem perturbed.

              My suggestion to you is write a diary about whatever points you want to address. I will be happy to read it with interest.

              Cheers.

              "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 Jun 10, 2007 at 06:26:35 PM PDT

              [ Parent ]

    •  btw (0+ / 0-)

      the important prep work is completely non-pharma.

      See http://www.pandemicflu.gov/...

      "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 Jun 10, 2007 at 02:50:31 PM PDT

      [ Parent ]

    •  Learn about recombination (0+ / 0-)

      The Angolan Marburg epidemic of 2005 didn't get anywhere past Angola because the virus wasn't contagious enough.  Case fatality rate was higher than 90%, which is stunnig when you think about it.  But it required transfer of body fluids from a victim in order to infect.  Not good enough.  And there were no "near neighbor" viruses which were capable of airborne H2H transmission from which it could obtain the necessary genetic material from, via the process of recombination.

      H5N1 is different, because airborne H2H influenzas happen every year.  So airborne H2H "near neighbors" to H5N1 are common as crabgrass.

      This raises the real possibility of H5N1 acquiring the genes for airborne H2H.

      Now let's do some very depressing math.

      Seasonal influenzas have an attack rate (percentage of the total population that gets sick) which is usually given as about 25%, from what I've read.  What keeps the annual death rate in the US as low as 36,000 fatalities per year is the relatively low lethality of normal seasonal influenzas.

      Now multiply 25% by .6 (case fatality rate of H5N1 to date) by 300,000,000 (present population of the US).  This gives us a "worst case" estimate of 45 million fatalities, in the US alone.  And from the disease alone; we have not factored in fatalities from civil disturbances.  Like riots.

      That, of course, assumes the attack rate and the CFR do not change.  But it also gives us a starting point to ponder.  15% of the population dead need not be a civilization-killer.  1347-1349 wasn't, and yersinia pestis killed more than twice that fraction of European populations.

      Now, turn that around.  1918 only killed 675,000, according to John Barry's "The Great Influenza".  That was less than 1% of the United States population.  But the social and economic effects were serious.

      We pretty much have to assume we're going to get hit.  How hard and how soon are imponderables.

      Given this starting point, the question then becomes "How do we best mitigate the effects of a pandemic in progress.

      •  Current case fatality rate in Indonesia (0+ / 0-)

        is now 80% plus.  Fluwikie has the details (translated reports from Indonesia, as I recall).

        This may be related to available health care reducing survivability, or it may be related to viral changes.  It's hard to say.

        Either way, once medical care is inundated in a pandemic and no longer functionally available, the point is moot.

  •  segment on BBC World news (0+ / 0-)

    states that a major flu pandemic hits approx. 3 times per century. The 1918 one killed approx 20 million.  9/11 killed 3,000. Do the math.

    Flu is a virus. Virus's mutate. Flu kills infinitely more people than any terrorist attack possibly could.

    The human race is in a race for survival against nature which includes bacteria and virus.

    Why are we so fearful of mandmade threats which are miniscule compared with our evolutionary place in the scheme of things.

    Or are the fundamentalist's of all stripes going to tell us, and we will believe them, that it is all god's doing? (in all his/her names.

    If in fact we believe that 'God' is the Creator, then it is all true.  If God created us then he also created the flu virus.  His own form of checks and balances.

    Why are we so afraid?

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