posted
Interesting article! I had not heard that about China giving amantadine to chickens. All we know about China is that they haven't told the truth in the past about SARS or about H5N1 outbreaks in birds. It's hard to have faith in anything at all that they say now. They claim no human cases but I don't think anyone believes that.
Lying governments really annoy me. We should all go online and tell the truth always so as to train all our governments not to lie, that they will always be found out and look far worse than if they'd just told the truth up front. In whose best interest are lies? Rarely does it protect the people. Usually the only thing to be protected is the pride of those in power. How many times has "national security" been misused as a reason for secrecy?
Still looks like Tamiflu is the best bet. Two years backorder is really bad news, though. I wonder if pharmacies are able still to fill prescriptions for it from their current stocks? I wonder, too, if any peramivir is available directly from BioCyst. They're right here in town.
The governments of the world seem so incompetent in this so far. All these snafus!
1) Human vaccines are still grown in chicken embryos taking months to develop (because of regulatory delays and weak financial incentives) while animal vaccines are grown in cell cultures which can be developed more quickly and manufactured in huge quantities.
2) There are only a few factories in the world that can make vaccines. Changing them over to faster manufacturing methods will take two years.
3) The WHO is desperately underfunded hampering their efforts at monitoring.
4) Lying by Asian governments and possessiveness by rich countries might take away our only shot at stopping the first outbreaks and buying ourselves time, perhaps the weeks or months needed to develop and deploy vaccines.
It's vitally crucially important for every human in the world to work together against this common enemy. Who was it said "We must hang together or we will most assuredly hang separately"? Sounds like Churchill. Posts: 6246 | Registered: Aug 2004
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BenjaminFranklin. The main thing that stockpiling Tamiflu will accomplish is provide cheap Tamiflu for farmers to add to their livestock feed: making the viruses mutate faster, incidentally creating Tamiflu-resistant strains faster.
quote: Officials in China have denied reports, published on the Internet, that 200 people have contracted bird flu in Qinghai province and that 121 have died from the infection.
The reports originated from the US-based Chinese news agency Boxun News and were repeated by ProMED—mail, an online reporting system that warns of outbreaks of infectious diseases.
In 2003, ProMed—mail broke the news of China's outbreak of SARS (severe acute respiratory syndrome) after it was reported by Boxun News. At the time, China had yet to report the outbreak.
Denying Boxun's claim that bird flu had claimed human lives in China, the official Xinhua news agency added that hospitals in Gangca county, where the bird flu cases were reported had opened a separate department for patients with fever.
The World Health Organization says it has no reason not to believe the Chinese authorities' denial of human cases of bird flu.
From the journal Nature as reported by SciDev.net here.
Because the officials are denying it, we have no way to know for sure if these people all got it from birds, or if human to human transmission is more likely. I tend to believe the Boxun News, who told the truth about SARS, as opposed to the Chinese government, who we know lied about SARS. The number of cases is highly suggestive of direct human to human infection, isn't it? Though we can't know for sure unless the Chinese government becomes more open about what's going on, and allows WHO investigators in, it sure does seem like this thing is starting. Posts: 6246 | Registered: Aug 2004
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More on the Northern Vietnam strains from Science magazine May 27th issue here.
quote: New genetic analyses of samples from recent human H5N1 avian influenza patients reinforce epidemiological evidence suggesting that new strains of the virus may be emerging in northern Vietnam. But an expert report detailing the genetic analyses, posted on the Web site of the World Health Organization (WHO) last week, cautions that data are too limited to draw firm conclusions. Even so, the report urges heightened surveillance, increased preparedness, and further research, warning that H5N1 poses "a continuing and potentially growing pandemic threat."
At a meeting to review data at the request of WHO, held in Manila on 6 and 7 May, scientists also concluded that human-to-human transmission of the virus may be more common than previously thought. The meeting--attended by 40 or so epidemiologists, virologists, public and animal health experts, and representatives from Cambodia, Thailand, and Vietnam--came on the heels of a visit by a three-person WHO team to Vietnam in late April.
Lance Jennings, a clinical virologist for the Canterbury District Health Board in New Zealand and a member of the WHO team, says epidemiological evidence, some of it previously reported (Science, 22 April, p. 477), indicates a changing virus: Clusters of infection are larger and more numerous than seen previously, and there is often a time lag between the onset of symptoms in the first case and subsequent cases within clusters. Among those infected were three infants, ruling out poultry tending as a route of infection in those cases. And in a few other cases, exposure to poultry could not be traced. Although these findings suggest that human-to-human transmission is occurring, Jennings adds that "there are other possible explanations." The virus could have acquired the ability to persist longer in the environment, or perhaps resistant poultry are now shedding the virus without signs of sickness.
posted
Reading more about the 200 or so people who died in Qinghai province, I understand why the WHO doesn't report cases that aren't confirmed by laboratory analysis. There's no way to know for sure what has happened. We do know that China was not honest about SARS outbreaks. We know the that the ProMed Mail, reporting from the Boxun news, was reliable before in what they said about SARS. If we can extrapolate from this that 200 people have died in Qinghai province, then that still doesn't tell us for sure what they died of, or if it's H5N1, what route the transmission took.
So all we know at this point is that there are highly suggestive reports. We just don't know what it means.
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If anyone wants to do a bird flu preparedness talk for enrichment meeting or any other church or community meeting, I've prepared one that could be adapted to go anywhere from five minutes to half an hour or more. I'd be happy to share my notes with anyone who wants them.
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I'm looking for stories or writings from LDS member journals from the time of the 1918-1919 influenza pandemic when so many people died. I just think personal first person accounts of that period would be really interesting to hear. Can anyone tell me if there are any journals which have been made public for family history searches and so on? Do we have access to any of the journals of church leaders or any others? Or are they all kept private within the families in which they are passed down? It occurred to me that the journals of someone like Brigham Young, who must have many many great-grandchildren, might have been made public as part of church history. (Of course he was not alive in 1918 but perhaps it might be true of others who were?) Does anyone know?
The 1918 influenza pandemic is nearly gone from living memory now, but I'd like to gather whatever firsthand accounts I can find, just to see what it was like, and to learn from past experiences, even if they are now beyond living memory.
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quote: I just think personal first person accounts of that period would be really interesting to hear.
Wow AK, you are really into this flu pandemic thing.
For a fictional account of the Black Death in England, you could read Connie Willis' The Domesday Book , about a time-traveller who goes back to document the plague.
It's well-written and -researched but a real downer...
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I'm specifically interested in the influenza pandemic of 1918. That seems to be the closest model we have for what a bird flu pandemic might be like.
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Tammy, I too feed the birds beside my house. Depending on the amount of illegal bird smuggling that goes on, there's probably as much chance that they will catch it from us as vice versa. Also the main species they have seen die in Asia seem to be geese, ducks, and chickens so far. That doesn't mean other species don't get it, though, for sure. Populations of songbirds are already way down across the western hemisphere. I really do hope this doesn't put another big dent in those.
One thing about which I'm not worried. Bird flu alone will not make the human species extinct. The only way it could trigger that is if we, in madness at our losses, decide to blame someone else besides ourselves for it and start wars with them.
During the 1918 influenza pandemic some people in the U.S. said the Germans were responsible --- and I don't know but some German people may have thought it was from the Jews or the Allies or someone. People don't tend to act too rationally when their family members are all dying and stuff. They want someone to blame, be it God or The Government, or The Enemy (whomever they perceive that to be).
Hopefully since we've all been reading the warnings for months, such rumors won't have much power. Certainly everyone with intelligence, among whom I count all of hatrack, will know better.
The social unrest is likely to be a factor we all need to take into account. People, even if they are dismissive of warnings beforehand, are likely to be angry after the fact that they weren't protected, given drugs, treated at the hospital, given vaccines, etc. There are likely to be lots of bitter feelings, human nature being what it is. Will that explode into riots or looting? Let's hope it won't.
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Yay, I found one such first person account! This was from a doctor in an army hospital in the U.S.
quote: Camp Devens, Mass. Surgical Ward No 16 29 September 1918 (Base Hospital)
My dear Burt- It is more than likely that you would be interested in the news of this place, for there is a possibility that you will be assigned here for duty, so having a minute between rounds I will try to tell you a little about the situation here as I have seen it in the last week. As you know I have not seen much Pneumonia in the last few years in Detroit, so when I came here I was somewhat behind in the niceties of the Army way of intricate Diagnosis. Also to make it good, I have had for the last week an exacerbation of my old "Ear Rot" as Artie Ogle calls it, and could not use a Stethoscope at all, but had to get by on my ability to "spot" ' em thru my general knowledge of Pneumonias. I did well enough, and finally found an old Phonendoscope that I pieced together, and from then on was all right. You know the Army regulations require very close locations etc.
Camp Devens is near Boston, and has about 50,000 men, or did have before this epidemic broke loose. It also has the Base Hospital for the Div. of the N. East. This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed. All assembleges of soldiers taboo. These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I dont know. My total time is taken up hunting Rales, rales dry or moist, sibilant or crepitant or any other of the hundred things that one may find in the chest, they all mean but one thing here -Pneumonia-and that means in about all cases death.
The normal number of resident Drs. here is about 25 and that has been increased to over 250, all of whom (of course excepting me) have temporary orders-"Return to your proper Station on completion of work". Mine says "Permanent Duty", but I have been in the Army just long enough to learn that it doesnt always mean what it says. So I dont know what will happen to me at the end of this. We have lost an outrageous number of Nurses and Drs., and the little town of Ayer is a sight. It takes Special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows. We have no relief here, you get up in the morning at 5 .30 and work steady till about 9.30 P.M., sleep, then go at it again. Some of the men of course have been here all the time, and they are TIRED.
If this letter seems somewhat disconnected overlook it, for I have been called away from it a dozen times the last time just now by the Officer of the Day, who came in to tell me that they have not as yet found at any of the autopsies any case beyond the Red. Hepatitis. stage. It kills them before they get that far.
I dont wish you any hard luck Old Man but I do wish you were here for a while at least. Its more comfortable when one has a friend about. The men here are all good fellows, but I get so damned sick o Pneumonia that when I go to eat I want to find some fellow who will not "Talk Shop" but there aint none nohow. We eat it live it, sleep it, and dream it, to say nothing of breathing it 16 hours a day. I would be very grateful indeed if you would drop me a line or two once in a while, and I will promise you that if you ever get into a fix like this, I will do the same for you.
Each man here gets a ward with about 150 beds, (Mine has 168) and has an Asst. Chief to boss him, and you can imagine what the paper work alone is - fierce,-- and the Govt. demands all paper work be kept up in good shape. I have only four day nurses and five night nurses (female) a ward-master, and four orderlies. So you can see that we are busy. I write this in piecemeal fashion. It may be a long time before I can get another letter to you, but will try.
This letter will give you an idea of the monthly report which has to be in Monday. I have mine most ready now. My Boss was in just now and gave me a lot more work to do so I will have to close this.
Good By old Pal, "God be with you till we meet again" Keep the Bouells open. (Sgd) Roy.
quote: China finds bird flu in Xinjiang China has announced details of a second outbreak of bird flu, this time in the western region of Xinjiang. The Ministry of Agriculture said more than 400 geese had died at a farm in Tacheng, and a further 13,000 birds had been culled as a precaution.
posted
Also more cases reported in humans in Vietnam.
Reports of some asymptomatic cases here, which can be either good or bad depending on how you look at it. The good part is that every asymptomatic case lowers the insanely high mortality rate (70% or 30% compared to 5% for Spanish flu). The bad part is that people who aren't sick themselves infect many more people on average than those who are quickly overcome by the disease.
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The first person account is really fascinating. My ex-husband's grandfather lost a brother to the epidemic. It really shouldn't be hard to find people here and there who remember this time, even if it is just anecdotes and reminiscing.
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Six new cases of bird flu in Northern Vietnam. Not clear if it's human to human transmission or not.
quote: HANOI, Vietnam (AP) - Vietnam has recorded six new cases of bird flu in the past week, state-controlled media and officials said Wednesday.
The six people, all from northern provinces, had been admitted to a hospital in Hanoi over the past week, the Pioneer newspaper said. Five of them were in stable condition, it added.
Officials at the Ministry of Health declined to comment Wednesday.
Nguyen Tran Hien, director of the National Institute of Hygiene and Epidemiology said those who had contracted bird flu since the last outbreak in December last year showed less severe symptoms of high fever, coughing and breathing difficulties.
He said the institute was researching whether the virus had evolved to allow for faster transfer, while becoming less virulent.
This is from The Star of yesterday, June 15th, 2005 here.Posts: 6246 | Registered: Aug 2004
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quote:Bird flu found in Indonesian man Indonesia has confirmed its first case of bird flu in humans. A farm worker in South Sulawesi has tested positive for the H5N1 strain of the virus, although he has shown no outward symptoms of the disease.
Again a farm worker isn't sick with it. This is suggestive that in some cases at least, immunity can exist, perhaps in people with prior contact with birds. My speculation is that previous strains of H5 influenza that weren't so virulent and deadly may have existed in birds before and been transmitted to some humans, conferring partial or full immunity. This would be analogous to the way cowpox protected dairy workers from smallpox.
That's just speculation, though. No way to know for sure without a lot of further study.
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quote: Vietnam reports five more new bird flu cases
HANOI, Vietnam (AP) - Vietnam reported Friday that five more people have contracted the bird flu virus as the country struggles to contain the disease, officials said.
Bird flu has ravaged poultry farms throughout Asia and jumped to humans, killing 54 people in three countries. Vietnam has been the hardest hit with 38 deaths so far.
The five latest cases bring the total of people infected with the virus to 11 over the past week, said Tran Quy, director of Bach Mai hospital in Hanoi.
The patients, all from northern provinces, are being treated at the hospital and are in stable condition, he said.
Quy said separately that a male doctor at the hospital who helped take samples from the patients initially tested positive for the disease, but a second test turned up negative.
Suggestive of human to human transmission. No way to know for sure without further study. I hope the World Health Organization is blanketing the area with Tamiflu, since the computer models suggest such outbreaks can be halted, buying the rest of us time to work on vaccines and preparedness, and giving the few factories time to manufacture more drugs.
quote: A Vietnamese doctor in Hanoi, who treated bird flu patients, has contracted the disease himself, leaders of the Bach Mai hospital reported Friday. The male doctor had been taking samples from carriers of the H5N1 virus, officials said, adding that his condition was stable.
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There are reports from recombinomics of more patients.
quote: >> The institute is treating a total of 23 local people with bird flu symptoms, of whom 11 have been confirmed to have contracted bird flu virus strain H5N1 by the hospital's officials, said the paper. The bird flu patients, all from northern localities, are instable health condition. <<
This is from recombinomics here. I'm not sure where they get their information so I count this as unsubstantiated so far. Still, it doesn't look good. Seems like we're having an outbreak of a type that would move us solidly into stage 5.
Has stage 6 already started? I hope not but it's possible that scientists will look back on these chains and clusters and small outbreaks and point to some time in this past month as having been the start of the pandemic.
quote: On Friday [17 Jun 2005], a senior health official said a number of suspected human-to-human cases of H5N1 had been detected by the National Institute of Hygiene and Epidemiology (in Vietnam).
"We have got a number of suspected cases of human-to-human transmission of bird flu, including a doctor from Bach Mai hospital", Nguyen Tran Hien, the director of the institute, told Deutsche Presse-Agentur. "We will need to do more research before coming to any conclusion".
ProMED mail has shown itself to be a reliable source of news in the past. This would seem to be a confirmation of the news report above.
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I think all these discrepancies in the numbers of cases come from the different standards of proof. While a local newspaper may find it enough evidence that a number of people are suffering from similar symptoms in the same area, bodies like the WHO require laboratory tests which meet a verified standard for accuracy before they will count a case.
I think people in Asia are actually afraid of this disease, having seen the deaths up close. (To us on the other side of the world it still seems, in a totally illusory way, to be comfortably far off.) I suspect fear may magnify the number of cases counted unofficially by the local news sources. However, the WHO number, which you can always be absolutely positive is not exaggerated, is probably too low, since not every suspected case is tested to their standards.
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quote: China reported a new outbreak of H5N1 in its far western Xinjiang region this week, the third time the virus has been found among birds in remote western China in recent months.
"It looks like the virus is still very active," Mona said.
From Reuters of June 22.
Everyone's all excited the last few days about China using amantadine on chickens and causing resistance, and the government has even admitted it now after many previous flat denials (I love how China does <laughs>) but scientists have known that for months from examining the viruses themselves. They developed specific resistance to amantadine which means they have to have been exposed to amantadine, and all the geographical evidence pointed toward China.
<digression> It's so funny how a newspaper can make something "a big story" as though it's breaking news, when it's something we've all known for months. But I'm glad they did it! China's government needs to take responsibility for the stuff they do, and maybe if they get caught lying often enough they'll even consider telling the truth from time to time. That would be awesome!
All governments should tell the truth always. That would make the world a much better place. It surprises me that we the people (who are the ultimate rulers) allow them to lie to us and we accept it. I wonder why it should be considered okay for governments to do anything it's not okay for people to do? </digression>
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In other news, the CDC updated their advice to travellers to Southeast Asia. I will give you just the high points.
quote: According to a 15 Jun 2005 World Health Organization (WHO) report, the Ministry of Health of Viet Nam has confirmed 4 new human cases of avian influenza A (H5N1) virus infection. All 4 patients are alive. 2 are from the northern city of Hanoi, the 3rd from the nearby province of Hai Duong, and the 4th from the central province of Nghe An. These are the latest in a series of sporadic human cases of H5N1 human infection reported in Viet Nam since December 2004. Also since December 2004, there have been 4 cases reported from Cambodia. As of 17 Jun 2005, there have been 107 human cases of avian influenza A (H5N1) reported in Viet Nam (86), Thailand (17), and Cambodia (4), resulting in 54 deaths [and one in Indonesia - Mod.CP].
It is thought that a few cases of person to person spread of H5N1 viruses have occurred. For example, one instance of probable person to person transmission associated with close contact between an ill child and her mother is thought to have occurred in Thailand in September 2004. More recently, possible person to person transmission of H5N1 viruses is being investigated in several clusters of human cases in Vietnam. So far, spread of H5N1 virus from one ill person to another has been very rare and transmission has not continued any further beyond one person.
I thought the summary of human cases was interesting. Plus, it's comforting how they summarize the human-to-human situation. I feel relieved that we aren't hearing each day of more and more new human to human cases in Northern Vietnam. Perhaps the H2H transmission efficiency is still very low.
quote: During travel: Avoid all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. Avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid handling surfaces contaminated with poultry feces or excretions.
As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often, using soap and water (or waterless alcohol-based hand rubs when soap is not available and hands are not visibly soiled), removes potentially infectious material from your skin and helps prevent disease transmission. Influenza viruses are destroyed by heat; therefore, as a precaution, all foods from poultry, including eggs and poultry blood, should be thoroughly cooked.
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No news of new human cases, however, in the last few days there have been bird cases detected in Japan, prompting large culls, (I believe in vaccination rather than culling), but it's H5N2, a strain that has shown no tendency to jump to humans, so it's not worrying.
No news is definitely good news! Posts: 6246 | Registered: Aug 2004
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How does it hide new cases? I thought the idea was to prevent them. How about human vaccination, after we have effective human vaccines? Does that hide new cases too?
Also, culling kills the very birds who might have developed immunity, or be genetically less susciptible, leaving flocks just as vulnerable as ever, right?
Obviously now that the virus is endemic among wild waterfowl, and because of cases detected in ducks and pigs who don't even appear sick, the hope of eradicating the virus altogether is past. This would seem to indicate to me that culling is a failed strategy and we should vaccinate instead.
Also, the people love their birds, and their livlihood in many cases depends on their birds. So in any case it would seem preferable to save as many birds as possible, and culling can only be justified if there's some reasonable chance of stamping out the virus altogether.
quote: A nagging question about avian (H5N1) influenza virus infection of humans in Viet Nam is whether there is considerably more mild, clinically undetected or inapparent infection than accounted for by only considering the most seriously ill cases admitted to hospital. Since the most seriously ill are the tip of the iceberg in most human viral diseases, this is a plausible concern. Its significance would be that there is more transmission of the virus -- either from poultry to humans or from human to human -- than has been conceded at present. Equivocal evidence to suggest this has apparently been obtained by a joint Vietnamese-Canadian research team working in Hanoi.
Using a method called western blotting, the researchers tested hundreds of stored blood samples to see if these showed evidence of antibodies to H5N1 virus. Rumors are that: "scores of samples came back positive." As a consequence the Vietnamese authorities have asked for international assistance.
A team of international influenza experts is in Hanoi, at the invitation of the Vietnamese government, to investigate worrisome signs that avian H5N1 influenza virus may be adapting in ways that may make it more likely to spark an influenza pandemic, the World Health Organization has confirmed. The group of about a half-dozen virologists and epidemiologists from the United States, Britain, Japan and Hong Kong will be following up concerns raised at a special WHO avian influenza summit held last month in Manila, spokespersons for the organization said on Thu 23 Jun 2005. The team will also be analysing some potentially disturbing but hard-to-assess test results that could suggest a significant number of additional human infections have occurred but went undetected.
see the Canadian Press report via Yahoo News, Thu 24 Jun 2005: here.
That's what we know at this point..... but Dick Thompson, director of communications for the WHO's communicable diseases branch in Geneva, stated that: "These are highly questionable results, difficult to evaluate at the moment".
The official explanation for this diffidence is the possibility the western blotting is not sufficiently specific to rule out [the possibility that] it is detecting antibodies to other influenza strains [serotypes] than H5N1, although for other viruses "westerns" are used as confirmatory tests because they are more specific than the conventional ELISA tests.
What this means to me is that there's a chance, though not definite yet, that there are a lot more human cases than we've yet heard about. I think that's a positive sign, meaning that the mortality rate is much lower than we think now, also that human immune systems may not be as utterly helpless in fighting this thing as we had previously thought. However, they seem to interpret it as a bad sign.
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Well, in addition to the good news of no new clusters of human to human cases being reported day by day there's also this.
quote:GENEVA, June 30 (Reuters) - Tests have yielded no evidence so far that the bird flu virus is mutating and becoming easier to transmit between humans, the World Health Organisation said on Thursday.
In May the WHO warned that the virus in Vietnam, the country with the highest number of cases, could be changing and becoming easier to pass on.
Such a mutation could herald the start of a long-predicted international flu pandemic capable of killing millions of people around the world.
But the Geneva-based body said in a brief statement that laboratory and epidemiological examinations of recent Vietnamese cases, carried out by an international team, had revealed no change to the virus.
"We did not find evidence to substantiate what was suggested in Manila," said WHO spokeswoman Maria Cheng, referring to the meeting in the Philippines where the concerns first surfaced.
They then go on to say more tests are needed to know for sure, etc. But so far, at least, it's looking good.
quote: UN experts urge action on threat of bird flu By Evelyn Rusli International Herald Tribune
TUESDAY, JULY 5, 2005 KUALA LUMPUR UN health experts warned at a conference here on Monday that the world had a limited time and opportunity to contain the avian flu virus before it could potentially become a global pandemic.
The UN conference was convened this week because of the concern among experts from around the world that the bird flu virus was in danger of spreading out of control, the health officials said.
"We are at a tipping point," the Western Pacific regional director for the UN's World Health Organization, Shigeru Omi, said in an interview on Monday. "Either we can reverse this situation or things will get out of hand." [SKIPPED SECTION]
The case is also particularly troubling because highly mobile carriers, such as migratory birds, could rapidly spread the virus to unaffected regions.
But Indonesia and China, the two most populous countries so far affected, are also major areas of concern, Domenech said.
China has not reported any human cases yet, but health experts are worried that lethal, more resistant strains could soon emerge because of renegade pharmaceutical labs in the country that have dispensed antiviral treatments to poultry farmers.
"By using the wrong drugs, it'll only make the virus stronger," Omi said.
It will be difficult to understand the extent of this problem because UN officials and the Chinese government do not know which labs are producing the antiviral treatments or how popular the treatments are, he added.
This is one thing I am worried about (I posted about it earlier in the thread), that enthusiastic measures taken to fight avian flu will make the virus more drug-resistant, harder to treat, and more lethal.
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The whole "renegade" thing is highly suspect. Other sources report the government for years encouraged farmers to use amantadine on poultry. We need to save human flu drugs for human use, for sure. But which humans get them is problematic.
Any use of antivirals whatsoever could possibly contribute to the development of resistance. That's just how evolution works. So while there's no sense in indiscriminate use, neither is there any sense in holding off and not using them at all. The most effective use, if the human species wants to be reasonable and smart, is to detect outbreaks of human to human (H-H) transmission very early and saturate the area with antivirals. That, combined with pre-vaccination, actually works to quell outbreaks, buying time (months or even years) before the next time the virus mutates to allow H-H transmission.
If such a strain should break out and spread past any chance of containment, though, the best use of antivirals would be for health care workers only. We probably don't have enough drug to cover all the doctors, nurses, and medical techs in the world so there's no sense in trying to cover anyone else. Perhaps heads of state, to prevent the chaos that would ensue if 1/3 of the world's governments changed hands simultaneously at the height of the pandemic, say. If we start trying to cover all essential workers, it's hopeless. Who isn't essential? Power plants? Garbage pickup? Water works? Police? Phones? Everyone is essential! I guess what everyone would hope is that nobody at all uses the drug except themselves. That way the drug retains maximum effectiveness.
There was just a big conference in Malaysia in which the WHO came up with a ten year plan for fighting the virus. They need $102 million to fund it, and so far only have $30 million. We should pony-up the money. That's a tiny fraction of what one day of pandemic will cost our economy.
The virus is now endemic in wild waterfowl in Asia so it is only a matter of time before it travels via migrating birds to all of the eastern hemisphere. More culling seems foolish at this point, since it is hopeless now to try to eradicate the virus altogether. Vaccination, along with breeding the birds who survive the scourges would seem to be the best method of protecting flocks. People's livelihoods depend on these birds. The fact that this strategy allows for immune avian carriers is something we have to accept. We've already seen that domestic ducks and pigs are immune carriers, as well as possibly some humans. Attempted eradication was a good strategy back in 1997 when H5N1 first appeared. It's no longer a useful method of combatting the virus. We need to switch to wide scale vaccination of bird (three options now for vaccines) and human (no options yet but we MUST rush this) populations.
There are no new chains of human cases being reported from northern Vietnam, which is very good news. If this outbreak isn't taking hold then it certainly buys us a little more time.
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I read yesterday that scientists are expecting it to spread to Europe, Australia, Oceania and maybe Africa by the end of next year.
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Reuters 7/13/2005: VIETNAM - Bird flu has killed another Vietnamese and infected three more... Thirteen others were suspected of being infected with the the virus.
Not good news. No definitive answers on if it's H2H transmission or not, but worrying. Also I fear that if it's happening in Vietnam, it may be happening too in China, but we aren't hearing about it.
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quote: Bird flu is suspected in the deaths of three people in Indonesia, the country's health minister has said. If confirmed, the victims - a man and his two young daughters - would be Indonesia's first human fatalities from the disease. ... Ms Supari said she was concerned the three victims could have contracted the disease via human-to-human transmission, because they had no known contact with poultry.
posted
Another interesting first person account of the flu of 1918 that I happened to come across in the autobiography of the aircraft design engineer and writer Nevil Shute (full name Nevil Shute Norway).
quote: In the Isle of Grain after the Armistice, therefore, I had to readjust my ideas considerably, and readjust them to the fact that there was a strange stuff called fun to be got out of life. Whatever capricious Fate decides the course of one's life was careful in my case to see that the transition to fun didn't come too suddenly, because my introduction to the merrry new world opening before me was by way of a series of funerals. At that time there was a terrible epidemic of influenza ravaging the country, and men and women were dying of it all over England. Deaths in the army became so numerous that my battalion was ordered to provide a permanent funeral party to tour round Kent with a gun carriage and a dozen specially drilled men to conduct military funerals.
posted
That article is a great summation. We can stop it, delay it, to give us enough time to prepare, but will we take the steps needed to do that? And will we spend the time we've bought so far preparing? Both seem unlikely at this point.
It seems like it has to happen before people will believe it, but it's definitely already happened in 1918, and we don't seem to have learned from that.
We still don't understand what makes different strains of flu have high or low virulence. My greatest hope at this point is that when it mutates into a form that's easily transmissible human to human, it will also get much much less deadly. Given that it's got a 30% - 50% mortality rate so far, compared to 5% for the 1918 flu pandemic, which was absolutely horrible, that hope seems pretty thin as well.
Set against that best-case scenario, the worst-case ones in which 1/3 of humanity dies within a few months. What would happen? Would civilization totally break down? Would it reassert itself once the worst was over? I can imagine food riots when the grocery stores are empty or closed, widespread looting, destruction of pharmacies who don't have any Tamiflu to give people, people crazed with grief blaming anyone and everyone for the disaster and striking out randomly against foreigners, Islamic people (how easily would a rumor that it was a terrorist biological attack spread?) or anyone who looks vaguely foreign. It's a real nightmare. Exactly how many deaths would it take to set off such things? The last time we had a bad flu pandemic, it hit a world already exhausted by war. Will we be as phlegmatic in the face of death as they? I hate to even let my imagination go there, but it's certainly as much a possibility as are my hopes that it will be no more deadly than the last two flu pandemics, which were not too bad.
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The frustrating thing about the flu pandemic news is that I feel completely helpless to do anything about it. China seems to care more about its national pride and "security" than someting that could easily wipe out a large chunk of its population (especially if, like other viruses, flu becomes less deadly over time because strains that don't kill have more opportunity to infect--China might well be one of the hardest hit). Not to mention the impact it's already had on the farming there.
And the U.S. government seems to have its head in the sand on this. The CDC is apparently paying attention, but I wonder if Congress or the President is aware of the danger at all...
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Not that this will be available any time soon, but researchers are working on a flu vaccine that would provide lifetime protections against all flu varieties.
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Wow, that would be so great if they could do that!
quote: Current flu vaccines work by giving immunity to two proteins called haemagglutinin and neuraminidase, which are found on the surface of flu viruses.
We aim to avoid the need for annual re-engineering and manufacture of the new product Dr Thomas Monath, chief scientific officer at Acambis
However, these proteins keep mutating which means doctors have to keep making new vaccines to keep up.
Scientists at Acambis' laboratory in the US, together with Belgian researchers at Flanders Interuniversity Institute for Biotechnology, are focusing their efforts on a different protein, called M2, which does not mutate, as well as other technology that they cannot disclose yet for commercial reasons.
...
Professor Karl Nicholson, professor of infectious diseases at Leicester University, said: "It would be enormously helpful to mankind to have just the one vaccine but sadly I think it is a long way off."
He said it might be 10 years before any such product could be ready for widespread use in humans.
I hope they manage it. Imagine how wonderful to never get the flu your whole life! I bet people's health overall would be so much better than that, and life expectancy would go up just from that one thing. I believe influenza episodes do permanent damage, quite often, even when the person seems to recover fully. And of course even regular flu kills millions yearly, before you ever start worrying about pandemics.
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In the last week, images of disaster have been brought home to all of us in an unforgettable way. Again I want to warn all hatrackers that Avian flu is another disaster that we have clearly foreseen. I want to invite everyone to think about two questions.
1. Are you ready?
2. What will you do?
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Tatiana, have you seen today's Slatearticle on the possibility of a bird flu pandemic? I find it puzzling that an MD would say that
quote:...the science behind all the worry is questionable. It rests on the unproven claim that the avian flu will develop exactly like the strain that caused the flu pandemic of 1918.
....The current bird flu, however, has a different molecular structure than the 1918 bug. And though it has infected millions of birds, there is no direct evidence that it is about to mutate into a form that would transmit from human to human.
The virus behind the 1918 epidemic is certainly not the only flu virus that has incubated in an animal population until it mutated into a form that was transmissible from human to human. Is this guy unaware of this? I mean, historically that's where all flu epidemics have come from, unless I'm misremembering the information in the WHO .pdf that Tatiana linked to earlier in this thread.
His comment that
quote:Even if the worst-case scenario does occur and the virus mutates, there is no current indication that it will spread the way the Spanish flu did in 1918. That disease incubated in the World War I trenches before it spread across the world, infecting soldiers who were exhausted, packed together in trenches, and lacked access to hygiene. These conditions were an essential breeding ground for the virus. Today, there is no way a huge number of people would be packed together in WWI-like conditions.
also seems to suggest that he isn't aware of the two later flu epidemics.
Furthermore, when he says "technology [today] allows doctors to diagnose and isolate flu patients far more effectively [than in the 1918 epidemic].", this indicates to me that he is unaware of how useless quarantine has proven itself to be, historically, in preventing flu epidemics from taking of. Quarantine can slow the onset of a flu epidemic, but not prevent it, if history is any guide.
I think that this doctor has a dangerously poor knowledge of the history of flu pandemics; I hope his views don't get picked up and transmitted through major media channels.
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