Sunday, December 31, 2006

December 30 Flu Update

The initial news was that four people were under suspicion of bird flu in Vietnam. This report from the Vietnamese press says there are actually six. They are in the same family, and are reported to have all eaten sick chickens.

More on the news from Vietnam.

ProMed on Vietnam.

Note that Tamiflu has been employed with these patients.

The Agriculture Minister in Vietnam is calling for stronger action against the bird flu.

ProMed is clarifying the actual number of cases due to confusion over reports from Egypt.

Some local efforts to combat the bird flu in India.

The government of Indonesia says that bird flu remains a threat to the nation in 2007.

Revere blogs this news....

The Federal Government in Nigeria is compensating farmers for culled birds.

Helen Branswell says that we should add emergency preparedness to our 2007 Resolutions.

Tech Blog on how the image at the front of this blog was developed, and how it could be used (hint: its a flu virus).


At 11:51 AM, Blogger Wulfgang said...


Let’s see, the latest news is the Vietnamese family tests negative for avian flu, and they only have pneumonia; and Indonesia is going to be bird-flu free in 2007…I’ll pass this information on to my friends who believe in Bigfoot, the Lockness Monster and UFO’s. They don’t exist either, but they firmly believe they do.

If you will indulge me, I have decided to exercise my mental faculties, or what’s left of my brain waves according to others, to develop an avian influenza prognostication, and in doing so, identify how we might spot evidence of an actual outbreak of a pandemic – in other words, where “ground zero” might actually pop up. Nothing of what I have come up with is terribly innovative as we leave 2006 behind, it’s just a matter of logic, updating and arranging the facts as we know them. I view things differently than most people. Whatever is fact, is true, and what’s not true, is well, my opinion. I will call this mental exercise…

Wulfgang’s Outlook for 2007 and 2008 – Like a Thief in the Night

The problem we all face in assessing H5N1 information, is that we are virtually bombarded with so many articles and studies, so very much so, that it is figuratively a kaleidoscope of information that challenges our cerebral cortex, just to assimilate and make sense of it all. It’s like trying to solve a Rubic’s Cube, when the colors mercurially keep changing before our eyes. The challenge is how do we make order out of all these tiny bits of information and avoid being too mordant or biased in the process. My motivation is pretty basic – if we all wait until the WHO, CDC, or HHS publicly change the threat condition from Stage 3 to Stage 4 or 5, as our primary indicator of an early- ignition pandemic, we may very well end up on the shortest side of things. It is my opinion that any action made by these entrusted authorities to raise the pandemic threat levels, will be tantamount to “crossing the Rubicon”, and will be met both with major reluctance and extreme trepidation.

One of the major problems with avian influenza is what scientists, mathematicians, statisticians, and physicists already know: the risk can be measured, quantified, assessed and analyzed, according to probabilities and statistics, using very sophisticated modern modeling techniques, like we’ve all seen published. But the uncertainty of a pandemic, or actually when the likelihood of the event is to occur, is incalculable and unpredictable. How does one overcome or bypass this conundrum? By using logic, probabilistic inference, looking at data points and patterns that will stare us all in the face. A looming pandemic in my opinion will exhibit unusual patterns and statistical perturbations which we must pay attention to. It all comes down to basic science and forensic data, and how we observe and process it. Think of it metaphorically as what one would expect to see when the slow moving pandemic train starts pulling into view of the station, knowing that a train doesn’t leave it tracks.

What we absolutely, indisputably know for fact, is that Influenza type A is the biggest pathogen for humans, and is responsible for all the pandemics around the world during the last two centuries. Influenza A has approximately 25-27 known subtypes, any of which can undergo antigenic drift (or shift), and these changes are essentially totally unpredictable. Influenza type B has not caused any known pandemics, only localized epidemics. There are no subtypes of influenza type B (or C), because these viruses do not change as frequently as type A. Of Influenza type A, there are only three known viruses currently circulating in humans: H1N1/H2N1, H1N2, and H3N2. The very first virus strain isolated was H1N1, in 1957 it shifted to H2N2, in 1968 it shifted to H3N2, in 1977 H1N1 re-emerged, then recently in 2001 H1N1 and H3N2 re-assorted into H1N2. Note that H5N1 is a type A virus, but it of course is not in wide-spread human-to-human circulation, nor is it even easily identified in field tests or laboratories at this point. Of the three basic type A’s, H3N2 is the predominant virus in both the northern and southern hemispheres over the last three flu seasons, even though there appears to be an antigenic shift with Influenza type B. Both Influenza types A and B have been in circulation simultaneously in some form, throughout the world, since 1973. Most notable is the fact that all pandemics since 1918 have been caused by descendents of the genes from the 1918 type A pandemic virus. This all tells me something mentally. Ordinary seasonal flu viruses will be the combustible medium to focus our attention on, and H5N1 will be the ignition source.

Logically speaking - viruses must adapt to infect higher life forms that function as their hosts and to ensure a stable reservoir of infection. The very nature of all influenza virus’s survival depends upon their ability to reproduce in significant high numbers, without killing their hosts. Viruses are totally dependent on their hosts for existence and must use their host’s cells to replicate. When they replicate, they mutate and survive, so it is not in their best interests to whole-scale destroy their hosts. To me, the most important fact to remember is that there are many billions of hosts in the world and many trillions, upon trillions of influenza viruses interacting every day (500 million can sit on the head of a pin) – all automatically and methodically seeking “the most stable reservoir” for infection and survival, which is ultimately humans. It is not birds, they are only the chosen temporary incubator host reservoir medium for H5N1.

So what does this all boil down to - a couple of important Wulfgang observations and conclusions: 1. H5N1 cannot and will not be eradicated, through vaccination or culling, simply because there are too many poultry and other animal reservoirs in the world (i.e. it’s already entrenched). Mass vaccination of poultry only leads to temporary immunity limiting virulence, through natural latency or quiescence, then it most likely seasonally reactivates itself; 2. The most likely scenario in my view that the H5N1 virus will take, in order to survive, will be to acquire deadly virulence transmissibility either directly from humans that are co-infected with both bird and animal strains of Influenza type A or B (genetic re-assortment through the mixing of genomes into a different virus); or it is almost certainly trying concurrently to recombine it’s genes in more suitable intermediary hosts, like swine (most human strains emerge from pigs); and 3. it’s most unlikely and doubtful in my mind that H5N1 will undergo a complete mutation (antigenic shift) on its own to become highly transmissible – it simply kills it’s hosts too often, and this violates the basic theorem of pandemics. I believe H5N1 must undergo clear re-assortment with an existing type A H3N2 or H1N1/H2N1 or H1N2 subtypes, or type B, to enable itself to become less lethal and more transmissible; or, vice versa. I rule out H7N7 and H3N8 because they mainly cause illnesses in horses. This appears to be the pathway of least resistance, as it must further reduce its total fatality rate dramatically on hosts, in order to survive and further replicate itself. That is its only primary goal for existing.

Assuming this is all correct, then a rational person might expect to see the following emerging signs of a true pandemic, by observing the following:

1. a significant and continual up-tick in weekly mortality rate data, or case-fatality-rate (CFR) – well above the Influenza combined A & B rate of .1%, that is the mean average in the US and Canada, today, for example. The actual reported mortality rate will fluctuate wildly during the first weeks or few months, between .1% and 60% (a very scary hypothesis), then settle down to several full percentages well above .1%, similar to 1918, so that the pandemic virus can replicate itself by the most efficient means. As further evidence, pneumonia and influenza reported mortality data will begin to leap well beyond the normal baseline thresholds, week by week. Admittedly, this kind of accurate data in very difficult to acquire from developing countries, but it is very accessible in the US, Canada, and west Europe.
2. a noticeable accompanying change in the “U” shaped fatality curve, perhaps towards the classic 1918 “W” shape, which would indicate a dramatic virulence shift in victim type and age.
3. followed by dramatic increases in pneumonia-like illnesses and hospitalizations, especially in young people, being reported on a weekly basis. This will occur in my guess in the southern hemisphere or in underdeveloped countries near the equator, during the first half of the year, since this is a seasonal pattern or trend, now becoming evident. So far, the basic theory that most flu strains originate from the far east, is holding true – but of course, that doesn’t automatically translate to mean that the Asia-Indo-China area will be ground zero. It’s simply most likely probable, due to population density and culture.
4. widespread abnormal epidemic flu outbreaks reported in both northern and southern hemispheres simultaneously, involving many countries. One, or possibly more ongoing epidemics in each hemispheric flu season at the same time would still appear nominal, but numerous multiple major epidemics in both hemispheres concurrently, would be highly unusual and abnormal, and should set off alarm bells.
5. Tremendous initial confusion for weeks and months at the onset, by the authoritative government entities. This will be caused by ultra-conservatism and through misclassification or misidentification of the novel virus, perhaps as a previous “A or B non-avian subtype”. At first, they may not even type the strain at all. And at first, they will essentially be stymied, as they attempt to decipher the same puzzling situation that the novices see – but they will need a very large number of case-counts and observable factual data, as well as delivered pre-pandemic samples, over time, before they will be willing to make any final confirmations and declarations. Fujian-like, or Shanghai-like ? Who knows. Some independent experts will diagnose it right, immediately. They will be the ones to listen to, in my opinion. The robust genetic sequencing, identification and diagnostic systems being touted by the federal government, to confirm pandemic flu strains, will not be evident at first, when it actually occurs. God created the world in seven days (yes, I know he actually rested on the 7th day), it will take much longer to verify an actual pandemic inducing virus.

Now the final kicker and perhaps the most important emerging pandemic sign that may be most noticeable – it may not be the pandemic virus itself…but the early sudden and irrational appearance of the movement of very large amounts of money in the international financial markets. Remember when I talked about the measurement and quantification of risk ? The probability of a pandemic is low, but the risk accumulates over time, regardless of uncertainty. Money managers, financial institutions, as well as large multi-nationals, and insurance companies, employ legions of risk management advisors and soothsayers to warn them of impending financial threats. Billions, if not trillions of dollars will move from hedge funds, bond and the equity markets, electronically, at the slightest hint of a real pandemic, away from suspect pandemic ridden areas into “safe financial zones”. Risk and money managers absolutely will not wait until any government authorities make a pronouncement – it will be “ready, fire, aim” in their plan book. These guys will sell their own children at the drop-of-the-hat, into slavery, rather than have their assets tied up in a pandemic-ridden country, frozen by a foreign government.

And the final tell-tale sign to watch for, but I’m not certain of this, may be suddenly large numbers of people attempting to flee across borders from the infected areas where they believe they will get sick and die. This is what has occurred in African countries. Generally though, wealthy people exit by their private yachts, sail boats and airplanes, and poor people leave by auto and foot. There is no way to fight this new plague, so they will most likely attempt to flee.

The best way to describe an emerging pandemic is found in Matthew 24:42-44.



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