Monday, January 08, 2007

January 8 Flu Update

So much for a flu-free 2007--Indonesia has its first case of the year. A 14 year old boy on a ventilator. There were apparently dead ducks near his home, though the exact exposure route has not been declared.

CIDRAP reports that there are actually two cases in Indonesia.

ProMed on the second case in Indonesia--cause is "unknown."

CIDRAP with news from multiple sources....Hong Kong, Vietnam.

WHO/FAO are preparing to investigate bird flu in Vietnam.

China says it has a human flu vaccine it developed in conjunction with the US CDC.

A US biodefense advisor to President Bush says 1918 fatality estimates are optimistic.

"I think that number is a very optimistic number if we are talking about a 1918-wide pandemic today," Rajeev Venkayya, Special Assistant for Biodefense to President Bush, said.

Provinces in Vietnam are gearing up to fight the flu.

The World Bank is putting $10M into the flu fight in Vietnam.

Vietnam says its was poor surveillance that allowed a recent spate of outbreaks.

Avian vaccine is still banned in Thailand.

A British veterinary officer says that a cold snap would increase the risk of bird flu.

Effect Measure points out that cold weather is already having its effect in Asia.

The McHenry County Board of Health has a weekly column starting, and this one (the first) is about preparing for a pandemic.

Hong Kong has tightened import controls following finding H5N1. ProMed reports.

Australian businesses are told to prepare for business continuity for 2-3 months, with 50% absences.

Michigan Public Health officials have a pandemic resource guide.

Recombinomics with a local translation on a cluster in Indonesia. For what it is worth...sometimes these pan out, sometimes they do not.

Computerworld author blogs on the difficulty of writing a cover story on the bird flu...striking a balance between communicating the risks and appearing hysterical.


At 7:32 PM, Blogger Wulfgang said...


It absolutely delighted me that you posted the Computerworld blog article entitled “What Computerworld’s cover story won’t tell you about a Pandemic threat”. The author, Robert Mitchell, does a superlative job pointing out the two conflicting prevalent views, held by the two different experts – which highlights the predominant dilemma we are being faced with. Two differing views…one is to worry, the other is not to be too concerned, essentially. One expert is a physician, Dr. Michael Osterholm, Director of the prestigious University of Minnesota, CIDRAP, the other expert is Martin Meltzer, a senior CDC health economist from Atlanta. It is understandable and healthy that two individuals would have different viewpoints – Dr Osterholm is, and has been continuously, quite pessimistic over the last two years, insistent, and outspoken about a looming pandemic, and the resultant potential for significant mortality rates, societal and infrastructure breakdowns, and questions the readiness of current “countermeasures and intervention approaches”. He has publicly warned on several occasions that a pandemic is a 100% certainty, and losses of lives in a worse case 1918-like situation, could exceed 1 billion people (yes, that’s a “B” as in billion). Meltzer is more conservative and skeptical of the pandemic’s economic impact and threat severity – more indicative of a “let’s wait and see what develops” kind of attitude. Does Dr Osterholm for example, create a sense of hopelessness about the whole situation, and does Meltzer’s attitude cause dangerous apathy and complacency? Don’t know, but it seems to me, that these two extreme viewpoints, also represent the two predominant opinions of the pandemic situation, in government and industry these days. Whom do you believe and is the answer some where in between these two extremes?

The variables of an avian pandemic are undeniably debatable and can be argued, ad infinitum: actual timing of the pandemic and mortalities and rates, extent of supply chain and societal breakdown (a fancy set of words for public panic), transportation, pharmaceutical and utility disruptions, border closures, quarantines, social distancing, economic and health care impacts, and intervention effectiveness. These specific things are truly unpredictable and if anyone says they know these answers, they are either pretending, or delusional. Even though I have had my annual rabies inoculation, I have no definitive answers to any of these situations.

Common sense dictates though, because we have extensive first hand experience and knowledge of the impacts of 9/11, hurricane Katrina, the Indonesian tsunami, as well as many other types of disasters, we can easily ascertain that any thing above a mild 1968-like pandemic, will cause grave consequences to our nation and the world. To think otherwise is foolish. Further, any pandemic approaching the scale of 1918, at even a 2.5% fatality rate, would be a world wide disaster on an unbelievable scale, unheard of in modern history. If one increases the fatality rate incrementally above 2-3%, which is then above the transmissibility and resultant mortality of the 1918 H1 virus, then we essentially are talking potential catastrophic and irreparable consequences. Wulfgang has no doubt, for you see, I am an economist too, Mr. Meltzer, among other special talents. It all comes down to the assumptions.

I suspect, and so do most of the other experts I work with, in my government agency, that what will occur, will be in middle of these two gentlemen’s viewpoints, some place - which still places the impact of a pandemic in an extremely worrisome and alarming category, well worth laying in the best plans we can muster. I do not regard myself as an expert, and where I work is immaterial. What I can tell you though is important: Dr. Osterholm isn’t the only expert who is extremely worried, there are others in our government who are very reluctant to speak out publicly. What they are willing to say publicly is much different than what they say privately. I have worked with my government agency on pandemic emergency operations planning for 1 ½ years now, worked with Deloitte and Touche out of New York, and I guess it could be said that on occasion, I do run with the big dogs on this subject. In summary it has been my observation that, the generally uninformed or naive, hold the very conservative viewpoint of Meltzer, but the preponderance of biological scientists, physicians and physicists I know and personally associate with (some of who are brilliant), are generally in agreement with Dr Osterholm’s views and those of Rob Webster of St Jude’s Children Research Hospital, and Dr. David Nabarro of the WHO.

We are preparing for the worse case scenario where I work (in stages), which translates to be the classic 6 month pandemic cycle, a 40-50% absenteeism situation, and remote work locations, etc. Every worker has been directed to have a minimum month’s supply of food and water on hand at all times – if they fail to do so, that’s their personal problem. We have stored emergency rations for 15,000 people, and have emergency operations communications that rival the White House and Pentagon. We have also had extensive dialogues with the local surrounding cities, to assure mutual support, facilities and emergency services. This should tell you and your readers something.

I believe everyone reading this should be professionally and personally prepared, to do otherwise would be a dangerous folly. Amen.



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