Friday, February 02, 2007

February 1 Flu Update--US report leads big news day.

The US bird flu effort is on display today as the US released new pandemic flu guidelines to cities and states. As usual, this generates many headlines.

Here's the New York Times' take....the plan calls for major disruptions in everyday life in order to buy time to get a vaccine produced. This is, in concept, similar to the containment strategy, which, as we know, included saturating an area with Tamiflu in order to keep flu from spreading out. This plan is a little more realistic in that it aims to lessen the severity of the first wave in the hope of stopping a second wave. I see the major problem in this plan as maintaining social order when the plan does not "appear" to work.

American cities should close schools for as long as three months in the event of a severe flu outbreak, sports events and movies should be canceled and working hours should be staggered so subways and buses are less crowded, the federal government advised Thursday in issuing new pandemic flu guidelines to states and cities.

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In an innovation, the new guidelines are modeled on the five levels of hurricanes, but ranked by lethality instead of wind speed. Category 1, which assumes 90,000 Americans would die, is equivalent to a bad year for seasonal flu, said Glen Nowak, a spokesman for the agency. About 36,000 Americans die of flu in an average year. Category 5, which assumes 1.8 million dead, is the equivalent of the 1918 Spanish flu pandemic. (That flu killed about 2 percent of those infected; the H5N1 flu now circulating in Asia has killed more than 50 percent but is not easily transmitted.)

More on flu news from the conference. The US says its goal is to have enough vaccine to cover the entire US population within six months of an outbreak. And that could be years away.

Helen Branswell, as always, has the best take on this. Note that the plan is based on severity of the pandemic. I believe the US plan sounds as if it is tailored to respond to the kinds of concerns Dr. Osterholm has raised. Here is what CDC had to say:

The recommended measures won't protect everyone and won't eliminate deaths in a pandemic, Gerberding warned. But they could reduce the death toll and soften the blow a pandemic would level on other aspects of life, such as the delivery of essential services and the transport of essential goods.

CIDRAP also weighs in. Note that severity of cases is based on CFR--case to fatality ratio.

Here is a link to the full report (I haven't read the report yet, perhaps tonight and tomorrow....

Here is a link to the HHS press release.

Here is a link to the transcript of the press conference CDC held.

The Wall Street Journal also says has triggered an immunity clause for companies making vaccines in response to the avian flu fear.

Leaving the US....

WHO says if pandemic risk grows, it will speed the release of viruses for vaccine development purposes.

A third outbreak has been reported in Thailand.

Meanwhile Phuket City in Thailand says it is bird flu free. So there.

Indonesia says it has a human bird flu vaccine in the "experimental" stages.

Nigerians unfazed by bird flu death, business at poultry market goes on as normal.

ProMed on Nigeria...note WHO has not confirmed the death there.

ProMed has this report from four countries, including a possible outbreak in Georgia.

Ukraine now has blocked bird flu imports from Russia as well as from Hungary.

Researchers says altering the "coat" of a virus could stop it from spreading.

Scientific American on this report as well.

An alert reader sent this along...note these quotes from Dr. Webster....

Each outbreak of the flu in birds, people and animals such as cats and pigs raises the possibility that it will mutate into a form that spreads quickly in people, Webster said. A resurgence of infections in countries such as Japan, South Korea and Thailand confirms that control efforts that appeared effective still need to be strengthened, he said.

``To me it means that we've failed,'' Webster said today in an interview in Washington. ``It's a lack of knowledge and political will to get at the source of the virus.''

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``It's a general failure,'' Webster said. ``I'm not pointing the finger at anyone; I've also failed. We as a whole have failed to understand the ecology of H5N1 well enough to control it.''


Note this quote, too, not from Dr. Webster, but from a Dutch scientist:

The virus undergoes so many mutations that it may already exist in a form that's transmissible in humans, said Ron Fouchier, a virologist at Erasmus University in the Netherlands.

``Chances are it would be out there somewhere,'' he said yesterday in a telephone interview. ``It just isn't in mammals yet; it's somewhere in a bird or poultry.''


Provincial officials in the Philippines met to prepare for the bird flu.

More on local preparations in the Philippines.

Continued vigilance is urged in Hong Kong.

A University of Chicago Economist have a speech on controlling bird flu, partly focusing on the need for proper compensation for third world poultry farmers.


Bird flu training is being conducted in Shreveport.

Scientific American reports that it is wise for flu fighters to keep less virulent strains are more likely to spread because they don't kill the hosts as fast. Note that some people believe H5N1 could adapt to human transmission without becoming less virulent.

Effect Measure on why all those suspected cases in Thailand were likely to be H5N1 negative.

2 Comments:

At 6:04 PM, Blogger Wulfgang said...

Orange;

You posted an incredibly long list of articles – I would love to comment on all of them, but unfortunately that is not feasible, so I’d like to provide further comments about the CDC guidelines for pandemic flu, announced at the CDC news conference yesterday.

Make no mistake about it, both within and outside of the government, there is a whole lot of skepticism and major concern about whether the CDC “hurricane based” classification and preparation assumptions and guidelines will work, at the Cat 4 and 5 higher levels. I will repeat what I said yesterday: once the severity and mortality of a Cat 4 or 5 type pandemic is evident, the assumptions can change dramatically. In many of our opinions, it can no longer be assumed that citizens will politely obey voluntary social distancing and self-quarantine – things could descend into panic and rioting, in a heart beat. The nation’s underfunded and understaffed public health system, as well as food supplies and pharmacies, could be quickly overwhelmed. Without any doubt in anybody’s mind, in a 1918-like scenario, law enforcement and the military, would have to use force to maintain calm and social unrest. These guidelines must be developed immediately.

Unless we begin now to address and resolve the real issues of citizen inequalities and unpreparedness, and combine these approaches with the CDC hurricane based type guidelines – we are doomed to repeat the failures of Katrina, only magnified by many times over. The working poor and totally unprepared, number in the tens of millions in the US and Canada, and they simply cannot afford to self-quarantine themselves or their families for longer than a week or two at most – without social unrest igniting. The government will have to step in and guarantee subsistence for these people, or the pandemic plan becomes unworkable at the Cat 4 and 5 level. It’s that simple. Telecommuting and avoiding public transportation is a viable solution for people who have the means and economic safety nets to take advantage of the opportunity, but it does nothing for the lower social classes and impoverished. These issues must be addressed.

Let’s see now, let’s get some semblance of how voluntary compliance during a 1918-like pandemic is going to work…. in the US in 2006, a record 7 million people, or one in every 32 American adults, were behind bars, on probation or on parole. Of the total 7 million caught up in the criminal justice system, 2.2 million were actually in prison or jail. More people are behind bars in the US than any other country. China ranks second with 1.5 million prisoners, followed by Russia with 870,000. America is a violent society, where for the most part, social programs, especially those dealing with education, poverty, urban development and health care, have mostly failed – and we expect the general citizenry to voluntarily submit to guidelines during a national crisis ? The number of citizens possessing firearms is staggering. Sounds more like a social and national security disaster waiting to happen, to me. More like the perfect storm.

While everyone, including myself applauds the efforts of the CDC and HHS with their health management guidelines, a much more concerted integrated and coordinated national and state planning effort needs to be made in the following areas, undoubtedly by the Department of Homeland Security, FEMA and the military: Consistent interoperable emergency communications equipment and frequencies, emergency internet reliability and integrity, national security and preservation of law and order, as well as assuring adequate stockpiles of food and emergency supplies. Note – all at a time when deployment of the National Guard to Iraq and Afghanistan, undermines homeland security and pandemic security planning.

Simple question Orange… for a Cat 4 or 5 hurricane, a person probably needs a week’s worth supply of food, but for a Cat 4 or 5 pandemic to the scale of 1918, a person needs the assurance of 3-4 months worth of supply of food.

Where is the lower social echelon and impoverished masses going to find this food during an emergency ? (the answer is… any where they can get it).

Wulfgang

 
At 1:04 PM, Anonymous Anonymous said...

While the medical response to pandemic flu will be important to controlling its spread and limiting its toll, there are considerable non-medical issues related to flu preparedness that are essential for ensuring the continued well-being of the nation's economy. Planning for Continuity of Operations (COOP) and Continuity of Government (COG) is critical to maintaining the overall viability of society. Thus, while we rightly prepare for the flu, we must be equally prepared to function during the flu.

The Center for Technology and National Security Policy of the DOD's National Defense University has prepared a number of freely-available items which can help civilians be prepared both before and during the flu. "Bird Flu and You" is a poster available in 9 languages with basic information about influenza preparedness. "Weathering the Storm" is a report with information about planning for COOP, including instructions for carrying out "tabletop excercises" with a COOP plan.

Electronic copies of the poster are available at http://www.ndu.edu/ctnsp/Bird_flu.htm. Electronic copies of the report are

available at http://www.ndu.edu/ctnsp/Def_Tech/DTP%2038%20Weathering%20The%20Storm.pdf, and to request hard copies of the
report, contact the Life Sciences group at lifesciences@ndu.edu.

Robert E. Armstrong, Ph.D.
&
Mark D. Drapeau, Ph.D.

Center for Technology and National Security Policy
National Defense University
Washington, DC

This is the view of the authors and does not represent the official view of National Defense University, the U.S. Dept. of Defense, or the U.S government.

 

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