Wednesday, February 14, 2007

February 14 Flu Update

A woman in Egypt has tested positive for bird flu. I believe this is a unique and new case.

ProMed on Egypt.

ABC News on the immunity story. Provocative quotes from Dr. Webster.

Back in 2003, the idea that some people might have limited immunity from the deadly H5N1 bird flu virus seemed almost impossible. I had a chance to ask one of the leading experts, Dr. Richard Webby of St. Jude's Children's Research Hospital, about the theory, and at the time he had doubts.

"I admit I was skeptical," he said now. "It did not seem likely, and that's one reason it took us so long to do the experiments."

Despite the contention that bird flu moved from Hungary to England, the EU sees no reason to change its approach.

A Thai expert says bird flu should go global no later than next year.

A bird flu simulation will be held in the Philippines.

WHO also says bird flu strikes the young more.

New York Times features an article that says people still need to pay attention to the bird flu. Here's a quote from Dr. Osterholm, the quote maker.

"I've gotten at least 10 media calls in the last few months asking me to deliver the death sentence for avian flu," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "But at any conference, if you get a group of virologists at the bar, after the fourth beer, they let their hair down and admit it — they don't know what is happening. They've been incredibly humbled by this virus.

Remember last year when Kleiner Perkins, a venture fund, announced $200M bird flu fund? Big splash, Daily Source Code, everything. This article looks back a year and says that KP obviously got into a risky business.

The news in Britain was a pandemic---a news pandemic.

Editorial urges Nigeria to fight the bird flu--including coming through with promised compensation for culled birds.

Ottawa Citizen author plays SARS forward to the current bird flu threat.

With bird flu in Pakistan, it is now noted that it is knocking on India's door.

OK--you can make your own mind up on this from Hungary's "underground" paper.

Yesterday in ProMed, there was a strong statement in favor of poultry trade--as opposed to migratory birds--being at the root of bird flu. The mod speculated that US surveillance would be clear, as it was in Canada. Today, the data (Hint--it was).


At 7:17 PM, Blogger Wulfgang said...


I’d like to comment on two of your articles today.

First on the Thai article expert’s comment, Supamit Chunsuttiwat, who expects a global pandemic, next year at the latest. It would be helpful if “experts” like him would share the information he bases his belief on, because I fail to make the connection between the H5N1 arriving in North American birds and the outbreak of an avian pandemic. Is this when the “East final meets West” in viral and environmental terms, or based on scientific data, or evidence of mutation, or exactly what ? We’d all like some more information from his Thai crystal ball. I’m postulating that he believes that once the H5N1 virus elevates to the HPAI level in North America, some point of “world endemic saturation” is achieved, which brings it to its fullest potential. I myself don’t believe there is any direct biological relationship at all between continental geography and the likelihood of a pandemic. It will come down to specific location, population density, widespread prevalence of the virus in the environment, mutation, faulty eradication and prevention/culling and host vaccination procedures (both human and animals), and lack of surveillance. Maybe just sheer randomness also.

The New York Times article contains some very predictably stark statements and some rather startling revelations, if one reads it carefully:

• Robert Webster statement – “My take home message is don’t become complacent. Don’t trust this one”
• Michael Osterholm statement – “… they let their hair down and admit it – they don’t know what is happening”.
• Joseph Domenech – “If it is explosive, you cannot miss it”
• Naipospos (Indonesian flu expert) – “In the 82 human cases studied, she said only 45 per cent of victims had direct exposure to sick poultry, and an additional 35 percent had indirect exposure, and 20% was inconclusive”
• Donald McNeil (author of article) – “But the bird flu is out of control in three countries – Indonesia, Nigeria and Egypt, with a combined population of 447 million people”

These statements taken collectively, indicate a couple of very important things that we all need to be continually cognizant of. First, based on the history of pandemics over the past 500 years, they are totally unpredictable, and can occur at any time of the year. Studies of the 1918 pandemic waves reveal that the first wave that occurred in the Feb/Mar timeframe was relatively benign, and was not particularly noticeable by anyone, anywhere – it in fact appeared to be a moderate epidemic, a real “sleeper”. However, the virus somehow underwent continuous mutations throughout the next successive two waves, resulting in an incomprehensible number of fatalities. So, initially, we may in fact miss spotting the initial wave – only a number of months thereafter, may we see the explosive stage manifest itself. We have very little “margin for error” in our understanding of what is transpiring and in our preparations.

We also have very little “margin of safety” in our pandemic planning to date, no matter what process, procedure or application one examines. The term "margin of safety" is used in design engineering to describe how over-engineered or robust a design is. In the medical community, it is sometime described as the amount between a therapeutic dose and a lethal dose of a drug. In financial terms, it is the difference between the intrinsic value of a stock (i.e. value based on stock valuation and what the company is actually worth) and the price that the market sets on a stock. In accounting terms, margin of safety is how much output or sales level can fall before a business starts making a loss.
In pandemic terms, the “margin of safety”, I believe, can only be described as the difference between what is actually occurring in out-of-control places like Indonesia, Egypt and Nigeria – and the resultant negative impact on our societies and infrastructures, should it become highly transmissible and deadly. Pandemic planning only lessons the impact.

I see our margin of safety getting smaller and smaller with each passing month. Maybe this is what Supamit Chunsuttiwat is really talking about - we run out of safety margin next year, or sooner.



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