Saturday, February 03, 2007

February 2 Bird Flu Hits Britain.

1,000 turkeys died in Suffolk and H5N1 is confirmed. Revere reports.

These links are from before confirmation was public...

A thousand turkeys died in Suffolk (UK), bird flu is being probed.

Promed with this story. Note mod comment:

Too early for clear-cut conclusions; however,in view of the fact that both cases have taken place on UK's eastern coasts, one is inclined to wonder if this is a mere coincidence or indicative of the wild-bird origin of thecurrent outbreak. - Mod. AS

Research indicates now that the H5N1 virus can infect cells in the upper respiratory path--in the past, some felt that the virus had not gone H2H because it had to infect deep lower lung tissue. However, the report says that alone has not made it more transmissible.

Revere blogs this study---must read. Research is important, but more steps needed.

CIDRAP has expert reviews of the bird flu plan CDC put out yesterday. Here's what Dr. Osterholm had to say.

Michael T. Osterholm, PhD, MPH, praised the CDC for devising a simple, clear approach to an extremely difficult public health problem.

"Now how do we take it to the next level? This is a work in progress and process," said Osterholm, director of the University of Minnesota Center for infectious Disease Research and Policy, publisher of the CIDRAP Web site. The onus is now on states and cities, which must take the plan and assess how they would make it work in their localities, he said.

Osterholm says he's not worried that officials would be reluctant to close schools in the event of an influenza pandemic, because parents will probably force the issue by keeping children home. But when to reopen schools may be a tricky question, he said. "How do you unring the bell? How do you make the school decisions if there are multiple waves?" he asked.

The community mitigation strategies such as school closures and social distancing for adults will have a big impact on businesses, Osterholm said. He added that it's positive that the CDC guidance does not mention closing borders. Closing borders is unlikely to slow a pandemic, and keeping them open will ease some of the supply-chain concerns that corporations will have, in his view

Crofsblogs found this less positive report from an epidemiologist.

Revere comments on the Indonesian story that the capital had been cleared of backyard fowl. Swallow any beverages before you read the quote below....

"I can guarantee there are no backyard birds in Central Jakarta," said Muhayat, the mayor, who uses a single name. "The people here are now fully aware of the disease and voluntarily culled their birds.

Here is the story that Revere refers to.

Japan confirms presence of virulent H5N1.

WHO is in Nigeria to help.

CIDRAP weighs in on the report about small changes that effect transmissibility.

Another downside of stockpiling Tamiflu...Asian countries will soon see there stockpiles pass their expiration dates.
The World Bank is supporting a flu program in Kosovo.

US experts apparently view Toronto as a model of pandemic preparedness.

Local doc updates Montana readers on bird flu.


At 3:12 PM, Blogger Wulfgang said...


Call me overly cynical if you will, but I would like to put a few things in proper perspective.

First the statement my Dr. John Bartlett of John’s Hopkins University, who believes that both Toronto and Hong Kong have “really good plans” when it comes to pandemic planning, based on their experience with the 2003 SARS epidemic. This may be the case,but in fact, the records show when SARS hit Asia and Canada in 2003, tens of thousands of people who had possibly been exposed to the virus were quarantined. In mainland China, Hong Kong and Singapore, police surrounded and cordoned off buildings, set up check points on roads, into and out of areas where the virus had been discovered, even installed Web-Cam’s in peoples homes, blocked off whole villages, and China even threatened to execute anyone who broke quarantines. Canada’s response was more acceptable, it enacted voluntary home quarantines, provided food, supplies and compensation for lost wages. I just thought I needed to point out, that when one translates comments and opinions from “experts”, many times the actual facts and events are a matter of interpretation. SARS caused less than 1,000 deaths and is in fact far less infectious than influenza. A pandemic influenza virus will move around the world more rapidly than SARS. This year in 2007, more than 1B people are expected to travel internationally, either by airplane or automobile. It is doubtful that either the Hong Kong or Toronto model will be palatable to the public or feasible for avian influenza planning, in the final analysis.

I read more expert’s comments in your CIDRAP article (“Experts give qualified praise to new pandemic guidance”) very carefully also, as they gave their opinions on the CDC’s new five-level Pandemic Severity Index (PSI) based, community intervention measures. I would basically describe them as politely “cautiously optimistic”, in the sense that, the US CDC and HHS finally have a start on a national set of guidelines, to build upon. Their comments very much coincide with the general view - a year or two, too late, but never the less, a good start.

Here’s the real situation though, as many of us see it, and correct me please if I am wrong: The sense of urgency and real comprehensive preparedness is lacking. We all as individuals have a personal responsibility to be preparing for something that will happen, and we all have to prepare for the worst. Flu pandemics occur historically ever 25-45 years on interval and have cataclysmic implications. That’s a fact.

Presently, there are vastly insufficient antivirals stockpiled and there is no human vaccines yet. It is tremendously naïve to assume that a modern day pandemic can be averted by blanketing communities with Tamiflu, within the first 48 hours of exposure. Neither the WHO nor the CDC or HHS, will be quick enough to diagnose an actual H5N1 type pandemic influenza outbreak to confirm it and blanket the area with antivirals, and to contain it. We are already seeing the tremendous time lags, co-infection problems and numerous testing complexities involved in distinguishing between the avian and normal flu viruses in multiple underdeveloped countries. What’s more, as the H5N1 mutates, there is no actual evidence that mass blanketing of communities with Tamiflu single doses will be entirely effective once the virus becomes highly transmissible, which may diminish the insufficient critical supplies significantly. The CDC pandemic planning mainly hinges on administering antiviral medications as a Maginot Line of first defense. Also, it doesn’t matter if we have candidate pre-pandemic or even an actual pandemic influenza vaccines developed, if we can’t manufacture it in large quantities until the next 5-10 years. Since 1997, when the H5N1 first appeared in Hong Kong, it has continued to rapidly mutate, in a pattern almost identical to the 1918 high pathogenic 1918 H1 virus. Both the H5 avian virus and the H1 1918 type virus, are the only two viruses known to show identical protein tags which cause the cytokine storm, that makes them both unique and equally every bit as dangerous as West Nile and the Ebola virus. Both have a 90% mortality rate.

So we must prepare for a pandemic with an increased sense of urgency in my opinion. We cannot falsely assume that in the event of an avian pandemic, that the mortality rate will be similar to the 1918 CFR of 2.5%, and that the present > 50% mortality rate of H5N1 human victims will attenuate. Neither the Ebola or the West Nile virus has. As John Barry points out from history, the 1918 pandemic came is waves. The CDC plan does not even address this fact. We have to begin considering now in our planning, to include hard core provisions for our total health care system to be overwhelmed, our economic system to grind to a halt, and for delivery of essential products and food to cease for a while. These situations may well effect every individual, town, state, and nation in the world – that’s the difference between a epidemic and a pandemic, and we need to plan for this likely disruption.

For a while, everybody is going to be on their own, and this is what is most alarming. For anyone to believe that an actual pandemic vaccine will be produced in adequate numbers to inoculate the entire population of the US and Canada in 6 months is in my book ridiculous. About as ridiculous as the mayor of Jakarta stating “I can guarantee that Jakarta has been cleared of backyard fowl”, when they can be seen by reporters roaming in suburban neighborhoods.


At 2:11 PM, Blogger Orange said...

I often wonder if people in the flu community would do if a solution did emerge. We should be careful, because we could end up as in denial as Marc Siegal if we don't keep our minds open.

No doubt, the containment strategy with antivirals is not workable. That wasn't what anyone was talking about. All I suggested was that we might be closer to averting the total meltdown many fear if we can employ a vaccine at some point early in the process, even on a limited basis. That's even more likely if there is some existing immunity, as there may be. Because yes, we will have another pandemic again. But not all pandemics are "cataclysmic"--it does not have to be a 1918 pandemic.

Finally, I don't believe anyone really ever prepares for the absolute worst that could happen. It isn't in our nature--and we would literally be paralyzed.


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