Tuesday, March 27, 2007

March 26 Flu Update

The NY Times weighs in with the question many people are asking...what is the bird flu doing? Is more going on than we see or know? Here is the key conclusion, certain to be controversial:

Today’s H5N1 flu is probably changing more slowly, because health officials have been vigilant about attacking clusters of cases, which presumably wipes out the most dangerous strains. Whenever several human cases appear, even in remote villages in Indonesia or Egypt, local officials and World Health Organization teams move in to kill all the local poultry and dose all the humans with antiviral drugs — the so-called Tamiflu blanket strategy.

Each stifled outbreak robs the virus of the chance to carom wildly through dozens of human hosts as it does in a flock of chickens or ducks. That fends off what virologists most fear: gene-swapping in people infected with both human and avian flu.

ProMed on Egypt and Hong Kong.

Given problems with its neighbors, India continues to be concerned about poultry imports.

Despite bird outbreaks, Bangladesh says no human cases.

This is interesting. In Canada, representatives of the food industry are thinking through how to handle food shortages during a pandemic.

"In a modern-day, just-in-time food-supply chain, also drawing inputs and ingredients from across the world, such [a] pandemic would not only have severe public-health implications but also pose significant economic impacts and challenges across the entire agri-food continuum," says a federal discussion guide written last year.

Anchorage has been working for a year on its bird flu plan, and it is continuing to work.

Some passengers grew ill on a flight from Hong Kong to Newark. Next thing you know "The Federal Centers for Disease Control sent members of its Global Migration and Quarantine Office from LaGuardia Airport in New York to Newark to check out the passengers, reports the Newark Star Ledger."

The great vaccine debate continues. Helen Branswell here. You will recall that Revere noted that it doesn't make sense to argue so much about so little--since production capacity for vaccines is so low. According to Branswell, WHO is trying to carry that message in a meeting with nations on the vaccine.

The three-day meeting, hosted by Indonesia, will see the WHO advance some modest proposals for improving access to vaccine, including the notion manufacturers might be persuaded to create a small virtual stockpile by holding back a portion of their output for developing countries. The WHO is also trying to use some donated funding to encourage partnerships between developing countries and vaccine makers which could see production or packaging plants located outside the developed world.

The WHO will also gently try to explain the hard realities of the situation, presenting data on global production limitations.

UNICEF says children are most vulnerable to the flu.

The Pennsylvania Department of Health is holding a pandemic planning seminar for colleges.


At 6:37 PM, Blogger Wulfgang said...


Very nice set of articles you posted today.

The NY Times article was really a first class piece of work, very well balanced and informative – I could see that the author really did his homework. I really can’t take any issue with the substance and points made, at all. The most disturbing part of the article, that I must admit has slipped by my attention prior to this article, is the study that was conducted last year when scientists created a “hybrid” type H5N1 virus, by combining a regular old H3N2 virus with H5N1 in ferrets, resulting in an approximate 33% fully transmissible situation. This is extremely worrisome, since it proves beyond a shadow of a doubt, that deadly host-to-host transmission, (caused by reassortment) is indeed easily viable. I believe what is going on in Egypt currently, is that several different strains are starting to emerge, a highly virulent one, and a less deadly version, at minimum. Three new cases alone, just in that country today, indicates that it is gradually slipping into the “Indonesia” category.

The title of the NY Times article should have read: “H5N1 – expect the unexpected”

Also, as the article points out quite clearly, the proven ability of the H5N1 virus to exponentially mutate over time, into multiple strains, and confer resistance to anti-viral’s, warrants constant vigilance of its hemagglutinin gene spikes. Probably if I were to take issue with any part of the article, it would be the author’s inference that the so called “tamiflu blanket strategy” and actions taken by “attacking clusters of cases, which presumably wipes out most dangerous strains”, that this process in effect is successful, and fends off gene-swapping in people infected with both human and avian flu. This sounds good in theory, but many of us are extremely skeptical that this process is in fact being as effective as it is touted. Nearly the same approach was taken for tuberculosis, and as a result, we are stuck with totally anti-biotic resistant highly virulent strains of TB, that there is absolutely no cure for. We know in Bangladesh that the government is monitoring 100 poultry farmers for suspected H5N1 infection, and most probably fed them all Tamiflu, as a precaution - is this blanket approach the correct scientific way to proceed ? I think this is probably only buying precious time, but unfortunately is the only first viable line-of-defense we have at the moment, other than thwacking a bunch of chickens dead.

The Indian article entitled, “Red alert sounded over bird flu scare”, is quite revealing. Notice the tremendous reaction and preparations being made by their government, as compared to some of the ineffectual measures other governments that have been plagued with H5N1 have only made feeble attempts to take – most notably, Indonesia, Egypt and Nigeria. One can really tell the difference. Even though Bangladesh and India have had no human cases of H5N1, I have a feeling they are theoretically on top of their preparation game – however, due to their dense populations, if it ever did become epidemic, it would easily spin out of control. No doubt at all in my mind at all.

Your article out of Canada regarding the necessity for the food industry and government representatives to strategize a workable food delivery chain plan, is quite thought provoking. Although almost everyone who is familiar with pandemic planning, has been clamoring for this kind of action to take place, the only actual news we’ve seen on the subject comes out of Canada, and not the US. Not a peep from FEMA, the Red Cross, Civil Defense, HHS or Homeland Security. I believe there is a patently false assumption in Washington that the food and grocery supply chains, the states, and individuals are addressing this potentially huge insurmountable problem. They are not.

One of the most significant problems any country or citizens will face when clear evidence of a pandemic begins to surface somewhere in the world, is how to continue feeding its people (even Napoleon said, “an army marches on its stomach”). Allocation of suddenly scare resources will be an immediate concern, in fact so much so in my opinion, that nearly everything that is now easily purchased, will become quickly unavailable during a pandemic. The vast majority of citizens in North America, for the most part, will be wholly unprepared, since they view avian influenza in the same vein as normal flu.

At the first indication of a pandemic, there will the panic buying of provisions, all across the US and Canada, similar to what we regionally see, during threatening hurricanes, blizzards and other severe weather.

The biggest question in my mind will be at what point will state and federal governments understand the dilemma and that they must insert themselves during a pandemic, in order to allocate the extremely scarce resources, to where it is needed and required. In addition, to what extent will they be compelled to exert their powers and exercise the control and coordination that is required in order to maintain law and order. If Katrina is an example, we will be in extreme chaos and social turmoil, in my opinion. For lack of adequate planning, if the state and federal governments were to begin “appropriating” the goods and services it needs from businesses and individuals, I am concerned there will be serious trouble. I am also concerned that nobody in the Bush Administration thoroughly has thought this national threat through – they are stuck on terrorism, and the war in that rat hole, called Iraq. There simply is no integrated nation policy with the farm suppliers, farmers, food producers, distributors, truckers, retailers, pharmacies or grocery chains – nothing. Not even with precious gasoline supplies, allocations and deliveries. Reality will bite.

Helen Branswell of course, wrote another excellent article on the situation there in Indonesia, describing their rather hopeless situation of only being able to provide H5N1 strains to the world, and in refusing to do so, hope that they hold a trump card. Of course the current news (post article), is that Indonesia has quickly agreed to provide the strains, starting immediately. My opinion always has been that this issue was primarily only a distraction and rather moot– Indonesia had no other choice: the fact still is, if a pandemic were to emerge tomorrow, the powerful world countries would take the pandemic Indonesian strains by force, wherever they are located throughout the world. Without any question. And there is still no absolute guarantee Indonesia will receive their “allocated share” of critical vaccines during a pandemic – first, they would have to wait up to a year for it (manufacturing time), then someone else could literally take it from the manufacturer. Its easier to ask for forgiveness after the fact, then permission beforehand.

Finally, your last article on the pandemic influenza planning seminar at Penn State. A university with enrollment of greater than 60,000 students, can only accommodate the first 75 people who register ?

Give me a break here, please.


At 9:33 AM, Anonymous Lisa said...

A thought that comes to mind when considering the food shortage issue is whether the governments (if they are still operational - who's to say their workers will show up on the job any more than anywhere else) will forcibly redistribute food supplies. In other words, if you have stocked up heavily on supplies, and your neighbour hasn't, will there be a possibility that someone will come along and take your carefully planned provisions to redistribute to your neighbour?

I think that anyone who takes the time to stock up should also plan a way to hide the fact that they have done so. It will literally be every family for itself if worst case scenarios play out. It is particularly problematic for farmers, who may store their crops in a granary for future consumption by their family and anyone else they care to share with. That would be an easy target, however, for government officials (and, depending on your side of the preparation fence, you may or may not agree with that action).

Everyone needs to think all of these issues through to their logical (or even illogical) conclusions to be fully prepared.


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