Wednesday, April 25, 2007

April 24 Flu Update

AP says that while bird has "flown" off the headlines in the West, it remains a big deal in other parts of the world. Article details the rich/poor struggle over vaccines, etc. Interesting quote from Dr. Osterholm, who has persuasively made the point that we are all in this together.

"It's not just about altruistic public health," said Michael Osterholm, a University of Minnesota infectious disease specialist. "When we realize Southeast Asia and China are shut down economically from a pandemic perspective, so goes our economy. So goes many critical products and services that we count on every day."

Latest flu misery index...WHO says $200B global hit, 1 billion sick, 2 to 7 million deaths.

For those of you who look for signals things are getting worse, here is an interseting quote from the lead official in the ASEAN bird flu task force.

The disease, according to him, is becoming more complicated and vaccines are not as effective.

WHO has provided grants to six countries to help them build production capacity for bird flu, partly in response to the rich/poor debate.

ProMed on research that shows three clades are circulating in Europe and Africa--and that, in fact, Nigeria has had two separate flu introductions.

The Philippines claim to be still flu free.

Meanwhile, China says its bird flu situation is stable.

Farmers in Bangladesh are worried about bird flu. Exports are halted, etc.

Officials in Des Moines, IA, are looking for a quarantine site in the event of a pandemic.

Experts in Lebanon, PA say that bird flu is no reason to panic, but it is inevitable.

The Waterloo ONTARIO plan for a pandemic has been released.

Interesting Canadian Construction industry talks about flu prep. Interesting points, including the benefit of cross-training during widespread absenteeism.

Effect Measure asks why the poultry company was reimbursed for its bird flu expenses, but not the workers who lost their job.


At 8:11 PM, Blogger Wulfgang said...


Very nice set of articles today. Real brain food.

I would like to make two quick observations about Indonesian Health Minister, Siti Fadilah Supari, and her comment in your first article. She states: “ Exploitation by industrialized countries toward poor countries is not something new… this situation brings poverty, suffering and stupidity”. First, since she has failed to live up to her word last month at the meeting in Jakarta (to provide vaccine samples), with the WHO, one can presume her word is pretty much worthless. Second, her comments are starting to sound like they are straight out of the Communist Manifesto. What’s next to come out of her mouth – “class conflict between the bourgeoisie and the proletariat ? How about the following: “the productive forces of capitalism are quickly ceasing to be compatible with this exploitive relationship, thus Indonesia will lead the avian influenza vaccine revolution for the elimination of social classes and unfair deaths” ?

She’s starting to really sound like a disciple of Karl Marx and Friedrich Engels to me.

However, your most stimulating article in my view, is what you term “the latest flu misery index”, or the Bloomberg article, which predicts a $ 200B global hit, 1 billion sick, and 2 to 7 million deaths. While I acknowledge upfront, that it is virtually impossible to estimate how many people will die from a modern day pandemic, broadcasting low numbers like these will most likely result in the famous “dangerous unintended consequences” – people, counties and governments everywhere, will not subscribe to the growing sense of urgency to prepare properly for the next major epidemic.

Here’s the major problem I have with these low numbers: in 1918, when the world population was only 1.8 billion, and the influenza pandemic conservatively incapacitated 500M to 1 billion of the entire population and killed 20-40 million people in the span of the first year. The CFR at that time was an estimated 2.2%. Today, April 25, 2007, the world population is an estimated 6.5 billion people – the same 2.2% applied to our current population, would reveal an very gross estimate of 145M deaths, conservatively, worldwide – roughly 20 times the WHO estimate in the article. The CFR, as you know, is presently a killer 60%, well out of the 1918 range.

Granted, the estimated numbers of deaths will depend on a number of complex factors, which are currently unknown: how contagious (CAR) and how lethal the pandemic virus (CFR) will be; immunities acquired through previous influenza infections; co-morbidity; different accesses to health care; the speed at which the pandemic will move through the population; and the extent to which medical services are overwhelmed - which will collectively cause further increases in the mortality rates. Practically speaking, if half the population of the world ends up sick, this logically means half the health care system will be sick also.

In my view, the big driver behind the larger unanticipated numbers of worldwide deaths in a modern day pandemic is fairly straightforward: 87% of the world’s present population resides in third world countries, developing nations and dirt-poor countries, like Sub-Sahara Africa and Indonesia. The poor will suffer disproportionately compared to the rest of us in North America. The vast majority of anticipated fatalities can be expected in these poorer countries, and fewer in the modern industrialized “rich” nations. Medical management and health care systems are admittedly much better now in 2007, than they were in 1918, but not in these third world countries. Furthermore, whether a nation is rich or poor, doesn’t matter if we have a high transmission rate: worker absenteeism will be skyrocket, causing systematic failures of the critical infrastructure’s everywhere, causing a near health care system collapse, power grid failures, food production, processing, distribution, and delivery failures. Healthcare in general will only be provided to those first infected and supplies of everything will be scarce. There is not going to be sufficient enough stockpiled anti-viral medicines nor vaccines, to provide to those in quarantined areas, in my opinion.

If anyone wants even a small inkling of how dismal health care will be like during a mild pandemic, read this article:

All of these things, in my opinion, will cause a dramatic predictable increase in the number of excess deaths. Both rich nations and poor nations will share in the pain, but unequally, driving up the total fatality numbers.

What is really troublesome about your articles today, is that sense of gravity that some of them convey: for example, there are at least 14 influenza subtypes that presently are embedded in avian hosts. There are 3 distinct strains circulating in the European and African regions, which are distinctly different than the clades in Indonesia and China – God only knows how many are really circulating there, because they both are refusing to provide samples. China describes their bird-flu epidemic situation there as “stable”, but when one reads the article from, China View, you suddenly realize they are referring to P-O-U-L-T-R-Y, not humans or human infections. Does anyone care about a status of their bi-annual vaccination program of 1 billion chickens and ducks ? Not really, we’re interest in tangible useful information.

Des Moines Iowa health officials can look for “alternative housing” quarantine sites for all the people who can’t or won’t stay home during a pandemic, but – this really smacks of Katrina, and people (I predict) are not going to be happy at all when they find out they may be treated like refugees or leper’s.

I think your article about Canadian Construction industry has it right. The construction industry really portrait’s what to expect with a modern day pandemic: as it states, “60 per cent of Canadian workers say they would simply not report to work if a co-worker were to come down with avian flu”. In addition, “72 per cent of senior executives surveyed have no plan to deal with disasters, and most of those who have plans don’t address pandemic situations”.

A pandemic will be like watching the 1952 science fiction classic thriller, “The Day the Earth Stood Still”. Nobody goes anywhere, or will want to.

Did you know that Fox has announced that it will remake this film, for release in the summer of 2008 ?


At 2:09 AM, Anonymous Anonymous said...

I wish that you also had a site like this one about XDR TB. "In February 2007, the department of
health also said that 269 cases were reported in South Africa since 2005. The 1st 60 cases were reported in KwaZulu-Natal. In total, 184 people died."

At 8:08 PM, Anonymous Wayne said...

The life expectancy of a person with HIV who contracts drug resistant TB is 16 days.There are now strains of TB that are resistant to virtually all antibiotics .


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