Saturday, May 12, 2007

May 11 Flu Update

10,000 birds were culled in Bangladesh as the flu spread.

Vietnam has a "problematic" batch of avian vaccine, which means it can't be used...which puts provinces out hard earned cash.

World Migratory Bird Day is launched. Hint: you don't get the day off work.

Research shows that seven new species of wild birds have been identified as H5N1 carriers.

ProMed on this study. Notes that while it may not be much value in studying H5N1, they provide invaluable data on the life of flu viruses in wild birds.

CIDRAP has an update for its business audience on the antivirals and bird flu. This is a great summary of the state of play. Note this for the good---and the bad--of Tamiflu.

"The numbers are so small that it's hard to know whether Tamiflu is efficacious at mitigating disease, but it's all we have, so it's worth trying because it has very limited toxicity [poisonous effects]," says Stephanie Black, MD, assistant professor of medicine in the section of infectious diseases at Rush University Medical Center in Chicago. Studies in mice have demonstrated a protective and therapeutic benefit of Tamiflu against the 2004 Vietnam strain of H5N1. However, this efficacy does not guarantee the same result in humans or with a pandemic strain.

A 2007 study of the effectiveness of Tamiflu in improving the survival rate of ferrets exposed to the H5N1 virus found that giving the drug within 4 hours of exposure (ie, before illness) resulted in 100% survival. When the treatment was delayed 24 hours after exposure, a higher dose was needed to achieve the same result. (H5N1 follows a similar course in ferrets and humans.)

CIDRAP notes that there is little resistance to Tamiflu, as noted by WHO. Of course, a Tamiflu resistant H5N1 is a nightmare of the first order.

CIDRAP also notes that Edmonton has added ginseng to its bird flu stockpile. (I'll stand in line longer for the Tamiflu.)

Brunei says it is stepping up its bird flu measures.

You saw where the US military released its bird flu planning doc this week. Given the performance of the military in Iraq, let's just say Revere is skeptical.


At 11:19 PM, Blogger Wulfgang said...


My opinion, after having read your CIDRAP and Effective Measure articles, is a mixture of reactions.

I too am quite skeptical if the military will be able to provide any major benefit during a full up pandemic, but not because of their performance in the rat hole called Iraq. That has nothing to do with it. I also have read the entire DOD Implementation Plan, cover to cover.

Here’s the most significant problem with dealing with a pandemic, as I see it: if in fact the death rate as the DOD is anticipating, is a paltry 1%, or 3 Million people in the US, similar to 1918, then our military and reserves, couple with state resources, should be able realistically handle the tragedy. However, any Case Fatality Rate (CFR) above this extremely optimistic 1% - then we are most definitely in my opinion going to experience a total societal meltdown.

Why? A number of reasons…

1. False assumptions that a vaccine will be produced in sufficient quantity within 5-6 months. Realistically, it will twice to three times that long before a pandemic jab will be stuck into any of our arms. If anybody thinks a pandemic vaccine will really be available in 5-6 months, they have a better chance of meeting an alien from another planet.
2. Tamiflu, as we all know is most effective if given within 4 hours of exposure to the virus. What are the realistic chances of this happening, under current planning assumptions ? Zero, my friends. If the federal government activated all of their transport aircraft, and the entire civilian fleet of commercial aircraft, we are looking at several weeks to a month, before the stockpiled Tamiflu, could reach mass population centers. This assumes no rioting or violence during its distribution.
3. The current average CFR of H5N1 is indisputably hovering at the whopping 60% level. How exactly does the influenza pandemic attenuate from 60%, down to 1% ? Does hope, prayer, or wishful thinking, make it less lethal ? This 59% margin for error spells real trouble. We should be planning for a worst case scenario, in my opinion, not a best case… best case situations are what are called epidemics.

Planning for a pandemic cannot just be a singular event. It must include simultaneous contingencies for other natural events that could easily occur also at the same time: severe hurricanes and evacuations, blizzards, forest fires, tornado’s, earth quakes, and other terrible things. This is especially true if the pandemic has numerous waves – how does the US and Canada deal with a major power grid failure, a western forest fire running out of control, and category five hurricane baring down on the East Coast during a pandemic ?

Other natural disasters don’t cease to occur just because there is a pandemic, is my point.

A pandemic will be like a cancer to our country, it will quickly weaken every system known, to the breaking point. The supply chains, services and health systems will fall like dominoes when they are exacerbated by other unrelated stressful events.

I would say the military will be doing an extraordinary job just to distribute the antivirals across the US and to assist guarding the prisons system, alone – anything beyond that and we are all on our own for quite some time.



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