Wednesday, March 12, 2008

March 12 Flu Update

In India, warnings are given to states near West Bengal.....

A cull is underway in Indonesia...though no recent outbreaks have been reported.

In Pakistan, poultry prices are going up.

Not good: bird flu compensation has been held up.

Japan is closely to developing a nasal bird flu vaccine.

The Royal Veterinary College in Britain is using computer to study the likelihood of the bird flu.

Commanche County,KS, is doing pandemic prep.

Revere blogs this big story on "community control" from yesterday. As you might expect....not a good review. Remember, the Revere perspective is by building community health systems....

ProMed on an International Symposium about the effectiveness of Tamiflu.

ProMed on the civets....


At 6:14 PM, Blogger Wulfgang said...


Judging from your first four articles, one could easily arrive at two conclusions: first, that bird flu containment strategies in India, Pakistan and Indonesia have been for the most part, ineffective; and second, none of them have a clue whether they are facing ordinary seasonal flu illnesses, or actual H5N1 infections. Simply, the only way they would know if the virus is mutating and becoming more dangerous, is if they suddenly started seeing an extraordinarily high number of actual human deaths they can't explain. I think India better free up some money quickly to reimburse their poor citizens for the millions of chickens they culled, or the entire situation there is going to go completely into the dumper.

Currently, according to news reports, a suspected cluster of 8-10 people in Lampung province, Indonesia, have been admitted to the hospital suffering from “bird flu like” symptoms; all of the elementary schools in Hong Kong have been forced to close for two weeks due to a severe seasonal influenza outbreak(3 children have died from H3N2 alone); in India 19,849 people are being “monitored” (meaning they are being stuffed with Tamiflu) and 24 people have been admitted to hospitals and five more marginal cases suspected; even Russia is reporting a flu epidemic of H1 and H3 sweeping through 12 cities and 3 regions. I’m not even going to mention what’s going on in Egypt – since NMRU-2 was forced under WHO oversight – accurate information about the virus and number of human cases there is almost nonexistent. And while all this is going on, China experts (Zhong Nanshan) are warning, “Bird flu showing signs of mutation and killing victims more easily”, and have mysteriously discovered “12 outbreak cases” this year alone. This all adds up to a theoretical gigantic mixing bowl of seasonal H1, H3 and H5 viruses potentially intermingling.

Some final observations on the subject of pandemic models, since you posted two articles on the subject. These days, almost anyone can build a model if they have intermediate or advanced Excel skills, and call it a “computer simulation’. It does seem to me that Revere (as usual), makes some very good observations, especially regarding the uncertainties and usefulness of models in general, as a tool to generate various scenarios. Based on my own personal experience, computer models are indeed very useful, but they can be somewhat limited in scope due to the skill level of the developer, and one has to be careful to not misinterpret the results, and be especially aware of the “sensitivities”.

I am not at all familiar with the Virginia Tech and @Risk Palisade software models, but I would be willing to wager that they do not incorporate and integrate unpredictable human behaviors and infrastructure events, for example: such as very large numbers of people fleeing out of infected areas (mobility factors), emergency services surges (fire, safety, utilities) and supply chain shortages. These unpredictable variables are equally as important as medical and non-pharmaceutical interventions.

If the IT and electrical grids end up overloaded or incapacitated, and you can’t get gas deliveries because people are sick, then you can’t get food deliveries and pharmaceutical supplies in… it really doesn’t matter how robust your health system is (or was). Every system we use in our daily lives and depend upon, has a “tipping point”, and these have to be factored into the modeling, since they are just as interrelated and interactive – if not more so. It’s not just all about Ro factors, CFR, CAR, and health and social system interventions, it’s also about anticipating human and social (mis?)behavior during a pandemic, and knowing that natural catastrophes don’t cease just because people are ill.

What happens if about a couple million panicky people suddenly pack up, hop in their vehicles, jump on the interstates, and attempt to flee their large mega-metropolitan areas to seek what they believe is a safe haven ? Or we face the complete inability to effectively distribute Tamiflu to certain geographical areas, or we simple “run out” of antiviral medication due to required double or triple dosing ?

Sound farfetched – nah, all within the realm of possibility, in my opinion.



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