Pandemic News/Awareness.

indigo girl · Mar 22, 2007

Pakistan still finding H5N1:

http://www.flutrackers.com/forum/showpost.php?p=72047&postcount=2

A case of another novel avian flu virus, H9N2 has appeared in Hong Kong:

http://crofsblogs.typepad.com/h5n1/2007/03/h9n2_in_hong_ko.html

http://crofsblogs.typepad.com/h5n1/2007/03/ending_the_hong.html

muffie, RN · Mar 22, 2007

thank you indigo for your efforts and keeping me aware

indigo girl · Mar 22, 2007

Tamiflu had been associated with suicide in teens in Japan. Japan has been the largest market for Tamiflu where it has been used to treat seasonal influenza.

http://www.flutrackers.com/forum/showpost.php?p=72032&postcount=1

This link to a poster at flutrackers postulates that there may be a genetic predispostion to suicide with this drug. Are there more suicides in Japan in general than in other countries? What about in this age group?

http://www.flutrackers.com/forum/showpost.php?p=72033&postcount=2

Because Tamiflu is the drug of choice that countries like the US are stockpiling, this is of course a concern. Then again, if H5N1 does trigger a pandemic, we do not have enough to treat even a small proportion of the population anyway.

indigo girl · Mar 22, 2007

Very sad news for Bangladesh is now reporting cases of H5N1 in poultry.

At first they were saying Exotic NewCastle Disease, but samples were sent out to the National Institute of Animal Health in Bangkok for confirmation, and they have had to admit that it is H5N1.

http://www.flutrackers.com/forum/showpost.php?p=72107&postcount=3

Saudi Arabia is now reporting cases of H5N1 in birds. This is their first reported outbreak:

http://www.flutrackers.com/forum/showpost.php?p=72110&postcount=1

indigo girl · Mar 23, 2007

An H5N1 strain in Thailand has been found to be resistant to amantadine. This is just one strain found in that country. The WHO had been talking about using a dual drug therapy of Amantadine and Tamiflu but clearly this will not work with this particular strain.

This is another reason for why viral sequencing is being done, and isolates taken from patients prior to drug treatment. It is critically important to know if any SNP (single nucleotide polymorphism) is present that is a marker for resistance to any of the antivirals.

http://www.flutrackers.com/forum/showpost.php?p=71685&postcount=1

indigo girl · Mar 24, 2007

My friend, Fla Medic has returned from his road trip, and has resumed putting out his excellent essays. This first essay that I am going to link to has to do with assumptions about the economic impact that a serious influenza pandemic would have on the nation. He is commenting on a work by The Trust for America's Health. The problem is that their numbers are based on what happened in 1918 with a different virus than the one that we worry that we may be facing.

http://afludiary.blogspot.com/2007/03/economic-assumptions.html

http://afludiary.blogspot.com/2007/03/economic-assumptions.html[/url]
The first assumption is that a `severe' pandemic would be on the order of the 1918 Spanish Flu. True enough, it was as bad as we've seen to date, and can rightly be called `severe' when compared to 1957 or 1968, but there is no guarantee that the next pandemic will not exceed that event in its attack rate or CFR (Case Fatality Ratio).
Their assumption is a severe pandemic will sicken 30% of the population, claim the lives of 2.5% of those afflicted, and come in 2 or 3 waves of 6 to 8 weeks each. They also assume that those infected, but that survive, will be `out sick' for 3 weeks.
Given that the H5N1 virus has killed in excess of 60% of those infected, assuming a 2.5% fatality rate would seem a bit optimistic.

indigo girl · Mar 24, 2007

This second essay looks at the dilemna of how to hold a country together.

There are some very serious issues of concern should the next pandemic present as a category 5 event. I should point out again that we already know that another pandemic will occur. We do not know when, which virus or how severe it will be. We just know that it will happen. There has been no cat 5 event since 1918. With the emergence of H5N1, we are forced to examine the possible effects.

Government planning does look at the very real impact of this type of event. Individuals should be planning too. The problem is that the public has not been informed of the consequences of a severe event.

It has often been wondered why the govt has not told the public to do more to prepare. Their PSA's have not been very noticeable. They have not stressed that pandemics can come in waves of infection, and that they can reoccur in communities already hit perhaps 2 or more times per year. This is the historical 1918 scenario. They have not reminded the people of the fragility of the just in time delivery system. Govt planners are very much aware of all of this, so why have they not told the people more clearly about what

they may be facing?

http://afludiary.blogspot.com/2007/03/big-

chill.html

http://afludiary.blogspot.com/2007/03/big-chill.
html[/url]
Individuals are likely to look at the risks during a pandemic and make decisions based on what is best for themselves or their immediate family. And in most cases, not getting sick and dying tops their list.
Governments don't have that luxury, of course. They are charged with keeping the infrastructure running, the country secure, and the economy stable.
And here we have a genuine conflict of interests.

indigo girl · Mar 24, 2007

In Bangladesh, chicken farmers are resisting the forced cull of infected birds.

This should have been anticipated by the international community. Culling the birds protects the citizens of the world. Should we not be assisting them financially to provide compensation and alternatives in impoverished countries? We can not expect any different scenario unless the world gets serious about fighting this disease.

http://www.news.com.au/

story/0,23599,21441261-38197,00.html

WORKERS at a state-run poultry farm near the Bangladesh capital have protested at the culling of chickens infected by the H5N1 virus, forcing authorities to call in the army to carry out the slaughter.
...employees opposed the measure, saying their livelihood was at threat.
“We cannot let this burning to go ahead,” said Jannatul Ferdous.
“If the birds go, we will starve to death,” she said.

indigo girl · Mar 25, 2007

U.S. Embassy in Bangladesh:

http://www.flutrackers.com/forum/showpost.php?p=72441&postcount=13

Impact on farm workers:

http://crofsblogs.typepad.com/h5n1/2007/03/the_impact_of_h.html

indigo girl · Mar 25, 2007

From Avian Flu Diary, with the permission of the author, FLA MEDIC:

Sunday, March 25, 2007

The Varnished Truth

# 586

One of the more frustrating aspects of blogging on the avian flu front is the decided lack of

straight talk coming from official channels. We hear that `transparency' and the `timely release

of information' are important, but the sad reality is, we get bits and pieces, often polished or

painted up to make things seem less dire than they are.

No, I won't go as far as to call them lies. But we do get a great deal of `spin', and to the casual

observer, spin works just about as well.

No one is without an agenda. And that includes the humble author of this blog. I view the threat

of a pandemic in the next few years as likely, and so my writing reflects that opinion. So while

I try to be fair, there is admittedly a built in bias to what I write.

Caveat Lector.

My agenda, however, is to raise awareness over what I perceive to be a genuine threat. I

makeno money off of this blog, have nothing to sell, and accept no advertising. I do this

because, right or wrong, I believe we face a real threat.

And it is important when reading anyone's take on avian flu, to take their agenda into account.

Words are wonderful and powerful devices. They can convey information (or disinformation),

and, depending on how they are used, change or form public opinion.

Governments, of course, want their citizens to believe they are doing all that is necessary, or

reasonable, to protect them. So we get semi-reassuring press releases telling us that they

are stockpiling drugs and working on vaccines and holding pandemic drills.

Here in the United States, and in many other developed countries, those preparations are

ongoing. So it isn't a falsehood. And usually somewhere in every statement is the admission

that `we have a long way to go'. That our stockpiles are not yet sufficient to handle a pandemic.

But the positives are stressed, and the negatives are usually glossed over. Even when officials

are unusually blunt, as is often the case with HHS Secretary Michael Leavitt or Dr. Nabarro from

the UN, the press, or some other agency, generally finds a way to downplay their words.

Balanced reporting, I believe they call it.

Balanced, perhaps, but in the end it just leaves the public confused and ultimately unprepared.

Depending on which newspaper articles you may have read over the past two years, you probably

anticipate that a pandemic could kill anywhere between 2 million and 1.5 Billion people. Yep.

That's the range we've seen printed.

The operative word in all of this reportage is `could'. It's a great word, really, because with it,

you can say almost anything and get away with it.

The problem is, no one really knows, and nearly every month a new `number' is promulgated by

one group or another (always with caveats), and the press runs with it.

When Dr. Nabarro warned that 150 million people could die in the next pandemic, his employer, the

United Nations, quickly stated that it was more likely that `2 to 7 million could die'.

Who's right?

Well, if the 1918 pandemic is any guide, when the world had but 2 billion total inhabitants and lost

50 million or so from the Spanish Flu, Dr. Nabarro's numbers seem far more plausible.

And Dr. Nabarro's projection is far from the worst case. Dmitry Lvov, a virologist in the Soviet Union,

has spoken of more than 1 billion deaths from the virus.

Yet, somehow, the `2 to 7 million deaths' number continues to find it's way into newspaper articles.

There is obviously a conscious choice by some reporters to select the most conservative estimate.

It is so difficult to simply say that a pandemic could kill anywhere between `2 million and 1 billion

people'' ?

We've also seen, almost to the point of inducing nausea, that a pandemic vaccine won't be available

until six months after a pandemic strain is identified. And yes, barring some new development

in pandemic research, this appears to be true.

But it's only part of the story.

Rarely mentioned is how little vaccine would be available after six months. Yes, sometimes reports

mention that supplies will be limited at first, but the reporting gives the illusion that if we can hang on

for six, or eight, or ten months, inoculations will be available to the general public.

With today's technology, we could have worldwide, perhaps 400 to 600 million doses of vaccine

18 months into a pandemic. Enough for 6% to 8% of the planet.

Yet I've even seen reports in foreign papers, from countries highly unlikely to ever see a vaccine,

that `progress is being made' in streamlining the manufacturing process.

While these stories may appease people today, and keep them from asking inconvenient questions

of their leaders, at some point someone will have to pay the piper.

The stated goal of most officials is to avoid panic. And for a variety of reasons, mostly economic,

that's their agenda.

And on the surface, that sounds reasonable. But it seems more likely that the real goal is

to avoid accountability. If people knew the real state of our preparedness, they'd ask

questions that would be difficult to answer.

Like, why haven't we done a better job preparing?

It isn't a surprise to scientists, or to government leaders, that the world will face another

pandemic someday. We've known that since the last one, and were reminded of that fact 30 years

ago with the swine flu scare. We simply decided to ignore that possibility, and spend our resources

in other areas.

As a species, we find it reasonable to spend trillions over the years to find ways to kill people more

efficiently, but are unable to spend a few tens of billions to save people's lives.

And that says a lot about our priorities.

And so the spin continues, the public is left wondering if the threat is real, and little gets done on the

local level.

But on the plus side, no one is panicking.

Not Yet, anyway.

posted by FLA_MEDIC @ 8:38 AM 0 comments

indigo girl · Mar 25, 2007

Bangladesh, avian flu appears to have spread beyond Dhaka, not surprisingly.

Are they employing the Tamiflu blanket there? It certainly sounds like it:

http://

www.flutrackers.com/forum/showpost.php?p=72529&postcount=17

...some 9,000 chickens were killed on Saturday on three farms north of Dhaka after laboratory
tests showed traces of the virus in the areas.
"We are awaiting test results to know if they had died of the avian flu," Motalib told reporters,
adding that all affected farms had been sealed.
Some 1,000 poultry birds were reported to have died in a farm at Narayanganj, 20 km from Dhaka.
Several farm workers in Bangladesh have been exposed to the virus. Another senior official at the
fisheries and livestock ministry, Syed Ataur Rahman, said authorities have been treating them,
without detailing what drugs had been administered.
Local newspapers and residents around the country have reported that more chickens had
become ill or had died, although not in large scale. Authorities said they had no official
confirmation of an outbreak of the virus.

indigo girl · Mar 26, 2007

Another case in Egypt, this time in a three year old. Luckily all of these recent cases have been mild,

and the children have all recovered:

http://www.

flutrackers.com/forum/showpost.php?p=72562&postcount=3

Here is some commentary from Dr. Niman, virologist and founder of Recombinomics. Basically,

he is saying that these recent pediatric cases

did not have the marker, M2301 in the viral strains that infected them.

All cases with M2301 have died.

http://

www.recombinomics.com/News/03250701/H5N1_Aswan_3.html