Bird Flu - how real is the threat?

Hmmm. I'm mildly skeptical, but 1918 does give one pause, as does this statistic:

Number of viral diseases we actually can cure: 0. There are a few we can at least beat up on, but anti-virals are so far as I know highly toxic, and flu moves quickly.

The real question is the replication rate.

OTOH, vaccines come out fairly quickly, and flu vaccine preparation is no longer a matter of research, it's an industry. So I would expect that if a particularly virulent strain appeared, a vaccine would appear quite quickly and quash it. Anybody out there involved in the business who could give us an idea how quickly we could expect this to happen?
 
Don't you think that all those other 'false wolfs' (SARS, Ebola, swine flu....mini skirts...) had their own experts?
Yeah, that's what I thought. Look, you want to present specific examples of risk projections that were made, then do that, and we can discuss whether they were overstated, and by how much, and by whom. Otherwise, you're just waving your hands around in the air.
 
flu vaccine preparation is no longer a matter of research, it's an industry.
Part of the problem is that it isn't a very profitable industry, at least not by comparison with some of the other things that might be done with the same resources -- this is why the U.S. currently has essentially no domestic capacity for vaccine production at all.

I would expect that if a particularly virulent strain appeared, a vaccine would appear quite quickly and quash it.
And before Katrina, many New Orleans residents probably expected that if a particularly powerful hurricane flooded their city, rescue workers would quickly appear to whisk them away to safety.

Anybody out there involved in the business who could give us an idea how quickly we could expect this to happen?
According to the WHO:

"Experience in the production of influenza vaccines is also considerable, particularly as vaccine composition changes each year to match changes in circulating virus due to antigenic drift. However, at least four months would be needed to produce a new vaccine, in significant quantities, capable of conferring protection against a new virus subtype."

http://www.who.int/mediacentre/factsheets/avian_influenza/en/index.html

An awful lot of people could be infected during the first four months of a pandemic. In addition to that, "significant quantities" doesn't mean "enough for everybody" -- not even close.
 
Something else I heard* is that a major reason for the deaths in 1918 was that people were too ill or weak to feed themselves and there was nobody to care for them. Nowadays, we have lots of people to care for the infirm.

All of whom will be equally susceptible to the mutated, easily transferrable virus.
 
Masks? Protective gloves? Soap and water, perhaps? Any way you cut it the infection rates can't possibly be as bad as they were in 1918, we're not just talking about technology here we're talking about a devastated post-war continent with no infrastructure.

I'd guess that had it struck in 1913 things wouldn't have been half as bad, but that is speculation.

--- G.
 
A recent paper hypothesises that the 1918 pandemic arose from the close association of many men (100,000+ soldiers) and animals (soldiers' food) together including poultry infected with avian flu. The return of these infected soldiers to their homeland would have contributed to the rapid spread of the virus.

Today the virus will be identified rapidly and measures taken to limit its spread.

Producing a vaccine is difficult because of the problems of trying to grow a virus in a system (hen's eggs) that are killed by the virus. On top of which there are the technical difficulties of manufacturing a vaccine at a high level of containment.
 
Masks? Protective gloves? Soap and water, perhaps?
You don't think they had those in 1918?

Any way you cut it the infection rates can't possibly be as bad as they were in 1918
Epidemiologists speak of the "attack rate" (the percentage of the population infected with the virus) and the "r-nought number" (the number of persons to whom each infected person can be expected to pass the virus on). Modelling the impact of a pandemic includes playing around with different factors to see how they affect these numbers.

The effectiveness and availability of antivirals and the seasonal timing of the initial outbreak are among the things that they consider, along with, yes, cultural and economic factors, infrastructure, etc. Of course. It is possible that a person not trained in epidemiology might, from the comfort of an armchair, arrive at some penetrating insight which has escaped all of the thousands of people dedicated to fine-tuning the accuracy of such forecasting methods -- but it doesn't seem very likely.

Those who would dismiss the whole matter as mere scaremongering would do well to consider that the numbers most often quoted are actually not worst-case projections, but are based on rather modest rates of attack and mortality (say 25% and 2.5% respectively). Until the pandemic virus actually emerges, it's guesswork. By way of analogy, we might note that until actually struck by a hurricane, there is no way to know for sure whether a city below sea level needs category 4 protection, or category 5 protection, or what. Currently, our level of protection against pandemic flu looks to me like somewhere between category 1 and category zip.

we're not just talking about technology here we're talking about a devastated post-war continent with no infrastructure.
The Spanish flu pandemic wasn't limited to the European continent; it was a global phenomenon. It spread quite rapidly even in places untouched by the wartime devastation (like Spain, for example). As for infrastructure, that's a bit of a two-edged sword. We've already noted that our ability to move quickly around the globe also provides efficient avenues for the spread of a virulent pathogen, but there's something else. The massive infrastructure that permits millions of people to live crammed together in densely populated cities also makes those people utterly dependent on that infrastructure staying in good working order. Modern distribution networks, with their emphasis on "just in time delivery", are fine-tuned to provide a competitive edge -- not to hold up well in the face of global catastrophe (of any kind).
 
Part of the problem is that it isn't a very profitable industry, at least not by comparison with some of the other things that might be done with the same resources -- this is why the U.S. currently has essentially no domestic capacity for vaccine production at all.
I wasn't aware of that. Where are the flu vaccines we (or at least the smart ones among us) get every year made?

And before Katrina, many New Orleans residents probably expected that if a particularly powerful hurricane flooded their city, rescue workers would quickly appear to whisk them away to safety.
A valid point. I suppose it doesn't help much that the people who would be the most capable of solving the problem seem to be the people who are in the forefront of the people who say it could be a really major problem. These points are why I am only mildly skeptical, and a great deal of that skepticism is evaporating.

According to the WHO:

"Experience in the production of influenza vaccines is also considerable, particularly as vaccine composition changes each year to match changes in circulating virus due to antigenic drift. However, at least four months would be needed to produce a new vaccine, in significant quantities, capable of conferring protection against a new virus subtype."

http://www.who.int/mediacentre/factsheets/avian_influenza/en/index.html

An awful lot of people could be infected during the first four months of a pandemic. In addition to that, "significant quantities" doesn't mean "enough for everybody" -- not even close.
Incubation of flu is a few days to a week, and the infection has generally run its course in another couple of weeks at most. Four months is not a particularly comforting figure. Thanks for bringing this evidence to my attention.
 
The threat is real enough. This isn't some media-fuelled hyped-up non-scare-story.

The two main unknowns are, will it actually materialise, and is there actually anything constructive that ordinary individuals can do to protect themselves or prepare for it if it does.

Rolfe.
 
Oh, not freakin out here- but I do get my flu shots, and I might consider prophylactic measures if it looked like it had broken out. Play the odds.
 
Has anyone mentioned the cytokine storm problem with H5N1? I understand it shares that characteristic with the 1918 version, and I suspect SARS, some of the hantaviruses, and ??? also kill by that method -- basically pneumonia and one drowns.
 
Boy will my face be red if we all die horribly... :D

Seriously, some very valid points have been made. We'll just have to wait and see, I suppose.

--- G.
 
I wasn't aware of that. Where are the flu vaccines we (or at least the smart ones among us) get every year made?
I seem to remember that the 2004 flu vaccine fiasco, where most of the output of a UK firm had to be discarded because of a bacterial contamination problem, put more of a crimp in the US vaccination programme than anywhere else. Was it Powderject (again)?

Funny, when the dust settled, the UK had most of its vaccine stocks, but dearie me, the export quota was the bit that was affected....

Rolfe.
 
Morrison's Lament said:
p.s. I have a website that will sell you placebo for 20% less than competing sites

Morrison's Lament said:
Boy will my face be red if we all die horribly... :D

Seriously, some very valid points have been made. We'll just have to wait and see, I suppose.

--- G.
I can't believe you tried to sell me placebo. Me! The greatest misowoo the world has ever seen!

There's informed scepticism, and then there's blind scepticism. It's good to be discerning not only in what you choose to believe*, but also in what you reject.

Anyway, I have a nice homoeopathic remedy for that red face of yours... :)


*Or accept, or know, or assimilate, or understand...
 
I'm not rejecting it at this point, though I admit I was at first. If this isn't universally dismissed HERE, of all places, then there's cause for concern.

As for your offensive comments about my extremely effectice placebos, I'll have you know that not only are they 20% cheaper than competing placebos, but they come with slightly less carefully worded guarantees than some hypothetical brands.

--- G.
 
Oh, goody, send me some- perhaps my lawyer can find a loophole in the disclaimers and I can get rich suing you! :D
 
I seem to remember that the 2004 flu vaccine fiasco, where most of the output of a UK firm had to be discarded because of a bacterial contamination problem, put more of a crimp in the US vaccination programme than anywhere else. Was it Powderject (again)?
Yeah. Aquired by Chiron in 2003. Just think; a single firm responsible for half the U.S. supply. There's currently a lot of talk about ramping up production capacity for vaccines and antivirals worldwide, but it's not the sort of thing that happens overnight.
 
the U.S. currently has essentially no domestic capacity for vaccine production at all.
Well, this is embarassing. I've just discovered that that little tidbit is just flat wrong, and I feel obliged to issue a correction. (I HATE when that happens).

It appears that Sanofi Pasteur of Swiftwater, Pennsylvania not only has large-scale production capacity located in the United States, but they're the No. 1 producer of influenza vaccines, with more than 50% of global production capacity.

Sorry about that. I was so sure, too. I'll just go somewhere and hang my head in shame now.
 

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