WHO's worried about bird flu?

[Dymanic]

Still have my fingers crossed, but it looks like I may just make it through another year without getting the flu. I'm always a little paranoid about that, because I have a chronic lung condition that would make a dose of the flu a life-threatening proposition for me. So I tend to keep a close eye on flu-related news, checking the CDC website for weekly updates, etc. I'm a little embarassed to admit it, but last year the flu came early, the media made a big deal of it, and I let them push my buttons. I guess I panicked a little. Went into what I call: "Howard Hughes mode"; pulled my kid out of school for a couple of weeks while it was peaking locally. In the end it turned out to be a relatively mild season (of course, I didn't get the flu, either, did I?). I try not to obsess on it too much, and I've promised myself not to panic again.

With that in mind, the talk about this new avian flu, H5N1, was, at first, sort of background chatter for me; interesting, but not my main focus. Asia is a long ways away. But they're starting to get my attention with stuff like this:

"A new batch of cases of the bird flu in Vietnam have experts worried that the disease has already mutated into a form that can be spread directly between humans.

The World Health Organization has warned that if and when the bird flu is transmittable directly between humans, a worldwide pandemic could occur, resulting in the deaths of tens of millions of people worldwide."

What really bothers me is these numbers from WHO:

"The first human cases of H5N1 infection, linked to poultry outbreaks in parts of Asia that have been ongoing since December 2003, were reported in January 2004 in Viet Nam and Thailand. Since then, altogether 69 cases have been reported, of which 46 were fatal.

Human cases have occurred in three phases: from January through March 2004 (35 cases, 24 deaths), from August through October 2004 (9 cases, 8 deaths), and from December 2004 to the present (25 cases, 14 deaths). In the present phase, the total includes a single case in Cambodia, which was fatal, in addition to those in Viet Nam."

Forty-six deaths out of sixty-nine cases? This is starting to sound like about chapter three of a collaborative novel by Robin Cook and Stephen King. I'm starting to get that bad feeling again. If anyone can talk me down, I'd really appreciate it.

Failing that, I'm wondering if it's even worth thinking about what preparatory measures might be taken to increase one's chances of avoiding this thing if it comes (surviving it probably isn't an option for me; my chances of surviving the strains going around now can't be much better than about 50/50).

I reckon there's a difference between concern and alarm, and considering that my track record in this regard is not exactly unblemished, it guess it's a good idea for me to check my head once in a while.

Because it is contagious before the actual onset of symptoms, the flu is hard to avoid, but to the extent that I can protect myself, I do take precautions even in the face of a typical flu season. I get a flu shot early in the season, my kid too. I keep a little stock of antiviral meds (to use if I know I've been exposed, or if I show symptoms). While the flu is making the rounds locally, I wash my hands a lot, make my kid wash his a lot. I Shun public food. No eating out, no grocery-store samples, nothing like that. I discourage visitors, and avoid public functions. Sort of a modified Howard Huges mode.

Unfortunately, that level of precaution doesn't seem likely to do much good against avian flu. For one thing, there isn't yet a vaccine for it. I can't see any possibility that such a thing could be contained once it made the break to human-to-human transmission. Now they're saying it may already have made the break. Next flu season I'm seeing myself bunkered up with bottled water, canned food, and a shotgun. You think I'm just freaking out again?

 

[Soapy Sam]

Look. You have to die of something . And if we get a global pandemic, house prices will come down, employment will go up, we won't be doing the environment so much damage and we'll make up the numbers in about three years anyway.

And whether you have a lung condition already probably won't make much diffference.

Don't worry. You may be in a bus crash tomorrow.

 

[jambo372]

I've got a mask ordered.
Everyone will die.

In 1918 after WWI more people were killed by the pandemic Influenza virus than died in battle.

 

[Soapy Sam]

(snip)
Everyone will die.

In 1918 after WWI more people were killed by the pandemic Influenza virus than died in battle.

Can't fault the prediction.

 

[AK-Dave]

I don't thing it is fair to try to determine the fatality rate of the bird flu based on those numbers. I bet that most cases were mild/non-fatal and were not recognised as being that specific virus.

 

[coalesce]

Keep in mind, though, where these cases are occurring and what level of health care the patients have access to. I could die of complications of a hangnail if I can't seek timely medical attention. The fatalities in Vietnam and Cambodia, did the WHO report say where they happened--the cities or the countryside? Were the people able to get proper medical care? What were their ages? Did they have any pre-existing medical conditions that left them weakened or vulnerable? There's a lot more to the report than meets the eye.

All the precautions you outlined were sensible enough, so I don't think you're going overboard. It's like I used to tell my clients when I was an exterminator: wash your dishes every night and throw away your garbage every day and you probably won't need to see me.

Don't let this latest scare turn you into a hermit, though. You still have to live your life. Remember, you're a person, not a veal.

Michael

 

[jambo372]

Can't fault the prediction.

No I'm wrong Samuel. I'll survive - I drink pish - just about everyone else will die.

Many types of Flu came from birds in the far east. Don't they usually mutate in an intermediary animal ( usually a pig ) to make them be capable of spreading from birds to people and cause disease ?

 

[Donks]

No I'm wrong Samuel. I'll survive - I drink pish - just about everyone else will die.

Heheh! Jambo is funny!

 

[Rolfe]

I'm worried about bird flu, I'm worried about that damn volcano in Yellowstone going bang, and I'm worried about global warming. (Well, if nothing else, the second would put paid to the third....)

However, in real and meaningful terms, there is nothing or next to nothing I as an individual can do about any of them right now, so I choose to spend my time not worrying.

Rolfe.

 

[Dymanic]

Originally posted by Soapy Sam

Look. You have to die of something

Right. My best bet might be to just relax and make the most of my summer.

And if we get a global pandemic, house prices will come down, employment will go up, we won't be doing the environment so much damage and we'll make up the numbers in about three years anyway.

Yeah, I thought of that. I just like it better if it really is we though, instead of just y'all.

Don't worry. You may be in a bus crash tomorrow.

I tell myself that all the time. That a thing like that can actually cheer me up seems a little weird if you think about it.

And whether you have a lung condition already probably won't make much diffference.

It might not seem like much unless it's the difference between a 30% chance of survival and a less than 1% chance.

Originally posted by AK-Dave

I don't thing it is fair to try to determine the fatality rate of the bird flu based on those numbers.

Let's hope not. Still, even if using those numbers results in overestimating the death rate by, say, three hundred percent -- assuming that this thing sweeps the globe, we're still talking, what, maybe a billion people? And as far as medical care, what kind of medical care will anybody be getting after a few weeks of that?

Originally posted by jambo372

Many types of Flu came from birds in the far east. Don't they usually mutate in an intermediary animal (usually a pig) to make them be capable of spreading from birds to people and cause disease ?

That's the thing. Nearly every house in rural southeast Asia seems to have an attatched enclosure with chickens, pigs, dogs, and kids running around together, eating each others' offal, etc. It's a microbiologist's worst nightmare.

Originally posted by Rolfe

I'm worried about bird flu, I'm worried about that damn volcano in Yellowstone going bang, and I'm worried about global warming. (Well, if nothing else, the second would put paid to the third....)

However, in real and meaningful terms, there is nothing or next to nothing I as an individual can do about any of them right now, so I choose to spend my time not worrying.

You forgot about the asteroid. The difference seems to be that while those are things that might happen, this is something that's looking like it's going to happen. Maybe a lot of what's got me buggin' is the idea that there might be something I could do to protect myself.

 

[Soapy Sam]

No, jambo, you were right the first time.

Everyone will die.

Not of flu, of course.

Age related stuff , mostly.

And drinking lager.
You hadn't realised? Yellow, foamy, tastes awful.
They've been drinking it all over the world for years.

They usually serve it ice cold to numb the tastebuds.

 

[Skeptic Ginger]

I've got a mask ordered.

Typical virus particle, including influenza, < 1 micron. Most efficient particulate filter in those masks, 1-5 microns. CDC suggests we health care workers use these masks but they don't mention no one has tested them to see if they will work with flu virus. Nor do they mention that theoretically, they shouldn't work.

In industrial settings, if there is an identified hazard, respiratory protection must be tested with the results submitted for NIOSH approval of the respiratory protection or the employer is in violation of the general workplace safety law.

The same law applies to health care employers. But then CDC made that flu guideline anyway. Lovely being in a female dominated occupation, isn't it?

Everyone will die.

In 1918 after WWI more people were killed by the pandemic Influenza virus than died in battle.

Actually, in 1918 it hit young adults the hardest.

Good News: This virus emerged in 1997. It took baby steps ...

Bad news....until last year. In the last few months it has taken biiiig steps including infecting pigs, and a few other mammals that might be precursors to the human version. It is thoroughly entrenched in SE Asia and it's too late to contain it fully. The best we can do is slow it down.

Good news...The WHO has sent out vaccine strains to manufacturers that look good so far.

Bad News...European vaccine manufacturers met last year to assess the crisis. They figure with all the manufacturers going at full capacity they have the ability to make vaccine for a mere 5% of the world's population.

Good news...There is a pretty good effort between the WHO and all the other countries' CDCs to monitor and control the situation. We await more epidemiology studies to tell us what the real # of cases have been so we can determine what the real death rate is. It won't be 70%.

Bad news...It will almost certainly be very very high.

So what is my plan given my specialty is infectious disease? One, I do have my own supply of Tamiflu. Very expensive and won't help if you don't know when to take it but if you can get over those two hurdles, get some before there's a run on the pharmacy. And two, you know that food you're supposed to have for the next earthquake or cyclone? I'd want enough for the family to hold up for a while. Figure your water will still run but you may want to keep the kids out of school and avoid crowded grocery stores at some point in the future.

I think it is still a ways off. Maybe months, maybe a year or even two. We will have some warning though it might not be very much. There will not be enough drugs and vaccines unless we have a few more years to prepare and that is unlikely. From there, predictions are impossible. Worst case is a repeat of 1918 with a vengeance. Best case is a moderate pandemic with most people in the better off countries getting vaccine or treatment.

Oh, and another thing, the post above about the people are only dying because it is the third world? Think again. That's a myth that will be dispelled in no time when people start dying in the street in a town near you.

http://www.stanford.edu/group/virus/uda/

People were struck with illness on the street and died rapid deaths. One anecdote shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig).

So is this an exaggeration. Not this time, I don't think so. But again, it all depends on how soon things get worse. In 1997 there was a lot of concern. That was 8 years ago. It isn't here yet. No one knows what a pandemic like this looks like in the first stages or how long the stages will be.

 

[Interesting Ian]

Unfortunately, that level of precaution doesn't seem likely to do much good against avian flu. For one thing, there isn't yet a vaccine for it. I can't see any possibility that such a thing could be contained once it made the break to human-to-human transmission. Now they're saying it may already have made the break. Next flu season I'm seeing myself bunkered up with bottled water, canned food, and a shotgun. You think I'm just freaking out again? [/B]

Yes I'm worried about it as well. But then I'm a notorious hypochondriac. Can't you and your family just basically stay stay indoors all the time and order food from the Internet once 10s of millions of people start dying. I know I will be! LOL

 

[Interesting Ian]

I've got a mask ordered.
Everyone will die.

In 1918 after WWI more people were killed by the pandemic Influenza virus than died in battle.

Nah, there should be a few survivors left to rebuild the world. Perhaps 0.01% of us. Hopefully I'll be one of those by avoiding all human contact whilst people are dying. It will be difficult work though. Lots of reproduction required to increase the population

 

[Interesting Ian]

I'm worried about bird flu, I'm worried about that damn volcano in Yellowstone going bang, and I'm worried about global warming. (Well, if nothing else, the second would put paid to the third....)

WOW! I'm worried about precisely those things too!

 

[CFLarsen]

I'm worried about bird flu, I'm worried about that damn volcano in Yellowstone going bang, and I'm worried about global warming. (Well, if nothing else, the second would put paid to the third....)

I'm so worried about the baggage retrieval system they've got at Heathrow.

 

[Soapy Sam]

They 've got a baggage retrieval system at Heathrow?

When did that happen?

 

[Dymanic]

Originally posted by skeptigirl

Typical virus particle, including influenza, < 1 micron. Most efficient particulate filter in those masks, 1-5 microns. CDC suggests we health care workers use these masks but they don't mention no one has tested them to see if they will work with flu virus. Nor do they mention that theoretically, they shouldn't work.

There do seem to be a lot of reservations about the protective value of wearing a mask, especially the cheap ones. It seems like the size of the virus isn't maybe as important as the size of the airborne droplets of mucus and saliva onto which virii are clinging. Even a simple dust mask might help with that, but getting a good, tight fit seems to be at least as important as how fine the filter is. There are a couple of ways that wearing a mask might actually do more harm than good. If you let it lull you into a false sense of security, you might take risks you would otherwise avoid. Also, wearing the same mask for a long period of time could create a moist environment which could collect particles you might otherwise have avoided.

A quick peek into my crystal ball indicates brisk sales of good quality masks during upcoming months.

 

[Skeptic Ginger]

There do seem to be a lot of reservations about the protective value of wearing a mask, especially the cheap ones. It seems like the size of the virus isn't maybe as important as the size of the airborne droplets of mucus and saliva onto which virii are clinging. Even a simple dust mask might help with that, but getting a good, tight fit seems to be at least as important as how fine the filter is. There are a couple of ways that wearing a mask might actually do more harm than good. If you let it lull you into a false sense of security, you might take risks you would otherwise avoid. Also, wearing the same mask for a long period of time could create a moist environment which could collect particles you might otherwise have avoided.

A quick peek into my crystal ball indicates brisk sales of good quality masks during upcoming months.

I wouldn't advocate NOT wearing the mask. I am saying, however, no one has done any research, or at least published any yet, to see if the masks will protect from flu virus.

There are many diseases we have evidence the masks do protect us. TB bacteria are 2 microns in size and it takes a large dose of bacteria to infect most people. SARS, it appears through experience but not controlled research, was prevented by the masks. It was also found though, that SARS was 'droplet spread'. That means the viruses are carried in droplets and are not necessarily free floating.

But measles, chicken pox, influenza, and a whole batch of viral diseases are true airborne pathogens. These viruses are not suspended temporarily in droplets, they are free floating in a particle size that allows them to stay suspended in the air for long periods and travel in infectious doses for various distances.

The flu virus isn't going to contaminate the air of an entire town, but the mask filter mechanism might fail on a bus, or in the grocery store, or in a classroom. And, if all you need is a virus particle hitting your eye, then it traveling down your tear duct to the exact location in your throat it prefers to settle, you also will not be protected by a respiratory mask.

I brought the issue up in my campaign to enlighten more health care workers on the issue of 'evidence based work place safety'. I have a pet peeve about the convenient ignorance of the health care industry as it pretends not to notice that testing issue. They conveniently didn't notice for about 100 years that surgical masks were designed to protect the patients from us and never vice versa.

"Here nurse Jones, put on this surgical mask and go take care of that patient with a deadly airborne virus. Have no fear, after all, you are practicing airborne isolation technique."

 

[Dymanic]

Originally posted by skeptigirl


But measles, chicken pox, influenza, and a whole batch of viral diseases are true airborne pathogens. These viruses are not suspended temporarily in droplets, they are free floating in a particle size that allows them to stay suspended in the air for long periods and travel in infectious doses for various distances.

I had to dig a while before I satisfied myself that this is accurate. The only room to quibble I could find is to note that while flu virus can be a true airborne pathogen, it also spreads through droplet transmission. (The latter actually seems more likely to me, but that's just standing back and taking an intuitive stab at it.)

How long are we talking? And how far?