Slashdot Mirror
A Flu Pandemic?
Pedrito writes "Scientific American is running a story in this month's issue about preparing for a flu pandemic. What this article tries to convey is that a pandemic is definitely coming. Whether it's from the H5N1 strain (which would likely cause hundreds of millions of deaths) or another strain a few years down the road. There have been 3 other flu pandemics in the past 100 years. The 1918 strain being the worst, with 40 million killed. The reason H5N1 is being followed so closely is because it's already spread to people and because it's incredibly lethal (a roughly 50% fatality rate at th moment). Even if the fatality rate dropped to 5% when and if it mutates into an easily communicable form, it would be twice as deadly as the 1918 virus."
Whilst this sort of thing has happened before saying it's definitely going to mutate is an overstatement. The same kind of sensationalist journalism not to long ago likened mad cow disease to a new sort of plague with predictions of obscene death rates when in reality it was statistically low. It could end up the same for this with a few hundred people dieing over several years ... nothing huge is definitely going to happen.
Yep, this is definitely the way to keep the public feeling safe. Tell them something is definitely coming to kill 40 million or more, only 50% of people infected will survive and that there is no cure yet.
I can see the same panic buying of the drugs that can help just like the panic buying of gas masks which happened when someone said that terrorists would use bio/chem weaps.
...means more sick & thus more dead. This doesn't make the coming pandemic more deadly.
I'm still waiting for SARS to get me, cos that's what I was told was going to kill me before. And then there was West Nile Virus. And we can't forget those killer bees that'll be here any day now. Shouldn't we all be dead from ebola by now, too? Or how about monkey pox?
Be a real patriot: Question authority. Think for yourself. Formulate your own conclusions.
Sounds like in "Things to Worry About", Asteroid Impact and Global Warming is OUT, and Flu Pandemic is IN. You have to know what the latest popular intellectual fashion is!
try { do() || do_not(); } catch (JediException err) { yoda(err); }
"The reason H5N1 is being followed so closely is because it's already spread to people and because it's incredibly lethal (a roughly 50% fatality rate at th moment)." ...maybe.
So far, fewer than 150 people worldwide have been infected with HN51. Many of those people were old and poor, and didn't have regular access to modern medical treatment. Estimating a human mortality rate from these cases is virtually impossible.
It's one thing to say that a flu pandemic is inevitable. But then, so are earthquakes, volcano eruptions, giant asteroids, and the heat death of the universe....
Let's try not to let fact interfere with our speculation here, OK?
I keep seeing these 50+% mortality figures being thrown around, which seems slightly misleading to me. Imagine if 100 people get a disease. 30 might get it asymptomatically. 60 might get the disease to such an extent that they're "sick" (feeling flu-ish, missing work, etc). 10 might get it to the extent that they wind up in the hospital. If 5 of those 10 die, what's the mortality of the disease? It might seem like 50% to a doctor treating these patients, but the actual number would be 5 percent.
Because we can only report mortality of cases which we actually see, health officials are already biased towards observing the most severe forms of the disease. With something like, say, HIV, or ebola, it might be safe to say that all reported cases = ALL cases. But with something like a strain of the flu, which people suffer to varying degrees, I'd guess there's some much larger number of cases that are simply never seen in hospitals.
Right now the US pharmaceutical industry makes most of its money with drugs the reduce symptoms and doesn't cure anything. Right now the flu symptom fixing drugs is about a 10 billion dollar a year industry. The common cold industry has a number of of drugs that make you feel much better but you end up being more contagious for longer so you can spread your cold to even more coworkers.
This is in sharp contrast to the pharmaceutical research done in other countries that are more interested in finding real cures.
Its no exaggeration to say this is the most significant threat we have faced in decade - orders of magnitude more important than a few terrorists. Yet there still is a sleepwalking feel to people's reaction.
So how are you prepared?
While I don't doubt that it could eventually get that bad, it seems like a lot of ifs have to happen. As it is, I think what a few hunderd people have been killed by the current version (not exactly a pandemic or communicable). I think scientists should continue keeping an eye on it, but we don't seem to be at the "sky is falling" stage we get from the media. At this point, one of the worst aspects to all of this must be the destruction (or possible destruction) of so many birds and the environmental impact that has.
Klein bottle for rent - inquire within.
Highly lethal viruses tend to not spread terribly far if they incubate quickly for the simple reason that those who are infected die before they can infect many others. This is one of the reasons why Ebola tends to be limited to individual communities - nobody lives long enough to get it to the next community.
A 5% fatal virus will leave 95% of those infected to act as carriers - and because of the low fatality rate, some percentage of those won't realize that they're sick and will take it on planes, etc. without being diagnosed.
Please remember that this is 50% mortality among REPORTED cases. There may be plenty of people out there who get sick with mild or moderate symptoms and treat it like the regular flu, stay home, take lots of liquids, etc. The mortality rate is among people who are admitted to the hospital, and this is probably only people already showing severe symptoms.
The influenza virus in the 1957 influenza epidemic may have actually been considerably worse than that in the 1918 epidemic.
What made a difference was the incredible advances in medicine between the epidemics.
As for the avian influenza, there is little indication that the virus is being spread between humans and no indication that it spreads easily between humans. If and when the virus mutates and that becomes possible, the mutation may also change the severity of the resulting illness.
Prepare for the worst and be thankful for the best.
It's impossible to answer this because as yet there is no pandemic. All of these stories boil down to speculation that the earth is due another flu pandemic because: (a) they have happened several times before; and (b) we haven't had one for a long time. People are fixating on bird flu simply because it has made the jump from birds to humans. And of course it seems to be coming from the far east and that is where SARS seems to have originated. In broad terms, the press is lazy and uninformed - sickness stories that have far east angle have more currency at the moment, so you hear more about them.
The seriousness of any pandemic will depend on how deadly the strain is and how readily it can jump from human to human. At the moment, H5N1 can't be transmitted from human to human. In order to be able to, it will have to mutate - what we don't know is how dangerous the mutation will be and how easily/quickly we can manufacture a vaccine. I would suggest that there is not much you can do about it, so don't worry too much. One thing that is fairly certain is that the healthier you are in general, the less vulnerable you are likely to be. Of course that's true of any illness, not just flu!
Reality is defined by the maddest person in the room
What really gets me is that even if there's some pandemic that could potentially wipe out half of the human race, at the same time, there's also a company that's charging $100 per dose for the treatment of the disease because they hold the patent to the medication or technique and they can milk it for all its worth.
I wholeheartedly applaud governments that step in and invalidate such patents under these circumstances so that they can procure and administer the treatment to their people as they see fit. However, I still find it unfortunate that only the wealthier governments can do this (look at AIDS and Africa). The poorer governments still need to rely on complying with the treaties to the letter or risk becoming even poorer. Even then, not all governments, regardless of wealth, will do this.
I am, of course, specifically talking about the good ol' US of A. When this killer flu arrives in the US, we all know the government isn't going to step in like some of the Asian governments. So what'll end up happening is that the poor and needy who have no health care are completely devastated because they can't afford the treatment or the insurance to pay for the treatment, while the wealthy survive unscathed because they can afford to. And that's really what's most sad--that the wealthiest nation in the world isn't charitable enough to care for its own people. Public welfare be damned, so long as the pharmaceuticals can make back their research money.
As for those screaming that the patent holder will likely license the patent for making generics in such an event, I have two things to say:
1) Licensing takes care of supply, but still doesn't address the cost issue for low-income, medically uninsured people.
2) The way diseases can so quickly spread, by the time anyone recognizes the gravity of the situation, it'll be likely to be too little, too late. Again, supply will go up moderately, but demand will skyrocket.
"If a nation expects to be ignorant and free in a state of civilization, it expects what never was and never will be."
Uhm, well, not in rural Vietnam where they more or less sleep with poultry in the so-called house in the fields. Diet and excercise, there, mean "near starvation" and "work all day in the fields".
Global warming is a cube.
One thing that is fairly certain is that the healthier you are in general, the less vulnerable you are likely to be. Of course that's true of any illness, not just flu!
That is absolutely wrong. People who know will tell you that bird flu kills those with healthy immune systems far easier than those with weak immune systems.
"I assumed blithely that there were no elves out there in the darkness"
Believe me, vitamin deficiency, malnutrition, lices, bedbugs, lack of "warm bedrooms" and simple medicines and even "hot soapy showers" are probably much more common in the world than you think.
Errr.... I believe you do not have to like the results of a theory to believe it... I tend to accept evolution (at least micro-evolution is pretty factual, and I have no better idea than macro-evolution at the moment), but that doesn't mean I would like to become the weak link that does not survive.
Thats like saying Bush wants to die in Iraqi gunfights because he believes the war in Iraq is right.
What's the current mortality on the regular flu this year? I'd bet good money that it's killed a fuckton more than 60 people this year.
Here [sciam.com] is a one-page
You mis-spelt scam
There's a reason that would limit the lethality of new mutant :
...
- The point of a virus is not killing its host, but making copies of it self.
- The lethality of H5N1 is a bad secondary effect.
- If a new mutant kills its host to quickly, it'll run out of hosts and wont replicate anymore.
Example :
- If one catch a new über-mortal flu
- brings it home
- infect familiy member
- the über-mortal flu kills very quickly and the whole family drops dead the same evening
- The virus will be "stuck" and won't be able to infect anyone else.
-> That's one of the reason we didn't see a Ebola pandemia
But, if it is a slower virus,
and the people survive at least a few couple of weeks (or don't die at all),
they will have plenty of time to go to work the next days, and transmit the flu to all co-workers, etc...
The kind of pandemia you see in movies, when some (hibernating/comating patient wakes up / austronaute lands / whatever else) and see everyone dead is not very likely.
The danger will be if a flu virus like H5N1 can both cross infect birds, but is almost harmless to them, and humans, and is highly lethal, then there's some chance of such a "everyone drops suddenly dead" scenario.
To put it in more Slashdot-friendly terms :
Imagine an internet worm.
If the worm crashes Windows immediatly after infecting the PC, even before having time to replicate and send copies to the whole Outlook addresse book,there's no way it could become widespread.
A few PC will crashes and that's the whole story.
But if the virus, silently installs backdoors/trojans/spywares and silently begins replicating, THEN you'll have a lot of infected boxen.
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
Even at 1% it looks like someone you know will die from it if not yourself.
Factors working against us:
* As a whole, people do not get as sick as in previous generations. The constant fuss over cleanliness reduces the general health of the immune system because of its lack of exposure to many diseases.
* Vitamin deficiencies are not as rare as one might think; while scurvy is no longer common, most people in the civilized world consume processed foods, which generally lack vital nutrients. As such, their body mass is maintained or expanded, but the gains made in nutritional science have not, as a whole, trickled down very far into the general population.
* Palliative diseases are of little use against a virus that causes tissue death in the lungs, encephalitis, and destruction of tissue membranes due to necrosis and apoptosis. H5N1 appears to cause a broad-spectrum attack on the human body in ways that aren't helped by rehydration or salt balance.
* The vast majority of people may live in their own bedrooms, but are more likely to congregate in large, relatively cramped areas for work, school (especially school!), and purchasing. The rise of mass transit means that especially in urban areas, people are crammed together for long periods of time sharing the same air. For instance, in Tokyo, one person could infect sixty to a hundred people on the ride to the Akihabara district with one sneeze. Same in New York on the A, 4/5/6, 1/2, or 7 lines.
Furthermore, many more people live in apartments with central ventilation. One infectious person can thus infect dozens, even hundreds, of people with whom he has no direct contact.
* International and cross-continental travel is much more common, leading to the possibility of faster spread. If the virus has a long presymptomatic infectious period, one overnight flight from China could lead to an infection that spreads through half of San Francisco and hopscotches to New York within a matter of days, catching public health authorities off guard.
* A virus that spreads via aerosolized particles isn't as susceptible to sanitary conditions as many other diseases. It helps, but isn't as useful in preventative care as you suggest.
As one of those researchers, I've got to ask -- given that Taiwan is already breaking the Tamiflu patent, what makes you think my bosses are insane enough to invest that research money when the product is going to be confiscated?
Geniuses like you have already brought the development of new AIDS treatments to a near halt. Personally, I think this flu hysteria is nonsense anyway, but stopping the drug pipeline to grab the not-very-good drugs on the market right now seems counterproductive to me. Anyway, we'll go make our money elsewhere, and you'd better hope any future treatments can be produced out of Creative Commons drum 'n' bass tracks...
What I'm listening to now on Pandora...
For me, this is another "don't worry, be happy" case, as there is only a very small probability for a danger to a big number of people. Remember the Y2K bug, remember Sadams WMD, remember SARS, remember the mad cow disease? (bonus question: which doesn't fit?) None of these things ever caused real trouble to a major part of the world's population, but on all occasions, people got scared real easy. In fact, people were worried about just everything all through history, back to hiding from fire like scared animals.
Looking at some facts, there is a number of good reasons not to worry about this.
* Until today, only about 100 people died from H5N1
* they were all in contact with birds
* the virus doesn't spread from human to human (yes, it may sometime, but then again it may not - who knows)
* even if you get the virus, you have a good chance of surviving
* concerning the spanish flu: it killed something below 50 mio people worldwide. This is a lot, but with a total population of 2 billions, it also means that more than 97.5% survived
* we got a lot more knowlege about hygiene and biology now
* our body's own immune system is quite sophisticated and very strong against viri - after all it went through a million years of evolutionary development. At least it was good enough for our parents to survive long enough and have children, and also for our 4 grandparents, our 8 grand-grandparents and our $REALBIGNUM other ancestors.
* the media likes to keep us scared, so we keep watching. don't trust them
* the corporate world also likes to keep us scared, so we keep buying their crap. don't trust them either
* don't forget, some companies make real big money from selling medecine to imaginary threats (and I'm not only talking about viri here - think about how many "psychological disorders" that didn't even have a name a decade ago now can be cured with $fancydrug)
And if all else isn't good enough, there is still the top reason for not worring ever at all:
* Yes, we are all going to die someday, but when the time has come, overhasty worries won't save you, or even help you just a little bit. In fact, since death is inevitable, it might be much better to spend the time beeing with something useful, instead of beeing scared all the time.
Of course not worrying doesn't mean not taking precautions, when there is a valid reason for concern, but "valid concern" certainly doesn't apply here. If you're going to panic, please consider looking about ten posts down at an article that says something about Climate Warming.
That merely highlights how much american doctors over-prescribe anti-biotics. A lot of disease is viral (meaning that antibiotics don't help), and your body can take care of most diseases by itself anyway
Han-Wen Nienhuys -- LilyPond
Because production(and therefore supply) is limited. The company that makes Tamiflu(Roche) wants to be able to sell it to people that actually need it/might benefit from it. They don't see any reason to sell it to rabid morons that have too much money. The heartless bastards.
Nerd rage is the funniest rage.
I still question that 60% figure used. How many rural farmers and chicken owners in Vietnam go to the hospital with the flu and then find out that they have the bird flu if they aren't on their deathbed? Honestly, how many people just got some extra rest and got over "the flu" when in all reality they had the dreaded bird flu? Many Americans don't go to the doctor or hospital for the flu unless it's bad, and they have doctors and hospitals just miles away from their home, unlike in rural Vietnam. Maybe it's just me, but it seems more likely that this disease has a 60% fatality rate for those who are REALLY sick.
You raise some very interesting questions. Fortunately, I do not have to worry so much about the government restricting sales of Tamiflu, as I acquired a personal stockpile well over a year ago now. It does pay to be a geek and read the medical journals. Bird flu is quite a serious pathogen.. H5N1 may not be the exact strain which jumps the species barrier, but if we are to learn anything from history, there *will* be another pandemic. This is guaranteed unless of course you don't believe in evolution. Sadly, a Hegel quote comes to mind: "We learn from history that we learn nothing from history."
;) Yet the flu disproportionately kills off young people thanks to our robust immune systems. So I feel it pays to have a personal supply for yourself and loved ones (hey, I really love all of you out there and would like it if we could have infinite Tamiflu but that just isn't possible) - current murine models (H. Yen et al. Virulence may determine the necessary duration and dosage of oseltamivir treatment for highly pathogenic A/Vietnam/1203/04 (H5N1) influenza virus in mice. Journal of Infectious Diseases DOI:10.1086/432008 (2005).) show that Tamiflu is most efficacious when taken for 10 days rather than 5.
I'm quite surprised at some of the posters here laughing about a flu pandemic. I know it's popular to go for the +5 Funny moderation, but the knee jerk reaction of a scaremongering media isn't always correct. It would be wise to recheck some of your basic assumptions. Many posters have expressed their lack of concern, believing that their "strong immune systems" will save them. This is precisely the problem with H5N1 - it turns your own immune system against you (re: cytokine storm).
If you believe that the government program to stockpile Tamiflu will save you, think again. From what I have read, Bush plans to distribute supplies of vaccine and antiviral drugs to the elderly as a priority. I guess they must be a strong voting block.
A few weeks ago I was visiting Canada, and had a chance to watch one of their national television interview shows. I forget the name but it was approximately "One to one" - where a (famous?) reporter interviews an expert on a currently hot topic in the news. The topic happened to be bird flu, and the expert interviewed was, IIRC, a top MD working at high levels of the government within the health care bureaus. Of course he was also really a PR guy and seemed famous also for giving 10,000 interviews a year. Anyways.. he said he personally had a supply of Tamiflu for himself and his family! When asked, "Is that because you are a medical professional and will be dealing with people who are sick and doing research on the virus... or because you think it is just common sense for anyone to do this to be careful?" - he replied, "A bit of both." Not the exact quotes of course and I am writing this while very tired... but if anyone wants me to dig out a transcript or the exact name and air date of the show I can easily do so. To make matters more interesting, the next day on the news I saw that Canada was totally restricting the sale of Tamiflu!
Now before anyone jumps on me for being a totally insane, dogmatic, selfish troll - I agree the government has a huge role to play, and it is important that people who are really sick do manage to get Tamiflu. If everyone were to stockpile it beforehand, there would be quite a shortage. But... it is very nice to be forward thinking and preparing for these events on the individual basis. After all, what is best for the entire society during an outbreak might not be best for you individually. As for resistance - yes - please don't abuse the drug and take it unless it is certain that you have no other options. We are already beginning to lose the war with antibiotics as they have been so overprescribed, let's not do the same with our new antivirals.
All in all - play it smart, educate yourself, and learn the true risks. I'm much more worried about influenza compared to terrorist attack. There is always the group that will follow the crowd in hysterics, and go overboard to protect themselves. But that doesn't mean they are *always* wrong. There is also the group which seeks to protect itself because it is the right course of action.
I saw an interesting analysis by someone who purported to know what he was talking about.
The way he put it was this: viruses don't evolve suddenly. They evolve over time. It won't abruptly be the mega-super-lethal virus from hell. It has to get there in stages. First it has to get into humans. Then it has to learn to move from human to human. Then it has to learn to do that WELL.
It is, apparently, very unusual for a highly lethal virus to become widespread. This happened in WW1, but that was largely because of the trenches. The virus was able to communicate itself from a downed soldier, and that was the key to it being so intensely virulent. It was, very possibly, the only time in modern history that that many people have been together in conditions that poor.
In other words, dying soldiers could still transmit the virus, so killing the host wasn't a evolutionary dead end.
In our modern world, with our intense awareness of bird flu, if it stays highly lethal, it will never be widespread. We will bring enormous resources to bear on isolating any such patients. If the virulence drops to something approaching a normal flu, it could become widespread... we might not notice it until it was too late. But it would probably never kill very many people.
Remember, the reaction of humans to the virus is also a selection process, and we will select very, VERY strongly against highly lethal strains.
Smallpox is extremely lethal and contagious. Smallpox no longer exists in the wild. That should tell you something.
"Since when does being well read on Stephen King count as being literate?"
Being literate does not assume that one only reads great works. It is just as important to be aware of highly influential works, and as the most eminent horror -and possibly the most popular American - writer of the late-twentieth century, it is important for a literate individual to be aware of King's major works simply so that one is able to comprehend King's influence on other writers, as well as the influence other writers have had on King.
That said, not all of Steven King's books are long-winded, profane, oversexed retellings of campfire stories. Books like Carrie, The Shining, and probably a few other King novels will long be remembered as American classics, and as for all of the crappy books, well, nobody was forced to buy them.
There is a lot of speculation in this thread, and very little of it seems to be from public health practitioners. Every major health organisation in the world has actually thought about this problem, so you could go and google their FAQs and advice pages if you want, but let me summarise.
1. H5N1 is not a pandemic virus. The scary thing is a mutation of H5N1. Forget about the statistical wrangling over 50%. The morbidity (deatharifficness) of the human cases is based on small numbers, and a human-to-human strain could have different characteristics in any case. Just accept that the current concern is real and that random computer programmers do not "know better".
2. PLEASE don't try and buy up Tamiflu. You don't know what to do with it, you don't know how to diagnose flu properly and it's needed elsewhere. If you think you, or someone else has something which you think should be treated with Tamiflu GET TO A FRICKING HOSPITAL. If it's the correct treatment they will have it.
3. IMPORTANT: If you are "at risk" of initial infection of H5N1 (professional chicken-kisser etc etc) or you are a high-risk flu group (old, asthma, child etc) then GET A FLU JAB for seasonal influenza.
Note: This will not do anything to stop you getting H5N1 (sorry), although it may (unproven) help you survive. The idea is that if you don't get "normal" flu in the first place then there is less chance of you getting H5N1 _at the same time_, which could result in in-cell reassortment (genetic mutation) of the virus. In other words, H5N1 could cross with whatever flu you got to make a new flu. That could then result in you being patient zero for the killer-flu we're all scared of. (which would suck)
4. If you want to be ultra-paranoid, you could postpone non-essential travel to, eg, SE Asia or put off your "All Eastern Europe Cockfighting" tour. Your call.
5. Frankly, for the majority here I doubt that there is anything in particular you should be doing differently right now. BUT just keep a weather eye on the news - if ever the pandemic hits then these recommendations will instantly be out the window and people will be talking about masks, quarantine and emergency plans.
The sky is NOT currently falling. It is fair odds that unless you happen to indulge in "the love that dare not speak its name" with poultry or enjoy fresh duck's blood soup then there's not much you can do - the sky will fall or it won't. However, the reason health agencies are making a lot of noise is that _were_ the sky to fall, right now, global preparedness is not as good as it could be.
Thanks.
Your are citing concern as a cause for further concern. If they handed out a 200 page manual about what to do in case of an imminent attack by flying monkeys, people would be concerned.
Someone asked for a couple of worst-case scenarios, and an "expert" provided them. They handed it to the people who would be first affected. It's an alarming read, as most worst-case scenarios are. So far, what you're telling me is facts about the panic, not about the disease.
The fact that the administrators of a town of 40,000 people are preparing for the lack of school age children and tax income tells me they are pretty unsophisticated. This sounds like something they tell the local press, so they look like they are doing their jobs. I'd ask them what they would do if bored anarchist kids and the economically disadvantaged start setting fire to cars in the dead of night, something a little more likely.
The fact that a bunch of hospitals have received emergency training, and have been alarmed by it, is not necessarily significant. Did they receive similar materials in light of SARS and West Nile? How about a dirty bomb or chemical weapons attack? Earthquake? Asteroid? They're all scary, and they're all "possible."
If the top 100 epidemiologists in the world came out and said: "This strain of flu can be easily spread between humans, has a 50% mortality rate, and has no vaccine or treatment" then I would be concerned, but telling me your nurse is shocked because she's been told to read a manual about how they are going to run out of storage space for the bodies, well, that's not scientifically relevant. Even if she is a healthcare provider.
You could be counted as literate just by being able to read road signs. Literacy does not necessarily have anything to do with books.