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."

Comments

Sensationalist Journalism?

[external400kdiskette]

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.

Re:Sensationalist Journalism?

[stevelinton]

Certainly H5N1 could go that way, but the flu virus is incredibly flexible, and there is
absolutely no reason why it won't come up with another variant as communicable and as lethal as the 1918 variant. If it does, the experts tell us that nothing modern medicine has come up with will help a whole lot. Basically it will infect everyone and kill a proportion and then the rest of us will be immune. Unless we can find a treatment that blocks, or ameliorates all varants of the influenza virus at once, or a way to mass produce a new vaccine in weeks rather than years, then we are still wide open to whatever mutation comes along.

Re:Sensationalist Journalism?

[kenrick]

Whilst this sort of thing has happened before saying it's definitely going to mutate is an overstatement.

Hardly - influenza viruses display both antigenic shift and drift: they are gentically one of the more unstable family of viruses. It is inevitable that H5N1 will mutate. What is debatable is whether it will mutate to a form where it is more infectious to a human host, or maybe some other (e.g. porcine).

Whilst sensationalist journalism is never good, it is important not to sideline flu - there will be a pandemic sometime in the near future, maybe not with H5N1, but we are 'due for one'.

Re:Sensationalist Journalism?

[smallpaul]

Did you RTFA? It says: "Scientists cannot predict which influenza strain will cause a pandemic or when the next one will break out. They can warn only that another is bound to come and that the conditions now seem ripe."

Maybe the bird flu is "the big one". Maybe it isn't. Even if it isn't, we should use the opportunity of its media ubiquity to figure out what we will done when the next big flu does hit. When, not if (unless there is a surprising development in medicine!).

Re:Sensationalist Journalism?

[v1]

Saying "we're due for one" makes you a nice sucker for Las Vegas. You are never "due" for a hit. You had the same odds last time as you do this time. If you roll two dice 200 times without getting snake eyes, you are not "due" for them. You still have the same 1 in 36 odds as you did last roll.

Some may look back and say "the odds of going THIS LONG without a hit are incredibly low" which is true, but you are factoring known events that have already happened into your odds, and that's just wrong. If it has already happened (or not happened) then the odds of that past outcome are 100% since we know what occurred. So those results don't have any effect on the odds of something happening tomorrow.

So we are no more "due" for a major outbreak this year than we were last year. OVERdue maybe, but not due.

Re:Sensationalist Journalism?

[IronBlade]

Absolutely sensationalist, just like SARS.
The common cold/flu kills around 40,000 americans (that's the stat I saw, don't know about world-wide) each year, but SARS with a handful of deaths globally got BIG press. Now this practically non-existant bird flu gets everyone all worked up.
I'll worry when there's a few thousand deaths. Until then, eat healthy food, exercise and keep that immune system running. If you're not one of the typical flu victims (elderly, very young or compromised immune system from other causes), you'll have an excellent chance to shrug it off, even if it does spread.

See http://www.fromthewilderness.com/free/ww3/101805_w orld_stories.shtml#5 for an interesting take on the whole situation...

Re:Sensationalist Journalism?

[Anonymous Coward]

AID's hasn't killed anyone. Other diseases kill a person with AIDs.

Also, life has a 100% fatality rate.

Re:Sensationalist Journalism?

[The_Wilschon]

we are 'due for one'.

Mutation of the flu virus into something seriously dangerous, like the 1918 variety, certainly qualifies as a Poisson process. The time between events in the Poisson distribution follows an Exponential distribution. The exponential distribution is "memoryless", that is, the probability that an event will occur in the first n years of a time interval is the same as the probability that, after any number of years in which an event has not occured, an event will occur in the next n years.

Shortly, the fact that we haven't had a flu epidemic recently has absolutely no bearing on whether or not one is coming soon. Even more shortly, we are not 'due for one'. This is known as the gambler's fallacy.

Re:Sensationalist Journalism?

[benjamindees]

Pandemics don't occur in a vacuum. The events themselves alter the probabilities.

If you're talking about a slot machine then, yes, you have the same odds every time. If you're talking about an event that, by its occurence, affects the odds of its recurrence within a period of time, then talking about being "due" is entirely appropriate. All evidence indicates that flu outbreaks are such events.

It's like looking at the weight on a pressure cooker. If steam hasn't come out in a while, you can say that it's "due" to come out soon.

You can argue that pandemics don't *have* to occur, but until we can go at least a few generations without having one, I'd say you'd be wrong.

Causing Panic

[AndyFewt]

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.

still waiting

[BushCheney08]

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?

Latest fad

[ch-chuck]

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!

Human Death Fetish

[Tim]

"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....

Re:Human Death Fetish

[Hektor_Troy]

Old and poor. Hrmm. Let's see.

Poor people? 40% of the population in Africa (south of sahara) and southern Asia lives below the poverty line. (that's 1 dollar a day).

Care to wager how many people that is in all? Hint - Asia has 4 billion people alone.

What kind of impact would that have do you think? And people don't just die from the flu - if 50% of an area dies from a disease, who's going to clean up the area? In poor regions? That'll lead to massive outbreaks of other diseases, breakdown of all kinds of other stuff (like say - food production). That in turn will lead to even MORE people dying.

Southern asia is probably one of the main providers of cheap labor for western companies ... but with a complete upheaval of their countries and entire region, who's going to worry about working for those companies? People will be one of a few things:
  * running for the hills (ie neighbouring countries)
  * giving up in dispair
  * trying to get their local areas self sufficient in food (as the ones that'd be bringing in stuff died)

Running for the hills could easily lead to border skirmishes and full fledged wars, as could the need for resources that the neighbouring countries won't supply.

Etc, etc, etc.

Just cause it's only poor people doesn't mean it won't affect you or anyone else.

About those numbers...

[Ari1413]

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.

Are you paying attention?

[sane?]

If you're not frightened by a flu pandemic, you haven't understood what it is or what it means. If the average case happens we could likely lose 150m worldwide, most probably from the wage earning, productive heart of each community. The speed and breadth of the disease will run it around the world in a matter of a few weeks with air travel and no medical system will have the chance to do much more than count the corpses. Governments are playing down the numbers, predicting from the basis of mild pandemics and allowing years to act.

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?

Highly lethal viruses

[JohnsonWax]

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.

50% may be wayyyy too high

[TheSHAD0W]

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 1957 influenza epidemic

[eric76]

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.

Re:concern?

[ctid]

Is this pandemic something that American college students at small schools should worry about? Obviously, there is a much higher chance at a university or much larger school (like Penn State with ~45,000 students from all over the world).

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!

It'll be a sad state of affairs when this happens.

[steelfood]

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.

There's is a reason

[DrYak]

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.

Re:Factors in our favor

[captainktainer]

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.

Re:it would change the pharmaceutical industry

[thogard]

How about the budget for Viagra marketing budget being more than the entire R&D budget of the company that makes nearly all of the existing flu vaccines. Then there is the stomach ulcer research in the US that brought out billions of dollars every year in anti-acids while a few guys doing real research fond the culprit and that wiped billions off the ulcer business. Check the drugs that are given in the 3rd world where the doctors may have one chance to immunize a kid for everything for their entire life. Most of those drugs aren't made by the US drug industry even though it spends many times more than every one else. If you want to find your own examples, look at the annual report of the different companies.

Re:It'll be a sad state of affairs when this happe

[Otter]

Public welfare be damned, so long as the pharmaceuticals can make back their research money.

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...

Re:Discovery Channel

[geoff127]

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.

Re:So why is Tamiflu withdrawn from customers?

[__aaijsn7246]

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."

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. ;) 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.

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.

Re:Offtopic?!? Hey Mods, B-O-O-K that spells book!

[supabeast!]

"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.

Flu Pandemic - What To Do (no, really)

[btg]

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.