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.
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.
"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.
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 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.
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 ]
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.
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.
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.
"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.