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."
Randall Flagg is cackling with glee right now. His plan as almost borne fruit. I'm stocking up on Nozz-a-la and heading for the hills. Who's with me?
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.
Here is a one-page, ad-free version of the article. Seriously, when articles are formatted like this, submitters should use the "printer friendly" version of the article as the submission.
As I've been living in a cave with a sneezing chicken. Thanks for bringing it to my attention, Slashdot.
The Discovery Channel will be having a special on about this at 10:00pm EST, it was on last night and I believe it was nearly a 60% fatality rate. In Holland they had to slaughter nearly 30 million birds (mostly chickens) because the disease spread there. The most cases and deaths have been reported in Vietnam, 41 deaths out of the total of 62. You might want to watch this special, it even talks about how they found out the 1918 flu was originally a complete avian strain, much like how this new one is.
Fear the turtle farming ninja!
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); }
Here is an article on "Bird Flu's Environmental Components", for those interested in the ecological side of it.
One thing that bothers me about all this sudden talk of pandemics, how much cause for concern is there for the average American citizen? This flu strain is apparently more dangerous than SARS, yet it has recieved nowhere near the amount of press that SARS did, and SARS primarily affected the elderly and people with poor immune systems (there were exceptions, though, back off).
In my case, I haven't been sick enough to need antibiotics in more than a year and a half. I'm a full time college student living in a thirty year old dorm in western Pennsylvania. I regularly have contact with over 1000 people on any given weekday. At any given moment, there is at least 5 people in my hall who are sick.
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).
Colin Dean Go a year without DRM
"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?
Am I the only one, having a somewhat strong immune system, that is not in the least bit worried about a pandemic?
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A string immune system is not garuntee that you will survive. The 1918 flu killed a lot of healthy people.
The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children.
http://www.stanford.edu/group/virus/uda/
The 1918 virus sometimes killed completely healthy people in killed overnight.
"Some people would go to bed healthy and never wake up."
http://www.cbc.ca/news/background/flu/fluepidemic
This was one of the flus that worked so fast the immune system couldn't keep up.
Fly me to the moon Let me sing among those stars Let me see what spring is like On jupiter and mars
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.
50% of what? Of people who got sick enough to go to a doctor. Where do the people who never showed up at a hospital fit into this statistic?
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?
Being somwhat affiliated with a few online pharmacies, I know, that Tamiflu (possibly a cure, or at least a good suport medicine to avoid getting any flu) has been withdrawn form public pharmacies and are stocked by the government.
.....
Why is that happening ?
Is this flu propaganda for the drug companies, and fear mongerin ?
These questions came up almost every day looking at searches for that medication, and many claim that this flue, when getting ins a country with decent medical practices/health services has a very small fatality rate. Most people get it in developing countries, and get it in agricultural professions (e.g. farmers being exposed to chickens)....
Before you start trolling on online pharmacies, I never send spam, or sell dangerous meds such as hydrocodone, so don't bother.
Anyway I am exposed to medication news because it became part of my revenue, and dunno what to think anymore about that flu panic....
Most people I know say, that it is just a panic by the drug mob to boost sales, but the stocking of flu meds by governments send me a different message....
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.
Am I the only one, having a somewhat strong immune system, that is not in the least bit worried about a pandemic?
Start worrying. Many of the deaths from the 1918 pandemic and from H5N1 have been related to a "cytokine storm," resulting in an overly vigorous immune response. The typical "healthy young adult" is very much at risk.
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.
We all know that the news cycle runs on hype, and that there are always charlatans, snake-oil salesmen, and fear mongers waiting to pounce when danger threatens.
However, immediately dismissing pandemic warnings is foolish. It makes sense to develop a vaccine and work on contingency plans.
That said:
There are a lot of differences between 1918 and 2005, and 1963 and 2005.
Diabetes and obesity epidemic aside, people are a lot healthier:
* Vitamin deficiences and plain malnutrition are rareities.
* Lice, bedbugs, intestinal worms and such, while not unknown and on the rise in certain populations, are very, very rare on the whole.
* The vast majority of people sleep in their own beds, in warm bedrooms.
* Simple palliative medicines like aspirin, decongestants, anti-diarrheals, and re-hydration drinks can turn what in 1918 were deadly menaces into something merely serious.
* Most people take hot soapy showers every day; soap and hot running water are available in restaurants and workplaces.
A pandemic would certainly be bad news for people on the margins, especially the very poor, very old, and recent illegal immigrants crammed into shared housing. But on the whole, the factors listed above will work together to turn a life-threatening menace into something serious -- possibly temporarily debilitating -- but survivable for most people.
Stefan
P.S. Hey! You! Wash your goddamn hands after you use the bathroom and cover you mouth when you sneeze. Yeah, you!
Short subject line -- in the 1918 pandemic the young and healthy were often fine in the morning and dead by nightfall. Even in the more common situation where it took a few days to kill, it struck the young and healthy disproportionately harder.
The problem? An immune system has to be _reactive_. Your immune system has to develop sensitivity to the new virus and that takes some time. The usual flu strain isn't a problem since it's very similar to the strains we've already seen (in infection or innoculation) and our immune system can quickly respond. There's also a lot of natural selection going on over time -- a virus would rather see us miserable and contagious for a week than dead and non-contagious within a day.
But we have no natural immunity to an entirely new strain, and some can kill before our immune system can develop an effective response.
That's why older people faired better in 1918. They hadn't seen the same strain, but they had seen enough variety that they had a stronger initial response than their younger peers.
For every complex problem there is an answer that is clear, simple, and wrong. -- H L Mencken
Am I the only one, having a somewhat strong immune system, that is not in the least bit worried about a pandemic?
Actually, this is to your disadvantage, as a strong immune system is probably what is going to kill you. Your immune system could trigger a Cytokine Storm which will basically dissolve your lungs through severe inflammation.
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."
Its name was Enza.
I opened the window
And in-flu-enza.
Stolen from: http://www.stanford.edu/group/virus/uda/
But not too reactive. The suggestion has been made that the problem isn't that our immune systems don't react to H5N1, it's that it reacts too vigorously, as per, for example, this article, Bird Flu Triggers Immune System 'Storm'.
Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota School of Public Health is quoted in that article as saying that this might be why the young and healthy get stricken more severely (presumably he's referring to H5N1, but perhaps that happened with the 1918 flu as well):
Before people jump on my back saying I'm an evil heartless person... I'm just putting things in to perspective. I don't want a pandemic to break out, but I'm just looking at this with an objective eye.
I'm assuming that 'twice as deadly', as meaning killing twice the number of people.
Yes, the new flu virus may will kill twice as many people as the 1918 pandemic did, however our population has more than tripled since the beginning of last century.
Lets say that the numbers are true. 40 million people died in the 1918, with a world population of, say, 2 billion people. This would mean that there was a 2% death rate.
Now, say in 2005, 80 million people die, with a world population of say 6.45 billion. The death rate would be 1.2% of the total world population.
That's 0.8% lower, than it was in the past. Actual numbers will most likely be less, with better technology, better sanitation in many parts of the world, and an understanding of genetics.
The numbers are here to scare people, and sell headlines.
Money cannot buy happiness, but can buy something soo darn close, that you can't really tell the difference
Two posters comment on a thread about a SUPERFLU with direct references to a bestselling book about a SUPERFLU, and moderators rate both posts as offtopic?? Where are we getting moderators these days, the Republic of Illiteracia? FWIW, I thought both posts were quite topical AND funny. "M-O-O-N" indeed :))
"He who throws mud, loses ground." - proverb
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 ]
Quasiman will save us!
And do it with a vacant stare, and a line of drool hanging from his chin, and a good 30% of his brain phased into some other reality.
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.
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...
Ok. Am I the only one, having a somewhat weak immune system, that is not in the least bit worried about a pandemic? ....
Polio is a particularly good example because it's been flaring up again in isolated areas on a regular basis due to lack of political will - for instance in Kano province in Nigeria in 2003 after muslim leaders caused the immunisation programs to be suspended over paranoia that Western nations used the polio vaccines to distribute drugs to reduce fertility and spread HIV... Yes, you read that right.
As of this year Polio is still endemic (exists in the wild) in at least 5 countries. The other countries with significant Polio outbreaks have all been cases of it being imported from elsewhere.
The good news is that the Polio vaccine programs in Nigeria were reinstated, though despite that Nigeria alone have had about a third of all Polio outbreaks this year.
According to the World Health Organization 34.3 million people in the world have the AIDS virus
24.5 million of them in sub-Saharan Africa.
Nearly 19 million have died from AIDS, 3.8 million of them children under the age 15.
5.4 million new AIDS cases in 1999, 4 million of them in Africa.
2.8 million died of AIDS IN 1999, 2.4 million of them in Africa.
13.2 million children orphaned by AIDS, 12.1 million of them in sub-Saharan Africa.
Reduced life expectancy in sub-Saharan Africa from 59yrs to 45yrs between 2005 and 2010, and in Zimbabwe from 61yrs to 33yrs.
More than 500,000 babies infected in 1999 by their mothers most of them in sub-Saharan Africa.
The more you know, the less you understand.
You only have to avoid eating the chicken RAW.
Unlike the mad cow disease (which is caused by [very rare] self-replicating proteins, not virii),
the flu virus (like other chicken disease, lysteria, and so one) doesn't survive cooking.
So if cook your chicken soup well, or roast correctly your roasted chicken, you're safe, at least from virii and bacteria.
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
---
the pen is mightier than the sword, the sword is mightier than the court, the court is mightier than the pen.
Everyone I know that actually deals with disease for a living, ... is scared, and takes bird flu VERY seriously
I was in the hospital last week for routine blood tests, chatting with my favorite nurse, and she was telling me about all the new plans they have in place for dealing with the coming pandemic. The top health authorities in each country have reviewed the actual hard data on what is coming, and getting ready for various worse case scenarios. They just aren't certain which winter it will hit, probably not this year, but almost certainly one of the next three winters.
The hospital had just reviewed and practiced for a "plan blanc" (white plan) of being overwhelmed with large numbers of highly contagious patients. The plan blanc was mostly aimed at preventing infection of the hospital staff, and how to isolate the sick and keep visitors from circulating and possibly spreading the disease. Next week they are reviewing their "plan noir", to deal with huge numbers of dead, and the disposal of highly contagious bodies and medical waste. The hospital never really had a plan noir tested before, what once was a short couple pages of suggestions is now a whole large book. In my town of 40k population, the hospital was looking for a place to store up to 1000 bodies, with 200-400 deaths per week over a 10 week period, and only being able to dispose of 100 per week. Scary shit, indeed.
The town authorities are preparing for a 50% worst case mortality rate, with all the subsequent recovery problems; no more younger school age children for years, half of the tax revenue generating population dead, food shortages if the borders are closed, longterm drop in tourism, local exports blockaded, and no financial aid from any direction because the devastation may be all around Europe.
All the hospitals in the Benelux, France and Germany are preparing for the worst, and its not in response to some poorly written articles in the mainstream press. They have the experts looking at the data and are getting very, very nervous.
I just got my flu shots, something I've never felt the need before.
the AC
Hemos is like...sci-fi fans;he thinks technology is cool, but he hasn't bothered to understand the science it's based on
The Spanish Flu (1918) killed young healthy people very quickly, it turned their lungs into sponge rubber. It was not at all like the "flu" that we are used to. People who blithely confuse the yearly 'achy go to bed for a few days' flu with the killer flu should read the books written during that period about what it was like. People were dying all over the place, sometimes within 24 hours of contracting the disease.
I remember back in the 90's taking some Amantadine to help fight the flu. And I wondered why the news keeps going on and on about Tamiflu. So I did a quick check and yes Amantadine is an antiviral drug, but thanks to the fucking Chinese they have made it useless to fight H5N1 because they'd been abusing it the way our ranchers abuse antibiotics. Amantadine costs a lot less but it doesn't matter. Now we have to use the much more expensive Tamiflu.
It gets better. One of the primary ingredients for making Tamiflu is something called Shikimic acid which is difficult to produce and is extracted from star anise that is only grown in four provinces in China. And their is a global shortage of star anise so that's why their's a global shortage of Tamiflu. Anyway it probably won't matter since H5N1 will probably develop a resistance to Tamiflu because of overuse. Anyway, we'll just have to wait and how the next pandemic evolves.
"You'll get nothing, and you'll like it!"
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.