Editorial: Pandemic

 

Over my three and a half decades of adult life, I have been surprised, especially in retrospect, of the relative stability of the world that allowed me to live out my own life, according to my sense of identity, as I saw fit, sometimes ghettoized, but with physical and communications mobility. The single worst incident was, of course, 9/11/2001. A number of grisly possibilities ranging from weapons of mass destruction to oil shortages and gas rationing to the AIDS epidemic have sometimes threatened that way of life. And now we hear dire warning of a super-flu, with plain old airborne contagion. something like Stephen Kings 1978 novel The Stand.

 

The July-August 2005 issue of Foreign Affairs contains dire discussion particularly of bird flu, and of the possible consequences of an epidemic this winter or some other year. In Asia, a new kind of virus, H5N1 avian flu, has moved to various farm mammals and sometimes to humans who have eaten infected chicken or animals. The mortality rate has been very high, although it is unknown if there are many milder unreported cases. The great fear is that the virus becomes transmissible person-to-person, a quite likely event which would probably make the virus less lethal as it adapted to a human host. The virus could become an airborne mammalian or human virus if it swapped genetic material with other flu viruses (in a manner analogous to biological sexual reproduction of true organisms) in a new host. But we are not sure how quickly, but we indeed have “probable cause” to become very concerned.  The virus deserves comparison with the 2003 SARS ourbreak, caused by a new coronavirus (a large virus which, in mild forms, typically causes laryngitis and acute bronchitis). Careful controls and occasional quarantines were actually effective in keeping SARS out of the west, although avian flu would almost certainly be much more contagious. Comparison with the 1918 Spanish flu is appropriate. That disease, in the young and strong, caused fulminant infection, with cyanosis and internal bleeding (resembling hemorrhagic fevers like Ebola) and possible disfigurement or disability in survivors. This “new” virus (well known since 2003) may be similar: it can attack organs outside the respiratory tract (it can affect the liver, the brain, the GI tract), which would increase morbidity and mortality. It is well to remember the comparison with HIV, which is transmissible only through blood and has long incubation periods (although in the 1980s right wing commentators would speculate on what could happen in HIV became more contagious or became insect-borne).

 

The social and economic impact of a 1918-style pandemic can be enormous. An epidemic would probably start in an Asian country, resulting immediately in cutting off air travel with the country and exports. (I recall before my pre 9/11 trip to Europe in Spring 2001 my concern that the trip could be disrupted by foot and mouth disease in livestock, a disease that broke out because of a single mishap in a Scottish restaurant!) Various manufactured goods like personal computers and electronics could become scare. Were a large epidemic to reach large cities in this country, mandatory closings of many businesses and curfews become conceivable. (On November 2, 2005, the government suggested that travel restrictions, even within the country, could occur; international travelers could be detained for hours for screening; “snow days” up to a week or so could close schools and many kinds of “non-essential” businesses.) Whole industries could be decimated. Given the very rapid incubation and spread of some flus, it is hardly to imagine that quarantine could be effective as it was with SARS. We may remember the health signs from 1918 when coughing and sneezing persons were not admitted to public places.

 

The social impact comes partly from the importance of personal mobility in today’s society. We have been before this before in different form with the thread of gasoline shortages and rationings. Many younger people and single people (including gays) socialize in large crowded events. For persons with normal immunity and with most common infections, such incidental exposure may actually strengthen a person’s immunity as he grows older (not to be confused with the case of STD’s). Another possibility with some pandemics is that some adults may become carriers, minimally symptomatic themselves but able to transmit fatal disease to children, as with teachers. At least a remote possibility could be the introduction of an avian flu epidemic by a bio-terrorist.

 

The possibility of enormous social and economic dislocations has a bearing on our social values and priorities. Individualism flourishes in a stable technological society where persons have considerable control over their own circumstances and opportunities. Older patriarchal value systems predicated on the family for its own sake, or tribal systems, often rooted in religious identity, assume that the world is that a hostile place and that one owes allegiance to family first as a principal mode for long term survival in the face of unpredictable external circumstances.

 

One observation is obvious. The administration and drug companies need to get a handle on the manufacture of sufficient vaccines and anti-viral medications. Liability issues and contamination problems like what happened in Britain in 2004 must not be allowed to run amok. Remember, however, the experience with 1976 Swine Flu where Congress had to relieve drug companies of contingent liabilities. There was no pandemic, and there were some problems with the vaccine (Guillain-Barre syndrome). However, risks and benefits often have to be weighed with many vaccines. Public health is one area where libertarian models have trouble stranding up. The concept of “herd immunity” applies, and misuse of antibiotics or antivirals by some persons (or some countries, as is already the case with China) can have global ramifications, as can unsanitary agricultural and industrial practices. We are already seeing similar observations with global warming.

 

Still, we need to keep a perspective. H5N1 may have been smoldering for years in Southeast Asia without jumping into a contagious flu, and the government obviously could overact in ordering costly quarantines and neighborhood closings. Still, how did the 1918 Spanish flu occur so suddenly? Was it because of overcrowding of the military or other peoples in World War I?

 

Articles in 2005 summer Foreign Affairs:

 

Laurie Garrett:  “Probable Cause: The Next Pandemic?” and “The Lessons of HIV/AIDS”

Michael T. Osterholm: “Preparing for the Next Pandemic”

William B. Karesh and Robert A. Cook: “The Human-Animal Link”

 

Marc Santora, “When a bug becomes a monster: New York prepares an already overburdened system for the threat of avian flu,” The New York Times, Aug. 21, 2005, p. A20

 

David Brown, “Scientists Race to Head Off Lethal Potential of Avian Flu,” The Washington Post, Aug. 23, 2005

 

Lynn Johnson, Tim Appenseller, “The Next Killer Flu: Can We Stop It?” National Geographic, October 2005. The article stresses the unpredictable nature of H5N1.

 

AFP, Yahoo, WHO World Health Organization director Lee Jong-wook warned that avian influenza was spreading from domestic fowl to migratory birds. http://news.yahoo.com/s/afp/20050906/hl_afp/healthfluasiawho “WHO repeats warning of rapid bird flu spread,” Sept. 6, 2005

 

ABC News gave a sobering report of the possibility of a pandemic on “Primetime Live” on September 15, 2005.  It would take 6 months to get a vaccine in place once an outbreak occurred. The one medication available is Tamiflu, (http://www.medicalnewstoday.com/medicalnews.php?newsid=15740 ) from one country in Switzerland (the Roche company), and it is impossible to get enough doses should an outbreak occur quickly. We have only 2 million doses on hand today, and up to 6 million are planned for. The United States seems not to have planned well compared to other companies. The company offers the vaccine on first-come, first-serve basis.  The ABC report mentioned possible huge and longterm quarantines of entire neighborhoods in large cities, with ruinous economic effects.

 

Senator Bill Frist, “The threat of avian flu: U,S. needs an action plan—and needs it now,” The Washington Times, Thu Sept 29, 2005, p A23.

 

ABC “World New Tonight” reported that President Bush was considering using the military to quarantine entire areas if an H5N1 outbreak appeared in the United States, and he thought that Congress should debate the issue; others feel that it should remain under control of public health officials. See Jennifer Loven, AP, “Bush considers military rule on flu fight; President Bush raises notion of using military to quarantine areas where avian flu breaks out,” Oct. 4, 2005, at http://abcnews.go.com/Health/wireStory?id=1182806

 

Denise Grady, “Danger of Flu Pandemic is Clear, if not Present,” The New York Times, Oct. 9, 2005. Link is http://www.nytimes.com/2005/10/09/national/09flu.html?hp&ex=1128830400&en=e1a0fad64313f36b&ei=5094&partner=homepage (may require a subscription).

 

The new website centralizing government and WHO information is http://www.pandemicflu.gov/

Also, for the Nov 2, 2005 announcement:   http://www.whitehouse.gov/homeland/pandemic-influenza.html  http://www.whitehouse.gov/homeland/nspi.pdf 

 

Here is the editorial by Fareed Zarika from the Oct 31, 2005 issue of Newsweek, “A Threat Worse than Terror: The government can’t even give intelligent advice to its citizens.”  http://msnbc.msn.com/id/9787690/site/newsweek/  The Newsweek story is “The Fight Against the Flu,” by Jerry Adler.

 

But in The New Republic, Nov. 21, 2005, Michael Fumento weighs in with “Fuss and Feathers: Pandemic over the avian flu.” Pandemic, he points out, does not imply “deadly epidemic,” just “worldwide epidemic”. Fumento dismisses the human death rate in Asia so far as “sample bias,” and explains the Spanish flu deaths in terms of complications (pneumonias) and unusual military overcrowding. He does make the sensible recommendation of widespread vaccination with the pneumococcal polysaccharide vaccine.

 

Justin Gillis, “U.S. Builds Stockpile of Vaccine for Flu Pandemic,” The Washington Post, Nov. 30, 2005, reports some increase in supply of experimental vaccines (4 million doses) with the possibility of dilution to stretch it. But he then writes, “A pandemic would be expected to confine millions of people to their homes for weeks or months, shutting down much of the economy.”

 

Some underground papers and websites from Asia (epochtimes.com) report that China has over 300 human deaths from avian flu and that there are a number of documented cases of human-human transmission (as of 12/1/2005).

 

 

Timeline:

 

Sept. 21, 2005: AP, Yahoo, CNN report a few more deaths in small children in Indonesia. It is expected that more reports will trickle in from that part of the world, but when would they signal human-human transmission?

 

Sept 29, 2005: ABC “World News Tonight” reports that Thailand and Vietnam have much better control of the disease in birds than does Indonesia. Brian Ross’s story is at http://abcnews.go.com/GMA/Flu/story?id=1169664&page=1  The issue is also to be covered on “Nightline” Sept 29, 2005. AP stpry http://abcnews.go.com/Health/Flu/wireStory?id=1160221

 

Oct. 8, 2005.  NBC “Today” reports that a male nurse in Vietnam may have gotten avian flu from direct contact with a patient.

 

Dec 15. Emma Ross, AP/The Review Alliance, “Pandemic Flu-Vaccine Prototype Promising”, http://hosted.ap.org/dynamic/stories/B/BIRD_FLU_VACCINE?SITE=OHALL2&SECTION=HOME&TEMPLATE=DEFAULT

 

Sanofi: Bird Flu Vaccine Data looks good (France): http://hosted.ap.org/dynamic/stories/S/SANOFI_PASTEUR_BIRD_FLU?SITE=OHALL2&SECTION=HOME&TEMPLATE=DEFAULT

 

China reports 6th human case. http://hosted.ap.org/dynamic/stories/C/CHINA_BIRD_FLU?SITE=OHALL2&SECTION=HOME&TEMPLATE=DEFAULT

Underground sources suggest that China is grossly underreporting.

 

Dec. 21, 2005 ABC News reports that there is some circumstantial evidence of Tamiflu resistance or ineffectiveness against H5N1 in humans. There seems to be a relevant study in the New England Journal of Medicine at http://content.nejm.org/cgi/content/full/353/25/2667 (you may need a subscription for a lot of content).

 

Jan 6, 2006  Three children have died of bird flu in Asiatic Turkey, apparently from playing with dead chickens. http://www.cnn.com/2006/HEALTH/01/06/turkey.birdflu/index.html 

 

Jan. 9, 2006.  Five more are infected in Turkey, with bird infection apparently reaching Istanbul. Benjamin Harvey, “The Sentinel”, http://hosted.ap.org/dynamic/stories/T/TURKEY_BIRD_FLU?SITE=MIHOL&SECTION=HOME&TEMPLATE=DEFAULT   As of 1/11 the total infected was 15 and there was some quarantining, even in Istanbul.

 

Jan. 10, 2006, Joyce Howard Price wrote a report on The Washington Times, “Study Questions Bird-Flu Paranoia,”

http://washingtontimes.com/national/20060110-122729-6822r.htm  about a Swedish study in Asia, although it is unclear that many of the recovered persons with mild symptoms really had been infected. This report would comport with The New Republic op-ed by Fumento.

 

Jan. 11, 2006, Maggie Fox, “New Test Could Monitor Bird Flu Virus Mutations,”

http://today.reuters.com/news/newsarticle.aspx?type=scienceNews&storyid=2006-01-11T130351Z_01_YUE112471_RTRUKOC_0_US-BIRDFLU-TEST.xml&src=cms

The article seems to indicate that it would take very little mutation to make the virus more transmissible from human to human. The avian form seems to infect many the GI tract or gut. To become more transmissible, the orthomyxovirus needs an affinity for the surface markers of human bronchial or lung cells.

 

Jan. 12, 2006 Daniel Williams and Alan Sipress, “Bird Flu Mutation of Concern, Experts Say: Health Officials Play Down Fear of Pandemic in Turkey,” The Washington Post, p. A12. The virus seems to be mutating but has not necessarily become easily transmissible, as discussed above.

 

Anita Manning, "Are fears of a pandemic exaggerated," USA Today, Jan. 17, 2006. http://www.usatoday.com/news/health/2006-01-17-bird-flu_x.htm?csp=N009  Marc Siegel, a medical school professor at New York University School of Medicine, has a book published by Wiley: Bird Flu: Everything You Need to Know about the Next Pandemic.

 

Jan. 24, 2006.  Dr. Michael Osterholm of the University of Minnesota appeared on the Oprah Winfrey show, and warned the public that there could be 90 million infections, 45 million that are symptomatic, and 2 million deaths. He claims that in the Spanish flu in 1918 7% of infected people between 20 and 40 died. 55% of infected pregnant women died. Osterholm warned that the virus targets young adults with healthy immune systems (an irony considering our experience with AIDS) because it causes immune overload (a “cytokine storm”) as the individual drowns in his own lung secretions. He was critical of our lack of commitment to a vaccine in our public policy. He warned that individuals could need food for four weeks in a pandemic. He expressed particular concern over events in Turkey. Another serious problem is that the “just in time economy” inventory philosophy endangers the public in dealing with an epidemic. Avian influenza affects more organs (including the GI tract) than does ordinary influenza. Dr. Osterholm warned also about the triage that would be necessary;  there might be a need to reserve ventilators and other treatment for younger people.  

 

Jan. 26, 2006.  Maggie Fox. Health and Science Correspondent for Reuters, provided a report “Bird flu viruses carry unique genes: study.” The story reports that the avian flu viruses carry genes that cause them to make forms of the NS proteins (NS1 and MS2) in cells much more destructive to cells than common human influenze viruses. It is possible that a mutation that made the H5N1 viruses more contagious person to person (that is, easily infection to respiratory tract surfaces) would make these proteins less destructive.

 

Feb. 28 2006. A cat dies of H5N1 infection in Germany near a dock where sea birds congregate. Some cats have died of H5N1 in Thailand. This is the first mammal to die in Europe.

 

Feb 28, 2006 Maggie Fox, Health and Science Correspondent for Reuters, writes, "Encourage sick leave in flu pandemic, firms urged." Half of all workers have no paid sick leave, and corporate culture, especially for salaried workers, encourages coming in to work sick. Telecommuting can help.

 

March 13, 2006. ABC News will start a special report on bird flu or "World News Tonight." The "Good Morning America" segment was particularly alarming. It suggested that infected birds will soon migrate to North America from Russia through the Bering Straits and Alaska. Vigorous quarantines will be in place if the virus mutates into a form that is easily transmissible among primates. For example, all members of an international flight could be held in quarantine for hours if a person shows symptoms and for days if the person tests positive for H5N1. According to early morning reports, Homeland Security is already suggesting that American stockpile food and water "just in case." Scientists claim that there is 50-50 chance of a major mutation resulting in easy transmission. One interesting parallel would be to the right wing speculations in the 1980s that HIV could undergo a similar mutation, but in the latter case HIV would have to change completely in nature and probably would become much less deadly. It is likely that if H5N1 adapted readily to the human host it would become less virulent in time, but would cause tremendous mortality and morbidity and economic disruptions for some time. 

 

The presentation was called "A Closer Look: Bird Flu: Fears, Facts and Fiction: What Every American Should Know." Michael Leavitt of HHS was interviewed. There are now some vaccine doses for H5N1 but there is now a second strain spreading rapidly. It could take only until mid April for H5N1 to reach birds in Alaska and August for it to reach birds in the lower 48 states.

 

ABC News has a four-page report by Adrienne Mand Lewin, "How Will Bird Flu Change Your Life? A Look at What Could Happen at Work, Home, School, and Your Community," March 13, 2006, at http://abcnews.go.com/Health/AvianFlu/story?id=1706048&page=1  (through page=4). The report is alarming. It maintains (in a quote of Dr. Joseph Argis of Houston) that mutation to a human-to-human readily contagious form is inevitable, but that the disease is likely to become less virulent as it reaches North America. The report goes on to analyze responses, and the tone of the report, while healthfully recommending telecommuting for many companies, tends to suggest that strict quarantines and long term business and school closings are preferable to trying to "get by." The report does mention that many people do not have paid sick leave and tend to be motivated by "presenteeism" which could be deadly with this virus. Another factor is that many companies have merged sick leave and vacation as personal leave, effectively penalizing people who take sick leave (even for sick kids, a point that I belabored in Chapter 5 of my first book). Many business models could be destroyed by forced closings, as in the entertainment and restaurant industries. Socially, an epidemic could reinforce "family values" or "people first" cultural values favored by social and religious conservatives.

 

ABC "Nightline" broadcast a small report on March 13, 2006, centered around bird flu in sub-Saharan Africa. The poorest country of all, landlocked Niger, was shown, where chickens are used as currency. Still, no documented human deaths from avian flu have occurred, despite the endemic poverty that helped contribute to AIDS.  Dr. Anthony Fauci from NIH was then interviewed. He pointed out that a major strategy when migratory birds reach the United States will be preventing them from having contact with chickens on farms, keeping poultry indoors and sheltered, a strategy that seems to be working in the European Union. However, the mutation to a contagious form and the introduction of a single known such case into the general population will immediately raise quarantine issues, a debate that the gay community learned in the 1980s when it was brought up in a rather phony fashion with respect to HTLV-III / HIV.

 

ABC "Good Morning America" on March 14, 2006 continued the report with a segment on what a home needs to keep stocked in case of any catastrophe (which can include storms and terrorism as well as pandemics). The recommendation is ten days' supply, including one gallon of potable water per person, and multiple canned and dried foods and many other emergency supplies.

 

ABC "World News Tonight" on March 14 2006 featured a spot on Robert Webster at St. Jude's Hospital (Memphis, TN), original discoverer of H5N1 in 1997. Webster claimed to have a three month stockpile of essentials at home and believed that a contagion mutation was inevitable. He said we have never had a major contagious infectious disease that could kill 50% of the people it infects.

The ABC story by Jim Avila and Meredith Ramsey is "Renowned Bird Flu Expert Warns: Be Prepared. There are "about even odds" that the virus could mutate to an easily transmitted form, he tells "World News Tonight" " at http://abcnews.go.com/WNT/AvianFlu/story?id=1724801&page=1

 

There was a more detailed account of home preparedness on March 17, 2006 on World News Tonight.

 

March 21, 2006: (WHO) Bird flu cause five deaths in young people in Azerbaijan, and these could have come from swans. Most human deaths have been associated only with chickens so far. It is not clear yet whether any human-human transmission has occurred.

 

Osterholm at the University of Minnesota has indicated that there is definitely some indication of some intra-familial transmission in a few of the cases overseas.

 

According to the Associated Press (Ben Feller), "Schools Told to Prepare for Bird Flu" school systems are being advised to prepare contingency plans for extended outages of snow days, especially being able to assign homework over the homework.

 

April 15, 2006: Elisabeth Rosenthal: "Bird Flu Virus May Be Spread By Smuggling" The New York Times, gives a story in which poultry, possibly infected, is smuggled into Milan, IT.

 

April 16, 2006: Ceci Connolly, "U.S. Plan for Flu Pandemic Revealed: Multi-Agency Proposal Awaits Bush's Approval," The Washington Post. The article reports that a normal flu year causes 36000 deaths in the United States; a moderate pandemic could cause 210,000 deaths; a severe pandemic, 1.9 million deaths. There are plans for closing public assemblies and even producing currency. Retired federal employees and military could be called back. Again, there seems to be some evidence that even pandemic strains actually cause many undetected cases with mild symptoms, as that may have happened in 1918. It is possible that young adults, with robust immune systems, may be more susceptible. There are some plans to redirect anti-viral medications to protect entire exposed families. It seems we are still lagging on vaccine development and production if this threat is real.

 

The Washington Post, April 21, 2006, has an editorial: "Planning for Flu: Pandemic preparation plans don't deal with the central question: how will hospitals cope?"

 

NBC "Dateline" presented on April 23, 2006 a dramatization of a sudden (fictitious) outbreak of pandemic flu in New York City when a woman travels back from Vietnam. Here is a review of that broadcast. Again, it is my belief that by posting these updates immediately, I am helping pressure the system to be better prepared to prevent a possible economic and social catastrophe.

 

The CDC wants airlines to maintain detailed manifests so that it could track any index case of H5N1. Airlines sat this would impose staggering costs on them. Leslie Miller, "Airlines Balk at Epidemic Safeguards," AP, Apr. 25, 2006.

 

NBC4 reported on April 28, 2006 that a Gaithersburg MD company IOMAI has developed a patch to put on the site of a flu vaccination to enhance immune response with a diluted dose. This could make a small supply of a future H5N1 vaccine work against several times as many people.

 

The White House issued its official report on pandemic preparations on May 3, 2006. Here is the basic link:

http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html

http://www.whitehouse.gov/homeland/pandemic-influenza.html (the "Official" document)

 

The CNN story that day is "Flu pandemic could be worse than terrorist attack." Perhaps a tautological statement. http://www.cnn.com/2006/HEALTH/conditions/05/03/us.birdflu/index.html

 

ABC showed a television film "Fatal Contact: Bird Flu in America" on Tuesday May 9, 2006 at 8 PM EDT. A pandemic starts with a businessman returning from Hong Kong, and he becomes "the index case." Joey Richardson and Stacey Keach star. My review is at http://www.doaskdotell.com/movies/m911.htm  ABC Nightline followed up with "Bird Flu: Facts and Fiction" late that night. Dr. Anthony Fauci appeared, and discounted the idea that a mutation would manifest so suddenly. Gov. Tim Kaine (D) of Virginia and HHS Secretary Levitt appeared and indicated that quarantines were possible but probably would be sporadic and locally enforced, and you wouldn't see the governor living in a bunker, as in the movie.

 

The CBS show "Numb3rs" had an episode on May 12, 2006 where Chinese girls infected with H5N1 were smuggled into the country for a sex trade, but it does not lead to a pandemic in the show.

 

Even though the rate of increase in human cases slowed in spring 2006, there was a cluster in Indonesia within one 8-member family (six deaths) that was reportedly human-to-human (not all family members had contact with birds). Tamiflu has been sent there. But there does not yet (as of 5/2006) seem to be widespread human-human transmission. If there were, travel from Indonesia might be restricted. The Reuter story by Richard Waddington is on ABC, "WHO probes possible human-to-human bird flu spread," at http://abcnews.go.com/International/wireStory?id=1995111  Test results do not yet show an actual biological mutation of the virus. It is possible that it could have been transmitted from pork. The AP has a story on June 24, 2006, by Margie Mason, "Bird-flu mutation spreads in family," reprinted in The Washington Times. There seems to be additional biological evidence of infection within this family by routine close contact, but it apparently did not move beyond the family. The communicability (a term from the 50s) may have been comparable to that of tuberculosis.

 

Here is a link discussing business continuity plans in light of avian flu (7/11/2006): James Myers "A Global Enterprise, An Individual Risk: The importance of BC planning for pandemic flu"
By James Myers http://www.contingencyplanning.com/archives/2006/jul/1.aspx?ebid=615

 

There is a disturbing report on a Time blog about underreporting of mutations of the H5N1 virus. Go to http://time.blogs.com/global_health/2006/07/mutations.html?cnn=yes

Also, a comment on a Nature report, at "Report: H5N1 mutated rapidly in Indonesian Cluster."

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jul1206mutate.html  There is a comment about one of the transmissions within the family: "a specific mutation found in the boy and his father marked the first laboratory confirmation of human-to-human transmission of the virus." The story reports 32 mutations within the family but in general is ambiguous as to the significance of mutations. It is possible for a viral mutation to "die out" in a family or community, but for another one to "take off" and spread beyond a community. This one did not seem to spread beyond the family. Generally, the more virulent a virus, the harder it is to maintain a long chain of transmission unless it has a long incubation period.

 

A Live Science report of a possible human-human cluster in Indonesia by Anthony Deutsch, AP, here.

 

On July 14, 2006 Tech Republic offers this pandemic readiness broadcast (membership required)    http://whitepapers.techrepublic.com.com/abstract.aspx?docid=236140&promo=106&tag=nl.e106

 

Urgent: Can a partially effective vaccine based on H5N1 proteins and surface geometry markers (both strain groups) be made more quickly, for mass innoculations by next fall? See Business Week, Oct. 25, 2005.

 

An experimental vaccine was given to 451 adults ages 18 to 64, and was only partially effective. CNN, March 29, 2006: http://www.cnn.com/2006/HEALTH/03/29/birdflu.vaccine/index.html

 

Dec. 19, 2006: The University of Maryland is looking for healthy volunteers 18 to 40 to test an experimental avian influenza vaccine, cultured in cells rather than eggs. Source: Washington DC ABC affiliate station WJLA. http://www.wjla.com/news/stories/1206/381107.html

 

Discover, Sept. 2006, has an article by Mary C. Pearl, "Natural Selections: The Potential Pandemic You've Never Heard Of: How the connections between pigs, bats and people could threaten your health," about the Nipah virus, which causes encephalitis and extremely high fevers, and could be spread from bats to people through palm juice (in Malaysia). Another dangerous virus mentioned in the article is Hendra in Australia.

 

In December 2006 there were extensive media reports of an outbreak of Ebola virus among gorillas in African, threatening them with extinction.

 

According to a report by Mary Beth Sheridan, Maryland and D.C. are poorly prepared but Virginia is well prepared for a pandemic flu outbreak. "Maryland, District unprepared for health crises, report says," from Trust for America's Health. The link is http://www.washingtonpost.com/wp-dyn/content/article/2006/12/12/AR2006121200988.html

 

Dec. 13, 2006. David Brown of The Washington Post reported on a CDC story to the effect that quarantine and public health measures during the 1918 Spanish flu epidemic had been more effective that previously thought. Story at http://www.washingtonpost.com/wp-dyn/content/article/2006/12/12/AR2006121201628.html  The current CDC/WHO classification for pandemic avian fly is Phase 3, "No or very limited human-to-human transmission", at http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

My latest blogspot entry Dec 13 is this: http://billonmajorissues.blogspot.com/2006/12/avian-flu-at-phase-3-1918-quarantines.html

 

Feb 1, 2007  The Washington Times contained a byline (p A12) indicating that one woman had died of bird flu in Lagos, Nigeria, and 11 had died in Egypt. Some cases are also reported in Djibouti.

 

On 2/1/2007 The CDC issued new guidelines suggesting restricting gatherings and closing schools for some "categories" of epidemic. Details are here on blogger.

 

On 2/2/2007 Reuters (Luke MacGregor) reported "Britain Has First H5N1 Outbreak in Poultry" here.

 

02/22/2007  H5N1 strain found in Hungary is matched to Asian strains.

 

On 2/26/2007 the FDA reported that the new avian influenze vaccine was only 45% effective, but it is recommending it for approval anyway. Story1: here   followup on approval here.

 

March/April 2007: Michael T. Osterholm of the University of Minnesota has an article "Unprepared for a Pandemic: Sounding the Alarm, Again," in the March/April 2007 of Foreign Affairs. He writes in the last section called "Now or Later" : "It is a particularly complicated problem because preparing for a pandemic challenges the very basis of the global just-in-time economy...In the short term, people around the world must understand that when a pandemic unfolds, their communities will largely be on their own to get through the crisis. .. They should plan now and learn to depend on themselves, their families, their neighbors, and their co-workers."

Here is a blogger entry.

 

April 30, 2007. Media reports about Ebola-like virus killing fish in Great Lakes. Link.

 

May 29, 2007. For the first time in 50 years, the CDC actually quarantines a man, but with unusual XDR tuberculosis, which is antibiotic resistant but only slightly contagious over prolonged exposure. HIV infected people could conceivably "amplify" such an antibiotic resistant strain that sometimes could affect non-HIV-infected people. The story, "US seeks fliers possibly exposed to TB", is on CNN at this link. This form does not appear to be the MAB form seen generally in AIDS patients. Blogger entry: http://billonmajorissues.blogspot.com/2007/05/quarantine-and-tb-patient-has-no.html

 

August 28, 2997:

The CPM Group (Contingency Planning Management Group) reports “Indonesia to Begin H5N1 Vaccination despite WHO Recommendations. The story is here: http://www.contingencyplanning.com/news/14.aspx  (requires registration).

 

September 5, 2007.  There have been two cases of anthrax in Danbury, Connecticut due to imported African drums. The Connecticut AP story is "Drummer, Relative Contact Anthrax; Neighborhood Cordoned Off During Investigation", here.

 

Blogger entry (Aug. 2007) on CDC policy on disease "contagion" (HIV, SARS, TB, H5N1).

 

GlaxoSmithKline has a page on bird flu and vaccine progress here.

 

There has been a small Ebola outbreak in the Congo, and it seems to be under control (10/2007); WJLA story

 

There has been a small resurgence of bird flu deaths in Indonesia (Feb 2008). WJLA story.

 

Contingency Planning & Management has a story 2/21/2008 explaining how the H1N1 flu virus in 1918 suddenly became contagious. The link is here. MIT researchers "showed that the 1918 influenza strain developed two mutations in a surface molecule called hemagglutinin (HA). This, in turn, allowed it to bind tightly to receptors in the human upper respiratory tract."

 

March 4, 2008: A disturbing story about the safety of US clinics (at least one in Las Vegas) with sterility of injections and Hepatitis C / HIV is here on AP, by Erica Werner, "CDC Warns of Safety Problems at Clinics", here.

 

March 16, 2008. A new story about bird flu in Bangladesh appears, and losses for the country's poultry industry, link here in The World and I.

 

March 31m 2008. Virginia Tech has run a simulation of an avian influenza pandemic, Contingency Planning story here.

 

April 2, 2008. A teenage boy who died supposedly of meningococcal meningitis donated his organs, and four people died from an undetected lymphoma in his blood. The actual Non Hodgkins lymphoma was "contagious." This may be the first time cancer has been "contagious" without an intervening virus (like HIV or HPV), although it is possible that a bizarre virus (particularly another retrovirus) could have caused the lymphoma (like the obscure HTLV-I, biologically related to HIV, which causes T-cell lymphoma and AIDS-like syndrome). CNN video story here

 

May 2, 2008.  A deadly enterovirus (intestinal) has spread in eastern China, 3000 cases with 21 deaths. Reuters story here.

 

May 5, 2008.  AP Leslie Tanner has story "Who should MS's let die in a pandemic? Report offers answers." Story here

 

June 5, 2008.  Indonesia has had 109 avian influenza deaths, but the Indonesian government will stop announcing the deaths, according to an AP story by Robin McDowell, here.

 

June 7, 2008.  Bird Flu H5N1 virus was found in chicken waste in Hong Kong and 2700 poultry were destroyed. AP story by Dikky Sinn,  here.

 

Feb. 7, 2009.  The Rocky Mountain News in Denver reports treating a visitor from Uganda for Marburg virus, link here.

 

Feb. 26, 2009  AOL repeats its "shocking clues" of diabetes including eyebrow color, breast size, and even balding legs. Link.

 

March 15, 2009. The Washington Post publishes piece by Philip Alcabes, "5 Myths about Pandemic Panic" here.

 

http://www.scienceagogo.com/news/20060026231144data_trunc_sys.shtml  (successful animal tests)

http://www3.niaid.nih.gov/news/newsreleases/2005/H5N1QandA.htm

http://www.usnews.com/usnews/health/articles/050404/4bird.b.htm 

http://www.hhs.gov/pandemicflu/plan/

 

In 2007 and 2008 NIH has been conducting trials of an H5N1 vaccine and antibody treatment. Blogger link.

 

Look at  http://www.who.int/csr/disease/avian_influenza/en/   or http://www.cdc.gov/flu/about/fluviruses.htm

 

http://travel.state.gov/travel/tips/health/health_1181.html 

 

http://www.osha.gov/dsg/guidance/avian-flu.html

 

 http://www.sciencedaily.com/releases/2005/08/050819085050.htm

 

http://www.worldchanging.com/archives/003253.html 

 

April 28, 2009. Authorities in Mexico impose social distancing to control swine flu; US CDC could consider it. Blogger.

 

©Copyright 2005 by Bill Boushka, subject to fair use.

 

Review of Daniel Kalla, Pandemic

 

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Letter to Jim Moran (D VA) on H5N1 vaccine manufacturers and downstream liability; second letter with reply

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