Bird Flu Disaster Background Material
Some thoughts on surviving a long term disaster. I'm not talking about losing power for 3 days, or suffering the effects of a major earthquake for a week or two, but trying to live for 12 to 18 months during an outbreak of the bird flu.
Up to this point I've pooh-poohed the hype on this flu, since only a handful of people have actually died, and since its not even known yet if it can or will mutate to the point where it can be transmitted from human to human (though recent reports indicate that there may have been at least one case where this occurred). Yet, given the likely severity, all encompassing range, and devasting speed with which the disease would strike, I believe its important to begin thinking and planning about how to keep my family alive.
State & Federal Government Assistance? (From the US Dept of Health & Human Services Strategic Plan for a Flu Pandemic
"If efforts to contain isolated outbreaks within the U.S. were unsuccessful and influenza spread quickly to affect many more communities either simultaneously or in quick succession—the hallmark of a pandemic—response assets at all levels of government and the private sector would be taxed severely. Communities would need to direct all their influenza response assets to their own needs and would have little to spare for the needs of others. Moreover, as the number of affected communities grows, their collective need would spread the response assets of states and the federal government ever thinner. In the extreme, until a vaccine against the pandemic virus would become available in sufficient quantity to have a significant impact on protecting public health [ME - Likely to take 3 to 6 months to produce, and longer to distribute], thousands of communities could be countering influenza simultaneously with little or no assistance from adjacent communities, the state, or the federal government. Preparedness planning for pandemic influenza response must take this prospect into account."
In other words, "Don't expect any help from the government."
Speed and Scope: (from: http://www.breitbart.com/news/2005/12/05/051206001434.cz1ycjxs.html )
"the epidemic will turn into a pandemic in just several weeks, spreading first in Asia before reaching Europe and the American continent 50 days later.
At the end of week six, Americans will see 722,000 pandemic cases in the United States, by week nine -- 37.4 million, by week 12 -- 90.8 million, and by the end of week 16, 92.2 million cases"
From the US Dept of Health & Human Services Strategic Plan for a Flu Pandemic
"The 1957 pandemic, during an era with much less globalization, spread to the U.S. within 4-5 months of its detection in China, and the 1968 pandemic spread to the U.S. from Hong Kong within 2-3 months. As was amply demonstrated by the SARS outbreak, modern travel patterns may significantly reduce the time needed for pandemic influenza viruses to spread globally to a few months or even weeks. "
A word on how long the flu might last: (From http://j.b5z.net/i/u/2148243/i/comingpandemicrevised.pdf)
"A feature of influenza pandemics not well appreciated generally is that they occur in waves.
The 1918 Spanish flu (H1N1) was associated with three waves while the 1958 Asian flu (H2N2) and 1968 Hong Kong flu (H3N2) pandemics have two distinct waves each. The reason for this wave behavior is not known but some have speculated that it is due to a change in the season of the year. The timing of a wave may also be related to a genetic change or mutation in the new strain of influenza virus. In past pandemics, the time between two waves was 3 to 9 months. A point to keep in mind about pandemic waves is that the second wave can be much more severe than the first or third wave of the series. During the 1918 pandemic, the deadly second wave was responsible for > 90% of the deaths for the entire pandemic.
[See this map/movie for an illustration of how fast that second wave spread througout the USA]
While the typical flu season predictably occurs from November through March, during pandemics, flu can vary from this script. The first wave of the 1918 flu occurred in the spring of that year ending in March. That flu was very severe by usual standards but the second wave beginning 6 months later in September was the most fatal. The third wave occurred during the following winter/spring and was the mildest of all. It is of note that pandemics end simply because all or most susceptible persons within the population have contracted the infection and have either died or developed immunity. "
Tamiflu (From: http://j.b5z.net/i/u/2148243/i/comingpandemicrevised.pdf )
"Over the course of the pandemic, predictions are that 25% to 50% of the population will become sick. There is an anti-viral antibiotic tablet, Tamiflu®, oseltamivir, manufactured by Roche Pharmaceuticals that is effective against Avian Influenza H5N1. The World Health Organization has recommended that every country establish a stockpile of enough drugs to treat 20% of its citizens in preparation for a possible Avian Influenza pandemic. Most of the developed nations have begun to do so.
The wholesale cost of Tamiflu is about $25 for a 5-day treatment course (10 tablets), a price that places it out of reach for the less developed nations to establish a Tamiflu stockpile. Manufacturing capacity for Tamiflu is also limited and manufacture of this Roche product takes place almost entirely in Europe. Most of the G8 countries have already placed their orders with Roche and governmental demand has been so great that this product was unavailable for a while in the spring of 2005 but as of June 2005, some Tamiflu has begun to trickle back into the retail chain but supplies remain tight.
Tamiflu works best if it is taken early in the course of the disease symptoms (within the first 48 hours of the illness). It might be useful even if started later but this is not established. I plan to administer it to very sick patients no matter how long they have had symptoms as long as there is hope they can survive.
It is also possible to prevent the flu by taking Tamiflu tablets at or immediately after exposure to the flu. While this strategy works, it requires the continuous use of the one tablet daily until the pandemic is past.
Under conditions of severe shortage of Tamiflu that we are likely to face during a pandemic, using the drug in this way is unwise. The strategy I plan to follow is to wait until flu symptoms are present before beginning Tamiflu treatment.
The recommended does is one tablet twice daily for 5 days. A worrisome US National Institute of Health study published in the July 2005 issue of the Journal of Infectious Disease reported that mice experimentally infected with the H5N1 avian flu strain required 10 days of Tamiflu treatment to prevent relapse and death instead of the currently recommended 5 day course of treatment. If this proves true for the pandemic virus it means that treatment for 10 instead of 5 days with Tamiflu would be needed which is a problem since the current stock of this drug would go only half as far thought initially.
Since half the population who contract influenza have no or only few symptoms of the disease, even if you don’t take Tamiflu in the preventive regimen you still have a 50% chance of not getting sick. By reserving the drug for those who become ill with flu, you will be able to effectively treat a much larger number of patients than if the drug is used in its preventive mode.
One recent development reported in May 2005 is the detection of some strains of H5N1 avian influenza that have crossed over from birds to humans in South East Asia that are developing resistance to Tamiflu.
While this is a disturbing observation, it does not mean that when pandemic flu arrives here it will be totally resistant to Tamiflu treatment. This is unlikely to be the case. It is likely however that some strains of the virus will carry this resistance factor meaning that some patients infected by those strains will not respond as well to Tamiflu treatment as expected. "
Early Warning
Up to this point I've pooh-poohed the hype on this flu, since only a handful of people have actually died, and since its not even known yet if it can or will mutate to the point where it can be transmitted from human to human (though recent reports indicate that there may have been at least one case where this occurred). Yet, given the likely severity, all encompassing range, and devasting speed with which the disease would strike, I believe its important to begin thinking and planning about how to keep my family alive.
State & Federal Government Assistance? (From the US Dept of Health & Human Services Strategic Plan for a Flu Pandemic
"If efforts to contain isolated outbreaks within the U.S. were unsuccessful and influenza spread quickly to affect many more communities either simultaneously or in quick succession—the hallmark of a pandemic—response assets at all levels of government and the private sector would be taxed severely. Communities would need to direct all their influenza response assets to their own needs and would have little to spare for the needs of others. Moreover, as the number of affected communities grows, their collective need would spread the response assets of states and the federal government ever thinner. In the extreme, until a vaccine against the pandemic virus would become available in sufficient quantity to have a significant impact on protecting public health [ME - Likely to take 3 to 6 months to produce, and longer to distribute], thousands of communities could be countering influenza simultaneously with little or no assistance from adjacent communities, the state, or the federal government. Preparedness planning for pandemic influenza response must take this prospect into account."
In other words, "Don't expect any help from the government."
Speed and Scope: (from: http://www.breitbart.com/news/2005/12/05/051206001434.cz1ycjxs.html )
"the epidemic will turn into a pandemic in just several weeks, spreading first in Asia before reaching Europe and the American continent 50 days later.
At the end of week six, Americans will see 722,000 pandemic cases in the United States, by week nine -- 37.4 million, by week 12 -- 90.8 million, and by the end of week 16, 92.2 million cases"
From the US Dept of Health & Human Services Strategic Plan for a Flu Pandemic
"The 1957 pandemic, during an era with much less globalization, spread to the U.S. within 4-5 months of its detection in China, and the 1968 pandemic spread to the U.S. from Hong Kong within 2-3 months. As was amply demonstrated by the SARS outbreak, modern travel patterns may significantly reduce the time needed for pandemic influenza viruses to spread globally to a few months or even weeks. "
A word on how long the flu might last: (From http://j.b5z.net/i/u/2148243/i/comingpandemicrevised.pdf)
"A feature of influenza pandemics not well appreciated generally is that they occur in waves.
The 1918 Spanish flu (H1N1) was associated with three waves while the 1958 Asian flu (H2N2) and 1968 Hong Kong flu (H3N2) pandemics have two distinct waves each. The reason for this wave behavior is not known but some have speculated that it is due to a change in the season of the year. The timing of a wave may also be related to a genetic change or mutation in the new strain of influenza virus. In past pandemics, the time between two waves was 3 to 9 months. A point to keep in mind about pandemic waves is that the second wave can be much more severe than the first or third wave of the series. During the 1918 pandemic, the deadly second wave was responsible for > 90% of the deaths for the entire pandemic.
[See this map/movie for an illustration of how fast that second wave spread througout the USA]
While the typical flu season predictably occurs from November through March, during pandemics, flu can vary from this script. The first wave of the 1918 flu occurred in the spring of that year ending in March. That flu was very severe by usual standards but the second wave beginning 6 months later in September was the most fatal. The third wave occurred during the following winter/spring and was the mildest of all. It is of note that pandemics end simply because all or most susceptible persons within the population have contracted the infection and have either died or developed immunity. "
Tamiflu (From: http://j.b5z.net/i/u/2148243/i/comingpandemicrevised.pdf )
"Over the course of the pandemic, predictions are that 25% to 50% of the population will become sick. There is an anti-viral antibiotic tablet, Tamiflu®, oseltamivir, manufactured by Roche Pharmaceuticals that is effective against Avian Influenza H5N1. The World Health Organization has recommended that every country establish a stockpile of enough drugs to treat 20% of its citizens in preparation for a possible Avian Influenza pandemic. Most of the developed nations have begun to do so.
The wholesale cost of Tamiflu is about $25 for a 5-day treatment course (10 tablets), a price that places it out of reach for the less developed nations to establish a Tamiflu stockpile. Manufacturing capacity for Tamiflu is also limited and manufacture of this Roche product takes place almost entirely in Europe. Most of the G8 countries have already placed their orders with Roche and governmental demand has been so great that this product was unavailable for a while in the spring of 2005 but as of June 2005, some Tamiflu has begun to trickle back into the retail chain but supplies remain tight.
Tamiflu works best if it is taken early in the course of the disease symptoms (within the first 48 hours of the illness). It might be useful even if started later but this is not established. I plan to administer it to very sick patients no matter how long they have had symptoms as long as there is hope they can survive.
It is also possible to prevent the flu by taking Tamiflu tablets at or immediately after exposure to the flu. While this strategy works, it requires the continuous use of the one tablet daily until the pandemic is past.
Under conditions of severe shortage of Tamiflu that we are likely to face during a pandemic, using the drug in this way is unwise. The strategy I plan to follow is to wait until flu symptoms are present before beginning Tamiflu treatment.
The recommended does is one tablet twice daily for 5 days. A worrisome US National Institute of Health study published in the July 2005 issue of the Journal of Infectious Disease reported that mice experimentally infected with the H5N1 avian flu strain required 10 days of Tamiflu treatment to prevent relapse and death instead of the currently recommended 5 day course of treatment. If this proves true for the pandemic virus it means that treatment for 10 instead of 5 days with Tamiflu would be needed which is a problem since the current stock of this drug would go only half as far thought initially.
Since half the population who contract influenza have no or only few symptoms of the disease, even if you don’t take Tamiflu in the preventive regimen you still have a 50% chance of not getting sick. By reserving the drug for those who become ill with flu, you will be able to effectively treat a much larger number of patients than if the drug is used in its preventive mode.
One recent development reported in May 2005 is the detection of some strains of H5N1 avian influenza that have crossed over from birds to humans in South East Asia that are developing resistance to Tamiflu.
While this is a disturbing observation, it does not mean that when pandemic flu arrives here it will be totally resistant to Tamiflu treatment. This is unlikely to be the case. It is likely however that some strains of the virus will carry this resistance factor meaning that some patients infected by those strains will not respond as well to Tamiflu treatment as expected. "
Early Warning
posted by Nas | 10:22 AM
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