Avian Flu

The NY Times grabs the ball on avian flu - a "top health official" has leaked the draft US plan to the Times:

WASHINGTON, Oct. 7 - A plan developed by the Bush administration to deal with any possible outbreak of pandemic flu shows that the United States is woefully unprepared for what could become the worst disaster in the nation's history.

A draft of the final plan, which has been years in the making and is expected to be released later this month, says a large outbreak that began in Asia would be likely, because of modern travel patterns, to reach the United States within "a few months or even weeks."

If such an outbreak occurred, hospitals would become overwhelmed, riots would engulf vaccination clinics, and even power and food would be in short supply, according to the plan, which was obtained by The New York Times.

...

The plan outlines a worst-case scenario in which more than 1.9 million Americans would die and 8.5 million would be hospitalized with costs exceeding $450 billion.

It also calls for a domestic vaccine production capacity of 600 million doses within six months, more than 10 times the present capacity.

On Friday, President Bush invited the leaders of the nation's top six vaccine producers to the White House to cajole them into increasing their domestic vaccine capacity, and the flu plan demonstrates just how monumental a task these companies have before them.

But while the administration's flu plan, officially called the Pandemic Influenza Strategic Plan, closely outlines how the Health and Human Services Department may react during a pandemic, it skirts many essential decisions, like how the military may be deployed.

I have a quibble with the Times reporting here.  My understanding was that the original draft was titled "Pandemic Influenza Strategic Plan - Operational Response".  However, this was rejected by the Undersecretary of Acronyms as excessively candid.

Oh, well.  The Times continues their coverage with more background on the avian flu.  Reassuring bits:

But scientists say that although the threat from the current avian virus is real, it is probably not immediate.

..."We should be worried but not panicked," Dr. Pavia said.

Nonsense - be afraid.  Be very afraid.

And let's say this - after Katrina, the Times checked their archives and found almost nothing about the poverty in New Orleans, or the dire levee situation.  That may happen again with some subject, but they won't be caught short on the avian flu.

MORE: "Pandemics and Pandemic Scares in the 20th Century" from Health and Human Services has short, interesting background.

"Information About Influenza Pandemics" from the CDC has more detail.

And "Preparing for the Next Pandemic" by Michael T. Osterholm in Foreign Affairs is on my reading list.

Michael T. Osterholm is Director of the Center for Infectious Disease Research and Policy, Associate Director of the Department of Homeland Security's National Center for Food Protection and Defense, and Professor at the University of Minnesota's School of Public Health.

 

Comments

[MainCa]

Don't have time to comment. An attack bird attempted to enter my home today, but was stopped by the window and fell to the ground. Gotta go, I need to get to my local vaccination clinic. Wherever that is...

[Cecil Turner]

And "Preparing for the Next Pandemic" by Michael T. Osterholm in Foreign Affairs is on my reading list.

Interesting article but, as in the Times piece, it's short on specific recommendations. His closest approach is this bit:

What should the industrialized world be doing to prepare for the next pandemic? The simple answer: far more. [. . .] what is needed is a detailed operational blueprint for how to get a population through one to three years of a pandemic.

Considering there's no way to tell what, when, where, or how many will be affected, that seems a pretty tall order. If and when bird flu mutates into a human-to-human communicable disease, there will be quarantines and a scramble to create vaccines for the new disease. Any delay in transmission will be helpful as it buys time for researchers, and local responses to travelers will likely become inflexible. Martial law and military quarantine enforcement seem inevitable. (Which has fairly obvious applicablility to the "who's in charge" question.)

I'm not sure what type of detailed planning is needed . . . and didn't come away from these readings much smarter. The vaccine production part is obvious, along with the need to quarantine. Not much else is.

[c]

For those of us who are acronmycally challenged:

PISP-OR

[kim]

What is the most effective way to develop herd immunity and a symbiosis with this denizen of the ecosphere?
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[kim]

Poe's sermon today will be entitled 'Masque du Mort Rouge'.
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[kim]

Mort Volant

better: Vol du Merde.
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[Jon H]

Well, at least the plan didn't consist of 'duct tape and plastic'.

[SteveMG]

Have any of these articles on the epidemiology of the virus mentioned whether there are certain groups or populations more susceptible than others? I've read these linked pieces (and others) and haven't found that.

I'm assuming that the very young, the very old and those with compromised/weakened immune systems are more likely either to contract the virus or succumb to it? And that we won't need to vaccinate the entire population; just those "high risk" groups?

Although I assume as well (double danger) that any mutated virus that is capable of human-to-human spread will require massive vaccination.

SMG

[Tollhouse]

Lots of ancedotal evidence from 1918 claim that the virus kills healthy people out of proportion but I'm not sure, and I admit I haven't read alot on the subject, exactly how that works. 1918 though seems a particularly outlier time in that large masses of young heavily physically stressed males were kept in close quarters to each other. I'm not sure how that relates to the idea that the healthy were particuarly vulnerable. Perhaps, they just were infected out of proportion to the population. Course, lots of scary numbers being thrown around.

[SteveMG]

Tollhouse:
Re the 1918 epidemic and healthy individuals.

Yeah, I saw that too in the Foreign Affairs piece. Healthy 18-40 year olds died during that outbreak.

Seems to me that we need to focus on the more vulnerable populations - if we can identify that group - and that a scattershot approach doesn't make any sense.

Why am I thinking of the old 1980s line that "we're all at risk of contracting AIDs" when in reality only high-risk behavior individuals were at risk (generally speaking).

SMG

[Tollhouse]

I don't think we'll be able to do anything once it starts. It will show up everywhere at once.

I think the majority of us are going to be stuck with face masks and latex gloves. Maybe carry around a bottle of that alcohol based sanitizer. Don't know how effective that is though, the web docs seem to like just soap and water. :/

[SteveMG]

"to be stuck with face masks and latex gloves"

Great, we'll all be wearing burkas or chadors?

You don't think OBL is behind . . . nah.

Checking out the more technical publications (JAMA, New England J of M), it appears that the epidemiologists just don't know whether some populations are more susceptible than others. Not enough scholarship on the topic.

Not an encouraging thought.

SMG

[kim]

Don't know what it does in humans, yet; lack of data. Be grateful for small favors.
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[kim]

It is all a matter of how soon infection with avian flu in humans coincides with some other contagious human virus, such as influenza. Then, basically they have sex together, and the lethality of avian flu combines with the infectivity of influenza y voila...Pandemeconium.
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[Roger Fraley]

I'm a big fan of this site but I think you're being caught up in the fear mongering that's going around. Yea, a pandemic could happen, but it's unlikely. I've written more extensively here: http://rfraley301.blogspot.com/2005/10/avian-flu-fear-mongering.html if you have the time and interest. Keep up the good work.

[Don]

Spend 200 billion on New Orleans - has killed 1,000 and dislocated thousands more and 5 billion on Flu vaccine/treatment.

Or should we spend 200 billion on Flu vaccine/treatment/preparation that could kill 80 million and 5 billion on New Orleans.

Everybody better get their priorities straight or our society could be set back 50-100 hundred years after millions of deaths.
You think you saw suffering in New Orleans, that would be nothing if we had an pandemic here.

[cathyf]

The problem with the fear-mongering is that they tend to take the worst-case individual characteristics of different bugs and combine them into a hypothetical "super bug" which is virtually impossible. One of the reasons that ebola is a failure as a virus is that it kills the host so quickly. HIV and herpes are brilliant successes as viruses because they do minimal damage to their host for long periods of time giving the host lots of opportunity to infect lots of other people. But that also means that while the individual suffering is quite real, as a society it doesn't have such a huge effect. You can imagine a disease as sneaky as HIV but as virulent as ebola, but it doesn't mean that it's all that likely. In order for the bird flu to have human-human transmission, it's going to have to mutate. We really have no idea whether it will still be as virulent after it mutates, or if it will end up being the same level of virulence as the run-of-the-mill influenza. Haven't there been other influenzas which we believe mutated from chicken and pig diseases?

We manage to come up with individual flu vaccines pretty quickly. If the flu becomes more dangerous to more people, then more people will get the vaccine. Which will increase the economies of scale for vaccine production and distribution, which will simultaneously lower the price and fatten the profit margins. That nasal vaccine has not been commercially very successful because it is aimed at the 5-60 yr-old crowd, who are normally not much at risk. If the healthy middle perceives themselves to be at enough risk that they are more willing to get vaccinated, and all the people who hate needles can get the nasel vaccine, then we could see very high vaccination rates, especially in western countries where it's seen as a very cheap insurance. Again, economies of scale mean lower price and fatter profits, but more importantly getting a huge chunk of the healthy population vaccinated each year for flu makes it much harder for pandemics to move around.

The reason that we have flu outbreaks every year is that it's a different disease every year. Everyone who recovers from the flu is immune to that strain for life. You are also partially immune to any strain which is similar to a flu you've had before or been vaccinated against. So the more people infected or vaccinated against more flue strains, the more unlikely that a particular virus can mutate in a way that it could cause a real pandemic, as opposed to a whole lot of folks who are miserable for 7-10 days and then get on with their lives.

kim asks:

What is the most effective way to develop herd immunity ?

Maybe the answer to that is "the NYT starts a media feeding frenzy, and gets hundreds of millions to get vaccinated who otherwise wouldn't have bothered." If so, then all of us naysayers-of-bird-flu-hysteria should just STFU...

cathy :-)

[The Unbeliever]

Waaaaait a second--600 million doses in 6 months? But isn't the population of the United States right around 300 million?

Surely they don't need a 2-for-1 redundancy for spoilage and lost shipments. Who are the other 300 million doses for?

[kim]

Well, Canada, and Mexico for starts.
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[kim]

Vol de Mort. Tu te mocque de nous.
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[kim]

I guess machine gun emplacements at street corners pales in comparison to the coming carnage at a certain newsroom.
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[kim]

The virus of fear of domestic totalitarian takeover has not morphed into epidemic contagiousness.
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[kim]

The number of episodes of co-infections, in humans, of the Avian Flu Virus and the Influenza Virus has been rising arithmetically, but naw may be turning logarithmic. That would shorten the timespan to pandemicity and make it more predictable.

Some silver lining, huh?
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[gary]

The estimated death toll of a bird flu pandemic doesn’t include the deaths that will occur from people starving when society breaks down. The masses are $9,000 in debt and living from paycheck to paycheck.

How do they stock up on a 24 month supply of food? And even if you have a huge stockpile of food, who is naive enough to believe they can keep it safe from the roving gangs of thugs who will be doing armed home invasions once the grocery stores have been emptied. The real death toll will be in the billions, not millions.

So rather than wasting billions of dollars on vaccines that will become useless every time the virus mutates, the governments of the world should unite and invest their resources in developing biological and chemical weapons that will kill all the birds. Simply make all wild birds extinct. Better them than us.

[kim]

Don't keep us in suspense, Mr. Hitchcock.
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