However, three days of food/water wouldn't have helped the New Orleans residents. I
don't feel like 3 days of preparation will help much if/when TSHTF in this bird flu case
either. The govt hasn't been leveling with the American Public, probably 'cause they/we
don't  know how.

Here's an interesting analysis on risk communication that I heard on NPR:
Peter Sandman interview

We and other fed officials need to do better. Give our employees and the American Public
the true info and encourage them to prep for a longer period, 6 weeks, 3 mo, longer?

Let's work on giving no double messages.

Tahoe Terrie

If you read my post I said it was important to be prepared. The state of Calif. has tried to tell the people of the state to be prepared for years. 3 days of food and water, 1st aid kit, medications, flashlight w/ extra batts, radio, etc,etc,etc. The folks of Louisiana that cried out that the help didn't come soon enough, they were not prepared. Some people just don't listen. Then they blame others for problems they helped create. You can lead a horse to water but you can't make him drink.

Remember the run on plastic sheeting and duct tape a few yrs ago, remember the Small Pox vac's all first responders were supposed to get, remember the people standing in line last yr waiting for flu shots for a flu that didn't arrive ??? Lets not dull the senses of those we are trying to protect. Don't cry Wolf.

Good first responders, (even those that don't live out in the sticks), should be ready for the worst. Maybe because I live out in the sticks I understand that the Govt. will not arrive to help us in a timely basis because they are taking care of all the morons in the city that didn't prepare.

Maybe I'm just fed up with folks that sit on their backside and blame others for their own mistakes ? (Mayor Nagan)

Pls don't think I'm mad at you Terrie cuz I'm not. My prediction is, The Bird Flu Pandemic will be a flash in the pan. But as a good F/F I will always have a contingency plan. That's what good F/F's do.

danfromord

Many of us live in cities or WUI surrounded by people that expect to be rescued in an emergency. In my thinking, they could do with preparation. Cities and towns could have pandemic plans to minimize confusion. So preparation...Don't knock it. At the federal level, it's our business even if we're not up to speed yet. At the individual & family level, it's a Darwin issue. Being prepared means no hysteria, means when push comes to shove you could stay at home to avoid contact with sick people that sneeze and cough germs that could kill you & your family.

If city people are not prepared and self-sufficient when this thing hits, they'll be coming to your farming community, Joe's wilderness resort area and my forest --for food ewtc like some of those fleeing hurricanes would of if they could have. Not necessarily bad if we have the resources, but... some unprepared people could bring their hysterical "save me" and "feed me" attitudes with them and bring their sickies to boot. I'd rather we all --and THEY be as ready as they can where they are.

Danfromord, what's wrong with creating a culture of being prepared? Does it go against our tough firefighter, can-do attitude? Too much to think about? Won't do any good anyway? Well, I beg to differ on that last one. Being prepared even a little gives you options. If you don't have to join people shopping at the grocery store, you won't be one of the unprepared spreading the bug to families in your community.

Re hysterical: If chat discussion indicates anything, no one writing in here about bird flu is hysterical-- No one is chicken little. No shortages, no pressure right now. Just preppin', just dealin', then no needs to think about it.

When I finished getting ready with some food/ water/ alternatives to deal with essential things, I thought: OK, I've done what I can, that's all I need to do. I've met my responsibilities. The rest is up to god to sort out. Ka-ching, I could move on. Now I can help my community. Those who are doing similar service, thank you...

For me and my family, it was a simply GREAT carefree Christmas!

Dan, the only reason Mike wrote in about the Baikal duck is he knows there are federal monitoring stations on National Forests, Wildlife Refuges and Parks that are monitoring and he's trying to find the fed contact for the Lompoc area. Mike, I'm also trying to find the contact for you. Many people are home with family this week and out of touch with their station. Thanks for the heads-up... (Please let me know via Ab if the duck moves on or if you get the info you want.)

Here's to a mighty fine NEW Year! Cheers!

Tahoe Terrie

This bird flu didn't threaten a pandemic in the '70s. I'm not certain anyone is exactly worried about the duck having it. Could be Mike is just seeking info. Ab.

Meet the Press, early Christmas morning:

It will be aired again twice later today on MSNBC, at 1900 and 2200 PACIFIC time.
You can view the entire hour here: www.msnbc.msn.com/id/3032608/

They have an important message to GET PREPARED! for all Americans:

Tim Russert, Ted Koppel, and Tom Brokaw briefly discuss the REAL bird flu threat...

Russert begins by playing a brief tape of WHO's Ryan (Nov 20, on Meet the Press) saying that pandemic threat is real. (Transcript follows. I made it from the video tape of the show.)

Russert: Let me talk about an issue that is of grave concern to people but we don't know much about it and that's the avian flu, the potential for pandemic. We had Dr. Michael Ryan of the World Health Organization on Meet the Press. Let's listen to him and come back and talk about how to deal with this.

(Videotape, from Nov 20, 2005):

Dr. Michael Ryan (World Health Organization): The avian flu strain has the potential to become a pandemic strain. It is very worrying that we see this virus transmitting across the species barrier into humans and the virus itself is evolving and we are probably closer to a pandemic at any time in the last 37 years, since the last pandemic of '68. This virus has crossed the species barrier. It has infected humans. It's killing a high proportion of those human beings and we need to prepare for the possibility of a pandemic.

(End videotape)

Russert: Ted Koppel, how do you cover a story like that without alarming people and still do your job as a journalist to prepare people?

Koppel: You can't. You have to alarm people because until people are sufficiently alarmed they're not going to listen to what has to happen. What you don't hear in that sound bite and what is rarely spoken of and what is rarely spoken of especially among politicians is that the kind of vaccine that would be necessary to treat the avian flu does not exist. It cannot exist until the strain of avian flu is developed and can be sampled and can be tested and then and only then can you begin to develop the vaccine. In order to develop sufficient quantities of that vaccine to vaccinate people twice you're going to need so many hundreds of millions of doses that it will take a minimum of 2 to 3 years to get them. In other words, by the time you get them, it'll be too late to treat most of the people who get the flu.

Obviously, that raises questions as what needs to be done, what can be done.

I tried just before I left Nightline to do a broadcast in which we brought some of the best experts on and said "Tell us what we need to know, tell us what we need to do." Among the things we need to do, and it sounds horrific to say it, is to put in a decent supply of food and water and whatever medicine is needed by a family, in each American home, now, before it's too late, so that if and when a flu hits an area like say our area here in Washington, that people especially older people or people with breathing problems, lung problems, people who have heart problems, can afford to stay home for two or three weeks... or longer...

Brokow: Have you done that?

Koppel: No, in truth. Have you?

Brokow: We have. We did it for a couple of reasons. We live in New York and have a house outside New York, and Meredith said this has to be our sanctuary, we have to be prepared in case something happens. And we did put in a small supply of food and water and...

Koppel: Yeah.

Brokaw: ...other things to have around on the ready. The avian flu and pandemic possibilities are a real commentary on the world in which we're living now. The mobility of people to move across places, the crush of population everywhere, how rapidly these things spread, and I think that leads in this country to a kind of unsettled feeling on the part of a lot of people, they have so much access to information now, they don't feel that they have their own sanctuary because it all happens at warp speed, and I think politicians aren't doing a very good job in my impression.

Koppel: But you see, doing what Tom and Meredith have done and what my wife and I have not done, yet, will do, I promise, wouldn't at this stage cause any shortages...

Brokaw: No.

Koppel: it wouldn't cause any panic, I'm not suggesting that people go out and buy instantly a four week supply of food, medicine...

Brokaw: Right.

Koppel: ...food, water. But if you start...

Brokaw: You have to think about it. Yeah.

Koppel: ...over a period of the next 3 months...

Russert: And that's the hard truth, it's probably the only thing you can do.

Brokaw: Yeah.

Koppel: Just... it's the only thing that the individual can do...

Brokaw: Yeah.

Koppel: ...so that at the very least, if the pandemic hits your community, you can stay at home, don't go out.

Brokaw: And having said that, I'm on my way to Southeast Asia. My doctor said to me, "Are you going to go to the countryside?" And I said, "Some." And he said, "Oh, God, you got to be really careful."

www.mercurynews.com/mld/mercurynews/news/breaking_news/13457441.htm

I am writing the newspaper to find out who they have contacted to get the bird
tested for the bird flu...

Mike

That would be good to know. Might check with Mike P on the LP.

During this holiday season, I hope people continue to prepare for being self sufficient for some months as we deal with the  avian flu. We definitely have a killer influenza virus on the move, geographically and across species. It may not be airborne yet, but it is ever more transmissible human to human. The genetics point to the changes, as do the family clusters of infection in Jakarta Indonesia. Scientists around the world are extremely concerned.

Local tests show Indonesian boy died of bird flu

The United Nations urged Jakarta to take steps to halt the spread of the disease.

"We are losing the battle against this particular avian influenza outbreak. It is a very nasty bird flu virus," David Nabarro, the U.N. coordinator for avian influenza, told Indonesian officials at a meeting in Jakarta.

"Act as though a pandemic influenza will start tomorrow. Don't think we can wait around and not worry it won't start for six months or one year," Nabarro said. "Once, it starts it is too late to prepare."

Children would be the most vulnerable group, he said.

Another report (on a business website) based on what the UN spokesman said:

World Is Losing Battle to Combat Bird Flu, UN Says

Outbreaks among birds in Ukraine, Romania and possibly Africa show the deadly H5N1 avian flu strain is spreading, David Nabarro, the UN's avian flu coordinator, told Indonesian government officials and reporters today in Jakarta.

Mellie

Business Forum: What if 30% of your workers call in sick?

Be sure your company is on solid legal ground, just in case.

Business Forum: History teaches what's best in a leader.

Whenever I ask prospective clients "How can I be the most help to you?" the best executives answer: "Help me anticipate future problems."

So I am distressed to pass on a Dec. 2 report from national consulting firm Deloitte- Touche concluding that "American businesses are only beginning to recognize that a flu pandemic would present a danger to their employees, operations and bottom line."

Deeper in the report is the equally distressing news that a basic pandemic risk-management technique -- waiving sick-leave restrictions to encourage work from home -- is either rejected or undecided by more than 73 percent of firms surveyed.

So, I ask you, when an employee reports his or her life-threatening communicable disease, what exactly are you going to tell them?

Why are so many American companies sitting on their hands regarding a possible flu pandemic?

A failure of leadership.

Read the rest of the article. Ask your bosses what's up?

Tahoe Terrie

That's this Ms Townsend:

Press Gaggle After Avian Flu Tabletop Exercise with Homeland Security Advisor
Fran Townsend, Secretary of Health and Human Services Michael Leavitt, and
Secretary of Homeland Security Michael Chertoff
The Stakeout

Do you think she's going to be trying to dial in the Incident Management Teams?

sign me MTWO

From Redlands Daily Facts, 12/12/2005: http://www.redlandsdailyfacts.com/news/ci_3302808

Bird-flu vaccine may be near
BEN BAEDER, Staff Writer

A Cal Poly Pomona instructor and a team of Los Angeles-based researchers say they are close to creating a vaccine against the avian flu, which has caused 70 deaths in Asia and which scientists believe has the potential to cause a worldwide pandemic.

Medical microbiologist Jill Adler-Moore and the team at the small Los Angeles firm Molecular Express Inc., have developed a vaccine that seems to be working in mice and has gained the attention of the national Centers for Disease Control and Prevention, said Dave Dagle, a CDC spokesman.

"They are working on a universal influenza vaccine that has shown promise," Dagle said. "It's in an early stage, but we are interested in partnering with them."

For those who think Avian Flu and preparedness doesn't directly connect to wildland fire discussions.... Please consider...

1) Fire Camps
2) Extended Families and Friends who could lose loved ones
3) Non-traditional responses that increase exposure needlessly
4) Airline travel that increases exposure
5) Lack of general preparedness or knowledge of the risks involved (much like requiring a Professional Wildland Firefighter to become a biological scientist, forester, etc "or the equivalent")
6) General lack of understanding of Dr. James Reason's Swiss Cheese Model
7) and the reliance on letting someone else "take the charge"....."Hey, they are already doing
something about it"... "I don't have to act or participate. I'll be fine just doing it the way I have always done it".

Getting prepared = Hope for the best, prepare for the worst. Facts speak louder than opinions (for most people).

Lobotomy

• One year supply of food for a family
• One year supply for two people
• Other packages
• Many other preparedness supplies

It is just an option for people who are getting supplies together.

Ken

Hotshot's Mom

Good reference on food storage: Prudent Food Storage by Alan Hagan

Here's another useful link: The Internet Grocer
You can purchase 3 month or year supply of food for one or year supply
for a family of 2, 3 or 4. The list of items gave me some ideas on what to
stock up on to have the bare minimum.

Take a look at Mellie's food and supplies list too.

Tahoe Terrie

Finals?? If so, I'm sure you did well. Well rest up, then the ball... Ab.

In preparing and planning for bird flu pandemic and possible infrastructure
disruptions, here are some categories we thought we should consider on
our desert island. Swiss Family Robinson, that's us:

• Food stockpile
• preservation
• preparation
• Nutrition: calories, vitamins, minerals, salt
• Water
• Shelter
• Electricity
• lighting
• heating/air conditioning
• Communications
• Active
• land line
• cell phone
• radio
• internet
• Passive
• radio
• TV
• scanner
• internet
• Clothes for all seasons, especially underwear, sox, shoes, winter coat
• Transportation
• car
• fuel
• bike
• Medical
• maintenance medications
• first-aid/trauma.
• influenza treatment, rehydration
• PPE and sterilization supplies
• N-95, N-100 masks
• goggles
• tyvec gowns
• hair covering
• foot covering
• gloves
• bleach
• alcohol
• Sanitation
• personal hygiene
• human waste
• trash/garbage
• Entertainment
• books
• art & craft supplies
• games
• gardening tools
• seeds
• canning equipment
• Pet food, pet medical supplies, critical immunizations up to date
• Addictions, comfort? coffee, tobacco, hair coloring, game boy while the batteries last?
• Defense

NorCal Tom

National Geographic Channel: Race against the Killer Flu video preview;
show to air tomorrow at 9PM eastern and pacific on the Discovery Channel.

This show comes before the CNN special: Killer Flu, a Breath Away.

Todd

China Hiding Bird Flu Cases: Expert

Mellie, hang in there with the info. We need it. Todd

"As we undertake these efforts, we are asking for your assistance as well. In order to ensure maximum preparedness, business should develop specific plans for the ways that you would protect your employees and maintain operations during a pandemic. Companies that provide critical infrastructure services, such as power and telecommunications, also have a special responsibility to plan for continued operation in a crisis and should plan accordingly. As with any catastrophe, having a contingency plan is essential."

If the federal government wants the public (ie-business) to adequately prepare, they should be the role model. As for me, I haven't seen one "official" memo, policy letter, or even an e-mail addressing agency preparedness or the development of a contingency plan. Maybe the USDA-Forest Service and the USDI agencies feel they don't offer "critical infrastructure"?

Rogue Rivers

For the other Mike... who asked about pandemic plans for public schools. I
just put out the word to try to find something, anything. Are there no DEEP
SURVIVORS advocating for our kids and grandkids? Hopefully someone
besides Canada is planning...

Aaaaarg, I wish all this would just go away and I could think about fire
training and other fun stuff! <reasoning brain like hamster on a treadmill>

Mellie

OK, got one bit of school pandemic plan info for Mike:
The American Embassy in India has a good one.
Hey, it's a small world, just a plane-flight away... Substitute San Francisco or Los Angeles, Portland or Seattle for the Deli trigger point. <little Ballywood smile> <sari caught in treadmill> <crash> <oof> <oh my>

There are 11 sections in all. The whole thing is posted here: www.pandemicflu.gov/plan/statelocalchecklist.html

Planning for pandemic influenza is critical. To assist you in your efforts, the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed the following checklist. It identifies important, specific activities you can do now to prepare. Many are specific to pandemic influenza, but a number also pertain to any public health emergency.

This checklist is based on the HHS Pandemic Influenza Plan, Public Health Guidance for State and Local Partners, but is not intended to set forth mandatory requirements. Each state and local jurisdiction should determine for itself whether it is adequately prepared for disease outbreaks in accordance with its own laws and procedures.

Section 1
Community Preparedness Leadership and Networking [Preparedness Goal 1—Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents, and naturally occurring health threats.]

Completed, In Progress, Not Started

• Establish a Pandemic Preparedness Coordinating Committee that represents all relevant stakeholders in the jurisdiction (including governmental, public health, healthcare, emergency response, agriculture, education, business, communication, community based, and faith-based sectors, as well as private citizens) and that is accountable for articulating strategic priorities and overseeing the development and execution of the jurisdiction's operational pandemic plan.
• Delineate accountability and responsibility, capabilities, and resources for key stakeholders engaged in planning and executing specific components of the operational plan. Assure that the plan includes timelines, deliverables, and performance measures.
• Within every state, clarify which activities will be performed at a state, local, or coordinated level, and indicate what role the state will have in providing guidance and assistance.
• Assure that the operational plan for pandemic influenza response is an integral element of the overall state and local emergency response plan established under Federal Emergency Support Function 8 (ESF8): Health and medical service and compliant with National Incident Management System.
• Address integration of state, local, tribal, territorial, and regional plans across jurisdictional boundaries in the plan.
• Formalize agreements with neighboring jurisdictions and address communication, mutual aid, and other cross-jurisdictional needs.
• Ensure existence of a demographic profile of the community (including special needs populations and language minorities) and ensure that the needs of these populations are addressed in the operation plan.
• Address provision of psychosocial support services for the community, including patients and their families, and those affected by community containment procedures in the plan (see Supplement 11).
• Test the communication operational plan that addresses the needs of targeted public, private sector, governmental, public health, medical, and emergency response audiences; identifies priority channels of communication; delineates the network of communication personnel, including lead spokespersons and persons trained in emergency risk communication; and links to other communication networks (see Supplement 10).
• Identify for all stakeholders the legal authorities responsible for executing the operational plan, especially those authorities responsible for case identification, isolation, quarantine, movement restriction, healthcare services, emergency care, and mutual aid.
• Make clear to all stakeholders the process for requesting, coordinating, and approving requests for resources to state and federal agencies.
• Create an Incident Command System for the pandemic plan based on the National Incident Management System and exercise this system along with other operational elements of the plan.
• Assist in establishing and promoting community-based task forces that support healthcare institutions on a local or regional basis.
• Identify the authority responsible for declaring a public health emergency at the state and local levels and for officially activating the pandemic influenza response plan.
• Identify the state and local law enforcement personnel who will maintain public order and help implement control measures. Determine in advance what will constitute a “law enforcement” emergency and educate law enforcement officials so that they can pre-plan for their families and sustain themselves during the emergency.
• Ensure that the plans are scalable, to the magnitude and severity of the pandemic and available resources. Revise as necessary.

Forest Service Employees as of June 2005 (FedScope):   45,586
30-60 percent infection rate (Osterholm, 2005):        13,676-27,352 sick employees
Worst Case Scenario (50% Death Rate of those infected): 6,838-16,411 deaths
Best Case Scenario (3-6% Death Rate of those infected):   410- 1,641 FS employee deaths

People have tried to raise situational awareness. So far the questions have been falling on deaf ears in Boise and Washington. In my opinion we're set for a major burnover. The FS will face lawsuits for many years afterwards if there is no pandemic business plan. Ab.

RG and Old Dude, I know the Forest Service doesn't have a pandemic business plan. Neither does BLM or NPS. Good question about when the Academy sends people home, RG... (Nerd, thanks for your input on fire department plans. I listened to your link last week. As far as projections, Osterholm has projections here at CIDRAP - pdf file - Ab.)

I do know that 25 of the largest business in the US/world got together last Friday with reps from H&HS to plan for the pandemic. Shearson Lehman preceded them by a week in their planning. I haven't heard what any of them came up with. I do know that business provides 85% of our national infrastructure -- as in food, water, medicine, essential services, fuel, energy, banking/investment, etc. To get through this incident whenever it comes and to rebuild most expeditiously, there must be a plan and contingencies in place for as many businesses as possible. People will continue to need the essentials. How to keep them coming??? What is essential that the FS, BLM, NPS, FWS, BIA does? Those things need to be defined and planned for.

Here's one good PANDEMIC BUSINESS PLAN I have recommended to several local NorCal businesses. Microbix is willing to share it with whomever wants to ask: www.microbix.com/1503.html

I already have most of the family and personal info and the ppe in the powerpoint I presented at FWFSA. However, I was lacking some of the info on this BUSINESS page: www.microbix.com/1503.html

The bottom of this page is also excellent. It brings practiced behaviors right down to earth with practical examples. www.microbix.com/150101.html
You could develop scenarios for at the office. Maybe there would be some logical places your safety officer could provide hand wipes, surface disinfectant, whatever else is needed to mitigate office infection - for as long as you need to physically be in the office.

(Hmmm, along the personal financial lines, I've got to think through which is the safest kind of investment for retirement funds... Most 401Ks let you choose the kind...)

Dan, I am honing the powerpoint I presented and getting permission for the maps from HN so as not to violate copyright. I'll let you know when the powerpoint with handout suggestions is ready to share. Maybe tomorrow or the next day, maybe not.

Thanks to ALL - Abs included - for being the terrific people you are. I'm proud to count you among my friends.

Mellie

I believe that the recent hurricanes proved one thing quite clearly - the US is not even close to dealing with heavy impact emergencies. For years we have done a fine job of mobilizing an army to war, but we are always behind the power curve when it comes to fires, floods, earthquakes, tsunamis, and epidemics. It's not that our emergency services are grossly inept, I believe that it is because our citizens are 95% clueless about how the natural world works and how our society's infrastructure interacts with the natural world around us. Just watch a Southern Californian drive in the snow and it becomes quite apparent that regular interaction with our environment teaches us humans about how to react when the conditions change around us. My first suggestion would be for every community in the US to have an evacuation plan that specifies travel routes, time frames and logistical support mechanisms to support a mass exodus. If a community is next to a large body of water, perhaps a system of barges/boats could be employed to relieve the congestion on the roads.

Aviation contractors need to be pre identified for SAR operations. Mobile hospitals need to be cached along with medical supplies, food and drinking water.

Bottom line- address the emergency before it arrives. Because the earthquake is coming to Southern California, the flood to Salt Lake City, the wildfire to Denver, the Tsunamis to Anchorage and the pandemic to everywhere in between. It's not a question of if but when. All of us know this instinctively. Why does the population as a whole fail to grasp the dynamic nature of life on planet earth? If a city lies below sea level- its going to flood. If a city lies on top of a twisted maze of earthquake faults the earth is going to fracture and shake. If you live in an area where the natural vegetation burns, you are going to have wildfires. If you have no natural resistance to disease, without medical intervention chances are good that you will die. Every community should take responsibility for developing their own comprehensive plans for dealing with disasters.

Ask your community about it's emergency response plans- the answer may surprise you.

Chicken Little's Brother
-Big Vulture

1. Recognize Forestry and Range technicians who specialize in fire as emergency responders and give them an appropriate classification for the hazards they perform. (A GS-5 who picks up trash for a living cannot be compared to a GS-5 who puts themselves and their family at risk each day.) Recognize these jobs as inherently hazardous.
2. Recognize and correct the recruitment and retention problems for wildland firefighters.
3. Require relevant education under the IFPM.
4. Give managers the power to manage for the safety of their programs without being told their mission is agricultural, biology, forestry, or natural resources in nature. Managers are primarily managing people in the fire program, secondarily managing the mission. Emphasis needs to change to safety.

The number one PPE for wildland firefighters is their brain. Any amount of PPE cannot replace the safety provided by someone who is educated, informed, and prepared for the hazards. Recognition Primed Decision-making (RPD) is the best PPE. Without RPD, good information, training, and discussion is the next best thing.

Wildland firefighting has greatly changed over the years. At some point, the focus on keeping people safe has shifted to appointing blame and keeping agency liabilities at a minimum. This shift began the process of appointing blame to an individual or group of individuals while shifting direction away from the real causes. It began when the Swiss Cheese Model (Accident Causation Model) was hijacked by Agencies without understanding what it really says. In short, what it says is that people will always make errors (active failure) and that cultural, agency, and systematic approaches should be in place to minimize these latent failures.

The accident causation model works from the bottom up. The last act in the chain is the active failure (act or omission). The underlying (bottom of the pyramid) failures allow the person or people at the top to make human errors when they don’t have the slides to be prepared for the event.

> From Human Errors, Dr. James Reason

“There is a growing awareness within the human reliability community that attempts to discover these latent failures will have a greater beneficial effect upon safety than will localized efforts to minimize active errors.”

“One of the consequences of the developments outlined above is that complex tightly-coupled and highly defended systems have become increasingly opaque to the people who manage, maintain, and operate them. This opacity has two aspects: not knowing what is happening and not understanding what the system can do.”

As far as Avian Flu, or any non-traditional response, or any type of simple preparedness…. The people who make decisions need to act on the latent problems….. Be leaders, give direction, set policy… inform and prepare the troops for the known hazards, the potential hazards, and the potential consequences. If not, when a pandemic strikes, I am going to give a refusal (and a middle finger).

Remember the hazards of the 9/11 response (silicates, asbestos, PAH, stress, etc) and the unknown hazards of the Cerro Grande fire. How many wildland firefighters were informed of these latent hazards before saying… “Can Do”? How many wildland firefighters have, or will have problems from these duties in the future?

Doctrinal review anyone?

Lobotomy

Thanks Nerd. Ab.

Bird Flu: Personal Preparedness Must Include These 4 Critical Areas
www.sciscoop.com/story/2005/11/14/114213/22

There are four essential areas that you must address to prepare for the bird-flu pandemic:

1. "social distancing" ( Social distancing refers to your living and work situations when the pandemic strikes. Without going to extremes, you want you and your family to be as far away from other people as possible.
2. commodities -- including food, soap, toothpaste, toilet paper, and virtually everything you can buy at stores such as Wal-Mart will be difficult or impossible to obtain -- for periods of weeks or months at a time.
3. personal protective equipment (PPE), and
4. financial preparation. Preparing your finances to sustain yourself and your family during (and after) the pandemic could prove to be the most important area of preparation.

The WHO (World Health Organization) came out with an official statement that the Chinese H5N1 had changed to be more infectious for mammals. This was determined by analyzing the gene sequences.

While China is not officially saying they have human to human transmission, many believe that the virus is much closer to a pandemic strain, or several pandemic strains.

From CIDRAP:
Many H5N1 cases bunched in families, report says
www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/nov2805family.html

What is CIDRAP?
CIDRAP = Center for Infectious Disease Research and Policy
Michael Osterholm is director of CIDRAP. He is also co-director of the Nat Center for Food Preparation and Defense for Dept of Homeland Security. He's an excellent researcher, excellent speaker, world renowned scientist, and a straight shooter regarding our need to prepare for a year to a year anbd a half of food stores. Lately he's simply trying to store food for 3 weeks. CIDRAP and Osterholm are trying to get the US to wake up! Unless people are doing it privately, and some are, we're going to have chaos when this H5N1 virus

Text of the report CIDRAP talks about is on the Center for Disease Control website:
www.cdc.gov/ncidod/EID/vol11no11/05-0646.htm

This also came out last week:

77 Fatalities in Liaoning Province, China?
www.recombinomics.com/News/11190502/H5N1_Liaoning_Deaths_77.html

(look back at the white table from 11/18 to see that's where the greatest number of unreported Chinese deaths -- some human to human -- are supposed to have happened.)

Culling the chickens of Heishan (Liaoning Province)
www.zonaeuropa.com/20051111_3.htm

Look at how bird flu has spread in birds in the last 6 months (squares and circles) and look at the deaths in humans (triangles).
Map: www.recombinomics.com/H5N1_Map_2005_QinghaiL.html

Lou Dobbs on CNN is doing Bird Flu updates.

Mellie

You probably have already seen this but I thought I'd forward this e-mail chain to you just in case. It's a little outdated, maybe 5 weeks. There has been a rapid spread of H5N1 in wild and domestic birds in Europe, Africa, and BC and Manitoba, Canada with fall migration. China has not been forthcoming with info and probably won't be until the Chinese New Year in February. (In the SARS epidemic they fessed up then; they didn't want to disrupt their national cash flow with negative press during that season of celebration and spending.)

Avian Influenza: Department of Homeland Security, 10/05 (1,560 K pdf file)

Folks are starting to get prepared -- some key people are starting to listen and forward preparation e-mails and ask questions about how we will do business in the advent of a global pandemic.

Many of these people forwarding the e-mail are decision makers; hopefully they will act and just not forward e-mails. There needs to be an official USFS, BLM, NPS, BIA, F&WS, etc... direction memo on how we do business, or how we have continuity of operations (if needed) if/when something bad happens. Asking questions and spreading the preparedness info is good; providing a solution or recommended action is better. Decision makers need to step up.

NorCal Tom

We have gotten this pdf file from a growing number of interagency sources. Thanks ALL contributors.

Some of those who have sent the pdf have sent a brief link to stories that city and state first responders have been having emergency preparedness drills, for emergencies like earthquake, terrorism, tsunami and bird flu. Those are a bit out of date now.

Speculation: On the fed side, I think there's a lot of denial (Houston we have a problem) in Boise and in the Washington office. It also could be that NIFC feels  wildland firefighters are not trained in epidemic or pandemic emergency response. I've heard some team members feel they haven't signed up for this kind of duty if it puts their families at risk. It's not clear that there is or will be enough PPE like that needed for the Exotic Newcastle Disease chicken choking assignments. I've wondered myself, what if teams just say no? I also have heard there are a lot of people retiring; the rest are very busy and overworked; many are in the "use it or loose it" mode on time off; some still remain on hurricane relief assignment.

Fact: We plan to stay up and running with the best info available through whatever comes.

Be safe. Ab.

I've been thinking long and hard about this bird flu thing. I'd like to sum up briefly what I've seen so far, and then continue on with my personal conclusions.

I see the situation as this: experts tell us that we are overdue for another influenza pandemic, which will in all likelihood effect the whole world in a matter of months. This pandemic will most likely strike in the fall, and will most likely involve a strain of influenza A, or avian influenza, to which the majority of humanity has no effective immune response. In 1996/1997, a strain of influenza A emerged in Hong Kong which appears to meet the criteria to be a pandemic-inducing candidate virus. Over the last eight years, press coverage of this particular virus has been increasing, as cases have slowly been appearing, in individuals and clusters, over Southeast Asia. Right now, confirmed cases, including cases of human-to-human transmission from outbreak patient to a first generation, have appeared in Thailand, Vietnam, Cambodia, Hong Kong, and China. I'm not sure about Laos. Statistics out of China are almost certainly suspect, given Chinese government policies. The US government appears to be taking the possibility of a pandemic seriously. We were told to watch for human to human transmission; this has occurred. Now we have to wait for transmission to go from clusters to chains. We have not yet seen infection more than one generation beyond the outbreak patient.

I am currently a graduate student, living in a shoebox. I expect to move three times in the next six to nine months. I am not in a position to stock up on food and medication. My influenza preparedness plan is based on staying informed, and hopefully taking myself from where I am now to somewhere where I can realistically protect and isolate myself and my family (about 2,700 miles from my current position) before the wave hits. If that fails, I suppose I will have to count on the fact that as a female of childbearing age with useful skills, society has a collective and biological interest in keeping me alive (fairly grim humor there).

For my small rural fire department, I am suggesting adding a box of 100 masks and a box of ten body bags to every EMS supply order we put out. I'm suggesting adding a case of MREs to every fire order we put out. I'm also taking a hard look at our in-place preplanning, looking for (or adding) things like preplanning for utility failures, temporary morgue facilities, and points of distribution for food supplies, etc. The response I consistently get is "But won't FEMA (or the Red Cross, or Public Health) deal with that?" Maybe, maybe not. It can't hurt to think it through like they won't.

This is a worst-case scenario plan; in all likelihood this will blow over like Y2K did, with appropriate preparation from a variety of angles turning the event into a non-issue. Statistically, we are more likely to see an event like the 1957 or 1968 pandemics than the more serious 1918 pandemic, but we will see a pandemic; maybe not this year, maybe not this virus, but we will.

>From the point of view of the wildland fire community as a whole, the implications of a pandemic are far-reaching. In unconventional response after unconventional response (SARS, the Columbia Shuttle Recovery, various Hurricanes), the wildland fire community has shown itself to be the most flexible and easily deployed federal response pawn on the board. There's been a lot of talk about FEMA; let's bear in mind that FEMA supplies resources and organizes responders; FEMA is emergency management, not emergency response. In one way or another, wildland firefighters will almost certainly be deployed to areas affected by a pandemic, in some capacity. The flip side of that coin is if the federal government institutes restrictions on movement in order to control the spread of disease. I'm not aware of any recent precedent for this, short of declaring martial law, but it could cripple the nation-wide wildland fire response system we've come to expect. Upshot: We may have to simply defend the urban-wildland interface and let the wildlands burn.

Realistically, do I think it will get that bad? No. Do I think it could get that bad? Hell, yeah. I'm not worried about my small rural community. I know there's enough poached elk in those freezers for a good long while, and if the power fails we can just pack everything in snow. I worry about the inner cities, where folks aren't prepared for days- or weeks-long power outages, where they buy dinner on the way home from work and expect the government to come save them if something goes wrong.

With apologies for going so long,

Nerd on the Fireline (or in this case, call me Cassandra)

Expert says bird flu has killed 300 people in China

Of course this bird flu "news" is really almost irrelevant to me unless it encourages you, my friends, to prepare to be self sufficient or to continue preparing...

We, as individuals, can have a positive impact by stocking up on food, water, meds, etc now. If we're prepared, we will not add to the chaos when the supply chain disruptions occur. This can help mitigate the economic and human disruption of all of us.

It's a case of: If you're not part of the problem, you are part of the solution.

Mellie

Happy Thanksgiving Everyone! I'll see some of you in Reno at the FWFSA meeting!

There's going to be a couple of specials on PBS tonight.

9PM pacific time ; rebroadcast at 1AM
Influenza 1918 - As the nation mobilized for war in the spring of 1918, ailing Private Albert Gitchell reported to an army hospital in Kansas. He was diagnosed with influenza, a disease doctors didn't know much about. Before the year was over, America would be ravaged by a flu epidemic that killed 600,000 people -- more than died in all the wars of this century combined -- before disappearing as mysteriously as it began.

2AM pacific time -
Secrets of the Dead - Killer flu - Modern scientists in both the U.K. and U.S. are in a desperate race to determine why the 1918 flu pandemic -- which killed an estimated 100 million -- spread so quickly throughout the world and with such virulence at the tail end of World War I.

The American Experience website: Influenza 1918
Secrets of the Dead website: Killer Flu
Schedule search is HERE.

Mellie

I'm getting ready. Got some rice and beans an angel hair spaghetti noodles and
sauce. The Italians invented noodles so the weevils wouldn't eat them on their
long sea voyages. Weevils were one problem with bread.

Haven't gtten vitamins yet but those same sailors had their teeth fall out due to
scurvy, caused by not enough vit c.

Got a crock pot too.

Tahoe Terrie

For about $57 you can buy:

• 50# pounds of rice (2 - 25# bags) for $12
• 50#  of pinto beans (2 -25# bags) for $18
• bottle of oil for $5
• a bottle of multi-vitamin for $12 (500 ct)
• a bottle of vitamin C for $10 (500 ct 1000 mg; take 1/2 a C a day, 500mg).

Someone wise once said, you only have to start.
Take the first step.
Start by doing what's necessary,
then by doing what's possible,
soon you'll be on your way to achieving the impossible.

You don't have to eat well to survive, you only have to eat what's necessary.
Look at having a food supply as insurance.
It's your fire shelter equivalent.

The smoke is getting thicker. It's beginning to build into a column... LCES

Mellie

City doctors in villages fighting epidemic
By Wu Yong (China Daily)
Updated: 2005-11-18 06:13

HEISHAN, Liaoning Province: Dr Zhao Guanlin has spent the last week fighting bird flu in Qitaizi Village, Heishan County.

He and four colleagues, from the No 1 Hospital in Tieling, Liaoning, have moved to Qitaizi to monitor the health of more than 2,000 villagers.

Heishan is the most seriously bird-flu affected county in the province. Since November 3, 18 of the county's 22 villages have had confirmed cases of the disease. Qitaizi is one of the 18.

According to a statement yesterday from Liaoning's bird-flu command centre, the situation in Heishan and neighbouring areas has been brought under control.

As of yesterday, no new cases had been reported in the county for seven days.

"We are responsible for directing and monitoring the disinfection of possible sources of infection," said Zhao.

His team has been helping farmers sanitize water supplies, chicken coops and living quarters.

Unaffected areas of the province have supplied 1,000 medical workers in 65 teams to Heishan County providing health checks and direct epidemic prevention work.

"We have mobilized all localities and departments at various levels to take part in the battle against bird flu. We will try out best to prevent it from spreading and from being passed to humans," said Dong Degang, deputy director of Liaoning Health Department.

Medical teams have checked around 450,000 villagers living in and around bird-flu hit areas, according to the Liaoning Bird Flu Prevention and Control Office.

All 72,000 villagers in Heishan are receiving check-ups twice a day.

Around 1.32 million villagers' houses have been disinfected and residents have also been given bird-flu education and anti-viral drugs, Zhao said.

Wang Sai, a farmer in his early 30s, raised 1,300 hens in Qitaizi village.

All his birds were culled to prevent the spread of the disease after a neighbouring farmer's chickens became sick.

"I know the virus is dangerous without protection. But I and my family are not worried because of the measures that have been taken to protect us," said Wang.

Zhao Fuhai, chief of the village's health centre, said he had never seen so many medical staff in the village. He said he believes the doctors brought by the epidemic will greatly improve the overall health of the people living there.

"After this, I will keep raising chickens. But I will pay more attention to keeping the henhouse clean," said Wang.

That's a lot of people to be disinfecting and a lot of anti-virals to be administering. Ab.

This Boxun Avian Influenza Report was translated by Peterpan.

Following release of this report, the Chinese government announced 3 deaths from bird flu. I wonder when they'll start reporting more?

Lobotomy, if this Boxun Report is true and there is human to human transmission, China won't be able to keep it secret. By the way, this Chinese version of the H5N1 virus is the same clade that Vietnam reports as having acquired genetic material that makes it more transmissible in humans.

Mellie

Here's the translation: ~~~~~~~~~~~~~~~~~~~~~~~~

CHINA:

Official from Ministry of Health Reveals 2005 Human Case Figures for Avian Influenza Outbreak in China

Since 2004, China has been continually plagued by Avian Influenza outbreaks of varying degrees and unverified reports of infection. In 2005, some of these outbreaks attracted the attention of the outside world. However, these outbreaks are not as straightforward as what is perceived by the world at large. Due to the deployment of the PLA to the epidemic zones, the Chinese Ministry of Health has been able to gain some form of control and organisation over the dissemination of information to the rest of the world. And although they have ostensibly allowed the entry of external health experts into the epidemic zones to conduct their investigations, they will still be bound by arrangements and rules dictated by the Chinese and hence their perception of the situation there would not accurately reflect the actual events that had occurred.

Currently, the Avian Influenza problem in China is very grave. Over the course of the outbreaks, Chinese officials have been briefed on the procedures to follow in order to control the outbreak the the spread of information. The Chinese Central Military Committee has directed that all suspect and confirmed cases of Avian Influenza infections be sent to specialized hospitals. Notifications must be sent to a higher centralized authority. They have also strictly prohibited any Chinese health officials to privately speak to the foreign media. If it is discovered that they have done so, they will be sacked immediately. There must be no mention made of the H5N1 virus in the cause of death of those who have succumbed to the virus. Patients who seek treatment for respiratory problems in non-designated hospitals will not be allowed to claim insurance or medical expenses.

(The statistical model used appears to be almost the same as that used during the previous Shenzhen Ebola outbreak)

The Original Boxun Table with 24 Provinces, ^^ indicates Human to Human transmission:


Translated headings

Although accurate till 12th November, these case figures are constantly changing. Also, since the cases figures have been collated by the Central State Council, they would have reduced it somewhat, and hence, the actual figures may be higher.

Currently, the situation in China is severe. Human to human transmission has occurred and affected personnel have been quarantined for long periods. Death figures are noticeably higher in B-H transmission regions. The situation has been gradually brought under control although it still remains critical.

These figures are thought to be cumulative totals to 12 November 2005, although the use of the present tense would suggest that the situation is on-going. B-H refers to transmission from bird to human, H-H refers to human to human transmission. The number quarantined is believed to refer to current number of people in quarantine. The number disappeared is thought to mean the number of people who have broken the quarantine.

~~~~~~~~~~~~~~~~~~~~~~~~

There have already been reported *limited* cases of human to human transmission of H5N1 in situations where there's an overwhelming lot of virus shed in intimate proximity, as in cases where family members are nursing sick relatives. In the past this transmission of infection hasn't gone much further than from chicken to one human to a second human. It's been a case of human infections in *clusters*, not in *chains* of human to human to human to human. The virus being shed and infecting the small human *cluster* is still essentially a bird flu, requiring the higher body temps afforded by higher bird metabolism for most efficient replication and transmission. However, there only needs to be change of one specific amino acid in the more than 4000 amino acids making up the genes of H5N1 to make it readily transmissible by humans on a pandemic scale -- to make it more transmissible in smaller amounts via coughs, sneezes, exhaled virus riding on water droplets.

Over the past several days Vietnam has reported that the Vietnamese H5N1 (which is also the Chinese strain) has acquired genetic changes that make it more transmissible in mammals. Humans are mammals. They are trying to indicate the threat without creating a panic. The new gene map should be out soon. We should know soon if the virus has gone "aerosol". If and when it does, we should be ready as we can be to keep our families out of harm's way. Doing that means having food on hand.

Mellie

Public Forum on Pandemic Influenza and Avian Flu Monday Nov 21

About this whole avoid panic' paradigm...

SE

"Infected birds shed flu virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated excretions or surfaces that are contaminated with excretions. It is believed that most cases of bird flu infection in humans have resulted from contact with infected poultry or contaminated surfaces. The spread of avian influenza viruses from one ill person to another has been reported very rarely, and transmission has not been observed to continue beyond one person."

> From: www.who.int/csr/disease/avian_influenza/avian_faqs/en/index.html

What is the significance of limited human-to-human transmission?

"Though rare, instances of limited human-to-human transmission of H5N1 and other avian influenza viruses have occurred in association with outbreaks in poultry and should not be a cause for alarm. In no instance has the virus spread beyond a first generation of close contacts or caused illness in the general community. Data from these incidents suggest that transmission requires very close contact with an ill person. Such incidents must be thoroughly investigated but – provided the investigation indicates that transmission from person to person is very limited – such incidents will not change the WHO overall assessment of the pandemic risk. There have been a number of instances of avian influenza infection occurring among close family members. It is often impossible to determine if human-to-human transmission has occurred since the family members are exposed to the same animal and environmental sources as well as to one another."

Lobotomy

R8 FF

Does anyone remember what we were required to wear for PPE when we were
killing chickens?

That's what we're going to need.

Panda Bear

NorCal Tom

What do you think is the chance that the birdflu virus in China will mutate
to human-to-human?

Cindy

I'd also ask how we fight a campaign fire in the middle of a pandemic
living in Fire Camp,etc? Camp crud? Symptoms are the same as
influenza - dry cough,etc.

Todd

NorCal Tom

Excellent links. I like The Osterholm image sequence of viral infection and replication in that first link.

Good thinking on mitigating the cytokine storm... You are a good critical thinker...

• Avoid infection (hunker down, avoid groups of people, use cleanliness techniques, PPE)
• Reduce replication of the virus during infection (take antivirals if the govt offers them to first responders)
• Reduce the bad effects of infection, that is decrease the damage to the lungs due to the cytokine storm

There are many asking the same question as you about ways to minimize the cytokine storm. I did some research on that several weeks ago and came up with a few things. Autoimmune diseases like rheumatoid arthritis are typically characterized by overactive immune response with the body damaging itself. Some treatments for some kinds of cytokine storms are not recommended for this influenza virus, however. You have to look at the kinds of cytokines that are stimulated. There are up-regulating and down-regulating messengers. Normally cytokines are good. The response is really a "cascade" of responses integral to healthy immune function.

Here's what I did and I need to revisit the question:

• As I recall, I ordered turmeric (specifically the kind with 95% curcumin); I've heard it should be taken with piperin (from black pepper) to enhance its activity.
• I also read that statins like lipitor also reduce the cytokine storm. A friend asked his doc, but I haven't read up on that in any detail.
• There was a Russian treatment used in 1918 with good success: Andrographis (Paractin) I have my brother finding out more about that. I don't think it's available in the US.
• Benadryl, or generic

Of course I am not an MD, just a citizen doing my research, planning, and trying to minimize possible bad effects for me and my family, fire family and home family. If I can find the refs, I'll shoot them to you. Ask your doctor about mitigating treatment for cytokine storm.

Mellie

This may be the answer to the H3N0 finding in Vietnam:
Vietnam finds new strains of bird flu viruses

The H5N1 virus is endemic in poultry in several countries in Asia and has killed 64 people, including 42 in Vietnam, since late 2003. Experts fear that H5N1 could mutate into a form that passes easily among people, triggering a pandemic.

"The presence of more subtypes of the flu virus in poultry make the virus all the more dangerous," Ha said, adding that samples had been sent to a World Organization for Animal Health (OIE) laboratory in Australia for further investigation.

State media reports said the new virus strains are H3N4 and H4N5.

Things are getting more complex.

“Although the H5N1 virus cannot move easily between people, experts fear it could mutate into one which can and set off a pandemic in which millions might die. The virus in its current form has killed around half of the people it has infected. Scientists in Hong Kong said H5N1 apparently causes a “storm” of immune system chemicals that overwhelms the patient. The H5N1 virus caused proteins known as cytokines to rush to infected lung tissue — evidence of a so-called cytokine storm, an immune system overreaction that can be fatal. The study, published in the online medical journal Respiratory Research, might suggest that if H5N1 does cause a pandemic, it could disproportionately affect the young and healthy as compared with seasonal flu, which kills many elderly people but few young adults. It also raises questions about how effective drugs will be in controlling such a pandemic, experts said.”

Lobotomy

Welcome ETI. Posing a question is easy, you just did it. No firefighter I know at any level has told people to keep quiet about the coming flu pandemic. In fact the highest med officials are trying to get the word out to get prepared so firefighters have lots of incentive to spread the word. There are ideas on the Bird Flu Watchout page on how to get ready and links to educate yourself. As I understand it, people will need to hunker down for a while and will need food and water and whatever meds they usually take. Dr. Osterholm (Department of Homeland Security) has said when it comes, the illness will come through in waves over a year and a half or two years. There was a good show on the Discover Channel in which he encouraged getting ready, reminded me of clearing a safety zone and having a plan. Ab.

Potential knock-on effects of flu pandemic make planning daunting task

northern firefighter

The US government site on pandemic flu:
www.pandemicflu.gov/

Pandemic Influenza update (pdf file) from the CDC

We all should watch it. Video tape it. Show it to your family so they'll be encouraged to prepare.
Take it to your community leaders so plans can be made. At the very least families should be
stocking up on food. It was stressed over and over that families and communities will be on their
own.

Tahoe Terrie

Readers,

Key to surviving a pandemic is preparation and thinking things through... the worst case scenario...

• Watch the news for the virus changing to Human to Human transmission
• Don't get exposed. Avoid plane travel and large gatherings. Have and use PPE - masks, protective eye gear, gloves, tyvek coveralls, footwear that can be disinfected. Be prepared to "shelter at home" with an adequate food and water supply to ride it out (the whole pandemic may last up to a year and a half or two and infection may run rampant in waves that last 3-6 weeks). Having a supply of food that allows your family to stay at home can prevent their exposure. Gather it ahead of time.
• If exposed and infected, those who can start on antiviral drugs within 24 hrs may recover. This is out of reach for the general population. The US has antiviral drugs (tamiflu, relenza) for < 1% of the population. These antivirals might be extended with the drug probeneced.  If you get sick, going to the hospital for treatment may not help if hospitals do not have antivirals and other medical supplies. (There is no vaccine that is proven or mass produced. We don't have much production capability in this country as yet. Once the pandemic virus is identified, it will take at least 6 months, probably longer to begin to make a vaccine. That vaccine will protect only part of the population.)
• If infected, reducing the cytokine storm might also help. (See my post below to Lobotomy for info on the cytokine storm.) Lots of smart people are trying to figure out how we could do that. There's some discussion at FluTracker.com. (Lobotomy, there's even a discussion of sauerkraut which is high in vitamins B and C.)

Mellie

Firescribe,

The "H3N0 variant in Vietnam" is a puzzle. There is no such known virus. It's not even possible given standard nomenclature. We have N subtypes that vary between N1 and N9: possibilities would be H3N1 to H3N9. The medical "powers that be" are scrambling to find out what Vietnam meant by that designation. The person who died of it had the bird flu symptoms. Has our common influenza (H3N2) somehow become more virulent? Or do they simply not know which N subtype it is? Puzzle...

Researchers and policy setters are now referring to the pandemic as "inevitable", the only unknown is when. My guess is that the inevitable coming pandemic will be a world defining experience. There will be the time "before the pandemic" and the time "after the pandemic". No need to get in a panic, just get motivated to prepare or continue preparing.

Mellie

Just asking questions (interesting article) and Lobotomy (as always, good questions),

As I understand it, more light should be shed on the origins of the 1918 pandemic via an article in the December 2005 issue of Virology. My guess is that Taubenberger and  Osterholm have not read or reviewed that. Until that info is available, it some scientists think the H1N1 virus of 1918 "jumped" from being purely bird to human. Remember that the DNA mapping for this virus was only finished last month. What it implies as to origins is still subject to many alternative explanations. Science will sort that out.

Mellie

H5N1 refer to proteins H5 and N1 on the virus surface that create its surface topography. Scientists often use a simple "lock and key" analogy. Virus surface topography is like the key that "unlocks the lock" on the host cell's surface to gain entry for replicating there. And after viral replication, surface topography "unlocks" the cell to let the replicated viruses out as the cell splits apart (lyses). When human immune systems have experience with a virus either through illness or through vaccination (or through mother's milk), the body recognizes the danger and the human immune system goes to work immediately to mount a defense.

The H component is like the viral key that unlocks the human host cell's surface to let the virus in. H stands for hemagglutinin, with 16 known influenza A subtypes [H1 - H16] that infect humans. (See Nerd's post below.)  Most humans alive today have experience only with H1, H2 and H3. The H component in this virus is H5, which most humans have never encountered before. The body's immune defenses are not up and running against an H5 subtype.

The N component  lets the virus out. N stands for neuraminidase. There are 9 known influenza A subtypes [N1 to N9] that infect humans. N1 was present in the 1918 pandemic virus. (The 1918 virus was H1N1.)

Your questions -- MY ANSWERS:

1. If a family member was exposed to, lets say, the 1918 virus, do those protections pass down to their children as immunities? NO.
2. If someone was exposed to a virus that had a similar H or N as they previously had or built immunities to, would they have partial immunity? THEY'RE PROBABLY BETTER OFF THAN SOMEONE WITH NO EXPOSURE, depending on how different the virus' surface topography is.
3. Even though I am confused and have questions, I know it is best to be prepared as always for any type of national or international disaster. RIGHT ON!

Two things make some of the H5N1 "clades" a devastating virus with high mortality. "Clade" is a term used to signify slightly varying races or strains of the virus. Even within H5N1 there are slightly different versions based on minor variations in the individual building blocks (amino acids).

The following two things will make H5N1 a pandemic killer when the virus changes to transmit human to human:

1. Human species lack of experience this virus: As described above, humans do not have experience with the H5 antigen on the virus' surface. The virus walks right into the unsuspecting human body without being challenged by the human immune system.
2. This virus provokes a cytokine storm that kills even healthy people: One of the H5N1 surface proteins (a key) looks like one of the signaling proteins that "turns on" the human body's immune system. Basically it hijacks the healthiest immune system and turns the body's own immune system against itself. This happened in 1918 pandemic and killed a lot of healthy young adults: 50% of people who died were 18-42 years old. Their bodies were overwhelmed by a "storm" of inflammatory immune system chemicals called cytokines. (Cytokines induced by H5N1 include interferon beta, interleukin-6, IP-10, and RANTES  Source). The patients' lungs and other organs failed, sometimes within 48 hours.

Please keep stocking up on food (and water), my friends.

Mellie

"As for that viral holocaust, the most able medical men of the time admitted that all their efforts had probably not limited the epidemic by an hour. One doctor called it the medical catastrophe of all time. Why it began, why it ended, where it went, no one knows to this day. Like a malign comet, the Spanish-influenza epidemic of 1918 sped over the earth, took 21 million lives, and vanished."

From: www.americanheritage.com/articles/web/20051012-flu-influenza-1918-epidemic.shtml

Did it lay dormant until the next replication, recombination, reassortment, or is it a new strain? In any case, it would prove a good idea to be prepared.

Sign me,
Just asking questions

1. If a family member was exposed to, lets say, the 1918 virus, do those protections pass down to their children as immunities?
2. If someone was exposed to a virus that had a similar H or N as they previously had or built immunities to, would they have partial immunity? and
3. Even though I am confused and have questions, I know it is best to be prepared as always for any type of national or international disaster.

Preparation is the key to survival when things go gunny sack. Dr. James Reason is author of "Human Error" and the person who first developed and presented the Swiss Cheese Model. In his book, he talks heavily about preparation and the need to have cultural and organizational barriers in place to prevent the things that cause people to die or be injured. His emphasis was upon the latent areas of failure that allowed individuals or organizations to make human errors. His version of the causation model seems to start at the pre-existing conditions, not at the unsafe act that so many people in the wildland fire community keep dwelling on. His book is a "must read" before anyone starts trying to understand the reasons why "bad things happen to good people".

The pre-existing factors are out there.... the only human errors at this point are people who are not preparing and educating themselves on the hazards of various flu types and the hazards they present to our families, friends, and the wildland firefighting community.

This is a real threat. It is something to be prepared for.

Lobotomy

Today: Pigs in China have tested positive for bird flu (H5N1):
Pigs in China's Hunan Province Test Positive for Bird Flu

There was also report of a death yesterday from H3N0 variant in VietNam.
First Vietnamese dies of bird flu virus H3N0

Influenza affects pigs, birds in China, kills man in Vietnam

Lo Wing-lok, an infectious disease expert in Hong Kong, said it is "not unexpected" that the pigs in Hunan could be infected with bird flu virus.

"Farmers do not separate their pigs from poultry in Hunan, making it possible for a chicken disease to infect pigs," Lo said. "In fact, pigs in Indonesia had been reported having contracted bird flu virus in 2004, where farmers placed the chicken cages on top of where they bred the pigs and fed the pigs with chicken droppings."

Since pigs can carry flu virus from different species, the virus could cross-mutate and allow bird flu to gain the ability to infect human, according to scientists.

"More species of bird flu virus found in pigs means higher chance for virus mutation and for humans to be infected," Lo said.

Lobotomy, you asked "Who is  Michael Osterholm?" ==> good guy, pulls no punches. Trying to get people to get prepared without causing a panic.

Ken, Lobotomy others, I've been really busy. Please continue to prep for being self-sufficient for at least 3 months, you should plan to have enough food, meds, etc. --Whatever you can do in a gradual fashion and sock it away. (Prep for a year would be even better. We live in an "on demand" world until the pipeline breaks down, then we have 2 maybe 3 days of goods available.)

Lobotomy, OK, here's one answer to one of your last ones. I believe the killer1918 virus did not jump directly to humans.

Evidence is beginning to suggest the 1918 flu virus began as a human or a pig flu virus had a recombination event between a human and a pig virus to evolve into the killer virus. As I understand it, the scientific details should be published in the December issue of Virology. Since the genome on the 1918 influenza virus has been mapped (more than 4000 genes on all the strands of DNA), it is possible to hypothesize with fairly good certainty what parts of genes came from which hosts and how they recombined, like analyzing evidence in a forensic study.

Here's a very short lesson on viral replication and evolution.

There are three ways a virus can evolve. Two of them require dual infections, in which one host is infected by two different viruses (some examples: bird and human; or human and pig; or bird and bird). The third does not require dual infections.

Let's say a host is co-infected by two different viruses, like a human being is infected with a bird virus (H5N1) and a human virus (H3N2) simultaneously. This is happening in China, Thailand and Indonesia and elsewhere today.

In this example, in the virus replication stage, both viruses, say one pink and one white, have hijacked the human host's cells for replication. This is what viruses do: they turn cells of more complex organisms into their reproduction factory. OK so at this stage, the interior of the hijacked human cell is like a soup with pink and white strands of virus genes replicating and floating around. I visualize virus genes as long strands of pearls. (Each influenza virus has 8 separate strands of DNA - 8 individual genes - or, visualizing them, 8 strands of pearls floating around using the energy of the human cell to make more.)

1. Reassortment of genes results when the new virus takes some whole genes (strands of pearls) from one parent influenza virus and some from the other. In reassortment when the viruses have finished replicating, they have swapped one or more whole genes (of their 8 pink strands of pearls) with the other kind of virus (that had 8 white strands of pearls) to create a new virus (with, say, 7 pink and 1 white strands of pearls). Some of these swaps are not adaptive for the virus and those viruses die off. However, some changes theoretically can be helpful to the virus. The new virus is more transmissible in a human host, leading to human to human transmission.
   
   Here's a simple flash program showing replication: www.guardian.co.uk/flash/0,5860,1131346,00.html
   Note on the maps at the end: The bird virus has spread across Europe, N Africa and Russia in the last month to six weeks and that's not represented on the last map.
2. Recombination of genes is different than reassortment, although it also requires dual infection of one host by by two viruses. Recombination results when the new virus takes some part of at least one of the genes (part of the pearls on one of the 8 strands of pearls) from one parent and the rest of the strand from the other. Imagine strands from each parent, say one pink strand and one white strand twining with each other in the host cell "soup". When recombination is complete, there's a new gene (technically called a chimera) that has sequences of pink, white, pink "pearls". The one it was twined with now has white, pink, white "pearls". They've traded DNA within strands of "pearls" to create a new virus as in the flash program above. (For those who understand this stuff, I'm talking about "homologous recombination", not non-homologous.) I think evidence will be out in December that implicates this as the mechanism that occurred in 1917-18 -- with great implications for evolution of the current avian flu virus.
3. The third kind of change is a point mutation: this does not require co-infection of a host organism. One virus type infects the host. In the process of replicating, there's a mutation is of one "pearl" on one strand of the 8 genes. A series of these kinds of changes can theoretically lead to a "drift" in the genetic makeup over eons toward a virus that may be more transmissible human to human (h2h). This kind of change may be less important in this rapidly-evolving bird-flu pandemic threat of today.

The reason the H5N1 virus seems destined for pandemic is that the range of the virus is expanding in wild birds around the world. Check the  Bird flu outbreaks in BIRDS (turquoise is November) and Bird Migration Flyways. The virus is also infecting mammals in Asia who get it from birds, including pigs and humans that can be co-infected to permit a recombinant "breeding ground". Each time new locations or new species are involved, there's new territory with new hosts where the viral  changes described above can occur. Time is on the virus's side.

Readers,

Please continue increasing your families' self-sufficiency. If any family members require medications as part of their daily intake, consider getting a multiple-month to a year's supply. If borders are closed during a pandemic, most meds will not be available nor will masks to protect against infection, syringes, IV bags, needles.

Lobotomy, regarding a flu shot:

Should you try to get the flu shot? It's a killed virus vaccine for several strains (or clades) of the H3 virus. Yes, in that it would allow you to rule out the regular flu if you get sick this winter. But flu shots are hard to come by unless you're over 65 (and if you are that old I would also recommend getting the Pneumonia vaccine as well, as that can be a secondary infection that kills in older people who survive the flu).

Here's an alternative to the flu shot: I've encouraged my sons who are in the "cytokine storm" risk age group to take be inoculated with Flu Mist, another vaccine made with an attenuated (weakened) live virus. No shot, it's puffed into each nostril. It includes the N part (N1) of the regular old flu virus which the flu shot does not. You may get minor flu symptoms from it as your body builds antibodies; most people I know who have done it, including my sons, got no symptoms. It's easier to find opportunities to do this vaccine as it's restricted to healthy people between 5 and 49 years old. Some pharmacies require a doc's Rx, some do not. To locate a place near you, use this Flu Mist Finder.

(Lobotomy, you also asked about partial immunity; the only significant partial immunity would come if you'd taken part in the SoCal limited clinical trials of the H5N1 vaccine collected from VietNam last year.)

I should talk about the cytokine storm at some point -- because in the 1918 pandemic 50% of those who died were 18 to 42 years old, just the age of our strongest, healthiest firefighters. Scary thought...

OK, I have to go get some other kind of work done... outside... I got sucked in... <chuckle>

Be safe All.

Mellie

Scientists Fear Possible Flu Pandemic: www.washingtonpost.com
The Washington Post interviews Dr. Michael Osterholm, Director, Center for Infectious Disease Research and Policy (CIDRAP). Straight-shooting scientist. The following is from the interview:

"Pandemic influenza will occur again in the future. Whether it's H5N1 or some other influenza virus that emerges, whether it happens tonight, next year or ten or fifteen years from now is all unknown. However, any preparedness activities that we embark upon today will never be wasted because we will use them someday. What I fear is that we will find ourselves much like the man who will attend his 25th annual class reunion tomorrow and decides that he must lose 55 lbs. The best he can do is get a suit that fits, shine his shoes, get a haircut and have a smile. The potential for pandemic influenza to be a catastrophic event in our human history is just too great of a risk for us to wait until the night before to get prepared. While this may all sounds scary to those reading this, our job in public health today is not to scare you out of your wits, but to scare you into your wits. We need you to let your federal, state, and local leaders, including those both elected and in the private sector, know that planning at the international, national and local level must be one of our highest priorities."

Nerd on the Fireline

Lobotomy, I'll post later when I have a chance.

Mellie

Cindy

An influenza virus is an RNA virus, which means that it's basically a cluster of proteins which hijacks your cells' own reproductive system to reproduce more virus. They're comparatively simple, with a high mutation rate. At the 'head' of the virus is a cluster of functional proteins which affect how the virus gets into the cells and what it does once it gets inside. There are two kind of these proteins, the hemagglutinin subtype and the neuraminidase subtype (I have probably misspelled both words). There are fifteen possible hemagglutinin subtypes, and nine possible neuraminidase subtypes, making for 135 different types of flu. Not all of these, obviously, affect humans, or even occur, but that's the number of possible combinations. Your body's immune system is 'triggered' by how it perceives these proteins, but you have to have immunities to both to have a protective immune response. For example, to have an immune response to H5N1, you have to have a functional immunity to H5 and to N1. If you only have an immunity to N1 and H3, you're not immune, and likewise if you have immunity to H5 and N2.

Now, apparently the highly pathogenic (very bad) strains with respect to poultry are the H5 and H7 strains, and there is some evidence to suggest that the same would be true in humans. The Spanish Flu was an H1N1 flu.

While we're on the subject, there's all this news coming out about "Avian Flu in Canada, Romania, where ever!" It's important to understand that Influenza type A, Avian flu, is endemic to wild bird populations, particularly ducks, and sometimes 30-40% of the duck population can have it. It's not a big deal. The big deal is that the flu virus gets into your cells by attaching to a particular sugar, sialic acid, on the surface of the cells. In ducks, this sugar is the alpha 2,3 variety. In humans, it's the alpha 2,6 variety. So avian flu doesn't generally function very well in humans. Pigs have both alpha 2,3 and alpha 2,6 sialic acid on their cells, so potentially pigs could get avian flu directly, the flu could mutate to deal with the alpha 2,6 sugar in pigs, and then infect humans more readily. Either that or I mentioned that the thing mutates very easily, well, it could just figure out how to deal with alpha 2,6 sialic acid through random mutation.

So, how 'bout tham Yankees?
Nerd on the Fireline

"The rationale for publishing the results and making them widely available to the scientific community is to encourage additional research at a time when we desperately need to engage the scientific community and accelerate our ability to prevent pandemic influenza. It would be impossible and counterproductive to attempt to enforce a worldwide ban on conducting research on the 1918 influenza virus or similar viruses because of fear of the misuse of such knowledge. Likewise, the dissemination of information emanating from this research should not be suppressed; rather, we must foster a culture of responsibility among the scientific community such that research is conducted under the safest possible conditions and research results are presented openly and responsibly for the purpose of improving human health."

GreenLawn

"The rationale for publishing the results and making them widely available to the scientific community is to encourage additional research at a time when we desperately need to engage the scientific community and accelerate our ability to prevent pandemic influenza. It would be impossible and counterproductive to attempt to enforce a worldwide ban on conducting research on the 1918 influenza virus or similar viruses because of fear of the misuse of such knowledge. Likewise, the dissemination of information emanating from this research should not be suppressed; rather, we must foster a culture of responsibility among the scientific community such that research is conducted under the safest possible conditions and research results are presented openly and responsibly for the purpose of improving human health."

GreenLawn

from UC Davis

Here are some other mask options in addition to the N95s that are standard wear:

Masks as a fashion statement

Worried, and looking for some humor as I make my food list.
KL

Nerd on the Fireline

Tamiflu requires a prescription from your doctor because it's not just an over-the-counter drug. The doc looks at whether you have any medical conditions that would put you at risk if you take it. I think liver function is one of the things docs check, but I can look further if you'd like for me to. Just handing tamiflu around isn't a good idea.

Dose: When clinical trials are done to get FDA approval for a drug, they look at optimal dose. That's what's put on the dose recommendations on the bottle or blister pack of the drug. You don't want to take too much or too little. You want just right. In the case of tamiflu, some caregivers in Asia who were taking it ahead of being infected (taking it as a prophylaxis) took 1/2 the dose. One girl who was nursing her brother got the flu anyway. At that point the docs upped her dose and she finally recovered. OK so the message there is to follow the directions on dosage of any drug.

When push comes to shove there will not be enough tamiflu for more than about 1% of people in this country. Others have had the same question you do. Here's some of the thinking I've heard. Tamiflu goes through the human system pretty fast. You take it, it's absorbed into the blood, your kidneys flush it out in your pee. One thing that could extend the good effects of tamiflu is a drug that reduces its excretion. Probeneced does that. It's been used for years for gout and other conditions. It's cheap, available and has very few side effects or drug interactions. There was an article in Nature... Dr Joe Howton (Med Director at Adventist Medical Center in Portland OR) came up with the idea of stretching tamiflu stores that way. Let me see if I can find anything online when I google that... OK, I didn't realize Nature is online. Here's the ref: www.nature.com/news/2005/051031/full/438006a.html

I hope that the powers that be use this drug to spread the precious little tamiflu around to our first responders.

Cindy, hope that answers your question. Talk to your doc; take the article with you. I'd have the conversation now. Don't put off until tomorrow what you can do today.

Mellie

I heard tamiflu the antiviral can help reduce symptoms if you get the bird flu.

I know it's not available in this country now. They may give it to first
responders if the pandemic hits us.

One of my brothers got some in europe on his way back from asia before all
the hype hit this country. My other brother is a firefighter. What I'm
wondering is if there's some way a person can take less and spread it around
to protect more of us?

Cindy

I have family members coming home from abroad. They're not taking any chances.
There won't be much warning when this virus goes person to person. We're as close
as a plane flight away.

http://news.yahoo.com/s/afp/20051030/ts_afp/healthflueconomybusiness_051030054656

KC

At some time in the coming pandemic borders will close, the Prez says quarantines may be imposed, schools will be closed and families will be encouraged to shelter at home. Grocery stores have only enough food for a very limited amount of time. I've heard only 3 days. We live in an outsourced and pipleline delivery reality.

Here's a Food and Necessities Supply List created by some friends who are brainstorming solutions and planning to have supplies for a year. I reviewed it and have added on. This list offers suggestions for what you could begin gathering to have on hand for your family at the point when grocery stores are not an option. If you buy in bulk (and on sale), package into manageable sizes, and write a date your food, you can eat off the front and add to the back. By cycling through your stores, there will be no waste with food going out of date. Given that we don't know how soon the H5N2 virus will go pandemic, this is a prudent approach. (Most medical folks I've talked with think this year or next year.)

Have a meeting with the adults and possibly the teenagers in your family to make your family food plan. Consider this list is a starting place. Undoubtedly your family will adapt it to your needs and preferences. You'll want to include items, ingredients and foods that your family like and eats. That's how this list began... people got some guidelines on caloric needs, food group needs, amounts needed, collected ideas on the internet from CDC and Homeland Security and other websites and just started. They live in a more rural town and the list posted here reflects that, too.

Also think about having a supply of Rx meds. Everything in medicine comes from abroad at some stage.

Just do it. The first step. Once you begin, it gets easier.

Control the things you can control. Mitigate the things you can't.

Mellie

NorCal Tom

Tahoe Terrie

Please buy the NIOSH approved N95 "respirators" or masks (or more highly rated N100 masks) for yourself and your loved ones. Here's the CDC list of NIOSH approved N95 masks. Here are photos of what they look like. (Do you have the item number for the particular type of mask that your local first responders will be using? I'm data gathering on this question...)

The masks some of my family and friends have gotten are the "3M 9211 Disposable Particulate Respirator". It is a slightly more expensive version, but will fit everyone in the family. (I would avoid the the Nanomask at this time, simply because it is not yet approved by NIOSH.)

The N100 is more protective than the N95 in that it has a filter efficiency of 99% or greater against airborne particles -- instead of a 95% efficiency. (I believe it filters smaller particles but I don't know how small.) It's also more expensive.

As I understand it, the N95 is rated for particle size down to 30 microns. The H5N1 virus may be somewhat smaller than 30 microns, but when coughed or sneezed out, adheres to larger droplets. I am not a physician or mask researcher, but I believe that for those wearing it, the N95 is likely to be at least somewhat effective in reducing the incidence of disease in comparison with those not wearing it. During the SARS outbreak which was spread by a Corona virus, for example, the N95 masks were worn by nurses in China and Canada and they provided increased protection.

Regarding other websites to gather more info about avian flu and  pandemic preparation:

There are several websites that have scientific contributors from around the world for more bird flu and preparation information to read right now over the weekend. I'm listing three of them below. If you start to get overwhelmed with info, take a deep breath, jot down your questions, email them to Ab with "Flu Watchout" in the subject line and I'll try to reply. Getting a handle on what to do to best prepare for this is do-able. The key is to not let your emotional brain hijack your reasoning brain for any longer than is absolutely necessary. Set the goal of educating yourself, step by step. No panic, no denial, just steps to get ready. Do something every day.

Current Events dot com:

• The Prep thread has a number of threads relating to what we'll need to help our families survive a possible pandemic. Preparations for living under quarantine are found there as well.
• The on Flutrackers.com is excellent for keeping up with breaking news. People copy and paste the articles from around the world. Translators help. Good critical thinkers, researchers, and/or many involved in the medical professions. (As with any open forum, some are not knowledgeable. You'll be able to tell who is and who isn't.) There are also professional contributors from around the world that provide links to their local news in their own language as well as offering eyes and ears to what they see happening on the ground. Direct info from citizen-reporters in China, Indonesia, Thailand, etc allows all of us to see discrepancies between what seems to really be happening there based on local reports and how these might differ from the country's "party line".

Fluwiki dot com is another excellent resource with contributors from around the world.

• It has good science FAQ on the flu, the bird flu, what to expect, etc.
• Also has a Pandemic Preparedness thread.

Info from WHO (World Health Organization)
WHO checklist (pdf file) for influenza pandemic preparedness planning (also, the checklist  In Spanish pdf)

Mellie

LOOKOUTS:
That's what we're doing for each other and our families.

COMMUNICATIONS:
Tips for how to read between the lines and prioritize the importance and significance of media reports:

There are several things that I (and others) watch for as we evaluate the spread of bird flu (the virus H5N1).

• The spreading avian flu epizootic (animal "pandemic") in wild birds. Large bird die-offs along major flyways suggest where the disease might be going next. Confirmed bird die-offs due to H5N1 in some countries but not adjacent countries show which countries are not reporting spread of the disease.
• The widening infection of domesticated chickens and ducks, pigs and other mammals that have contact with humans and also provide their own "mixing vessel" environment for the evolving virus.
• The infection of humans from birds. This is called bird-to-human transmission and can be abbreviated  B2H.
• Other species of mammals have also gotten H5N1, probably from birds. Lions and tigers have died by the hundreds in Thailand and India, probably as a result of eating bird carcasses.
• The infection of humans by other humans, initially from those who may have gotten the flu from birds. This human-to-human infection can be abbreviated H2H. Timing of exposure from whom, symptom development, etc, gives another clue to whether disease transmission is H2H.
  • Human-to-human transmission may first be expected to show up in family *clusters*. It may be unclear if it truly was H2H transmission or simply that they ate the same food, ran around in the same barnyard.
  • Much more worrisome is if H2H transmission shows up in *chains* of infection within communities and spreading outward. This would indicate the beginning of the real pandemic spread of the disease.
• The area of the world the reports come from.
  • Some countries have the resources to test and report fairly accurately. They are motivated to share information and try to contain outbreaks. Others are poor.
  • Some countries have social, political or economic reasons to not share accurate information. They do not have "transparency". They may feel a need to save face. They may not want to be known for asking for help. Who wants to be known for starting a pandemic? They may want to protect their growing tourist trade or their developing export business. They may want to host the Olympics in 2008. They may want to control the masses of their citizens so they don't panic. Alternatively, deaths within the ranks of their "huddled masses" may not draw attention or resources and it's only when disease starts to affect the rich that attention is drawn.
  • One way to get at finding out what's happening in countries that have some sort of reporting problem is to compare news reports from local areas within the country with news reports to the world. The internet can make us a very small world. There are those within countries who are willing to translate.
• Avian influenza can share symptoms with other killer diseases in third world countries. For example: Japanese encephalitis and Dengue fever. Thus, an outbreak of some other disease with high mortality could mask the rise of human to human transmission of the H5N1 virus.

One troubling report that came out today following report of a very large outbreak of H5N1 in Jakarta Indonesia yesterday is the following: Indonesia, puzzled over bird flu cases, investigates cats as spreaders

Of course, alternatively, this may be the first appearance of the *chain* of H2H infection...

ESCAPE ROUTES: Our escape routes may take us to our homes. How do we go out in the world and not bring disease back to our families? More on that much later.

SAFETY ZONE:
I'll post more tomorrow on the practical first step to getting ready and being ready -- having a food supply for your family to fall back on...

Thanks to those who called and sent personal emails. If people have questions, send 'em in and I'll reply or research and reply.

Mellie

Avian Flu / Pandemic Influenza
Key Messages

No one really knows when or if the avian flu will become a pandemic.
• Pandemic diseases have occurred periodically throughout human history.
• We can study the past for lessons learned on how to prevent or respond to a pandemic.
• We have the advantage of being able to plan for a possible avian flu pandemic.

In the years since past pandemics, public health officials have greatly improved our ability to detect and control infectious diseases.
• We have become more vigilant in our surveillance.
• We will recognize a new strain more quickly when it emerges.
• We will be able to take precautions to reduce the impact of a new influenza virus strain.

Public health officials worldwide have been preparing for a pandemic flu for several years.
• LPHAs will utilize many of the same responses they use on a daily basis to control the spread of disease.
• The focus on planning for bioterrorism attacks has strengthened LPHAs’ response plans for all public health emergencies.
• LPHAs’ local plans will be strengthened with guidance and support from state and federal levels.

No one knows for sure how serious or deadly a worldwide avian flu outbreak would be.
• Scientists and government believe it could pose a serious threat to public health.
• Some estimates place the number of deaths as high as 360 million people.
• Avian flu should be taken seriously and planned for.

The general public can take steps today to prepare themselves and their families for an avian flu pandemic.
• Become more diligent about good hygiene.
o Hand washing
o Respiratory etiquette
o Avoid touching your face
• Improve your overall health.
o Quit smoking
o Improve eating habits
o Exercise more
o Get immunizations
• Listen for information.

The CDC has a robust system for national influenza surveillance.
• Collaborating laboratories of the World Health Organization (WHO) and the National Respiratory and Enteric Virus Surveillance System (NREVSS) report the number, types, and subtypes of influenza viruses detected.
• Approximately 2,250 sentinel health-care providers report patient visits for influenza-like illness (ILI), and approximately 500 of these providers continue regular reporting throughout the summer. (Missouri DHSS has approximately 30 sentinel sites.)
• 122 U.S. cities report weekly mortality attributed to influenza and pneumonia.
• A national surveillance system records pediatric deaths associated with laboratory-confirmed influenza.

Health experts expect the next pandemic to be caused by a new subtype of influenza A.
• The new subtype will most likely emerge in the Far East due to the mingling of human and animal influenza viruses there.
• Vaccine for the novel influenza virus causing the pandemic is not expected to be generally available in Missouri before the virus reaches the state.
• Initial distribution of vaccine to Missouri will be extremely limited and must be prioritized to maximize effectiveness.

An outbreak of avian flu (H5N1) has been reported in several countries throughout Asia, and recently in Europe.
• Human infections have been reported in Thailand, Vietnam, Cambodia and Indonesia.
• Humans have been infected by close contact with their domestic fowl.
• Rare instances of limited human-to-human transmission of avian flu have occurred.

Rare instances of limited human-to-human transmission of avian flu have occurred.
• These cases have occurred in association with outbreaks in poultry and should not be cause for alarm.
• In no instance has the virus spread beyond a first generation of close contacts or caused illness in the general community.
• To date, human infections with avian influenza A viruses detected since 1997 have not resulted in sustained human-to-human transmission.
 

(excerpts) "A nation unprepared… We are all gonna die… Who do you like?... The yankies or the red sox… Sensibly tuned between panic and indifference…. The national mood needs to be calibrated that is somewhere between indifference and panic. 5 % of the world population would die."

This is important legislation just as are many pieces of legislation that come before the Congress.... some have immediate needs and some have preparedness needs....

Thanks for the links Mellie... it is always good to be prepared for a potential looming catastrophe. Avian flu is something that at least a few upper level managers of federal land management agencies have been discussing seriously and starting the preparations for... ie - a "camp crud".... except this time it could be a potential fatal camp crud. An unseen or or recognized hazard to the wildland fire community that has national significance.

Gizmo

An audio version of the Nightline program (9/30/0, ABC) worth listening to.
Nightline Program on Pandemic Flu (mp3 audio): About 35-40 min. Ted Koppel interviews Senator Frist (who's a physician), Senator Reed, Michael Osterholm (Center for Infectious Disease Research and Policy) and others. Excellent introduction.

Audio & Photomontage on the Next Killer Flu (relatively short piece) from the October 2005 issue of the National Geographic

PBS Wideangle: Avian Influenza (Sep 2005), including an interactive map, photo essay, filmmaker’s notes and an online trailer. (It's gotten much more complicated than the PBS story in the last month... Bird Migration Routes and October Bird Epizootic Map). (Epizootic is the wild bird equivalent of pandemic. Wild birds transmit virus to domestic birds, pigs, humans and other mammals.)

For Nerd on the Fireline and others who might like to sit through an hour-long lecture on the biology, virology, sociology of the H5N1 virus and the beginnings of the emerging pandemic in Southeast Asia. It's 2 hrs. The first hour by Dr. Suarez (SE Poultry Research Station, US Dept of Agriculture) is excellent science info.
Pandemic Influenza - Alabama Public Health Training Network, 2004. (Uses Realplayer.)

I have more audio-visual links and links to websites where you can read up, ask questions and get answers. I have suggestions for how we can prepare for our families. I'm willing to do the research. Just say the word and I will share. Preparation is what it's all about. Timing may be everything. We will have the equivalent of Katrinas and Wilmas in many cities and communities around the US and the world one day soon. That will not be the time to ask each other what we should do. We should and can be ready.

Mellie -
Old Chinese blessing: "May you live in interesting times."

We can make another page if need be. Ab.

Avian Flu Pandemic:  Implications for Fire

Thoughts from Mellie
10/10/05

This email is to give a heads up on a global and national situation -- an influenza pandemic -- that is likely to involve the IMTs*  and all-risk wildland firefighters sooner or later. A pandemic is an epidemic that affects the entire world almost simultaneously, usually causing great illness and great loss of life. This flu pandemic will not be caused by one of our garden-variety, get-your-current-flu-shot type of virus strains, but by a mutated bird flu virus - H5N1 - that's new to mankind. Human bodies have no experience with it and no natural immune defenses against it. Right now the human mortality rate from H5N1 is 52% but this may decrease with further mutations as it's beneficial to a virus not to kill all of its hosts.

Currently our country and the world are not prepared with a vaccine to prevent this flu or with antiviral medication (Oseltamivir, aka Tamiflu), that may increase a person's chance of surviving infection. In addition, the United States is not ready with national or local plans to mitigate the spread of pandemic disease once it gets to the U.S. or to deal with the associated chaotic disruptions that widespread illness and death are likely to bring.

As you undoubtedly have heard, there is a growing discussion among world policy makers and epidemiologists regarding virus H5N1 and the growing likelihood the world will face a human influenza pandemic similar to the pandemic of 1918-19. I have been following the epidemiological developments relating to H5N1 for about a year with growing concern.

If you're having trouble getting your head around the implications of PANDEMIC, join the crowd. The first psychological response to the "worst case scenario" must be the "deer in the headlights" syndrome. I sat down to write about this two weeks ago, but unlike my normal self, found I was unable to "speak the unspeakable". As many of you know, my personal "Deep Survival" style is to "just get busy and figure it out", make some decisions, do it and move on. Normally, like most of you, I define the problem, do the research, strategize for the worst while hoping for the best, and if appropriate, share what I've learned with family, friends and colleagues, then act on my best choices. I usually move through the process fairly quickly, sometimes with radical and surprising results.

Not so this time... It's taken me a bit longer with this PANDEMIC situation to get to the sharing stage... The reason I'm sharing now is that I feel that ICS* and NIMS* will be an important structure for responding to a pandemic. No doubt the federal incident management teams will be called to serve. Whether you and our groundpounders choose to go in harm's way, you should have the facts as best they are known, know what to look for as the world-wide disease situation develops, know what PPE* and safety behaviors are necessary (but far from sufficient) to protect yourselves, and consult with your families to develop a family survival plan. No one can think clearly while on assignment if they're worried for their family at home.

OK, so what is the potential for pandemic of this avian flu?
There are three prerequisites for a PANDEMIC to develop:

1. The presence of a new virus for which there is no immunity: The new virus is Avian Flu Type A(H5N1).
2. The virus has the ability to replicate in humans causing serious disease: H5N1 does that and has a 52% mortality rate.
3. The virus evolves and is efficiently and easily transmitted from one human to another in community-wide outbreaks: H5N1 has not yet demonstrated human-to-human transmission with absolute certainty (except possibly for two outbreaks; one in Thailand that may have resulted from transmission between a stricken person and her family members; and one in Vietnam in which a girl may have caught it from her older brother.)

You can find the World Health Organization's excellent 62 page report (2,550K pdf file) entitled Avian Influenza: Assessing the Pandemic Threat (January, 2005) at www.who.int/csr/disease/influenza/H5N1-9reduit.pdf. It's very readable. Updates on the current number of cases and most recent outbreaks can be found at the bottom of this page: www.who.int/csr/disease/influenza/WHO_CDS_2005_29/en/.

Developments as of 10/9/05: Yesterday chickens were found infected with H5N1 in Turkey and Rumania and have been destroyed. Europe is worried. There was a new case of human infection with H5N1 in Indonesia. The total number of confirmed human cases is 117 with 60 deaths, 52% mortality.

In my opinion another influenza pandemic is inevitable; we have averaged three per century over the last few hundred years. This H5N1 virus is a very likely emerging candidate for pandemic and we haven't had one since 1968.

The primary questions that arise in my mind are:

• How much time might we have to prepare? Can we somehow dodge the bullet?
• Once it's transmissible person-to-person, how quickly will it spread around the world?
• How deadly could it be? For what age groups?
• In the presence of widespread illness, what other impacts on our lives should we expect and prepare for?
• How can we mitigate impacts on our families, our communities, our region, country and the world?
• What can we do to keep our families and ourselves safe?
• Do we accept IMT assignments? If we're off on assignment, when should we decide to head for home?
• What PPE should we consider?

What does pandemic history tell us about a potential worst case scenario?
If the proportions of infection, illness and death are similar to the 1918 Flu Pandemic, the following pattern could emerge:

• How long we have to prepare depends on how long before H5N1 mutates to spread human-to-human involving whole communities. That could be as soon as tomorrow or could take several years or more during which we could prepare. The deep survivor in me (who knows flu viruses mutate every year and require new vaccines) has a gut feeling we may have less time rather than more.
• Once it goes human-to-human, the virus could spread worldwide in 3-6 months and reoccur in several "waves" over as long as 2 years (sometimes reoccurrence has happened a month after the first wave). Some of the human-to-human spread is "silent". That is, the virus can spread to other people prior to the onset of the first person's symptoms. (Symptoms usually appear 1-2 days following infection.)
• Death may occur in all age groups including healthy young adults, not only in babies and the elderly. No one possesses natural immunity. In addition, those with the healthiest and hardiest immune systems are at added risk because their bodies respond too vigorously. In 1918, half the deaths occurred in those age 18-44 due to their immune system's extreme inappropriate response -- the "cytokine storm".
• 1/4 of all people might fall ill, need to be nursed and not able to participate in the general commerce of the world;
• 5% of the world population could die, that is 300 million people world-wide. (I've heard some epidemiologists say "5%" or "1 in 20"; others say "150 million" - which would be 2.5% of our 6-billion person earth population. I think all of us are staggered by the 300,000,000 number.)

Just imagine the impact of loosing 1/4 of our work force, plus their caregiver family members. Imagine having multiple "Katrina" incidents in cities around the US. Neighbors from adjoining states and countries won't be able to help; locals will be taking care of their own as best they can.

• Our health care systems will be in very high demand and will be overburdened and possibly non-functional. In hospitals now we have limited intensive care and floor beds and limited numbers of ventilators, for a start. There is also a nursing shortage.
• Beyond the public health emergency, there will be significant concomitant social, economic and political emergencies.
• Global economy will grind to a halt.
• Borders will close and regional quarantines may be imposed.
• International commerce will cease.
• In today's global marketplace, we have complex global procurement procedures. Some food supplies, medicines, and other goods won't flow, including replacement parts for critical infrastructure (for example power & water systems). Most cancer medicines come from abroad. Vaccines and antiviral medicines will go first to the countries producing them, which are not the US.
• Authorities at all levels will be making decisions in the midst of uncertainty and possibly backed by little public confidence.
• There likely will be large social unrest, at least in some cities (as there was in New Orleans post-Katrina and in Baghdad post-Sadam).

What can families and communities do? Incident Management Teams?

Personal Hygiene: Make a serious habit of hand washing and disinfecting, every time you've been out in public. When hand washing is not available, carry steri-wipes and use them. Don't touch your mouth, nose and eyes. Avoid close contact. Cover your mouth and nose with a tissue when coughing or sneezing. Ask people who are coughing and sneezing to please cover their mouths. Train your children (grandchildren). Get your kids' schools to include a unit on hygiene. Routinely disinfect potentially contaminated surfaces in your home. Practice good habits at home, at school, at work, in fire camp.
Stay home when sick.
Wearing Masks: From what I've read, no mask protects entirely. Viruses are teeny-tiny. At the time when masks are advised, inexpensive polypropylene surgical masks may be a better choice because they're cheap enough to use and throw away. Their main function will be to stop water droplets (other's sneezes and coughs).  The outside of the mask may become contaminated. Have many disposable masks on hand. (N95 face masks are much more expensive, not entirely effective, and people are likely to want to reuse them due to cost. The key is to use PPE of this sort one time and then discard it.) [I'm revising this: I feel there will be times when the N95 mask will be needed. For dealing with those who are ill, we'll need full Level 3 protection, eye protection, head covering, tyvek suits, foot coverings, gloves, etc. (Centers for Disease Control). Mellie]
A 72-hour emergency kit??? How about a year-long supply of food, meds, way for making drinking water safe, etc.? (Better yet, have a 2-yr supply.) There's the pandemic and then there's potential collateral disruption. Think of what you would really need to get somehow if goods didn't flow for a while. The more self-sufficient you and your family can be, the better. (Toilet paper!!! Otter Pops!)
Quarantine may work to some degree in the early stages of the pandemic.
People in communities may go through times when they should avoid public gatherings, close schools, institute travel restrictions. From the local level on up, we need to agree upon clear guidelines for who will do what to provide people with the essentials. Local cooperation among public servants will be a necessity.
Communities should have a plan for ministering to the sick and collecting and disposing of the dead as systems become overloaded. We should consider what people and services support critical infrastructure, and plan for backup. We'll need additional personnel who can fill in behind those who fall ill. For example, fill in for those who can no longer monitor or work on water treatment plants, electrical grids, telecommunications, transportation, etc.
Communication between communities, organizations and agencies; Communication with the public: We must strengthen risk communications. We have much to learn from what didn't work with the Katrina response. We and Congress need to resolve what nationwide radio spectrums will be used for those managing incidents, quickly learn the limitations of new systems and mitigate them. We also need to streamline how we get info out to the public. There were several good theysaid posts in September on both these topics.
Incident Management Teams managing fire crews have slaughtered chickens in the past. Those chickens were infected with Exotic Newcastle Disease - not caused by an influenza virus. (Rather, it is a virus related to the mumps virus and does not pose a great threat to humans.) What will teams decide if they're called on to kill chickens infected with H5N1? What about being asked to go abroad to help save human life during a pandemic? Asked to go to large US cities where the epidemic may be raging? What PPE will they need?

For an additional list of "Non-medical Interventions at the National and International Levels", see the World Health Organization Publication I mentioned earlier, Appendices 4 and 5 (pp 50-61): Avian Influenza: Assessing the Pandemic Threat (2,550K pdf file). It's clear that different actions should be planned for and advised at different stages. In my opinion, preparedness planning must begin now at the local and family levels as well as at the fire interagency level.

This is just a beginning of the discussion I think we must have and I've described the worst case scenario. Right now LCES* are not identified or in place. There are critical considerations that must be addressed by incident management teams, by wildland firefighter responders and by friends and our families. We need to plan -- for our families, for our communities, and for the IMTs and firefighters who may choose to respond to regional, national and international needs. Only by knowing the best choices for our families can we make good choices for responding at the national level and above.

(* Acronyms in order of appearance:
IMT= Incident Management Team;
ICS= Incident Command System;
NIMS= National Incident Management System, fashioned after NIIMS, fire's National Interagency Incident Management System;
PPE= Personal Protective Equipment;
LCES = Lookouts, Communications, Escape Routes and Safety Zones).