Email  abercrombie@wildlandfire.com  if you have something to share.

DATE	SUBJECT
2/6/ 2008	Here's a very fine 20 minute video, created by Public Health Seattle and King County They are leaders in pandemic awareness and preparation in the US. This excellent video covers issues such as social distancing, economic impacts, workplace preparation, the prospects of power outages, food shortages, fire department responses, and an overburdened EMS and health care system caused by a pandemic flu. Pandemic Video: Business Not As Usual # 1622 This video is a free download from the Internet or is available as a free DVD. www.metrokc.gov/health/pandemicflu/video/ Watch the video HERE (Windows Media Player Required.) Get this, watch it, and think about sending it to everyone you know who is planning or should be. Here is the King County Press release.
12/28 2007	Avian flu deaths reported in Egypt, Indonesia, Vietnam www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/dec2607avian.html Dec 26, 2007 (CIDRAP News) – A young woman in Egypt and another of almost the same age in Indonesia died of H5N1 avian influenza yesterday, raising the global H5N1 death toll to 211, the World Health Organization (WHO) said today. Also, a Vietnamese official said a boy who died recently in northern Vietnam had the H5N1 virus, according to an Associated Press (AP) report published today. The WHO has not yet confirmed his case. The Egyptian victim was a 25-year-old woman from Bany Suwef governorate, south of Cairo, the WHO said in a statement. She was hospitalized Dec 21 and died yesterday. The WHO said the source of her infection was under investigation, while Egypt's health ministry, according to a Reuters report published today, said she had had contact with birds thought to be infected. The Indonesian woman who died was a 24-year-old from West Jakarta municipality who fell ill Dec 14 and was hospitalized Dec 19, the WHO said in a statement. The source of her exposure to the virus is under investigation. An official at Indonesia's avian flu center said the woman had bought a live chicken at a market and slaughtered it there before taking it home, according to a Reuters report published yesterday. But he said the case was still being investigated. Indonesia has had 116 cases of H5N1 illness with 94 deaths, while Egypt has had 39 cases and 16 deaths, according to the WHO. The global count is 342 cases. In Vietnam, testing has confirmed avian flu in a 4-year-old boy from Son La province in the north, according to an AP story quoting Nguyen Huy Nga, director of the health ministry's preventative medicine unit. The boy died Dec 16 in Hanoi after a 5-day illness, the story said. Son La, about 187 miles northwest of Hanoi, has not had any recent H5N1 outbreaks in poultry, the AP reported. If the WHO confirms the boy's case, he will be listed as Vietnam's 101st case-patient and 47th fatality. Indonesian cluster ruled out In other developments, Indonesian officials reported on Dec 22 that testing had ruled out avian flu in a family cluster of illnesses. Lab tests excluded H5N1 infections in six members of an Indonesian family who were hospitalized Dec 21 with suspected cases, according to a Dec 22 Reuters report. Their cases had raised concern about possible person-to-person transmission of the virus. Nyoman Kandun, Indonesia's director-general of communicable disease control, said two sets of laboratory tests on the six patients were negative for H5N1, Reuters reported. The patients are from a village in Banten province. They fell ill with high fevers after more than a dozen ducks died in their backyard, the story said. Test results pending in Pakistan In Pakistan, confirmatory testing was not yet complete for a group of eight patients, including five in one extended family, in whom previous preliminary tests indicated H5N1, a WHO official said today. John Rainford, a WHO spokesman in Geneva, told CIDRAP News he expected confirmatory test results would probably be released tomorrow. But he said the results of genetic sequencing of the viruses will take longer. "The sequencing is on a different track [from the confirmatory tests], and that can take a week or possibly longer," Rainford said. He also said there may be a new suspected H5N1 case in Pakistan, but information so far was very sketchy. The local disease surveillance system is "engaged and ramped up," with the result that flu-like illnesses are more likely to be reported, he noted. According to previous reports, the Pakistan patients who tested positive included a veterinarian who had helped cull infected chickens, three of his brothers, a cousin, and three other people: a man and his niece who were involved in poultry culling in the same vicinity as the veterinarian, and a farm worker from another town nearby. Another brother of the veterinarian died of an H5N1-like illness but was buried without being tested. The WHO sent a team to investigate the Pakistan situation last week, and US Navy Medical Research Unit 3 in Cairo sent a portable lab. The cases occurred in northern Pakistan, not far from the Afghan border. The WHO's Keiji Fukuda said last week that the Pakistan cases probably represent a mixture of poultry-to-human cases and human-to-human transmission arising from close contact when people cared for sick relatives. The WHO has said there has been no evidence of sustained transmission. See also: WHO statement on Egyptian case www.who.int/csr/don/2007_12_26a/en/index.html WHO statement on Indonesian case www.who.int/csr/don/2007_12_26/en/index.html WHO case count
9/13 2007	A warning from WHO about getting/being complacent... Warning against the dangers of complacency, the World Health Organization today urged Member States not to drop their guard against the threat posed by avian influenza. Dr. Shigeru Omi, WHO Regional Director for the Western Pacific, said many countries still do not have the minimum systems in place for pandemic response. In some countries this has the potential to hinder preparations for pandemic preparedness. At a meeting of the WHO Regional Committee for the Western Pacific here, Dr. Omi stressed that the avian influenza situation remained as serious and dangerous as ever, and that the world faced extremely serious consequences, with the threat of a human influenza pandemic showing no signs of abating. Countries need to include rapid containment of an emerging influenza pandemic in their national pandemic preparedness plans, especially in those countries that have not experienced an avian influenza outbreak, Dr. Omi said. "Most countries still need to develop their country-level operational capacity for rapid containment. Gary W. Helmer MAS, MBA, MS, CHCM, CPEA, CSHO Safety and Occupational Health Manager United States Forest Service
2/10	I am continuing to monitor the spread of birdflu -- H5N1 -- on a daily basis. I do this with an international group of professionals at FluTrackers.com. (I post as Mellie there.) There are many of us monitoring outbreaks in birds; in other animals, including mammals that could be the "mixing vessel" that lets the genetic changes occur that take this pandemic; and in humans. I will post here and on theysaid if it looks like the virus has made a leap to a pandemic virus that is easily transmitted human to human. In the near future Ab will be providing a signup so people can get an email alert if it seems a pandemic form is emerging. The virus continues to evolve, acquiring the pieces of gene segments necessary to make the virus more able to infect humans through coughs and sneezes. Several things the flutrackers are watching for that might signal the beginning of pandemic flu are more clusters of human to human transmission within families, and human to human infection infecting non-family members like hospital care workers, teachers, or journalists working in areas like Indonesia and Egypt where clusters are occurring. Mellie
2/9	From Laidback Al and the flutracking community at FluTrackers.com: www.flutrackers.com The number of countries with human H5N1 infection is increasing.
2/1	This little video clip lays it out: http://www.msnbc.msn.com/id/12375868 Hit the Play button to watch the spread from 2003 until present.
1/1/07	"We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security." - Dr. David Nabarro
12/31	From Laidback Al and the flutracking community at FluTrackers.com: www.flutrackers.com The number of clusters of Human to Human H5N1 infection among family members is increasing.
12/15	From Firescribe: Date: 15 Dec 2006 From: David S Blehert    dblehert @ usgs.gov Source: USGS - National Wildlife Health Center The US Geological Survey's National Wildlife Health Center has completed necropsies on 6 mallards and one American widgeon from the Idaho wild-bird die-off. Gross observations and preliminary laboratory results are consistent with acute fungal infection. Body conditions ranged from good with primarily lung involvement to fair with more advanced fungal plagues throughout the body. Multiple laboratory tests are pending to confirm genus and species identity of the fungus and to rule out any other disease problems. -- David S Blehert, PhD Microbiologist USGS - National Wildlife Health Center http://www.nwhc.usgs.gov/
12/15	From IDgirl: www.localnews8.com/news/local/4924401.html click on "play" to watch the podcast
12/15	Thanks IDgirl. Mellie
12/14	From IDgirl: www.alertnet.org/thenews/newsdesk/N14186968.htm Infection blamed for 2,000 Idaho duck deaths 15 Dec 2006 00:22:18 GMT Source: Reuters By Laura Zuckerman SALMON, Idaho, Dec 14 (Reuters) - Two thousand mallard ducks in Idaho likely died after they ate moldy grain and contracted a fatal infection, scientists said on Thursday. Paul Slota, a wildlife expert with the U.S. Geological Survey's National Wildlife Health Center, said a fungal infection known as aspergillosis was the likely killer. "The results are certainly consistent with that diagnosis," Slota said. Dave Parrish, regional supervisor for the Idaho Department of Fish and Game, said further tests would be conducted. The preliminary finding eased fears that the massive mallard die-off, which experts say is unprecedented in Idaho, was linked to bird flu. Birds can contract aspergillosis after feeding on waste grain and silage pits during bad weather, according to the National Wildlife Health Center. Large-scale, rapid die-offs among waterfowl have chiefly affected mallards, it said. An estimated 2,000 mallards died between Friday and Wednesday near the agricultural community of Burley, about 150 miles (241 km) southeast of Boise. State fish and game officers on Wednesday retrieved carcasses from a stream clogged with dead and dying mallards. The stream is surrounded by farmland and a cattle feedlot, potential sources of the moldy grain, officials said. Concerns over the deadly H5N1 flu strain and an extensive national monitoring network prompted officials to submit samples from Idaho to labs specializing in detecting avian influenza and drew the U.S. Department of Homeland Security into the investigation. A similar aspergillosis outbreak killed 500 mallards in Iowa in 2005, the wildlife health center said. Moldy grain was the culprit in that case. The disease is not contagious.
12/14	Conference call at 4 PM with update on the evening news. IDgirl
12/14	From Firescribe: Duck die-off in Idaho sparks fears www.hemscott.com/news/latest-news/item.do?newsId=38287485998417 Officials May Never Find Mallard Die-Off Source www.cattlenetwork.com/content.asp?contentid=91141 Duck deaths mystery: More than 1,000 water fowl found dead; six agencies join investigation www.magicvalley.com/articles/2006/12/14/news/local_state/102482.txt
12/14	Hi Everyone involved with the wildlife side of things: More than 3,400 residential and migratory mallards have died along the Land Creek Springs near Oakley, Idaho in the last few days. If anyone hears of the cause, please let us know. At this point they don't think it's birdflu, but they're continuing to check. ID Dept of Fish & Game, U.S. Fish and Wildlife Service, U.S. Department of Homeland Security, Department of Environmental Quality, Department of Agriculture and South Central District Health are investigating and testing the ducks; and Norfolk County -Canada- residents are being requested to keep an eye out for duck die-off, as some of the ducks are Canadian migrants. Land Creek Springs near Oakley, Idaho is about 20 mi from the borders of NV and UT. Thanks, Mellie 2,000 ducks found dead www.ktvb.com/news/localnews/stories/ktvbn-dec1306-ducks.78133c2.html A Fish and Game spokesperson says that it is unlikely bird flu in a cause in the mass deaths, but an investigation is underway. “Preliminary diagnosis is a bacterial infection is the likely cause,” said Magic Valley Fish & Game supervisor David Parrish. “State veterinarians in Boise have found the lung tissue of the ducks to be full of white and yellowish bacterial abscesses. They also found hemorrhaging around the heart. At this point in time, however, we are not ruling out any potential cause.” Norfolk County : Be On the Look-Out for Dead Ducks & Geese www.cd989.com/modules/news/article.php?storyid=7180
12/7	Read the info then try the quick time movie. Mellie www.lanl.gov/news/images/avianflu.shtml Los Alamos Modeling of the pandemic flu sweeping the USA. Simulation of a pandemic flu outbreak in the continental United States, initially introduced by the arrival of 10 infected individuals in Los Angeles.
10/9	Here's a simple game that reminds me of the tractor starting analogy to clusters of transmission of pandemic flu: http://frenchfragfactory.net/ozh/download/gridgame.swf Also works for GR's analogy of people flicking lit matches at a pile of logs which are surrounded by explosive fatwood sticks. Most matches won't land and light the fatwood. Some will. Some fatwood will fire intensely and will die out. And finally, varoom, the fatwood will ignite fully and set on fire the tinder-dry logs, as well as other fatwood sticks crossing the one already lit. NorCal Tom
10/7	Preface: Gaudia Ray is an international businessman, a friend of mine who is also a member of an international group of professionals who have been following the developing avian flu pandemic for several years. He is concerned with maintaining continuity of his business and the safety and health of his work force. This is his report back to us as he describes below. Mellie GaudiaRay (GR) Notes and Comments on Mike Osterholm at World Affairs Council of Ventura County, CA, meeting, Sept 20, 2006. (Osterholm bio) GR Observation: Mike as Assistant Director of DHS has been run ragged this past week over the E. coli spinach affair. He's gained weight in the past 8 months (my guess...he's swamped with meetings, and extensive travel). He looks a bit pale. His spirits and his machinegun delivery were very positive and unchanged since last Feb. He referred to his nickname, "Bad News Mike". The key points he made: The average age of those who died in 1918 was 27. The average age of those who WHO reports as dying due to H5N1 is 27.   The risk of a pandemic happening is "one"... it is not an optional event.   He met with Chan from WHO either earlier today or yesterday, in Wn, DC. (so to me, he knows as much as anyone about what's happening out there vis a vis the virus' evolution.)   He, his wife, and his family now plan for his not returning home during the pandemic. He is committed to work; it is clearly a heartfelt obligation he has. He expects his family will sequester (at their new home in the countryside outside of Minneapolis, alongside a stream) and he will not endanger any of his family by visiting them during the pandemic. This is very surprising and new news. [Daniel Defoe in his "Journal of the Pandemic Year" references the boatman who too would not step foot in his family home but who left money and food on a rock outside of the home and who would call out to his wife to retrieve them, with him keeping a far distance so that she not become infected, albeit there unsuccessfully.] Mike's term is "protective sequestration". The reason he and his wife have concluded that protective sequestration is the right option for them is "social distancing won't work" in an urban environment; antivirals will be too few and have a low probability of being effective; there will be no vax timely available; there will be a lack of facemasks and gloves; and hand cleaning products will be scooped up and run out overnight.   His slide show concluded with a statement, "To do nothing is unacceptable... to promise protection is unethical." Osterholm's answers to our group's questions for which there was enough time: A.) Lenore / Cathypeanut question regarding Nat'l plan for emergency implementation of mass vaccination. They are 3 to 5 months off after the start of the pandemic, just to start, and mass vax won't start for 6 to 8 months... He said "the modern medical system will collapse". "Vaccine and antiviral drugs will have limited impact on the pandemic if it occurs in the next several years" "". Mike said this very sincerely. He reported he was just in Wn DC meeting with Chan and others, and he is sure that there is nothing on the horizon in the area of vax that will be available vax solution in any useable time frame should the pandemic start sooner rather than later. [I think this is a serious warning and is probably the most important conclusion stated by him, and not only reached earlier by him but reinforced by what he had confirmed over the past few days in Wn, DC. "DON'T GET SICK" is in my opinion, and in the honest opinions of many here, the only viable option.] B.) DH asked me to ask if there are any efforts being made for "serious stockpiling". Mike complimented me after the talk on the quality of this question. Mike's answer to DH's questions, 'Are any big distribution systems like Walgreens taking it on themselves to violate the "JIT" (Just In Time) efficiencies in order to stockpile say 6 months of meds or supplies?' is "If I were Walgreens, I wouldn't stockpile. Nothing in the system rewards that type of activity. There is no economic incentive to do so." He is miffed that at MBA schools there is no interest in "stockpiling" but instead all are focused on saving that additional 1/2 of one percent. DH, your answer from Mike is "No! No company he knew of is doing that." Mike is writing a paper along with Robert Rubin, the Economic Advisor in Clinton's White House. They both believe the pandemic is coming sooner rather than later. They see no economic incentives to effectuate the outcome DH asked about. As an aside, I had opportunity to meet with a representative of a major oil producer. The production company is seriously considering just shutting down during the pandemic!!! Or running at a very reduced level!! They're fully aware of the risks to their employees. Their view is "Why bother risking the lives of our white collar workers or any of our workers when our resource, oil, will be there after the pandemic as well as during? This has got to drive Goju through the roof. Goju is correct, given what I heard from both this major, major, major producer and from Osterholm. There is a huge probability of oil and refined oil products being shut in during a pandemic!! Mike said that he fully expects from what he's heard from the oil refiners that they will be understaffed and unable to refine the petroleum products. That would force the oil producer to shut in. That would stop 80% of all oil from being available, assuming all small producers continued to pump and some refiners continue to refine. (The 80% estimate is from the oil producer, not from me.) The oil producer has not heard a peep from FEMA. Remember when I posted that in the Feb meeting, I met with the FEMA public-private industry liaison in Minneapolis? He said he was not concerned about power. Well, as usual once again FEMA employs a total F up. That guy swaggered his opinion that power would stay on. He forgot to tell us what I'm telling you now; the oil industry has not done more than a superficial pandemic plan, that they're late to the planning table, that there are highly placed individuals within the oil companies who advocate to do little to nothing to prepare for this event as it is yet an inchoate threat, and that neither FEMA nor any other federal agency has contacted them to say, "Stay open and operating." GR: You know what this means. It means that everything we are basing our business continuity plans on appears to be stepping on lilypads on a pond. We're going to see some serious infrastructure collapses. Mike said he expects major collateral damage to occur, well beyond the impact of the illness itself. He said that at the beginning of his talk and 1 1/2 hours later at the end of his talk... serious "collateral damage". He knew of only one example where the governmental institution has prepared for a disaster and can respond immediately and effectively, and those are the fire departments at international airports. Continuing re the oil company: they produce into a pipeline. If the pipeline is full due to the slowdown at the refineries, they cannot produce. They will shut in most if not all of their production. They believe they face a serious ethical issue, and that being, "Why should we endanger our workforce over this life or death disease?" They are not pledged to risk their lives, unlike the law enforcement and medical communities. They are businesses, and they've not be deputized or nationalized; so they are looking at how to take no more than a prudent economic risk. GR's thinking: there's zero reason to be casual and expectant that oil and refined oil products will flow during a pandemic, and that means that a major portion of our electrical generation will also shut in. This ties directly with what Mike Osterholm says, that there will be a 12 to 18 month "blizzard", and he believes sincerely that "today" Washington, DC is dysfunctional. This in my opinion assures a high probability that Katrina will in fact be a tiny "scout" for the pandemic "army" that will soon follow when infrastructure collapses throughout the developed world. ---- CIDRAP did a study, Osterholm said, on evacuation and population of a reasonable, not a tall, office building using social distancing. He said it would take 28 hours to evacuate the building if social distancing were used. I assume that's one person per elevator run. He thinks the idea should be viewed based in light of this understanding. ---- Osterholm, re: dead bodies, said they're no more contagious than any other body. Their skin will probably have the virus on it. If you seriously want to know, you should ask DMORT at FEMA. Disaster Morticians = DMORT. ------ GR: Osterholm is more concerned now than he was in February. He has now taken a hard decision, protective sequestration. He has seen the Taubenberger study re: H1N1. He speaks with the most knowledgeable people on this topic worldwide at the most senior levels. And I sensed that while he still references now "key mutations" as the evolutionary manner of change for this virus, rather than recombination, and different from point mutation which to me back in Feb sounded like it was more random and less common, he has now nearly totally abandoned reassortment, and now recognizes this; and this is my paraphrase of what he said, "The process of H5N1 evolution is via key mutation... enough changes and the easy ability to mutate... will result in the the pandemic." --- Mike said, re Oprah Show, he lightly self-jabbed by saying he nearly shut down the email system at U Minn due to responses emailed to him. He identified two primary responses, both of which he termed "the easy response" which we should anticipate will be the response from the masses at the time the pandemic is announced. The first group said, "You should be locked up. You scared us needlessly." The second group said, "You're not telling the truth. We're all going to die anyway." GR: I think he was saying: There are the doubters on both sides. The information was too vague. The easy response is the extreme response. Expect the vast majority in their thinking to go to one extreme or another. Mike said, in response to these two groups of thought, "The fact is we're in the middle." Regarding the WHO position on avian influenza: Like almost all of us, Mike thinks the WHO is a political institution pressed very hard by its members to conclude somewhere in the middle of the varying positions. The WHO is always, "Just Right." Mike is very surprised and emphasized emphatically that for WHO to take the public positions it does regarding avian influenza, there must be something very serious that is occurring to cause them to be as bold as they are now being. He listed ten points now posted by the WHO. I copied down just a few of those points. It's not clear from my notes if these are verbatim, but WHO's website will have them listed. In light of what Mike just said, I think they should be reposted in FC and FT and FW. I'm a bit inept and I'm really supposed to be at work... but I want to upload more of these notes, yet just a small amount of what I've gathered. 1. The world may be on the brink of another pandemic. 2. Collateral damage WILL occur. 3. The modern medical system WILL collapse. 4. Vaccine and antiviral drugs will have limited inpact on the pandmeic if it occurs in the next several years. There are more WHO points, but I don't have 'em here. (Check the link: www.who.int/csr/disease/influenza/pandemic10things/en/index.html ) That's what Mike was saying, just what's there. So Mike is WHO mainstream, for all his fervence, he's still middle of the road in his thinking. He did say that he would in his talk tell the truth as he knows it to be now. -- He showed many slides. One was of the Karo cluster (though not marked as such) (Mellie: location in Indonesia of a human to human to human cluster of H5N1 infection and death). He showed Mother infecting children, nephew and the nephew then infecting his own father. The H2H2H (human to human to human) was clear as a bell. -- On the topic above on protective sequestration, those who've not yet read it yet should read Daniel Defoe's "A Journal of the Plague Year". Do a Google search and pick your poison, including a free, downloadable audio book. Defoe's folks onboard those ships in the Thames avoided the plague completely and left those ships in full good health (those who did not become infected by allowing anyone near them, save food, which we know now also may carry the virus due to handling) and as if nothing negative had transpired. That's protective sequestration 1665 style. When I read that about a year + ago, I responded by posting what Clawdia and many here also agree with, "Don't Get Sick". This is in direct contravention with the open heart of so many, including and especially Goju, who hope outloud that the powers that be (TPTB) would do more than say, "We can't and we won't be able to help." He raised almost Biblical questions at the start of his speech. "Who Will Be In Charge? What Can We Do About It? Will We? Do We Have Enough Time?" Gotta go for now, but here's one more line. On the quality of health reporting, to say it's degraded at present, from reporting to now entertainment, would be a compliment to the majority of those reporting. He cited as especially confusing and untrustworthy for the most part those editorials posted by Donald G McNeil, Jr. in the NY Times. The message is that Don's reporting is unhelpful, and Don is one of the better reporters. He did not mention Helen Branswell who we here all appreciate. Karo cluster... Mike showed the slide and said, "This reminds me of my grandfather who in Iowa had a John Deere tractor. I can remember when it started up. At first, there's a sputter, and then a rup-rup, and then, when he tried again, it would make a huge varoom". [I'm paraphrasing as closely as I can recollect.] (Mellie note on the Karo cluster: In May of 2006, there was a new cluster in the Karo regency in north Sumatra, Indonesia. This outbreak was the largest to date and involve secondary and tertiary transmissions of H5N1. Scientists around the world who are studying H5N1 were anxious that pandemic might have started. 7 of the 8 extended family members who were infected over a 3 week period eventually died.) GR: Mike sees this Phase 6 event (a la the John Deere tractor starting) as imminent. (WHO's Pandemic Phases) He said, "the current statistics on the number of people infected is the tip of the iceberg which is reflecting the breadth of the influenza virus in the birds." GR: I heard that as, "The bird virus is expanding. Here's a flyway slide [we in the newsgroups have seen that slide many times in the past]. The human illnesses reflect the expansion of avian infections." Mike recognized that high virulence Avian Influenza (AI) is not yet in the Americas. He also said he did not know why this was the case; but he expected it due to the flyways meeting in the far northern hemisphere. I will, in my last postings re: Mike's content, include housekeeping info that's in my opinion less relevant but as it's here I'll list for your edification as well. Mike then talked "chicken". He showed a slide on the explosive growth of pig and chicken population in China over the past ?? decade? forty years? Anyhow, it's huge. He said the average life of a chicken is 30 days. He said we humans have "sacrificed" over 15 million poultry to H5N1. But in China, which grows 12 or 15 billion chickens a year, they sacrifice as their protein source 1 billion chickens a month. His point is that when there's a disease in the poultry population, there's never a time when poultry is not present and alive, and thus the disease never burns out. GR: I immediately thought of Indonesia where the culling of poultry has been, oh let's say, the greatest farce on earth?! This virus never is without a populated playing field there. Say the Indonesians, "Ah, but we did cull within 100 feet of where the poultry died!" They've said that for a year, since the father and daughter in the Jakarta suburb died. The joke's on us folks, and everyone here knows it. Osterholm next said, "No one can predict if, when, or where the influenza virus will break out." He then said this virus will (most probably?) start in Asia. He termed the area, "the Asian roulette table". My notes say Mike next said, "...at present nothing appears to stop it." Mike's Definition of Phase 6 Pandemic: "The first evidence of a pandemic will be sustained third generation infection." [GR: Mike's saying that when the Karo-type cluster starts again and sustains into that third generation (the dad/uncle), then that's the "E" Ticket, the beginning of in my opinion the rockiest ride of our lives.] Mike still thinks the infection is now bird to human but for Karo type cases, the John Deere's trying to start up. In my opinion (IMO), there's not a person in our group who doesn't think the same thing. It's at least reassuring that TPTB are fully conscious of what's happening out there in Asialand; they see what's happening and that's why WHO is anxious and very bold in its statements. Mike made no big deal, not even a mention, over the fact that right now there is no cluster recognized as occurring. IMO, I for one used to think I needed and deserved a linear expansion of the flu, 1 2 4 16, whatever... But now, we have all seen that the virus is appearing in fits and spurts, like Mike's Deere tractor start up effort, as if the virus is fiddling with the sparkplugs and timer to "get the mixture just right." Mike challenged the recent Wall St Journal article which listed the advancements in the production of vaccine. "We are many years off from a modern influenza vaccine which has production capacity for the whole world." I may have gotten this a bit wrong, but he considered the WSJ article to be another feel good deception foisted by the reportorialists among us. He showed a slide, 300 million doses of 15 umg doses per year; we know this fact very well and we know what this means, even if the vax plants producing those were able to switch in an instant to PI (pandemic influenza) vax. He said there are 35 current H5N1 candidate vaxes which are still years away from FDA approval. He says it takes 3 to 5 years to get FDA approval to build a vax plant! [GR: refrain of Osterholm's famous line, "We're screwed." Sadly, Mike didn't offer it up last night, unlike entertainment stars who never miss a chance to utter their iterations ad nauseum.] His 2005 co-authored? Foreign Affairs article called for many efforts to be undertaken by the US government. He said "Five percent of what I wanted was done." Mike said he has had one or more US Congressmen say to him, "You public health people are always whining for money for yet your latest projects." We all know that the president's office asked for $8 billion and got $3 billion [GR: of which right now IBM and Florida are trying to take $500 million for a computer and some geeks to literally repeat in part the MIDAS study, leaving chump change for the event planning itself.... color me "idiot".] Mike mentioned but not by name Senator Doctor Bill Frist who called for a Manhattan Project, but he too has failed to assure even the majority of the $8 billion requested. [Again, we can hear Mike say to himself, "We're screwed."] Before we go further, there were 100 people in attendance at this meeting, 8 chairs at a round table. RobT and I represented 2 out of that 100. That's pretty kewl. I sat next to the reporter from the Ventura Star Press. He knew, I surmised, little to nothing. I didn't choose to talk with him, but instead to focus afterwards on lobbying the rep from the large oil producer how essential it is to assure loyalty of employees, simply as a protective proactive step to avoid head hunters from pulling their talent away after a severe pandemic which guts a significant portion of the workforce. The rep liked that idea and saw it as useful when engaging with the senior officer who's seriously at such odds with what everyone here perceives as the needs of our society. This person was no slouch; they knew very well much of what I knew; they're part of the international conglomerate who itself is projecting costs of protecting their employees. I mentioned the need to protect the employee's families, their pets (who for single people are often as dear as any family member), and their extended families, offering carrots of knowledge and PPE and food supplies during the pandemic as ways to attract the workers to do what they've been contracted to do, work in the oilfields. [You folks don't know me; I owned oilwells in California in the past in the midst of a flood field and I'll vouchsafe that they need electricity and they need constant, periodic checking and rarely but routinely, servicing; that servicing involves oilrig operators and hands; those men at the wellheads work within inches of each other for hours on end and typically day after day, stripping the well, doing the work, and resetting the pump, rods and tubing. Surface piping is rarely an issue. It's at the wellhead that most work takes place for fieldhands, and in the office where much work is done by field engineers, accountants, and crew managers. This rep did say they were looking at how to move some of the work into telecommute status; but the fieldhands are essential and must be exposed to one another if we are to maintain current production during a pandemic. If foreign oil stops flowing due to higher mortality for the many obvious reasons, we'll need domestic production to stay online.] Here's the "shocker" as Osterholm said what I said recently (RobT, plz correct me if wrong). Osterholm thinks this virus H5N1 will become aerosol transmitted. He did not explain why. He gave an example that he could not just with water droplets but via aerosol transmission infect the people at the back of the room. [GR: this is my impression of what he said; I admit I was distracted prior to hearing the word "aerosol" at which point my ears opened wide, but by then, I had missed the first part of his sentence and assume this is what he was saying as he was referencing aerosol spread to the back of the room.] Regarding the current Transfusion threads: Basically Osterholm thinks it's silly, not because of the concept about which he said nothing, but because he said, "Transfusion methods are JIT. Transfusion medicine will collapse over night." Tamiflu: Osterholm believes Tamiflu is "of no use 2 days after infection". [GR: yes, I know this can be parsed and is vague, but Mike sees Tamiflu as useful for prophylaxis. He recognizes the logic of taking Tamiflu to avoid getting sick, and he sees, imo, the silliness of first world societies thinking they can continue to operate by treating with Tamiflu or even by dosing the front-line workers with Tamiflu to keep them healthy for 6 to 8 weeks.] Mike did not mention the fact that Tamiflu has shown itself in Ginting quickly circumvented by H5N1. (Mellie note: Many members of the Ginting family died in spite of getting tamiflu; they are the extended family of the "Karo Cluster" which is a location name.) Mike also did not mention that his family had a supply of it. Last February, he said his family had Tamiflu. At that time, he was still flirting with the idea that he would work and they all would be safe due to Tamiflu in their possession. Now, 7 months later, Mike has decided that it's too great a gamble for him to return to the family home at all during the pandemic. This is "wake up" news to everyone here. This man has become either more paranoid or has applied current research which validates Dan Defoe's observations 250 years ago. Dan Defoe spoke to us in his book and he was clear as a bell in his stated intention, to talk to the future via his novel, to tell us what he saw and his elders witnessed and experienced when they encountered a "plague". ~~~~ My next communication will be a hodge pot of miscellaneous statements and facts on Mike's slides. ~~~~ Thx to each of you who posted your appreciation of this news. I'm beyond pleased, too, to help expand the envelope of knowledge about what we all (but for one it appears) believe to threaten society as we know it. I think we're all fortunate to have the internet at our disposal... Mike wasn't touting its ability to stay up during this upcoming event. So, as service to yourselves, may I suggest Fredness' postings at FW and your downloading at least electronic info on what to do during pandemic so if you lose the internet but have electricity, you can access relevant prep and factual info? Miscellaneous Comments / Observations by Mike Osterholm at World Affairs Council of Ventura County meeting, Sept 20, 2006. Check out the CIDRAP website. Plan Now, Not Tomorrow. Develop a Crisis Plan. Develop a Communications Plan. Do not expect the cell phone system to continue unaffected. Identify alternative ways of communicating. [GR: I've both landlines and a cellphone, and internet via radio transmission as well as via landline. I figure it's cheap insurance.] This will be "a 12 - 18 month blizzard." 30-60% of world will be infected [I think 1.6 billion deaths based on current Case Fatality Rate (CFR). Mike doesn't think this will happen. However, I did 2 years ago when a Russian virologist said this was a real risk, when Niman said this was a real risk and when I concluded, along with you know who you are as well, here, that this was a real risk. It was my "wake up" call.] It was clear it happened in the past, many times. Vaffie's work posted in the other F newsgroup has identified others beyond what Mike and his team are uncovering. Vaffie simply read the British medical journal, Lancet, and reported on the news reported and referenced from hoary tomes. Mike gave not reason one save and except "it has to" to support attenuation. To me, that may be responsible, so he's not considered a kook, but it's really irresponsible to the spur to get those who "must" to act defensively, now. (An aside...where I live there's a 100,000 acre wildfire burning right now, about 8 miles away, to the NE. Tonite, the fire dept held a meeting for the County. They said, we've put in a fire break and we hope to hold the fire. But starting tomorrow, nature may unleash 60 to 90 mph winds for up to 3 days. We think you need to be "aware". My reaction, as I'm leaving town on biz? Tomorrow, I'll rent a big truck and hire day labor and pack out everything I consider irreplaceable and valuable; and then I'll move that truck to a safe area for the time I'm gone, the full time of the identified risk. My cost is inconsequential, maybe a few hundred dollars, compared to the loss of any small pile of items I'm about to remove from the home. My alternative is to assume risk. My choice is zero risk, and nearly total indifference to loss. Insurance will cover what's left. I'll be inconvenienced if this place burns; but it will not threaten a thing which I consider to be most valuable. Like with bird flu, I get the message, and that message is that this is a natural event over which humans can make a valiant effort to save what they can save from destruction. Beyond that valiant effort, it's absolutely essential for me to take care of myself. With AI/PI/BF/H5N1, I show the same respect that I do to this wildfire. Others may do as they wish; I pledge to myself and I honor myself enough that I will do all I can so I do not get caught as victim.) Last night, Mike had something to say about this. He said, "Hope and despair are not strategies. Business continuity planning is not optional...[G]overnments will have limited resources to respond "everywhere" to everything for [the duration of the event --in the case of H5N1, 12-18 months]. He opened and closed on the same note, "We'll get through it just like every pandemic in our history." GR: Thank you, Michael Osterholm. IMO, Mike said it best when he repeated the John Deere tractor start-up story. It's the same story as I"ve posted now years ago, the one of people tossing lit matches at a bonfire of logs which are surrounded by explosive fatwood sticks. Most won't light the fatwood. Some will. Some fatwood fire intensely and will die out. And finally, varoom, the fatwood will ignite fully and set on fire the tinder-dry logs, as well as other fatwood sticks crossing the one already lit. The fact that GSGS doesn't see cluster cases TODAY means nothing imo, absolutely nothing. GSGS is applying a human desire, an imperative demand, that the virus infections be presented linearly, measurably, calculably. That's hogWHO. It's BS. Do appreciate that I too expected that about 2 years ago. I saw postings of many here who believed the same way. Many of those have also modified their expectation and become more like Mike, "we just don't know". It's a matter imo of looking at patterns. When I was in the convocation student introduction, with the rest of the 100 or so souls then starting the first year of Law School at Stanford, the then Dean, Bayliss Manning, described the task of the students as a challenge, to learn to "telescope and microscope" on the issues at hand, and to be aware that the issues are much more complex than at first glance. The law students at Stanford did not study the law to prepare to pass the bar examination; they and I were trained on how to focus and stay out of focus, to see a broad field of vision and yet to examine closely minutia, independently and interconnectedly, in a search to find a defensible pattern of logic for the issue at hand. It was for me not a novel way to see reality, but instead was the first time the way I thought was officially verbalized and held out as legitimate. Osterholm I believe has shown his ability to do this repeatedly. Do appreciate that I yet don't trust him fully as I've seen sophists spout and dazzle many times in my life and I yet distrust his facile and fast paced command of the concepts and the language with which to present them. Osterholm I believe has changed (of course as he's thinking the way I did in the past when I first assessed this issue, I now blushingly, immodestly concur with his thinking as it is now tracking mine, and due to his superior knowledge of, and access to information on this topic, I also concur with those aspects of what he says which agree with my own conclusions). He now sees "key mutations" taking place rapidly and across (betwixt and between) huge numbers of avian hosts. This is different from his "point mutations" he posted on his slide in February. He then did not at the Feb Biz Continuity conference in Minneapolis even come close to emphasizing the torrent of key mutations which are now taking place. [All here know I disagree with him as I see these as does Niman, as recombinations; yet the effect is the same, a torrent of polymorphic (is there such a word?) changes occurring for reasons obvious to virologists and which will eventually light the firewood / start the tractor.] For him, imo, this is his main reason for his in-reality reactions and change of personal familial protective strategy. That Osterholm has made the same decision I thought was the only safe decision, irrespective of the mental, emotional hardship it entails, preventative sequestration for his wife and 2 of his 4? children, tells me that he believes exactly as he says, "Plan Now, Not Later." His prior plan did not include this radical step towards the defense of his family. He recognized that cases have more than doubled during the past 9 months when measured year to year, and he applies last year's history, the norm for human flu and possibly for H5N1, to conjecture what is about to occur, multiply more human cases, which portend more "3rd Generation" clusters. His definition of what WHO calls Phase 6 pandemic is, "First evidence of of a pandemic will be sustained transmission [in the] 3rd Generation". Mike's added a simple litmus test, the first fatwood flame which has set the logs afire. Mike requires nothing more. Neither do I. He's not seeking verifications, measurements, angles... nothing; he's seeking nothing more than what I just quoted. And, he's the most pre-eminent epidemiologist in the USA who focuses on this area of our mutual interest. I don't think we need to expect any development in any location or region. But when we see the event, we should be able to immediately discern if it fits telescopically into our model of H5N1 infection with possible transmission via the 3rd Generation. It is here that I disagree so strongly with GSGS. I don't give a rats feather what the exact science is. I understand the big picture. I look at the "way" the disease presents itself and, based on all the prior knowledge posted here and what I've decided is important, yet another law school jargon phrase pops to mind, "If it looks like a duck, walks like a duck and quacks like a duck, it's a duck." I just don't think it necessary for my purposes, protective sequestration, to know more than enough to determine two of the three criteria stated immediately preceding this sentence. I'm not involved in a scientific debate with GSGS, and those who are scientists have way too often shown his logic to be less than bankable. However, as it's an opportunity to look at what changes of mind there are in Osterholm over the past 7-8 months, I believe that to be constructive. Finally, while glancing over this topic in his speech on Wednesday night last, he mentioned business continuity this time with a sense to me of profound frustration and much lowered expectation. He said that only 5% of what he had hoped in his 2005 Foreign Affairs article had been approved by Congress. For Mike, I believe this is a stinging wake up call. For me, it's a catastrophic and immeasurably large failure of the Republican Party, in control of both Houses, to the citizens of the USA. Back in February, he was quite hopeful that business would be able to prepare for the pandemic; now, as he says, I believe his guiding principle is his decent Irish Catholic, Iowan heartland-America hierarchy of values and loyalties which is embodied in what we could say is CIDRAP's banner, "To do nothing is unacceptable...to promise protection is unethical." To GSGS, Mike's banner is what drove me to travel and allocate time/money back in February. Mike at that meeting I thought "didn't get it", that irrespective of this situation about to be so tragic, imo then cataclysmically tragic, to do nothing is unacceptable (and this being based on a core commitment, private, personal, and profound). IMO, Mike's change and therefore mine to him, is that he "gets it" now.
10/2	Outbreak: Preparing for a flu pandemic By Michael Mager/Features Editor www.cleburnetimesreview.com/siteSearch/apstorysection/local_story_268173348.html Editor’s note: This is part two of a three-part series. By the time Hurricane Katrina stormed ashore, Gulf Coast residents, scientists and government officials had known for years that the landfall of a major hurricane would likely wreak havoc. This was especially true in New Orleans, which is largely built in a bowl that lies below sea level and depends on a complicated system of aging levees to keep water from flooding the city. Yet, when Katrina’s powerful sea surge inundated large parts of the region, causing the frail levees to fail, there was major loss of life, a significant blow to the economy and a long period of civil anarchy in the streets of the Big Easy. There had been years to prepare a plan against such a catastrophe. A great deal of the blame for a lack of preparedness and a seemingly uncoordinated response to the catastrophe was placed first at the feet of the federal government and later at the feet of state and local officials. Large parts of the Gulf Coast still are unprepared and the ability of the levees to hold back the waters of Lake Pontchartrain are still suspect. Many believe that the government is not looking down the dark barrel of yet another, possibly more perilous, disaster and the question remains, “Are we ready?” Unlike the tragedies of Hurricane Katrina and the devastation of the Sept. 11 terrorist attacks, which were largely local and regional, if the nation is forced to deal with a pandemic as vicious as one avian flu might bring about, the crisis will not be a local, a statewide or national one: It will likely be a worldwide crisis. “A pandemic of avian flu could result in 350 million deaths globally,” a State Department report says. How prepared will we be? How well coordinated will the response be? How well have we learned from past disasters and pandemics? The Spanish flu In the pandemic of the so-called Spanish flu of 1918, an estimated 50 million people died. And the world population was considerably smaller then. The world was not as urbanized as it is today. There also was no such thing as fast intercontinental transportation to carry those people who had the virus across vast distances in hours. According to the World Bank, a pandemic of the same scope of the Spanish flu would cost the world economy somewhere in the trillions of dollars. Jim Higgins, a doctoral candidate at Lehigh University in Pennsylvania, has been researching that pandemic. In an article on the Science Daily Web site, he claims that there are lessons that we can learn from that tragic outbreak of the early 20th century. “Most communities were woefully unprepared for the health crisis they faced,” said Higgins. “Those cities that passed muster, relatively speaking, had been building a strong medical infrastructure for decades, and had sound public health policies based more upon science than politics. I’m not sure that’s the case today.” He said he is increasingly concerned by what he sees as a divided “health care system where the best, state-of-the-art care is available to some, but not to others at the lower end of the socio-economic spectrum.” He finds himself wondering what will happen when those hospitals that do have a limited number of beds for lower-class and uninsured patients run out of those beds, while those that cater to the insured and financially fortunate accept new patients. According to the National Center for Political Analysis, one forth of all Texans do not have health insurance. How will those uninsured individuals receive the care they need? Scenario Experts at the Centers for Disease Control in Atlanta have worked out a possible scenario for an avian flu pandemic. At a certain point, most likely during the 2006-07 southward bird migration, the H5N1 virus will be discovered to have reached the wild bird population in North America. Birds that had been living and breeding in the northern parts of North America will make their yearly trek south to warmer climates. Some of them will have come from Asia, where the virus has already been found and millions of birds have already died. Along with the migrating birds will likely come the viruses the birds host. The viruses living in these birds will likely be passed on to other birds that are native to North America, domestic flocks and animals that prey on those birds in the wild. Not all birds who harbor the virus become ill or die because of it. Some are carriers and simply pass it along to other birds. It is possible that, as in Asia, there will be some infection of humans who come into contact with infected birds or bird droppings, resulting in some illness and possibly death. However, if the virus’ nature changes so that it becomes communicable from human to human, the disease might begin to spread as quickly as the human flu does. According to the World Health Organization, “Prompt and accurate reporting of H5N1 influenza cases to [the World Health Organization] is the cornerstone for monitoring both the global evolution of this disease and the corresponding risk that a pandemic virus might emerge.” Doctors in the United States are required by law to report incidents of the flu to the CDC so that, if a pattern of infection from the H5N1 virus begins, the CDC will be able to notify the White House and the president will then institute the government’s action plan. The plan The federal plan calls for doses of flu vaccine, broad spectrum antibiotics and the anti-viral drugs oseltamivir and zanamivir (better known under the brand names Tamiflu and Relenza) and other medical supplies to be sent beforehand to each state under armed guard. Stored at a number of undisclosed, secure locations, those medicines and supplies will be stockpiled and kept safe to use. Each state will have sufficient materials to set up a number of pre-determined local centers, each of which will be given the go ahead to open with a command from a local judge. In the case of Johnson County, that person would be County Judge Roger Harmon. The vaccine doses will then be distributed to these centers, again by armed guard. The human flu inoculations will first be given to first responders and their families. First responders include police, fire, emergency and medical personnel. “We have more than enough (flu vaccine) to go around,” said Gerald Mohr, Johnson County emergency management coordinator. “We shouldn’t run short. Johnson County is pretty well prepared.” Judge Harmon agreed. “Johnson County was the first in the state to determine that these centers would be situated at schools,” Harmon said. “Schools are ideal places for mass inoculations. They all have gymnasiums, people know how to find them and they all have kitchens to feed the workers who will be there over a long period of time. There are a lot of counties that are following our lead and making their schools their centers. We don’t want anyone to know which schools we’ve designated, though, for obvious reasons.” “Gerald Mohr,” Harmon said of his colleague, “is the perfect person for this job. He’s sharp as a tack and he’s got his heart in it. He knows what he’s doing.” Both Mohr and Harmon have modeled a county-wide response to a pandemic on federal guidelines issued to help deal with a biowarfare scenario in which a biological agent such as smallpox is let loose on the country by terrorists. In fact, much of the money supporting the county’s preparations for a pandemic come from the Department of Homeland Security. There are, however, a few flies in the ointment. First of all, even though Tamiflu and Relenza have been shown to be effective against this form of H5N1 in mice with two human-sized doses a day, much more may be needed for an infected adult human. Also, there is not enough of these drugs to go around. An article in Scientific American said that treating 25 percent of Americans would require more than the number of doses stockpiled. It would take 130 million doses to protect all health care workers and first responders in the country. According to the Department of Homeland Security’s paper on avian flu, as of September 2005, the total number of doses available was about 22 million. Additionally, there are those who should not take the medicine for medical reasons; there will also undoubtedly be some people who will refuse the drug for one reason or another. According to the Centers for Disease control, if the patient comes for treatment beyond a 48-hour window of opportunity, it’s not likely the drugs will work. Next, because flu viruses are ever-changing, it is not known if the vaccines presently under development will work against new strains of flu. The same is true of broad-spectrum antibiotics which, while they do not have any effect on viruses, do control secondary bacterial infections that set in once the body’s immune system is compromised. Finally, there is the question of maintaining law and order during a time of widespread fear and illness. “That,” said Harmon, “is the thing that scares me the most. I worry about what will happen if our first responders go down with the flu and I worry about whether or not we have the resources to maintain law and order if they do. That’s the part that keeps me up at night.” According to World Health Organization statistics, avian flu thus far appears to be a very lethal killer. Of those who have been infected, approximately 50 percent did not survive. In other words, once it is spread, it will likely kill more than half those it infects. Fortunately, it does not yet seem to be transmissible from one person to another, only from an infected animal to a human who comes into contact with that animal. As a comparison in mortality, the much-dreaded smallpox, for the most part, has a mortality rate of about 30 percent. If a pandemic of a human-transmissable form of avian flu does occur, the potential losses from the disease alone could be very high. What Harmon and others are worried about is how to keep associated, non-disease-related deaths and injuries at a minimum. If the social chaos and civil disorder that followed the devastation of Hurricane Katrina is an example of what could happen, then keeping numbers of non-disease-related deaths low might be challenging, considering that there may be only a possible skeleton crew on duty. According to both Harmon and Mohr, the challenge becomes greater still in a vast and essentially rural place like Johnson County. Quarantine and communication A quarantine is a prescribed period of time in isolation to keep a disease from spreading. The word dates back to the time of the plague in Italy when people were kept restricted to their home for 40 days to halt the transmission of the disease. It is widely assumed that a brief quarantine might be the only effective way to limit the march of a human-transmissable avian flu once it gets started. There has never been a national quarantine, so no one really knows what the public response might be to such an order, which would, necessarily, come from the White House. In the past, individuals have been quarantined, but never whole cities, states or countries. If children could be kept home from school, workers home from their jobs, ships from docking and planes from landing and so on for two to three days, it might be possible to staunch the spread of the disease. The question is, though, will people willingly stay home and stay away from work to stop the spread of the flu? In large cities, this might be easier to do than in small, rural areas with limited police presence. How would such an order be enforced and by whom? Because of Johnson County’s close proximity to a major metropolitan area, Harmon worries that there could a mass exodus of people seeking to flee the cities to our north for the more sparsely populated areas like Johnson County. “How will we keep them out?” Harmon asked. “There is no model for anything like that. I can see a scenario where we could have infected individuals looking to protect their families by heading off into the country by turning onto I-35 heading south. In the best of circumstances, we simply don’t have the manpower to stop them all from coming here.” Although such a quarantine would likely be effective in slowing the progress of a pandemic and although the quarantine would only need to last 48 to 72 hours, both Mohr and Harmon express doubts that there would be 100 percent cooperation on the part of the public. They also agree that cooperation and communication are crucial in coordinating the effort to keep the spread of the flu in check. Mohr indicates that the area is working hard to complete a communications system that will keep all first responders on the same frequency, thus addressing a major problem that cropped up as the result of Sept. 11 and again in the wake of Hurricane Katrina. County Medical Examiner Arthur Raines has been pushing for the purchase of technology to do just that. For his part, Harmon is making sure that all of the communities in the county are aware of and familiar with the national, state and local protocols if a state of emergency is declared. It is anticipated that there will be a high demand for medical services with the onset of a pandemic such as avian flu. “We have only a limited capacity to help here,” said Michael McEachern, safety manager at Harris Methodist Walls Regional Hospital in Cleburne. “We don’t have a huge emergency room, so we’ll probably handle only the sickest people. We keep refreshing our stockpile of things that have a limited shelf life, like surgical masks. Because they’re able to filter out particles as small as viruses, those will probably be in very high demand.” Another thing that McEachern wonders about is the inevitable buildup of bodies. “We don’t have much of a morgue here,” he said. “I guess we’d be forced to use things like refrigerator trucks or the refrigeration at retail stores and distributors.” For Part I: www.cleburnetimesreview.com/homepage/local_story_260141349.html?keyword=leadpicturestor%20y
9/28	www.fortwayne.com/mld/newssentinel/news/local/15630885.htm World Health Organization: Deadly bird flu virus mutating Associated Press GENEVA - The deadly H5N1 strain of bird flu which has killed at least 148 people is showing signs of being able to mutate and develop resistance to the most effective anti-viral drugs and any possible vaccines yet to be produced, a WHO scientist said Thursday. The H5N1 virus is splitting into genetically different groups, said Mike Perdue, a team leader with WHO's influenza program who took part in a two-day bird flu conference earlier this week sponsored by the U.N. health body. No vaccine for the H5N1 virus has been produced yet, but scientists are confident they will develop one in future. However, the virus has now been shown to mutate like seasonal flu viruses that require new vaccines every year. "We are going to have to come to the realization that these viruses are genetically variable," Perdue said. "The vaccines that we have predicted to be protective today may not be protective a year from now." The two most effective anti-viral drugs currently in use are also in danger of losing their potency, according to influenza experts. "We know from surveillance studies and from hospital clinical studies that resistance to the two primary anti-viral drugs, the Tamiflu and Amantadine drugs, have already occurred," Perdue said.
9/11	From Mellie: I haven't posted much because I've been off working on Northern California fires, but I am carefully watching the increasing numbers of clusters of H5N1 human to human in Indonesia and Thailand. Here's a commentary from Dr Henry Niman below. If you haven't stocked up on an extra 2-4 months of food, please do so now. www.recombinomics.com/News/05050502/WHO_H5N1_Pandemic.html (text below) -------------------------------------------------------------------------------- WHO: Flu Pandemic May Have Begun Recombinomics Commentary May 5, 2005 In Asia, there are hints that the virus is indeed changing. "Incomplete evidence suggests that there may be a shift in the epidemiology of the disease," says Stöhr. "More clusters are being seen than last year, older people are now coming down with the diseases, and more cases are milder." Taken together, these characteristics could indicate that the virus is becoming less virulent and more infectious, he says, which could signal the start of a pandemic. (Klaus Stohr of the World Health Organization) Klaus Stohr's comments above are the first acknowledgement by WHO that the 2005 flu pandemic may have begun. The clearest signal was the simultaneous admission of a family of five in Haiphong on March 22. All five were confirmed to be H5N1 positive and all five recovered. Earlier signals were the transmission from patients to nurse(s) in Thai Binh and the 195 commune members in Quang Binh with flu symptoms. Although samples were collected from over 30 individuals, the results have yet to be released. The same is true for the neighbors of the Haiphong family and the patients at Vietnam Sweden hospital in Thai Ninh. 1000 samples were collected, and those results were not announced either, but the shipment of samples to CDC for analysis was a very big red flag and these changes correlated with an amino acid loss, presumably in the HA cleavage site, are a clear signal that the H5N1 in northern Vietnam was a recombinant. The virus clearly has all of its ducks in a row, and humans are simply sitting ducks, unaware or unconcerned about the looming mayhem in the fall.
7/17	H5N1 is still a virus that is clearly on the move. It's approaching world-wide expansion in birds, sporadic world-wide expansion into mammals, including humans. Every once in a while it becomes more adapted to the upper respiratory tract of humans, that is, it has developed greater affinity for humans and less for birds. It has maintained its virulence. It has killed 7 out of 8 people it infected in the last cluster that demonstrated human-to-human transmission in Indonesia. It is evolving. One of these days it will find the combination and open Pandora's box. As it infects more species on more continents, its opportunities for recombining and reassorting grow. More medical people around the world are amazed and alarmed at the speed of the genetic changes, the evolution, the spread into new species and new parts of the world. We need to be ready. Mellie PS This little video clip lays it out: http://www.msnbc.msn.com/id/12375868 Hit the Play button to watch the spread. There has been more spread since this was posted.
7/17	H5N1 found in dead bird in Spain. Indonesia has another bird flu fatality, now equals human deaths as in Viet Nam. http://news.bbc.co.uk/2/hi/europe/5158162.stm Tom M.
7/17	Tom, I agree 100%. Nitrile exam gloves are recommended in the R5 pandemic plan for the very reason you mention. Also, some people are allergic to latex. If you're following the biohazard 3 standards, you would "double glove": wear thicker gloves over thinner ones. So the top layer would be more like gloves you would wear for dishwashing or cleaning with bleach or some other caustic or toxic chemical. Mellie
7/17	Hello, I saw the message from JD on what the U.S. Fish and Wildlife Services is ordering. The first item has me troubled. If you are protecting yourself from a virus, you would want a Nitrile EXAM glove. These are thicker (almost doubled the 5 mil on this order). Yes, they cost a bit more but if you want to protect yourself, you wouldn't want to skimp here. This will be the first contact with whatever you are touching or moving. Everybody has expertise in what they do. I would check with the paramedics and nurses on ordering this type of PPE. Would you ask a nurse what type of Pulaski to order? Tom M.
7/14	US Fish and Wildlife Services must be anticipating handling sick birds (and animals?). The Denver office is soliciting bids for PPE for avian influenza in the following quantities.   Line# Description Quantity Unit 0001 Nitril Gloves - Length 9.5"; thickness 5 mil 15 box 0002 REPEL Tyvek Suits - Size XL 15 case 0003 Tyvek Coveralls - Size XL 15 case 0004 Tyvek Coveralls - Size XXL 15 case 0005 Boot Covers - Size MEDIUM 15 case 0006 Boot Covers - Size LARGE 15 case 0007 N95 Respirators 30 case 0008 N100 Respirator 15 case 0009 Biohazard Bag - Size 36" x 45" 15 case JD
6/26	From Todd: Pandemic of 1918 offers lessons on body disposal They brought in steam shovels to dig graves. Caskets were rented -- just long enough to hold a brief memorial service -- then passed on to the next grieving family. The death toll of the 1918 flu pandemic was so overwhelming that the military commandeered entire trains to transport dead soldiers; priests patrolled the streets of Philadelphia in horse-drawn carriages, collecting bodies from doorsteps. "One of the most demoralizing things was the inability to move bodies out of the home," said John M. Barry, author of "The Great Influenza," the definitive work on the 1918 pandemic. "They just literally stacked up, sometimes for three, four or five days." Now, with medical experts and government leaders racing to prepare for a potential pandemic, a cadre of mortuary specialists has begun quietly grappling with the grisly but essential question of what to do with the dead if it happens again. Opinion is varied on when and how virulent the next global flu outbreak would be, but even a modest epidemic -- similar to the pandemic that hit in 1968 -- could kill between 89,000 and 207,000 Americans. If the next virus mimics the far more potent 1918 strain, the U.S. death toll could reach 1.9 million. In either case, experts foresee an 18-month period of funeral homes being short-staffed, crematories operating round-the-clock, dwindling supplies of caskets and restrictions on group gatherings such as memorial services. Morgues and hospitals would quickly reach capacity. And most of the federal Disaster Mortuary Operational Response Teams (DMORT) would be too busy in their own communities to deploy elsewhere. Some fear that the Bush administration, in all its detailed planning for pandemic flu, has paid scant attention to fatalities. "It's the one thing nobody wants to address, because it's ugly. People don't want to think that anyone will die," said John Fitch, senior vice president for advocacy at the National Funeral Directors Association. "We can't put our head in the sand and say response stops at prevention and treatment." Officials say much more is happening behind the scenes. In March, the administration helped organize a two-day conference at Fort Monroe in Virginia with medical examiners, funeral directors, public health experts and casket makers. Among the more innovative, albeit jarring, ideas being considered are backyard burials, virtual funerals and storing bodies at ice hockey rinks. "Virtual funerals" broadcast over closed-circuit television or the Internet would be advised, said Nesler, who ran the Fort Monroe conference. "The very worst thing you can do during an epidemic is have large gatherings of people" such as memorial services, he said. Some families may bury relatives on their own property, said deJong, who is also chairwoman of the mass fatality management committee of the National Association of Medical Examiners. "We've forgotten that people do die from infectious diseases, and our process of dying has become very sanitized," said Norwood, who is also a psychiatrist. "For the whole Western world, it's going to be a shock."
6/23	From Firescribe: Another good site to follow Dr Niman's comments on the changing genetic sequences: www.recombinomics.com/whats_new.html
6/23	From Firescribe: WHO admits to genetic changes in H5N1... Bird Flu Passed From Son to Father, W.H.O. Says www.nytimes.com/2006/06/23/world/asia/22cnd-flu.html?_r=1&oref=slogin  An Indonesian man who died of H5N1 bird flu caught it from his 10-year-old son, the first laboratory-confirmed case of human-to-human transmission of the disease, according to a World Health Organization investigation of an unusual family cluster of bird-flu cases. The investigators also found that the virus mutated slightly when the son had the disease, although not in any way that would allow it to pass more readily among people. Flu viruses like H5N1 mutate constantly, although most of the mutations are insignificant biologically; that appears to be have been the case in the Indonesian cluster.
6/23	The pandemic stage is not only a mater of numbers but perspective. The top table is the original from Current WHO phase of pandemic alert www.who.int/csr/disease/avian_influenza/phase/en/index.html And the table at the bottom is the same one with a different view, if you take into account the increasing number of human-to-human transmission clusters. This virus is evolving repeatedly to be human to human. One of these days the virus will nail it. It's not a random process any more than water flowing downhill is a random process. We'd best be as prepared as possible when we reach the "tipping point". Mellie
6/22	http://orange.advfn.com Six Respirator Manufacturers Warn President Bush of Imminent Shortage of Masks Necessary for Avian Flu Pandemic Response WASHINGTON, June 22 /PRNewswire/ -- The leaders of six respirator manufacturers representing approximately half the respirator production capacity of the United States urged President Bush in a letter delivered today to the White House to back federal legislation ensuring the supply and availability of disposable respirator masks (N-95 respirators) for healthcare workers and other first responders. The letter from the industry echoes a letter sent to the Administration in May by a bipartisan group of 86 Members of Congress calling for the National Strategy for Pandemic Flu Influenza to stockpile N-95 respirator masks instead of surgical masks. (Mellie comment: Surgical masks are not N-95 masks. If you are called to serve, ask exactly what PPE you will have available.) "Unfettered liability costs will dramatically affect our nation's ability to respond to an avian flu pandemic," wrote the respirator company executives. "Costs of defending litigation, aside from settlements or verdicts, amount to hundreds of millions of dollars. In fact, currently, 90 to 94 percent of profits are being consumed to maintain litigation efforts. "Disposable respirators are inexpensive, so there is no practical way to add unfair liability costs to the price of our products," the letter continues. "Thus, we are compelled to withhold further investment in production capacity, exit the marketplace or manufacture abroad for foreign buyers where no litigation crisis exists. This is not in the public interest. Respirator manufacturers are not, and have never been, part of the problem underlying end-user illnesses, but we can be part of the solution to minimize the spread of avian flu in the U.S. if a pandemic occurs." The National Institute for Occupational Safety and Health (NIOSH) tightly regulates the respirator industry by setting strict design standards, conducting tests to ensure they are met, and approving each and every respirator model as well as the warning labels that accompany the product. However, relying on asbestos-style litigation tactics, trial lawyers have deluged the industry with lawsuits claiming defective design or failure to warn users -- despite the fact that manufacturers cannot affect how or when the respirators are used. "Without legislation, the ability for American manufacturers to address emergency preparedness or have surge production capacity is and will be severely constrained," wrote the company heads. "Already, one major manufacturer has announced that it will no longer produce N-95 respirators for the industrial market. Another is seriously considering withdrawing from the market, and it has become difficult to convince shareholders to invest in new capacity in the United States." France has begun stockpiling 685 million N-95 respirator masks just for first responders, while the U.S. Government to date has had one request for proposals for 50 million masks. The recent experience with SARS showed that countries will embargo exports of respirator masks in the case of a global pandemic and the US will need its domestic sources for these masks. The Coalition urged President Bush to support bi-partisan legislation introduced by Senators John Cornyn (R-TX) and Ben Nelson (D-NE) in the Senate (S. 1406) and Representatives Bud Shuster (R-PA) and Tim Holden (D-PA) in the House (H.R. 2357) that would preempt lawsuits claiming defective design or insufficient warning if a respirator is NIOSH-approved. The six manufacturers who sent the letter include members of the Coalition for Breathing Safety: Aearo, Bacou-Dalloz, Inovel, Moldex, MSA and North Safety. The Coalition for Breathing Safety was formed in 2004 to ensure that millions of emergency responders, workers and citizens across the globe continue to have access to respiratory safety products. For additional information, please visit www.breathingsafety.org/ .
6/	Dr Henry Niman's analyses and comments: www.recombinomics.com/News/06030604/H5N1_Phase_4_5_Out.html Phasing Out H5N1Bird Flu Pandemic Phase 4 and 5? Recombinomics Commentary June 3, 2006 Dr. David Nabarro, chief pandemic flu coordinator for the United Nations, said that even if some unexplained cases were human-to-human, it does not yet mean that the pandemic alert system, now at Level 3, "No or very limited human-human transmission," should be raised to Level 4, "Increased human-human transmission." Level 4 means the virus has mutated until it moves between some people who have been only in brief contact, as a cold does. Right now, Dr. Nabarro said, any human transmission is "very inefficient." Level 6, meaning a pandemic has begun, is defined as "efficient and sustained" human transmission. The above comments from Donald McNeil Jr's New York Times report, "Human Flu Transfers May Exceed Reports," suggests that movement from Level 3 to Level 4 is not necessary because Level 4 and Level 5 are being phased out. Once H5N1 achieves efficient transmission as defined by transmission by causal contract on a pare with transmission by a cold virus, the final Pandemic level will have been reached. The current system, which uses six phases, is designed to identify two intermediate phases (4 and 5) which represent increasing efficiencies of transmission. These changes mark progress toward increased efficiency, but at an early stage when intervention may limit progression. The description of level 4 above, is really the current phase 6, which is efficient and sustained human transmis8sion. Transmission of a cold virus is efficient and sustained, which would also apply to H5N1. Currently H5N1 can efficiently replicate within humans, but transmission between humans is inefficient. However, these efficiencies have been increasing, as seen in large clusters in Turkey, Azerbaijan, and north Sumatra, Indonesia. The turkey cluster was linked to a change, S227N in the receptor binding domain, which increases efficiencies and generated the largest and most sustained cluster recorded to date. Azerbaijan also had a large sustained transmission chain, but the sequence of the H5N1 has not been released. Although these transmission chains are among the largest recorded, the transmission was limited to family members or close contacts. This limited spread was also seen in north Sumatra, and again the sequences have been withheld, so genetic remains unclear. The increased concentration of H5N1 in the nose and throat may signal a PB2 E627K acquisition, which is another small change associated with increased virulence which may translate into increase transmission because of the preference of E627K for cooler temperatures of 33 C. The changes in the H5N1 associated with these changes have been small incremental changes, such as those that would be measured by a pandemic phase system the distinguished the incremental steps. Since these incremental steps have been taken previously but not acknowledge, the definition above simply eliminates these intermediate phases. However, the local response to these small changes has been to flood the region with Tamiflu and treat the outbreak as it would be treated if it were at a higher phase. Thus, phase 4 and 5 appear to be phased out, and the current status of the pandemic is one step away from the old pandemic level, 6, which is now being called level 4.
6/9	Teams and DMORT, where does it lead? NorCal Tom www.washingtonpost.com A Grisly but Essential Issue Pandemic Plan Skims Over How to Deal With Many Corpses By Ceci Connolly Washington Post Staff Writer Friday, June 9, 2006; 12:32 AM They brought in steam shovels to dig graves. Caskets were rented -- just long enough to hold a brief memorial service -- then passed on to the next grieving family. The death toll of the 1918 flu pandemic was so overwhelming that the military commandeered entire trains to transport dead soldiers; priests patrolled the streets of Philadelphia in horse-drawn carriages, collecting bodies from doorsteps. "One of the most demoralizing things was the inability to move bodies out of the home," said John M. Barry, author of "The Great Influenza," the definitive work on the 1918 pandemic. "They just literally stacked up, sometimes for three, four or five days." Now, with medical experts and government leaders racing to prepare for a potential pandemic, a cadre of mortuary specialists has begun quietly grappling with the grisly but essential question of what to do with the dead if it happens again. Opinion is varied on when and how virulent the next global flu outbreak would be, but even a modest epidemic -- similar to the pandemic that hit in 1968 -- could kill between 89,000 and 207,000 Americans. If the next virus mimics the far more potent 1918 strain, the U.S. death toll could reach 1.9 million. "It's almost too big to wrap your arms around," said John Nesler, a specialist in mass fatalities advising the military. If the worst were to occur, Nesler predicted the impact would be akin to "20 nuclear detonations" simultaneously knocking out multiple cities and towns. In either case, experts foresee an 18-month period of funeral homes being short-staffed, crematories operating round-the-clock, dwindling supplies of caskets and restrictions on group gatherings such as memorial services. Morgues and hospitals would quickly reach capacity. And most of the federal Disaster Mortuary Operational Response Teams (DMORT) would be too busy in their own communities to deploy elsewhere. "I can't see myself packing my bags to go to another state to help out," said Joyce deJong, a Michigan medical examiner who worked on DMORT teams after the Sept. 11, 2001, attacks and Hurricane Katrina. "I'll be here dealing with an increase in the number of bodies." Some fear that the Bush administration, in all its detailed planning for pandemic flu, has paid scant attention to fatalities. "It's the one thing nobody wants to address, because it's ugly. People don't want to think that anyone will die," said John Fitch, senior vice president for advocacy at the National Funeral Directors Association. "We can't put our head in the sand and say response stops at prevention and treatment." In the 227-page response plan recently released by the White House, the term "medical examiner" appears just once -- and "autopsy" not at all. A single paragraph on page 112 recommends that hospitals, medical examiners and government officials "assess current capacity for refrigeration of deceased persons, discuss mass fatality plans and identify temporary morgue sites" to handle surges. Officials say much more is happening behind the scenes. In March, the administration helped organize a two-day conference at Fort Monroe in Virginia with medical examiners, funeral directors, public health experts and casket makers. Among the more innovative, albeit jarring, ideas being considered are backyard burials, virtual funerals and storing bodies at ice hockey rinks. Seattle's King County came up with the ice rink idea when officials realized their mass fatality plan would accommodate no more than 50 deaths, perhaps in a plane crash, said interim health director Dorothy Teeter. "This is so much bigger," she said. "We project 11,000 potential deaths in six to eight weeks." Several participants said they will have to consider temporary mass graves because they will not have the staff to keep up, especially if some of their workers or family members contract the flu. "They would bury the person with all the identification material and carefully keep track of that information," said Ann Norwood, a senior analyst at the Office of Public Health Emergency Preparedness at the Department of Health and Human Services. "After things calm down, we can locate the family, exhume the casket and put it wherever the family ultimately would like the body to rest." "Virtual funerals" broadcast over closed-circuit television or the Internet would be advised, said Nesler, who ran the Fort Monroe conference. "The very worst thing you can do during an epidemic is have large gatherings of people" such as memorial services, he said. Some families may bury relatives on their own property, said deJong, who is also chairwoman of the mass fatality management committee of the National Association of Medical Examiners. In a pandemic, one problem would likely trigger several more, Norwood said. Fuel shortages, for instance, would mean added complications transporting bodies and keeping refrigerated trucks cool. If funeral directors and other mortuary workers are not given anti-viral medication or a vaccine when it becomes available, they will likely stay home, said Robert Fells, external chief operating officer for the International Cemetery and Funeral Association. "Ironically, funeral directors were at the bottom of the list," he said. White House officials said a priority list for medicine and vaccine has not been finalized. "Noticeably absent from the discussion" at Fort Monroe were representatives of the Department of Homeland Security, even though they will have overall coordinating responsibility in a pandemic, said Fitch. "Right now, there is no single agency or individual responsible for mass fatalities." However, much of the burden will fall to local communities and the states, Bush administration officials said. Virginia's chief medical examiner, Marcella Fierro, said local hospitals, funeral homes and health departments must take the lead, but the state is trying to help now by developing software systems for clerical tasks such as keeping track of the dead and contacting next of kin. She is also compiling a list of retired employees who could step in. One of the many lessons to emerge from Hurricane Katrina is that Americans are not accustomed to seeing unattended bodies on the streets of a major city, said Michael Osterholm, head of the Center for Infectious Disease Research & Policy at the University of Minnesota. He said less-developed countries may be better positioned to deal with huge numbers of flu fatalities. If the next pandemic strikes with the same ferocity as the 1918 flu, even the most thorough planning will not prepare people for the emotional toll of such widespread death. "We've forgotten that people do die from infectious diseases, and our process of dying has become very sanitized," said Norwood, who is also a psychiatrist. "For the whole Western world, it's going to be a shock."
6/6	Thanks for the post, Tom. Looks like Romania was only an outbreak in domestic fowl, not human. The Romanians are trying to get admitted into the EU so they were quick to react (maybe overreact???). Here's something of interest for those staying abreast of pandemic phase and human-to-human transmission. It's on the most recent outbreak in Indonesia: I'm going to copy and paste the NY Times article that came out on Sunday about human-to-human birdflu transmission. Some of the close tracking that my scientific watch-group of volunteers is doing -- as reported by Dr Niman (of the birdflu maps on my ppt) -- is finally having a bigger impact on mainstream media. The NYT reporting is great and the story has gotten picked up around the world. Now all we need is for the H5N1 gene sequences to be released so we can show that it is indeed becoming more adapted to upper respiratory transmission among humans even if not yet as easily transmissible as the regular flu. Supporting that is the fact that there was a much higher viral load found in the upper respiratory tracts of the family members who died than in other non-cluster cases. After this most recent scary outbreak in Indonesia, the WHO can now no longer deny that transmission human to human has occurred and has been occurring. Their solution is to rewrite their Pandemic Phases to eliminate Phases 4 and 5. Result will be that we'll shift from Phase 3 to full-blown pandemic when the bug goes H2H with ease (highly efficient upper respiratory transmission). Lots of economic and political pressure on the WHO to not make big waves yet. Many countries pandemic plans are tiered to the WHO Pandemic Phases and those countries want to avoid the economic fallout of dealing with possible pandemic for as long as possible. Human to human transmission in Vietnam last year, in Turkey/Iraq/Azerbaijan in January-February responded to the tamiflu blanket the WHO threw out. Unfortunately, because of its far-flung geography, lack of education, small war-lord/headman rule, Indonesia will not respond to a tamiflu blanket (as clusters occur over time) as Vietnam, Turkey, Iraq and Azerbaijan have. Last outbreak in Indonesia at least one of the ill family members escaped the hospital, went home, called in the witch doctor, got an exorcism and then died. People in his village chased off the WHO people, refused tamiflu and said the family died because of "bad spirits". So far that outbreak seems to have ended with the deaths of 7 of the 8 people in the family who got infected. I haven't looked today, but I think there are 2 other clusters of h2h still going on in other areas of Indonesia, one in suburban Jakarta. Heaven help us if the genetic changes occur in an outbreak in a cosmopolitan city. It's no wonder Dr Osterholm (DHS and CIDRAP) thinks the pandemic will come out of Indonesia. OK, let me copy and paste the NYT... Cheers, Mellie ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ June 4, 2006 Human Flu Transfers May Exceed Reports By DONALD G. McNEIL Jr. In the wake of a cluster of avian flu cases that killed seven members of a rural Indonesian family, it appears likely that there have been many more human-to-human infections than the authorities have previously acknowledged. The numbers are still relatively small, and they do not mean that the virus has mutated to pass easily between people — a change that could touch off a worldwide epidemic. All the clusters of cases have been among relatives or in nurses who were in long, close contact with patients. But the clusters — in Indonesia, Thailand, Turkey, Azerbaijan, Iraq and Vietnam — paint a grimmer picture of the virus's potential to pass from human to human than is normally described by public health officials, who usually say such cases are "rare." Until recently, World Health Organization representatives have said there were only two or three such cases. On May 24 Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention in Atlanta, estimated that there had been "at least three." Then, last Tuesday, Maria Cheng, a W.H.O. spokeswoman, said there were "probably about half a dozen." She added, "I don't think anybody's got a solid number." And Dr. Angus Nicoll, chief of flu activities at the European Center for Disease Prevention and Control, acknowledged that "we are probably underestimating the extent of person-to-person transmission." The handful of cases usually cited, he said, are "just the open-and-shut ones," like the infections of nurses in the 1997 Hong Kong outbreak and of a Bangkok office worker who died in 2004 after tending her daughter who fell sick on an aunt's farm. Most clusters are hard to investigate, he said, because they may not even be noticed until a victim is hospitalized, and are often in remote villages where people fear talking. Also, he said, by the time doctors from Geneva arrive to take samples, local authorities "have often killed all the chickens and covered everything with lime." The W.H.O. is generally conservative in its announcements and, as a United Nations agency, is sometimes limited by member states in what it is permitted to say about them. Still, several scientists have noted that there are many clusters in which human-to-human infection may be a more logical explanation than the idea that relatives who fell sick days apart got the virus from the same dying bird. For example, in a letter published last November in Emerging Infectious Diseases analyzing 15 family clusters from 2003 through mid-2005 in Southeast Asia, scientists from the disease control centers, the W.H.O. and several Asian health ministries noted that four clusters had gaps of more than seven days between the time family members got sick. They questioned conventional wisdom that only one, the Bangkok office worker, was "likely" human-to-human. In one Vietnam cluster, not only did a young man, his teenage sister and 80-year-old grandfather test positive for A(H5N1) avian flu, but two nurses tending them developed severe pneumonia, and one tested positive. In another questionable case, the Vietnamese government's assertion that a man developed the flu 16 days after eating raw duck-blood pudding was publicly ridiculed by a prominent flu specialist at Hong Kong University, who said it was more likely that he got it from his sick brother. Dr. Henry L. Niman, a biochemist in Pittsburgh who has become a hero to many Internet flu watchers and a gadfly to public health authorities, has argued for weeks that there have been 20 to 30 human-to-human infections. Dr. Niman says the authors of the Emerging Infectious Diseases article were too conservative: even though the dates in it were fragmentary, it was possible to infer that in about 10 of the 15 cases, there was a gap in onset dates of at least five days, which would fit with the flu's incubation time of two to five days. And in a study published just last month about a village in Azerbaijan, scientists from the W.H.O. and the United States Navy said human-to-human transmission was possible. That conclusion essentially agreed with what Dr. Niman had been arguing since early March — that it was unlikely that seven infections among six relatives and a neighbor, with onset dates stretching from Feb. 15 to March 4, had all been picked up from dying wild swans that the family had plucked for feathers in a nearby swamp in early February. While Dr. Niman is an irritant to public health officials, his digging sometimes pushes them to change conclusions, as it did in the recent Indonesia case. The W.H.O. at first said an undercooked pig might have infected the whole family, but Dr. Niman discovered that the hostess of the barbecue was sick two days before the barbecue and the last relative was infected two weeks after it. His prodding, picked up by journalists, eventually led the W.H.O. to concede that no pig was to blame and that the virus probably had jumped from human to human to human. The health organization's periodic updates on the number of avian flu cases and the death toll concentrate on cases confirmed by laboratories. The updates use no names and are often cleared by the affected country's health minister. Dr. Niman, by contrast, trolls local press and radio reports and uses Google software to translate them — sometimes hilariously — looking for family names, onset dates and death dates. For example, a May 15 report quotes a village midwife named Spoilt describing the death of a woman in Kubu Sembilang, Indonesia and the hospitalization of one of her sons: "Praise br Ginting experienced was sick to last April 27 2006, with the sign of the continuous high fever to the temperature of his body reached 390 C was accompanied by coughs... Added Spoilt, second casualties Roy Karo-Karo that also the son of the uterus from Praise br. Gintin after his mother died last May 3, also fell ill, afterwards was reconciled to RSU Kabanjahe." Dr. Niman contends that the largest human-to-human cluster so far was not in Indonesia, but in Dogubayazit, Turkey, in January. W.H.O. updates recorded 12 infected in three clusters, and quoted the Turkish Health Ministry blaming chickens and ducks. Dr. Niman counted 30 hospitalized with symptoms and said the three clusters were all cousins with the last names of Kocyigit and Ozcan, and that most fell sick after a big family party on Dec. 24 that was attended by a teenager who fell sick on Dec. 18 and died Jan. 1. A patriarch, Dr. Niman said, told local papers that the two branches had had dinner together six days after the 14-year-old, Mehmet Ali Kocyigit, had shown mild symptoms. He died on Jan. 1, and several other young members of the two families died shortly after, with other relatives showing symptoms until Jan. 16. No scientific study of that outbreak has been released. Dr. Niman also said clusters were becoming more frequent, especially in Indonesia. Just last week two more emerged there, one including a nurse whose infection has not yet been confirmed. With 36 deaths, Indonesia is expected to eclipse Vietnam soon as the world's worst-hit country. Dr. David Nabarro, chief pandemic flu coordinator for the United Nations, said that even if some unexplained cases were human-to-human, it does not yet mean that the pandemic alert system, now at Level 3, "No or very limited human-human transmission," should be raised to Level 4, "Increased human-human transmission." Level 4 means the virus has mutated until it moves between some people who have been only in brief contact, as a cold does. Right now, Dr. Nabarro said, any human transmission is "very inefficient." Level 6, meaning a pandemic has begun, is defined as "efficient and sustained" human transmission. Ms. Cheng of the W.H.O. said that even if there were more clusters, the alert would remain at Level 3 as long as the virus dies out by itself. "A lot of this is subjective, a judgment on how efficiently the virus is infecting people," she said. "If it becomes more common, we'd convene a task force to raise the alert level." http://www.nytimes.com/2006/06/04/world/asia/04flu.html?_r=3&oref=slogin&pagewanted=print&oref=slogin
6/3	Hello, I have been following articles on the H5N1 virus and I like your web site having been in fire/rescue the last twenty-eight years. The recent quarantine in Bucharest, Romaina is not the first time they have reacted quickly to reports of this virus. CNN.com (International) reported in October 7, 2005 that Romanian officials quarantined a Danube delta village of about 30 people after three dead ducks tested positive for bird flu. They sealed off the village of Ciamurlia and banned hunting and fishing in eight counties and suspended imports of chickens and other poultry from 15 countries (mostly in Asia). Due to their location in the world, they are taking no chances.  Tom M. see: http://edition.cnn.com/2005/HEALTH/conditions/10/07/birdflu.romania/
5/23	For all you all risk folks, you gotta try this one! The birdflu game. It has sound (you might want to turn it down). Very therapeutic! www.galaxygraphics.co.uk/games/birdflu.php Mellie
5/22	Here's the summary... Romania: (probably more about fowl than about humans) Today 13,000 people were quarantined in a quarter of the Romanian capital Bucharest; troops and police sealed off streets; may last for up to 3 weeks. All chickens will be culled. They've thrown out a tamiflu blanket. 4 people are in hospital, but they may be people with the regular flu who are worried. Test results on those in hospital should come in next week. It's the first Level 1 quarantine in a city put into place for birdflu. No one is being let in or out except for medical vehicles. We'll see how quarantine works. I hope people have enough food, water and baby formula, etc. http://channels.netscape.com 4 people in Romania suspected of bird flu (could just be people with the flu who were worried enough to go to the hospital) www.daily-news.ro/article_detail.php?idarticle=26531 Iran: (humans) (Northern portion, Kurdistan, very close geographically connected with western Turkey, Iran, and Azerbaijan, where there were family clusters of avian flu illness and death in January, February and March this year.) Today 2 Dead (brother and sister) with Suspected Avian Influenza Symptoms www.promedmail.org 3 other family members ill and in hospital, one in a coma. Confirmed H5N1 late today. www.alertnet.org/thenews/newsdesk/BLA258201.htm www.alertnet.org/thenews/newsdesk/OLI267222.htm Indonesia: (humans; overall Case Fatality Rate = 78%) For more than a week now epidemiologists have been trying to figure out how a 7 members in a family (cluster) that doesn't raise chickens got ill (6 died). It's the largest cluster to date and has characteristics (staggered or bimodal/multimodal symptom onset) that suggest human to human transmission. Last year there were several small family clusters in the same area in May 2005; the pigs tested positive for H5N1 then and it was ordered that 200 of them be culled. Only 20 were culled, so the virus has had a whole year of mucking around and changing inside a mammalian "mixing vessel"... It's considered to be endemic in the area now. Most recent gene sequence from one of the dead shows it has changed in a way that probably makes it more infectious to humans. (The longer string of bases at the hemaglutanin (HA) cleavage site is hypothesized to make its entry into the human host cell easier.) Today a 32yr and a 38yr old were diagnosed with H5N1 and died. www.alertnet.org/thenews/newsdesk/JAK110548.htm Tamiflu antiviral: The US shipped lots and lots of tamiflu to Southeast Asia. What is Health and Human Services Leavitt thinking? www.smh.com.au/news/World/US-sends-Tamiflu-stockpile-to-Asia/2006/05/23/1148150224202.html WHO Director: The head of the World Health Organization (WHO) died following surgery today to remove a blood clot from his brain. Poor man. Bird flu has killed 64% of those people known to be infected with the virus this year (at least 47 of 73 people). Last year, 2005, it killed 41 of 95 or 43%, according to World Health Organization statistics. www.who.int/csr/disease/avian_influenza/country/cases_table_2006_05_19/en/index.html