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"THE  BIRD  FLU  WATCHOUT"
Eyes on the situation...
 Last Update:  05/17/2013 10:46  PDT

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:

  1. 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.
     
  2. The risk of a pandemic happening is "one"... it is not an optional event.
     
  3. 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.)
     
  4. 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.
     
  5. 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

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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
The number of fatalities in the first 5 months since January 1, 2006 exceeds the entire 2005 number.

The areas of the world requiring tamiflu blanket to avoid more widespread outbreak are increasing.

Mellie

5/8 Fatal Contact: Bird Flu in America
Tuesday, May 9 at 8/7c

Starring Joely Richardson, Stacy Keach, Ann Cusack, Justina Machado, Scott Cohen and David Ramsey

Informational Announcement
To date, there have been no cases of the H5N1 virus in the United States nor has there been a human transmission of the disease in a form that could fuel a pandemic. However, experts around the world are monitoring the Avian Flu situation closely and are preparing for the possibility that the virus could begin to spread from person to person. For information on the virus log onto pandemicflu.gov.

There are times that test humanity and challenge the soul of a community or a nation. News images and headlines tell stories of rising waters, quaking ground and tragic acts by man himself. But the real story, the human story, is found in the lives changed forever, in the strength of the survivors, and the resilient hope that gives them the courage to recover.

Fatal Contact: Bird Flu in America follows an outbreak of an Avian Flu from its origins in a Hong Kong market through its mutation into a virus transmittable from human to human around the world. The meticulously researched film stars Joely Richardson (Nip/Tuck), Stacy Keach (Prison Break, Blackbeard), Ann Cusack (Grey's Anatomy, Ghost Whisperer), Justina Machado (Six Feet Under), Scott Cohen (Street Time, Law & Order: Trial by Jury) and David Ramsey (All of Us).

John M. Barry, Distinguished Visiting Scholar at Tulane University and writer of the New York Times bestseller, The Great Influenza: The Story of the Deadliest Pandemic in History, served as a consultant on the project. Barry's book, which includes a new afterword on today's Avian Flu, focuses on the 1918 Spanish Flu which killed between 50-100 million people.

[Editors Note: The film deals with the current threat of the Avian Flu virus (H5N1). Scientists continue to debate the degree to which the virus can mutate and be easily passed among human beings.]

http://abc.go.com/movies/birdflu.html

5/4 What do I need to know?
5/2 Think how this will relate to firefighting, fire camp and your families. Mellie

www.theworldlink.com/articles/2006/05/02/news/news30050206.txt

Government forecast massive disruptions if pandemic flu reaches U.S.

By Nedra Pickler, Associated Press Writer
Tuesday, May 2, 2006 2:24 PM PDT

WASHINGTON - Employers should have plans to keep workers at least three feet apart, colleges should consider which dormitories could be used to quarantine the sick, and flight crews should have surgical masks to put on coughing travelers under a draft of the government's pandemic flu plan obtained by The Associated Press.

The Bush administration forecasts massive disruptions if bird flu or some other super-strain of influenza arises in the United States. A response plan scheduled to be released at the White House on Wednesday warns employers that as much as 40 percent of the work force could be off the job and says every segment of society must prepare.

“The collective response of 300 million Americans will significantly influence the shape of the pandemic and its medical, social and economic outcomes,” says an undated 228-page draft version of the report that had not been finalized. “Institutions in danger of becoming overwhelmed will rely on the voluntarism and sense of civic and humanitarian duty of ordinary Americans.”

An outbreak could lead to a variety of restrictions on movement in and around the country, including limiting the number of international flights and quarantining exposed travelers. But the government does not foresee closing U.S. borders to fight the spread of flu, in part because it would only slow the pandemic's spread by a few weeks and because it would have such significant consequences for the economy and foreign affairs.

It's impossible to predict when the next pandemic will strike, or how great its toll might be. But concern is rising that the Asian bird flu, called the H5N1 strain, might lead to one if it eventually starts spreading easily from person to person.

So far, H5N1 has struck more than 200 people since 2003, killing about half of them. Virtually all the victims caught it from close contact with infected poultry or droppings.

The government is preparing for a worst-case scenario of up to 2 million deaths in the United States.

With no border restrictions, pandemic influenza would arrive in the United States within two months of an outbreak abroad, the document estimates. But models of influenza's spread suggest that sealing the U.S. border would not only be impractical - 1.1 million people cross the nation's 317 official ports of entry daily - but it would only delay the inevitable by a few weeks, it says.

Ship and plane captains already are required to report certain on-board illnesses upon arrival, but crews would be trained to take such steps as putting a surgical mask on a traveler who is coughing.

The new document calls mandatory quarantine a last resort, and urges planners to consider, for example, that closing a community would sever it from the delivery of groceries and other essential goods.
The report aims to energize the private sector, noting that 85 percent of the systems that are vital to society, such as food production, medicine and financial services, are privately run.

Not only would sick workers stay home, but so would anyone who was caring for ill family members, under quarantine because of possible exposure to the flu or taking care of children when schools shut down. The same could go for anyone who simply feels safer at home.

Included in the report's advice:

  • Employers should have workers remain at least three feet apart or otherwise limit face-to-face contact to limit the flu's spread, including by working from home or substituting teleconferences for office meetings.
  • Colleges should consider whether dormitories could be used to house or quarantine the sick, and establish mandatory sick-leave policies for anyone exposed to the flu.

The report envisions possible breakdowns in public order and says governors might deploy National Guard troops or request federal troops to maintain order. The military also could be activated to enforce travel restrictions and deliver vaccines and medicines, the report says.

Last fall, President Bush announced a $7.1 billion strategy to fight the next flu pandemic, focusing largely on public health preparations, including plans to stockpile enough bird flu vaccine for 20 million people and anti-flu drugs for 81 million. So far, the stockpile contains enough vaccine for 4 million people and medication for 5 million.

---
On the Net:

Heath and Human Services Department site on pandemic flu: www.pandemicflu.gov

This new report is Step 2, outlining how every branch of government would have to work with federal health officials to try to contain a pandemic and minimize its damage to the economy and society. By early next month, government agencies are to release the specific steps they plan.

The report attempts to settle any turf battle within the administration, saying the Health and Human Services Department would lead the government's interagency response effort and the Homeland Security Department would have a secondary role to assist with the health response and non-medical support.

---
AP Medical Writer Lauran Neergaard contributed to this report.

5/1 A number of people have been asking to have and/or use a copy of the pandemic
flu powerpoint I have presented at safety and team meetings, and about the
handouts I provided.

You may use my powerpoint. Ab gave me permission to make it available on
wildlandfire.com. You can download it here:
www.wildlandfire.com/temp/h5n1teams.ppt.
The handout I provided is also available here:
www.wildlandfire.com/temp/5simplethings.doc.

Creating this slide show took a lot of my time. I am making it available for
educational purposes and have chosen not to charge a fee for my time. However,
I ask that if you find it valuable to you, in return for using it or part of it, please
donate $10 or more (or whatever amount you like) to the Wildland Firefighter
Foundation. A check is fine. Your donation is tax deductible. As most here
know, the Foundation helps families of wildland firefighters across the nation
who die or are hurt on the fireline. www.wffoundation.org/index.html

Address and phone number below:
Wildland Firefighter Foundation
2049 Airport Way
Boise, Idaho 83705
Ph (208) 336-2996

Mellie

4/21 MSNBC has a lot of stuff on birdflu.It would be really cool if it
weren't so scary.

Here's a neat map of spread: http://msnbc.msn.com/id/12375868

Todd

4/21 Hi All,

NorCal Tom:

You asked when the R5 Pandemic Response Plan will be final. Pretty soon. From what I've heard, Forest Safety Officers from across the US are all down at the National Safety Officers Meeting in San Diego. I'm going over the plan now with a fine tooth comb. When they're all home, it's likely we'll put the final touches on it and send the plan on up the foodchain in R5 and on to the WO. (We sent the draft up to the WO safety office for comment earlier and got a few suggestions back, mostly grammatical and formatting... I heard from someone back there in January that they were interested but didn't want to pay for it... Figures...)

~ ~ ~ ~ ~ ~ ~ ~ ~ Mellie's Tribute to R5 Pandemic Response Planners ~ ~ ~ ~ ~ ~ ~ ~ ~

I want to salute Michelle Reugebrink (former Redding SJ and Tahoe NF Safety Officer), Gene Smalley (Six Rivers NF Safety Officer) and Peter Tolosano (R5 FAM Safety Officer) for their work on this. These people are truly Public Servants. We began in January immediately following the R5 Safety Officers' Meeting, at that time having no interest or support from the WO Safety shop.

Michelle has been AMAZING! She's taken all the info and coordinated the effort. I know she worked nights and weekends on it with her positive and focused energy. Smart woman and the backbone of this effort. (Perhaps some of you have seen her professional 60 second safety video messages. Inspired.) In my book, she's awesome. Thanks also to Peter who got the bird flu safety ball rolling last year and has contributed to and reviewed the plan; and thanks to Gene who met with us in Reno to work on the plan and has also gone beyond the call of duty. Consummate professionals all -- Michelle... contributing many hours after hours to get this done. You know how busy everyone is with extra duties. Imagine taking on a project like writing a R5 Pandemic Response Plan in addition to other everyday duties? My hats off to you three. Thank your families for me.

Thanks also to those around R5 who contributed feedback to the rough draft. I don't have your names at the moment, but excellent thoughtful and detailed feedback came from two people on the Shasta Trinity NF, one of whom suggested that wildlandfire.com be used to keep people updated in the face of pandemic. <grin> Thanks also to the Dispatchers Ed Hotalen and Rick Addy on the Six Rivers NF. Since the Dispatchers and LEOs are likely to fill critical pandemic response functions, they (and we) need to figure out how to minimize their risk with a mini-plan aimed at Dispatchers and another aimed at LEOs. We should do this soon.

It's clear that even with a plan for Forests, there need to be more local "Unit" mini-plans (Districts & Forests & Regions around the US, and Functions like Dispatch and LEO and whatever else is essential). We also need IMT plans for an "incident within an incident" if pandemic hits during fire season. NorCalTom as you mentioned, Jeanne Pincha-Tully (CIIMT 3) saw the firecamp need and had  two people on her team -- Scott McKenney and Frank Gruhot -- begin work on the physical medical structure and logistics of a firecamp response.

It does my heart good to see this kind of leadership and follow-through. (It was pretty clear to those of us who began the process in January that leadership would have to come from the ground early on.)

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

Pandemic planning that includes fire is also being done by the DOI and the DOA (and Dept Homeland Security: DHS) within the structure of NIMS and the National Response Plan (NRP) ... under the Essential Service Functions (ESFs). Sorry for the alphabet soup... For those who don't know...

NIMS (one-eyed nims =National Incident Management System - national level "all risk") is based on our NIIMS. Within the NRP, the ESF 4 is Firefighting and the USFS is the lead agency on that, but IMTs are asked to assist other lead agencies in support functions on many of the other of the 15 ESFs.

NIIMS (two-eyed niims =National Interagency Incident Management System - federal level fire). It began in CA in the '70s to coordinate wildfires raging across fed/state/county/city jurisdictions. You know, it's the Incident Command System created by wildland firefighters and used for years...

There is a NIMS Integration Center (NIC) located at FEMA in Washington.

Steve Gage is the wildlandfire representative at NIC and the person bringing the components of NIIMS to light and building the strategic direction for and oversight of NIMS and the NRP. [Steve is a fine, intelligent man. He was Deputy IC (CIIMT5) on the Big Bar Complex. photo (Steve in foreground and Hutch (IC) at computer). Later, Steve was IC on CIIMT 3 when the team went to assist at the Pentagon following 9/11... Team photo ... Well I digress...]

Anyway, Steve Gage and other good interagency fire people are working on plans for fire team all-risk incident response in the face of pandemic. Katrina gave us a small taste of what we will be up against when the pandemic hits (very soon or too soon, in my opinion). Response will need to be LOCAL. The Feds (the Prez, Congress, DHS, CDC, etc.) have made it clear pandemic will overwhelm the federal level. We all need to get ready to ride this out: Fire people and R5 FS people are. Communities, schools, hospitals, cities, our FAMILIES,  need to plan LOCALLY as well.

So NorCalTom and all, that's the state of affairs as I know it with Wildland Fire and National Forest Pandemic planning.

Thanks to everyone who is working to get ready and working to plan our response at the Forest level and if fire season is already underway.

Mellie

We plan to stay up and running during any pandemic, allowing all to share information. Ditto on the THANKS. Ab.

4/18 Pandemic Flu Response Planning:

Thanks to CIIMT 3 (Scott McKenney, MEDL and Frank Gruhot, (sp?) LCS,  and to Jeanne Pincha-Tully, IC) for creating the discussion paper on pandemic influenza response in firecamp. Does anyone have a digital version? I know it's draft, but I'd like to send it to fire friends.

Another Q: Anyone know when the R5 Pandemic Response Plan will be final? Thanks to Michelle Reugebrink, Peter Tolosano, Mellie, and Gene Smalley for their work on that. I only saw the draft. I'm waiting for the final. I know there were some folks on the Shasta-T that gave good feedback. Hopefully it will be incorporated.

Pandemic Flu Movie coming up next month on ABC. Info below.

NorCal Tom

http://abclocal.go.com/wtvg/story?section=primetime&id=4091093

"Fatal Contact: Bird Flu in America"

April 18, 2006 - The movie follows Avian Flu through its mutation into a virus transmittable from human to human.

On Tuesday, May 9 (8:00-10:00 p.m., ET), ABC will bring to television a two-hour original movie. "Fatal Contact: Bird Flu in America" follows an outbreak of an Avian Flu from its origins in a Hong Kong market through its mutation into a virus transmittable from human to human around the world.

The meticulously researched film stars Joely Richardson ("Nip/Tuck"), Stacy Keach ("Prison Break," "Blackbeard"), Ann Cusack ("Grey's Anatomy," "Ghost Whisperer"), Justina Machado ("Six Feet Under"), Scott Cohen ("Street Time," "Law & Order: Trial by Jury") and David Ramsey ("All of Us"). The movie opens with an American businessman flying to Hong Kong to meet with his Asian manufacturers. After 11 meetings in three countries in six days, he starts his return to Virginia. But before he returns home, the Chinese government has informed the World Health Organization that a new strain of the Avian Flu virus was discovered in a local marketplace. Over 1.2 million infected birds were killed in an attempt to eradicate this strain. Dr. Iris Varnack (Richardson) of the Epidemic Intelligence Service receives an emergency summons to China, where she discovers these efforts may have come too late. Despite the early warning, the H5N1 virus has mutated into a version that can spread from human to human -- shown in eye-opening detail whenever the microbes start to permeate the atmosphere - across races, nationalities, genders and ages.

John M. Barry, Distinguished Visiting Scholar at Tulane University and writer of the New York Times bestseller, "The Great Influenza: The Story of the Deadliest Pandemic in History," served as a consultant on the project.

Barry's book, which includes a new afterword on today's Avian Flu, focuses on the 1918 Spanish Flu which killed between 50-100 million people.

The film deals with the current threat of the Avian Flu virus (H5N1). Scientists continue to debate the degree to which the virus can mutate and be easily passed among human beings.

4/18 Pandemic Flu Response Planning:

Thanks to CIIMT 3 (Scott McKenney, MEDL and Frank Gruhot, (sp?) LCS, and to Jeanne Pincha-Tully, IC) for creating the discussion paper on pandemic influenza response in firecamp. Does anyone have a digital version? I know it's draft, but I'd like to send it to fire friends.

Another Q: Anyone know when the R5 Pandemic Response Plan will be final? Thanks to Michelle Reugebrink, Peter Tolosano, Mellie, and Gene Smalley for their work on that. I only saw the draft. I'm waiting for the final. I know there were some folks on the Shasta-T that gave good feedback. Hopefully it will be incorporated.

Pandemic Flu Movie coming up next month on ABC.

NorCal Tom

4/18 http://msnbc.msn.com/id/12371022/

Reporting the Avian Flu (Ann Curry, Dateline and Today show anchor)

It is against my nature to want to scare people. Even as a kid, I didn't understand what was fun about sneaking up on someone.

So I am struggling with my discomfort in reporting what we at NBC News have learned about the Avian Flu.
This is the virus, first found in Hong Kong, that has in recent years, spread like wildfire in birds, into Southeast Asia, then last year into Central Europe, this year reaching all the way to Great Britain, and just a few months ago, into Africa.

So far, 200 people have been made sick, more than half have died, all it appears, infected by birds.

When experts began predicting it could reach the U.S., I suggested at a Dateline story meeting, that we start asking questions: are there safeguards to protect the American people? What should we do to protect ourselves? Dateline's senior producers assigned a team to investigate.

Ever wish you'd never asked?

Our NBC News team, contacted some of the world's top experts in the field of influenza, including leading officials at the World Health Organization, the Centers for Disease Control, the U.S. Department of Health and Human Services, and more.
Here's what they told us:

  1. As the Avian Flu spreads, it is mutating, increasing the chances it will turn into a virus that can be spread not just from birds to humans, but from humans to humans. If this happens there would a pandemic. No one knows whether or not this will happen.
  2. If a pandemic starts, chances are it cannot be stopped. The World Health Organization told us, it would try to stop it, if warning signs come in time. But this has never been tried before.
  3. According the U.S. Department of Health and Human services, in a severe pandemic, as many as 90 million people could get sick worldwide. Most people who would survive, but by some estimates almost two million people might die.

    At this point, you are probably thinking, as I was, you've got to be kidding. But that's what the government is saying.)
     
  4. It would likely take at least 6 months to produce a vaccine, once the new, mutated virus is identified. So during the height of a pandemic, a vaccine will not be available.
  5. It is very possible the current strain of Avian Flu will not mutate into a virus that can be transmitted by humans. Still, according to these same experts, a flu pandemic of some sort is "probable," because history tells us "pandemics happen." There have already been three in the last century, the worst in 1918, killed up to 40 million.

    But certainly, you might be thinking, "Surely, with all the medical advances at our fingertips, America will never see a pandemic like 1918, right?" The U.S. government isn't so sure.
     
  6. The nation's Secretary of Health and Human Services, Mike Leavitt, who has closely studied the 1918 pandemic says America is "underprepared," that if a pandemic were to start, people would die, hospitals in the U.S. would be overwhelmed, and that even when a vaccine is found, it may not be widely available, as there are not currently enough vaccine manufacturers to produce all that would be needed.

Here's the good news. We can better protect ourselves if we are informed.
So our news team asked the same group of world experts on influenza to help write a scenario on how a pandemic could start, how it could affect daily life, and what people can do to protect themselves.

Because we needed to illustrate the scenario, NBC News took the unusual step of using volunteers and a few community actors working with NBC news cameramen to go through the motions of visualizing what could happen.
The team worked to stay strictly within the bounds of good journalism, and it was a challenge under the unusual circumstances. Pains were taken to make certain we stayed true to what the experts were telling us.

The final report is a full hour, which airs this coming Sunday night, April 23rd, on Dateline NBC.

I hope you are informed and empowered. But please forgive us. We may, because of the subject matter, also scare you a little.

4/17 Here's an excellent preparations list from fluwikie.com..

www.fluwikie.com/pmwiki.php?n=Consequences.PersonalPreparedness
If this doesn't work, it's reposted at flutrackers.com at the link below. (fluwikie.com is overloaded sometimes.)

www.flutrackers.com/forum/showthread.php?t=4404#post8694

I was out of town last week, but did look up current H5N1 deaths by age (World Health Organization) before I left.

What are the patterns?

More than 50% of those who currently die are between ages 5 and 24.
(Younger than in the 1918 pandemic when 50% were between 18 and 40.)
96% of those who became ill are younger than 45, but only 1 of the 5 older than 45 who became ill recovered.

Small numbers, I know, but interesting if I can put my mind in the purely academic place.

Message is this:

Prepare for the worst case scenario human to human pandemic. Whatever your age, don't get sick!

Prepare yourself and your family with adequate food, water and Rx meds to ride out the times when the illness will be sweeping your community.

Age Ill Recovered Dead % Dead of Total Cumulative % Dead
Less than 5 24 8 16 14.5 14.5
5-14 38 9 29 26.4 40.9
15-24 39 10 29 26.4 67.3
25-34 24 7 17 15.4 82.2
35-44 15 0 15 13.6 96.3
45-54 3 1 2 1.8 98.1
55-64 1 0 1 0.9 99
65 or older 1 0 1 0.9 100
Total 145 35 110 100  
4/12 IAFF (International Association of Fire Fighters)

INFLUENZA PANDEMIC CHECKLIST (updated 1/11/06)



I. PLANNING LOGISTICS

Establish an Incident Management System that meets NFPA 1561, Standard on Emergency Services Incident Management System, including written Standard Operating Procedures (SOP) and Mitigation Plan.

Identify and define roles and responsibilities of Incident Commander who will coordinate the emergency response and the response teams (NFPA 1500, chapter 8.1).

Inter-Agency Cooperation: Establish relationships with community public health department and other emergency management groups.

Define functional roles and responsibilities of internal and external agencies, organizations, departments, and individuals, and establish lines of authority.

Communications Plan: Establish systems and procedures (how, how often, when, what, and to whom will the information be disseminated) and articulate resource requirements.

Set up authorities, triggers, and procedures for activating and terminating response plan.

Develop and plan for scenarios likely to result in an increase or decrease in demand for your services during a pandemic (e.g. search and rescue, assist with quarantine, etc).

Define potential roles outside of usual duties (i.e. assisting healthcare facilities in mobilizing patients from one location to a quarantine location or other unusual activities).

Determine training and define needs for training (NFPA 1600, 5.12).

Implement an exercise/drill to test your plan, and revise periodically. Develop a disaster recovery plan.


II. INFECTION CONTROL

Ensure adoption of an infection control program that meets the requirements of NFPA 1581, Standard on Fire Department Infection Control Program.

Ensure fire department has a written infection control policy statement defining the department’s mission in limiting the exposure of members to infectious diseases during the performance of their assigned duties and while in the fire station living environment.

Ensure fire department has an experienced individual within the department designated as the infection control officer. Ensure availability of all flu vaccines. (Mellie Note: No effective pandemic influenza vaccines are currently available.)

Ensure training and education is a component of the infection control program and includes proper selection and use of personal protective equipment, standard operating procedures for safe work practices in infection control, proper methods of disposal of contaminated articles and medical waste, cleaning and decontamination, exposure management, and medical follow-up.

Ensure fire department implements and enforces hand and skin washing practices and decontamination procedures.

Establish fit testing and skill training on all respirator types used to prevent exposures.

III. Inventory Checklist Community: Develop an understanding of the local community dynamics, available resources, and how they may shift during a pandemic – size and distribution of population, number and location of health facilities, quarantine sites, transportation issues, large spaces that could be transformed into healthcare or shelter facility, etc.

Resources: Identify requirements during surge capacity (i.e. during a pandemic) – PPE, medical gloves, P-100 respirators, vaccines, emergency supplies for potential shelter-in-place at worksite, etc.

Establish funding sources for planning process and for surge capacity.


IV. IMPACT ON STAFF

Determine impact on staff – absenteeism due to illness or attending to ill family member or afraid to come into work, and develop Contingency Plan for such an event.

Determine potential safety issues and plan for prevention Train and prepare ancillary workforce (e.g. contractors, non-first responders, support staff)

Encourage and track vaccination history (annual influenza, HepB, HepA, Td, etc.).

Evaluate staff access to, and availability of, healthcare services during a pandemic.

Services should include mental health and social services.

Establish policies for restricting travel and preventing influenza spread at the worksite.

Encourage proper hygiene practice and universal precautions.


V. RESOURCE ALLOCATION EDUCATION:

Disseminate Influenza Pandemic Information.

Utilize information developed by IAFF and other materials on pandemic.

Communication Channel: establish two-way information flow.

Disseminate information frequently to all staff to prevent misinformation or fears based on rumors.

Establish a dedicated staff member who is responsible for disseminating information.

Staff must also be able to easily provide feedback to designated staff member on what they are facing, including those issues experienced in the field.

Establish funding for training sessions.
4/7 Deaths are still from Cytokine Storm and ARDS (Acute Respiratory Distress
Syndrome), so are in those with the strongest immune systems. Our next
generations.

I'll look it up.

Mellie

4/7 Younger so far with this virus for who gets infected. I wonder what ages the deaths are???

In 1918, 50% of deaths were in the 18-40 age range.

Terrie

4/6 Respectful thanks to Bernd Sebastian Kamps, M.D.
of Influenza Report 2006
http://influenzareport.com

Age Distribution of Human H5N1 Cases

6 April 2006

An analysis of demographic data published by WHO shows the following age distribution of human H5N1 influenza cases (n=144). 50% of cases were 17 years or younger; 75% of cases were 29 years or younger; 90% of cases were 37 years or younger. Most patients were born after 1968.

For patients with available data (n=144; 6 April 2006), the age distribution is as follows:
<5 years: 11.8%
5-14 years: 28.5%
15-24 years: 25.7%
25-34 years: 16.0%
35-44 years: 13.2%
45-54 years: 2.8%
55-64 years: 0.7%
>=65 years: 1.4%


You may download the corresponding Microsoft Access file.

50% of cases were 17 years or younger
75% of cases were 29 years or younger
90% of cases were 37 years or younger

Most patients were born after 1968.

http://influenzareport.com/ir/figures/ad060406.htm

3/28 Ab,

Here's the Influenza Workforce Protection Plan the Bosworth mentioned:
www.wildlandfire.com/docs/2006/fs_influenza_protection.doc (doc file; clicking will download it)

Silk

Thanks, Silk. Good info here. Ab.

3/27 Here is an amazing article in the LA Times… These are top avian flu researchers talking and they sound very worried.

 Please if you have not yet done so put aside a food supply to keep your families safe for a month or six weeks. Not having to go out and mingle at grocery stores may save your family's life. If this virus sticks to its current patterns when it goes human-to-human, it kills approx 60% of those it infects. Last time I looked, more than 50% of deaths are in children and young people 5 to 26 years old with slightly more females dying than males. The sample size for confirmed human infections is still near 186 and deaths are 105. Kids and females may handle more poultry.

Please get ready with food and water. This is not about panic, this is about being prepared. It's the logical thing to doMellie

http://tinyurl.com/h7dc3

“Title: Bird Flu Defies Control Efforts"

The culling of flocks has failed to slow the rapid spread of the virus, due in North America this year. Vaccination of poultry is under study.

The spread of avian influenza to at least 29 new countries in the last seven weeks — one of the biggest outbreaks of the virus since it emerged nine years ago — is prompting a sobering reassessment of the strategy that has guided efforts to contain the disease…”

“…”Something generally disturbing is going on at the moment,” Nabarro said. “It’s certainly in the bird world, and it’s pushing up against the human world in a serious way.”…”

“…”We expected it to move, but not any of us thought it would move quite like this,” said Dr. David Nabarro, the United Nations’ coordinator on bird flu efforts…”

“…We cannot contain this thing anymore. Nature is in control,” said Robert G. Webster, a virologist at St. Jude Children’s Research Hospital in Memphis…”

“…”Each morning I sit down at the computer … there’s another country, another outbreak or another human case,” said Nancy J. Cox, chief of the influenza branch at the U.S. Centers for Disease Control and Prevention.

“It keeps us breathless,” she said.”

“…”Once it’s in migratory fowl, you really can’t contain the movement of the disease,” Cox said. “In an ideal world, we’d put the spark out, but that’s in an ideal world.”

“…Work on a human vaccine is proceeding, and the CDC has begun stockpiling millions of doses of an H5N1 vaccine undergoing clinical trials.

That vaccine, which was derived from a strain of the virus circulating in Vietnam in 2004, is being produced by Chiron Corp. of Emeryville, Calif., and French drug maker Sanofi Pasteur.

Researchers have begun work on another human vaccine derived from a more recent version of the virus, the U.S. Department of Health and Human Services announced this month. That version is based on a strain harvested from Indonesia in 2005 and is more closely related to strains in Europe, Africa and the Middle East.

The key now, said Cox of the CDC, is buying time to develop vaccines and devise a strategy for using them effectively….”

3/27 News coverage has been full of information and predictions about avian influenza and the potential for a world-wide incident similar to the Spanish Flu pandemic in 1918. I’d like to give you my take on this.

While I think it is good business to do some organizational and personal contingency planning, I don’t want people to panic and assume the worst case scenario. The Forest Service is the best organization I know of at planning for and managing emergencies. We need to bring that expertise to this potential in a calm and professional manner.

Attached is a copy of Avian Influenza Bulletin #1. This is the first of our periodic information updates on the avian influenza and potential pandemic. We will send status reports and new information as it becomes available in the future.

We also recently distributed an Influenza Workforce Protection Plan. This document provides direction for field units on developing local plans. Bulletin #1 describes several other actions underway for communicating up-to-date, factual information on this emerging issue.

There are many unknowns at this point. While experts think avian influenza will probably get to the United States sometime in the next year by migrating wild birds, no one knows if it will mutate which would set the stage for a potential pandemic influenza outbreak. It would be wise to be prepared and I know we will be.

That’s my take.

Dale Bosworth
Chief, USDA Forest Service

USDA Forest Service Avian Influenza Bulletin #1

3/26 Here's a 1918 pandemic story from the east SF Bay area. SoCal CDF

Posted on Sun, Mar. 26, 2006

As flu pandemic swept world, locals sought isolation

www.contracostatimes.com/mld/...jsp

Virus of 1918, which killed tens of millions, meant East Bay residents donned masks, closed public gathering places

By Sandy Kleffman
CONTRA COSTA TIMES (CA)

Concord shut down its saloons, suddenly becoming "a bone dry town."

Livermore banned card playing and dice shaking.

UC Berkeley required students and faculty to wear masks, creating an eerie atmosphere on campus and more than a little identity confusion.

The 1918 flu pandemic profoundly affected the East Bay.

As the virus swept the world, killing 40 million to 50 million people and making many others gravely ill, local residents hunkered down, isolating themselves in often-vain attempts to prevent the virus' spread.

The Richmond city health officer closed schools, pool rooms and bowling alleys "until further notice." The schools remained shuttered for more than two months, according to Times' historical writer Nilda Rego.

"The entire state is practically all closed up," reported the Independent, a Richmond newspaper.

Livermore leaders encouraged residents to avoid public gatherings, including church services, notes historian Gary Drummond in an article on the pandemic. Attendance at funerals was limited to family members.

In Martinez, the Shell Oil Company converted its old mess hall into a temporary hospital for employees. Workers who fell ill had to present a doctor's certificate verifying their recovery before they could come back inside the refinery gates.

Many cities aggressively enforced mask requirements. Oakland created a 300-person special police force to crack down on its residents, notes Rex Adams in an article for the Chronicle of the University of California.

Two days after Berkeley's mask ordinance took effect, authorities arrested 171 men and four women "mask slackers." They faced fines up to $500.

Fears of the virus extended to weddings. On Oct. 28, Abraham Rothenstein kissed his bride, Annie Nicholson of San Pablo, through a gauze mask.

At UC Berkeley, the virus first spread rapidly among members of its Students' Army Training Corps. To protect the city, the university quarantined the SATC students, banning them from leaving campus.

As the virus spread throughout the university, halls and gyms became infirmaries for hundreds of ill students.

Classes continued, but with many empty seats. The UC Berkeley president recommended a moratorium on new class assignments for 10 days to prevent large numbers of students from falling behind.

The demand for masks exceeded supply. UC Berkeley women began producing them by the thousands, as did Red Cross volunteers in Martinez.

One student, writing in the UC Berkeley campus newspaper, remarked on the anonymity of those who wore masks.

"It was rather an unusual sight to see people go about the campus yesterday, trying to decide whether the persons in front of them were or were not acquaintances. No doubt several unintentional 'snubs' were given and probably some may have thought a wildly democratic fever had suddenly seized every member of the university.

"... Few of us stopped to consider the serious side of the order issued to wear masks."

Research librarian Camille Donaldson contributed to this story.

3/23 Important discussion of probable avian flu pandemic when the virus goes human to human
Interview with Dr. Michael Osterholm: 

The flu bug that could bring the world to its knees

Print this one off and send it to your family members, friends, and to your Safety Officers. Ab.

3/22 Hi All,

Oh my, I do wish it were this simple and safe for humanity as people would like the newest research to suggest. Scientists surveyed in a Carnegie Mellon University Study say we will need a "breather" or "lull" of at least 3 years to begin to dodge this current pandemic bullet. It would be so nice to have that to count on...

This information my two friends sent in the link on physical preferences of the H5N1 virus binding has been known (kinda) for a while. An article was published in Science last year. (I can dig the article up if you want; it's pretty technical.) The authors of that article discussed the differences in H5N1 affinity at the cellular level: H5N1 does have greater affinity for receptors in the gut of birds and lower affinity for receptors in the upper respiratory tract of mammals. (Thank goodness or we'd be in pandemic now.) This newest Kawaoka research published today reinforces and clarifies that finding from a different direction. Good science builds upon itself...

Kawaoka is right that the cells in the upper portions of the human respiratory system lack the surface receptors that allow H5N1 to dock with the cell. It's true that receptors are molecules on the surface of cells that act like a "lock". A virus with a complementary binding molecule - the "key" - can use the surface receptor to gain access to the cell. Once inside, it can multiply and infect other cells.

The point is, the virus "key" continues changing genetically and is now more frequently getting inside mammalian cells and infecting mammals. It's infected a number of different mammals in many parts of the world (including humans and pigs, domestic cats, lions, tigers, dogs, martins). It is largely transmitted bird to mammal, infecting the mammal's deep lung tissues. To be infected, mammals probably have to be infected with a substantial viral load and/or possibly have a weakened immune system.

Once infected, Houston, we have a problem... Mammals (including humans, pigs, cats etc) can get co-infected with two virus subtypes (for example, H5N1 with H9N2 or with H1N1 the 1918 virus). That is, mammals can have two infections simultaneously; and two infections can bring about viral change for the worse with respect to pandemic.

When the viruses are replicating in host cells, the two subtypes of viruses can exchange genetic information. Many scientists believe that mammals provide the "mixing vessel" that will let the H5N1 virus exchange genetic material with another virus subtype in the co-infected mammal. In the host cell, it's like a soup of viruses of both types. They get tangled up and cross-over and break, exchanging pieces of genes, in a process called homologous recombination. The gene exchange that can make new baby viruses transmit human-to-human can be very simple. As few as one or two sites on the gene segments need to change. For example, changing part of the HA gene segment to alter the shape of the HA cleavage site on the spike on the virus' surface may be all it takes to make  H5N1 prefer human (mammal) upper respiratory cells.

In the analogy of the lock and key, the human "lock" hasn't changed; the virus "key" has. The virus key has acquired another "tooth" shape that activates another tumbler on the host cell's surface lock, getting it ever nearer to efficient entry. (One spot on the HA gene segment that takes H5N1 closer to having human-to-human transmission is S227N or S223N if you read it by a different counting standard. This change turned up in Turkey. Given genes present in that environment where flyways cross, it was predicted to occur there... Result: There was at least one human to human cluster of deaths in Turkey.)

I'm certain that one reason everything is ramping up preparation wise around the world is that many scientists feel that we may be only one or two "teeth" off from having the perfect "key" for efficient human-to-human or mammal-to-mammal transmission. When that will finally occur is unknown, but I'd rather think it's soon and plan for pandemic than be caught flat-footed. This is one of those high risk, low frequency events that Gordon Graham talks about in risk assessment and planning... He says we should train for those as best we can!

Clusters of H5N1 human to human infection are occurring among family members. Even WHO acknowledges this in Azerbaijan, in Indonesia, and in Vietnam, (probably also in Turkey, Iraq and possibly among soldiers in Tiblisi, Georgia around the Caspian Sea.) It's just not yet efficient human to human transmission in the upper respiratory tract. You could say we're still lacking a tooth or two on that "key" to get those tumblers to fall in place. 

But the virus keeps moving around the flyways from Asia into Africa and Europe, into new populations of domestic fowl, into barnyard mammals that act as mixing vessels and into humans. Huge numbers of pigs (250,000 in South Africa alone) and ostriches are being culled in Africa. 

Although the human sample size is still small (103 deaths of 173 infected with H5N1- official from WHO), I find it interesting that 6% of all human deaths from H5N1 have been reported in the last 48 hours. They're from from Azerbaijan.

For those interested in reading, here's another interesting understandable article just out:
How a Pandemic Spreads: www.sci-tech-today.com/story.xhtml?story_id=11200002TIS0&page=1 

Good basic H5N1 virology info for those interested:
www.fluwikie.com/index.php?n=Science.InfluenzaPrimerII#command 

Just a few thoughts... I wish I could believe that human to human transmission changes aren't coming soon... that we could dodge this pandemic... I don't. I think virus changes will keep coming at the recent rate and the virus will continue to do its thing... unfortunately...

Mellie

3/22 Several emails have come in from friends providing links to articles focusing on some new research published today. They'd like some feedback. See post above for that. Mellie

Cell barrier slows bird flu's spread among humans
By Terry Devitt 
Some good graphics on this one...

and this, posted here for the sake of discussion...

Why bird flu is so hard to catch
By Mark Henderson

Fears that human beings could fall prey to a pandemic have been eased by new research.
SCIENTISTS have explained why the bird flu virus does not readily spread from person to person, shedding light on how it would need to mutate in order to cause a human pandemic.

The H5N1 influenza strain struggles to infect cells high up in the human airway, significantly limiting the extent to which victims can pick up the virus and pass it on by coughing and sneezing, according to research. The findings, from separate teams in the United States and the Netherlands, suggest that H5N1 will probably have to evolve substantially if it is to become easily transmissible between people; the key step that would make a pandemic possible.

The research also highlights several critical mutations that would ring alarm bells if spotted in virus samples, allowing for improved surveillance of the threat it poses to humans.

While the H5N1 virus is highly virulent when contracted by humans, with 184 cases and 103 deaths confirmed by the World Health Organisation, it does not easily infect people and all the victims so far picked it up by direct contact with birds.

This resilience to H5N1 stems from the way the virus binds to cells in the airway, the new studies indicate. While ordinary human strains of influenza readily infect cells in the windpipe, only cells much deeper inside the lungs have the right receptors that allow H5N1 to dock with them. This is important for two reasons: the upper airway is more likely to be exposed to the virus than the inner pockets of the lungs, and infections in the windpipe are also more readily passed on.

When the virus is present only in the lower respiratory tract, it is unlikely to be released by coughing and sneezing. People with upper airway infections, however, are likely to expel millions of virus particles with every splutter.

“Deep in the respiratory system, cell receptors for avian viruses, including avian H5N1 viruses, are present,” said Yoshihiro Kawaoka, of the University of Wisconsin-Madison, whose study is published today in the journal Nature.

“But these receptors are rare in the upper portion of the respiratory system. For the viruses to be transmitted efficiently, they have to multiply in the upper portion of the respiratory system so that they can be transmitted by coughing and sneezing.

“Our findings provide a rational explanation for why H5N1 viruses rarely infect and spread from human to human, although they can replicate efficiently in the lungs.”

The second study, led by Thijs Kuiken, of the Erasmus Medical Centre in Rotterdam, reached similar conclusions and is published in the journal Science. It found that the airways of cats and ferrets are affected by H5N1 in similar fashion to humans, making both good animal models for further research.

Dr Kawaoka said that the research pinpoints several key mutations, in the haemagglutanin protein that the virus uses to bind to cells, which would be of grave concern if they were to be identified in H5N1. “Identification of H5N1 viruses with the ability to recognise human receptors (in the upper airway) would bring us one step closer to a pandemic strain,” he said. “Recognition of human receptors can serve as molecular markers for the pandemic potential of the isolates.

“Mutations in the haemagglutanin for avian H5N1 viruses to recognize human receptors are needed for the virus to become a pandemic strain. No one knows whether the virus will evolve into a pandemic strain, but flu viruses constantly change. Certainly, multiple mutations need to be accumulated for the H5N1 virus to become a pandemic strain.” The results come days after a team in the US identified that the virus has split into two distinct genetic subtypes, widening the gene pool from which a pandemic strain might emerge. 

3/21
Wildlife Health Bulletin #05-03

To: Natural Resource/Conservation Managers
From: Leslie Dierauf, Director, USGS National Wildlife Health Center
Title: Interim Guidelines for the Protection of Persons Handling Wild Birds With Reference to Highly Pathogenic Avian Influenza H5N1
Date: August 23, 2005
These Guidelines have been developed in consultation with the Centers for Disease Control and Prevention. They are advisory in nature and intended to provide guidance for field biologists and others working with or handling wild birds with specific reference to highly pathogenic avian influenza. The guidance reflects information available as of August 2005 and may be updated as more information becomes available.

Highly Pathogenic Avian Influenza H5N1
To date, Highly Pathogenic Avian Influenza A H5N1 has not been detected in humans, poultry or wild birds in North America and no data suggest that H5N1 should be suspected of being in North America or in wild birds migrating from Asia to North America this fall (2005).

Avian influenza, or bird flu, is a virus typically found in wild birds, especially waterfowl and shorebirds. The virus is only found in a small number of birds in the wild, and generally does not cause clinical signs of disease. The virus is shed in fecal droppings, saliva and nasal discharges.

Since 2003, a particularly virulent strain of this virus has emerged in Asia —the highly pathogenic avian influenza (HPAI) H5N1 virus. The HPAI H5N1 virus probably originated from domestic poultry in that region and is of concern because: 1) it poses a threat to domestic poultry, especially chickens; and
2) it has caused illness in 112 persons, including the deaths of at least 57 people as of August 2005. Most human cases are thought to have become infected with the virus through direct handling of infected poultry, consumption of uncooked poultry products, or contact with virus-contaminated surfaces/materials.

However, to date, the risk of H5N1 transmission to people through direct contact with infected poultry remains very low. Probable, limited person-to-person transmission of H5N1 viruses in a small number of cases has been reported.

There are an increasing number of reports that HPAI H5N1 is infecting and causing death in wild birds, including some migratory species. These events and the associated spread of the H5N1 virus to new geographical areas in Asia have created concerns and questions about the possibility that the H5N1 virus could be carried into North America in migratory birds.

These Guidelines provide advice about practices and precautions people should exercise to mitigate the risk of HPAI H5N1 viral infection based on the level of exposure to wild birds. Because situations can change quickly, we have included recommendations for handling wild birds in the event that HPAI H5N1 is detected. It is important to check with your respective public health, animal health, and natural resource agencies for up-to-date information on HPAI H5N1.

There is no known case where H5N1 has been transmitted from wild birds to humans. However, even apparently healthy wild birds can be infected with microorganisms other than HPAI, some of which are currently of more concern to human health in North America than HPAI H5N1.

Recommendations:
Thoroughly washing hands with soap and water (or with alcohol-based hand products if the hands are not visibly soiled) is a very effective method for inactivating influenza viruses, including HPAI. These viruses are also inactivated with many common disinfectants such as detergents, 10% household bleach, alcohol or other commercial disinfectants. The virus is more difficult to inactivate in organic material such as feces or soil.
The General Public should, as a general rule, observe wildlife, including wild birds, from a distance. This protects you from possible exposure to pathogens and minimizes disturbance to the animal.
  • Avoid touching wildlife. If there is contact with wildlife do not rub eyes, eat, drink, or smoke before washing hands with soap and water as described above.
  • Do not pick up diseased or dead wildlife. Contact your state, tribal or federal natural resource agency if a sick or dead animal is found.
Hunters should follow routine precautions when handling game.
  • Do not handle or eat sick game.
  • Wear rubber or disposable latex gloves while handling and cleaning game and thoroughly wash hands and all knives, equipment and surfaces that come in contact with game.
  • Do not eat, drink, or smoke while handling animals.
  • All game should be thoroughly cooked (well done or 160 o F). Additional information can be found at: www.who.int/entity/foodsafety/fs_management/No_02_Avianinfluenza_Dec04_en.pdf. (pdf file)
Field Biologists handling apparently healthy wild birds in areas where HPAI H5N1 is not suspected
should work in well-ventilated areas if working indoors. When working outdoors work upwind of animals, to the extent practical, to decrease the risk of inhaling aerosols such as dust, feathers, or dander.
  • When possible, wear rubber or latex gloves that can be disinfected or disposed of and protective eyewear or a face shield while handling animals.
  • Wash hands with soap and water often and disinfect work surfaces and equipment between sites.
  • Do not eat, drink, or smoke while handling animals.
Field Biologists handling sick or dead birds associated with a mortality event should:
  • Follow the recommendations above and at a minimum wear protective clothing, including coveralls, rubber boots, latex or rubber gloves that can be disinfected or disposed.
  • Minimize exposure to mucosal membranes by wearing protective eyewear (goggles) and a particulate surgical mask (NIOSH N95 respirator/mask is preferable).
  • Decontaminate and properly dispose of potentially infectious material including carcasses. For additional Information see USGS Field Guide to Wildlife Diseases:
    http://www.nwhc.usgs.gov/publication.../chapter_4.pdf (pdf file)
  • Do not eat, drink, or smoke while handling animals.
Recommendations if HPAI is detected in North America

Field Biologists working with wild birds in areas where HPAI H5N1 has been detected
, particularly during disease control operations, should consult with a health care provider and follow the latest guidelines from CDC and the WHO for prophylactic medications and precautions for persons involved in avian influenza disease control: www.who.int/entity/csr/diseas...0Influenza.pdf (pdf file)
www.cdc.gov/flu/avian/profess...otect-guid.htm
  • Follow the recommendations above and the basic guidelines for infection control, including how to put on and use, remove, disinfect or dispose of personal protective equipment and clothing.
  • Wash hands frequently and disinfect exposed surfaces and field equipment between work sites.
  • Do not eat, drink, or smoke while handling animals.
  • Wear coveralls, gloves, shoe covers, or boots that can be disinfected or discarded, a respirator (NIOSH N95 respirator/mask is preferable) and protective eyewear (goggles).
  • Monitor your health for clinical signs of influenza infection during and for one week after your last exposure to potentially HPAI virus-infected or exposed birds.
  • Contact your healthcare provider if you develop fever, flu-like symptoms or conjunctivitis (eye inflammation). Inform them prior to arrival that you have potentially been exposed to HPAI.
Additional information about HPAI H5N1 can be found at the following Web links:
USGS National Wildlife Health Center : www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp
Centers for Disease Control and Prevention: www.cdc.gov/flu/avian/index.htm

www.nwhc.usgs.gov/publication.../WHB_05_03.jsp
3/20 CIDRAP - US agencies report plans to detect H5N1 in birds
Amy L. Becker Staff Writer

Mar 20, 2006 (CIDRAP News) – The chiefs of three federal agencies, predicting that the H5N1 avian influenza virus will enter the United States, today unveiled their joint plan for quickly detecting the virus.

"We're closely monitoring the rapid spread of the H5N1 virus overseas," said Agriculture Secretary Mike Johanns. "We now believe it is likely that we will detect it within our borders in the United States. It is critically important to understand that the detection of this virus among birds will not signal the start of a pandemic among people. The time is now to expand our early warning system."

Interior Secretary Gale Norton and Health and Human Services Secretary Mike Leavitt, along with Johanns, conducted a joint press conference today to prepare people for the possible arrival of the H5N1 virus in the US. The news conference was broadcast live via the Internet.

The interagency plan, which received final approval today, Johanns said, relies on a number of methods to screen wild birds, notably birds migrating along the Pacific flyway to and from Alaska.

The recent rapid spread of H5N1 in other countries underscores the likelihood of the virus spreading to the United States.

"It is increasingly likely that we will detect the highly pathogenic H5N1 strain of avian flu in birds within the US borders, possibly as early as this year," Norton said. She outlined a plan for systematic monitoring of birds that includes:

  • Testing of sick or dead wild birds
  • Testing of live wild birds, particularly the highest-risk species, using capture and sampling (not killing birds)
  • Targeted sampling of hunter-killed birds
  • Monitoring and testing of sentinel animals, including backyard poultry flocks and waterfowl placed in wetlands to mix with migratory birds
  • Testing of environmental samples, including water and avian fecal samples

Systematic investigation of sick or dead wild birds offers the highest probability of detecting H5N1 early, Norton added. Authorities expect to collect 75,000 to 100,000 samples for testing in 2006. The US Department of Agriculture (USDA) and the Interior Department have tested more than 16,000 birds in the Pacific and Atlantic flyways since 1998, according to a news release. The birds have all tested negative for the lethal H5N1 strain, but 22 low-pathogenicity avian flu isolates have been identified.

Samples will be tested at the appropriate laboratories, Norton said, but she cautioned that initial positive tests are considered presumptive, not definitive. Positive samples will be sent to the USDA's national laboratory in Ames, Iowa, for confirmatory testing.

"We anticipate that presumptive H5N1 results may be announced 20 to 100 times this year," she said. There could be dozens of reports of H5N1 without any highly pathogenic strains, she added.

Discussing how the agencies will collaborate, Johanns said:

  • The Interior Department will monitor wild birds through the US Fish and Wildlife Service (USFWS) and the US Geological Survey (USGS), as well as the National Park Service (NPS).
  • The USDA has a connection to wild birds through its Animal and Plant Health Inspection Service and the Agricultural Research Service, although its main focus is domestic flocks.
  • HHS is chiefly responsible for human health.

Johanns also described efforts to prevent the possible spread of H5N1 virus from wild to domestic birds.

"None of us can build a cage around the United States," he said. He emphasized that the nation's $29 billion poultry system is highly biosecure, so the presence of H5N1 in migratory birds does not necessarily mean that commercial poultry will be infected. Further, he said the US has demonstrated an ability to handle outbreaks of highly pathogenic viruses, even as recently as 2004.
In addition, producers will be compensated for destroyed birds, and they have demonstrated that they'll notify the government at the first signs of illness among their birds, he said.

"Unlike what we have seen in some countries, where producers are reluctant to report the virus because of economic losses, our producers know their loss will be covered if they call us," Johanns said. Although he mentioned the possibility of limited vaccination in a ring around affected areas, he said culling of infected flocks would be the chief approach to eliminating the virus if it reaches commercial poultry.

Leavitt provided an overview of preparations for a human pandemic that hewed closely to his talks at pandemic meetings in several states. He reiterated a point made by all three secretaries as they sought to prepare people for the arrival of the virus in US birds without provoking undue fear or panic.

"At this point, if you're a bird, it's a pandemic," Leavitt said. "If you're a human being, it's not. It's as simple as that."

See also:
USDA news release about the interagency briefing
Link to recorded Webcast
www.usda.gov/wps/portal/usdahome
Full text of US strategy for early detection of highly pathogenic H5N1 avian influenza in wild birds, Mar 13, 2006 (91 page pdf file) www.usda.gov/documents/wildbirdstrategicplanpdf.pdf

www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/mar2006presscon.html

3/18 This last week, Dr. Robert Webster, head of St. Jude Children's Research Hospital said: 50% probability of a pandemic in the near future, and the pandemic would kill one half of the US population over an 18 month to 2 year period.

Those are very heady words. Coming from this man who is conservative and rational (though imo wrong in failing to see the major roll that recombination plays in viral evolution...the answers not yet fully in), the concept Dr. Webster expressed deserves IMMEDIATE and INTENSIVE though and reality exploration.

RECOMMENDATION # 1:
ACTION: Cross train staff, immediately add more staff, immediately cross train the new staff as well.
My first recommendation is that companies who wish to continue in business immediately cross train staff and where possible, hire now backup staff. The loss of 50% of the workforce means that job skills will disappear. There is a need for legacy information and techniques to be understood so the business can continue, even though its customer base will have shrunk.

RECOMMENDATION #2:
ACTION: Secure alternative supply sources throughout the vertical production and delivery chain.

RECOMMENDATION #3:
ACTION: Begin to woo labor now. This will be costly. It will involve their belief that you are protecting them against this disease.
After the pandemic, labor will be in extreme shortage. Act responsibly now, and the labor will stay, albeit at higher prices.

GR

GR, I heard his interview. It amazed me. He has certainly changed his tune. I wonder what he knows that is not public knowledge. Ab.

3/17 Just pass'n it along... GH

Pandemic Influenza Preparedness

According to www.PandemicFlu.gov, managed by the Department of Health and Human Services, Avian Flu is caused by influenza viruses occurring naturally among wild birds. Its H5N1 variant is deadly to birds and can be transmitted to humans. The website explains that if the disease also spreads easily from person to person, then a global outbreak or pandemic of severe illness is probable.

This probability is an extraordinary issue that warrants the attention and activity of Emergency Services Sector (ESS) organizations nationwide. The Emergency Management and Response-Information Sharing and Analysis Center (EMR-ISAC) has seen estimates from credible sources that over a million Americans could die from an H5N1 pandemic, with millions more becoming seriously ill.

Considering the potential for a flu pandemic, the ISAC urges all public and private components of the ESS, community stakeholders, business and industry, and educational institutions to acquire reliable information about this possible threat to the United States. The EMR-ISAC specifically encourages community leaders and first responder departments and agencies to expedite their education regarding applicable planning procedures, preparedness activities, and preventive measures that should be taken to eliminate this threat or mitigate the consequences of a widespread flu outbreak.

Dedicated pandemic influenza planning and preparedness could save the lives of emergency responders, the lives of many others, and prevent significant degradation of organizational continuity of operations and "response-ability." The following are a sampling of public and private sources that can provide detailed flu pandemic information for planning purposes:

3/15 www.upmc-biosecurity.org/pages/events/birds/recommendations.html

A symposium on avian influenza sponsored by the Center for Biosecurity of UPMC, Deutsche Bank, and Contingency Planning Exchange, Inc.

Synopses of Recommendations

Center for Biosecurity of UPMC Synopses of Key Recommendations Made at the Symposium

Tara O'Toole, M.D., M.P.H.
CEO and Director, Center for Biosecurity of University of Pittsburgh Medical Center, UPMC

  • There is a deep, growing concern among scientific and political leaders around the world that the avian flu strain H5N1 could develop the capacity to spread efficiently from person to person and initiate a pandemic that could kill tens, even hundreds of millions of people.
  • The U.S. bears special responsibility for leading efforts to prepare for such an event given its scientific leadership, talent, resources and health systems.
  • Such a crisis would certainly have a grave impact on global businesses, which should be making their own plans to cope as best they can, and examining ways to use their considerable resources (e.g., IT, logistical systems, distribution processes) to helping communities or even governments prepare to cope with a pandemic. (view transcript)
Rajeev Venkayya, M.D.
Senior Director for Biodefense, Homeland Security Council, The White House:
  • The U.S. Government judges the avian flu threat to be very serious and has engaged all federal agencies in the governmental response. From a historical standpoint, the world is overdue for a major pandemic, and even if it does not happen this year, it will surely happen in the years ahead.
  • The U.S. Government recommends that business leaders prepare their own organizations and business communities for the possibility of an avian flu pandemic that is prolonged and pervasive. Business should integrate its activities into existing federal and local planning efforts.
  • The financial sector should model the impact of infectious diseases on the industry to help guide and prioritize preparedness activities within the industry. (view transcript)
James L. Pavitt, Principal
The Scowcroft Group; former Deputy Director of Operations, CIA
  • Current outbreaks of H5N1 around the world have provided strategic warning about the avian flu threat, and the U.S. should act accordingly, expecting no further advanced warning. The Katrina response has shown that near perfect intelligence about an impending crisis is not sufficient -- planning and execution will matter the most.
  • The U.S. government has not yet dedicated resources commensurate with the scale of the avian flu threat; it would be irresponsible if the U.S. did not fully use the extraordinary scientific talent and economic power of the nation to prepare the cope with this problem.
  • Businesses leaders should not only have pandemic plans; they must exercise them. Recent history has shown that many plans that are not tested or transparent are worth little in the midst of crisis.
Robert Webster, Ph.D.
Rose Marie Thomas Chair of the Virology Division, Department of Infectious Diseases, St. Jude Children's Research Hospital; Director, WHO Collaborating Center on the Ecology of Influenza Viruses in Lower Animals and Birds
  • The H5N1 virus has killed more than 50% of those infected, including many healthy adults. It is highly lethal in animals (the most lethal flu virus Dr. Webster ever worked upon), constantly mutating, and will eventually develop the capacity for easy transmission from person to person.
  • Scientists have made tremendous strides in understanding the science of the H5N1 virus, for instance, it is now clear how to formulate a new vaccine from a new viral strain in 15 days, but developing the capacity to manufacture massive amounts of vaccine is now the responsibility of policy -makers , not science. Scientists have performed their work, and now it is time for political leaders to do their part.
  • The public, the private sector, and national governments must realize the seriousness of this threat and immediately bring to bear the resources necessary to develop effective surveillance, produce adequate amounts of vaccine and antivirals, and expand distribution capacity substantially. (view transcript)
Robert Shapiro, Ph.D., M.Sc.
Former U.S. Under Secretary of Commerce for Economic Affairs
  • The impact of natural catastrophes and terrorist attacks on the macroecomony of nations has depended on (and will continue to depend on) key factors, such as the size of a nation's economy, the structure of its markets, and the geographic extent of the crisis. The U.S. has not suffered major macro-economic damage following the 9-11 attacks, nor is it likely to after Hurricane Katrina.
  • The impact of avian flu pandemic on the economies of smaller countries could be devastating; whereas, the impact of an avian flu pandemic on the U.S. economy would be likely to be more localized and less severe, assuming the U.S. is taking all logical steps to prepare now, and assuming that steps could be taken to prevent the pandemic from being pervasive and protracted in the U.S..
  • It is deeply concerning that the U.S. government appears to still be in the process of developing its pandemic preparedness plans, nationally and internationally. The U.S. should clearly be making the necessary modest public investments and planning steps now necessary to shorten the duration of an epidemic and minimize its impact.

Isaac Weisfuse, M.D., M.P.H.
Deputy Commissioner, New York City Department of Health and Mental Hygiene

  • The NYC Department of Health has made substantial investments in avian flu preparedness -- working with its hospitals, laboratories, and the city's large clinical community. Business leaders should be educating their own organizations about avian influenza now in preparation for a pandemic.
  • Businesses should engage with their local health departments to understand and coordinate with local preparedness planning.
  • Businesses should consider specific steps they could take in the event of a pandemic to minimize major disruption, such as increasing the portion of their workforce that telecommutes for a time, expanding online transaction and self-service options to keep essential services running, giving employees good information before and during a crisis, encouraging clinicians and employee health offices to register with the Health Alert Network, and reinforcing prevention messages such as hand-washing and staying home when sick. (view transcript)
Klaus Storh
Project Leader, Global Influenza Programme, Department of Communicable Disease Surveillance and Response, World Health Organization (WHO)
  • H5N1 is a major pandemic concern, and it will continue to spread widely in animals, making animal and human surveillance a top priority. Improvements in animal surveillance may necessitate profound changes in national agricultural and poultry production systems.
  • Adequate stockpiles of antivirals cannot be produced in the near term due to limited production capacity, nor will generic antiviral medications be available in the short-term; therefore, the global community needs to invest in long-term solutions that will improve global supplies of influenza vaccines and antivirals and improve and streamline vaccine and drug development processes.
  • Hospital and community preparedness plans around the world need to take into consideration the scarcity of drugs and vaccines, since vaccines and antivirals will only be available to a small number of countries and only a portion of their populations. Plans for preventive interventions such as masks, social distancing, voluntary home stay, etc., will be key. Incentives for collaboration among affected countries would be necessary in a crisis and strong international collaboration is needed now.
David S. Fedson, M.D.
Former Professor of Medicine, University of Virginia School of Medicine, and former Director of Medical Affairs, Aventis Pasteur MSD
  • The World Health Organization (WHO) (with just 12 people working full-time on global pandemic preparedness) has not received appropriate political or financial support from donor nations including the U.S. ; member countries must provide more resources and support to the WHO for it to develop a strong response to avian flu.
  • For there to be any chance that the U.S. will have enough vaccine for its whole population during an avian flu pandemic the U.S . (and other vaccine producing nations) must immediately pursue the development of an antigen sparing vaccine so that we are able to protect more people per volume of vaccine produced . This will require a change in the U.S. F.D.A policy and public funding for clinical trials of low dose antigen sparing vaccines on urgent time frame.
  • To maximize global vaccine production, the U.S. should lead the effort to: 1. Coordinate the efforts of the 9 global vaccine manufacturers to make low dose antigen/adjuvant vaccine; 2. Reach agreements on the requirements for emergency licensing; 3. Resolve intellectual property issues that now impair development of vaccine; and, 4. Make serious plans regarding how to allocate vaccines internationally in a crisis.
  • Research into other substances for treating influenza, such as cholesterol-lowering statins, which have been shown to be of possible benefit in preliminary studies, should be pursued immediately. (view transcript)
Gene Matthews, J.D.
Director, Institute of Public Health Law; former Legal Advisor to CDC
  • The SARS outbreak in 2003 revealed how bad the impact of an epidemic can be for businesses and illustrated the interdependence of governments, businesses, and the public health sector in such crises.
  • In future epidemics, in the U.S. or elsewhere in the world, the private sector will certainly be called upon to help provide resources and assistance in efforts to cope. Because their role in responding to and recovering from a public health emergency will be at least as important as that of the government, businesses should build external preparedness networks geographically and industry-wide.
  • It is essential that businesses engage in local, state and federal preparedness efforts with public health; those working relationships and bridges between the sectors must be established in advance of a crisis. Businesses should verify that local, state and national governments have the necessary institutional and legal frameworks in place to respond to a large public health emergency. (view transcript)
Peter Sandman, Ph.D.
Risk Communication Specialist
Effective communication, with employees and others, about avian influenza is essential and includes
  • Frightening people may be necessary and appropriate in order to assure that they are adequately concerned about the risk and taking the threat of pandemic influenza seriously. Fear is rational and useful in response to frightening events, and it may help motivate necessary action.
  • Acknowledging the uncertainty of the situation publicly and providing candid and transparent information as early as feasible.
  • Giving people useful actions to take.
  • Once an event has occurred, focusing communication on helping people to cope and "bear their fears." It is the responsibility of leaders to accept that responsibility and to help people to cope appropriately.
Kenny Seow
Director, Regional Head of Business Continuity Management, Asia Pacific, Deutsche Bank AG, Singapore
Building on lessons learned from SARS, he suggested that businesses should:
  • Build a knowledge base by reaching out to individuals, organizations, and disciplines that may be beyond the usual practices. These should include disease, legal, and regulatory experts.
  • Define the "trigger points" for when contingency measures should be executed.
  • Be aware that while plans will be made for global operations, execution will, ultimately, be local; therefore, all plans should assimilate health and legal guidelines from local governments.
  • Maintain open and honest communications. It is essential that senior managers and employees be educated on plans and policies, which should also be communicated to employees and stakeholders.
  • Even with well-crafted plans, flexibility and adaptability are essential, because there has to be capacity for addressing the new and unknown that will always arise
3/14 ABC is now responsibly addressing how you can prepare for the bird flu pandemic.
Lots of good suggestions. Kudos to them. Mellie

How Will Bird Flu Change Your Life?
A Look at What Could Happen at Home, Work, School and in Your Community

3/7 The R5 FS Pandemic Response Plan is almost done. I don't know
about the other firefighting agencies.

All counties in California have been directed to get their Pandemic
Plans done by the 17th of March.

Mellie

3/7 More info on projections if pandemic occurs.

From an economist:
Factoring the bird flu risk into your strategic planning, now

So how can companies and individuals best prepare themselves financially for all of this?

Well, think about what you would do if you couldn't work for five or six months, or if your business was completely disrupted for the same period. In addition, assume you'd be trying to assure you would not be forced to sell your assets at a dramatically reduced price, for example your home or stocks you own. You would only want to be in very high quality investments, such as blue-chip dividend-paying stocks.

In other words putting yourself in a position where you could sustain yourself for those five or six months without selling assets. So you'd need alternative income sources, while at the same time reducing liabilities. This means paying off any debt as quickly as possible and avoiding any new debt. It all comes down to pulling in the purse strings, spending less than you earn. Hopefully, one would have a reasonable period of time to initiate all this, but we just aren't sure, so all the more reason to evaluate such measures now.

More ongoing discussion here: www.flutrackers.com/forum/forumdisplay.php?f=7

Mellie

3/7 Does anyone know if the Forest Service, BLM, NPS, FWS, BIA has a pandemic plan?

Our county in CA doesn't even have one yet.

GG

3/7 peregrine,

We also decided we'd rather be safe than possibly sorry.

We're in the process of shifting investments/retirement money into 2-3
year Treasury bills and into American Blue Chip stocks with good
financials. We've always been invested in growth stocks, but we feel
better not being in that category until this all sorts out.

Folks, on financial preps, our sons said it might be good to have a stash
of cash and coins in case banks close for a while. They're taking care of
that, the guns, the chainsaws and fuel. Thank goodness for young men  in
the family who like all that stuff. My daddy did train me up in guns about a
milliondy years ago, but my husband has made me promise none 'o that.
He says my Willie Nelson and liplock will forestall anyone bent on mischief.

Mellie

3/6 Mellie,

I have rearranged my money in my Thrift Savings Plan to the G fund until
the avian flu problem either passes or happens. I had the bulk of my money
in the I and S funds (both overseas, high growth-high risk funds).

Would you consider sending this in to the bird flu watchout page just to let
people know they should also be thinking about the financial aspects of
avian flu?

peregrine

Peregrine, you're welcome to send in posts yourself. Just send the to abercrombie@wildlandfire.com. Put "bird flu" in the subject line please. Ab.

3/6 Bird Flu:

Just a heads up. Now house cats in Germany and Austria are testing positive
for bird flu. Cats are mammals like humans. Does this mean the H5N1 virus is
more transmissible to humans? This species barrier jump is not what scientists
like to see. In studies done in the lab, cats were injected with the virus, allowed
to eat infected meat and healthy cats were housed with infected cats. All cats died.
It appears the virus transmits cat to cat in addition to bird to cat shown in SE
Asia where hundreds of large cats died in a game preserve. Will will the virus
transmit cat to human and human to human to go pandemic soon is the question.

Please put some extra food and water, and vitamins aside for your families. Ask
your doc to prescribe you a small stock of Rx meds.

Love you all.
Mellie

FluTrackers.com for up to date birdflu info.

2/21 Here are two website you can bookmark if you're interested in following breaking bird flu articles around the world. New articles come out every 5 minutes.

www.flutrackers.com/forum/

www.newsnow.co.uk/newsfeed/?name=Bird%20Flu

Bird flu (H5N1) may not seem to be a problem in the United States yet, but it is present in birds in Africa, the Middle East and Europe now and in humans in Turkey, Iraq, Iran, India Asia and Southeast Asia.  The virus could easily go pandemic, efficiently infecting humans around the world if it changes genetically to acquire a few more "polymorphisms" (genetic variations). It will have that opportunity in Europe over the next few weeks (or months) to pick up the genetic changes.  When migrating birds return from Africa next week, recombination (sharing of genes) can occur in European pigs if they become co-infected with H5N1 while already carrying H1N1 (the 1918 pandemic strain).

Mellie

My friends, please prepare. Doesn't have to be elaborate, as Striker said. Consider it an insurance policy for your family, if nothing else:
beans,
rice,
oil (polyunsaturated oil, or lard -keeps without refrigeration, good for flavor),
spices,
canned tomatoes, sauce or puree (contain vitamin C),
daily multivitamin & vitamin C supplement
whatever else you like to eat

2/15 Ab, Here's the bare minimum people need in inexpensive prep food:

Beans (dry beans keep for years)
Rice (white rice keeps well)
Fats (lard and oils)
Salt and spices
Vitamin C (vitamins, tomatoes canned or juice)

Striker

2/14 Graph of Age Distribution of Human H5N1 Cases as of 2/10/06. The sample size is small (116), but it seems that children and teens, so far, comprise most of the confirmed infections from bird flu.

Age Distribution of Human H5N1 Cases

An analysis of demographic data published by WHO shows the following age distribution of human H5N1 influenza cases (n=116). 50% of cases were 16 years or younger; 75% of cases were 29 years or younger; 90% of cases were 39 years or younger. Most patients were born after 1968.

2/9 UPDATE:

There are thought to be 8 new human birdflu cases in Iraq today, including cousins
of the southern Iraqi pigeon breeder. This is reported in both the Italian and
French press. It's confirmed today in birds in Greece.

There's a new human case in China, just got breaking news of 35 new human cases suspected
in China. First H5N1 infected bird found in Hong Kong, and 4 new human cases in Indonesia.

List of Countries with confirmed or suspected H5N1 in Birds or Humans.

Last few days 60,000 chickens died in Nigeria and were thought to be infected with H5N1.
In the past as in Turkey and Asia, human H5N1 infection (bird to human) has showed up
1-2 months following massive bird dieoffs.

The most worrisome thing is that the H5N1 virus is ON THE MOVE. It is clearly continuing to

  • expand its range geographically,
  • expand the range of species it infects, and
  • expand the number of individuals it's infecting within species
  • expand its genetic makeup, demonstrating many (more than 250) different strains or
    polymorphisms.

This results in an ever-widening "mixing pot" for hosts (human, pig, bird, etc) some of
which are likely co-infected with two viruses:

  1. a deadly one (H5N1) and
  2. one that may not be deadly but which infects humans (eg, human flu virus - H3N2 or
    birdflu virus H9N2).

When one host is infected with two viruses, there is frequently a recombination of
genetic material. If the dominant virus being shed from the host has the specific gene
makeup for the deadly strain of H5N1 and has also gained the specific gene makeup so it
can easily infect humans, then efficient human to human transmission and pandemic will occur.

Many many scientists think we're very near that point. In fact, the only thing that may
have prevented efficient human to human transmission already in Turkey was that a
tamiflu blanket was thrown over the outbreak. And yet the virus spreads via human
or agricultural commerce between the Kurds in Kurdistan (Turkey, Iraq, Iran) and via
migratory birds to Africa, Greece, Bulgaria, etc. As the expansion of H5N1 continues
its spread in humans its evolution and reach will outstrip our ability to blanket it.

I really do hope YOU, my fire friends, are preparing to be self sufficient for a time when this
pandemic arrives here. I see no way we can dodge this "burnover". The only solutions will
be personal use of a fireshelter (family food storage, water storage, prescription meds) and
community defensible space (prep among agencies, organizations, hospitals, schools, health
departments, businesses). Please be sure your family's fireshelter is ready. Please foster your
community's preparedness. This is nothing new, except for scale, with the risk being many
deaths.

Please bring your leadership and planning skills and vision to bear on this coming pandemic.
If you haven't begun, please begin today. Thanks to those I know are working on this!

Mellie

2/7 Mellie, have you seen this?

Avian influenza – situation in Iraq - Update 2

It says there are more than one h5n1 human cases in Iraq, one in southern Iraq and that
massive culling of domestic fowl is going on. This is even posted on the WHO
website.

Tahoe Terrie

2/5 From Firescribe:

NORTHCOM Prepares for Possible Pandemic

"Officials consider a pandemic - a global epidemic - a possibility due to increasing numbers of people around the world contracting a life-threatening flu virus from birds. So far, humans infected with the avian flu virus have been verified in Vietnam, Cambodia, Laos, Korea, Japan, Indonesia, Malaysia, Russia, Kazakhstan, Mongolia, Turkey and, most recently, Iraq."

. . .

"NORTHCOM will not be running the show in the event of a pandemic," said Dave Wilkins, the NORTHCOM exercise facilitator. "We will be taking guidance and requests from other agencies, such as the Department of Homeland Security, via the secretary of defense."

"One most critical NORTHCOM mission during a possible pandemic is to keep the American public informed. The command will work with the Department of Defense, the Department of Health and Human Services and other agencies at federal, state and local levels and will use a variety of methods, including traditional press releases and the agency's public Web site, to disseminate information, said Michael Perini, director of NORTHCOM public affairs."

"Staying informed is really the best preparation," Perini said. "What we want to do here is to be an integral part of the overall communications process and keep people informed so that they can be prepared.""

 

2/5 Here's a useful map of bird outbreaks, human cases and bird migration flyways from BBC. http://news.bbc.co.uk/2/shared/spl/hi/world/05/bird_flu_map/html/1.stm

It's similar to a series of maps done by Dr. Henry Niman at www.recombinomics.com.
Henry started tracking bird die-offs and human infection/death last year when it was just
starting to become really clear that wild birds, re-infected by Asian domestic fowl that
were living in close proximity with pigs and humans, were carrying highly pathogenic
H5N1 around the world.

With his permission, I have used a monthly series of Henry's maps in different presentations
to illustrate a  dangerous bird flu virus "on the move".

Go here to follow his daily commentaries on birdflu (H5N1): What's New. His sources
include professionals from around the world, information gleaned from the main stream media
and gene sequencing information from H5N1 outbreaks in birds and humans as countries
release that information. Gene sequencing data is available at GenBank, the NIH database.
You have to have access to read all the codes.

Mellie

2/3 Report from December 6-7, 2005 meeting of the
Armed Services Epidemiology Board (pdf file). Start
reading on p 107 - about p130. Some good info there
on the military approach, what is and isn't available.

Mellie

2/2 Really good news:
Common cold may save us from bird flu
www.newscientist.com/article.ns?id=dn8667

Adenovirus, one cause of the common cold, may help protect against pandemic flu. Two separate groups of US scientists have successfully vaccinated mice and chickens with an adenovirus-based DNA vaccine against different strains of H5N1 bird flu. And they now want to test it in humans.

Bad news?:
CBS news said last night that we will still need 5 to 7 years to build the vax plants to manufacture the vaccine.

Mellie

1/30 Good evening:

I am a former Army officer (active duty 1982-1986) and currently a member of an online forum that is tracking the development and spread of a highly pathogenic avian influenza (HPAI) strain referred to as H5N1. My concern is for the troops in Iraq and neighboring countries in the Middle East who may be exposed to this virus.

A teenage girl from the town of Sulaymaniyah in northern Iraq died on January 17, 2006 after presenting with symptoms consistent of having contracted avian influenza. Test results performed by a U.S. Navy Medical Research Unit in Cairo, Egypt on samples from the girl confirmed the presence of the H5N1 strain. Those results were just released today. In addition, an Iraqi man identified as a relative (uncle) of the girl who died also presented with similar symptoms several days later. He, too, has died. While there is no confirmed indication of this virus transmitting efficiently from human to human, evidence from an outbreak in Turkey that began January 1, 2006 indicates that the virus has likely developed at least a limited human to human transmission capability.

If there is anything that you might suggest as a way to get information about this to the troops, it would be appreciated.

Regards,
John Diedrich

Iraqi health authorities go on bird flu alert
Five mobile hospitals with special equipment were due to arrive in northern Iraq later today.

1/30 Firescribe, they added the reference to more suspected cases back in a more recent report:

www.forbes.com/home/feeds/ap/2006/01/30/ap2487457.html

Mellie

1/30 From Firescribe:

Birdflu spreads in the Kurdistan part of Iraq. I hope they protect our troops.

Iraq health minister says dead teenager had bird flu (she died on 1/17; her uncle died 1/27 with the same symptoms...)
Reuters Alert Net

There was another report that appeared then disappeared from the web of 30 others being tested and a report of 5 cases in Basra...

PS Another report www.channelnewsasia.com with Kurdish leaders asking for the WHO to come and test more suspected cases. List of related articles of infections (b-->h?) around the world at the bottom.

1/30 Ab,

A friend sent me the following food list for ideas. It's not so extensive as the
one Mellie et al came up with, but gives some other ideas. I also shared the
list here with her.

More Ideas for your Emergency Pantry

Hotshot's mom

1/28 Re bird flu:

Stanford to begin human tests of bird flu vaccine

Stanford Medical Center is already recruiting research volunteers so they can begin the screening process. They are looking for healthy adults between the ages of 18 and 64 to take part in the experimental testing. The phone number to volunteer is (650) 498-7284.

They just posted the trial on their website. http://vaccines.stanford.edu/clinical_trials.html

A randomized, placebo-controlled, Phase I/II, dose-ranging study of the safety, reactogenicity, and immunogenicity of intermuscular inactivated influenza A/H5N1 vaccine with different adjuvants in healthy adults

  • SUMMARY: The emergence of the avian influenza virus strains in human populations outside of the U.S. has added urgency to ongoing efforts to develop plans for responding to potential world-wide outbreak. Three influenza pandemics have occurred during the last century. This study is sponsored by the NIH and will help us compare the safety and immune response of varying doses of an avian influenza vaccine, either alone or when combined with adjuvants (substances designed to enhance immunity). The vaccine will be administered to healthy adults by intramuscular injection in the arm as two doses, given one month apart.
  • The study will involve one screening visit and six clinic visits over a 7-8 month period. At the first and third clinic visits, subjects will receive an avian flu vaccine given in one of 8 possible combinations. It is also possible (1 chance in 9) that subjects will receive a placebo vaccine. A blood sample will be taken at each of the screening and clinic visits. Subjects will receive reimbursement for completed study visits ($30.00 per visit). There will be no costs for participation.
  • ELIGIBILITY: We are enrolling healthy adults who are 18 to 64 years of age.

FOR MORE INFORMATION: Please contact the Stanford-LPCH Vaccine Program at (650) 498-7284.

Enrollment may close quickly, so please call as soon as possible if interested

(For further information regarding your rights as a participant, please call 1-866-680-2906 or write the Administrative Panel on Human Subjects in Medical Research, Administrative Panels Office, Stanford University, Stanford, CA 94305-5401.)

Mellie

1/27 Hi SoCal CDF, NorCal Tom, Hotshot's mom and others. I hope you're still working toward several months of self sufficiency...

A number of medical people who are following the pandemic have wondered why the World Health Organization has not raised the Pandemic Level from Level 3 to Level 4 (pdf file) thereby putting the American public etc on higher alert and fostering greater preparedness. I have speculated that level 4 will have serious economic and political repercussions.

Consider this, WHO was criticized during SARS (2002) for "causing" losses in the billions of dollars for some countries... and SARS didn't end up going pandemic. Countries who criticize fail to acknowledge that it didn't go pandemic because WHO and member nations worked very hard at containing outbreaks, and part of that containment was the result of WHO increasing the Pandemic Level when appropriate. ... So WHO is in a catch 22 with pressure to not up the pandemic level warring with pressure to share information and report honestly.

Today WHO lent credence to my speculation. They came out with the WHO pandemic influenza draft protocol for rapid response and containment (90K pdf file) in which they state the following:

6. Pandemic phase assessment
A WHO decision to change the phase of pandemic alert will be made separately from the decision to initiate a rapid response or rapid containment effort. Since a change in phase is expected to trigger a number of potentially cascading actions by countries, possibly including travel restrictions and border closures, such a decision will be highly visible and is expected to have significant political, social and economic implications. The decision to declare a phase change will be made by WHO Director-General after briefings and consultation with WHO technical staff, the WHO Pandemic Task Force, and other advisers as deemed necessary by the Director-General.

Given the widespread illness in Turkey, I personally believe that if there were no economic/political ramifications of increasing to Pandemic Level 4, WHO would have done so. We have had ever-growing person-to-person transmission in 3-4 very large family clusters in Turkey, evidenced by staggered infection (bimodal and now multimodal pattern in which some people get sick and 3-4 days later people in the same family get sick, followed by more cousins 3-4 days later). Granted, it's not taking off like wildfire, but it is multimodal involving a number of large clusters and it mnight have taken off if the antiviral tamiflu hadn't been given to everyone infected or suspected of being infected.

Without anyone at WHO willing to tell it  like it is, it looks like this emerging pandemic might charge ahead from a Level 3 to full blown Level 6 and people in this country will not have been sufficiently alerted to prepare.

Mellie

1/26 Wired has a computer simulation of bird flu spread in the US.

The Battle to Stop Bird Flu

Click on the map thumbnail. Oh no, it starts near me!!!

SoCal CDF

1/26 I don't think many Americans even realize that hundreds of people were infected with bird flu in Turkey or that Europe has been very worried. A tamiflu blanket was thrown over Turkey. Schools were let out for a religious holiday and now the winter is harsh, forcing isolation. Here are several articles that describes the infections and deaths:

'We must Defeat Ignorance About Bird Flu'
www.zaman.com

A total of 596 bird flu patients were brought to VYU's School of Medicine Research Hospital, four lost their lives in late December from Dogubayazit in the province of Agri.

Turkey Copes With Bird Flu
A new outbreak offers the chance to better prepare for a pandemic
www.time.com

Out in the remote, impoverished Turkish town of Dogubeyazit, a chicken is more than just a bird. For the hardscrabble villagers, it's often the only source of dietary protein, and for their children, the only toy. So it was no surprise that 15-year-old Fatma Kocyigit and her 14-year-old brother Mehmet Ali played with the sick fowl their father had brought indoors for protection from the bitter December cold. The fun proved fatal. The children came down with high fevers and bleeding throats; when they went to a nearby hospital, they received ordinary medication for a cold and were sent home.

A week later, when the children did not improve and their father told doctors about the chicken deaths, they were transferred to a better-equipped hospital in the nearby city of Van. Blood samples from the Kocyigits were sent to Ankara for tests, which showed that the children had contracted the deadly h5n1 strain of bird flu that has killed about half of those in Asia whose infections have been reported to the World Health Organization (who). By then it was too late; Mehmet Ali died on Jan. 1 and his sister four days later, setting off the latest upsurge of fear that the lethal virus might be invading Europe.

The virus has already crept stealthily into the four corners of Turkey. As a stopover on migratory bird routes, the country has known for months that it was vulnerable to the natural spread of the disease.... click the link to read more...

Mellie

1/26 Someone linked to this 1918 flu earlier. A graphic reminder that this will come in waves:

1918 pandemic flu spread

A business conference on Pandemic Flu put on by Dr Osterholm's group. Look at the
agenda. He was the one on Oprah.

JD

1/26 The way you're keeping up on this stuff is amazing....you may already have this link. But, if not here ya go.

Greg

From pandemicflu.gov:

Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist

1/25 From the U.S. Department of the Interior, U.S. Geological Survey

Avian Influenza: Science at the Forefront

Experts agree that the dangerous form of avian influenza currently found in Asia and Eastern Europe could reach North America in the next few years. When it does arrive, the disease could have significant economic, social, and ecological impacts. Early detection and rapid, effective response are essential to minimize the spread and the effects of such a highly pathogenic avian influenza virus. Come hear how the U.S. Geological Survey (USGS), the U.S. Fish and Wildlife Service (FWS), and the USDA’s Animal and Plant Health Inspection Service (APHIS) are working with other Federal and State partners in a coordinated, scientific surveillance program designed to provide an early warning to the agriculture, public health and wildlife communities, as well as to the public.

When it comes will we all be called on for culling?

NorCal Tom

1/23 Firefighters,

Oprah Winfrey is going to have Dr. Michael Osterholm (sp?) on her show tomorrow talking about the coming bird flu pandemic. Today my daughter (east coast) told me her topic was terrorism. At the end of today's show, she set things up for tomorrow. She said:

"I URGE you to watch tomorrow's show and prepare to
have your eyes opened
in a HUGE way. It may be one
of the most important shows we've ever done."

I can't watch it until I get home tomorrow, but I'm set up to tape it. I hope everyone who can watch it will watch. If you firefighters don't want to watch Oprah, get your Significant Other to watch and ask her/him some questions afterwards. I need to order my N-95 masks tonight, before the run on them.

Hotshot's mom

1/21

All,

Recently, the World Health Organization has produced excellent reports
on pandemic influenza.

(1) A succinct overview of pandemic influenza, the first report appeared
December 9, 2005, in the WHO publication Weekly Epidemiological Record.

To access the report, titled "Ten things you need to know about pandemic
influenza," go to:
www.who.int/wer/2005/wer8049.pdf  and scroll down to the report.

(2) The second is a two-part report on pandemic influenza preparations
at the international, national, and community levels. It appears in the
January 2006 issue of the CDC journal Emerging Infectious Diseases
(EID).

To access a ready-to-print (PDF) version of Part I ("Nonpharmaceutical
interventions for pandemic flu, international measures"), go to:
www.cdc.gov/ncidod/EID/vol12no01/pdfs/05-1370.pdf

To access a web-text (HTML) version of it, go to:
www.cdc.gov/ncidod/EID/vol12no01/05-1370.htm

To access a ready-to-print (PDF) version of Part II ("Nonpharmaceutical
interventions for pandemic influenza, national and community measures"),
go to:
www.cdc.gov/ncidod/EID/vol12no01/pdfs/05-1371.pdf

To access a web-text (HTML) version of it, go to:
www.cdc.gov/ncidod/EID/vol12no01/05-1371.htm

(3) The January issue of EID is devoted to a discussion of various
aspects of epidemic influenza, including history, pathogenesis,
prevention, policy, and research.

To access a ready-to-print (PDF) version of the complete issue, go to:
www.cdc.gov/ncidod/EID/vol12no01/pdfs/Vol12No01.pdf

To access a web-text (HTML) version of it, go to:
www.cdc.gov/ncidod/EID/index.htm

1/8 Howdy Mellie,

Don't worry about me, keep up the info. We just need to keep the info accurate. I'm not saying it has not been.

Here is an example of what can happen when accurate info is misunderstood by the public. A small town in Nor-Cal is threatened by a large river that is rising. In the past 20 yrs this area has been evacuated 3 times and the gallant crew of the Minnow has saved the day every time. Now the townspeople don't heed the warning to prepare for an evacuation because their perception is "we've never flooded before, it won't flood now. The crew of the Minnow will save us" and they even get mad at the local authorities when they advised them to prepare for evacuation. A few years ago during a big flood, a medical response was needed. As most VFDs do, the pagers and the siren sounded. The phone at the station rang for a hour because the town folks panicked and thought it was the notice to evacuate. What I'm trying to do is show that information (even good and accurate information) can put the public into a panic.

I am not saying that the information should be withheld. It just has to be accurate and not misleading.. As I said in an earlier post. we must prepare for the worst. If its predictable - its preventable. I was set off by a post that would lead some people to believe that a bird that migrated here needed to be tested just in case it had the dreaded illness. The fact remains that migratory birds from the infected area have been migrating here for eons. We can't stop them at the border.

Two nights ago I attended a meeting with 1 of the local service clubs to inform them of the risk of flooding and the condition of our Levy. I gave it to them straight. It's ugly. But, They now know we have a plan to take care of them. They will prepare, and be ready next time. I will be meeting with the other service club next week. Let's just call it damage control. In case you're wondering, that little town is Hamilton City, Ca. The river is the Sacramento. The Levy is approx. 100 years old and in terrible shape. A local grassroots level group has been getting closer and closer to getting Federal funding to build a new Levy system around the town. If all the stars and planets line up right the new levy could get here around 2010 or so. We basically had the last 9 years off. 1997 almost drowned us all. We won't survive another flood of the likes of 1997. Thankfully we are getting support from our elected officials, both local and far, far away.

When you see t he news reports about flooding in Nor-Cal, keep us in your thoughts and if the Bird Flu does hit us as predicted by some folks, pray for us all.

AB, I'm getting windy'er as I grow older.
Never a Boy Scout but always prepared,

danfromord

1/7 hahahaha, vfd cap't, you're a crack up! fishing eh?

I have never advocated anyone leaving his or her "profession" or their post. If you look at everything I've written from day one, I have said that families must be cared for first before we truly have the freedom of mind to make the best choices for what to do in the given moment. At least that's what I need in order to have the freedom to focus as completely as possible on the problem or situation at hand.

There's a show on PBS tonight in half an hour at 9PM Pacific called Killer Flu that includes scenarios where family members and coworkers talk about issues that come up in families and for first responders as the pandemic flu moves through a community. Dr Osterholm, one of my academic heroes, talks about what is needed to get ready for the worst case scenario. He's currently working for Dept of Homeland Security. (He'd say he's no hero, just doing his job, but he's an inspiration to me nonetheless. He stays on focus and pulls no punches.) I hope you get to see it.

I must also stay on focus and pull no punches. You all have taught me a lot about the integrity of that kind of behavior.

Thanks!

Mellie

1/7 re: bird flu preparations

Ab,

I encourage everybody to have a general emergency preparedness plan for their families, to include a supply of food, water, medicine/first aid supplies, etc.

Yet, I have to question Mellie's advice that wildland firefighters make preparations to abandon their profession in event of a bird flu pandemic. Staying at home is not an option for most of us.

However, if any firefighter is really making those kind of plans, I suggest they make application to the New Orleans Police Department. I hear they are hiring now, and one could live up to a not-so-fine tradition of public service until a crisis comes.

vfd cap'n
1/6 Bird Flu Virus and families being prepared:

From Firescribe

Thanks, Mellie, for keeping us heads up.

It seems the tone and level of federal government information is changing, at least as I read it on their websites. They're now telling people to stock up. I even read somewhere they're advising parents to have a plan for home schooling, if kids have to stay home longer than initially thought! To me this is a trigger point for re-sizing up the threat.

WHO (World Health Org) also seems worried about the outbreak in Turkey and Europe is very worried.

New York Times
New Bird Flu Cases in Turkey Put Europe on 'High Alert'

"I'm not sure we've seen a cluster like this in terms of numbers, and certainly it's a concern," said Maria Cheng, spokeswoman for the Division of Epidemic Preparedness at the World Health Organization. "Is the virus being transmitted more easily from birds to humans, or even from humans to humans? We need to put all the pieces together before we can come to conclusions."

Article from Reuters
Worried about bird flu? Stock up, Health and Human Services advises

This website from Health and Human Services is fairly new:
"Pandemic Flu Planning Checklist for Individuals and Families", www.pandemicflu.gov/planguide/checklist.html:

  • Teaching children to wash hands frequently and appropriately, covering coughs and sneezes with tissues, and modeling the correct behavior
  •  Having ready-to-eat canned meats, fruits, vegetables, soups, bottled water and cleaning supplies on-hand for an extended stay at home.
  • Having any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes and vitamins.
  • Talking with family members and loved ones about how they would be cared for if they got sick or what will be needed to care for them in another home.

Items to have on hand for an extended stay at home:

Examples of food and non-perishables Examples of medical, health, and emergency supplies
  • Ready-to-eat canned meats, fruits, vegetables, and soups
  • Protein or fruit bars
  • Dry cereal or granola
  • Peanut butter or nuts
  • Dried fruit
  • Crackers
  • Canned juices
  • Bottled water
  • Canned or jarred baby food and formula
  • Pet food
  • Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
  • Soap and water, or alcohol-based hand wash
  • Medicines for fever, such as acetaminophen or ibuprofen
  • Thermometer
  • Anti-diarrheal medication
  • Vitamins
  • Fluids with electrolytes
  • Cleansing agent/soap
  • Flashlight
  • Batteries
  • Portable radio
  • Manual can opener
  • Garbage bags
  • Tissues, toilet paper, disposable diapers

1/6 Bird Flu Update: The virus is changing.

The next two days will tell if we're only dealing with a H5N1 virus that is better at transmitting bird to human (which is of concern in and of itself) or if it's gained the capability of transmitting human to human and going pandemic. I'm working my contacts to keep abreast of info coming out of Turkey, but the growing numbers of families infected and what they mean are cause for concern. It's the children and teens who are dying. WHO  is clearly concerned: WHO Teams are on their way to Turkey. Given the number of infected and the numbers of large family CLUSTERS infected, the virus has changed.

My friends, if you do not have extra food in your pantries, please add some to your shopping list next visit to the store. What I keep seeing in my mind's eye is that "time and options" graphic from the Leadership course. Recall that it is wedge-shaped - like a doorstop - with the wide part at the left and the narrow part at the right. The floor axis (horizontal) represents time; the vertical axis represents the number of possible options or choices for action that can save you and your crew's life. At the beginning of an incident we're at the fat part of the wedge: we have many option or choices for action that can save us and our family's lives. As time passes, options decline, choices narrow... If we don't make good choices when we can, we become the "victims" as did for many of those who refused to or could not get out of Katrina's way in New Orleans. Unfortunately, this time when this killer flu bug makes the leap to human-to-human transmission, we're going to have a world of Katrinas.

In my opinion, this bird flu bug is evolving; we are all are moving along that time axis whether we want to recognize it or not. The number of options we can choose from is diminishing. One big factor that will determine who lives and who dies is going to be who gets infected. We and our families need to be prepared to ride this out at home when the killer flu goes pandemic. Our best bet will to not get infected. We will need a supply of food at home, food for some months. Because of our just-in-time mode of food and  medicine delivery, each family needs to stock up.

The big picture:
Bad things happen. Over time some really bad things are inevitable. It's part and parcel of being human and living on planet earth. Whether the bad things happen to you and yours "before your time" is in part your choice. It's the result of your leadership and your planning. Lawrence Gonzales, author of Deep Survival, would agree with me. There are things YOU can do. Get about YOUR work of protecting your families, if you haven't yet done so.

Preparation ideas:

  • buy extra food when you go to the grocery store, stock up on non-perishables;
  • look at the food list on the Bird Flu Watchout page;
  • go to one of the websites where professionals are sharing tips for getting prepared ( FluTrackers.com Click on prep

Don't get caught in denial, become the "deer in the headlights" or wallow too long feeling helpless. You've watched others do that in the face of crisis. You are wildland firefighters! Get over that stuff! There are many simple things you can do. Preparation gives you future options.

Mellie

1/5 From Firescribe:

Third child dies in east Turkey of bird flu

Huseyin Avni Sahin, the head doctor at Van hospital where the children died, told CNN Turk 23 people were now being treated at his hospital for suspected bird flu.

"Fifteen of them are in bed, one in a critical condition. Eight are able to move about. Most of the patients are children," he said.

1/4 Bird Flu Update:

About 10 people from two families have bird flu in Turkey. Two of the original 4 children who presented with symptoms several days ago are dead. There are not enough ventilators in the hospital in Van to treat all patients.

These are the first cases of bird flu outside of South East Asia and they're in clusters involving 2 families. It seems likely that this is still bird-to-human transmission and they got the virus from touching and/or slaughtering their chickens. The next few days should clarify the mode of transmission.

(Danfromord, I'm not anxious, just keeping people appraised. I know you think the bird flu pandemic, if it comes, will be simply a "flash". I think it is clearly coming, given the spread in birds and the changing genetic makeup which we can now identify. I also believe it will be much more than than a "flash" and there's much families and communities can do to be prepared.)

From CNN: Turkey says dead boy had bird flu

From Reuters:  Second Turkish child dies from bird flu

Mellie

PS 1/5 update: I just heard from a Turkish friend that the number of people hospitalized with birdflu like symptoms is growing (symptoms include pneumonia, bleeding gums, and difficulty breathing). They're still trying to pin down numbers. The hemorrhagic (bleeding) component is worrisome. In addition, it's unusual to have this many infections in a bang like this in four sparsely populated provinces. It seems that the H5N1 (bird flu) virus is evolving to be more transmissable to humans, even if it is still bird to human transmission. While it doesn't appear that it has evolved to human-to-human transmission yet, the efficiency of H5N1 infections of humans seems to have increased. When the gene sequences are submitted to genBank, we'll likely have more info regarding increased risk to humans (or not). Before then the pattern of infection and deaths should give us more clues. Here are the numbers he thinks are infected:

  • 15 patients hospitalized in the city of Van  -->14 patients from the town of Ağrı (includes members of 2 families, including the 2 kids who died) and one patient from Van
  • 5 patients from the town of Horasan hospitalized in Erzurum
  • 6 patients from the town of Aralık in Igdir County (if these were sent to Van, this could be overlap)
 

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