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April 13, 2005

Avian Influenza

Perhaps we should all be worrying about Avian influenza (I’m never quite sure whether we should put an apostrophe on flu. Is it ’flu? or flu? Too much Lynn Truss obviously). As Instapundit put it recently there’s quite a lot of official notice being taken. The US has in place the legal structure for a quarantine, the CDC is alerted, stockpiles of Tamiflu (at least partially effective in treatment) are being built. Then The Guardian reports today:

Avian flu - caught directly from birds, and which kills in seven cases out of 10 - could suddenly sweep through the human population, killing 70 million people according to World Health Organisation estimates, a Nobel laureate warned yesterday.
....
"If it comes, it will probably come out of somewhere like south-east Asia and it will probably come very fast," he said. "It is highly lethal in birds, and in humans, when they catch it, it is something like 70% lethal. So it is very dangerous."
....
Governments had begun to stockpile an antiviral called Tamiflu, which was effective if taken early enough. "But if we got a real outbreak ... with massive numbers of cases there would probably be enough Tamiflu to protect key medical professionals, perhaps politicians ... it is whether there is enough of it around," he said.


That sounds to me like it might be worth buying a few vials of Tamiflu to stick in the fridge. But what really scares the **** out of me is this:

"We may duck the bullet. We may be lucky. But I think it is a reasonably high probability, because you have a lot of human flu," Prof Doherty said. "We will always have flu epidemics. Once the thing hits, we would deal with it extraordinarily well."

I would gladly listen to someone who tells me I’m wrong but I take that to mean, reading between the lines, a Nobel Laureate in Medicine, stating that it is not whether but when it will happen, that a re-run of the Spanish ’flu (whether this current Avian version or another) is virtually certain at some point in the future. Ouch.

Update. Welcome Instapundit readers. Thanks Glenn, a day early for the first bloggiversary and welcome for it.

Feel free to have a look around this Anglo/US blog written from a Liberal/Libertarian viewpoint. (Please note, Classical Liberal, not current American usage of the word). Economics, Environment, Politics, whatver else takes my fancy and a bit of rugby too.

April 13, 2005 in Health Care | Permalink

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"But if we got a real outbreak ... with massive numbers of cases there would probably be enough Tamiflu to protect key medical professionals, perhaps politicians ... it is whether there is enough of it around," he said.
The WHO recommends nations stock enough Tamiflu for 25% of the population. The UK already does. It's cheap and easy to make and influenza is a simple virus - there are only two main surface structures on the virus and tamiflu targets one of them - neuraminidase - pretty effectively.
Of course, if a different strain of flu without that surface molecule arises, don't bother buying shares in Roche after all. And avoid crowds.

Posted by: actualfactual | Apr 13, 2005 9:24:16 AM

Isn't Lynn Truss a Yank, if so her advice on apostrophes is inaccurate for the UK usage.
The only *word* I use an apostrophe for is 'til (until), and I use it inconsistently.

I once heard it argued hippo's is correct English as hippo isn't a proper word, the word is hippopotamus (pl hippopotamuses) - but I think that's BS. Next people will say we shoud talk about 'fridge's!!

Tim adds: Don’t know where she was born but she’s been working in the English media for a couple of decades. Hippo’s doesn’t look quite right but it may be, ’fridge is formally correct but archaic and the plural is hippopotami

Posted by: Monjo | Apr 13, 2005 11:28:13 AM

I've already stockpiled a course of tamiflu in my freezer (it comes as pills in a blister pack, not a vial). If you plan to do this, do it now before there's a run on stocks. During the pandemic it will be rationed.

Posted by: anonymoud | Apr 13, 2005 1:15:13 PM

Tim, avian flu has been known since 1997. In all that time, nearly all of the people infected with any of the varients, including the H5N1, were directly involved with handling poultry. The instances of human-to-human transmission are few, and subject to speculation. Most of the drumbeating about this disease in by people who will receive money if they can convince us that it's a coming disaster.

Bird flu is the latest in a long line of medical disasters that were predicted but never happened. SARS did not destroy the planet. Anthrax turned out to be far less deadly than predicted. Go way back to swine flu, and you see the same hype.

The fact is that flu pandemics happen. We know of three, though there is still some uncertainty that the "Spanish flu" was influenza. A future pandemic is probable. No one, no one, can predict when or what strain it will be.

In the United States, the last pandemic killed 34,000 people. Influenza currently kills between 30,000 to 35,000 people in the U.S. in a normal flu season.

I blogged the issue here.

Posted by: Chuck Simmins | Apr 13, 2005 2:10:32 PM

OED hippopotamus Pl. -muses, -mi
let's call it a draw

Posted by: Adrian | Apr 13, 2005 2:11:19 PM

"that a re-run of the Spanish ’flu (whether this current Avian version or another) is virtually certain at some point in the future. "

It will definitely happen. The flu viruses mutate very rapidly. Each new flu season brings a new batch of viruses. It is only a matter of time before a highly lethal strain arises again.

In the last 40 years we have forgotten that sweeping epidemics were once just part of life. They will come again. If we prepare we blunt their effects but we will never escape them entirely.

Posted by: Shannon Love | Apr 13, 2005 2:13:35 PM

The greatest threat from any pandemic is to the third world. In the United States, EMT's like myself routinely deal with epidemics all the time. HIV, West Nile virus, influenza and dengue fever are all currently an issue someplace in the U.S. Hanta and bubonic plague also rear their heads on occasion.

Sweeping epidemics occur in places where public health and hygiene are poor. The life expectancy in Angola is 40. It's not at all surprising that Marburg is killing more frequently than it did in the European outbreak. Remember that the Spanish Flu originated in an Army camp in Kansas [curiously for a supposed influenza]. Tons of folks, crowded together, with poor hygiene, no sewers, etc.

Posted by: Chuck Simmins | Apr 13, 2005 2:59:19 PM

Shannon Love opined, "In the last 40 years we have forgotten that sweeping epidemics were once just part of life. They will come again. If we prepare we blunt their effects but we will never escape them entirely."

People love their eternal verities, don't they? If they can't make themselves certain of a bright future, they'll make themselves certain of a dark future, or at least a drearily similar future. Anything is better than the humiliation and fear that goes with not knowing and knowing that you don't know. Oh God, let me die, but don't let me be ignorant of what the future holds for me.

Posted by: Doug | Apr 13, 2005 3:26:49 PM

lawdy mercy duz is mean i kaint have sex with my faverite chiken? it a dizaster!

Posted by: bubba | Apr 13, 2005 3:46:16 PM

Why wait around for a mutation to occur?

http://www.msnbc.msn.com/id/7480239/

Read down to the list of recipient countries; see where it says Lebanon? That would be Syria, Hizb' Allah and their good buddies Iran. If that's a little too indirect a possibility, how about Saudi Arabia?

This little bug accounted for millions 50-odd years ago (per the AP) without anyone helping it along. Factor in five decades of improved global transportation capability and a half decent dispersion plan and ...

Sometimes I wonder how we humans have managed to live as long as we have.

Posted by: Will Brown | Apr 13, 2005 4:10:23 PM

What amazes me is the lack of attention given the Marburg virus outbreak in Angola. This outbreak is killing roughly 100% of its victims--unlike past outbreaks in Angola and Congo, which displayed a case fatality rate of closer to 30%--and has apparently spread to the densely populated slums of the capital city, Luanda.

Now, Luanda isn't exactly London, but being a national capital puts the virus close to an international airport.

Back to the flu: What are the odds that a virus that's been out of circulation for almost 40 years is "accidentally" shipped to 5,000 laboratories?

Posted by: Derek Gilbert | Apr 13, 2005 7:27:04 PM

Derek: Marburg data, up to date sourced to the WHO, here

The WHO info about the virus shipment is here.

While a few H2N2 laboratory acquired infections have been documented in the past, the likelihood of laboratory-acquired influenza infection is considered low when proper biosafety precautions are followed. The risk for the general population is also considered low. As a precautionary measure, WHO is recommending that all samples of the proficiency testing panel from CAP and any other proficiency testing providers containing H2N2 and any derivates be destroyed immediately. WHO further recommends that biosafety procedures be reviewed for use on influenza viruses that have not circulated recently in humans and against which the majority of the population would have no protective immunity.

It was a routine matter, that in the post 9/11 atmosphere, has caused an over abundance of caution.

Posted by: Chuck Simmins | Apr 13, 2005 8:30:07 PM

Monjo, I thought that tamiflu was to be stored in a warm , dry place. That's what it says on tamiflu fact sheet. Can you advise?

Posted by: unpathedhaunt | Apr 26, 2005 6:08:55 PM

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