June 19, 2005

China ruins best chance of beating bird flu epidemic. A Vietnamese doctor who treated bird flu patients has contracted the disease himself. New fears that H5N1 is now entering the final (Phase 6) stage (efficient human-to-human transmission) to become a global pandemic. Warnings grow DIRE . . . and the beat goes on.
posted by mecurious 19 years ago
  • This is one of my top five things to worry about uselessly. It's right up there with a massive asteroid hitting the earth, peak oil and the attendant return to feudalism, gamma bursts, and the possibility that there is no life after death.
  • Time to invest heavily in any company makes surgical masks.
  • Stan the Bat: If there is no life after death, at least life during life is pretty good, eh? I've done some reading about the flu epidemics during WWI. Thousands, even millions, contracted the disease. Many died, but if you look at the stats, it was usually those who had compromised immune systems anyway. This may mean that, in modern America anyway, those who will be most likely to die from the new epidemic if it happens, are those who are very young, very old, or very uninsured.
  • >those who are very young, very old, or very uninsured. In other words, except for our kids, our parents, and ourselves, we're in the clear...
  • I've done some reading about the flu epidemics during WWI. Thousands, even millions, contracted the disease. Many died... That's an understatement. I'll assume you are talking about the Spanish Flu, which killed between 25 and 50 million people and infected some 20% of the global population. There are stories of people feeling fine as they walked to work in the morning and dropping dead before the end of the night. Entire villages were wiped out. ... but if you look at the stats, it was usually those who had compromised immune systems anyway. This may mean that, in modern America anyway, those who will be most likely to die from the new epidemic if it happens, are those who are very young, very old, or very uninsured. True. It's also worth mentioning that (at least in the US) sanitation and general health has greatly improved over the last 85 years. In 1918 there were only three useful vaccines -- smallpox, rabies, and plague -- and even these were poorly understood at best. Penicillin, the wonder drug of the 20th century, had yet to be invented. Hell, even chlorination of the drinking water was just starting to see implementation, and you can forget about effective over-the-counter remedies. So even today the fate of the "uninsured" is incomparable to the vast majority of the population back then. Hell, I bet that most of the insured people who fall ill with the bird flu won't even think about seeing their doctor. They'll take a couple days sick leave and then go back to work. However, it's worth mentioning that we do have something in common with 1918. WWI brought together millions of tired, malnourished, injured men who slept in cold trenches in close quarters. When the war ended they took more than their love back to their hometowns. Today we have the modern transportation system filling part of that roll. Within 24 hours you can probably be anywhere on the planet you want. Combine this and a highly contagious strain with a low mortality rate and you could see something much worse than the Spanish Flu. All that being said, I'm with Stan the Bat and his original comment. I don't worry because worrying won't do us much good. The diversity in nature dwarfs the human experience, and eventually something like or worse than the bird flu will come along. The best long term strategy is to stop dangerous practices (like raising large quantities of immuno-suppressed poultry and swine in close quarters, or xenotransplantation). Ohhh... and although I mentioned penicillin above, don't look towards it. Anti-bacterials are almost useless against viral infections like the flu. As one researcher pointed out the best treatment we have for any viral infection is for HIV. That should give you pause. One last thing: feel free to disagree with me. I'm a EE/programmer by trade, but infectious diseases fascinate me. I've read a couple books here and there and a ton of articles. So I'd hardly call myself an expert... more like an enthusiast.
  • According to the dire report, over half of the 104 human cases of H5N1 have been fatal (and I seem to recall that a lot of the victims were not in the infant/elderly/immunosuppresed category that is most vulnerable). If that mortality rate holds and this thing starts spreading like wildfire, this will be much worse than the Spanish Flu. Even if it only infects 20% of the world's population, that means more than 1 in 10 people will die within a very short period of time. I really shouldn't read these articles late at night.
  • Wow you just freaked me out mecurious. I'm listening to a record for the first time ever (Quantric), and the main line that's been dropped so far is "and the beat goes on". (I don't know if it's a sample from Sonny and Cher or not)
  • I've been worrying about the possibility of serious antibiotic-resistant illnessses for year. Since I read Gina Kolata's book on the 1918 flu epidemic, I've been really worrying about this bird flu, too. I've been interested in the topic since I found out that my grandmother died of the flu in 1923. My mother is visiting China this fall. I'm now really worried about her.
  • Get your Tamiflu now while you still can.
  • SARS was pretty damn scary, and spread very quickly. Probably originated from species to species transmission.
  • If the bird flu does in fact spread like wildfire, I'm gonna hop me a plane to Singapore and "hang" out for a year. When SARS dropped, Singapore took drastic measures and essentially managed to contain the outbreak. Court-ordered quarantines, and all persons entering the country were "instantly" screened. The first time I entered during the outbreak, passengers were greeted at the plane's exit by physicians with equipment to take our body temperature. And my second time entering Singapore during the outbreak, they had "high-tech" equipment in place that took your temperature instantly as you walked past a scanner. Heh... fun times indeed! In the U.S., they asked that passengers who had a cough or high temperature to identify themselves voluntarily.
  • If that mortality rate holds and this thing starts spreading like wildfire, this will be much worse than the Spanish Flu. The virus must mutate for efficient human-to-human transmission. It does this by infecting a human (or pig) that is already sick with another (perhaps low grade virus). The two viruses swap (or is it "combine"?) genetic material. Humans may be more succeptible to the resultant mutated virus, though it may be less virulent. I would not anticipate mortality rates with the pandemic that we see early on. An efficient virus must keep its host alive at least long enough to infect many others. However, H5N1 could be worse than the Spanish flu because we live in a world with transportation where a virus can be thousands of miles away in a matter of hours. (Think sitting on a plane back from China breathing the same recirculating air as the other passengers and then everyone disembarking in San Francisco or Vancouver).
  • Also, how many people die is only one aspect of a pandemic's degree of damage. The impact on the economies of nations (and perhaps the world) could be enormous: "The economic impact would be vast. Already one estimate suggests the crisis in Asia has caused more than $10 billion of damage to the economies of the most seriously affected countries. This would pale into insignificance if there were to be a human pandemic."
  • As usual, I recommend Ewald's "Evolution of Infectious Diseases". I'm certain he's right about some things and that the general process he describes is real and a substantial factor. He wants it to be the only explanation, however, excluding the species-jumping explanation for virulence, and he's probably wrong about that. But people should be aware that evolution of pathogens happens on the time scale of even individual infections and in most environments there is a lot of selective pressure for a pathogen to evolve towards lowered virulence. However, any environment which has a disease vector external to the host (such as a biting insect, contamination of water supply, contagion via health care workers) is an evironment where the selective pressure favors pathogens that can afford to be extremely virulent. Artificially high levels of host mobility could allow this as well (for example if you have hosts using relatively effective pallative drugs to remain ambulatory while they flee in all directions).
  • You need to re-read your WWI sources Doohickie; the thing that shocked people about the flu was that it killed a lot of the healthy young men and women who normally don't get hit by flu pandemics. And one of my grandmothers-in-law is old enough to have been a child during that one. I can do without seeing the scenes she witnessed - like the morgues and cemeteries overflowing to the point that the bodies were being bagged and hung from the rafters of the Auckland town halls.
  • Ewald's explanation for the virulence of the WWI flu is that the conditions in the trenches with extreme close proximity of soldiers and the rapid cycling of sick soldiers to hospitals replaced by healthy soldiers created an environment where the flu could evolve to a very high level of virulence--the pathogen didn't need for its victims to be mobile to infect new hosts, we provided that service rapidly and efficiently.
  • Wikipedia entry: Spanish Flu. One sociological aspect of the public's attitude toward the subject of pandemic that I find fascinating is the implicit faith in science and medicine to prevent such things from occurring (in our times). Certainly, our knowledge and response times should be significantly improved, but until we have another worldwide pandemic, modern man really can't appreciate how total prevention is not possible. And, as mentioned above, there are aspects of our knowledge/science/progress that could actually make matters much worse. The degree of interconnectedness of the world's nations economically is just one aspect of that.
  • "One sociological aspect of the public's attitude toward the subject of pandemic that I find fascinating is the implicit faith in science and medicine to prevent such things from occurring (in our times)." Not to harp on Ewald, but the practical point he made was to invent and promote "evolutionary medicine". We simply cannot win against pathogens the way we fight them. They will always evolve faster than we will find ways of controlling them. (Maybe not in specific cases, but in general--and therefore we will always be at the mercy of some virulent pathogens. Some which will be capable of pandemics.) So the idea of evolutionary medicine is to account for how pathogens rapidly evolve and use that information in our favor. How we use it in our favor is to create environments where the selective pressure is to lower virulence, and to eliminate or avoid environments where the selective pressure is to increase virulence. And the thing is, there's a variety of things that are common practices today that encourage virulence. Ewald examines something in depth that few people are aware of: the various outbreaks of extremely virulent pathogens in hospital nurseries that kill most of the infants. This has happened a good number of times and each time it's only been controlled by closing the whole ward down for a number of weeks. That's just one example.
  • The sky is falling. Again.
  • Interesting kmellis. Can you find any documentation of such nursery occurances? I'd like to learn more.
  • kmellis: Is this an example?
  • The sky is falling. Again. Meaning . . . ? This is the other interesting sociological attitude that interests me. Many people are apparently so desensitized by the sheer number of warnings (of various kinds) that have little or no (apparent) impact on their lives, that they tend to downplay all warnings, while somehow feeling intellectually superior for their cynical approach. Car alarms go off so often that when we hear them now, few of us really think that a car is being stolen (because usually, it isn't). Ironically, this has allowed car thieves to steal cars armed with alarms, because nobody looks twice. There seems to be a similar phenomenon at work regarding the warnings of this pandemic. It also seems to be downplayed because (by its very nature) it isn't moving fast enough for people's short attention spans. So they seem to think that the warning is being falsely repeated, when in fact it is the same warning being given as the more accurate and alarming evidence of its progress is being reported.
  • Maybe. It depends upon whether that fungus is more widespread, and usually benign, than they thought. The Ewald book is in storage, so I can't refer to it. I'm sure that one very bad case was in a hospital nursery in either Australia or New Zealand (apologies to both Aussies and Kiwis that I conflate the two in this recollection). Another that I recall he described was in the midwest US somewhere, I can't recall where. But the link you found isn't an example of what I was describing. What has happened in several hospital nurseries is that a common, usually mostly benign pathogen becomes very virulent and concentrated in the nursery, and almost impossible to eradicate. I now that the antipodean nursery shut down for a several weeks, and that eliminated it. It's hard to imagine an environment that could be more hospitable to an increasingly virulent pathogen than a hospital nursery. Babies have poor immune systems to begin with. Hospitals in general (for the same evolutionary reasons I'm describing here; but also because of antibiotic use) are hotbeds of unusually virulent normally benign pathogens. Babies in hospital nurseries are kept in relatively close proximity with a handful of caregivers handling all of them, often and in quick succession. Infants are prolific producers of bodily fluids. The pathogen has a near-perfect incubator in the infants, and a near-perfect transmission vector in the caregivers and their equipment. Since the two things are seperate, and both optimal, the pathogen can become extremely virulent to the babies without it limiting its contagion. Once the virulent strain has evolved, it always has a large evolutionary advantage in that environment and so even if you eradicate 99.99999% of the pathogens, it will spring back up very rapidly. It may be surviving benignly in the caregivers, their homes, their families. It has to be completely eliminated before the epidemic will stop. In these cases, closing the whole thing down for a considerable length of time was necessary (and sufficient). An obvious solution to the problem in general is to not have these sorts of nurseries. Keep the infants with their mothers as soon and as much as possible, and let the mothers (or someone similar) do most of the caregiving. If the nursing staff still has to do most of the caregiving, then very strident antiseptic procedures should be followed between every interaction with an infant. This selective pressure toward or away from virulence is why, for example, pesticides against mosquitoes in malaria endemic areas is so successful. It's not just reducing the availability of the transmission vector; but in doing so the pathogen is encouraged to evolve toward being more benign (because it necessarily needs to be to have enough time to be transmitted). Fewer people will get malaria...nevertheless some will. But fewer of those people will die from it because it will be a less virluent strain.
  • mecurious- what would you prefer that people do? panic? wash our hands? duct tape the house? genuinely curious.
  • In case you're in the mood to stay up at night worrying, check out Avian Flu -- What We Need to Know and the Agonist's Disease Outbreaks discussion board.
  • I refuse to run about wringing my hands over every potential disaster. There are too many of them, and life is too short. Besides, what good does it do? A quote from a physician in one of the links above suggests what we can do: "Almost nothing."
  • On postview, what Wedge said.
  • Individually, it may appear that we can do little. But PUBLIC education and awareness is the beginning of everything. The more people are ignorant (or downplaying) significant events (of any kind) the less likely governments are to recognize a need to do anything. That includes governments like China who attempt to deny that there is a problem until forced to do so - all the way down to governments like the United States who fund watchdog agencies like the CDC. It makes no sense to have a smoke detector with a snooze button. Blogs, in particular, are an excellent tool for publicly pointing at things that deserve our attention. Well-read blogs are the equivelent of a bunch of people pointing in the sky. Anyone passing by has to at least glance up.
  • This is a pretty interesting discussion, nevermind the good links. It's a shame that a probably - preventable epidemic (then pandemic) looks increasingly likely to happen. This preventable nature is exactly why we should keep ourselves informed; if all we can do is put political pressure/political support (huh!) where it will make a difference, then so be it. None of us has personally experienced anything on the scale of a pandemic, nor do we have any really good animal models handy, for the general public to appreciate what this actually would mean. Two diseases in domestic species with very high morbidity come to mind: myxomatosis in rabbits, which still has a pretty high mortality rate, in spite of the virus becoming more host-adapted over time; and maybe foot and mouth disease in ruminants, which may have a lower mortality rate in adult animals, but can cause permanent health problems in survivors (hence the huge economic impact). Now imagine if there were no health controls to animal imports/exports worldwide. Human flu affects 100 million people in Europe/Japan/USA alone huh, limited stats. What all the song and dance is about, then, is the fact that this H5N1 strain causes severe disease and kills a large percentage of those who catch it. If it is already resistant to the most readily-available retrovirals, then that's one important weapon missing from the medical arsenal. If we're lucky, H5N1 won't get over the virulence barrier (though mercurious' 3rd link suggests that may be happening as we speak).
  • Feudalism's coming back??? Kick ass.
  • "Two diseases in domestic species with very high morbidity come to mind: myxomatosis in rabbits, which still has a pretty high mortality rate, in spite of the virus becoming more host-adapted over time..." How well does this fit Ewald's evolutionary analysis of virulence? I'm going to follow your link and see; but before I do I'll predict that if Ewald's model is correct, myxomatosis must have a unusually high mortality rate because it has an independent vector for transmission. Hmm: "Myxoma virus, a member of the poxvirus group, is transmitted by mosquitoes, fleas, biting flies, and direct contact." I'd bet you that the high mortality rate strains are in environments where transmission is far more often by an independent vector than direct contact. You'd know this by correlating, say, mosquito population with incidence and mortality. I didn't say this explicitly, but the traditional theory of virulence is that pathogens inevitably evolve towards benignity and high virulence occurs primarily from species-jumping or the introduction of the pathogen into a pristine environment (which is another way of saying the other). How true this is, and how true Ewald's theory is, is very important in a practical sense because right now, for example, because of the traditionalist view, epidemiologists concentrate their attention on potential species-jumping pathogens. They also always make the assumption of species jumping, which has central importance in terms of how to pratically respond.
  • This is the other interesting sociological attitude that interests me. Many people are ...tend to downplay all warnings, while somehow feeling intellectually superior This is actually an important modern psychological phenomenon. With the mass of modern information people are unable to properly filter important information from that which is unimportant. People's natural tendency is to dismiss all information, even from qualified experts, as being of questionable value. We over-estimate our ability to weigh the value of information. Spin doctors now take advantage of this phenomen regularly. Effectively impuning reliable information provided by their opponents simply by putting out their own version, no matter how nonsensical in comparison.
  • People's natural tendency is to dismiss all information, even from qualified experts, as being of questionable value. We over-estimate our ability to weigh the value of information. There is also the idea in which each year the CDC makes rather dire pronouncements (remember Ebola?), the media dutifully touts each as the end-of-world-as-we-know-it and, amazingly, the world manages to proceed apace. While I agree that Bird Flu has the pontential for causing significant problems, comparisons to the Spanish Flu, increasingly ludicrous body counts, and complete discounting of modern medical and hygiene technologies tends - no offense - to make those of us who've lived through several CDC ends-of-the-world a little jaded about this sort of thing.
  • Many people are ...tend to downplay all warnings, while somehow feeling intellectually superior Not sure about that. Y2K is an example where in fact the warnings got taken *way* too seriously.
  • Y2K is an example where in fact the warnings got taken *way* too seriously. Y2K is what happens when warnings are sensationalized. There were definitely some problem systems out there, but nearly all of them were fixed well before 1999-12-31. (Or at least, workarounds were put in place which should hold us until the world ends in 7 years...)
  • for sbutler and any others who may consider themselves to be disease enthusiasts, the Encyclopedia of Plague & Pestilence is a handy fact-filled reference!