February 22, 2005
Avian Influenza May Mutate Into Killer Human Pandemic

Public health officials are starting to sound downright scary in their pronouncements about the potential danger to humans of the H5N1 influenza strain which is spreading through populations of chickens, ducks, and other birds in Southeast Asia. Julie Gerberding, head of the US CDC, told a meeting of the American Association for the Advancement of Science (AAAS) that we are probably in a period equivalent to the historical period right before the 1918 influenza pandemic which killed tens of millions of people.

In an address to the AAAS Annual Meeting in Washington, D.C., Dr. Julie Louise Gerberding noted that the in its current form poses a relatively limited problem for humans. But, she said, the current situation "probably" resembles the period before the 1918 Spanish flu outbreak when the virus was quietly mutating into a strain that would eventually leave 50 million people dead.

"Most people who are looking at this recognize it is a very ominous situation for the globe in terms of statistical probability" of a larger outbreak among humans, Gerberding said.

Gerberding's comments Monday came just a day after Dr. Nancy Cox, the CDC's chief influenza scientist, suggested to a AAAS audience that further mutation in the avian flu in Asia could precipitate the worst pandemic in human history.

Researchers believe that prolonged contact with infected birds or consumption of raw, infected chicken meat is required for the virus to jump to humans. But once it does make the jump, it appears to be lethal: According to a report Monday in the Financial Times, the current outbreak has infected 55 humans in Asia and killed 42, a mortality rate of 76 percent.

There is some question as to whether the bird flu really does kill three quarters of the people it infects. If more people are being exposed but developing symptoms too mild to be diagnosed as bird flu then the reported deaths might represent a smaller fraction of a much larger number of infected. Dr. Cox says people who may have been exposed to the bird flu are being tested for immune responses to the flu virus as a way to determine if they managed to have mild cases of bird flu.

"Some studies are going on to get a better handle on what the real case fatality case is," she said. For example, poultry workers exposed to the virus would be checked for any H5N1 antibodies in their blood.

However, some of the previously undiagnosed human cases of bird flu infection appear to have been fatal. The disease may be occurring more often in humans than previously expected but without typical influenza respiratory symptoms.

Two Vietnamese children who died in 2004 of diarrhoea and apparent encephalitis actually had H5N1 bird flu, British and Vietnamese scientists have reported.

The cases raise the frightening possibility that there have been far more human infections with H5N1 than thought, because many cases have been overlooked by doctors watching for the fever and cough of typical flu.

The cases of the Vietnamese children suggest that other cases of bird flu are not being diagnosed.

Dr. Menno de Jong, with Oxford University's Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City, said he and fellow researchers believe the boy's case, which wasn't linked to bird flu until months later, may mean that other cases with no respiratory symptoms have gone unnoticed.

The discovery of these H5N1 bird flu cases in the two children was accidental because some scientists happened to be investigating the causes of encephalitis (brain inflammation) in southern Vietnam and found the bird flu link.

One complicating factor in any analysis of antibodies to H5N1 influenza strains is that earlier and far less lethal strains of H5N1 provoked immune responses a few years ago that will show up in tests for H5N1 infections today. Yet the H5N1 of today appears to be much more lethal than the strains from 5 years ago.

Well dear reader, should you be worried about this? I think so. I would not be the least bit surprised if later this year or in 2006 or 2007 tens of millions of people died worldwide from a further mutated strain of the H5N1 bird flu. All it would take would be for that bird influenza virus and an influenza virus from humans to infect an animal or human at the same time. Then the two strains could have their DNA recombined into a strain that has the deadliness of the avian flu and the transmissibility of a human flu. The result would be a pandemic in which each of us would lose family members, neighbors, and friends.

We desperately need more rapid ways to make and scale up the production of influenza virus vaccines. The current method of growing influenza viruses in fertilized chicken eggs for months is too slow and does not scale up rapidly. But when an influenza strain with high human lethality finally springs up we are not going to have a year or two to get ready.

CDC officials are not alone in sounding the alarm about bird flu. Joseph Domenech, director of animal health at the United Nations Food and Agriculture Organization (UN FAO), says the H5N1 avian influenza is a sword of Damocles hanging over the world.

"The time is ripe today for the international community to see how the virus constitutes an enormous sword of Damocles in terms of public health and the rural economy," Domenech told AFP during an interview.

The World Health Organization thinks wealthier governments should stockpile vaccine against H5N1 bird flu.

Governments should consider stockpiling vaccine against H5N1 bird flu now, before a pandemic starts, a World Health Organization report out next month will advise.

The change in policy reflects growing fears that an H5 pandemic is likely, and that there will not be time to produce much vaccine once it starts. "When we realised H5N1 is not going to be eradicated in poultry in Asia for at least another couple of years, that made the risk of H5 much higher," Klaus St�hr, head of the WHO's influenza team, told New Scientist.

That story reports that the United States government plans to stock 4 million doses. With a new strain of flu 2 doses are required for full immunity. So those 4 million doses are even more inadequate than they initially appear to be. As for the rest of the world, France and Italy are going to stockpile a couple million doses each.

If a pandemic with high rates of lethality breaks out then I predict a black market in the vaccines that are available against the virus.

Two companies have developed pilot batches of vaccine against H5N1 influenza virus.

Two companies, Sanofi Pasteur and Chiron Corp., are currently under contract to make H5N1 vaccines for the United States. Each company received a contract in May 2004 to make small pilot batches. In September, Sanofi (formerly Aventis Pasteur) received a contract to make 2 million doses. US officials have said that clinical trials of those vaccines are expected to start soon. Chiron is also under contract to make 40,000 doses of an H9N2 vaccine, another flu strain regarded as having pandemic potential.

A Chinese team has also developed a vaccine against H5N1 influenza. But the initial development of a vaccine is not the hard part. The hard part is scaling up vaccine production to make doses for billions of people.

If and when a big killer bird flu crosses over into humans the most rational response should be to find ways to greatly reduce human-to-human contact while we wait for vaccine production to be scaled up. We will need to radically alter our lifestyles for a year or two while waiting for vaccines to be produced for billions of people.

Share |      Randall Parker, 2005 February 22 01:27 AM  Dangers Natural Bio


Comments
Robert Silvetz said at February 22, 2005 12:20 PM:

Well, this is just criminal insanity. What is so f'ing hard about scaling up vaccine production? I can make grams of any antigen in my lab, admittedly not to GMP standards, but grams nonetheless. And I'm small time. A real lab should be easily be in the 100 gram range and should just through parallelization scale to tens of kilos e.g. a couple billion doses.

Not that this wouldn't be expensive mind you, but for crying out loud, it's tens of millions of dollars, let's dump one B-2 bomber and save the planet from a pandemic.

Garson Poole said at February 22, 2005 12:38 PM:

Robert Parker said: "We will need to radically alter our lifestyles for a year or two while waiting for vaccines to be produced for billions of people."

One possible response to an outbreak of a dangerous communicative disease would be a massive upsurge in telecommuting.
Here is a a">http://varifrank.com/archives/2005/02/changing_the_wo_1.php">a link to a blogger who describes a disaster situation that made telecommuting necessary:


In 1989 I was a part of a vast experiment in forced “homesourcing”. Like 3 million other people, I was working in an office in San Francisco when the Loma Prieta earthquake occurred. The loss of the Bay Bridge and the damage to streets and offices in the city itself put a severe cramp in the ability of people to get to and from San Francisco to work. Did they stop working? ... No. They took their new office PC’s home and began to work out of their homes, coming into the city only when it was absolutely necessary. PC’s had only just arrived, but they made a world of difference in the ability to distribute work.

The emphasis of the discussion in the blog posting is actually on reducing fuel consumption; however, telecommuting is also very relevant to increasing biological safety in an emergency I think.

Robert Silvetz said at February 22, 2005 12:55 PM:

I doubt that there is any way to change our lifestyles sufficiently.

Food distribution is set up from central distribution [warehouses, transhipment points] to peripheral node [supermarket]. Are we going to stop shopping for food e.g. coming together to spread the virus at our common food acquisition point?

What about schools? Are we going to shut them all down?

What about economic impact when every restaurant has to close?

And then, what about our super-breeding ground, the likely ground-zero of the future pandemic? The hospital. These people can't even keep normal bugs in check, what are they going to do when they are overwhelmed in their waiting rooms...

One sneeze has a 3-meter droplet spread radius. It contaminates every surface within that radius. Are we going to H2o2 fog every surface in every office, trolley, waiting room, cinema, bathroom, keyboard, door handle?

Understand that minimizing human contact won't do it. Human to human transmission is not the primary spread -- human-to-surface-to-human is.

No, Parker is right -- the vaccine is the right solution and the amounts being produced are woefully inadequate.

Garson Poole said at February 22, 2005 1:17 PM:

Fast and accurate diagnosis coupled with widespread and regular screening would help detect medical diseases and help contain epidemics. Now, I would ask readers to suppress all impulses to scatological humor and try to imagine the one device located in every home that could be used for biological and medical diagnosis. This device is typically used every day and can perform tests on urine and stool specimens. Here is a link to an article that originally appeared in the New York Times called Japanese Masters Get Closer to the Toilet Nirvana. Here is an excerpt:

"We are going to install in a toilet devices to measure weight, fat, blood pressure, heart beat, urine sugar, albumin and blood in urine." The results would be sent from the toilet to a doctor by an Internet-capable cellular phone built into the toilet. Through long-distance monitoring, doctors could chart a person's physical well-being.

Imagine a toilet that can check for the presence of bacteria and viruses in samples shed from the body by using a vast array of genetic probes. It might also be able to check for signatures that identify cancerous cells and do many other tests. Collecting urine, stool and saliva samples at frequent intervals would be easy and automatic. Unfamiliarity and price would be obstacles to deployment. Perhaps some research dollars can be designated to facilitate work in this area?

Randall Parker said at February 22, 2005 1:20 PM:

Robert,

It is my impression (and someone please correct me if I'm wrong) that influenza vaccine is NOT made from a single antigen. My impression is that full virus is grown on fertile chicken eggs. This takes much longer, months in fact. Also, there is a limited number of facilities that have the right kinds of chickens, the right equipment for growing the eggs under special conditions, etc. This is why I argue for the development of DNA vacciness and other approaches that are more rapidly scalable. How about yeast genetically engineered to produce influenza antigens? The stuff could be grown incredibly rapidly. Though how to purify out the antigens would be a problem. Attach the antigens to stuff that is easily separable?

Randall Parker said at February 22, 2005 1:51 PM:

Robert,

I think lifestyle changes are doable. Here are a whole bunch to chew on:

1) Exposure risks from store visits could be drastically reduced.
- People could stagger out their store visits by coming in at different hours of the night and day.
- They could buy a lot per visit and therefore go far less often. I'd be willing to go buy a couple of months food. In fact, I personally could stop going to the grocery store right now and live off what I have for a few months.
- In the extreme people could call up and order a list of items in advance and pick them up outside (external ATM kiosk to pay or pay via the internet in advance and get a payment and account code before arriving) and avoid entirely entering stores.

2) Stay-at-home mothers could do home schooling. Millions already do this. Tens of millions could as well if the alternative was dying.

3) Schools could reduce exposures all sorts of ways.
- Reduce the number of kids in a building at the same time. Schools could have their different classes meet on different days of the week for longer hours each session. Some kids could have classes delayed till summer.
- Rent some smaller buildings and mobile homes to make single class standalone schools so only kids in the same class could pass influenza to each other.
- Shrink class sizes with more teachers.
- Make the kids wear gloves and thick cloth face masks to reduce cough droplet travel.
- All kids could be required to have their own thermometer and show its temperature once or twice a day. Elevated temperatures and coughers get sent home quickly.
- Reduce the number of horizontal surfaces in schools so kids have less stuff to touch.
- Videotape lectures so kids can watch lectures at home.
- Make kids from the same family attend the same schools (to the extent possible) so that kids in the same family do not serve as vectors for moving pathogens between schools.

4) Restaurants:
- Again, take out.
- Make all kitchen workers wear thick cloth over their faces and gloves to reduce the chances of food contamination.
- Also, use lots of automated cooking equipment.

5) Droplet travel radiuses: This is an argument for dropping long transparent plastic curtains down from the ceiling in big office buildings that have miles of aisles of cubicles.

6) Humans touching surfaces: Lots of things could be done:
- Everyone would have to wear gloves.
- Everyone would have to wear facial covering that can capture cough and sneeze droplets.
- Doors could be modified to be openable in either direction by pushing with the back of an arm or a foot. I've opened doors with my feet when I was carrying things in both hands. It is doable.
- Remove some surfaces such as guard rails to give people fewer things to touch.
- Some surfaces could be cleaned very regularly.
- How about UV lights on in bathrooms whenever no one is in them?
- Return to semi-full service gas stations so that each individual visitor wouldn't have to touch the fuel pumps.
- Dollar bill readers to pay without another person touching the bills.
- Sale of devices that sterilize money.

7) Financial transactions automation.
- A truck driver shouldn't have to get out of a vehicle to sign a bill of lading or other documents.
- Instead of touching all the ATM kiosk buttons you could have a PDA that plugs into the Kiosk and you'd enter your transaction by typing on your own PDA.
- Everyone would be encouraged to sign up for automatic debit to pay bills and automatic deposit to get paid.
- Other "reduced exposure" ways to do business could be concocted.

8) Lots more home office work.

I could come up with more ideas. There are tons of ways to reduce risks of virus spread.

I figure we could pretty easily slow the rate of spread of influenza by an order of magnitude and with more severe measures by two or three orders of magnitude.

rsilvetz said at February 22, 2005 1:55 PM:

Randall,

You are one hundred percent right.

The number of antigens doesn't really matter, the fact remains that between e.coli and yeast, given a few dna segments for the antigen protein viral capsid stuff we need, we should be able to make kilos of this stuff. What I suspect we are seeing, is once again, regulatory inertia. The ultra-slow egg yolk nonsense is probably "approved" and all the recent biotech stuff isn't, and rather than do what's right, they are doing what's expedient.

I wish I could confirm this somehow, because we could really embarrass the powers that be into concerted action.

Garson Poole said at February 22, 2005 2:00 PM:

Robert Silvetz: I appreciate your knowledgeable comments. I certainly think that the development and wide scale deployment of a vaccine is of fundamental importance when facing deadly influenza strains. I was not proposing telecommuting as some kind of sole alternative strategy. I was suggesting it as a necessary complementary strategy when facing diseases for which medical counter-measures are not contemporaneously widely available.

An epidemic can kill multiple people before it has been biologically characterized. The lag-time in manufacturing vaccines requires authorities to sometimes guess which strain of a virus will emerge to cause a pandemic, as you know. Of course, better manufacturing methods to reduce this lag time are desirable. Yet, there is a deeper problem. Randall Parker has posted many times about the dangers of biological attacks. Time will be required for researchers to characterize the organisms used in biological attacks and to develop counter-measures.

But society has no choice. It must react immediately and try to save lives even when a vaccine or medicine is unavailable. The problems that you have enumerated in your post are certainly formidable. But, I think that each must be tackled.

rsilvetz said at February 22, 2005 2:29 PM:

Just an FYI, our U.S. dollar is remarkably sterile. Years ago I tried to culture stuff off some used ones and fives. Not a damn thing grew out. I suspect the ink is viricidal and bactericidal.

This, however, is not true of coin. I got all sorts of gram-positives and some gram negatives, off 25cent pieces.

Marvin Meyer said at February 22, 2005 2:35 PM:

indeed human - human contact is a priority I’ve had the rare opportunity to meet Dr. Hans A. Messner a world-renowned immunologist Dr. specializing in immune systems and bone marrow transplant procedures.
Everyday things that we take for granted will have to become top priority. We will have to clean the light switches, the doorknobs, the refrigerator handle, the telephone receive, and the newest item, the keyboard keys. Us humans do not think of contact points where other humans have touched, possibly ones that have the flu virus. Rolling up your sleeve over your hand when opening that outside door entering the public shopping mall.

Also brought to mind is just a simple task of washing your hands. It will have to be done, not with antibacterial soap, but by friction and running water. Again one of those marketing myths that has been imposed on us by the media. Personal hygiene will dominate the news headlines. Yet hospitals and nursing homes will either be in lock down mode or “gown-up & mask up” will be required.

Productivity in industry will also suffer. An interesting concept I have always wondered is a medical study on workers who work normal shifts, (40hrs week @ 8-12hrs each) vs the rare one who only works a “weekend” shift that consists of 12hrs @ time and a half plus 12 hrs @ double time which equals a 42 hr work week. I happen to be a rare case, in which I rarely obtain colds/flu. Perfect work record for 11yrs now.

Governments will wait till its too late................
Regards


Robert Silvetz said at February 22, 2005 2:50 PM:

Ok. Looked at how they make this vaccine. Basically they do grow it in a hen's egg, inactivate chemically, purify and dose it. So we are mired in 1970 technology. Which is the absurd way to go about this. You couldn't scale this to pandemic proportions. It just isn't a solution.

The obvious approach is to get DNA from the viral RNA for epitopes of interest and massively expand in culture. I can't believe someone with their brain turned on isn't doing this. Additionally, I wouldn't be shocked if conserved segments wouldn't provide immunity against H5 lethality -- e.g., I give you a DNA vaccination of conserved segments, you will still get sick as a dog if infected, but it won't kill you.

Either that or we can breach a taboo subject, and use antivirals of the ozonide family...

Randall Parker said at February 22, 2005 3:11 PM:

Robert Silvetz,

Yes, the way influenza vaccine is produced is ridiculously and dangerously antiquated. Development of faster vaccine production technologies should be treated as an extremely urgent matter.

I've posted about this before. I can not believe that more is not being done about it. We are at risk of millions of deaths that would be avoidable if we just made the effort to modernize our vaccine production techniques. The next big influenza pandemic is coming sooner or later. We ought to get ready for it.

Getting ready for it would yield benefits long before the pandemic hits. A vaccine production technique that is faster would be cheaper. It could be used to adapt to changes in more conventional influenza outbreaks. Lower costs would allow larger numbers of people to afford to be vaccinated.

Aside: I'd love to see faster vaccine production techniques applied to the production of vaccines aimed at the common cold. Colds are caused by a large assortment of viruses, some rhinoviruses, some others. Why not produce vaccines that target dozens or hundreds of viruses and strains thereof? Every time a new strain popped up within a few months a vaccine could be produced that incorporated it. Think of the money that would be saved by the economy if people didn't get sick as often as they do now. Couldn't this be done?

Robert Silvetz said at February 22, 2005 3:28 PM:

Well, I'll be damned. Guessed right for a change.

Immunization in mice with conserved DNA segments impedes H5 lethality!

"H5 viruses differ in virulence, and one cannot predict which strain might emerge in a future pandemic. With the threat of a pandemic and suboptimal existing vaccine candidates, new approaches to influenza vaccination should be considered. Our results suggest that DNA vaccination with conserved components has the potential to ameliorate disease caused by H5N1 viruses. The immunity induced by this mode of DNA vaccination does not completely prevent infection but passed the stringent test of protecting against lethal H5N1 challenge. Vaccines inducing neutralizing antibody could be administered subsequently to confer immunity against even the most virulent strains. In the absence of an antigenically matched HA-based vaccine, this approach might be useful as a first line of defense against a rapidly spreading influenza pandemic and should be further explored."

from
DNA Vaccine Expressing Conserved Influenza Virus Proteins Protective Against H5N1 Challenge Infection in Mice

Suzanne L. Epstein, Terrence M. Tumpey, Julia A. Misplon, Chia-Yun Lo, Lynn A. Cooper, Kanta Subbarao, Mary Renshaw, Suryaprakash Sambhara, and Jacqueline M. Katz

Emerg Infect Dis 8(8), 2002. © 2002 Centers for Disease Control and Prevention (CDC)

Randall Parker said at February 22, 2005 3:55 PM:

Robert Silvetz,

Great find on that paper. I want that vaccine!

So how hard is it to manufacture DNA vaccine? How is it done? Are microorganisms used to do it with plasmids that get separated out in purification? Or are the DNA strands built chemically? Or what?

Would it be reasonable to expect DNA vaccines to have a long shelf life?

Could a vaccine like this H5N1 DNA vaccine be developed and delivered to the entire population now befor a particular lethal strain emerges as a way to get partial immunity to the eventual lethal strain? Wouldn't that make the infections far less likely to be lethal even though the virus would still manage to infect some people?

Marvin Meyer said at February 22, 2005 4:55 PM:

Randall;

It is my understanding (joggin my memory of course) talking about this now I remember the JC Virus. this virus effects 80% of the population. In other words most people already have it. Our immune system is always fighting this and others, then along comes another virus, it may be stronger or more potent or weaker. The immune system then fights or attacks it.

The H5N1 is "just another" one. In marrow transplant victims, and I call them victims for the sake of my deceased brother, this is the high risk factor. You see, our own system is weakend trying to fight off a new attack. While being weakend the other virus (jcv for example) strenghtens and expands to other organs. So if the H virus does not kill then we are left dying from another, such as the JC virus. There is no specific antiviral therapy that has been proven effective for JCV.

I am no doctor, just remembering the words from Messner's mouth while treating my brother.
Regards

Eric said at February 22, 2005 5:56 PM:

From the DNA vaccine paper:

Plasmid VR1012 was obtained from Vical Inc. (San Diego, CA) under a Materials Transfer Agreement. Full-length influenza genes for NP and M of A/PR/8 were prepared and inserted into VR1012 as described previously (27). The plasmid B/NP expresses the full-length NP gene from B/Ann Arbor/1/86 (B/AA), derived from a baculovirus vector generated by Rota et al. (34) and subcloned into VR1012. Plasmid DNA was prepared and tested as described (27). Endotoxin levels were [less than] 1 EU/100 mg dose.

H5N1 viruses used in this study were HK/156, HK/483, HK/485, and HK/486 (31). Other viruses used were H1N1 virus A/PR/8; reassortant virus X-31 with surface glycoproteins of A/Aichi/2/68 (H3N2) and internal proteins of A/PR/8 virus; and B/AA. The A/PR/8 and X-31 stocks were mouse adapted by passage through mouse lungs. Virus stocks were propagated in the allantoic cavity of embryonated hen eggs at 37°C for 24 hr (H5N1 viruses) or 34°C for 48–72 hr (other viruses). Fifty-percent egg infectious dose (EID50) titers and mouse infectious dose (MID50) titers were determined by serial titration in eggs or mouse lungs, respectively, and calculated by the method of Reed and Muench (35). All experiments with infectious H5N1 viruses were conducted under BSL-3+ containment, including work in animals.

BALB/c female mice were purchased from the Division of Cancer Treatment, National Cancer Institute, Frederick, Maryland, or from Jackson Laboratories, Bar Harbor, Maine. DNA was injected intramuscularly, 100 [micro]g/mouse of each plasmid, three times at 2-week intervals, starting at 6–7 weeks of age.

T. C. Dean said at February 22, 2005 8:21 PM:

Randall,

It's a great service to bring up this topic. I can't imagine why there isn't more coverage in the mass media.

There is a very obvious need to immediately apply the incredible technology of genetic engineering to rapid response vaccine design and production. Mother nature is about to produce a devastating viral attack with the avian flu and we have had years of warning about the design parameters. What will happen when terrorist genetic engineers get to work on an optimum design combining the virulence characteristics of a cold virus with the lethality of ebola or HIV? We should be spending billions on avian flu as well as the general rapid response vaccine problem. Scientists have already shown that we can create a virus from scratch with amino acid components. It is actually easier to create designer viruses by combining viral genetic materials.

Robert Silvetz said at February 22, 2005 8:26 PM:

Ultrasimple primer on DNA vaccines...

http://people.ku.edu/~jbrown/dnavac.htm

Dave Schuler said at February 23, 2005 7:58 AM:

This discussion is highlighting some that's worth considering on its own: our system rewards large, monolithic organization that are increasingly unable to respond rapidly. Why aren't there 10,000 small labs making vaccines? Simple. The approval, inspection, etc. processes make it impractical.

Dave Schuler said at February 23, 2005 7:59 AM:

Make that “highlighting something”.

T. C. Dean said at February 23, 2005 10:32 AM:

Well, it seems there now is more coverage of the avian flu pandemic potential. Unfortunately, we still don't know how the virus will achieve it's breakout into the human population and so will not be able to design a foolproof vaccine until it is too late. We not only don't have the infrastructure to produce the virus, we don't have the public health infrastructure to distribute and administer in on an emergency basis. A reasonable goal for a fast moving flu or terroristic designer virus would be to identify the virus, create the vaccine, distribute and administer within two to four weeks. We are currently very far from this goal. Currently we would be lucky to have a vaccine in six months.

This is one of those areas that is critical to public well-being where government must play the leading role. There are simply insufficient incentives in the free market to continually stay several steps ahead of nature and terrorist genetic engineers by creating vaccines that will probably never be used. There should clearly be a Manhattan Project type effort to put this infrastructure in place as quickly as possible.

Ken said at February 23, 2005 11:13 AM:

"This is one of those areas that is critical to public well-being where government must play the leading role. There are simply insufficient incentives in the free market to continually stay several steps ahead of nature and terrorist genetic engineers by creating vaccines that will probably never be used."

That's mostly because government has been taking the leading role in buying and distributing vaccines and in setting the prices for same - it's taken the profit right out of it, and discouraged vaccine production. Lots of companies that should have been working on ways to quickly scale up new vaccine production to allow a huge demand for a brand-new vaccine to be met in time and reap a windfall have gotten out of the business entirely.

Another useful idea is to lift most controls on the posession and use of life support equipment, and encourage the development of cheaper, portable life support devices that can be used at home - this will alleviate hospital overcrowding in a pinch, and also decrease the huge end-of-life expense that most of us experience. For many diseases, once you've come down with it, your only hope is to be artificially kept alive long enough for the disease to run its course, and a wider deployment of cheaper, easier to use life support machines can be helpful here. They won't be deployable to the general public the very next day, but in the absence of controls, there's money in making them progressively cheaper and easier for average people to use.

T. C. Dean said at February 23, 2005 3:34 PM:

"That's mostly because government has been taking the leading role in buying and distributing vaccines and in setting the prices for same - it's taken the profit right out of it, and discouraged vaccine production."

Well Ken, have you ever heard of the concept of "providing for the common defense"? What is the fundamental difference between a nation's need to defend its citizens from a maurauding foreign army or to defend its citizens from a rapidly spreading fatal illness? In neither case can we expect the free market to maintain the necessary infrastructure to get the job done for the common welfare. Did I say "welfare"? Is that your problem?

If there is insufficient profit incentive to encourage the pharmaceudical industry to develop a fast response vaccine development and production capability, then the government should put it out for bid, just as it does when we need a tank or a fighter to defend our country. Is it the opinion of the Miltonians there in Chi town that those folks (and their children) without the sense and money to obtain the vaccines or anti-viral drugs to defend themselves from lethal viruses are not fit to survive? Personally I think the wisdom of our founding fathers as embodied in the constitution is an advancement over the law of the jungle.

Garson Poole said at February 24, 2005 11:26 AM:

Making flu vaccines is apparently a difficult market for some companies. In 2002-03, the company Wyeth made 21 million doses of a flu vaccine. They threw away 7 million unsold doses, for a loss of $30 million. Next, Wyeth helped develop a new "live" virus vaccine that you squirt up the nose called FluMist. The product failed. They sold only 450,000 doses. Finally, Wyeth pulled out of the market. This information comes from a Washington Post article entitled http://www.washingtonpost.com/wp-dyn/articles/A38776-2004Oct16.html ">“How U.S. Got Down to Two Makers Of Flu Vaccine”.

Makers of vaccines also face large uncertainties because of potential legal liabilities. Trial lawyers have been able to win multiple large judgements against vaccine manufacturers as described http://www.weeklystandard.com/Content/Public/Articles/000/000/004/793dgqvs.asp ">in this article from the Weekly Standard. The polio vaccine, whooping cough vaccine, various childhood vaccines, the anthrax vaccine and others have been entangled with litigation. For some vaccines the government has obtained a powerful “monopsony” position as Ken mentions above. (Monopsony is sometimes referred to as the buyer's monopoly.)

Garson Poole said at February 24, 2005 12:05 PM:

The ideas for "lifestyle changes" that Randall Parker and Marvin Meyer discuss could form part of a comprehensive ameliorative response to a possible pandemic. There is a research project that is trying to determine the best interventions. If you have ever played “SimCity” or “The Sims” you will not be too surprised at this approach.

The upcoming, March issue, of Scientific American describes "the largest individual-based epidemiology simulation model ever created". It is called EpiSims and is being developed at Los Alamos National Laboratory (LANL). Here is link to the online article that describes a huge simulation with 1.6 million virtual residents.


The TRANSIMS virtual version of Portland incorporates detailed digital maps of the city, including representations of its rail lines, roads, signs, traffic signals and other transportation infrastructure, and produces information about traffic patterns and travel times. Publicly available data were used to generate 180,000 specific locations, a synthetic population of 1.6 million residents, and realistic daily activities for those people. Integrating all this information into a computer model provides the best estimate of physical contact patterns for large human populations ever created. With EpiSims, we can release a virtual pathogen into these populations, watch it spread and test the effects of different interventions

When the researchers ran a simulation of the release of smallpox here is part of what they found out.

The speed with which people withdrew to their homes or were isolated by health officials was the strongest determinant of the outbreak's extent. The second most influential factor was the length of the delay in officials' response. The actual response strategy chosen made little difference compared with the time element. In the case of a smallpox outbreak, these simulations indicate that mass vaccination of the population, which carries its own risks, would be unnecessary. Targeted vaccination would be just as effective so long as it was combined with rapid detection of the outbreak and rapid response. Our results also support the importance of measures such as quarantine and making sure that health officials give enforcement adequate priority during highly infectious disease outbreaks.
David N. St. John said at February 26, 2005 8:10 PM:

Randall -- (and other commenters) -- I read all of the above with a great deal of interest and no little dread, but I suspect the situation may not be quite so dire as everyone seems to believe. There is an antiviral chemical that is relatively safe to use, lethal to a broad range of both viruses and bacteria, readily available, and fairly cheap.

So what's not to like? Trouble is, this one is so common it gets overlooked: it is just ascorbic acid, generally buffered and administered intravenously. Yes, you read it right -- plain old Vitamin C, in massive doses, usually 15,000 milligrams over a few hours. As far back as the late 1940's all this was known, and in fact was written up in an article in the Southern Journal of Medicine. The doctor doing this used it on both smallpox and polio, with excellent results. I do not have the exact references at home where I can put my hands on them, but I will try to look it all up for all of you, sometime early next week.

It would be tragic to lose millions of people, in a situation where something so simple could mean the difference between being somewhat sick for a few days, and dying. I suspect that this could be like the use of common antibiotics like tetracycline to cure ulcers -- a technique that was discovered and then lost for many years. It also ties in with the comment above, that we need more home life support equipment. In this case, all that would be needed is sealed, pre-measured doses of Vitamin C and buffering compound, and simple IV equipment and instructions. How tough could this be, and how many lives could it save?

David N. St. John

Tj Green said at February 27, 2005 11:41 AM:

Part of the problem is that we have a first,second,third,and fourth world.A divided world is a divided species,and a divided species is weaker.If we can make poverty history,then disease,which feeds on poverty,will die of starvation.

Robert Silvetz said at February 27, 2005 8:40 PM:

Uh no and not to start a flame war-- Vitamin C in any dose has clearly been shown NOT to change the rate of infection, duration of sypmtoms.

http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/colds.html

I don't know why this particular myth persists -- I tend to see it in the cancer community as well, where IV vitamin C is a staple.

The simple truth is that it doesn't do what's claimed. The very few times it works has to do with restoring NK cell capacity to mount oxidative attacks.

John Hart said at February 28, 2005 9:53 PM:

Enjoyed reading your post. It's very accurate. A handful of comments:
1. Using eggs as incubators for vaccine production is elementary at best. It's time for an entirely new method.

2. 2 million does of a vaccine won't even cover Rhode Island.

3. H5N1 can reassort faster than you can say "I'm sick." One vaccine will not protect against H5N1 if it reassorts, or mutates. Look at the list for next season's H3 influenza: A/California, A/Caledonia, and on and on.

4. One commenter said there wasn't much media coverage. Not true. The story has been in very major media source, as well as weekly source, around the world. You know it's news when you see it on the front page of USA Today, the NYT, Wash Post, and LA Times.

5. We cover H5N1 daily at Pathogen Alert, using proprietary bots as well as others. Not only H5N1, but other infectious diseases. A cholera outbreak in Nigeria is, at the moment, is very threatening.

6. There isn't any use in calculating how to stop human casualties in this upcoming pandemic. What we should be doing is calculating ways of protecting our families. There are three things you can be doing now. Check Pathogen Alert. And don't waste your money buying an N95 particulate filter mask. It can barely stop paint chips, and it sure as hell won't stop H5N1.

Tj Green said at March 3, 2005 11:08 AM:

Haven`t we seen something like this before,virus endemic in wild birds infecting domesticated chickens? Thousands of years ago,by changing our enviroment(for farming),we also created an ideal breeding ground for the mosquito. With the introduction of chickens everything was now in place for the most devastating interaction humankind had ever seen,malaria.Plasmodium or virus the story is the same,interacting with other species can be bad for our health. Reduce the interactions.

Samson Alva said at March 10, 2005 6:23 AM:

If such a pandemic were to occur, we'd be left with a larger proportion of OCD people, what with their desire for cleanliness and orderliness and minimal human (and often sruface) contact.

Finn Cosgrove said at March 13, 2005 10:37 AM:

I am surprised that so little has been said about the use of face masks, particularly as there are some masks which are not protective.

Because there will be so little time if and when human to human viral transmission occurs, what if a large percentage of the population of a country or region supplied themselves with the N95 face mask in advance - like now! If there never is a pandemic, what's a few dollars between neighbours in a crowded space!

If there is a pandemic, we could put on our mask immediately in the absence of both anti-virals and vaccine. We could put them on as soon as we are told on the News that a pandemic has started. We could put them on either whenever we left the house or when we are entering a crowded place, and certainly whenever we are in the presence of someone coughing.

We could do so much for ourselves, and we can all do it now! If a significant proportion of people did this, the infected droplets would fall to the ground to dry out with no mortality to their credit.

Isn't the SARS epidemic something we can learn from? After all, human to human transmission IS known to occur.

Prof Seto, SARS study leader and chief microbiologist at Queen Mary Hospital in Hong Kong, has stated that wearing a mask confers up to 13 times more protection compared with not wearing one.

True, this was comparing hospital staff looking after SARS patients but, then, if masks can protect those coming into daily contact with a high-density viral atmosphere, how much less likely would the man or woman in the street or supermarket get infected when wearing the same mask.

And all for about $6 per mask!

Seto stated in the Lancet (Vol:361; p150) that "droplets are probably the main mode of transmission of SARS outside the hospitals as well". He told the New Scientist that "Masks seem essential for protection. This finding fits well with droplet transmission, because droplets are generated at the face level."

The findings he was referring to were that most of the 13 staff to become infected with the SARS virus did not wear a N95 (or a surgical) mask even though they washed their hands, wore gloves and a paper mask. None, however, of the 69 staff who had used protective masks and who did all the others things became infected.

And since bird 'flu is influenza, then droplets will be sneezed and coughed out or simply exhaled so, surely, the comparision with SARS is valid.

Today on the BBC morning news, Prof Hugh Pennington, who is the UK guru on viral diseases, stated two things. Firstly, that he considers the UK government to be doing too little about an avian flu epidemic in spite of their ordering, I believe, anti-virals for 1:4 of the population. Secondly, he believes that the UK government is underestimating the death rate in the UK at 50,000. Prof Pennington estimates 2,000,000 deaths!

Just a day or two ago, it was reported that a nurse in China may have caught avian flu from a patient. If so, then human to human transmission is here, and can only spread to the rest of the world in due course.

Only surgical masks and N95 masks, which are designed to block airborne particles, will work.

But so easy! So effective! So cheap!

I have yet to order mine! O hypocrite, I am!

Randall Parker said at March 13, 2005 10:47 AM:

Finn,

I have read that N95 masks become moist and then cease to block the passage of additional moisture through them. If my understanding is correct then we'd need to each get a lot of face masks.

I'd really like to hear from a face mask expert on what the deal is with face masks and how long they last.

Finn Cosgrove said at March 14, 2005 6:31 AM:

Randall,

I agree that a face mask expert is essential at this stage in our conversation. I notice that Prof Seto didn't wear his mask the whole time he was outside but when he felt it to be necessary. On the other hand, hospital care staff would have been using theirs for prolonged periods, but then they would have had access to a change easily. I am not sure that surgeons change their masks through a long operation nor even between operations.

I have communicated with 3M about their mask but have had no reply. I also suggested that they might like to have someone contribute to FuturePundit and have given the webaddress.

Maybe some of us would like to search for websites of both Respirator and of surgical mask manufacturers, and try to get them to communicate with us.

I have been in touch with www.3m.com/product/m_index/Mask where they describe their N95 Particulate Respirator. No mention, however, of the potential problem you describe which does need an answer.

Maybe Professor Wing Hong Seto of Queen Mary Hospital in Hong Kong has a website. Perhaps someone would like to get in touch with him?

Randall Parker said at March 14, 2005 8:55 AM:

Finn,

3M has N100 and P100 masks that last for 150 hours of use. They cost more. But my guess is they are worth the extra money because they last much longer.

Finn Cosgrove said at March 16, 2005 2:19 AM:

Randall

The N100 does look very complicated and seems to require some sort of training in its use. The P100 is used for oily particles and is probably not appropriate for the bird flu virus. It is more expensive than the N95.

I have discovered that the N95 is also called the SARS mask by a distributor if not by 3M. Although they disclaim 100% protection, they do call it the "SARS mask".

The price of the N95 is, in fact, £2 here in the UK so $6 dollars was a bit out in my first contribution.

Frankly, I am now persuaded that the N95 is well worth purchasing for family members. Prof Seto says that he didn't use his the whole time he was outside but only when he was near someone coughing. Such use would prolong its life, which is described over here as being of many hours.

Perhaps we could consider what sort of situation we would use the mask in, being carried on the person when out and about. Perhaps always on a bus, metro and in a supermarket! Perhaps not!

DSW said at April 1, 2005 8:12 AM:

The typical N-95 masks has flaws - An inability to effectively seal against the face. The breath will typically follow the path of least resistance - around the sides of the mask. The nano mask seals better against the face.

Here is a quote from John Hart explaining more reasons why the N95 is flawed:

"Here is a table showing virus sizes, so you can judge for yourself. The abbreviation nm means nanometer, which is
one billionth of a meter. N95 can only filter out material greater in size than .3 microns, which equal to 300 nanometers.
Every virus you see in the table below is smaller than 300 nanometers, therefore, N95’s are useless against these viruses.
Virus Description Size

Bacteriophage MS-2 20nm
Hepatitis 24nm - 30nm
Adenovirus 70nm
HIV (AIDS) 80nm
Cytomegalovirus 100nm
Orthomyxovirus 120nm
Coronavirus (SARS) 80nm - 160nm

NanoMask® has been tested down to 27 nanometers or .027 microns.
Good enough to stop H5N1, SARS, and most other viruses listed in the Virus Size Table above."

Randall Parker said at April 1, 2005 1:01 PM:

DSW,

Most aerosol viruses are not going to be floating around as single viruses. They are going to be in a water drop and possibly clumped together. So N95 masks will certainly greatly decrease the odds of infection.

As for NanoMask: Do you think it works as well as they claim?

Also, how long does it last? The 3M N100 and P100 masks last for 150 hours. Lots of other masks last for several few hours.

Finn Cosgrove said at April 4, 2005 11:13 AM:

DSW

I would like to support Randall's point that avian flu viruses will not be floating around in the atmosphere as individual viruses in the manner that allergic molecules do.

His point that they will be contained within water, phlegm, sputum is extremely important, and fits with Professor Seto's point that "droplets are probably the main mode of transmission of the SARS virus outside the hospital" and that ALL those hospital staff wearing N95 masks did NOT get SARS.

Presumably some viruses could get around the edge of the mask, but there is a dose relationship of virus to getting the viral infection.

Besides, you didn't tell us what the cost is of the nano-mask.

It may be prohibitively expensive for people to buy, or its extra cost may not justify both the difference in effectiveness between the two masks, and the ground-level low-likelihood of the individual outside a hospital getting the infection in the first place.

Please would you advise us of the cost of the nano-mask.

Professor Seto states that the N95 mask confers 13 times more protection than not wearing a mask for the SARS virus. This multiplication of protection is surely enough for most of us at £2 a mask!

Finn

DSW said at April 9, 2005 10:53 AM:

At Bird Flu Protection it costs $6.99 US for a mask, and a package of 10 filters are $5.99 US. I'm not saying that N95's are completely useless, I'm just pointing out the nano masks strengths. They are definitely an improvement over the traditional N95 masks. Their straps are stronger, the seal is better, and the "holes" are smaller. And, in most cases they are less expensive. What's wrong with this logic?

Finn Cosgrove said at April 21, 2005 11:07 AM:

DSW

I am afraid that I'm one of those wretched people, who likes discussing something right the way through to an end. This is what I have been doing in regard to masks. It is an intellectual challenge for me, but it is, of course, risky because I might say something really stupid, and which I have to live with for the indefinite future.

However, it can draw good points out of me, points that I was not conscious were present somewhere within me. So, being an intellectual is risky but it is also exciting.

Your heartfelt question, "What's wrong with this logic?" has prompted my rather personal comment by way of introduction. I do want to respond to your last post, not because I have anything to do with the manufacture or sale of N95s but because the discussion, once begun, needs to come to a final intellectual point. At least, it does for me!

And besides, there is something philanthropic about our discussion of masks. Let us debate the respective merits of each type so that those, who read and those who are influenced by those who read what we have been saying, can really make the best decision for themselves and their loved ones during any terrible epidemic of avian flu virus.

And the matter is now even more urgent because this wretched H5N1 avian flu virus has now been found in pigs in Indonesia. There are already human-adapted viruses currently infecting pigs so that the fear now is that H5N1 may recombine with one of these. The consequence, as someone else has already explained, is that human transmission would then be possible causing a human pandemic.

So! The importance of both the State and the Individual protecting themselves! Let the State produce anti-virals and vaccines, but let the Individual think hard about self-protection.

Which brings us back to masks!

You say that "I'm not saying that N95s are completely useless". Good, because you cannot say this and not have me comment on the logic of your last post. However, you add the word "completely" to "useless", which implies that, though N95s are not completely useless, they are in fact useless.

This is quite unacceptable for a number of reasons. Firstly, both Randall and I have pointed out that we are not dealing with nano sized molecules or particles and not even the 300 nanometres of the N95 mask. We are dealing with goblets of sputum and phlegm coughed up by infected people; we are talking about the virus being coated in a watery mucus.

Secondly, hospital staff working shift after shift looking after SARS patients did NOT get SARS when they wore the N95 mask. Far from being "useless" or even "completely useless", they were totally 100% effective when used in an environment supercharged with the SARS virus.

Thirdly, the researched and statistical data from that ward of expectorating SARS patients was that the N95 mask gave a 13 times level of protection to those who wore what the manufacturers are willing to call the "SARS mask".

You say that the nano-mask is "definitely an improvement over traditional N95 masks". Indeed! But is this improvement necessary in preventing a person becoming infected with H5N1? No, it is not, because the N95 does the job as effectively as the man or woman in the street requires.

Therefore, the nano-mask is NOT an improvement on the N95 mask, because there is no meaningful improvement to be obtained by fitting a nano over your face as opposed to a N95.

I am totally perplexed by your statement that "in most cases the nano-masks are less expensive". On what grounds? Not on the cost figures you gave of $6.99 US plus $5.99 for 10 filters. If nano-masks really are cheaper than N95 masks, you haven't made your case from the figures you have given us. Do you have other costs you are referring to but have not told us about?

The N95 mask costs $3.89 US and the nano-mask costs $6.99 US each. So the nano is almost twice as expensive as the N95 for no necessary extra benefit in avian flu virus protection.

Then, the nano requires the purchase of filters. I suppose these are the real nano part of the mask. Well, a nano-mask is useless without the filters, so when you buy a nano-mask, you must pay a total of $12.98 for your mask because it won't work without the filters.

The nano with filters is now 3 times more expensive than the N95! This is a minimum since you must buy a packet of ten more filters after you have had ten shots with the nano-mask.

I have long come to the conclusion that it is unwise to ask, especially in a rather public forum like this, "what's wrong with this logic?"

You might not get the answer that you would like!

Randall Parker said at April 21, 2005 11:14 AM:

The N100 mask seems the better deal because it lasts 150 hours.

Another point: If a big flu outbreak happens we won't be able to buy the better masks. They'll all be sucked into hospital use. Buy in advance if you want to be ready.

DSW said at April 27, 2005 7:42 PM:


I’m glad I came back to this discussion. I appreciate you taking the time to clearly respond to my post.

You said: “…they were totally 100% effective when used in an environment supercharged with the SARS virus.”

I did a google search for this information and couldn’t come up with any figures to back this up. Could you post your reference? Until I hear back from you, I will concede for this debate that your facts are true and the N95 doesn’t need improvements.

You said: “The N95 mask costs $3.89 US and the nano-mask costs $6.99 US each. So the nano is almost twice as expensive as the N95 for no necessary extra benefit in avian flu virus protection. Then, the nano requires the purchase of filters. I suppose these are the real nano part of the mask. Well, a nano-mask is useless without the filters, so when you buy a nano-mask, you must pay a total of $12.98 for your mask because it won't work without the filters. The nano with filters is now 3 times more expensive than the N95!”

If you were to only use the mask one time, your math is correct. I believe it is more practical to assume if there is an outbreak, most will use masks every day. Let’s say a person uses one N95 per day for 30 days ($3.98 x 30 = $119.40) the cost will be $119. If one person buys a nanomask and uses one filter per day ($.60 x 30 = $18 + $6.99 = $24.99) the cost will be $25. This assumes that the N95 and the filters are only used one per day. I think is reasonable.

Do I dare say it…”what’s wrong with this logic?”

Finn Cosgrove said at April 28, 2005 7:58 AM:

DSW

Thank you for your last post, which I saw as I was preparing myself to reply to Randall's last one, above yours. I will respond, and I appreciate your graciousness. On initial glance, it does seem as if your mathematical logic is superior to mine, though I will argue that the N95 is to be used many times more than once.

Randall

You say that the N100 is a better mask to purchase because it lasts for 150 hours. The problem is, as I see it, that there are other factors, which each of us needs to take into account, assuming that the figure of 150-200 hours of usage is, in fact, accurate for most people when they wear the N100.

Firstly, according to the Canadian Medical Journal (cmaj.ca/cgi/content), the N100 requires that a person receives "appropriate training". I have seen this on the 3M site described as going on a course of training.

Secondly, the mask has to be properly "fit-tested". This, I believe, requires the use of something like a fume-cupboard into which are blown sugar particles. With your head in the cupboard and your N100 on your face, you breathe away. If you taste sweetness, the fit isn't good enough.

Thirdly, the wearer - you or I - has to undergo a medical surveillance examination. I don't know what this means or involves, but it sounds like a nuisance if it is nothing more than that. It also implies the possibility of failure which would be a problem if you had bought your mask already.

Whilst the N95 does require guidelines for use for those working in some sort of institution like a hospital, the N100 does appear not to be allowed for straight-forward sale to anyone, such as us in the street, to use unless they have undergone "appropriate training", "proper fit-testing" & "a medical surveillance examination".

I cannot find the N100 advertised as a purchasable product on the 3M site, which suggests that it cannot be bought just like that and not with the ease of the N95.

I have found that the UK distributor of these N masks, for example, does not stock the N100 though he has now sent me 20 of the N95s with no problems. Maybe the demand is so small for the N100s because of all the rigmarole to go through that he knows that only institutions or companies will purchase them, and they will bypass the retailer by going straight to the manufacturer.

I am speculating on the lack of availability of the N100 mask to John Doe!

The cost of the N100 is $10-95 US compared to $3-89 US advertised price for the N95. This makes the N100 almost three times the price of the N95. This would be more than offset by the greater length of time the N100 can be used compared to the N95.

However, I am suspicious of the 150-200 hour figure from the manufacturer for the following reasons.

Firstly, this time-span will surely be based on "appropriate training", "proper fit-testing" and "a medical surveillance examination". Where do you and I go to get all this done? I haven't a clue even assuming that we have been able to purchase a N100 to use for this training course in the first place!

Secondly, Good Housekeeping indicate that all the N masks (including the N100)are designed to be used for up to 8 hours only. This is a figure more appropriate to the N95, but this is way short of 150 hours.

Even if Good Housekeeping is wrong in regard to the N100, it makes me feel uncertain about the 150 hours unless it is being used in a laboratory or under institutionally controlled conditions. And those of us thinking about Avian flu protection are not going to be using our masks in such ideal conditions.

Thirdly, the 150-200 hours is qualified by 3M with the words "under normal circumstances". I don't know what this means but, because of the very refined protection given by the N100 mask, I feel certain that its use in the shopping mall or supermarket is not "normal circumstances". They add that anything containing oil with ruin the N100, possible also the N95.

The New Zealand government has given Recommendations on Mask Use in Relation to SARS for both health workers and for what they call "close contacts" who have been put into isolation.

In both cases, it is the N95 which is recommended and not the N100 presumably because the N95 is more than sufficient for the task of viral protection and because it does not require "appropriate training", "fit-testing" and "a medical surveillance exam".

What's good enough for the NZ government, and what's good enough for Professor Seto in Hong Kong is good enough for me! Especially with no "training" required, easier availability if replacements or other members of the family need a mask, and with a lower outlay of dollars to start off with.

Nevertheless, I am in full agreement with you that we do need to buy in advance, even though we run the risk of never, ever using them. The internet seems to indicate that more and more people are getting stocked up.

I found your website FuturePundit not many pages into a Google search on masks, so congratulations!

But please let us know if you get hold of any N100s. I'll assume that you have not been able to until we hear from you to the contrary.

Finn Cosgrove said at May 6, 2005 9:51 AM:

DSW

I think your daring to say, "What's wrong with this logic?" is totally justified. You have helpfully challenged the assumption on which my maths was based.

I have been told that the N95 can be used for "many hours". Whilst this is infuriatingly vague, it does not say that it cannot be used intermittently. In other words, if it is taken on and off the face, the actual hours of usage could be included in several days. Professor Seto describes himself as taking his mask with him outside the hospital, and putting it on when he thought sputum was being coughed up near him.

Good housekeeping talked about eight hours of usage. If these eight hours were not used continously, then the N95 might last for some days.

To get the cost of the N95 to equal the $25 US for 30 days of nano-mask usage, I calculate that the N95 could be discarded after 4-5 days of intermittent use. In this way, we equalize out the cost, and no longer have to focus our attention on the greenback any longer.

However, what about the apparent unavailability of the nano compared to the N95? What about obtaining replacements for the nano viz-a-viz the N95? What about the appropriate training? How does one get the proper fitting of the nano done? Who and where is the medical surveillance check going to be done? Will there be a long queue for all these if the nano is used by many, many people?

I've bought my masks and they were easily available. There is a simple instruction sheet in the box describing how to put it on and to wear it. I know I can get more from the distributor. No training; no fitting; no medical surveillance! Easy!

My remaining problem with the N95 is how to keep it when I am out and about but not wearing it. Do I put it into a plastic bag and hang it from my belt? Would that encourage any virus on the outside to wander around in the bag and settle on the inside?

I think I will stuff the inside with dry tissue or material, and attach it to my belt with the outside facing outwards. Do I need to put it into a bag whilst being carried?

When I wrote that the N95 masks were "100% effective in an atmosphere supercharged with the SARS virus", I was using my own words. However, I reckon that they were a reasonable, if flowery, description of Professor Seto's article in the Lancet (vol 361; pp1519-20; 2003)

If you do a google for: Seto SARS mask , you should come up with a New Scientist summary of this paper. If you find it, please would you write in with your thoughts including any criticisms of my interpretation of that paper or summary of it.

Randall Parker said at June 17, 2005 5:09 PM:

Finn,

As for the availability of the N100 masks: Using Google's Froogle shopping search engine I can find N100 masks easily purchaseable in the United States. My guess is you can buy them in the UK and elsewhere if you can find the right place.

As for fitting the mask: I'd expect that to be a problem for any type of mask.

As for what constitutes "normal circumstances": I do expect shopping malls to be mormal. For abnormal circumstances I suspect they have in mind places where there are large quantities of airborne particulates such as at a construction site where perhaps cement is being mixed or in a bakery factory. In other words, lots of dust will build up in a mask. Also, in high humidity conditions such as in rain or in a fog water could build up more rapidly than from just moisture in exhaled air.

Nigel Hawthorne said at June 24, 2005 11:06 PM:

As a layman reading your technical comments on the avian flu pandemic, I would think that such a killer flu would virtually bring the commercial world to a halt as people hide in their homes for fear of contracting it. We would have an economic meltdown and only essential services would be maintained such as utilities, policing, fire, military, civil service (to collect taxes), public sanitation, hospitals, food distribution, etc. Even then the population would be triaged for medical services with the aged allowed to pass through without heroics and the terminally ill left on their own. Disposal of corpses would have to become a priority with mass cremation the preferred method of disposal. Mass burial would be logistically difficult and corpses would become the property of the state to dispose of as deemed necessary.

Basically everybody would be left to fend for themselves, with only the politicians, health providers, and essential service workers getting preferred treatment. The rich will always be able to secure the medical assistance and medicines for themselves and their families. It would become a desperate situation, particularily if the pandemic came in several waves.

Food and water storage, fuel, masks and body bags would be about all that the general population could hope for once the pandemic strikes with force. That's how it sounds to me. With a human world population of 6.5 billion, a 5% or about 300 million deaths would not be missed but disposal of corpses would be challenging. If there were 15% or about a billion dead, things would get nasty. I assume that avian flu would be more virulent in third world countries than those of the first world.

Randall Parker said at June 25, 2005 9:58 AM:

Nigel Hawthorne,

I believe we can figure out ways to allow many parts of the economy to continue to function in spite of greatly reduced human-to-human exposure. We could do that much better if we prepared in advance. Alas, I don't think people will take it seriously until the pandemic starts spreading across the world.

William C. said at July 30, 2005 4:26 AM:

As for N95 masks, I purchased a box from this site: http://www.emprep.com/Respirator%20face%20mask.html less than 1 dollar each.

I was wondering, do those new Ionic air filters protect against SARS?? also are there natural ways to build your immunity in case of a pandemic? for example raising body Ph etc?

Dave Trowbridge said at August 5, 2005 10:02 PM:

According to David Brown's recent article in the Washington Post (here), the lethality of the HN51 variant of avian flu is now down to 34%. Declining lethality is one of the harbingers of a pandemic, as it heralds adaptation of the virus to its host (diseases like Ebola with high, rapid lethality never become pandemic for obvious reasons).

Time to start stocking up on food, water, and supplies?

Randall Parker said at August 5, 2005 11:13 PM:

Dave,

You should definitely prepare for how you can get as much done as possible with the least amount of contact with other people. Isolation is the key to survival. If you don't get exposed to people with the virus or to surfaces they've touched or coughed on it is very unlikely you'll get sick.

One problem with estimates of lethality is that there might be people getting it who are not being identified as having avian flu. Also, the mutation that makes it break out into human populations might not happen in a genome that has mutated to lower lethality. It might mutate to easy transmission in a particular virus that is still very lethal. We just can't predict.

Nano Mask said at September 24, 2005 6:41 AM:

Dear All,

We have imported the Nanomask for the UK at www.nanomask.co.uk.

Thanks
NAnomask.co.uk

Jason said at September 30, 2005 6:16 PM:

Latest from the WHO September 29, 2005

The Ministry of Health in Indonesia has today confirmed another fatal human case of H5N1 avian influenza. The patient, a 27-year-old woman from Jakarta, developed symptoms on 17 September, was hospitalized on 19 September, and died on 26 September.

Confirmatory testing was conducted at a WHO reference laboratory in Hong Kong.

Initial investigation has revealed that the woman had direct contact with diseased and dying chickens in her household shortly before the onset of illness.

The woman is the fourth laboratory-confirmed case of H5N1 infection in Indonesia. Three of these cases were fatal.

As a result of intensified surveillance and heightened public concern, growing numbers of people with respiratory symptoms or possible exposure to the virus are being admitted to hospital for observation and, when appropriate, treatment. Until a conclusive diagnosis is made, these patients are classified by the Ministry of Health as suspect cases. While many do not have symptoms compatible with a diagnosis of H5N1 infection, screening of patient samples is being undertaken in national laboratories as part of efforts to ensure that no new cases are missed.

Laboratory testing to confirm human infection with H5N1 avian influenza is technically difficult; some tests produce inconclusive or unreliable results. To ensure a reliable assessment of the situation in Indonesia, authorities are, after initial screening, continuing to send samples from people considered likely to have H5N1 infection to WHO reference laboratories for diagnostic confirmation.


According to FAO, highly pathogenic H5N1 avian influenza is now endemic in poultry in many parts of Indonesia. As influenza virus activity in Indonesia may increase during the wet season, from November to April, human exposure to animal virus could be greater during the coming months. Further sporadic human cases can be anticipated.

Doug Heath said at October 3, 2005 5:25 PM:

You can find information and buy Nano Masks at: http://2hdistributors.com/
They have great package deals and will soon have the Nano2 mask. That is a new mask that is mush like a surgical mask. EZ to carry and wear.

The testing on the Nano Filters was done by Nelson Labs and it has been proven to stop and kill virus in under 30 seconds.


M.Brees said at October 5, 2005 4:08 PM:


wouldn't money spread the "bird flu" ? I am more scared of money then walking by someone.

G Reeves said at October 6, 2005 8:16 AM:

Re: Scared of money.

Hence the saying "Money is the root of all evil" could be given new impetus if the virus was in fact able to be transmitted through currency handling. It seems unlikely, but better safe than sorry (wear surgical gloves?). [Note: Remember that the correct saying is "The LOVE of money is the root of all evil!] The current scientific meetings in Washington DC will influence this site quickly, don't you think?

nanomask said at October 8, 2005 5:49 AM:

we have the nanomask at our site, www.nanomask.co.nz and www.nanomasks.co.nz and www.nanomask.us we ship worldwide, paypal converts currencies easily....! thanks nanomask.

Dr. Deborah Hall said at October 9, 2005 11:37 AM:

Hello,

This is my first visit to this site. Thank you for the high level of constructive
dialogue and debate. I am very relieved to find kindred spirits willing to face
and deal proactively with this very real danger. I am a psychologist. Denial
and passivity are our worst enemies in dealing with potential/probable scourge of any kind. See Albert Camus--The Plague.

Throw me a question, if I can contribute on some level to this discussion.

Thank you!

Rmplstlskn said at October 9, 2005 7:10 PM:

To NANO or not to NANO, this is the question...

Good technology but as many here have explained, not necessary for the rarely-exposed guy on the street.

My biggest problem with the NANOmask is the lack of an EXHALATION VALVE. I don't know about anyone else, but when I'm working with a mask on, my exhalation quickly builds up MOISTURE in the mask, often reducing the ability to filter after several hours. The NanoMask would appear to have the same problem... Am I wrong?

I now use 3M 9211 N95 masks with an exhalation valve... very sweet mask. It folds flat before use for easy packing and is super comfortable. If NanoMask comes out with a mask with a valve, I'll be a long-time customer.

Rmpl

Windy said at October 11, 2005 1:55 AM:

What a great site. Finally information that is thought provoking, helpful and resourceful. However, I have 3 small children and I have not been able to find adequate information regarding childrens mask. I only came up with one made by 3M. There was not much information about it and since fit apparently is key, why is there not a nano mask or N-95 versions for small children? Does anyone have any links or information that may help me protect my children? I am amazed and incredibly concerned that this part of our population is being virtually overlooked! I don't know about you, but if my children became ill and died (hypothetically of course...)in part because I didn't not do my best to protect them ie; masks, isolation ect. It would absolutley do me under. I'm sure I represent a majority of our population with this concern. Any information would be greatly appreciated...since I can't seem to get it anywhere else.

Cliff Kavanaugh said at October 11, 2005 7:56 AM:

I am wondering if cloth gloves (seems like everyone in Japan wears them) would be a good thing to wear

Nicki Williams said at October 14, 2005 2:39 AM:

I too have children and was very concerned that there didn't seem to be any products out there. However I have just ordered some child size face masks made by Kimberly Clark from
www.masksnmore.com. It says its 97% protective, which I guess is OK? I also got 160 N95 masks for $101, which is pretty cheap.
There is a hefty shipping charge to the UK but overall its still very reasonable.
Hope this helps!

Pater said at October 15, 2005 4:28 PM:

Global Avian Influenza Pandemic Survival Plan,

Should we become Prepared Against The Bird Flu, Avian Influenza “ H5N1?
Is the End Near?

I hope that you all are as concerned as I am, to the developments of the Bird Flu.

Here is how I can help, atleast so far I must say that all must try to help themselves very soon!
Hope you find what you need.

http://www.6pater6father6.org/?page=1180

Good Luck

Sev said at October 18, 2005 3:59 PM:

I have not been able to find any information on any governmental health websites (CDC, WHO, French government) about the Nano mask.
the other masks - N95 & N-100 are US standards, well documented and been approved by governmental body. In Europe the recommended standard is FFP3. The nano mask looks like an attractive alternative : cheap, light, reusable (contrarily to N-95 and N-100 and many of the 3M respirators offered on European websites), but who can prove it does what it claims ?
Has anyone seen an official government website or even news from a trusted newspaper that would confirm that nano masks are not a fluke? For my part, the only info I have found comes from the sites that are selling it - seems a bit too good to be true... Let's not forget that in the context of panic we are experiencing now, it is far too easy to abuse people's trust.

angi said at October 18, 2005 9:55 PM:

Will NanoMask fit on my children?
Yes. NanoMask is adjustable and will fit on children age two and up. In an emergency situation, a parent can hold a NanoMask against the face of a baby.

Trained Skeptic said at October 19, 2005 3:56 AM:

The "NanoMask" is a scam... if you want to risk your life on an uncertified mask made by an obscure company go ahead... I think the world is overpopulated anyway

I'll stick with my N95 mask made by 3M... a long established company with a wonderful track record for innovation high quality products

Scott said at November 3, 2005 6:03 AM:

Why not invest in both masks? N95 and Nano mask, having a few options
available may not be a bad idea.

A few preparedness suggestions:
Masks 3M N95 and Nano mask
Surgical Gloves
Goggles
Immune system enhancing Vitamins
Tamiflu and or Relenza
Zithromax

Zithromax (Z-Pack) which is commonly prescribed for pneumonia which develops secondary to the flu.
Historically, death from the flu is commonly caused by pneumonia.
The flu causes tissue damage to the lungs allowing a bacterial infection to take hold.
Zithromax is used for curing bacterial infections.
Zithromax is not an antidote for the flu, it has no effect and is only useful
for treating the secondary bacterial infection that takes place in the lungs
caused by the flu damage.

I have heard that Relenza is a better flu inhibitor over Tamiflu, although
this is just what I have heard and have no data to verify this.
Tamiflu and Relenza help to block a protein the flu uses to infect other cells
and can help to lessen symptoms.

I am not a doctor, this is information I have obtained by doing some research.
Hopefully some of this information will prove useful.

Marc Walker said at November 19, 2005 2:40 AM:

I am a single father of three boys. We live with my widowed mother. We have a large house and are preparing to put it to use in the form of a 'clean house' for the children of our family. My children, my brothers children, our friends and family. This house could comfortably house 20 or more people at a time for relatively short periods. Meaning the 3 months the first wave of this pandemic will likely last. Plastic covering everything. An area of quarantine. An exterior entrance to a decontamination shower then into the home. This may seem extreme to some, and I too felt it odd when my mother brought it up. However, I do not trust this or any government to foresee this pandemic for what it COULD be. We all hope and pray it is all blown out of proportion. However, if it happens that it is true, and people will die in large numbers,I am happy I, nor my family will be counted amongst the dead. We are armed, plan on being stocked, and already have the space. We expect widespread looting and criminal behavior when this hits. This is not something you telecommute to work and stop worrying. This is going to kill millions. Economies will crash worldwide. Work is no longer an option unless you are required by your government for you possess a special skill set.

I urge you all to not panic, and not assume it is as bad as some say it will be. But rather,assume it MIGHT be, and be properly prepared to do the right thing and protect all you can protect. We will continue, this is certain. But with millions less people than just months earlier.

Susan said at November 20, 2005 8:43 AM:

I was looking around for protection on the avian bird flu and found a site http://www.respirators.us where they offer 3M 1860 Surgical Respirators for 20 cents each. Are these 3m masks a good form of protection against nthe bird flu?

Mary Kay said at December 27, 2005 6:18 PM:

God designed our bodies to fight against disease. If my family is infected with Bird flu I will not treat the fever with aspirin or any other fever reducer, though for a while one may feel better, the virus will continue to rage, eventually out of control, until the symptoms no longer can be quieted. Fever will destroy a virus, and suppressing it will feed the virus until the patient succumbs. MKMason RN

swankyc said at January 7, 2006 10:01 PM:

Both Angi and Trained Skeptic are wrong. Nano Masks DO NOT fit children and they are not a scam. Just google "Nano Masks" and you will find news sites with articles about them. Unfortunatley, Trained Skeptic knows nothing about the nature of NBC (Nuclear Biological Chemical) survival and those heeding his advice will probably regret it. The Nano seals over your lower face, unlike those N95 masks by 3M. Fit is key, and in the case of a bird flu outbreak, the Nano Mask will work far better than a mask that has NO SEAL OVER YOUR FACE. I bought two of them and tried one on my 4 and 6 year old kids and it doesnt even come close to fitting them so keep looking, I am.

Andrew Milner said at January 12, 2006 5:35 PM:

That headline: "Bird Flu in Turkey". I sense a pun coming on.
But first an urgent advisory to chicken jugglers: You might want to consider switching to rattlesnakes.
Considering the "inhumane" conditions in which chickens are raised, I have little sympathy for humans that catch bird flu. The chickens may yet have the last laugh if bird flu becomes the bubonic plague of the 21st century. The USA is particularly exposed, as lack of health care insurance will discourage many poorer people from seeking medical advice. One way and another, King George seems determined to bring America down. Have a nice day: What’s left of it.

sally said at February 16, 2006 3:38 PM:

Hi, I have bought my nanomasks from www.nanomask.co.uk. I got them within a couple of days and now I feel safer... Im thinking of gloves and other stuff now...

Are people stocking up on food too?
Thanks
SR

Brutus said at March 19, 2006 8:55 PM:

Well, I've been feeding the kids Sambucol and an antiviral supplement and I will be stocking up on Kidney support supplements and liver support supplements. I've read it's important to stregnthen your lungs and vital organs cause thats this flu goes down. But, that said, it seems it is also extremely important to have an anti viral component to whatever you use to stregnthen your immunity because I have read that the stronger you are immune wise- the harder this thing hits you (ie: kills healthy adults with zeal). It seems that it is important to at some point be strong enough to survive this thing cause it doesn't look like we're gonna be able to avoid it with masks and gloves until it blows over. And who knows what resources will be available to even produce a vaccine? With a 50% + or - kind of track record I think it's also important to become as virulent to this flu as it is to us.

Owen Andrew said at March 30, 2006 10:45 PM:

Hello,

My name is Owen and I work at a small internet advertising company. One of our clients is interested in advertising on Health related websites like yours.

We are only interested in purchasing text link advertising or “directory style” listings - no banners or CPC models. We would like for the links to be included within the body section of your page - not on the footer or sidebar sections. The links can be on the home page or on internal pages of your site.

If you are interested please reply back with the URL of your site (we handle advertising for multiple clients so if you reply back with your URL it'll help us to expedite the process), the monthly pricing for a text ad on your homepage and or interior page, and your preferred method of payment.

If you haven't done this before and are not sure about pricing, let me know and I can send you some ideas. Below is a very general pricing guide.

$10 - $25 per link (monthly) – Quality lower traffic sites

$25 - $60 per link (monthly) – Quality medium traffic sites

$60 and up per link (monthly) - Quality High Traffic sites

Once we add your website to our database we usually bring in multiple clients. We will sell up to 10 link ads on a page. The lower your prices the more our clients usually like to buy. Even at $20 per link you can make $200 a month per page if we purchase 10 link ads over time.

Thank you very much
Owen Andrew
(714)350 9575
owen@authoritydomains.com

Peter Tuharsky said at May 23, 2009 11:58 PM:

Silvetz: Of course, that vitamin C WORKS. I tested it myself.

The cheesy quack link You provided is quite a tragedy. Every clinician, that worked with PHARMACOLOGICAL doses claim, that the effective dosage starts with AT LEAST 30 grams, and for some disease it is 200 grams per day, or more! Heavier case of flu needs 150 grams a day.

Now, what is the quacker Marshall trying to tell, reviewing a literature where the usual dose is 1,5 gram and of the greatest are 5-gram doses? These doses are barely of a DIETARY character, compared with any mammal. Nevertheless, taking them daily for a half year would significantly improve the immune system. But they are by NO MEAN of pharmacological importance.

Do You expect 5mg of paracetamol to cure headache? I'd suppose not. YES, IT'S THAT SIMPLE. IT'S THE DOSAGE THAT MATTERS. Even the paracetamol is used sometimes in doses up to 150mg/kg/day, under hospital supervision. Now who is using at least the same dose of vitamin C?

The micro-ammounts used today are a pure tragedy.

Please, learn yourself:
Frederick R. Klenner, B.S., M.S., M.D., F.C.C.P., A.A.F.P. Significance of high daily intake of ascorbic acid in preventive medicine. J. Int. Acad. Prev. Med., 1:45-49, 1974. http://www.seanet.com/%7Ealexs/ascorbate/197x/klenner-fr-j_int_assn_prev_med-1974-v1-n1-p45.htm

Irwin Stone, PC-A. The Healing Factor: Vitamin C Against Disease. Grosset and Dunlap, New York, 1972. ISBN 0-399-50764-7. http://vitamincfoundation.org/stone/

Robert F. Cathcart, M.D. Vitamin C, titrating to bowel tolerance, anascorbemia, and acute induced scurvy. Med Hypotheses. 1981 Nov;7(11):1359-76. PMID: 7321921. http://www.orthomed.com/titrate.htm

Frederick R. Klenner, M.D., F.C.C.P. Observations on the dose and administration of ascorbic acid when employed beyond the range of a vitamin in human pathology. J. App. Nutr., 23:61-88, 1971. http://www.orthomed.com/klenner.htm

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