June 17, 2005
More Warnings On Avian Flu Danger To Humanity

Foreign Affairs has a series of articles coming out in their July/August 2005 edition on the threat posted by the Avian Influenza H5N1 strain. Michael Osterholm makes the argument that governments have not sufficiently prepared for the possibility of a bird flu pandemic in human populations.

What should the industrialized world be doing to prepare for the next pandemic? The simple answer: far more. So far, the World Health Organization and several countries have finalized or drafted useful but overly general plans. The U.S. Department of Health and Human Services has increased research on influenza-vaccine production and availability. These efforts are commendable, but what is needed is a detailed operational blueprint for how to get a population through one to three years of a pandemic. Such a plan must involve all the key components of society. In the private sector, the plan must coordinate the responses of the medical community, medical suppliers, food providers, and the transportation system. In the government sector, the plan should take into account officials from public health, law enforcement, and emergency management at the international, federal, state, and local levels.

The full articles are not yet available online. But you can read longer excerpts if you click through.

In the same Foreign Affairs issue Laurie Garrett is interviewed on how the avian flu could kill hundreds of millions of people and cause trillions of dollars in economic losses.

Q: If an outbreak does occur, what is the state of preparedness planning between nations, across regions, among departments and ministries of individual governments and throughout the non profit sectors?

Planning is abysmally inadequate, given the likely severity of a pandemic caused by a human-to-human transfer of a virus as virulent as the current H5N1 strain.

Q: Without adequate preparations, what would be the likely toll of such a pandemic globally and in the United States?

The answer depends on the virulence level of the pandemic virus. The 1918 strain, which killed 50 to 100 million people, only killed about two to three percent of the people it infected. The H5N1 strain now in circulation kills 100 percent of the birds it infects and has killed more than 50 percent of the people known to be infected so far. If it manages to mutate into a human-to-human form, and retains even half its current virulence, the death toll would be in the hundreds of millions. The WHO issued a report a few months ago putting the estimate at eight million and has since retracted that estimate, preferring far higher reckonings.

Q: How serious might be the economic, social and political impacts?

One Oxford University computer model, assuming a virus with low virulence, put global losses at two to three trillion dollars. The Oxford team concluded that it is impossible to guess the catastrophic economic toll of a high virulence strain.

Trillions of dollars add up to a serious amount of money. Major killer pandemic have occurred within the lifespan of some people still living. The most famous pandemic in modern times occurred in 1918 with 20 to 50 million killed from a much smaller world population. The avian flu cases recorded in humans to date killed at least half of those infected. A world pandemic of such a lethal strain would make the 1918 outbreak seem mild in comparison.

In a separate article Garrett underscores the unpredictability of avian flu's future path.

According to the March 2005 National Academy of Science's Institute of Medicine flu report, the "current ongoing epidemic of H5N1 avian influenza in Asia is unprecedented in its scale, in its spread, and in the economic losses it has caused."

In short, doom may loom. But note the "may." If the relentlessly evolving virus becomes capable of human-to-human transmission, develops a power of contagion typical of human influenzas, and maintains its extraordinary virulence, humanity could well face a pandemic unlike any ever witnessed. Or nothing at all could happen. Scientists cannot predict with certainty what this H5N1 influenza will do. Evolution does not function on a knowable timetable, and influenza is one of the sloppiest, most mutation-prone pathogens in nature's storehouse.

We do not know the probability for an avian flu crossover into the human population that would develop the abiltiy to cause a massive pandemic. We do not know what the fatality rate would be from such a pandemic. Political leaders have reacted to this uncertainty by doing very little. The public has done the same.

Osterholm points out that food distribution networks do not have large reserves of stored food.

He saved his most flatly worded warning, however, for a news conference organized by the Council on Foreign Relations, which publishes the respected journal. In an interview from Washington following the briefing, he repeated his blunt message of how dire things would be if a pandemic starts in the short term.

"We're pretty much screwed right now if it happens tonight," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Osterholm said the "just-in-time" delivery model by which modern corporations operate means food distribution networks don't have warehouses brimming with months worth of inventory.

Most grocery store chains have only several days worth of their most popular commodities in warehouses, he explained, with perhaps 30 days worth of stock for less popular items.

Anthony Fauci says the emergence of a deadly pandemic is just a matter of time.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the threat of a deadly pandemic is growing.

"This is not going to go away," Fauci said during a forum on the issue Thursday at the Council on Foreign Relations. "Get rid of the 'if.' This is going to occur."

Some fairly cheap things could be stockpiled in advance. High quality face masks seem the most obvious. Given that governments look set to fail to make adequate preparations you might want to buy your own stockpile of high quality particulate filtering face masks. On Google Froogle check out 3M N95 models which can go for less than $1 USD per mask when buying boxes of 20 or more. Note that those masks last for only several hours (forget the exact amount of time). A possibly more cost effective choice is the 3M N100 models which cost more but last for 150 hours. The 3M P100 models also last 150 hours.

One drug might help. Seriously consider getting a Tamiflu prescription and store the package unopened.

How and when should I take TAMIFLU?
TAMIFLU should be taken twice daily (once in the morning and once in the evening) for five days. TAMIFLU can be taken with or without food. As with many medicines, if taken with a light snack, milk, or a meal, the potential for stomach upset may be reduced. You should complete the entire treatment of ten capsules, even if you are feeling better. Never share TAMIFLU with anyone, even if they have the same symptoms. It is important that you begin your treatment with TAMIFLU as soon as possible from the first appearance of your flu symptoms.

Tamiflu comes in 10 and 30 tablet amounts. The 10 tablet amount is enough for 1 person. If you are not living alone or have other people you'd want to help in event of an outbreak then keep in mind that the 30 tablet size costs much less per tablet. In the United States you are looking at perhaps $70 to $80 USD for the 10 tablet amount for a single person and perhaps $190 for 30 tablets (and don't skimp by buying from the more questionable online vendors - go brand name). Canadians living in price controlled socialism get to pay less (and get to live off of the labors of market price paying Americans). But once the big crunch comes don't expect to be able to pay even current American prices if you can find Tamiflu at all.

If you think that come a crisis Tamiflu production will rapidly scale up think again. While research a previous post on avian flu I found an expert who claims it would take 18 months to scale up Tamiflu production. Higher demand from governments to stockpile Tamiflu would help make more available. But don't count on governments. If you can afford to then protect yourself and your loved ones.

If you can afford to stockpile food and have the room to store it then buy a lot of dried and canned food. Keep in mind that if you think you are going to eat the food eventually then the money won't be wasted.

If money is no object here is my deluxe version of what to do:

  • Stockpile about 50 or 100 times more Tamiflu than you or your family could use. You can use it to barter if food and other distribution systems break down. Or you can use it to help every friend, acquaintance, and business associate you have. Want to get great deals from a supplier? Give him some Tamiflu and save his life. He'll remember.
  • Stockpile thousands of 3M N100 and P100 face masks. Again, they will make valuable barter material. Or you can give them away to people who do work for you.
  • Stockpile a couple of years of dried and canned food in a dry cool place. I'd also suggest a couple hundred pounds of salmon filets so you can eat healthy even as the supermarkets go empty.
  • Buy a house in the country so that you can avoid contact with other people.
  • The country house should be self sufficient. That means it should have a well, two or three electric generators, and enough fuel to run the electric generators for several months. Photovoltaics in the roof and/or a windmill for electric power would be prudent.
  • If you have to stay in the suburbs make sure you have an extremely well sealed house and high quality filters on air brought in from outside. Though the odds are pretty low you'll get sick from a neighbor's cough.
  • Whether in the country or suburbs make sure your house can function without maintenance for years.
  • Stock your house with whatever else you might need for 2 or 3 years (e.g. seeds and fertilizer for the garden).
  • Be extremely ready to drop everything and isolate yourself with less than a single day's notice. Avoidance of exposure is the best defense. The news says an outbreak is ripping through Tokyo or Shanghai or Calcutta? Time to quit going to work and head for the country or at least stay in your suburban home.
  • If you need to travel to get to a hideaway best to have a lot of gasoline in a small towed trailer to make the trip since you won't want to fly and even exposure at a gasoline station is best avoided (and under panic conditions you can't count on finding gasoline to buy anyway).

Isn't survivalism fun? Though if your country hideaway doesn't have DSL don't expect me to visit.

If you aren't rich but have some money to spend then at least consider some cheaper measures you can take now such as purchase of high quality face masks and Tamiflu. If you live in an apartment with central air you might want to get HEPA air filters for your apartment. If you live in a city but can afford a cheap small piece of country land you could park a cheap travel trailer on it. Don't expect to be able to buy most of these things when the pandemic starts.

If your work lends itself to use of a home office then set one up in advance. Even if your employer does not currently allow working from home make sure you have the basic supplies of a computer, broadband internet connection, and other materials. When a pandemic starts employers will become much more flexible about working conditions than they are now. Any person who can avoid entering the office during a deadly flu outbreak is one less person who might infect the boss.

My guess is that in Western industrialized countries the first year of an avian flu outbreak will bring millions of deaths. But by the second year the mechanisms for how to operate societies while minimizing human-to-human contact will be well worked out. Also, by the second season an increasing number of people will have been vaccinated or will have survived infection. So more people will be able to safely move around and carry out the tasks that involve more human-to-human contact.

The economic and human losses from a highly lethal flu pandemic could be greatly reduced with aggressive advanced preparation by governments and industry. But until the public at large becomes concerned I don't expect governments to do much about it. If biological scientists and medical doctors think this threat deserves greater preparation efforts then a lot more scientists and doctors ought to write op/eds and letters to the editor. Too few people are sounding the alarm. Until that changes you are on your own.

Back during the early Cold War era many people took steps such as building fall out shelters to protect themselves against nuclear war. Today we face a danger whose probability of coming true might well be higher than the chance of nuclear war during the Cold War. Yet few people are taking any steps to protect themselves from a highly lethal pandemic because pandemics do not evoke dramatic images. Infections do not create huge visible blasts. Our buildings and other physical structures are left unharmed by a virus. So governments and individuals do far too little to prevent or defend against a massive killer outbreak that could kill many more people than all the wars of the 20th century.

The other odd thing about the lack of preparation for the avian flu is the larger effort being made to protect against bioterrorism. At this point in time in the year 2005 I think we are at far greater risk from a new natural killer influenza strain produced by Darwinian natural selection than we are from a man made strain produced in a laboratory. Yet in the West we have become so accustomed to controlling and defeating the will of nature that we fear more what other humans can do than what nature can throw up at us. I see this as a premature shift in emphasis. Perhaps 20 years or 30 years from now we will face greater threats from bioterrorism than from natural pathogens. But I think right now we are still living in the twilight of the era when natural selection is more likely than terrorists to produce a new deadly pathogen strain.

Also see the special avian flu articles from Nature.

Nature's editorial on avian flu makes clear they think too little is being done.

If the next pandemic were to arise five years from now, there would have been breathing space to stimulate our drug and vaccine industries to limit the damage it would cause. But that requires urgent action now. As matters stand, a vaccine against a pandemic flu would not be ready until at least six months after a pandemic starts. Too late: by then the worst of the pandemic would already have happened.

A vaccine that can be produced more quickly demands a research effort akin to that for a strategic military weapon, not business as usual. We also need to be able to produce enough of such a vaccine to cope with the surge in demand during a pandemic. At present, the entire world production capacity can produce only enough doses for 450 million people. To stimulate an increase in capacity, we need health policies that boost demand for existing flu vaccines in ordinary years. The same goes for antiviral drugs.

But the worst-case scenario is that a pandemic starts within two years. We would have no vaccine and few drugs, and we would be dependent on governments and the WHO to try to extinguish the first outbreaks at source. That's why the first priority must be to prevent a pandemic emerging in the first place, by extinguishing the disease in animals.

Time for action

Unfortunately, the current situation does not bode well for the abilities of governments and international agencies to cope with this challenge. We should be monitoring in almost real time the genetic changes in the avian and human viruses that could herald the emergence of a pandemic strain, for example. But there is no international funding to help affected countries build decent and sustained surveillance programmes. And while outside researchers want data from affected countries, they aren't engaging enough in the meaningful collaboration needed to build trust and open sharing. The international community is not offering incentives, such as drugs for the Asian countries that would be in the front line of a pandemic. Combine this with the fact that countries are reluctant to share the few data they have because their analysis could affect their trade and economies, and the current mess in surveillance is hardly surprising.

If I was King I'd allocate $20 billion per year in the United States for preparations against avian flu. But I'm not King and neither is anyone else. So instead I'll just give you my warning: We ought to do orders of magnitude more than we are currently doing to get ready for the next highly lethal influenza outbreak, whenever it might come.

Share |      Randall Parker, 2005 June 17 04:42 PM  Dangers Natural Bio


Comments
Invisible Scientist said at June 17, 2005 10:03 PM:

Randall Parker:

You wrote:
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"In short, doom may loom. But note the "may." If the relentlessly evolving virus becomes capable of human-to-human transmission, develops a power of contagion typical of human influenzas, and maintains its extraordinary virulence, humanity could well face a pandemic unlike any ever witnessed. Or nothing at all could happen. Scientists cannot predict with certainty what this H5N1 influenza will do. Evolution does not function on a knowable timetable, and influenza is one of the sloppiest, most mutation-prone pathogens in nature's storehouse."
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But is it possible for malevolent people to help this virus mutate .to a human to human contagious type in a laboratory, in order to weaponize it... However, if the virus is really 100 % deadly, then how can the epidemic spread if people who are carrying it are dying so quickly? Maybe the incubation time can be extended by the malevolent scientist-terrorists. Also can the terrorist-scientists develop their own vaccines before releasing the virus?

Tom said at June 18, 2005 10:06 AM:

I keep a N95 mask at work, and another in my car, since I work just outside DC. Call me nuts... :)

Kurt said at June 18, 2005 3:24 PM:

If the plague happens for real, it will definitely terminate the housing bubble in the U.S.

iInvisible Scientist said at June 18, 2005 4:15 PM:

Kurt:
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"If the plague happens for real, it will definitely terminate the housing bubble in the U.S."
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For the big cities, this is true... But the plague might also cause a new housing bubble in the RURAL areas, since people will then panic and they will try to move to rural areas. In fact, in the event of successful WMD attacks in the Western World, a new rural decentralization wave will start, which will cause a housing bubble in the rural areas.

Marvin said at June 18, 2005 4:58 PM:

You don't expect many people to take this seriously, do you? Having a course or two of Tamiflu around won't hurt anything. But the rest of it is a bit whacked.

Don't relax, though. Biotech research isn't that hard to understand or to do. Although most arabs and muslims have low IQs, the upper end of their bell curve will supply ample fanatics who will penetrate the biological sciences departments of western universities and biotech companies. The ones who don't blow themselves up in Iraq trying to kill Iraqi civilians, that is. The surviving high IQ fanatics are going to be a problem.

Randall Parker said at June 18, 2005 5:43 PM:

Marvin,

What is whacked about it? Do you intend to expose yourself to just as many people once the big killer pandemic breaks? Do you expect that food distribution and regular commerce will continue uninterrupted if a flu breaks out that kills double digit percentages of the infected?

Isaac Newton was out in the country in Lincolnshire to escape a plague in London and Cambridge when be did major work on calculus and classical mechanics. So going to the country to escape disease outbreaks is a very old practice. We haven't seen this practice for a long time. But given the right conditions I expect we'll see it again.

Randall Parker said at June 18, 2005 5:46 PM:

Marvin,

BTW, in this post I took the personal approach of what to do about a dangerous flu pandemic because the governments of the world are doing far too little to prepare. The chances of a pandemic are high enough that we ought to think about how to prepare to protect ourselves.

James Bowery said at June 19, 2005 1:25 AM:

The actuarial significance of this sort of problem shouldn't be overlooked.

How much of the costs of risk behavior is being externalized?

Since these bird flus don't necessarily travel via birds across the Pacific without human assistance, isn't it the case that international traffic has huge externalities associated with it -- the costs of which are born by those who do not benefit directly (or possibly at all) from said traffic?

So why aren't there appropriate premiums being paid by travelers with those premiums compensating those who do not wish to subject themselves to technologically amplified ecological panmixia?

Bob Badour said at June 19, 2005 6:12 AM:

James,

But one could also say that asian peasants living with their fowl has externalities and these peasants should absorb the cost of the increased risk.

James Bowery said at June 19, 2005 9:13 AM:

Badour, I see where you're coming from. However, you must understand that so long as we have laws and national borders within which bodies politic decide how we should socialize, your concerns must take a back seat to mine. You don't have a right to impose risk of death on me via the US federal government just because you can argue reductio ad absurdum that international law is ineffective. First, I never said it was and second you are imposing costs on me by advocating the shift of risk, off global corporations and others who profit from human traffic over international borders, via the federal government.

Rob McMillin said at June 19, 2005 9:43 AM:

I really don't get the hysteria here. We are dealing with a "what if" scenario that doesn't seem to me to be very likely. What if ebola develops a pneumatic transmission vector? The fact of the matter is that the the flu virus they're fretting over doesn't even exist. What this looks like to me is just another white paper in favor of giving some guys a whole lot of money and a whole lot of power over essentially a hypothetical scenario.

Randall Parker said at June 19, 2005 11:32 AM:

Rob,

The odds of Ebola mutating into an easily transmissible virus are very small.

The odds of avian flu mutating into an easily human transmissible virus are orders of magnitude higher. Avian flu just has to co-infect with an existing flu strain and swap some genetic material. This sort of thing happens frequently and other flu strains that attack humans have come from pigs (e.g. the 1918 flu is also known as Swine Flu - get it? Swine?).

Are you aware of the argument that the 1918 flu was around in 1916 infecting and killing British soldiers at a camp in France and that it gradually mutated into a more lethal strain? Said camp had a large number of hogs in a part of it that were used to feed all the soldiers. It might have hopped from pigs to humans in 1915 or 1916 and mutated until it finally burst forth and killed tens of millions.

James,

But a tax on air passengers won't actually prevent the spread of a killer flu virus. Whereas concerted efforts by governments could greatly reduce human-bird exposure in East and South East Asia and decrease the odds of a bird flu crossing over to humans. Ditto for reducing human-pig and other animal exposure. The big threat comes from the conditions Bob describes. If the conditions are not changed the threat will eventually produce a killer flu.

BTW, the killer flu of 1918 didn't have a problem travelling the world in 1918 when air flight between continents was impossible.

Invisible Scientist said at June 19, 2005 7:24 PM:

Randall Parker wrote:
------------------------------------------------
" Do you expect that food distribution and regular commerce will continue uninterrupted if a flu breaks out that kills double digit percentages of the infected?

Isaac Newton was out in the country in Lincolnshire to escape a plague in London and Cambridge when be did major work on calculus and classical mechanics. So going to the country to escape disease outbreaks is a very old practice. We haven't seen this practice for a long time. But given the right conditions I expect we'll see it again."
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Sir Isaac Newton also owned a lot of gold coins, which protected him from inflation during the plague at that time, because during such catastrophes, both the production and transportation of goods would be hindered. Especially during the present era, when most of the manufacturing of computers and LCD screens is in Asia, we would face an epic inflation in these areas. I have recently purchased 2 additional 1600 by 1200 LCD monitors, and 2 more computers, one of the new computers is a dual processor 64-bit Xeon, so that I would have the capability to run both the 3n2 bit and 64 bit software. Also, I am contemplating buying an additional Laptop from IBM (which is now a Chinese company!!!) due to its durability, together with some spare hard disks, which are cheap now, but there
will be a shortage of hard disks when the international trade is disrupted when the antichrist starts the gene wars.

James Bowery said at June 19, 2005 8:30 PM:

concerted efforts by governments could greatly reduce human-bird exposure

So who should pay the costs of those concerted efforts if not those who are creating the risk of exposure?

BTW, the killer flu of 1918 didn't have a problem travelling the world in 1918 when air flight between continents was impossible.

I didn't say "air flight" but more to the point there was this little thing called WORLD War I. Remember?

Randall Parker said at June 19, 2005 10:23 PM:

Invisible,

I don't see a disruption of PC distribution as having all that severe an impact on the economy. An increasing fraction of PCs go into homes. Industry has plenty. 4 or 6 year old PCs are plenty fast for most purposes. People could sell the ones they use for recreation to anyone who wants to set up a home office in order to stay away from their regular office. The point is, we could get by with some adjustments. Ditto for monitors. We have plenty of monitors. People replace their tubes with flat panels just to get a nicer monitor.

I'd be more worried about food and fuel distribution disruptions.

Also, keep in mind that if people travel less they will need fewer new cars. So the car industry will take a hit. But readjustments to the economy could allow a much higher ratio of other kinds of economic output to miles travelled.

James Bowery,

We are talking chump change for reducing animal exposure as compared to what an avian flu epidemic would cost. A big pandemic would cost trillions of dollars in lost production.

Do I remember that WWI helped spread the flu? As I just suggested above, the British military camps in France might have helped breed the virus to give it conditions where it could mutate into greater human virulence.

Yes, WWI helped to spread the virus. But the virus spread all over the world and WWI was not a real world war on the scale of WWII. How'd the virus get to Africa, Latin America, and India? Didn't take troop transport ships or trenches of fighting men to cause it to spread to those places.

Daran said at June 20, 2005 12:43 AM:

Don't forget about the guns. And make sure you have practised with them.

cathy said at June 20, 2005 7:19 AM:

How do you stock up on prescription drugs? I doubt if my doctor would write me a prescription for Tamiflu 'just in case there is a pandemic'. And what sort of quack would give you 100 presciptions so you can have some to barter?

Ken said at June 20, 2005 7:55 AM:

"How do you stock up on prescription drugs?"

By breaking dumbass laws and getting away with it.

"I doubt if my doctor would write me a prescription for Tamiflu 'just in case there is a pandemic'. And what sort of quack would give you 100 presciptions so you can have some to barter?"

One that is willing to break dumbass laws for his patients' benefit.

Of course if people drop like flies and there isn't enough Tamilflu to go around and few people have been able to stockpile it, I'll lay long odds that the dumbasses that wrote our prescription laws and those that chose to add to them rather than get rid of them will not get even a part of the blame.

Randall Parker said at June 20, 2005 8:22 AM:

Cathy,

I know people who go to their doctors and get extra prescriptions. Maybe your doctor won't give you 100. But he might give you the 30 pill size for each member of your family (assuming you don't live alone). If you have an HMO doctor they have a particular incentive to comply because they don't get paid per visit. They want to give you anything you might need in the future so you don't come back.

If you have the money to buy 100 prescriptions then you have the money to visit a couple dozen doctors.

I have always wondered how the online pharmacies work with prescriptions. If they want the prescription faxed what is to stop a person from faxing to a dozen online pharmacies?

Then there are countries where you don't even need a prescription. If I lived in Mexico I'd certainly stockpile Tamiflu and probably several other things.

It comes down to how determined you are. I don't know if the last three approaches are legal. But my impression is that the US government doesn't much care as long as you aren't trying to get drugs that are controlled as addictive or mind altering.

James Bowery said at June 20, 2005 9:19 AM:

We are talking chump change for reducing animal exposure as compared to what an avian flu epidemic would cost.

What does it cost to get governments to politically comply with such precautions? There are hidden costs here.

And even if the costs are as trivial as you say, there is still the question of who pays.

In reality the hidden costs here are the costs of political mobilization which can be completely intractable.

When I say I don't want to eat the sewage of the globalists, the responses I get are pretty predictable -- everything from the equivalent of "Get an electron microscope and pick out the Hepatitis C particles before you eat the sewage." to "You're a supremacist -- that's why we can't let you have your independence." I don't want to be in a position where I have to argue with them about it. A pandemic may just provide the destruction that makes it possible to become free of them.


How'd the virus get to Africa, Latin America, and India? Didn't take troop transport ships or trenches of fighting men to cause it to spread to those places.

No but it did take the same "technologically amplified ecological panmixia" that I earlier discussed. The reason World War I was considered a "World" war was because those involved _were_ in Africa, Latin America and India -- as trade-route colonists.

If the disease vector can't behave himself, then its time to terminate the disease vector himself.

Ryan said at June 20, 2005 9:43 AM:

How long does Tamiflu last? 6 Months? A year?

Erik Starck said at June 20, 2005 9:59 AM:

"The 1918 strain, which killed 50 to 100 million people, only killed about two to three percent of the people it infected."

So 1.7 billion to 5 billion were infected? That's quite a lot considering that the population of the world at that time was slightly above 1.5 billion:
http://www.prb.org/Content/NavigationMenu/PRB/Educators/Human_Population/Population_Growth/Population_Growth.htm

Randall Parker said at June 20, 2005 10:29 AM:

Eric Starck,

First of all, not everyone got infected.

But I think Garrett gets it wrong anyway. The estimates I've read for the dead are from 20 million to 50 million. However, we really have no idea how many died in the average village in India, China, or Africa.

James Bowery,

If the disease vector can't behave himself, then its time to terminate the disease vector himself.

Then do you advocate killing all the ducks and chickens in East Asia? Or do you advocate killing all the people who raise ducks or chickens in East Asia? Or do you advocate killing all airline passengers? Or just the ones who get infected?

As for your "technologically amplified ecological panmixia": Horsemen were enough to bring the plague from the Asian steppes to China and Europe in the 14 century.

Randall Parker said at June 20, 2005 10:31 AM:

Ryan,

Tamiflu does not last long at all. It is a drug. It gets broken down and excreted. The idea is that Tamiflu will slow the influenza virus long enough to give your immune system time to mount an immune defense.

Ryan said at June 20, 2005 10:52 AM:

Randall,

Thanks for the info, but I meant to say "shelf life" of Tamiflu. Some googling answered that. It's manufacturer says 4 years, the UK NHS says 5 years.

-Ryan

bigelow said at June 20, 2005 11:40 AM:

"Thanks for the info, but I meant to say "shelf life" of Tamiflu. Some googling answered that. It's manufacturer says 4 years, the UK NHS says 5 years."

Roughly every 10F drop in temperature doubles the shelf life of stored foods and seeds. I read that Tamiflu should be stored at 77F (with excursions permitted to 59 to 86F). Do not freeze.

So how long is an excursion, or how about tossing it in the fridge?

James Bowery said at June 20, 2005 10:10 PM:

Then do you advocate killing

I advocate termination of trade empires like the Mongols or the present globalism -- whether constructed via military organization or technological prowess or a combination of both. You can talk about what you would do if you were King all you want -- but you aren't. The qualities that are required to get control of thes empires are anithetical to control of epidemics. Hostility to borders and to any "isolationism" or "nativism" is precisely what they require. A good clue as to what is in store for said empire is the fact that guys like us can't isolate ourselves from their panmixia without profound costs to ourselves -- and I don't mean loss of access to cheap manufactured goods from China. I mean things like fleeing our own cities and towns for the countryside.

Richard said at June 21, 2005 6:10 AM:

From the Newscientist.com

"last month the WHO reported that a patient in Vietnam had a strain of H5N1 resistant to Tamiflu"

Well, at least we can all save some money.

Randall Parker said at June 21, 2005 8:25 AM:

Richard,

The Chinese let their chicken farmers use amantadine (another anti-viral) against bird flu and the result is widespread amantadine resistance in Chinese strains of the avian flu. Neat, huh?

Your best defense is isolation until a vaccine is developed.

bigelow,

My guess is the pandemic is coming soon enough that a 4 year shelf life is long enough. I wonder if it just loses some of its potency after that and if an extra tablet a day would compensate for the loss of potency.

Lono said at June 21, 2005 1:29 PM:

Richard,

I believe that the most virulent strains, which perhaps would be more resistant to Tamiflu, are not the pandemic ones we need to worry about.

That is because the more deadly the virus, the less chance it will spread in a far reaching way, due to rapid host incapacitation.

Therefore, with a little luck, the less virulent strain which is capable of creating a pandemic will not be so resistant to it.

And, don't forget, the placebo value is nothing to sneeze at!

Curious said at June 21, 2005 3:13 PM:

Is is it more or less likely that there will be an avian flu outbreak this year than last year? than in any of the previous ten years? fifty years? How much more or less likely?

If the answer isn't that it is at least an order of magnitude more likely, what's the big deal?

Randall Parker said at June 21, 2005 3:43 PM:

Curious,

The odds of a killer pandemic are orders of magnitude more likely this year than on the average year.

You should read the Recombinomics commentary on why avian flu should be seen now as entering phase 6.

Oh, you ask, what's this talk about flu pandemic phases?

The World Health Organization (WHO) has developed a global influenza preparedness plan, which defines the stages of a pandemic, outlines WHO’s role and makes recommendations for national measures before and during a pandemic. The phases are:

Interpandemic period

Phase 1: No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

Pandemic alert period

Phase 3: Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.

Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).

Pandemic period

Phase 6: Pandemic: increased and sustained transmission in general population.

The debate now is really over whether we are in phase 5 or phase 6. I think we are on the phase 6 on ramp. The reports coming out of Vietnam sure seem like they are for human-to-human transmission.

Bob Badour said at June 21, 2005 6:04 PM:

Regarding tamiflu shelf life: don't count on having the full shelf life to play with. When you go the the pharmacist, he is not going to sell you the shipment that was made yesterday -- he is going to sell you the stuff that's been on his shelf for a year first.

Darwin said at June 21, 2005 8:54 PM:

Wow, Randall. I don't have too much to say about the contents of this post.. but I have to make this comment :

I am absolutely amazed by the nutjobs your posts attract. You have the best crazy commentors I have ever seen on any blog anywhere. Like this guy..

I advocate termination of trade empires like the Mongols or the present globalism -- whether constructed via military organization or technological prowess or a combination of both.

Good luck with that..

=darwin

Randall Parker said at June 21, 2005 9:51 PM:

The best crazy commentators? I see your point. Yes, a lot of blogs have really lousy crazy commentators who are dull and unexciting. Then even worse there are the non-crazy yet boring and predictable commenters. When I get the boring nutcases posting (and, yes, it does happen) it is always such a downer.

BTW, love your name. Whenever I think of the Mojo Nixon and Skip Roper song "Elvis is everywhere" I think to myself that they should have sung "Darwin is everywhere".

Darwin said at June 22, 2005 9:47 AM:

BTW, love your name. Whenever I think of the Mojo Nixon and Skip Roper song "Elvis is everywhere" I think to myself that they should have sung "Darwin is everywhere".

Darwins are definitely everywhere.. off the top of my head I know about 5 people with the nickname "Darwin" and there's many, many, many more. One of these days I'm going to get around to building my community site for people with the nickname "Darwin." We'll have a grand old time, I'm sure.. :)

Thanks for FuturePundit, btw.. one of the few blogs from which I consistently learn.

=darwin

remo williams said at June 22, 2005 11:08 AM:

Why not phase 4 if limited to Vietnam?

Randall Parker said at June 22, 2005 12:35 PM:

remo,

The argument is being made that it is spreading human-to-human and that the rate of human to human spread is accelerating. This is a judgement call.

Follow the reports on the Recombinomics and Avian Flu blogs and decide for yourself whether the pattern of human infection in Vietnam suggests accelerated human-to-human transmission.

Randall Parker said at June 22, 2005 12:46 PM:

remo,

Why do you say human cases are limited to Vietnam? Did you even bother to click thru and read the Recombinomics argument for why we are entering phase 6? How about Cambodia and China? Also, even within Vietnam the spread into the north away from areas with lots of chickens suggests more human-to-human transmission.

carol said at June 22, 2005 6:31 PM:

According to Dr. David Suzuki we are going to encounter a situation where we all die. Well, most of us die and that's all it will take to put us back in the caves. A few of us surviving here and there will not be able to FUNCTION as what we call human beings.

If this doesn't happen to us, then it will happen to every other species that exists and then to the Earth itself. We will kill ourselves ultimately by killing everything else first.

Speaking as a crazy commentator, of course.

remo williams said at June 22, 2005 9:01 PM:

Garret is NOT the person who should be talking about this. Let the WHO and scientists weigh in rather than Garret with her irresponsible comment that "hundreds of millions" could die. Even the WHO (which in contrast to her interview has not retracted the 2million to 8 million fatality estimate - just considers it a best case scenerio if a breakout occurs) places an upper estimate of 60 million. True, no one knows with 100% certainty.

If you live in the US, an outbreak occurs and 'only' 8 million die, the odds that you bite it are 0.1% and that you lose a nuclear or extended family member to 1% to 2%. That is still a tragedy to be avoided, but people shouldnt assume an outbreak is the end. And the odds are really worse in SE Asia.

Taking an average of best/worst case scenerios, 34 million die. Randomly distributed, you'd now have about a 0.5% chance of dying and maybe a 5%-10% chance of an extended family member dying. A tragedy to be sure, but a high quality site like this needs to include some pespective rather than just quoting a journalist saying "hundreds of millions" might die.

According to the WHO, 7 million die of lower respiratory infections a year.
Again, not to diminish the threat of Avian Flu...

Randall Parker said at June 22, 2005 9:32 PM:

remo,

If avian influenza goes pandemic it probably isn't going to have a double digit percentage mortality rate among those actually infected. Though it could. Reports from Vietnam suggest the mortality rate has fallen. But it easily could be higher than 1% of those infected.

8 million? In the US or in the world? In the US 8 million would be almost 3%. But maybe you are talking about the world?

7 million from lower respiratory: But they tend to be old or immunocompromised or malnourished. The average healthy American is at little risk of death from lower respiratory infections in a typical year.

The 1918 flu pandemic was notable for the age brackets it killed. It didn't have as high a mortality rate among the old as it did among the young (and I forget what were considered to be the most vulnerable age brackets - in the 20s and 30s maybe?). The speculation for this is that older people had partial immunity to it due to an earlier similar strain that was not as lethal.

Currently the avian flu is more lethal than the 1918 flu. So high death toll estimates are certainly within the realm of possibility. Though I would expect the industrialized countries to do a far better job of isolating subpopulations and of developing vaccines as compared to 1918. So a high lethality rate among the infected could still not translate into a high total lethality rate if governments responded with alacrity and competence and if companies and other organizations did so as well. Still, a new pandemic would just tear through much of Asia, Africa, and parts of Latin America.

remo williams said at June 22, 2005 9:47 PM:

I was referring to the 8 million Garret initially cited and you post on your page. I read in another place that the 'best case estimate" fatality figures would be between 2 million and 8 million in the world. A few articles discuss the 1918 epidemic in the US, and I was surprised to read that many didn't think it was a major event at the time. Most were focused on the closing months of the war and were resigned to the fact that people died all the time from flu, polio, etc. Mass media was quite different then as well.

By the way, I get a 18deaths/59cases mortality rate (WHO), or 30% as opposed to the 'over 50%' Garret stated.

Isn't China claiming initial success with a vaccine?

And arent we doomed anyway once it becomes easy to design a virus in a basemnt?

James Bowery said at June 23, 2005 1:11 PM:

I advocate termination of trade empires like the Mongols or the present globalism -- whether constructed via military organization or technological prowess or a combination of both.

Good luck with that..

=darwin

Why don't you go to your local building inspector and tell him "Good luck with that." when he advocates destruction of a building that is unsuited for human habitation?

No luck is involved... its inevitable. The only question is how many people must die first.

Do you have any idea what the drivers are of how rapidly critters are evolving to eat all that food out there in human form? Think before you respond...

James Bowery said at June 23, 2005 1:40 PM:

I would expect the industrialized countries to do a far better job of isolating subpopulations ... as compared to 1918.

Wrong. The politics of AIDS should give you a clue here. When I was advising Gary Hart's AIDS policy committee in 87 all of the effective means of controlling the epidemic were opposed by the very blocs that were most threatened with death. The reason: People can no longer tolerate the public health measures that just a generation before were common sense.

PS: If I'm a kook then why was I the only person to discover the error in May and Anderson's 1987 AIDS epidemeology model for AIDS where they mis-defined a key parameter as probability of transmission per partner contact rather than as probability of transmission per partnership? (See their correction in a later Nature article.) This error led at least one CDC-affiliated AIDS activist to spread the "good news" that the AIDS epidemic was over to various mass media outlets. Stupidity kills -- bad judgement about who is a kook can kill even more.

Randall Parker said at June 23, 2005 2:07 PM:

James Bowery,

I do not expect the mainstream population of America, faced with a dangerous pandemic that could kill them, to be as suicidal as homosexual males. Sure, they were willing to let the homosexual male activists undermine public health measures against HIV/AIDS. But that kind of complacent willingness to go along will be absent once everyone is in danger.

Bubba said at August 17, 2005 12:00 PM:

"run to the rural country to survive"
What makes you think us dumb rural country types are gonna let you come wading into our land carrying your avian flu?
I got a buncha buddies says you don't make it outside of the city limits Hoss!
And if you get out here, well you may survive the flu jess ta die of lead poisoning LOL
;^D

Denise said at August 29, 2005 7:32 PM:

ditto bubba - here in rural Alaska, we enjoy the benefits of our isolation and don't want no crazy germ-laden Californians who can't take care of themselves, knocking on our doors! Re: James "Since these bird flus don't necessarily travel via birds across the Pacific without human assistance" - they don't need human assistance to cross the pacific - they "mix" with the migratory asian birds in northern Alaska (only place on globe where that happens), then migrate down the flyways to all you folks! There are many biologists chasing down wild and domestic fowl with Q-tips here - haven't found any flu yet! If they don't mix and transport it south this fall (they're currently overhead in central AK) we may gain a year's grace for this vector. Next fall could be a totally different story. Whole Alaskan villages were wiped out in 1918....too many years of isolation.

WildChild said at September 30, 2005 1:10 AM:

Who are you guys? You all seem to know so much about bird flu , it's scary. Does any one here have Tamiflu? Do you really think it will work , in any way? I'm 16 and have no money ,I bugged my parents to buy Tamiflu , but they think I'm being paranoid. Can I join your safe families with your Tamiflu and abundant paranoia? If there is an outbreak , I am locking myself in my room with 2 years supply of montana bars and juice and not coming out for no one.

George said at October 12, 2005 1:55 PM:

I'm just curious, I am not a doctor or a specialist on this subject at all. Of the people who have died so far in recent years, did any of them die from contracting the avian flu directly from another human? And hypothetically, if it were to become transmissable from human to human, would it have a transmission rate greater than any common flu we currently have circulating the globe? Will it sweep the globe in a matter of days, months or years? Also, what is to stop it from mutating further into something that Tamiflu can't protect you against? Why is Tamiflu the only cure? Surely a patent on something so valuable to the world as a whole should be morally questionable... every country is on the "waiting list". How difficult is it to manufacture? Why can't Roche increase it's capacity or at least outsource production? If so many hundreds of millions of people are going to die, won't it be in the best interests of Roche to keep these people alive so it can't have some customers left alive? This all boggles the mind, and mine is not even a learned one...

Barbara Mathews said at October 20, 2005 10:38 PM:

To those concerned about obtaining prescriptions for Tamiflu, this shouldn't be a problem. Read ALL the instructions on the Tamiflu website. Primarily, you will need a relationship with a good physician who can write prescriptions for you and the other members of your family.
I came down with flu like symptoms this past week, and went to my doctor and merely requested a prescription. I've been on it for two days now. I feel satisfied that as long as there is a supply available, if I were to ask to have a preventative dosage on hand, (just in case), that my doctor would cooperate by allowing me to have some stored for myself and other members of my family. It just seems like good medical practice to me, to keep the flu from spreading. I think most physicans understand this nowadays, and it's not like they are writing scripts for addictive prescription drugs.

Wondering said at December 12, 2005 9:56 AM:

Hi...wow...this is an interesting conversation...I watched the CNN special on Bird Flu. I can't help but to recall the Sars scare and the Y2K fears....but being that I'm anal retentive, these topics appeal to me. So, I sit here wondering if I should worry...should I stock pile perishable foods...I live in Florida and have to stockpile for the hurricane season anyways...so I'll use it for something...be it a hurricane, the bird flu, or just because I run down low on food on some days.

Wondering said at December 12, 2005 9:56 AM:

Hi...wow...this is an interesting conversation...I watched the CNN special on Bird Flu. I can't help but to recall the Sars scare and the Y2K fears....but being that I'm anal retentive, these topics appeal to me. So, I sit here wondering if I should worry...should I stock pile perishable foods...I live in Florida and have to stockpile for the hurricane season anyways...so I'll use it for something...be it a hurricane, the bird flu, or just because I run down low on food on some days.

Wondering said at December 12, 2005 9:56 AM:

Hi...wow...this is an interesting conversation...I watched the CNN special on Bird Flu. I can't help but to recall the Sars scare and the Y2K fears....but being that I'm anal retentive, these topics appeal to me. So, I sit here wondering if I should worry...should I stock pile perishable foods...I live in Florida and have to stockpile for the hurricane season anyways...so I'll use it for something...be it a hurricane, the bird flu, or just because I run down low on food on some days.

SummerBreeze said at January 16, 2006 1:16 PM:

How much food are we supposed to stockpile? Enough for three months? Six months? A year? And how much food is that exactly? Also, my insurance company allows only a maximum of three months worth of medicines and one of the meds my handicapped child takes is made from a compound that can only be made once a month. It's my understanding that the average pharmacy only keeps around a two month supply of most drugs. Even if I pay for the medicines myself so I can get a six month supply, two of the medicines my child takes on a daily basis are $400 and $355 respectively every month. That would mean I would have to fork over in excess of $5,000 for a six month supply of medicines - there's no way I can afford this. I guess I can only hope that Jesus comes before the Avian flu!

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