September 20, 2005
Comparing National Tamiflu Stockpiles Against Flu Pandemic Threat

Roche's Tamiflu (a.k.a. oseltamivir phosphate) is the most effective known drug against influenza infections. Should an H5N1 avian influenza strain mutate into a form capable of causing a large deadly human pandemic then for those infected Tamiflu might be the only drug that will reduce the odds of dying. With that in mind I've decided to start looking for information on national Tamiflu stockpiles around the world. If anyone comes across information about countries buying large amounts of Tamiflu let me know what you find.

United States Health and Human Services Secretary Mike Leavitt says the US government plans to build up a 20 million dose stockpile of Tamiflu.

Leavitt said the federal government was looking to stockpile 20 million doses of a bird flu vaccine and another 20 million doses of Tamiflu, an antiviral medication to treat the illness.

While those talks with Roche are still underway currently the United States has just 2.3 million Tamiflu doses available.

The United States has a stock pile of 2.3 million doses of Tamiflu, enough for just one percent of its population.

The United States currently has a population of 295.734 million. So the current 2.3 million dose stockpile provides only 0.778% coverage, not even a whole percentage point. Once the stockpile reaches 20 million doses (and that probably will take years the coverage level will still be just 6.7% and probably lower than that due to population growth. Plus, in event of an outbreak I expect a lot of Mexicans to cross into the United States illegally seeking treatment. This'll accelerate the spread of the virus as well as placing a still heavier burden on completely overwhelmed hospitals.

New Zealand is in much better shape.

The ministry has also ordered 835,000 courses of Tamiflu, the last of which should arrive by the end of the year.

New Zealand has 4.035 million people. So New Zealand will soon have a 20.7% coverage rate. Plus, New Zealand can much more easily cut itself off from the rest of the world in order to prevent the spread of the virus.

Best stockpile for Tamiflu I've come across so far is in France with 14 million doses expected to be in stock by the end of 2005. With about 60.656 million people France will soon have an impressive 23.8% coverage rate.

Britain will eventually surpass France in coverage rate but not for a couple of years (and perhaps not soon enough).

The UK government said on Tuesday it had ordered 14.6 million doses, enough for one in four of the population.

...

The UK order is worth around $384.4 million and the doses will be delivered over two years. Analysts at Morgan Stanley estimate that potential U.S. and European sales could total $3.9 billion.

With 60.441 million people the UK coverage level will eventually reach 24.2 %. But that will not happen for two years. Whereas the French will achieve their 23.8% coverage rate by the end of 2005. The French are clearly most ready and will continue to be most ready for quite some time.

What is an adequate coverage rate? It depends on what percentage of the population gets a pandemic flu strain. If the total infected can be kept to 20% or less (and that seems achievable in industrialized countries) then 20% coverage is adequate.

Your best bet during a highly lethal pandemic is to isolate yourself. Home school your kids. Try to get work you can do from home. Shop rarely, buy lots of stuff when you do shop, and shop at off hours when few are in stores. Better yet, get delivery. Also, stockpile your own Tamiflu and get face masks, preferably longer last face masks such as the 3M N100.

If anyone comes across reports on national Tamiflu stockpiles and order levels let me know.

Update: Australia has 3.5 million doses of Tamiflu stockpiled. (and that link has an excellent discussion of what a severe pandemic would be like including an image of a deserted NYC Grand Central Station).

Officials in Australia, however, have 3.5 million courses of treatment, and in Great Britain, officials say they have ordered enough to cover a quarter of their population.

Australia has 20.09 million people. So Australia's coverage comes it at a very respectable 17.42%. Australia already has 3 times better Tamiflu coverage than the US government hopes to achieve in a couple of years.

Update II: Indonesia has made only token preparations to handle a pandemic.

The WHO was also working with the government to source new stocks of the anti-viral drug Tamiflu from India to bolster local stocks, he said.

"It's not very much, it's rather puny. They definitely need some more," Petersen said, adding that stocks being rushed from India were less than 1,000 doses.

Tamiflu is an anti-viral tablet that can help against infection. Several companies are working on a vaccine, but tests are not expected to begin until later this year.

Supari said Indonesia had 10,000 Tamiflu tablets.

I suspect Supari meant "doses" and not "tablets". Indonesia has 242 million people. Indonesia typifies the vast bulk of the countries in the world: Should the pandemic come I expect most countries will fail totally in attempts to control the pandemic. Order will break down in many countries as soldiers and police abandon their posts in order to avoid exposure to the virus.

Update III: The World Health Organization will not have a few million Tamiflu doses until mid 2006.

According to public health officials, Southeast Asia needs to stockpile antiviral drugs to treat at least 3 million people if the deadly H5N1 virus mutates to one that could explode into a pandemic.

But meeting this demand is already proving to be a problem due to limited stocks for the developing world. The World Health Organization (WHO) is due to receive 1 million doses from Swiss pharmaceutical giant Roche, the producer of Tamiflu, by the end of this year and another 2 million by mid-2006.

Currently the WHO has only 80,000 Tamiflu doses and is getting more doses only because Roche is donating the three million doses.

WHO currently maintains a stockpile of about 80,000 treatment courses of oseltamivir, known commercially as Tamiflu, Omi told reporters outside a WHO conference in New Caledonia.

Last month, Swiss-based Roche Holding AG announced it would donate 3 million treatment courses of Tamiflu to a WHO-managed stockpile, but the first million courses will not be ready until early next year and the remaining 2 million will not be ready until mid-2006.

Also see the comments where one commenter claims a double dose of Tamiflu is more effective than a single dose. If this is true then you folks who are stockpiling for your families ought to double your orders.

Update IV: Thailand and Singapore Tamiflu coverage reported here:

Until this week, Indonesian doctors had only a few hundred courses of the anti-viral drug oseltamivir. Sold by pharmaceutical giant Roche as Tamiflu, the drug is widely seen as one of the few effective options to treat the H5N1 virus in humans and, potentially, contain an outbreak.

Even after 10,000 courses ordered through the World Health Organisation are added this week, supplies for the country of 220m will be dwarfed by the far wealthier nearby island-state of Singapore, which is assembling a stockpile of 350,000 courses for 4.2m citizens - or the 700,000 Thailand has now and the 3m it wants by 2007.

Singapore is trying to achieve 8.3% coverage. But it is not clear when they will do so. Thailand has 65.444 million people and so their 700,000 doses count up to 1.07 coverage. They might achieve 4.6% coverage some time in 2007 which would still be very inadequate.

Update V: A US Tamiflu production plant will not be ready before the end of 2006.

The federal Centers for Disease Control and Prevention have stockpiled enough to treat 2.3 million people. Hoffmann-La Roche, the Swiss pharmaceutical giant that is the world's sole supplier of the drug, has pledged to build a U.S. plant to produce Tamiflu before the year's end, but the drug supplies from that plant would not be ready until late 2006.

The later a pandemic comes the better the shape we'll be in to handle it.

Share |      Randall Parker, 2005 September 20 05:36 PM  Pandemic Prepare Government


Comments
Theresa said at September 20, 2005 10:48 PM:

Norway has stockpiled 1.4 million doses of Tamiflu. With a population of 4.5-4.6 million people thats -- what? -- 30% of the population? (Sometimes Big Government does ok. But, don't tell anyone I said that...!)

http://www.vg.no/pub/vgart.hbs?artid=288217

http://smdm.confex.com/smdm/2005ca/techprogram/P2143.HTM

Randall Parker said at September 21, 2005 12:19 AM:

Theresa,

The first link is in Norwegian. Can you read Norwegian? I see the 1.4 million mention in it. But is that existing or planned stockpile?

With 4.593 million people that would be 30.5% coverage if they really have that many doses already.

iFlu.org said at September 21, 2005 1:24 AM:

Both Finland and Sweeden have also stockpiled suffient for their needs too, I'm told.

PacRim Jim said at September 21, 2005 3:32 AM:

What's the storage life? If it's six months or so, the stockpiles will be tossed.

Andrew Berman said at September 21, 2005 9:25 AM:

The shelf life is 5 years. It's a dry pill.

Most expiration dates on medicines are bogus-- they're the result of some lawsuits 30 years ago. The drug companies make *tons* of extra money because pharmacies have to throw out expired drugs that are perfectly effective-- especially the dry pills.


Sebastian said at September 21, 2005 12:21 PM:

Your best bet, and I would recommend it if you have an extra $60 (for 10 doses), is just to get an emergency supply for your family (Google Tamiflu). Or get a prescription if you have health insurance.

Bob Badour said at September 21, 2005 12:55 PM:

Randall,

My allergies are bothering me too much to conduct the analysis myself right now, but Theresa's comment sparks a thought: On average, are homogeneous countries better protected than countries with heterogeneous populations?

I would hazard to guess they are.

Hugh Angell said at September 21, 2005 5:03 PM:

A few comments: How effective is Tamiflu? The exact nature of the avian flu virus that
might cause the pandemic is unknown at this time. H5N1 is the variant that is currently
causing infection but not, as yet, human to human unless a few cases in Indonesia are
confirmed as being the result of that.

Pharmaceutical and Biotech companies in the US and elsewhere are working on a vaccine as
a method of controlling any pandemic. Of course, they too are laboring under the constraint
of not knowing exactly what form the flu might take. Then there is the problem of scaling
up production and distributing a vaccine, should one be developed. The difficulty Chiron
encountered with conventional flu vaccine last year is not encouraging but other methods
could be used to increase vaccine production if I am not mistaken. These might have other
risks but if a avian flu pandemic was severe enough and mortality rates high enough normal
precautions might have to be abandoned.

However, if a pandemic broke out and mortality rates were high,distribution might be the
big hurdle. Again, the experience of last year with flu shots is significant.Whereas before
demand for flu shots was never high, the mere mention of a 'shortage' changed all that.
Lines formed, panic broke out. Imagine the scene if a influenza pandemic occured and a
significant number of those infected were dying. The "Spanish Flu" pandemic for example
hit young adults particularly hard. Imagine a similiar scenario today and then imagine
the danger of trying to dispense a vaccine or Tamiflu in an urban enviroment in the USA
today. I think one's health might be in greater danger attempting to acquire Tamiflu or
receive a 'flu shot' than by taking the precautions Randall Parker mentioned.

Marvin said at September 21, 2005 5:07 PM:

Small homogeneous countries like in Scandinavia have much fewer problems caused by a large, impoverished, uneducated underclass, than larger mixed population countries have. You cannot compare the US with Canada, Australia, Sweden, etc. Compare the US with China, Brazil, Indonesia, India instead.

Randall Parker said at September 21, 2005 5:23 PM:

Hugh,

We do not know how effective Tamiflu is against H5N1 strains.

If you can afford it then the prudent thing to do is to buy and stockpile some Tamiflu now.

There are even more prudent things to buy than Tamiflu:

1) Face masks. I recommend the 3M N100 or P100 masks. They last longer (150+ hours).

2) Eye gear. Don't want viruses settling on your eye balls.

3) Gloves that extend up your arms.

4) Any other protective clothing that looks like it might help.

5) Air filtration systems if you live in an apartment (or, better yet, get out of the apartment).

Theresa said at September 21, 2005 11:14 PM:

On that article from the Norwegian newspaper:

"Norsk Medisinaldepot fikk i sommer levert et gedigent lager av Tamiflu til en verdi av 190 millioner kroner fra leverandøren Roche.

"Lageret på i alt 1,4 millioner doser er båndlagt med tanke på eventuelle utbrudd av fugleinfluensa i Norge."

Here's my rough, "literal" translation:

The Norwegian Medical Depot had delivered (fikk levert = got delivered) in the summer a gigantic supply of Tamiful worth 190 million Norwegian kroner from the supplier, Roche.

The supply (or stockpile, I guess), in all 1.4 million doses, is "båndlagt" (? sounds like bound-stored to me, i.e. reserved) with the thought of a possible outbreak of the bird-flu in Norway.

Says at the end of the article: "Leverandøren har garantert en holdbarhetstid på Tamiflu på minimum fem år."

The supplier [Roche] has guaranteed a storage life for Tamiflu of a minimum of five years.

Theresa said at September 21, 2005 11:27 PM:

Looked it up. Båndlagt = obligated. So, yes, the 1.4 million doses has been reserved or set-aside in case of a bird-flu outbreak.

Bob Badour said at September 22, 2005 5:33 AM:

Marvin,

In what respect is the US not comparable with Canada? Or Australia for that matter?

Bob Badour said at September 22, 2005 7:38 AM:

From Malta: "As already advised by the department, sufficient medicine to treat 50,000 people will arrive next year." With a population of 400k, that's enough for 12.5% of the population.

Lisa said at September 23, 2005 1:30 AM:

Regarding Marvin's statement. I dont' think it's a matter of homogenous country. I think that the quantity of supplies depends just on the importance the government give to public health. And on how much money is destined to the health sector. In Us health is highly privatized and this is the reason for the lack of supplies.
In Scandinavian countries public sector is still effective. I really hope that this emergence will teach us that privatization is not the solution for everything.
LIsa

Bulldog said at September 23, 2005 4:49 AM:

Great Britain was barely saved by Thatcher, using privatisation. Thank goodness for privatisation. Europe would be a massive rotting hulk of Soviet style obsolescence if not for privatisation. Germany is dying for lack of privatisation. Tamiflu is not the answer.

Bob Badour said at September 23, 2005 9:34 AM:

Lisa,

While the Feds only have about 2 million doses, I read there are already something like 20 million doses in the US so private medicine is not as large a failure as you might think.

When compared with Canada, I notice that Canada did not take action to make a stockpile until February 2005 and plans to stockpile only enough for 1 in 34 Canadians with federal funding and expects provincial and local funding for stockpiles to bring that up to only 1 in 20 Canadians.

"Canada is recognized as a world leader in pandemic preparedness," said Minister Dosanjh.

One wonders: "Recognized by whom?"

Lisa, Are you suggesting that Canada, the poster child for socialized medicine, doesn't consider public health important and doesn't commit sufficient funds to medicine?

Might I suggest that when tribalism works somewhat it works for... well for tribes? If not homogeneity versus heterogeneity, to what do you ascribe the difference between Canada and Scandinavia?

Julian Braggins said at September 24, 2005 1:01 AM:

Yes, Tamiflu if you can get it. There are some useful tips though, if you can't. Stock up on essentials so you won't have to leave home so often, wear the protection as suggested above, get a personal spray and keep filled with Hydrogen Peroxide at gargling strength, Garlic and Ginger are easily obtainable anti virals, Bird flu acts by overproduction of inflammatories, virtually drowning the victim, anti inflammatory herbals are available, ginger, curcumin from turmuric ,basil,dandelion, being common ones, and the mineral supplement selenium has been shown to reduce severity of flu and other very serious viral diseases. Remember that flu virus stays active on hard surfaces for two hours or so, (door handles , money, goods, cards etc.) half hour on hands, can infect through eyes ,nose , mouth, ears!,reinfect from tissues, spread a metre by sneeze. Don't forget the old standby of vit C every two hours if infected either.

Marvin said at September 24, 2005 7:25 AM:

It is interesting to look at Avian Flu as another in a long line of "doomsday cults" dating from at least the middle ages, down through the present day. You need to obtain the proper warding to fend off doomsday. Do not neglect the remedy. Look at many of the modern issues of today in light of the "doomsday cult" phenomenon. The muslim menace, global warming, globalization, peak oil. Doomsday is an ancient form of entertainment from before the days of television and cinema.

Randall Parker said at September 24, 2005 10:53 AM:

Marvin,

I do not buy the "doomsday cult" argument. 1918 really did happen. Go to my recent post "United States Orders French Bird Flu Vaccine While Indonesian Cases Suspected". Read the first comment I posted in response to another commenter. You will see links and excerpts for some evidence for why H5N1 could make it into the human population in pandemic form.

Marvin said at September 24, 2005 3:49 PM:

Randall, "doomsday cult" is not an argument, but rather a perspective. An enlightened person will view potentially important phenomena from various perspectives, not in order to eliminate bias which is impossible, but rather to look through different sets of biases. Doing so can be instructive.

Spence said at September 25, 2005 3:14 AM:

An important consideration that almost all of the reports are missing is that the typical dose for avian flu should be a 10 day treatment (not 5 days, that is typically used for the normal seasonal flu). All of the current cases in Asia are receiving treatment with Tamiflu for significantly more than 5 days. In addition, animal studies being conducted at St. Judes Children's Hospital (one of the leading sites for vaccine testing in the U.S.), report that the survival rate after infecting the test animals with the H5N1 virus (not just exposing them, but making sure they were infected) was 100% fatality in the control group, 50% for the group with a 5 day treatment and 20% (80% survival) with an 8 day treatment.

Beyond the current low stocks reported for most countries, the actual stock is actually half of what is being reported (Assuming a 10 day treatment (twice a day) rather than a 5 day treatment (twice a day).

Roche Pharmaceutical is currently the only manufacturer of this anti-viral medication. They are currently working to rapidly increase their production capacity, but the current annual output is reported to be 40 million treatments (5 day treatments). Based on the higher treatment level, the annual production is only 20 million doses (10 day treatment).

Given that this appears to be our primary weapon for fighting this virus, I believe that the national governments should pull the patent protection for this drug and immediately engage multiple pharmaceutical companies in producing this drug, so that it would allow time for other companies to produce, and allow some time for a rapid review and approval of safety of their production by the respective national government regulatory body.

A profit sharing arrangement could be put in place for Roche to make up for the lost patent. But helping to protect society is much more important than protecting a companies profitability.

The story with vaccine development is even worse. The current vaccine being tested and developed and in the U.S. based on the avian version of the virus (avian -> human, rather than human -> human) requires a very large dosage rate to create an immune response. Based on early testing, to create an immune response, a dosage had to be given of 90uL, rather then the normal vaccine level of 15uL. In addition, because we have no natural immunity to this virus, we need to have two vaccines given, a month apart, for a total dosage of 180 uL (90uL X 2). This reflects a total required dosage of 180uL which is 12 times the normal dosage. Unless studies using Adjutives and other methods to reduce the required dosage prove successful, our reported production capacity for flu vaccine in the U.S. of 90 million annual doses, is actually only a capacity of 7.5 million doses (vs a population of roughly 296 million or a 2.5% coverage rate). Add this to the likely low effectiveness of the vaccine (it is being produced based on the current strain directly from birds - the pandemic strain that spreads from humans to humans is likely to be significantly different), the effectiveness of the current vaccine may only be 20 - 40% effective (no one knows until the strain breaks out, but based on prior vaccines that were a poor match to the final virus). The world wide vaccine production capacity is currently 300 million doses, or 25 million at this higher dosage rate. With a world wide population of 6.45 billion. This would only cover 0.4% of the worlds population. Not very encouraging news.

I recently started developing a site to track the latest news and information about the avian flu from around the world, as well as documents from world, national and state public health entities to help prepare for a potential pandemic. The site is directed at supporting public health planning for a potential pandemic, but has good reference information for anyone. The site is http://avianflu.futurehs.com.

Dean said at September 25, 2005 11:54 AM:

Wow - great information. I was wondering how to get Tamiflu if you don't have a prescription? Can someone start a personal stockpile by purchasing online if you don't have a prescription? How would you get a prescription for this if you aren't currently sick?

Thanks for any information!

Randall Parker said at September 25, 2005 12:01 PM:

Dean,

You need a prescription in the United States and probably in all Western countries.

Just ask a doctor to write one. Most will probably say yes. Try to get two or three for the reasons mentioned above by Spence.

If you want it then do it quickly. The pandemic could break out at any time.

Dean said at September 25, 2005 12:51 PM:

Thanks so much Randall. I have two young children (7 and 3) - should I request prescriptions for them through their pediatrician?

Thanks again,
Dean

Randall Parker said at September 25, 2005 12:58 PM:

Dean

My advice: Ask every doctor you, your wife and children see. Go to a G.P.? Ask for yourself and the rest of your family. Your wife has an OBGYN? She should ask that doctor for herself and for the rest of your family. Pediatrician ditto.

Try to get multiple prescriptions from every doctor you see. If you can afford it then get them all filled. You can always help out your extended family, friends, neighbors should the crunch come. If the crunch comes and you have surplus then just one dose series will be sellable for 10, 20, 50 times what you paid for it.

Carol said at September 26, 2005 10:52 PM:

You know I feel a little like a gun-totin' redneck survivalist ... without the gun, and hopefully without the redneck tendencies, but I've just come back from my GP with multiple rx for my family - 2 adults, 2 toddlers - and successfully purchased the Tamiflu. It would seem most pharmacies in Australia are starting to feel the pressure ... most of my local pharmacies have none.

Dean .. please note that for your children (under 10), your GP should probably give you the Tamiflu suspension. This is no good as the pharmacist makes it up and it has to be used straight away.

Both my GP and pharmacist gave me the information from the Tamiflu website on children's weights and percentage of the contents of a capsule to be administered.

Re: selling it for lots more than you paid for it "if the crunch comes". While it might sound like a nice idea, it is likely to create considerable resentment and get you in a fair bit of hot water (perhaps from a redneck with a gun)!

Good luck!

Andrew said at September 27, 2005 6:55 PM:

I suggest to anyone who is unable to obtain Tamiflu, that they grab some Relenza - information recently published suggests it is more effective than Tamilfu anyway in regards to possible resistance as well as other factors -relenza seems to be a bit easier to find also

Bruce said at September 29, 2005 2:18 PM:

Howdy
I appreciate all that I’ve learned from this forum. If you Goggle Tamiflu you can find several online pharmacies that don’t require a prescription. With a bit of info their Doc will write the prescription. You’ll pay extra for this service. Does anyone have any experience with these pharmacies? It would be a real drag to wind up with imitation Tamiflu.

Thanks, Bruce

Matt said at September 30, 2005 7:16 AM:

Something I noticed, and this is IMPORTANT:

The author is confusing DOSES with COURSES OF TREATMENT. Effective treatment with Tamiflu requires 10 DOSES administered over 5 days, and some studies suggest that with a highly virulent flu, 16 doses over 8 days might be more appropriate.

So to say that the 2.3 Million DOSES of Tamiflu the U.S. has 'stockpiled' will cover 0.778% of the population is INCORRECT by an order of magnitude. Coverage is sufficient for 230,000 people (0.0778%) - one tenth of what the author states, and even when the government get to the level they want there will only be enough courses of treatment for 2 million people.

I got mine last night and my wife is getting hers today. This is seriously scary.

Mayte said at September 30, 2005 9:15 PM:

I am an expatriate living in Hong Kong and my employer has just told us they are sending 6 packages of Tamiflu, of 10 tablets each, for everybody at our Hong Kong office. So they seem to be counting on our having to take it for 60 days in case of a pandemic. Incidentally, my Hong Kong doctor is doubtful about the usefulness of Tamiflu and recommends something called Vira 38, which I am also going to keep at hand, just in case.

Randall Parker said at September 30, 2005 9:32 PM:

Mayte,

I'd recommend getting Relenza too. It is a different neuraminidase inhibitor and preliminary indications are that it will work as well as Tamiflu.

Also, get very high quality face masks before the shortage happens during a pandemic. Most face masks that will be available during the pandemic will not be nearly as good. The 3M N100 and P100 face masks last 150 hours.

Also, get goggles or safety glasses or some other eye gear that reduces the odds that airborne virus droplets will hit your eyes.

I did some googling about Vira 38 and there appear to be no clinical research published in reputable journals showing that Vira 38 works against influenza.

If you want to go the extra mile to protect yourself get a respirator (which will be in short supply) and also get some antibiotics to deal with secondary infections.

Mayte said at September 30, 2005 10:06 PM:

Thanks for the advice and info on Vira 38. I shall take your advice on Relenza and anti-biotics. I must confess, however, that the idea of wearing a facemask and goggles such as you recommend is rather off-putting. I would also feel strange walking the streets with that outfit, surrounded by other people less well protected, no matter how irrational that may seem. - The Hong Kong government is planning to impose a week-long curfew, anyway, in the case of an epidemic breaking out. Therefore I am making sure that the supply of drinking water and food in my home will always be enough for at least 10 days.

Randall Parker said at September 30, 2005 10:32 PM:

Mayte,

I'm guessing you weren't in Hong Kong during the SARS threat. You won't be unusual for wearing a face mask if the influenza pandemic comes.

BTW, in Japan some people on trains wear face masks. I don't know if they are trying to protect themselves from colds and flus or trying to protect others. But there you won't be considered abnormal if you wear a face mask.

Joe said at October 3, 2005 4:29 PM:

Why aren't there other drug companies producing Tamiflu like drugs? There are knock off designer jeans, why not Tamiflu?

Randall Parker said at October 3, 2005 4:35 PM:

Joe,

Until recently the market for Tamiful and Relenza has been disappointing. You have to get yourself to a doctor and get the drugs in the first couple of days of symptoms or else they do not help. Most people can't be bothered until symptoms are really bad and even then they figure they are best to just stay home in bed rather than make the exertion to see a doctor.

Low sales reduced the incentive for similar drugs to be developed.

Joe said at October 3, 2005 5:09 PM:

It now appears that there is going to be a very large demand the for drug. That would an incentive for any profit oriented drug company. I would be delighted to buy Tamiflu for my family and I just in case. If a pandemic does occur, getting the drug within 48 hours could be very difficult, if at all. I noticed that European firms are selling the drug on the web without a perscription. Is it advisable to stockpile (so to speak) the drug?

Randall Parker said at October 3, 2005 5:16 PM:

Joe,

First of all, Tamiflu is hard to synthesize. So scaling up production facilities is hard. Roche is constructing a new manufacturing facility in the United States. But the facility will not be operational until the end of 2006.

Second, to develop a new competitor drug takes many years of testing in cells, animals, and humans. So do not expect new drugs any time soon.

Third, yes, getting prescriptions for your family makes sense. I suggest asking your doctor for multiple prescriptions for your family.

Fourth, be careful where you buy it. Fly by night mail order places can sell counterfeit drugs. Stick with well known big web sites if you buy on the web.

You can also get Relenza which is also a neuraminidase inhibitor and is FDA approved as an antiviral.

Joe said at October 3, 2005 5:31 PM:

Thank you for the advise. I have a daughter in New York. A daughter and 4 year old grandson in Phoenix, and a son in Milwaukee. After reading all of the doom and gloom predictions of the Avion flu I'm obviously concerned about all of them. Any parent would want to see their children protected. I will attempt to obtain multiple perscriptions from my doctor. Thanks again!

Joe said at October 3, 2005 5:34 PM:

Go to this site regarding Relenza. http://www.adrugrecall.com/relenza/relenza.html

Bruce said at October 3, 2005 7:08 PM:

Howdy
My Doc just came through. I asked for a script for 40 Tamiflu but due to some guidelines for docs. he wound up writing two scripts for 10 with one refill each. I contacted drugstore .come and they don’t seem to be having a problem keeping it in stock at this time but said that demand is rising since the weekend news broadcasts. I called Costco in Seattle and they are out and don’t think that they will be able to get any more.
Better hurry.

Michael said at October 4, 2005 10:47 PM:

Are there any specific online pharmacies in the U.S. or Canada that you would recommend for obtaining Tamiflu or Relenza or, preferably, both? I can always get a prescription or two but several prescriptions (my wife and I have eight children) might be a problem. Any referrals to reputable online pharmacies that will write the prescriptions would be most appreciated.

Lastly, is there a specific respirator you would recommend and what secondary infections (necessitating antibiotics) are you speaking of?

Many thanks.

Randall Parker said at October 4, 2005 11:35 PM:

Michael,

As for getting multiple prescriptions: Ask. If your doctor knows you have 8 kids he might just write a prescription for each of them. If your wife goes to a different doctor she can ask too. Ditto for whichever doctor(s) you use for your kids. Plus, you can always go to the walk-in immediate medical care clinics that a lot of towns now have and ask a doctor at such a place. I realize the doctors visits cost money though.

Online pharmacies: The problem is that the ones that do not require prescriptions are the ones I'd be reluctant to buy from. Maybe they sell legitimate stuff. But what if they sell counterfeits? I do not know much about the online pharmacies that find ways around the rules. Maybe there are reputable ones in Canada or Europe that sell stuff without prescriptions to Americans.

Secondary infections: If your lungs get heavily congested during a severe flu then bacteria can grow. So antibiotics might help. Mind you, I'm not saying antibioitics will always help. But they'll be in short supply if you need them during a big pandemic.

There's also evidence that statin drugs (normally used to lower cholesterol) reduce the severity of influenza. So Lipitor or Crestor might help you survive an infection.

Respirators: To clarify, I'm talking about oxygen enrichment, not filtering face masks. For example, you can buy an oxygen concentrator or an oxygen machine that hydrolyzes water to produce enriched oxygen. Check out Froogle Google and search on "oxygen concentrattor" and you will see what I'm talking about. I do not know the brands. I helped someone use one as he died some months back but forget what the hospice service provided. You could ask a local hospice organization what brands they use since they use them a lot.

Though face mask respirators are helpful in reducing the chance of getting influenza in the first place.

Melissa said at October 5, 2005 6:05 AM:

I found an article at www.edition.cnn.com on 30th Sept 2005 that stated the H5N1 strain found in Vietnam had proved to be resistant to Tamiflu. The article mentioned relenza as the alternative. From what I have read the Australian Government has only stockpiled Tamiflu, which is of great concern. A concern for all countries if this is the case. We have not heard anything of this apparent Tamiflu resistance through mainstream media. Has anyone else ?

Randall Parker said at October 5, 2005 9:31 AM:

Melissa,

Yes, the Tamiflu-resistant strain in Vietnam has been reported by a variety of publications.

Keep in mind:

- That resistant strain in Vietnam may not be the strain that goes pandemic (assuming a pandemic happens).

- The resistance may not be total, it may only be partial. So Tamiflu might still be useful to take against that strain.

- Relenza is another neuraminidase inhibitor. Currently it is availably only as a spray (like asthma medicines I'm guessing) and not as a tablet. It is not clear to me how efficient a spray would be at getting all over the body and H5N1 does infect the intestines in its current strains.

Ronnie (U.S.) said at October 5, 2005 2:51 PM:

what amazes me is that even though infuenza can cause viral pnenumonia, the avian flu tends to also be causing bacterial pneumonia, which of course is the more serious form of the illness, yet no government is recommending pneumonia shots which are 80% effective in healthy adults.

Bottom line, flue coes from other people. If a pandemic starts, have a 406 month supply in the house, shut the door and wait it out.

If you pick up your mail, leave it in the garage for 48 hours in case it has a virus on it (use gloves).

Put the garbage out with no can to retrieve.

Telecommute to work if you can.

Buy the N100 and NON VENTED goggle. Vented and indreict vented will do no good. Relenza is supposed to work similarly to Tamiflu and is for A AND B strains of influenza. Someone is secretly stockpiling it (govt?) because my parents went to get theirs yesterday and the pharmacy had to call three distributors to get it. Two said they were not being allowed to release their Relenza supplies.

Bryan said at October 5, 2005 4:20 PM:

Has anyone had any experiences with various specific online pharmacies that do not require a standard perscription?

I just saw http://goldpharma.com and they offer both Tamiflu and Relenza. Any comments?

Ross Wilson said at October 5, 2005 8:51 PM:

I feel that it's only a matter of time before a pandemic of avian flu engulfs the world. One can be sure that
at first hints of such an epidemic, there will be a run for antivirals on drugstores in Western countries.
Accordingly, I keep on hand for my wife and me, four courses each of Tamiflu and Relenza antivirals; and a high-potency broad-spectrum antibiotic. I've chosen the two antivirals as contingency against any evolving resistance to one of them; and the antibiotic as protection against possible follow-on bacterial pneumonia. Four courses of antivirals will protect us against an initial epidemic wave, and a follow-on wave possibly of a mutated virus. Surely, this is cheap insurance against a long-overdue catastrophic pandemic.

Ross Wilson

Dave Kinney said at October 6, 2005 9:32 AM:

What is the proper dose for Relenza RE avain flu.

When would you begin taking it, how much and for how long?

I have seen lots of info on board for Tamiflu but nothing specific on Relenza.

Thanks

Ross Wilson (Menlo Park; Lake Tahoe, USA) said at October 6, 2005 9:55 AM:

Relenza typical dosage is 10mg inhaled twice daily for five days within
two days of onset of flu symptoms.
Although Relenza is inhaled, it is nevertheless a powder with a
company stated 3-year half-life. Here is a link to GSK, the manufacturer: http://us.gsk.com/products/assets/us_relenza.pdf

Needless to say, to help prevent any post-flu bacterial pneumonia complications,
one should get a readily-available pneumonia vaccination now.

Ross

Heather (Hawaii) said at October 6, 2005 2:46 PM:

So glad to find all this good info. Does anyone know the dosing for Relenza on kids; how young can it be used; and can pregnant women use? Same question on pregnant women for Tamiflu? (I have 2-and 4-year olds, and one on the way...)Thanks and aloha....

wally said at October 6, 2005 10:11 PM:

PLEASE cut, paste and send the following to your "friends". Stopping the spread of this problem is the best cure for all of us.
--------cut here-----------

BF day, the day BF arrives in your country, will be the day all future preparations change from safe to dangerous.
Going out in public will be both a risk to you and a perceived threat to others.

It takes between 2 hours and 10 days to die of BF.

Governments in South East Asia, including Australia, have agreed to donate drug stocks to each other in the event of an outbreak. When have governments thought and acted so fast. The drug Tamiflu recalled from chemists by the Australian government and has reputedly been sent to another country. So the bells are ringing.
Some countries have enough drugs for up to 25% of their population. The hangers at Sydney airport are to be converted into hospitals.

There are 3 ways to protect your self.
A/ Anti viral medication after you have caught the H5N1 virus and been diagnosed by a laboratory test.
B/ Isolation.
C/ Natural remedies.

ALL OF THE ABOVE. The last 2 are closer aligned to "natural selection" than blasting away at each aliment with drugs so don't despair if you have no drugs. BF mutates "on the fly" so drugs may be useless anyway. Kick in Plan B.

A/ Drugs.
Do not use anti viral drugs as a defense against catching flue, because you "think" you have BF or just to stop a common cold. This lets the virus see its enemy and work around it. The drug Tamiflu is said to be already loosing its effectiveness due to improper use. Do not use anti viral drugs unless you are confirmed to have avian flue by hospital test.

An alternative prescription defense is Relenza. However it is said to be a difficult drug to take and taking a difficult drug while sick would best be done in hospital. It's also probably out of stock.

I know nothing of SYMMETREL but it may also be known as: Amantadine, Mantandan, Mantadix, Virofral

Internet drugs are often counterfeit. The danger from TB once thought to be almost extinct is on the rise due to "cut" drugs, manufactured in India, being sold Africa. We hope the Indian health minister is enjoying his alleged new Bently. Taking a half strength drug is probably worse than not taking a drug at all as the virus will build its own defense to the drug and then kill your Doctor, nurse and family as well as you.

About Vira 38, There appear to be no clinical research published in reputable journals showing that Vira 38 works against influenza. Even though the site reads well. Maybe it cures jock itch and snake bite as well.

B/ Isolation.
Isolation is the real key for most people after the stock of anti-viral drugs held by governments run out .

B1/ Personal protection.
B2/ Physical isolation.
B3/ Feral bird discouraging and reduction.

B1/ Personal protection.
Get very high quality face masks, gloves and goggles before the shortage happens during a pandemic.
Most face masks that will be available during the pandemic will not be nearly as good and all the sick people will be in the same shop as you. And hey would you be selling to sick people, who couldn't get their act together when it was safe, despite all the warnings.
The 3M N100 and P100 face masks last 150 hours.
Get sealed goggles or safety glasses or some other eye gear that reduces the odds that airborne virus droplets will hit your eyes.

The flu virus stays active on hard surfaces for two hours or so, (door handles , money, goods, cards etc.) half hour on hands, can infect through eyes, nose, mouth, ears, re-infect from tissues and spread a metre by sneeze.
Get a personal spray and keep filled with Hydrogen Peroxide at gargling strength.

If you want to go the extra mile to protect yourself get a respirator (which will be in short supply) and also get some antibiotics to deal with secondary infections.

B2/ Physical isolation.
Be prepared to wait out the virus, in a non air-conditioned and non common vented place.
Expect to be isolated for over one month. If it hits all work will cease. Only the foolish will go to work, and only the stupid will enter a building or train.
The first few days after the first case is diagnosed in your country will be when the virus will spread suburb to suburb via evelavator, plane, train, buss and car. In the following weeks it will spread neighbor to neighbor.
Lock your door. Tape it shut. Put a small amount of bleach down the sink, toilet and floor wastes daily.

Water, power and gas may not be available if people start dropping like flies.

Fires will be as big a killer. The great fire of London occurred during a plague when people were unable or unwilling to help.
Bye food you do not have to cook.

Water supplies may mot be chlorinated for long and birds dyeing in your local reservoir are a risk.

Get a small radio to listen for the all clear and a torch for emergencies. Torches may attract looters so think before you advertise your food stock.
Get a basic first aid kit.

Stock up on essentials before BF day. The supermarket may be a death sentence in terms of looters/flue/salmonella.

Stock pile per person.
2 liters of water per day 15L @ $5.49) x 4
Tinned steak and vegies, 400g @ $1.55 x 20
Full cream milk powder 1kg @ $5.95 x 4
Multi vitamins x 30 tabs @ $ 15.00
Packet muesli 750g @ $3.00 X 3
Tinned fruit salad 700g @ $ 1.90 x 15
Tinned baked beens 440g @ $0.66 x 4
Tinned sardines in oil 225g @ $0.49 x 10
Tinned tomatoes 400g @ $0.66 x 5.
Dried fruit 750g @ $ 3.15 x 2
Bleach 2L @ $2.15
Gaffer tape
Toilet paper rolls @ $3.00 x 4
Total bill $120 to $200 per person including the medical equipment. Nothing in terms of your health.

B3/ Feral bird discouraging and reduction.

Ring/email/post your local radio, TV and local, state and federal parliamentary rep's, requesting;
The eradication of feral bird populations.
The outlawing of feeding feral birds.
The netting of urbane local water supplies, waste transfer stations and garbage tips.
The separation of pet birds from native birds by solid surfaces and double netting.

C/ Natural remedies.
Garlic and Ginger are easily obtainable anti virals.

BF acts by overproduction of inflammatories, virtually drowning the victim. Anti inflammatory herbals are available, common ones being; ginger, curcumin from turmuric, basil, dandelion.

The mineral supplement selenium has been shown to reduce severity of flu and other very serious viral diseases.

Don't forget vit C every two hours if infected either.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Great Plague, London, 1665, 20% dead
Black plague, Europe, 1747, 66% dead
Spanish flue, World, 1918, fifty million dead

Ring around the rosies
a pocketful of posies
atishoo, atishoo
we all fall down

Check out

http://www.who.int/csr/don/2005_09_29/en/index.html
http://www.who.int/csr/disease/avian_influenza/en/
http://www.who.int/mediacentre/factsheets/avian_influenza/en/
http://www.sqiss.com/pages/bird-flu.html

irina verney said at October 7, 2005 4:22 AM:

he Netherlands have bought 3 million tabs. of Tamiflu in the event of the mutation of the bird flu.

K. Alexander said at October 7, 2005 4:39 AM:

Wally,
WHO says 5-150 million taken in a future pandemic--that's a maximum of 2%--and they're back-peddling on these comments.

Viruses are tough things, though. I had a farm in Central America for 6 years. Virus carriers quickly mutate in response to chemicals, and once a plant is ill, it dies. Whole fields of particular plants can get wiped out.

But that doesn't mean anything, really. There are 1.2 million automobile deaths per year worldwide, and that's rising.

I think a reasonable assessment of manufacturing capacity in the event of a pandemic would have to integrate emergency behaviors. Private companies, as opposed to the governments which generally do little more than constrain and rob them, will rise to the challenge with today's incredibly advanced technologies (which certainly were not available during the Black Plague).

In other words, don't go quitting your job or moving to the hills just yet.

And the last thing we should be doing is throwing away property rights, intellectual or otherwise, as suggested by an earlier poster. Defending the basis of human rights, through the self-ownership made possible by property rights, is the only important function of government!

Erica (Hong Kong) said at October 7, 2005 7:10 AM:

I live in Hong Kong and I am really worried. If bird flu hits, how can we isolate ourselves? We live in high rise apartments. Also, there is no restriction on the number of Mainland Chinese who visit Hong Kong on tourist visas, so with such a high flow of traffic, bird flu would spread quickly.

I am stocking up on the drugs but my concern is : how do I know what I am buying is real or fake?

Also, please look into Vira 38 because that was used in SARs.


Duane said at October 7, 2005 12:57 PM:

DON'T go here to get tamiflu.

http://www.1st-us-farmacy.com/prodTamiflu.htm
(Spell farm with ph above)
I ordered 3 weeks ago with overnight delivery...
Called today "We don't know when it will be available."

Bill Fernald said at October 9, 2005 12:32 PM:

The bird flu threat of today is being compared to the 1918-19 Spanish flu pandemic. While some comparisons are valid, some are not. For instance, the threat that a secondary bacterial infection will kill you is less today than in 1918 because most bacterial pneumonia is quickly quenched by antibiotics which did not exist then. Remember, however, MRSA is rampant which modifies this modern protection from bacterial pneumonia somewhat.

Another large difference in the two pandemics is the transportation modes used in their respective ages. It took weeks to travel around the world then; today, it takes hours. By the time the first cases which are easily transmitted between humans are identified, the pandemic could be underway in a dozen countries.

Perhaps the most glaring difference between the two Avian flu strains is that the Spanish flu had a 5% kill rate. The H5N1 has over a 50% kill rate. The Bird flu pandemic we are preparing for is 10 times as lethal as the one in 1918-19! If this thing gets into the general population, it could generate deaths of truly biblical proportions: Revelation: 6:verses 7&8

"7When the Lamb opened the fourth seal, I heard the voice of the fourth living creature say, "Come!" I looked, and there before me was a pale horse! Its rider was named Death, and Hades was following close behind him. They were given power over a fourth of the earth to kill by sword, famine and plague, and by the wild beasts of the earth."

one fourth of the population of the earth is approximately 1.5 billion. With a kill rate of 10 times the that of the Spanish flu, this is a feasible figure. BTW, the greek word used for beast is "Therion" which means"little beast". Funny, huh? The smallest beasts of the earth are viruses. Go figure. Not trying to be "religious" here, but it makes one think, what with every other week that passes, we hear of another disaster of "biblical" proportion. Tsunami, Katrina, Pakistan earthquake, etc., and now the "Therion flu!"

You can relax, however, if you have made preparations. Just go here for how to get prepared......in an ultimate sense.
http://freegift.net (seriously). Then you can go here: http://alternative-health-news.com to get prepared.......in a practical sense.

God bless you all real good.
Bill Fernald


PAED said at October 9, 2005 9:27 PM:

I am a doctor. People CALM down. Avian INfluenza has NOT mutated to human transfer ability. THere is a chance that it could but that chance is VERY low. People CAN contract this virus from infected birds. Let me do some explaining here. H5N1 is a nasty strain of flu. The 50% mortality rate is a VERY VERY VERY misleading statistic. The people who have died from this strain were in area of the world that is not famous for its cutting edge healthcare. Secondary infections and respiratory distress brought on from Pulmonary edema are the two factors that couse death in influenza. If you contracted h5n1 and presented to a western hospital with symptoms you would be watched. Antibiotics would be used to ward off or treat existing bacterial infections and guess what folks?????!! Since 1918 science has given us the tools to treat respiratory distress. In fact Pulmonary edema can be treated lots of different ways. Worst case scenario would be ventilator support but medicines would keep most people off such a thing to allow for the sickness to run its course. If the 1918 pandemic would have happened 90 years later it wouldn't have even been a minor footnote in history. You can cut the mortality rate down to less than 5% in countries with modern hospitals. SO please quit playing false prophet with your bible quotes and as John Paul II said be not afraid.

Worriesmom2b said at October 10, 2005 11:02 AM:

Thank you SO much PAED. This put my heart at ease. People have been saying I should be concern since I am pregnant and at risk and it is great to hear from you with "down to earth" advice. I know when it comes down to it I need to put my trust in God. Thanks again PAED.

Randall Parker said at October 10, 2005 11:19 AM:

PAED,

I have my doubts about your really being a doctor. Or perhaps you are and you just do not know much about the 1918 pandemic.

In 1918 a lot of people drowned in their own blood. How's a respirator going to help if a person's lungs go to mush?

A lot of people in 1918 died far too rapidly to have died from secondary infections. Haven't you read accounts of people being perfectly healthy in the evening and dead in the morning? Bacterial complications didn't cause that. The 1918 strain caused internal organ damage. What's the H5N1 doing? Oh, just causing kidney failure, liver failure, lung damage, and other internal organ damage.

And so you present at some hospital during the height of a pandemic. Well, lets see. The hospital is full. You need to be put on a respirator. Ooops, there are far fewer of them than there are hospital beds - which, again, are full.

Not a minor footnote? Try thinking in thru in more detail.

AnotherWorriedMom said at October 10, 2005 11:51 AM:

Does Vira 38 provide any efficacy in fighting H5N1?

Paed said at October 10, 2005 2:41 PM:

Not gonna argue. 1918 was (A) H1N1. "drowning in blood" you mention was aveolar damage secondary to Pulmonary edema. If you work in healthcare you know the CHF Pts get aveolar damage similar to this. You know the frothy rusty sputum thing. Pulmonary edema can be reveresed fairly quickly with Oxygen (didn't have it medically availible for use in 1918) nifedipine (didn't ave this in 1918 either) and dexamehtasone. (guess what randy din't have that in 1918 either.) Lungs going to mush.......Jeepers!!!! Pulmonary edema could be treated very rapidly in the parking lot of the hosptial as long as there is supplemental o2 availible. Which could easily be delievered with portable o2 concentraters. (the kind you see in nursing homes) Also I did say worst case scenario would be ventilation. but why should I argue with an armchair epidemiologist. Bye for now Mr. "Dr." Randall.

PAED

paed said at October 11, 2005 6:15 PM:

OK I am going to post one more time on this subject.

Heres the deal..I stumbled onto this message board when I googled Tamiflu. The Reason why I googled Tamiflu was for the very reason I could grasp an idea of the availibility of this drug for the upcoming flu season. I plan to have some on hand for my pts (NOT BECAUSE OF THE AVIAN FLU MAKE THAT CLEAR) because the elderly and chronically ill people always have more problems when they come down with influenza of any type. When I stumbled onto this site I got sick to my stomach reading some of the posts. Why am I so livid? Because people like randall and bill (see above) unwittingly spread scandal and rumors by the tone of their posts. I really could care less what people think of me or the fact if they actually believe I am a physician or not. Reality is folks people are shouting FIRE in a crowded theater and people WILL get hurt from this. Bill....Randall do your realize what you are doing???? Being a Christian I find it very confusing that two people are using scare to "save" people. You are very wrong and are doing a bad thing by scaring people with your apocalyptic mish mash. Lets take the likely scenario should we? In all likelyness avian will not be a threat but another strain of influenza will be for the young and elderly. You are telling people to Horde Tamiflu and relenza by getting multiple scripts filled by different doctors. (which is against the law by the way) So now we have a bunch of healthy strong adult (pseudo?) christian men keeping everything for themselves and in a few months when the flu season hits my sick, elderly and infirmed people won't be able to obtain Tamiflu or relenza because of YOU!! SHAME! Jesus himself said whatsoever you do to the least of my people, SO you do onto me! SHAME on YOU! SHAME! Here I sit thinking about a particular asthmatic child will need tamiflu this year because of a plain old flu bug and can't get some because some billy bob Randy Weaver type Named Bill... is bible quoting his way across the internet with his armchair epidemiologist pseudo science. It makes me Know that some people THINK they are Christian because they spit out the sinners prayer but are going to be shocked when Jesus stands in front of them questioning about why they didn't take care of the sick and infirmed. SHAME!!!!!!!!!

smallwheel said at October 11, 2005 8:36 PM:

Paed, wtf (what the fuck!) does JHC or any religion has to do with the discussion and concern of people wanting to prepare to cope with a pandemic such as the bird flu? To take your theo-crapo the extreme, why do you care about the body anyway, as the soul is the only permanent thing. But if the body is important, why don't we just subscribe prayers? The medieval theo-crap used to keep people in line is a dated BS by the privileged to rule the people, while they themselves can enjoy a bit of luxuries in this life while morally having reserved for themselves a golf course membership for eternity. And I say to people like you, "go to heaven and play golf right now (actually it might be more fun to spend times with the 47 virgins of the sex of your choice)". What a medieval thinking piece of theo-crap. And I saith unto thee, "Let my people go". Not for them, but for you. Do not bullshit with theo-crap in this age. If you have something to contribute as a scientist or a caring civic member, do so.

To the point of concern --- is it or is it not the case that we can trust our government (in the US or any country) to deliver. If one would put on one's hat on as an actuarian and think of the math possibility of an outbreak vs. the probable efficacy of available remedies, what is good math?

Factoids:
1. W Bush signed an executive order in April to exercise quarantine in case of an outbreak. http://www.whitehouse.gov/news/releases/2005/04/20050401-6.html
2. Will the US government handle an outbreak with more competence than Katrina?
3. Last week the Senate passed a $4B bill for stockpiling the vaccine. This gets attached to the $440B defense budget. A republican senator from Alaska tried to kill the $4B bill, claiming that the avian strain has not shown to be a threat to humans yet. JfhC! http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/sep3005avian.html

"The kingdom of heaven is (possible) among you."

Oscar said at October 11, 2005 9:13 PM:

I am a psychologist. I don't know the odds of the bird flu mutating. I am anxious though. The U.S. govt is not stockpiling anti-virals or vaccines enough for the population. I want my own suppy for myself and my son.
Since a friend told me about this just 5 days ago, I started researching, and have gotten really concerned. I have wondered whether the fear is more unhealthy than the possibility of the flu. Perhaps getting afraid will lower my immune system, and I will get sik. Or perhaps collectively the human race will be so scared that enough people's immune systems will lower, and we will be more likely to facilitate mutation.
That's my two cents. Thanks for reading.

Wally said at October 12, 2005 5:06 AM:

Well I've got enough stock for a year, so I cant open the front door (should take care of the isolation), I'm hyperventilating from carrying all my oxygen cylinders up the stairs...and my prayer mat hasn't arrived in the post yet from the mail order catalogue.
ha hum, sorry got carried away.
Can the god squad lighten up

paed said at October 12, 2005 10:08 AM:

SORRY FOR THE GOd squad stuff. I was replying to some above posts that had links in them that led to religious websites that are set up to proselytize. Smallwheel The bird flu is not partisan issue either. I usually don't wear my religion on my sleeve..I used to think like you. BTW if everyone in this world were believers then prescribing prayers would be exponentially more powerful than any vaccine. I offer you my freind pascals wager....If my view of things is wrong then I will only look like a fool for about 40 more years. If my view of things is right then you the non-believer will be a fool for eternity.

badmonkey said at October 12, 2005 4:45 PM:

All this discussion can seem a little paranoid. However, whether or not the avian flu ever becomes an issue here in the states, it's probably not a bad idea for everyone to have a month or so worth of food, water, hygeine, and first aid supplies available and to be up-to-date on general vaccinations.

The possibility of another major virus, weather supprises, a bio-terror attack, widespread civil unrest, or some breakdown of government infrastructure is always a reality. Why not have the option of staying home? For a few hundred dollars per person, we can each provide some degree of security via isolation and self-sufficiency. And, once a year, before the supplies have reached their expiration dates, the goods can be donated to a worthwhile relief agency.

If everyone would show enough foresight and personal responsibility to do this we would have far less looting and ethical dilemmas (i.e. "should I share with my neighbor who didn't prepare?") when disaster hits.

Brenda said at October 13, 2005 12:47 AM:

The "pneumonia vaccination" is only for pneumococcal pneumonia...not a cure-all. I read that the influenza virus can remain viable on exposed surfaces for 2-3 weeks, not hours.

Dee said at October 13, 2005 6:51 AM:

Does anyone know if the tamiflu available through goldpharma.com is imitation or is the real thing?

peter ludlam derbyshire u.k said at October 15, 2005 11:24 AM:

can vinecar kill the virus

Edson said at October 16, 2005 12:07 AM:

I live in Sao Paulo-Brazil
I read your information about the virus.
I am thinking about, and I will buy this drug. I dont know how much our government have (Tamiflu)...I heard that heare in Sao Paulo (Butanta), in the next year, they will make this drug...Excuse my bad english...Let's go help our brothers around the world, Africa and other countries. Probably, in some countries dont have these drugs, Tamiflu and Relenza.
Thank you for reading!

Constance said at October 16, 2005 8:14 AM:

My Pediatrician refused to give me a prescription for Tamiflu for my two children. He almost seemed mad. He stated that he was not going to start a panic and that H5N1 had no began to infect human to human. He also made it clear that the self life was short.
On the other hand my pharmacist told me he had stocked piled 80 capsules for his family and his supplier had only 5,000 packs left in stock.

Where can I get this or Relenza easily?

Invesatator said at October 16, 2005 8:18 AM:

I'm just sitting here worrying about more esoteric things like the Dow Jones Industrial Average. If the the flu becomes King, the market will go down to about 1000 from its present, lofty 10287.

Sooo-ooo--oo bug gold. As reference, when the boat people of Vietnam went afloat, those who brought gold, not coin of the realm, did really well, shaving one inch slices of bullion, later cashing it in for convenience stores, and fast food stores all over the world.

Will you have fries with that?

Investatator in Canada

Randall Parker said at October 16, 2005 8:26 AM:

Constance,

Go to another doctor. Ask friends if they managed to get a prescription and if they did go to their doctor. Go to your own doctor.

Shelf life is at least 5 years. That's probably conservative.

Your doctor is wrong in that if we wait for a pandemic to start buying Tamiful there won't be enough to meet the supply. Buying in advance gives the manufacturer incentive to open more factories and hence increases production capacity both before and during a pandemic.

If you find a doctor who will write Tamiflu prescriptions then also ask for Relenza prescriptions as well.

Andy said at October 16, 2005 9:57 AM:

THANKS PAED FOR YOUR THOUGHTFUL AND INFORMED COMMENTS.

It seems that the panic is on tho and a run on tamiflu is inevitable tho.

The apocalyptic religous stuff is hilarious.


wally said at October 17, 2005 5:57 AM:

H5N1 has been reported in Hungery.

wally said at October 17, 2005 5:59 AM:

or was it Romainia. Shit. It's moments like this that I wish I could spell. In Australia it is a comon topic of conversation. My boss today bought a huge freazer and fild it with food.

wally said at October 17, 2005 6:03 AM:

From the WHO web site
avian influenza – new areas with infection in birds – update 34

13 October 2005

Tests conducted by the World Organisation for Animal Health (OIE) have today confirmed the presence of highly pathogenic H5N1 avian influenza in samples taken from domestic birds in Turkey.

In Romania, investigations of recent poultry deaths have, to date, identified the H5 subtype of avian influenza virus. Further testing is under way to determine the strain and whether the virus is highly pathogenic. Authorities in the two countries have undertaken control measures as recommended by OIE and FAO. WHO is sending diagnostic reagents and other supplies to support testing in national laboratories. Viruses from both outbreaks have been sent for further analysis to the Central Veterinary Laboratory Agency-Weybridge (UK), which is an OIE/FAO reference laboratory. Viruses are also being sent to WHO reference laboratories for comparison with human H5N1 isolates from Asia.

Public health implications

The spread of H5N1 to poultry in new areas is of concern as it increases opportunities for further human cases to occur. However, all evidence to date indicates that the H5N1 virus does not spread easily from birds to infect humans. WHO advises countries experiencing outbreaks in poultry to follow certain precautions, particularly during culling operations, and to monitor persons with a possible exposure history for fever or respiratory symptoms. The early symptoms of H5N1 infection mimic those of many other common respiratory illnesses, meaning that false alarms are likely.

The WHO level of pandemic alert remains unchanged at phase 3: a virus new to humans is causing infections, but does not spread easily from one person to another.

WHO continues to recommend that travellers to areas experiencing outbreaks of highly pathogenic H5N1 in poultry should avoid contact with live animal markets and poultry farms. Large amounts of the virus are known to be excreted in the droppings from infected birds. Populations in affected countries are advised to avoid contact with dead migratory birds or wild birds showing signs of disease.

Direct contact with infected poultry, or surfaces and objects contaminated by their droppings, is considered the main route of human infection. Exposure risk is considered highest during slaughter, defeathering, butchering, and preparation of poultry for cooking. There is no evidence that properly cooked poultry or poultry products can be a source of infection.

Countries located along migratory routes need to be vigilant for signs of disease in wild and domestic birds. Recent events make it likely that some migratory birds are now implicated in the direct spread of the H5N1 virus in its highly pathogenic form.

SteveC said at October 17, 2005 1:17 PM:

Ok, so where the heck can I buy Tamiflu or Relenza for my family? Has anyone had ANY luck online? Are there any other ways to get these drugs? All US and CAN pharamcies require a perscription. Any pointers to ligit web sites would be great.

Thanks..

the droid said at October 18, 2005 7:58 AM:

I've had a good read through all the comments above. It seems to me that the threat is real. As a husband and father I have a responsibility to protect and provide for my household and as an admirer of Jesus Christ to provide as far as possible for some others who would not otherwise be provided for. I cannot look after everyone, and if I try I will end up looking after no-one. I was therefore a few weeks ago thinking / praying about how far my responsibility extends. It clearly extends beyond my immediate family to my "neighbour", according to Jesus, and so I ask him: who is my neighbour?......and I am pointed to the story of the good samaritan. I concluded then that I have to be ready as far as possible to help / protect my immediate family (my wife and children) and those God puts across my path. In my circumstances with the limitations of my own health and wealth the number 7 or 8 seems within my capabilities. Therefore I cannot agree with Paed that with a very real threat approaching I should not have bought sufficient Tamiflu or food and water, protective clothing (masks / gloves etc. for entering hot zones, visiting the sick etc.,) for my household and those I know of who are on their own and defenceless and not in families ("orphans and widows" to use the language of Jesus' brother James). So, a few weeks ago, before the panic set in I began to make provision for all those in my immediate family and several I know of that are likely to be very much on their own if the pandemic comes. I bought Tamiflu when it was readily available for my household and sufficient for some who could not afford to buy it for themselves, as well as encouraging some I know and love, who live on their own and can afford the medication, to buy their own. I am also preparing my house to take in as many as I can who may need nursing / shelter if the worst happens. I do not see the advantage to anyone of my not protecting my family by not providing medication etc., and would hope that if the pandemic hits we will be well enough to nurse and visit those who are sick. So I will make sure that we have sufficient supplies to provide food and other necessities for several beyond our own family unit, as well as proprietary medicines to ease the plight of the seriously ill. I felt I should also not forget the immediate suffering in the rest of the world, unrelated to bird flu and so got hold of myself firmly and sent a load of money to Concern for Asia. What I find hard is that so many folk are living as if nothing is coming their way. It seems to me that many folk are like those lying on the beach with a Tsunami approaching, musing about what to order for dinner that evening, at the hotel that is about to be swept away. The newspaper we read has been giving dire warnings about this threat for most of this year...........It would be unforgiveable for me not to have heeded the warning.

Nicole said at October 19, 2005 7:16 PM:

I read the Maclean's article "The real pandemic is fear" and what resonated with me was if we (individuals in G8 countries) stockpile relenza and tamiflu, there will be a severe shortage in the areas where it will most likely be needed. The WHO has had the potential avian flu pandemic at a level 3 (out of 6?) for two years. Yes, we have heard a lot more about it in the media as of late but that does not mean that this particular flu will be the next pandemic. I will protect my family as best I can mainly by having savings that we can survive on if any catastrophe happens in our area. I do not think I will purchase any anti-viral drugs at this time as it doesn't sit right with me.

Nicole said at October 19, 2005 7:32 PM:

[FuturePundit edited this down because inclusion of an entire article violates copyright. If you want someone to read an article excerpt it and provide a link.]

I thought I'd pass on the Maclean's article to anyone who is interested. It helped alleviate my fears.


Forget SARS, West Nile, Ebola and avian flu. The real epidemic is fear.
We keep bracing ourselves for one cataclysmic threat after another. Our perceived lack of safety has become an obsession.

Lianne George

Gregory Fields is a pharmaceutical maverick. He calls his company, Canadian Drug Delivery, based in Nanaimo, B.C., an "online pharmacy intermediary," which means, if you're looking for the best price on medication -- anything from Amoxicillan to Zoloft -- Fields will comb the globe to find it and have it shipped to your home. In some cases, you won't even need a prescription. Suddenly, business has exploded, and it's all thanks to one pill -- an antiviral called Tamiflu that's selling like candy.

Tamiflu was recently found to be the only drug effective in treating H5N1, the deadly strain of avian influenza that has been spreading fear throughout Southeast Asia since late 2003, and may be heading west. The virus has already infected 115 humans, killing 59 -- with 16 more people under observation in a Jakarta hospital -- and ravaged commercial poultry flocks in China, Vietnam, Cambodia, Indonesia, Laos, Thailand, Hong Kong and Russia. The world's leading flu experts, including the World Health Organization, are warning that this could be the Big One, an apocalyptic nightmare to rival the most overwrought Bruce Willis movie.

Randall Parker said at October 19, 2005 8:24 PM:

Nicole,

Private purchases of Tamiflu increase the demand for the product and increase incentives for Roche to expand production. That expanded production capacity will help during a pandemic, not hurt.

The less developed countries lack sufficient Tamiflu because they do not spend the money on it, not because affluent people buy a lot of it for their personal stockpiles. Roche could ramp up production much more quickly than it is doing currently. More demand might make Roche try harder.

Shawn Robbins said at October 20, 2005 12:34 AM:

Good Morning,

My doctor gave me a prescription for Tamiflu, and I had no problems in getting it filled. The shelf life on my box says that it expires in 2009. I also purchased from www.3mmasks.com the P95 mask. I found this site to be honest, not selling fakes, and the person who owns the company was just on MSNBC news.

I also asked my doctor for a prescription for an antiobiotic, and I had no problems in getting the prescription filled.

Personally, I beleive if you can't get Tamiflu, at best, get the P95 mask, and a prescription for an antiobiotic to guard agains't any secondary infections.

Please don't be afraid to ask your doctor for a prescription...

I am sure he, or she, already has the Tamiflu tablets themself.

Stay Safe, Be Prepared.

Shawn Robbins

Webb Hester said at October 26, 2005 4:38 PM:


The demand for Tamiflu in the last two weeks combined with the Newsweek Cover story on it forced La Roche to cut off the Canada supplies to consumers. Those of us who started reading this sites exhortations last week are out of luck. Best to lobby the feds to break La Roche's sole right to produce the drug then start mass producing a generic Tamiflu and settle with La Roche. Now onward to the next items on the list to prepare.

"Swiss drug giant Hoffman-La Roche moved to temporarily suspend pharmacy sales of its drug Tamiflu in Canada on Tuesday to conserve stocks as flu season nears.
It also issued a companywide directive that supplies of the drug destined for the public market worldwide should be prioritized for use as treatment for seasonal flu.
The move was a response to soaring sales that threaten to drain the entire winter's allowance of the drug before the flu season actively starts - typically somewhere in the weeks before or around Christmas.
When distribution resumes in Canada, the remaining available drug will be saved for use in high-risk settings - long-term care facilities and hospitals, explained Roche Canada executive Paul Brown."

Sigvold said at November 1, 2005 12:04 PM:

Your cite should also list stockpiling orders of Relenza. To date, countries have order the following amounts:
The confirmed stockpiling orders as of 16 Sept. 2005:

France: 2000 packs

Germany: 1,700,000 packs

Hong Kong: 150,000 packs

USA: 84,300 packs

Holland: Amount is confidential - media reports the order was for 5,000,000 doses.

Australia: Currently negotiating a large Relenza stockpile order.

Sigvold said at November 1, 2005 12:04 PM:

Your cite should also list stockpiling orders of Relenza. To date, countries have order the following amounts:
The confirmed stockpiling orders as of 16 Sept. 2005:

France: 2000 packs

Germany: 1,700,000 packs

Hong Kong: 150,000 packs

USA: 84,300 packs

Holland: Amount is confidential - media reports the order was for 5,000,000 doses.

Australia: Currently negotiating a large Relenza stockpile order.

Bob said at November 1, 2005 4:56 PM:

I don't know how many hysterical comments there are on this site but there's hardly any good advice. This is the flu. It's a special flu for two reasons. 1) We don't have any build up immunity to it because it's a new strain. 2) One of the ways are immune system responds to it is to overreact, specifically through producing a proinflammatory cytokine named Tumor Necrotic Factor Alpha or TNFa. Because we have no built up immunity it takes our immune system a little while longer to figure it out. Because our immune system overreacts to it along certain documented pathways, pneumonia secondary to the flu symtoms is probable. There are herbs (Curcurmin and He Shou Wu) that can mitigate the proinflammatory immune system response. Add things like Bioperine and Ginger to the mix to increase the bioavailability of the first two herbs and if your not old and infirm or under 8 years old, you'll probably be alright if you do come down with something that might not even show up for a few more years. Take it easy. Panicing over and ignorance of this specific virus is not going to do you any good. This sort of stress is bad on the body in general and the immune system in particular.

Sally said at November 12, 2005 7:32 PM:

Does anyone know how you can obtain tamiflu or relenza in the UK? People who have posted on this site recommend going to different doctors to find one that will prescribe the drugs for you, but over here in England you are registered with just one doctor who has all your medical records. You can't go and see another doctor without them sending all your records over to the new place, and then you would have to stay with that new doctor (basically I mean you can't go and see another doctor if yours won't prescribe the drugs for you). Also, even if you did go and see another doctor it wouldn't help because you can't get a doctor to prescribe something for you unless you are actually ill with a condition that requires that particular drug. Because doctors visits are free and we only pay a set rate of £6.40 for a prescription and the government pays the rest of the cost, doctors will only write them if you really really need it. I count myself very lucky to live in a country with a free healthcare system. Unfortunately though it does mean I can't see a way of getting tamiflu or relenza prescribed.

Does anyone have any ideas?

CRB said at November 20, 2005 11:25 PM:

Here's the problem - Tamiflu capsules must be stored at 77 degrees fahrenheit - period. Brief excursions to 59 degrees and 86 degrees means just that - brief. That is not possible under any normal household or warehouse conditions. I even varified it at the pharmacy where the temperature is generally 60 to 75 degrees in the storage areas. UPS/FedEx can get to below freezing in their planes and trucks in the winter. All this means that Tamiflu will be worth nothing when you go to take it. The box states that storage is 59 to 86 degress but this is not stated at the Roche website where more extensive information is given for only 77 degrees. Anyone have any input from a Roche Rep to the contrary?

Online Wong PoKér Hu said at November 24, 2005 3:02 PM:

An indication that Tamiflu is effective as a cure for Bird Flu has yet to be established. However, there are news buzzing around that an antidote has already been created. The thing is, it costs too much that it is hard to be afforede by poor households.

Ed Winters said at December 11, 2005 10:22 AM:

Just be aware that Vira 38 has no studies to back up what the developer says it does. Before it can be accepted as a cure for the bird flu it needs some real note worthy studies. The only products you should purchase are the ones that have real research and studies behind them. I have been in the pharmaceutical industry for a long time and know value of clinical studies. As they say, consumer be ware.
E. Winters.

Andrew Williams said at December 20, 2005 3:04 PM:

See this link as referenced by Jon Barron, noted alt health researcher. Tamiflu has been tried by Dr Van of Viet Nam on his 41 patients with H5N1 and is ineffective on this avian flu strain. Get a grip, it hasn't even mutated to human to human ability yet, and may not ever do so.

http://www.sciencedaily.com/upi/?feed=TopNews&article=UPI-1-20051203-21493000-bc-britain-tamiflu.xml

tess said at March 31, 2006 8:23 AM:

Well, maybe it is not if a pandemic wil occur, but when. With todays bio industries all over the world, the infrastructure that will take you to even the most solitaire places, it is only a matter of time before a pandemic wil actually hit the world.

In this time, it seems almost inevetable that some sort of virus, (weather it is the H5N1, Ebola, Marburg or anything else,) will strike us. People get on plains every day. Easy for a virus to travell from person to person.
Think about this;
When a man in kenya has gotten the virus and gets on the plain to Europe, loads of other people get that virus on the plain.Those people one will go home, infect their wife an kids, who on their turn will infect the other kids at school, who will infect their parents, who will infect people from work and go so on.

I am not trying to scare anybody, just simply stating the facts. The thing is that we do not know when it will strike us, maybe in a year, maybe in ten. So why worrie for something we do not know. It is important however to take procaucians, so when it hits us, we all will know what to do!!!

Tess

Andy said at June 10, 2009 3:14 AM:

Now there is a new flu wave in USA and the run for Tamiflu is start again!

martin said at January 26, 2010 2:15 AM:

Well, I'm just sitting here worrying about more esoteric things like the Dow Jones Industrial Average. If the the flu becomes King, the market will go down to about 1000 from its present

I am sure he, or she, already has the Tamiflu tablets themself.
Stay Safe, Be Prepared.

Marcus said at January 18, 2011 3:44 AM:

How come you say the tamiflu pills are a scam? Is there any evidence in that they will not provide a sufficient protection and treatment for influenca? I can agree in that the tamiflu-manufacturor do some heavy marketing campaigns as soon as they see any indication that the bird flu, swine flu or regular flu is on the way. But hey! Can you blame them? Wouldnt you do the same if you could provide a product for it?

Gavin said at October 4, 2011 3:00 PM:

I've had a good read through all the comments above. It seems to me that the threat is real. As a husband and father I have a responsibility to protect and provide for my household and as an admirer of Jesus Christ to provide as far as possible for some others who would not otherwise be provided for. I cannot look after everyone, and if I try I will end up looking after no-one. I was therefore a few weeks ago thinking / praying about how far my responsibility extends. It clearly extends beyond my immediate family to my "neighbour", according to Jesus, and so I ask him: who is my neighbour?......and I am pointed to the story of the good samaritan. I concluded then that I have to be ready as far as possible to help / protect my immediate family (my wife and children) and those God puts across my path. In my circumstances with the limitations of my own health and wealth the number 7 or 8 seems within my capabilities. Therefore I cannot agree with Paed that with a very real threat approaching I should not have bought sufficient Tamiflu or food and water, protective clothing (masks / gloves etc. for entering hot zones, visiting the sick etc.,) for my household and those I know of who are on their own and defenceless and not in families ("orphans and widows" to use the language of Jesus' brother James). So, a few weeks ago, before the panic set in I began to make provision for all those in my immediate family and several I know of that are likely to be very much on their own if the pandemic comes. I bought Tamiflu when it was readily available for my household and sufficient for some who could not afford to buy it for themselves, as well as encouraging some I know and love, who live on their own and can afford the medication, to buy their own. I am also preparing my house to take in as many as I can who may need nursing / shelter if the worst happens. I do not see the advantage to anyone of my not protecting my family by not providing medication etc., and would hope that if the pandemic hits we will be well enough to nurse and visit those who are sick. So I will make sure that we have sufficient supplies to provide food and other necessities for several beyond our own family unit, as well as proprietary medicines to ease the plight of the seriously ill. I felt I should also not forget the immediate suffering in the rest of the world, unrelated to bird flu and so got hold of myself firmly and sent a load of money to Concern for Asia. What I find hard is that so many folk are living as if nothing is coming their way. It seems to me that many folk are like those lying on the beach with a Tsunami approaching, musing about what to order for dinner that evening, at the hotel that is about to be swept away. The newspaper we read has been giving dire warnings about this threat for most of this year...........It would be unforgiveable for me not to have heeded the warning. TV Deals

Medizinisches Wörterbuch said at August 16, 2013 1:02 AM:

Medizinisches Wörterbuch http://www.infoarzt.com/ Danke für den Artikel und nützliche Informationen. Fand eine Menge von notwendigen Informationen

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