H5N1 Mojo

Cody Barstow at Mojo City News is worried – very, very worried – about the Bird Flu, and has developed a series of pieces addressing the likelihood of pandemic, damage and mortality rates, policy failures, policy prescriptions, and then some.

I’m not quite sure how terrified to be. I know a couple folks at the CDC who seem concerned, but not at all panic-stricken. However, we don’t seem to be mounting a program of action that’s in line with either the top end or mid-point of the threat probability range as I understand it. Which could mean that I understand it wrong, or it could mean that the government is failing to act appropriately. (Will and Steve, you’re both invited to comment here and tell me where I’m wrong.)

Now, I trust the folks I know at the CDC. But I do not trust legislators and our friends in the executive branch. You know, the ones who gave us this:

“Brownie, you’re doing a heck of a job.”

I can’t help wondering if the White House’s grand strategy involves using a pandemic as an excuse to deploy the military on US soil under the pretense of preventing further spread of the disease. And if you think Bush’s lack of an exit strategy for Iraq bothers me, ask me how I feel about the lack of an exit strategy for North Carolina.

One thing I fully agree with Barstow about, though. The last thing in the world I much care about is Roche’s patent rights in the face of this sort of threat. Let the lawyers sort that one out later….

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5 thoughts on “H5N1 Mojo

  1. I really think pandemics will strike the human race regardless of immunization development and policies. Certain segments of the RNA or DNA of the virion can mutate within one generation. If the DNA or RNA in the virus mutates by merely one genetic sequence, say an A-T instead of G-C, it can render the immunization useless. Since influenza can bind to so many different chemokine receptors of human lymphocytes and macrophages, the probabilities of a rapid mutation in the RNA via the mRNA grow exponentially. Viral antigenic drift is especially prevalent in influenza because it is an RNA based virus, and is the reason the vaccines must be modified on a yearly basis. Basically, if a pandemic REALLY wants to sweep through the human race, there’s little we can do to stop it. Entire species have been wiped out by viral infections.
    Aloha,
    Jeff

  2. Avian Flu
    Right now, H5N1 is HIGHLY lethal once it manages to infect a human (> 50% lethality). Luckily, so far, H5N1 doesn’t seem to be readily human-to-human transmissible, by air or any other route, that I am aware of. There seems to have been a possibility of some limited human-to-human transmission in some H5N1 infection cases as I believe that some close family members have also become infected with H5N1 after another family member was initially infected. However, it may not have been human-to-human transmission as the supposedly “secondarily-infected” individuals may also have come into direct contact with the infected fowl (handling or processing raw fowl or consuming fowl). Virus concentrations can reach quite high levels sometimes in infected fowl, so, if a person(s) was handling a really sick fowl, as appeared to have been the case in a number of the human H5N1 infections, then their exposure dose (of virus) may have been quite high.
    A vaccine: We COULD make a vaccine against H5N1 right now but it probably would NOT be very protective as whatever H5N1 variant eventually “breaks out”, if one ever does, it will probably be quite different than the strain that is circulating amongst the chickens, ducks and geese (and the occasional human) right now. It’s like the problem surrounding the fact that you have to get a flu shot every single year because the influenza viruses change so quickly.
    A vaccine against H5N1 right now might produce SOME limited immunity against another form of H5N1 if one broke out, but it almost certainly would NOT provide complete immunity if it did happen (a “break out” strain of H5N1). I think that the USA DOES need to improve our production capacity for vaccines AND ways for producing a vaccine faster. Would probably take a lot of money to do that though.
    Tamiflu: I think that I read/heard somewhere that some variants of H5N1 are already showing resistance to Tamiflu.
    For sure, if a highly lethal and highly human-transmissible form of H5N1 broke out right now and got loose, then yeah, in my personal opinion, it could be really bad. If something like that got loose, believe me, we’d ALL be praying that our government would impose quarantines to try and keep infections localized. Will an outbreak of highly lethal, human-transmissible H5N1 happen? Don’t know, and neither does anyone else. What I can say with a high degree of certainty is that sooner or later, there WILL be another pandemic of SOMETHING. Realistically, there could be an outbreak of some other highly lethal influenza virus that has escaped our notice and H5N1 may NEVER produce a pandemic. Maybe they will get a good enough head start on H5N1 that H5N1 never produces the threat that we fear it might. Hope so. Wouldn’t want to bet any money on it either way. Just no way to know yet.
    In my humble opinion, if you believe in probabilities, chance and statistics, right now H5N1 is definitely looking like a possible player (the longer that H5N1 hangs around and the more fowl that are infected with it and the more places that it shows up, the greater the chance that sooner or later it’s going to become human transmissible – if that happens, we just have to hope that there is a HUGE attenuation of its lethality or that there is a vaccine available by that time). But maybe some unseen comet will wipe us out before then. It could happen (but my money is on a virus or something similar).
    Here is a web site about the bird flu that is pretty informative –
    http://www.usnews.com/usnews/health/bird-flu/
    Steve

  3. Unfortunately, I just hope I’m not around the next time a pandemic breaks out. Look what the plague did to Europe: An event of similar magintude could break out in the present, and unfortunately would be accelerated due to the faster transportation.
    Aloha,
    Jeff

  4. Reply from Dr. Will Bower
    I got this from my buddy Will at the CDC, and am passing it on.
    ______________________
    I’m reading the MoJo City stuff now. I think Cody is being too dramatic and has some facts wrong.
    For example, when he talks about “Is using the 50% kill-rate irresponsible fear-mongering?” he quotes a source that the mortality rate of the 1918 flu was 3%. I believe that number is used incorrectly. The 1918 pandemic killed 3% of the world’s population. That is very different than a mortality rate, as not everyone in the world was infected. Also I believe that producing millions of doses of a vaccine that may or may work only gives a false sense of security. When the virus develops efficient human-to-human transmission there will be some lead time to produce some vaccine; what we need to spend money on is surge capacity to produce the correct vaccine (though politicians are not very good at forward thinking).
    He is correct that there will be an economic impact, but it is anybody’s guess how bad it will be. I personally believe the truckers will still work, because if they don’t they don’t get paid. And if they don’t that is where the military comes in. We may disagree on this, but with a disaster on the scale of a pandemic, the military is the only chance we have of controlling it. Here is something you can turn into a blog: how bad will it be for us if our troops are in Iraq when the pandemic hits?
    As for Tamiflu, he does not mention the real issues behind stockpiling antiviral. The FDA has to approve any drug used in the US, which can take years even with the new fast-track regulations. You could probably say this is a one-time global priority, but that could lead to the proverbial slippery slope and the next AIDS drug would claim that it needs special treatment and so on.
    As you yourself have pointed out the average American is dumb as dirt, so “available to the public” makes little sense. I know pandemic plans are out there. I have tangentially worked on them. They’re currently recruiting people to work on pandemic flu. I considered applying for the job, but was talked out of it because right now there is a turf battle going on between the HHS and WHO as to who should be the lead on pandemic flu.
    That is sort of all I know on the subject. It is true there is going to be a flu pandemic. No one knows how bad it will be. I believe in the US, with our health care system being the best in the world and our ability to quarantine quickly (remember there was no SARS transmission in the US), we will be OK. Asia and Africa not so much.
    And if I’m wrong, plan B is a shotgun and a cabin in the mountains of NC.

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