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October 26, 2005

Medical Movie-Plot Threats

Movie-plot threats aren't limited to terrorism. Bird flu is the current movie-plot threat in the medical world:

Just in time for Halloween, the usual yearly ritual of terror by headline is now playing itself out in medical offices everywhere. Last year it revolved around flu shots; a few years ago it was anthrax and smallpox; a few years before that it was the "flesh-eating bacteria"; and before that it was Ebola virus, and Lyme disease and so on back into the distant past. This year it's the avian flu.
"I was crossing Third Avenue yesterday and I was coughing so hard I had to stop and barely made it across," a patient told me last week. "I'm really scared I'm getting the avian flu."

I just looked at him. What could I say? He has smoked two packs of cigarettes a day for the last 50 years. He has coughed and wheezed and gasped his way across Third Avenue now for the last 10 years. His emphysema is not going to get any better, but it might stop getting worse if he were to stop smoking.

Remember when people were seeing terrorist plots under every rock? The same kind of thing is at work here. When something is in the news, people believe it is common. Then they see it everywhere.

Posted on October 26, 2005 at 11:41 AM • 44 Comments

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Comments

Anonymous • October 26, 2005 12:08 PM

If something is in the news then the chances are that its not going to happen to you.

havvok • October 26, 2005 12:16 PM

This is because people are, generally speaking, fairly stupid. Ignorance of the facts, and ignorance about the impact of our own behaviours breeds the fear described by the patient in the above quote.

If you explained to the patient that he is responsible for his own health issues, he would probably emphatically deny the negative health impacts of smoking citing industry studies or simply writing off it as liberal pseudo-science.

An ignorant population is a fearful one, and a population stricken by fear is easy to control; all you have to do is convince people that you can make the source of that fear go away if they follow your directions.

Anonymous • October 26, 2005 12:23 PM

@havvok

I think that the current anti terror legislation frenzy proves your last point quite nicely

Chris Walsh • October 26, 2005 12:39 PM

An interesting example of this sort of mass hysteria, Cold War-style, can be found at http://www.washington.historylink.org/output.cfm?...

dk • October 26, 2005 12:44 PM

@havvok

You and I excepted, of course. :-)

Jo_Ava • October 26, 2005 1:06 PM

Thank god. And here I thought it was only me who believed that the panic-mongering surrounding avian flu was getting a little out of control. I mean, come on, does it *really* merit a full one-hour special on the news channel? Does my workplace *really* need to channel time and energy and other resources into developing a flu pandemic contingency plan? Do governments *really* need to spend billions of dollars stockpiling a patent cure for 1% of their populations, instead of directing those monies towards current, existing medical threats?

Shura • October 26, 2005 1:19 PM

Yes, people are pretty naive. There was a report on TV on avian flu yesterday, and one woman who was interviewed on the street said that she wasn't buying chicken anymore, for fear of contamination.

Nevermind that the disease hasn't come even near this country yet. Nevermind that it has been to a handful of cases so far. And, most importantly, nevermind that the virus is pretty fragile and gets destroyed after a couple of seconds at (IIRC) 75 degrees Celsius or so...

It's the same scare as the BSE one from a few years ago; there were lots of people who didn't buy beef anymore then.

People.

Anonymous • October 26, 2005 1:24 PM

To be fair to the woman who stopped buying chicken; As we all know security is about tradeoffs. Not eating chicken is a free countermeasure which gives a miniscule return in terms of reduced risk. But you could argue that the cost/benefit warrants it.

Davi Ottenheimer • October 26, 2005 1:31 PM

The Colbert Report on Comedy Central had a good piece on this. He showed a headline from FOX news:

"Bird is the word on the street. Why the avian flu could send stocks soaring."

http://www.nytimes.com/2005/10/25/arts/...

"Mr. Colbert praised Fox News for always finding something positive in bad news, be it about the Bush administration or the nation. 'Every global pandemic has a silver lining,' he said approvingly. 'Remember, the Medici made their money investing in the bubonic plague. A lot of people did. Until the boil burst.'"

radiantmatrix • October 26, 2005 1:31 PM

This isn't surprising. Ever hear of Medical Student Syndrome?
http://www.medterms.com/script/main/art.asp?...

Nick • October 26, 2005 1:50 PM

According to a microbiologist friend of mine, at least, there's more substance to the hype than you might think. All human influenzas originally started off as avian flus, and the result of a new one crossing the species gap has often been pandemic - 1918, for example. It does look like this is a plausible threat.

Chris • October 26, 2005 2:05 PM

Perhaps a bit off-topic, but this reminds me of the dumbest thing I'd ever heard on television...

About 20 years ago, there was severe storm that caused a fire at local community college (name withheld to protect the, um, anyway...). At least two buildings were destroyed, and the local media descended on the campus to get eyewitness interviews.

After the usual littany of of student accounts, they came to one last female student. The reporter asked "You were in the building when the fire started, were you afraid?" The student's reply: "Oh, no. I've got good life insurance."

Not afraid to die in a fire because she's got good life insurance. Must have been Gold Cross or something.

She's probably out there right now looking for pet insurance to save herself from the bird flu.

havvok • October 26, 2005 2:37 PM

@dk

I didn't make any exceptions. Given the right circumstances I assure you, either of us would prove our stupidity beyond a doubt.

jayh • October 26, 2005 2:41 PM

A while back there was an outbreak of Newcastle's disease (in Calif as I remember), very contagious to birds but not harmful to people. There are numerous reports that valuable pet birds were seized and destroyed even without evidence of infection, that mail carriers and others were enlisted to identify houses that kept birds (it's pretty hard to hide a parrot--they won't shut up) for follow up raids.

I can only imagine what things would be like during an avian flu panic.

Martin Wehlou • October 26, 2005 2:44 PM

Nick is right. The avian flu, if and when it crosses over to humans and starts infecting human-to-human will be a very big deal. Governments should stockpile Tamiflu, but even more important; they should get off their asses producing sufficient vaccine. They seem to have a hard time getting this, relatively simple, effort going.

Now, the avian flu hasn't yet mutated to a human-to-human infecting form, so people in the street have no reason to think they're infected.

There is no comparison between the really dumb fear-mongering we see when in comes to terrorism and the real threat of the avian flu. So, please guys, scepticism is healthy, especially with current state of politics, but don't go into total denial now.

That's my look at the thing from following the scientific litterature. And being an MD.

Jilara • October 26, 2005 3:58 PM

All this seems terribly familiar. I remember friends talking me into lining up with them along with rest of the population of the U.S. to get vaccinated against the Dreaded Swine Flu, that was supposedly coming. You remember the Swine Flu epidemic, right? Thought so.

My response has been to wonder what all this Avian Flu hoo-ha is supposed to distract us from. Earthquakes, hurricanes, abuse of the Patriot Act, the fact that old-fashioned Whooping Cough is making a comeback?

Anonymous • October 26, 2005 4:30 PM

@Martin Wehlou

Somehow, you managed to sputter out the following...

>>...avian flu, if and when it crosses over to humans...

>>they should get off their asses producing sufficient vaccine

>>...avian flu hasn't yet mutated to a human-to-human infecting form...

>>...being an MD.

Mebbe, Martin, you should check with one of the older kids, or an adult - but I'll think you find you cannot produce a vaccine for a virus that doesn't yet exist. Treatments for classes of virus, sure. Vaccines, however, can only be incubated from, and effective against a single strain. You can even mix 2 or 3 vaccines in a single dose, but they must be cultured from existing strain(s).

In short, they can't get off their asses and produce ANY vaccine until it has already mutated to a human-passable strain.

Man, I hope you were kidding about that being an MD part!

Jim • October 26, 2005 4:30 PM

I wanted to comment on this, but Martin Wehlou, above, said what really needed to be said. It's hardly a movie plot threat when it's already happened several times in the last century (1918, 1958 and 1967) and killed tens of millions of people in one of them. The probability of a virus developing that can pass from human to human is pretty high. So, based on expected cost, worrying about this is pretty reasonable.

Well, governments worrying about this is reasonable. The guy on the street convinced he has avian flu is an idiot.

blake • October 26, 2005 5:37 PM

On a related note, I heard a piece on NPR's On The Media, last week, that had me rolling on the floor:

http://www.nydailynews.com/news/gossip/story/...

Apparently, in an attempt to float the idea that importing drugs from Canada is a terrible idea, Big Drug funded a thriller novel based on terrorists using them as an attack vector. At some point, somebody realized what a terrible idea this was... but the authors wouldn't take the buyoff. All quite amusing.

Mary • October 26, 2005 7:57 PM

Some of this may be due to the fact that if someone has a bad heart or is 100 lbs overweight, it has crept up on them bit by bit. They've lived with it for a while, so it doesn't seem as dangerous as the new stuff out there.

jammit • October 26, 2005 9:02 PM

For the lady who was afraid to buy chicken, I'm going to act the same way I did when people were afraid to buy hamburger because of BSE. I'm going to take advantage of the cheap meat and go on a BBQ feast. This so called avian flu is for the birds (I'm surprised someone hasn't said that yet). This is another one of those "if it bleeds, it leads" stories. It's really a lot more exciting to talk about this than about 2000 dead soldiers (and many more non-combatants).

Jo_Ava • October 26, 2005 9:11 PM

@Martin Wehlou:
"they should get off their asses producing sufficient vaccine. They seem to have a hard time getting this, relatively simple, effort going."

Please define "relatively simple".

Is it this?
"Amid fears that a deadly avian influenza in Southeast Asia could trigger a global pandemic, researchers are readying an experimental vaccine that might protect people against infection. But developing and deploying it could turn out to be one of the biggest challenges in public health today. The new vaccine for the avian-flu bug designated H5N1 is one of the first produced via a new gene-swapping technique, and no one knows if it will work." (http://www.post-gazette.com/pg/05061/464529.stm)

Or this?
"The best preparation against an existing pandemic would be to produce a vaccine quickly and in sufficient quantities to protect people soon after the pandemic strain of virus emerged. Unfortunately, this is not yet possible. If an outbreak were to happen tomorrow, it would take four to six months to produce a vaccine ... Work is under way to change this, but it will take time." (http://www.economist.com/printedition/displaystory.cfm?story_id=5053648)

Honestly, if a pandemic is coming, realistically there is no vaccine that will be reliably effective. All that stockpiling is the result of governments trying to demonstrate that they're ahead of the game, which is all show, the biggest and most visible ass-covering manoeuvre they can think of.

I don't object to vaccinations in theory, but let's stay realistic in our expectations of what they can accomplish in a situation involving highly mutable viruses.

miguelito • October 26, 2005 9:49 PM

You know, the thing about epidemics is that they're a hell once they start!
Once there's that spark that lights the brush fire, the paranoia of stockpiling expensive water tanks will seem to have been such a good idea all along!

John Moore • October 26, 2005 10:53 PM

Medical microbiology isn't my speciality, but let me summarize why the medical establishment is shit scared over avian flu.
1. Avian flu is transmitted directly from afflicted fowl to humans. It was thought that an intermediate host, such as pigs, was required for transmission of flu from fowl to humans.
2. It's highly lethal for a flu strain and the lethality includes young adults and older children. Onset is sudden. Death is sudden. Mortality thus far is approaching 100 %.
3. It was first seen in Asia where most of our modern pandemics have originated.
4. The 1918 influenza pandemic killed 50 million people worldwide and it killed young adults and older chidren, two groups that are normally not at risk. Onset was sudden. Death was sudden. It has been said that the 1918 pandemic resulted in the end of WWI because there weren't enough fit soldiers left to fight.
5. Molecular reconstruction of the 1918 influenza strain shows that it was an avian strain.
6. The Chinese are giving their avian livestock antivirals in an attempt to prevent economic losses at the expense of creating a drug-resistant strain of avian influenza. (personal communication)
7. The public health service has a right to be paranoid because influenza is an airborne virus which means it can spread rapidly through a population, unlike HIV, and there is historical precedent for a killer strain of influenza.
8. Our public health infrastructure has been allowed to languish for several decades now.
9. Money spent on hypothetical bioterrorism threats could have been used to beef up the public health service instead (as Bruce has stated in other columns).
10. Two years ago, the group in charge of selecting the strains used for the annual flu vaccine goofed and chose strains that did not match the prevalent strain that year, over the objections of the two flu experts on that panel (I believe) resulting in a vaccine that gave little protection.

Now there is little historical precedent for 99% of these movie plot threats, but there is excellent historical precedent for an avian flu pandemic that makes ordinary flu pandemics look tame. If there is any fault here, it is that the medical establishment isn't educating the public about the dangers of influenza , particularly this strain, and what they plan to do about it if it does start to become a pandemic. The media aren't helping at all because they are just creating a sensation, but there is a risk here.

Roxanne • October 27, 2005 12:45 AM

The comments that this post has generated are quite interesting, but some are not quite correct in facts. The 1918 Spanish flu was mutated from a bird flu, and did kill anywhere from 40-100 million people. However, the actual mortality rate was quite low--the virus killed, overall, less than 5% of the people it infected. It was very contagious, but not very virulent. A lot of people were infected, which is why the death toll was so high.

Surprised? Yes, many people are. And one reason for the high rate of infection was laxity in public health services. Plus, a war was on, and the flu proliferated in crowded army bases and trenches.

As far as the bird flus of 1957 and 1968, they did not cause a pandemic, and a huge death toll. The mortality rates were a little bit higher than the average flu season, but they most certainly did not cause the scenario that is being portrayed right now.

As far as this bird flu goes, it first passed from chicken to person in 1997. It is very diffucult to catch from birds at the moment. Since 2003, about 120 cases have been confirmed with 60 deaths. Out of hundreds of millions of people (ever been in an Asian city???) who have been exposed to the virus, only 120 odd cases. The cases occured in those who have had very close contact with infected birds, like those who partake in drinking blood from raw infected ducks! And the high death toll is largely attributed to substandard medical care in many of these countries, as well as getting medical care too late.

Does the avian flu present a potential for a pandemic? Yes, of course, but the key word here is potential. Should we improve our public health system? Of course. Should we be aware of the bird flu and maybe take practical steps, like improving conditions on poultry farms to keep chickens healthier and less likely to catch the flu? Of course.

But do we need this over-hype in the media? No. And that's what it is. In the meantime, while the isolated cases of flu in birds is being picked up, the number of human cases is not growing, nor is the death rate.

miguelito • October 27, 2005 12:55 AM

5% is an interesting estimate of a "low mortality rate"... The U.S. has a population of about 300 million, say twenty percent of it gets infected during an outbreak, that's 3 million dead. Low enough for you?

Ian Eiloart • October 27, 2005 3:54 AM

@roxanne:

No, 5% is not a low mortality rate for a flu virus. Most flu viruses have less than one-tenth that mortality rate. Anyway, the important thing is that the 1918 virus affected every part of the inhabited world, infected one in five of the worlds population, and killed tens of millions of people. It killed more people than died in combat in either WWI or WWII, and may even have exceeded the total military and civilian casualties on both wars combined.

All this happened in living memory (not my living memory, you understand). And, twice since we've had near misses. Clearly, panic isn't required, but we do need people to be aware of the possible consequences. Look at New Orleans for lessons in ignoring real threats. Look at Iraq for lessons in fighting imaginary threats. And, realise how important it is to get your threat assessment right.

Henry T. Hill • October 27, 2005 3:59 AM

My wife and I have lived on Marco Island, Florida since 1999. We have never evacuated before a hurricane. We decided to stay for Wilma. We are tired of the tension. We went outside and looked Wilma in the eye (the eye passed over Marco) and then went back inside to ride out the back side of the storm. I installed the hurricane shutters myself and nailed down my roof. I did not lose a shingle and the storm shutters held. Grow up. If you are alive and know it, move on. Stuff happens. I like Ring Lardner's quote, "Three out of three people die, so shut up and deal."

Ian Eiloart • October 27, 2005 4:00 AM

@roxanne:

Henry T. Hill • October 27, 2005 4:35 AM

To havvok regarding "This is because people are, generally speaking, fairly stupid. Ignorance of the facts, and ignorance about the impact of our own behaviours breeds the fear described by the patient in the above quote."
I taught high school English and history for 31 years. Knowing comes on three levels. The first level is to be able to talk about the "facts" of the subject. For example, a 12 year old can tell you how to drive a car safely. The second level is the be able to actually do or not do the procedure. A 16 year old can actually drive a car safely. But safely driving a car is not part of their everyday behavior. The third level (if they live long enough) is to have driven a car for 200,000 miles or more. Airplane pilots are rated by hours at the controls. A good quote told to me by a retired pilot is, "There are old pilots and bold pilots. But there are no old bold pilots." Knowing at the highest human level is to have incorporated the learning into your very heart of hearts. I never used illegal drugs. I trusted my local beer maker to take care of me. I loved my pot smoking friends who were health food nuts, organic and vegies, and sucked their brains out on a weed. There are millions of old beer drinkers still at it who have been very creative and productive throughout their lives.

Felix Dzerzhinsky • October 27, 2005 4:53 AM

I am with @roxanne on this issue. Pandemics are a real threat. There has been a decline in public health services worldwide as rich people think they can avoid public health services with private insurance and hiding in gated communities.

The idiots who are not buying chicken aside, there are real grounds to be concerned about this. The polititicians are way behind on this issue.

These people are a lot smarter than me:

http://www.nature.com/nature/focus/avianflu/...

http://www.foreignaffairs.org/background/...

"The potential for a pandemic comes at a time when the world's public health systems are severely taxed and have long been in decline. This is true in both rich and poor countries. "
quote from Laurrie Garrett

Grainne • October 27, 2005 5:38 AM

I think a comedian I was listening to on monday night summed it up nicely (racial prejustice aside he makes a good point) - He said that in Asia only 26 people have died out of how many millions that live together in close proximity? And that their human-to-chicken contact is alot higher, they have live chickens on the street stalls, on buses and even in there houses! There's chickens everywhere! So what's eveyone so worried about over here!

John Moore • October 27, 2005 6:07 AM

This isn't the forum to discuss virology, but I'll try to explain. Influenza is one of those viruses that can recombine with another strain of itself. There are several flu strains running around Asia and the world at any given time. Say a person gets a human flu strain and the bird flu strain at the same time and those two viruses recombine to form a virulent hybrid strain. The hybrid strain has the best characteristics of each parent, the lethality of the avian strain and the ease of transmission and reproduction of the human strain, giving you a new highly virulent, lethal human influenza strain the world hasn't seen since 1918, or perhaps ever. Something that the human race hasn't seen since the Black Death. It takes 6 months to make and stockpile flu vaccine. The "old" way to make the vaccine relies on growing the virus in chicken eggs, although there is a newer method available, but I don't know if it's in production. This current avian flu strain kills chicken embryos most likely rendering the egg method useless (?). The reconstructed 1918 flu strain also swiftly kills chicken embryos. As I stated earlier, there is some evidence that the Chinese are feeding antivirals to chickens for economic reasons, thereby negating another line of defense against a pandemic. If you were running the Public Health Service, wouldn't you be a bit worried?

Joe Fred • October 27, 2005 10:00 AM

@ miguelito

Actually, yes, it is. One out of one hundred? While it is admittedly a very high death toll, given what we're used to, the Plauge took out a MUCH higher percentage of the population in areas where it was present. And while it may have sucked to be one of the people who died, the societies survived, and by some measures, changed for the better. Not to say that I'm hopeful, or even optimistic that a worldwide, nationwide, or even local avial influenza outbreak would spark some wonderful change in the human condition, but I think that our collective fear of dying tends to be overblown. Sooner or later, you're going to die - there's no preventing that fact. And while that's not to say that one shouldn't bother with precautions, many people seem willing to go to any lengths to ward off the Grim Reaper - in the face of some obvious and mediagenic threat. But the fact is that we do any number of things that are hazardous to our lives. The days that I'm impressed that I didn't watch anyone carelessly cause a fatality on the expressway during my commute are becoming more and more frequent. You can get people to squawk about bird flu, when you can't get them to signal before changing lanes at 70+ miles an hour...

Davi Ottenheimer • October 27, 2005 11:42 AM

I see that the movie-plot threat has thickened:

http://www.theregister.co.uk/2005/10/27/...

"The Naiva-A Trojan masquerades as a Word document containing information about the bird flu epidemic in order to dupe unwitting Windows users into opening the maliciously constructed file."

Crux • October 27, 2005 2:56 PM

Stepping back for a moment, I think like this, on a basic level some people:
. are intelligent
. have sense
. are informed
. do care
. take action

You may have any number of these attributes, in any combination, in any strength; however, the chance of having all the of them is slim to nil.

Pre-Coperinicus, the world on one issue was heavily mis-informed. Galieleo was the crux that pivoted the informed world in the new direction. Perhaps one of the slim to none types.

Today, no different from yesterday, everybody knows everything, perhaps another 'crux' is approaching, giving us an opportunity to reinform the world again. Will it be the avian flu? Or some terrorist's recombination of it?

28 days later, we might know, we might not.

But in the end, we need to realize the 'sense' that the movie writer's are trying to portray. An exaggeration of an event makes a good movie. Perhaps, even a message. Perhaps the artist is trying to show some ways that horrible events could unfold, with the insanely humble hope they could make a difference, by influencing those that 'care' to 'take action'. Did anyone really believe political and corporate policies would change after movies like 'The Day After' ...well, you get the idea.

But in the end, everyone is too intelligent for that. And those that can 'take' action instead scorn. But I won't get into some of the negative attributes of human beings here. They are well known, think we're 'informed' about them.

Perhaps a strong 'care' feeling in leadership today is restricted by the sense of this quarter or this fiscal year's requirements and opportunities. After all, who would benefit from a project that takes 5 to 10 years to implement if you are only in office for 2 years or 4 or if your annual performance goals are richly rewarded and your human care attributes completely ignored.

Whatever the reason, it was said, we will all die.

Does it matter? 'Care'.
I don't know enough about it.'informed'.
Chances are it won't affect me.'sense'
Someone else can worry about it. 'take action'

Survival is based on the ability to adapt to negative events. The ability to work as a community towards a goal larger than an individual. The ability to communicate needs and devise solutions. So, this thread seems to portray the overall need to ignore and scorn. Is that the answer? 'intelligence'

PostNote: There have always been the 10 to 20% of the people in a society that may not have hardly any sense nor intelligence. However, it's often seen that they care more about things and are willing to do something about them. It's up to those in the know, with perhaps sense, perhaps intelligence to have care to help or inform. Yes, this may require patience and careful communication, real work.

"But oftentimes, to win us to our harm, the instruments of darkness tell us truths," MacBeth.

Are you an instrument of darkness or light? ( not speaking religion here, but of support or disdain ) It is easy to scorn, is that the road you trek?

Davi Ottenheimer • October 27, 2005 3:11 PM

@ Crux

"Pre-Coperinicus, the world on one issue was heavily mis-informed. Galieleo was the crux"

From a Western perspective, perhaps. Other civilizations did exist and made incredible use of information, you know?

"Are you an instrument of darkness or light?"

Hmmm. How scornful of you to pose such a false dilemma.

Where does someone with an intelligent degree of uncertainty fit in the world of "are you a puritain or a rationalist" or in the sense of "are you with me or against me when I declare war on those who are not with me"?

crux • October 27, 2005 3:55 PM

@ Davi

Always a degree of grayness. It is this perspective that I wish to adopt and be adopted. An adaptation to the inquiry designed for reflection not response and using the quote as reference might be, "Are you more often an instrument of darkness or of light?" Meaning do you generally withdraw energy and support from your environment or do you lend it?

War is an element of nature, typically associated with survival. The hive declares war on the invader, the starving herd invades other domains to forage, the bacteria infest to duplicate.

Humans tending to be the only beings on the planet with the ability to reason and resolve, could provide survival with much reduced need to declare war on nature and itself. However, it is clear, our abilities are severely limited, with whimsical battles plaguing the planet from the rainforest to the children. Whether about having enough furniture and minerals or finding support in a delusion of diety, human wars are the despicable kind. We are this era's locusts. This negative energy is based on the belief that humans could be extremely better than we demonstrate across the planet.

In answer to your question, you don't fit in a category. You are the sum of your attributes and what you do with them. Whether your flavor this moment is negative and harassing, have the sense to understand why and do something about it. Or at the very least, support those that do. Support not meaning military support, but intellectual, sense, wisdom, care, inter-action.

Roxanne • October 27, 2005 4:31 PM

Ah, the backlash to my post about a 5% mortality rate. Before all of you get your knickers in a twist, I should explain that while 5% is high for influenza, it is quite low compared to what most people think the death rate was for the Spanish flu. Many think it was akin to Ebola, and that 90% or more of people infected with it died. The general thinking is that the Spanish flu was so deadly that virtually everyone died. And that was not the case. The 5% rate may be high for the flu, but is a low rate compared to what the public perceives about the Spanish flu.

I would say that many think that the Spanish flu was similar to the bubonic plague, which probably killed better than 50% of those infected. Especially in its most virulent form, the pneumonic plague--which has an extremely high mortality rate.

Thank you, Ian, for your enlightenment about the death toll. I already mentioned it in my previous post, that the reason so many died was because so many were infected. And you have to take the time period into consideration, when looking at the death toll. The officials in the US, for example, tried to ignore the outbreak of flu; patients were not isolated, no quarantines, public parades and other large gatherings were not cancelled, etc, so it spread very quickly. Due to the war, there were large groups of people gathered together very tightly, as in army bases and the soldiers in the trenches. You also had a breakdown of healthcare services throughout Europe. And the virus also made its way to very densely populated areas in Asia, where healthcare was nil.

"Look at New Orleans for lessons in ignoring real threats. Look at Iraq for lessons in fighting imaginary threats. And, realise how important it is to get your threat assessment right."

New Orleans didn't ignore the real threats. Truth be known, Ian, thousands of people had no method of getting out of the city. The poor lacked transportation, and even if they could escape, had nowhere to go. The govt was well aware that a sizable portion of the city's population was stuck, and they did not provide any assistance. The vast majority of those who could leave, did so.

Also, money had been cut (thank you George Bush) from projects meant to strengthen and improve the levies in NO, money cut from projects to stop the erosion and build up the area, and so on. So people were well aware of the prcarious situation in NO. That the city was not ready had nothing to do with ignoring the threat.

So I still stand by what I said. A 5% mortality rate is not high, when compared with previous disease outbreaks that have plagued the earth. And the other two outbreak of a bird flu derived human influenza did not cause a pandemic, or come remotely close to it. We should be aware of it, that it COULD happen, but the experts who are talking gloom and doom and giving their projected death rates should be muzzled. The bird flu is extremely difficult to catch at this time--unless you think that 120 cases over a two year time period, out of probably 500 million exposures (at least) indicates a very contagious disease.

David Harmon • October 28, 2005 8:22 AM

Avian flu only has a few cases so far, because it hasn't "broken out" yet. The alarm is because we are already seeing a version which can kill many of those humans who manage to catch it from birds. It isn't (yet) jmoving easily from human to human, but the thing is, we *know* how this story goes. Sooner or later, in one of those victims, that avian flu will recombine with a "normal" human flu (that is, human-infectious but not very lethal), to produce a pandemic flu.

The first kicker is that this only needs to happen *once*, and the Law of Large Numbers indicates that it will certainly happen eventually. But we don't know *when* it'll happen; this season, next season, next year, the year after....

The second kicker is that this being a new strain, current vaccines won't help very much, nor will most peoples' natural immunities. Exactly *how* lethal the human version will be, is another unknown, but both the bird-to-bird and bird-to-human cases are disturbingly lethal (not really 100%, but still nastier than we want to see in flu). If we're lucky, some of that lethality might be shed in the recombination, but that isn't a chance we dare to bet on.

There are antiviral medications which *might* help, but those aren't being produced in nearly enough quantity, because there's no *current* market (this financial quarter/year) for the amounts that a pandemic would demand. For similar reasons, no government has stockpiled enough for a pandemic. Of course, if the Chinese are training their bird-to-bird flu in antiviral resistance, the drugs may not help that much anyway, or they may only help for the first season.

Either way -- when the breakout comes, you'll know it! It will almost certainly clobber Asia first, before spreading to other continents, but spread it will, and (with Bush in office) America in particular is unlikely to be ready to cope.

Crux • October 28, 2005 1:07 PM

"(with Bush in office)"

Time to be 'scornful'.

Considering I'm somewhat more a techo-scientist than a social-scientist, what exactly were the majority (sic) was thinking when this was elected, twice at that.

It was always transparent that this guy had none of the qualifications of world leader, er strike that, leader of the free world. ( There are enough world leaders that are even worse. )

It is in fact, very difficult to find a single positive point of reference for his entire life, let alone his current regime.

Are we as the leading advanced society reduced to voting for smiling idiots and movie heroes to stand before us representing our responsibilities for world events and it's best interests?

Good god man, don't even think there was a tangent to this thought. Terribly sorry. I will humbly stop posting. Time to start my own blog perhaps.

Good day and vote wisely.

blue avian flu magoo • March 30, 2006 11:31 AM

You’re not going to believe what I just got in my e-mail today at work, which is for a major energy company in the NE.

Details about my company's "Asset Management Pandemic Planning" and we even have a PowerPoint presentation from our "Pandemic Flu Taskforce", I kid you not.

So is this threat evolving from a medical movie plot into something more serious or do we just have one or more of our senior management coming down with advanced Avian Flu Pandemic paranoia?

Angladrion • May 12, 2006 7:26 PM

Site bookmarked to see whether, if bird flu doesn't materialise at all, human to human, those above so adamant that it will, will have the grace to admit they got it wrong.

And to the person above who stated that the 1918 flu started as avian flu, that's wrong. Do a bit more research before posting an assumption.

Why has no-one mentioned the fact that H5N1 was first identified in Scotland in 1959? Perhaps they never bothered to look at the WHO website...

Senior management always comes down with paranoia, be it SARS, or whatever is the latest theory. Then when the real threat comes along, everyone is had enough, because they remember the boy who cried wolf... and usually, the real threat comes out of left field and was the very thing left out of the original equation.

Such is history. Trouble is, most people don't know their history any more and still think that people in Ivory Towers are actually in touch with the real world.

Anonymous • April 29, 2009 1:01 PM

Time is on my side. Yes it is, the worst of the past is coming back.

Now that H1N1 is rearing its ugly head, well not such a movie plot, but REAL.

Peace through strength and preparation.

Get your archived food, etc all ready.

Lysol concentrate, listed as killing Influenza A.

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