Bird Flu Stories

by DemFromCT

As noted by many, the Romanian agriculture ministry confirms that the H5 noted previously in birds is the highly pathogenic avian influenza (HPAI) known as H5N1.

A spokesman for Britain's Department for Environment, Food and Rural Affairs confirmed the tests conducted at a lab in Surrey, south of London, had determined the Romanian virus was the H5N1 strain.

But he said further tests were needed to trace the origin of the virus and determine how similar it was to the viruses found in Turkey and in Asia.

This puts the bird flu definitively in Europe for the first time, as predicted by migratory bird patterns. See this map by Henry Niman at Recombinomics for the spread over time of the H5N1 (note the square markers are unconfirmed).

Also of interest is a new report of partial resistance to tamiflu. More details can be found here, here, and here (in ascending geek factor). Of interest in the report is that it strongly suggests H2H spread in the Vietnam patient (brother to sister), sitll rare but no longer 'never reported'. The last of the three links shows that whereas earlier (2001) bird flu was binding to avian receptors only, the Vietnam strain was able to bind to human sialic acid receptors  as well, suggesting the mutation pattern that is so evident over time.

None of the above means we are in the midst of a pandemic. The WHO still insists we are phase 3 (human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact), though many believe we are in phase 4 (small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans) based on reports from Indonesia.

Nor does partial tamiflu resistance in a single patient mean tamiflu doesn't work. What is does is raise the issue of widespread community use with subsequent emergence of resistant strains. And it also highlights one of the roadblocks in international pandemic preparedness:

When asked to comment on the implications of this study, infectious disease expert Michael T. Osterholm, PhD, MPH, said the new study is important in that it confirms what we have known--that strains of H5N1 resistant to oseltamivir are emerging as the disease spreads and treatment expands. However, "What remains to be seen is how this will play out if a population is blanketed with treatment, as would be the case early in a pandemic. It would support emergence of resistant strains and even give those strains selective advantage."

Osterholm, director of CIDRAP, publisher of this Web site, added that while the stockpiling of zanamivir is a scientifically sound recommendation based on the current findings and others, limitations in the supply chain remain the roadblock. "Neither oseltamivir nor zanamivir can now be manufactured in quantities that would be meaningful once efficient human transmission started."

This leads to a diary I put up a few days ago on the preparedness issue. This is not just about high-tech unaffordable non-existent fixes (that's the government's worry). From Peter Sandman:

 

What does all this information on vaccines and antivirals have to do with risk communication?  Five things:

 

• The focus on the pharmaceutical fix is excessively optimistic. It is keeping people from focusing enough on worst case scenarios.
  
  
• The focus on the pharmaceutical fix is excessively medical. It is keeping people from focusing enough on non-medical preparedness.
  
  
• The focus on the pharmaceutical fix is excessively governmental. It is keeping people from focusing enough on what civil society, the private sector, and individuals can do
  
  
• The focus on the pharmaceutical fix is excessively national.  It is keeping people from focusing enough on local preparedness.
  
  
• The focus on the pharmaceutical fix is excessively first-world. It is keeping people from focusing enough on ways to help Africa, Asia, Latin America, and the Middle East prepare for a pandemic

We all have our local, individual things to do. Start by staying informed. Use sites like the CDC, CIDRAP or Flu Wiki to learn details. Stay away from snake oil and folks trying to sell you stuff. We're not in the midst of a pandemic, so don't panic... worry is a normal reaction and so is a little depression, by the way.

And consider the pros and cons of stockpiling medication (also discussed in the Sandman article). There's no right or wrong here.

An educated public is an effective public. Plan for a blackout or power failure for a day, then extend it when you can to 3 or 4 days (happens for various reasons, and in New England that's standard for blizzard prep). You'll accomplish something, won't waste your time, and will not feel like you're just spinning your wheels.

And when Mike Leavitt returns from SE Asia and releases the CDC report, we get to talk about rationing and other topics that need discussion prior to implementation.

Comments

[LeisureGuy]

A WaPo story includes this interesting/frightening note: "The girl harbored three strains -- one resistant to oseltamivir, one partially resistant and one susceptible. All three were probably descended from the single strain that initially infected her." That indicates a fast mutation rate.

In terms of "worst-case" planning, I have a post where I list some things a plan should include, based on my reading of The Great Influenza, by John Barry. It includes things like:

- All city and town administrators (city managers, mayors, councilmen, etc.) notified of steps to be taken in event of pandemic (school closings, closing movie houses, cancellation of events with large public attendance, temporary hospital openings, etc.)

- For each city, town, and state clear (and lengthy) lines of succession for all critical positions of authority--i.e., who succeeds to a position in the event the current holder is incapacitated, dies, or cannot be located. Positions for which such succession must be defined include civil authorities, police chief, health authorities, coroners, fire chief, and the like.

- How to keep essential functions operational even when many personnel fall ill--e.g., combining fire stations if there are too few ambulatory firefighters at a station to effectively fight a fire.

[one thought on keeping healthy]

Good points. There are some simple, commonsense ways to fight the spread of the flu, like--make sure you get enough sleep and keep your stress levels relatively low, so your immune system stays strong. Sort of the personal-ecological conservation-minded approach. And as likely to be governmentally encouraged as real energy conservation has been so far.

[DemFromCT]

excellent ideas. When flu spawns, it's produces many different mutations because RNA is such an unstable genetic template (DNA viruses are more stable and evolve or mutate less quickly). Some scientists have labelled the progeny of influenza a 'mutant swarm' because the many variants produced allow for selection of a winner. Nature has perfected a killer.

[LeisureGuy]

Besides the 11 planning points in the post I referred to above, I commented on my own personal protection plan: avoid all crowds, wash hands often, etc. I also ordered a supply of surgical masks, since I suspect they'll be hard to find when the pandemic really hits. The Great Influenza really lays it all out quite well: what worked, what didn't, what steps were taken, what steps that should have been taken that weren't, etc.

[DemFromCT]

For those politically inclined, The Great Influenza (a terrific book) lays out how to make things worse as well: do what the wilson administration did. Lie about the degree and the depth of the problem to avoid morale issues during a war.