More On Pandemic Flu Preparation

by DemFromCT

Following Bush's press conference ( and see thispre-presser post from Effect Measure regarding the vaccine manufacturers' interests), a couple of new items are worthy of commenting on.

First of all, taking a tip from Flu Wiki, the CDC has launched Pandemicflu.gov, which is a links page for convenient pandemic flu info. On this new page, one can find the latest (sometimes fresh, sometimes a year or more old) advisories and information about individlual health and safety, key facts, FAQs, travel advisories, etc. While it's a welcome addition, note some of the things that aren't there... advice about masks or Tamiflu stockpiling for individuals,for example. These are two unclear and controversial issues, with different advice given to different audiences by existing authoritative sources from around the world.

Although public health authorities are suggesting a limit of personal stockpiling in favor of government and institutional stockpiling, many people are concerned about the apparent lack of availability of the most commonly recommended antiviral (Tamiflu or oseltamivir). One of the reasons for not engaging in personal stockpiling are listed here ibn a.pdf from the State of Massachusetts Department of Public Health (echoed by CO and IA):

While we support the federal efforts to stockpile antiviral agents, the MDPH does not
recommend personal stockpiling of oseltamivir or other antiviral agents for the following
reasons:

• Personal stockpiles of oseltamivir will compound the existing problems with availability of this antiviral agent in the United States during the upcoming influenza season for those who may need it most. Commercial supplies of oseltamivir are expected to improve gradually over the next few years and the national stockpile will increase as well.

Expect more of the states to issue their own similar advisories. This illustrates one of the hurdles to pandemic planning –  as seen with Katrina, the Federal-State interface isn't as smooth as many assume. Traditionally, much of the public health burden has fallen on the states, and it will take some work to make sure that something as simple as advice about masks and antivirals is simple, consistent and available.

Another issue with antivirals is their scarcity, whether in individual or institutional stockpiles. A very intersting article along these lines was published to day in Nature:

Wartime tactic doubles power of scarce bird-flu drug

It describes the suggested use of the drug probenecid, which for decades has been used as an addition to antibiotics. It can raise antibiotic serum levels by deceasing renal excretion, and has a long track-record of use. The article suggests that there is data showing the same can be true of Tamiflu. By talking probenecid and Tamiflu together, it might be possible to use less Tamiflu to get the same protective serum levels. In a shortage situation, that's an attractive concept. Interestingly, some of the doctors interviewed have been involved with the Flu Wiki and are therefore known, at least by name, to us.

But perhaps the take home message (while researchers do the due diligence of checking the idea for safety) is that local concerns of preparedness are sparking creative thinking about how to manage. Not all of this can be top down. Not all of the interests (pharma vs fed vs local vs individual) are completely aligned at this point. And without the impetus of pushing for local preparedness (a la Flu Wiki), some of these new ideas would never have been considered at all.

The Lord helps those who helps themselves. Get ready to work with your state and local officials... that's much to be done, and much that the feds won't cover. We have time, but we also have a lot to do.

Comments

[Meteor Blades]

Congrats to you, DemFromCT, and the other folks at Flu Wiki for pushing the CDC into a needed action. And for keeping us all up-to-date in a non-hysterical way.

If only we, as a nation, would take this "opportunity" presented by this potential threat and transform it into a permanent bolstering of our tattered public health system(s). One gets the impression that even impoverished, dictatorial Cuba would do a better job if a human-to-human avian flu were to strike.

[Patrick]

So, why is no one reporting on the fact that Donald Rumsfeld just happens to be the Chairman of the Board of Gilead (the patent-holder for Tamiflu)? There is an interesting article concerning this fact here >>> http://www.mercola.com/2005/oct/25/rumsfeld_to_profit_from_avian_flu_hoax.htm#

While I am by no means convinced the bird flu situation is a hoax, I am entirely convinced of our current adminstration's make-money-at-any-cost-and-war-and-terror-(pandemics included)-are-the-most-effective-methods" mindset.

I think we need to look at all aspects of this story, rather than just our government's "need" to buy more of this drug. Especially since most medical professionals seem rather unconvinced of Tamiflu's effectiveness. If the flu pandemic is a real threat, we need to make sure that what we are clamoring to buy is really an effective treatment.

We should also be looking at preventative (non-medicated) measures we can use to diminish (or curb entirely) the spread of the disease. I find it rather disconcerting (if not downright disturbing or scary) that everyone seems to be inferring that the only way we can beat this thing is to have everyone injected with a proprietary substance. There are so many avenues for abuse in such a situation. What assurances would any citizen have that: 1. they actually needed the injection, 2. the injection would actually do anything to prevent the disease, 3. what they were being injected with is actually a flu vaccine, 4. nothing other than the vaccine would be injected into their body, etc. etc. etc.

This may sound paranoid to many people reading this. It would have sounded paranoid to me just a couple years ago. But now we have a government that has no qualms about lying to the citizenry (about life-or-death matters, including war) and seems bent on gutting our tax revenues for the sole benefit of their corporate associates.

This administration is untrusted by a sizeable majority of our population. Do you want to let them inject something into you based on no more information than what they are telling you?

[DemFromCT]

Do you want to let them inject something into you based on no more information than what they are telling you?

risk vs benefit? yes. but I'd check with my own doctor, first.

[John Casper]

Sorry OT.

Per Harry Reid and the Democrats, U.S. Senate is meeting in closed session. Reports say Democrats are forcing GOP to discuss pre-war intellignece that was used to "sell" the War in Iraq.

About 2:00 PM Tuesday.

John Casper

[emptypockets]

really dumb basic question: my understanding was that all influenza is endemic to waterfowl. Why did this virus get called "bird flu" -- isn't all flu "bird flu"? (answer in form of link is fine) thanks

[DemFromCT]

All flu is bird flu, its natural home. Well, at leat influenza A, anyway. But this bird flu is H5N1, even though there are actually 16 different varieties of H. Humans get H1, H2, and H3. We've occasionaly gotten H5, H7 and H9. Birds get all 16.

But this flu is now spreading amongst birds all over the world. Even though there's not much in humans, it's a pandemic amongst birds.. a panzootic. So bird flu it is.

[Fred in Vermont]

>So, why is no one reporting on the fact that Donald Rumsfeld
just happens to be the Chairman of the Board of Gilead (the
patent-holder for Tamiflu)?<

You are correct about Gilead holding the Tamiflu patent, and Rumsfeld was chairman of the board, but according to this 2001 statement from Gilead Rumsfeld resigned at the start of that year to take his current job.

http://www.gilead.com/wt/sec/pr_04262001

[Fred in Vermont]

The report is interesting. The part that really caught my eye was here

http://www.hhs.gov/pandemicflu/plan/pdf/AppD.pdf
Where it says, way down in the part about Tamiflu, where it list the "assumptions" on which it is based, it says this about the expected supply:

"The primary source of antiviral drugs for a pandemic response will be the supply of antiviral drugs that have been stockpiled. Before annual influenza seasons about 2 million treatment courses of oseltamivir are available in the U.S. U.S.-based production of oseltamivir is being established; expected capacity is projected at about 1.25 million courses per month."

If this is true it is a bombshell. What happened to the patent? Who exactly is "establishing" production in the US? What is the deal with Roach and with Gidian (the US company that holds title to the Tamiflu patent)?

[DemFromCT]

I've heard that there ar enegotiations to ramp up production, but n othing solid.

BTW, there are suggestions of ways to stretch the supply.

[LindyH]

So much has happened since this administration took office five years ago...most of it's been pretty ugly.

The other day, the city of New York was permeated with a sweet fragrance and when I heard about it, it made me wonder if there were some sort of biological weapons attack on. I haven't seen any follow-up news on where the odor came from or what its composition is. I did, however run across this article, which sent a shiver up my spine. What a way to change the subject...a flu scare, a biological attack under the guise of a pandemic...

Someone needs to tell me I'm making too much stew from one oyster. I came here to see if anyone has seen any sort of explanation for what happened in New York. I suppose it's a measure of just how bad I think this administration is (ok, and maybe of my own paranoia) that I don't rule out the possibility they would attack their own country to duck criminal charges...or for any reason they happen to think of.

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