January again and the bird flu news is unsettling

It's January and once again the bird flu news is unsettling. Reports from Indonesia suggest a new cluster there and one of the isolation wards to be used for suspected bird flu cases is reported to be overwhelmed, although the small number of beds in these facilities doesn't mean huge numbers. Enough to be concerned, though. Another story says that the virus is prevalent in feral cats in Indonesia. That has yet to be confirmed. Besides the list we noted yesterday, Thailand is now reporting a poultry outbreak. Given all this, I continue to be cautious about how to interpret the January bad news. Why?

One year ago yesterday, 16 year old Fatma Ãzcan died of bird flu. Here's an account in an excellent story by Caleb Lauer in The Turkish Daily News:

Fatma Ãzcan's aunt gathers laminated copies of two newspaper articles from another room and brought them into the living room. Both articles are dated Jan. 16, 2006, the day after 16-year-old Fatma died. The headlines read: "Hiç YaÅamadı Ki" and "Ve Fatma Ãldü' Rough translation: "Too short a life" and "Fatma is dead." A year ago, here in DoÄubayazıt and Van, Turkish doctors and international experts were fighting an outbreak of bird flu that killed four children including Fatma Ãzcan. One hundred thousand doses of the anti-viral drug Tamiflu were flown in. More than 600 were examined at one hospital alone. There were almost 300 suspected cases with 12 cases confirmed. The planet hadn't seen so many cases at once before. Within the first two weeks of January, more children, Mehmet Ali KoçyiÄit, Fatma KoçyiÄit, Hülya KoçyiÄit had died along with Fatma Ãzcan. Now one year later, the bird flu outbreak in eastern Turkey offers no clear verdict or lessons. The story is a mix of tragedy, science and politics. (Caleb Lauer, Turkish Daily News)

What happened in Turkey could easily have signaled the start of the much feared pandemic. It certainly had some of the earmarks and concern was justified. In recounting the episode in his long a detailed story, Lauer dug up a quote from us we'd completely forgotten:

In the fall of 2005, the H5N1 influenza virus that killed the three KoçyiÄit children and Fatma Ãzcan had probably traveled with wild birds migrating from China and infected chickens and ducks across Turkey. As the virus circulated among domestic poultry under-detected and under-appreciated, Agriculture Minister Mehdi Eker said: "There is no bird flu in Turkey." Two days before Mehmet Ali KoçyiÄit died, Mr. Eker was quoted saying there was 'no cause for concern.' On Jan. 2, 2006, the day after Mehmet Ali died, reputable public health internet blog Effect Measure posted this entry: "The New Years' weekend saw a worrying report of six cases of suspected bird flu in Turkey...Today the wires are full of the good news from the Turkish health ministry that tests on the 14-year-old who died yesterday 'didn't show any trace of the disease or any other form of influenza.'...It is a natural tendency of state bureaucrats to minimize problems. I am not yet ready to dismiss these cases." Three days later, the World Health Organization (WHO) made its first announcement about the situation in Turkey. The sober statement began: "The Ministry of Health in Turkey has confirmed its first two cases of human infection with avian influenza caused by the H5 virus subtype. Both cases were fatal."

We are all operating with too little data and too many possibilities consistent with what we are seeing or hearing or believing. The more I see of this virus the less I am inclined to draw conclusions quickly. What is happening in Indonesia (or Vietnam or Thailand or Nigeria or Japan or China or ?) could easily be the signs of the leading edge of a pandemic, clearly visible on hindsight. Or not.

I don't think our caution does any harm. There is no shortage of people willing to speculate and I think we owe a debt of gratitude to the many citizen epidemiologists out there who are fast becoming the eyes and ears of a worldwide early warning system. That system is sensitive and will likely pick up the signal when it comes. But it isn't very specific. It also is tripped by many false signals. That is inevitable with any surveillance system and this one more than most. While in many surveillance systems the cost of running down the false alarms is high, in this one the cost is usually measured in having the patience to wait a few days or a week while the false signals fade and the true ones become clearer.

It's January and once again the bird flu news is unsettling.

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Regardless of whether the events of the past week or so are the leading edge of pandemic, the undeniable fact is that H5N1 continues to move in the direction we'd rather it not. The news only continues to worsen. To fail to prepare your family and your home is foolhardy.

It sounds like we're about to have a full blown bird flu pandemic. I found an online bird flu message board and the people on there are really taking this thing seriously. The message board is at http://www.Avianflutalk.com

Crazy stuff...

By Justin Moore, Jr. (not verified) on 16 Jan 2007 #permalink

"We are all operating with too little data and too many possibilities consistent with what we are seeing or hearing or believing. The more I see of this virus the less I am inclined to draw conclusions quickly. What is happening in Indonesia (or Vietnam or Thailand or Nigeria or Japan or China or ?) could easily be the signs of the leading edge of a pandemic, clearly visible on hindsight. Or not."

I absolutely agree with every word.

The thing that I worry about, is that even if everybody and every country runs very hard to prepare now, if a pandemic happens in 5 years' time, we will still be not ready. Such is the degree of complexity of pandemic mitigation.

I think it was Jared Diamond in his book collapse that asks the retorical question "What were the Easter Islanders thinking as they cut down the last tree" - since their civilization depended on food from the sea and trees were necessary to build canoes one would have thought they would have stopped cutting trees to haul stones for statues before they were all gone.

Perhaps someone in the future will also wonder why this civilization spent money on churches and Disneyland while miserly parceling it out for health care and pandemic preparation. Of course with all the possible disasters for humankind that are looming perhaps there will be no one left to wonder about our priorities.

K: Churches and Disneyland are hardly the worst places to spend money on. Try military spending; diverting 20% of the money the world spends on weapons would fund efforts to solve _all_ major problems the world is facing.

"isolation words" are about all some govts are using...

Justin Moore, Jr, nothing crazy and nothin' new; if you haven't spent the past year or two getting ready for a deadly panflu year to break out at any time, maybe you're missing some of the more alarming pieces of the puzzle?

Influenza is contagious before people look or feel sick.

There is no scientific reason the current very deadly cfr has to drop for H5N1 to go pandemic;

it has plenty of other bird and mammal hosts, and, we pass influenza before we are "hot, high, breathless", and "most flat" (sorry; too much toggletext out of Indonesia the past year); we could drop dead, after going about our normal business for a day of two first, and it would not stop the virus.

We are so much less self-sufficient than society was in 1918. Our fragile supply chains will trip us right up, far before half the people or more in a region start getting sick with something they have no immunity to. Dr.Osterholm tried to warn about the collateral damage, years ago.

A pandemic strain (given a superspreader or two getting on planes?) might be global in as few as 21 days,
(Dr.Nabarro said "21 days" in Dec. 2005, and, that it might keep its current cfr. The late 2006 Report from the WHO still said, H5N1 could keep its cfr during pandemic) and consider; we might lose a week in people going to the doctor, getting test results, another week for govts deciding whether to say anything, or, just let us figure it out for ourselves...

Govt already, (US govt, by putting up some website pages and making a speech or two), "warned" you, not to expect any aid during a pandemic influenza year.

Any extra ads about "flu" or "emergencies" or "all hazards" also expect you to act as if they had said, "you might have to cope through waves of a deadly virus for 1 to 3 years, and don't expect federal or state or mutual aid, nor effective medical treatment, nor vaccine, nor routine medical treatment...

I think we'd be lucky if we got 24 hours notice; not find out because suddenly our local ERs and hospitals are filling up with very very sick patients; young, healthy ones, too.

Dec 2005 Dr.Nabarro: ..."it would be rather foolhardy not to prepare for it, given the enormous human, economic and other consequences"

If we get lucky for another whole year; great! But we can't gamble lives on luck alone. Modern science has finally been able to give us warning before a pandemic, but individual officials haven't become long-sighted enough to use it yet.

If any of these past clusters had been the start of panflu, we all would have found out the hard way; they only know it isn't the start of pandemic when it stops.

By crfullmoon (not verified) on 16 Jan 2007 #permalink

crfullmoon. That...is a beautiful piece of writing. Thanks.

MK - churches and disney land were just examples - picked not for the amount of money spent (although if all Christians are tithing, churches would be using a huge part of the national wealth). Rather I picked them for the mindless uselessness of them. The military budget, for all its faults, is attempting to secure the American way of life (including disneyland) for the future (for at least some who live in America) by getting control of where much of the world's remaining oil is.

If there is no God churches are wasted - social centers would be better ways for people to socialize and would be more readily converted into temporary medical centers. Its not clear that if a God exists he/she/it is impressed with the houses built to his glory as the people who build them die some which say anyway.

Disney land represents to me all the ways americans spend their money for distraction. I bet if you honestly counted up how much is spent over and above what is necessary for survival it would be much larger than the US military budget. Since 1/2 the world survives on $2 a day or less, $2 a day is sufficient for survival eh? all the rest is extras.

"What were the Easter Islanders thinking as they cut down the last tree"

The one who ordered it cut was thinking, I have special privileges because I am important, besides the Gods of the Market have spoken and I'm doing this for the good of all. The eco-terrorist was running around shouting, we are doomed, we are doomed. The guards chasing him were growling, why do you keep running, it's an island for christsake, we're gonna catch you eventually, the longer you make us run the harder we're gonna thump you. The rest were thinking, gee, I'm goning to miss that tree, but that's progress for you.

Posted by: k | January 16, 2007 11:20 AM

K, get out of my head!

Greg - sounds about right
Tink -what do you mean by your comment?

So we say thanks to the many citizen epidemiologists. Assured enough that those who are paying attention will at least have some chance of making it through this adventure, or mis-adventure, however you choose to think of it.
It's like revere says, the early warning system, our citizen epidemiologists.
Speculation does nothing to help us cope while we wait for the lid to blow off of the steaming tea pot.
K: Honestly it's highly doubtful that anyone will be concerned in the future about why this civilization spent money on churches and Disneyland versus health care and pandemic preparation. People will always pursue their pleasures first.

K, I simply meant that I agree 100% with what you wrote, implying that you read my mind to write what you wrote. Just a small attempt at humor. But, seriously, I agree with your sentiments.

Lea, historians do concern themselves with why people did what they did in the past in the hopes of preventing mistakes in the future. Which is why Jared Diamond wrote "Collapse" examining why he thinks some civilizations collapsed dramatically while others with similar situations only declined. Given that we have a global ecconomy now, collapse could mean for our generation the total collapse of human civilization. That should sober us enough to examine our ways. That it doesn't is perhaps predictive of total collapse.

Not every person pursues their pleasure first. There are some humans who in fact pursue the survival of their family first (that is how 3 billion people who live on less than $2 per person a day not only survive but continue to reproduce). Some thousands of US soldiers consider patriotism ahead of pleasure - I think they are misled in the current war but most of them are not seeking pleasure in going to Iraq. Some dedicated people are willing to live on less and work hard to better the lives of others as hard as that might be to believe for most Americans.

If first and second world citizens and their countries continue to put pleasure ahead of all, they will have their pleasures for a while. But they will destroy the world for "stuff" - Ghandi called that stuff "badges of impotence" and correctly IMO determined that the stuff and fluff that capitalism provides, not only impoverishes the third world, but does not bring deep enduring happiness to those who obtain it, and in the end will likely destroy the world as a home for humans (cockroaches may live just fine after we are done trashing the planet tho).

But you are right, no one in the future will likely be concerned about how this civilization spent our money because if any humans are alive 100 years from now they will be more worried about how to start fires with flints than about the history of the generation that destroyed themselves.

"badges of impotence"

The correct public health terminology is, "symptoms of impotence".

12-steppers call them "habits of choice".

Greg, I don't know if Ghandi's comments exactly translate to 12 steppers "habits of choice". What Ghandi was specifically referring to was the rich Rajas who wore lots of jewelry. Knowing his philsophy it is not a stretch to extend it to all people who need to wear fine clothes and jewelry (as well as owning fancy homes and cars) to try show the world how great they are. True strength comes from within and is shown by actions not by garb and wealth. Thus this little man could present himself, scrawy and clothed only in a loin cloth to the King of England (as St. Francis similarily presented himself in a ragged robe to the bejewelled Pope). All the kings horses and all the kings men turned out to be impotent against a bunch of poor people in India. Crowns and diadems, are no match against people willing to risk their life for a cause. Unfortunately individuals such a Ghandi, who can inspire the meek to acts of courage, are few. Our genetic programs to one up our neigbhors, aided and abetted by advertising, are sufficient however to convince the majority that some piece of stuff will make us happy and show what great humans we are. And so buy diamonds purchased with the blood of poor African miners because the rock on one's finger symbolizes worth to the wealthy. Since the virtual slaves that now serve the first world are unseen we don't have to have any qualms at the cost of first world wealth.

I would have been surprised given it's flu season if we hadn't seen some activity in January, but like Revere, I don't think it's cause for panic. We do need more data--ever met a scientist who says that he or she has all the data they want? Rare. My observation is that the changes needed in the HA subunit of H5N1 to make it much more infectious are a significant barrier; those changes will likely have to come from a rare recombination event with another strain in which there is a crossover at the right point. My prediction is that come spring, we will see a diedown of human and avian cases.

"AN Icelandic company claims that an enzyme it has found in cod could help scientists find a drug to beat avian flu."

Yeah too bad we've fished that species almost to extinction in some places. Again the same short sighted stupidity that caused the last tree to fall on Easter Island...

K, the only real disagreement I have with your comment is, "genetic programs to one up". You see something deeper than most do in Gandhi's remark, and agree, excepting a few trifling details.

People who find no power / meaning / satisfaction / self-esteem in their lives, whether through lack of capability or through being prevented, often resort to substitutes. They try shopping-therapy / false personae / conspicuous display / boasting / sex / mindless music / chemicals. None of these are actually the power they pretend. They may fool others but not the pretender. No matter how many toys, no matter how big the gun, no matter the size or shape of the rented body, no matter how full the syringe, it is not enough.

There is little difference between Imelda Marcos looking for another pair of shoes and a nameless junkie looking for another hit. What they will find is not what they seek.

The slaver's symbols of potence display his impotence. Few who display diamonds can compel the scrawniest little black kid to crawl down deBoer's hole.

The diamond says, I am strong. The diamond says, I did another's bidding and he gave me to show this badge of my submission.

Strength is not entirely within. It is also without. It is also knowing.. both within and without. Knowing weaknesses. Knowing shackles. Knowing too possibility. Knowing powers. Knowing levers. Knowing friends.

It is not genetics. It is pedagogy.

The very phrase "badges of impotence" says, those who wear the badges.. the diamonds, the guns, the needle-tracks.. and those who bow to them have been fooled. Somebody has taught them both selective blindness.

Revere calls them theist but many false prophets are atheists.

Greg, I think you and I are largely in agreement, but I would still assert that there is a genetic basis for human need for proof of worth. The specifics are governed by culture. The peacock demostrates his worth (to potential mates) with the display of his tail, but the bower bird moves outside his own body and demostrates his worth with the little "house" he builds. The one with the biggest and best gets the desirable mate. Hunter-gatherers are not without various sort of displays - but they are usually tied to actual worth as a genetic mate or provider - badges of potency one might say.

That is why the MOST powerful way to advertize false symbols of potency is to use sex - men or women will find you sexy if you wear these jeans, this makeup, this jewelry, drive this car etc.

In human culture this has become skewed so that it is hardly recongnizable but I believe the success of the pedagogy lies here. The question is "can we recognize and move beyond our genetic programs and cultural programs". Or one might say "do we have free will"?

Yes, K, we are wandering into nature vs nurture territory, genetics vs culture. There are far too many political and economic, and perhaps personal and psychotic interests out there, cultivating disinformation, for that to be a satisfying debate.

Although, I agree completely "there is a genetic basis for human need for proof of worth"... "worth" is not the same as "one up"; I think "one up" is a false "worth", a specific "governed by culture". Perhaps we might agree on that point, also?

In any case, I am mostly interested in culture/nurture issues, especially in separating base human culture?s? from local variations.

Most people in the world do not see twenty times an hour a vignette, some dweeb rubs the magic beer-bottle and suddenly he is surrounded by attractive women unaccountably attracted to him. I think that is a far more powerful myth than Kruger's physical force or than the metaphysical force against which Revere preaches every Sunday.

If you can induce someone to believe, against firsthand evidence, that magic beer-bottles attract babes, or magic spray-cans scour bathrooms and hunt down germs cowering in cracks,,, that the remedy for failure is to repeat the same ineffective spell,,, then Fumento can be a respected authority.

Greg I think we are mostly in agreement. But in the end we are created not out of nothingness but out of the uniting of 1/2 the genetic material of our mother and 1/2 the genetic material of our father. Whatever we do, can be induced to do, whatever free will we have starts with those 23 chromosome pairs. Society and culture are composed of human beings created the same way. Whatever stories then can tell us they are able to create because they became a human being out of the programing of those 23 chromosome. Unfortunately the evolution of the genetic material in those chromosomes is no where near as fast as the evolution of the culture and machines we have been able to create. The disconnect in timing means that we are seemingly incapable of seeing that our inventions and culture have become our doom. For example, rabbits over time evolved a way to control their population in times of stress - they either reabsorbed fetuses or ate their young. At 6 billion and growing we have the technology to limit the unsustainable growth of the human population but we find women at 35 who never wanted children suddenly being grabbed by the notion that their biological clock is running out and becoming desperate to have children....we got around the brain program to have sex by providing birth control, but the brain program to have progeny pops up when least expected.

K, you don't get to be a 35-year-old nullipara with out a great deal of ideological intervention and economic support. Like the magic spray-can, they eventually fail.

I don't think I can accept that the urge to have progeny is EVER unexpected. A passing acquaintance with the theory of evolution would convince anyone, regardless of ideology, that it must the primary urge. Certainly, our culture devotes the clearly greater parts of its programs and efforts to control or to exploit it.

Some people appear to be quite successful at avoiding those thoughts, and at drowning them in distracting activities or chemicals when they break through. However, few, likely none, are always successful and I am fairly sure that nobody is ever completely unaware of any thought which they are pretending not to think.

I have no opinion on free will vs determinism per se; I'm quite sure the question is undecidable, at least in the forms it is usually posed.

I observe, that people who believe in free will tend to be nicer, while determinists can be exceedingly nasty. Also people who decide to exercise free will appear to be able to do so, while those who can't be bothered are pushed around by events and others both present and past.

I don't recall ever hearing of anyone launch a diatribe about their rights and freedoms when they have discovered that they must eat or breathe or even being wounded bleed.