Pandemic Flu Awareness Q&A and Links
With the news of new human cases in Turkey, I thought now would be a good time to make my long-plotted avian flu post. Thanks to bailunrui for looking it over for me. Any errors are mine.
Disclaimer: I am not a scientist or pandemic flu expert, just someone who's spent some time reading about it. This post is made in good faith to spread awareness and increase preparedness for a pandemic flu, and is not meant to substitute for medical advice or professional expertise in pandemic flu or disaster preparedness. Links are provided for convenience and further reading, and not to endorse any product. Any liability from use of this information and these links is explicitly disclaimed.
It's a long post, so I put a few of the Q&As that sort of begin sections outside cut tags. Some of the information is specific to the U.S., but much applies wherever you are. Without further ado...
Q: What would be so bad about bird flu, anyway?
A: Bird flu, also known as avian flu or influenza, has the potential to become a worldwide pandemic. The specific virus involved now, the H5N1 virus, is one that humans have no immunity for, because until recently it's only been found in wild birds. [Learn more at Pandemic Influenza: Key Facts from the CDC.] What has epidemiologists worried is that it's become widespread in domesticated poultry (in Southeast Asia), and it's developed the ability to infect human beings. Those are two of the three steps necessary to turn a virus that used to be limited to wild birds into a human epidemic. The third step would be developing efficient human-to-human transmission. [The CDC breaks the development of a pandemic into six phases, of which they say we're currently at 3.] So far a relatively small number of people have died because it doesn't transmit very easily from a patient to others... to their family members, to their health care workers, to their families, to their co-workers, to the people they pass on the street, to... you get the picture.
As of September, H5N1 killed 55% of the people it infected. In the event of a pandemic this percentage would likely drop precipitously (it may also be artificially inflated now because mild cases may be unreported), but even a 2.5-5% mortality rate (such as is estimated in for the 1918 Flu Pandemic) in a worldwide pandemic would result in tens of millions of deaths.
The 1918 Flu Pandemic is relevant because it's believed to have been caused by a similar scenario to now, of an avian flu virus evolving to affect and infect human beings. One of the ominous things about it was that it seemed disproportionately to kill people who would usually survive the flu. Over 30,000 people a year die of the regular flu in the U.S. every year, but they're usually those with weak immune systems, the very young or the very old. The 1918 flu was deadliest amongst people with the strongest immune systems, young adults ages 20-40. One theory as to why this is so is that that flu may have caused in the patients who died a typically rare and poorly-understood phenomenon called a cytokine storm. The short, as brought to you by a former English major, version is that cytokines are messengers in the immune system, which tell various immune functions to start and stop. If the stop messages aren't sent, or aren't received, the theory goes, a patient's own immune system may run amok and kill them, making death technically autoimmune. If that's true, the people with the strongest immune systems would be most at risk. [More on cytokine storms & H5N1.]
Scientists are also worried because H5N1 has been found in Turkey, which now has the first confirmed human deaths outside China and Southeast Asia. Reports are now that there are human outbreaks of bird flu in several locations, for a total of fifteen confirmed cases although the exact situation is unclear. See Effect Measure for the latest news.
Q: But there's been no human-to-human transmission yet?
A: That's the way media reports tend to put it, but it isn't strictly true. There have been several cases of suspected human-to-human transmission, but they've been amongst people in extended close contact with a patient, for example, a mother who was caring for her daughter later became ill. (If they'd both gotten infected from the same infected bird when plucking or preparing it, you'd expect them to have fallen ill at the same time, since flu has a fairly standard incubation period.) But there is a difference between such limited cases, and efficient transmission. It's still a further cause for worry, though. And we don't know yet how the kids in Turkey got sick.
Q: How likely is an H5N1 pandemic flu?
A: That depends on who you ask. Some experts say it's not if, but when. Family doctors are likely to understate the risk, while epidemiologists are very worried. But the truth is, we don't know if H5N1 in particular will develop the ability to transmit person-to-person; it could happen with another, less deadly, strain. We can expect that there will be a pandemic flu eventually; we had three in the twentieth century, but the later ones weren't as virulent as the one in 1918. Each new human case of H5N1 is worrisome because it gives the virus another opportunity to develop efficient person-to-person transmission.
Q: OMG, I have bird flu right now! *cough* *cough*
A: No, you really don't. Right now, in order to contract H5N1, you'd need to be living in close contact either with infected domestic birds or in very close contact with people who have it... and believe me, you'd know about that. Unless you're living somewhere where H5N1 has been detected in domesticated birds, and you've been in extensive contact with domestic poultry, and you've been doing things like plucking birds, eating raw chicken blood soup (stop that!), or performing assisted breathing on your fighting cock (er... yeah), you don't have the bird flu.
Q: Will getting my yearly flu shot protect me from avian influenza?
A: No. Yearly flu shots are designed to protect against what scientists predict to be the dominant strain(s) of regular flu going around in a given year. If they get even the strain of regular human flu wrong, the flu shot has far less, if any, effectiveness. So the ordinary flu shot you may have gotten in November... or the one you might get in November of this year... won't do you much good against avian flu.
However, one way the H5N1 could become easily transmissible among humans would be by coinfection of one person by both H5N1 and the usual flu. In that case, immunity towards the human flu would be a good thing, but that's really only relevant if you're likely to be exposed to H5N1 before it becomes a pandemic. So far, H5N1 hasn't been found in North America in either humans or birds, so people in Ohio probably don't need to run out and get flu shots for that reason.
(ETA 10/1/06: A new study in mice has shown that there's a possibility of a regular flu vaccine having some partial effectiveness against H5N1. The data suggests that because the regular vaccine shares the N1 part of H5N1, it might reduce the risk of death from H5N1, although even if that were true, people would still get sick. This is only a small preliminary study, and it's on a different vaccine than that given to humans. And as one scientist has on his door, "you can prove anything in mice." But it's new information.)
Q: So why the hell can't they/aren't they making a vaccine against H5N1?
A: Some people are making one; some people have made one. The problem is, nobody knows what mutations could take place in the current H5N1 virus as it became the possible pandemic flu virus. So making large quantities of H5N1 vaccine now might produce a vaccine with, say, only 40% effectiveness, or less.
Q: But once the virus mutates and starts spreading quickly among humans, we can make an effective vaccine, right?
A: Not in time to help during the first phase of the pandemic. It takes at least six months to ready a flu vaccine for use, during which time the disease would probably circle the globe once. There are additional challenges to making a pandemic vaccine, challenges both of science (unlike human flu, H5N1 kills domestic poultry, and we usually use chicken eggs to grow vaccine) and logistics (we don't have the infrastructure in place to produce vaccine on a mass scale quickly).
Q: What about antibiotics? They didn't have those in 1918.
A: Well, antibiotics won't do anything against the flu itself, because it's caused by a virus, not a bacteria. Antibiotics can be effective against secondary infections such as bacterial pneumonia, but it's unknown how many of the deaths in the 1918 Flu were caused by secondary infections.
Q: But we'll have Tamiflu, right?
A: First off, probably not. The company that makes Tamiflu, although expanding production, has refused to allow any other companies to make the drug, and there are huge waiting lists. The U.S. announced with fanfare last summer that we were negotiating with the makers of Tamiflu to acquire a stockpile. Well-informed flu-watchers scoffed. Negotiate to do what, skip the year-plus waiting list of other countries waiting to buy Tamiflu? Even Australia, perhaps the best prepared for pandemic flu of any country, has enough doses for all their health care workers for only six weeks. (Tamiflu has to be given continuously, unlike a vaccine which may be administered once or twice.)
If we as a country do get a stockpile of Tamiflu, it will be reserved for workers in critical professions, such as health care workers. Before you get cranky about this, remember: we really want them to show up for work, and if they're totally unprotected, they may not. It's better for everyone if they get priority, even if it may not seem like it on a personal level. Yes, you can buy Tamiflu without a prescription online - no responsible physician will give you a prescription unless you have the regular flu now - but it's not necessarily a great idea. First off, you may not get what you pay for. And inappropriate use of Tamiflu by panicky people at the first sneeze during a pandemic may reduce its effectiveness. (ETA 2/20/06: Although various authorities have said this, it isn't true; see Lanard and Sandman's Tamiflu essay to learn why. The dilemma of personal stockpiling is that you might be better off if you do, whereas society as a whole is better off if people don't.)
Second, though, nobody knows for sure if Tamiflu will even be effective against a H5N1 pandemic virus. That's right: the drug every developed country is scrambling to stockpile may not even work.
Q: So what treatments are there?
A: You can find out about the medical treatments for fever, diarrhea, how to treat dehydration, when to seek medical care, and what the key symptoms are at FluWiki's Medical Therapy page. Also see their Alternative Medicine page. Not every remedy on there will be effective and/or safe; for discussion of this, and some that have evidence behind them, see this WaPo article. Two that I've read a bit about and think sound promising are Essential Fatty Acids, such as fish oil and borage oil, which seem to be anti-inflammatory and may be of benefit to patients with ARDS (Accute Respiratory Distress Syndrome); and Elderberry Extract, which two randomized, placebo-controlled, double-blind (all this is science speak for well-designed and respectable) studies have shown to have anti-viral effects. (ETA 2/12/06: Because elderberry extract increases the production of certain cytokines which may contribute to a cytokine storm in avian influenza, it probably isn't a good choice for treatment of H5N1.) And it's probably not a bad time to cook with turmeric and garlic, or ginger for GI symptoms. There are dozens of supplements, some with evidence in favor of them, some with little or none, on FluWiki's page.
Q: If an H5N1 flu outbreak starts spreading efficiently from human to human, what happens?
A: Well, the best hope is that we might contain a human outbreak before it gets too large. If caught within a week or two, an H5N1 epidemic in a single city or small region might be contained. This is why monitoring is so important. However, once the number of infected got beyond a certain relatively small number... hundreds or very few thousands... it would be virtually impossible to contain.
Officials like to talk up airport screenings as a way of stopping the spread of bird flu, but this isn't very realistic. They might catch some cases, but it's not just a matter of stopping people who look sick. A person can have the flu virus for days before they show any symptoms, and are contagious that entire time. By the time a person would even know they shouldn't travel, they could have flown around the world.
Q: What can I expect the impact of a pandemic flu to be?
A: The impact would be serious, and not necessarily confined to the areas you might immediately think of.
Healthcare
Most U.S. hospitals do not have the "surge capacity" to deal with hundreds or thousands of pandemic flu patients. Even assuming doctors, nurses, PAs, TAs, lab technicians, and maintenance people can and will show up to work - they may be sick themselves, or unwilling to take the risk - hospitals won't have the beds, medicines, and personnel to deal with the number of patients they would receive during a pandemic flu outbreak. There won't be enough of critical life-saving equipment like respirators. Doctors offices and clinics will likewise be swamped. Chances are, if you come down with pandemic flu, you may be fighting it in your own bed.
Infrastructure
Estimates are that between 15-30% of the workforce may be absent at the height of a flu pandemic. Public services such as water, sewer, phone, gas, and electricity may break down if they don't have the staff to maintain and repair them. You may lose your cable and/or internet. Your garbage may not get picked up, your home heating oil may not get delivered, your mail may not come, your train or bus may not run. Your employer may shut down or ask employees not to come in, and if they don't you may have to/choose to stay home.
Even if your own area is lightly affected or well-managed, breakdowns in the supply chain may cause shortages of food and basic necessities. Anything from sick truck drivers to travel restrictions to the cost or availability of fuel could prevent or slow delivery of goods. And even if those don't occur, there could be slowdowns or gaps in planting, harvest, processing, and production due to sickness, shortages, and absenteeism at those steps.
Social fabric
Schools, daycares, and universities may close. Large public gatherings, such as concerts and sports games, may be banned to try to stem infections. There may be travel bans, either voluntary or enforced by law enforcement. Crime may increase. Martial law may be declared.
Worldwide
If a global flu pandemic occurs, many people will die. The estimates range from a few million to one hundred fifty million or more. Also, some commentators warn that if first world nations reserve whatever medicines and vaccines we develop for ourselves, we may earn the unquenchable and justifiable hatred of poorer nations.
Q: How prepared are we?
A: As of last summer, we weren't very prepared. Experts were openly saying, We're screwed if it hits soon. In November, Bush announced a plan and billions in funding for flu preparedness, but how much of that a) is actually helpful and not just corporate pork, and b) has had time to do much good by now, is an open question. We may be more ready than we were, but as of January 1, 2006, the CDC says we're not ready.
Q: Can I freak out now?
A: If you like.
Q: AAAAAAAAHHH!!!
A: *pat* *pat*
Remember, even if a flu pandemic does occur, it won't be the end of the world. Don't get me wrong, I'll be terrified right along with you, probably hiding under the bedclothes, but any "It's the End of Civilization!" talk goes too far. There will likely be economic and social breakdowns as people become too sick or scared to work, but eventually life will go on. There have been epidemics and pandemics before. It wasn't all that long ago that every human being on the planet was at risk from diseases like smallpox, diptheria, and polio. A highly contagious deadly disease that science doesn't have an immediate answer for is a frightening concept for those of us living in developed countries, (yes, there's AIDS, but it's not highly contagious), but there are people alive even here who remember the days before antibiotics and vaccines, when people still muddled along somehow, facing the outbreaks as they came. None of this makes the prospect of a pandemic any better, or the danger any less real, but I think it's important to remember that, as a species, we've coped before, and can again.
Q: What can I do to be prepared for pandemic flu?
A: A bunch of things. Here's a general list:
I. Personal disaster preparedness
To learn how to be ready on a household level for any disaster that leaves you stranded, read this excellent multi-part guide by AlphaGeek at DailyKos, posted after Hurricane Katrina. It covers everything from determining what your risks are to developing a disaster plan to the ever-popular stockpiling of essentials, and has dozens of links and ideas. If you're not preparing for pandemic flu, it's equally useful for being ready for disasters such as hurricanes, earthquakes, fires, and blizzards.
II. Community pandemic flu preparedness
In a pandemic, the federal government won't be stepping in to fix things, because the crisis will be everywhere. States, cities, and towns will for a large part determine what their own response to a pandemic is, and those responses will affect the spread of the disease, treatment options, community cohesion, and to what extent people will be endangered by secondary issues, such as problems with infrastructure and supply chains.
Start by finding out what your state's plans are. And then start asking questions of local officals: "Does our hospital have the surge capacity to deal with pandemic flu?" (Answer: No. But you can ask.) "What happens to our public works if a third of the workforce is out sick?" "What are our plans to keep vital services operating?" [State and Local Pandemic Influenza Planning Checklist] Ask if they've run tabletop simulations of a pandemic flu crisis, and point them to resources about how to do so if they haven't. Ask your employer what their plans are; if you're a manager or similar, set about making the plans yourself. [Business Pandemic Influenza Planning Checklist]
Since last September when the blogosphere had Pandemic Flu Awareness Week, avian influenza has appeared on the public's radar. There have been lots of news stories on it, and there are government websites telling us how to prepare for it. This means you can discuss the possibilities without seeming like an alarmist or a nut. So talk to people about pandemic flu. Encourage people to think about their own preparedness, both practical and mental. Talk to your family about your disaster preparedness plans. (AlphaGeek recommends you not reveal the specifics of your family disaster plans to anyone not involved in them, for safety's sake.)
III. Practicing good public health: Prevention information.
Even before a flu pandemic hits, or if it never does, there are things you can do to keep yourself and those around you healthier. And developing good habits now makes it more likely you'll use them when it really matters.
Wash your hands often and well with soap and water. (Anti-bacterial soaps aren't necessary.) Sneeze into a tissue, or into your elbow or forearm (not into your hands), and wash your hands after sneezing. If you can't wash your hands, use an alcohol-based hand sanitizer. Avoid touching your nose, eyes, and mouth. If possible, stay home from work or school when you're sick.
When you have a cold, consider using a mask to help prevent spreading it. Ordinary masks don't protect against the inhalation of particles as small as the flu virus, but they can block water droplets in which cold and flu viruses are expelled when you cough or sneeze. When I lived in Japan, everyone wore masks whenever they had a cold. I remember when I was first thinking of making this suggestion in a post, I thought, nah, in this country you can't just go around with a surgical mask on. Shortly after I saw a woman shopping downtown wearing one. I don't know if she had a cold and was protecting others, or a compromised immune system and was trying to protect herself, but those both occurred to me before any thought that she might have OCD. Point being: you can wear a mask without looking like a crazy person. And better that we all get used to the sight and idea of wearing them now, I figure.
There are masks that offer finer filtration than the standard ones you can buy at CVS, called N95 masks, as described in this report about SARS (pdf), which are 95% effective against particles 0.3 microns across or bigger, but they may not provide protection during an avian flu outbreak because the influenza virus is smaller than that. (The makers of Nanomask claim it has fine enough filtration to block the flu virus, but the general consensus among people who aren't their shills seems to be that this is a shoddy product. By the manufacturer's own admission, Nanomasks are not approved by NIOSH.) I'm not linking to any vendors because I cannot vouch for the masks' effectiveness; I mention it only to cover the topic, and not to recommend their purchase or use. You will have to use your own judgement.
Take care of yourself. Excercise, a good diet, and sufficient rest are vital to maintaining a healthy immune system. Stress surpresses the immune system, so do whatever stress-relief works for you: yoga, meditation, bubble baths... pr0n. *g*
And don't freak out too badly. Nothing you can do will make you completely ready, but every little thing, whether it's buying extra canned soup when they're 2-for-1, or prodding your boss to make contingency plans, is something.
Flu Link Allstars
Flu Wiki has general information about H5N1, speculative scenarios of a pandemic, and news and updates. I've gotten most of my info and the rest of these links by surfing around this site, and following links from it. An excellent all-around resource.
AlphaGeek's Daily Kos series Are YOU ready for a disaster? is a detailed guide to preparing for disasters and a must read. It covers everything from water storage/disinfection/purification and stockpiling food, to heating your home during a power outage, to self and home defense during a crisis. (Stocking up on essentials is part of flu planning for two reasons: one, because there may be shortages or disruptions in supply; and two, at the height of an epidemic, your best bet for preventing yourself and members of your household from getting sick may be going home and staying there.) Links to pretty much anything you might need to buy to prepare for evacuating or holing up in your house for six months.
The Avian flu blog and Effect Measure are two places to stay on top of the latest bird flu news.
Official resources
World Health Organization (WHO): Confirmed Human Cases of Avian Influenza; Checklist for influenza pandemic preparedness planning(PDF). (Say that five times fast.)
The WHO also lists National Influenza Pandemic Plans for countries from Australia to the U.S. And the Health Protection Agency (UK) has an Avian Influenza FAQ.
The U.S. Department of Health and Human Services: PandemicFlu.gov, where you can download Pandemic Flu Planning: A Guide for Individuals and Families. They also have State Pandemic Plans for the states that have them.
The Centers for Disease Control: Pandemic Influenza. They also have a Weekly Report: Influenza Summary, but not only is it rather technical, it's only about the regular seasonal flu so far, since again, there is no pandemic now.
***
So now you've read some or all of this post, and are going... "now what?"
Well, that depends on how you're feeling and thinking. If you're someone who's reassured by taking action, you can start with the Are YOU ready? guide, or go directly to buying non-perishable food items. You could write letters to your mayor, city councilor, or state representative; you could bring it up at work, with social/religious groups, or school. If you're skeptical of the risk, I'd start by reading more about current happenings with H5N1 at the Avian Flu Blog or Effect Measure. If you're confused or just want to learn more, try FluWiki. And if you're powerfully freaked out, take a break. Watch a movie, read some fanfic, play with the dog. Find the (gallows) humor. The possibility of a pandemic will (unfortunately) still be here tomorrow.
One of my favorite essays about flu preparedness is Jody Lanard and Peter Sandman's Superb Flu Pandemic Risk Communication. In it, they dissect a speech by an Australian official to highlight what this official gets right that so many other officials get wrong. Ok, part of why I like it is that this detailed examination appeals to my inner English major, but it's full of information I hadn't seen elswhere, and is a good introduction to the best ways to talk about a possible pandemic. That article is mostly about official response, but Sandman also offers tips for spreading the word in The Flu Preparedness Snowball, where he also deconstructs some of the popular misinformation. These essays can help you feel more confident bringing up the subject of a possible flu pandemic.
If you're not up to being a community organizer, you can spread the word by making your own avian influenza post, linking to FluWiki or back to this post if you want. If you have corrections, comments, or favorite links, please share them in the comments.
x-posted to my journal.
Disclaimer: I am not a scientist or pandemic flu expert, just someone who's spent some time reading about it. This post is made in good faith to spread awareness and increase preparedness for a pandemic flu, and is not meant to substitute for medical advice or professional expertise in pandemic flu or disaster preparedness. Links are provided for convenience and further reading, and not to endorse any product. Any liability from use of this information and these links is explicitly disclaimed.
It's a long post, so I put a few of the Q&As that sort of begin sections outside cut tags. Some of the information is specific to the U.S., but much applies wherever you are. Without further ado...
Q: What would be so bad about bird flu, anyway?
A: Bird flu, also known as avian flu or influenza, has the potential to become a worldwide pandemic. The specific virus involved now, the H5N1 virus, is one that humans have no immunity for, because until recently it's only been found in wild birds. [Learn more at Pandemic Influenza: Key Facts from the CDC.] What has epidemiologists worried is that it's become widespread in domesticated poultry (in Southeast Asia), and it's developed the ability to infect human beings. Those are two of the three steps necessary to turn a virus that used to be limited to wild birds into a human epidemic. The third step would be developing efficient human-to-human transmission. [The CDC breaks the development of a pandemic into six phases, of which they say we're currently at 3.] So far a relatively small number of people have died because it doesn't transmit very easily from a patient to others... to their family members, to their health care workers, to their families, to their co-workers, to the people they pass on the street, to... you get the picture.
As of September, H5N1 killed 55% of the people it infected. In the event of a pandemic this percentage would likely drop precipitously (it may also be artificially inflated now because mild cases may be unreported), but even a 2.5-5% mortality rate (such as is estimated in for the 1918 Flu Pandemic) in a worldwide pandemic would result in tens of millions of deaths.
The 1918 Flu Pandemic is relevant because it's believed to have been caused by a similar scenario to now, of an avian flu virus evolving to affect and infect human beings. One of the ominous things about it was that it seemed disproportionately to kill people who would usually survive the flu. Over 30,000 people a year die of the regular flu in the U.S. every year, but they're usually those with weak immune systems, the very young or the very old. The 1918 flu was deadliest amongst people with the strongest immune systems, young adults ages 20-40. One theory as to why this is so is that that flu may have caused in the patients who died a typically rare and poorly-understood phenomenon called a cytokine storm. The short, as brought to you by a former English major, version is that cytokines are messengers in the immune system, which tell various immune functions to start and stop. If the stop messages aren't sent, or aren't received, the theory goes, a patient's own immune system may run amok and kill them, making death technically autoimmune. If that's true, the people with the strongest immune systems would be most at risk. [More on cytokine storms & H5N1.]
Scientists are also worried because H5N1 has been found in Turkey, which now has the first confirmed human deaths outside China and Southeast Asia. Reports are now that there are human outbreaks of bird flu in several locations, for a total of fifteen confirmed cases although the exact situation is unclear. See Effect Measure for the latest news.
Q: But there's been no human-to-human transmission yet?
A: That's the way media reports tend to put it, but it isn't strictly true. There have been several cases of suspected human-to-human transmission, but they've been amongst people in extended close contact with a patient, for example, a mother who was caring for her daughter later became ill. (If they'd both gotten infected from the same infected bird when plucking or preparing it, you'd expect them to have fallen ill at the same time, since flu has a fairly standard incubation period.) But there is a difference between such limited cases, and efficient transmission. It's still a further cause for worry, though. And we don't know yet how the kids in Turkey got sick.
Q: How likely is an H5N1 pandemic flu?
A: That depends on who you ask. Some experts say it's not if, but when. Family doctors are likely to understate the risk, while epidemiologists are very worried. But the truth is, we don't know if H5N1 in particular will develop the ability to transmit person-to-person; it could happen with another, less deadly, strain. We can expect that there will be a pandemic flu eventually; we had three in the twentieth century, but the later ones weren't as virulent as the one in 1918. Each new human case of H5N1 is worrisome because it gives the virus another opportunity to develop efficient person-to-person transmission.
Q: OMG, I have bird flu right now! *cough* *cough*
A: No, you really don't. Right now, in order to contract H5N1, you'd need to be living in close contact either with infected domestic birds or in very close contact with people who have it... and believe me, you'd know about that. Unless you're living somewhere where H5N1 has been detected in domesticated birds, and you've been in extensive contact with domestic poultry, and you've been doing things like plucking birds, eating raw chicken blood soup (stop that!), or performing assisted breathing on your fighting cock (er... yeah), you don't have the bird flu.
Q: Will getting my yearly flu shot protect me from avian influenza?
A: No. Yearly flu shots are designed to protect against what scientists predict to be the dominant strain(s) of regular flu going around in a given year. If they get even the strain of regular human flu wrong, the flu shot has far less, if any, effectiveness. So the ordinary flu shot you may have gotten in November... or the one you might get in November of this year... won't do you much good against avian flu.
However, one way the H5N1 could become easily transmissible among humans would be by coinfection of one person by both H5N1 and the usual flu. In that case, immunity towards the human flu would be a good thing, but that's really only relevant if you're likely to be exposed to H5N1 before it becomes a pandemic. So far, H5N1 hasn't been found in North America in either humans or birds, so people in Ohio probably don't need to run out and get flu shots for that reason.
(ETA 10/1/06: A new study in mice has shown that there's a possibility of a regular flu vaccine having some partial effectiveness against H5N1. The data suggests that because the regular vaccine shares the N1 part of H5N1, it might reduce the risk of death from H5N1, although even if that were true, people would still get sick. This is only a small preliminary study, and it's on a different vaccine than that given to humans. And as one scientist has on his door, "you can prove anything in mice." But it's new information.)
Q: So why the hell can't they/aren't they making a vaccine against H5N1?
A: Some people are making one; some people have made one. The problem is, nobody knows what mutations could take place in the current H5N1 virus as it became the possible pandemic flu virus. So making large quantities of H5N1 vaccine now might produce a vaccine with, say, only 40% effectiveness, or less.
Q: But once the virus mutates and starts spreading quickly among humans, we can make an effective vaccine, right?
A: Not in time to help during the first phase of the pandemic. It takes at least six months to ready a flu vaccine for use, during which time the disease would probably circle the globe once. There are additional challenges to making a pandemic vaccine, challenges both of science (unlike human flu, H5N1 kills domestic poultry, and we usually use chicken eggs to grow vaccine) and logistics (we don't have the infrastructure in place to produce vaccine on a mass scale quickly).
Q: What about antibiotics? They didn't have those in 1918.
A: Well, antibiotics won't do anything against the flu itself, because it's caused by a virus, not a bacteria. Antibiotics can be effective against secondary infections such as bacterial pneumonia, but it's unknown how many of the deaths in the 1918 Flu were caused by secondary infections.
Q: But we'll have Tamiflu, right?
A: First off, probably not. The company that makes Tamiflu, although expanding production, has refused to allow any other companies to make the drug, and there are huge waiting lists. The U.S. announced with fanfare last summer that we were negotiating with the makers of Tamiflu to acquire a stockpile. Well-informed flu-watchers scoffed. Negotiate to do what, skip the year-plus waiting list of other countries waiting to buy Tamiflu? Even Australia, perhaps the best prepared for pandemic flu of any country, has enough doses for all their health care workers for only six weeks. (Tamiflu has to be given continuously, unlike a vaccine which may be administered once or twice.)
If we as a country do get a stockpile of Tamiflu, it will be reserved for workers in critical professions, such as health care workers. Before you get cranky about this, remember: we really want them to show up for work, and if they're totally unprotected, they may not. It's better for everyone if they get priority, even if it may not seem like it on a personal level. Yes, you can buy Tamiflu without a prescription online - no responsible physician will give you a prescription unless you have the regular flu now - but it's not necessarily a great idea. First off, you may not get what you pay for. And inappropriate use of Tamiflu by panicky people at the first sneeze during a pandemic may reduce its effectiveness. (ETA 2/20/06: Although various authorities have said this, it isn't true; see Lanard and Sandman's Tamiflu essay to learn why. The dilemma of personal stockpiling is that you might be better off if you do, whereas society as a whole is better off if people don't.)
Second, though, nobody knows for sure if Tamiflu will even be effective against a H5N1 pandemic virus. That's right: the drug every developed country is scrambling to stockpile may not even work.
Q: So what treatments are there?
A: You can find out about the medical treatments for fever, diarrhea, how to treat dehydration, when to seek medical care, and what the key symptoms are at FluWiki's Medical Therapy page. Also see their Alternative Medicine page. Not every remedy on there will be effective and/or safe; for discussion of this, and some that have evidence behind them, see this WaPo article. Two that I've read a bit about and think sound promising are Essential Fatty Acids, such as fish oil and borage oil, which seem to be anti-inflammatory and may be of benefit to patients with ARDS (Accute Respiratory Distress Syndrome); and Elderberry Extract, which two randomized, placebo-controlled, double-blind (all this is science speak for well-designed and respectable) studies have shown to have anti-viral effects. (ETA 2/12/06: Because elderberry extract increases the production of certain cytokines which may contribute to a cytokine storm in avian influenza, it probably isn't a good choice for treatment of H5N1.) And it's probably not a bad time to cook with turmeric and garlic, or ginger for GI symptoms. There are dozens of supplements, some with evidence in favor of them, some with little or none, on FluWiki's page.
Q: If an H5N1 flu outbreak starts spreading efficiently from human to human, what happens?
A: Well, the best hope is that we might contain a human outbreak before it gets too large. If caught within a week or two, an H5N1 epidemic in a single city or small region might be contained. This is why monitoring is so important. However, once the number of infected got beyond a certain relatively small number... hundreds or very few thousands... it would be virtually impossible to contain.
Officials like to talk up airport screenings as a way of stopping the spread of bird flu, but this isn't very realistic. They might catch some cases, but it's not just a matter of stopping people who look sick. A person can have the flu virus for days before they show any symptoms, and are contagious that entire time. By the time a person would even know they shouldn't travel, they could have flown around the world.
Q: What can I expect the impact of a pandemic flu to be?
A: The impact would be serious, and not necessarily confined to the areas you might immediately think of.
Healthcare
Most U.S. hospitals do not have the "surge capacity" to deal with hundreds or thousands of pandemic flu patients. Even assuming doctors, nurses, PAs, TAs, lab technicians, and maintenance people can and will show up to work - they may be sick themselves, or unwilling to take the risk - hospitals won't have the beds, medicines, and personnel to deal with the number of patients they would receive during a pandemic flu outbreak. There won't be enough of critical life-saving equipment like respirators. Doctors offices and clinics will likewise be swamped. Chances are, if you come down with pandemic flu, you may be fighting it in your own bed.
Infrastructure
Estimates are that between 15-30% of the workforce may be absent at the height of a flu pandemic. Public services such as water, sewer, phone, gas, and electricity may break down if they don't have the staff to maintain and repair them. You may lose your cable and/or internet. Your garbage may not get picked up, your home heating oil may not get delivered, your mail may not come, your train or bus may not run. Your employer may shut down or ask employees not to come in, and if they don't you may have to/choose to stay home.
Even if your own area is lightly affected or well-managed, breakdowns in the supply chain may cause shortages of food and basic necessities. Anything from sick truck drivers to travel restrictions to the cost or availability of fuel could prevent or slow delivery of goods. And even if those don't occur, there could be slowdowns or gaps in planting, harvest, processing, and production due to sickness, shortages, and absenteeism at those steps.
Social fabric
Schools, daycares, and universities may close. Large public gatherings, such as concerts and sports games, may be banned to try to stem infections. There may be travel bans, either voluntary or enforced by law enforcement. Crime may increase. Martial law may be declared.
Worldwide
If a global flu pandemic occurs, many people will die. The estimates range from a few million to one hundred fifty million or more. Also, some commentators warn that if first world nations reserve whatever medicines and vaccines we develop for ourselves, we may earn the unquenchable and justifiable hatred of poorer nations.
Q: How prepared are we?
A: As of last summer, we weren't very prepared. Experts were openly saying, We're screwed if it hits soon. In November, Bush announced a plan and billions in funding for flu preparedness, but how much of that a) is actually helpful and not just corporate pork, and b) has had time to do much good by now, is an open question. We may be more ready than we were, but as of January 1, 2006, the CDC says we're not ready.
Q: Can I freak out now?
A: If you like.
Q: AAAAAAAAHHH!!!
A: *pat* *pat*
Remember, even if a flu pandemic does occur, it won't be the end of the world. Don't get me wrong, I'll be terrified right along with you, probably hiding under the bedclothes, but any "It's the End of Civilization!" talk goes too far. There will likely be economic and social breakdowns as people become too sick or scared to work, but eventually life will go on. There have been epidemics and pandemics before. It wasn't all that long ago that every human being on the planet was at risk from diseases like smallpox, diptheria, and polio. A highly contagious deadly disease that science doesn't have an immediate answer for is a frightening concept for those of us living in developed countries, (yes, there's AIDS, but it's not highly contagious), but there are people alive even here who remember the days before antibiotics and vaccines, when people still muddled along somehow, facing the outbreaks as they came. None of this makes the prospect of a pandemic any better, or the danger any less real, but I think it's important to remember that, as a species, we've coped before, and can again.
Q: What can I do to be prepared for pandemic flu?
A: A bunch of things. Here's a general list:
I. Personal disaster preparedness
To learn how to be ready on a household level for any disaster that leaves you stranded, read this excellent multi-part guide by AlphaGeek at DailyKos, posted after Hurricane Katrina. It covers everything from determining what your risks are to developing a disaster plan to the ever-popular stockpiling of essentials, and has dozens of links and ideas. If you're not preparing for pandemic flu, it's equally useful for being ready for disasters such as hurricanes, earthquakes, fires, and blizzards.
II. Community pandemic flu preparedness
In a pandemic, the federal government won't be stepping in to fix things, because the crisis will be everywhere. States, cities, and towns will for a large part determine what their own response to a pandemic is, and those responses will affect the spread of the disease, treatment options, community cohesion, and to what extent people will be endangered by secondary issues, such as problems with infrastructure and supply chains.
Start by finding out what your state's plans are. And then start asking questions of local officals: "Does our hospital have the surge capacity to deal with pandemic flu?" (Answer: No. But you can ask.) "What happens to our public works if a third of the workforce is out sick?" "What are our plans to keep vital services operating?" [State and Local Pandemic Influenza Planning Checklist] Ask if they've run tabletop simulations of a pandemic flu crisis, and point them to resources about how to do so if they haven't. Ask your employer what their plans are; if you're a manager or similar, set about making the plans yourself. [Business Pandemic Influenza Planning Checklist]
Since last September when the blogosphere had Pandemic Flu Awareness Week, avian influenza has appeared on the public's radar. There have been lots of news stories on it, and there are government websites telling us how to prepare for it. This means you can discuss the possibilities without seeming like an alarmist or a nut. So talk to people about pandemic flu. Encourage people to think about their own preparedness, both practical and mental. Talk to your family about your disaster preparedness plans. (AlphaGeek recommends you not reveal the specifics of your family disaster plans to anyone not involved in them, for safety's sake.)
III. Practicing good public health: Prevention information.
Even before a flu pandemic hits, or if it never does, there are things you can do to keep yourself and those around you healthier. And developing good habits now makes it more likely you'll use them when it really matters.
Wash your hands often and well with soap and water. (Anti-bacterial soaps aren't necessary.) Sneeze into a tissue, or into your elbow or forearm (not into your hands), and wash your hands after sneezing. If you can't wash your hands, use an alcohol-based hand sanitizer. Avoid touching your nose, eyes, and mouth. If possible, stay home from work or school when you're sick.
When you have a cold, consider using a mask to help prevent spreading it. Ordinary masks don't protect against the inhalation of particles as small as the flu virus, but they can block water droplets in which cold and flu viruses are expelled when you cough or sneeze. When I lived in Japan, everyone wore masks whenever they had a cold. I remember when I was first thinking of making this suggestion in a post, I thought, nah, in this country you can't just go around with a surgical mask on. Shortly after I saw a woman shopping downtown wearing one. I don't know if she had a cold and was protecting others, or a compromised immune system and was trying to protect herself, but those both occurred to me before any thought that she might have OCD. Point being: you can wear a mask without looking like a crazy person. And better that we all get used to the sight and idea of wearing them now, I figure.
There are masks that offer finer filtration than the standard ones you can buy at CVS, called N95 masks, as described in this report about SARS (pdf), which are 95% effective against particles 0.3 microns across or bigger, but they may not provide protection during an avian flu outbreak because the influenza virus is smaller than that. (The makers of Nanomask claim it has fine enough filtration to block the flu virus, but the general consensus among people who aren't their shills seems to be that this is a shoddy product. By the manufacturer's own admission, Nanomasks are not approved by NIOSH.) I'm not linking to any vendors because I cannot vouch for the masks' effectiveness; I mention it only to cover the topic, and not to recommend their purchase or use. You will have to use your own judgement.
Take care of yourself. Excercise, a good diet, and sufficient rest are vital to maintaining a healthy immune system. Stress surpresses the immune system, so do whatever stress-relief works for you: yoga, meditation, bubble baths... pr0n. *g*
And don't freak out too badly. Nothing you can do will make you completely ready, but every little thing, whether it's buying extra canned soup when they're 2-for-1, or prodding your boss to make contingency plans, is something.
Flu Link Allstars
Flu Wiki has general information about H5N1, speculative scenarios of a pandemic, and news and updates. I've gotten most of my info and the rest of these links by surfing around this site, and following links from it. An excellent all-around resource.
AlphaGeek's Daily Kos series Are YOU ready for a disaster? is a detailed guide to preparing for disasters and a must read. It covers everything from water storage/disinfection/purification and stockpiling food, to heating your home during a power outage, to self and home defense during a crisis. (Stocking up on essentials is part of flu planning for two reasons: one, because there may be shortages or disruptions in supply; and two, at the height of an epidemic, your best bet for preventing yourself and members of your household from getting sick may be going home and staying there.) Links to pretty much anything you might need to buy to prepare for evacuating or holing up in your house for six months.
The Avian flu blog and Effect Measure are two places to stay on top of the latest bird flu news.
Official resources
World Health Organization (WHO): Confirmed Human Cases of Avian Influenza; Checklist for influenza pandemic preparedness planning(PDF). (Say that five times fast.)
The WHO also lists National Influenza Pandemic Plans for countries from Australia to the U.S. And the Health Protection Agency (UK) has an Avian Influenza FAQ.
The U.S. Department of Health and Human Services: PandemicFlu.gov, where you can download Pandemic Flu Planning: A Guide for Individuals and Families. They also have State Pandemic Plans for the states that have them.
The Centers for Disease Control: Pandemic Influenza. They also have a Weekly Report: Influenza Summary, but not only is it rather technical, it's only about the regular seasonal flu so far, since again, there is no pandemic now.
***
So now you've read some or all of this post, and are going... "now what?"
Well, that depends on how you're feeling and thinking. If you're someone who's reassured by taking action, you can start with the Are YOU ready? guide, or go directly to buying non-perishable food items. You could write letters to your mayor, city councilor, or state representative; you could bring it up at work, with social/religious groups, or school. If you're skeptical of the risk, I'd start by reading more about current happenings with H5N1 at the Avian Flu Blog or Effect Measure. If you're confused or just want to learn more, try FluWiki. And if you're powerfully freaked out, take a break. Watch a movie, read some fanfic, play with the dog. Find the (gallows) humor. The possibility of a pandemic will (unfortunately) still be here tomorrow.
One of my favorite essays about flu preparedness is Jody Lanard and Peter Sandman's Superb Flu Pandemic Risk Communication. In it, they dissect a speech by an Australian official to highlight what this official gets right that so many other officials get wrong. Ok, part of why I like it is that this detailed examination appeals to my inner English major, but it's full of information I hadn't seen elswhere, and is a good introduction to the best ways to talk about a possible pandemic. That article is mostly about official response, but Sandman also offers tips for spreading the word in The Flu Preparedness Snowball, where he also deconstructs some of the popular misinformation. These essays can help you feel more confident bringing up the subject of a possible flu pandemic.
If you're not up to being a community organizer, you can spread the word by making your own avian influenza post, linking to FluWiki or back to this post if you want. If you have corrections, comments, or favorite links, please share them in the comments.
x-posted to my journal.