The Bird Flu Pandemic
 

Could happen, most likely will not. If the strain acquires better human-to-human transmission ability, we are in for a wild ride. Conservative worst-case puts the kill rate at 2% in the U.S., including a lot of healthy young adults.

There are currently about 25,000 available unoccupied ventilators in the U.S. Up to a million people would require ventilation, and several hundred thousand certainly would in an almost-worst-case scenario.

The best way to prevent the disease is to prevent people from congregating, especially children. The very first major public health step should be to close all schools and day cares immediately. There is no mechanism for doing that in many states, and the decision power when it is defined generally resides in each state. Presumably the President could order it nationwide, but he is a politician and singularly bad at these kinds of assessments. He will delay.

If schools and day cares are closed, huge numbers of nurses will not be able to go to work unless alternative care is arranged. It would not be acceptable to have big day care substitutes in a hospital for obvious reasons. Many other hospital and ER staff would be affected as well. The system would have dramatically reduced throughput.

Even at full capacity, the health care system cannot handle a major pandemic. Thousands would simply not get seen, even people who are dying.

Tamiflu would reduce your chances of dying somewhat. There will not be anywhere near enough of it. Black market Tamiflu will get interesting.

With massive numbers of people staying home to take care of children and to avoid the disease, the economy would be seriously impacted. Food and fuel shortages could result.



Two good options in case of worldwide bid flu pandemic with a virulent strain:

1. Bend over, kiss rear end goodbye just in case. Get two holdem cards. If it's a pair JJ or higher, you get to find out if your religion is right.

2. Hole up on in Montana with a couple months' worth of provisions, several firearms, a fly rod, and an internet connection. Walk around with your 4-inch "gun" a lot. Paint your willow tree bases to protect them from bird flu-addled beavers.


One of the more interesting side stories in a pandemic: the country will run out of ventilators the first week or two. Then first question will be do you let those in vegetative states die in order to save healthy people, or do you sacrifice the healthy people and leave the vegetatives on the vents? Every person in a vegetative state left on the vent will result in an average of two healthy people dying. Second and more interesting question: many thousands will need to be ventilated but won't have ventilators. An Ambu bag, an oxygen bottle, a little training and several really close friends who will bag you around the clock without missing for longer than 1-2.5 minutes for 1-3 weeks will keep many alive who would otherwise die. You do not want to tap friends with ADD for the job, or people who aren't bright enough to self-correct when they aren't actually ventilating you.

Fun exercise: List those friends and relatives.

Re: The Bird Flu Pandemic
 

Scary stuff. I don't have much to say as I'm not too educated on the topic but I definitely dont want this thread to die. Chime in people!

Re: The Bird Flu Pandemic
 

This is very interesting and a bit scary...where'd you get all this info?

Re: The Bird Flu Pandemic
 

Weren't we saying this about SARS not too long ago? It is good to get information out, but having less than 70 deaths (per WHO) people die of something in SE Asia being extrapolated into a worldwide pandemic seems a little alarmist to me.

More people die every year of the common flu (due to age/immune system difficulties) and for that matter Ebola, but you don't see a worldwide scare for those.

Re: The Bird Flu Pandemic
 

SARS was a relatively new disease and simply did not acquire major transfection factors. The odds were in our favor.

Flu has a much better track record for pandemics. However, the odds for this year are still well in our favor. Remember, if it does not acquire good human-to-human transmissibility, you do not get a pandemic.

Re: The Bird Flu Pandemic
 

Please forgive my ignorance, but know very little about this (except that you have now scared the living [censored] out of me) -

1) Ventilator - very expensive? who produces them? how long to mass produce? ventilation does what now for an infected patient? Can not self ventilate due to being too sick?

2) SARs vs. Bird Flu - What is the current level of human-to-human infection? Is there research to suggest that this is becoming more virulent and possible?

Re: The Bird Flu Pandemic
 

[ QUOTE ]
Then first question will be do you let those in vegetative states die in order to save healthy people, or do you sacrifice the healthy people and leave the vegetatives on the vents?

[/ QUOTE ]

Well this would be a clear violation of the Hippocratic Oath. As well as many other local laws. other than that, I have no input into the greater moral questions being asked. My first instinct is to say pulling dying people off respirators is wrong. I'm not a big 'the ends justify the means' kind of guy.

Re: The Bird Flu Pandemic
 

"1. Bend over, kiss rear end goodbye just in case. Get two holdem cards. If it's a pair JJ or higher, you get to find out if your religion is right.
"

well said

Re: The Bird Flu Pandemic
 

Que sera, sera
Whatever will be, will be.
The future's not ours to see.
Que sera, sera.

Re: The Bird Flu Pandemic
 

Well I don't know much, but here's what I know from my bio classes... Viruses are the most rapidly mutating things on earth. Sure, we're fine now while you basically have to molest a chicken to get this, but when/if it mutates to an airborn virus, that's when we're screwed.

Re: The Bird Flu Pandemic
 

Best current article on the real risk of bird flu.

Fuss and Feathers: Pandemic Panic over the Avian Flu

Summary. Yes, we should be worried and prepare. Anything with this much potential for death has to be paid attention to. But it proably won't happen this year. It may not happen for 30 years. Be alert, but keep perspective.

When in doubt, consult Michael Fumento for a rational evaluation of all things scientific.

Re: The Bird Flu Pandemic
 

Matt,

Are you by chance a sales rep. for a ventilator company?

Swede

Re: The Bird Flu Pandemic
 

It's very hard to predict. The 1918 "Spanish" flu pandemic was an extremly virulent strain, and sometimes killed helthy young men in a matter of hours. the 1968 Hong Kong flu wasn't much worse than your typical seasonal flu, but a lot more people caught it because nobody had immunity. It would make sense to be prepared for a "worst case" scenario, but i don't really see any reason to panic.

Re: The Bird Flu Pandemic
 

There are so many dormant viruses, bacteria, and parasites in the US that are lethal to humans it amazes me we don't have more plagues. Especially considering how prevelant mosquitos are.

For instance, a significant number of dogs have tested positive for Trypanosoma cruzi from Georgia to Minnesota. There is no shortage of mosquitos in the US. Why the leap from dogs to humans is not made in the US but happens to occur in Mexico and South America never ceases to amaze me.

Re: The Bird Flu Pandemic
 

If that scenario really happened, the effects of the ensuing panic would be a lot worse than the effects of 2% of the population dying.

Re: The Bird Flu Pandemic
 

Long article in a Pediatric journal about flu preparedness in North Carolina. Also, my wife sits on the Pediatrics committee that advocates for preparing for these things in NC.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
If that scenario really happened, the effects of the ensuing panic would be a lot worse than the effects of 2% of the population dying.

[/ QUOTE ]

A lot worse than the deaths of 5 million people in the US?

Re: The Bird Flu Pandemic
 

[ QUOTE ]
[ QUOTE ]
If that scenario really happened, the effects of the ensuing panic would be a lot worse than the effects of 2% of the population dying.

[/ QUOTE ]

A lot worse than the deaths of 5 million people in the US?

[/ QUOTE ]

absolutely.

Re: The Bird Flu Pandemic
 

Yea, these stats are all scary, but the real reason we have heard so much about bird flu: the [censored] 24 hour news channels that need to fill up space, so they find "potential" threats like this and pump them up as much as they can. No one is going to call them on it either if they are wrong or wildly inaccurate, they'll just keep watching and worrying.

Bird flu might be a problem someday, but I have no worries for this or the next couple years. Hopefully by the time it actually is a threat they have a better plan than whats in place now.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
Please forgive my ignorance, but know very little about this (except that you have now scared the living [censored] out of me) -

1) Ventilator - very expensive? who produces them? how long to mass produce? ventilation does what now for an infected patient? Can not self ventilate due to being too sick?

2) SARs vs. Bird Flu - What is the current level of human-to-human infection? Is there research to suggest that this is becoming more virulent and possible?

[/ QUOTE ]


I believe ventilators cost several thosuand dollars, but it would depend on the model. There is no stockpile. Production capacity would not meet the demand. However, there will likely be enough Ambu bags and oxygen bottles.

Healthy people's immune systems can respond so vigorously to the flu virus that healthy adults can drown in their own fluids: essentially the lungs fill with reactive inflammation. Ventilation increases the oxygen being delivered into the blood stream by (1) using oxygen instead of air and (2) using pressure to force air into the lungs (vs suction, which is what you use when you breathe in). There's more to it, but other docs on the forum would give you better answers.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
SARS was a relatively new disease and simply did not acquire major transfection factors. The odds were in our favor.

Flu has a much better track record for pandemics. However, the odds for this year are still well in our favor. Remember, if it does not acquire good human-to-human transmissibility, you do not get a pandemic.

[/ QUOTE ]

I agree with you. I just think too many people are panicking when this thing has not mutated to human on human.

I think the scientific breakthroughs in medicine over the past 50 years along with increasing worldwide sanitation is something that is downplayed too often. These are two of the main reasons we have not a seen a pandemic similar to the Spanish flu of 90 years ago.

Wasn't swine flu supposed to kill millions in the mid-1970's? I think I even got vaccinated when I was 7 or 8. I just don't see a reason to get excited.

News has been slow lately so the press has to report something and this seems to be a story that will sell newspapers so they run with it.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
[ QUOTE ]
Then first question will be do you let those in vegetative states die in order to save healthy people, or do you sacrifice the healthy people and leave the vegetatives on the vents?

[/ QUOTE ]

Well this would be a clear violation of the Hippocratic Oath. As well as many other local laws. other than that, I have no input into the greater moral questions being asked. My first instinct is to say pulling dying people off respirators is wrong. I'm not a big 'the ends justify the means' kind of guy.

[/ QUOTE ]

I disagree. The Hippocratic Oath states first do no harm and is all nice comfy in conditions of abundant health care resources. In a flu pandemic, I feel battlefield medicine rules apply and triage is in order. Save as many lives as you can with what you have. There is moral debate that usually centers around doing vs not doing: e.g., the classic you are on a train that is going to run over disrupted tracks, derail and kill all 100 people aboard. You have the option to switch to a safe track, but a helpless child is tied to those tracks and would be killed by your action. What do you do?

Re: The Bird Flu Pandemic
 

[ QUOTE ]
However, there will likely be enough Ambu bags and oxygen bottles.


[/ QUOTE ]

Ambu bags? How long would you have to use an Ambu bag on someone? A week 24/7? Also, I assume whoever is using the Ambu bag would be at high risk of contracting the disease.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
[ QUOTE ]
Please forgive my ignorance, but know very little about this (except that you have now scared the living [censored] out of me) -

1) Ventilator - very expensive? who produces them? how long to mass produce? ventilation does what now for an infected patient? Can not self ventilate due to being too sick?



[/ QUOTE ]

I believe ventilators cost several thosuand dollars, but it would depend on the model. There is no stockpile. Production capacity would not meet the demand. However, there will likely be enough Ambu bags and oxygen bottles.

Healthy people's immune systems can respond so vigorously to the flu virus that healthy adults can drown in their own fluids: essentially the lungs fill with reactive inflammation. Ventilation increases the oxygen being delivered into the blood stream by (1) using oxygen instead of air and (2) using pressure to force air into the lungs (vs suction, which is what you use when you breathe in). There's more to it, but other docs on the forum would give you better answers.

[/ QUOTE ]

Thank you - very helpful.

Ambu bag + oxygen bottle may = the new gas face mask i'm thinking...

Re: The Bird Flu Pandemic
 

[ QUOTE ]
Matt,

Are you by chance a sales rep. for a ventilator company?

Swede

[/ QUOTE ]


lol no, but it's a good industry right now.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
[ QUOTE ]
Matt,

Are you by chance a sales rep. for a ventilator company?

Swede

[/ QUOTE ]


lol no, but it's a good industry right now.

[/ QUOTE ]

Especially since the run on duct tape seems to be losing its steam.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
Best current article on the real risk of bird flu.

Fuss and Feathers: Pandemic Panic over the Avian Flu

Summary. Yes, we should be worried and prepare. Anything with this much potential for death has to be paid attention to. But it proably won't happen this year. It may not happen for 30 years. Be alert, but keep perspective.

When in doubt, consult Michael Fumento for a rational evaluation of all things scientific.

[/ QUOTE ]


Fumento and I have said nothing different. Neither of us have assigned a probability the event will happen this year, save to agree it is >0.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
For instance, a significant number of dogs have tested positive for Trypanosoma cruzi from Georgia to Minnesota. There is no shortage of mosquitos in the US. Why the leap from dogs to humans is not made in the US but happens to occur in Mexico and South America never ceases to amaze me.

[/ QUOTE ]

I did not know that. Do you have a link?

My favorite is prarie dogs in California are rampant with the Black Death.

Re: The Bird Flu Pandemic
 

So if I'm a 2nd year medical student who will be starting rotations next year with a history of empeyema requiring a thoracotomy does this mean I should be worried?

I am so [censored].

Re: The Bird Flu Pandemic
 

This was originally posted by JaxUp over in Micro. It was from a newspaper running a story on Bird Flu.

http://i23.photobucket.com/albums/b366/jaxup/pigeon.jpg

Re: The Bird Flu Pandemic
 

sanitation here in the US might be great, but not in other countries...In China, people sleep with the chickens in their pen so that no one steals there chickens. That means they probably eat around them, possibley don't wash their hands after handleing the chickens...In Romainia, there was a quanrantine because all the birds had the virus...to get in or out of the city, you have to walk through a pond of disinfectant. when this old guy was walking through, he lets out a chicken from under his shirt that he was trying to sneak in...just stupid stuff like this is going to allow this virus to get out..not to mention that birds FLY all over the world...and this virus is different because humans don't have any immunity built up. most viruses are a mix between human and animal viruses...the avain flu crossed the human barrier intact, meaning that we havne't had time to built up immunity...
also, this virus starts with similar symptoms of the common flu...people aren't going to rush to the hospital to get treated, and therefore, are going to spread it around...
so no, it hasn't actually been transmitted from human to human, but there is a high chance that it will be able to...it's just a matter of time

Re: The Bird Flu Pandemic
 

[ QUOTE ]

When in doubt, consult Michael Fumento for a rational evaluation of all things scientific.

[/ QUOTE ]

I don't agree with this. He picks obviously flawed arguements made by ignorant people or complete idiots. This tactic makes it easy for him to seem like he's always right while only giving an incomplete answer. He never tackles the really tough questions that take hardcore research.

For instance his article on oilsands completely ignores what tar sand mining will do to the atmosphere. He doesn't mentioned the toxic lakes created by this process that will be larger than our own great lakes either. It paints a very rosy picture when it's really not that rosy at all.

Also, he's written almost a hundred articles on global warming but never mentions ITER, Richard Smalley, Mellilo, or any of the big name respected scientists. He only attacks the media.

Michael Fumento is for lightweights that don't know how to think critically.

Re: The Bird Flu Pandemic
 

I'm glad that your well-documented disease paranoia has a new way to express itself. You must be relieved! [img]/images/graemlins/smirk.gif[/img]

Re: The Bird Flu Pandemic
 

[ QUOTE ]
If that scenario really happened, the effects of the ensuing panic would be a lot worse than the effects of 2% of the population dying.

[/ QUOTE ]

What hard-to-predict things do you predict would happen?

Re: The Bird Flu Pandemic
 

[ QUOTE ]
I did not know that. Do you have a link?

[/ QUOTE ]

I worked for a global infectious disease unit for a while. So most of my information came from field researchers actually doing the work and journals passed out during lab meetings. I'll try and dig up some info. Cruzi is not the only bug that's like this though.

Here is an article about sero positive racoons in georgia.

http://www.bioone.org/bioone/?request=ge...5&page=1155

The indirect immunofluorescent antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA) were compared with blood culture for the detection of Trypanosoma cruzi infection in 83 raccoons (Procyon lotor) trapped in 4 counties of southeast Georgia.

...


Forty-five of 83 serum samples (54%) were positive for anti-T. cruzi antibodies with the ELISA, and 47 were IFAT positive (57%).

Re: The Bird Flu Pandemic
 

[ QUOTE ]
Yea, these stats are all scary, but the real reason we have heard so much about bird flu: the [censored] 24 hour news channels that need to fill up space, so they find "potential" threats like this and pump them up as much as they can. No one is going to call them on it either if they are wrong or wildly inaccurate, they'll just keep watching and worrying.

Bird flu might be a problem someday, but I have no worries for this or the next couple years. Hopefully by the time it actually is a threat they have a better plan than whats in place now.

[/ QUOTE ]

Good points. My guess is the true probability is a lot closer to you than to CNN.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
[ QUOTE ]
However, there will likely be enough Ambu bags and oxygen bottles.


[/ QUOTE ]

Ambu bags? How long would you have to use an Ambu bag on someone? A week 24/7? Also, I assume whoever is using the Ambu bag would be at high risk of contracting the disease.

[/ QUOTE ]


Yes and yes. Makes you think about your friends doesn't it?

Re: The Bird Flu Pandemic
 

[ QUOTE ]
[ QUOTE ]
If that scenario really happened, the effects of the ensuing panic would be a lot worse than the effects of 2% of the population dying.

[/ QUOTE ]

What hard-to-predict things do you predict would happen?

[/ QUOTE ]

I would guess the economy collapsing or at least being crippled for a few months would lead to many more deaths and hardship, especially in third-world countries.

Re: The Bird Flu Pandemic
 

[ QUOTE ]
So if I'm a 2nd year medical student who will be starting rotations next year with a history of empeyema requiring a thoracotomy does this mean I should be worried?

I am so [censored].

[/ QUOTE ]

Naw, you're in good shape. We should have a vaccine next year - or at least I hope so.

But you are [censored] anyway because you are going into medicine. ;-)

Re: The Bird Flu Pandemic
 

[ QUOTE ]

Yes and yes. Makes you think about your friends doesn't it?

[/ QUOTE ]

With an electric motor, some flexible tubing, and an ambu bag I'd make my own respirator. Seriously, there is no reason why a respirator should be expensive or in short supply. Yes they won't be as good as the uber expensive hospital ones are, and it might not have all of the electronic alarms and such, but I'd put good money on my ability to make one that was almost as reliable from parts obtained from home depo.