Bird Flu—Schmird Flu

We have been inundated in recent years with warnings against "emerging infections" that will carry off vast numbers of people. Some seem to take delight in the prospect and some even claim that we must stop global warming because malaria infections will increase. Of course, the worry du jour is pandemic bird flu. The feds have just released their plan to combat the disease should it strike, warning that it could kill 2 million Americans.

There is potentially very good news on the bird flu front--Vical, a California pharmaceutical company, may have come up with a universal flu vaccine. No more annual flu shots to keep ahead of the nasty newly mutated varieties of the virus that in a normal year kills about 30,000 Americans, and no more worries about a bird flu pandemic.

Oh, all right, the foregoing is a tad optimistic, but Vical's research points in the direction that treating infectious disease outbreaks is going to take in this century. Emerging infections will be stopped by ever more sophisticated diagnostics combined with rapidly produced vaccines or antibiotics and antivirals that will defeat infections before they can become epidemic. Of course, we are still vulnerable now, but by mid-century epidemics will be historical curiosities. Thus will human ingenuity knock the third of the Four Horsemen of the Apocalypse (Pestilence) from his saddle.

Comments

[Matt L]

Thus will human ingenuity knock the third of the Four Horsemen of the Apocalypse (Pestilence) from his saddle.

Cool. Only war, famine, and death left.

[D.A. Ridgely]

Sure, sure, but what will your opinion be 20 years from now?

(Sorry, couldn't resist.)

[Timothy]

Does anybody else remember how SARS was going to kill us all?

I thought not.

[fyodor]

Ron, if people stopped worrying the sky was about to fall, what would you do with yourself?

[the other Mark]

I can't believe you passed up such a golden opportunity for a Metallica reference. Booooooo! Booooooo! to you!

[Ron Bailey]

Two choices--(1) go back to school and become a molecular biologist or (2) move to the Virgin Islands and become a sailing captain. 🙂

[Phileleutherus Lipsiensus]

Of course, we are still vulnerable now, but by mid-century epidemics will be historical curiosities. Thus will human ingenuity knock the third of the Four Horsemen of the Apocalypse (Pestilence) from his saddle.

While I have no problem with such research, this seems overly optimistic. It seems to me that viruses, etc. will remain a chronic problem that we'll successfully manage over time.

[P Brooks]

"...if people stopped worrying the sky was about to fall...."

-This is dreadful, dreadful news. There are far too many people as it is. Overpopulation is KILLING THE PLANET!!!! Can't you see? It's madness- madness, I tell you.-

Have no fear.

[SR]

"Does anybody else remember how SARS was going to kill us all?"

No, no, it's the swine flu that's going to kill everybody.

[kwais]

"No, no, it's the swine flu that's going to kill everybody."

Dude, the cops are going to start a desease?

[sage +P]

Dude, the cops *are* a disease.

[Jennifer]

In a way I kind of feel sorry for the media in regards to stories like this. Sooner or later there will be a flu virus that mutates into something as horrible as the Spanish flu of 1918. But there's no way of knowing in advance when this will happen. So here's the media's choices: report each new flu and the possibility of it mutating, and then look like an ass when nothing happens; or ignore each new flu, and look like an ass in retrospect when you miss The Big One.

I'm not sure I share Bailey's optimism about epidemics being destined for the dustbin of history anytime soon. I recall reading about some health official back in the 1960s or so saying humanity could "close the book on infectious diseases," but of course then the germs started evolving resistance to antibiotics and other drugs. Even when the next wonder drug is invented, it will probably only stay wondrous for a couple of generations before the germs evolve again. The battle will never end, but with any luck we can at least always keep the upper hand.

[ESB]

What ever happened to the dreaded swine flu or the killer bees from Mexico?

[fyodor]

I recommend choice #2: move to the Virgin Islands and become a sailing captain

But then, why haven't you done that ALREADY?

But then, why haven't I done that already???

[Lisa the GP]

Hm.

Guys, you may not remember SARS, but public health departments do. SARS fizzled not because it wasn't a threat, but because interventions against it succeeded.

Flu, unlike SARS, is contagious before you show symptoms. This makes it much more difficult to contain. If H5N1 bird flu mutates to become as easily transmitted between people as H3N2 (the current seasonal flu), then we're hosed.

Vical's technology looks promising, but past experiments with vaccines against the M2 protein in flu wound up causing a hyper-reaction to some kinds of flu, similar to the Dengue Hemorrhagic fever that can occur when a person immune to one serotype catches one of the other Dengue serotypes. So we cannot yet be certain that the Vical technology will not cause problems. It may be years before adequate safety testing is completed; it would be bad to give everyone a shot and then find out that it makes a large number of them die upon exposure to *any* flu.

One of the mutations believed critical for human-human spread of H5N1 occurred in a case in Turkey, somewhere around the 180th patient. But this person had been identified by exposure to dead chickens before she became ill, and had been started on Tamiflu, so that strain had no chance to spread to other people. If you play with the statistics (nominal value of 0.5% of WHO-recognized human cases developing that mutation, 95% confidence range from >0 to 7.6%), you can estimate there's a 95% chance of that same mutation cropping up before case number 1240 worldwide. On average though, we'd expect to see 5 more instances of that mutation by the time we get to that many human cases.

Will we get to 1240 cases before the pandemic burns out in birds? Will we get lucky and see that mutation only once more, or will we have to contain it 5 or more times before that point? Is this indeed the critical mutation, or are others also needed? Only time will tell.

The risk is high enough that congress has already approved $3.5 billion dollars in handouts to big pharma to combat it (and none to local hospitals, who are being told they're on their own, are you surprised?) With that in mind I think it only prudent that everyone stock up so that if TSHTF, you have something to fall back on.

Even if this thing is no more deadly than seasonal flu, the equation of 40% absenteeism (due to nobody having immunity) + a just-in-time economy = some serious inconvenience if you don't plan ahead.

Besides, inflation's going to go through the roof with the gas price hike. Anything you buy and store now is gonna seem cheap in two months, so you might as well stuff your pantry. (Buy stuff that doesn't need power to store it; if the power goes out it could take a few days to restore with only 60% of the usual line-workers on hand, and whats in your freezer will melt.)

[Maurkov]

"...if people stopped worrying the sky was about to fall..."

The sky would fall. Major problems become historical curiosities because people work to fix them. People are disinclined to work on important, non-urgent issues (thank you Stephen Covey). No panic; no work.

[R C Dean]

I disagree, Maurkov. In my experience, people who are constantly in crisis mode tend to be tactical and reactive, and often wind up in strategic cul-de-sacs.

Its the people who don't get sucked into the fire brigades who accomplish the important, strategic tasks.

[B.P.]

So, I tried to make a funny about Bailey's ownership of Vical stock and Reason's infamous server spits a message at me about contacting the listed e-mail address with information about what I may have done wrong to make the server crap out. Talk about blaming the victim...

[anonymous]

dean--that's why if you want to make sure to screw over someone's life you just get others to keep attacking them about little unimportant stuff so they spend so much time stomping out the brushfires they can never reach their potential. Give them a ton of busywork and make sure they can never achieve.

[RC]

Don't you all see, we're screwed, as soon as the super virus comes along. All the current viruses will migrate to the rainforests and mutate together along with endangered rainforest plants to form Avian West Nile Severe Acute Resipiratory Syndrome Virus (AWNSARSV). Once the virus has been formed it will be carried by the killer bees and global warming mosquitos on an unstoppable march northward into the United States, which is of course the only country on the planet anyone cares about, infecting and killing everyone along the way. Then once it has eliminated the United States (you know, the good country) it will attach itself to giant squids mutated by our dumping of toxic waste and misuse of nuclear technology and destroy the rest of the world as we know it.

See, we are screwed and people just don't know it yet, because they're distracted by the pseudo-super-viruses (PSV's).

[Lisa the GP]

RC--you have a brilliant future in screenwriting. 😀

[Mr. F. Le Mur]

No more annual flu shots to keep ahead of the nasty newly mutated varieties of the virus that in a normal year kills about 30,000 Americans, and no more worries about a bird flu pandemic.

Never had any worries about it. Mean people like me never get sick and those stupid germs are too small to hurt anything except flimsy birds, and fewer birds crapping on my pickup is a good thing.

BTW and for real, flu kills only a few hundred people a year. Nearly all of those 30K+ deaths are from (non-flu) pneumonia; the CDC combines them into one category, then people omit the 'pneumonia' part. It rather like the feminist trick of saying things like "XX% of women were beaten half to death or got in a verbal argument," then later the "verbal" part is omitted.

[mediageek]

Oh, sure, Pestilence may retire on account of modern medicine, but he'll be replaced with Pollution, whose motorcycle leaks.

/shouldn't be too obscure for this crowd.

[wayne]

I was going to post something along the lines of, "there is valid reason to worry, flu viruses mutate rapidly and it would not be a big jump to get a bird flu strain that is transmissible by humans... blah, blah, blah"

This board is obviously much too sophisticated to believe such government babble though, so let's all just lick the ass of every sick bird we find and see what happens.

[perv]

I prefer to lick the asses of fit birds, so I will have to pass on sick birds.

[Les]

so let's all just lick the ass of every sick bird we find and see what happens.

I think you're the only one suggesting that. Arguments of unrealistic extremes aren't very constructive.

[Lisa the GP]

Mr. F. Le Mur,

I'm sorry, you are misinformed about the details of H5N1 bird flu.

It doesn't kill a few hundred people per year. It has killed just over 200 people since 2004, and that number is increasing. Prior to that it killed a few people in Hong Kong in 1997. Its ancestors prior to that time were not known to have infected humans.

The problem isn't how many it has killed so far, but the direction of change in that number. Last year it killed 41 people in 12 months. This year in 4 months it has killed 37 people.

People who die from ordinary flu often die from a secondary bacterial pneumonia. But the H5N1 bird flu kills by a different mechanism. By poorly understood means, it causes over-expression of TNF-alpha--the body's anti-tumor hormone. This misexpression causes the body to attack the lungs (and other organs) as if it were attacking a tumor, destroying the lungs without requiring the presence of any pathogen other than the virus itself.

Because this destruction acts via the body's immune system, those with the healthiest immune systems are among the most likely to die. So far, 50% of the cases have been under 25, 75% under 35, and 90% under 45 years old. This is a disease of, and killer of, young, healthy people.

[Lisa the GP]

Mr. F. Le Mur,

I'm sorry, you are misinformed about the details of H5N1 bird flu.

It doesn't kill a few hundred people per year. It has killed just over 200 people since 2004, and that number is increasing. Prior to that it killed a few people in Hong Kong in 1997. Its ancestors prior to that time were not known to have infected humans.

The problem isn't how many it has killed so far, but the direction of change in that number. Last year it killed 41 people in 12 months. This year in 4 months it has killed 37 people.

People who die from ordinary flu often die from a secondary bacterial pneumonia. But the H5N1 bird flu kills by a different mechanism. By poorly understood means, it causes over-expression of TNF-alpha--the body's anti-tumor hormone. This misexpression causes the body to attack the lungs (and other organs) as if it were attacking a tumor, destroying the lungs without requiring the presence of any pathogen other than the virus itself.

Because this destruction acts via the body's immune system, those with the healthiest immune systems are among the most likely to die. So far, 50% of the cases have been under 25, 75% under 35, and 90% under 45 years old. This is a disease of, and killer of, young, healthy people.

A similar age distribution was seen in the 1918 H1N1 Spanish Flu, but we don't have enough tissue samples to verify that the same mechanism was in play in that pandemic.

[The Best Bird Flu Blogs team.]

We have today added the "Bird Flu--Schmird Flu" entry of your blog, to the "Best Bird Flu Blogs:.." section of our web site: http://www.birdflubreakingnews.com .

This is the SECOND entry with thae heading of "Bird Flu--Schmird Flu" today!

hmmmmm

Your entry certainly seems to have resulted in a lively discussion!

Thank you for this and we hope that we will have many further contributions from you.

The Best Bird Flu Blogs team.

http://www.birdflubreakingnews.com

[Dave W.]

I hope the government negotiated us, the taxpaying, medicinecraving public, a good patent license last time they gave Vical one of those big grants. Sometimes they forget to do that and the medicine is very expensive for the consumers and their insurers.

[Mr. F. Le Mur]

I'm sorry, you are misinformed about the details of H5N1 bird flu.
I was talking about all influenza deaths in the US, not bird flu.

A la:
"Are US flu death figures more PR than science?"
http://bmj.bmjjournals.com/cgi/content/full/331/7529/1412?ijkey=FXyhZx2lyNbaVLE&keytype=ref
The CDC website states what has become commonly accepted and widely reported in the lay and scientific press: annually "about 36 000 [Americans] die from flu" (www.cdc.gov/flu/about/disease.htm) and "influenza/pneumonia" is the seventh leading cause of death in the United States (www.cdc.gov/nchs/fastats/lcod.htm). But why are flu and pneumonia bundled together? Is the relationship so strong or unique to warrant characterising them as a single cause of death?
CDC's model calculated an average annual 36 155 deaths from influenza associated underlying respiratory and circulatory causes (JAMA 2003;289: 179-86[Abstract/Free Full Text]). Less than a quarter of these (8097) were described as flu or flu associated underlying pneumonia deaths. Thus the much publicised figure of 36 000 is not an estimate of yearly flu deaths, as widely reported in both the lay and scientific press, but an estimate-generated by a model-of flu-associated death.

QED.

Conspiracy types claim that the CDC grossly inflates the number of flu deaths as part of an ad campaign for flu vaccines.

[Mr. F. Le Mur]

A couple more tidbits from BMJ (same URL):

Yet this stance is incompatible with the CDC assertion that the flu kills 36 000 people a year-a misrepresentation that is yet to be publicly corrected.

Yet this bill obscures the fact that CDC is already working in manufacturers' interest by conducting campaigns to increase flu vaccination.

If flu is in fact not a major cause of death, this public relations approach is surely exaggerated.

Perhaps the people at BMJ wear tinfoil helmets, or perhaps Ron Bailey fell for CDC's phony flu statistics.

[Lisa the GP]

Thank you for the clarification Mr. F. Le Mur.

[Thomas Paine's Goiter]

It doesn't kill a few hundred people per year. It has killed just over 200 people since 2004, and that number is increasing.

200 people / 2 years = 100 people per year.

He overestimated.

[Mr. F. Le Mur]

He overestimated.

Underestimated, apparently. Though my 'IIRC' guess of 400/year was off by 3X, the CDC is off by about 30X:
http://bmj.bmjjournals.com/cgi/eletters/331/7529/1412#126859
(just under 1200 deaths/year from flu in the US in the 1990s; CDC claims over 35,000)

[SR]

"Oh, sure, Pestilence may retire on account of modern medicine, but he'll be replaced with Pollution, whose motorcycle leaks."

Of course the thing that's odd about that discussion in the book is that (a) the other Horsemen comment that Pestilence wouldn't have retired if he'd known the Apocalypse was coming; but (b) Aziraphel and Crowley knew that the world would end in 1996. Why were the Horsemen ignorant of the specific date if a lesser angel and demon knew?

[Jake Boone]

The Horsemen weren't the detail people. That's what the lesser peons were for, after all; to worry about specific dates and such. In fact, the Horsemen don't even read newspapers, I hear, and prefer to get their news from their advisors... no, wait. I think I'm confusing them with someone else.

[Dentistry Roseville]

Studies done in laboratories suggest that the prescription medicines approved for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to determine the effectiveness of these medicines.