H5N1 Pandemic: What Are We Looking For ?

I don't have the answers to that question but I hope with your help we can build up a picture that will give us all an indication of the signs to look out for.

* Currently some cases of H5N1 are turning up in Indonesia without any identifiable link with human to bird contact meaning that some low level human to human infection is possibly taking place.

* A possible next indication that an pandemic is close would be a cluster of cases in the absence of other animal contact. Quite likely in a hospital or perhaps a school.

* A hospital in Indonesia begins strict quarentine procedures.

* Other clusters are reported.

* Some countries impose travel restrictions on people moving from the restricted country. Travel advisories suggest not travelling to Indonesia (if this is the country it starts in.)

* Other cases and then clusters are reported in neighbouring Asian countries.

* Travel restrictions and advisories are extended. Hospitals around the world revise procedures in preparation for a Pandemic.

* Essential key workers in emergency services and government begin a process of vaccination.

* Cases then clusters start to appear around the world. Modern travel means that normal patterns of pandemic spread can be virtually ignored.

* Panic buying of food stocks and bottled water begin. People start to stay away from work. Danger of civil unrest.

* State of Emergency / Marshal law / Restrictions on freedoms of movement (however you want to dress it up) is declared.

Pandemic

Anyone think there are steps that I've missed out or who think that any of the steps I've mentioned are unlikely please say so.

[edit on 26-9-2005 by John bull 1]

Only 3 areas I would differ in:

I'm not sure you would see the initial cluster in a hospital. Likely initial reports would identify a certain area or province or worst case scenario, a poor area of Jakarta

Your spot on with reports of non animal contact would be a huge "WARNING" sign esp. if they are reporting 100's of cases.

I think that while neighboring Asian countries in that scenario would show cases, you also have to include ANY major travel city in the world as a potential site for clusters. Out of curiosity, I went to Orbitz and the number of daily flights that start in Jakarta and end up on the west coast of North America are staggering. So you may see clusters in alot of places at the same time. This would be the sign I would look for IMHO. This is an indicator that things will be bad.

* Essential key workers in emergency services and government begin a process of vaccination.

4-8 months depending on what book you read for the development of a vaccine for whatever strain of H5N1 makes this jump. Tamiflu may have an effect, but it may not.

At the first sign of an area with an outbreak, the government needs to be on the spot and quarantine the area.

If not, then as the hospitals become overwhelmed people including staff WILL leave. This will also occur during the panic buying of emergency supplies.

But the key event to look for IMHO will be the reports of 100's and thousands of cases that appear to have human to human transmission

However if these occur in China, given thier total lack of responsibility they exhibited during the SARS outbreak, the virus may have already spread before any attempt at guaranteed has been made :shk:

Likely initial reports would identify a certain area or province or worst case scenario, a poor area of Jakarta

The big problem with using this as a marker is that it is very difficult to distinguish this from Bird to Human contact. There is already a small cluster in a poor area of Jakarta (as we speak) but because these poor areas have so many poutry running free it is difficult to say is it's any different.

I think that while neighboring Asian countries in that scenario would show cases, you also have to include ANY major travel city in the world as a potential site for clusters. Out of curiosity, I went to Orbitz and the number of daily flights that start in Jakarta and end up on the west coast of North America are staggering. So you may see clusters in alot of places at the same time. This would be the sign I would look for IMHO. This is an indicator that things will be bad.

I think you're right on this one. It could spread very quickly without warning.

I think our best indicators of the situation will be how governments around the world react. You're right about a vaccination but when emergency staff are given anti-virals then that is a big pointer of an impending pandemic.

I think by the time 1000s of cases have been identified it'll be too late. In the event of 1000s of human to human infections coming to light it will no longer be a national or regional problem but global.

Allow me to ask perhaps the dumbest question in this forum, but what does H5N1 stand for? Looks like a chemical equation or some acronym.

Originally posted by therainmaker
Allow me to ask perhaps the dumbest question in this forum, but what does H5N1 stand for? Looks like a chemical equation or some acronym.

Not a dumb question at all. I have been too busy to start an thread on this very subject but its a way of classifing the virus based on the antigens it shows on its surface

Influenza A viruses are classified into subtypes (hemagglutinin and neuraminidase subtypes) based on antigenic differences in their surface glycoproteins (1). Of 15 identified hemagglutinin (H1–H15) and 9 neuraminidase subtypes (N1–N9), only 3 hemagglutinin subtypes (H1, H2, and H3) and 2 neuraminidase subtypes (N1 and N2) have established stable lineages in humans (1). Because the natural reservoir of known influenza A subtypes is found in birds and waterfowl (2), subtypes other than those typically found in humans have the potential to cross the species barrier and infect humans (3).

Avian influenza A virus H9N2 was isolated from two children in Hong Kong in 1999, and avian influenza H7N7 infected 89 persons during a simultaneous outbreak in poultry in the Netherlands in 2003 (4–7), although these infections resulted in only mild illnesses. The first outbreak of a highly pathogenic avian influenza (H5N1) in humans occurred in Hong Kong in 1997; 6 of 18 people with confirmed infection died (5,8). Despite attempts to prevent disease, two cases of influenza A H5N1 occurred in Hong Kong in February 2003 (1), followed by outbreaks in Vietnam and Thailand in January 2004 (9,10). Data are limited on the epidemiologic characteristics, signs and symptoms, and outcomes of avian influenza H5N1 exposure in healthcare workers. We report atypical avian influenza H5N1 and follow-up surveillance of 35 exposed healthcare workers; we also review relevant literature in this area.
www.cdc.gov...

[edit on 9/26/05 by FredT]

This is something I posted back in Febuary.

I hope it helps.

www.abovetopsecret.com...

Originally posted by FredT

I think that while neighboring Asian countries in that scenario would show cases, you also have to include ANY major travel city in the world as a potential site for clusters. Out of curiosity, I went to Orbitz and the number of daily flights that start in Jakarta and end up on the west coast of North America are staggering. So you may see clusters in alot of places at the same time. This would be the sign I would look for IMHO. This is an indicator that things will be bad.

I think this is a major fear as when the Spanish Flu hit in 1918 (I think it was?) The pandemic spread fast and that was without the airlines we have now and without people traveling at the rate we take for granted now. So the transmission that took weeks or months then will happen in days now.

This is my take on it but I admit I am not a scientist or highly educated so it is probably really simplistic. So if I am wrong please tell me.

Out of curiosity, I went to Orbitz and the number of daily flights that start in Jakarta and end up on the west coast of North America are staggering

Wanna hear something even scarier? Of those flights in and out of the US to Jakarta, how many people visited between the dates of Sept 19 - 23rd? Of those how many visited the Jakarta Zoo that they recently closed down?

We are seeing many people flood the hospitals in Jakarta because they visited the zoo and those people are exhibiting symptoms of the flu. How many of those were Americans that have since flown back to the US and are just now exhibiting symptoms?
Because the mode of transmission has not been determined we would have no reason to believe that perhaps it has already come into our country. Or has it?

Thanks FredT...veeeeeeeeeery interesting indeed!

John bull 1

For what it's worth, here are my thoughts...

* Currently some cases of H5N1 are turning up in Indonesia without any identifiable link with human to bird contact meaning that some low level human to human infection is possibly taking place.

Check. This, of course, appears to already be happening.

* A possible next indication that an pandemic is close would be a cluster of cases in the absence of other animal contact. Quite likely in a hospital or perhaps a school.

Check. Appears to already be happening. See here.

* A hospital in Indonesia begins strict quarentine procedures.

My sense is that this will not happen until WAY later. Indonesia looks to have poorly coordinated their response to H5N1 and I sincerely doubt they will anytime soon. Your next event will happen first. See here.

* Other clusters are reported.

Check. Appears to already be happening.

* Some countries impose travel restrictions on people moving from the restricted country. Travel advisories suggest not travelling to Indonesia (if this is the country it starts in.)

Much later.... Remember these countries appear to either be negligently reporting the status of H5N1 in their countries or willfuly doing so. Moreover, my sense is that it will explode in a very short period of time in several countries. I think Europe will record the first western cluster, before the US. My bet is the UK and France who have substantial buisness contacts in the affected Asian region.

* Other cases and then clusters are reported in neighbouring Asian countries.

See comment above.

* Travel restrictions and advisories are extended. Hospitals around the world revise procedures in preparation for a Pandemic.

This is when there will be a MSM explosion.

* Essential key workers in emergency services and government begin a process of vaccination.

Of themselves, but not of the general populous. The math just doesn't work for this one. Moreover, there is some question whether a vaccine is even possible for more than six months at best! BY then this thing will be well out of control.

* Cases then clusters start to appear around the world. Modern travel means that normal patterns of pandemic spread can be virtually ignored.

My guess is within one to two weeks of travel restrictions and advisories being implemented. Of course, it will be too late.

* Panic buying of food stocks and bottled water begin. People start to stay away from work. Danger of civil unrest.

Only locally, at first, in affected cluster areas. Then as new clusters develop within Europe or the US, 4-6 weeks, you will see this behavior in non-cluster areas.

* State of Emergency / Marshal law / Restrictions on freedoms of movement (however you want to dress it up) is declared.

Yup, but not all at once. Infected cluster areas will be quaranteed- no highway or air travel... Will look a lot like Berlin after the War. Supplies will be brought in by the military. If clusters develop outside quaranteend areas, then national air travel will be restricted for non-essential business. Look in the US for possible nationalization of the airlines. International travel will be halted. We will pull the majority of foreign deployed military resources to secure domestic enforcement.

Thoughts?


[edit on 27-9-2005 by loam]

Originally posted by DDay
Wanna hear something even scarier? Of those flights in and out of the US to Jakarta, how many people visited between the dates of Sept 19 - 23rd? Of those how many visited the Jakarta Zoo that they recently closed down?

It think the incubation period is around 6 to 10 days before respiratory problems occur and people realise it's not just a normal flu. That puts us at Sept 25 to October 3.

Loam posted this in another thread and it speaks volumes:


How does that fit into the scenario? Is this an advanced stage?
.

It spooks me out every time I see that map!

It's worse than a horror movie.

What is surprising to me about that map is the amount of human cases in India, Pakistan, and Bangladesh. Very good map.

One trouble with it is though it's easy to see the geographical spread of infection it's hard to see any rate of increase in infection with a map like that. It would be easier if there were a graph.

Thanks for the comments Loam.

Can you or anyone else think of any other pandemic indicators or markers ? Most of these from here on in with be governmental or intergovernmental responses.

I seem to remember that during SARS some governments made medical inspections (temperature) of passengers before departure and on arrival. That may be one to look out for.



[edit on 27-9-2005 by John bull 1]

It might be worth looking more closely at what was done during the 1918 Pandemic. That would serve as a foundation for expected government action. No?

I'll see what I can dig up.

[edit on 27-9-2005 by loam]

I've just heard reports that local Toronto hospitols are taking this threat very seriously. They are encoraging everyone to get their normal flu shots so that it will free up beds for the H5N1 patients when they arrive. Authorities used the word Pandemic a number of times so they are taking this seriously. How goes preparations down south?

Originally posted by sardion2000
How goes preparations down south?

I have no idea. Frankly, I've only been following this issue for a little more than two weeks. Of course, now that I know, anyone I speak to about this seems to be in the dark like I was. I HATE that blank stare I get when I mention "bird flu". Drives me crazy!

[edit on 27-9-2005 by loam]

Originally posted by loam

Originally posted by sardion2000
How goes preparations down south?

I have no idea. Frankly, I've only been following this issue for a little more than two weeks. Of course, now that I know, anyone I speak to about this seems to be in the dark like I was. I HATE that blank stare I get when I mention "bird flu". Drives me crazy!

[edit on 27-9-2005 by loam]

Well Toronto got hit hard by Sars so we're a bit on the ball on this stuff as it affected our economy
quite severely(you remember SARSStock? Rolling Stones, AC/DC and a bunch of others did a relief
concert for my city ) In some places where flu pandemics havn't happened in a while
I would expect lots of blank stares what with our Short Memory and all....

After seeing a green lorikeet type bird flying with a flock of native Philadelphian birds, I can only speculate, that we may get hit next. Were starting to approach flu and cold season already. I just wish I knew what to look for. It was amazing the amount of dead crows last year here.

Originally posted by loam
It might be worth looking more closely at what was done during the 1918 Pandemic. That would serve as a foundation for expected government action. No?

I'll see what I can dig up.

Honestly, for a number of reasons I doubt you can draw up any comparisons that will help in this case except in the way that hospitals got clogged up.

Communication, travel, advancements in medical knowledge and the small matter of the First World War would make it virtually impossible to draw helpful comparisons. I doubt the initial progress of the 1918 flu epidemic is even recorded.

That map is a supposition of what they spread could look like. Also consider how many cases to date have not been reported or have been underreported.
Then there is also the situation where in Indonesia they are misdiagnosing patients with Dengue fever which is very similar to flu symptoms.

The scenerio I painted just lends credibility to the fact of how easy it can get into the country without anyone being the wiser. In the US, the flu season kicks off in Oct so how many cases of flu are going to sprout up and of those which are going to be the deadly N5N1?

John Bull you mentioned that the gov can take temperatures of passengers going in and out of the airport. While yes that is true, it has also been mentioned that with SARS the patients showed a fever right away and it was dectectable on the radar so to speak. With the flu, passengers will be asymptomatic for up to 3 days before exhibiting symptoms however, remain in the most contagious stages before onset of fever. They wouldn't show up on the radar with a fever at that stage.