On Borrowed Time

It was a fictional weblog that got me interested in avian flu.

Its imaginative putting me in the place where a pandemic is happening, telling me a story in other words, made me begin to grasp the seriousness and the likelihood of a global flu pandemic in the next few years.

Like most other people, I'm the victim of my own experience. Never having suffered a public pandemic, it's hard to imagine one. Never having experienced public panic or a breakdown of essential services, it's hard to imagine them. Somehow, I expect that all the wonders of our modern age from medicines to the Internet to an abundant supply of food, will continue without interruption forever into the future. I fancy myself a student of history, so you would think I'd know better.

Didn't the 9/11 Commission point to a "failure of imagination" as a principal reason that kept US officials from understanding the al Qaeda threat?

I think we are at a similar point now.

Have you heard anyone in the Centers for Disease Control talk about this? Maybe they are ashamed about their obesity fiasco. You remember that or do you? In 1999, the CDC director said obesity was epidemic in the United States, accounting for more than 300,000 deaths a year. Last year in a widely publicized study , the CDC upped obesity-related deaths to 400,000 until the figures were exploded as the whoppers they were. A embarrassing comedown for the CDC who had to admit only 25, 815 obesity deaths. Nevermind

It took a magazine, not a government agency, to alert me. And they did it with a story and a weblog.

Nature magazine is devoting its current issue to highlight progress and "incoherence in the world's response to a potential human pandemic."

From its editorial

Millions of people killed in highly developed countries within months. Tens of millions worldwide. The global economy in tatters. A Hollywood fantasy? No — it's now a plausible scenario. The first act, the spread of avian flu to, and probably between, humans, has already started across Asia. Unless the international community now moves decisively to mitigate this pandemic threat, we will in all probability pay heavily within a few years. Then, hard questions will be asked as to why we were not prepared.

Sceptics abound, convinced that talk of a pandemic must be scare-mongering, or scientists crying wolf. Surely with support care, drugs and vaccines, at least the rich world can easily stand up to a flu virus? After all, this is 2005, not 1918, when a flu pandemic killed up to 50 million people worldwide. But while the science and medicine of flu have advanced substantially, our ability to mount an effective public-health response has made remarkably little progress over the decades, and the potential for panic is, if anything, greater given the impact of television and the Internet.
...........................
The time for diplomacy and denial is over. It is time for advocacy and action.

The avian viruses in Asia are evolving: they've jumped the species barrier to infect pigs in Indonesia and human-to-human transmission may well have occurred. According to World Health Organization earlier this month, the H5N1 viruses "are continuing to evolve and present a continuing and potentially growing pandemic threat."

I'm in no way qualified to assess this threat, so I went to Effect Measure whose editors are senior public health scientists and practitioners who write anonymously and link to all the blogs writing on avian flu. They call the conclusion of the WHO report "chilling"

Evolution of a pandemic strain of virus may be preceded by numerous small steps, none of which is sufficient to signal clearly that a pandemic is about to start. This poses a difficult public health dilemma. If public health authorities move too soon, then unnecessary and costly actions may be taken. However, if action is delayed until there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop, then it most likely will be too late to implement effective . . . responses."

WHO is openly admitting that everyone is unprepared.

"We are working on pandemic preparedness on borrowed time," the WHO's top influenza official, Klaus Stohr, told the meeting, reiterating that conservative estimates indicated that up to 7.4 million people might die.

"The objective of pandemic preparedness can only be damage control. There will be death and destruction."

"National pandemic response plans are the key," he said.

If millions of lives could be lost, if state and local governments don't know what to do, why in God's name has the CDC been more concerned about obesity and even getting that wrong. Not until this week did the CDC Director Julie Gerberding say

Even a "medium level pandemic" in the United States could result in 89,000-207,000 deaths and up to 734,000 people people being hospitalised...... According to Gerberding, between 15 percent and 35 percent of the US population would be affected by a flu pandemic and the cost to the US economy would be between 71 billion and 166 billion dollars.

The US has only a draft pandemic response plan, and has ordered only 2.3 million doses of Tamiflu, the only antiviral medication that seems to work.

It's Decisive Inaction.

The US pandemic influenza plan, in the works for five years and in only in draft form since last August will be completed in final form "by the end of the summer."
Marcia Cross, the [the Government Accountability Office's] director for health care, told lawmakers that federal officials have yet to determine what role the federal government will take in purchasing supplies of vaccine against bird flu and other flu strains. The government has also not cemented which population groups would be priorities for emergency vaccination in the event of an outbreak or finalized plans for possible quarantines or travel restrictions.

The delay has left state health departments unable to properly plan for flu emergencies, she says. (Via WebMD).

If there is a pandemic, it will be everywhere.
The scene of the disaster will be everywhere.
Everywhere is local. All the battles will be fought on the local level.

So, if the government is not prepared, what can ordinary people and businesses do to prepare? What will happen when 25% of the workforce gets sick

Effect Measure has begun a Pandemic "To-Do" list which I hope they make it a public wiki.

1. Rationing. Who gets what first? Who gets what at all? Who secures scarce supplies?

2. Care-giving. There are simply not enough hospital beds. There are not enough nurses. There are not enough caskets.
Time NOW to offer minimal nursing training for volunteers and a way to keep track of them. One commenter said many died needlessly in 1918-1920 from lack of hydration and nourishment.

3. Emergency equipment
and I'll add

4. Emergency plans to carry on essential services like water, electricity, fuel, banking and food supply. It's time for businesses to review their emergency contingency plans as well as their business continuity plans NOW. Time NOW to establish policies for people working at home and the means for them to do so. Time NOW to introduce Wikis to capture the knowledge necessary to keep businesses going. Time NOW to prepare crisis management blogs. Time NOW for people to assess their own personal and family preparedness.

If you need more to break out of your complacency, read Canada Sue's imaginings of what would happen in her hometown of 100,000.