Preparing for the Flu Pandemic

Sometimes getting media attention is more a curse than a blessing. There is a ton of misinformation out there about the flu, and what to do about it, and the media, by dealing with the issue piecemeal, is contributing to the confusion, inappropriate reactions, and misdirected fear, rather than helping the situation.

Lets start with what not to do about the flu:

  • Don’t panic about the unavailability of vaccine: The vaccine out there is for established influenza viruses, not for those that haven’t (yet) evolved into pandemic strains. Get a flu shot if you’re at risk from these established strains, but otherwise don’t get stressed if there isn’t enough.
  • Don’t assume the risk of pandemic is all media hype: History is punctuated with flu epidemics, and there is no current or foreseeable science that will prevent this from continuing. We’re overdue for a big one. The chances of a flu pandemic in any year varies from about 3% to 10%. It’s rare for any generation to completely escape one. That hasn’t changed — recent science has not equipped us to reduce the risk or severity of flu pandemics..
  • Don’t blame the birds: The current poultry flu, the H5N1 strain, does not easily pass from poultry to humans. It spreads from poultry flock to poultry flock, due to (a) the increasingly few different breeds of poultry raised around the world (b) the horrific concentration of farmed poultry, and (c) the high volume of international trade in poultry. These dangerous farming practices mean that poultry flu outbreaks are virtually inevitable and spread like wildfire. As a result, the massive slaughter of poultry is becoming almost routine. Quarantining poultry flocks is pretty futile — there are too many flocks and too much trade to hope that we can hermetically seal off an infected flock from the rest of the world. Although some migratory birds can carry the disease,there is no evidence that non-poultry birds have played any significant role in the spread of poultry flu around the world. The market has done this. And flu is a very adaptable virus — it can mutate to be able to jump from one overcrowded species (poultry) to another (humans). But this happens very rarely, so there is no reason to get paranoid about contact with birds, or even, if that is your preference, from continuing to eat poultry worry-free. And if a mutation of the poultry H5N1 jumps to humans, then the problem has nothing to do anymore with chickens — the pandemic will spread simply and very quickly person to person. Or an existing human flu variant may mutate to make it immune to our vaccines, so the pandemic may well be entirely ‘man-made’. And we can’t “cull” human herds to stop the spread, so it will likely spread faster among humans than among poultry.
  • Don’t believe muddle-headed politicians who say that the government is taking care of the problem and there is nothing they as individuals need to do or worry about. Especially presidents of countries who have already shown they are utterly unprepared for and incapable of handling disasters.

OK, some basic facts about influenza:

  • H5N1 is a scientific description of a strain of influenzas.This strain is very virulent (high death rate), but currently does not spread from human to human, or from other species to humans, as effectively as other flu strains. But since viruses are so opportunistic (mutate in multiple ways so that the more successful mutations evolve to replace less successful ones), it’s almost inevitable that some mutation of H5N1 or of another influenza strain will emerge that is more transmissable, and that’s when the pandemic will occur. That’s will, not might.
  • Tamiflu and Relenza anti-virals are not vaccines or super-vaccines. If taken regularly they can stave off the effects of a variety of viruses. But they are far from a panacea, and not nearly as effective as a vaccine targeted to a specific flu variant. And the stockpiles that would be needed to equip an entire population are astronomical, so they will only be useful for front-line emergency workers and already-infected patients, as a supplement to other procedures to try to limit the spread of a pandemic. And there is evidence that the latest flu strains could be resistant to Tamiflu.
  • The current ‘business’ of vaccine research and manufacture is archaic and risky. We are beginning to realize this, and improved methods, much more public funding of research, manufacture and distribution of vaccines will eventually improve this. But this will take decades. And there is no way to know whether vaccine technology will ever be able to catch up to the astonishing ability of viruses to mutate opportunistically. So drugs (anti-virals + vaccines) are not the answer. 

So what should we do?

  • On a global, national and local basis, we need to develop contingency plans for worst-case scenarios of flu pandemic — coordinated plans for what governments, authorities, companies and individuals will do when a pandemic hits. We need to learn the lessons of Katrina and of history — especially the H1N1 1918 flu pandemic (which did not stem from birds). Those contingency plans include preparing for provision of food, clean water, medicines and heat and other essential supplies to people to keep civil society operating when the economic infrastructure temporarily collapses. They include providing a level of emergency security that was so pathetically absent after Katrina — and that doesn’t mean sending in untrained, unprepared, clueless military recruits. They include designating delivery people as essential (immunized) workers — instead of us all going out for what we need, if these immunized workers bring it to our homes, the risk of spread is drastically reduced. They include identifying and mobilizing people who are found to have a natural immunity to the influenza (even though we won’t know how many or who these will be in advance). And at every level — right down to the local school, hospital, municipal fire and police and municipal planning department — these contingencies plans need to be put in place ready to launch on short notice. And it means establishing a degree of coordination and open, honest communication between governments that today is non-existent and which, for cultural reasons, will not come easily,
  • On a global level, we need to help third world countries be prepared to handle a pandemic as well as we do. Pandemics respect no borders, and it is almost fruitless to prepare some countries and not others. This is a lesson some “build a wall” advocates seem incapable of learning. Would we be willing to give our stockpiles of anti-virals to a poor nation infected with H5N1, to try to ring in the infection there before it can spread to us? Don’t bet on it.
  • We need to accept that a pandemic is very likely, sooner or later, and that its death toll is likely to be high (anywhere from 5 to 150 million is probably not a bad guess), and that the death toll will be mostly a function of the virulence of the strain, not on anything we do to prevent or try to stem its spread. So let’s say what the politicians won’t: There will be another flu pandemic, and millions are going to die. Our preparedness won’t significantly change that, but it will help us cope with the fallout from that massive death toll, possibly preventing riots, civil strife, wars, and collapse of our economic and health care systems. That alone makes it worth being prepared, even if it doesn’t save a single life.
  • At a personal level: (This is what you were looking for, right?) 
    • We need to ensure we follow and teach others basic hand-washing, cough- and sneeze-covering (with tissues, by wearing a mask when sick, or if necessary using our sleeve rather than our hands) and other hygiene. This needs to be reinforced with signage, and automated no-touch restroom hygiene in public places. 
    • We need to think, at our workplaces, about how we will keep things running when absenteeism suddenly soars to 20% — or 70%.  
    • We need to think about switching work to home, and school attendance to home schooling or ‘virtual’ schooling.
    • We need to think about what we will do if we are infected but don’t contract the disease — because that natural immunity makes us a very valuable commodity, and perhaps imposes a personal responsibility on us to get out and do volunteer work during the pandemic that we might otherwise not do. 
    • We need to learn, and decide, what to do if a loved one becomes ill when we are not.
    • We need to have a list of essentials to stockpile now, or at the very first sign of an outbreak. 
    • We need to appreciate that if a pandemic occurs, it will become global quickly, and if it hits us, for the most part we will be on our own. No emergency help will rush in — it will be far too late for that. Once it starts, at best our area will be quarantined, at worst completely ignored. And pandemics occur in waves before they subside, so surviving a first infection may not be the end of it — we need to be prepared for the long haul.
    • We need to become involved in bottom-up community preparedness programs, ensuring that our local authorities are as ready as we are.

Feel better now?

Thanks to all the writers of level-headed and useful material on this subject, such as WHO, HHS, various science journals and especially Peter Sandman’s wonderful article on preparedness, for the information summarized above.

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16 Responses to Preparing for the Flu Pandemic

  1. Yule Heibel says:

    Dave, have you checked out the Flu Wiki yet? Did you find it useful?

  2. Dear Dave,Thank you for sifting through and clarifying a great deal of information, and for offering it in a form that’s absorbable. Thank you too for the link to Peter Sandman’s article, which I’ll be forwarding to many colleagues (I’m a naturopathic dr/acupuncturist, working with family practic MDs and a variety of other kinds of health care practitioners and students).I do feel better now! Because I know that you have a large number of readers who are very thoughtful and smart, and when their minds are made up are willing to put their convictions into action.Dear Yule:I like the fluwikie website–lots of information on the science and history of influenza as well as ideas on community and individual preparedness.

  3. Beautifully written. Thank you.How can we persuade people to wear masks when sick? Right now I can’t even buy sneeze masks at Walgreens (in fact, I’m not sure where I can buy them at retail — medical supply stores?), and if I walk around wearing one, people will think I’m insane. This could be a very effective means of slowing the spread of respiratory illness, but it seems that a lot of effort will be required to establish it, even in the US — let alone the kind of countries where laws of any kind are mostly objects of jokes.

  4. Doug Alder says:

    Dave with the recent news that the genetic code for the H1N1 (1918 Flu virus) had been successfully sequenced it was apparant to those researchers that it was a bird flu that migrated to humans. The Science Daily article you point to is 3 years out of date.From“analysis of the final three pieces of the virus’ genetic code has revealed mutations that have striking similarities to those found in flu viruses found only in birds, such as the H5N1 strain currently found in south east Asia.”

  5. feithy says:

    Thank you for this, Dave. Hey! Were your ears burning yesterday? I was talking about you.

  6. lugon says:

    Dave, I’m glad you’ve published this piece. You know I’ve made noises here about flu, so I wanted to know your thoughts on this – this piece exceeded my expectations (which are now higher, sorry). We’ll link to your piece from fluwikie. Now, I’m trying to set up a contest between bloggers, for “best preparedness ideas” – we all win. Folks at and and and might take part.Christy, nice to meet you here! The law of two feet keeps working nicely!Yule, I work at fluwikie too. I’m helping to translate a few important pages into my first language. I’ve read the fluwikie now has over 1,000 content pages. So I’m trying to gather a few geeks to create a scafolding system to aid human translators. Right now, when a wiki page is updated, the translation is left out of sync, so we want a way to show the differences between the old original and the new original, and translate only what’s needed. I do believe a flashmob of 20 translators per language could translate the most important 100 pages in a few days. Talk about a “global immune system”!

  7. lugon says:

    Dave, three more comments:You write that the main impact depends on the virulence of the virus, and we can’t change that. But slowing down transmission will mean a given hospital won’t receive it’s quota of, say, 100 severe cases, all in one week, but along a number of weeks. This would help the hospital cope better and save a few more lives. At least hypothetically. So it should be tried.A flu pandemic will freeze much of our movements: less travel, less shopping, less schooling. This will happen either because fear tells us to, or because it’s sensible public health advice, or probably both. This in itself will have an effect. Tourism-based places will be hit by this secondary economic wave. Anyone who depends on supplies may or may not receive them on time. How big these (networked) effects is, as with virulence, anyone’s guess. And guess we must, if we want to plan to minimize those secondary effects. is something we might all use. I know of a multinational corporation who is aparently using the services of to prepare. We’d do well in focusing on one type of “shop” at a time, as in and (call it open consulting).

  8. Dave Pollard says:

    Thanks, all, for the compliments and links. Kragen: I think it will have to start in the schools (kids here already know to sneeze into their sleeve, not their hands, and like bike helmets they’ll be the first to adopt safety measures like masks). To those who have written that migratory birds *are* to blame for the spread of the avian flu, I’d still say the jury is out — there are several sites that say it spread by commerce and that the few dead migratory birds weren’t likely enough to transmit it to poultry. Lugon: Excellent points, thanks.

  9. Dave Pollard says:

    I’d question whether the flu pandemic will necessarily freeze human movements — it may in fact cause people to panic and flee infected areas and spread it faster.

  10. lugon says:

    Hmm – freeze, panic, probably a mixture of both. I get a bit dizzy with so much unpredictability and so many combined options :-/ so I hope someone is better at this fractal future; I know I get a bit of a future shock – time for collective intelligence?Re migratory birds and ilegal or careless commerce – both may be beyond control.News: at least one blog has taken up the “challenge” for practical ideas.

  11. Avalanche says:

    A little reactionary discussion: who decides and how?11/6/2005Let me put on my paranoid reactionary hat. Many of you will have read the following in the New York Times. My comments below…

    October 8, 2005Bush Plan Shows U.S. Is Not Ready for Deadly FluBy Gardiner Harris…A key point of contention if an epidemic strikes is who will get vaccines first. The administration’s plan suggests a triage distribution for these essential medicines. Groups like the military, National Guard and other national security groups were left out.Beyond the military, however, the first in line for essential medicines are workers in plants making the vaccines and drugs as well as medical personnel working directly with those sickened by the disease. Next are the elderly and severely ill. Then come pregnant women, transplant and AIDS patients, and parents of infants. Finally, the police, firefighters and government leaders are next.The plan also calls for a national stockpile of 133 million courses of antiviral treatment. The administration has bought 4.3 million. …http//

    This kind of stupid, short-sighted “planning” drives me crazy!! Why can we never find people willing to discuss and actually make the hard decisions we need to have made? “The elderly, the severely ill, and transplant and AIDS patients” should not even be considered in the calculations for treatment in a pandemic.Yes that means my elderly mother, and some of my friends — and possibly even my husband — might die of the pandemic flu, whichever virus it turns out to be. Yes, that’s a dreadful and hard thing to consider. But there are two types of triage — one is standard medical triage (treat first those injured or ill most likely to survive; which applies in a shorter-term, less-than-globally-catastrophic situation). The other triage, and in the case of the pandemic, the one that HAS to over-ride the first, is the long-term continuation of the … the … the tribe, the nation, the civilization. We must first protect the personnel necessary for social order and the continuation of the infrastructure, technology, and food production needed to keep the country going. The distribution of vaccines and such ameliorative methodologies as we can come up with needs to be focused on continuation of the SOCIETY, not on the individual members — especially not the weakest members!And yes, that means every country for itself. The United States doesn’t have the drugs, the money, or the personnel to try to save every little two-bit country across the world. Or even any of the 16-bit ones. Does anyone really believe Switzerland will continue to export Tamiflu after the pandemic begins? (After all, Roche has already stopped exporting to AMerica just to prevent “hoarding”!) Or will they (I’d suggest correctly) use their supplies for their own people? There is nothing rational or normal about letting your own family/people die in order to save someone else’s family/people.Such vaccine as we are able to get or manufacture should be given first to medical personnel; then police, firefighters, and the military (but probably NOT those off fighting a foolish war unrelated to the continuation and health of our country!); and those workers necessary for the continuation of the services required to keep the society running.That means the folks operating services such as potable water and sewer services and food production/delivery and electricity generation and distribution. Think about what happens if the electricity plant workers in NYC all fall sick; how will NYC manage for a week or more without electricity — and with no other city able to provide help? Even if, say, Chicago has electrical workers to spare, it wouldn’t be able to send them — quarantine/travel restrictions, Chicago’s own need for back-up workers if their workers get sick, and the workers’ (rightful) unwillingness to jeopardize their own lives by travel means NYC is on its own! If NYC has “wasted” their vaccine/treatments on the elderly and transplant patients, and their infrastructure personnel get sick, the elderly and transplant patients will likely die in the riots, and cold or heat and dark that will follow.Hospitals fail without electricity: Katrina was a trial-run, and we FAILED! You cannot have nurses hand-bagging 100,000 flu victims when the power goes out!. Many elderly and medically compromised people will die — that’s tragic — but their age and medical status do not and cannot put them at the head of the line for restricted resources. Their contribution to the continuation of the *society* is nowhere NEAR as necessary as those folks who keep the society running.Sadly, that does mean politicians of some sort will also have to be protected — but I’d suggest a determination of the necessity of the top levels of (which) certain agencies and not many of the mid- and low-level govt employees. Some employees of the Department of Agriculture are important for managing the production and transport of food supplies — but the guys assigned to “sell more sugar” should have to wait for medicine/vaccine just like all the other non-essential personnel — because they are!The attitude of the New York Times writer is typical of the frustrating blindness of most people — they refuse to recognize that Nature means some people die. (Well, ALL people die, just some much earlier than others.) Our idiotic society, which has (over-)protected so many members from a familiarity with Nature and death, has created an expectation (at all levels) that “big Daddy govt” can save them. When the pandemic comes, there is no question that the govt can’t (possibly) save them, and people will die, and it will be lots and lots of people. So why can’t we just accept that, and try to do our best to keep our SOCIETY continuing through and after the pandemic? If we “waste” the vaccine on the elderly and medically compromised, and don’t save it for the people who, by chance or vocational choice, are necessary to keep the majority of the population from falling into anarchy and destruction, is that a good choice?Did not the lessons of Katrina have any impact on these people? If the police desert as in New Orleans (or, as it turns out — were phantom employees who didn’t exist at all!), or are struck down (sick or dead) by the pandemic, as would happen were they NOT the first in line for vaccines and treatment — who will keep order in the streets? Do people truly believe anything has changed since Katrina? Will the black poor be any more prepared or any less likely to riot and loot? (And oh, come on: If we’re going to be facing a global pandemic, it’s time to start speaking the truth! It’s NOT the white poor who riot and loot! Remember Watts, Cincinnati, Newark, Detroit, Los Angeles, Chicago, New Orleans?! More than 30 cities in this country have seen black riots. Shall we pretend it’s not true, and develop our plans on the basis of politically correct lies? Didn’t they do that before Katrina? Look what happened there! Can you honestly say it’s not going to happen again next time? Remember Toledo just a couple of weeks ago, anyone?!)If our plans to manage this pandemic are based on foolish and politically correct falsehoods, how will this society survive? If we vaccinate grannies and AIDS patients before firefighters, who will fight the fires? (Does anyone think fires WON’T break out just because everyone is sick?) If we vaccinate parents of infants before first responders and police, who will staff the ambulances and the hospital emergency rooms and who will keep order in the streets? It WON’T be the elderly and the medically compromised!I also prioritize the parents ofyoung children and pregnant women *after* the people necessary to keep the society running. As harsh as it sounds — children and parents can be replaced (numerically, not individually; the govt is SUPPOSED to be planning for the country, not the individual!). The necessity for a continued/maintained/repaired infrastructure of the country for those who survive, and those who, after the pandemic finally ends, can become parents to orphans, and new parents, is higher than the necessity for current parents and children!But no, we’ll continue lying and prevaricating right up until the lights go out and the rioting starts.Avalanche

  12. Dave Pollard says:

    Avalanche: You have more faith than I do that some kind of coordinated top-down approach to planning and apportioning resources would work. Tamiflu is not a panacea — it kills some of its users and doesn’t work for many others, and some strains have already mutated to be immune to it. The only thing that will work is bottom-up, community based planning, on a worst- (and most likely) case scenario: That the feds will be MIA when it happens, that the vaccines will be inadequate, unavailable or ineffective, and that panic will set in quickly. In any pandemic much of the population has or develops a natural immunity and either doesn’t get sick or fully recovers. The task will be to ensure those of us that are so blessed focus our attention on helping the rest of our local community to cope. That means we need to know what to do — isolate victims, deal with the dead and with our own grief, keep essential services operating so we don’t freeze, starve, run out of water or otherwise die of causes not caused by the epidemic itself. The issue of who should get Tamiflu is moot — when the pandemic hits, it will be far too late to expect any such decisions to be honoured or enforceable.

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