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:
OK, some basic facts about influenza:
So what should we do?
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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Dave, have you checked out the Flu Wiki yet? Did you find it useful?
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.
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.
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 The Science Daily article you point to is 3 years out of date.From http://news.bbc.co.uk/2/hi/health/4308872.stm“analysis of the final three pieces of the virus’ genetic code has revealed mutations that have striking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.”
Thank you for this, Dave. Hey! Were your ears burning yesterday? I was talking about you.
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 http://effectmeasure.blogspot.com and http://crofsblogs.typepad.com/h5n1/ and http://avianflu.typepad.com/ and http://www.epidemi.ca 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”!
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.http://www.fluwikie.com/index.php?n=Consequences.LetterToNeighbours is something we might all use. I know of a multinational corporation who is aparently using the services of http://www.openspace-online.com to prepare. We’d do well in focusing on one type of “shop” at a time, as in http://www.fluwikie.com/index.php?n=Brainstorming.CaseStudies and http://www.fluwikie.com/index.php?n=Consequences.Coping (call it open consulting).
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.
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.
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. http://effectmeasure.blogspot.com/2005/10/lugons-challenge.html
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…
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
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.
Dave, Check out our website listed above. Shouldn’t Sanidoor be a product local, state, and federal health agencies should be excited about, especially as we enter cold and flu season? I’ll wait to hear from you.
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