H5N1 & Mutations

A worthwhile discussion so far on ETS, as this is truly a survival issue with global implications.
My family is quietly beginning to prepare for the worst; here in Australia we are as much in the frontline as anywhere.
A recently produced documentary, backed by National Geographic and other reputable institutions, raised some interesting points:

* Avian flu is not the actual killer. The virus, or mutants of it, trigger the human immune system. The strong, fit, and young die because they have the best immune systems. We drown as our immune system tries to beat the invaders.

* The next key indicator to a pandemic will be confirmed human-to-human infection.

* The great fear among experts is that the virus becomes air-borne, with human to human infection ability.

* Official, ie Government and WHO responses rely on extermination of poultry populations and careful screening at national borders. But there are no guarantees here.

* It doesn't matter whereabouts in the 'western world' you live; hospitals, and all our usual medical backup, will not be able to cope. Science, and government agencies are in constant catch-up mode.

* A vaccine, even if it is efficacious for the latest variation of H5N1, will be available only to a minority, typically those in the frontline: the military, police, hospital, medical and vital industry.

On a personal note, living in a typical suburb, I have a decision to make if there is a pandemic: Do my family 'hunker down' in our home, Or do we 'go bush' ? , as we say in Australia.
My instinct is to 'go bush' ; I just believe I already have the equipment, the survival skills and with preparation and common sense, the ability to isolate my family from human contact for weeks.

Yes, I do understand that migratory birds fly over and infect the most remote places on earth, and yes I do understand that a bio-lab is ultimately the only defence against a mutated airborne H5N1 virus.
In this 'worst case' scenario, I can see that convincing my family to continue wearing respirators in the bush [ the type that provides best protection against actually inhaling a virus ] will be very difficult.
Not to mention dealing with all the other sorts of privations that flow from removing ourselves from the rest of the human race.
It all sounds terrifyingly selfish, individualistic and Darwinian.
But I still see it is better to discuss these issues with loved ones in a sober and calm fashion BEFORE it all becomes a huge public affair.
Cheers, PeterR

Interesting points raised. Long post following......



yes, (potential) lethality from avian influenza infection will probably be from secondary bacterial infection and our immune systems going into overdrive - ARDS (adult respiratory distress syndrome). No effective way to stop it, prevent it or treat it effectively. Just supportive treatment i.e. ventilate. Of course the crunch comes when the number of patients overwhelms the resources available, as envisioned in most pandemic scenarios.......what then? Hopefully, the measures in place to stop transmission would be effective in curbing the spread.... QUARANTINE and ISOLATION would be the KEY.



Very true. Most medical systems will be overwhelmed. Care will have to be delegated to the primary care centres (your family physician / GP). The secondary centres (hospitals etc) will be stretched to the limit. Again, focus would be on isolation and reduction of transmission. If the virus spreads unchecked, we're screwed.
Medications available (tamiflu/relenza) IMHO are marginally effective and are what I consider 'better than nothing'. I won't be betting my money on them being of much help.
Vaccines are a long way off yet.Maybe 2-4 years...?



I would stay at home and hunker down. My reasons are as follows:
*hygeine - personal hygiene would be of paramount importance. Proper sanitation, running water, baths all go a long way in reduction of transmission risk. Proper handwashing etc. You are not likely to get those luxuries 'in the bush'

* proper nutrition and rest are vital for your immune system to fight off any infection. In the home environment where there are little variations in ambient temperature, it would be best to stay warm and comfortable and not be subject to the variations of the temperature in the bush.

Resting in their own beds would do a world of good to ensure proper rest and allow your immune system to function best.

* food and water - I would stock up on these at home and ensure a supply for 3-4 weeks at least. I doubt if you would be able to lug that much food and water into the bush. Will you be relying on living off the land? The nutrition of you and your family may suffer if that were the case. Again, not too good for the immune system.

* You hit the nail on the head when you mentioned isolation from people. You can remain isolated from people in your own home for ages if you wish. People leave the home for various reasons - buy items, work, visit people, leisure etc. In a pandemic situation, most jobs may be on hold, and I assume if you are going to 'bush' it, you will not be turning up for work. So if you stock up on essential supplies i.e. food / water/ batteries / hardware for repairs / bulbs / medications / cash etc you can stay isolated from the rest of the population for weeks.

* information - at home you will have more resources with which to get information on the progression or resolultion of the problem. TV, radio, internet, this website <img src="/images/graemlins/grin.gif" alt="" />. The most you would have in the bush would be a radio, cell phone etc.

* Medical care - IF you are out in the bush and if you do get sick, being nursed at home with stockpiled medcition would be a better option than being sick in the bush with limited meds....

Sorry for the long post, but when it comes down to it, my family will be isolated at home with stuff stockpiled at the ready. I will transport sufficient amounts of medication from my clinic back home and hope for the best. I will be called to the front line to help deal with this situation, praying that my N95 mask and personal protective equipment holds out. I will be isolated from the rest of my family so that I wouldn't run the risk of spreading any potential infection to them and basically be hoping for the best.....
You prepare and you take your chances.....
<img src="/images/graemlins/grin.gif" alt="" />

How many other people have to "go bush" in order for the bush to look like a commercial campground? I would imagine that you would be able to get as far away from your home as 1/2 tank of gas will take you (you need the other 1/2 tank to get back). What is 100 other people have the same idea? 1000 people? 10,000 people?

Not to mention that the Aussie bush is quite a bit different than most of the "bush" folks in NA would have.

Good points, Trusbx. I also agree that "hunkering down" is the better choice for most people, rather than "going bush".

PeterR, I haven't seen the TV show you are referencing or what they are claiming, but influenza isn't generally something that lingers in the air, wafting through neighborhoods and through cracks in your house to infect you like some poisonous vapor. My apologies if I'm misinterpreting your comments, but it sounds like this is the doomsday scenario you are envisioning, and that just isn't the way influenza generally spreads.

Influenza virus can be suspended in the air on dust particles or aerosolized droplets from coughing and sneezing, but in general, you have to be in relatively close proximity to be in danger of infection. There has been some rethinking about how airborne transmission occurs, in light of SARS, but that's still being investigated. I wouldn't worry about it at all if I were standing outside by myself. So, even if 1918 happened all over again, you could still tend to your garden or let your kids play outside in safety as long as they were by themselves.

Much of this has already been discussed in recent forum threads, but in reality, there isn't a whole lot that regular citizens can do in the face of such a pandemic. That's not a comforting thought, especially if many people start dying, but that's the reality. You can try to minimize contact with other people, especially crowds, be scrupulous about hygiene, try to maintain your health and nutrition, consider alternative work arrangements like telecommuting, store supplies in case of disruptions in utilities and transportation, and for heaven's sake, don't watch TV news if a pandemic starts because it will make you think that humanity was on the verge of dying out regardless of how few people were actually coming down with the disease.

I commend you for making preparations, but for the time being, the risk for a pandemic in the near future is still extremely, extremely low. Store those supplies for any general emergency/disaster. In reality, you and your family are much, much more likely to be killed in a fatal auto accident by a driver who had a few too many Fosters than by a pandemic.

I'm thinking Victoria Bitter instead of Fosters... MAN, do I need to get back to Sydney. <img src="/images/graemlins/smile.gif" alt="" /> Friendliest city I've ever visited, and I know the beer didn't hurt that perception.

Trusbx,

With the news media being the fear-mongers that they are, I am wondering what medical professionals really think of this pandemic "scenario".

In your own, personal opinion, do you really think it's likely to turn into a pandemic of the proportions that are being broadcast? I ask, because the news media seems to bring it back to the forefront when it's an otherwise slow news day.

My naturally suspicious and cynical self wonders about stuff like this. <img src="/images/graemlins/smile.gif" alt="" />

Sue

Thanks people for your responses; you won't believe it but I forgot about the beer! If I go bush, how am I going to keep the beer cold! That's decided it; I'm staying home, pandemic or no pandemic.

But seriously folks.. more good points raised by you all...

When I examine myself and my bias towards going bush I find my decision is swayed by the fact that I have spent an awful lot of time in the wilderness, and that doesn't mean commercial camping grounds.
And yes, it is a selfish decision; but I guess no more selfish than if I stayed home and hunkered down, refused to answer to door to anyone, refused to help neighbours because they might be infected, refused to share my resources because this would increase the risk to my family.

You see the problem? You stand to catch the virus from your dearest relative/best friend/neighbour if he/she is infected.

And what if all the emergency services personnel took the same view and abandoned their posts? I don't just mean the people who man police/ambulance/stations and hospital wards.
Think about all the people we rely upon to keep our way of life happening: the people at power/water/communications/a whole range of supply utilities. The list goes on and on...

The average Australian/American suburban family is awfully dependent on a lot of people not being sick, and turning up for work.

What happens if these people go bush, or are so struck down that your power/water goes down at your home?

These are the ethical issues which trouble me.

Going bush is a way of 'cutting and running' if you like; out there I won't have to make decisions between my immediate family's health and my neighbour's. I won't have to rely on the props of suburban living to survive.

I should explain also that Australia still has an awful lot of open space [ as have certain States in the U.S.] Thorough planning NOW while there is time, thinking through the issues, is what I am about.

And because my wife hasn't the same survival experience as myself these things have to be discussed with her.

Addressing some of your points Trusbx... I agree with you about the hygiene/immune issues. Water, shelter, food, hygiene... these are the basics which you have to get right.
A big factor is that our climate allows us to live outdoors comfortably all year round which makes going bush a more realistic proposition than other places.

Is it so that the virus can survive around 24 hours 'outside' the body? This is what the virologists on the programme I watched have postulated.

Cheers, PeterR

I don't know the answer to this one. Although most influenza viruses don't last long outside the host, who knows what a mutant strain might be able to do. Bacteria like MRSA and pseudomonas can survive on fomites (i.e. taps, sinks, on the surface of beds etc) for 24h or more, I think most people will be playing it on the safe side and assuming the worst and disinfecting all contact surfaces. The same thing happened here with SARS.
When I saw a patient whom I suspected to have SARS, I had to shut down my clinic after the ambulance came and transported him to the hospital and disinfected all the surfaces, changed all my personal protective equipment (PPE), junked my clothes, took a bath and went home......hoping for the best....
Well, I'm still here.... <img src="/images/graemlins/grin.gif" alt="" />

My personal opinion of this is:

* The possibility of a pandemic is likely. It is only a matter of time. We have got our gear at the ready.

* Most people will not have immunity to the virus - True, but I doubt the numbers about the lethality of this bug. All the numbers tossed around about the 1918 Spanish flu killing millions of people neglected a few major points.
- Most deaths would have been from secondary bacterial infections (i presume this was the case as it is today - the flu virus weakens you and you get a seconday bacterial infection) which are easily treatable today with the antibiotics available

- a small percentage would have ARDS and succumb no matter what you do, I'm not sure how many, probably not as many as the media would claim.

- personal health, nutrition and hygiene now as compared to 1918 is now leaps and bounds ahead. This is, of course, discounting the malnourished poor in the third world countries. If it spreads there, it would be a disaster......

* communication networks today would help the health authorities to quickly monitor and contain any potential cases thus limiting its spread. In 1918, this would not have been possible.

* Most healthy people who get the flu will recover. Its the elderly, infirm, poor and malnourished, immunocompromised people I'm worried about.

* There will also be a number of people who get the flu virus and will not show any symptoms. Their immune systems simply kill off the darn thing. Hopefully this group will not spread the virus first before killing off the virus.....

In summary,
NO I don't think it will be the doomsday TSHTF scenario the media is painting
NO I don't think its going to kill of millions of people like the media says it will
Hopefully it would be like SARS, with limited pockets around the world.....

This of course is a personal opinion.....
<img src="/images/graemlins/grin.gif" alt="" />

I believe there are much more effective, economically sound ways of avoiding infection. If epidemic outbreaks were imminent, the simplest solution is to protect the exposure points, which in the case of influenza are the mouth, nose, eyes, and other orifices. I've converted motorcyle helmets into biofilters for field expedient hazmat systems, and with a tyvek suit, established a level c protection factor (the helmet became a PAP for biologics and particulates). If you take proper precautions when doffing the equipment after being exposed (such as disinfectant wash, UV exposure, etc) then you can fairly easily avoid becoming infected.

Granted, you will look a little silly wearing a helmet or some such to work everyday (unless that is the normal course of your business), but you will be safe. You could get by with a mask and eye protection I suppose. The point is, it isn't that hard in this day and age to protect ourselves from such biological hazards if we are but willing. It certainly doesn't warrant running for your lives, or buying a gross of saran wrap and sealing up the house. They do make HEPA filter systems that can be installed in homes for fairly reasonable prices.

The CDC says human influenza virus can survive 2-8 hours on non-porous surfaces. Survival time for airborne particles is probably similar, even considering the time required for aerosolized droplets to settle. I'm sure that there have been experiments where human influenza virus survived for 24 hours, so 24 hours is not an outlandish figure, although probably on the high side.

Any commercial disinfectant (check the label and follow the directions) or even a bleach solution should take care of disinfecting non-porous surfaces very nicely. Frequent and proper hand washing and avoiding touching your eyes/mouth/nose will go a long way to avoiding infection, regardless of what surfaces you have been touching.

I'm a military medical professional and can comment on a couple of issues. For starters, we are getting almost NO briefings on the avian flu, which means that the folks upstairs are not considering it serious yet, or have not formulated/selected a plan. Even my infectious disease collegues are not panicking.

In comparison, I sat in innumerable briefings about biowarfare, anthrax, smallpox, even SARS a few years back. Those were considered very real threats. I don't think avian flu has graduated to that level. It is still confined to those with intimate contact with lots of animal vectors, something that just doesn't happen in the US. If we start getting breifings, I'll try to pass them on.

My personal plan is to bug in. A few weeks in self imposed isolation with my immediate family should ensure our safety. I would expect the usual shortages (water, perishables, batteries, gas) should it hit, but I don't expect any massive infrastructure failures. My hospital would be forced to use their mass casualty plans and I'm sure I would still be working daily (probably pressed into triage), but otherwise most essential services would continue.

We as a country survived the 1918 flu, polio, HIV, SARS, and every other "mass epidemic" to come by, and I suspect we will make it through the bird flu.

Seeing as how the pot of avian influenza is boiling over the sea in Indonesia, the medical community, ministry of health and ministry of defence here in Singapore have drawn up various contingency plans for the pandemic, should it occur.

If it does spread, chances are, we'll be one of the first places to be hit, just like SARS. ......

The flu threat will be small compared to the threat of a paniced nation. I fear unprepared scared people way more than I fear the flu. The best way to prepare is to strengthen your immune system. All of us, no matter where we live, should have several back up safe houses prepared. make plans with family members and friends. Have your home serve as a back up safe house for them and theirs for you. I have well water and food and supplies stored for several months for 5 times occupancy of my house. There are some dozen or so herbs that help boost the immune system. Buy them. Buy the seeds to grow them. I take mega doses of vitamin C and Omega-3 suppliments. Stock up your mineral bank. Your bones store minerals. When you don't eat enough minerals, your body draws from your bones. Stock up. Be as healthy as you can be.

The posts reccomending personel hygiene measures make a lot of sense and use of N95 masks can help during a flu outbreak. The idea that various homiopathic remidies strengthen the immune system is science fiction. There is no true scientific evidence these OTC herb suppliments provide any support for the human immune system.
The suppliment industry conned Congress into allowing the sale and advertising of these quack remedies without the FDA regulated testing required of ethical drugs.
Buy them if you like, it's your money, but no one should place any dependance on them.

Good nutrition is the first defense against disease, so please don't be so snotty. <img src="/images/graemlins/mad.gif" alt="" />

Many natural remedies have been used for many, many years because they seem to work. As they are gradually investigated, there are some (so far) that HAVE been found to have elements that DO help. When school-educated doctors scoffed at using cobwebs for blood coagulation, little did they know that the cobwebs actually DO have something in them that coagulate blood.

Man tends to think he knows everything. He doesn't. And the medical theories that are currently in use are just that: theories. And they keep changing.

Sue

Agreed Trusbx.

Might I just add one factor to the comparison between previous pandemics/epidemics, and that is the vast increase in air travel.

I don't want to be a doomsdayer, but there is no doubt the sheer numbers of people flying between continents mitigate against our improved knowledge and hygiene.

There seems to be little defence against an infected [ and undetected ] air passenger. I believe there are heat detectors at a few airports which may reveal passengers carrying a high temperature.

If we agree that H5N1 can survive outside the body for up to eight hours, that timespan allows plenty of time for an unmasked carrier to spread the nasty throughout the aircraft.

Eight hours is about the flying time between Australia and Indonesia... a country of 220 million spread over hundreds of islands, with billions of chickens, an endemic bird flu problem, and absolutely no chance of imposing the necessary extermination/hygiene standards on vast numbers of poor people.

Dozens of aircraft fly between Asia and Australia every week...
Oh well...on with the preparations...

I'd have to disagree. Knowledge is power. If we do get a contagious strain of H5N1 started, it will transport quickly as you predict, but once it is known that the flu is on, we can all certainly take suitable precautions to limit or even elimnate exposure risk. Protocol won't occur quick enough to stop the spread of the virus, but those who aren't immediately exposed have plenty of means to reduce the risk.

There's virtually no chance of stopping the disease, but there's a lot we can do to avoid it once we know it is there. Heck, we could start implementing those measures anytime and it would significantly decrease the spread of the current influenza which is having a heyday here in Denver.

Want to keep people from bothering you while still staying in your house.....I forget where I read it (may have been here) but someone gave the idea of making Quarantine signs (they said to include some sort of official emblem when making it).

I know that I WOULDN"T even THINK of approaching the house. LOL