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Here is what I'm going to give friends, neighbors and family this weekend

by: LMWatBullRun

Thu May 07, 2009 at 18:32:26 PM EDT


So after participating in the various debates here the last couple of days, I was thinking about what I ought to tell people this weekend.  It seems to be becoming clear that the present outbreak is not nearly as bad as it could be, and people need to know that.

On the other hand, there is probably a long way to go before this pandemic is over, and the path forward may be much less attractive than it looks at present, and people need to hear that, too.

So what to tell people now, about what's going on and what to do about it?  

Here is my draft-

LMWatBullRun :: Here is what I'm going to give friends, neighbors and family this weekend
Well, again we have good news and bad news.  The bad news is that we are indeed in the early stages of a worldwide influenza outbreak, and it has killed a number of people.  The good news is that here in the USA this outbreak has not yet proven to be severe.  But we don't know yet how this will turn out in the end, or even how this first wave will turn out.  There are many unknowns when it comes to the flu.

"I do not know".  Those are the words I hear from responsible influenza scientists in response to many questions about this current pandemic.  That's not what we are hearing from the media because "We don't know" does not sell papers or improve viewer and listener numbers.  As a result there has been a lot of misinformation circulating.  This update will concentrate on what we DO know, what we think to be true, what we expect to happen (and why), what might happen (and why), and what I recommend people do, and why.

We know the following:
Confirmed cases in the USA have continued to increase over the past week.  {Comment-  this was expected.  Many more people will get sick before there is enough immunity in the population to limit the number of new cases.}

CDC has stated that they will not attempt to confirm new cases in an area where the presence of the Mexican Flu has already been confirmed, but will focus testing on suspect samples from areas that have no confirmation yet.  {Comment-  this means that the actual case numbers will remain significantly greater than those 'confirmed'.  Or in other words, don't put much stock in the 'confirmed case count' as any measure of the spread or prevalence of this disease.}

There have been two confirmed deaths from this virus in the US, and over 30 people have been hospitalized.  The median age of those taken ill is under 20.  This virus may be different from the 1918 virus in HOW it kills people, but it can be lethal when given the opportunity.

The apparent severity of the disease as it presents in Mexico is greater than in the USA.  The reasons for this are not known; more about this later.

'Mild' for an epidemiologist is not what a layperson would call mild.  When the media says 'mild', what they  mean is you probably won't die.  Mexican flu symptoms include:
Fever of  up to 104 degrees F
Severe muscle pain
Severe bone and joint pain
Severe nausea
Vomiting
Diarrhea
Debilitating weakness both during and after.
{comment- Hydration fluids, anti-viral drugs, and OTC meds for these symptoms are a good thing to have on hand.  Another way to put it is that you can be so sick that you cannot text.  Apparently this resonates with teenagers}

Immuno-compromised people,  those with chronic respiratory ailments, and pregnant persons are especially at risk from influenza.  If you are in one of these risk groups, be especially careful to avoid infection.

I think the following is true:
This Mexican Flu virus appears highly infectious, based on the rapid increase in reported and suspect cases.  Suspect case counts double in less than 2 days.  
Based on the scanty epidemiological data and case descriptions, it appears that hundreds of people have died from it in Mexico, but the data are fragmented, and the actual total will never be known.  

The apparent difference in severity between Mexico and the USA could be explained by one or more of the following factors:
This flu strain does not present as typical flu; there is far more GI involvement, for one thing, and much greater myalgia, for another.  

Misdiagnosis during the early stages of this outbreak in Mexico seems highly likely, whereas the US had more warning and knew better what to look for.

It seems likely that the total number of Mexican cases has been  significantly under-reported; the vast majority of milder cases were probably never recorded as flu cases.  A seroprevalence study would help, but those results would not be available for months.

Mexican culture and economic conditions discourage those taken ill from seeking professional treatment until much later in the course of the disease;  Most Mexicans won't go to the doctor until they are VERY ill.
Tamiflu was not generally prescribed until late April when the nature of the outbreak was determined; Mexican cases treated early with Tamiflu show roughly the same prognosis as US cases.

So far, the USA has seen relatively few cases, and fewer still have progressed to conclusion.  {We may yet see significant numbers of hospitalizations and more deaths here in the US.}

Mexico City has one of the highest population densities on Earth, encouraging a higher initial infectious bolus, and more possibility of infection;

Mexico City's poor water quality discourages adequate hydration; dehydration is a significant amplifier of the severity of any influenza outbreak;

There may be other factors, but the takeaway message is that it is TOO EARLY TO SAY that we can safely ignore this pandemic outbreak.  
The virus appears to continue to be Tamiflu sensitive; early use of Tamiflu is thought to be one reason why the death rate so far in the USA has been lower than in Mexico.  {comment- There is no way to know when this will change, but most experts are very concerned about this eventuality, and I agree with their concern.}

There is debate about this in the scientific community, but this virus appears to have a longer than normal incubation period, and a longer than normal infection period compared to seasonal flu.  There is speculation that this may be one reason why this virus is so infectious.

Non-Pharmaceutical Interventions appear to be effective.  Mexico significantly slowed their outbreak by closing down all public functions for a week.  School closings appear to slow the chain of infection in our children.

What we can expect to happen:
I expect to see case counts increase for the next several weeks, until a significant fraction of the population has been exposed and infected.  It would not surprise me to see 100 times as many cases in three weeks. Although you may not yet have experienced it, or know anyone that has, if this reproduction rate continues, you soon will.  This means that there will be 100 times as many opportunities for the virus to acquire nastier characteristics.

When that 'knee' or leveling off will be seen is dependent on too many variables, including weather, for anyone to be able to confidently predict at this time, but at some point, the number of new cases will stop increasing.  In past pandemics, this started to occur once about 15-25% of the population had become ill; ultimately, I expect somewhere around 1/3 of the people in the US to have had some form of this disease.  This may be a low estimate; nobody knows for sure.

With CDC revising the recommendation for school closure, I expect to see many fewer school closures, and an increase in the rate of school age infections.

If past history is any basis (and it may or may not be, for reasons discussed later) then we may see a respite in June or early July due to hot weather which may last until the fall, at which time we may see a return, a second wave, which might be more severe than this one.

Eventually, I expect to see this virus acquire the Tamiflu resistance gene, and Tamiflu will no longer work.  There is no way to know when this will happen, but the consensus opinion is that it will.  This change may or may not include  Relenza resistance; it depends which genes it picks up.  The selection pressure for Relenza resistance is thought to be lower than that for Tamiflu resistance, but there is no way to know for sure what will happen.  The consensus opinion is that Relenza resistance is less likely, but it is not known whether or not Relenza will continue to be effective.

At best, the health care system will be severely stressed if enough people get sick, and at worst, it might not be able to function.  Shortages of anti-viral drugs are already reported, and the present vaccine production in the USA will only protect a fraction of the population.  Shortages of care, vaccines and drugs can be expected, either this summer or more likely later this fall.

What might happen:
With the changes in travel since the last great pandemic in 1918, the waves that we have seen in past pandemics may not occur.  It may be that we won't see any summer downturn in cases, and that there will be continual re-infection of North America from the Southern Hemisphere, and vice versa. This acceleration of viral evolution could result in a continuous chaotic pandemic of increasing severity which might progress for 12-24 months, or longer.  No way to know how likely this is, but it is being discussed as a possibility.

It is also possible, for reasons we do not know, that this outbreak will quickly fizzle out soon, and not return until the fall.  It is even possible that it may never return.  I think this to be highly unlikely, given what we have seen so far, but it cannot be ruled out.  I would not, however, bet my family's well-being on it.
It is possible, if enough people get sick, either during this first wave or later on in the year, that there would be interruptions in power and phone service, or to water and sewer service in towns and cities.  The Internet could be down.  These service interruptions could be brief, or extended. If generation capacity were affected, and not just the upkeep of the power distribution system, these outages could be prolonged.

Health care facilities, especially hospitals, could be swamped if enough people get sick at once.  Doctors and nurses have a higher infection rate than the general public, so if this virus becomes widespread, it may be difficult or impossible to find professional treatment.

It is possible that this H1N1 virus could swap genes or portions of genes with other influenza viruses now circulating in human, or other mammals, producing a more virulent strain, possibly much more virulent strain.  The Mexican Flu is currently showing a case fatality rate of about the same as the 1918 pandemic, when Tamiflu is not used;  simply acquiring the Tamiflu resistance gene would multiply hospitalizations and deaths many fold, and this is not the worst possible outcome.  There are possible nightmare scenarios that I see no point in discussing here, but they do exist.

In view of the above, here is what I recommend:

Continue to exercise reasonable prudence, because WE DO NOT KNOW what will happen.  An influenza pandemic is a marathon, not a sprint.  If this pandemic is like the others we have historical records on, we are only in the early stage of the first of what may be several waves.  I suggest that you limit your exposure to limit the opportunity this virus has to change into something worse, and to keep you and your family from having to experience an extremely unpleasant and possibly deadly disease.
Make a pandemic plan. Prudent people prepare properly.  
Stock up on essentials:
Food
Water
Medicine
Sanitary supplies
PPE
Avoid getting ill-
Exercise cough discipline;
Practice social distancing;
Practice good hand hygiene
Avoid interaction with obviously ill individuals.
Avoid 'sharing' the flu  with others; stay home if you are sick, and encourage  sick people to stay home.
Educate yourself and your family on what the flu is, and how to treat it.  Check out these websites-
FluWiki
GetPandemicReady
PlanForPandemic
CDC
WHO
BirdFluManual
Make sure that your family knows the plan;  having flu medicine stockpiled will be no good if the only person who knows where things are kept is ill.
Continue to monitor this outbreak.  Check the CDC pages and the flu blogs regularly.

In particular, I would recommend that you NOT actively seek this infection.  There is no way to know what sort of case you will get, nor is there any way to know whether an early infection will confer any immunity against a subsequent strain of this virus.

I solicit comments and questions, and if anyone wants to copy some or all of it, feel free!

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bump N/T


KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


most excellent, LMW, thank you!
Let me add a couple of thoughts for your consideration:

1) The age distribution of the hospitalized (in the US) and fatal (in Mexico) cases suggests this virus is acting more like 1918 than 1957 or 68.  

2) We don't know what will happen but past pandemics tend to subside and come back, often more severe than the first time round.  The 1918 one was particularly so, mild first wave, severe second wave.

3) Although it's theoretically possible for this virus to fizzle out, historically that wasn't what happened.  It would be highly unusual for a virus that is so widespread and easily transmissible between humans, to disappear of its own accord.  You should make plans with the assumption that it's likely to come back repeatedly for the next 1-2 years.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


You are welcome-
I may disagree with you, Susan, but I have great respect for you.  Appreciate the feedback.

1) The age distribution of the hospitalized (in the US) and fatal (in Mexico) cases suggests this virus is acting more like 1918 than 1957 or 68.  

I touched on this in the "what we know section"; do you think more detail will mean anything to a relatively uneducated audience?  I'm asking, not being rhetorical.

Re 2 and 3, I take your point, and that is what has happened in the past, but while people are people and the flu is the flu, the ENVIRONMENT of today is REALLY different from even 30 years ago.  Hence my emphasis on not knowing what will happen.  I'll ponder that some more, I am not planning on sending this out till Saturday.

I thank you for your support, and now return you to your irregularly scheduled pandemic.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
those were just thoughts
in case people need evidence to be convinced.  My experience is most people want to see some 'data', before they will believe what you say.

The other thing that was on my mind, was to guard against what they will hear/read from MSM - eg that it will fizzle away, etc.  So I'd give them some 'science' eg flu viruses that are so widespread do not fizzle away.

Something like that.  Just random thoughts.  ;-)



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
two good points
And I will ponder them.

Thanks!

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
there is also some danger
with people hearing from 'experts' saying they don't know what will happen.  Most people are not very scientific-minded.  When they hear "don't know", they take that to mean "ain't gonna happen".

The other thing (somewhat unrelated) is that most people are not good at risk assessment.  They tend to confuse probability with severity and/or impact.  Or mildness with "not likely to happen".  

In this case, I'd say, the probability of it coming back is very high.  The probability of it staying 'mild' is only moderate.  But since the impact of anything more than 'mild' is pretty substantial, they need some education on how to interpret what they will hear/read from experts.

That will require a bit more thinking...  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Age distribution like 1918?
Recent reports suggest that Mexico fatality cases were those who did not seek help until very late. And many of the early US cases were children who had been to Mexico. So I am not quite ready to suggest this is 1918 behavior.

However, our young folk are very much at risk and that is my focus right now in our community.

Agreed. From past history, these strains can come and go, come and go.  


[ Parent ]
Age distribution like 1918?
Recent reports suggest that Mexico fatality cases were those who did not seek help until very late. And many of the early US cases were children who had been to Mexico. So I am not quite ready to suggest this is 1918 behavior.

However, our young folk are very much at risk and that is my focus right now in our community.

Agreed. From past history, these strains can come and go, come and go.  


[ Parent ]
oops sorry
oops sorry 'bout the repeat

[ Parent ]
Great job Professor n/t


To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

Appreciate the compliment, BUT
I'd appreciate constructive criticism which leads to improvement even more!

This is adequate, but I am sure it can be improved.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
If this is being emailed
I'd include links.

To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

[ Parent ]
yup
I was planning to do that.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
Use of technical terminology
Wonderfully written, balanced and very informative.  Minor observation would be that a couple of the more technical terms used may be unfamiliar to those lacking a medical background (eg. "GI involvement" and "myalgia").

"It's the job that's never started as takes longest to finish" - J.R.R. Tolkien LotR

[ Parent ]
Jargon- one of my many failings
I'm old enough to know better, but you are spot on.

Will revise that, thanks!  Good catch.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
Unless it's attenuated
by us moving into the summer, I would expect an increase more on a factor of 250 in three weeks.

To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

Weather is hard to predict,
which is why I phrased it as I did.  I think I used 'at least', but will check.  thanks!

BTW, folks who know me, know that I place high value on the precise meanings of words.  Those who don't will learn!

Those who don't read it, well, too bad for them!

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
Nope, I did not.
Good catch, Thanks! I'll ponder how best to make that change.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
Copies?
When it's fine tuned will it be available for those of us who would like to share a copy with the folks we know, too?

This is very good. I'm trying to keep people focused on the fact this this "ain't over yet" and that they need to look forward to the fall. Quoting the CDC and WHO as being concerned with that is helping to keep it in front of folks.

My only fear is that it is a long letter and some may not read all the way through. Have you thought about that? It's hard to put such important information into a short draft. :(

Nicely done. -k

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -


I tell you what, I will post the released version here and at least one other place
Right after I send out the update this Saturday.

RM, you are right, it IS long, but if I cut any more, I'll be deleting important information.  If you have suggestions about editing it post 'em.  I'm seeking constructive criticism......

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
LMWatBullRun~
You've made a convincing argument for people to not let their guard down. Very well done.

I would love to post this on my blog. Would it be alright to do so?

United we stand: Divided we fall
www.flunewsnetwork.com


[ Parent ]
sure
Help yourself.

You want the Word.doc?


KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
That will be fine. Thank you. n/t


United we stand: Divided we fall
www.flunewsnetwork.com


[ Parent ]
-sorry-
That's MY downfall, too! It's so hard to know when to 'cut' when getting this information out to folks. A local presentation can run to close to 2 hours, if we're not careful. Actually, they HAVE run 2 hours. There is SO MUCH to tell.

I feel for you. Get the word out. Get them to read it ... to the end.  -k

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -


[ Parent ]
Include an "abstract" or a summary at the very beginning? n/t


[ Parent ]
My Family...Finally Believes!
My mom and my sister believe that a second wave of this H1N1 may mutate and become deadly.  These people two months ago were laughing at me because of my preps.  They thought I was a little nutty.  Well they no longer think that in fact my sister went and stocked up on bottle water and food for 5 people for two weeks and put it in her basement.

That folks is a real testament that what is being said on TV is working.  Why because my sister is a real nay sayer and if she is prepped for two weeks I think many more have also gone ahead and followed what has been said on TV.


Already Adapted and given out some copies-
I've already taken this, adapted it slightly, and added quotes w/ links and charts in appropriate areas to give to my hairdresser & employees.

I've talked to her several times about panflu (the H5 variety) and today, when DD went in to get her hair done for prom, I took these in.  She (of course) thought this was all over and there was nothing to worry about. (sigh)

I also offered a presentation to employees and she seemed open to the idea. Thanks so much for pulling this together! Just adding quotes and charts took a long time. -k

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -


Here is the final version I just sent out-
Well, again we have good news and bad news.  The bad news is that we are indeed in the early stages of a worldwide influenza outbreak, and it has killed a number of people.  The good news is that here in the USA this outbreak has not yet proven to be severe.  But we don't know yet how this will turn out in the end, or even how this first wave will turn out.  There are many unknowns when it comes to the flu.

"I do not know".  Those are the words I hear from responsible influenza scientists in response to many questions about this current pandemic.  That's not what we are hearing from the media because "We don't know" does not sell papers or improve viewer and listener numbers.  As a result there has been a lot of misinformation circulating.  This update will concentrate on what we DO know, what we think to be true, what we expect to happen (and why), what might happen (and why), and what I recommend people do, and why.

We know the following:
Confirmed cases in the USA have continued to increase over the past week, especially in large urban centers, and the case counts are accelerating.  {Comment  this was expected.  The progression will be geometric before there is enough immunity in the population to begin to limit the number of new cases.}

CDC has stated that they will not attempt to confirm new cases in an area where the presence of the Mexican Flu has already been confirmed, but will focus testing on suspect samples from areas that have no confirmation yet.  {Comment  this means that the actual case numbers will remain significantly greater than those 'confirmed'.  Or in other words, don't put much stock in the 'confirmed case count' as any measure of the spread or prevalence of this disease.}

-There have been two confirmed deaths from this virus in the US, and over 30 people have been hospitalized.  The median age of those taken ill is under 20.  This virus may be different from the 1918 virus in HOW it kills people, but it can be lethal when given the opportunity.  

-The apparent severity of the disease as it presents in Mexico is greater than in the USA.  The reasons for this are not known; more about this later.  

-'Mild' for an epidemiologist is not what a layperson would call mild.  When the media says 'mild', what they  mean is you probably won't die.  Mexican flu symptoms include:
Fever of  up to 104 degrees F
Severe muscle pain
Severe bone and joint pain
Severe nausea
Vomiting
Diarrhea
Debilitating weakness both during and after.
{comment- Hydration fluids, anti-viral drugs, and OTC meds for these symptoms are a good thing to have on hand.  Another way to put it is that you can be so sick that you cannot text.  Apparently this resonates with teenagers}
Immuno-compromised people,  those with chronic respiratory ailments, and pregnant persons are especially at risk from influenza.  If you are in one of these risk groups, be especially careful to avoid infection.

Presently, hospitalizations are running around 9% of the confirmed cases (Comment it is likely that the real rate is lower, because many cases go unreported, but this is a worrisome trend nonetheless. )

I think that the following is true:

-This Mexican Flu virus appears highly infectious, based on the rapid increase in reported and suspect cases.  Suspect case counts double in less than 2 days.

-Based on the scanty epidemiological data and case descriptions, it appears that hundreds of people have died from it in Mexico, but the data are fragmented, and the actual total will never be known.  

-The apparent difference in severity between Mexico and the USA could be explained by one or more of the following factors:
-This flu strain does not present as typical flu; there is far more diarrhea and vomiting, for one thing, and much greater muscle pain, for another.  Misdiagnosis during the early stages of this outbreak in Mexico seems highly likely, whereas the US had more warning and knew better what to look for.

It seems likely that the total number of Mexican cases has been  underreported; the vast majority of milder cases were probably never recorded as flu cases.  The present estimates are around 11,000 cases so far.  A seroprevalence study is being considered, but those results would not be available for months.

-Mexican culture and economic conditions discourage those taken ill from seeking professional treatment until much later in the course of the disease;  Most Mexicans won't go to the doctor until they are VERY ill.
Tamiflu was not generally prescribed until late April when the nature of the outbreak was determined; Mexican cases treated early with Tamiflu show roughly the same prognosis as US cases. {comment- I expect the reverse to be true- US cases not treated with Tamiflu can be expected to be more severe}

So far, the USA has seen relatively few cases, and fewer still have progressed to conclusion.  {At present, the hospitalization rate for confirmed cases is around 510%.  We may yet see significant numbers of hospitalizations and more deaths here in the US.}

-Mexico City has one of the highest population densities on Earth, encouraging a higher initial infectious bolus, and more possibility of infection;

-Mexico City's poor water quality discourages adequate hydration; dehydration is a significant amplifier of the severity of any influenza outbreak;

There may be other factors, but the takeaway message is that it is TOO EARLY TO SAY that we can safely ignore this pandemic outbreak.  

The virus appears to continue to be Tamiflu sensitive; early use of Tamiflu is thought to be one reason why the death rate so far in the USA has been lower than in Mexico.  {comment There is no way to know when this will change, but most experts are very concerned about this eventuality, and I agree with their concern.}

-There is debate about this in the scientific community, but this virus appears to have a longer than normal incubation period, and a longer than normal infection period compared to seasonal flu.  There is speculation that this may be one reason why this virus is so infectious.

NonPharmaceutical Interventions appear to be effective.  Mexico significantly slowed their outbreak by closing down all public functions for a week.  School closings appear to slow the chain of infection in our children.

What I expect to happen:
-I expect to see case counts increase for the next several weeks, until a significant fraction of the population has been exposed and infected.  It would not surprise me to see at least 100 times as many cases in three weeks, possibly more. Although you may not yet have experienced it, or know anyone that has, if this reproduction rate continues, you soon will.  Every new case means more opportunities for the virus to acquire nastier characteristics.

When that 'knee' or leveling off will be seen is dependent on too many variables, including weather, for anyone to be able to confidently predict at this time, but at some point, the number of new cases will stop increasing.  In past pandemics, this started to occur once about 1525% of the population had become ill; ultimately, I expect somewhere around 1/3 of the people in the US to have had some form of this disease.  This may be a low estimate; nobody knows for sure.

-With CDC revising the recommendation for school closure, I expect to see many fewer school closures, and an increase in the rate of school age infections.
If past history is any basis (and it may or may not be, for reasons discussed later) then we may see a respite in June or early July due to hot weather which may last until the fall, at which time we may see a return, a second wave, which might be more severe than this one.

-Eventually, I expect to see this virus acquire the Tamiflu resistance gene, and Tamiflu will no longer work.  There is no way to know when this will happen, but the consensus opinion is that it will.  This change may or may not include  Relenza resistance; it depends which genes it picks up.  The selection pressure for Relenza resistance is thought to be lower than that for Tamiflu resistance, but there is no way to know for sure what will happen.  The consensus opinion is that Relenza resistance is less likely, but it is not known whether or not Relenza will continue to be effective.

At best, the health care system will be severely stressed if enough people get sick, and at worst, it might not be able to function.  With hospitalizations running around 9% of confirmed cases, this is of concern.  Shortages of antiviral drugs are already reported, and the present vaccine production in the USA will only protect a fraction of the population.  Shortages of care, vaccines and drugs can be expected, either this summer or more likely later this fall.

What might happen:
With the changes in travel since the last great pandemic in 1918, the waves that we have seen in past pandemics may not occur.  It may be that we won't see any summer downturn in cases, and that there will be continual reinfection of North America from the Southern Hemisphere, and vice versa. This acceleration of viral evolution could result in a continuous chaotic pandemic of increasing severity which might progress for 12-24 months, or longer.  No way to know how likely this is, but it is being discussed as a possibility.

It is also possible, for reasons we do not know, that this outbreak will quickly fizzle out soon, and not return until the fall.  It is even remotely possible that it may never return.  I think this to be highly unlikely, given what we have seen so far, and given how well distributed this virus already is.  I would certainly not bet my family's wellbeing on this virus not coming back.

-It is possible, if enough people get sick, either during this first wave or later on in the year, that there would be interruptions in power and phone service, or to water and sewer service in towns and cities.  The Internet could be down.  These service interruptions could be brief, or extended. If generation capacity were affected, and not just the upkeep of the power distribution system, these outages could be prolonged.

-Health care facilities, especially hospitals, could be swamped if enough people get sick at once.  Doctors and nurses have a higher infection rate than the general public, so if this virus becomes widespread, it may be difficult or impossible to find professional treatment.

-It is possible that this H1N1 virus could swap genes or portions of genes with other influenza viruses now circulating in human, or other mammals, producing a more virulent strain, possibly a much more virulent strain.  The Mexican Flu is currently showing a case fatality rate of about the same as the 1918 pandemic, when Tamiflu is not used;  simply acquiring the Tamiflu resistance gene would multiply hospitalizations and deaths many fold, and this is not the worst possible outcome.  There are possible nightmare scenarios that I see no point in discussing here, but they do exist.

In view of the above, here is what I recommend:
Continue to exercise reasonable prudence, because WE DO NOT KNOW what will happen.  An influenza pandemic is a marathon, not a sprint.  If this pandemic is like the others we have historical records on, we are only in the early stage of the first of what may be several waves.  I suggest that you limit your exposure to limit the opportunity this virus has to change into something worse, and to keep you and your family from having to experience what can be an extremely unpleasant and possibly deadly disease.

-Make a pandemic plan. Prudent people prepare properly.  

-Stock up on essentials:
Food
Water
Medicine
Sanitary supplies
PPE

Avoid getting ill
Exercise cough discipline;
Practice social distancing;
Practice good hand hygiene
Avoid interaction with obviously ill individuals.

-Avoid 'sharing' the flu  with others; stay home if you are sick, and encourage  sick people to stay home.

Educate yourself and your family on what the flu is, and how to treat it.  Check out these websites
FluWiki-http://www.fluwikie.com/
GetPandemicReady- http://66.236.6.202/
PlanForPandemic- http://www.planforpandemic.com/
CDC- http://www.cdc.gov/h1n1flu/
WHO- http://www.who.int/csr/disease...
BirdFluManual- http://www.birdflumanual.com/
-Make sure that your family knows the plan;  having flu medicine stockpiled will be no good if the only person who knows where things are kept is ill.
-Continue to monitor this outbreak.  This is not even well started, let alone over.  Check the CDC pages and the flu blogs regularly.
In particular, I would recommend that you NOT actively seek this infection.  There is no way to know what sort of case you will get, nor is there any way to know whether an early infection will confer any immunity against a subsequent strain of this virus.

readyMom I would like to see what you did.  Can you share?

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


Those dratted dashes! In the wrong place,
you get surprises.
#to start a new subject, maybe.
doesn't work very wellwith other dashes in the text
-/doesn't work very well-/with other dashes in the text

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
yah.
Oh, well, another lesson learned!

Unless there is strong objection I won't repost.

L

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
Thanks for sharing this, LMW!
It's a wonderful piece!

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
Feel free to share, but
some of this is likely to be OBE soon.
let me know if you want a WOrd copy and I will send you one.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
OBE has a lot of definitions. LOL
Acronym Definition
OBE Overtaken By Events
OBE Overcome By Events
OBE Order of the British Empire
OBE Out of Body Experience
OBE Outcome-Based Education
OBE On-Board Equipment
OBE Operating-Basis Earthquake
OBE One Boson Exchange
OBE Other Buggers Efforts
OBE Over Bloody Eighty (gifts)
OBE Our Best Effort
OBE Open Book Examination
OBE On-Board Equivalent (NASA)
OBE Out-Board Electronics
OBE Outboard Booster Engine
OBE One Behind the Ear
OBE Online Bidding Event
OBE Old But Everlasting

http://acronyms.thefreediction...
I deleted a few, too.  

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
also Order of the British Empire. n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
I doubt her Majesty will be calling on me anytime soon N/T


KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
Who uses "One behind the ear" ? [bug-eyed icon here]


"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
I don't work for THAT company (grin) N/T


KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
Prep addition
Not wanting to extend your prep list too much, I would include fuel for cooking and heat.

To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

Fuel-
Some will need it and some already have it.

If I go down that road I wind up with a list a mile long.

All of the folks getting this update already know that I think they may be OTO soon.  It's not possible for me to do ALL of their thinking for them.  At some point they have to start taking responsibility for their own actions.

This is intended as a "kick in the ass" to remind them, broad brush, of what MUST be done.  If they want their food hot, fine! FIGURE IT OUT!

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


thank you
I just sent a copy of your letter to my sister.  I am hoping she will read it.  Thank you for putting into words what I find so hard to express. pam

This might be confusing
to those who are new to the subject:

Shortages of care, vaccines and drugs can be expected, either this summer or more likely later this fall."

I think it's a mistake to put vaccines in with care and drugs, since it implies a vaccine for this strain currently exists.  It doesn't, as I'm sure you know.  And it only will in the fall if a decision is made to switch over from seasonal vaccine production.  And even then, it would not be available in any quantity in September.

Instead, I would say something like:

Shortages of care and drugs can be expected, either this summer or more likely later this fall.  No vaccine for this novel strain exists yet, and if one is made, it's unlikely to be available for months, possibly after the arrival of a second wave.


Caia-
Good point.  If I issue any sort of revision to this I'll rephrase the part about vaccines.  I suppose that my mindset was- "well of course they are making a vaccine for this!"  Sigh.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


I get that. And I hope they do too.
But even if you're right, and they do make a novel H1N1 vaccine, we should spread the word that it could take 6 months or more to make a vaccine in any quantity.  Otherwise people will assume it will just be there when they need it... and feel betrayed and angry when it's not.

[ Parent ]
Please issue the update...
LMWatBullRun please do the revision, your document is more than valuable and quite well written

Thank you


[ Parent ]
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