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Why won't SIP/JAH work?

by: cottontop

Tue Apr 01, 2008 at 07:17:32 AM EDT


After reading the good Doctor's response in
"What's The Role The Internet Will (And Should) Play During A Pandemic?", I was somewhat amazed that he does not believe SIP will be effect in anyway.

"I read about peoples plans for SIP and NPI and think "these folks have no clue".  We will all try to avoid this bug but will fail to do so.   None of these plans are really going to work.  We will not be able to enforce social distancing or the use of NPI.  Isolation won't work voluntary of involuntary." -Dr. Dave
   
cottontop :: Why won't SIP/JAH work?
O.k. Dr. Dave, and everyone else: Please explain to us why SIP does not stand a chance in survival? How would isolating yourself NOT be effect? I need to know why this would be. We would all like to know.

cottontop's curious mind must inquire about this.
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Why won't SIP/JAH work? | 128 comments
just my opinion
I'm definitely not a health care professional, nor am I answering on anyone's behalf but I think maybe there is some truth in what they are thinking.

SIP/JAH is not the solution to a pandemic.  Basically SIP/JAH is a mitigation method until herd immunity, widely available vaccine, etc. become available. SIP/JAH is not a true preventative for pandemic infection, it will slow it down in a community but not stop it.

The thing is, as I understand it, pandemics are pandemics because no one is immune to a bug that becomes easily and effeciently transmissible H2H.  So, hypothetically a pandemic is not going to be over until everyone is exposed and develops immunity of some type or is given artificial immunity in some way.

SIP/JAH doesn't provide immunity and there are still a ton of factors that could lead to inadvertant exposure and/or infection.

I think that what I'm trying to say before I confuse the heck out of the whole situation is that SIP/JAH is a tool, not a solution.  Make sense?

Never doubt that a small group of thoughtful, committed citizens can change the world, indeed it is the only thing that ever has. -- Margaret Mead

I agree with Kathy
SIP/JAH is a tool not a solution.

It buys you time.  It improves your chances.  Eventually everyone will be infected by the new virus, or get immunity by receiving the right vaccine.  All that you are hoping to do with SIP/JAH is to avoid being sick at the worst time, when everyone else is sick and resources are overwhelmed and meds are not available.

What you can hope for while you are doing SIP, is either that an efficacious vaccine becomes available, or that there are good antiviral drugs that will improve your chance of recovery if and when you catch the virus, or that you are lucky and get a mild illness and become immune.  Or some variation of such options.



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

[ Parent ]
agree completely
SIP/JAH is not a true preventative for pandemic infection, it will slow it down in a community but not stop it.
it is a great tool, but merely a tool and not THE solution.
[ Parent ]
Yes, I agree. That was my thought
process in planning SIP. I've always looked at it as a "chance," but Kathy summed it up better. A tool. And by george let me tell you, if I have a tool to use to try and say my family, I'm going to use! Because without it,  what do you have?  

I understand that people are not going to make the right decision and stay in place. I understand that people will be unprepared and go looting, and to family/friend's homes looking for handouts. I understand that people are still going to be roaming around outside for one reason or another. I also understand that TPTB, will do everything in their power to not panic the people, and encourage them to continue with their daily routine. This makes the pre-pandemic stage very dangerous to be out in.

Pandemic flu will be doom and gloom, but we are gathering as many tools as we can to help increase our chance of survival, and just as Kathy said, SIP is just one of the tools we have. It might work. It might not. Those of us who have decided to plan, and go for it, what do we have to loose by doing so?

On a personal note: if there was some other way to get around SIP, I'd do it. Being couped up with my lot, and the physo, overactive Min Pin, it's not my idea of a way to try and stave off the flu!  


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

[ Parent ]
check out this chart
showing mortality in 1918-22.  You can see the unique pattern, the W-curve was repeated for several years and only gradually subsided after 1922.  

Most 'textbook' descriptions of a pandemic being over in 18 months is actually not exactly accurate, cos those who are immunologically naive will still get infected even if they were lucky and didn't get infected the first year.  It then becomes a matter still of surviving the infection.  

The question is, would your chances be better if you get it later when services are not so overwhelmed, or perhaps doctors have gained some more experience of optimal treatment?  Or maybe you can get a vaccine?



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

Better chances . . .
I think the answer to your question, Susan, would be an unqualified "yes" - of course one's chances would be better to get the flu later, when it might be possible to obtain adequate medical care.  I certainly don't think there'd be any adequate care available at the height of pandemic, so it seems a no-brainer that later would be better.

Later, the virus might lose some of its virulence, too, so later might be better in many different directions.

I do not see SIP as a cure any more than does anyone else - what I do see is that it could buy time, precious time, and at that point, I'd gladly take any delay I could get.

[ Parent ]
Just a quick correction
It was Dr. Grattan Woodson that made the comment that cottontop quotes at the top of this diary, not Dr. Dave.  

http://www.newfluwiki2.com/sho...

Hey, could it be possible that we have too many "Dr.'s"  Nah....!  

Thank you Pixie for
clearing that up. I stand corrected. ;-)

Maybe there are too many doc's!

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

[ Parent ]
heh
maybe. ;-)
[ Parent ]
Agree with the Dark Doctor

Never have we had so many people who are inherently selfish and apathetic as at present.  The press has dutifully cried "Wolf" and "Sky is Falling", for so long (years) that the general public has grown immune to perceived risk of pandemic illness.  The public firmly believes that vaccines and drugs will be "there" to ease mortality and protect them against the worst of the infection onslaught. They can't conceive of being turned away from overwhelmed public care facilities. They couldn't possibly conceive of a breakdown of services nor of the need for personal sacrifice for the good of all.

Public behavioral patterns of everyday living are absolutely counter-intuitive to adaptation to NPI.  If people don't practice at least a modicum of behavioral change and proactive self-control before the pandemic, how can you possible expect them to adhere to NPI that isn't reinforced by military and police-enforced lockdown?

State government will resist that step, fully expecting the clueless people who can't even adhere to oft-recommended simple steps to reduce seasonal influenza contagion, to think for themselves and practice self restraint for WEEKS at a time, in personal risk avoidance.

They couldn't do it in 1918; and they didn't do it 1957 or 1968.  They almost didn't manage it for SARS, a very recent close call.

Most people are NOT risk avoiders because risk recognition is faulty.  Personal risk has been passed off for so long by various panacea - for generations - that the average person is unable to connect personal action with adverse effect and avoidance activities. Instead, we have become 'bad news' avoiders, through practice of apathy and perceived isolation from really big disasters.

More to the point, many don't care, period.  There will be very little adherence to NPI, because John and Jane Doe and their chittlins have longstanding pattern of lifestyle choices that are innately selfish.  They don't donate and volunteer, they don't conserve, they don't recycle, don't practice sensible lifestyle choices that contribute to social good and reduce social costs.  They are absolutely convinced that science and Uncle Sugar will bail them out of disease and disaster.  They are selfish and largely apathetic, paying little more than lipservice to 'social consciousness' through community action and self-sacrifice.

And they are addicted to bad news without comprehending the meaning behind it and the apathy it generates.  The internet is loaded with dire warnings that has become a source of dark entertainment, without relief of psychological burden it induces in the listener.  Hence, blatant apathy becomes the counter to endless stream of electronic media negativity.

That is the point the Dark Doctor refers to, that the average citizen is incapable of practicing personal restraint and proactive planning to reduce their risk, be it pandemic, food and energy shortages, climate change, or changing behaviors to reduce disease risk.

They are too used to foisting personal responsibility off to others. assured that a safety net is always available to bail them out. Government is hardly much better, casting a blind eye to marked evidence of economic, social, physical infrastructure and environmental degradation, in trade-off to massive expenditures necessary to play global statesman and protector. The government, too, believes in "just in time' magical solutions to our most pressing problems.  

You may be right
I don't know Oracle if I agree with you that the average citizen (American?)"is incapable of practicing personal restraint and proactive planning to reduce their risk".

But let's say hypothetically that you are correct, and that the federal and state government planners agree with you.

In that case, it would make sense to plan on mitigation measures that, for the most part, do NOT require the average citizen to practice restraint.

If schools are closed, then schools are closed.   There's no choice involved by the average citizen.   Schools are just...closed.   Similarly, shutting down large gathering places just shuts them down.  You can't close EVERYTHING, but you can shut down a lot.  Including public transportation.   In at least those instances -- no schools, no churches, no sporting events, and no malls, let's say -- people WILL participate in NPIs because there will be no events to attend.   They will be shut down.


GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
yeah and here's what happens
when schools close.  From the experience in Hong Kong.





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

[ Parent ]
Which dates?
SusanC,
 Hi. could you annotate your chart for the non doctors on the floor.

 I assume at weeks 11 and 25 schools closed and the number of cases dropped like a stone. A heavy stone in free fall.

 Right?

Kobie

[ Parent ]
for the dates
and a better exploration of the data, follow the 2 diaries on Hong Kong, March 18th and March 31.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Get dates from diary
SusanC,

 Will do. I saw some of the entries in the diaries. Thought you might have some milestones or critical points seperate from what was there.

Kobie

[ Parent ]
NPI without individual choice includes
humidity + heat in airports etc (if it works, which may have to be tested, now or at the onset of the pandemic)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.
[ Parent ]
Counter intuitive but good point
Lugon,
 Good point. There are lots of currently installed things we can do.

 I said couter intuitive becasue birds have a higher body temp and H5N1 is trying to our colder bodies.

 High temp to aide is drying surfaces which means the hummidity is not 80,90 or 100% yet the humidity is high enough to keep mouth, airways and skin moist, crack free and not dry.

 So what is optimal?

 Will people go overboard with drinking water?

 What about Iron and vitimins? I've read internet postings saying 30% of folks are anemic. At blood drives this does come up. Mostly women but men as well. I've heard a few say "Men should not take iron suppliments." without any explination.

  Just thinking we will be working some long and hard hours for many months. Perhaps even two years or more.

Kobie  

[ Parent ]
an antidote to darkness
I have no illusion about mankind...nor have I given up on my species.  There is no magic bullet for any of this - we are are personally responsibile for ourselves and our families - we always have been - in this case and every other case. Doctor Dark choose his name and his viewpoint I am not willing to let him chose mine.  The attitiude save yourself and to h--- with everyone else is part of the same sad commentary that has no faith in mankind.  TPTB are wrong, your neighbors are wrong...following all that logic life on this planet must be wrong.  

Progress is only made by those who try...it's not a job for the lazy or easily defeated.  It is hardwork but I happens to like my country (with all its warts)and I haven't lost faith in it or it's people. If I'm wrong I have lost nothing - if I'm right I have gained something.  When I die regardless of what - I will at least know I did something to try to impact the outcome for the good.  That knowledge alone is worth it.  

I know, I have impacted it through my actions - I have more to do.  Too often people will tell us - we are victims - we can't defy the odds.  If we listen to them we become defeated and cease to try and it becomes self-filling.  Only those who defy the naysayers know if they can win and transend the odds...that what my ancestors did.  

I only write this for one reason - the discussion here has taken on a "we are doomed and all efforts you make but to save yourself and a select few are worthless".  That veiw does this wiki and its participants a disservice.  We must each decide for ourselves - I have - my view may have no more value than that of others but it has no less.

I'm not normally religious
but Amen to your worldview (bolding mine). Thank you.

Progress is only made by those who try...it's not a job for the lazy or easily defeated.  It is hardwork but I happens to like my country (with all its warts)and I haven't lost faith in it or it's people. If I'm wrong I have lost nothing - if I'm right I have gained something.  When I die regardless of what - I will at least know I did something to try to impact the outcome for the good.  That knowledge alone is worth it.  




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
I don't think
that anyone here is thinking "well its TEOTWAWKI so let's go dancing on everyone's graves that didn't listen to us."

There may be some frustration but certainly not prophetic glee that everyone will eventually say that we are "right" and to hell with them now for not listening to us in the first place.

Cottontop just asked for some clarification on what other people were thinking with regard to SIP/JAH.

Well, that is still my goal for my family.  Not because I'm tired of playing Cassandra but because of the risk factors in our home.  I have five kids, very little extended family, and a lot at risk.  It behooves me to be realistic in my approach to this stuff.

SIP/JAH is still my tool of choice.  But it is a tool I have no illusions about.  Heck, I even brought out some of the potential problems with it in A Will to Survive so I'm well aware that it isn't a panacea by any stretch.

I believe that most of us are doing what we can with the resources we have.  Most of us are spending time shoring up our individual plans and that's OK.  So is working at the community and national levels.  All of our skills are needed ... either by overt activities or by unspoken examples within our own families and neighborhoods.

There is no panacea.  Every action forward is an action forward toward success.  But success may very well have different definitions for different circumstances.

Just as SIP/JAH is part of my pandemic road map, it may actually be counter productive for another.  As many have said before, this is a marathon, not a sprint, but no one is quite sure where the home stretch is or when it is going to show up.


Never doubt that a small group of thoughtful, committed citizens can change the world, indeed it is the only thing that ever has. -- Margaret Mead

As I see it
Two hikers were running from an enraged grizzly bear.  By running down a steep hill they managed to get a little bit ahead and stop to catch their breath.  One hiker pulls some sneakers out of his pack and puts them on.  The other hiker says, "Those won't let you outrun that bear."  He replies, "No, but they'll help me outrun you."

I look upon my preps as giving my family a chance to outlast the first and second waves.  Hopefully, by then there will be vaccine for the rest of us; I don't count on it.  Regardless starvation and small bands of looters will fail to take us out.  And there will be way less people in the world to come in contact with.  I can build the ark, but it's up to God to see me through the flood.

If flu makes it into our sanctuary, we will treat it as good or better than any hospital, except for lack of ventilators which would not be guaranteed at a hospital either.

If the pandemic occurs tomorrow, it is TEOTWAWKI.
If it occurs ten years from now it might be a non event.

Our predictions of when are mostly wrong. See poll question one: http://www.newfluwiki2.com/sho...
61% of us were wrong in predicting it would go pandemic before Dec. 2007.  If it doesn't go pandemic this year, that will make 86% of us wrong.

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.

Hmm very sobering
61% of us were wrong in predicting it would go pandemic before Dec. 2007.  If it doesn't go pandemic this year, that will make 86% of us wrong.

It's one of those things that you think but would much rather you are wrong about...



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

[ Parent ]
2011 - 100% wrong - whoo hoo
SusanC,

 If it waites till 2011 I would be happy. Yes I've got coins down on China in 8-8-08, but with 100th anniversary of Scouting in the US in 2010 I would like H5N1 to hold off for a while. A long while so we can figure this out.

 What if we get good and eradicate H5N1 from Indonesia?

 This is my first major pandemic so I'm still new at the game. Just want to be safe before betting and loosing the farm (American term for loosing it all)

 I would like to be wrong. I hope with all the new medicine we are cathching this way early in the game. We just have to be prepared incase it suddenly flairs up. Unless someone can tell me the excact steps H5N1 needs to take to become leathal.

 Did I mention it may not be H5N1 but some other bug that is the pandemic?

Kobie

   

[ Parent ]
actually I do have some thoughts about eradication
A very long shot, but not unreasonable, I think.

Based on a combination of changing agricultural practices ie no more free-grazing ducks unless the rice paddies are rotated with other crops, and the use of vaccines specifically targeting the HPAI component of the virus.

I'm still putting together some theories in my head.  I have to warn that this is speculative, but if you're interested, it's a combination of thoughts from these 2 diaries

http://www.newfluwiki2.com/sho...

http://www.newfluwiki2.com/sho...

I made those speculations a year ago, not thinking they were going to go anywhere.  I'm ready to re-visit them now.  Give me a little time, let me do a little more thinking about this.  I'll write about this when I've gotten the data together.  I need to ask some scientists some questions as well.



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

[ Parent ]
Food and location
SusanC,
 I've only scaneed your two diaries but have a few questions.

 1) If we ask farmers to do one crop per year then extra food for the people and money to the farmer needs to come from somewhere.

 2) Ducks in seperate ponds. In the early 1900's when the US took over the Panama Canal dig from the French the first thing they did was eradicate breeding areas. Low lying swamps and pools of water where drained.

 Now we can not do that for ducks - unless there are duck friendly pools and duck hostile rice patties. Also duck friendly pool aids in capture and innoculation. The problem is sanitation of the pond water. Unless the water is ciculated past plants and over rocks it will soon be filled with "100% post duck by product"

 Lugon, we will need your ideas on how to make the solution simple, eco friendly and use a rural power source to build upon SusanC's ideas.  

 Anyone else is free and welcome to chime in for problems or soultions.

KObie

[ Parent ]
Kobie, SusanC, and others
I know SusanC is busy so when she asks for more time, that's it.  I too am writing as a "note to self" for when there's that time.

Dealing with infections in animals, in an attempt to at least diminish viral load "out there", is important: there would be less oportunities for mutation and reassortment, and we might be buying some more time.

At the same time, dealing with animals means dealing with what people need to do, are used to doing, with animals.  We need the food and all the rest.  Add science and lack of it, and a bit of politics, and even minor problems may be (or become) quite complex.

Just as an example, there are many ideas on how to use animal faeces in biodigesters, for many benefits (biodigesting viral load being one of them, but farmers get free energy).  So things can be done, at least from an engineering point of view.

All of that said, if someone wants to start a diary with links and essentials, then maybe others, as Kobie says, will be able to "chime in for problems or solutions".

Any title will do, as even that can be changed later.  So folks, feel free to help! ;-)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
What the wiki is
Lugon,

 Biomass for fertilizer and fuel - forgot about that one. Thank you Lugon.

 Where everyones knowledge and solutions com together - what the wiki is about, right?

 Even if it is something we do not impliment - the knowledge is posted for others.

Kobie
"this little light of mine, I'm gonna let it shine" - a kids song.

[ Parent ]
yes, Kobie you are right
there are many practical issues to think about.  But it all starts with science.  Let's see if there is enough knowledge from science to build a credible strategy first, and then we need more research to verify any hypothesis, and then applications to real situations.

Right now it's still at brainstorming stage.  All I'm saying is I'm not giving up on eradication - I believe with a lot of work it may be feasible within the next decade or so.  I know it sounds like a really long timeline, but think back to 1997 when it first happened in Hong Kong.  That's 10 years, and a lot of advances have happened, a lot of things have become possible.  

It may not work out.  All I'm saying is there appears to be scattered pieces of scientific information that may give us some solutions.  Just as David Fedson and myself and others have been pushing on the statins research, all this takes long term commitment and focus.  

I need to study this some more and ask various scientists' opinion, but I may be able to write up someth tentative thoughts in a couple of weeks hopefully.  Thanks for your patience.



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

[ Parent ]
Dreams feed the facts people should look for.
SusanC,

 Walking on facts is far safer than dreams :o)

 Patience? Looking at your Archive of posts and knowing that you not only travel but find time to eat and sleep as well :o) LoL.

 It took a while for me to understand the Japonses saying"That when the student is ready the teacher will appear"  Blaise pascale wrote calculas hundreds of years before I was eight. Yet it took me ten more years when I was 18 to understand it. And a few more years after that to be good at it. Just as many to forget most of it - but know I know where to look and how to use it and see is application everywhere.

 The facts where here long before me and will be here long afterwards. Its all in what we do with them and which ones we see. The physics and facts of 2008 are the same as 1988 - people just know more of them. Ditto for the physics and facts of 2028 are the same as 2008 - people just know more of them.

 If I rush ahead, head long into the unknown its just to see what to look for. In theory what should or should not work. Test drive in the mind before paper or metal.

 No hurry.

Kobie
"Imagination is far more important than knowledge" A. Einstine, genius.
Source: http://wiki.answers.com/Q/Why_...

"thinking is the best way to travel" - Moody Blues.

[ Parent ]
So you found my archive lol
Patience? Looking at your Archive of posts and knowing that you not only travel but find time to eat and sleep as well :o) LoL.

thanks Kobie.  Yes, I really hate having to scroll page after page to find my earlier diaries, so I created a diary for the archive.  But when I add new diaries, after a while, it gets pushed into the second page again.  So now I just make a new archive every time it happens.  Saves a lot of my time.  ;-)



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

[ Parent ]
Most welcome. You generate alot of conversations and ideas. I find it all worth the reading. n/t

[ Parent ]
...marathon, not a sprint...
and makes me pause about anyone who is sure and certain about this. Those who are sure and certain it's nothing, those who are sure and certain it's TEOTWAWKI... how can we know what we don't know?
[ Parent ]
Change is coming anyway.

The end of things as we know it (now) is coming, whether or not there is a pandemic in our near-future.  Our natural system sustainability level is at it's lowest point in history, while our population is at it's highest. Urban foot print is growing rapidly, while quality agricultural land shrinking at an even faster rate, the result of land degradation. We're stuck in over-consumption mode - a taste recently acquired by developing nations now competing for the same resources as demanded by industrialized nations to fuel insatiable appetite for MORE.

And there is absolutely ZERO interest in reducing our overwhelming human population.  Not even an attempt to slow its rolling growth, never mind reduce it's teeming masses in the most densely populated urban centers. Apparently, the plan is to let it cruise until the global population reaches equilibrium in another forty years, without a thought to natural processes, plentifully in evidence in our historic past, that periodically attenuate overpopulation.

We got LaLa Land imagineering like this: (rosy-glasses link on the Google search page today)

"For thousands of years, the human race has spread out across the Earth, scaling mountains and plying the oceans, planting crops and building highways, raising skyscrapers and atmospheric CO2 levels, and observing, with tremendous and unflagging enthusiasm, the Biblical injunction to be fruitful and multiply across our world's every last nook, cranny and subdivision."

(at this point, you would be hoping that Google mental masters were going to announce a new social awareness initiative to help save the planet before the biological shit hits the proverbial environmental fan).  

Nope, they're not interested in stopping runaway ecological degradation and the climate warming-drought-famine-pestilence cycle that accompanies overpopulation.

"Earth has issues, and it's time humanity got started on a Plan B. "  Let's go to Mars!  

Pandemics are not happenstance, they are not something that just rolls around the planet every once in a while. They occur due to the accumulation of logically predictable factors.

Indonesia presently very nearly approximates the panopoly of factors that collude to spark regional epidemic in a chain reaction of events.

We are just shy of the tipping point needed for infectious disease critical mass, to jump from local to regional epidemic, and then go pandemic by dint of human carriage by air travel.

Nonetheless, Life as We Know It is going to change whether we have this pandemic now or later on - and it's not going to wait another decade.  An influenza pandemic will only accelerate the rate of decay towards an inevitable conclusion of enforced change, by temporarily checking human population growth - at enormous social cost, mostly in developing nations.

We cannot sustain our present course.  

[ Parent ]
...
i think several things can kick off what will become TEOTWAWKI...  pandemic is certainly high on the list, but isn't a list of one.

TEOTWAWKI is an interesting term...  alot of folks, tho, seem to mean it without the AWKI part...  when i use the term, i certainly don't mean to say "the end of the world" -- just the end of the one we know...  an EMP weapon could easily achieve TEOTWAWKI - and kill no one.  what happens afterward - the secondary and collateral impacts within society --- that won't be the EMP killing people, it will be other people as well as the inability of a high percentage of our population to survive without technology ---- in which case, it's really the people that will have killed themselves through short-sighted choices and habits.  resilience can mitigate the loss of technology that our societies have become dependent upon - regardless what series of events leads to the loss of that technology.

absent a meteor strike, tho, i continue to see AWKI firmly attached to TEOTW...  

i've not gone back and re-read what GW said, but i do recall that the context of the statement was in regard to **urban** environments.  i have no argument with that --- the night the tornado went through Atlanta, there was discussion on the tv news that looting was occurring in some of the areas where power had been lost.  one very urban area, not a particularly massive impact, some power outages -- and looting from businesses within a few hours of the start of the event.  that bodes poorly.

[ Parent ]
...
and looting in residential areas..
http://www.11alive.com/news/ar...

and this is with just a tornado - what will that area be like 3 wks into a pandemic, when there is no food or water?

[ Parent ]
Agree with KatyInFl and Spartan
  KathyInFl wrote "SIP is a mitigation tool" it is not a solution.

Spartan wrote "If I work and nothing happens I die anyway, but if I suceed then I have gained something"

 We have written about hte ROI of preparation. Being prepared for one disaster prepares you for another.

 Indonesia and India show what does happen and can be extrapaleted out.

 So where is the hold up?  

 We need more than just SIP. We can not go home for three months and let the world run it self. Well the world will, but our world of machines and interdependence will not.

  Ohh the money makers would be most miffed if we did not spend our paychecks!

  Yes things will go down hill. That is not the end of the story. How far down and fast it bounces back is up to us. We can let it go so society drops like a free falling stone or we can slow the descent. Then we can shorten the recovery time.

  To go into an unavoidable pandemic with the full intention of comming back out again quickly. Not going day to day with "what next" attitude but with a plan. Load up on supplies, weather the storm, rebuild and teach leassons learned to future generations.

 SIP alone will not do it. But what is the worst that could happen - TEOTWAWKI? The dark ages? We where there after the fall of Rome and bounced back. It is just a pandemic, not the end of all life on earth.

 How good a job can we do?

KObie

tangentially - pantries are not just for SIP (i know we all know)


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.
Pantries, not just for SIP anymore
Lugon,

 Absolutly, I've had some of my best midnight snaks and nips of whine from a pantry :o)

 With food prices going up - buying in bulk seems the only way to go.

 Lugon - you hit the nail on the head by saying "I know we all know" Its getting the other 300 million folks informed.

 I wonder if "generic" foods will make a comeback?

Kobie

[ Parent ]
The problems with SIP as an effective survival strategy
I don't think SIP will be very effective for several reasons that are based upon my view that the pandemic will be severe and will not be solely a medical event but will have secondary far reaching and even more devastating social and economic effects.  

First, to be effective you will need to SIP for at least as long as the pandemic lasts or there is an efficacious vaccine available in sufficient quantities to ensure you and your family will receive a jab when you come out of hiding.  I think we can all agree on this as the basic SIP strategy most people who plan to SIP intend to follow.

At the present time it will be about 6 months before a matched vaccine is available in the US and only 30 million doses will be available at that time point.  CDC has already allocated those doses to the folks on the priority list and that will not include 90% of the people in this country.  

(Consider this: You are classified as a critical worker with a high CDC priority but your spouse and children are not.  Vaccine become available.  You will have to break SIP to get in line for your jab and doing so will almost certainly expose you to the virus.  You get your jab but then what?  Vaccination does not prevent infection, it just makes it less severe.  Vaccinated people who contract the virus will still be infectious.  What will you do, go home and possible expose your family to the virus.? Go somewhere else for a self-imposed quarantine period?  What happens if you get sick? Who will help you then?)

The next batch of vaccine will be ready in about 4 to 6 months from the arrival of the first batch.  After delivery and administration of the second batch, 80% of the population will remain unvaccinated.  

Consider that for this scenario to occur there must be no hiccups in the process including the availability of 1.2 billion fertilized chicken eggs.  Thats a lot of eggs and remember BF is 100% fatal in this species of poultry.  There are a lot of other technical things that effect vaccine production too that could go wrong or delay production that I will skip here for the sake of brevity.  

So, given these facts, what do you think your chances will be for getting a vaccine and how long will you and your family have to SIP in order to get a jab?

The second issue concerns the ability of people to SIP for a prolonged period of time.  I simply do not think most folks have the discipline to do this.  It is inconceivable to me that many people have the psychological equilibrium to remain cooped up in their home for even 1 month not to mention 6 or 10 or 14 months.  This is simply not credible in my view.  

Third, is the issue of where people plan to SIP.  If they intend to SIP in any urban environment anywhere, they will be at great risk of being displaced by civil disorder, fire, or simply impossible living conditions.  For those unprepared, how long can they SIP without clean water, electric power, food and heat?  Not very long.  While the pandemic prepared might have enough of these items or effective alternatives to SIP for quite a while, will they be able to repel the Zombie attacks once they and their cache of commodities are discovered?  They might be armed to the teeth and able to hold out for quite a while but eventually, they will probably be overrun.  

So, it is my view that SIP within any urban environment irrespective of how prepared one is will be a very risky proposition at best and more likely to be a failed survival strategy.  

I think the most survivable strategy is to relocate to a rural environment and work with others in a mutually supportive manner that will improve the chances of all involved to make it through the emergency.  This makes the most sense to me.  My thinking is that I will be able to remain effective and functional as a HCW in this environment for a whole lot longer than in any other setting.  There will be many people who will need care in rural areas including all the people who live there permanently as well as the many refugees sure to pile in from the urban areas.  This is where I intend to make my stand and do my work as a doctor.  I do not see this choice as abandoning my current patients or the people who live in the cities.  It is not that at all.  I simply do not see any possibility of remaining within an urban environment as being a sustainable or survivable option.  If I am killed by civil disorder, how many people can I help?  What good does this sacrifice make?  If I did stay and saved some lives or contributed to their recovery but those that I helped were killed by Zombies, starved to death or died in a conflagration, did I really make a difference?  Maybe a little.  On the other hand, if the people I assisted survived and lived on to participate in the recovery then my succor may well have a greater and more lasting benefit, IMO.

I plan to do the above but will not be SIP there but instead will be doing what I can to help those that are sick with flu.  I will use NPIs but know that masks and gloves even when used properly will not protect me completely.  I know my family and I can't SIP for a year in isolation.  I expect to get the flu and hope I survive.  In fact, I think I will survive and I also think most of you will too.  

While I think the pandemic will be very terrible, the civil disorder and economic collapse that follows in its wake will be much worse.  My projections (CAR, CFR, Death Number) suggest that overall 50% will become clinically ill and of those about 8% will die in the advanced nations with 12% succumbing in the emerging and less developed nations.  (These projections are just guesses and really only my way of saying that I think the pandemic will be really bad but of course as Susan C and many other respected experts so eloquently point out, no one including me knows for sure.  While there is a lot of uncertainty about these statistics what you should not be in doubt about is the bottom line, the pandemic is coming and when it does it has a high enough probability of being bad enough to justify the time and effort required to prepare for it thoroughly) .  

While these projections are really bad, the catastrophe will not result from these deaths, the real cause for concern will be how all this impacts our fragile world societies and the weak social fabric that binds it together.  The collapse of these will result in many more deaths and much greater disruption than caused by the flu itself.  I can't imagine a more dangerous place to try and SIP under these conditions than in any crowed urban environment filled with unprepared folks.  There will simply be too many Zombies to manage, even Rambo would be challenged.  

These are my views on the subject.

Dark Doctor

Dark Doctor....
I do think what you are saying is a realistic point of view, however awful it is. I've never heard of a pandemic that was "sugar and spice." ;-)

And I agree too, that most people will not have the discipline to stay put for that long. They will be doing good to stay put for a week.

I am in a rural area, so SIP can be a viable option for my family. Now my question: we humans like guarantees, so what guarantee can you give us that this will last as long as you believe it will? I mean, the virus hasn't even hit, and we already have months predicted for onset, devestation, vaccine development, and recovery. Are you appyling this "prolonged period of time" for the virus H5N1? A current strain of flu that has mutated? Exactly what "virus" are you stating your point of view on?  I ask this because you have to help others and myself understand why your predictions are so dire. Which virus, or what virus are you attatching your predictions to?

I understand your dire warnings, but after reading your post, I honestly felt like just giving up all thought of trying to "do something." But of course I can't do that.
 

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

[ Parent ]
"batches" of vaccine?
The next batch of vaccine will be ready in about 4 to 6 months from the arrival of the first batch.
Is the process really batch-y like that? I had been assuming that it was pipeline-like, so that how long it takes to get the first vaccine depends on how "long" the pipe is, and how much comes together at first is determined by how "wide" the pipe is, but that after it starts coming, it trickles on rather than stopping and starting. (I mean, obviously it wouldn't come out of the factory every hour, but I'd been assuming small quantities every week, at least, after the start.) Am I wrong? If so, what stage of the process is it that makes it this way, and are people working on fixing it? (E.g., if it's because the stuff has to sit in a vat for 4-6 months, so that the next lot can't be started until the first lot frees up the vat, we might build another vat, leaving the rest of the production process alone...we certainly wouldn't want parts of the vaccine production equipment lying idle waiting for the next batch to arrive, if we could help it.)
[ Parent ]
no, you're right
and the conventional vax comes out as x number of doses/day or doses/week.

However, novel cell techniques such as culture-based or cell-based vaccines really are batches.

[ Parent ]
I don't know the answer to the 'batches' question
but I'll hazard a guess.  I believe the biggest limitation always has to do with availability of eggs.  They have to be fertilized eggs at a particular stage of embryonic development, ie there's a small window of time of the order of a few days, I believe, (don't have time to check right now, sorry) after fertilization when the eggs can be used.

I'd imagine for the purpose of mass production they have to do that in batches.



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

[ Parent ]
eggs and batches
http://flusupplynews.com/manuf...

# Because of the nature of flu vaccine production, vaccine companies must place their egg orders 5-8 months in advance before they begin producing vaccines.

# This process consumes hundreds of millions of eggs (270 million or more for the United States alone) to produce a sufficient supply of vaccine for the United States.

# "The egg method isn't very flexible if you need to rapidly ramp up vaccine supply," says Jonathan Seals, director of Process Development at ID Biomedical Corporation of Northborough, MA. "Vaccine manufacturers need to arrange for egg supplies months in advance - and you can't tell a chicken to lay more eggs."



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

[ Parent ]
I bet the Gov't. has already thought of this....
and have a constantly ready supply avalible at a moments notice.  I also bet there are contengency plans to take more by force if necessary.  
[ Parent ]
yes, but the egg-laying limitations remain
the gap is simply too big.  Bruce Gellin, director of the National Vaccine Program, frequently says how even if every single American becomes chicken farmers, they would still not be able to have enough eggs to make enough pandemic vaccines for everyone.

More on the limitations of egg-based production in this diary.



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

[ Parent ]
US should be fine
My last comment was specifically about the United States.   Since the government (US) is currently subsidizing pharma companies to leave production lines open just for vaccine production.  I would assume (pretty sure) they have made plans to supply these lines.

The United States exported about 2 percent of its egg production in 1990, some 1,200 million eggs including shell equivalent of egg products.

http://findarticles.com/p/arti...

USDA Publication

http://www.ers.usda.gov/public...


In the United States, more than 300 million laying hens produce eggs,

An Animal Rights Group web site
http://www.eggindustry.com/cfi...

1.5 billion eggs out of mississippi alone

http://www.mdac.state.ms.us/n_...

[ Parent ]
not the usual eggs though
these have to be fertilized eggs of 8 - 10 days old.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Yes, but if I do the math....
60 trillion eggs avalible...

12 eggs per vaccine, that comes to 5 trillion.

We would need only 5% of those eggs.  And since the population will be dieing off, even less.

I am sure there are number crunchers behind the scenes that have already gone over this and have a plan in place.  Even by force if necessary.   So it takes 8-10 days after fertilization, this is trivial.  Just adds a few days.

Now yes, I agree.  People outside of the US are in trouble the first months after it starts.  

[ Parent ]
I'm afraid it ain't that easy ;-)
I don't know what other specifications there are for the fertilized eggs, but every single official and scientist that I've spoken to, including those working for the FDA, HHS, vaccine companies, all unanimously say there will not be enough, and that the gap is HUGE.

If you look at the seasonal flu vaccine.  With full production capacity, they can make maybe 120 million doses each year, give or take.  On US soil.

But that as I said is a trivalent vaccine with a total antigen content of 45 ug, with a (seasonal) virus that has reasonably predictable good yield.  H5N1 gives 1/3 of the yield, but requires double the dose (90ug) x 2 doses, assuming no adjuvant and no other dose-sparing methods, ie only using seasonal flu technology.

With the same capacity that is making approximately 120 million doses now, you can make enough for 20 million people (reduced by a factor of 3 cos of poor yield, reduced by half cos each person will need 2 doses).

So, no, the US does not have enough eggs, to make enough pandemic vaccine using traditional methods.



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

[ Parent ]
adjustment to the 120 million figure
the latest from the cdc

http://www.cdc.gov/flu/about/q...

At the current time, the 5 U.S. influenza vaccine manufacturers are projecting that as many as 132 million doses of influenza vaccine will be available in the U.S. for use during the 2007-08 influenza season. This will be the most flu vaccine ever distributed in the U.S. during a single influenza season.

Notice however this was only the projected figure from the manufacturers.  I'm sure the maximum capacity is not going to be much more than that, assuming no mishaps.



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

[ Parent ]
Ain't saying it will be a walk in the park........
If you look at the seasonal flu vaccine.  With full production capacity, they can make maybe 120 million doses each year, give or take.  On US soil.

Thats with current manufacturers.  Not the ones we have in reserve.  Don't have any clue how much more capacity the have, but bet it's more than double, possibly more than triple.

So, no, the US does not have enough eggs, to make enough pandemic vaccine using traditional methods.

If you just look at the numbers I have listed, you have to see there are more than enough eggs produced here.  With your numbers, that would only be 5% of production.  hat leaves 95% excess to use.
[ Parent ]
there is zero reserve
that is what I'm trying to explain here.  Unfortunately.  It's a very harsh reality.  These figures have been worked through ad nauseum by lots of officials and scientists.  It's presented in meetings many times and explained over and over again.

What you see is all you're going to get.  Any expansion will be marginal, unless we use cell-based technologies.

If you just look at the numbers I have listed, you have to see there are more than enough eggs produced here.

Well, I wish you were right, I really do, but the reality is unfortunately very far from that. It doesn't matter how many other eggs are produced, eggs for the purpose of vaccine production have specific requirements, especially with the narrow window of fertilization.  And if you read the document I quoted, how arduous it is to process these eggs one by one, there just isn't room for much expansion at all.

Read what Bruce Gellin has to say in this interview

NJ: Right now, how many doses of a pandemic vaccine could be produced entirely within the United States?

Gellin: We estimate that if we were to ask Sanofi to dedicate their facilities entirely to H5N1 vaccine, they could produce approximately 30 million to 40 million doses of H5N1 vaccine in a year. At two doses per person, we could vaccinate only 15 million to 20 million Americans in a year. Of course, this would also mean that the company would have to stop making next year's flu vaccine in order to do this.





All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Ok now am confused.
This interview seems to verify alot of what I said.

From his interview

vaccine will be in short supply everywhere, and we can't assume that vaccine produced elsewhere will be delivered here

No S**t, said that earlier. We will have to take care of ourselves.

There are other vaccine production facilities within the U.S.

and
Because a pandemic will be caused by a virus that we've not experienced before, a pandemic vaccine is likely to be a much higher dose to achieve the immune response needed for protection.

and
We estimate that if we were to ask Sanofi to dedicate their facilities entirely to H5N1 vaccine, they could produce approximately 30 million to 40 million doses of H5N1 vaccine in a year.

As I stated earlier, there are 2 facilities (neither of them Sanofi) that have taken empty lines and converted them to production of the vaccine.  They are currently setting idle and waiting to start production tomorrow.  I would bet there are more facilities other than those 2.

How is HHS helping to improve our vaccine preparedness for a pandemic?  we've worked with manufacturers and egg suppliers to shore up the egg supply so that hundreds of thousands of eggs are available to produce a pandemic vaccine at any time.  

and
we are working with companies to diversify the manufacturing of influenza vaccine so that we are not totally dependent on eggs. There are other ways to grow viruses in massive quantities.

and
we are encouraging companies and the scientific community to explore approaches that will allow the dose of a pandemic vaccine to be lower than what we found in the initial studies of the H5N1 vaccine. There is emerging evidence that this could work by adding an adjuvant or giving the vaccine into the skin rather than the muscle to enhance the vaccine's immune response.

What is the government doing to help companies make these transitions?  we also recognize the need to increase the number of manufacturers. The appropriation provided by Congress in December allows us to build on this effort.

Think this is in my comments too.  See above.
[ Parent ]
my best suggestion ;-)
is this podcast from the cdc, on influenza vaccine production.  Very early in the podcast, they are saying how the manufacturers are producing at or near capacity, to produce the 132 million estimated for this 2007-08 season.

http://www2a.cdc.gov/podcasts/...



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

[ Parent ]
Your ignoring part of the discussion
I can look at all kinds of reports, podcasts or anything else you want, but they are based on current manufacturers.

I repeat, current manufacturers.  They do not include the idle lines we have waiting just for the pandemic.  The lines that are not running right now.  The lines they we are paying to keep open just in case TSHTF.   The lines that have workers in the wings, trained, ready to go at a moments notice.  The workers that are NOT producing flu vaccines right now.  

So lets quit talking about what happened last year or the year before that.  We are talking about preparations for the pandemic.  period.  not the seasonal flu.

So with hat out of the way, can you at least agree that 60 trillion eggs are alot????????  

[ Parent ]
where are the idle lines?
They do not include the idle lines we have waiting just for the pandemic.

I'm sorry, I'm not sure I know what you are talking about. ;-)  Can you explain?

Cos my understanding is all the figures are based on full production capacity, and that there is almost no room for expansion, even though they ARE working on it.

But if you understand it differently, can you explain how there are idle lines that are not running and just waiting for the pandemic?  Do you know this?  I'm very curious about that.

Thanks!



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

[ Parent ]
You answer mine, I'll answer yours.....
Do you at least agree that 60 trillion eggs are alot?
[ Parent ]
yes but how much of that are the right eggs? n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Ok, we are making progress....
so, 60 trillion eggs we agree are alot.  We'll drop that for now.

Do you agree/disagree that fertilizing eggs is more of a logistical matter that could be over come?

and

That waiting the 8 days or so is just another small logistical hurdle that can be overcome?  

[ Parent ]
look, you keep saying these are small logistical hurdles
and I'm happy that that might be a possibility.  But that is not what I'm hearing/reading from the experts and from industry.  Unfortunately, I don't work in that industry, so I can't tell you why they cannot turn 60 trillion eggs into good use.  But my understanding is that

a) there are specific requirements which I don't know about, so if you know how exactly those hurdles can be overcome please do share, and tell us your source of information

b) even IF you have the eggs, there is the question of production capacity, of turning those eggs into vaccines.

Again, I can only tell you what I know, from hearing those who are supposed to know these things.  Now if you know differently, please do enlighten us.

Here's a chart from a presentation by Rajeev Venkayya, White House Homeland Security Council, in the CDC Community Mitigation Stakeholders' Meeting in Atlanta that I attended.  From the powerpoint slide #8, if you double click on the graphic, it opens up an Excel chart.  If you click on sheet 1, you will find all the projections for vaccine production under various scenarios, and you will find this chart.  (I'm giving this long explanation just so readers know where this chart comes from.)





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

[ Parent ]
eggs
Found this;
Egg Supply
Until recently, the egg supply was organized to support seasonal vaccine production, and there were often gaps of three or four months when eggs were not readily available. Clearly, this is an unsatisfactory situation in preparing for a pandemic. Working on pandemic preparedness with manufacturers, the U.S. government awarded Sanofi Pasteur a contract to improve the egg supply and develop new technologies and has asked manufacturers to provide expert knowledge and solutions to specific problems in vaccine manufacturing.

To address the variability in the egg supply, Sanofi Pasteur restructured its flock management so that embryonated eggs would be available to support vaccine production at full capacity throughout the year. Because embryonated eggs are themselves potentially susceptible to avian influenza, flocks associated with vaccine production are under strict contract and must be completely housed, monitored by veterinarians, and raised under biosecurity regulations. With government support, Sanofi Pasteur has also established contingency flocks as a backup against avian influenza and other risks.
http://www.nae.edu/nae/bridgec...

There is no pleasure in having nothing to do; the fun is in having lots to do and not doing it." -Mary Wilson Little

[ Parent ]
thank you, that's a good article n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Nice Find!!!! n/t

[ Parent ]
sorry still wrong
the calculation.

It should be enough pandemic vaccine for 10 million not 20 million people, with a full year's production.  For a population of 300 million.

  • 120 million doses capacity,
  • reduced by 1/3 cos of poor yield,
  • reduced by half cos we need 90ug per dose instead of 45 ug,
  • then reduced by half again cos we need 2 doses.

Worse and worse.  ;-(

Also, the 132 million includes vaccines manufactured abroad, so the 120 million is the more likely figure (that I remember but can't find the reference) for production on US soil.



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

[ Parent ]
get your calculator...
60 trillion eggs produced a year.   How is that not enough???????  Please show me your math.
[ Parent ]
the math is not in the total egg production
but in the type of eggs required.  As I said, I don't know the exact requirements but I do know there ARE very exact requirements and a very narrow window before wastage, ie around day 11 after fertilization.

The thing is, I didn't come up with those numbers, it's quoted by industry as well as officials, in the context of trying to get enough pandemic vaccines.  

But the major math also lies in the poor yield and how we need more antigen and double dose.  

http://www.newfluwiki2.com/sho...



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

[ Parent ]
No the numbers are the biggest hurdle....
and facilities.  Getting them fertalized and in the right order is just logicstics.  Not that big of a problem (in the overall scheme of things.

As far as yield, with 95% excess, we can have a smaller yield.  

[ Parent ]
...
and what do your numbers tell you on needles, syringes, and vials?  to be effective, it has to be administered.  what is the domestic US capability for those, once imports are cut off?
[ Parent ]
yes that's another problem n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Most commerical eggs aren't fertilized ...
because commericial laying hens are kept in individual pens and not exposed to roosters. People don't like little spots in their egg yolks. Therefore these huge numbers of eggs are unfertilized eggs and useless for vaccine production.

"Farm" eggs (for lack of another term) are usually fertilized. The problem is that most small farmers have a couple of dozen hens at best.

[ Parent ]
just found this wonderful article
Influenza Vaccines: What's In That Needle?

Vaccine production is a slow, cumbersome process utilizing 500,000 fertilized chicken eggs per day for up to eight months. The two primary manufacturers of the influenza vaccine for the U.S. market, Chiron and Sanofi-Aventis, order hundreds of millions of eggs that become "mini-incubators" for the cultured viruses. The first step of the process involves a labor-intensive method known as "candling"-examining by hand each and every egg with a specialized light. This process allows for the handler to discard any eggs that have not been fertilized, are not growing, or have cracks in the shell.

When the embryo in the fertilized egg is 11-days old, selected eggs are labeled with specific identification numbers and placed into a tray with the blunt end up. The tops are cleaned using a 70 percent ethanol wipe and a tiny tuberculin needle is used to punch a small hole into the shell over the air sac. The amniotic membrane of the chicken embryo (the egg white) is then injected with a drop of viral-containing solution. Enough solution is contained in each syringe to inoculate three eggs before it is discarded. The puncture hole in the egg is sealed with a spot of glue and eggs are maintained for two to three days in a controlled environment between 91.4°F and 93.2°F (33°C and 34°C). During that time, the viruses infect the lungs of the developing chicken embryo and begin to rapidly replicate.

Several days later the eggs are placed into a cooler and chilled to 39°F (3.8°C) overnight. The next day sterile forceps are used to chip open the shell and the fluid from the three similarly inoculated eggs is collected into a test tube. The gooey viral suspension must be centrifuged-sometimes more than once-to remove as much chicken blood and tissue solution as possible. Some residual egg proteins frequently remain within the final product, hence, those persons with an eggs allergy are strongly advised against receiving the flu shot.

After this "purification" step, a test is performed to detect the presence of an active form of the virus; if none is detected, the specimen is discarded. If virus is present the solution is submitted for further chemical processing before it is placed into ampoules for sale. The entire process, from egg selection to viral harvest, can take at least six months.





All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Supply Problem already taken care of
The rest I am not educated enough on the subject to comment.  But like I said, I know of 2 facilities just sitting there waiting to start producing.  And neither are the ones mentioned in the article.  I am sure that TPTB have plans in place to get the ball rolling as son as possible.

500,000 eggs a day?  No problem, since we produce 60 trillion, thats 120,000 days worth.  Or 164.4 million a day.  We ca prduce vaccines and still have an occasional omelet.  

[ Parent ]
well I'd suggest that you look at this carefully
because it does matter for everyone's wellbeing.  The US cannot produce enough pandemic vaccine for itself without the use of new technology, and neither can any other country.  Which is why the rest of the preparation, and the use of novel technology such as cell-based recombinant vaccine, is a must.

As we discussed earlier, with a pandemic virus, sooner or later everyone will either get infected, or they will have to get vaccinated.  Whether we can make enough vaccines matters a great deal for everyone, in the US and in other countries.

Just my bit of thought on this..  ;-)



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

[ Parent ]
Yes additional production methods.....
are gonna be needed, especially with the idea of a vaccine or the world.  

First, I would bet all countries, including the US will take case of their own first.  I would also be willing to bet, that there are countries out their looking to use the pandemic to their own benefit (take out old foes, ect...).

Since we are ranked in the top 4 in egg exports, alot of countries had better come up with alternate vaccine production methods.  I bet the supply chain dries up quick once "it" starts.

[ Parent ]
here's a good reference
for free.  A review written by David Fedson

Vaccine development for an imminent pandemic: why we should worry, what we must do.



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

[ Parent ]
indypokerboy41, there are no doubt
any number of foreign govs/entities that believe that exporting panflu vax to the U.S. will be one of the greatest cash cows in history.  It can be expected that some are gearing up for that, regardless of the needs of their own populations that may ultimately be ignored (there's too much potential in the way of personal enrichment for a few well-placed individuals to expect all of them to disregard the "opportunity" to sell abroad what might more ethically be used at home).  

But as far as being on the purchasing end, I think the U.S. will be loathe to grab untested foreign panflu vax containing mystery adjuvants.  Better the monies be placed into a Manhattan-style vax production effort which, by the time panflu is knocking on their own personal door, is an effort most of our citizens will suddenly be very willing to get behind (so it won't be a problem for the politicians to fund it).  They might even be willing to get behind such an effort now, if they fully understood the implications of pandemic influenza, but no, they're being coddled more softly than those fertilized chicken eggs.  When the time comes, we will step up and do what is needed.  We always do. ;-)

[ Parent ]
vaccine
is it more ethical to give vaccine to the own population, to
close friends than to those who need it more urgent
or pay more ?
Even if, the countries who produce vaccine will likely be able
to expand capacities beyond covering their own population,
just a matter of price.
E.g. EU - would it be more ethical to sell to other
EU-countries than to US ?
It might even be used as a weapon for political pressure.

I think the US-decision to spend most money on building own
vaccine-capacities was maybe wrong. It takes too long,
APAs might be more appropriate. (however they couldn't
know in 2005...)
Currently some European countries poorer than USA and without
own vaccine production and fewer investment have better
coverage than USA

ask experts for their subjective
panflu death expectation values
and report the replies

[ Parent ]
I found this description a bit more enlightening.
I was at a loss to figure out why candling would be such a big deal, as I do it all the time.  It is not a highly skilled task.  Those special lights?  Not that special.  All you really need is a floodlight.  Bah...

http://www.vegsource.com/talk/...

Aventis starts making vaccine more than a year in advance, around August on nearly 50 farms throughout Pennsylvania.

"They're fairly small operations," many with only 10,000 birds, said Sam Lee, a 40-year-old chemical engineer who is the company's operations team leader.

White leghorn hens are used. The exact type is a company secret. The breeder holding the patent supplies the eggs, which take 21 days to hatch and become chicks.

They're moved in late September into buildings where they can move freely as opposed to cages and coops, and spend three months maturing into hens.

Egg-laying starts in late December, typically one a day. How many eggs it takes to make a flu shot is another Aventis secret, but Chiron's Bryett said: "If you're very lucky, you'll get three doses per egg." That's for a single flu strain; three strains go into each dose of vaccine.

The fertilized eggs are collected by two large egg producers, who incubate them for seven to 12 days and then bring them to Aventis. Eggs delivered in January would hatch into chicks if not used for vaccine, so manufacturers often gamble and start making whichever of the three flu strains WHO seems most likely to choose.

(snip)


Millions for defense, but not one cent for tribute!

[ Parent ]
thank you, this is good stuff.
The problem with vaccine issues is so much is proprietary information that it's sometimes just hard to connect the pieces together.  So if anyone finds even snippets that might be useful, post away!!

Thanks!



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

[ Parent ]
hat tip to SophiaZoe ;-)
(via her blog) for finding this old comment of mine http://www.newfluwiki2.com/sho... which explains how we need 12 eggs per person for pandemic vaccine, using traditional techniques.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Are supermarket eggs fertilized eggs? n/t


"The truth does not change according to our ability to stomach it."  Flannery O'Connor
[ Parent ]
no, they are not
http://en.wikipedia.org/wiki/E...

Most commercially produced chicken eggs intended for human consumption are unfertilized, since the laying hens are kept without roosters.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Thank you! 2006: salmonella w/vax?
...At ASU, researcher Roy Curtiss is taking one of the more radical approaches: using salmonella. If it works, it could mean that people will drink a liquid with a salmonella bacterium that has been neutralized and laced with flu-virus genes....
http://www.azcentral.com/arizo...

...When production is in full swing at the only major flu vaccine manufacturing facility in the U.S., Sanofi Pasteur, trucks carry hundreds of thousands of specially fertilized eggs across the bridges of Swiftwater Creek, Pa., every day. Hens and roosters at Cornell University produce the eggs, which act as incubators for the flu virus injected into them at Sanofi Pasteur.... (from Dec. 2005)
http://www.npr.org/templates/s...

A quick search didn't find out how many fertilized eggs are produced, but from the above, it doesn't sound like it has a lot to do with the food eggs that there are so many of (at least we have them these days).

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

[ Parent ]
It is my understanding
that the H5N1 virus can not be grown/cultivated(?) in eggs to produce the vaccine. That H5N1 is the only flu virus that will not do this. Do I have this wrong?

United we stand: Divided we fall
www.flunewsnetwork.com
[ Parent ]
not all eggs are killed
only some eggs are killed.
H5N1-vaccine can still be produced in eggs, but it's
more difficult, more expensive

ask experts for their subjective
panflu death expectation values
and report the replies
[ Parent ]
Numbers, gs ;-)
About what percentage of eggs are killed? Is there data on that gs?  

United we stand: Divided we fall
www.flunewsnetwork.com
[ Parent ]
yes, the HPAI virus kills the eggs
but what the WHO does, in its reference labs (I believe it's the one in London), is to reverse engineer the virus to remove or alter the connecting peptide, the characteristic polybasic amino acid that joins the 2 parts HA1 and HA2 to form the full HA antigen.  This in effect turns the virus back into LPAI.

This reverse engineered vaccine strain however has several problems, including much lower yield than the normal seasonal flu vaccine strain, and also has very low immunogenicity, so that compared to seasonal flu where each strain needs only 15ug each (there are 3 strains in the seasonal flu vaccine), the H5N1 vaccine requires 90ug to produce immunogenicity, in the absence of adjuvants.

I also think that changing the composition of the major antigen against which the immune system reacts, is not only the major cause of the vaccine being ineffective, but possibly in the case of avian vaccines, may favor the persistence of HPAI over LPAI, and that we need a re-think on vaccination strategy.  More details and references here Re-considering vaccination approach: targeting virulence



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

[ Parent ]
So, it isn't a matter
of "when the H5N1 vaccine" will be manufactured, but "if it can be manufactured?"

Once they find the "key" to producing an effective H5N1 vaccine, should that strain mutate, can they use that same "key" to produce vaccine for that strain?  

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

[ Parent ]
no, it can be manufactured
it has already been manufactured, using the conventional egg-based techniques.  That vaccine from Sanofi Pasteur has been licensed in the US for pandemic use, but it needs 90ug per dose to be effective.

In a way you can say they found part of the key, except that it isn't very effective, hence the need to either improve immunogenicity with adjuvants, or use cell-based techniques to produce massive quantities.



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

[ Parent ]
Ok. I underdstand now.So
unless they can get an effective H5N1 vaccine soon,(a few months, or a few years given pan flu hasn't happened) there are still some variables that can impact the masses getting this vaccine, as a poster just pointed out, having enough supplies to administer the vaccine. So it could be, that there may be enough vaccine, but not enough supplies to give it.

You know, I think the Dark Doctor(do I have the right doc?)probably has a point to what he has said. It does sound like no matter what tool you use and for how long, we're gonna be you know what. What are the odds of there being enough vaccine, and supplies to administer it to the masses? Maybe I won't hold my breath during SIP. ;-)

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

[ Parent ]
don't hold your breath ;-)
OTOH, a pandemic may not happen for a while, and in the meantime, science is churning out more and more knowledge.  One of the 'benefits' of having had this H5N1 problem is simply that a lot more money has been put into research.  Not enough, of course, but certainly a lot more than had been available for decades.  It takes time for any usable results to be turned into actual benefits, but over time this should increase.

The vaccine scenario is not all that bleak, in the medium term.  Look at this chart from Robinson, HHS.  

The issues for licensing for pre-pandemic vaccine are being worked on.  The RFP (request for proposal, ie HHS solicitation for contract proposals) for advanced development of recombinant vaccines are being reviewed, and contracts are expected to be awarded in the next few months.  Meanwhile, vaccine production capacity is being increased.  It will be a long while before there is 'enough', but IMHO there is realistic hope particularly with the recombinant vaccine of a massive increase in capacity if and when that gets licensed.

This other chart shows the advantages of recombinant vaccine:





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

[ Parent ]
on the subject of supplies
like syringes etc.  Yes nobody has enough of a stockpile, and I suspect no matter how we work on it, there will still be not enough, simply because the political will for such spending will range from low to nil, prepandemic.

However, this is where the mitigation issue comes in.  Suppose we can successfully promote CMG measures all over the world, such that the reductions in AR and deaths seen in St Louis in 1918 is seen in many countries.  What will be the effects of that?  Nobody knows for sure but I suspect it will mean a very dramatic slowing down of the global pandemic.  Let's say instead of the first wave hitting all countries in the world and FINISHING within 6 months, we get that to be prolonged but attenuated, so that it becomes less of a tsunami-type wave but  more like waves in a normal storm, say extending over 2 years instead (WARNING: these numbers are hypothetical) and that as a result supply chains do not break down completely nor over extended periods.

If and when a pandemic breaks out, assuming we can keep society running albeit in a scaled down way, governments I'm sure will pour massive resources into scaling up production os such essential items as syringes.  The public will demand it, and the political will will be there.  We may even go low-tech again, and use old-fashioned reusable glass syringes that can be re-sterilized.  Why not?  We may decide as a society that in comparison risks that were not acceptable in normal circumstances will become acceptable after all!

I believe there are substantial benefits for every country if we promote CMG measures globally, to create that massive slowing down of a pandemic.  As long as society does not come to a grinding stop, we still have hopes of work-arounds.  Human beings are ingenuous and will find solutions however imperfect.  

Just my thought.  As usual, your mileage may differ.  ;-)



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

[ Parent ]
Bottom line.....
There are things in the works that the government is not going to discuss publicly for what ever reason.  They are aware of the consequences of lack of preparation.  I am positive they are aware of certain supply issues and are making preparation to solve that.   I am not sure how long we will have to wait for the vaccine, but it will come.  And because of this, Yes I do believe that SIP will be a good option for everyone to consider.  Prep yourselves the best that you can.

Since I have been asked not to comment further on this particular subject.  This will be my last trip to this diary.

[ Parent ]
apologies if this is a misunderstanding ;-)
Since I have been asked not to comment further on this particular subject.

Did you mean asked by someone here?  Or offline?  I don't mean to pry, and please don't respond if it's problematic for you, but I just wanted to make sure there is no misunderstanding.  I don't believe I read anyone asking you not to comment on this topic, on this forum.  And I don't see any reason for that at all, it's a great and important discussion.

I hope things are ok, and that you can comment on this and other topics.  Thanks!  



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

[ Parent ]
The vaccine issue
Clearly there are some who don't get the vaccine issue despite the very thorough and detailed explanation provided by Susan on this diary.  My impression is the hopeful expressions being made here are due to denial.  The truth is that there are no unused vaccine production lines waiting to get the job done, the current pre-pandemic vaccine that the US DHHS bought and the CDC has licensed is not likely to be very effective during the pandemic.  At the very most, the hope is that it might convey a little cross reactivity with the pandemic strain once it emerges but even this is a stretch.

This is an important issue and I am going to start a new diary about it today.  The basis for this diary will be the last chapter of my new book which deals with these and other related issues in detail.  I hope this will provide some clarity here where apparently there is too much optimism based upon the notion that the USG has a secret plan and a technological answer to this critical but alas unsolved issue.  This reminds me of Nixon's "secret plan to end the Vietnam war" in 1968.  It was bull then and this new secret plan is bull now.

Grattan Woodson, MD

[ Parent ]
ah, I see that I mistook your question
I have a paper somewhere describing the production process and timeline. I have to dig through a lot of stuff to find it, but when I find it I'll post the stuff.  

Sorry..



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

[ Parent ]
I'll look too
at a certain stage it's beyond batching and it is not in monthly production aliquots.
[ Parent ]
found it!
follow this link for interactive graphic, on bottom right of the page

http://flusupplynews.com/manuf...




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

[ Parent ]
this is a good source
with lots of information and charts

2006-2007 Influenza Vaccine Production & Distribution from the Health Industry Distributor Association.

One interesting graphic is this, showing, for seasonal flu, how the demand always peaks before supply:






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

[ Parent ]
Interesting, thanks!
And inevitable - just as in panflu everyone will want to be first (modulo worrying about side-effects) it's easy to see why almost everyone who wants a seasonal flu vaccination at all wants it ASAP. I suppose the only way to tackle this would be to tell people that it wears off, so that they might prefer to have it closer to the peak... hmm. Tinfoil hat off :-)
[ Parent ]
Esteemed CottonTop
You are obviously a wise person with a cool head (pun intended) ;~}

Yes, I think H5N1 will become the pandemic strain and it will be very bad as stated in my previous post on this diary.  I think the pandemic will last for about 1 year but the aftermath much longer, 2 to 4 years.

I think the most prudent course of action is the ride this period of several years out in a rural community for the reasons stated in the previous post.  

I recommend having enough store bought supplies to last 12 months and then be prepared to grow your own and essentially self sufficient for a while thereafter.  

Humans are gregarious animals and we need each other.  We are completely interdependent and this will not change.  It is my professional opinion that my views on the CAR, CFR, and Death number will be born out but it could be worse or better, no one can tell.  These statistics are irrelevant.  What is important to understand is that the risk we all face from this event has a probability of being bad enough that it is high enough to warrant it being a prudent choice to prepare for it.  Knowing what those of us who visit this and the other forums have learned about this issue over the last few years should be adequate, in my view, to uphold this opinion.  Otherwise, why are you here and reading this?

I think most people who get BF will survive it.  Some will not.  No pandemic in recored history has had a CFR of 70% like the current pre-pandemic strains of this bug.  It is very unlikely, IMO, that the thousands of prior influenza pandemics that have surely occurred since the human race first evolved ever had a CFR that high.  Why?  Well it is simply that if it did, the human race would have become extinct.  It is not extinct.  This is a manifest fact. So, this is why I think this pandemic will behave like the others we know about that have happened over the last 2500 years.  I do think this pandemic will be severe like the 1918 pandemic.  I also think it will be worse than 1918 not because the bug is worse, I think the bug will be very similar in fact.  There are a large number of genetic similarities that H1N1 (the 1918 flu) and H5N1 share that cause me to think this to be so.  

So, my guess is that it will be a very bad pandemic.  What will make it worse than 1918 is not the bug but the tripling of the human population that has occurred since then and its concentration into a big cities.  Another factor is because I think the virus will spread through the world with unprecedented speed during this pandemic.  One other factor is the age of the human population and the relatively large number of fragile members of our societies.  All these factors are known to increase the transmission rate of an infectious disease and influenza is one of the most if not the most infectious human disease.  The higher the transmission rate the worse the pandemic.

So, these factors will make a bad pandemic disaster into a societal catastrophe.  A catastrophe is an order of magnitude worse than a mere disaster.  The reason for my elevation of the coming pandemic to the status of a catastrophe from that of a disaster is not based on the virology but rather on my opinion that current conditions extant predict that this pandemic will result in the temporary but never the less prolonged collapse of social order and the world economy.  These events will be what will make this pandemic so severe and much worse than 1918.  

This is what I see and yes it caused me to be very depressed.  In fact, it is why I dropped out of the community for the last year.  I was trying to cope with this view.  With time I have worked through these nightmares and chosen my course of action.  One of my choices has been to return to this forum and share what I think with the community.  I do this not to discourage anyone.  Rather the purpose is to try and bring this possibility to as many people's attention as possible.  My purpose in doing so is to widen the parameters of what we could be in store for so that those who see the validity in this opinion can better prepare for it.  It is the subject of my new book.

For instance, 18 months ago, I wrote and advocated storing 3 months of food for the pandemic.  At that time I thought that would be adequate to see a survivor through to the point where recovery in the supply chain would be adequate to get new food.  While researching the food issue for the new book, I discovered just how fragile and complex the food issue is.  After developing a clearer understanding of all the inputs required to produce a bushel of corn or pound of beef, it became painfully obvious to me that we will loose at lease one full crop cycle and possibly two to the pandemic.  This coupled with the 25 year low in grain stores and the fact that 2 billion people in the world have no food security adds up to a real horror show.  

Food security in the developed world is also tenuous at best and it is of note that when you next visit the grocery store be sure to take a look around.  What you see on the shelves is all there is.  There is no warehouse full of food.  Everything is trucked in daily.  So, all those folks that live in the cities are at the trail end of a very long and complex food supply line.  This food supply line is very fragile and can be disrupted for any number of reasons.  Suffice it to say that many of the potential causes for its disruption are easily predictable as a result of a bad pandemic on the order I expect.

It is food shortages in the cities more than any other factor that I foresee as the inciting factor in the collapse of civil order.  This is our and every societies Achilles heel and when food security is lost, well I think you can imagine the rest.

So, your motto United we Stand Divided We Fall is mine as well.  I just don't think it is rational to Stand in front of a locomotive of civil disorder coming at me at 100 MPH in the city where I live today.  That makes no sense at all to me.  

I am confident that many will survive the pandemic but none will prosper.  We will need each other during and after this emergency more than ever.  Those who prepare well for the pandemic will have a much better chance of survival than those who don't.  Of this I have no doubt.  Of course we all know being prepared does not ensure survival.  This is simply a risk we who do prepare need to accept.  Most of us are not just preparing for ourselves.  Most are including their families and friends in their preparations.  This is a rational choice and even if you personally fail to make in, your preparations are surely going to be useful for others around you.  

The Doctor

let's use all ten (or was it twenty) sides of our brains
May I kindly challenge our thinking just a little bit, to make it fuller?

You've looked at what can go wrong, and what makes this "new one" more dangerous than all other previous pandemics.  I may have not researched things in as much detail, but I certainly agree with many things as stated by this new Dark Doctor (welcome back!), and the full picture does indeed include devastating possibilities.

Now, What are our strong points, How do we build on them, and How do we build on them fast enough, are also importants points.  What does the Bright Doctor (and all of us who care to think out loud) say? :-)

Here's what I find in a rush:
- a diverse flubie "non-community" (where the one feature is "pandemic concern", all else being greatly different, which is good), probably growing in numbers as we speak
- a much deeper understanding of issues than, say, last year
- small, copyable tools, a number of them still in developement (good home care, then a dvd, now several attempts to go for small community care (see diary on "austere care"); getpandemicready.org; Citizen's manual)
- the readymoms movement plus the IdahoEM threads on county preparedness
- what vaccine companies are doing may also make a difference IF time to first arm is reduced many months, quantities are hugely increased, dependency from eggs is dropped, etc

There's also a number of other elements of uncertainty in the horizon I see from here.  It's in our hands to try and get ready to make use of those first moments: we'll need to learn if "simple masks used by many" make for flatter waves everywhere.  We'll need to know if "simple treatments" (statins) make a difference.  There's the distinct possibility that learning, on a planetary scale, will be huge and blitzcriegingly fast (measured in days to a few weeks).

It's still an uphill battle, and stuff is far from settled, and there are just too many things going on to even keep track of it all.  Personally, after sticking my neck out to look at what many are doing, I prefer to dive back into what I can personally do today ("which is, let me check, ah, yes ...").

Paraphrasing something I read in WorldChanging.com long ago, in complex matters it's not easy to be fully optimistic or fully pesimistic.  I don't know what will come out at the other end of the next pandemic.  I think it will be it's own peculiar brand of TEOTWAWKI because "more than zero things" will change and some of those changes will be here to stay.  (Alternatively, and just as an example, maybe more folks will grow their own food only for a short while, and then go back to full speed globalisation.  I don't know.  It will be the role of survivors to do as they wish on all matters big and small.  Not my problem.)

Finally, I hope there's some more time to make more of a difference.  It's not over until it's over.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
cottontop, very stringent SIP did work during 1918
for some whole communities who attempted it, it seems.  The strategy might be one to keep in mind and perhaps evaluate seriously at the local level.  Certainly, given the evidence, is not a strategy to discard out of hand.  

While stringent SIP cannot shield us from the carry-on effects to the food supply chain, etc., that Dr. Woodson highlights which will linger on post-pandemic, stringent SIP can be a tool to be used during a pandemic with the goal of avoiding infection for at least small "sub-communities," whether they be family units, institutional settings, or even perhpas small towns.  This kind of strategy was one approach that did meet with success during the inflenza of 1918.

A study reported in CDC's Journal of Emerging Infectious Diseases (Dec. 2006 issue) addressed this issue.  

The researchers (who included Howard Markel and Arnold Monto) termed this sort of community collective SIP "protective isolation.".  It's an NPI strategy, but it's an NPI strategy in our toolbox which we don't see discussed very often.  It should be, if we wish our communities to endure.

Nonpharmaceutical Influenza Mitigation Strategies, US Communities, 1918-1920 Pandemic

Howard Markel,*  Alexandra M. Stern,* J. Alexander Navarro,* Joseph R. Michalsen,* Arnold S. Monto,† and Cleto DiGiovanni Jr‡

http://www.cdc.gov/ncidod/EID/...

Abstract

We studied nonpharmaceutical interventions used to mitigate the second, and most deadly, wave of the 1918-1920 influenza pandemic in the United States. We conclude that several small communities implemented potentially successful attempts at preventing the introduction of influenza.

The 1918-1920 influenza pandemic was the deadliest pandemic in human history (1-6). We undertook a historical evaluation of nonpharmaceutical interventions (NPIs) during that pandemic.  [snip]

We selected 6 US communities that reported relatively few, if any, cases of influenza and no more than 1 influenza-related death while NPIs were enforced during the second wave of the 1918 pandemic: San Francisco Naval Training Station, Yerba Buena Island, California; Gunnison, Colorado; Princeton University, Princeton, New Jersey; Western Pennsylvania Institution for the Blind, Pittsburgh, Pennsylvania; Trudeau Tuberculosis Sanatorium, Saranac Lake, New York; and Fletcher, Vermont. [snip]

The US Naval Base at Yerba Buena Island in San Francisco Bay (12) and the mining town of Gunnison, Colorado (13), also offer potential lessons for contemporary pandemic influenza preparedness planning. Under the direction of public health officers, the still-healthy island and mountain town essentially cut off all contact with the outside world to shield themselves from the incursion of influenza. The 2 sites saw almost no cases of infection and thus experienced no deaths, for 2 and 4 months, respectively.  

Most important, these communities enacted a policy we have termed protective sequestration, or the measures taken by the authorities to protect a defined and still-healthy population from infection before it reaches that population. These measures include the following: 1) prohibitions on members of the community from leaving the site; 2) prohibitions against visitors from entering a circumscribed perimeter; 3) typically placing in quarantine those visitors who are allowed to enter for a period of time before admission; and 4) if available, taking advantage of geographic barriers, such as an island or remote location.

Several themes emerged from our historical research.

First, coordination among public agencies is essential to any effective public health response. [snip]

Second, neither Gunnison nor Yerba Buena could have escaped the flu without full cooperation from the local population. [snip]

Finally, these communities had the advantage of early warnings to prepare their populations. Both tracked influenza's westward movement from August to September and, unlike communities along the East Coast, could implement protective health strategies before cases appeared at their doorsteps.

[snip]

Indeed, these communities represent the exception rather than the rule in terms of how most American communities experienced the influenza pandemic of 1918-1920 (14,15). This leads to several intriguing questions regarding what these escape communities can teach us about pandemic preparations today, let alone the question of whether such measures can even be replicated.

Conclusions

First, protective sequestration, if enacted early enough in the pandemic, crafted so as to encourage the compliance of the population involved, and continued for the lengthy time period in which the area is at risk, stands the best chance of guarding against infection.

Second, available data from the second wave of the 1918-1920 influenza pandemic fail to show that any other NPI (apart from protective sequestration) was, or was not, effective in preventing the spread of the virus. Despite implementing several NPIs, most communities sustained considerable illness and death. We could not assess how the timing of NPI implementation across the nation affected disease mitigation efforts nor whether these NPIs lessened what might have been even higher rates had these measures not been in place in various locations. Moreover, we could not locate any consistent, reliable data supporting the conclusion that face masks, as available and as worn during the 1918-1920 influenza pandemic, conferred any protection to the populations that wore them (16). In fact, evidence suggests that in most American communities NPIs did not prevent the spread of virus in 1918. What remains unclear is the extent to which they may have been partially effective in reducing spread or mitigating community impact.

However inconclusive the data from 1918 are, the collective experiences of American communities from the pandemic are noteworthy, especially in light of the fact that, if faced with a pandemic today, we would likely rely on many of these same NPIs to attempt to mitigate the spread of the infection until pharmacological supplies of vaccine and antiviral agents were available (17-19). It is true that the United States of today is a much different nation than it was in 1918, with a larger, more mobile, and more complex society. It is equally true that the communities we examined were all small and relatively isolated (or isolatable). Nevertheless, in the event of another influenza pandemic, many specific subcommunities (e.g., military installations, college and university campuses, nursing homes) may wish to consider protective sequestration measures as potential means to prevent or delay the onset of epidemic influenza in their populations.

Very interesting Pixie
"protective isolation" a much better term

 

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

[ Parent ]
Not likely.
"Nevertheless, in the event of another influenza pandemic, many specific subcommunities (e.g., military installations, college and university campuses, nursing homes) may wish to consider protective sequestration measures as potential means to prevent or delay the onset of epidemic influenza in their populations."

These are the institutions that are LEAST likely to institute protective isolation.

The universities will discharge students and the military will be mobilized for support of civilian emergency management and policing ops. Nursing homes, like hospitals, are service intensive, and therefore are unable to adopt 'protective isolation', other than to turn away visitors.  

As far as I know, vaccine and anti-viral drug dose set-asides are insufficient to treat medical care workers in nursing homes.  Not that it's really necessary, since we can expect to see a comparable age-group histograms to that of the 1918 strain (I personally dislike the term 'panflu' which sounds like some exotic appetizer).

Isolation did not help the Alaskan natives avoid influenza, but it did help certain isolated South Pacific islands.

The case of the TB Sanitorium in NY is special, as is that of the New Hampshire town examined. If you read the chronicles carefully, you'll find that latter, in fact, didn't curtail social interaction, despite the reports of heavy outbreaks in nearby towns.  The former did have cases, but under peculiar circumstances.

Once you understand the mechanics of modern civilization and that of pandemic influenza, you'll realize why most NPI efforts will be ineffective.  

[ Parent ]
Will the age related mortality seen in 1918 occur with the coming pandemic?
Studies of crude mortality from the 5 years prior, during, and 5 years after the 1918 pandemic show that virtually all the excess deaths occurred in those under age 55.

The reasons for this are not known and we really don't have any influenza specific data for 1981, just crude death rates that include all causes of deaths.

There has been much debate about the reason for the lack of an increase in the death numbers in the older groups.  A leading theory is that the pandemics in the 1880s led to cross-immunity to the H1N1 strain that caused the Great Influenza 40 years later.  Another idea proposed is that older people's immune systems are fundamentally different from younger folks in a way the resulted in their not experiencing cytokine storm and ARDS that was found commonly in younger flu victims and nearly always fatal.

We have very good virology today and there is little chance that older people alive now who lived through the 1957 and 1968 pandemics have any cross-immunity to the H5N1 strain.  There is some evidence that the pre-pandemic H5N1 strains are more lethal in younger than older victims who do seem to suffer cytokine storm more commonly.  So, this aged immune-system factor may be operative to some degree during the next pandemic.

While we can and should hope for the best here, this is not something we can expect to make a whole lot of difference in my view.  The aged immune system benefit will, IMO, be small compared with the increased frailty factor of the population as a whole (children and adults alive today with chronic diseases who in past time would have succumbed to their primary illness) and the fact that many populations have significant numbers of aged within them that will be more vulnerable to influenza and its complications at a time with the healthcare system will be overwhelmed and unable to provide routine care.  

Dark Doctor

[ Parent ]
which would mean a large number of
collateral deaths in comparison to the 1918 pandemic, at least in my opinion.

We have a lot more technology-dependent-for-extended-or-quality-life individuals of all ages these days.  We also have a lot of technology assisted births compared to the early 1900's.

To me that means that the collateral deaths, both those indirectly and those only very indirectly related to pandemic infections, will equal or surpass deaths directly attributable to pandemic infection.

Loss of primary caregivers for technology dependent individuals will add to this problem even further pushin the "indirect effect" even further.

I'm not sure if I'm making myself clear but I know this has been discussed before.

Never doubt that a small group of thoughtful, committed citizens can change the world, indeed it is the only thing that ever has. -- Margaret Mead

[ Parent ]
Collateral deaths, A BIG ISSUE
Lets look at this aspect of the pandemic for a minute because it is really important.

Consider these facts:  
1) Hospital capacity is tight now without a pandemic.
2) The much ballyhooed Surge Capacity is a myth.  There is very little real surge capacity.  Only a small number of the surge beds are real hospital beds.  Most are cots setup in halls and auditoriums not real setup and staffed beds. Some will be in new "inflatable hospitals".   The weak link is not just beds, the weakest link is staffing.  Nurses, doctors, allied health staff and the legions of non-HCW staff required to make a hospital work are simply not there now and won't suddenly appear during the pandemic.  The fact is the number of HCW and the others needed to staff the current beds will fall sharply during the pandemic due to illness and death among them and their families plus voluntary withdrawal of services.
3) With all the beds filled with sick flu patients, where will those with treatable but severe common illnesses be treated.  No where, thats where.  The death rates of these folks will be very high without access to a setup and staffed hospital bed.  This is one of the sources of collateral deaths that will be very high but not directly related to flu itself.

The bottom line is that these factors are going to be a very big problem and one that will not have any good or easy answers.

Dark Doctor

[ Parent ]
Yes, an immense problem
We have a starting point here

http://www.newfluwiki2.com/sho...

and would appreciate thoughts on additional policy/procedural methods that we can consider for the collateral death issue. (County population is about 38,000)

[ Parent ]
SIPing in 1918 and today, do the lessons learned then apply to today?
Not really IMO.

Those isolated hamlets that kept everyone out did OK but were self-sufficient communities.  They grew their own food and had very little need for outside sources of power or other supplies.  There were no organized gangs of Zombies running around looking for targets of opportunity that needed to be defended against.  

I simply don't see this strategy working today.  We have simply become way too interdependent.  All these little bergs rely on the electric grid.  Most farm families buy their food at the grocery store rather than harvesting it from the garden as in 1918.  Todays farmers grow one or two cash crops like soy beans, wheat or corn.  Most don't have gardens out back with 20 different varieties of vegetables etc.  Their wives don't can the surplus for the coming winter.  Most probably don't even know how to can anymore.  

These folks and their rural neighbors will be in the same pickle their urban counter parts will be in, up the creek without a paddle.  Now, they will be in a much better position to survive for all the reasons I have given in prior posts in this diary relating to less risk from civil disorder.  They will also be better prepared to put in a big garden, have access to freshly slaughtered livestock and many already have and know how to use guns to protect themselves.  These advantages will take them quite a way to the survival goal line if the act quickly once outbreak happens.

The notion that they will be able to SIP with success or institute a reverse quarantine is not one that I think likely however.  They will need to help each other and pull together.  They will need to quickly organize and have good leadership to make it.  They will need to deal with hundreds of refugees that pour in from the cities with nothing but the clothes on their backs and an empty stomach.  While some communities might try to keep these desperate new travelers out, this attempt will quickly become a bloody nightmare and is sure to fail.  There will be many more refugees than original members of the community and if the community uses violence against these folks, then in the end it will fail and lead to their deaths and disaster.  

So, I really don't think the lessons on SIP from 1918 have much to teach us today simply because the circumstances then and now are so different.

Dark Doctor

[ Parent ]
Different, but still lessons to be learned
Simply recognizing the potential problems with SIP gives us the opportunity to address them.  

There are some huge problems with SIP; physically and psychologically. However the problems aren't insurmountable with broad strokes of creativity.

The "SIP" of 1918 will not be the SIP of the next pandemic, but that doesn't mean that it isn't doable.  

First, there are far too many single parent families to make sweeping SIPs feasible from an economic perspective.  The social issues alone with only one enforcing adult are unrealistic.  But, you could have a "cluster" of single families operating together in a cooperative arrangement.  In this instance disinfecting, as well as behavioral, protocols will have to be extremely well organized and enforced.  But, it is possible.

Even two parent, or two supporting adult, households will be severely challenged to maintain discipline in a strict SIP setting.  Again however, it is doable with some creativity.  Economically it would make some sense for one adult to be strictly sequestered with any children and the other adult to be in a modified SIP with strict enforcement of rules/regs being the community contact.

There are a number of combinations of this type of situation that can be utiliized.  A lot will depend on the virility of the pandemic and the individual family's or group's make up and personal circumstances.

SIPing 1918 style doesn't make any sense.  We'll need to institute SIP as appropriate for our current timeframe, environments, and circumstances (financial, physical, and emotional).

Simply saying that something can't be done is not constructive in my opinion.  We need to take the useful from the unrealistic and mold it into a more applicable plan.  We also need to take the applicable plan and mold it for more individualized use whether that is for a single person, a single family, or at the community or national levels.

Never doubt that a small group of thoughtful, committed citizens can change the world, indeed it is the only thing that ever has. -- Margaret Mead

[ Parent ]
i agree about the creativity
and even if, say, only 40% people could SIP part-time, while most of the others take other NPI actions, that would make a big difference.

Computer models need lots of computer power to compute.  I say this because it might be good to try out many creative combinations (of different strategies) and see what happens.

These days I'm trying to keep in mind the "slow mo" approach: things are done in a certain way for 2 weeks, some lessons are learned, we move on to 2 more weeks, etc.  That's why I found the CDC approach in their recent table-top exercise (with a team of 10-15 people doing strategic thinking amid the noise and haste of a 1000 people simulation exercise) was so good.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Some in and some out
I won't be in isolation, I'll be out and about taking the risks and helping where I can.  My wife, daughter in-law and grandkids will be as isolated as possible till we see what's going on, my son will be isolated as well as he can but it's not likely to be total.  The logistics of this won't be easy, but It's the only way I can see to go.  If needed my wife will break isolation to care for either my son or I if we get sick.

The truth is that we need more people, spread the load and share the risks.

Planning in advance to have a couple of livable places is needed.

I figure that if I can find about two other people to help me we could scavenge and support 10 to maybe 15 families. Everybody seems to be looking out for only #1, that's a sure way to doom everybody.

I couldn't agree with you more!
community resilience is the key to survival.
[ Parent ]
good for you!
I figure that if I can find about two other people to help me we could scavenge and support 10 to maybe 15 families. Everybody seems to be looking out for only #1, that's a sure way to doom everybody.

Yep, I agree.  We are going to have at least 12 people in our household, but I figure there's likely to be more.

Some way of creating separate living spaces is always a good idea.



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

[ Parent ]
The dangers of relying on scavenging during the pandemic
If you must do some scavenging during the time of civil disorder, here are some things to consider.  As for who should venture outside of the community, well thats easy.  The first members of your group who contract and survive the flu are the ones who will be able to safely travel about outside of your contained area with no fear of getting sick or bringing the bug back to the community.  Of course they could still be killed while on their mission.  Also, trying to sustain a group by stealing precious food or fuel from others who are not yet dead is not a positive sum game and could lead to reprisal attacks on your group.

Depending on scavenging within a dangerous urban environment will probably get you killed.  A better idea, IMO is to stockpile what you and your group will need and work toward self-sufficiency.  A modestly sized group located in a rural area that achieves some degree of self-sufficiency has the best chance of making it.

I predict trading with other self-sufficient groups  located near each other will become popular and become the dominate form or commerce for a while during and after the pandemic.  This is a positive sum approach to securing items needed by your group and making good use of those items your group may have in surplus.  Trading in this way and the interdependence and trust it brings to both groups involved could easily become the basis of mutual defense against Zombie attack.  This would be an important added value to good trading.  

Another problem with relying on the scavenger model is that those engaged in this activity are likely to encounter armed gangs of Zombies.  If the scavengers are captured alive, it is easy to understand how they could be persuaded, with prejudice, to reveal where their safe little group is hold up, what defenses they have and other items of intelligence that would be of use to Zombies that may wish to pay your group a little visit in the middle of the night.  The more trips one makes out in the wild west pandemic world during the period of civil disorder, the more likely that one of these adverse experiences will befall them and by extension their group.

While I do not intend to SIP, I hope to prevail upon the group I am with to limit venturing out into the wild west to as little as possible for the above reasons.  This is why I favor a self-sufficiency strategy.

Dark Doctor

[ Parent ]
Running and hiding
Someone is going to have to try to save more than the prepped, otherwise we'll lose our humanity and just be superior animals.  I guess I just refuse to think that living in fear while others that I could help die is the right thing to do.  Working together and helping each other will keep many from becoming the Zombies you fear.

One thing you might consider is that when the rules fall they fall for all, I know far more lethal people who would kill zombies than I know people who would become zombies. There are many of your proto zombies I've not touched because the cost to do so is to high, take the rules off and that cost goes away.  My gut feeling is the death of zombies will be far faster and often than most here expect.  Rules right now protect the protozombies, post AF they become fair game and minor infractions of civility will become death sentences.  Many will get the ultimate lesson in civility and others will see the lesson and learn.

[ Parent ]
...
not so much running and hiding, as falling back to a more defensible and sustainable position.

it is a pendulum, and there are an infinite number of positions within its arc; extremes on either end, and quite a bit in between.

if we have seed to plant, we can certainly grind that seed into flour, to satisfy an immediate hunger - and starve tomorrow.  or we can exert some measure of discipline, and keep the seed safe until it can be planted, grown, and harvested.

as for humanity - i have seen humans do things to other humans that animals do not; humanity is a spectrum as well, yet the times people reference the term, they rarely refer to more than the perceived good within humanity --- and telling only part of the truth is the greatest form of deception.

[ Parent ]
Reading
I keep remembering a diary I read at the local historical society, it was one that a young wife and mother had kept during the 1918 flu.  In the diary it recounts how her husband had brought food for her and the children and left it on the porch everyday, talking through the door to her and the children.  He worked and lived at the local gas works for months on end, not a pleasant way to do things, but kept his family and the community safe.

I guess it all comes down to taking risks for what we value.

That was echoed on 4-2-2008 HHS webcast
Corky52,

 The idea that HCW would work at hospital and then sleep at hotel came up during the HHS webcast.

 Also, the problems of quaranteening whole areas due to interdependence of goods and food transportation came up. All the pannelests where heavy on keeping borders open.

 Be it a hospital, gas works, or IT shop some may be in for the duration.

Kobie

[ Parent ]
DeCon
After keeping some level of services going I think the next major question is going to be what's needed for decontamination to ensure that stuff I bring to people is safe.  

I figure the smaller the group you keep people in isolation in the less risk of a massive loss through a mistake.  Isolate kids and Mom's, in houses and keep them safe, maybe massive tranks for the Moms.  Once we learn the new rules then we can decide how to proceed.   Hard fact is that some of us are going to have to take risks and some of those risks will be lethal.  I'll have to fly blind and just make a best WAG as to what's safe and what's not, learn from those who guess wrong and hope others learn from me, if I blow it.

Massive tranks for moms??
I don't think moms can afford to lose any concentration, until the kids have learned on a gut level what they cannot do anymore.  Moms will be closely supervising kids in a wide age range, because accidents can be fatal when there's no ER.   (whisper) Are tranks bad for kids? ;-)

"The truth does not change according to our ability to stomach it."  Flannery O'Connor
[ Parent ]
(whisper) Benedryl n/t


There is no pleasure in having nothing to do; the fun is in having lots to do and not doing it." -Mary Wilson Little
[ Parent ]
Ironic - using eggs to combat bird flu
I'm sure I'm late is saying this but it jsut hit me as Ironic.

Kobie

Question
When it is stated that there will be vaccine to treat ?% of the population, are they using the percent of people, pre first wave?  Hypothetically if the CFR is high enough they could have enough vaccine to treat 100% or the population. (Heaven forbid a CFR that high)

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.
Planed to stay for an extended time
I have been reading about some that will SIP or not, and the discussion pro and con to that affect. Actually I am on the pro side of the question, as my wife and I do plan on staying in place for as long as we need to be. Even if it takes two years. Have done the water thing, food thing, and have given thought to most of the questions. Now do I expect marauding  bands to quickly come thru our area to clean out everyone. No, the desert kinda keeps the riff raff down somewhat and with a good percentage of the people out here older (retired and military), many people I know have prepped for some time just as a basic thing to do. Those that done, will be helped somewhat, even I have enough to share with neighbors at arms length, thru the fence, and will make sure they have something to eat.

What I envision though, if and when the pandemic happens, is that most people will be holed up in their houses, if they have the flu, that is where they will stay for better or worse. What happens after the death toll rolls thru he community is open to speculation though. And out in the desert the main problem is water, not food and if the infrastructure electrical grid has brownouts, blackouts, or totally go down in an area, then water will be the main issue. Luckily not only I but neighbors have means to get water out of the wells, without the use of electricity, but I still have in storage about 1000 gallons of emergency water, which is alot more than most.

Anyway, staying in place will do my wife and I well, as we do not have any family withing 900 miles that will be here, and the brother that is next door, even though he does not believe in any of this, will be protected if he wants. Rule number one with us though, is if you go out inpublic during the pandemic, you are on your own and do not cross the 6 foot chain link fence around our property.

Working together within small groups is my ideal way to survive
Again, with the greatest respect and good intentions for all of you who have planned to SIP for the duration, this approach will not work.  This NPI as well as all the others proposed by public health officials are not designed to prevent you from becoming infected by flu.  The purpose of these measures is to try and slow down the transmission rate of the virus.  We in healthcare and those in public health know that NPI are an temporizing strategy not an effective one for preventing infection ultimately.

No one in medicine and public health every contemplated citizens SIPing for more than a few weeks or months at most.  We know it is not a viable strategy.  The notion that this can be carried on for a prolonged time is simply not credible.  I have provided you with some of the reasons that address the problems of remaining isolated for a long time.  Those with good preps here on the flu boards are a very small percentage of the population as is well known.  

Most unprepared folks have a few weeks of food and water at most.  It is in the interests of the public as a whole that the NPI are recommended and these recommendations take into consideration the projected resources the average family will have on hand to SIP with not the Mega pandemic prepared that post in flubloggia.  So, please understand, the recommendations made for NPI especially SIP, social distancing and even quarantines are all seen as short term measures to slow down the viral spread.  The US DHHS projects that if the public as a whole follows their NPI guidelines well, a big if IMO, then the virus can be slowed down by about two months.  This is a pretty optimistic projection but there you have it.

You will not be able to keep the virus out of your house or compound.  It is a much more crafty creature than most folks think.  It will come in where you least expect it and get to you whether you like it or not.  This is my professional opinion as an experienced internist and student of influenza.

So, what should you do if what I say is correct, abandon NPIs? No, I will wear my N-95 mask and latex gloves and try to prevent getting infected as I care for the ill.  I will change clothes and wash them in bleach and dry them on the line in the sunshine. We will wash down our ad hoc clinic with a 1:10 bleach and water solution to get rid of infectious agents.  I will advise people to avoid crowds and that as soon as the flu reaches the US to take their kids out of school and college not waiting for the government to act.  All these things I will advocate because they will all save some lives and take strain off a collapsing healthcare system as well as my ad hoc flu clinic.  It will help to prevent secondary bacterial infections in flu survivors with weakened health.  

That said, I know I will get the flu and so will almost everyone else.  The CAR is much smaller than the actual attack rate in seasonal flu and I expect that the same will occur during pandemic flu.  It is my firm belief that the vast majority of people will survive their infection but that will be only the first part of surviving the catastrophe.  

This second part is going to be even more challenging than the first half and it is then that you will need to be gathered together with your friends and neighbors to help each other make it through.   It is my view that this part of the emergency will be a good old one of man against man and man against nature.  It will require a lot of skills that most modern people have forgotten and are unprepared to perform.  Human history teaches us that forming into small groups or tribes for the general good of all its members is a good survival strategy and superior to being hold up for months or years with one or two other folks.  SIPing in isolation is akin to being a hunter gatherer except you plan to stay put rather than move around.  

Our ancestors act of moving from hunter gatherers to tribes was an advance in civilized behavior and gave them a survival advantage over the hunter gatherer.  This is why those who clung to the HG model became extinct while those that embraced tribal dominated humankind for thousands of years until the agrarian revolution with its millions of slaves overwhelmed the tribal social structure.  

Anyway, think about forming your own group of people who will agree to work together.  In the beginning, your tribe will be dealing with a medical crisis but in the end you will be dealing with the pressure of maintaining self-sufficiency in everything from food production, children's education, and most assuredly group/community defense and security.  So, this chapter will be a whole lot different than the first one and will require a whole different set of skills and requirements than SIP in isolation to avoid infection.  

You are going to need your neighbors and friends.  You are going to need to take in as many refugees as you can manage.  These thoughts may surprise you but they are what I think will make the difference in the times to come after the medical emergency has past and you will be faced with a whole new set of conditions that require a whole new set of responses.

Whatever you plan to do and in fact do, I wish you all the best of luck and hope that your plan will succeed,

The Dark Doctor

Why won't SIP/JAH work? | 128 comments
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