Is the avian flu the next SARS/Mad Cow?

[KingMerv00]

We've all seen the news coverage of the avian flu. According to CNN, Fox News, and NPR we are all going to die sometime before lunch today. The press isn't really known for their constraint and they will inflate the dangers of any infectious agent. Remember SARS and mad cow disease? The TV told me that there should be a pandemic by now.

Is this fear justified or is it just another example of media overkill?

[Bikewer]

IF the virus mutates into a form transmissible from human to human, and IF it retains it's present state of virulence, yes it could be.

The 1918 flu epidemic involved a virus strain related to the current Avian Flu, as I understand it. Millions died, and there was less international travel and slower transportation than now.

[Amapola]

It's hard to say if any fear like this is justified........ if avian flu never manages to emerge with a human-to-human form that maintains the same characteristics (the high death rate) then it will seem to be a silly story that got exaggerated. But if avian flu does manage to emerge to a human-to-human form with a high death rate, well, then everyone will be saying we did not do enough to prepare!

I have not been able to find anyone who can make a sensible prediction on the potential danger of avian flu, despite asking doctors about it. At least in my area, hospitals are now gearing up for the normal flu season and healthcare workers are being urged to get their flu shots - but of course those flu shots won't help against avian flu, if it emerges. Apparently there is at least a possibility that this avian flu is a danger, but unless and until it emerges in a different form we won't really know.

[drkitten]

I have not been able to find anyone who can make a sensible prediction on the potential danger of avian flu, despite asking doctors about it.

That's because we're waiting on a long-term random event (a mutation in the current version of the flu).

If I could use a recent historical example for a moment, consider Hurricane Katrina. We know that category 4 hurricanes happen, mostly at random. The engineers knew that the New Orleans levees would not withstand a category 4 hurricane, On the other hand, New Orleans has been around for a long time without getting hit by such a hurricane. How do you assess the risk and make a reasoned expectation about whether it's worth spending the money to reinforce the levees?

Because, of course, the problem hasn't gone away. I don't think that Charleston, SC, is capable of withstanding a category 5 hurricane either. How much money do you think should be spent on disaster preparations for Charleston, given that a) a category 5 hurricane will hit the Charleston area at some point in the future, but b) we don't know whether that will be later this month, or a thousand years hence? When will this hurricane happen?

The reason no one can give you a sensible prediction is because no one can make a sensible prediction.

[Nick Bogaerts]

I would like to think we will be able to deal with it quickly and efficiently as we did with SARS when/if it mutates. I sincerely hope it won't be the comedy of errors the handling of the mad cow disease was.

[Dymanic]

That's because we're waiting on a long-term random event (a mutation in the current version of the flu)
Most people nowadays know at least enough biology to have some idea of what the term "mutation" means, but since the details of viral reproduction don't seem to be among the most popular areas of focus, some clarification might be in order as to the sort change that is anticipated. What is most feared is what is referred to as "reassortment", significantly different from "mutation" in the ordinary sense. This is basically just a mixing -- originally taking place within a single cell within a single organism -- of RNA from two different viruses. In an instant, such an event could produce a new virus; a degree of change that would take longer to achieve through ordinary (say, single-point) mutation by orders of magnitude. Virologists regard it essentially as statistically inevitable that such an event will occur. Whether it is H5N1 that will combine with another influenza strain to produce the pandemic or not, and whether it happens this winter or next winter or ten winters from now, it will happen. I think it's a real good idea if we take a serious look at what we might do to prepare.

[Betenoire]

I'm thinking "Killer Bees" is the best analogy for Avian Flu.

[Dymanic]

I'm thinking "Killer Bees" is the best analogy for Avian Flu.
I think a better analogy is the risk of a wildland fire:

It's late summer in Southern California, the Santa Annas are blowing, and every local news broadcast in LA has something to say about the high fire danger. Somewhere up in one of the canyons, some guy tosses a butt out his car window and starts a little patch of grass on fire. What happens over the next few minutes, hours, days, or even weeks depends a lot on how soon somebody spots it. Maybe somebody comes along right away and sees it; he can maybe just jump out and stomp it out with his foot.

Just as likely not, though, which is why the State of California keeps a lot of fancy equipment around just for dealing with this sort of problem. Nobody can predict just when and where it will be needed, which is too bad, because how much equipment you need to get control of a fire can depend a lot on how long it takes you to get it there. When one of those suckers really gets going, no matter how much you've got, it's not going to be enough. It gets into the manzanita, the wind comes up, that fire will just laugh at everything you've got; basic firefighting technique at that point switches to "run for your life".

The epidemiologists are basically telling us that we're living on Planet Manzanita, the Santa Annas are blowing, and the only fire truck we've got hasn't had a tune-up since the 1940's.

[zakur]

All I know is that it doesn't sound nearly as cool as "Monkey Pox."

[Amapola]

Not really, Betenoire. For one thing "killer bees" only vanishingly rarely actually kill, and flu is a known killer. "Killer bees" (or actually, Africanized honey bees) can not survive at elevations over 4,000 feet, which is another huge difference - flu can survive anywhere humans can. Also, Africanized honey bees are known to succumb to the varroa mite, whereas with this flu, at the present time, there is no agent to fight it with.

Africanized honey bees WERE hyped up by the media, and the threat from them was greatly exaggerated. That much is certainly true. Let's hope that proves true for avian flu (hey - that rhymes!) but it is a little early to know that for sure.

[drkitten]

Most people nowadays know at least enough biology to have some idea of what the term "mutation" means, but since the details of viral reproduction don't seem to be among the most popular areas of focus, some clarification might be in order as to the sort change that is anticipated. What is most feared is what is referred to as "reassortment", significantly different from "mutation" in the ordinary sense. This is basically just a mixing -- originally taking place within a single cell within a single organism -- of RNA from two different viruses. In an instant, such an event could produce a new virus; a degree of change that would take longer to achieve through ordinary (say, single-point) mutation by orders of magnitude.

Thanks for the details. I should also point out that the influenza virus has a notoriously high rate
of these kind of reassortment events, and that in addition to the "avian flu," there's a very good source of potential reassortment partners in the various "swine flu" strains that are much, much more infectious in humans.

So all the pieces of the disaster scenario are in place, they're on the board, and they're moving.

Virologists regard it essentially as statistically inevitable that such an event will occur. Whether it is H5N1 that will combine with another influenza strain to produce the pandemic or not, and whether it happens this winter or next winter or ten winters from now, it will happen.

... and that, as I said, is the problem. Statistical inevitability tells us nothing about when we can expect an event. Most Christians would regard the second coming of Christ as "statistically inevitable" in this way, but very few would lay a place for him at dinner tonight -- and rightly so.

[drkitten]

I think a better analogy is the risk of a wildland fire:

It's late summer in Southern California, the Santa Annas are blowing, and every local news broadcast in LA has something to say about the high fire danger. Somewhere up in one of the canyons, some guy tosses a butt out his car window and starts a little patch of grass on fire. What happens over the next few minutes, hours, days, or even weeks depends a lot on how soon somebody spots it. Maybe somebody comes along right away and sees it; he can maybe just jump out and stomp it out with his foot.

Just as likely not, though, which is why the State of California keeps a lot of fancy equipment around just for dealing with this sort of problem. Nobody can predict just when and where it will be needed, which is too bad, because how much equipment you need to get control of a fire can depend a lot on how long it takes you to get it there. When one of those suckers really gets going, no matter how much you've got, it's not going to be enough. It gets into the manzanita, the wind comes up, that fire will just laugh at everything you've got; basic firefighting technique at that point switches to "run for your life".

The epidemiologists are basically telling us that we're living on Planet Manzanita, the Santa Annas are blowing, and the only fire truck we've got hasn't had a tune-up since the 1940's.

Wow. I wish I had written that.

[Badly Shaved Monkey]

We've all seen the news coverage of the avian flu. According to CNN, Fox News, and NPR we are all going to die sometime before lunch today. The press isn't really known for their constraint and they will inflate the dangers of any infectious agent. Remember SARS and mad cow disease? The TV told me that there should be a pandemic by now.

Is this fear justified or is it just another example of media overkill?

Don't know.

I'm not sure for SARS and BSE whether we really knew if they were overblown or if we skirted the abyss by adequate intervention (no matter that it was chaotic with BSE).

I don't think it's likely that H5N1 will be the pandemic this year. I think it's too late in the N Hemisphere autumn already. But, that really is just an amateur opinion.

[Betenoire]

Not really, Betenoire...

Africanized honey bees WERE hyped up by the media, and the threat from them was greatly exaggerated. That much is certainly true. Let's hope that proves true for avian flu (hey - that rhymes!) but it is a little early to know that for sure.

Which is what I expect avian flu to end up analogous to. Not just the over-hyping, but the utter vanishing from our minds after a few years of pointing and screaming in terror.

[tsg]

I have no idea whether avian flu really is a threat, but the media has a habit of selling fear. And when it doesn't end all life on the planet, they can point back to their fear-mongering and say "See? Because we warned everybody, disaster was averted."

I'm reminded of Y2K[1].


[1] Yes, I know there was a real problem. No, it wasn't as bad as the media would have had us believe.

[Dymanic]

I don't think it's likely that H5N1 will be the pandemic this year. I think it's too late in the N Hemisphere autumn already. But, that really is just an amateur opinion.
You may be right. Though the risk of the reassortment event ocurring is increasing, both due to the onset of the regular flu season in the northern hemisphere and to the continued spread of the virus throughout wild and domestic bird populations across Asia and Europe, diffusion patterns seen in previous flu pandemics suggest that pandemic outbreak may not follow immediately after the virus "goes H2H"; a new subtype may require period of further genetic shift during which its transmissibility increases enough to enable it to drive a global pandemic.

[GodMark2]

We got lucky with SARS, in that it was Sudden and Acute. You would start showing symptoms very quickly, such as a high fever. You wouldn’t be infectious before showing symptoms.

The flu doesn’t play so nicely. It’s possibly to be very contagious while showing minor, or even no symptoms. Stopping the spread of it won’t be as simple as forcing airport patrons through a screening process.

One thing about reassortment events: They’re much more likely to occur after a virus crosses species boundaries. H5N1 (‘The’ Bird Flu) has recently started showing up more and more often in human patients. This brings it in possible contact with many more human-transferable strains of flu than ever before. That, in turn, increases it’s chances for a reassortment crossover, and it’s chances to create a pandemic-capable version.

That’s why virologists are worried sick.

[Dymanic]

I have no idea whether avian flu really is a threat, but the media has a habit of selling fear.
At least you know enough to take what they say with a few grains of salt. But then, some of us are well advised to limit our salt intake. Taken too far, labeling the media as fear-mongers might be considered the complement to a position at the other extreme, which holds that they are (either negligently or deliberately as part of some conspiracy) downplaying the seriousness of the threat.

I'm surprised they don't seem to have discovered Henry Niman. If you REALLY want to push some fear, try a leading researcher in the field who has been willing to stick his neck out with global fatality estimates well into the hundreds of millions, and has this to say about the United States flu pandemic preparedness plan:

"It is appropriately called a draft, because the "plan" is full of holes. It plans for distributions of vaccines that don't exist, anti-virals that are not available, hospital beds that are not available, doctors and nurses that are not available, and a death rate that is much more wishful thinking than anything remotely approaching reality."
http://www.recombinomics.com/News/05300502/Pandemic_Plan_Unprepared.html

When I first discovered Niman, I thought "this guy has to be some kind of crackpot". I'm still not entirely sure that isn't at least partly true; but if it is, he's a crackpot with credentials, and one who has made some noteworthy contributions to the field.

[.13.]

I'm wondering how lethal the current virus would be if it transmits from human to human. Especially given our better standards of living and healthcare compared to 1918. I doubt we would get anywhere near the fatalities back in the 1918. Any ideas?

[Dymanic]

I'm wondering how lethal the current virus would be if it transmits from human to human.
That may not be on the usual list of the "Questions Science Can't Answer", but it's right up near the top of the list of "Questions of Particular Interest Currently".

Especially given our better standards of living and healthcare compared to 1918. I doubt we would get anywhere near the fatalities back in the 1918. Any ideas?
None you are likely to find very comforting. For one thing, the differences in those standards worldwide from what they were in 1918 may not be a great as you might think if you happen to live in one of the more modernized countries. It might make a small difference in the speed with which the virus spreads, but probably not very much. One thing to keep in mind is that since our population has not only roughly tripled since that time, but also experienced a strong shift in demographics toward urban lifestyles, a lot of places are even more crowded now than they were then.

A lot of people seem to be counting on the wonders of modern medical science to protect them from this threat. Allow me to pop that bubble as well. Treating flu patients still consists mainly of keeping the patient warm, and trying to keep fluids in him. If he develops primary viral pneumonia, there isn't really all that much we can do for him now that they couldn't have done in 1918. Anti-inflammatory drugs may be administered to minimize damage from the innate immune system response (though not everyone agrees with this practice). If the patient is having trouble breathing, he may be intubated -- if a ventilator is available. Since, at any one time, a large percentage of the total number of ventilators available are in use now, that's a big potential problem right there. If the patient recieves care early enough in the course of the infection, antivirals may be effective. Except there aren't anywhere near enough to treat more than the tiniest fraction of those who could be expected to be taken ill during a pandemic.

[hammegk]

... http://www.recombinomics.com/News/05300502/Pandemic_Plan_Unprepared.html

When I first discovered Niman, I thought "this guy has to be some kind of crackpot". I'm still not entirely sure that isn't at least partly true; but if it is, he's a crackpot with credentials, and one who has made some noteworthy contributions to the field.
The only bit of good news in that link was that the death-rate dropped to 1 in 5 for the human-to-human strain. If I understand what I looked at on the net, this 20% rate is nearly 10 times more lethal than the 1918 variety.

Are those death rates based on just on hospital admissions? How does one estimate the number of cases that didn't result in hospital admission, but fought through with just home-remedy, or were basically symtomless?

[Dymanic]

The only bit of good news in that link was that the death-rate dropped to 1 in 5 for the human-to-human strain.
According to the WHO, of course, an H2H strain has yet to emerge. We can expect the mortality rate to drop significantly; nobody knows how much.

If I understand what I looked at on the net, this 20% rate is nearly 10 times more lethal than the 1918 variety.
It's important to recognize where the numbers are referring to the number of infected patients who can be expected to die from the disease, and where they refer to the percentage of the population who can be expected to become infected and subsequently die. Estimating the latter involves some other numbers, such as the "R-naught" number; the number of other people to whom each infected person can be expected to pass on the virus (epidemiologists have their own weird lingo for all this stuff).

In this age of "just-in-time delivery", it's worth giving some thought to the global economic impact of having something like a third of all the people on the planet flat on their backs for a week or two even if NONE of them died.

Are those death rates based on just on hospital admissions? How does one estimate the number of cases that didn't result in hospital admission, but fought through with just home-remedy, or were basically symtomless?
That seems to be one of the first things everybody asks. I think they make the assumption that since the success rate of home-remedies is not likely to be much better than what they've had in the hospitals, such methods are likely to produce at least as many dead bodies (which are much less likely to go unnoticed). If large numbers of asymptomatic patients are going unreported, that isn't necessarily all good news, since it would indicate that our ability to monitor the situation is even worse than we thought.

[hammegk]

According to the WHO, of course, an H2H strain has yet to emerge. We can expect the mortality rate to drop significantly; nobody knows how much.
My comment was based on your link.


In this age of "just-in-time delivery", it's worth giving some thought to the global economic impact of having something like a third of all the people on the planet flat on their backs for a week or two even if NONE of them died.
Ugly thought alright.


That seems to be one of the first things everybody asks. I think they make the assumption that since the success rate of home-remedies is not likely to be much better than what they've had in the hospitals, such methods are likely to produce at least as many dead bodies (which are much less likely to go unnoticed). If large numbers of asymptomatic patients are going unreported, that isn't necessarily all good news, since it would indicate that our ability to monitor the situation is even worse than we thought.
Although wouldn't lots of asymptomatics cases say immune systems are better able to handle the avain flu strain (at least in some genetic groups)?

[Dymanic]

My comment was based on your link.

Hence my haste to clarify. Niman's position differs significantly from that of the WHO in a number of regards, but it's been said that he's not exactly just some guy in a garage.

Although wouldn't lots of asymptomatics cases say immune systems are better able to handle the avain flu strain (at least in some genetic groups)?
If you really get down with the details, you'll see that one of the reasons virologists are so concerned is that the entire human population can be expected to have little or no natural resistance to H5N1. It's not so much a matter of genetics as one of individual histories; the only individuals who now have antibodies against this subtype are those few who have already been infected and survived. For the same reason, if H1N1 (Spanish flu) made another round, we'd expect to see markedly fewer serious infections among those persons over 87 years old, very little resistance among those younger than that, and not much variation in this pattern across genetic groups.

[Badly Shaved Monkey]

Does anyone know off-hand what the mortality rate has been in affected birds?

[Mercutio]

I seem to recall hearing that, because of the nature of this particular flu and its effects on immune system, that paradoxically the most at risk are those with healthy immune systems--the opposite pattern from the annual flus that we see.

Does anyone know anything about this? Did I (please) mis-hear?

[Dymanic]

Does anyone know off-hand what the mortality rate has been in affected birds?
Whereas some wild birds (particularly ducks) can carry the virus without developing symptoms themselves, mortality rates in some bird populations often approach 100 percent.

Mercutio:

I seem to recall hearing that, because of the nature of this particular flu and its effects on immune system, that paradoxically the most at risk are those with healthy immune systems--the opposite pattern from the annual flus that we see.
A large percentage of the fatalities during the Spanish flu pandemic were previously healthy young adults. It is proposed that the direct cause of death in many cases is what is called "cytokine storm". This is essentially an overly-robust immune system response (called the "innate" response, it is the immune system's first line of defense, deployed while the "adaptive" response is being worked on). I speculated in another recent thread (http://forums.randi.org/showthread.php?t=45507&page=3#post1225697) that this might be more pronounced in those with healthier immune systems, but I liked Capsid's slant on this better.

[tsg]

Taken too far, labeling the media as fear-mongers might be considered the complement to a position at the other extreme, which holds that they are (either negligently or deliberately as part of some conspiracy) downplaying the seriousness of the threat.
They have done that to themselves. TV News has absolutely no credibility left.

[Rolfe]

They have done that to themselves. TV News has absolutely no credibility left.Where abouts are you? I would give quite a lot of credibility to the BBC news - and to ITN too, I guess.

Rolfe.

[Soapy Sam]

I wonder about the effects of a rapid killer pandemic (as opposed to a slow killer like AIDS) on economic and other aspects of society.
Imagine some genius decides to shut down all air travel.
Or there is a 5% die off among young and middle aged adults.
I predict trivial effects, such as a correction in the ludicrously overvalued UK housing market. But what else could happen to society?
I'm thinking of the sort of events we saw in New Orleans.

[Dymanic]

I wonder about the effects of a rapid killer pandemic (as opposed to a slow killer like AIDS) on economic and other aspects of society.
Imagine some genius decides to shut down all air travel.
Personally, crowded airplanes are just the sort of environment I'd be inclined to avoid during a pandemic, but that's just me; during the early stages of a pandemic, I imagine lots of people's first instinct upon hearing of an outbreak would be to try to evacuate to someplace "safe". Naturally, since a lot of those people will be infected already, that's just going to spread the virus faster -- a fact which may be more readily appreciated by folks living in the places chosen as destinations by these evacuees than by the evacuees themselves. It certainly doesn't seem unreasonable to expect to see official restrictions on travel in many places.

For that matter, the imposition of such restrictions doesn't seem all that unreasonable a measure, where such restrictions could be enforced without causing too much civil unrest -- the problem being that in many places, such restrictions are likely to be quite unofficial, and enforced through civil unrest. In the throes of a pandemic, distribution of (say) antivirals (even if they were available) could be complicated by not only by official enforcement of official cordons sanitaire, but by the efforts of vigilantees to enforce unofficial ones of their own through such methods as impromptu barricades and sniper fire.

Since there isn't anyplace "safe" anyway, evacuation is a pointless exercise. If people could be educated about that -- if they could be persuaded that hunkering down (with an adequate stockpile of vital supplies) would be a lot better than jumping on a crowded airplane or bus or train or boat -- the impact of the pandemic might be lessened considerably.

The more people move around, the faster the virus spreads. The faster the virus spreads, the more people that are sick all at the same time. The more people that are sick all at the same time, the more difficult it is to keep things like power plants and water treatment plants and food distribution systems working. When that stuff quits working, people are more likely to start moving around. The more people move around, the faster the virus spreads...

[Rolfe]

I imagine lots of people's first instinct upon hearing of an outbreak would be to try to evacuate to someplace "safe".It may not just be that. My first instinct would be to try to get back to Scotland so that I'd be in a position to look after my elderly mother if she fell ill.

Rolfe.

[Psi Baba]

Hence my haste to clarify. Niman's position differs significantly from that of the WHO in a number of regards, but it's been said that he's not exactly just some guy in a garage.
He seems quite convinced that human-to-human transmission "is well established", while the WHO still maintains that hasn't happened yet. I wonder which we should believe.

[Betenoire]

I have heard of a single instance of human-to-human. There was no further spread beyond that, though.

[Bowser]

Niman may be off on the timing, but he has an excellent understanding of what it would take for an efficient H2H strain to develop (11/5 archive):

http://mp3.rbnlive.com/Geri05.html

[Dymanic]

It may not just be that. My first instinct would be to try to get back to Scotland so that I'd be in a position to look after my elderly mother if she fell ill.

I think having that as your first instinct speaks quite highly of your character.

Psi Baba:

He seems quite convinced that human-to-human transmission "is well established", while the WHO still maintains that hasn't happened yet. I wonder which we should believe.
Niman also places much emphasis on recombination versus reassortment as a mechanism for change in the virus. I cautiously favor the WHO's position, but continue to augment that by keeping an eye on what Niman has to say. He appears to have a record of being right about things before.

Even though many of them surely deserve it, it still seems a little unfair to label as a sensationialist every reporter whose tone is an acurate reflection of the tone of his sources, such as statements like:

"If we are unprepared, the next pandemic will cause incalculable human misery."
- by Lee Jong-wook, director-general of the World Health Organization,

or:

"About 60 per cent of countries have a pandemic preparedness plan, but in most cases it is only a piece of paper."
- by Mike Ryan, WHO's outbreak response director.

However incalculable the cost in human misery may be, there doesn't seem to be anything preventing bean-counters for the World Bank from estimating the cost in dollars: $800 billion, if the pandemic lasts a year. (I'd be willing to entertain the notion that that number reflects a bias, but it's hard to view those guys as raving media sensationalists).

Betenoire:

I have heard of a single instance of human-to-human. There was no further spread beyond that, though.
Everything I've seen confirms this as well. Except, of course, for what Niman says.

[casebro]

All speculation.

Without knowing how many folks have caught bird flu, and didn't even need hospitalisation, we don't have anything to base all this doom and gloom on.

My friend caught West Nile virus. The Dr. told him to take NSAIDs for the headache. Big hoo-hoo, eh?

[drkitten]

Without knowing how many folks have caught bird flu, and didn't even need hospitalisation, we don't have anything to base all this doom and gloom on.


Not true.

If nothing else, we know that the pattern of people being hospitalized and dying from H5N1 is radically different from the standard pattern for influenza, which in and of itself is worrisome.

Normally, flu hospitalizes and kills a fairly well-defined "at risk" group of people, mostly elderly or otherwise identifiable. The number of "healthy" young adults with intact immune systems hospitalized for flu is very small and vastly outnumbered by the frail pensioners. Walk through the flu ward at your local hospital and you'll notice this instantly.

This doesn't seem true for H5N1. If you look at the demographics of people treated in hospital for H5N1 (or the people killed by it), they don't look at all like normal flu demographics. This alone is sufficient grounds for worry.

[Dymanic]

All speculation.

Well, not exactly. There is, without a doubt, much speculation. Getting a good feel for where the science ends and the speculation begins involves a little work, but a person of average intelligence shouldn't find the fundamentals hopelessly out of reach. There is a great deal of knowledge (of a non-speculative nature) regarding the receptor binding properties of influenza haemagglutinins in general, and about human antibody responses to avian haemagglutinin in particular. Once the significance is grasped of H5N1 being both highly pathogenic and a subtype to which the current human population has no natural resistance, it isn't so hard to see why virologists do not believe that large numbers of mild or asymptomatic cases are going unreported.


My friend caught West Nile virus. The Dr. told him to take NSAIDs for the headache. Big hoo-hoo, eh?
Considering that there isn't any particularly efficacious treatment for West Nile, that it isn't transmissible between humans, and that the virus produces serious illness in only about one in 150 people infected anyway, the value of that anecdote seems as subject to question as is its relevance to the threat posed by avian influeza.

[casebro]

(SNIP)

If you look at the demographics of people treated in hospital for H5N1 (or the people killed by it), they don't look at all like normal flu demographics. This alone is sufficient grounds for worry.

Sooo, if the Oriental Bird Farmers and Bird Butchers are not frail old pensioners, you wouldn't see a bunch of frail old pensioners in the 'bird flu wards', would you?. And, if bird flu is as virulent amoungst the domestic fowl as the WHO would have us think, zillions of OBF&BB's have been exposed, with what, about 200 hospitalised? Methinks it's mortality rate could be ummm, speculative?

That thought brings up a question for you: With only about 200 folks hospitalised, is your "demographic sample" meaningful ?


Sooo, does speculating about H5N1 mean anything more than speculating about Mumps, Rhinovirus, Herpes mutations? I guess, like the news media, it gives us something to talk about.

[drkitten]

Sooo, if the Oriental Bird Farmers and Bird Butchers are not frail old pensioners, you wouldn't see a bunch of frail old pensioners in the 'bird flu wards', would you?.


And if you make another false hypothetical, you'll get another equally false conclusion.

Almost every family in rural Asia keeps chickens, and kills them themselves. The bird farmers and butchers have the same distribution as the rest of the rural population, because they are the rural population.

Any other straw men you'd like to erect?


And, if bird flu is as virulent amoungst the domestic fowl as the WHO would have us think, zillions of OBF&BB's have been exposed, with what, about 200 hospitalised? Methinks it's mortality rate could be ummm, speculative?


No, but thanks for playing. You're confusing two separate issues -- the mortality rate, and the infectiousness. Most people exposed to bird flu don't catch it, because, unlike the flu you normally think of, this version isn't very infectious.

But if you catch it, you are in serious trouble.

If this were a normal flu, there would be a lot more cases reported, but most of the reported cases that required medical treatment would be among the elderly, and almost all of the deaths would be among the "at-risk" group.


That thought brings up a question for you: With only about 200 folks hospitalised, is your "demographic sample" meaningful ?


For about the same reason that flipping a coin 200 times and getting 150 heads is enough for me to say the coin is biased.


Sooo, does speculating about H5N1 mean anything more than speculating about Mumps, Rhinovirus, Herpes mutations? I guess, like the news media, it gives us something to talk about.

Ask away. But listen to the answers you are given.

[casebro]

And if you make another false hypothetical, you'll get another equally false conclusion.

Almost every family in rural Asia keeps chickens, and kills them themselves. The bird farmers and butchers have the same distribution as the rest of the rural population, because they are the rural population.

Any other straw men you'd like to erect?




No, but thanks for playing. You're confusing two separate issues -- the mortality rate, and the infectiousness. Most people exposed to bird flu don't catch it, because, unlike the flu you normally think of, this version isn't very infectious.

But if you catch it, you are in serious trouble.

If this were a normal flu, there would be a lot more cases reported, but most of the reported cases that required medical treatment would be among the elderly, and almost all of the deaths would be among the "at-risk" group.



For about the same reason that flipping a coin 200 times and getting 150 heads is enough for me to say the coin is biased.



Ask away. But listen to the answers you are given.

If it stays only mildly infectious, where is the epidemic?

Are you saying that most don't get it, some die from it, some recover, BUT THERE ARE NO MILD CASES?

200 coin tosses is a valid test of a particular coin. But is 200 cases with 50 tails out of a population of BILLIONS a valid sample? Haven't most of the studied cases been amoungst urban "Bird Butchers", rather than in the rural farmers? I feel there is a huge bias in the sampling here, since the ONLY stats used are of hospitalised folks.

I'd think the urban folks would be full time (working age) employees, while the farmers would tend to be more elderly. So inner city hospitalisations would be amoungst working age folks. As well as the fact that out in the sticks the farmers are less likely to seek medical help at all, and mild cases are probably seldom reported. And old folks die of 'old age'.

[drkitten]

If it stays only mildly infectious, where is the epidemic?

Are you saying that most don't get it, some die from it, some recover, BUT THERE ARE NO MILD CASES?


No, although a lot of virologists are, on biochemical evidence.



200 coin tosses is a valid test of a particular coin. But is 200 cases with 50 tails out of a population of BILLIONS a valid sample?


Um, yes. It is. I'm sorry your statistics is so poor that you don't realize this.


Haven't most of the studied cases been amoungst urban "Bird Butchers", rather than in the rural farmers?

No.

I feel there is a huge bias in the sampling here, since the ONLY stats used are of hospitalised folks.

No, because the null hypothesis against which it is being compared is the distribution of hospitalized folks of a normal flu infection.

I'd think ...

I'd think you'd want to check your facts before posting uninformed speculations.

[Adrian]

Ah yes, another go at the old bird flu question. I would like to warn most of the innocent in this forum to avoid blindly accepting the claims of both DrKitten and Dymanic; poor skeptics both. I would recommed reading the entire previous thread crafted on this topic for a full display of the various viewpoints on this topic.

For those of you who actually like to form objective opinions on real data and do more research than simply watching CNN, I would recommend going to the links and sources below for a sampling of data on H5N1. I will not repost the WHO information, since it has already been posted in this forum.

http://www.cdc.gov/flu/avian/ - Nice resource (similar to the WHO) provides a great recent article that states directly that there have been no confirmed human-to-human transmittals. Quote: "Dutch authorities reported three possible instances of transmission from poultry workers to family members"

http://liam.gnn.tv/blogs/10014/Bird_Flu_Reality_or_Manipulation_Biodefense_and_Pa ndemic_and_Vaccine_and_Drug_Development_Act_of_200 5 - A little alarmist and conspiracy-ridden, but still some good information. Read with caution.

http://www.foreignaffairs.org/20050701faessay84401/laurie-garrett/the-next-pandemic.html - An incredible paper by Laurie Garrett that rationally considers much of the evidance and provide a clear picture for action. She reminds us of the many hyped diseases that were supposed to kill us all that did very little to nothing in reality. She makes it clear that actions must be taken, but manages to not throw objectivity to the wind.

Enjoy the links all. I usually try to keep more childish remarks out of skeptical inquiry, but I really have to respond to these two:


200 coin tosses is a valid test of a particular coin. But is 200 cases with 50 tails out of a population of BILLIONS a valid sample?

Um, yes. It is. I'm sorry your statistics is so poor that you don't realize this.


Yes DrKitten... I am also sorry that your grammar "is" so poor.


I'd think you'd want to check your facts before posting uninformed speculations.


Wise advice sir. I would think you would be wise to follow you own advice.

[Dymanic]

I would like to warn most of the innocent in this forum to avoid blindly accepting the claims of both DrKitten and Dymanic.
Hear, hear. Blindly accepting anyone's claims is a bad idea. I'd encourage everyone here to investigate the details personally (though in general, I have found such warnings to be perhaps somewhat less necessary in this particular place than in some others). I'd recommend starting here:
http://www.fluwikie.com/index.php?n=Science.InfluenzaPrimerII

http://www.cdc.gov/flu/avian/ - Nice resource (similar to the WHO) provides a great recent article that states directly that there have been no confirmed human-to-human transmittals.
Which is of course exactly in agreement with what both DrKitten and I have been saying. I suppose it never really ocurred to me than very many JREF forumites would be likely to have trouble finding the CDC flu site on their own.

http://liam.gnn.tv/blogs/10014/Bird_..._Act_of_200 5 - A little alarmist and conspiracy-ridden, but still some good information.
As worthless a source as any biased, rambling blog by "an independent journalist who writes about the abuses of big pharma and profit-driven medicine" could be expected to be.

An incredible paper by Laurie Garrett that rationally considers much of the evidance and provide a clear picture for action.
More recycling of the same information available in thousands of places on the internet -- and most of it (again) in agreement with what Drkitten and I have been saying. That you found it "incredible" tells me a lot about your ability to evaluate sources of information (and following your lead, I might point out that your opinion might also be more compelling if it came from someone who could at least spell the word "evidence").

[casebro]

No, because the null hypothesis against which it is being compared is the distribution of hospitalized folks of a normal flu infection.


I'd think you'd want to check your facts before posting uninformed speculations.

Re: comparison to 'normal' flu, what is the hopitalisation rate vs 'mild' case rate? 1:10,000? How would that relate to Avian flu?

Re: my uninformed speculations- I enjoy the net as an interchange of ideas. I'm not here to win any debate, so I don't care about, or respond to, criticism of my debate style. I come here to point out weaknesses in the basis of mass hysteria, and hope to simplify everybody's life thereby.