Wednesday, October 05, 2005


Fact v. fear on the avian flu

Thanks to MEC for starting the discussion on avian flu. This is part of a larger phenomenon, the marketing of fear. One "product" in the fear line is nuclear materials, to which I will return in another post. The second "product" is disease. Our readers need to understand these issues in depth and in context. Both nuclear materials and pandemics are serious issues, but they are not new issues. For decades, we haven't had to worry much about them because our leaders have done their jobs. But just as Bushco can turn a Category 4 hurricane into the worst (caveat: in raw but perhaps not relative terms) natural disaster in (caveat: recorded) American history, they can certainly turn Al Qaida from a few hundred thugs into a superpower, or a normal pandemic into a plague. By January of 2004, the threat of avian flu was clearly identified by that enemy of the American government, the United Nations. Indeed, it is hardly a new threat. Here are the key facts: * To date, all outbreaks of the highly pathogenic form have been caused by influenza A viruses of subtypes H5 and H7..... * During a 1999–2001 epidemic in Italy, the H7N1 virus, initially of low pathogenicity, mutated within 9 months to a highly pathogenic form. * In the absence of prompt control measures backed by good surveillance, epidemics can last for years. * All type A influenza viruses...are genetically labile and well adapted to elude host defenses. ...[C]onstant, permanent and usually small changes in the antigenic composition of influenza A viruses [due to errors in replication] are known as antigenic “drift”.... * Influenza viruses ...can swap or “reassort” genetic materials and merge. This reassortment process, known as antigenic “shift”, results in a novel subtype different from both parent viruses. ... no existing vaccines can confer protection * antigenic shift has historically resulted in highly lethal pandemics. * Antigenic shifts are promoted by the proximity of chickens, human beings, and pigs. About two weeks ago, the US government actually started to seek to make vaccine supplies available. One can predict that adequate stocks will probably not be available in the US for 6-12 months. I may be wrong, but it is one thing to sign a contract and another to scale up manufacturing to produce 20 million doses of vaccine. (continues in comments)
Now, this is not entirely the fault of the US government. It takes time to develop vaccines, and they often aren't ready until late in the season. The virus hunters who do vaccines on rapidly-mutating diseases like flu are immensely clever and resourceful, very much underappreciated. The manufacturing people who do scale vaccine production in a hurry are stars. However, even in May, the US was way behind the curve:

All the United States has is an experimental H5N1 vaccine that was scheduled to start clinical testing this month and 2 million doses of anti-viral drugs. Britain, in contrast, has procured 15 million doses, enough to treat about a quarter of its population. About 75 million doses would be necessary to reach 25 percent of the U.S. population, according to the Trust for America’s Health, a nonprofit, nonpartisan medical think tank in Washington.

Anti-virals are the second line of defense. If the flu mutates to evade the vaccine, they could be the only line of defense. On the downside, by the time one realizes that an elderly person or a baby has the flu, it could be too late. You only have a 48 hour window

Health experts say at least some of the Tamiflu should be diverted from rich Western countries to Southeast Asia, where it's needed.

"Several million courses sent to Thailand would be more effective than hoarding for nearly 300 million people" in the USA, Emory's Longini says. "If you stop the spread at the source, it's much better."

As it turns out, those 2 million doses of anti-viral may not be what it sounds like. A Roche product, oseltamivir or Tamiflu is what seems to be indicated. This is a very specific enzyme inhibitor. As of June, we had enough to treat 1% of the population. Unfortunately, the manufacturer is selling it as a preventative, meaning that we'll see the same phenomenon as with Cipro: the rich will stockpile it.
But Americans are not the people who need it the most:

Health experts say at least some of the Tamiflu should be diverted from rich Western countries to Southeast Asia, where it's needed. "Several million courses sent to Thailand would be more effective than hoarding for nearly 300 million people" in the USA, Emory's Longini says. "If you stop the spread at the source, it's much better."

And that brings us to the real problem.

The real problem is much bigger than avian flu, which may or may not materialize as a serious threat this year. The real problem is that Republicans have gutted public health and driven the immigrant population underground. This has already resulted in serious crises like the emergence of drug resistant TB.

Over a century ago, as the United States became the first nation to welcome immigrants. Far-sighted public officials saw that this would introduce the risk of disease. One of the first effective public health systems began to emerge in New York City. This model was quickly was adopted as so obviously in the nation's benefit that we could not rely on anything except government to deliver it. In the 1950s, we broke the polio epidemic not only thanks to researchers like Salk and Sabin but because we understood we had to work together as a nation through an effective system of public health.

In the 1980s, in the early stages of the AIDS epidemic, far-sighted people saw that we needed to extend public health to the populations most at risk-- drug addicts, prisoners, gays, illegal immigrants. That meant de-stigmatizing those groups, bringing them up from the underground, giving them health care they could not afford. Why? If nothing else, to protect the public health. Once epidemics start raging below ground, they quickly spread, from the addict to his doctor, from the prisoner to his guard, from the closeted gay to his wife, from the illegal immigrant to the customers whose dishes he washes and whose food he prepares.

Thanks to Ronald Reagan and the "Christian" right and their un-Christian, un-conservative, and un-American attitudes toward public health, this nation let the AIDS epidemic get going.

Despise the poor and the powerless and you destroy yourself.

Twenty years later, the Republican Party has systematically destroyed that national treasure, the public health system, placing every American at risk. Even the rich, even the powerful. And they are joined in this idiocy by the Chinese government, which once boasted (with lesser or greater justification) of its "barefoot doctors," and now can't muster the semblance of a public health response to an obvious crisis. Their response is to gag the medical people.

If you have to be afraid, don't be afraid of the flu.

Be afraid of people who would destroy public health for private profit.
It's entirely possible that "avian flu" is this year's "Orange Alert", the Orange Alert being no longer politically useful since JuliusBlog exposed the curious correlation with bad new for Bush. Keeping people afraid keeps them dependent on Big Daddy.

What's even more worrisome is that "fear fatigue" may be setting in, which means that people won't take valid warnings seriously and take necessary precautions. We all remember what happened to the boy who cried wolf.
During the Spanish flu outbreak of 1918 everybody in the world was exposed to the disease, and half the people on the planet actually caught it.

As a healthcare worker, I'm concerned. I fear the disease itself, for my family, for all the work it will make for me, and for the fact that the Bush administration is likely to just piss on me while I do my best to help the sick.

I would expect him to cut my wages. He'd welcome the excuse.
I hope we are near the end of the Bush era, shrimplate.

I title my folders according to where I think we are.

2001 Florida and Beyond
2002-2005 Era of the Regime
2005- The Moment of Decision

It can go either way. Indictments and rumors of indictments suggest to me that the corruption is about to become impossible to deny. Either Bush outright seizes absolute power or the weight of his incompetence and criminality brings him down.

In that sense, these last years have not been a waste. Had Bush seized power on 9/11, it might have been impossible to stop. At this point, further attempts to gain power are seen as cynical attempts to avoid the comeuppance due to him. In these last years, working patiently we, and more important the soft, sloppy smack of reality have shown the American people who this man is.

In the endgame, we have to have a clear sense of where we want it to go. Yes, Bush and his cronies must be removed from office and competent people installed. But the American people have to see that this is not an ideological battle as the "Christian" right wants to portray it. It is definitely not a battle between good and evil. It is a battle between flawed but sane people and flawed but insane people.

Being afraid is the last thing we want to be. When the storm comes upon you, sometimes the safest way is straight through the heart of darkness.
Straight through I will go, Charles, and when the Bush mess is over I will expect to see you folks there too, but we all may be in need of a good shoe-cleansing afterwards.
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