What IF the Bird Flu Pandemic Is Coming: What Do You DO? (1)

The ABC news report last night that a 7-year old Chinese girl has contracted Avian flu in Beijing, nearly 750 miles from Shanghai – the source of the outbreak-  ought to send chills down the spine of every sentient being. Though we don’t know exactly how she contracted the disease, whether from a distant wild bird or human – this we do know- this virus is evolving even as I write.

If we soon learn the virus has fully mutated to the highly pathological H5N1 form, and a global pandemic may be imminent what do you do? Of course, the first reaction (dumb!) of many will be denial: ‘It’s just a flu for cripes’ sakes!’, or ‘Look, the government is hyping it to try and get us under control!’ or: ‘I ain’t doin’ nuthin’ until I actually see people in my neighborhood getting’ sick!’


Devoid of any knowledge of the Spanish Flu Pandemic – which killed over 50 million over 1918-19- it is probably human nature to treat any flu outbreak as ‘no biggie’ but that could be a fatal error. I saw what my wife endured, with H3N2 flu and it was perhaps only one or two more days (unless she recovered) before I’d have had to rush her to an ER.

In the case of Avian H5N1 Flu, you'll not likely have weeks to endure and recover, but maybe a day or two. In that time you or a loved one will know if you or your loved one(s)  will live or die. And bear in mind here, hospitals will be overrun and switchboards clogged, so there will be little they can do once hordes of Avian-flu infected people begin pouring in.  This is also why a Will is essential for any Avian flu planning as well and I will go into that in the next blog.

What do you do when no one is yet ill but the Avian flu is rapidly spreading? First, note a huge difference between the H3N2 outbreak last year and a future Avian flu is that in the former one could still make multiple runs to the supermarket, and supplies didn’t run out. There were only limited numbers of the severely ill, perhaps 10,000 in a given community. This will not be so if Avian flu strikes the U.S. and millions of severe cases emerge within very short time spans. (Refer to the highly pathological effects, symptoms listed in the previous blog post)

Then, multiple runs will be made on every major supermarket,  corner grocery and even 7-11s as the outbreak takes down hundreds of thousands in the first week. So you can almost bet that will mean scarcity of grocery supplies within days. Don't be in the position of trying to build up your supplies, food stores when everyone else is, unless you don't mind getting stuck with Kibbles 'n Bits, lima beans and lemons.  The cautious move then is to begin (gradually) stockpiling food, water, etc. as soon as the CDC confirms human- to- human transmission of the H5N1 flu. Even if this is in Asia! So yes, that means you set to work BEFORE the first case is confirmed in the U.S.  Bear in mind here that this thing can and will be transmitted at the speed of modern jet flight - so after you hear the human-human transmission is verified in China, it may only be a day - perhaps 2 or 3 at most, before the first U.S. case shows up.  When that announcement is made by the health authorities, look for all hell to break loose!


The Y2K scare, though bogus, did provide an insight into how much food to cache. You are basically looking at a minimum of perhaps 3 months in isolation (with little or no gov't help)  and possibly local quarantines, once the flu strikes. Obviously, with runs on supermarkets the rule, there’ s little room for mathematical error. You begin by stocking as many diverse canned goods as possible: tuna, salmon, Spam, pineapple, chicken, beans, corn, spinach, whatever your family can go with and over a fairly long time. (In the next blog I will discuss cooking options, even if there’s no electric.)

How much to stockpile? That begins with the size of your household. Let’s say there are three people: 2 parents and one child. You will likely need (daily) the equivalent of 2 gallons of fresh water, and eight cans of tuna (or 4 cans tuna, 4 cans Spam) and three cans of corn (or three cans of beans, or pineapples). The sheer volume of stocked food is also another reason why it’s ridiculous to try and grab everything needed once the flu lands in your area. By then, you’ll only be able to get the dregs! So, what you’re likely looking at is a 2-3 week time interval to try to collect all the canned goods, water you estimate you will need.

Btw, that implies having a manual can opener – since electricity can’t be assumed to remain unaffected!

Re: water, remember to fill any bathtubs as well, since if the water ceases to be available (remember it depends on pumping which depends on electricity) you will still be able to flush the toilet.  Use the available water filled in bathtubs and  in any other containers you can find to flush toilets. Save the purchased bottled water for drinking. Since this flu brings on a “cytokine storm” as an over reaction of many human immune systems (see prior blog) and is liable to cause severe diarrhea and vomiting, you will definitely want to have enough to flush toilets!

Other items you will need to buy and store before the U.S. outbreak:

1- Functioning cellular phone with well-charged battery (rapid re-chargers should also be kept in reserve)

2- Obtain one or more dependable self-winding watches so you don't have to use batteries, or chargers to get the time.

3- Flashlights (e.g. Mag-lite) , and also keyring-sized LED lights such as those from Photon-Microlight,which can be worn on a ring.

4- A small AM/FM radio - to receive emergency broadcasts - and note there are several compact, magneto-driven wind up models  (Eton Emergency radio) available for most uses. Battery -operated models are also ok, provided you have on hand extra long life batteries.

5- A good First Aid kit, which contains adhesive bandages, antiseptic wipes, burn cream and other supplies. It's also a good idea to have plenty of boxes of spare antiseptic wipes on hand to wipe down surfaces if one or more in  your household becomes ill.

6- Disposable dust masks to filter out air pollutants (e.g. from mass- disposal pyres)  if you need to go outside. Also be sure to have a good supply of face masks, or "flu masks" - see e.g. .
http://www.webmd.com/cold-and-flu/features/swine-flu-h1n1-and-face-masks especially in the early phases of the U.S. Avian incursion.

7- Cash. Always have enough cash available, for example if food stores run out - or other critical stores (batteries) - and you may have only scalpers to buy from. One Survival Handbook recommends having on hand at least ten $100 bills, and at least twenty smaller denomination ($20) especially since if the electricity supply is interrupted there won't be any working ATMs.

More in Part 2 (Including hygiene, cooking without electricity and Will preparation)

Evidence Found Bird Flu Is Evolving: Will There Be A Pandemic Within 6 Months?

Electron micrograph of H5N1 influenza virus particles. 

The report appearing in yesterday's Milwaukee Journal -Sentinel was brief but had the impact of a blow to the solar plexus. Word, for word, it reported:

"Genetic analysis of the H5 N1 avian flu virus responsible for at least nine human deaths in China portrays a virus evolving to adapt to human cells, raising concern about its potential to spark a new global flu pandemic.

The collaborative study, conducted by a group led by Masato Tashiro of the Influenza Virus Research Center, National Institute of Infectious Diseases, and Yoshihiro Kawaoka of the University of Wisconsin-Madison and the University of Tokyo, appears in the current edition of the journal Eurosurveillance. The group examined the genetic sequences of H7N9 isolates from four of the pathogen's human victims as well as samples derived from birds and the environs of a Shanghai market.

"The human isolates, but not the avian and environmental ones, have a protein mutation that allows for efficient growth in human cells and that also allows them to grow at a temperature that corresponds to the upper respiratory tract of humans, which is lower than you find in birds," Kawaoka, a leading expert on avian influenza, said in a news release from UW-Madison.

The findings, drawn from genetic sequences deposited by Chinese researchers into an international database, provide some of the first molecular clues about a worrisome new strain of bird flu, the first human cases of which were reported on March 31 by the Chinese Center for Disease Control and Prevention. So far, the new virus has sickened at least 33 people, killing nine. Although it is too early to predict its potential to cause a pandemic, signs that the virus is adapting to mammalian and, in particular, human hosts are unmistakable, says Kawaoka.

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The preceding ought to be enough to get any normal human's nerves on edge. Also, if unleashed in an outbreak against an essentially 'naked" (from immunity) populace, the results would be devastating. In 2003, world-renowned virologist Robert G. Webster published an article titled:  "The world is teetering on the edge of a pandemic that could kill a large fraction of the human population" in American Scientist. He called for adequate resources to fight what he sees as a major world threat to possibly billions of lives. 

On September 29, 2005, David Nabarro, the newly appointed Senior United Nations System Coordinator for Avian and Human Influenza, warned the world that an outbreak of avian influenza could kill anywhere between 5 million and 150 million people. The reported mortality rate of highly pathogenic H5N1 avian influenza in a human is high; WHO data indicate 60% of cases classified as H5N1 resulted in death.

My take, given the H5N1 would (from cases analyzed thus far) incept a "cytokine storm" - similar to what the H1N1 Spanish Flu did, is that at least 500 million would perish, and possibly as many as 1 billion. I believe the reason the CDC is now barely a step from emergency mode (their website info now is partially 'redded out' with reference to old info and the emphasis is now on 'real time information) is because they are fully aware of the fact the Avian flu in its H5N1 human-to human manifestation could wipe out up to one seventh of the global populace.

Richard Besser, former CDC doc and now medical correspondent with ABC News, sounded downright nervous in his report last night from China, talking about a "race against the clock".

Back to the phenomenon of the cytokine storm: Research on genetically restored Spanish flu discloses that death likely arrived via a cytokine storm. In the current Avian flu cases,  one boy documented with H5N1 experienced diarrhea followed rapidly by a coma without developing respiratory or flu-like symptom. This shows that one can perish that suddenly, and with no evident breathing problems. There have been studies of the levels of cytokines in humans infected by the H5N1 flu virus. Of particular concern is elevated levels of tumor necrosis factor-alpha, a protein associated with tissue destruction at sites of infection and increased production of other cytokines. Flu virus-induced increases in the level of cytokines is also associated with flu symptoms, including fever, chills, vomiting and headache.

The inflammatory cascade triggered by H5N1 has been called a 'cytokine storm' by some, because of what seems to be a positive feedback process of damage to the body resulting from immune system stimulation. H5N1 induces higher levels of cytokines than the more common flu virus types.

The latest CDC Notice is given as follows:

The highly pathogenic avian influenza A (H5N1) epizootic (animal outbreak) in Asia, Europe, the Near East, and Africa is not expected to diminish significantly in the short term. It is likely that H5N1 virus infections among domestic poultry have become endemic in certain areas and that sporadic human infections resulting from direct contact with infected poultry and/or wild birds will continue to occur. So far, the spread of H5N1 virus from person-to-person has been very rare, limited and unsustained. However, this epizootic continues to pose an important public health threat.

There is little pre-existing natural immunity to H5N1 virus infection in the human population. If H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result, with potentially high rates of illness and death worldwide. No evidence for genetic reassortment between human and avian influenza A virus genes has been found to date, and there is no evidence of any significant changes to circulating H5N1 virus strains to suggest greater transmissibility to or among humans.

Genetic sequencing of avian influenza A (H5N1) viruses from human cases in Vietnam, Thailand, and Indonesia shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza. This leaves two remaining antiviral medications (oseltamivir and zanamivir) that should still be effective against currently circulating strains of H5N1 viruses. A small number of oseltamivir resistant H5N1 virus infections of humans have been reported. Efforts to produce pre-pandemic vaccine candidates for humans that would be effective against avian influenza A (H5N1) viruses are ongoing. However, no H5N1 vaccines are currently available for human use.

Research suggests that currently circulating strains of H5N1 viruses are becoming more capable of causing disease (pathogenic) in animals than were earlier H5N1 viruses. One study found that ducks infected with H5N1 virus are now shedding more virus for longer periods without showing symptoms of illness. This finding has implications for the role of ducks in transmitting disease to other birds and possibly to humans as well. Additionally, other findings have documented H5N1 virus infection among pigs in China and Vietnam; H5N1 virus infection of cats (experimental infection of housecats in the Netherlands, isolation of H5N1 virus from domestic cats in Germany and Thailand, and detection of H5N1 viral RNA in domestic cats in Iraq and Austria); H5N1 virus infection of dogs (isolation of H5N1 virus from a domestic dog in Thailand); and isolation of H5N1 viruses from tigers and leopards at zoos in Thailand). In addition, H5N1 virus infection in a wild stone marten (a weasel-like mammal) was reported in Germany and in a wild civet cat in Vietnam. Avian influenza A (H5N1) virus strains that emerged in Asia in 2003 continue to evolve and may adapt so that other mammals may be susceptible to it as well.

Highly pathogenic H5N1 in people can include:


Symptoms:

• Fever and cough

• Acute respiratory distress

• Shortness of breath/difficulty breathing

• Abdominal pain

• Diarrhea

Complications:

• Pneumonia

• Respiratory failure

• Shock

  * Altered mental state


• Seizures


• Failure of multiple organs (e.g. kidney failure)


• Death


The other bit of news (from flu.gov) is  that Thailand has begun a phase 1 clinical trial to test an H5N1 avian, or bird, influenza vaccine in a needle-free, nasal spray form. This trial is a result of international collaboration with health agencies around the world, including the U.S. Department of Health and Human Services’ Biomedical Advanced Research and Development Authority (BARDA). This is the first step in testing the new vaccine in humans. The study and data analysis is expected to be complete by May 2013.


People need to also grasp that even if an initial vaccine is successful, such virulent influenza outbreaks often come in waves. In the case of the Spanish flu there was a first relatively mild wave, then a much more deadly form (that incepted more cytokine storms).  The flu virus also mutates so that a vaccine that may work for the initial H5N1 onslaught may not work for a later one.  For a fairly good depiction of what could transpire, see the movie: 'Fatal Contact: Bird Flu in America'.  We are talking of so many dead that corpses have to be collected daily in the streets by garbage trucks, driven to landfills, stacked like cordwood and buried or set afire. We're also talking of massive dislocation of supply lines, supermarket shelves bare, and even the possibility of water, electricity output affected.  As for hospitals....the floods of patients in every city and town will overwhelm them and their resources within days!

Having seen what my own wife suffered - barely able to breathe at times-  with the H3N2 flu last December (written about in my Dec. 25 blog post) I don't want to see anything any worse! We may need to pare down the world's burgeoning populace- but not this way!