How big is the bird flu vaccine gap?

It's foolish to represent that the current capacity of 300MM doses would be available, or an imaginary rabbit 500MM doses because, oh heck, it's an emergency and the first world can up the production.

Why is it foolish?

1. This number assumes that while a pandemic is ravaging the vax plants would continue to function and produce vax as if they existed in a magic bubble, immune to infection. Even if the vax workers were protected, and their families, and everyone associated with vax distribution, their suppliers won't be protected, nor their families, and right on up and down the supply chain. The number is based on ceteris paribus, and that's poppycock.

2. The number, 300MM, is based on a 15 mcg trivalent vax. We have zero reason to believe that 15 mcg, injected once, is enough to create immunity. Nobody in their right mind would bet on that, given what's known about the effectiveness of the only vax proven to create immunity, the 2004 Vietnam strain out of Webster's lab. That was 90 mcg, injected two times over a period of a month or two. It's a none starter idea, but if we're finding rabbits in hats, it's a nice one to hold onto, like viewing all the clouds to hold onto after falling out of an airplane.

Even if it were half that 90 mcg x 2, it would be 45 mcg x 2 which is TWO TIMES the vax level assumed included in the 300MM annual doses.

So, we're looking at 150MM doses of pandemic influenza vax, potentially manufacturable, if all humans associated with the vax mfging process were healthy and were willing to work during a pandemic, and if every ingredient dowstream were deliverable, and every distribution chain element upstream were intact. Oh, and how about the reality that there will be real, spot power outages?

The supply chain will be in tatters, but the discussion is on allocation of the end product. Nice! At university, in the ivory towers, this is an "A" paper. In reality, this pure poppycock.

I'll bet zero that this will be the case. As Osterholm has set up for his own family, Protective Sequestration, by the individual, the family, and the community is the only reasonable option.

The governments around the world have failed to build vax plants for now 3 years, since the danger was obvious in Vietnam. The real fact that pandemic influenza carries an extremely high consequence outcome is based on an impossible to predict event-time-probability has had the natural outcome of negligible pro-active actions while there is no reality of societal and industrial breakdown.

What say you?

GR-well between you and Revere you slapped this one up against the head. This is the kind of stuff that the governments of the world only brush against to prevent a panic. I couldnt see for the life of me that even if you took the time in motion just to vaccinate people and added it to the above that we would be able to do a damned thing about it anyway. Exercise in futility. We have to have a vaccine in hand when it breaks and thats the cart before the horse. As for spotty outages of power, I would say there will be blackouts pure and simple and it might not come back for months. Keep that one in mind especially in the NE where the grid is very old, and very tenous already. They are working on it but it will take 10 years to replace all of the problem points that are already known.

MRK - How do you gain your vast knowledge on such a wide array of topics? From Pandemics, to power grids, you are a wealth of knowledge.

I must agree at this point, with todays technology, that the chance of seeing a WIDELY DISTRIBUTED vaccine is doubtful. I do, however, think we should continue to research new vaccines and new vaccine production methods. If you can triple production while using adjuvants requiring lower doses, it may make a dent or at least be relevant.

While we are still in the dark ages in regard to viruses, we do have a larger arsenal then we have had in the past. Perhaps we can find the appropriate weapon. Some of the antivirals (some new) appear somewhat encouraging.

Perhaps, in the bowels of some research center a new weapon or weakness of the virus (or all viruses) is being discovered.

Then we could have yet more gradations of vaccine effectiveness. Say that at some choosen dosage, patients can still get the infection, but are better able to fight it off. They likeley still have an R0 greater than zero, but hopefully smaller than for the non vaccinated. So estimating the herd-immunity efficacy of a strategy ahead of time is likely to be very uncertain. That doesn't mean we shouldn't develop strategies. If a pandemic is very robust, we probably can't stop it, but if it's spread is fairly marginal even modest efforts could stop it in it's tracks.

Vaccines are potentially useful for viruses you know are coming. For newly-evolved or intentionally-released viruses, we need other ways to reduce R0. How hard is it to reduce human-to-human spread enough to prevent mass mortality, while still keeping food distribution, utilities, etc. functioning? How much would it help if more employers explored work-from-home options, even if only allowed during emergencies and "drills?"

I'm not knowledgeable enough on immunology to know to what extent your suggestion could be successful, bigTom. But it is an interesting suggestion.

You are the first, to my knowledge, to suggest a marginal event could be stopped in it's tracks with modest efforts. Is that possible?

bigTom, Patch: The point of the post was to say the degree of needed herd immunity is very difficult to estimate if R0 is uncertain. If R0 is close to one, you can stop spread relatively easily, but "easily transmissible" implies an R0 significantly greater than one, and that is hard to stop by any means we have available except perhaps a vaccine, which won't be available for some time after the spread starts unless we find something with signifcant cross-type activity (which is possible but not for a while if at all).

I would hate to rain on the vaccine effectiveness parade but again, where is the proof that influenza vaccines work.

I believe that vaccines and antibiotics are the greatest technological advances of our time...but antibiotics no longer work against many bacteria and influenza viruses shift faster than the vaccine can currently be prepared...and the potential production numbers are such a joke that a vaccine isn't really even worth discussing at length.

I guess our new technologies depend on the time-frame...the window of opportunity before the pandemic hits.

Are we discussing a five year, twenty year or one hundred year time frame?

Thanks Revere. I understand.

But could a marginally effective vaccine lower the R0? I guess I can see, that a vaccine would not lower R0. Or could it?

But likewise, could a marginally effective vaccine (or one administered at lower doses) lower the CFR (with higher or "normal" attack rates)?

Would you agree that treatment options (or preventions like vaccines) can not simply be stated as "work" or "not work". In other words, it's not simply black and white. There may be shades of gray that may not be white, but at least it won't be black.

Does that make sense?

Patch: No, again, that was part of the point of the post. If the vaccine increases resistance R0 goes below one, the virus will not spread over the long run, although it can increase over the short run by chance, but it won't sustain that growth. But my further point in the comments was that an easily transmissible virus will be far from one in its R0, so you won't stop it with a marginally effective vaccine.

The question of CFR is different. It has to do with the virulence of the virus, not R0. So a marginally effective vaccine could affect CFR without affecting R0 at all, or it might even increase R0.

And again, the point was that "work" or "doesn't work" is not a very meaningful criterion unless you say what each means. A marginally effective vaccine might work in a biological sense but not a public health sense or might not be worth the investment, etc. Or conversely. Does this help? It's not a striaghtforward questionl, which is part of what I was trying to say.

It does help. And I think we are on the same page. I'm just not very good with terminology and therefore, communicating my questions or my view.

There is one additional variable missing in efforts to model how much vaccine will be needed: how many living people won't need it by the time it is available?

By the time X amount of vaccine becomes available, Y number of people will have already survived a case of pandemic influenza (presumably from a strain close to the vaccine strain, early on at least).

Thus, Y number of people will not need the vaccine.

It may be useful to develop quicker, cheaper, and more available ways to screen for convalescent antibodies to the pandemic strain, so that precious vaccine isn't wasted on survivors.

PF: Good point. I was implicitly including them in people with some immunity but didn't say it explcitly and it is good to keep in mind.

Excellent point Path Forward.

Unless the pandemic holds off for twenty years, by the time the current capacity production run is done (total current potential = 40 million doses), the pandemic will be over...

...good thing too because by the time the vaccine is ready, the virus will have evaded it.

Patch-I am a National Incident Manager, Command General Level 800. We get the briefings. I also get to try to feed about 1.5 million in the local area if the food is available. Feel free Patch to take the online course and show up for a table top or actual one or two disasters. My last one was Katrina and its one of the reasons I am all over Blanco when it comes up-I sent about 20 planes down there and they sat while they tried to decide who was going to be in charge. One carried 40 tons of IV's and needles so they could rehydrate people. People were dying in the terminal from the lack of fluids while Blanco, Nagin and Bush were in the middle of a pissing contest. All Blanco would have had to have done is lean forward, pull a pad out and request all federal assistance in those words, signed it, then handed it to Bush. The law would have been followed.

As for other info, we also have the advantage over many that we have Webster here in town. His latest read in a word---screwed! Frist and company were personal friends and they did a lot more than just line their pockets. There was a lot going on behind the scenes that no one ever knew. Frist also tried to get nearly 1 billion dollars approved, but the Congress only ponied up 500 million and most of that has just now started arriving in the states. They could have approved 1 trillion and it wouldnt be enough for BF.

But to your original question, one of the biggest fears is the power grid, middle of the winter in the NE or generally north of the 35 latitude line. There is by everyones admission only about a 25 day supply of coal on hand. They take the nukes offline during the winter and the spool back up to springtime is pretty slow, so the fossil fuel plants are online. So what then? After 25 days they run out of coal so the power goes down. No way that only nukes could hold the load. Bush Administration has been working to increase cross connectivity from other grids to pull the load but they get their coal from the same places and their nukes are also offline too. Catch 22. But cross connectivity also means a cascading/domino effect if its not properly handled and its a big handled handle to get that. It takes about a year to build 10 miles of wire, along with EPA standards for wildlife considerations. We need about 30,000 miles worth to get that connectivity. California in particular is most difficult because each time they string a wire the environmentalists go nuts.

Tom DVM's last post pretty well covers what I am told about vaccine unless there is a major breakthrough and we will be in bags and waiting to be buried before they get the first vaccine distributed. Thats the reason I say that Supari in Indon is only after the money so they can put up the moats, machine guns and concertina wire around their estates. It takes time to properly steal all of the money. Cant have too many trails to it.

Path Forward, based on 1918, the commentaries I've seen did not support your thesis that once infected and surviving the first wave virus that one is immune from second or third wave virus iterations.

So, your thought that those who survived don't need no stinkin' vax is without merit, unless you trust Webster's claim (and he claimed it's gonna be reassortment); so hope and wish as we may, protective sequestration sounds sweeter every time the news on the vax front validates that in reality, but for research (and I do think that is valuable and will contribute), the vax hope ain't standin' up with a capital H as in HOPE.

Ro is interesting. It's just total speculation. Have you seen the models that predict Ro? Neither have I. It's the gruel of epidemiologists, but it ain't predictable until it's measurable, and at that time, isn't it a bit late?

The history of pandemics show us severe pandemic Ro's. A forecast based on the past at least gives us a range under which to plan our decisions. But who bothers with history nowadays? It's so much more fun to guess and guess again.

M. Randolph Kruger, you really think anyplace has bought enough body bags, (if so, told enough people where they are and how to get them) and, that people will be around, putting identified bodies in them?

I also don't dig the "waiting to be buried" part of the plans lowly me has access to Google up.
Could be a long wait, since it looks like they're using their "limited disaster/outside aid" mce plans, with "Pandemic" pasted over top.

If clueing in the public wasn't officially taboo, there's a lot could be done to get neighborhoods able to handle their own mortuary piece of the puzzle. (Of course, the reactions/attitude adjustments take so long for both KillerPanFluYear, and, YesThatMeansMortality, that the fact the local and state level govt refuses to powershare enough to give the public full and fair disclosure makes it rather certain there will be no proactive preparations; not even to try and mitigate the circumstances that look to be lining up a depopulating event, for which they have totally inadequate preparations in place for burying all the bodies.)

GaudiaRay: Apparently you don't bother with history. There is no warrant to say, as you do so confidently, that infecton in the first or second wave didn't protect against a third wave. Or that the history of pandemics all show a "severe" R0 (whatever that means). All estimated R0s for flu are quite moderate compared to really contagious diseases like measles and most are below 3, many estimates below 2. Since you don't believe in R0 (it's just a figment of epidemiologists) why do you bring it up, anyway? And most of what you "know" comes from epidemiology, so how do you know it if what we do is imaginary? Unless what you wish to do is cherry pick the evidence to fit your preconceived commitments, which is what you do continually.

( How many sub-clades do we have now that could independantly go pandemic on their individual timetables? )

Do "co-circulating receptor-binding variants" explain why one could, (and some people did, whether by not falling ill or by not dying) get through one "wave" but get sick in the "next wave"?

http://www.cdc.gov/ncidod/EID/vol9no10/02-0789.htm
..."strains separated by over 7,500 miles (Brevig Mission, Alaska, to London, United Kingdom) and several months (September 26, 1918, to February 15, 1919) share a sequence identity of 99%"...

..."Despite the uniformity of the 1918 strains, one of the variable sites is an amino acid known to be important in receptor binding (21). At a subset of amino acids critical for receptor binding, avian strains differ from swine H1s at only one amino acid, E190D (15).

At these amino acids, two of the cases (A/New York/1/1918 and A/London/1/1919) are identical to that of A/sw/Iowa/1976/31 (a classical swine strain).

The other 1918 cases have an additional change from the avian consensus at amino acid 225. Since swine viruses with the same receptor site as A/sw/Iowa/1976/31 bind both SAa2,3Gal and SAa2,6Gal (14), A/New York/1/1918 and A/London/1/1919 probably also had the capacity to bind both receptors.

Because two of five 1918-19 analyzed fall wave strains from case-patients have the swine-like receptor-binding pattern, the E190D change alone is apparently sufficient to allow viral replication in the human respiratory tract.

However, the existence of three strains with the additional G225D change shows that both receptor-binding variants were co-circulating throughout the pandemic .

The current evidence does not suggest progression from one receptor-binding pattern to the other during the pandemic, since the two variants are present, on both continents, both early and late in the pandemic.

Since residue 225 has also been identified as part of the Ca antigenic site (19), the co-circulating strains possibly differed in antigenic reactivity as well as receptor-binding characteristics.

This study is the first to examine the genetic homogeneity of a pandemic influenza virus directly from clinical material.
The results suggest that in the early stages of a pandemic, mutations that occur during replication do not become fixed so that a uniform consensus strain circulates for some time"...

Remember that the antibodies are not to the receptor binding site, they are to other sites ("epitopes") on HA or other proteins. So the antibody recognition sites and the antibody binding sites are separate. Selection operates on both because R0 is affected by both, but I don't know of evidence that says that people infected in one wave were still fully susceptible to the second.

In the last five years they have been two or three failurew in the production of seasonal vaccine.

Unlike seasonal vaccines, both chickens and eggs are susceptible to H5N1 infection...so in a pandemic, thirty percent of the workers in the barns that grow the chickens that produce the eggs that make the vaccine will be sick with pandemic influenza or treating loved ones with influenza...now if just one of these persons enters the barn when they are infected, infectious but asymptomatic...then you have no birds and no eggs to make pandemic vaccine...

...your biosecurity must be airtight...you cannot afford one mistake.

The odds of this happening...zero.

Therefore, they had better put all of their finances into a method without the need for chickens or eggs or they might as well assume that there will be no vaccine.

If they want to deal in 'slight of hand' and illusions or continue the 'dance of a thousand veils'...by all means carry on...

...but at the end of the day, what are you going to tell those young parents that you assured vaccine supplies to.

...eventually the deliberate lack of honesty must end.

...and there are better places to put the scarce financial resources.

Other than that...the vaccine doesn't work.

Revere, if recovery from H5N1 were such a protective situation, those people would be recruited to do the contact work sans PPE. Ah, but there are nearly none who are adult and who survived, and from what I see, they're being ignored. Be that as it may, there is Webster's claim that 2004 Vietnam strain protects animals against infection from different strains. My recollection however from historical anecdote is that there's no assurance of protection any more than being sick with last year's H3N2 assures protection against this year's reassorted (chortle) strain.

As to Ro, the transmission level is high enough as witnessed in Karo and Turkey for us to say let's not play academic games over whether or not severe. Karo Ro was enough to quickly whack 7.

There's a continuing unstated assumption that this virus will have a low Ro, and society will continue as if nothing is happening. Please... it's more palliatives made from angel dust. Every location where the virus has appeared, panic is the first response; it's the normal human response. The Ro will get a special "lift" from the masses who will not self-quarantine. This is not the normal flu; it's death. Remember the recent hemmorhagic fever in Africa? Remember that the people fled? Remember Karo? Remember? That's what continues to happen whenever the locals think themselves at risk. This belief that all will remain the same is unsupportable by history.

The vertical chain of supply and distribution to produce vax will be broken at numerous locations when PF gets going in earnest. Without vax plants sufficient to produce enough to create herd immunity, this is an exercise in intellectual onanism; fun, but unproductive.

I'm not pulling selectively. I am watching objectively. I don't have a positive view towards what humans can do. The nobility you think will be called out is certainly imo well hidden at this time. I don't need a tombstone that says, "Well, at least he tried." Nope. I'll pass on the tombstone by being prepared for the encounter, expecting nothing from others as they too want to save their own lives. Back to Osterholm's approach for his family... protective sequestration.

You know I favor Niman's approach to vax planning. I also see nothing being done to advance vax capacity (oh, there's one or two new plants and one refurbished plant..in the west... as in nothing being done)

GR: Karo did not have an R0 of 7. There were at least two, possibly three serial intervals involved.

What part of the concept "panic" don't you get?

A glance at the listing of articles reporting on the public's reaction when someone gets infected with bird flu is not,
damn the torpedoes, full speed ahead. It's panic.

I'm stating, and you can take this to the bank, the infrastructure will collapse due to immeasurable fear. Remember our discussions on not being able to determine the probability of when? Well that same incapacity and unwillingness to invent a solution is going to come back and bite the academics on the nose and on the tush, and rightly so.

If there's a refusal to plan for panic, then the outcome will be as it will be, and that's a breakdown in the vertical delivery system leading to the jab in the arm.

As I've said privately, promise the 3rd world mandarins anything they want to hear, and give them exactly what will be available later, little of little, bordering on nothing, when it comes to vax available to save them and their famililes.

Just get the virus so those of us who believe that speculating when the virus will be at the doorstep of Level 6 can attempt to manage our business and personal lives with that level of risk in mind. That would be a true public service.

Ah, but the academics would rather discuss whether it's 300MM or adjuvanted it's 301MM doses available. When you learn where they'll be handing it out, do post the address. I'll see if at that time I can bicycle that far so I can get some too, as the fuel and power issues are I'd say coequally unaddressed in the face of panic.

Protective sequestration is the way you spell "vaccine" when the pandemic reaches Level 6.

GR: Well, maybe everybody will react like you and maybe they won't. The world's a big place and not everyone is like GaudiaRay. Believe it or not. Sounds like you've already panicked, which accounts for much of your world view.

Revere/GR - Yes to all that this should be blaring across the media like there is no tommorow, because there may not be. I dont slight GR one damned bit because he is scared that this will get out of hand. Out of hand to the point that he might have to whack a good friend or neighbor to ensure that his family survives. But and there is always a but, this could wave us nearly out of existence. Adaptive mutation was extensively covered and I aint a doc but that in itself ensures it will be with us for years in some form.

Not everyone will react the same. Its the mob that I fear more than the individual. GR as long as you have your stuff and a primary and secondary position to fall back to, and you have informed your neighbors that you politely will defend your turf and family then you have done enough. My long streets in the subdivision are now prepared and even if I am not here things will be taken care of. A pact if you will has been achieved. I am becoming more successfull at getting people to pay attention as its now broaching into the town adjacent to me. Lots of calls, lots of fear, lots of telling people what they dont want to hear and putting them on the highly quoted EM on my email list that I send everyday.

1918 flu likely circulated for about 20 years prior to its hit. There is a correlation between that and whats happening now and if they are like type bugs we are on year 17 which is the first indication that I have been able to pull of "strange deaths" in the Bug Valley of China. Ok, its not scientific but I did make the connections and it could be wrong or right, it doesnt matter. If everyone prepares to at least a two or three month level then well, you've done just about all you can feasibly do. Cost/storage/cycling all come into play. Many people like Mike P. are pissing into the wind in the NE because he is smarter than the morons that are elected in his town. Okay so he screams, he rants but he is having an effect. People are starting to prepare and only because HE is preparing. It might never come folks. Its a possiblity but I dont buy that it wont. In fact statistically we are really preparing for pandemic X and that is the sure bet. You will use those supplies in your lifetime or wish you had bought them when the "X" bug shows up.

Vaccine... Screw it. I had lunch yesterday with my club buddy the immunolgist and he said that he doubts like Revere we could field it, distribute it, and above all make one in time for it to be used. So I asked the straight question for the straight answer, "Will they be able to make one?" He said very likely not, but that they might be able to use some haired up existing vaccine to produce better outcomes. The CFR's likely will be skewed he said by only a percentate point or two and less if the rate is very high.

So GR dont beat up Revere too much about this item. You are right that the only vaccine we have is hole up and watch re-runs of old movies if the power is on. Tom DVM I am sure is prepared up to the hilt and he will likely see it in animals first before the humans unless we get something interesting out of Indon. I have basically resolved myself to printing off free disks of lists, preparations and leaving them in consipicuous places such as the public library. Its cheap and I get the calls within a day or two of the drops. Parents that can read and write are the most concerned and my email list is now in the hundreds. I dont know what to to with the poor though. I drop the things at the libraries there and either they cant read or they dont understand. I think they will take the biggest hit from this stuff. Dont know what else I can do as this is the group that government will have to take care of else they WILL panic and become that mob that I am concerned about. They would be warned to turn back or else and the or else would be severe, no arrests in this mess unless they can store them. No camps, just severe response is what I see.

Fingers crossed that it doesnt happen.

Karo: I thought sequences showed the index case infected 6 people.

http://web.mac.com/monotreme1/iWeb/Pandemic%20Influenza%20Information/K…

(We're lucky she didn't have a train ride, or plane flight. Neither did her contacts.
Luck won't last forever. We don't even realy know what is going on the past couple of months, in too many countries now. Too many "known unknowns".)

Osterholm's new home constructed next to a stream in the countryside? That ain't panic is it? Nah, he's an epidemiologist; so he's just building a nice new home in a cutesy woodsy semirural area...just because.

Gimme a break. We agree the infrastructure is hamburger when people panic. I guess that you have the ability to project your calm, balanced view on "the people". You are a Jesus figure, in spite of your irreligiosity, if you believe you can do that. The cops kept the NOrleans residents from crossing the bridge by killing them. It's PANIC that's the real challenge. We're hardwired to panic, unless we're a distinguished academic with no special interest in his own survival. Maybe a reading of Charles Mackay's book, online to make it easier for you to access, will help you see that people always go to extremes. It's noted below. People always go to extremes. And the consequences are not very nice. In this case, only the Revere's of the world will believe that by attending to life as usual, the vax will finally arrive, and the situation is not life threatening.

Ask the pregnant mom, the first of the myriad, who just died in Medan, Indonesia. Was it life threatening? Was it any less virulent than 2 years ago? As to Ro, when the authorities examine 52 people in the immediate vicinity and via tracing, I'd say that the boots on the ground are panicking, right, Revere? Heck, it's not easily transmissible, so why be concerned?

I panicked alright, when I first looked at this issue because there was a dearth of information. The epidemiologists were out on break, attending yet another soire in some fun place in the world. Now that the websites have congregated those who are interested, I know as much as many, and I don't panic about food, water, medicines, etc. I am struck by the infrastructure demise under a pandemic of equal severity as that now not yet efficiently transmitting.

The Ro has little to do with the CFR. So, we wait for the Ro to do its next transformation.

Meanwhile, as one doc said on NPR 2 years ago, all you need to do at this time is to wash your hands more thoroughly.

Squeezing the little soap bottle...

And if I may, as I see it, Darwinian reassortment will get rid of all those who are on the "maybe they won't" side of the table. I think that's perfectly fine; don't you?

Charles Mackay
Memoirs of Extraordinary Popular Delusions and the Madness of Crowds
http://www.econlib.org/library/mackay/macExContents.html

Extraordinary Popular Delusions and the Madness of Crowds is a popular history of popular folly by Charles Mackay, first published in 1841

GR: Exactly what is it you are trying to say? What is it you are suggesting we do? What exactly is your point?

revere, GR has never had a point. He just likes to hear himself talk. Ten years from now, when a bird flu pandemic still hasn't transpired, GR will still be screeching that the world lacks preparation from "panic".

Thank you for asking.

My points:

The portending virus invites both fight and flight.

1. FIGHT: Understand that this disease may be societally destructive. Act positively now; serious statements about the impact of the virus on individuals and what this means to groups of each level when at Levels 5 and 6. Make a societal decision that survival is worth the run, and run towards it via multitudinous preparatory efforts. In the US, Leavitt's tour was a joke...unheard of by most, unthought in its presentation, "overdue" being an obvious lie, eviscerating the message as yet another Administrative incompetency of evaluation.

The response so far, for the 3+ years I've observed this, has been in a range from faint pulse present to none at all.

If there's a fight to be undertaken, then bring it on. The Manhattan Project urged by Frist led to money being IMO basically wasted on feint vax prep efforts.

Publicly rebuke those who failed to see recombination (not because it's fair or decent, but because it will be a magnetic swing in the opposite direction. Governments can say they were misled, that there is a mistake which has put their citizens at grave risk. It's both true and it would justify a run for the goal, hardening and protecting infrastructure, and family planning.

The naysayers should be pilloried, delighting the public, and allowing them to coalesce around new leadership (not Leavitt who too should be given his walking papers...pressing family matters, you know the drill).

The goal is to get the public to think about preparation, not to place cans of tuna under their beds. They need to ask the food, water, medicine, entertainment/activities questions and think about flight.

Publish clear industry priority lists and mandate those industries to prepare. I've posted that my conversation with a senior manager of a leading oil producer in California revealed that they were considering shutting in and closing down, instead of being fully aware that they were targetted as a key industry, obligated to stay up and operating, with necessary governmental guidelines or tax benefits for that effort.

Remember, I've said that the cost of this pandemic, if at the current Indonesian level, will be 1/4 of one quadrillion dollars ($250 trillion), to the world of which the US would bear easily $50 trillion (more than 10 years of face value of total commercial transactions at every level, or about 40 years of net profits). The cost of preparation is a farthing compared to what is quite easily calculable.

It's like the sub prime lending debacle. It was obvious that the cheaters were the lenders and the borrowers, a victimless crime. The government did nothing to stop this (thx to the laissez faire policies of Republicans). The point being that it was obvious that it would lead to a bubble and ruin to all. But short term profits, piggery, left nobody willing to be targeted as the person who rained on the parade.

Without someone having strong character and saying something that you will rankle at, "What is happening now has no reason to modulate when it alters its Ro". That is the message. It's not being said by anyone in senior position. Unlike the more managed societies, the US has feckless leadership and the outcome will not come to pass, until there is a change of federal managerial philosophy. I know this is wishing, but someone I think must stand up and say: "This will be the outcome, ceteris paribus."

2. FLIGHT

It's the old, "abandon all hope all ye who enter here" reality (as H5N1's CFR maintains worldwide at rates unheard of in a disease which can be, and has been historically, pandemic.)

The conclusion was well known, documented by Daniel Defoe, and now, by waste of money, epidemiological-1918-historical investigations. The solution is protective sequestration, for individuals and for communities. And that conclusion requires solutions for food, water, medicine...power, water, transportaion, sanitation. It's a rather cookie cutter solution, but not once have I seen it presented to the public.

Debate over school closure have led to even more uncertainty and unsupportable hope that the CFR will be low and that Ro will be low. It's foolish to abide this type of vested interest vetting. The bottomline is that the virus as it now stands is stunning in its CFR, and for all the hopes and recent proofs, there are very clear instances of massive human life terminations due to "plagues". H5N1 bears the mark of being yet another. Or in my comically religious viewpoint, God is about to void his contract with the Jews made after the 10th Plague, that he would never cause yet another massive die out of the young. Well, God's contract was with Moses, not with his multithousand year descendents, and H5N1 is signalling death to the pregnant, death to the young, death to the young adults, and this time, death to most of those who are drug and medical technology dependent.

This ain't rocket science. Those observable and probable outcomes require all of society, and each individual in a position to do so, to consider seriously and embark upon plans for locally sustainable protective sequestration.

A WORD ON THE PRIOR DEBATE

There's no question that as you've pointed out repeatedly there are arguable gray areas. This is a Gordion's Knot. The Knot exists. Dissecting it the way science has chosen to do has cost huge amounts of time and has led yet now to yet more unknowns and indecisions. Either the virus is "on" or it's "not on". If it's "on", then Katy bar the door, it's Manhattan Project time because every single logical analysis proves that there is no possiblity of othe rthan paliative preparation for the virus at the time the virus reaches Level 5.

I see it this way: The virus is unstable and we are fortunate that the virus has not yet changed polymorphisms which will allow for easy H2H transmission. While we don't understand why that is, we also have no reason to believe that it will not happen. In the case of H5N1, with destruction of infrastructure at 40 to 100 years of prior human societal effort, and loss of life at 5 to 50% (numbers not discussed here), society has no choice. It must Fight.

It's like going to the Moon. It has no direct impact on an individual; but it has impact on society. We have many technology improvements due to that effort, and that for a reason of vanity, not societal survival.

I think you would serve us all by advocating that the decision be made, and that the trigger be pulled. The naysayers can rail all they want, but societal infrastructure must be prepared and have answered the participants tough moral personal question, "Do I go to work during a Level 6 pandemic?" If this is not answered, the society will collapse, and only those who have individually protectively sequestrated will stand a chance of survival. It's an ugly alternative. Thus the only conclusion is to engage in vigorous debate now and embark on many preparatory actions, now.

And why now? Because neither you nor I nor anyone know when the fateful polymorphic change will transpire. Guys like Niman see Karo and say, "there it is, and it will be back". Others say Karo proves that the virus can't sustain. Others lie by omission (the UN's WHO for too long) and say Karo doesn't exist (like I guess China is doing about its own cases as the virus is everywhere around them, but not in China!) Egypt and now the mideast, courtesy of the NAMRU-3's honest and open scientists, can now tell their people the truth of what they see. Some societies cannot prepare...the 3rd world can do nothing as it has no resources, but the 1st world can do a lot more, a massive amount more.

Revere, I study the US and world economies daily. I see the games being played and I know they are self aggrandizing and do not factor in probable outcomes on a macro scale. For governments to allow commerce, the unseen hand, to control epidemiological destiny, is societal suicide. It's happened many times in the past. And while there are always counter arguments, there comes a time (my cheap way of saying that there's strongwilled leadership that either will surface or will not gain centerstage), in some societies, where the good of the group requires that all individuals dance to the same tune. That's done every time during "war". Well, the virus has declared war. It's killing, just like the dedicated religionists in the middle east. We either mount a counter-offense or we will all lose what we cherish so much, the complex social structure of the first world as it exists today.

I'm not setting actions here; but if you asked, they're the same that WHO said 4 years ago: power, water, transportation, sanitation. Without those, the infrastructure will not exist; society will not exist; conditions will degrade to bestial survival; civilization's thin veneer will have been stripped off. I don't want that. You don't want that. Nobody reading this wants that. Yet I see no other outcome should CFR sustain and Ro increase.

Specific actions? If you ask, I'll post my thoughts. But the key is a decision. In the US, there's a war chewing through the people. They're fatigued societally. The leadership is in shambles and rightfully distrusted as politically inept. Appointments continue to favor holiday sneak-arounds, terribly made decisions...certainly not by the president as he continues to be as he was incapable of engaging his own mind in rational analysis; such a shame. So, at least as to the USA, guys including Osterholm and Niman need at some point to be recognized and called upon to sit at the leadership table (yes, I know they don't see eye to eye, but they both have well considered views), call in the studies, hear the debates, and tell political leadership what to do.

While I'm not a Leavitt and won't say "it's overdue", I do say that it's a high probability that what's in motion, what's evolving, will stay in motion, and will continue to evolve...right into a pandemic, with amazing CFR's and an Ro that will frighten the public and lead to social dissemblage.

Thx for asking.

Stan, if you got proof that nothing will transpire for 10 years, lay it out. Terrific. Stan, you're going to explain to me why Level's 5 and 6 will not appear for 10 years. Please...please do so.

GR-Stan could be right and so could you and I. I think it will be sooner because Webster thinks it will happen pretty soon. There is no proof that anyone will be right. I dont think anyone wants bragging rights that it will be sooner or later. If this comes I almost would want to do the flight thing rather than the fight thing but its not in my nature.

The fighting about when it comes is irrelevant. If we devoted 3% of the US GDP for 10 years and its beyond 5% for a CFR, we will not be able to handle it more than about a month. The system will collapse and we will be blaming the government for the response. There is no response here. We will throw the rocks at the demon and he will still take the number he came for. We might distract it from the few but not many. Doom and gloom? Yeah it is. I see where they appeased Indon yesterday and put Supari on the WHO board. Yippee, so now we have Aunt Margaret and Supari calling the shots. The ultimate effect is that they were already represented and now they are super-represented. We will now be answering to a third world nation about what we are going to do with our resources and all in the name of getting samples. We should have just waited and let a few more cases come rolling down the street as I believe it will be a much more mutated strain that comes after us.

I dont respond well to threats and extortion. Supari was put on the board by 60 nations. Okay, but thats what was done to get the samples. It also indicates to me that this is a FAR bigger problem now than it was a year ago and that indeed the scientific types think it is too. Time will tell but GR is a prepper, Stan I hope you are. Shouldnt fight too much about the when, should be arguing about the what to do when.

We could always argue about what the WHO is going to do next. Indonesia only wants one third of the non-existent vaccine supplies for their country. They also want that in writing for their samples.

FWIW, I think this is going just about the way I thought it would.

This will help:

US Dept of HHS will sponsor a blog summit on Bird Flu.
More details in a week.

It's all over the newsgroups: Here's one reference,
https://www.singtomeohmuse.com/viewtopic.php?t=1079
and another, as the PFI is https,

http://www.flutrackers.com/forum/showthread.php?t=24289

GR: Your position seems to be that no one is taking this seriously (enough) and that we need to get cracking. Like how? What does it mean to "pull the trigger"? I don't want you to post actions here. Feel free to do so on the other sites you frequent or start your own. But all I hear from you is, "It's going to be really bad. Get ready." But no clue as to what would have to be done except that we have to decide to do it, whatever it is. I, personally, would say much of what you have said, but about climate change, not influenza. But I know a lot more about climate change than you do and as much about influenza, so maybe that's why we differ.

From the beginning of our "association," going back several years, you have expressed yourself in the most strident, dogmatic and abusive terms. I remember your excoriating me more than two years ago for not agreeing that the temperature recommendations on the Tamiflu box weren 't as rigid as you thought they were (I was right; you were wrong, BTW).

Everyone's wrong but you -- according to you. All governments, almost all flu scientists, all of epidemiology, etc., etc. What would you like Mike Osterholm to do? I'll tell him for you. I'm sure he'd be glad to know. BTW, I've always given you the benefit of the doubt about your financial investment in the recombination proposition and Niman's company. I think it would be nice if you gave others the benefit of the doubt about their competence and motives, too, something you invariably fail to do. Full disclosure: I have no financial interest in the flu world at all. None. I lose money doing this because it takes away from my regular professional activities.

BTW, if you want a documented description of the plague you might go to Samuel Pepys, not Daniel Defoe. Defoe wrote a novel a half century later. Pepys wrote a diary at the time.

Your point is you think it's going to be really bad and no one is doing enough. Thanks for nothing.

In my own personal preparations to shelter in place I had always rather relied on Path Forwards argument that my position in the vaccine cue would be greatly improved by the numbers of people who had been removed by infection.
As to infection in the first wave providing immunity in any subsequent wave my reasoning goes like this. Flu mutation is extremely rapid, so much so that vaccine formulations are changed annually for seasonal flu. An AI virus that has just gone epidemic in a new host will undergo significantly more rapid evolution as it has the added selection pressures provided by adapting to a new host. If the preceding statement is true then the dominant strain in each wave may be significantly different even if the waves are only months apart. I have no reference I can give to prove or disprove the statement one wave provides immunity to subsequent waves but would assume any protection would be partial. In the 1918 pandemic the second wave seems to have been significantly different clinically with a much higher CFR.
On the thorny problem of vaccine capacity and dosage; regardless of any benefits accruing from improvements in adjuvtants, production capacity is currently a commercial operation matched to the population of at risk individuals in countries with the wherewithal to pay. It is also based on the old and slow egg based production method and I would council against wholesale attempts to vastly increase capacity to achieve herd immunity levels by this option, even if it means we miss the boat for an H5N1 pandemic and suffer the horrendous consequences that might entail. I would prefer we start again and view pandemic influenza as an unrelated phenomenon to seasonal flu and address it as a national security issue. History shows us it is at least as great a threat to our populace as a major war and should be treated - and funded as such. As pandemic vaccine production is only required every few decades a system for producing it needs to be adaptable to some other purpose in inter-pandemic periods. This leaves two options (that I can think of) either all animal vaccine production plants are built to be switchable to human vaccine production at short notice (remember China undertook to vaccinate all its poultry est. 12 billion birds) or a cell, or monoclonal antibody, solution is adopted for which the plant is also suitable for other purposes. I personally prefer the air-lift fermentation Mab route as antibodies to specific epitopes can be formulated in advance and an appropriate cocktail produced for seasonal or pandemic flu once the strain is know. Both of the latter systems are much more scaleable and have a significantly shorter lead time.
I hope someone will comment and show the flaws in my logic.

Pepys was a randy, full-of-himself guy who lucked into a position of political power. He used it to bed many women. Very impressive.

As to Pepys observations about the plague (yes, I've slogged through way too many pages in way too many chapters of his talking about this gal and that gal he bonked), he has precious little to say. It was as if there were annoying flies all about but none that seriously endangered him. His footman I think died or became ill. He lost support staff. But it was a big non-event in his life. He liked shipping his wife and kid to the countryside so he could continue his trysts in London. He was so suspicious that wifey was doing the same that he literally lifted her skirts to be sure she was wearing undergarments when she met with the dance instructor. I learned that. I learned nearly nothing about London during the plague.

Your dismissal of Defoe is sadly unreflective. Defoe wrote that about 45-50 years after the plague, when plenty of people were yet alive who had lived through it. As novels were the movies of that time, many read what he stated. I have never yet to see one negative comment regarding historical accuracy. He knew very well to whom he was writing. He avoided discreditation and disgrace by writing accurately.

Your personality and mine are included in that book. What strikes me and I would have thought strikes you is that the ones who survived were those who protectively sequestered on the boats in the Thames and in the country manors, closed to outsiders. For them, it was as if nothing negative had transpired. For those who served, like you will, death was a constant visitor. We all die. I like mine on different terms. I don't meander on foot drunkenly on the freeway, and I don't accept low virulence, low Ro either. But as you've said many times, we don't know what it will be. I see a freeway. You see road construction. For the recently dead courtesy of this virus, including the pregnant 26 yr old in Medan, her family sees it my way. You look at it any way you wish as you're on the line. I'm a biz guy watching how to avoid the storm that's swirling in multiple countries, so I can continue to do what I do after it's all over. I have no doubt that by protective sequestration, wrong or right as to CFR and Ro, I'll be just fine.

GR: "As to Pepys observations about the plague (yes, I've slogged through way too many pages in way too many chapters of his talking about this gal and that gal he bonked), he has precious little to say. It was as if there were annoying flies all about but none that seriously endangered him. His footman I think died or became ill. He lost support staff. But it was a big non-event in his life."

That, dear GaudiaRay, was the point. The guy who lived through it versus the novelist who didn't.

From FluWiki... DemfromCT, the government's hardball questions for discussion (smiles)...as in community college remedial English questions, to promote discussion. Oprah would have asked the same.

Where the heck are the stated facts up front, on which to respond, like CFR Indonesia 80%+, CFR Egypt 100% - 0%, CFR China - 40%, and Karo Ro 2 or 3, Turkey Ro possibly 3, Egypt Ro 3, as examples of real clusters and real Ro's in real familial clusters?

Not there? So, all that's being asked is speculation based on nothing. It's another governmental effort.

Further, the choice of representative from Flublogia is your buddy and a state-employed epidemiologist in FL, each very sincere, and each with their own agendas, which have zero to do with mine, mine being survival of individuals and the institutional structure as a whole. You know DfromCT's views. They're conservative and proven by studies to be wrong.

Maybe you missed the Federal Study. Shelter in place, protective sequestration, is the one sure way to avoid this pandemic killing you. That's the conclusion. Add in other steps and maybe that will be sufficient without the elusive vax to create some window of what can pass for herd immunity, because the herd is not out in the pasture. That's the same news that Defoe stated without the Federal bucks funding his existence. Get the heck outta Dodge City, and stay at home. That means have enough of everything to make that work. Most won't be able to do that. But some can, and they should be motivated to do so. Where I live, probably 30% can do that. Where I live, the community could do a large amount of it. Will they? Not-a-chance...without the Feds saying, "DO IT."

Ah, but then the poor will scream that they weren't included, like they are doing about the subprime loans they signed (not their fault...right?!). They're not going to be included. That's all there is to it. I don't like it; but I can't do much about it.

In sales, there's a saying: 1/3 will, 1/3 won't, and 1/3 may be persuaded.

Flu prep is the same. More and more will; many won't; and some can be persuaded. The poor are stuck unless they organize now to assure food, water, power, sanitation and transportation. This is not a welfare state. The line starts with those who have "seen the light" and prepared. Noah was a stupid old fool to all...until the flood. If there would have been no flood, he would have been a stupid old fool. We each throw the dice, and we live by the numbers that appear.

Government's are stupid and wrong, and you know it. Indonesia could have tamped their outbreak quickly by following the WHO guideline when the first father and daughter died in Jakarta. Instead, they looked at the surrounding area, found nothing and left all the animals including fowl, alive. They did it repeatedly. Now, you are insulting of me for my belief that governments are negligent, reckless, and self-serving of those in power (not all, just many, and mostly in 3rd and 2nd world countries). I give you...Indonesia. And I extract and accept your apology for peppering a misconstruction of reality with invective.

So, here's the Fed's latest, from Flu Wiki.

How will the blog summit work?
To help drive the conversation, a set of specific questions on ideas and plans for preparedness will be asked throughout the blog summit (see below for a list of discussion questions)...

What are the questions?
Week 1:
Why should we, as Americans, be concerned about personal preparedness for pandemic influenza? Why is it important that individuals commit to prepare? Why is this particularly important to me, as a community, business/labor, religious, or health care leader?

Week 2:
What challenges will I, along with my peers, face in mobilizing those whom I influence? What are my community?s concerns? What do I need from the Department of Health and Human Services ? or others ? to be able to make a contribution? Have I faced other challenges in mobilizing my community from which there are lessons learned? What is an appropriate role for me as it relates to this issue? What am I willing and able to do?

Week 3:
Are there existing programs that I am aware of that might be useful to helping to communicate the importance of personal preparedness for pandemic flu? How can they help? What is it that motivates me to lead and how can this knowledge help me to motivate others to lead as well? Who else in my community would I want to be engaged in this issue?

Week 4:
What are some of the lessons learned from the Leadership Forum?

Week 5:
What will be the top factors in achieving our collective goals? What will successful mobilization look like? What will be my next steps?

Sounds more like the govt is asking for "leadership" lessons. (Too late.)
Just more stalling telling the public?

Govt. could tell the public to prep for 12 weeks minimum.
(Or, ask Dr.Osterholm what they should tell the public, not that govt. seems to have listened very hard to him in the past..)
TPTB haven't really told the 1/3 that will prep,
and they haven't even tried to persuade the persuadable 1/3.
(Those thirds cut across all income and education levels, I'd bet; some in each.)

GR-He used it to get chicks in bed? Hmmmmm..........

I wonder if my wife would get pissed if I did it in the name of science?

Guys, come on and lighten up. I have said it before and that is that its time to embrace the horror. Supari wouldnt have gotten onto the board of the WHO unless they REALLY needed the samples and information and as stated there will be those that prep up and those who dont. Those that dont will die in miserable conditions because they are poor and they will die like that by the boxloads. There is simply no way that any country could do enough for its population. We will do what we can with what we have when it comes. If we have prepared and its below 8% it can be managed. But 8% CFR actually equates to about 30% infected and thats a hard bowling ball to swallow.

Wouldnt want you guys to keep going at it over and over again about this. Better GR to go out and get someone to prepare and do like I do which is to try to get them to do something about it. BTW my wife says I am not full of myself, she says I am full of shit of the finest grade. Revere concurs I believe. Both are right and I am humbled in their presence. I am getting a lot more pragmatic about BF, but I am encouraged because my little email info daily to about 300 has now produced a lot of results. If I save one or more because I scared them enough to do something about it then it will have been worth it.

FWIW Revere(s) deserve an attaboy because even though this is a political blog it cuts thru the BS of other blogs and gets straight down to the nuts and bolts. Revere(s) fine analysis from the left wing almost always draws a response from the right and it moves both towards the middle which is never a bad thing. If and when it comes he said he wont have prepared for it and that is an automatic fatality. Takes real guts to make an informed decision like that. Many will take the same position and its not suicide, its inevitability.

He has stated that he is too old and in his profession if there is an outbreak it will finish what he does for a living and that is research. Either it will go because there wont be students, there wont be grants, there wont be anyone to use said research on. So then what? This will be the set back for many in the research fields and its the lay of the land during the pandemic and post of it if its a high number one. Resources would and will be scarce and money might not be worth squat.

My bet is that he will be there helping folks out medically and commenting here if he can. Blogs might be the only way to communicate.