The back and forth about WHO over the weekend generated plenty of comment. I am still of the mind that WHO is an important part of the pandemic flu picture and we should try to help it do better. After defending them on Friday of last week I turned around and slammed them for poor risk communication on Sunday. A commenter observed that this may have been bad reporting, and while I allowed the possibility, I thought it too similar to past examples to accept this as the first explanation. However yesterday I received the following email from Mr. John Rainford, the WHO spokesman I took to task in my post. Mr. Rainford did not ask I post his email, and in fact said it was not necessary from his point of view, but I am doing it anyway because I want to make several points about it.
First, here is the email:
A colleague brought to my attention your recent post on the blog Effect Measure. A quick note on the AFP story mentioned. The story was actually the second for the reporter, their first effort mistakenly reported a confirmation of human to human transmission instead of a confirmation of a Pakistani case of human H5N1 (limited h to h being suspected, but not confirmed). We pointed this out and they agreed to file a correction. Their second effort, unfortunately, was similarly problematic. They combined two separate quotes to then draw a wrong conclusion. (my rough transcript Q: "Do you know if the virus has mutated " A: " We have no evidence of any mutation as the sequencing is ongoing" ...later on... Q: "So how do you know a pandemic has not started?" A: "One warning sign in t he risk assessment investigation would have seen contacts of suspected cases falling ill.")Happening as it did over the holidays, the reporter was unfamiliar with the subject matter. Similarly, it was harder to line up our technical experts to do the interviews (always our preference). As such, you could argue this was an unusual case. On the other hand, if we ever did get into a more serious situation, such communications challenges would be straightforward in comparison.
I've been in the field of outbreak communications for a few years now and , truth be told, the challenge is as difficult as ever. So while I wanted to send along a bit of context to the AFP story, I also wanted to say that we should continue to be held to account. We can and should get better.
This is a refreshing and non-defensive posture. It is also clear that there was some lousy reporting here. Agence France Presse is a major news service, but, though it pains me as a Francophile to say it, it is substandard in many ways. It is not just their reporting. They have remarkably obtuse and off target headline writers that often reverse the sense of the story. AP, Reuters and Bloomberg stories are consistently better reported than AFP's, something to keep in mind when reading the news wires.
But this is not just a matter of WHO and newswires. There are many more players on the scene now. Blogs and dedicated flu sites are in the mix, enough in the mix to be cited by conventional media, have links on official sites and get responses from agencies. We are not all alike and we play different roles. Our objective here is to be as fair and accurate as we can be. We put a premium on that over advocacy and speed. But there is an important role for advocacy and speed in the flu world and we encourage others to pursue both of those objectives. There is room for all of us and with luck, the chemistry will work out.
Which brings up one final point. WHO needs to recognize -- and Mr. Rainford does recognize -- that the public gets its information in many ways today, not just through conventional media outlets. The media are now often the followers, not the leaders. So WHO needs to learn to negotiate the new information diffusion landscape or it will continue to stub its toe. Stubbing your toe can be a very painful experience.
Mr. Rainford's final point is worth repeating:
I also wanted to say that we should continue to be held to account. We can and should get better.
It applies to WHO. But it also applies to AFP, other reporters and to blogs and flu sites like ours. We make mistakes. We should not only own up to them, but try to get better. I think that's an accurate and fair assessment.
Correction: After proclaiming a priority for accuracy I misspelled Mr. Rainford's name (it has no "s" in it). My face is red. Apologies to readers and, of course, to Mr. Rainford.
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Congratulations Revere. IMHO, this is one more feather in your cap in regard to the high level of achievement of this blog. Obviously this is a serious, high level place for the dissemination of BF information. Dare I say THE best?
And as I maintained earlier, the WHO is an organization doing it's best (or at least trying) under very difficult circumstances. You make a good point in that this is a very refreshing and non-defensive posture. But I believe they've always been of that mindset while having to jump political hurdles or obstacles.
Maybe not always perfectly...they are after all, scientists who aren't always the best communicators. Or at least not all are as good as Revere. :-)
Thanks for sharing Revere. It gives me even more confidence in the work they are doing. Additionally, it reassures me that this is THE place to be for rational information.
By the way, I also appreciate the alternative topics you sometimes blog about. Not only are they interesting, but they are a divergence from what can be a all consuming subject.
I'm interested to hear some of the regulars weigh in on this email. If one were to keep an open mind, there can be no doubt that this should renew at least some level of confidence in the WHO. It should, by the way, also tone down to some degree the "it's happening right now" rhetoric.
I echo what Patch said. I would also note however that WHO, like CDC, NIH etc. are primarily political entities and it is politicians rather than scientists that by definition pull the strings (e.g., scientists don't go out and create these bodies themselves politicians create them). Consequently, have to keep politicians happy and the politicians try to keep there own (often economic) stakeholders happy. Result is there necessary political calculation in WHO communications (as with CDC etc.), it does not mean that WHO is lying, it does mean they take more than pure science into account in making decisions (I do not believe that WHO would make a decision respecting phase 3,4,5 of a H5 pandemic without taking into account how it affect tourism etc.). Add to that minor language changes both by WHO and local reporters that add new coloration to WHO communications. For example, in the Pakistan cluster, WHO commented on sustained COMMUNITY HtoH transmission rather than just plain HtoH, a number of folks noticed that and wondered wheather WHO was changing the goalposts to avoid changing pandemic level and impact trade/tourism etc. maybe they were and maybe they were not but that simple word's difference was observed and commented on. In sum IMO it is true that WHO is a political body that does take politics into account in its communications and activities, it is also true that reporters are sloppy and slight changes in language generate notices perhaps byond the significance of the change.
Much the same mess for all mainstream (AFP, AP, CNN, etc.) science reporting, that is of course in areas where I am clued in enough to see it is rubbish, so I assume the rest is as well.
WHO as an Intl org does publish a lot, contrary to some Gvmt agencies, not to mention private labs etc. If you go to WHO, input -avian influenza- or equiv. you get the updates - they are pretty bland and do not address the issues that the public at large or journos want to hear about.
*That* transmission uses the ancient conduit of the spokesman (of the Lord, the King, the top bottle washer) to the questioner or petitioner (the peon, the scribe, the anxious or belligerent nut..) and is rife with obfuscation, misunderstanding, spinning, etc. Why doesn t the WHO write its own proper press releases, take it or leave it? Why do innumerate journalists beholden to their corporate masters for their children s schooling and their own SUVs and blue pools get to scribble the news? Why are these several layers of "filter" used, or necessary? As the poster above said, the politicians pull the strings..and WHO is not independent. Still, general questions about dissemination of information...
revere,
I must voice my agreement with your concluding paragraph:
"It applies to WHO. But it also applies to AFP, other reporters and to blogs and flu sites like ours. We make mistakes. We should not only own up to them, but try to get better. I think that's an accurate and fair assessment."
Why do we not set the same standard of accountability for at least the opinion leaders and frequent posters of flublogia? There are those frequent posters who not only extrapolate the news, but even fabricate a story to push a point of view. They defend their actions by calling it freedom of speech, and if you call them to account, they invoke the "personal attack", "censorship" armor, and attack your voice as "bad behavior" or "flu board wars". For too long, flublogia has been hijacked (yes, hijacked - those who hijack call dissenters hijackers) for dubious purposes. Going into 2008, we must collectively stand up and stop this nonsense, and not be intimidated.
Excellent job revere and I must say that I couldn't agree more with anon.yyz.
The World Health Organization is an
"intergovernmental political" organization...it is not a science based agency and it is not a regulatory agency...instead, the world public health arm of the United Nations.
If we keep in proper perspective, the fact that every statement made by the WHO is political in nature and nuanced to represent the best interests of their political masters...we will not have a problem going forward.
revere,
It is indeed a refreshing and encouraging response from the WHO. Those of us who depend on news media for information often have difficulty differentiating what is the truth, what is spin, and what is bad reporting. The WHO like everyone else has it's job cut out trying to get accurate information out. Kudos to them for acknowledging that.
I absolutely agree. It's always frustrating to be in the dark, but when the information we are getting is unclear, it will serve us well to err on the side of caution and accuracy, and label all speculation and extrapolations as such. As you said, we have gained some ground in building enough credibility to be taken notice of in the ways you described, but such credibility is fragile - hard to gain, easy to lose.
The bigger goals that we try to achieve via advocacy can only come about if we do not open ourselves to criticisms of scaremongering, dodgy science, and taking liberties with the truth. The best way to deny a case, any case, is to discredit the messenger. It will be foolish to set traps for own demise, IMHO.
Actions speak louder than words Revere. So far the WHO has done a pretty good job of letting the infected nation speak. They cant call a pandemic in their countries unless its a slam dunk, nor can they call epidemic or give out information unless that country okays it. This is the chasm that they keep falling into and will until this changes. I look for that about 3013.
They DO have to do a better job of information dissemination. My mom who was on the front lines of public relations for an absolutely huge corporation would have said that by information they have created a sense of dis-information. The public isnt stupid and they are and have been calling them on it. The only way now to break that chain is to come out with the truth and that could be detrimental to the facts and situation.
Your description was dead on though. Now its up to them to fix their little problem.
Well said SusanC. I think your thoughts are extremely important. Especially here.
Revere, would you say that somewhat like the music industry needs (or has had) to rethink music distribution, the WHO, CDC, etc, may need to rethink information distribution. The landscape has changed.
Patch: It's a good analogy. The music industry is going to lose about because it is being dragged kicking and screaming into the new world of content distribution the internet ushered in. WHO and US gov't and other national agencies need to figure out how to maneuver in this new setting or they will be harmed. It's that simple. Rainford understands this. I'm not sure how widespread the understanding is, however.
The pandemic issue should not be played down through "risk communication". In fact, "risk communication" is a bad symptom of a bad situation, where not only are we facing natures wrath, but we also have to endure the lies and concepts of arrogant minds, of grand egos, whose words are just tools in a playground, disconnected from reality. I fear more these games than I fear nature itself.
I have to chime in here about the WHO. Disclaimer up front: I worked there for 4 years in the late 80s on a secondment from the World Bank (now don't hold that against me!)
Tom DVM has it half right. WHO is a multi-level agency and has some very good technical level people (P-level in UN salary grade parlance) whose work is either constrained or facilitated by the directors (D levels) above them. I was very lucky to have an excellent Director whose work was so excellent that he was the first to be chopped when Hiroshi Nakajima, probably WHO's worst ever DG, took over from Halfdan Mahler... but that's another story! Directors and above are usually politically appointed and are also quite responsive to the demands of the governing board, the World Health Assembly, and to governments. One such government is our very own which has an embassy just the other side of a big fence from the WHO HQ. So -- don't forget that there are a bunch of highly qualified technical people working away, UNDER the heavy blanket of the political masters -- and sometimes they are able to produce some excellent work, worth paying attention to. WHO also has regional offices which vary tremendously in the degree of politicization and quality of their output, and as usual, those in greatest need (Africa) have the lowest quality of service provided....whereas the European office in Copenhagen has a lot to recommend it, as does the AMRO (based at PAHO HQ in Washington.... PAHO actually existed before the WHO was formed.) more than you wanted to know, probably!
Revere,
Great work ! ! !
For the WHO Outbreak Communicator:
Dear Mr. Rainford,
Give us the sequences that Dr Niman asks for. Please include;
Patient hometown, age and sex
Dates for:
Onset of symptoms,
Type of test and result
Treatment type started & facility,
Start (if applicable) of tamiflu, and
Release from hospital (horizontal or vertical)
KISS = Keep It Simple, Spokesman
.
gilmoreaz: Note that if these were American patients this would be illegal. Not every single piece of information is appropriately shared. Sequences, fine. Medical info, as modulated by local conditions and the wishes of the patients and the doctors. I don't believe WHO has the authority to release this information without the agreement of the member state and its health authorities. Suppose, for example, you were diagnosed with TB. Do you want it up on the internet? I am a bit taken aback at the notion of entitlement.
The notion of entitlement is one of the main drivers for WHO bashing and the elegant evolution guy is at the forefront of this.
The WHO will find itself being viewed less critically if it finds a way to become more transparent in its release of comprehensive H5N1 information to the public. Speculation occurs when posters discuss a topic without the key information provided. Shared knowledge is a critical component to our survival.
I hope in '08 we will see more of a collaboration with the WHO in these important areas. We share in their concern about a possible pandemic. Many of us are on various flu boards because we want to help our fellow man.
Let us not forget that the WHO has helped millions worldwide. I can not imagine what our world would be like without their help.
Big surprise, no adaptive changes in the virus recovered from latest Pakistan victim. This will probably upset the doomers and will certainly cause some attacks on the WHO's sampling, testing methods, etc.
http://canadianpress.google.com/article/ALeqM5hzVNDNi9TjlNv5Oo4_V5C7t6U…
Like I said, just like Groundhog's Day.
Now Stan, you know us doomers like to get all the facts in before we make statements we cant back up.....
As in you didnt read that the full data hasnt been sequenced. But I would say that Dr. Hayden has a problem that doesnt square with the facts....
Its dead people. If there were no dead people then I would feel a whole lot better but there lies the rub with what you are saying. The facts of dead people mean they havent a clue whats going on with this. These are the only sequences we will have seen in what - 2 years. Helluva blanket statement you are making
Adaptive mutation means that it should be moving towards us. But the fact is that its killing humans without adaptive mutation or so it appears...What if its just infectious without adaptation. That does happen you know. It obviously is infectious as evidenced by the pine box count. I guess they just got Pneumonia instead of BF?
Please do comment while read something in from the Netherlands that indicates some 48 cases might be in Egypt that are not counted. Some have been tested though and found negative...2 I believe out of 48. But I have to wait for 3rd party verification.
Adaptive mutation doesnt guarantee a lack of infections. Humans ARE being infected so it has by whatever means mutated itself to be infectious. Its just one end of the endless puzzle on this. This is a bird disease and by simply saying that its no big surprise again doesnt prove what you are saying because they are sick and dying. Can
Get your crystal ball out on that one Stan and lets hear your input on what killed these people. I would be really surprised if you come up with something that is verifiable.
MRK, you never cease to amaze me with your fantasy. As I've stated in earlier posts, you love to blurr the lines between suspected and confirmed cases (fantasy & reality). This is the only way to keep your religion alive....false negatives, hidden cases, third world media reports, boxun reports, etc.
Egypt has wound down and the Pakistan "event" is over with. Time for you to get your fearmongering geared up for the next false start. I keep saying it because it's obvious to everyone outside of the doomer cult, Ground Hog day is alive and well!
-Goodnight MRK, your addiction to fiction is truly starting to bore me.
One more thing, since you obviously won't be satisfied until I address deaths, I must say that I have no idea what kills each specific person in a third world country. I do know this, however, that more that 4,000,000 people die annually from lower respiratory infections (non-bird flu pneumonia) globally while only ~100 die from bird flu. This would mean that any individual pneumonia death would have 40,000 to 1 odds against being bird flu! Those are mighty big odds MRK.
Satisfied?
Of course you will say no and instead keep spinning the big lie that each pneumonia related death or patient, is highly likely to be bird flu. To us outside of the cult of doom, this would seem like complete and total lunacy.
Stan,
If you call Pump 'N Flush Inc, they will tell you the Receptor Binding Domain must have changed, and since the WHO announced no changes, the test must be flawed. Furthermore, NAMRU-3 has now been "assimilated" by the WHO, so now NAMRU-3 is also a Chinese sock puppet (didn't we hear Pakistan is already a Chinese client state?) and you know what, next week I predict this company will announce Margaret Chan you know WHO has been secretly appointed Admiral of the U.S. Navy.
For more information, call 1-8xx-PUMP-FLU.
If the subject isn't so serious, it would be really amusing. Some people just have no better use of their time.
MRK - With rare exceptions, at this point it is not particularly infectious to humans. 345ish I think. And it has killed before (around 200ish). I think Stan's point is it hasn't changed. You seem to be suggesting it has.
And to that end, contrary to what you say, the facts DO line up. The numbers don't add up to support your argument.
If you are saying that should "it" (H5N1 pandemic) occur, as pointed out elsewhere, it may look very similar to one of these many false starts, then OK...I can maybe go with that. But Stan doesn't seem to think this is it. Nor do I, or the WHO apparently.
But just one thought....even a H2H2H chain, while worrisome, isn't the exponetial growth we'll see if this thing goes. It'll be more like H2HH2HHHH2HHHHHHHH. You do understand that...right?
That's why Stan's point is well taken. Crying wolf is hazardous. I think it's important to choose your words carefully.
It's late and it's been a long day...I may not be choosing my words carefully. Good night all!
"A stitch in time" -- This centuries old proverb expresses a similar idea to that of "An ounce of prevention is worth a pound of cure..."
As an unpaid freelance transgenic pathogen research analyst, I clicked into an evolutiuonary paradigm we call "horizontal gene transfer and recombination" to explain bizarre pathogens such as SARS and H5N1. The explanatory literature exists online, so I aint gonna go into it...
Anyway, the point of this posting is simple -- those WHO officials charged with H5 sequence testing should do the whole shaboooly on the samples to see what is going on with the evolutionary side of this pathogen that painfully destroys humans and animals alike. I consider the sensible comments of Science Teacher and Randy Kruger commensurate with the proverb "A stitch in time"! The goal is to understand and prevent that which may occur -- socially responsible behavior...
We who post on EM can only draw upon the facts which our governments give us... If head honchos at WHO or elected gov agencies choose to ignore our questioning desire to comprehend the full monty, well...
Thank God for the public record!
************************************
Subject: Avian flu
To: photoniqueer@yahoo.com
From: Hazel.Mendonca@dh.gsi.gov.uk
Date: Fri, 10 Mar 2006 15:04:28 +0000
Our ref: TO00000073916
10 March 2006
Dear Mr Singleton,
Thank you for your email of 5 January [2006] to the
Home Office about avian flu. As this is a health
related matter, your email has been passed to the
Department of Health for response. I have been asked
to reply.
With regard to a possible link between genetically
modified food and avian flu, may I suggest that you
address your concerns to the Food Standards Agency as
they are best placed to comment on this matter...
What you dont understand is that I am crying preparedness as is Revere. Sitting back and doing nothing? 10 years ago it only infected birds. Now its infecting birds and what besides humans? It is moving out into the animal population as it did with birds. Do you recall that 1 out of 3 cats tested on the streets of Jakarta had it. There were lots of dead and dying cats when they were testing and the silly Indons let them go rather than putting them into the trash can with Co2 gas in it.
So lets just call it preparedness instead of doom. Obviously every government health agency believes as I do that we should prepare for the absolute worst and hope for the best. Pandemic is coming, it might be H7 or something else but come it will. You see Stan history is on us doomsayers side. You will eventually and very simply be wrong. So if its sitting on the shelf and the doors are locked then you very likely wont get it.
Whats your state of preparedness?
Is that what your posts are all about MRK? All of the fearmongering, twisting of facts, hysteria, etc is simply about "crying preparedness"? It's funny how you pull revere in as your associate(s) in this endeavor yet none of their posts read anything like yours... It's probably because their posts are actually about preparedness.
Your accusation toward me is a clever trick that seems to only be applied to anyone that lives outside of the cult of doom who questions whether H5N1 is 100% destined to become panflu. Many of us have seen it time and time again (yet another recurring script). If a doomer is loosing the debate he/she simply pulls the trump card of "you are irresponsible because you are obviously against preparing" in a feeble attempt to discredit.
I'm 100% certain that I'm not alone when I say that you appear delusional MRK. Nothing that I have ever written says that I am against preparing for unknown disasters and to suggest that I have is another example of you using an outright lie to prop up a fantasy position.
why don't they(WHO) put their version with corrections and comments on the
WHO-webpage ? Why don't they make up a forum so we can discuss
it and maybe get some occasional input from the WHO-people ?
It seems that they are not interested to say any more than they must.
Withholding information as good as possible seems to be their strategy.
Ideally you would have several clickable levels of information content:
headline
summary
story
additional links,comments,discussion
Each level about 3 times as long as the previous one.
Why do they have to talk to AFP anyway ? They could anticipate the
reporter's questions, put the info on their webpage so AFP can grasp
it there.
I have been aware of this impending disaster for 12 years.You can re-arrance the deck chairs on the Titanic all you want...but the end result will be the same.We have already crossed the Rubicon of wasted time.The emphasis now must be to take charge.WE ARE NOW THE ONES RESPONSIBLE FOR CREATING THE "TEACHABLE MOMENT".If we wait for WHO and CNN to agree on when is the "proper" time to scare the crap out of people,millions more will die.Sooo...take action in your city.Do not ask your leaders what to do.TELL THEM RESPECTFULLY WHAT MUST BE DONE.We who are not leaders by vote must become leaders by volition .We must accept the persecution that comes with bringing awareness...and begin to prepare the public to store all they need to survive NOW!!
Now dont be too hard on Stan. He is basing his reaction on what he considers to be the truth. I dont know what his credentials are or if by taking Tom on that he is a doctor or a veterinarian. I have 13 in as a bio-warfare specialist, concurrent with being a EW officer and I did the gig with the USGovt. after the military and became a national incident manager level 800. But Stan might have a credential or two as well to toss out there. Tom gets his by default, as does Revere. He has a lot on his little roster of life accomplishments.
But in this little slice of time, Stan could be right. But its only temporary and that is fact. Every doctor, scientist and even Gomer Pyle knows that pandemic is inevitable in our future. How bad is going to be the big question. It might not happen on my shift or his but it will happen. Bird flu is pandemic in the beaked population of the world. It has gone transgenic into humans and other animals so the point is moot.
The WHO says its human to human and its clustered. They are violating their own protocol by not calling it Pan-4 at the very least. So technically Stan could still be right because in our great and very political world the WHO is still a political body, subject to the whims of the political wind. Remember, and I had to look it up, there is no pandemic unless the WHO DG calls it. When they violate their own rulebook, then you have to assume its for a reason. Good or bad. I think its bad when they establish a procedure and then walk around it like a turd on a sidewalk. Sooner or later it has to be dealt with.
Stan just takes offense at the simple fact that he might be wrong and have to defend his position. Thats fine. I dont mind defending mine but that snarly little tone he puts into everything is unnecessary. Beyond that I guess time will tell who was right and wrong. I hope you are right Stan because if you are not, then the outcome for so many who might have done something about it might have changed.
Two or three years ago on the old EM, Revere posited that he thought that BF would be a splash in the pan and then gone. I wont speak for him but the bottom line is whatever he wants to say about it. I know he is concerned, but to the point that he thinks its coming? I dont know. He does posture now though that we should beef up the healthcare system to have better outcomes. And we would, but only slightly if the numbers are right. It cost over 250 G's just to keep one guy in China alive. 1 million of those survivors and the insurance companies would go broke. If UHC was in place, IT would go broke. So its a ride that we might all have to share into Hell.
Lets hope Stan is right and that the declaration of Human to Human transmission is wrong. If he is wrong there will simply be more cases. I wont beat him up here if he is and ask that no one else do it either. He will just be wrong and thats it.
Permissum nemo iacio prothoplastus calx
Take a deep breath MRK and refocus. We are not discussing whether some pandemic will occur at some point, or how much time you spent in the military, or how many calves Tom DVM has delivered. We are talking about how your interpretation of the events is severely tainted by the fact that you are a doomer! It's called being delusional.
I've back up my points using hard numbers (ie 40,000 to 1 odds agains any lower respiratory death being caused by H5N1 globally). If you simply look at lower respiratory infections (not just deaths) the odds against it being caused by H5N1 is likely closer to 1,000,000 to 1, yet you will argue that anyone with pneumonia in Egypt, Indonesia, etc almost certainly has bird flu and that the WHO is simply not counting them.
Number don't lie MRK and the fact is that H5N1 is infecting no more people now than it has since our recent "discovery" of it. It may upset you that your time in the military has not translated into you having a unique ability to predict a future flu pandemic, but the reality is that the fearmongering, twising of facts, irrational statements that spew from you posts hurts the cause of "preparing". Rational, clear thinking people end up lumping the good folks like the reveres into the wacky, doomer crowd because of people like you. The bottom line is that if you are truly "crying for preparedness", you are not helping.
Stan wrote:
"I'm 100% certain that I'm not alone when I say that you appear delusional MRK."
"The bottom line is that if you are truly "crying for preparedness", you are not helping."
And you are helping with namecalling, psychiatric diagnosing, abusive, insulting behaviour?
"Rational, clear thinking people end up lumping the good folks like the reveres into the wacky, doomer crowd because of people like you."
I believe people can better interprete and judge posts without your "clear thinking" and risk communication.
Side step Stan. I would think that if a doctor of any kind spoke up about BF one way or the other that I would definitely listen. Even if its a DVM because they go to the same medical schools. To boot Stan, nearly all of the ugly bugs start in something other than humans and go transgenic. Pretty snarky statements.
But by making statements about refocusing you are right. What other than by stating the numbers can you establish your position on? I'll give it to you that there are statistically few cases but it has crossed the threshold officially now and by the NPFP and the Brits and NZ and Aussie and just about every plan out there we should be at pan level 4. So you would contest the doctors who established this two years ago and the same ones who updated it this year. Please tell me how you know more than they do as we are at 3 right now and in the alert phase. I believe that is the reason they established this criteria. The Brits have moved themselves to the equivalent of 3.1 under their and the US plan. Something caused this and apparently it was coincidental with Pakistan and not Egypt.
Do try to stick to the facts this time.... Not the personal stuff. I want to hear what you think is wrong with the governments of the world and that you have right and they dont.
The only fact that matters MRK is that no more people are being infected by H5N1 now than several years ago. Even with the geograhic spread of the virus and increased serveillance there is no increase in infections! With no greater affinity towards humans, the virus is no closer to being panflu than it was 10 years ago when it infected a handful of people. This is reality!
As far as governments go, they are PURELY polital organizations. The actions they take in many/most cases have very little to do with "greater good" and instead are made to reward/protect a few.
I must say that I am very surprised at how often you've used government action/spending to support your point(s) over the past few days. Revere better take note as MRK seems to be drifting to the left of center.
Overall I am tiring of this circular debate with you. You are a doomer through and through and that is not going to change. You will go so far as to abandon your own political beliefs to support your doom position and that in and of itself says all that needs to be said.
Enjoy and get ready for the next false start event, we'll all be watching.
~Cheers
Stan: No one -- not you, not me, not Randy -- knows how close or how far H5N1 is from being easily transmissible. You sound like the man who jumped from the Empire State Bldg. and when he passed the 14th floor was heard to say, "So far, so good." I'm keeping an open mind about this since I don't know what's going to happen and I don't think any of the history is particularly relevant to telling me. I think you and he and others have had a chance to make your views clear and we should call this thread over.
"You sound like the man who jumped from the Empire State Bldg. and when he passed the 14th floor was heard to say, "So far, so good." I'm keeping an open mind about this since I don't know what's going to happen and I don't think any of the history is particularly relevant to telling me."
The man passing 14th floor does have a history before passing 14th floor, and judging from that history he will continue going down in his very near future.
You do learn from history, even though the present does not offer too many options to mitigate shortcomings in future.
I want to add to the analogy that while continuing, going down, there is not much helping you denying the history as irrelevant. It is even worse when you add to that a too open mind, so open that you do not even realizing the obvious, that you are going down. While going down, you can of course put together words sounding sound and rational, so much so that nobody really knows for sure anything. While spending too much time making good words coming out of your mouth, there will be no time for any preparation for mitigation when it is time for impact with reality.
rc: I'm not clear what you are saying. If you read my comment again (please do) you will see I am saying that looking at the history of H5N1 over the last four years doesn't tell us how close or how far we are to becoming easily transmissible. If you think it does, then I invite you to say why. Note that just the passage of time doesn't count. We could be moving farther or closer. How you would know which it is (or if it hasn't changed) I'd like to hear. You have space to say it here in the comments.
Communicating can be more obscure than necessary.
Trying to make my point clear I will refer to our climate situation. For a very long time many people have tried to communicate the dire situation that will be upon us sooner than we would like. Other people questioned the warnings arguing that nobody knows for sure how to interpret the steadily incoming data of our climate situation. Today the "doomsayers" at last made it through, but only when
hard data no longer could be dismissed. Arctic ice is disappearing faster than any previous predictions, and the ice could be gone already in a decade or two from now.
When finally realizing that the unleashed mecanisms of nature are becoming unmanageable, some say we have already lost our opportunities to reverse the damages upon our earth. We should have acted already yesterday, they say.
It is my opinion that we have lost too much time to childish and irresponsible scepticism. The climate change most probably are unleashing hitherto unknown mecanisms, variables complicating matters. Dismissing new data as too many, and impossible to interpret beyond doubt, will again do as great harm. To prepare for the worst will do us less harm.
Communication should be straightforward, educating people how vulnerable our JIT-societies are, and that not too heavily impact from nature will (not could) have enormous consequences to our lives.
With our climate situation we have to prepare ourselves for unprecedented consequences. Viruses are just adding to an already bad situation, and H5N1 is not going away.
Revere, I think my last post made it clear that I'm done with this thread.
I would like to point out that while I've never claimed that an H5N1 pandemic couldn't happen, MRK and the doom crew repeatedly claim 100% that it will. I'm thinking he might need the sermon about "not knowing" and "open mind" more than me. Furthermore I've not used twisted/non data to support my position (ie blurring the lines between suspected and actual cases, media reports from the Netherlands, Boxun reports, etc).
Like I pointed out earlier, the one thing I feel comfortable in using to judge where the virus is in terms of becoming more human panflu like, is monitoring the number of cases and they're not going up, even while the virus has spread to a much larger geographic area. This while the doom crowd has consistently said over the past few years that a pandemic is almost certainly going to happen any day now. Kind of like the guy with a sign on the street corner proclaiming that Christ is returning tomorrow...yet he's been there saying it for a week.
"Like I pointed out earlier, the one thing I feel comfortable in using to judge where the virus is in terms of becoming more human panflu like, is monitoring the number of cases and they're not going up, even while the virus has spread to a much larger geographic area."
Maybe you are staring too much at numbers of officially confirmed cases? Do you know for certainty that these numbers reflects reality? Maybe you are making too much assumptions from incomplete data, and too much effort bashing people who are not agreeing with your opinions?
As you said, virus has spread to a much larger geographic area, and there seem to be no indications that it is not continuing spreading. It is not going away.
risk communication,
I can't speak for Stan but I will say that on flublogia there is too much extrapolation. While I subscribe to the precautionary principle (I was first to question the HHS Dr. Raub in May 2007 during the HHS Blog), which said I won't wait for scientific certainty to take action, I can see Stan's point of view of Groudhog Day behavior of flubbies. Paraphrasing Revere, there are those who almost wished the pandemic is here and will make assumptions about unseen data to reach conclusions and then suggest that there are conspiracies to hide the unseen data. All of these "doomers" that Stan referred to focus solely on H5N1. The risk of a strain specific (H5N1 mostly frequently cited) has nothing to do with our perception. Last year, almost every one thought it was imminent. It hasn't happened but it doesn't mean it won't or it will be sooner or it will be later. No one really knows the answer.
My most current realisation is that H5N1 mutating alone to an efficient H2H^n is not the only avenue for a pandemic strain to arise. My concern is a high CFR virus like H5N1 reassorts with an avian or swine flu already with highly efficient H2H capabilities and still "novel" to humans to form the high CFR/high H2H strain with H?N? that makes it hard to plan for a vaccine. As I understand it, such an reassortment event could take place all of a sudden with no incremental characteristics being observed.
I noticed today the WHO just sent a warning to Egypt about possible swine flu mixing with bird flu. The WHO has also recently stated that it may not be wise to vaccinate or plan on H5N1 only as the other subtypes H7, H9 are also likely candidates. This past week, we had this story about H2N3 Swine flu adapting to humans in Missouri (I think). The Indian Health Minister had it on record as an Introduction to the New Dehli Conference on pandemic in early December 2007, that there was a new apprehension about a second strain previously harmless to humans. All of these signals tell me that the authorities are shifting gears and I will suggest that in 2008, the risk focus will be on novel reassortants, not just plain vanilla H5N1.
Finally, I want to say that the "doomers" are doing a disservice to our community by destroying credibility, knowingly or unknowingly. You can only cry wolf so many times.
Thanks, Reveres!
You know, the WHO folks should just start blogging themselves -- tell the world the info directly.
Then none of us would have to rely on going through journalists -- third parties who can, like all humans, sometimes get things wrong. It's a difficult subject to report on -- especially if you haven't got the background knowledge.
Revere wrote and asked:
Medical info, as modulated by local conditions and the wishes of the patients and the doctors. I don't believe WHO has the authority to release this information without the agreement of the member state and its health authorities.
Suppose, for example, you were diagnosed with TB. Do you want it up on the internet? I am a bit taken aback at the notion of entitlement.
***************************************
No problem being identified on the internet if it was limited to the by the criteria I suggested:
Patient hometown, age and sex
Dates for:
Onset of symptoms,
Type of test and result
Treatment type started & facility,
Start (if applicable) of tamiflu, and
Release from hospital (horizontal or vertical)
No names, but information. It's PUBLIC health and the public should have a right to know if someone amongst them is capable of spreading a nasty-ass killer bug via casual contact. WHO limits the info put out and "moves the goal posts" as it sees fit by changing terminology of H2H transmission.
As Joe Friday said "Just the facts"
glimoreaz: Of course it would be duck soup to identify you with that information. Is everything about your health public if it bears on "public health"? How about your genetics? It might be useful to know if you should marry my daughter. I assume that the current laws in the US that prevent what you suggest should be changed? (I'm asking. Maybe they should. But know that your gov't now says it is illegal.)
Look, for public health purposes I'm with you. But this is a Grand Balancing Act. We are not entitled to this information. We decide it is in the public interest or not and then we make rules accordingly. But the Great Law of Unintended Consequences is also at work and needs to be thought through very carefully. We shouldn't put on blinders because we are currently interested in something. Can you truly say that making this information available to YOU would make the rest of us safer? I rather doubt it.
Gee Stan, I am a prepper and have been prepping other people and that lumps me with doom and gloom.... I should feel so honored because those same preps would be helping people out in Katrina, Rita, the Oakland fires, the San Diego Fires, the current wind and snowstorm and the impending New Madrid quake.
If you were one of those particular casualties I wonder what your response would be? Bird bug is just one of the things that I prep for. The effects of all are bad but bugs would be the longest and worst.
Gilmore-There is a raging battle out there right now by government and insurance entities to issue government identification. Both would have you wearing a RFID chip that would hit you like a traffic cam wherever you are. Every couple of thousand feet or so they uld be able to determine everything you do in life. I am big on counter-terrorism as most know but this crosses the line. A good case in point is that one of the insurance companies here tossed rather than shredded 61,000 peoples records into the trash... old client. Within a week they were being hacked to death by credit card fraud and filings for new insurance paid for by those cards with the same company. It gets better....they couldnt prove fraud because these people had all of the requisite information on the pre-existing conditions.
I agree with Revere. We might just have to ride this one out with just a numbering system that starts with 1 and then goes on, or not at all. You give someone personal information in the information age and you can bet that it will be misused somehow.
How about an electronic Star of David? Or how about... He had bird flu once. Then they find a continuing condition say lesions on the lungs. That would automatically prevents them from getting insurance at all? Not too far off the mark.
Noble idea though Gil. I know you just want to be able get the information that we all need to make decisions.
Revere & MRK,
The camel's nose under the tent and the slippery slope are evoked by what I suggest, but for diseases that are contagious with little interaction (being on same plane) we should be able to get the word out who is the "culprit".
Not long ago a TB-X patient from Russia came to the Arizona and sought treatment here. . . Then skipped taking meds and disregarded the publics health by coming and going as he pleased. Wound up in county lock-up until ACLU got him transfered to Denver.
Insurance companies are truly the scum of the earth, but I disagree with MRK about coverage for all. We provide it for seniors, just keep dropping the age limit every year until all US citizens are covered. We pay for the uninsured via free ER visits anyway. . .
Today, China confirmed it has experienced H2H in the recent father-son infections, and there is no poultry connection.
Does that fit in with the Stan view?