A couple of good resources on the subject of pandemic influenza: http://www.fluwikie.com (they linked me here) and http://www.effectmeasure.com (a public health blog). For the deeply interested in the genetics: http://www.recombinomics.com/whats_new.html, and of course, the CDC (http://www.cdc.gov/flu/) and WHO (http://www.who.int/csr/disease/avian_influenza/en/) sites.

I had the same thoughts as Jonathan RE: the statins. If we put everyone on statin drugs and it didn’t work to protect us from cytokine storm, at least the heart attack rate should go down…

Elphaba makes a good point about Tamiflu, it is an anti-viral, while a vaccine primes your own immune system to fight the bad bugs.

Laurie Garrett (and others, i’m sure) makes an interesting point about when the virus gets to Africa, where a significant percentage of the population is immune compromized. They won’t mount the cytokine storm, and more may survive. Will this be a good thing, or might the virus “learn” things from HIV, or (perhaps worse) “teach” it things. Maybe they will end up with a bunch of infected “carriers” who never clear the virus and so serve as a continuing source of infection and a possible “mixing vessel” in which the virus can mutate into something even worse.

One of the problems with the poultry vaccine is that it does not necessarily stop the birds from becoming infected, it just keeps them from dying. Eating/handling infected birds is (currently) the primary way of getting infected.

Historically, disease has had major impacts worldwide. When syphillis first emerged from who knows where, in a few months it killed 40% of those who contracted it. We in the US are mostly european, that is because our diseases had close to a 90% kill rate on the native population. This was only a few hundred years ago! I don’t want to see a microbial outbreak go around the world and wreak havoc.

I often dispair at the destructiveness of humans, but I am hopeful that our wonderful brains will come to our rescue and we will learn to live in balance.

I think immunizing poultry in some areas would be a good strategy. I believe they are doing that in Vietnam. Wealthy countries should support this. I think immunizing poultry is better than automatically thinking of culling all poultry in an area where the birds may be exposed. Its unreasonable to expect people who sit next to starvation to kill and throw away both the chicken and the egg. Reducing bird flu in birds would lower the exposure to humans and therefore lower the odds of mutation of a bird flu that will transmit human to human.

There are a lot of problems with vaccines for flu. In this case we’re talking about a strain that hasn’t emerged. The vaccine for this years flu is ineffective for 90% of the cases.

I believe that Tavisflu and Tamiflu are not vaccines, they are anti-virals. A vaccine gives your immune system a heads up so it can recognize a virus and kill it when it shows up.

Jonathon Shay – Have they considered using the statins in the outbreaks in Turkey and Asia this year? Are they seeing the cytokine response in the cases they have now? I know that the strain that is infecting people now isn’t the same as what it would be if it crossed over; is the cytokine response typical of the avian flu?

Did you know that this so-called vaccine against the avian flue has been shown to BARELY work. In that fact lies the hidden danger: Taking so long to kill the virus gives the avian flu virus the opportunity to mutate and get even stronger.

so what happens is that you take a vaccine hoping to avoid the avian flu and death and then are killed because Rumsfeld’s vaccine actually makes you worse, the avian flu bug stronger.

Just as he has dealt what maybe a lethal blow to our society Bill of Rights-wise, so he does it to our people from another form of corruption, that of the body from the avian flu.

Why was this not mentioned last night?

I’m still feeding them.

We have stockpiled enough food to quarantine ourselves for 3 months if necessary and we have a supply of latex gloves and masks. Don’t laugh. But it may be futile.

And what if there is a second wave and third wave of it? And what will the world be like with people dying all around like the during the bubonic plague?

One such strategy has a face appeal: the commonplace drugs to lower cholesterol, the “statins” are inhibitors of parts of the inflamatory machinery [cytokines] that kill the young and fit in a 1918-type flu pandemic. Unlike the antiviral drugs, [1] dozens of pharmaceutical firms have the know-how to manufacture these and [2] one of the statins, lovistatin, is off patent, and simvastatin will come off patent this summer. [I have no financial interest in this whatever, in case you are wondering.] [3] if this works, someone recovering from the non-lethal case would be totally immune from catching it again, and could care for others and carry on basic services without fear.

See the following for the scientific background to the plausibility of this approach

Science vol 309 pp 1976f, 23 Sept 2005

Circulation 110:880-885 (2004)

Clin. Infect. Dis. 33:1352-1357 (2001)

Circulation 109:2560-2565 (2004)

Am J Respir Crit Care Med 171:606-615 (2005)

Respiratory Research 6:82 (2005)

What is not known is:

Whether this is more than just a persuasive story

Whether one statin is better than another

What dose

Whether the statin has to be taken for a period [how long?] before exposure, or whether it can be started after exposure, or after symptoms first appear

IF this is a good approach, we could prevent millions, possibly tens of millions of deaths, while not stopping a single infection.

[TO THE PRODUCER: IF YOU WANT TO SEE THESE PAPERS, SEND ME A WORKING E-MAIL ADDRESS. I CANNOT FIND ONE ON YOUR WEB PAGE]

Respectfully,

Jonathan Shay, M.D., Ph.D.

Barry was the only speaker who wasn’t a professional health care worker or biologist. He pointed this out in his talk, noting that many such conferences have tapped him to speak on the flu because at this point he knows just about as much as anyone else does on the subject. This was pretty surprising to him, as he initially had thought that there must be hordes of doctors and MPH’s who were way more informed than he was. Turns out he’s emerged as a real expert on pandemic flu. That’d be kind of like tapping Jonathan Schell to head Bush’s war cabinet or something.

I was thinking about why there are so few panflu experts and I remembered a point from Barry’s talk: a pandemic flu strain arises just about every 40 years. That’s about the length of a scientific career and enough time for researchers to stop caring until another outbreak begins to threaten. That’s too bad. Imagine if we had started preparing for this outbreak after the last one in ’68?

(another fun fact from Barry’s talk, not sure if it’s apocryphal or not: Because Spain wasn’t in WWI, they were the first western nation to start freaking out about the flu despite the fact that it was already ravaging other countries as well. Because their papers were the only ones reporting on it, it gave the impression that they were the only ones suffering from it, hence The Spanish Flu.)