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  • gsgs
    Re: Osterholm warns about pandemic

    Gina Kolata : "Influenza" pages 176-179 about "Alexander Questions"
    (I only have it in German, but quotes are translated from US-books)

    automatic translation back to English:
    Gina Kolata: "Influenza" pages 176-179 about "Alexander Questions"
    (I only have it in German, but quotes are translated from US-books)

    As the Advisory Committee met on the following day.
    There was a crackling atmosphere in the room. Soon, one would
    submit the immunization project of public. In addition to
    Members of the press were also scientists like Kilbourne
    come, who already had hinted leave, that he the
    In favour of immunization campaign.
    Today, over twenty years later, you may have difficulty
    to understand the motivations of the leaders of that time.
    Therefore, should the detailed report of the two
    Political scientist Neustadt and Fineberg, read a
    Year later commissioned by Joseph Califano, Secretary of State
    for health, education and welfare, the participants of the
    The Committee questioned what had moved them to their decision.
    They asked each participant to his personal opinion to the
    Operations a year ago, and if this one from his statements
    differed in the press, they asked him, which is why he against his
    Conviction acted; in this way, they tried
    the background to reconstruct.
    Neustadt and Fineberg learned that each participant of the
    Advisory Committee secretly had calculated, with which
    Were likely to expect a dangerous flu epidemic.
    Their estimates were in a frame between two
    and twenty percent, but nobody talked about it. "Everyone kept
    their estimates for themselves", wrote Neustadt and Fineberg.
    "Finally they couldn't be doing on scientific facts,
    but rely only on their personal judgement.Today they speak
    openly about it, at that time they held back."[15]
    It was because fair of the two policy experts wondered
    Kilbourne, of the group the blame, in vain their
    Thoughts to read? "I personally would have it at the time
    He said absurd thought, to express the risk in numbers".
    "Because even if the odds of 100 to 1 against a pandemic"
    would have said, so it would be still too high risk
    Neustadt and Ernest R.May, a historian at the
    Harvard University, analyzed the total later
    Moments in favor of the swine flu vaccine. As so often in
    serious decisions, so the two reporters would have
    those responsible in hindsight wondered: "what three
    We thought our Devil's name only?" [16]
    Vaccine Committee on the 10 March meeting was a turning point
    the story, and it shows us that the ghost of 1918
    even sober scientists in his knees forced.

    Neustadt and may emphasize, that the experts at the meeting of the
    10 March never openly admitted how they assessed the probability,
    that America was afflicted by a deadly flu epidemic.
    If the nation were no precautions and immunized population.
    That was who they said have been a blunder. Experts to public
    One of the best methods to be to force comments
    An argument for laying bare weaknesses. Of course, they continued
    the Federal officials had, before taking a decision so momentous
    as a nationwide immunization campaign met, the physician
    should ask candidly to tell them how their opinion of the
    Odds were that a deadly disease threatening the nation.
    "If doctors and their colleagues in the research is not a thing"
    are sure, then they an expert consult, the in
    They said Government Affairs is experienced". "Once you are"
    different forecasts has listened to you can make a decision.
    It is important that the expert, before the scientific layman Yes or no
    must say, reveals his starting point to other experts and not
    "rashly on 'if' a ' then ' you can follow." [17]
    Still a possibility, people secret speculation and not loud
    the so-called "Alexander" is expressed opinions to elicit,
    how after one of the men call the Neustadt and may at the
    Session participated in the 10 March, Dr.Russel Alexander,.
    Professor for Health Affairs at the University of Washington.
    Alexander was the group a question, the Neustadt and may for so
    applicable held that considers many errors avoid settled.
    If political strategists themselves made it a habit, "Alexander questions"
    to provide.

    This question was as simple as it is ingenious: what information, so Alexander,.
    the Committee could make to change his mind the
    Was need to immunize the entire nation? Sufficient for the
    Committee to the proof that every case of swine flu was harmless, it
    to bring back off of his decision? Or the fact that
    except for the soldiers at Fort Dix nobody was ill with swine flu?
    Was when and where someone had been diagnosed with it important? [18]
    When Alexander asked these questions to Neustadt and may, during the session,
    "he received no reply. Here, he would have hit the nail on the head.
    Have you paid attention to him, his question would perhaps other questions
    are drawn, which also nobody was, for example, whether the
    Preparation may have had side effects like the vaccination should take place,
    who would oversee them, the question of the seriousness of the cases and the
    Spread of the disease, the question of the storage of serum, and so on."
    In fact, to Neustadt and may, Alexander's question would have causal connections
    brought to light, which seemingly had validity by past experiences.
    She have demonstrated how much power the threatening comparison with the flu of 1918
    had and that not enough scientific data were available, a
    Decision to justify.
    Although it was dodged his question, Alexander advised caution,
    proposed to make the serum and to store quite sure until you
    whether that was a dangerous pandemic approaching. But Alexander was
    a fairly shy person, someone, the other his own point of view
    not imposed. He wielded no speeches, only very little said.
    Alexander got to Neustadt and Fineberg, in fact rather "dispassionate"
    woven and so gentle, "that other members, we have spoken"
    only vaguely remember that he said something about 'Bearings'."[19]
    Neustadt and Fineberg for her report on the swine flu affair
    Information compiled and interviewed Alexander said this:
    "I think more caution is advised if you human"
    Organism brings them to the foreign matter. Certainly, if it involves 200 million
    Organisms are.In this context, one should rather conservative
    decide.If it is not absolutely necessary, you should prefer the finger
    Let them"[20]
    Alexander's fears were simply among the in the heat of the moment
    Table Vice, especially you verge, one in the history of unique
    To undertake that effort in favor of public health by one
    would vaccinate the entire nation against a disease, which is to the
    deadly pandemic could expand. And the arguments of the
    wanted to continue, were hard to hear.

    [15} Neustadt and Fineberg, "the epidemic that never what", S. 25]
    [16] Richard E.Neustadt and Ernest R.May "thinking in time:"
    The use of history for decision makers", New York
    (The free press) 1986,S.xii.
    [17] Ibid. S. 152
    [18] Ibid S. 152f
    [19] Neustadt and Fineberg, "the epidemic that never what", S. 27
    [20] Ibid.

    Als das Beratungskomitee am darauffolgenden Tag zusammentrat,
    herrschte eine knisternde Atmosphäre im Raum. In Kürze würde man
    das Immunisierungsvorhaben der Öffentlichkeit unterbreiten. Neben
    Angehörigen der Presse waren auch Wissenschaftler wie Kilbourne
    gekommen, der bereits hatte durchblicken lassen, dass er die
    Immunisierungskampagne befürwortete.
    Heute, über zwanzig Jahre später, mag man Schwierigkeiten haben,
    die Beweggründe der Verantwortlichen von damals zu verstehen.
    Deshalb sollte man sich den detaillierten Bericht der beiden
    Politikwissenschaftler Neustadt und Fineberg durchlesen,die ein
    Jahr später im Auftrag von Joseph Califano,dem Staatssekretär
    für Gesundheit,Erziehung und Wohlfahrt, die Teilnehmer des
    Komitees befragte, was sie zu ihrer Entscheidung bewogen hatte.
    Sie baten jeden Beteiligten um seine persönliche Meinung zu den
    Vorgängen vor einem Jahr, und wenn diese von seinen Äußerungen
    in der Presse abwich, fragten sie ihn,weshalb er gegen siene
    Überzeugung gehandelt hätte; auf diese Weise versuchten sie
    die Hintergründe zu rekonstruieren.
    Neustadt und Fineberg erfuhren, dass jeder Teilnehmer des
    Beratungskomitees sich insgeheim ausgerechnet hatte,mit welcher
    Wahrscheinlichkeit eine gefährliche Grippeepidemie zu erwarten war.
    Ihre Schätzungen bewegten sich in einem Rahmen zwischen zwei
    und zwanzig Prozent, aber niemand sprach darüber. "Alle behielten
    ihre Schätzungen für sich", schrieben Neustadt und Fineberg.
    "Schließlich konnten sie sich dabei nicht auf wissenschaftliche Fakten,
    sondern nur auf ihr persönliches Urteil berufen.Heute sprechen sie
    offen darüber, damals hielten sie sich zurück."[15]
    War es denn fair von den beiden Politikexperten, fragte sich
    Kilbourne, der Gruppe die Schuld zuzuschieben, vergeblich ihre
    Gedanken zu lesen ? "Ich persönlich hätte es zum damaligen Zeitpunkt
    für absurd gehalten, das Risiko in Zahlen auszudrücken", sagte er.
    "Denn selbst wenn die Chancen 100 zu 1 gegen eine Pandemie
    gestanden hätten, so wäre man immer noch ein viel zu hohes Risiko
    Neustadt und Ernest R.May, ein Geschichtswissenschaftler an der
    Harvard Universität, analysierten später die ausschlagenden
    Momente zugunsten des Schweinegrippeimpfstoffs. Wie so oft bei
    schwerwiegenden Entscheidungen,so die beiden Reporter, hätten
    sich die Verantwortlichen im Nachhinein gefragt: "Was in drei
    Teufels Namen haben wir uns nur dabei gedacht ?" [16]
    Sie Sitzung des Impfstoffkomitees am 10.März war ein Wendepunkt
    der Geschichte, und sie zeigt uns, dass das Gespenst von 1918
    sogar nüchterne Wissenschaftler in die Knie zwang.

    Neustadt und May betonen, dass die Experten auf dem Treffen vom
    10.März nie offen zugaben, wie sie die Wahrscheinlichkeit beurteilten,
    dass Amerika von einer tödlichen Grippeepidemie heimgesucht wurde,
    falls die Nation keine Vorkehrungen träfe und die Bevölkerung immunisierte.
    Das sei, sagten sie, ein grober Fehler gewesen. Experten zu öffentlichen
    Stellungnahmen zu zwingen, sei eine der besten Methoden, um die
    Schwächen eines Arguments bloßzulegen. Natürlich, fuhren sie fort,
    hätten die Bundesbeamten, bevor sie eine so folgenschwere Entscheidung
    wie die einer landesweiten Immunisierungskampagne trafen, die Mediziner
    bitten sollen, ihnen in aller Offenheit zu sagen, wie ihrer Ansicht nach die
    Chancen standen, dass der Nation eine tödliche Seuche drohte.
    "Wenn Ärzte und ihre Kollegen in der Forschung sich einer Sache nicht
    sicher sind, dann sollen sie einen Experten zu Rate ziehen, der in
    Regierungsangelegenheiten erfahren ist", sagten sie. "Sobald man sich
    unterschiedliche Prognosen angehört hat, kann man eine Entscheidung treffen.
    Wichtig ist, dass der Experte, bevor der wissenschaftliche Laie ja oder nein
    sagen muss, seinen Ausgangspunkt vor anderen Experten offenlegt und nicht
    vorschnell auf 'falls' ein 'dann' folgen lässt." [17]
    Noch eine Möglichkeit, Personen heimliche Spekulationen und nicht laut
    geäußerte Meinungen zu entlocken, ist die sogenannte "Alexanderfrage",
    wie Neustadt und May sie nach einem der Männer nennen die an der
    Sitzung am 10.März teilgenommen haben, Dr.Russel Alexander,
    Professor für für Gesundheitsfragen an der Washington University.
    Alexander stellte der Gruppe eine Frage, die Neustadt und May für so
    treffend hielten, dass sich ihrer Ansicht nach viele Fehler vermeiden ließen.
    wenn politische Strategen es sich zur Gewohnheit machten, "Alexanderfragen"
    zu stellen.
    Besagte Frage war ebenso einfach wie genial: Welche Informationen, so Alexander,
    könnte das Komitee dazu veranlassen, seine Meinung zu ändern, was die
    Notwendigkeit betraf, die gesamte Nation zu immunisieren ? Genüge dem
    Komitee der Beweis, dass jeder Fall von Schweinegrippe harmlos verlief, um es
    von seinem Entschluss wieder abzubringen ? Oder der Umstand, dass
    außer den Soldaten in Fort Dix niemand an Schweinegrippe erkrankt war ?
    Sei es von Bedeutung, wann und wo jemand erkrankt sei ? [18]
    Als Alexander während der Sitzung diese Fragen stellte, so Neustadt und May,
    "erhielt er keine Antwort. Dabei hätte er den Nagel auf den Kopf getroffen.
    Hätte man ihm Beachtung geschenkt, hätte seine Frage vielleicht andere Fragen
    nach sich gezogen, die ebenfalls niemand stellte, zum Beispiel, ob das
    Präparat möglicherweise Nebenwirkungen hatte, wie die Impfungen ablaufen sollten,
    wer sie beaufsichtigen würde, die Frage nach der Schwere der Fälle und der
    Ausbreitung der Krankheit, die Frage nach der Lagerung des Serums und so weiter."
    In der Tat, so Neustadt und May, hätte Alexanders Frage Kausalzusammenhänge
    ans Licht gebracht, die scheinbar durch vergangene Erfahrungen Gültigkeit hatten.
    Sie hätte gezeigt, wie viel Macht der bedrohliche Vergleich mit der Grippe von 1918
    hatte und dass nicht genügend wissenschaftliche Daten vorhanden waren, um eine
    Entscheidung zu rechtfertigen.
    Obwohl man seiner Frage ausgewichen war, riet Alexander zur Vorsicht,
    schlug vor, das Serum herzustellen und vorerst zu lagern, bis man ganz sicher
    sei, dass eine gefährliche Pandemie im Anmarsch war. Aber Alexander war
    ein zurückhaltender Mensch, jemand, der anderen seinen eigenen Standpunkt
    nicht aufdrängte. Er schwang keine Reden, sagte überhaupt nur sehr wenig.
    Alexander habe, so Neustadt und Fineberg, in der Tat eher "leidenschaftslos"
    gewirkt und so sanft, "dass andere Mitglieder, die wir gesprochen haben,
    sich nur vage daran erinnern dass er etwas von 'Lagern' sagte."[19]
    Als Neustadt und Fineberg für ihren Bericht über die Schweinegrippeaffäre
    Informationen zusammentrugen und Alexander interviewten, sagte dieser:
    "Meiner Ansicht nach ist immer Vorsicht geboten, wenn man dem menschlichen
    Organismus Fremdstoffe zuführt. Erst recht, wenn es sich um 200 Millionen
    Organismen handelt.Man sollte in diesem Zusammenhang eher konservativ
    entscheiden.Wenn es nicht absolut nötig ist, sollte man lieber die Finger
    davon lassen" [20]
    Alexanders Befürchtungen wurden im Eifer des Gefechts einfach unter den
    Tisch gekehrt, zumal man kurz davor stand, eine in der Geschichte einmalige
    Anstrengung zugunsten der Volksgesundheit zu unternehmen, indem man
    die gesamte Nation gegen eine Krankheit impfen würde, die sich zur
    tödlichen Pandemie ausweiten konnte. Und die Argumente derer, die
    weitermachen wollten, waren kaum zu überhören.

    [15} Neustadt und Fineberg, "The Epidemic That Never Was",S.25
    [16] Richard E.Neustadt und Ernest R.May "Thinking in Time:
    The Use of History for Decision Makers",New York
    (The Free Press) 1986,S.xii.
    [17] Ibid. S.152
    [18] Ibid S.152f
    [19] Neustadt und Fineberg, "The Epidemic That Never Was",S.27
    [20] Ibid.

    Leave a comment:

  • gsgs
    Re: Osterholm warns about pandemic

    pingback from

    Alexander was the son of Grand Prince Mikhail of Russia and became Grand Prince himself in 1326 on the execution of his older brother Dmitry II by the M...


    google hits about "Alexander's Question"

    The best health professionals can do is convert unknown risks to known risks.

    Leave a comment:

  • Jonesie
    Re: Osterholm warns about pandemic

    Originally posted by gsgs View Post
    doesn't look like he is one of these 1000-10000 top experts ?!
    no expertise in virology AFAICT. No publication at pubmed.

    this is silly.
    Now, don't give up just yet. He just might be on the verge of being a top-expert with a lot of expertise in virology. All that doesn't come overnight, you know. And getting something published on pubmed in the future could be highly likely..
    Time will tell.
    But while you are waiting ... in the meantime, I suppose you will just have to be patient, take a little time off, and sift through all the 10,000 top-experts who do have something published on pubmed.
    Good luck!

    The microbe is so very small
    You cannot make him out at all.
    But many sanguine people hope
    To see him down a microscope.
    His jointed tongue that lies beneath
    A hundred curious rows of teeth;
    His seven tufted tail with lots
    Of lovely pink and purple spots
    On each of which a pattern stands,
    Composed of forty seperate bands;
    His eyebrows of a tender green;
    All these have never yet been seen -
    But Scientists, who ought to know,
    Assure us they must be so ...
    Oh! let us never, never doubt
    What nobody is sure about!

    -- Hilaire Belloc -- (1897) --

    Leave a comment:

  • Anne
    Re: Osterholm warns about pandemic

    doesn't looke like is an expert, nor a virologist, nor...
    Last edited by Anne; May 28, 2007, 01:04 AM.

    Leave a comment:

  • gsgs
    Re: Osterholm warns about pandemic

    doesn't look like he is one of these 1000-10000 top experts ?!
    no expertise in virology AFAICT. No publication at pubmed.

    > History over the last three centuries has taught us that novel
    > avian pandemic flu occurs every 91 years (plus or minus 3.5 years
    > for antigenic drift). Given that the last major pandemic was the
    > 1917/1918 Spanish flu this means that we can expect a pandemic
    > flu outbreak between 2006 and 2013.
    >It is a mathematical certainty.

    this is silly.

    Leave a comment:

  • Jonesie
    Re: Osterholm warns about pandemic

    Quote: gsgs: I'm referring to the ,well, maybe 1000-10000 top-experts worldwide.

    gsgs: I think I found that one expert that will answer all your questions on the Pandemic. And he states in one of his articles that it is a mathematical certainty that the pandemic will arrive. Plus he states you cannot prepare for an 18 month pandemic, so maybe now you have no need to prepare at all. You can't get any better than that. So I don't see any need to question those 1000-10000 top-experts of yours. Maurice seems to have all the issues regarding this pandemic down in a nutshell.

    Maurice is good with numbers, just like you, and he is so kind to give out his email address on his website also, so now you can inundate him with all your queries:

    Maurice A. Ramirez, DO, CNS, CMRO
    The Blog of Disaster Planning, Preparation, Education, Response & Recovery by the Founding Chair of the American Board of Disaster Medicine.

    Here are two of his articles:

    Pandemic / Avian Flu
    March 18, 2007

    I Will Watch My Friends Die

    The most ominous words ever uttered by a disaster preparedness expert were voiced during a deep background interview. This expert stated simply that given the current state of hospital preparedness and the current rate at which facilities are becoming disaster ready, there will be no meaningful level of preparedness in this decade unless someone blows up a hospital. This may seem a bit extreme, but declassified documents show that Al Qaeda seeks to steal an ambulance and blow it up at a major American trauma center.

    Unfortunately, this scenario is based on the lesser of the threats currently facing healthcare. History over the last three centuries has taught us that novel avian pandemic flu occurs every 91 years (plus or minus 3.5 years for antigenic drift). Given that the last major pandemic was the 1917/1918 Spanish flu this means that we can expect a pandemic flu outbreak between 2006 and 2013.

    It is a mathematical certainty.

    Dr. Richard Garden and others have begun to discuss the impact on the healthcare workforce in accurate terms. These pundits are absolutely correct that up to 50 percent of the workforce may not report to duty. The reasons are well demonstrated in the history of pandemics.

    The true impact of this disease lies in the numbers. In 1918 100 percent of the entire world was exposed to what would later be called the Spanish Flu. This new strain of avian flu had never been encountered before by a human population, and as a result, there was no immunity to this particular strain. Of that world population, one third would ultimately fall ill, in fact, 50 to 80 percent of the youngest, healthiest, and strongest would fall ill when future generations would divide out the victims.

    When these ominous numbers were scrutinized further, a far more dire picture evolved. Research into the 1918 pandemic, as well as pandemics before and since 1918, have shown that the majority of illness and death occurred not in the very old or the very young, not in the sick and infirm, but in those who are in the "prime of life"; those age 18 to 40.

    But there is a bigger problem.

    Because of the way that novel avian viruses (pandemics) attack the lungs and cause "immune system storms", the ultimate irony of a pandemic is that the younger and stronger you are the more likely you are to die. In 1918 fully two-thirds of all those who became ill were in the age range of 18 to 40. More distressing is the fact that 98 percent of all of those who died were age 18 to 40 years. In fact, those over age 55 had no greater rate of illness or death during the pandemic of 1918 than they did in any other flu season in the years immediately before or after that great pandemic. Similarly, those less than 18 years of age suffered no increase in death rate.

    The implications for America's hospitals and healthcare institutions are inescapable. Fully two-thirds of the active workforce will fall ill during the 16 to 18 months of the disease throughout the pandemic. Twenty-five percent of the young workforce (the 18 to 40 years) will die in that 18 months. Who will replace them?

    Dr. Garden is also correct that correctional institutions as well as the disabled and children have not been considered in local, regional or state pandemic planning. In fact they are barely mentioned even in federal planning. In June of 2006 the Institute of Medicine published reports on the state of preparedness but pointed out that even emergency services had been left out of much planning.

    It is imperative that healthcare professionals of all stripes become expert not only in pandemic planning but in the "All Hazards" approach to disaster and catastrophic event planning. Whether it is a pandemic, a hurricane, an earthquake, a forest fire, or a terrorist event that threatens the community, bitter experience has taught us that concentrations of individuals living in institutional settings whether in prisons, military barracks or university dormitories become the "cave canaries" of society.

    In 1918 Spanish flu outbreaks, which actually began in Kansas, were first seen in epidemic form in U.S. military barracks. The outbreaks of measles in the 1980s were first seen in university dormitories across the United States. And the largest concentrations of the recurrence of tuberculosis, as we all know, is seen in correctional institutions.

    The 2003 SARS outbreak also provided us a small scale example of the effects for a pandemic on healthcare. Following the outbreak of SARS in Canada, healthcare workers in 4 Toronto area hospitals began to fall ill. Soon nurses and doctors were looking through protective equipment at colleagues and friends. The disease had changed the normal ?us and them? relationship to ?us and me.? These professionals watched their friends die. The result of SARS on the healthcare professionals who worked in these 4 Toronto hospitals was that 50% left healthcare entirely.

    What does all this mean for the healthcare industry?

    During the outbreak, up to 50% healthcare workforce absenteeism
    During the outbreak, up to 25% healthcare professionals death rate
    Following the outbreak, 75% of healthcare professionals still alive
    Following the outbreak, 50% of remaining healthcare workforce quits
    The final outcome for healthcare:

    25% will die
    37.5% will resign
    37.5% will remain

    Lest healthcare embrace the lessons for preparedness this is the fate of us all.

    Posted at 11:50 AM in Pandemic / Avian Flu | Permalink | Comments (0) | TrackBack (0)


    gsgs: I think this article will ease your mind on the need to prepare:
    Quote: And you cannot stock 18 months of food and water to safeguard yourself and your family during that event.
    So what can you do?

    Bring pressure to bear on the healthcare community to better prepare for surge capacity.....

    December 17, 2006
    Setting The Record Straight on Pandemic Preparedness

    The November/December 2006 issue of the AARP magazine carried an interesting story on pandemic flu. The expert virologist who authored the article painted a grim picture of the future of the coming pandemic and gave one view of how to prepare.

    Let's set the record straight.

    Almost all of our predictive models for pandemic flu are based on 1917/1918 Spanish flu (which actually originated in Kansas); the 1957/1958 pandemic and the 1968/1969 pandemic. The 1918 Spanish flu is known in virology circles as H1:N1. Genetic reconstruction has allowed us to isolate this virus from pathologic specimens collected in 1917 and 1918 and stored by the U.S. military and other organizations. This means that we can now study the actual virus H1:N1 aka the Spanish flu and compare it to the current pandemic risk H5:N1 aka Avian flu. What makes avian flu more likely to be a pandemic?

    As we all know now from the media, influenza virus mutates over time. Small mutations are known as antigenic drift while large mutations are known and antigenic shift. These drifts and shifts slowly change the virus from something that the human immune system can recognize and therefore protect against to something that is novel or new to the human population ? a pandemic. In short it is something that the human immune system has never seen before.

    In 1918 the H1:N1 strain was seen. Like all of pandemics before, it struck with a predictable infection rate (attack rate); approximately 1 in 3. Of these 1 in 3 on average in the population half would become seriously ill. Half of those would develop severe lung disease and half of those with the severe lung disease would ultimately die.

    The picture changes significantly, however when you look at the infection by age group. H1:N1 caused virtually no more deaths in those over age 65 than the average flu. In fact in 1918 you were no more likely to die of the pandemic if you were over age 65 than you had been in 1915 or than you would be in 1920.

    So what does that mean for the coming Avian flu (H5:N1)? Pandemics are very consistent. They act virtually the same every time they occur as long as they are a novel avian virus. H5:N1 has not been different to date. It is expected to cause no greater number of deaths in those greater than age 65 than the flu did last year in 2005 or the year before in 2004.

    Yes, there will be an increase in the number of people who become ill across the age spectrum from birth to those over 100.

    Yes, there will be a total increase in the number of people who die. Unfortunately the vast majority of those will be between the ages and 15 and 40. This was the age group that showed the greatest increase in death rate in 1918, in 1958 and 1969.

    AARP magazine is to be tremendously complimented in their January/February edition they published an exquisite interview with Anthony Fause, a noted expert in infectious disease and pandemic preparedness. That interview asked insightful questions and gave good, logical answers. Unfortunately the same cannot be said of the recommendations made in the November/December edition.

    The article in the November/December edition recommended stockpiling food and other supplies in anticipation of infrastructure collapse and supply chain failure. This advice ignores the lessons learned from history. In 1918, as with all other pandemics, 100 percent of the population was exposed despite social isolation efforts. In 1918, one third of the working population was out of work and yet food was still delivered. Farms still produced. Society did not collapse. There is no reason for panic.

    Stockpiling medication is also a formula for disaster and disappointment. The current strain of H5:N1 is already showing resistance to Tamaflu, requiring far higher than usual and longer than usual doses to be effective. Tamaflu's shelf life is also far shorter than the window of likely infection from the pandemic (as late as 2012). This means that you may purchase Tamaflu and have it expire before the disease attacks.

    Finally, previous pandemics have come in multiple waves over an 18 month period. In most cases the disease appears first as a low level infection in the population, followed by a large flood of influenza and then an aftershock of disease. You simply cannot stock enough Tamaflu for all three events. You cannot prevent yourself from being exposed during those three events. And you cannot stock 18 months of food and water to safeguard yourself and your family during that event.

    So what can you do?

    Bring pressure to bear on the healthcare community to better prepare for surge capacity.

    There are fewer than 1,000,000 hospital beds in the United States and in an average cold and flu season fewer than 40,000 hospital beds are empty. The federal government recommends between 150,000 and 190,000 available hospital beds even during the peak of an average cold and flu season. The United States is woefully short of hopsital beds and it falls to private hospital corporations to provide that surge capacity.

    The New England Journal of Medicine in 2004 an article by Dr. Michael Osterholm they found there are 105,000 ventilators in the United States. Eighteen percent of those are either broken, in repair or in cleaning at any given moment. Sixty-seven of those are in chronic use for ventilator dependent patients outside of the hospital. This leaves 16,000 ventilators available nationwide.

    If we break down the expected number of illnesses just in those over age 65, those 16,000 ventilators will all be in use. What happens to those between age 15 and 40, the children and grandchildren of those who read the AARP magazine?

    The healthcare community must step up to the plate rather than pedaling panic in the pages of the AARP magazine. The juxtaposition of the Avian flu article in the November/December issue and the far more insightful and useful interview in the January/February issue show the division within the house of medicine. The AARP magazine has the largest circulation and readership in the English-speaking world. Which side of that division will its members come down upon - Panic or preparedness?

    It was once said of the generation that now reads the AARP magazine that they are the "Great Generation".

    The Great Generation earned this title because of their self-sacrifice during World War II. They guided a great nation through an industrial revolution and a technological revolution that became an economic revolution that swept the planet. Many have tried to discount the Great Generation because they are now the "Geriatric Generation." I believe the Great Generation will lead us again not into panic but into a new era of preparedness.

    I'm sure Maurice truly believes in his approach, but I think I will still go out and buy more beans and rice today.

    "Worries go down better with soup than without."
    - Jewish Proverb -

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  • gsgs
    Re: Osterholm warns about pandemic

    thread 674 seems to be non-existant.
    But it did happen in 2003, you must have missed it since
    it only lasted 20 days:


    On February 7, 2003, concerns about terrorist threats associated with an Islamic holiday caused a raise of the threat level to orange. Ridge encouraged Americans to stock up on food and water, as well as plastic sheeting and duct tape for sealing doors and windows. Ridge was criticized for what some observers described as scare mongering. On February 27, the threat level indicator again returned to yellow. When Ridge hiked it to orange again on March 18, 2003, at the beginning of the war with Iraq, such specific recommendations were not included with the warning; instead it was simply noted for Americans to be vigilant for multiple attempted attacks.


    Ridge was the chief of HHS at that time.
    Later it had been argue that the terrorist danger had been overblown
    to influence the 2004 presidential elections.
    Anticipating that Republicans would be considered more competent
    in fighting terrorism.

    Now the danger is, that the same might happen with panflu.
    HHS just started its panflu-blogs. The timing is almost the same,
    1 year before elections national stockpiling of food and water
    is being propagated.

    There had been a "pandemic"- movie yesterday BTW...

    Now, we can expect some H5N1-outbreak in USA before the
    next elections and it will be interesting, how the press and
    the politicians will react...
    Attached Files
    Last edited by sharon sanders; May 27, 2007, 07:30 AM. Reason: removed US political references - we are apolitical and do not endorse any political candidates or parties

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  • sharon sanders
    Re: Osterholm warns about pandemic

    bump this

    Leave a comment:

  • sharon sanders
    Re: Osterholm warns about pandemic

    This is one citation from the National Strategy for Pandemic Influenza published November 2005. Since then there have been more recommendations from the United States government that every citizen stockpile essential items for a period of time.

    "Keeping supplies of materials at home, as recommended by authorities, to support essential needs of the household for several days if necessary."

    I am 50 years old and this is the first time that I can remember the U.S. government recommending such action, nationwide, for any reason.

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  • gsgs
    Re: Osterholm warns about pandemic

    here in Europe, you won't hear much about pandemic plans.
    And I never heard about recommendations to store food or water.
    People just won't believe it, when you tell them that the
    US-government recommends storing food for a possible pandemic.

    The first time ever in US-history, AFAIK. (?)

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  • Sally Furniss
    Re: Osterholm warns about pandemic

    gsgs many other countries have pandemic plans.

    A list of some of them can be found here.

    I don't know what proportion of those pandemic plans contain recommendations to stock food and water.

    Leave a comment:

  • gsgs
    Re: Osterholm warns about pandemic

    I'm referring to the ,well, maybe 1000-10000 top-experts worldwide.

    AnneZ, I'm pretty sure for Germany and most other EU-countries.
    I'd be surprised if any EU-country would recommend stockpiling food
    because of the pandemic threat.
    Also some people from Canada,UK,Australia,NZ here and I can't
    remember that I ever heard this from them.
    And I think, these are the 1st world countries
    with the largest pandemic-awareness.


    seems that I was wrong with New Zealand,
    found this with google :

    Joined: Tue Oct 18th, 2005
    Location: Auckland, New Zealand
    Posts: 64
    Posted: Tue Nov 29th, 2005 09:01 pm

    The New Zealand government announced their plan a few weeks ago.
    In case of an outbreak, all airports and harbours will be shut down. Being an Island, this means no one will get into the country or out. Public places like supermarkets, petrol stations and so on will be shut down as well. The government recommends stocking up on dinking water, food and candles since facilities like power plants might have to be shut down due to no workers. It was even recommended to buy a chemical toilet since even water supply might be shut down.

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  • Goju
    Re: Osterholm warns about pandemic

    after the NYC Conference, i can confidently say that I am an expert.

    Leave a comment:

  • Niko
    Re: Osterholm warns about pandemic

    Originally posted by gsgs
    Somehow I feel that still no one here agrees that the most
    important thing ATM is to get the experts give us their estimates.
    Same in other forums.

    People don't want it to be elaborated, how big the threat is.

    People in forums don't become meditative when experts and normal
    people have completely different estimates than they have.

    Weird and disappointing. And unlogical. And prevalent, even among
    "Expert" bolded by Niko

    Words are important, IMO. gsgs seems to refer to "experts" frequently. Many of us use the term expert quite loosely. I went in search of a definition of expert. This is what I found on Wiktionary...


    A person with extensive knowledge of a given subject.
    "We called in several experts on the subject, but they couldn't reach an agreement."

    in the nature of an extent, wide, widespread


    Range of values or locations.
    A boundary, limit, border or edge

    Knowledge (uncountable)

    1.Relevant information that one is able to recall from memory.
    2.The product of assumption.
    3.Recognition of cause and effect (which is NOT wisdom).
    4.Knowledge comprises all cognitive expectances that an individual or organisation actor uses to interpret situations and to generate activities.
    "He completed it entirely without my knowledge."
    Based upon the above definitions, I am declaring that I am an EXPERT!!!

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  • Sally Furniss
    Re: Osterholm warns about pandemic

    Originally posted by gsgs
    >4) The U.S. government has recommended that all citizens
    > obtain a supply of food and water for their homes,

    However other countries haven't done this. Why do you think the
    US-government is more credible than the governments of other
    countries with similar conditions ?
    gsgs "Other countries havn't done this!" How sure of this are you?

    Leave a comment: