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John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

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  • John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

    This is 178 pages long but each page/session can be scanned or viewed without downloading. Speakers were Fauci, Fineberg, Ferguson, Gellin, Gerberding, Goodman, Leavitt, Stohr, Treanor & Webster. The list of workshop participants is long.
    I found it interesting to read something from 3 years ago and compare the recommendations then to where we are now.

    Some comments of interest:

    Page 13: We do not know why so many young people died from influenza in 1918–1919. Certainly the stereotypical explanation has cited complications—particularly bacterial complications, although a 1976 review in the New England Journal of Medicine suggests that they might not have been the reason for so many deaths. Case reports, a review of the pathology literature, and recent experiments with influenza virus constructs containing genes from that pandemic strain suggest other potential explanations for the high incidence of shock and death associated with that pandemic.
    Page 100: And when you really start to peel the onion and look at what’s there, it is clear that 1918 was not unique. It looks like 1830-1832 had a very similar picture of deaths primarily between 20 and 35 year olds, and a very classic W shaped curve again, just like we saw in 1918. Whereas, if you get into the 1880, you get into the other ones, there are at least 10 in the last 300 years; they really fall into two camps, those that had the classic accelerated or exaggerated Y shaped curve, and those that had the W shaped curve. Which would suggest to me, that there are several mechanisms for pandemics to occur?

    Page 55: Tamiflu is under patent from Roche. It costs about $3 a pail to buy the drug in bulk.

    Page 57: PARTICIPANT: We are talking about the availability of new technologies and new approaches. While on the science side that makes a great deal of sense, we are overlooking the supply side. Can we actually provide the new technologies, and what is the surge capacity per item? Given all the orders for antivirals, it’s going to be years before they are actually going to be filled. Today two companies own 80 percent of the market for N95 masks and have no surge capacity. The United States also lacks surge capacity for mechanical ventilators. The country has 105,000 ventilators, and in any one day 70,000 are in use; during flu season 100,000 are in use. Unless we are prepared to spend money to create capacity that will not be used except during a crisis, we can develop all the technologies we want, but our actual ability to bring a stockpile to market is going to be limited.

    During the anthrax situation, the biggest problem many of us in the states faced concerned reagents for testing for bacillus anthracis—they just did not exist. We couldn’t make them fast enough. Even though scientists might come up with wonderful diagnostics for influenza, I question how many will be available during a crisis. Wonderful new technology tools may have little applicability if they are not available.

    Page 133: PARTICIPANT: I have a couple of comments on the theme that history can lead us to ask certain questions. First, in the seventeenth century, when crossing the ocean took at least 6 weeks and sometimes 10 to 12 weeks, influenza made it from England to the colonies. Those were small ships. One would have thought that in a population as small as 50 and no more than 250, the virus would have burned itself out on that voyage. Information on the population of the ship that carried the disease and the exact duration of the voyage might be useful to your modeling.

    The other point is that in the 1889–1890 pandemic, the third wave was the most lethal wave. In researching 1918, I found that public health officials were concerned about that. New York City was the only major city I know of that did not close its schools, but it did quarantine cases. Unlike practically everywhere else in the world, New York experienced peaks in the second and third wave, yet the killing was much more level. Philadelphia had less than one-third the population of New York City yet experienced a higher peak death toll. On a per capita basis, the death toll for Philadelphia and New York was almost identical, but the fact that the peaks were so different, and that the virus moved to the latter city so much more slowly, may be worth investigating. I can not imagine that the quarantine was effective enough to account for the lower peak death toll. Perhaps the fact that fear, prompted people to stay off the streets and normal traffic dropped significantly brought movement below a critical mass.

    Page 159: However, human studies will be invaluable in answering questions such as: Are some patients super shedders of influenza viruses? Which influenza virus strains transmit more easily from one patient to another? At the present time, we do not have enough data to answer such questions.

    Page 167: PARTICIPANT: [snips] Just to follow-up on the issue of funding and how we are going to do this. .. We have already discussed you do not need an H5N1 in a world of 6.5 billion people today to create economic chaos for 12-18 months.

    As a world, we invest all the time in things that are insurance policies. Today, some of the best funded fire departments in this United States exist in our major metropolitan airports; airports that have not had a plane crash in 50 years. Airports that have incredible equipment, and never can leave the airport compound, because they have to be there. And we pay for that day in and day out, because we have made a decision if it ever does happen, you have to be able to respond in the force that is equivalent for a plane crash. We do that with our federal oil reserves. We have spent billions of dollars stockpiling oil in the salt domes of the Gulf States. I think we have to change our mind set to say that this is an insurance policy that we are not going to sit here and try to scare you and say this H5N1, although many of us think that still is a real possibility, but it is going to happen. And we need a Manhattan-like project that encompasses many of the issues that have been discussed here today; it is going to be an economic insurance policy.

    To follow-up on the previous comment about the international piece, I would remind people that if we totally protected ourselves, if we had 300 million doses or 600 million, depending on the two dose regimen in the United States, we would still be devastated, because the economic consequences of a worldwide pandemic minus the United States would still have incredible implications. We saw it during SARS. The computer industry of this country shut down, because no one realized that 95 percent of the computer chips in the world were made in the Kwong Dong province of China. And when they couldn't travel, nothing else traveled. And if you start looking at the consequences here, we can demonstrate to our policymakers that this is in fact a very wise use of resources.
    And so, I would urge us to take a step back, get away from this idea that if we could just keep expanding inter-pandemic flu, not that no one does not want to do that, because that is like motherhood and apple pie. But I think we are ready for a sea change. We are at a point where if we do not do it now, we are not going to it.

    And then I would just add one last piece. I have absolutely no doubt about it, and all of you in this room will be part of it, there will be a post 9/11-like commission one day that will ask the questions why we did not do what we could have done, when we could have, because people were afraid that we would scare people, or that somehow we would be seen as scare mongers, that we have not put it together.

    And I guarantee you, just as many of the very fine people who pre-9/11 said I wish I had done more, ended up being identified and well documented in that 9/11 commission report. There will be post-pandemic flu commission, make no doubt about it and the people in this room are going to be the people who are on the front line. So, it is time that we either make a decision that we are going to actually not live for another 20 or 30 years, whenever the pandemic occurs, trying to do this, and actually for once set out an international policy that says to our world leaders you can not afford not to do this.

    http://books.nap.edu/openbook.php?re...=11448&page=R1
    The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

  • #2
    Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

    1830:W
    1890:Y
    1918:W
    1957:Y
    1968:Y
    1977:W
    (?)

    a pail of Tamiflu for $3 in 2005, how many standard doses, how much in 2008 ?
    Payments for those government stockpiles is clearly more

    influenza evolved a lot since the 17th century. It may have persisted on ships then,
    but not now.

    http://books.nap.edu/openbook.php?is...9097312&page=7
    Michael Leavitt:
    > I have learned many lessons from his excellent book:
    > The Epidemic that Never Was: Policymaking and the Swine Flu Scare.
    apparantly not so much from the part about probability estimates and Alexander questions.
    No probability estimate from Leavitt :-( ["pandemics happen"]


    > I have absolutely no doubt about it, and all of you in this room will be part of it,
    > there will be a post 9/11-like commission one day that will ask the questions
    > ...And I guarantee you, .. There will be post-pandemic flu commission,
    > make no doubt about it and the people in this room are going to be the people
    > who are on the front line.
    how could that person be so sure ? That's not credible.
    I'm interested in expert panflu damage estimates
    my current links: [url]http://bit.ly/hFI7H[/url] ILI-charts: [url]http://bit.ly/CcRgT[/url]

    Comment


    • #3
      Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

      influenza evolved a lot since the 17th century. It may have persisted on ships then, but not now.
      So you think its evolution brought a shorter life span?

      how could that person be so sure ? That's not credible.
      Well, he should have added: *In my opinion*. Many flubies agree that our govt should be held accountable for not telling people, for not preparing enough. If a severe pandemic hit this fall, I would certainly hope someone would be asked to explain to the public why we are so woefully unprepared.
      The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

      Comment


      • #4
        Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

        >> influenza evolved a lot since the 17th century. It may have persisted on ships then, but not now.
        > So you think its evolution brought a shorter life span?

        maybe. If you consider a virus lurking somewhere as "living".

        Persisting in some niche for months or years could have been a useful feature of influenza
        in earlier centuries but could be outcompeted today by viruses with efficient short-distance
        spread while relying on human travel for long-distance spread.

        >> how could that person be so sure ? That's not credible.
        > Well, he should have added: *In my opinion*.

        that's hardly possible, when he started with "I have absolutely no doubt..." and "I guarantee you..."

        > Many flubies agree that our govt should be held accountable for not telling people,
        > for not preparing enough. If a severe pandemic hit this fall, I would certainly hope someone
        > would be asked to explain to the public why we are so woefully unprepared.

        I would hope that being asked independently from whether a pandemic hits this fall or not.
        According to the information available, shouldn't we do more ?
        As long as this question is being avoided and evaluated in detail,
        you can't really know whether we are woefully unprepared. And a pandemic
        happening does not necessarily change that.
        Was China, is Tokyo or San Francisco woefully unprepared for an earthquake ?
        Is New York woefully unprepared for a volcano eruption ?
        You must first try to reasonably estimate the risk. This is not being done.
        I'm interested in expert panflu damage estimates
        my current links: [url]http://bit.ly/hFI7H[/url] ILI-charts: [url]http://bit.ly/CcRgT[/url]

        Comment


        • #5
          Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

          that's hardly possible, when he started with "I have absolutely no doubt..." and "I guarantee you..."

          >I didn't see an identy for *Participant*. Maybe he/she is someone who can speak with such certainty.

          According to the information available, shouldn't we do more ?
          As long as this question is being avoided and evaluated in detail,
          you can't really know whether we are woefully unprepared. And a pandemic
          happening does not necessarily change that.

          > If our govt has stockpiles we don't know about; then maybe we aren't as woefully unprepared as I think we are.

          Was China, is Tokyo or San Francisco woefully unprepared for an earthquake ?

          > Imo, based on reports, it seemed that China was prepared to respond to the earthquake. I don't know about Tokyo or SF. China at least had enough military to respond. I have no idea what our response might be if we had a catastrophy on that scale.

          Is New York woefully unprepared for a volcano eruption ?
          > Probably.

          You must first try to reasonably estimate the risk. This is not being done.

          > You have estimated the risk. Are we prepared based on what we know?
          The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

          Comment


          • #6
            Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

            that's hardly possible, when he started with "I have absolutely no doubt..." and "I guarantee you..."

            >I didn't see an identy for *Participant*. Maybe he/she is someone who can speak with such certainty.

            God ?

            > If our govt has stockpiles we don't know about; then maybe we aren't as woefully unprepared
            > as I think we are.

            yes, but it also depends on the magnitude of the (estimated) risk, how likely it will happen.
            You can't prepare for everything.

            > You have estimated the risk. Are we prepared based on what we know?

            much info is not available to me (secrecy).
            But even with the conservative estimates, I'd say we don't do enough.
            I once made a rough calculation that we should triple our spendings,
            that should be here in the archive.
            Well, meanwhile the risk is being considered lower -
            so I may go down to "double" from "triple"
            I'm interested in expert panflu damage estimates
            my current links: [url]http://bit.ly/hFI7H[/url] ILI-charts: [url]http://bit.ly/CcRgT[/url]

            Comment


            • #7
              Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

              God ?
              > We'll be sent to the comedy room.

              so I may go down to "double" from "triple"
              > So, does that qualify as slightly, not very well or woefully unprepared?

              And you are right; we cannot prepare for everything. However, I believe we can do much better in some areas. If there is really going to be a glove shortage... how many do we have in our stockpile?
              The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

              Comment


              • #8
                Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

                >> God ?
                > We'll be sent to the comedy room.
                increases the chance to be read

                >> so I may go down to "double" from "triple"
                > So, does that qualify as slightly, not very well or woefully unprepared?
                not very well, I'd say. If you insist to transfer clear numbers into unclear
                English language.

                > And you are right; we cannot prepare for everything.
                > However, I believe we can do much
                > better in some areas.
                how much is "much" in numbers ?

                > If there is really going to be a glove shortage...
                > how many do we have in our stockpile?
                ~100. If/when prices triple we can sell 85% and reuse the others. Or make our own
                gloves from tinfoil and adhesive tape or just paper or such. (and sell them)
                I'm interested in expert panflu damage estimates
                my current links: [url]http://bit.ly/hFI7H[/url] ILI-charts: [url]http://bit.ly/CcRgT[/url]

                Comment


                • #9
                  Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

                  Some of your ideas aren't so good. Tinfoil gloves being one of them.
                  As you can see, you can't bend your hand without tearing the foil.

                  The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

                  Comment


                  • #10
                    Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

                    On the other hand, Glad Press'n Seal food wrap does a surprisingly good job doubling as a glove. It sticks to the hand well and can be sealed between the fingers to allow movement. I don't know that I'd want a brain surgeon working on me wearing a pair of these; but they might be better than no protection at all. So far, my test piece is holding water so it might give a tight enough seal to protect the hands.

                    The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

                    Comment


                    • #11
                      Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

                      " Moreover, none of the 3 pandemics during the century before 1918 (in <b>1830</b>, 1847, and 1889) are thought to have been associated with multiple, rapidly successive waves; W-shaped mortality curves; a predominance of aggressive broncho-pneumonias; or marked hemorrhagic features characteristic of the 1918 pandemic [8, 17, 18, 72–79]."

                      The 1918 Influenza Pandemic: Insights for the 21st Century. David M. Morens and Anthony S. Fauci. J Infect. Dis. 2007:195 (1 April) • 1018-1028.


                      Clearly, other experts do not believe that the 1830 pandemic had a W-shaped age-cohort mortality plot.

                      Comment


                      • #12
                        Re: John R. La Montagne Memorial Symposium on Pandemic Influenza Research: Meeting Proceedings (2005)

                        Excerpts:

                        PUBLIC HEALTH
                        REPORTS - VOL. 36. FEBRUARY 11, 1921 No. 6 - EPIDEMIC ENCEPHALITIS (ENCEPHALITIS LETHARGICA, NONA).


                        REPORT OF STUDIES CONDUCTED IN THE UNITED STATES.

                        By ir. F. SMITH, Passed Assistant Surgeon, United States Public Health Service.

                        Historical
                        Résumè of Epidemic Encephalitis.
                        OCCURRENCE IN EUROPE.

                        The first accounts of epidemics of 'this morbid con(litioni, to which thle terms schlafkrankheit, sleepinig sickness, nona, brain influenza, and more recently, lethargic encephalitis and epidemic enicephalitis hiave, more or less aptly or inaptly; been applied, are rather vague, but sufficiently comprehensive to leave no reasonable doubt
                        that they relate to the same morbid condition that made its appearance in epidemic form in the wake of the pandemics of influenlza of 1889-90 and 1917-18.

                        Elias Camerarius 1 in 1712 publisdied an account of an epidemic of catarrhal fever at Tiibingen, which in a few months had spread w.idely to many countries and provinces and wlhich presented innumerable chaniges and forms accordingo to tho severity and combination of symptoms. In another account 2 of all epidemic at Tflibingeii a- few vears later, Camerarius refers to it as being characterized by somnnole-nce with pronounced brain symptoms, and as being called "Schlafkranckheit."

                        The (delirium occurred, lie says, "particularly at night with wild, turbulenit phantasies." Concerning ptosis as the most striking symptom of oculo-motor disturbance,

                        he says there was made "frequently during the day also complaint of eve affliction, not of inflammation, but of (lifficulty in opening the eyes." In 1768, Lepecq de la Cloture 3described a "coma somnolentum" following grippe, while Ozanann, wlho in
                        1835 published a hlistory -of epidemic (liseases, mentioned epidemics of "catarrhal fever" with "soporositV" as having occurred in Germany in 1745, in Lyon in 1800, and in Milatn in 1802. A- review of the nona literature was publislhed by Longuet 4 in 1892, but unfortunately the volume containiing this report was niot available for reference inl Washington at the time these studies were being....''

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