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What about all the hype, the extreme warnings, about swine flu?

3 September 2009

We’re bombarded with warnings about the next wave of the swine flu epidemic. I don’t know what this all means. Any thoughts are welcome!  Other chapters in this series:

(2)  Update: about the swine flu epidemic, 9 October 2009
(3)  Is the Swine Flu pandemic being used to an excuse to expand government powers (UK edition)?, 14 October 2009
(4)  Who to blame for the delay in producing the swine flu vaccine?, 4 November 2009
(5)  More about the swine flu pandemic: about Cassandras, 26 November 2009 

From Center for Disease Control CDC H1N1 forced quarantine docs leak, Zero Hedge, 2 September 2009 — Excerpt:

… it was only last week that the Massachusetts State Senate passed a law making it a relatively serious crime to refuse a mandatory vaccination or to break a quarantine order. This law also includes rather astounding violations of the 4th Amendment, including warrantless searches and seizures of property if deemed necessary in an ‘emergency’. This new Massachusetts law also included authorizations for illegal arrest without a warrant and of forced vaccination of the public. But the political activity is not limited to the states.

Yesterday Obama held meetings with senior cabinet officials regarding H1N1 ‘pandemic preparedness’ including HHS Secretary Sebelius. So this is not idle speculation. There is something going on here. Either the government knows something we do not, or this is the biggest hype since the dot com bubble.

Contents

  1. Valuable background reading
  2. Some handy forms for your pandemic police state
  3. The Daily Kos provides another perspective on this
  4. A detailed analysis by the ACLU
  5. Update:  similar measures taken in the UK
  6. Articles about the 1918 pandemic
  7. Afterword

(1)  Valuable background reading about the swine flu hysteria

  1. Pandemic preparedness (influenza), World Health Organization
  2. Wikipedia entry for the Model State Emergency Health Powers Act
  3. Cops jump on swine-flu power: Shots heard ’round the world“, WorldNet Daily, 1 September 2009 — “Pandemic bill allows health authorities to enter homes, detain without warrant.”

(2)  Some handy forms for your pandemic police state

None of these are from primary sources, so they might be fake.

  1. Florida Quarantine of Facility Order
  2. Florida Quarantine to Residence Order
  3. Florida Quarantine to Detention Facility Order
  4. Iowa Home Quarantine Order

(3)  The Daily Kos provides another perspective on this

A series at the Daily Kos by DemFromCT about The National Response Framework And You, Fall 2007

  1. About the National Response Framework
  2. The 15 Emergency Support Functions
  3. Pandemic Flu Preparation and the Role of Internet Communities
  4. The National Response Framework And You
  5. The ACLU, Pandemic Preparedness, and You, 20 January 2008

(4)   A detailed analysis by the ACLU

Executive Summary from “Pandemic preparedness“, American Civil Liberties Union, 14 January 2008 — “The need for a public health approach – not a law enforcement/national security approach.”

The spread of a new, deadly strain of avian influenza has raised fears of a potential human pandemic. While the virus is not easily transmissible to humans, were it to mutate to be more highly contagious to or between humans—a possibility whose probability is unknown—an influenza pandemic could occur.

Government agencies have an essential role to play in helping to prevent and mitigate epidemics. Unfortunately, in recent years, our government’s approach to preparing the nation for a possible influenza pandemic has been highly misguided. Too often, policymakers are resorting to law enforcement and national security-oriented measures that not only suppress individual rights unnecessarily, but have proven to be ineffective in stopping the spread of disease and saving lives.

The following report examines the relationship between civil liberties and public health in contemporary U.S. pandemic planning and makes a series of recommendations for developing a more effective, civil liberties-friendly approach.

Conflating Public Health with National Security and Law Enforcement

Rather than focusing on well-established measures for protecting the lives and health of Americans, policymakers have recently embraced an approach that views public health policy through the prism of national security and law enforcement. This model assumes that we must “trade liberty for security.” As a result, instead of helping individuals and communities through education and provision of health care, today’s pandemic prevention focuses on taking aggressive, coercive actions against those who are sick. People, rather than the disease, become the enemy.

Lessons from History

American history contains vivid reminders that grafting the values of law enforcement and national security onto public health is both ineffective and dangerous. Too often, fears aroused by disease and epidemics have justified abuses of state power. Highly discriminatory and forcible vaccination and quarantine measures adopted in response to outbreaks of the plague and smallpox over the past century have consistently accelerated rather than slowed the spread of disease, while fomenting public distrust and, in some cases, riots.

The lessons from history should be kept in mind whenever we are told by government officials that “tough,” liberty-limiting actions are needed to protect us from dangerous diseases. Specifically:

  • Coercion and brute force are rarely necessary. In fact they are generally counterproductive—they gratuitously breed public distrust and encourage the people who are most in need of care to evade public health authorities.
  • On the other hand, effective, preventive strategies that rely on voluntary participation do work. Simply put, people do not want to contract smallpox, influenza or other dangerous diseases. They want positive government help in avoiding and treating disease. As long as public officials are working to help people rather than to punish them, people are likely to engage willingly in any and all efforts to keep their families and communities healthy.
  • Minorities and other socially disadvantaged populations tend to bear the brunt of tough public health measures.

The Problem with Post-9/11 Pandemic Plans
Current pandemic planning policies fail to heed history’s lessons. Since 9/11, the Bush Administration has adopted an all-hazards, one-size-fits-all approach to disaster planning. By assuming that the same preparedness model can be applied to any kind of disaster —whether biological, chemical, explosive, natural or nuclear — the all-hazards approach fails to take into account essential specifics of the nature of the virus or bacteria, how it is transmitted, and whether infection can be prevented or treated. Following this flawed logic, several state-based proposals have sought to address any “public health emergency,” ignored effective steps that states could take to mitigate an epidemic, such as reinvigorating their public health infrastructure, and instead resorted to punitive, police-state tactics, such as forced examinations, vaccination and treatment, and criminal sanctions for those individuals who did not follow the rules.

Specific pandemic flu plans have also been adopted by the federal government and nearly every state and locality. The plans are poorly coordinated and dangerously counterproductive. By assuming the “worst case” scenario, all of the plans rely heavily on a punitive approach and emphasize extreme measures such as quarantine and forced treatment. For example, the U.S. Department of Health and Human Service’s Pandemic Influenza Plan posits a “containment strategy” that calls for massive uses of government force, for example to ban public gatherings, isolate symptomatic individuals, restrict the movement of individuals, or compel vaccination or treatment.

Toward a New Paradigm for Pandemic Preparedness

This report calls for a new paradigm for pandemic preparedness based on the following general principles:

Health — The goal of preparing for a pandemic is to protect the lives and health of all people in America, not law enforcement or national security.

Justice — Preparation for a potential pandemic (or any disaster) should ensure a fair distribution of the benefits and burdens of precautions and responses and equal respect for the dignity and autonomy of each individual.

Transparency — Pandemic preparedness requires transparent communication of accurate information among all levels of government and the public in order to warrant public trust.

Accountability — Everyone, including private individuals and organizations and government agencies and officials, should be accountable for their actions before, during and after an emergency.

… The threat of a new pandemic will never subside. But the notion that we need to “trade liberty for security” is misguided and dangerous. Public health concerns cannot be addressed with law enforcement or national security tools. If we allow the fear associated with a potential outbreak to justify the suspension of liberties in the name of public health, we risk not only undermining our fundamental rights, but alienating the very communities and individuals that are in need of help and thereby fomenting the spread of disease.

Maintaining fundamental freedoms is essential for encouraging public trust and cooperation. If our public agencies work hand in hand with communities to provide them with a healthy environment, access to care, and a means for protecting their families, rather than treating them as the enemy, we will be far better prepared for a potential outbreak.

(5)  Update:  similar measures taken in the UK

Response by The National Council for Civil Liberties to the UK Department of Health’s proposed changes to the Mental Health Act of 1983 with regard to Pandemic Influenza, October 2009 — Excerpt:

(I.) The purpose of the consultation is to ensure the MHA can still operate effectively if the number of medical professional staff is reduced through illness during the swine flu pandemic. It states that the current planning assumptions are for a 10-12% rate of absence from work in the general population in the peak period of the pandemic and states that health and social care organisations as a whole have a high number of staff with childcare and caring responsibilities so the percentage of staff off work could be up to 25%. No references are given as to where these figures come from. Reference is made to the fact that front line health and social care workers will be offered the swine flu vaccine, yet any reduction in the number of those affected as a result of vaccination is not estimated in the consultation document.

(II.) In particular, the consultation proposes reducing from two to one the number of doctors required to approve the involuntary detention and forced treatment of a person. It also proposes removing the need for a second opinion doctor before a person is compulsorily medicated. In respect of people detained under Part 3 powers, who are in involved in criminal proceedings, it proposes suspending the time limits by which a person is admitted to hospital after a court order or conveyed to hospital etc (proposals are to amend over nine sections). It also proposes allowing people who do not have formal evidence of competency or the completion of training to be approved as those who can make certain orders under the MHA.

(III.) While we understand the Department of Health’s very real concerns about the impact a pandemic could have on our hospitals and the potential gravity of future swine flu outbreaks, we do not believe these proposals have been properly considered. A comprehensive public consultation response is also now unlikely given that the total consultation period is less than four weeks. While we understand the urgency of the perceived threat of swine flu, it is reasonable to imagine that the Government would have been planning contingency measures for a number of years for a pandemic of this sort given there have been other scares in the past (i.e. Bird flu, SARS etc) and that consultation on any such measures would have been published back in June when the pandemic was announced. It is also questionable whether the area of mental health is the only area in which changes like these would be necessary in the event of staff shortages due to the pandemic. Arguably prison services, police services, immigration facilities, remand centres etc would all be affected, yet as far as we know no proposals for change have been made in respect of these services. We are therefore unclear as to why the operation of the MHA has been singled out and we do not believe that the case has properly been made out to show that temporary measures of the kind proposed here are necessary. No evidence is given as to where the estimate of staff absenteeism comes from and it is not broken down into the relevant staff categories (i.e. doctors, psychologists etc).

(IV.) It is important to recognise the intrusiveness of the powers contained within the MHA. Depriving a person of their liberty and requiring them to undergo medical treatment significantly engages a person’s human rights. …

(V.) We are concerned that this rushed and seemingly ill-thought through proposed measure will have longer term implications that will outlive any swine flu pandemic. The use of such ‘emergency’ measures sets a worrying precedent when linked with NHS staff shortages. …

(6)  Articles about the 1918 pandemic

(a)  “Bacteria main cause of 1918 deaths“, Reuters, 6 February 2009 — A good non-technical explanation.

(b)  Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic“, John F. Brundage and G. Dennis Shanks, Emerging Infectious Diseases, August 2008 — Excerpt:

Deaths during the 1918–19 infl uenza pandemic have been attributed to a hypervirulent infl uenza strain. Hence, preparations for the next pandemic focus almost exclusively on vaccine prevention and antiviral treatment for infections with a novel influenza strain. However, we hypothesize that infections with the pandemic strain generally caused self-limited (rarely fatal) illnesses that enabled colonizing strains of bacteria to produce highly lethal pneumonias. This sequential infection hypothesis is consistent with characteristics of the 1918–19 pandemic, contemporaneous expert opinion, and current knowledge regarding the pathophysiologic effects of influenza viruses and their interactions with respiratory bacteria.

This hypothesis suggests opportunities for prevention and treatment during the next pandemic (e.g., with bacterial vaccines and antimicrobial drugs), particularly if a pandemic strain–specifi c vaccine is unavailable or inaccessible to isolated, crowded, or medically underserved populations.

(c)  Transmissibility of 1918 pandemic influenza“, Keith P. Klugman, Christina Mills Astley, and Marc Lipsitch, Emerging Infectious Diseases, February 2009 — Excerpt:

Brundage and Shanks have studied time to death from the onset of influenza symptoms during the 1918 pandemic in military and civilian populations and found a median time to death of 7–11 days. They argue that these data support the idea that the deaths may be predominantly due to bacterial superinfection after the acute phase of influenza. We observed a similar 10-day median time to death among soldiers dying of influenza in 1918, a finding consistent with the time to death for a bacterial superinfection, specifically pneumococcal bacteremic pneumonia.

The major bacterial pathogen associated with infl uenza-related pneumonia in 1918 was Streptococcus pneumoniae. Neither antimicrobial drugs nor serum therapy was available for treatment in 1918.

(d)  Pandemic Payoff from 1918: A Weaker H1N1 Flu Today“, Christine Soares, Scientific American, November 2009 — Excerpt:

Although the swine flu outbreak of 2009 is still in full swing, this global influenza epidemic, the fourth in 100 years, is already teaching scientists valuable lessons about pandemics past, those that might have been and those that still might be. Evidence accumulated this summer indicates that the novel H1N1 swine flu virus was not entirely new to all human immune systems. Some researchers have even come to see the current outbreak as a flare-up in an ongoing pandemic era that started when the first H1N1 emerged in 1918.

(7)  Afterword

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20 Comments leave one →
  1. mclaren permalink
    3 September 2009 5:04 am

    We simply don’t know. Biology, despite various claims, is not an exact science, and the molecular biology epidemiology especially so.

    Things we currently don’t know include:

    [1] Which specific exons and introns will produce especially virulent immune reactions in the common flu when transposed or when one jumps from one species to another;

    [2] The exact likelihood of interspecies transfer of genetic material. We have learnt that the percolation of generation information between species is far more common than was once thought, but we have as yet no idea precisely why one block of genetic materials drifts relatively easily from one species (such as livestock) to another (such as homo sapiens), while another gene sequence nearby on the chromosome does not;

    [3] We still have little idea of the location and nature of the natural reservoirs of some viruses. Aquatic fowl are known to be the natural reservoir of influenza A, but only very recently, for example, was the natural reservoir of Marburg Virus identified. This matters because there are a great many more genes in nature than we have identified in common diseases, and genes have a way of jumping from one species (such as bacteria) to another (such as aquatic fowl). Many of these newly discovered genes have only been identified statistically, by computer analysis of mass gene-sequencing of ocean samples: we still don’t know the source of the vast majority of these new genes.

    [4] Most important of all, we still don’t know why horizontal gene transfer among prokaryotes appears to have sped up so much in recent evolutionary times as compared to the distant past.

    Prokaryotic horizontal gene transfer may seem an esoteric arcanum fit only for molecular evolutionary biolgists to discuss, but, as Jared Diamond pointed out in his book Guns, Germs and Steel, prokaryotic horizontal gene transfers gives one of the more concise explanations for the global dominance of Western culture (along with European geography, which gave rise to political systems capable of fostering modern science and strong central governments able to field large modern armies). Westerners conquered cultures like the Incas and the American Indians not primarily by arms, but by bringing diseases to the New World to which the Westerners had long since become immune courtesy of horizontal prokaryotic gene transfer from European livestock, but to which the native peoples of the New World had no immunity.

    Deadly mutations like those which gave rise to the Spanish Flu prove especially provocative, since medical records from 1918 show that the main victims of the Spanish Flu were not old people or young people, as you might expect due to their weakened immune systems. On the contrary, the main victims of the Spanish Flu were healthy adults with highly active immune systems. Turns out the robust immune systems of adults reacted with especial ferocity to the proteins in the Spanish Flu’s viral coating, producing massive collateral damage within the human body due to the immune system overreaction. The rapidity and the severity of onset were also unprecedented outside of extreme cases like Ebola and Marburg.

    If you want to scare yourself, read the 1994 book The Hot Zone by Richard Preston. There are more pathogens in heaven and earth, Horatio, than are dreamt of in your gene sequencing.

  2. Jonathan permalink
    3 September 2009 5:17 am

    Interesting, back in April the Feds decided against tighter border controls with Mexico with Obama stating that it was “akin to closing the barn door after the horses are out.”

    I wonder if the feds are still unconcerned about new cases walking into the USA? The government, at least in MA, sure seems to be worried now.

  3. Oblat permalink
    3 September 2009 9:47 am

    Swine flu is a false alarm, no more dangerous than normal flu. But it does show what a mess the real thing will be.

    The militarization of all aspects of American life is part of the response to decline. Running a country on the basis of an 18th century culture (which the military is) is a very poor way to solve any problems. Other countries also have problems from lack of information to simple lazy less.

    Buy a bag of rice.

  4. pluto permalink
    3 September 2009 12:10 pm

    I am also of the opinion that it is much preparation against nothing but that will have to wait a couple of months to be proven.

    The only positive I can find from this is that it is very similar to the Y2K preparations (the only thing that was required to solve that problem was convincing company management that they could suffer severe consequences if they didn’t treat the problems, everything after that was insignificant noise). A lot of good came from that overblown crisis; a lot of old computer systems finally got junked and a tremendous amount computer code was brought up to modern standards and made easier to work with going forward.

    But the negatives from this pseudo-crisis, training the sheep (ur, citizens) to respond in fear to the unknown, far outweigh the positives.

    I find myself almost hoping that there is an epidemic just to justify all of the nervous energy that has been expended on it. Each time the public is exposed to a built-up crisis that turns out to be nothing reduces the public’s willingness to behave in an intelligent way and as post #1 points out, we are going to have an epidemic someday.

  5. Nicholas Weaver permalink
    3 September 2009 12:45 pm

    Swine flu is an interesting case. Its not exactly a false alarm, but its not exactly a super-killer either. It seems to have some very interesting properties:

    1) It grossly outcompetes (rather than combining) with other influenza strains. This is both a refied and a worry. Its a relief because it means its less likely to pick up some more interesting genes. Its a worry because it means it will be the dominant flu strain this winter. It already is in the southern hemisphere.

    2) Its novel to the not-old. Although the fatality rate on H1N1 doesn’t seem to appear worse than normal influenza, it strikes a very different population: rather than the elderly, it affects adults, and hard. This means the seasonal flu vaccine, both now and in the past, confirs zero protection.

    3) There could easily be another 1918 pandemic. This is probably not be the case for H1N1, but the earliest reports sounded like it might be. Thus we really DO neeed infrastructure in place to understand and mitigate something like this, after it becomes widespread.

    Oh, and 1918 flu was ALSO an H1N1 family virus…

  6. underscore permalink
    3 September 2009 2:56 pm

    i had the swine flu earlier this year… it’s not fun, but not deadly. that being said, this winter’s strain is supposed to be stronger and like Nicholas says, it’s got some similarities to the 1918.

    all that said, pandemic or not, these measures do seem extreme. if we’re getting into book recommendations i would suggest Blindness by Jose Saramago. it is hyperbolic fiction, but in terms of depicting what our response to a pandemic would be, i think it’s fairly accurate.

    color me cynical, but i often get the feeling that we really view “civil rights” and the due process of law as entitlements only during good times, while during the disasters they become inconveniences that are quickly eliminated. i have a feeling that IF a pandemic started, the healthy populous would want stronger isolation measures and be furious if politicians “stood on ceremony” by defending our constitutional rights…

    and if there’s no pandemic? no problem.

  7. Nicholas Weaver permalink
    3 September 2009 3:43 pm

    Finally, the biggest thing which would help…

    Get it through people’s skulls: IF you feel sick, take the day off! Not only is it rude to everyone else, but you’ll tend to heal up faster if you just, at the first sign of “ICK”, call it a day.

    A federal mandate for some level of paid sick time would really help here, to eliminate the most common excuses.

  8. 3 September 2009 4:52 pm

    A common theme in Kurt Vonnegut’s books was “Be careful what you seem to be…because you are what you seem to be.”. More and more we have people saying “I know I seem like a jack booted thug, but I’m really not because…”
    1. I’m trying to stop a disease from spreading.
    2. I’m saving you from the Taliban.
    3. And so it goes.
    Looks like it’s time to send a few bucks to ACLU. Why don’t we have two or more ALCU’s? We need a left leaning one to fight for human dignity, freedom from warrant less search etc. But we need a right wing version focused on property rights, gun rights, etc.
    Cough into the crook of your arm. Disease spreads by hand contact and snot/sputum on the hands. Wash snot off. It’s not rocket science, but it works.

  9. Reynardine permalink
    3 September 2009 7:00 pm

    Sounds like I’d better not tell anyone if I start to feel sick—otherwise I’ll bring down the jack-booted forces of Homeland Security on my house and perhaps the whole neighborhood.

    It seems to me that militaristic and despotic thinking has become the universal response to every crisis—even natural ones—in this once great country. Of course, there have been other times of great national paranoia; perhaps McCarthyism was just a sign of things to come. But not even Joe McCarthy would have called out the storm troopers in response to an attack by a virus. The worst thing is that this delusional thinking is not just prevalent in Washington; it finds echoes everywhere in the Homeland.

    There is a general psycho-cultural drift in the U.S. that I can only describe as decadent paranoia. Militarism is only one facet. Others include a total aversion toward any sort of risk coupled with the conviction that we are always in great danger; imperiled both by ill-defined hostile people (“terrorists”), as well as natural forces (“climate change”, “ozone hole”, “energy crisis”, “AIDS”, etc. etc. etc.).

    The so called “zero tolerance” policies enforced by many schools of the Homeland is a clear illustration of this psychology, as well as an effective method of assuring its transference to every new generation. We immerse our children in an environment where rules are enforced rigidly without regard for either logic or a sense of proportion—where bringing a picture of a gun to class, saying something which is construed by someone as being a threat or sexually degrading, or praying out loud, all result in the awful majesty of the judicial machinery of the state being brought to bear against the unfortunate child who has transgressed. Literally, everything becomes a “federal case”. The lesson is plain: all evils are equally dangerous, and all evils justify the most drastic possible remedies; critical thinking and deliberative judgment are a sign of weakness.

    I’d say that this disease is far worse than any influenza.

  10. underscore permalink
    3 September 2009 7:46 pm

    I’m just going to go ahead and say that we’ve always been a pretty paranoid people. Before McCarthy there were the Palmer Raids and I think both men would’ve called the marines in on the sick if they could determine communism was a pathogen.

    As the ACLU article points out, we have enacted vaguely similar laws during previous pandemics. We’ve been restricting civil liberties since John Adams. Given all that, I think it’s a tough sell to say it’s getting worse. Maybe just different. For your “zero tolerance” example, I am sure there have been people of all stripes opposing guns in this country for generations–but they’ve only really gained ascendancy in the national dialogue as guns have become less necessary to our livelihood.

    Considering the fact that our Bill of Rights is a series of negative rights (i.e. the government cannot…) and our history has shown executives of all stripes ignoring it, it seems to me that our whole understanding of the relationship between government and the people is that you can never trust the government to do anything and that people are cows that need to be herded for their own good. Maybe the balance of power has shifted slightly between government power and civil liberties, but more or less, its the same (some schools don’t let you talk about guns, DC was forced to allow handgun ownership). So when it comes to diseases, the government’s job is to make sure the sick don’t spread their cooties.

    For me that’s probably the most frustrating part, because like the ACLU says, previous pandemic control measures have not been proven effective, but it’s the playbook we design policy out of.

  11. Arms Merchant permalink
    3 September 2009 10:03 pm

    Re #8 — bc, there is a conservative counterpart to the ACLU – it’s the American Center for Law and Justice (ACLJ), () which focuses primarily on First Amendment rights of free speech and religious freedom, as well as international human rights, primarily religious persecution. Wikipedia has a summary of SCOTUS cases.

    I get where you’re going with this, but I’m not sure that a temporary general quarantine constitutes a grievous threat to personal liberty.
    .
    .
    Fabius Maximus replies: I suspect it is the fear that this could be misused. It’s a potentially powerful tool. The enabling legistlation is usually both too broad and too vague.

  12. anna nicholas permalink
    3 September 2009 10:22 pm

    This could end the occupations of Iraq and Afghan , as the military will be needed at home to pin down the dissenters . We will fight them ( the Jabbers ) on the beaches , in the hills , on our streets , under our stairs and in our bathrooms . I will fit my bog brush with scalpel blades .
    Alternatively I will have the Jab , and sue . Never Able Lift Arm again ,£20,000,000.

  13. Fred permalink
    3 September 2009 10:49 pm

    The focus on the deprivation of constitutional rights misses the point. H1N1 showed up in April 2009. Right now even with the waiving of standard testing protocols, there is no guarantee that, if needed, a vaccine will be available or effective. So what then?

    Since April both the MSM and the CDC in an effort to reassure us by “putting everything into context” have persistently reported that on average 36,000 people die annually in the U.S. from the seasonal flu. Yet they don’t report that this figure is based on a mathematical model, as there is no historical practice of the contemporaneous gathering of medical records or death certificates. It has also been reported by the MSM that by the middle of August 1800 people have died worldwide of H1N1. So 36,000 a year in the U.S. alone from the seasonal flu versus 1800 worldwide in 4 to 5 months from the “killer” flu?

    If H1N1 turns out to be a killer (which I don’t think it will be) and the vaccine is too late or doesn’t work, all of us will be a lot better off if some serious thinking and preparation have already been done. The beauty of this is that it can be done on a local level.

    For example, has the local school district developed a policy on school closings, on student/staff absences, where in the school will a sick student be kept until he can be picked up by a custodian, ect. These policies should already have been thought out. These policies can’t wait until the next regular meeting of the school board on the second Tuesday of each month.

    Likewise emergency rooms could be swamped by panicing, demanding people with nothing but bad chest colds. Such people will expose themselves to the H1N1 already in the ER and interfer with the treatment of the people actually sick with H1N1 or other illness or injuries. There is a real risk of violence in these situations. Have the local hopitals and police departments developed policies to deal with this.

    I am not advocating for any particular policy and I definitely want the Constitution respected. But if H1N1 is a killer, fewer people will die and there will be less damage to the Constitution, if some serious thinking has already been done.

  14. 4 September 2009 1:03 am

    Section #5 added, with links to valuable articls about swine flu

    (a) Swine flu: nothing new“, Turi McNamee, True/Slant, 26 April 2009 — Cuting thru the hype.

    (b) Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic“, John F. Brundage and G. Dennis Shanks, Emerging Infectious Diseases, August 2008 — Excerpt:

    Deaths during the 1918–19 infl uenza pandemic have been attributed to a hypervirulent infl uenza strain. Hence, preparations for the next pandemic focus almost exclusively on vaccine prevention and antiviral treatment for infections with a novel influenza strain. However, we hypothesize that infections with the pandemic strain generally caused self-limited (rarely fatal) illnesses that enabled colonizing strains of bacteria to produce highly lethal pneumonias. This sequential infection hypothesis is consistent with characteristics of the 1918–19 pandemic, contemporaneous expert opinion, and current knowledge regarding the pathophysiologic effects of influenza viruses and their interactions with respiratory bacteria.

    This hypothesis suggests opportunities for prevention and treatment during the next pandemic (e.g., with bacterial vaccines and antimicrobial drugs), particularly if a pandemic strain–specifi c vaccine is unavailable or inaccessible to isolated, crowded, or medically underserved populations.

    (c) Transmissibility of 1918 pandemic influenza“, Keith P. Klugman, Christina Mills Astley, and Marc Lipsitch, Emerging Infectious Diseases, February 2009 — Excerpt:

    Brundage and Shanks have studied time to death from the onset of influenza symptoms during the 1918 pandemic in military and civilian populations and found a median time to death of 7–11 days. They argue that these data support the idea that the deaths may be predominantly due to bacterial superinfection after the acute phase of influenza. We observed a similar 10-day median time to death among soldiers dying of influenza in 1918, a finding consistent with the time to death for a bacterial superinfection, specifically pneumococcal bacteremic pneumonia.

    The major bacterial pathogen associated with infl uenza-related pneumonia in 1918 was Streptococcus pneumoniae. Neither antimicrobial drugs nor serum therapy was available for treatment in 1918.

    For a non-technical report on this, see “Bacteria main cause of 1918 deaths“, Reuters, 6 February 2009.

  15. senecal permalink
    4 September 2009 4:24 am

    Reynardine (#9) makes a great point: not only is our government treating this inappropriately as a homeland security measure, but we citizens are so attuned to that style of thinking that we actually feel fine about it.

    One further point, not mentioned here so far, is that the government may be deliberately exaggerating the threat in order to create a pretext for further repressive social measures — mandatory vaccinations, arrests, quarantines, etc., for dealing with possible unrest as the economy worsens, and war drags on.

  16. Ulenspiegel permalink
    4 September 2009 6:56 am

    The 1918 strain was not very lethal but highly infectious and it is known for years that most of the people died of secondary infections with bacteria, which could in most cases be treated with antibiotics today. This topic was discussed in the news/opinions section of one Nature issue a few years ago.

    The danger today is that a combination of a really lethal strain with an highly infectious one create a situation, that runs out of controle, when we consider the time that is neede to produce sufficient amounts of vaccine. The creation or spread of such a strain may be delayed/hampered by appropriate but unpopular measures.
    .
    .
    Fabius Maximus replies: I believe you misunderstand how professional journals operate. They do not publish articles repeating things that “everybody knows”. From Wikipedia:

    Emerging Infectious Diseases is a peer-reviewed journal established expressly to promote the recognition of new and reemerging infectious diseases around the world and improve the understanding of factors involved in disease emergence, prevention, and elimination. The journal is intended for professionals in infectious diseases and related sciences, and is published monthly by the Centers for Disease Control and Prevention (CDC).

  17. Indian Investor permalink
    4 September 2009 1:16 pm

    What a prescient Obama administration the US has! Three months before the swine flu pandemic was identified they gave a $ 486 million contract to Novartis to manufacture pandemic flu virueses!

    US Department of Health and Human Services awards Novartis USD 486 million contract to build manufacturing facility for pandemic flu vaccine, 15 January 2009 — “Commercial production of pre-pandemic and seasonal flu vaccines planned after completion in 2012.”

    “CDC determined that two cases of febrile respiratory illness occurring in children who resided in adjacent counties in southern California were caused by infection with a swine influenza A (H1N1) virus.”, 17 April 2009.
    Link to the first isolation of Influenza A (H1N1) by CDC in an MMWR report dated April 21, 2009.
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    Fabius Maximus replies: It’s always nice to hear from the Gamma Quadrent! However you are, as usual, mistaken about events on Earth.

    * Obama took office 5 days after the contract was awarded. The decision to fund this project was probably made during Bush Jr’s first term (these projects move s l o w l y).

    * The Novartis factory is not designed to fight the specific strain causing the current pandemic — as you imply by juxtaposing these two events. It is designed to fight influenza pandemics, which we have know were a threat since 1918. Since large scale productino is scheduled for 2012, it will not help now.

  18. Ulenspiegel permalink
    4 September 2009 3:40 pm

    FM: “I believe you misunderstand how professional journals operate. They do not publish articles repeating things that ‘everybody knows’”.

    Believe me, I do not misunderstand how professional journals operate, I write and peer-review scientific paper myself. My science is better than my English :-)

    Nature & Science have a section for their reviewed papers and in addition provide professionals opinions, explanations of the results for non-experts of the field and some kind of supplemental material which allow to put the paper in a useful scientific and political context. A few years ago the genome of the 1918 influenca strain was sequenced from samples obtained from frozen corpses and the results published in Nature, the other pieces of information I gave above were added in the non-reviewed section, hence, it was for me “old stuff”.
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    Fabius Maximus replies: If you are attempting to say that these recent articles are part of long investigation into the role of bacterial infections during the 1918 pandemic, then the answer is “of course.” Isn’t that obvious?

  19. Ulenspiegel permalink
    5 September 2009 9:49 am

    FM, here you miss the point, the fact that most people in 1918/19 were very likely killed by bacteria has been known for years and, therefore, to describe the virus strain of 1918 as highly lethal in public media was/is nonsense. To use a similar motif in the introduction of a scientific publication with “Deaths during the 1918–19 influenza pandemic have been attributed to a hypervirulent influenza strain…” by the authors of the first paper in order to sell their stuff is IMHO weak.

    This criticism of course does not challenge the quality of the drawn conclusions in both papers.
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    Fabius Maximus replies: Thank you explaining; I did not see this implication. As it out of my field of expertise, I cannot comment on it. Interesting, if true. Any citations?

  20. awakened permalink
    5 September 2009 10:10 pm

    Comment #1: “Turns out the robust immune systems of adults reacted with especial ferocity to the proteins in the Spanish Flu’s viral coating, producing massive collateral damage within the human body due to the immune system overreaction.”

    My understanding of this from my recent personal research is this reaction is called a “cytokine storm“. Not everyone will have it, but some very healthy people will. I think of it like an allergic reaction to a bee sting. Most who are stung do not go into anaphylactic shock.

    The possibility of a concurrent bacterial infection, specifically a mycoplasma type infection is of greater concern to me. These strains of bacteria (mycoplasma) are already spreading throughout the population and are strains that could be transmitted via vaccine. Additionally there is the very real possibilty of them already having been transmitted via past vaccines since labs have only recently been made aware that their culture mediums may contain strains of these bacterias. And while these are slower growing bacterias, other more virulent bacterias could also become attached to the virus.

    There is no way that I will ever willingly take a vaccine for H1N1. In fact there is another very real possibility that I have already been exposed making the need for a vaccination null. The symptoms of this H1N1 are minor upper respiratory with a lessor amount of stomach symptoms. I have already experienced this mid-summer when they stopped monitoring it.

    All I can say is that someone is going to make alot of money. And hey, if they cant make us all submit to crappy mandatory health insurance they can try to make us all submit to their crappy vaccines. Or they will try for both.

    Some people will get rich from this and some of us may die. I hate to be such a pessimist, but post 911 and the anthrax mailings there is now nothing that would shock or surprise me.

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