Avian Flu - What we need to know

Australia to close all ports if bird flu strikes

Australia's air and sea ports would be closed off from the world in the event of an Asian bird flu outbreak.

The dramatic safeguarding measure against the deadly disease is part of a Federal Government draft management plan circulated for comment to health professionals, the tourism sector and state governments.

[...] Under the draft plan, if there was a serious outbreak of the disease the Government could ban gatherings of people, close schools and quarantine anyone suspected of carrying the virus.

"Fever clinics" would be established and certain hospitals designated as specific "influenza hospitals" or "care centres" to stop the spread of the disease. Mobile medical teams would roam suburbs treating home quarantine cases.

The story mentions Australia expects some 13,000 casualties in the event of an outbreak. Read the entire article in the Sun-Herald. Thanks to Chris Berkeley for the link.

The economic consequences of avian flu

We plan to cover this topic in more detail.  In the meantime, here is one recent report:

Canadian financial analysts predicted that an avian flu pandemic would have dire consequences on the global economy, its impact comparable to the Great Depression of the 1930s. 

n a first-of-its-kind report on the financial impact of a possible pandemic, BMO Nesbitt Burns researchers warned that an outbreak could devastate the airline and hospitality industries, trigger mass foreclosures and bankruptcies, decimate insurance companies, and disrupt food chains as people switched from animal to vegetable diets all costing hundreds of billions of dollars.

"Its economic impact could be comparable, at least for a short time, to the Great Depression of the 1930s," said BMO chief economist Sherry Cooper, noting that the report, dubbed "An Investor's Guide to Avian Flu," "is not meant to be alarmist" since an avian flu pandemic is unlikely to occur anytime soon and would only last a few months.

Here is the story.  Here is the study.  Here are a few more predictions:

Attendance of sporting events, theme parks and movies would drop, if not banned outright. Patronage of bars, restaurants and hotels would plummet, he said.

As more people stayed home, e-commerce might flourish, as long as postal and courier services were maintained.

"Financial markets could prove as vulnerable as unvaccinated humans," Coxe said.

Treasury markets would be vulnerable to a sell-off by Asian banks whose holdings are enormous, she added.

And, the high death rate would create a housing oversupply and puncture the current real estate bubble, Cooper said.

"In relatively short order, the deceleration of almost all non-essential economic activity would trigger a rampant decline in spending," leading to deflation and massive job losses, she concluded.

A few comments:  A pandemic would last more than a few months, most likely.  Housing oversupply would not be a major problem, although many asset price bubbles would burst.  The continuity of public affairs did better in the 1918-1919 flu pandemic than one might have expected, although admittedly early microbe-caused deaths (e.g., tuberculosis) were a more typical medical event in those days.  The economic consequences would be devastating, although probably unlike the Great Depression in qualitative terms.  Rather than employees looking for work, we could expect employers looking to lure workers out of the home but failing.

Tamiflu purchases

Here is one recent update to Flu Wiki, on buying tamiflu and why you should be suspicious of some tamiflu offers.  NB: We have not tested this information and this is not intended as medical advice.

Latest WHO update

Read it here.

Britain to train GPs for bird flu

Every GP in Britain is to receive instructions on handling an outbreak of bird flu, it has emerged.

Many experts have warned that a global flu pandemic is inevitable, and it is feared that an outbreak could kill up to 50 million people worldwide, including more than 50,000 in Britain.

As part of its preparations, the Department of Health will send out information packs to GPs and other primary care staff next month.

The packs will include a copy of the Chief Medical Officer's 50-page technical guide, Explaining Pandemic Flu, as well as leaflets aimed at the general public.

The DoH said the timing of the distribution did not signify a heightened state of alert but was part of general preparations.

The story is from the Daily Telegraph, with thanks to Mike Fieschko.

Stimulating vaccine research

Tim Harford mentions a new report written by the Center for Global Development which deals with the practical details of creating a "market for vaccines":

Making a commitment in advance to buy vaccines if and when they are developed would create incentives for industry to increase investment in research and development. New commercial investment would complement funding of research and development (R&D) by public and charitable bodies, accelerating the development of vital new vaccines for the developing world.

This report presents the proposal from theory to practice, by showing how a commitment can be consistent with ordinary legal and budgetary principles. A draft contract term sheet is included, highlighting the key elements of a credible guarantee.

This generation can leave an historic legacy. By creating arrangements that devote the same scientific effort to diseases of the poor as we put into diseases of the rich, we can make a lasting contribution to the defeat of poverty.

As the last paragraph indicates, the report focuses on diseases that affect poor countries disproportionately, where funding from private sources is often insufficient. Still, the same logic applies to bird flu: the more orders for vaccines/anti-viral drugs, the more money will go into their production/research.

Has bird flu reached Europe?

Russia is investigating mass bird deaths in a region to the west of the Ural mountains in what could become the first case of the deadly bird flu virus spreading to Europe, officials announced yesterday.

But Russia's chief animal health official said a preliminary analysis had shown the deaths in Kalmykia may not have been caused by the dangerous virus that can also kill humans.

The Russian state health watchdog, in a statement posted on its website, said the bird deaths occurred on a farm in the Caspian region of Kalmykia 2,000 km from the region where Russia's first flu outbreak was reported.

[...] There was no final word on what had caused the Kalmyk deaths but Sergei Dankvert, chief animal and plant safety officer, said the birds may have died from an infection caused by parasitic worms.

[...] Separately, Interfax news agency reported that health officials were looking into mass deaths of ducks near a reservoir in the Sverdlovsk region which borders a number of regions hit by the virus.

Full story.

Report: pandemic's financial impact

BMO Nesbitt Burns researchers put out a report covering the imapct of a flu pandemic on financial markets (here is a shorter AFP news article on the story). The paper has a good review of what we know about flu, and tries to make speciffic forecasts on what would happen to financial markets if a pandemic hit: commodity stocks and poor countries would suffer the most, and a large number of casualties may cause housing prices to drop. Some financial survival tips:

Cash, put options on volatile stocks, high-quality bonds, and high-quality dividend-paying stocks of companies with minimal exposure to the risks we have described will be the best survival packs. They will provide the survivors of the pandemic with the capital to take advantage of the wide array of cheap assets that will—however temporarily—be available after the virus has joined its predecessors in whatever resting places the world has on offer.

Hat tip to John Hill.

Progress of a sort

According to the White House, one of three books Bush chose to read on his five-week vacation is "Salt: A World History" by Mark Kurlansky, who chronicled the rise and fall of what once was considered the world's most strategic commodity.

The other two books he reportedly brought to Crawford are "Alexander II: The Last Great Tsar" by Edvard Radzinsky and "The Great Influenza: The Epic Story of the Deadliest Plague in History" by John M. Barry [emphasis added].

Here is the story.  Here is the other relevant bit:

Barry, author of "The Great Influenza," said that he too had been a Bush critic. But his views have not deterred the administration from seeking his advice on the potential for another pandemic like the 1918 outbreak that claimed millions of lives worldwide.

Although Barry was not aware that the president planned to read the book, he said he had been consulting off and on with senior administration officials since its release in February 2004. He had lunch with Health and Human Services Secretary Mike Leavitt two weeks ago.

The administration, Barry said, was investigating what steps public officials could take to lessen the severity of a flu pandemic. A central theme of Barry's book is that the 1918 outbreak was exacerbated in America by the government's attempts to minimize its significance, partly to avoid undermining efforts to prevail in World War I.

"One lesson is to absolutely take it seriously," Barry said. "I'm not a great fan of the Bush administration, but I think they are doing that. The Clinton administration I don't think paid much attention to it as a threat."

Update on the Indonesian bird flu fatalities

Dr. Amin Soebandrio from the Ministry of Research and Technology Republic of Indonesia comments at ProMedMail on the source of the bird flu virus that killed a father and his two daughters in Jakarta over a month ago:

It could be true that the "escaped" bird(s) across the street were the source of the avian influenza A (H5N1) virus that infected 3 members of a family in Tanggerang, Jakarta, based on the finding of a trace of avian influenza virus in the dried bird droppings. However, this does not explain why only those 3 were affected, while the other family members showed negative results for both serologic and PCR tests. Also, none of the neighboring families showed a positive result.

There is also a question as to whether those 3 victims were exposed to the source at the same time or whether one of them was the index case and transmitted the virus to the other close family members sharing the same genetic susceptibility to the virus. As we know, the 2nd case showed symptoms 10-11 days after the 1st, the 3rd case a few days later: an unusual incubation period for avian influenza if they were exposed at the same time. My hypothesis is that they were grossly exposed to a (so far unknown) source, possibly repeatedly. Alternatively, one victim could have become a new infection source for the others who have similar genetic susceptibility. Could an intentional targeted spreading of the virus
possibly play a role in this case?

The ProMedMail commentators go on to say that

Dr. Soebandrio has made the interesting comment that differences in genetic susceptibility may have played a role in the Jakarta incident. This is an issue that deserves further study, particularly with respect to an apparent greater vulnerability of Vietnamese people to avian influenza virus infection.

This is an interesting hypothesis, and there may well be something to it in the case of the three Indonesian deaths. In general, I think the "greater vulnerability" observed in Vietnam seems likely to have more to do with how poultry is raised, cooked and consumed than with differences in genetic susceptibility.