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ВОЗ: в случае пандемии птичьего гриппа в Азии выживет только Таиланд

08 сентября 2005 | 12:39
Подробности
По материалам: Медновости

http://podrobnosti.com.ua/health/2005/09/0.../08/241618.html

В случае развития пандемии птичьего гриппа в Южной и Юго-Восточной Азии только Таиланд сможет что-то противопоставить инфекции, сообщает Reuters. Об этом заявили в среду эксперты Всемирной организации здравоохранения. По оценкам специалистов организации, вирус уже вплотную подошел к мутации, которая сделает его легко передаваемым от человека к человеку.

Глава управления ВОЗ по инфекционным болезням Джай Нараин (Jai P. Narain) огласил эти данные на конференции, проходящей в рамках Южноазиатского форума. По его оценкам, глобальное распространение инфекции может унести от 1 до 7 миллионов жизней. "Больше нет вопроса - возникнет ли вообще пандемия птичьего гриппа, теперь существует вопрос - когда она возникнет", - подчеркнул эксперт.

По информации Нараина, из стран региона только Таиланд имеет план действий в случае возникновения пандемии, кроме того, в стране накоплен запас антивирусных лекарств. Эксперт также предупредил, что вирус теперь распространяется не только через домашнюю птицу, но и практически через все виды диких птиц. Особую опасность представляют перелетные виды, ставшие причиной эпизоотии в российских регионах.


Добавлено в [mergetime]1126231499[/mergetime]
http://www.alertnet.org/thenews/newsdesk/COL141587.htm

Bird flu pandemic a question of when, not if -WHO
07 Sep 2005 14:07:59 GMT

Source: Reuters

COLOMBO, Sept 7 (Reuters) - The world is going to face a pandemic of the bird flu strain lethal to humans and Thailand is the only nation in South and Southeast Asia ready to deal with it, the World Health Organization (WHO) warned on Wednesday.

WHO officials said the virus could mutate into a form that could pass easily from one human to another, making it easier for it to spread rapidly across great distances and kill between one million and seven million people worldwide.

"We may be at almost the last stage before the pandemic virus may emerge," Dr. Jai P. Narain, Director of WHO's communicable diseases department told a news conference on the sidelines of a Southeast Asia health summit in the Sri Lankan capital.

"Whether the avian influenza pandemic will occur, that is not the question any more, (but) as to when the pandemic will occur," he added.

"So far there is only one country in Southeast Asia with a pandemic preparedness plan ... Thailand... They have a stockpile of anti-viral drugs," Narain said. "At the same time we are in dialogue with our member countries. We are in the process of preparing this pandemic preparedness plan."

The deadly bird flu virus, now feared to be heading for Europe, killed one person in Vietnam last week, taking the number of deaths in Asia from the disease to 63.

The death took Vietnam's bird flu death toll to 44, with 23 of the victims dying since the virus returned in December 2004, after sweeping through much of Asia in late 2003.

It has also killed at least 12 people in Thailand, four in Cambodia, three in Indonesia and has struck six Russian regions and Kazakhstan, causing the deaths of nearly 14,000 fowl.

Narain said migrating birds posed a serious risk of spreading avian flu around the world and Asia was very vulnerable as winter approaches.

"It is no longer poultry. We are concerned about a whole range of bird species," Narain said.

"The virus has been detected in migratory birds in some former Soviet states where the these birds traditionally fly towards Asia to escape the cold winter months," he added.

Добавлено в [mergetime]1126231723[/mergetime]
BIRD FLU: PROF. PREGLIASCO, DANGER FROM EPIDEMIC TO PANDEMIC
(AGI) - Rome, Italy, Sept 8 - "There is the danger that bird flu may rapidly evolve into a pandemic." Thus underlinied in an interview on www.tutelafauna.it, Prof. Fabrizio Pregliasco, virologist at the University of Milan on the dangers of virus H5n1 that has hit the East. "Mixing between local and migratory birds may spread the virus. All forms of surveillance need to be used to avoid the danger of a pandemic." Bird flu, in South East Asia since 2003 has killed more than 60 people and led to more than 150 million animals, is moving west and has already hit Russia e Kazakhstan, killing 11,000 animals and leading to the killing of 130,000 others to stop the disease from spreading. Migratory birds, according to recent investigations - said Pregliasco - can carry the H5N1 virus and thus lead to a pandemic. International bodies following the problem, such as FAO and WHO, have launched the alarm so that countries on the migratory routes introduce measures to limit contacts between migratory birds, farmed ones, and human beings. Hunters are in danger, as is anyone touching raw meat. The danger exists and experts indeed believe that H5N1 has the potential to cause a pandemic, with devastating consequences. "It is impossible to completely protect the whole population", concluded Prof. Pregliasco. (AGI)

http://www.agi.it/english/news.pl?doc=2005...e-eng.oggitalia
probegallo
Росбалт, 19/09/2005, Главная лента 14:03

В Крыму объявлена тревога из-за угрозы птичьего гриппа

КИЕВ, 19 сентября. На всем Крымском полуострове объявлена тревога в связи с угрозой птичьего гриппа. Орнитологи Крыма обеспокоены, что полуостров может стать центром эпизоотии во время массовой миграции на юг перелетных птиц из зараженных в России зон. Как сообщили «Росбалту» в пресс-службе крымского правительства, этой теме будет посвящено заседание кабмина.

Местом массового заражения птицы может стать озеро Сиваш, которое является постоянным местом отдыха для перелетных птиц на пути в Африку. Ежегодно здесь отдыхают более полумиллиона птиц. Пока массового перелета птиц не наблюдается из-за необычайно теплой осени, но уже к октябрю начнется массовый перелет диких гусей, уток, куликов, лебедей, журавлей. Введение мер безопасности коснулось только птицефабрик. Однако и домашняя птица в приусадебных хозяйствах может заразиться от диких сородичей.

Заведующий Азово-Черноморской орнитологической станцией Иосиф Черничко считает, что необходимо срочно создать службы оповещения о грозящей эпидемии по всей стране, поскольку перелетные птицы летят через всю Украину в Турцию, Болгарию, Грецию, Румынию, а оттуда дальше в Западную Европу, Африку, Америку. Кроме этого, необходимы собственные экспресс-лаборатории, которые бы могли определить вирус птичьего гриппа. Пока же анализы, взятые у птиц, отправляют в лаборатории Шестого флота США и ответ приходит через несколько дней.

Постоянный адрес статьи:
http://www.rosbalt.ru/2005/09/19/226844.html

Добавлено в [mergetime]1127148565[/mergetime]
ВОЗ: угроза пандемии птичьего гриппа "очевидна"

19.09.2005 19:26 MCK

Читайте сюжет: Эпидемии птичьего гриппа
[версия для печати]

ПАРИЖ, 19 сентября - Угроза пандемии птичьего гриппа является "очевидной", и всем странам следует тщательно принять все надлежащие меры. Об этом заявил сегодня генеральный директор Всемирной организации здравоохранения /ВОЗ/ Ли Чон Ук, открывая в Нумеа /Новая Каледония/ конференцию регионального комитета ВОЗ для западной зоны Тихого океана.

"Необходимо сделать так, чтобы ни в одной стране мире руководство не оказалось застигнутым врасплох. Все должны быть готовы" к возможной пандемии птичьего гриппа и мутацией вируса, заявил глава ВОЗ. Он особо подчеркнул важность того, чтобы каждая страна разработала планы по борьбе с пандемией. В настоящее время такие подробные планы есть лишь у 40 из 192 стран ВОЗ.

"Совершенно очевидно, что произойдет пандемия вируса, для этого существуют все условия. Весь вопрос теперь в том, чтобы определить, сколько времени до этого остается", - подчеркнул Ли Чон Ук. Глава ВОЗ считает, что необходимо развернуть широкое сотрудничество "заинтересованных стран, компаний частного сектора и мирового сообщества" с тем, чтобы "как можно ранее выявить начинающуюся пандемию".

Ряд выступивших на заседании в Нумеа экспертов указали на необходимость того, чтобы богатые страны Запада, создавшие крупные запасы вакцины, поделились ею с бедными странами, испытывающими нехватку лекарств. Также было отмечено, что во многих сельских зонах Азии, где разводится домашняя птица, не существует должного контроля за возможным стремительным распространением вируса. Во встрече в Нумеа принимают участие около 200 представителей 37 стран мира - в том числе тех, на территории которых существует вирус птичьего гриппа "Эйч-5 Эн-1". Конференция продлится до пятницы. Об этом сообщает ИТАР-ТАСС.

http://www.strana.ru/news/259928.html
SwD
Цитата
Росбалт, 19/09/2005, Главная лента 14:03
В Крыму объявлена тревога из-за угрозы птичьего гриппа

Гм... откуда они, интересно, уперли новость эту... я так думаю, что с НТВ...
probegallo

Крым может стать центром эпидемии птичьего гриппа

19 сентября 2005 | 14:42
Подробности
По материалам: FromUa, Новый Регион (Крым)

В связи с угрозой заражения птичьим гриппом на крымских птицефабриках впервые за многие годы работы введены особые меры безопасности. Орнитологи обеспокоены, что полуостров может стать эпицентром эпидемии.

Специалисты говорят, в октябре начнётся массовая миграция перелетных птиц. Многие из них на пути в Европу и Африку используют крымское озеро Сиваш в качестве перевалочного пункта. Об этом в первую очередь свидетельствует статистика, по данным которой ежегодно через Сиваш - "международный птичий вокзал" транзитом пролетает более полумиллиона птиц из разных стран. Таким образом, в условиях вспышки птичьего гриппа озеро Сиваш может стать эпицентром эпидемии.

Cотрудники Азово-Черноморской орнитологической станции ведут наблюдения в тревожном ожидании.

Из-за очень теплой осени прибытие перелетных стай на "птичий вокзал" задержалось на две недели, но к октябрю, говорят ученые, начнется массовый перелет.

Гуси, утки, кулики, лебеди и журавли летят из регионов, уже зараженных птичьим гриппом. Сейчас ученые окольцовывают и внимательно осматривают первых "транзитников". Впервые за многие годы работы экспедиции орнитологи ввели особые меры безопасности.

"Протираем инструменты тщательно каждый раз после работы. Мало чем поможет врач. Потому что этот грипп так быстро видоизменяется, что прививки уже не действуют. Это заболевание опасно тем, что летальный исход грозит многим", - рассказала старший научный сотрудник Азово-Черноморской орнитологической станции Раиса Черничко.

Введение мер безопасности на птицефабриках никак не коснулось домашней птицы. Гуси и утки, которых разводят для продажи сельские жители, плавают в водоемах рядом с перелетными птицами.

По словам заведующего Азово-Черноморской орнитологической станции Иосифа Черничко, это может привести к серьезным последствиям.

"Как только домашняя птица заразится, то всё идет по непредсказуемому пути. И тогда это становится социально опасным явлением", - говорит он.

Необходимо, говорят ученые, срочное создание в Украине Службы оповещения о грозящей эпидемии. Даже в не морской столице Крыма, на Симферопольском водохранилище, на зимовку останавливаются тысячи птиц. И за ними - никакого контроля.

"Если начнет гибнуть утка, она будет расклевана чайкой, а дальше по цепи - воронами. И будет этот вирус разноситься по городу", - уверен Александр Гринченко, председатель Крымского общества охотоведов, орнитолог.

SwD
Угу... именно так и будет, что самое занятное...

Добавлено в [mergetime]1127155452[/mergetime]
А информация, как я и предполагал, пошла гулять после репортажа НТВ
bredonosec
Цитата
вирус уже вплотную подошел к мутации, которая сделает его легко передаваемым от человека к человеку.
- Хм.. вирус подошел к мутации, или спецы в центре распространения инфекционных болезней в атланте вплотную подошли к созданию жизнеспособного штамма, передающегося от человека человеку? ...
SwD
Цитата
отправляют в лаборатории Шестого флота США

А проблема попросту в том, что на территории Украины негде делать такие анализы, хехе... Нет лабораторий... А отправлять в Россию — видимо религия не позволяет... или нынешние «братские» отношения между нами...
bredonosec
Цитата
анализы отправляют в лаборатории Шестого флота США
-мдя.. весьма любопытная деталь.. Автоматическое возвращение результатов с целью проверки устойчивости и эффективности штамма.. Испытания на регионе с >2 миллиардным населением.
Цитата
А проблема попросту в том, что на территории Украины негде делать такие анализы, хехе... Нет лабораторий... А отправлять в Россию — видимо религия не позволяет..
- а на территории европы, которой это дело также угрожает, также лабов нету? Дикари живут? Али тож религия не та? wink.gif
SwD
Цитата
а на территории европы, которой это дело также угрожает, также лабов нету? Дикари живут?

А хрен их знает... Опять же таки — шестой флот где базируется? Может — туда ближе?
А вообще грустно... Три последние серьезные эпидем-опасности («коровье бешенство», атипичная пневмония, птичий грипп) — и ко всем трем в Украине абсолютно не были готовы... и более того — даже не могли провести анализы...
probegallo
Цитата
А хрен их знает... Опять же таки — шестой флот где базируется? Может — туда ближе?

В Европе в Германии и Италии точно есть. Да и вообще, весной в Австралии начали выпускать экспресс-тесты (с временем определения за сутки) - по 100 баксов за штуку всего - любой врач их может использовать. Но укры видать жмотничают до сих пор.
bredonosec
Цитата
шестой флот где базируется?
Вай! Таких вещей не знать! С советских времен - средиземное море. Контроль за балканами и акваторией.

probegallo
World finally wakes up to threat of bird flu pandemic
By :
Date : 22 September 2005 1337 hrs (SST)
URL : http://www.channelnewsasia.com/stories/afp.../169615/1/.html


SINGAPORE : After treating bird flu as a largely Asian problem, the world is now waking up to the danger that millions of people could die from a pandemic if drastic counter-measures are not put in place.

US President George W. Bush has called for an "international partnership" against the threat with the dreaded H5N1 virus now creeping into Europe, and countries are stocking up on flu medicine as scientists search for a vaccine.

The fear is that the H5N1 virus in domesticated poultry and migratory birds will develop into a strain that is easily transferable among humans.

Experts fear there will only be a window of a few weeks to contain an outbreak before a pandemic virus spreads with lethal speed.

Indonesia's health minister Siti Fadilah Supari on Wednesday warned the country was facing a bird flu epidemic as two more possible victims, both young girls, died after showing signs of infection, following four confirmed deaths from the virus.

"Inevitable is a strong word," Bob Dietz, a spokesman for the World Health Organization (WHO) Pandemic Response Team in the Asia-Pacific region, told AFP when asked about the probability of a pandemic.

"But the virus is so widespread at this point that we would be irresponsible not to prepare as if the situation is indeed inevitable," he said by email.

"No one can quantify the probability of a pandemic strain of influenza emerging, but over time the likelihood seems so high that for the sake of protecting global health we must treat it as just that -- 'inevitable'."

The WHO has been warning about avian flu for more than 18 months and welcomed strong US involvement in the battle against the menace. It has been helping Asian countries develop national counter-measures.

In a regional meeting Wednesday in New Caledonia, the UN health agency's Asia-Pacific member countries approved a strategy to counter emerging diseases including bird flu.

Dr. Shigeru Omi, WHO's regional director, warned that the plan could not be carried out without the help of wealthier nations and urged Asian countries to change their farming practices to prevent the spread of the virus.

The latest avian flu outbreak was detected in South Korea in late 2003. It has now hit 11 countries, with the H5N1 strain killing 63 people in Southeast Asia so far, excluding the two latest deaths in Indonesia.

But the current death toll would be a mere hiccup compared to a pandemic.

The WHO says that based on historical patterns, influenza pandemics can be expected to occur three to four times each century. The great influenza pandemic of 1918-1919 caused an estimated 40 million to 50 million deaths.

The US Centers For Diseases Control and Prevention (CDC) predicts that "a medium-level epidemic" could kill up to 207,000 Americans, hospitalize 734,000 and cause a third of the US population, or 100 million people, to fall sick.

The direct medical cost would top 166 billion dollars, excluding vaccination.

US Health Secretary Mike Leavitt said he would lead a delegation to Southeast Asia next month for talks with government leaders to seek "their critical involvement and personal commitment to preparedness and response".

During the visit to Thailand, Cambodia, Laos and Vietnam, Leavitt would be negotiating agreements with the most affected nations to offer US assistance to build their capacity to identify outbreaks and respond rapidly.

The WHO had been watching the virus since 1997 and tracked its spread and development until it had the capacity to make humans ill.

In many parts of the region, the H5N1 virus in animals is endemic.

"It is embedded. But we still see the need to try to control the virus within the animals that keep it alive --- poultry and wild fowl. It's a frontline response, and one that might not work. But we need to mount as many defenses as we can, if for no other reason than to buy time," the WHO's Dietz said.

The H5N1 virus is now active in animals in three contiguous regions -- the Western Pacific, Southeast Asia and the easternmost parts of Europe.

"We try to stay out of the business of making predictions, but it seems reasonable to assume that the virus will continue to spread to adjacent areas," Dietz said.

"Migratory birds are the main distributors on the international scale and there is no way to stop them. Locally, migratory fowl and the trade in live and recently dead poultry keep it in circulation, too."

The WHO has urged countries to prepare for a pandemic by stockpiling antiviral drugs and positioning them in high-risk areas, intensifying efforts in vaccine development and preparing for social and economic disruptions.

The US government has signed a 100-million-dollar contract with French vaccine maker Sanofi-Pasteur to provide up to 20 millions doses of an experimental vaccine that promises to protect humans against bird flu.

Washington also plans to stockpile 20 million doses of anti-flu medication, from the current level of 2.5 million doses.

- AFP/ch



• EU calls for donor conference to help Asia fight bird flu: report
• Malaysia sets up multi-agency task force to prevent bird flu
• Health minister warns Indonesia on the brink of bird flu epidemic
• Indonesia says it is facing bird flu epidemic
• Indonesian girl dies after showing bird flu symptoms
• WHO chief issues new warning on avian flu
SwD
Цитата
Вай! Таких вещей не знать! С советских времен - средиземное море. Контроль за балканами и акваторией.

Цитата
а на территории европы, которой это дело также угрожает, также лабов нету?

Очень хорошо. Отсюда делаем вывод — к флотским штатникам действительно ближе отправлять анализы, чем в европейские цивилизованные страны... Ибо у тех, кому зараза угрожает (Румыния, Болгария), с лабораториями так же, как и у нас...

bredonosec
Цитата
к флотским штатникам действительно ближе отправлять анализы, чем в европейские цивилизованные страны...
Хм.. а по карте с линейкой? blink.gif
Цитата
Ибо у тех, кому зараза угрожает (Румыния, Болгария), с лабораториями так же, как и у нас...
- А больше она никому не угрожает? Совсем?
Самому еще не смешно? bleh.gif
SwD
Цитата
Хм.. а по карте с линейкой?

А это зависит от того, в каком именно месте средиземноморья лабы штатников торчат. Может вообще в районе Анталии какой-нить...

Да и какая разница, собственно? Главный факт — Украина, как обычно, совершенно не готова к возможной эпидемии... Доблестный Минздрав больше занят переделом аптечного рынка, чем контролем за эпидемической ситуацией...
probegallo
Цитата
Да и какая разница, собственно? Главный факт — Украина, как обычно, совершенно не готова к возможной эпидемии... Доблестный Минздрав больше занят переделом аптечного рынка, чем контролем за эпидемической ситуацией...

Сегодня наконец-то укроТВ (Новый Канал) сообщил что начинают выделяться средства на закупку тест-систем по птичьему гриппу.
slavAnka
и кому от этого легче? Вы думаете, если у какой-нибудь "Нашей Рябы" начнут дохнуть куры она срочно вырежет все поголовье? Хотя может и вырежет и на прилавок пустит. У нас как всегда спасение утопающих дело рук самих утопающих. Вот только птичку жалко
SwD
Цитата
Хотя может и вырежет и на прилавок пустит.

Ну... если не вырежет — оно само передохнет, хехехе...
А по поводу прилавка — вирус не выдерживает высокой температуры... так что сырое мясо юзаем, надевши ОЗК и обильно поливая какой-нить дезинфицирующей дрянью всё вокруг... а уж после термической обработки мясо можно есть не боясь.
probegallo
Итак:

Wilson Center Pandemic Flu event
Transcript of Osterholm and Branswell inside.


This is part one of three. Second part will be Helen Branswell. Third will be Q&A.

I am not sure if this is of any use to anyone. If you are familiar with the beast and have been keeping up with Flu news, the things Doctor Osterholm says are not so shocking to our ears. I have bolded some important passages but this may be unecessary. I thought it might help if people were trying to pick choice passages for showing the unaware.

I also added some arbitrary sub-titles to break it up a bit. I estimate the accuracy of the transcript at about 95%. Some words may have got subsituted or missed out, phrasing mashed. Spelling errors may also have sneaked in.

Finally, I'm not sure as to the legality of this. Having a written record of comments made off hand (essentially) may be embarassing or legally awkward somehow, for the good Doctor.


But here's the transcript FWIW.






Start of Doctor Osterholm approx 8 minutes in, but with no timestamp on the webcast, hard to tell.

Started a few seconds before Doctor. O speaks.

BEGIN TRANSCRIPT


HOST: very pleased to have Mike kick us off, so I'll turn the floor over to him.


DOCTOR OSTERHOLM:

Thank you Jeff, for the introduction I'd like to thank all of you for being here today and for the Wilson Center for allowing this activity to take place. It's one that I could say at the outset, its one that would not have taken place later than this to help wake people up to what is I believe is an inevitable situation coming down the line.

Let me make just two comments as I start in what will be a relatively brief and unfortunately somewhat high level overview, and we'll get it to Questions and Answers but:

I have been in public health for nearly thirty years at the ground level, having been involved in the earliest days of things in like Toxic shock syndrome and HIV/AIDS, antibiotic resistant emerging infections, bioterrorism and so forth, and I can tell you that without a doubt if you were to add up my entire public health career concerns, worries and in some cases nightmares, if you added them all together, they collectively do not meet the concern the worries and the nightmares that I have about the issue of a pending pandemic event influenza, and today and I'll share with you their construct.

The other thing that I want to give you the sense with of this is that in 9/11 of 2000 actually I published a book called "Living Terrors" a book on the bioterrosim and the concerns we had in terrorism in general, and in that book I specifically talked about the World Trade Center Towers and the Al Qaeda and if you had asked me in the year between the years 9/11 2000 and 9/11 2001 what the likelihood of events of 9/11 unfolding as they did despite what I had talked about, I would have told you it was probably about 1 in 10,000, you know in some number like that.

I want to leave you today that the risk of a pandemic influenza event is 1. It is going to happen. It is not *if* it is going to happen, it is when and where and how bad. And that I think has to be the understanding we have today as we talk about this issue.

This is probably the most important slide that I have in my entire repertoire of thousands of slides. And what this really points out is that we live in a very different world today. Just in the last 150 years we have gone from a world population of about 700 million to a world population today of 6.5 billion. In 1918, one of the dates we'll come back to, the world had 1.8 billion people. Today roughly 1 out of every 9 people who have every lived is on the face of the Earth. In addition we have changed how we get around this world, and this concept of a global one-stop, non-stop world is a reality. Although we have not increased the speed at which we get around the world, and from the 1950's with jet travel, what goes around the world, and the dependency we have on other parts of the world for our everyday lives, is huge. That is an overlay for understanding today's concerns of Pandemic influenza.

THE PANDEMIC FLU VIRUS

Now let me just give you a very brief primer (for those of in the audience that have expertise in the area you can take a brief break) for those that don't let me just remind you that influenza type A, the kind that causes pandemic and causes the annual intra year concerns we have with annual flu, basically is made of a series of different virus that can be characterised by their different Hemagglutinin antigens and neuraminidase antigens, HA and NA -- or as you know come to know it, H and N then some number (and I'll come back to that).

Human disease historically has been caused by three subtypes of, Hemagglutinin H1, 2, 3 and two subtypes of neuraminidase. These are key because the Hemagglutinin is a very important part of the virus in terms of getting into the human cell. If the Hemagglutinin doesn't have the right receptors or right chemical structure to get into the human cell, it may be floating out there in birds or whatever, but it's not likely to infect humans.

The Neuraminidase is a very important part of the virus: it allows it basically to get out of the cell, so that even if a human gets infected, will they themselves then be infectious, and capable of transmitting the virus.

All known subtypes of Influenza A can be found in birds, and only two subtypes, H5 and H7 have caused severe outbreaks of disease in birds as we now know it today. The natural reservoir for influenza virus, all of them, is wild aquatic birds. And not just in the Far East, although that has been a very important source, but across the world. And for whatever reasons and we may go into those on a scientific basis, they have not then made the jump of change in the Hemagglutinin and Neuraminidase structures to become human pathogens, only but rarely.

Now the way Influenza virus get out of the bird population, and in this case from wild birds to domestic birds (and there is a difference by the way) is that the virus has to change.

METHODS OF CHANGE: REASSORTMENT AND RECOMBINATION

There are two ways the virus can change to become this new virus, the one we are most concerned about. One is reassortment the other is one called recombination.

We have traditionally thought of pandemic, the emergence of a virus out of the wild birds to humans as the result of reasssortment. Reassortmewnt occurs when this very promiscuous indiscrete and sloppy virus is in a lung cell of, we used to think pigs, potentially humans, and it comes into close contact with another type of influenza virus which is already human adapted.

This cartoon from the New England Journal of Medicine shows on the left side in this case, H5N1, this unique virus that we'll be talking about and has caused us such concern, and if it were to infect either in a pig or a human population, a co-infected with an already existing influenza strain such as the common H3N2, which is the one we see year after year, and was the cause of the pandemic of 1968 [you'll get a new virus]. These two will swap genes very easily. There are 8 genes in the Influenza virus and if it acquires enough [genetic] material from the human adapted strain, keeps the important disease causing and immunologically distinct characteristics of the new strain well you'll get a new strain of the virus that now will infects humans and will cause lots of problems.

That is how we traditionally have thought that pandemics start. H5 has not done that since its first documentation in 1997.


Instead what we see is a series of "point mutations", these gradual changes where the virus keeps passing and passing and passing through living specimens, I.e. primarily birds, and with each of those passing the changes occur get it closer and closer to what would be in the sense a result of a cataclysmic event like a recombination. Why might that be a possibility? This gives you some sense of how that world has changed.

in 1968 the year of the last pandemic, there were 788 million in mainland china. In 1968 in a very different social political and economic time, there was 5.2 million pigs in china. Today there are 508 million pigs. In Poultry there were 13.3 million chicken. Today there are over 13 billion, and I might add the average life expectance of a chicken today, from time of hatching to harvest is about 18 weeks. So that you can see that in a years time you have to triple that number in the sense of what passes through the system. [Please check figures here]

What we have today is an ideal incubation, kind of the forest fire of forest fires, because the potential is instead of you know, a mountain state park or a national forest somewhere you basically have a virgin forest from San Francisco to New York, kind of thing that can burn.


This virus will not burn itself out in the current environment of Asia, because of this ongoing potential for the virus to be transmitted.


Each one of those transmissions, each one of those infections results in another opportunity for this virus to continue those mutations that accumulate over time and is what is driving what we believe is, the concern ultimately unleashing a pandemic strain.

ABOUT PANDEMICS

Now to understand Pandemic influenza epidemiologically: pandemics are an epidemic that becomes very widespread, effects a whole region, a continent or the World.

Now we got to acknowledge that technically every year we have a pandemic of influenza in terms of the seasonal flu. That really does meet that definition, but that’s not what we are talking about with a pandemic. What we are talking about really is this new virus emerging for which there is very little human protection from previous experience of the virus, the virus may have characteristics that make it more likely to cause severe disease.

There have been at least 10 pandemics recorded in the last 300 years, the most notable one is the 1918 one, but let me tell you as we start to study previous ones, 1830-32, 1766, there clearly were other pandemics that had an impact that for the time and population may not have been that dissimilar from 1918.

In 1830-32, was similarly severe in a smaller population as we saw in 1918-1920. You'll see lots of numbers thrown around about how many people died in 1918 and 1919. Let me just say that I refer back to a publication that recently appeared in the bulletin of Medical History which basically was an examination by a group of historians that went back and actually took country by country data and they came up with an estimate of minimum of 50 million and they actually said in there that they believed that it could have been as high as high a 100 million people perished in 1918-19 experience.



Now pandemics occur when a novel influenza strain emerges from the bird population through other animal species into humans that:

a) can be readily transmitted between humans, so it's got to have the right lock and key to get into the lung cell i.e that Hemagglutinin has to change just enough, keeping the bad disease causing properties but now readily affecting humans. Today H5N1 only has a little bit of that, it occasionally gets into humans but not readily.

2) it has to be genetically unique, meaning that there is not a whole lot of us out there that have pre-existing antibodies, so that when it starts to spread it will spread unchecked and

3) what really makes it a different situation is increased virulence, with the increased ability to cause disease in a different way. And I'll share with you that not all influenza virus, even pandemic strains, were created equal. Pandemics are different with regards to their population mortality rates and cannot be characterised by a single risk predictive model.


So today when people talk about pandemics in previous history please do not allow yourself to think that that idea, "there is only one kind of pandemic". There is not. And I'll show you this right here.

[SLIDE CHANGED]

These are the three pandemics documented during the 20th century. In the United States, for which we have probably some of the best data (these are the data of [something Simonson?] and the NIH,) you can see that in 1918-19 there were roughly 500,000 excess deaths in this country. In the pandemic in 1957 and 58 and the pandemic 1968-69 respectively there were 60-40,000 increase excess deaths, which when you think about influenza every winter kills between 35-50,000 Americans, you can argue that the bottom two numbers while for the population being smaller then that it is now, still it wasn't that major a departure from what we are talking about could potentially be the situation.

Now the 1918-19 pandemic is one we must study. And I'll come to that in a moment because I believe that the H5N1 virus if it is to be the pandemic strain, and again I said there’s a chance of one that there will be a pandemic, I am not going to tell you that it will be H5N1. Everything in my science bag tells me that that's the case but tomorrow we could be surprised and a new virus pop up somewhere else, re-assort and spread, so we have to keep our eyes open 360degrees across the board.

But in that particular pandemic we now know retrospectively that it was an H1N1 strain(of course we didn't have viriological technique back then). we have now completely sequenced this virus either from specimens from pathology specimens, from soldiers who died in 1918 and for which we have excellent records, or from exhumed bodies that came from permaforst, and collectively now, the virus has been totally sequenced. 200 million to 1 billion people were infected as I pointed about more than 50 to 100 million died. It killed a disproportion of healthy young adults: "the W curve".

H5N1: VIRULENCE AND DISPROPORTIONATE DEATH

Traditionally we think of pandemic influenza or for that matter inter-pandemic years like every other year, we expect to see a U shaped curve, with the highest rates deaths in the very young and very old. In 1957 and 68, that U shaped curve generally was just pushed up at all levels i.e. a rising tide. IN 1918 the curve was very different. It was a classic W shape curve, affecting the very health of use the most and I'll come back to that in a moment.

Another thing that happened in 1918 a summary of 13 studies, throughout the world, actually demonstrated that among pregnant women 23-71 per cent died, 55 per cent overall median death rate which also is important, in the sense, observation because pregnancy in the human condition is the single most precarious immunologic time in our lives because the woman is carrying something biologically that in part doesn't belong to her, it's not her, in the same time as working very hard as working very hard to protect that thing from any insult. And immunologicaly the immune system is at a very precarious trigger point in terms of what happens so if you have a virus that can actually impact the immune system you can see some very deleterious effects as we saw in 1918.

That makes it of great importance to us today because there are two recent studies to suggest that H5N1 is “deja vu all over again” of 1918-19. And in fact a study of a Boston group and additional studies that are coming out very shortly in several major publications, support that in act the H1N1 pandemic strain basically created an over exuberant immune response in the host, its what we call a "cytokine storm".

Why is it then that people in 18-40 group were at highest risk: because who has the strongest immune response in our general population? You spent the first 18 years of the life generally building up your immune system and unfortunately for the two or three in the room over age 40 its on the way down after that. So in a sense, it really goes at the very opposite of what we usually think of in influenza, it goes for the very healthiest of all of us.

The clinical picture and epidemiology as we now know it in South East Asia, with those H5N1 cases we have is this exactly, both in terms of laboratory based data and the epidemiology. This is a cartoon from a paper I published in The New England Journal of Medicine in May which basically just shows this H5n1 in the upper left hand corner setting off a whole cascade of events in the immune structure of the host ultimately resulting in the severe Acute Respiratory Stress syndrome we see in cases of H5N1.

Let me just ell you at the outset we are not much better able to handle Acute Respiratory Distress Syndrome any number of cases today than we were in 1918. So don't go back and say it's different today, it's not 1918. Unfortunately folks it is 1918 all over again, even from a clinical response standpoint.


COMPARING THE PAST WITH THE POSSIBLE

These are data which give you a sense of what I was talking about in the W shaped curve, these are actual data from Boston. [SEE SLIDE]

The top graph is the actual historical data from 1912 to 1916 for the months September October, November. On the left axis is actually the death rate per 100,00. For the top graph, 100, 200, 300, 400. On the bottom where it may be cut of for some of you, is 0-9, 20-29, 30-39, 40-49, 50-59, 60-69. (PLEASE CHECK) Note historically the rates are highest in the very young for pneumonia and Influenza like illness and gradually increases with ages, again this is a rate per absolute population so it's not just absolute numbers.

Look what 1918 did in September to October for Boston, an event replayed over and over again around the world.

Now the axis is 1000, 2000, 3000, 4000, 5000 reaching 57 000 per 100,000 ie 5.7 [CHECK PLEASE!] per cent. You can see what happened is a slight increase, well a ten per cent increase based on historic data in the very young, but when you look at the rate for 20-29, 30-39 it approached almost 6% of the population died during that time. That’s a remarkable concept to think about happening again today. And of course it came down over time.

So that in a sense this is what we all worry about. if we take the 1918 numbers and people will throw numbers out all the time, and I can't tell you what happens if H5N1 comes and it follows this pattern, will be like.

All I can share with you is that if you take today’s population and you extrapolate the 1918 data, the exact rate of deaths and cases, you can expect to see in a state like Minnesota in a state where we have almost 5 million people, 3 million living in the Twin Cities, you see 18,000 deaths in our city, over the period of a year to a year and half, but more notably in the US 1.7 million, worldwide if you take the lowest estimate of 30 million, all the way up to upper bound of what was the 1918 number of 384 million. Just to give you a sense remember that HIV/Aids in the space of 30 years has killed somewhere in the name of 30 million. That is a horrible tragedy and yet in comparison you understand what we are talking about here.

Now we have this situation in Asia, the actual number of cases in the last several years is not completely clear, it is somewhere on the level of 120 cases and 60 something deaths, but you can see the spread that has occurred in both birds and humans.

"What's the issues here in terms of pandemic preparedness?"


VACCINES

There are really three aspects: either prevention, treatment or collateral damage response, i.e. what happens beside the pandemic. In terms of vaccination I know Helen will be talking more about this, in terms of prevention we have vaccination, anti-viral therapy and prophylaxis.

In terms of vaccination I would just say that for those in the audience who are old enough to remember a slide rule as your primary tool for mathematical calculations understand that today's vaccine, procurement development and actually production doesn't vary a whole lot from what it did in the time of the slide rule.

We have a couple of new tweaks on it, but we are basically producing the vaccine with cell...with chicken egg, culture based approaches the same way we did in 1950.


Grown in chicken eggs takes, 6 or more months. We use reverse genetics. One of the new techniques does allow us to develop prototype vaccine we do have a live attenuated vaccine now, but a very [small part of the market?] and it must still be grown in chicken eggs.


We need an immediate and comprehensive program for developing the cell culture system for vaccine production with surge capacity.

We can make some vaccine now with the current existing H5N1 strain, at the best that will be a priming dose. Most of us agree we will need two doses of a new vaccine effective against H5N1, if that were to be the emerging pandemic strain.

We could use the current virus to some degree, the problem with that is you'll still need the circulating virus to get the ultimate protection, just like the annular flu what we need to do in terms of changing the vaccine year after year, so that means we won't even have the seed virus until the pandemic begins, which if it takes six months, means we won't even have any production for almost that time period.

Current annual international capacity for influenza vaccine production using egg culture is approximately 300 million trivalent doses, as we now have, or 900 million monovalent.

That assumes a dosage of the current size we use in our vaccines [is correct]. As Helen will talk about, NIH has recently done it's initial analysis suggesting we need 12 times the amount that we need to provide protection on an individual now with this as opposed to what we use everyday for H3N2.

Now we hope we can bring that number down. But it still means we are even going to have a shorter supply than this. Almost all the World's influenza supply is produced in 9 countries. Which 12% of world's population.

Make no mistake about it. Just like in 1976 when we nationalised the H1N1 vaccine as part of [something?] and wouldn't let any other country have it, any country who has a plant within it's border will not allow that vaccine to leave it's countries boundaries, so in a sense we've already greatly leashed down the number of people who would even have access to any vaccine.

Production capacity will not increase significantly in the next few years. Understand that this is not about money anymore. Money is a necessary part of the equation, but a question of the infrastructure. If I said to you today "we want to build a 150 story building in downtown New York and we have all the money in the world we wanted, it doesn't matter but I want it done by Christmas" there's no way in Hell that will happen.

It won't happen for years even under a crash program. Today for us to build this new vaccine infrastructure on a worldwide basis, and however we paid it, it will take years to occur, that's if we launched a Manhattan-like project tonight.

Finally new and more timely methods of production are desperately needed.



ANTIVRIAL DRUGS

In terms of the antiviral drugs, let me just say, we are really only concentrating on the Neuramindase inhibitors, the two bottom drugs [on the slide], the top one you know as Tamiflu. The top drugs, the two M2 protein inhibitors are likely not to play much of a role because right now most of the strains we have coming out of Asia are resistant of the drug and would quickly develop resistance if we used this on a widespread basis.


Let me just point out here we don't know if these will work.

There are conflicting data which says "yes they will work against an H5N1", but other data which suggest that the cytokine storm, this immune response is different than in a typical H3 and N2 infection and it may not work. So I would not for a moment suggest not working on this issue, but let's be clear:

We don't know.



LOGISTICAL ISSUES

The second thing is I would tell you is again the same pipeline issues that are operative with the vaccine are operative here. People have these wonderful orders in for Neuraminidase inhibitor drugs which they don't tell you will take years to fill, as at current capacity production.


Let me just very quickly briefly say, we've got other issues: facilities and staffing.

You have no vaccine. You have no anti-viral drug and I'll point out in a moment you have no masks for these:

Who's going to come to work? Where are they going to come to work?


Right now, we have gnawed our healthcare down, even in the developed world, to the bone and we are sucking calcium.

The bottom line is we will be operating in gymnasiums and community centers, wherever we can find space.

And we have to wonder: "who is going to show up for work?"

Would YOU show up to work? Would your loved ones show up to work if they were being exposed to a life threatening infection with virtually no protection?


Worker and patient protection will be key. Medical devices and therapy, we will run out of those quickly. We will run out of all the other drugs.


Today we have a global just-in-time economy that provides all our pharmaceutical products. Right now in this country we have a shortage of 7 major antibiotics and 3 paediatric oncology drugs. All because of the fact that one plant somewhere in the world makes them and all it takes is just ONE glich in that operating supply chain...and they go down.


Under a crisis, where we shut down border and where we have a major decrease in international trade and traffic and travel we will see tremendous collateral damage from other conditions we think of being routinely treated for. For which now those drugs will not be available. They just won't make it through the supply chain.


Other medical devices, let's take masks I mentioned. Today two companies in the world, both American companies own well up to 90% of the market share in the masks know as the N95 respirator mask. Today those companies have virtually no surge capacity whatsoever to make more masks. Those masks are made off-shore with in addition their masks are actually made by obtaining raw materials from 2nd and 3rd tier counties. The bottom line is we will run out of masks very quickly. And again, think of the panic.

And fear that will just be there: "I can't get a vaccine, I can't get an antiviral drug that will work and I can't get a mask. What do I do?"

Ethical issues around allocation of resources and so on will be huge. Use recovered volunteers how will we be bringing these people into the system? They may not be healthcare workers but they will be doing healthcare work, if there are people who have had the virus and lived.

Finally corpse management.

In 1969 in this country, the average time from a casket being constructed to the time it was in the ground was months. Today it is a little over two and a half weeks. Today we will run out of caskets overnight.

Second of all our crematorium capacity is limited. We will find it very hard to process the number of bodies we will expect to have. When that begins to happen, let me tell you it adds a whole 'nother dimension to the concept of fear and panic, and what it means to know that we can't even manage the bodies that come from a situation like this even with a relatively modest pandemic.


SCARCITY OF SUPPLIES

Finally the collateral damage response. Everything from pharmaceutical products, food, equipment parts are all going to shut down with the global just-in-time economy shuts down. And I have no doubt it will happen.

In the Foreign Affairs [insert link] piece I extensively discussed the SARS situation and as much as it was a very limited response (and Helen will talk about that), the global implications were huge.


CONCLUDING REMARKS.

Finally, let me just conclude by saying “what do we do?”

I think frankly from my perspective, we Pray, Plan and Practice.

If Katrina taught us nothing else, it's not enough to have something on paper. It's also something of much greater magnitude than just that chessboard step. It's the whole game we've got to figure out in advance such as the private supply chain.

It's not a matter of if, it's when and where. Am I telling you it will be H5N1? I'm not. I think it will be but no matter there will be more pandemics. If we can't stop Tsunamis, Hurricanes and Earthquakes we surely can't stop pandemic influenza either.

Lack of international political will and support right now: Most of the world doesn't get this.

I have to tell you that as much as our own government has done, we don't understand, that this will make the catastrophic events of the past weeks, pale in comparison. At a minimum assuming we will have virtually no vaccine for 6-8months and supplies remain limited. And our best analysis maybe 1 and half per cent of the world will have access to vaccine within the six months. But even if our country had that luxury, the global economy will still collapse.

And finally I think that given the viral characteristics, the epidemiology we are seeing, we have to understand that there is more than just a passing resemblance between the 1918-20 experience and the current H5N1. There really is a model here we have to look carefully at.

We can't be surprised if the Levees break here. And I'm afraid that as a World we will be.

We have to understand these are the implications, this is what we are facing. And if we do nothing else we have to plan as if "what if this is tonight, what if it is one year, what if it is five years from now". And we need to move all three of those together.

Thank you very much.

[muted applause]


[END TRANSCRIPTION]

Transcribed by Nick Wellings 21 Sept 2005

http://www.curevents.com/vb/showthread.php?t=22803



Добавлено в [mergetime]1127764944[/mergetime]
Part Two: Helen Branswell's Talk
Here's Part TWO.

I think Helen B's talk is a little better than's Doc O's. I think she may have been reading from notes.

Again there are probably errors here, I added a few titles, and bolded bits, probably too much bold. I'd estimate this is mostly accurate transcription, as sual I left out hesitations and wordsalad jumbles. And as usual [?] means [Not sure what they said]. I had thought of adding an Editorial type opinion when she talks about drugs expiring, and my thought was that might not happen as they have longshelflives, unless people are expecting this thing within 2-4 years.

But the same mesages prevail: you are on your own.

Kind of.


Q&A I have begun, but will take more time.

___________________________

[BEGIN TRANSCRIPT]



HELEN BRANSWELL:

Hi. Welcome to my nightmare.


I've spent about most of the last two and a half years researching pandemic influenza in general, and the avian strain Mike was talking about, H5N1, in particular.

That's the strain, the renowned Flu expert, Robert Webster from St. Jude's in Memphis so eloquently described to me last November as: "The one that scares us shitless."


In the time I have been working on this I have interviewed hundreds of scientists and public health authorities, vetenarians, vaccine and drug makers, health care workers about this topic.

While Dr. Webster's remark was the most eloquent and a little bit too graphic for my editor I have to confess, all of those people talked to me in terms that I could not ignore. The urgency in their voice was just palpable. A number including leading influenza experts told me they all suffer sleepless nights.

In that two year period, and I took a three and a half month break to go to the CDC at that time, I have written 90 articles about influenza. To put that in a little context, I wrote 41 that mentioned the one cancer which is hardly an insignificant medical subject and I wrote 6 about diabetes.

The Canadian Press which is Canada's rough equivalent of the Associated Press here in the United States, conveyed my articles to the major daily newspapers and to the broadcasters and the news websites across my country....and they fell into the great News Void. Or, if they were run at all, they were run on the back pages.

For reasons I can't fathom many news outlets in North America aren't paying attention to this story as a human health issue, as a global security threat as a potential economic disaster.

There are some exceptions of course and I certainly don't want to suggest that I am the only person paying attention to this, but for most news organisations "Bird Flu" as people like to rather imprecisely call it, really hasn't been on the radar.

You know the expression about ignoring the elephant that's in the room with you? I think of pandemic flu as the elephant people don't SEE in the room with them. Once you do though it's really hard to ignore the threat it poses.





LEARNING FROM SARS

I was primed though to take this story seriously [by SARS]. I live in Toronto and I covered SARS. I watched what a simple, not very highly transmissible virus did to a modern city with some of the finest healthcare facilities available. A city snugly situated in the developed World.

For four months in the Spring of 2003, SARS turned Toronto on its ear. Hospitals were locked up tighter than a drum. No visitors were allowed in even initially not even to comfort the dying.

In the early stages all non-urgent surgery was cancelled. Cancer biopsies, joint replacements, organ transplants and other important health procedures were delayed, to the anxiety of the affected patients and their families.

We journalists weren't allowed into the hospitals at that point, but by all reports they were in chaos. Health care workers were exhausted and petrified they'd get sick and in fact, a lot of them did. 43% of the cases in our outbreak were healthcare workers, and two nurses and a doctor died.

Healthcare workers were even more frightened that they'd bring the virus home and infect their family and indeed that happened as well.

And some will privately tell you that although they turned up for work, there were others who called in sick. Or who pulled rank so as not to have to treat SARS patients.

In the community, about 20,000 people were put into quarantine for ten days apiece because they'd come in contact with somebody who went on to develop SARS. This is a paramedic [refer to slide], who's doing an interview on the balcony of his apartment.


Eventually the World Health Organisation told people not to go to Toronto and while that angered our political figures mightily it didn't really change very much because the damage had already been done.

At that point tourism in the city had plummeted. Hotels were empty, major conventions were cancelled. Movie shoots moved away. Concerts wouldn't come to Toronto, Billy Joel and Elton John refused to come and play in our city. Theatre shows went dark for a period and some of them closed: The Lion King is no more in Toronto. Restaurants, particularly in Toronto's bustling Chinatown, fell on very hard times. People just hunkered down and stayed home.

And that all of course will happen when a pandemic starts.

Governments may or may not move to close their borders and block international flights in and out of their countries. But as Australia's Health Minister Tony Abbot mentioned recently, "I don't think we'll need to close the borders because people simply won't travel." that will have a huge impact on the Hotel and restaurants industries worldwide and on the people who work in them. And as well on airlines and grounded planes mean grounded goods.

But let's go back to SARS for a second. Severe Acute Respiratory Syndrome was a frightening event in medical history. Don't let anyone tell you otherwise. It sent shockwaves through the economies of Asia and Canada. But for all the panic that was attached to it, there were only really six true outbreaks of SARS in the world, China Vietnam, Thailand- Taiwan excuse me, Singapore and Toronto.

All that fear, all that economic disruption and only six real outbreaks. What will a global outbreak of disease bring?

From my perspective SARS should have taught us a couple of key lessons and the first is that in the modern world, infectious disease travel fast: Jet speed. Pandemic planners tell us we may have up to three months before a pandemic virus hits North America [from the time a pandemic starts?]. I have no idea why they are so optimistic. SARS was rampaging through Toronto's hospitals before it even had a name, before the WHO warned anyone to be on the lookout for the disease.

The second lesson, and this is something that was tragically driven home earlier this month in New Orleans: We are not very well prepared for emergencies.

And the third is that it doesn't really take very much to tip systems over the edge.

In the case of healthcare systems, at least in my country, there's virtually no surge capacity. On any given day, in any given city: most beds are claimed, especially in Acute Intensive Care units. A bad flu season or an outbreak of norovirus can easily swamp emergency rooms around the city.

FATALATIES

How then do we expect them to cope with a crush of patients a pandemic will bring? The hundreds of thousands the mathematical models predict? Don't forget, these numbers are in addition to the load the hospitals are bearing day after day. And they could be very optimistic numbers as Dr. Osterholm's presentation suggests.

One of the most commonly cited mathematical models was devised be a delightfully outspoken health economist at the CDC in Atlanta, Martin Meltzer. He deliberately used conservative figures, attack and fatality rates based on the relatively mild pandemics of 1957 and 1968. Nothing like the carnage of 1918 with the Spanish Flu. He even devised a program called FluSurge, which hospital administrators can use to try to figure out what the demand for care will be in their catchments areas. He says when he runs that program for hospital administrators, they invariably blanch.


And then there are the fatality projections. [refer to slide] You can see lots of them and they are confusing. They are all over the board. The first and the most conservative is the WHO's estimate of 2 to 7.4 million [deaths]. That's extrapolated from Martin Meltzer's model.

The second is the number that's been floated by Dr. Shigeru Omi, director of the WHO's Western Pacific regional organisation. I have never seen anything to indicate how he's come up with this number of 100 million fatalities.

The third is the number that Dr. Osterholm used in his Foreign Affairs piece, 180 million to 360 million potential deaths, and that's looking at the population now versus 1918 and looking at breaking it down into age group and laying the two across.

The final figure which has been used by a few people that I've seen and most recently by Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia. I don't have any idea how that figure was arrived at, though it looks like someone took the worlds population, assumed a 30% per cent attack rate and 50% fatality rate. That's a lot of assuming I think.


At the current time there's really no way to know what the numbers will be, but what is clear is that whatever the number will be it won't be very pretty.

INFRASTRUCTURE TRYING TO COPE

During SARS, doctors came to Toronto from across Canada to help out and they even came from the United States. The same thing happened, as it should have, when Katrina decimated New Orleans. Paramedics from Vancouver drove themselves to Louisiana to pitch in.


In a pandemic, every jurisdiction is going to need every single doctor, nurse, lab technician, orderly and paramedic they can muster. No one is going to be able to rely on the cavalry arriving.


So how are we going to cope when the whole World gets sick in a pattern that could resemble a wave at a sporting event?

How do businesses continue to function, when a third to a half of their workforce calls in sick?

How do crops get harvested?

How do grocery store shelves get stocked?

What does it do to our families, our economies?

[slide I think here]

Sherry Cooper is a very prominent economist in Canada. She works with BMO and Nesbitt burns, a brokerage house. She and a colle
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