Wednesday, December 03, 2008

Pandemic - Not If, But When!

Dr. Susan Puls, a cardiologist, was appointed by the First Presidency of The Church of Jesus Christ of Latter-Day Saints as the head of the church's pandemic committee. She also works with the governor's pandemic committee and the federal pandemic planning agency. She claimed that she was not an expert on pandemics as this was not her specialty but in the two years she's been in her position, she is fast becoming one.
She said a pandemic is coming - not 'maybe' but is DEFINITELY coming. She says the pandemic is expected within the next two years but she personally believes it will be 'sooner than later.' The various groups (CDC, WHO, etc.) do not know what the pandemic will be but 'first' among their lists of suspects is the avian bird flu. It's only one mutation away from being easily transmitted from birds to humans and from human to human.
She also said the World Health Organization expects 40% of the world population to become sick. Of those who become sick, they expect 50% will die. If you do the math - there are over 6 billion people on the earth today - that puts the death rate at over 1.4 billion people - and she says these deaths will happen over only a 3 to 4 month period.
When the pandemic hits the US, mandatory quarantine's of all infected and non-infected peoples will occur within the first 48 hours. Only emergency personnel (Doctors, nurses, firemen, police, national guradsmen, etc.) will be allowed to leave their homes. This quarantine will last the duration of the 'pandemic cycle' which will last approximately three months.
The main point, according to Dr. Puls, is that everyone will need a MINIMUM of 3 months supply of food as the governments of the world will be overwhelmed within the first week and cannot be counted on to provide food, medical help, etc..
Pandemic Influenza
An influenza (flu) pandemic is currently being predicted by experts at the World Health Organization. This website describes pandemic influenza, the risk of it occurring in Canada, what makes it different from the 'ordinary' influenza we get every winter, and what the province is doing to prepare for a possible influenza pandemic.
What is pandemic influenza?
Pandemic influenza is a type of influenza that occurs every few decades and that spreads rapidly to affect most countries and regions around the world.
Key Facts about Pandemic Influenza
· Until the virus is identified it is not possible to make a vaccine.
· Pandemic influenza will spread very rapidly because people will have no immunity.
· Pandemic influenza is likely to be more severe than ordinary influenza.
· Groups at particular risk won't be known until the disease starts to circulate—they may be different from those in ordinary influenza years.
· Antivirals are being stockpiled but they have limitations—their effectiveness won't be known until the virus is circulating.
How does an influenza pandemic start?Influenza viruses are constantly changing, producing new strains and varieties. Pandemics occur when a virus emerges that is so different from previously circulating strains that few, if any, people have any immunity to it. This allows it to spread widely and rapidly, affecting many hundreds of thousands of people. A new pandemic virus may be the result of an animal virus and a human virus mixing to produce a new strain. The animal virus usually comes from birds.
How likely is an influenza pandemic?
Three pandemics occurred in the last century. Scientists predict that another pandemic will happen, although they cannot say exactly when that will be.
The virus
· Unlike the "ordinary" influenza that usually occurs every winter in Canada, pandemic influenza can occur at any time of year.
· There is a difference between a pandemic and an epidemic. A pandemic affects a higher number of people and a much larger geographic region.
· Pandemics of influenza have occurred occasionally for centuries—three times in the last hundred years—resulting in many thousands of deaths.
· Experts predict another pandemic, but cannot say exactly when it will happen. When it does, it may come in two or more waves several months apart. Each wave may last two to three months. · Pandemic influenza is much more serious than ordinary influenza. As much as a quarter of the population may be affected—maybe more.
· Pandemic influenza is likely to cause the same symptoms as an ordinary influenza, but the symptoms may be more severe because nobody will have any immunity or protection against that particular virus.
· A serious pandemic is also likely to cause many deaths, disrupt the daily life of many people and cause intense pressure on health and other services.
· Every pandemic is different. Until the virus starts circulating, it is impossible to predict its full effects.
Who's at risk?
Once an influenza pandemic starts, everybody will be at risk of getting pandemic influenza. Certain groups may be at greater risk than others. Until the virus starts circulating, we will not know for sure who they will be.
Were Tainted Vaccines a Conspiracy to Provoke a Pandemic?Dr. Mercola
March 26 2009
Czech newspapers are questioning whether the shocking discovery of vaccines contaminated with the deadly avian flu virus -- distributed to 18 countries by the American company Baxter -- were part of a conspiracy to provoke a pandemic.
Because of laboratory protocols that are routine for vaccine makers, mixing a live virus biological weapon with vaccine material by accident is virtually impossible.
Baxter flu vaccines contaminated with H5N1 (the human form of avian flu) were received by labs in the Czech Republic, Germany and Slovenia. Initially, Baxter refused to reveal how the vaccines were contaminated with H5N1, invoking “trade secrets.” After increased pressure, they then claimed that pure H5N1 batches were sent by accident.
But in the Czech Republic, reporters are investigating whether the contamination was part of a deliberate attempt to start a pandemic. The fact that Baxter mixed the deadly H5N1 virus with a mix of H3N2 seasonal flu viruses may be the smoking gun. The H5N1 virus on its own has killed hundreds of people, but it is less airborne. However, when combined with seasonal flu viruses, which are more easily spread, the effect could be a potent, airborne, deadly biological weapon. March 5, 2009
Dr. Mercola's Comments:
Last month vaccine maker Baxter International sent a mix of flu vaccine and unlabelled H5N1 virus (the human form of bird flu) to an Austrian research company. Expecting the shipment to contain only flu vaccine, the Austrian company then sent portions of the contaminated product to the Czech Republic, Slovenia and Germany.It was only when researchers at a Czech Republic laboratory injected ferrets with the vaccine, and they unexpectedly died, that the contamination mistake was discovered.But is “mistake” really an accurate term to describe this?If this batch of live bird flu and seasonal flu viruses had reached the public, it could have resulted in dire consequences. Even though H5N1 doesn’t easily infect people, the flu virus does. So if people were exposed to both of these viruses, they would have become hosts for the combined viruses, and would have become highly contagious and able to transmit the deadly bird flu virus to others.There is actually a name for this mixing of viruses; it’s called “reassortment,” and even The Canadian Press has pointed out that it is one of two ways pandemic viruses are created.
Could the Contamination Have Been a Plot to Start a Deadly Pandemic?A spokesman for Baxter said the virus material was supposed to contain a seasonal flu virus and was contaminated after “human error.” Yet, other sources say Baxter International adheres to something called BSL3 (Biosafety Level 3). This strict set of laboratory safety protocols is in place to prevent the cross-contamination of materials, and according to some may have made it virtually impossible for the live bird flu virus to contaminate a flu vaccine by accident.Czech newspapers are among those questioning whether this was a deliberate act to start a pandemic, and there’s even been talk of plans to use the vaccines to carry out a form of population control. But then there’s the issue of motive. Would Baxter have had any reason to carry out such a malicious and deadly scheme? Well, if a bird flu pandemic suddenly broke out, the demand for bird flu vaccines would certainly skyrocket … and the profits from such a mass vaccination program would be astronomical.
Does the Past Give us Any Clues?You may be thinking that such a conspiracy is too far-fetched to be accurate. But it is worth mentioning that some scientists say the most recent global outbreak -- the 1977 Russian flu -- was started by a virus leaked from a laboratory. Further, drug companies are certainly not best known for their sterling moral values. In 2006, for instance, it came out that the drug company Bayer sold millions of dollars worth of an injectable blood-clotting medicine to Asian, Latin American, and some European countries in the mid-1980s, even though they knew it was tainted with the AIDS virus. So while it is unthinkable that a drug company would knowingly contaminate flu vaccines with a deadly bird flu virus, it is certainly not impossible.
How to Prevent All Flu’s, Even the “Deadly Ones,” Without VaccinationsWhether or not the conspiracy theory is true, this whole scenario brings up two very important points:
1. Vaccines can be contaminated with dangerous substances (even above and beyond their already dangerous components)2. Vaccines are not the answer to protecting yourself from flu outbreaks of any kind
Remember back in 2005, when headlines warned that the U.S. was facing a cataclysmic extermination event, with a calculated 2 million Americans succumbing to the bird flu, and the best-case scenario taking only 200,000 lives?The case of “the impending pandemic of the Avian Flu” might as well have been a fictional mini-series, as it never materialized. What was really going on was a scenario filled with greed and political corruption. By igniting fear in the public and massaging some key statistics, the powers-that-be were able to justify the expense of a massive vaccine stockpile to ward off the bird flu.At $100 per dose, the United States used taxpayers’ dollars to purchase some 20 million doses of the highly questionable Tamiflu, lining the pockets of then Defense Secretary Donald Rumsfeld who was president of Gilead Sciences when they created the drug.But I digress. If you want to read more about all the lies and corruption surrounding the avian “super-flu” that never was, read my book The Great Bird Flu Hoax.For now, my point is that there are always going to be threats of flu pandemics, real or created, and there will always be potentially toxic vaccines that are peddled as the solution. But you can break free of that whole drug-solution trap by following some natural health principles.I have not caught the flu in 20 years, and you can avoid it too, without getting vaccinated, by following these simple guidelines, which will keep your immune system in optimal working order so that you’re far less likely to acquire the infection to begin with.
Optimize Your Vitamin D Levels. Getting appropriate amounts of sunshine (or taking a vitamin D supplement when you can’t get healthy amounts of sun exposure) is one of my KEY preventive strategies against the cold and flu, as it has such a strengthening effect on your immune system.
Avoid Sugar and Eat Right for Your Nutritional Type. Sugar decreases the function of your immune system almost immediately, and as you likely know, a strong immune system is key to fighting off viruses and other illness. Be aware that sugar is present in foods you may not suspect, like ketchup and fruit juice.
Get Enough Rest. Just like it becomes harder for you to get your daily tasks done if you're tired, if your body is overly fatigued it will be harder for it to fight the flu.
Deal With Stress. We all face some stress everyday, but if stress becomes overwhelming then your body will be less able to fight off the flu and other illness.If you feel that stress is taking a toll on your health, consider using the Emotional Freedom Technique (EFT), which is remarkably effective in relieving stress associated with all kinds of events, from work to family to trauma.
Exercise. When you exercise, you increase your circulation and your blood flow throughout your body. The components of your immune system are also better circulated, which means your immune system has a better chance of finding an illness before it spreads.
Take a Good Source of Omega-3 Fats Like Krill Oil. Increase your intake of healthy and essential fats like the omega-3 found in krill oil, which is crucial for maintaining health.
Wash Your Hands. Washing your hands with plain soap and water will decrease your likelihood of spreading a virus to your nose, mouth or other people. But don’t overdo it. Washing your hands too much can actually remove much of the protective layer on your skin and increase your changes of acquiring an infection.
Eat Garlic Regularly. Garlic works like a broad-spectrum antibiotic against bacteria, virus, and protozoa in the body. And unlike with antibiotics, no resistance can be built up so it is an absolutely safe product to use.
Related Links:Big Pharma Ties Want to Shut Down Vaccine 'Conspiracy Theories'
Vaccine Studies: Under the Influence of Pharma
How the U.S. Government is Covering Up HPV Vaccine Side Effects
Next pandemic overdue, bird flu a likely candidate
"... in a pandemic, the world will need billions of doses. The surge capacity is just not there ... We are in a race against time where pandemic vaccine production is concerned!"
The Sun, 26 Nov 2005
ASIA PACIFIC SOCIETY for Medical Virology president Prof Emeritus Datuk Dr Lam Sai Kit provides some food for thought on a possible bird flu pandemic. theSun: How do we know a pandemic is looming? What are the signs? How worried should we be? A pandemic or global epidemic, by definition, implies a severe disease which appears on multiple fronts, affecting many countries, with high morbidity, i.e. infecting a large population and high mortality or increased number of deaths. Since influenza historically has been known to cause pandemics (three in the last century) and is a virus known to undergo frequent antigenic changes, it is anticipated that the present avian influenza strains, especially H5N1, are likely to be the candidate for the next pandemic strain. It has been over 30 years since the last pandemic and we are due for another one! The latest data on avian flu affecting humans in several countries in the region with high mortality is therefore a cause for concern. Fortunately, the last criteria before declaring a pandemic has not been met, namely high infectivity in humans globally. This means the virus H5N1 still remains very much species-specific, affecting birds, both domestic and wild types, and there is still little evidence of human-to-human transmission.
It is appropriate to sound the early warning of an impending pandemic since influenza viruses, being RNA viruses, are known to mutate and undergo genetic reassortment to give rise to new strains. One of these genetic changes could lead to a strain that will spread easily among humans. It will be too late to take action once the pandemic starts.
As to being worried or not, it depends on the day-to-day situation through global monitoring. If the situation remains as it is today over the next three to four months (the northern winter months), with very few human cases and deaths, then we can remain hopeful that the pandemic will not take place. Let us remain hopeful but vigilant. However, should a pandemic happen, it will spread much faster than in 1918 during the first flu pandemic because of the speed of travel. We are looking at days instead of months. How do we know that it is the H5N1 virus which will be the cause of the pandemic? Any of the avian influenza strains (H5, H7, H9) which have shown evidence of being capable of infecting humans can pose as a candidate for pandemic flu although the evidence to date points to H5 being the most likely candidate. The high mortality rate due to H5 (over 50% of infected cases die) makes this a much feared candidate compared to other avian strains.
There is no certainty that it will be H5 and this makes it a dilemma for vaccine manufacturers and early preparation and production for a pandemic vaccine.
What if a lot of resources are pumped into preparing this vaccine and then the pandemic is caused by another strain? Vaccine manufacturers are not prepared to take this risk and would rather wait for the pandemic strain to be declared before starting to make the vaccines. Fortunately, the technology is in hand to prepare pandemic vaccines within a few, say six, months. The issue of preparing a pandemic vaccine is not so much the lack of science but economics. Vaccine manufacturers are reluctant to invest in a vaccine for a pandemic which may not occur, or if there is a mismatch of strains.
At the moment, vaccine companies can produce 250-300 million flu shots a year (catering for 5% of global population only) but in a pandemic, the world will need billions of doses. The surge capacity is just not there. In the light of such a shortage, the ethical and moral question arises as to who should be entitled to it at the national level. We are in a race against time where pandemic vaccine production is concerned! Can we prevent a pandemic especially with today's technologies both in surveillance and medical advances? It has been shown over the last few years (since H5N1 was first identified in HK in 1997) that culling of domestic birds has been very successful in preventing spread. This is still an important step to take. It is sad that there are countries which are unwilling to be totally committed to take this measure due to the cost and the lack of money for compensation.
Vaccination of domestic birds using avian bird vaccines (not for human use) has also been recommended under circumstances and preliminary results have shown promise. It is now one of the recommendations of WHO to prevent avian flu spread.
New technologies will make the preparation of pandemic vaccines for human use a reality as shown by the rapidity with which a candidate pandemic vaccine strain became available within four weeks using a new molecular technique known as reverse genetics. This was done by the St Jude Children's Research Hospital in Memphis, Tennessee. Clinical trials on this and other H5 vaccines are ongoing in several countries.
As for surveillance, the use of polymerase chain reaction is the cornerstone for the identification of the flu viruses, whether they are H1, H3, H5 or other bird strains. We cannot assume that a patient with influenza symptoms is having the avian form. Tests must be conducted using PCR or similar technologies to confirm this finding. If the wrong assumption or diagnosis is made, then there will be a hefty price to pay for unnecessary culling.
Medical advances have led to effective antiviral being made available against influenza. Unfortunately, antiviral are rather specific and useful against some strains and not others.
The much touted Tamiflu (oseltamivir) is effective against influenza A viruses and is considered the front line for treatment of avian flu. However, recent reports of genetic changes in avian H5 influenza virus leading to possible resistance to Tamiflu is a cause for concern and require further surveillance a n d study. A recent paper (October 2005) published by the St. Jude Children's Hospital, Memphis, USA, showed that amantadine-resistant variants among avian viruses with potential pandemic potential (H5, H7 and H9 haemagglutinin subtypes) have started surfacing. The antiviral drug amantadine is still effective against H3N2, the current strain of influenza virus (non-avian) but not the avian strain. Tamiflu is the drug of choice for avian flu despite some reports of possible resistance and side effects (behavioral changes and suicidal tendency). Is it worth making a vaccine now? The only way to stop an influenza pandemic has to be through vaccination. We cannot go on culling animals to prevent the spread! However, because of the uncertainty of which strain to use, there is hesitancy in making the pandemic flu vaccine. When the pandemic virus has been identified, it will take several months to get the production going. The problem will be getting enough doses for the whole world. Even with the traditional flu vaccines, there is a problem of producing enough, what more a new vaccine?
Recommendations will have to be drawn up to see how best to make use of this vaccine. In the light of anticipated global shortage by the few commercial companies making them, mainly in developed countries, developing countries are urged to consider producing their own vaccine for national needs. What are the recommended steps in containing the virus? Is it any different from how we contained the Nipah virus? Culling, quarantine measures, changing agricultural practices, preventing contacts between infected birds and humans, surveillance, all these are recommended. Nipah was also a zoonotic disease (common to humans and animals) involving mainly pigs as distinct from avian flu. However, culling was also used to prevent spread. This is an important step in all zoonotic diseases, including mad cow disease. It is certainly an expensive step to take but useful as a stopgap measure. Indonesia says culling would be an economic disaster and so it has stuck to disinfecting potential areas. Would that be adequate? Can disinfectants kill viruses? The main reason why Indonesia is not following strictly international guidelines of culling is because of economics as they cannot afford compensation of culled birds. Disinfection is part and parcel of the fight against this disease. It must be remembered that a lot of virus particles are discharged by infected birds into the environment and disinfection will prevent spread. Certainly disinfection can kill viruses in the farming environment (and also in market places, hence the success in HK in stopping the outbreak). It was also used during the Nipah outbreak. Can the H5N1 virus be killed? How? H5N1, like almost all viruses, are not very stable outside of the host (animal or man). They do not thrive in the environment for very long and most are killed within minutes in the tropical heat. That is why close personal contact with an infected person is the easiest way to spread the germ. Frequent hand washing and improving personal hygiene are important steps to take to avoid catching the flu. We need to increase our awareness about the spread of influenza through educational campaigns.
H5N1 in certain aquatic birds (ducks and wild birds) can spread the virus because they remain symptom free. This is where the danger lies ­ if ducks rather than chickens are infected. What is so great about Tamiflu? What about the side-effects? If every country stockpiles now and the pandemic does not occur, would it be a waste? Tamiflu is the frontline drug in the fight against H5N1 and is very much part of the national plan of preparedness in the face of the pandemic threat. Tamiflu (and the chemically related zanamivir known as Relenza) belong to a class of drugs known as neuraminidase inhibitors. They do not eliminate the virus, but they reduce its release from infected cells by blocking a key viral enzyme. If taken within 48 hours of the onset of symptoms ­ the earlier the better ­ they reduce the duration of symptoms and also limit the severity, such as pneumonia. Side-effects to Tamiflu are generally mild and the drugs have a long shelf-life for at least 10 years without losing their activity.
It is, however, not wise for individuals to stock up on this drug. It is a prescription drug and should not be available over the counter at pharmacies like aspirin. Even if you manage to get a supply of this scarce and expensive drug, do you know when to take it? It is not a vaccine which gives protection for several months. How long can you afford to take this expensive drug? What about the problem of resistance if not taken as prescribed? What about possible side-effects as suggested in two cases in Japan? Tamiflu should be used as part of the national preparedness plan, not by individuals.
Doctors will prescribe it based on clinical needs and risk assessment (person with flu-like symptoms and history of contact with H5 patient or infected birds). Not otherwise. Self-medication is a no-no! What can people do to minimize the effects of a pandemic or avoid being infected by the flu virus? We have heard the WHO recommending various preparedness plans. These plans, which include stockpiling of Tamiflu and building up infrastructure and surge capacity, for example, increasing hospital beds, equipment, etc, are varied, based on national resources but serve as useful guidelines.
However, individuals must also have what I call individual preparedness plans. Do we, as individuals, know what to do when a pandemic is declared? Don't leave it only to the government to fight the pandemic. Every individual should help to reduce the chance of getting infected by this wily virus and thus contribute to reducing morbidity and mortality. We must start thinking about individual preparedness, just in case.
Many lessons were learnt during the SARS outbreak and these lessons must be put to use to prevent ourselves from getting infected with pandemic flu.
During a worse-case scenario of a pandemic, there will be panic and social upheaval and advice will be given not to go to crowded places. We should, therefore, stock up on essentials to reduce trips to markets as soon as a pandemic is declared.
We should have a list ready and it should include a supply of face masks, for example. Any other advice? Stay optimistic! Being the ever optimist, I am hoping that the next pandemic will not occur in the coming winter. Why so? Well, the avian flu virus, although having been around for eight years, has not undergone sufficient genetic changes to make easy human-to-human transmission.
We are still reporting individual cases and deaths, one here, one there. To date, there have been only about 120 human cases with over 60 deaths. If this trend persists, then it is not likely that we will face a pandemic in the next few months.
Moreover, every case with rare exceptions can be traced to contact with infected chickens or other domestic birds, indicating that it is still very much an animal-human transmission. This will not lead to a pandemic.
Let us hope it stays that way, thus giving the world a window of opportunity to be better prepared when the pandemic really hits us. By then we should have better capacity to tackle the pandemic, including the production of new vaccines and antivirals.
The virus has not changed sufficiently to become resistant to Tamiflu. With the stockpiling of the drug, nationally, regionally and globally, it is hoped that enough will be made available to treat cases at source (no matter which country and whether affordable or not) and thus stop the virus in its tracks.
Delaying the onset of a pandemic will allow better supply of this precious commodity. It is a hopeful sign when global partners are talking about sharing resources, including Tamiflu stockpile, to stop the outbreak at source to prevent a pandemic from taking place.
Lessons from previous avian flu outbreaks, especially the successful control in Hong Kong in 1997, and lessons from SARS, will be harnessed and used to control the spread (of the disease).
China reports two more bird flu outbreaks
By David Ljunggren and Randall Palmer
The Star, 29 Nov 2005
BEIJING (Reuters) - China has confirmed two new outbreaks of the deadly H5N1 strain of bird flu in poultry in the northwestern region of Xinjiang and in central Hunan province.
China has culled more than 20 million birds this year to contain the spread of avian influenza and has reported 24 outbreaks since mid-October in nine regions and provinces from the far southwest to the frigid northeast.
Three people have been confirmed infected with the H5N1 avian flu virus, two of whom have died.
A dead chicken lies in a coop in Shanghai in this November 18, 2005 file photo. (REUTERS/Aly Song)
The Ministry of Agriculture said on its Web site that 288 birds that died last week in Shanshan country in Xinjiang and 402 poultry that died in Yongzhou earlier this month were confirmed to have H5N1.
The two provinces had earlier outbreaks of bird flu.
Local veterinary departments have culled more than 65,000 poultry within three kilometres (two miles) of the affected areas, it said.
The virus is known to have infected 133 people in Asia since late 2003, killing 68 of them. It remains hard for people to catch but the fear is that it could mutate into a form that could be passed easily from person to person, sparking a global pandemic in which millions could die.
A team from the World Health Organisation began an investigation on Monday into two human bird flu cases in China's eastern province of Anhui, Xinhua news agency reported.
The WHO team, along with officials from China's Health Ministry and its Centre for Disease Control and Prevention, will spend three days in the Anhui counties of Xiuning and Zongyang, where two female poultry workers fell ill and died of bird flu earlier this month.
China has had one other confirmed human case, in a nine-year-old boy who survived infection, while his dead sister is a suspected case.
Lab tests from China's human bird flu cases show the virus has mutated into a form different from that found in human cases in Vietnam, the official Xinhua news agency reported, quoting Ministry of Health spokesman Mao Qun'an.
Mao said the virus has mutated "to a certain degree" but added that it was not in a form that could pass easily from person to person.
Man dies of bird flu in Vietnam
A man has died of bird flu in Vietnam, in the first confirmed human death from the virus there since 2005, health officials said.
The 20-year-old died in the northern Ha Tay province, state media reported.
Bird flu has killed 43 people in Vietnam and officials have warned of more human cases as the virus spreads rapidly in poultry in many provinces.
None of the country's five recent human bird flu cases has been confirmed by the World Health Organization (WHO).
Two have recovered and two are receiving treatment, Vietnamese authorities say.
Pandemic fears
The 20-year-old - the fifth case - died of the H5N1 strain of the virus on 10 June, state-run Vietnam News Agency quoted Vice Health Minister Trinh Quan Huan as saying.
He became ill on 2 June and died two days after being admitted to the National Contagious and Tropical Diseases Hospital in the capital, Hanoi.
His family raised fighting cocks and ducks, state media said.
In May, Vietnam announced its first human case of the deadly H5N1 virus after containing a previous outbreak since November 2005.
The H5N1 strain has killed more than 190 people since 2003, according to WHO figures. Indonesia has been hardest hit, with 80 deaths.
Scientists fear the virus could mutate to a form which could be easily passed from human to human, triggering a pandemic.
Millions to be mobilized
NST, 29 Nov 2005
JAKARTA, Mon. --- Indonesian President Susilo Bambang Yudhoyono today said his country was preparing a nationwide bird flu monitoring system that would involve millions of people at village level.
“We are currently looking at a concept for preventive steps for the entire archipelago, that is, ‘Village Preparedness’”, Susilo said after talks with health and agriculture ministers.
Under the scheme, at least five personnel in each village would monitor any case of bird flu among birds and humans “so that reporting can be done speedily”, the president said.
The scheme would also see doctors trained to handle bird flu cases.
Indonesia is home to more than 400,000 villages.
“We hope that ‘Village Preparedness’ can be implemented within one month. The sooner, the better. We are seriously handling this so that our country can be safe from bird flu”, he said.
Indonesia’s Government was accused of covering up initial outbreaks of bird flu and has been repeatedly warned that it must take quick action to stem the spread of the virus.
Seven fatalities from the H5N1 strain of avian influenza have been confirmed as carrying the virus but have either recovered or are still receiving treatment.
Susilo said in order for the scheme to proceed well, the participation of the entire nation was needed “as well as the tenacity of all heads of the regions”.
He said in some regions, efforts to prevent the spread of the bird flu had not been serious enough and he warned regional heads to improve their response in the next two to three days or be personally reprimanded by him.
Indonesia has obtained permission to produce anti-bird flu vaccines for birds and the Government had appointed the state-run Biopharma to churn them out.
Indonesia said on Saturday it would produce 220-million Tamiflu tablets, the drug deemed most effective to respond to a bird flu pandemic.
Susilo said two million tablets would still be imported ahead of manufacturing beginning here.
Indonesia last weeks pledged a year-long fight against the virus. --- AFP.
Bird Flu Reaches Africa
Brian Handwerkfor
February 9, 2006
The deadly H5N1 strain of bird flu has reached a newcontinent—Africa. Migrating birds or the poultry trade may be to blame, experts say.
Yesterday Nigerian authorities informed world health officials of an outbreak at a large commercial farm in the northern state of Kaduna. Tens of thousands of caged birds died on the site. A laboratory in Padova, Italy, has confirmed the presence of the H5N1 strain in a dead bird from the facility.
No confirmed cases of human infection have been reported in Nigeria.
Nigerian officials have culled thousands of birds, enacted farm quarantines, and curbed poultry shipping in attempts to check the outbreak.
"The federal government is doing everything to contain the disease within the three centers that have been located," Tope Ajakaiye, a Nigerian Agriculture Ministry spokesman said in a prepared statement.
International experts are also in Nigeria to assess the situation and assist local authorities.
"[UN] Food and Agriculture Organization inspectors are already in Kaduna, Kano and Jos," a World Health Organization (WHO) official told Reuters news service in the Nigerian capital of Abuja.
"They want to trace people who have had contact with sick chickens and send out simple messages that there should be no human-bird contact," she added.
The WHO reports that the virulent strain has been responsible for 166 human infections and 88 deaths in seven countries since 2003.
Africa Ill-Equipped to Battle Outbreak
The disease's impact could be significant in a nation that's home to perhaps 140 million domesticated birds.
As in Asia, many of those birds are kept in free-range backyard farms as sources of income and food.
The birds live in close proximity to humans and freely interact with wild birds, which can carry the disease.
So far authorities believe that bird flu's human victims have acquired the disease from infected birds, rather than from human-to-human transmission.
If H5N1, or another bird flu strain, acquires the ability to pass easily from person to person, a devastating global pandemic could be imminent, experts warn.
In much of Africa the disease surveillance and monitoring that are key to coping with bird flu are inadequate. Birds often die of poor nutrition and illness, raising the possibility that outbreaks might be missed.
"I hope that this outbreak raises the issue of the benefit of a worldwide surveillance network for emerging disease [in] wildlife so that we can have early warning for H5N1 and other diseases," said Hon Ip, diagnostic virologist at the U.S. Geological Survey's National Wildlife Health Center in Madison, Wisconsin.
Economics present another challenge. Many African nations lack the funds to adequately compensate farmers, who may resist the killing of their valuable birds.
Migrating Birds or Humans to Blame?
Bird flu has been spreading steadily westward from its East Asian source. In recent weeks it has been responsible for human deaths in Turkey and Iraq.
Experts aren't certain how the virus reached Africa.
"We don't know how it got there," said Juan Lubroth, a Rome-based senior animal health officer with the UN Food and Agriculture Organization (FAO).
"There may be some points we're missing along the way, where the infection was present and not detected, so we don't have all the dots to connect."
Preliminary genetic sequencing information indicates that the strain is of Asian lineage, similar to that which recently spread into Turkey.
Officials were not shocked at the deadly flu's appearance in Africa. In October the FAO announced that the virus would likely reach Africa in the near future, citing migrating birds that would soon be moving from breeding grounds in Asia to their winter habitat in Africa. (Read "Bird Flu's Spread to Africa Could Be Imminent, UN Warns.")
Migrating birds are prime suspects in the African appearance of bird flu, but their role remains uncertain.
If they transmitted the disease, Ip wonders, why weren't outbreaks seen earlier in the season? Why weren't they detected along the migration route such as on Africa's Mediterranean coast? "Countries in Africa are significant importers of poultry products from Southeast Asia," Ip said."
Borders are also relatively porous in many areas. There are many possible routes—including other domestic birds at the farm and legal and illegal trade—[by which] the H5N1 virus could have arrived in Jaji [Nigeria] in addition to introduction by wild birds.
"The location of the outbreak is the only argument for migratory birds as the cause of the spread. I would suggest that these other mechanisms are at least as likely.
" The FAO's Lubroth agrees that wild birds may not be responsible—or may have been responsible but received significant human help.
"There are other ways diseases move around the world," he said. "It could be that wildlife introduced the virus, but through our own activities of commerce, the disease spread."
Human Pandemic More Likely?
Today the African appearance of H5N1 doesn't appear to have moved the world closer to a human pandemic.
Preliminary genetic work suggests that the African strain has not mutated into a form more lethal to humans than that seen so far in Asia."At the moment the concern is that here is another example of a long-distance geographical spread," Ip said.
"Whether it is by wild birds or human activity is unclear, but the concern is that the world does not appear to be able to stop the advance of the virus."
Full genetic information about the Nigerian virus strain should be available later in the week, which will allow scientists to compare the strain with those that have caused human infections in other countries.
The data should paint a clearer picture of the current risk to African humans, but Lubroth stresses that even without large-scale human infection, the outbreak is already a disaster. "We're still talking about people's livelihoods that depend on poultry and also a critical food source," he said. "So for us it's still an emergency. We're in emergency mode."
Thailand bird flu outbreak
Tue Nov 11, 2008 3:05pm
ISTBANGKOK (Reuters) - Thailand has culled more than 200 chickens after detecting the H5N1 bird flu virus in a rural area more than 400 kms (250 miles) north of Bangkok, the Agriculture Ministry said on Tuesday.
Tests confirmed the country's first outbreak in 10 months near the ancient capital of Sukhothai, where villagers had found several dead chickens.
"Lab tests showed that the chickens died of the deadly H5N1 virus and we have killed all chickens in the area," Agriculture Minister Somsak Prisnanantakul told reporters.
"We are confident that everything is under control," he added.
The highly pathogenic virus was last found in Thailand in late January in the northern provinces of Nakhon Sawan and Phichit, where thousands of birds were culled.
There were four outbreaks in Thailand last year, but no new reports of human infections in the country where H5N1 has killed 17 people since 2003.
The virus has killed 245 people out of 387 infected people so far, according to the World Health Organisation, and is endemic in poultry in parts of Asia.Bird flu remains an animal disease but scientists fear the H5N1 virus could mutate into a form that could spread easily among humans and kill millions of people.
Japan announces plan to cope with birdflu outbreak
The Star, 15 Nov 2005
TOKYO (Reuters) - Japan on Monday announced plans to cope with a possible outbreak of bird flu among humans, which include declaring a state of emergency, shutting down schools and banning large gatherings.
The action plan unveiled by the Health Ministry, which also set up a headquarters to deal with the issue, estimates that as much as a quarter of Japan's 127 million people could be infected and up to 640,000 could die.
The H5N1 bird flu virus cannot move easily between people, but experts fear it could mutate into one that can, setting off a pandemic that causes millions of deaths worldwide.
The plan would allow the health minister to declare a state of emergency once the disease had spread within Japan, a situation that would then allow authorities to close schools and forcibly hospitalize people who have been infected.
The ministry estimates that between 170,000 to 640,000 people could die from the disease and between 530,000 and 2 million could be put in hospital.
The plan is divided into six phases ranging from ordinary influenza to a worldwide pandemic, with the current situation -- transmission from birds to humans -- at phase three.
Japan will aim to increase its stockpile of the anti-flu drug Tamiflu to enough for 25 million people to be treated over five days rather than three days under a previous target.
Ministry officials said they hoped to carry this out by the end of the 2006 fiscal year on March 31, 2007, adding that while no budget has yet been assigned to cover the costs, they expected one would be.
Japan's Chugai Pharmaceutical Co. said on Monday it has reported to the government that two teenage boys exhibited abnormal behavior that led
to their deaths after taking Tamiflu, made by Chugai's Swiss parent Roche Holding AG.
The comments came in response to weekend news reports that Japan's health ministry was investigating the deaths of two teenage boys who died in accidents linked to odd behavior shortly after taking the drug.
Health ministry officials were not immediately available for comment.
A separate report issued on Monday by Dai-Ichi Life Research Institute Inc. said a birdflu outbreak lasting a year could reduce Japan's nominal gross domestic product by 1.4 trillion yen ($11.9 billion) or 0.27 percent.
The H5N1 bird flu virus is known to have infected 125 people in Asia, of whom 64 have died.
India reports outbreak of bird flu in northeastNovember 29, 2008 10:15 am TWN, Reuters
GUWAHATI, India -- Authorities in India’s northeastern state of Assam have ordered culling thousands of chicken and ducks after a fresh outbreak of bird flu in poultry was detected late on Thursday, a senior official said.
“We were informed that the samples sent to laboratories in Bhopal and Pune have been tested positive. So we have ordered for culling in the area, which will start today,” R. C. Jain, a senior state government official said on Friday.
“It is H5N1 stain,” he said in Guwahati, the region’s biggest city.
More than 30,000 chickens and ducks would be slaughtered in next three days in 20 villages, after one of them was hit by bird flu, officials said. Authorities started to worry about a new outbreak after hundreds of poultry died in Rajabazar village, just 35 km (21 miles) west of Guwahati.
Romania confirms H5N1 virus in Danube delta poultry
The Star, 22 Nov 2005
BUCHAREST (Reuters) - Romania's agriculture ministry said on Monday that laboratory tests in Britain had confirmed the deadly H5N1 virus in poultry found dead last week in a Danube delta village.
"Regarding the samples in Caraorman, the laboratory in London confirmed it was the highly pathogenic H5N1 virus," the ministry said on its website.
Romania said on Nov. 14 that four new cases of avian flu in domestic birds had been discovered in Caraorman. It said the village, which has no road access, would be quarantined and 2,000 domestic birds would be slaughtered.
The Balkan state last month became the first country in mainland Europe to detect the deadly H5N1 virus in poultry in two villages in the Danube
delta, Europe's largest wetlands near the Black Sea.
The H5N1 strain has killed more than 60 people in Asia since 2003 and led to the slaughter of millions of domestic birds. Scientists fear the virus might mutate into a form that could be easily transmitted between humans.
Kuwait says it finds first bird flu cases in Gulf
The Star, 11 Nov 2005
KUWAIT (Reuters) - Kuwait has found two cases of bird flu, the first in the Gulf Arab region, and has culled the diseased birds, an official said on Thursday.
It was not immediately clear if the birds had the H5N1 strain of the virus, which can be lethal for humans.
"The expertise of our authorities has prevented two incidents (of bird flu) in Kuwait," Sheikh Fahd al-Salem al Sabah, head of the public authority for agricultural affairs (PAAAFR), said.
A source at the authority said the birds came from outside Kuwait and had been culled.
Sheikh Fahd told reporters: "The problem was dealt with immediately and it was not allowed to spread."

Global impact of bird flu
BBC News:
The lethal avian-flu virus that has affected so much of the globe continues to kill birds and humans alike.
But while the deadly H5N1 strain has hit more than 60 countries in less than five years, there are signs that the epidemic has peaked, at least for now.
Millions of birds have died or been destroyed as a result of outbreaks as far apart as northern Europe and the Far East.
And the number of cases among humans has also continued to rise since the strain emerged in South-East Asia in 2003 before spreading to Europe and Africa.
But provisional data for the first half of 2008 appear to confirm the rate is continuing to tail off after hitting a peak in the corresponding period in 2006.
By the mid-point of 2008 a total of 15 countries had suffered human cases, with Burma, Pakistan and Bangladesh added to the list since the previous autumn.
Although the number of new human cases fell in 2007 to its lowest annual total for three years, the mortality rate continued to rise, topping 60% by the end of the year - a trend that continued in the first half of 2008.
There were 37 human cases of bird flu confirmed between January and the end of June - the lowest total for the corresponding period since 2004, when the current outbreak first established itself.
The number of human deaths during that time was the lowest since 2005, as was the number of new outbreaks among birds.
The Food and Agriculture Organization of the UN declared in an article in June 2008 that "the peak of the crisis" was over, but that the fight against the disease was not.
The 300th human case was confirmed in spring 2007 and the 200th death occurred in the September.
In June of the same year Indonesia became the first country to have 100 confirmed cases of H5N1 among humans - a figure that has continued to grow.
The first human deaths from H5N1 outside Asia, in January 2006, heightened concern about the spread of the disease, but the World Health Organization pointed out that the deaths, in Turkey, were among people who had been in close contact with infected birds, and were not passed from human to human.
And although a cluster of deaths in Indonesia that year sparked renewed fears about transmission between humans, the WHO maintained there was no evidence of sustained spread from person to person, and scientists do not believe it is mutating into a version that spreads more easily among humans.
The main concern is that each new human case increases the chances of the feared "human" mutation.
Bye Bye Tweetie Pie as Shanghai stops songbird sales
Lucy Hornby
The Star, 29 Nov 2005
SHANGHAI (Reuters) - A chirpy corner of Shanghai will fall silent this week after the city government bans the sale of pet birds as a precaution against bird flu.
But the parakeets and brown songbirds in the bamboo cages lining the city's Flower, Bird, Fish and Insect market will be spared for the moment, since the government's ban on selling birds from Dec. 1 does not require them to be culled as long as China's commercial hub remains bird-flu free.
"We'll all contribute to keep them somewhere until bird flu passes," said a woman, knitting a sweater in front of a row of tidy red-billed Leiothrix, known in Chinese as "pining love" birds.
The market is a cacophony of bird calls, puppies barking and the whirr of crickets. Smoke curls toward the plastic roof as gamblers cluster around a cricket fight.
Bird sellers said sales had fallen due to fears of bird flu.
Recently, no new bird shipments have come to Shanghai from the southwestern province of Sichuan --
the main source of the birds -- due to bird flu precautions, and sales are below their normal level of at least 20 birds a month from the bigger stalls.
But the sellers were unconcerned about the health of their own birds, which sell for nearly 100 yuan ($12) each.
"The disease came from other countries and was brought by migratory birds, but mine are never loose," said the woman knitting the sweater, adding "you can use my opinions but not my name".
"If they were loose, or around chickens, they might get it but mine are always in their cages."
Experts fear the H5N1 virus, which causes bird flu, could mutate into a form that could spread easily among humans. The virus has killed nearly 70 people in Asia since late 2003, though it remains hard for humans to catch.
China has culled more than 20 million birds and reported 24 outbreaks since mid-October, while two of the three people confirmed to have caught the disease have died.
Chinese retirees, who often take pet birds for morning walks in covered cages, are being more cautious, sellers said.
"People's birds are really precious to them so they don't take them out for air any more or buy any new ones, because they don't want their birds to catch bird flu," said an aproned woman selling bird feed.
At another stall selling silkworms, a man clipped the end of a cocoon, squeezed out the caterpillar and flipped it into a wooden tray marked 40 yuan a pound. Silkworm sales are still strong, he said.
"Shanghai doesn't have bird flu yet. As long as it doesn't crop up here, we're good," he said, dragging on a cigarette.
"But if it does, it's all over, because then people will have to kill their birds at home too."
OTTAWA, June 6, 2008 – The Government of Canada is committed to protecting the health of Canada's domestic poultry flocks from avian influenza (AI) viruses. That is why this Government is enhancing its AI surveillance for commercial poultry flocks in Canada.
This program is one of a number of domestic and international initiatives that have been implemented to prevent, detect and eliminate the presence of harmful AI viruses in Canada's domestic poultry flock. The expanded program was developed in collaboration with provincial and territorial governments, poultry farmers and other industry representatives.
The enhanced Canadian Notifiable Avian Influenza Surveillance System (CanNAISS) has been designed to meet current guidelines from the World Organization for Animal Health (OIE) and new requirements from the European Union that take effect in January 2009. The system will provide information about NAI viruses in Canada's domestic poultry flocks that will be required for Canadian poultry farmers and processors to continue doing business internationally.
While most AI viruses pose little or no animal health risk, two subtypes, known as H5 and H7, may lead to serious illness in birds. CanNAISS testing will identify poultry farms where these viruses may be present and enable the Canadian Food Inspection Agency (CFIA) and farmers to control potential disease spread.
More information about CanNAISS will be made available on the CFIA Web site as the implementation details are finalized.
Is a Flu Pandemic Imminent? (Part 1 of 3)By Greg Ciola
December 31, 2008
Every year when flu season rolls around the public is barraged with news stories about the reasons to get a flu shot. This year is no different. From coast to coast the headlines are blaring “Get Your Shot!” Within the past few months the CDC even lowered the recommended age for the flu shot to children as young as six months old. Basically, that means they think that just about everyone in the country should get the shot except for newborns in order to stay well.
I have been trying to counter the propaganda regarding the flu shot for a number of years and for a number of reasons. Here are a few of them.
1. The flu shot contains toxic agents that could be harmful to your health. The shot could contain aluminum, formaldehyde, thimerosal (mercury), ethylene glycol, polysorbate 80, antibiotics and other adjuvants. Ask for the package insert on the shot for more details or do some research on the Internet. None of these compounds are 100% safe to inject into your body, even in the smallest of amounts. A slew of research points to them being serious culprits in a number of health challenges, including permanent disabilities and death. An excellent source where you can learn more about all vaccines and download the package inserts is
2. The flu shot does not guarantee immunity. There is no evidence that the flu shot actually works. Pharmaceutical companies play a guessing game each year to try and determine which viral strain or strains will be circulating during flu season and that’s what they’ll put in the shot. The problem is viruses can mutate and change forms very easily so trying to guess which virus to protect against is analogous to a Vegas Craps shoot. Every year in recent memory, including the 2007-08 flu season, they have vaccinated against strains that have been proven to not be the culprit. According to a story written by Sheryl Walters for, “In 2004, The National Vaccine Information Center reported that the vaccine given that year did not contain the flu strain that caused the majority of flu outbreaks that year. A study published in the Lancet in August revealed that there was no correlation between the flu shot and reduced risk of pneumonia. Further, a large study of 260,000 children between 23 month and 6 discovered that the flu vaccine is no more effective than a placebo. This was reported in the Cochrane Database of Systematic Reviews.”
According to the CDC’s own data, preventing influenza with the shot in the past has only ranged between 30-40%. That means that 60-70% of those who have taken the shot in previous flu seasons were not protected from the flu at all. This flu season (2008-09), the CDC is making bold claims that the shot will be 70-90% effective. This is being stated before flu season really kicks into high gear, and it is being stated after last year’s shot was proven to miss the mark. Sadly, the failure rate is never given. Most in society have been conditioned to believe that if you get a flu shot you’re protected. 3. The flu shot helps spread the flu. The shot contains something called attenuated virus. Attenuated basically means half-killed. The shot has to evoke an immune response and therefore has to have some form of viral activity to it to stimulate that immune response. The theory is to give you a tiny dose of the flu so your body will build immunity to it. Anyone who thinks that they are not contagious after getting a flu shot is woefully mistaken. Most of the package inserts will even tell you that you may exhibit mild flu symptoms for a few days after getting a shot. There are also a percentage of people who receive the shot and get very sick. If you don’t want to get the flu one way to avoid it is to stay away from people who get the shot for at least two weeks.
While these are just a few of the many reasons to question the flu shot, I feel that all of the potential risks and dangers need to be called into question on a much bigger scale than they have thus far because the entire planet may be mandated to get pre-screened and vaccinated in the near future to combat a pandemic.
The CDC has been warning the world of a flu pandemic for years and have intensified their warnings and preparations even more so this year. The World Health Organization (WHO) recently stated that they believe the world is now closer to another influenza pandemic than any time since the last outbreak in 1968. I’m sure you’re familiar with the standard line that’s continuously parroted; “It’s not a matter of if, but when.” A simple Google search on the Internet will lead you to an endless number of stories regarding the preparations taking place to combat a flu pandemic. Just about every city, county and state government in the country is actively working on pandemic preparations. The CDC has been giving grant money to various state health departments to help them prepare for a pandemic. Most hospitals and health care workers have either run exercises on preparing for a pandemic or have received detailed training. Most front line emergency personnel have received pandemic training. The military has been running exercises on dealing with a pandemic.
The one common theme that exists in all this news is that the flu shot will protect you. An example of this absurdity comes from an October 1, 2008 story appearing on the website “Officials with the Centers for Disease Control and Prevention are once again recommending a flu shot for almost everyone. Despite the recommendations every year to get a flu shot, most of those who really need the vaccination fail to get it. The CDC is trying to avoid a potential pandemic and the only way to do that is to get a flu shot.”
Further pandemic preparations include the FDA’s approval of a new CDC test to detect the flu through a scanner. Here’s a clip of the story from the CDC’s website:“The Food and Drug Administration (FDA) today cleared a new test developed by the U.S. Centers for Disease Control and Prevention (CDC) to diagnose human influenza infections and the highly pathogenic influenza A (H5N1) viruses. The device, called the Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel (rRT-PCR Flu Panel), uses a molecular biology technique to detect flu virus and differentiate between seasonal and novel influenza.
The device is used to isolate and amplify viral genetic material present in secretions taken from a patient's nose or throat. The viral genetic material is labeled with fluorescent molecules, which are then detected and analyzed by a diagnostic instrument called the Applied Biosystems 7500 Fast Dx, also cleared today by the FDA for diagnostic use simultaneously with the CDC's rRT-PCR Flu Panel. The test panel and diagnostic system can detect and identify commonly circulating human influenza viruses as well as influenza A (H5N1) viruses. Results can be available within four hours and the system can test multiple samples at once.”
How this new testing equipment will be implemented on a wide scale remains to be seen but we can expect to see it popping up all over the place very soon. The reality is there may very well be a flu pandemic upon the horizon. Many ominous signs seem to point to the possibility of one. Whether or not it’s this year, the likelihood of a pandemic in the near future is almost certain because the CDC and the pharmaceutical industry have repeatedly told us one is inevitable. The fact that they have been actively coordinating their efforts with the World Health Organization, the U.N. and virtually every international health department and agency in the world is a strong indication that they are privy to some inside information that we aren’t.
There’s a reason why FEMA has an estimated half a million plastic coffins sitting in an open field in Georgia. There are similar reports surfacing in other parts of the country as well about large quantities of plastic coffins to dispose of dead bodies. There are pictures and video clips of these posted on the Internet. The federal government has been actively preparing for a mass casualty event in this country for a long time – even before 911.
See FEMA Coffins here: video 1, video 2, and video 3
In my opinion, a flu pandemic is a perfect cover for some sort of clandestine operation. Think about it for a moment; who is going to get blamed for a flu pandemic? Nobody! A pandemic would be blamed on natural causes or an act of God. However, it could provide the necessary justification to issue a national emergency, implement martial law and turn American sovereignty over to the hands of an international body like the U.N., similar to how we are being told that the economic crisis we’re in needs to be resolved on a global level through international organizations like the IMF and World Bank.
I also have strong reasons to believe based on the evidence I have seen that if there is a pandemic, the flu shot will play some kind of role in either causing it or spreading it. That’s right! The very shot we are all being told we need to avoid the flu may very well be a major culprit.
I don’t think anyone knows for sure what effect the flu shot can have on the body’s DNA or immune system and the long term damage it may cause, except perhaps some demented geneticist working under the cover of protection in a black ops project. No one knows for certain when you start tinkering with viruses through genetic engineering that there won’t be unpredictable consequences. In fact, if you look at what’s in this year’s flu shot from the CDC’s own website, after each listing it says “like virus”. That means it was created through genetic engineering. There is such a mad rush to produce vaccines to fight the flu that health authorities are willing to throw caution to the wind as far as safety studies.
See CDC website link regarding the viruses in this year's shot:
All anyone needs to do is look at the damaging consequences various aspects of genetic engineering have had with crop production or in the farming community with animals that became sterile, and in the food chain where people had serious allergic reactions to recombinant bacteria to understand that there are definitely risks inherent with all shots, but especially those that are produced through genetic engineering. Do any of you recall StarLink corn that happened to make its way into the food chain? How about Monsanto’s rBST hormone used to increase milk production?
Also See:
Is a Flu Pandemic Imminent?
Pandemic Planning Site
Most of our lives are a combination of work, family and community involvement. A pandemic can affect all of these areas. Pandemics happen when a new kind of virus spreads easily from person to person throughout the world.
Planning for a pandemic is essential. Being informed and knowing what to do will help minimize the impact in our daily lives, work, and activities
Browse the Pandemic Planning site for helpful documents and tools. Use the Links section to find out more information on various aspects of this situation.

A sneeze can be deadly!
The Influenza Pandemic of 1918
The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster.
In the fall of 1918 the Great War in Europe was winding down and peace was on the horizon. The Americans had joined in the fight, bringing the Allies closer to victory against the Germans. Deep within the trenches these men lived through some of the most brutal conditions of life, which it seemed could not be any worse. Then, in pockets across the globe, something erupted that seemed as benign as the common cold. The influenza of that season, however, was far more than a cold. In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children. It infected 28% of all Americans (Tice). An estimated 675,000 Americans died of influenza during the pandemic, ten times as many as in the world war. Of the U.S. soldiers who died in Europe, half of them fell to the influenza virus and not to the enemy (Deseret News). An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby). 1918 would go down as unforgettable year of suffering and death and yet of peace. As noted in the Journal of the American Medical Association final edition of 1918:
"The 1918 has gone: a year momentous as the termination of the most cruel war in the annals of the human race; a year which marked, the end at least for a time, of man's destruction of man; unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings. Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there. Now it must turn with its whole might to combating the greatest enemy of all--infectious disease," (12/28/1918).
The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza. In 1918 children would skip rope to the rhyme (Crawford):
I had a little bird,
Its name was Enza.
I opened the window,
And in-flu-enza.
The influenza pandemic circled the globe. Most of humanity felt the effects of this strain of the influenza virus. It spread following the path of its human carriers, along trade routes and shipping lines. Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific (Taubenberger). In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people (Brown). The Great War, with its mass movements of men in armies and aboard ships, probably aided in its rapid diffusion and attack. The origins of the deadly flu disease were unknown but widely speculated upon. Some of the allies thought of the epidemic as a biological warfare tool of the Germans. Many thought it was a result of the trench warfare, the use of mustard gases and the generated "smoke and fumes" of the war. A national campaign began using the ready rhetoric of war to fight the new enemy of microscopic proportions. A study attempted to reason why the disease had been so devastating in certain localized regions, looking at the climate, the weather and the racial composition of cities. They found humidity to be linked with more severe epidemics as it "fosters the dissemination of the bacteria," (Committee on Atmosphere and Man, 1923). Meanwhile the new sciences of the infectious agents and immunology were racing to come up with a vaccine or therapy to stop the epidemics.
The experiences of people in military camps encountering the influenza pandemic:
An excerpt for the memoirs of a survivor at Camp Funston of the pandemic Survivor
A letter to a fellow physician describing conditions during the influenza epidemic at Camp Devens
A collection of letters of a soldier stationed in Camp Funston Soldier
The origins of this influenza variant is not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a dead soldier and is now being genetically characterized. The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/1918) where it allegedly killed 8 million in May (BMJ, 7/13/1918). However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US. Few noticed the epidemic in the midst of the war. Wilson had just given his 14 point address. There was virtually no response or acknowledgment to the epidemics in March and April in the military camps. It was unfortunate that no steps were taken to prepare for the usual recrudescence of the virulent influenza strain in the winter. The lack of action was later criticized when the epidemic could not be ignored in the winter of 1918 (BMJ, 1918). These first epidemics at training camps were a sign of what was coming in greater magnitude in the fall and winter of 1918 to the entire world.
The war brought the virus back into the US for the second wave of the epidemic. It first arrived in Boston in September of 1918 through the port busy with war shipments of machinery and supplies. The war also enabled the virus to spread and diffuse. Men across the nation were mobilizing to join the military and the cause. As they came together, they brought the virus with them and to those they contacted. The virus killed almost 200,00 in October of 1918 alone. In November 11 of 1918 the end of the war enabled a resurgence. As people celebrated Armistice Day with parades and large partiess, a complete disaster from the public health standpoint, a rebirth of the epidemic occurred in some cities. The flu that winter was beyond imagination as millions were infected and thousands died. Just as the war had effected the course of influenza, influenza affected the war. Entire fleets were ill with the disease and men on the front were too sick to fight. The flu was devastating to both sides, killing more men than their own weapons could.
With the military patients coming home from the war with battle wounds and mustard gas burns, hospital facilities and staff were taxed to the limit. This created a shortage of physicians, especially in the civilian sector as many had been lost for service with the military. Since the medical practitioners were away with the troops, only the medical students were left to care for the sick. Third and forth year classes were closed and the students assigned jobs as interns or nurses (Starr,1976). One article noted that "depletion has been carried to such an extent that the practitioners are brought very near the breaking point," (BMJ, 11/2/1918). The shortage was further confounded by the added loss of physicians to the epidemic. In the U.S., the Red Cross had to recruit more volunteers to contribute to the new cause at home of fighting the influenza epidemic. To respond with the fullest utilization of nurses, volunteers and medical supplies, the Red Cross created a National Committee on Influenza. It was involved in both military and civilian sectors to mobilize all forces to fight Spanish influenza (Crosby, 1989). In some areas of the US, the nursing shortage was so acute that the Red Cross had to ask local businesses to allow workers to have the day off if they volunteer in the hospitals at night (Deseret News). Emergency hospitals were created to take in the patients from the US and those arriving sick from overseas.
The pandemic affected everyone. With one-quarter of the US and one-fifth of the world infected with the influenza, it was impossible to escape from the illness. Even President Woodrow Wilson suffered from the flu in early 1919 while negotiating the crucial treaty of Versailles to end the World War (Tice). Those who were lucky enough to avoid infection had to deal with the public health ordinances to restrain the spread of the disease. The public health departments distributed gauze masks to be worn in public. Stores could not hold sales, funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines enforced by extra officers (Deseret News). Bodies pilled up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers (Knox). The conditions in 1918 were not so far removed from the Black Death in the era of the bubonic plague of the Middle Ages.
In 1918-19 this deadly influenza pandemic erupted during the final stages of World War I. Nations were already attempting to deal with the effects and costs of the war. Propaganda campaigns and war restrictions and rations had been implemented by governments. Nationalism pervaded as people accepted government authority. This allowed the public health departments to easily step in and implement their restrictive measures. The war also gave science greater importance as governments relied on scientists, now armed with the new germ theory and the development of antiseptic surgery, to design vaccines and reduce mortalities of disease and battle wounds. Their new technologies could preserve the men on the front and ultimately save the world. These conditions created by World War I, together with the current social attitudes and ideas, led to the relatively calm response of the public and application of scientific ideas. People allowed for strict measures and loss of freedom during the war as they submitted to the needs of the nation ahead of their personal needs. They had accepted the limitations placed with rationing and drafting. The responses of the public health officials reflected the new allegiance to science and the wartime society. The medical and scientific communities had developed new theories and applied them to prevention, diagnostics and treatment of the influenza patients.
Severe acute respiratory syndrome
Severe acute respiratory syndrome or SARS is a respiratory disease in humans which is caused by the SARS coronavirus. There has been one major pandemic to date, between November 2002 and July 2003, with 8,096 known cases of the disease, and 774 deaths (a mortality rate of 9.6%) being listed in the WHO's April 21, 2004 concluding report.
The epidemic of SARS appears to have originated in Guangdong Province, China in November 2002. The first case was reportedly originated from a rural area in Foshan, Guangdong in Nov 2002, and the patient, a farmer, was treated in the First People's Hospital of Foshan. The patient died soon after, and no definite diagnosis was made on his cause of death. ("Patient #0" -- first reported symptoms -- has been attributed to Charles Bybelezar of Montreal, Canada) and, despite taking some action to control it, Chinese government officials did not inform the World Health Organization of the outbreak until February 2003, restricting media coverage in order to preserve public confidence. This lack of openness caused delays in efforts to control the epidemic, resulting in criticism of the People’s Republic of China (PRC) from the international community. The PRC has since officially apologized for early slowness in dealing with the SARS epidemic.
The first clue of the outbreak appears to be November 27, 2002 when Canada's Global Public Health Intelligence Network (GPHIN), an electronic warning system which is part of the World Health Organization's (WHO) Global Outbreak and Alert Response Network (GOARN), picked up reports of a "flu outbreak" in China through internet media monitoring and analysis and sent them to the WHO. Subsequently, the WHO requested information from Chinese authorities on December 5 and 11. Importantly, while GPHIN's capability had recently been upgraded to enable Arabic, Chinese, English, French, Russian and Spanish translation, the system was limited to English or French in presenting this information. Thus, while the first reports of an unusual outbreak were in Chinese, an English report was not generated until January 21, 2003.
In early April, there appeared to be a change in official policy when SARS began to receive a much greater prominence in the official media. Some have directly attributed this to the death of American James Earl Salisbury. However, it was also in early April that accusations emerged regarding the undercounting of cases in Beijing military hospitals. After intense pressure, PRC officials allowed international officials to investigate the situation there. This revealed problems plaguing the aging mainland Chinese healthcare system, including increasing decentralization, red tape, and inadequate communication.
In late April, revelations occurred as the PRC government admitted to underreporting the number of cases of SARS due to the problems inherent in the healthcare system. Dr. Jiang Yanyong exposed the coverup that was occurring in China, at great personal risk. He reported that there were more SARS patients in his hospital alone than were being reported in all of China. A number of PRC officials were fired from their posts, including the health minister and mayor of Beijing, and systems were set up to improve reporting and control in the SARS crisis. Since then, the PRC has taken a much more active and transparent role in combating the SARS epidemic.
Spread to other countriesThe epidemic reached the public spotlight in February 2003, when an American businessman traveling from China became afflicted with pneumonia-like symptoms while on a flight to Singapore. The plane stopped at Hanoi, Vietnam, where the victim died in The French Hospital of Hanoi. Several of the medical staff who treated him soon developed the same disease despite basic hospital procedures. Italian doctor Carlo Urbani identified the threat and communicated it to WHO and the Vietnam government. The severity of the symptoms and the infection of hospital staff alarmed global health authorities fearful of another emergent pneumonia epidemic. On March 12, 2003, the WHO issued a global alert, followed by a health alert by the United States Centers for Disease Control and Prevention (CDC). Local transmission of SARS took place in Toronto, Vancouver, San Francisco, Ulan Bator, Manila, Singapore, Hanoi, Taiwan, the Chinese provinces of Guangdong, Jilin, Hebei, Hubei, Shaanxi, Jiangsu and Shanxi, the Chinese municipality of Tianjin, the Chinese Autonomous Region of Inner Mongolia, and the Chinese Special Administrative Region of Hong Kong.
In Hong Kong the first cohort of affected people were discharged from the hospital on March 29 2003. The disease spread in Hong Kong from a mainland doctor on the 9th floor of the Metropole Hotel in Kowloon Peninsula, infecting 16 of the hotel visitors. Those visitors traveled to Singapore and Toronto, spreading SARS to those locations. Another, larger, cluster of cases in Hong Kong centred on the Amoy Gardens housing estate. Its spread is suspected to have been facilitated by defects in the sewage system of the estate.
Initial symptoms are flu like and may include: fever, myalgia, lethargy, gastrointestinal symptoms, cough, sore throat and other non-specific symptoms. The only symptom that is common to all patients appears to be a fever above 38 °C (100.4 °F). Shortness of breath may occur later. Symptoms usually appear 2–10 days following exposure, but up to 13 days has been reported. In most cases symptoms appear within 2–3 days. About 10–20% of cases require mechanical ventilation.

Imaging a Killer: Tackling SARS in Torontoby George Wiley
July 2003
Out of the blue, radiologists at four Toronto teaching hospitals found themselves working under a Code Orange alert to identify probable cases of SARS: the epidemic transformed the medical landscape; it struck hard at the wallet, too
For the health care community in Toronto, Canada, March came in like a lion, but it did not go out like a lamb. It was not until June that the SARS (severe acute respiratory syndrome) cases, caused by a virus imported unknowingly by a traveler returning from Hong Kong, were said to have peaked. By that time the Toronto hospital system had been tested and changedpotentially for the better, some people say. Caught in the thick of the battle against SARS were radiologists at four coadministered hospitals aligned with the University of Toronto. This is the story of how their joint departments responded to the SARS outbreak and what it meant in business terms to do so.
The initial reaction, says Andrew Holt, MHS, director of medical imaging for Mt Sinai Hospital and the University Health Network (UHN), was "counterintuitive."
Logic would dictate that in a major external disaster (Code Orange alert) emergency, medical, and support staff would be called to the hospital in high numbers. With the SARS epidemic the opposite was the case. Staff, eager to join in the fight against the disease, was told instead to go home and stay. The immediate response as SARS patients were admitted was to isolate them and shut down everything else. Within hours of the Code Orange, all but emergent cases were canceled across the hospital. Medical imaging canceled thousands of procedures. Literally overnight, SARS wards were constructed and staffed in order to isolate and contain SARS within the hospital and prevent it from spreading to the community. Within a day or two, the hospital was a place where masked and gowned hospital staff moved with lonely purpose, forbidden to congregate or even to eat together. "The lounges and cafeterias were shut down," Holt says. "It was a ghost town around here."
For those who remained on site, there was a huge amount of work to be done. Because all but emergent surgeries had been halted, operating room staff was sent to man the single ground level entrance at each hospital through which people had access. Body temperatures were checked at the door. Everyone had to say if they felt feverish or were experiencing the other flu-like symptoms associated with SARS: muscle aches, severe headaches, shortness of breath, and dry coughs. Once inside, they had to be masked, gowned, and gloved during their entire time in the hospital.
The SARS epidemic in Toronto began after an elderly female traveler returned from Hong Kong feeling ill. In Hong Kong she had stayed on the same hotel floor as a single Chinese physician who is believed to have set off the spread of the disease. Back in Canada, the woman fell ill. Believing that she had the flu, she stayed home, and in doing so spread SARS to other relatives. Eventually, she and other family members were admitted into a hospital in Scarborough in late February. By mid March, Toronto and Canadian health officials realized they had a problem. On March 30, the Ontario Ministry of Health issued a Code Orange for Toronto, and the battle to contain the as yet undiagnosed disease intensified.

Mt Sinai Hospital and the UHN was in the thick of that battle. UHN is composed of three hospitalsToronto General (TGH), Toronto Western (TWH), and Princess Margaret. SARS patients were admitted to all four sites and isolated in SARS wards with strict infection control in place. The first cluster of SARS patients had been at Scarborough Grace Hospital, unaffiliated with UHN-Sinai. Some victims in the original cluster were medical workers who had no idea SARS was a threat. Sinai and the UHN hospitals are affiliated with the University of Toronto, and are teaching hospitals. Holt says they have a combined bed count of about 1,500. According to its web site, UHN is one of Canada's largest teaching hospitals with an annual budget of close to $850 million (Canadian). Between them, UHN and Sinai have about 13,500 employees.
The First objectiveIn the first 48 hours after the Code Orange was declared, Holt says, the whole focus was on halting the spread of SARS. That meant drastically limiting physical contact with any SARS patient or any probable or possible patient. At the time, Holt adds, health officials did not know what disease they were dealing with. But several people had died. The war in Iraq was ongoing and the threat of bioterrorism was a remote consideration. "That was the backdrop," Holt says. "You didn't think that was what it was, but you didn't know.
"The entire health care system responded as one system," recalls Holt. "From a public policy perspective, this is the most extraordinary part of the story. We are talking coordination all the way from the bedside to the World Health Organization (WHO) to international research groups. We as an imaging service had to coordinate with that. The medical imaging team mobilized along with the large-scale mobilization, and within that we set up, on international, provincial, hospital, site, and departmental levels, a mechanism for communications and changes in practices as information became available from the international effort that was churning out data."
Holt camped out in his office and began working on the logistics of shutting down nearly all imaging. Typically, the four hospitals see as many as 1,500 imaging patients per day. They conduct about 650,000 studies per year. "We went from about 2,000 examinations to, on that first Monday, just over 400, and then a day later 300 examinations," Holt says. "We held at that level for the first week. At about week three, we had canceled close to 6,000 patients." Radiological interpretations at UHN-Sinai are done by a single physician groupMedical Imaging Consultantsmade up of about 60 radiologists. The hospitals employ another 450 technical and support personnel in imaging. The imaging equipmentabout 170 devices in all, including MR, CT, ultrasound, digital and plain film mammography, nuclear medicine, and general and portable x-rayis owned by the hospitals.
Imaging was not all that came to a halt. Only emergent surgical, medical, and other health services were provided. Because there were no incoming patients to speak of, all departments slowed to a crawl. Construction on a new hospital wing was stopped. Engineers were quickly called in to construct negative-pressure SARS isolation rooms for a SARS ward at each site. The negative pressure kept air contaminated by patients from leaving the rooms and infecting others. Staff members who were thought to have been exposed to the SARS virus were sent home to quarantine. Like thousands of others, including whole schools of teachers and students, they were required to spend 10 days in separate rooms in their houses or apartments, not mingling with and not eating with family members. "Anytime people met within three feet of each other, there was the potential for contamination," says Holt. "It was very simple; if you didn't cut down the physical transmission, it was going to spread."
A pathologist at Mt Sinai isolated the cause as a coronavirus. At the same time, the spread of SARS in Singapore, Hong Kong, and other areas in China was being flagged. Canadian health officials then realized that Toronto was host to a SARS epidemic. Toronto doctors began communicating with doctors in Asia. Every day, Holt says, protocols were adjusted. "Should you put on your mask first and then wash your hands, or should you wash your hands and then put on your mask? There were hundreds of things like that to be deliberated." Holt says his phone bill "was huge" afterward. Teleconferences between health officials and administrators were organized and expedited by the phone company. A month later Holt had in his SARS file more than 3,000 emails.
Imaging the disease
Narinder Paul, MD, is a diagnostic radiologist, trained in Britain, who has been at UHN-Sinai for about 3 years. He is division chief for chest and cardiac imaging, and he was one of the first who set about compiling x-ray profiles on SARS patients. Because the patients were in isolation, technicians shot films of their lungs once or twice daily on portable machines. There was no transporting of patients down to radiology suites. Paul was never in contact with patients himself, and therefore has nothing to say about personal danger.
"For radiology, we were asked to rule if we had a suspect SARS case. We were asked to look for abnormalities and rule out other causes of fever. The diagnosis itself was clinical, so everybody with symptoms initially was a suspect case," he says.
Many of the patients Paul examined did turn out to have other reasons for their fevers. "They had community-acquired pneumonia or tuberculosis or something else," he says. Those patients who could not be ruled out on the basis of "classical presentations" were marked for further study. As Paul was developing profiles of probable SARS patients, he began communicating with doctors in Hong Kong, where the first SARS outbreak had been confirmed. "They started publishing on the web site all of the cases they had. That was quite useful," Paul says. "The University of Hong Kong and Prince of Wales Hospital put both CT and plain film images on the web."
Asked what distinguished the SARS cases, Paul says, "Mainly, it was not looking like the normal bacterial pneumonias that we see. The key thing at first was to make sure there weren't other causes, and then as we got more experienced, we saw there were patterns involved, and we could then say with some confidence in a given situation whether it was a SARS patient or not."
Eventually, Paul defined four different patterns of chest abnormalities that were variations of SARS. About one fourth of the patients initially exhibited normal radiographs, which a short time later "converted to abnormalities," he says. Another group of patients, just under half, showed mid- and low-lung pneumonias, but for most of these patients the disease did not progress. "It resolves over several days to a few weeks," he says. The third group showed "multifocal disease, small diffuse areas, patches of pneumonia in both lungs, a patch in the mid-zone or the low-zone." Sometimes the patches would move from one part of the lung to another part quickly, like overnight. "About 60% of these patients stayed relatively stable," Paul adds. Then, there was the fourth group, the group from which all of the deaths came. In this group there was widespread diffusion, "a near whiteout, opacity of both lungs," Paul says.
Patients who succumbed to SARS were elderly in the main, according to Ontario Ministry of Health numbers listed on its web site. The youngest victim was a 39-year-old male who died on April 30; the oldest a 99-year-old woman who died on April 17. By June 10, there had been 33 deaths out of 425 possible or probable cases in Toronto. But there were no deaths for days before that, and on June 9 Toronto health officials said they were cautiously optimistic the epidemic had peaked. On June 10 another 176 cases remained under investigation. On June 5, the WHO declared that SARS was "over its peak worldwide." Paul says many of the patients who died had other complicating factors like heart disease or diabetes.

The economic impact
At the peak of the Toronto epidemic, the city made a WHO list of places for travelers to avoid. This WHO travel advisory angered many, especially small businessmen who relied on conventions and tourism to make their own livings. There wasand isa sense in Toronto that the SARS outbreak was sensationalized in the press. One headline in the Toronto Star warned "Every Ambulance a Trojan Horse." (For a recap of the Star's coverage, access its web site at .) Because more than 100 of those initially infected with the SARS virus were health care workers, many who worked in health care reported that they and their family members were being shunned.
Patrice Bret, MD, is chief of medical imaging at UHN-Sinai, and, like Narinder Paul, a diagnostician and professor of radiology at the University of Toronto. It has been left to Bret and administrators like Andrew Holt to assess the economic impact in the SARS aftermath.
"We're no different than a Chinese restaurant or one of the hotels," Bret says. "A huge number of businesses have been affected, and we're one of them." Unlike staff at the hospitals, the radiologists work on a fee-for-service contract paid by the government health service. When imaging was drastically curtailed at the start of the outbreak, fees for interpretations fell off to near nothing too.
"Overall, we canceled about 7,000 patients or about 15,000 exams in a 7-week period. In the first week we dropped to 5%-7% of our normal ambulatory volume," Bret says. Like many Canadian doctors in other specialties, radiologists at UHN-Sinai tried to shift some patients to private offices, but there are far fewer privately owned MRIs and other imaging devices in Canada than in the United States. The impact of shifting patients was "a drop in the bucket," Bret says.
Neither Bret nor Holt wants to say just how serious the income loss for radiology and the radiologists at UHN-Sinai has been. While the figures are proprietary, they are not minor. "If you do 30% of your regular imaging for a month, that's a big hit," Holt says. "Radiologists have mortgages and kids too." Canada's system of global health care financinga stipulated amount allocated up front, and when it is spent, there is no morealso makes the losses hard to compute, Holt adds.
Bret says there are ongoing negotiations with the government about covering some of the losses suffered by physicians, not just radiologists but surgeons and others on fee-for-service who lost out too. He says the government has indicated it may approve $700 million in SARS emergency funding, but how much would go to physicians is unknown.
It was not just the falloff in patients that impacted radiology. Bret says volumes are back now to 80% of normal. But radiologists and staff are working extended hours and weekends, and not all of this extra work is for catching up. To keep SARS under control, modalities that once got by with a change of sheets for patients to lie on now have to have tables thoroughly wiped with disinfectant. This adds 15 minutes between examinations. "So, if it takes 20 minutes to do a CT and 15 minutes to clean up the room, then your productivity has come down by 50%," Bret says. Patients are still being screened at the door. All of this adds up to lost time and that turns into lost revenues. To get an idea of how cumbersome and time-consuming handling the SARS epidemic has been, health care workers told the Toronto Star they were going through 10 masks, 10 gowns, five sets of green scrubs, and 25 gloves in a single day.
There is also a patient care angle. UHN-Sinai is one of the largest cancer centers in North America. Cancer staging is an important part of its imaging. Bret says some patients at first went too long without follow-up to check disease progression or regression. The same applied to monitoring cancer treatment results. "Those are extremely time-sensitive. Staging and re-staging are absolutely essential and that is where we are mostly caught up," says Bret. "In cardiology, we're still behind. The electives like renal stones, abdominal pains, diarrheathose patients are still in the backlog."
Both Bret and Paul decry what they see as alarmist media coverage that they claim continues to scare patients away.
"There is concern about SARS," says Paul. "The death rate in our series was about 6%. That's a concern. But there's a difference between being concerned and being hysterical. This outbreak should be looked at with a degree of measured calm. After all, influenza kills thousands of people per year. You have to keep this in context."
Bret says the hysteria over the disease continues to cause patients to stay away, sometimes to their own detriment. "In MRI we're still way behind [capacity]," he says. "In CT we're almost caught up, in general radiology we're almost caught up; in ultrasound we're behind, in mammography we're behind because there are a lot of women who don't come or who say they'll wait. They'll wait another year, and we're going to see some negative effects from that."
Bret estimates the number of no-shows for examinations at 10% to 15%. It is especially frustrating because no one knows who will show up and who will not. "People have their own sensitivities," he says. "They feel anxious, or they think we're still closed, or the news has been too complex for them to handle. They don't come, and it makes it very difficult."
Silver linings
The SARS epidemic in Toronto is not over. As of this writing, there was concern that dialysis patients in the Regional Municipality of Durham east of the city may have become infected and spread the disease to others, but this was proven to not be the case. Because the symptoms are so general, the health care system has had a difficult time identifying these cases up front. Three or four cases remained hospitalized across the UHN system in late June. Nurses at Mt Sinai Hospital have charged in the press that the provincial directive for all staff to wear protective clothing in some instances was ignored, perhaps exposing infants, new mothers, and health care workers to the disease. Canadian officials have called for an investigation into how the epidemic was handled, and there have been charges that the health care delivery system was stretched much too thin. Tourism in Toronto is still nonexistent. A fur dealer's convention set for late May was canceled and moved to Copenhagen.
Nonetheless, adverse events can have silver linings, and the SARS outbreak in Toronto is no different. Andrew Holt says some of the silver linings were purely serendipitouslike the installation of DR equipment and a PACS (picture archiving and communications system) upgrade that were able to proceed quickly because of the reduced patient load. More than that, there was what Holt calls "a breakdown of the silos" where teams from various departments were thrown together to handle the emergency. This, he says, has resulted in a collaborative spirit institution-wide that was not there before. Paul agrees, "Health people were concerned, and even when their colleagues were going down with symptoms, they still stuck at it. That is a hard thing to do when your colleagues are becoming sick."
Other silver linings may come slowly and be on a larger scale. Bret says the SARS outbreak has given impetus to a desire to move away from hospital-based care and more into the ambulatory care arena, such as has been done in the United States. Paul suggests that cleanliness protocols put in place for the outbreak may become permanent. Holt agrees, saying, "Your whole approach now is dictated as much by infection control as it was by radiation safety. We are obsessed with both now."
But the biggest silver lining may come from what Holt calls SARS: a "pre-test." The next epidemic will hit with lines of attack already in place. "We will come out of this stronger," he says. "This is the era we're moving into, and the next time we'll respond more quickly."
In an age of monkeypox and mad cow disease, it does seem likely that a new test will come.
New SARS cluster found in Canada as Asia eases
Monday, 26 May 2003
Dwindling SARS cases across Asia fuelled hopes the new disease might be contained, but the optimism was tempered by a clutch of new cases in Canada which might yet lead to a global resurgence.
As life began returning to normal in the SARS hotspots of Beijing and Hong Kong, Canadian health officials were probing a suspected new infection cluster in its financial hub of Toronto, where three more deaths took the total to 27.
More than 800 people have been asked to enter quarantine in an effort to control the fresh outbreak of Severe Acute Respiratory Sydnrome, which surfaced 12 days after the World Health Organisation (WHO) took the city off its danger list.
The experience of Canada, the worst SARS-affected country outside of Asia, comes as a stark warning to other nations already toasting success in combating the pneumonia-like epidemic which has killed some 700 people worldwide.
On Friday, the WHO lifted an advisory against travel to Hong Kong and southern China's Guangdong province, where the disease is believed to have originated in November. Only one new infection has been reported in Hong Kong since the advisory was removed, prompting the former British colony to draft plans to revitalise its badly-hit tourism and business sectors.
In China, which has a nationwide SARS death toll of 315 - half in Beijing - authorities claimed the disease was largely contained to the capital as tumbling infection races eased fears of a countrywide mass infection.
Official Chinese figures show the virus is concentrated in the Beijing area, which accounted for more than 80% of new cases over the past five days. China reported 16 new SARS cases and seven more deaths on Sunday, with Beijing accounting for four of the deaths and 13 of the new cases.
In Taiwan, where officials insist the outbreak is coming under control, some 22 new infections brought the country's caseload to 570. The number of cases was an increase of 10 on the previous day - well below the record 65 announced on Thursday. So far, 72 people have died from the respiratory illness on the island.
Taiwan authorities on Sunday also rejected China's offer of medical protective gear, saying Beijing could have done more to help the island's fight against SARS by not blocking its bid last week to join the WHO.
Although clouds appeared to be lifting from Hong Kong's economy, Taiwan continued to return gloomy forecasts, with analysts predicting a return to 5% unemployment, despite measures to create jobs and limit SARS damage.
In Singapore, where SARS has killed 31 people out of 206 cases, leaders were warning of the need for a stimulus package to breathe new life into an economy ravaged by the disease. Deputy Prime Minister Tony Tan said early action was required to prevent job losses.
Meanwhile, hopes of a medical solution to SARS were fuelled by the discovery that SARS antibodies were discovered in southern Chinese traders who sold wild animals believed to have been the origins of the disease.
Following the discovery of the virus in the endangered civet cat, a delicacy in China, researchers found several traders were carrying SARS antibodies without developing symptoms.
"This could be a very significant step if accurate," said Bob Dietz, a WHO spokesman in Beijing. "It means that we could be closer in finding the link between animals and humans that has always been suspected, but it is still not sure if these findings will help lead to a cure for SARS."
Doctor who exposed China's SARS cover up is in custody being brainwashed
06 Jul 2004
Last year a doctor, Jiang Yanyong, 72, exposed China’s SARS cover up. According to a source, he is now in custody and is undergoing ‘study sessions’ after he called for a reassessment of the Tiananmen Square protests which took place in 1989.
Dr. Yanyong is not allowed to meet anyone from outside. He and his wife, Hua Zhongwei, who used to work as a doctor at the Academy of Military Sciences, were arrested at the beginning of June. Coincidentally, the arrest took place just a couple of weeks before the 15th anniversary of the crackdown of the Tiananmen Square protests.
According to a statement issued by a source, obtained by Reuters, Hua went on a hunger strike in protest. She was released on June 15th and warned not to talk to reporters.
The Chinese Health Minister and the Mayor of Beijing were both sacked as a result of Dr. Yanyong’s whistle blowing last year when he exposed China’s SARS cover up.
In February of this year Dr. Yanyong wrote to Chinese leaders asking them for a reassessment of the Tiananmen Square protests. The protests were brutally crushed by the army - many people died.
The couple had to write down their thoughts. The study sessions will continue until their thoughts become more politically correct. Basically, this means they will be subjected to brainwashing sessions until they conform.
Dr. Yanyong is a 72-year-old man. What on earth are they playing at!!!