bird flu vs. aids

[unblock]

• disease:                              bird flu                                                 aids
  
• early appearance:                  2005                                                  1981
  
• early name:                          avian flu pandemic                                gay man's disease, gay-related immune deficiency syndrome
  
• early deaths:                        about a dozen                                     around 100,000
  
• likely deaths:                       maybe a hundred                                  millions and millions
  
• official response:                   panic, alarm, billions in funding               silence
  
• most likely acquisition route:   cock fighting                                         unprotected heterosexual activity*
  
• social stigma:                       none                                                   worse than lepers
  

*unlike every other country in the world, aids' first victims in the united states were predominantly gay men and thus the most likely acquisition route in that one country at that time was unprotected homosexual activity. aids now infects more heterosexuals than homosexuals in the united states, just as it always has in every other country on the planet.

[LiberalVoice]

1. "official response: silence"

Ok well thats not even remotely true. Sorry. :eyes:

Do we give enough? No
Do we do enough? No
But we're far from silent.

[bigscott]

2. i respectfully disagree

we WERE silent for years and years as hundreds/thousands died. In 8 years of the Reagan Administration I don't think he mentioned AIDS, ARC, Gay Cancer ONCE -

[Cobalt Violet]

4. Kind of like we are with Hepatitis C now.

[pitohui]

56. bigscott is correct

reagan would not discuss aids, he was notorious for refusing to allow the word or the early phrase "gay cancer" pass his lips

he just didn't care to acknowledge what was happening in our cities

for protest act-up had people laying in the streets to block traffic in san fransisco, our nat'l media said nothing, i live in new orleans, which also had a big affected population, did i hear abt these protests on the news, hell no, they were only reported to my knowledge in some of the underground zines

there is a reason the slogan "silence = death" became popular, it is because there were years of silence from public officials who wouldn't say anything

finally in the late 80s some surgeon general sent around a memo to every house (at least in louisiana, i assume the usa) telling that aids was not spread by mosquitoes or casual contact, before that, even kids w. aids from blood transfusion, they were treated like dirt, there was a famous case of a house w. a hemophiliac kid being firebombed to the ground

plenty of silence, ignorant, and hate in the early days

whereas bird flu, the mutation hasn't even happened yet and may NEVER happen, but we've still got to give welfare to big pharma

the original poster did a fine job and i don't think it should be nitpicked

[unblock]

3. perhaps i should have said "early presidential response"

i was referring to the fact that reagan refused to acknowledge the existence of the disease until late in his second term. the u.s. government was clearly criminally slothful in coming to the rescue of americans under attack from this disease.

oh, true, the republicans did have operatives out creating the stigma for the disease, so you're right, not entirely silence....

[bigscott]

5. exactly!

"And the Band Played On" by Randy Shilts was the definitive book on the silence of the raygun administration to all things "AIDS". Hepatitis C is indeed very similar - if it were not for the HepC community advocacy groups (and there are some), this would be JUST as ignored as HIV was 20 years ago - and potentially MUCH more deadly. Hep C is a huge problem now and will only get exponentially worse with time

[LiberalVoice]

70. I didnt realise you meant early.

I was thinking you meant now. We need to do more still though.

[Horse with no Name]

19. Oh yes

AIDS was met with stonewalled silence and was called the Gay Cancer.
Nobody gave a shit.

[iconoclastNYC]

100. Read "And the Band Played On"

IF you want to know what the OP is getting at.

[FearofFutility]

6. A little perspective

The total death toll from AIDS is around 23 million. HIV has been around for 25 years or so. When compared to the death toll from the 1918 pandemic, it boggles the mind. Somewhere between 50 and 100 million people died and most of these deaths occurred in less than 24 weeks. The world population now is around 6 billion. The world population in 1918 was around 1.8 billion.

I think that a lot of experts now believe that the bird flu probably won't be the one to cause the next pandemic because if it was going to mutate making human to human transmission possible, it would have already happened. I do believe, however, that all experts believe that another pandemic triggered by a virus that we haven't seen before, and therefore have no immunity against, is inevitable.

Additionally, every year influenza kills around 36,000 Americans which is triple the AIDS death toll. In my opinion, the flu is the one that receives too little attention. I may be wrong, but it seems to me that a lot of money and time has been spent, and is still being spent, on new and improved drugs to treat HIV greatly prolonging life expectancy. This is not the case with influenza.

(I just finished reading "The Great Influenza. The Epic Story of the Deadliest Plague in History" by John Barry. I highly recommend this book.)

[NNN0LHI]

7. A little more perspective

If you read the book Bush recommended we all read about the 1918 pandemic you would know that most of the deaths were not from the flu but rather secondary infections for which there was no cure for in 1918-19. But there is now. That detail is kind of important isn't it?

>>> (I just finished reading "The Great Influenza. The Epic Story of the Deadliest Plague in History" by John Barry. I highly recommend this book.) <<<

http://www.msnbc.msn.com/id/6315717/site/newsweek/%20

From John M. Barry's book:

The 1918 flu—variant H1N1—spread with terrifying speed; in six days at a single Army base, Barry writes, the hospital census went from 610 to more than 4,000. It killed with devastating swiftness: pedestrians literally collapsed in the street; people woke up healthy and were dead by nightfall. It attacked multiple organs in the body, but always the respiratory system first, laying waste to the defenses by which the body keeps pathogens out of the lungs. Most victims succumbed to a secondary infection of bacterial pneumonia, for which there was no treatment in 1918. But in other cases, the virus was fatal in itself. Multiplying explosively throughout the respiratory tract, it provoked an immune response so furious that it devastated the lung's delicate tissues. And it was those deaths that explained H1N1's unique terror. Influenza typically kills the very young and the old, whose immune systems are too weak to fight it off, but Spanish flu killed young men and women in the prime of life.


And of course we will have another pandemic. We have had two more pandemics since 1918. I lived through both of them. A lot of people have. Modern medicine is a wonderful thing.


The "Spanish Flu", 1918-19. Caused about 25,000,000 deaths in the United States

The discovery of penicillin, 1928. By bacteriologist Alexander Fleming

The "Asian Flu", 1957-58. Caused about 70,000 deaths in the United States

The "Hong Kong Flu", 1968-69. Caused about 34,000 deaths in the United States.


Does anyone notice a pattern here?

Don

[Silverhair]

8. It has already been pointed out to you, that the 1918 flu...

...had a peak mortality in the healthiest segment of the population, and that most of those deaths were sudden. The virus provoced an extreme over-reaction of the immune system which destroyed the lungs.

You really should actually read that book, instead of taking that one selected paragraph from it.

[NNN0LHI]

12. And it has already been pointed out to you that...

...the peak mortality rates has nothing to do with the fact that most people didn't die from the flu in 1918, but rather from an illness that there was no cure for at the time.

I am not even sure why you keep bringing peak mortality rates up? There was no cure for what most people died from in 1918. There is now. I don't hear no one disagreeing with that.

Don

[Silverhair]

14. Because you try to act like "most" means "all".

Most means at least 50.1%, it does not mean 99.9% Enough off-peak people also died from secondary infections so that they still outweighed the peak deaths. But the peak deaths, (I have previously posted tables showing the rates, but don't feel like looking them up again.)were well into the 40%+.

In your early posts on the topic, your dismissed bird-flu completely as any threat, claiming it was the merely the latest panic.

The aggravating thing, is that I hope that bird-flu does not mutate, and the you will be able to claim victory.

It is obvious that you have NOT read the entire book, but have somehow found a one paragraph quote that you use over and over.

So Bush read it. So what?

[NNN0LHI]

24. Its not just antibiotics

Everything has changed since 1918. I have read without the drugs and just the knowledge we have gained over the last 90 years in the medical field many more would have survived. No one wore a mask or washed their hands in 1918. They didn't understand the way the flu was spread. They actually gathered in "breathing rooms" by the dozen full of oxygen hoping it would help them. Actually all it did was pass the flu to others. They didn't even know they went through a flu pandemic for several years later. I can remember not too long ago when the damn doctor made his hospital rounds with a cigarette in his hand. Imagine that? Times change.

Don

[Silverhair]

28. Masks were widely used in 1918.

There are lots of pictures of people wearing homemade masks to ward off the flu.

Much has indeed advanced since 1918, but there is still no cure for flu.

[FearofFutility]

33. As the lethality of the flu became obvious,

they did wash their hands, wear masks,quarantine, cancel all public gatherings, avoid contact with those they knew or suspected of having the flu. They did in fact know that they were facing a flu pandemic, but they didn't know what organism was responsible for the flu. Scientists were desperate to find the cause and a cure. The reality was all around them. Bodies stacked on top of each other. Entire families wiped out. People literally dropping dead within a matter of hours. Where did you read that they didn't know they went through a flu pandemic until several years later?

[NNN0LHI]

37. Cancel all public gatherings? Your joking. Ain't ya?

http://www.1918redsox.com/season.htm

1918

The Season


January 4 The Chicago Cubs acquire Boston Braves ace Lefty Tyler in exchange for veterans Larry Doyle, Art Wilson and $15,000. Tyler will win 19 games for the Cubs this year.

January 8 Buck Herzog, in New York Giants manager John McGraw's doghouse since last September, is traded to the Braves for Larry Doyle (acquired from the Cubs four days ago) and pitcher Jesse Barnes.

January 9 Brooklyn sends OF Casey Stengel and infielder George Cutshaw to Pittsburgh for pitchers Burleigh Grimes and Al Mamaux and infielder Chuck Ward.

January 10 Connie Mack alarms Philadelphia by dealing Stuffy McInnis, the last player in his $100,000 infield, to Boston for 3B Larry Gardner, OF Clarence "Tilly" Walker, and catcher Hick Cady. ... Acknowledging that Ty Cobb, Speaker, and Collins are all good ball players, Cap Anson picks his all-time team, leaving them off. In the current issue of The Sporting News, Anson selects, Buck Ewing and King Kelly (C); Amos Rusie, John Clarkson, Jim McCormick (P); himself (1B); Fred Pfeffer (2B); Ed Williamson (3B); Ross Barnes (SS); Bill Lange, George Gore, Jimmy Ryan, and Hugh Duffy (OF). snip

May 14 Sunday baseball is made legal in Washington, DC. District commissioners rescind the ban in view of the large increase in the city's wartime population and the need for recreation and amusement facilities.

[FearofFutility]

43. Ok you caught me committing the sin of hyperbole

Not all cities canceled public gatherings, but it was tried in many cities. My point was they knew that contact was the cause of transmission.

[muriel_volestrangler]

46. Gosh, how dishonest of you to talk about baseball again

when we clearly showed to you before that the baseball season did not conicide with the flu pandemic, and so therefore is totally irrelevant. Do you want me to post the examples of all the public things that were cancelled again, so everyone can see how you're bringing up a red herring that has already been disproved to you? Will that help your reputation?

Baseball=summer
Flu=winter

[NNN0LHI]

48. Are you sure you posted a list on this board? Don't remember seeing it

Why don't you just go ahead and provide a DU link to that expansive list you provided here so we can all have a look see? Still pushing the Tamiflu muriel?

Don

[muriel_volestrangler]

50. Archives unavailable at the moment, but I think this was one of the links

Still, to merely scan the front pages of those old newspapers is to realize, even as the epidemic broke out in Adams County, that the war remained the top story. Literally surrounding the story of Mrs. Robare’s death that October 9, are bulletins from the Allied advance in France, the draft numbers for the county, a notice of the death of former Nebraska governor James Dawes—of pneumonia—and a headline screaming, CRISIS NEARS ON 4TH LIBERTY LOAN. The public health issues raised by the epidemic were still a distant second in public interest. Thus, it’s hardly surprising to find disagreements among local officials on how to best respond to the outbreak. The first casualty of these was the city physician, Dr. J. V. Beghtol. On Sunday morning October 6, he and Mayor Madgett had spoken by telephone regarding the possible need to close public gathering places, to fight the spread of the epidemic. The doctor had advised the mayor that Omaha and other cities in the eastern part of the state had closed theaters and other public places, and expected that Hastings would have to do the same. He deferred any final recommendation, however, until after a combined meeting of the board of health and city council scheduled for that afternoon. The mayor apparently wasn’t satisfied with this; he contacted the president of the ministerial association, and issued a proclamation, announced from all the pulpits of the city that Sunday morning, that the churches and theaters were to be closed until further notice. The scheduled afternoon meeting then took place; Dr. Beghtol testified that, over the intervening hours, he and Dr. J. W. Straight, health inspector for the schools, had investigated the situation—and found only four confirmed cases of flu in the city. Given this data, the decision of the board was that schools and other public places remain open. Understandably, the mayor took offense at what he considered Dr. Beghtol’s “flip-flop” on the issue. Dr. Beghtol, in response, took offense at the mayor’s indulging “his penchant for issuing proclamations and edicts,” and resigned. Dr. J. W. Brown was appointed in his place. The epidemic was barely underway, and local nerves were already fraying. Two days later, 35 cases of flu were recorded in Hastings.

Thursday October 10, the decision was reversed. Mayor Madgett, this time acting as chairman of the board of health, issued an order “closing theaters, churches, schools, pool rooms and card rooms as a precautionary measure against influenza.” Military pickets were posted around the perimeter of the Hastings College campus, to prevent resident students from leaving. But students living at home in Hastings were still allowed to come and go—”if there is no sickness of any kind in the home.” Obviously, irrational compromises in policy were still the order of the day. Irrational “home remedies” were, as well, ranging from garlic amulets to baking powder in water, as recorded in the Tribune. There were 81 recorded cases in Hastings by October 14; 198 cases four days later. Drs. Brown and J. H. Hahn were themselves reported ill with influenza. The obituary columns of the Tribune were littered with flu victims. And, mirroring the epidemic worldwide, these were primarily previously-healthy people in their twenties and thirties. Flu has always disproportionally killed the very young and the very old; the 1918 epidemic killed a hefty share of people in the prime of life. Secondary bacterial pneumonia, particularly with the germ that came to be known as Hemophilus influenzae, a common pathogen in younger people, probably played a major role. But as previously noted, the flu virus itself was particularly aggressive that year. On October 21, the Nebraska State Board of Health placed a ban on all public gatherings, indoors and outdoors.

The disease continued to rage in private. There was a drastic shortage of home nursing care. Given that there was no effective medical treatment for influenza, this was even more devastating than any lack of access to a physician. Instances were recorded where whole families were stricken with the disease and, one member having died, an undertaker was called to remove the corpse, but no one could be found to stay in the home overnight or do anything for the sick members. A call went out from the Red Cross for volunteers to help in caring for influenza patients. Mrs. Alice Brooke and Mrs. Margretta Dietrich set up feeding kitchens in their own homes, organized volunteers to deliver food, and personally visited hundreds of local homes at the height of the epidemic. Other volunteer nurses included Mrs. Herman Stein, Mrs. C. B. Hutton, Mrs. Fred Parker, and Miss Georgia Holmes. The Hastings woman’s club, through its president, Mrs. S. B. Lyman, also organized a diet kitchen “where food suitable to the needs of invalids is being prepared and may be secured daily at cost.” By the 6th of November, this diet kitchen had provided assistance to 76 flu victims. Though the Hastings schools reopened that same day, deaths due to the flu continued to be recorded.
...
Schools had reopened November 5. Students were supposed to wear masks to prevent the spread of respiratory disease, but this met with resistance. By the week of November 17, a quarter of the students were reported absent. Similarly, there was a major upswing in flu cases following the victory parade that marked the Armistice of November 11. It was becoming apparent that half-measures in behalf of the public health were as good as nothing at all. On Thursday December 5, 36 new cases of flu were reported to the city physician. All schools in the county, including Hastings College, were ordered closed until December 30. Churches and theaters were closed, and restrictions were placed on businesses’ evening hours. The State Board of Health issued rules for handling influenza as an “absolutely quarantinable disease,” with entire families remaining under quarantine in their homes “until four days after the fever disappears in the patient.” Notices were printed to post on the doors of affected families’ homes. No one other than an attending physician or nurse was allowed to enter. Now that the war was over, full attention was finally being paid to the enemy within. Whether these actions had the intended effect, or the epidemic was simply burning itself out, by mid-December, flu cases were sharply down. Effective Sunday, December 22, churches and theaters were allowed to reopen—but attendees were only allowed to sit in every other row! This restriction was lifted on Tuesday, January 7, 1919. At that time, only dancing remained under the ban, which was finally lifted on January 20.

http://www.adamshistory.org/flu1918.html

Churches, theaters, schools closed, homes under quarantine, and a ban on all public gatherings. But in your universe, the fact that the summer baseball season went ahead trumps everything that happened in the winter.

[NNN0LHI]

55. Big parades allowed in Chicago and Boston though during the same period

From your link:

In the face of this evidence of brewing disaster, what did the authorities do? As little as possible. To win the war was THE thing. When a Norwegian vessel with 200 active flu cases and three dead men on board docked in New York on August 12, the city health commissioner announced that all of the sick put ashore had pneumonia, not flu, and added, “You haven’t heard of our doughboys getting it, have you? You bet you haven’t, and you won’t.” I’m sure the irony in that statement was totally unintentional. The chief surgeon of the New York port of embarkation was even more blunt: “We can’t stop this war on account of Spanish or any other kind of influenza.” The same day that the first civilian case of flu was admitted to Boston City Hospital (September 3) 3,000 sailors and shipyard workers marched down the streets of Boston in a “Win-the-War-for-Freedom” parade—no doubt spreading the disease in their wake. As late as October 4, with money for the war effort running short, the Chicago health department gave the okay for a huge Liberty Loan parade, assuring the participants they would not catch the disease if they went home, stripped, rubbed their bodies dry, and took a laxative! To say that the authorities were still in a state of denial is to put it mildly. Nor was the German enemy itself without suspicion. It was suggested that German U-boats were landing infected agents on American soil. And as the fall epidemic spread, the U.S. Public Health Service was obliged, under political pressure, to waste its limited resources on investigating whether Bayer, producing aspirin under what had originally been a German patent, was poisoning its customers with flu germs.

I guess they are safe as long as they were wearing their garlic amulets?

Don

[muriel_volestrangler]

72. SO you've seen that allowing public gatherings was being in denial?

Good - maybe now you'll realise that you're in denial too.

[muriel_volestrangler]

71. Here you are - we went through all this in October

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=104&topic_id=5034466

People pointed out to you that the baseball season was irrelevant to the flu pandemic - and your response was "play ball!". They pointed out that the Stanley Cup finals were cancelled (one of the players died, other were in hospital) and your response was that they managed to play the baseball World Series in October 1919 - 6 months after the flu pandemic. And there's the link to military pickets around a college to prevent people leaving, church services banned, schools closed - but here we are a few months later, and you think that your factoid about baseball proves something - or at least you think it will convince someone if you're not called on it.

Your ability to ignore evidence is breathtaking. Either that, or you don't understand a calendar.

[Cessna Invesco Palin]

9. One thing, though...

Having a cure isn't the same thing as having the capacity to cure everyone who falls ill. Certainly there will be many preventable deaths in any pandemic, mostly due to inadequacy of supply and delivery of cures for preventable infections, etc. This might not be hugely true in the US, but it would certainly be true in less developed parts of the world.

[FearofFutility]

11. I guess you didn't read the book

Yes, most did succumb to secondary bacterial pneumonia. What you're forgetting is the increased resistance to antibiotics. It is a HUGE problem. Furthermore, the subsequent pandemics were relatively mild viruses. According to the CDC, MORE people are actually dying from "ordinary endemic influenza" due the the fact that there are a large number of people with impaired immune systems alive today because of medical advances. (i.e., cancer survivors, those with HIV, transplant recipients etc.) Did you know that the US only has about 100,000 respirators? Did you know that there is not adequate excess capacity in hospitals to accommodate and SERIOUS pandemic? I'm talking about a flu that we have never been exposed to before and therefore have no immunity against.

I had no idea that Bush recommended the book. Are you trying to insinuate something? If you read the book, you will see that the sentence that you put in bold should give you no comfort whatsoever.

[NNN0LHI]

13. How many respirators were available in 1918?

You want to start talking about increased resistance to antibiotics that is fine. Thats a complete different subject that I admit I do not know much about. But that is the comparison of increased resistance to antibiotics to NO ANTIBIOTICS. Big difference.

Don

[FearofFutility]

15. And how much bigger is the population now?

The fact that we have respirators now will help very few. Read the book.

[SaveElmer]

25. The real difference between 1918 and now...

Is the conditions under which the flu spread....

1918 was the middle of WWI, men crammed together in squalid unsanitary trenches, lacking food and medical care, no attempt to quarantine and isolate the sick, and a continuous flow between the US and Europe of ill soldiers. Obviously no anti-biotics and no anti-virals, and no way to rapidly communicate when outbreaks occurred to begin quarantine and isolation, plus propylactic vaccination. Not to mention a war ravaged European population scratching out a living.

The whole situation was like sticking the virus in a petri dish and letting it grow. And the fact that it particularly attacked healthy young adults is probably because that is where it primarily incubated, among young soldiers

Even in the crowded cities of Asia the conditions are no where near this level. SO I really think when making comparisons between the 1918 pandemic and Bird Flu we really need to look at all the conditions, not just the superficial similarities.

[FearofFutility]

27. You are correct about the soldiers in WWI

but crowding is a very real concern now, especially in cities. We are much more densely populated now than we were in 1918, not to mention the fact that we are much more connected on a global level due to air travel. Yes, we have antibiotics that are becoming less and less effective, anti-virals that show only marginal promise, and vaccinations that are developed on a best guess basis and would be in very short supply if a SERIOUS pandemic were to erupt. And I'm not too confident that all nations would be honest (think China and SARS)about outbreaks.

[SaveElmer]

30. The difference however...

Is that the 1918 flu incubated in those conditions...which it may not have done otherwise. Even in crowded cities there is nowhere near the conditions that existed in those trenches.

The Bird Flu, if it mutates, will do so in rural areas first, because that is where humans and birds are in most contact. In order for it to spread effectively under such conditions, a mutation that is less lethal will have to become dominant to avoid killing its host before it can spread. And indeed, the recent concern about a mutation that popped up in Turkey (but had been seen before), made the virus more likely to infect humans because it attacked the nose and throat rather than the lungs. This in itself would make it less lethal, and more like other forms of influenza.

There is also the likelihood that the virus, even in its current form, is not as deadly as it appears from the statistics. Recent studies have stronly suggested far more have become infected but were simply not sick enough to be hospitalized.

Of course any influenza virus will spread rapidly in urban areas, no matter where it started. But in the case of the 1918 bug it likely incubated in those conditions, making it more lethal.

[Silverhair]

31. Then why did it spread so badly in cities, worldwide?

And even among civilians the peak deaths were in the 17-25 age group.

Nor did it confine itself to Europe. It spread worldwide, even to Inuit villages.

[SaveElmer]

32. For very good reasons...

It is precisely the 17-25 age group that were inhabiting those trenches. The virus incubated and adapted to humans in that environment. Once the virus was loose, there was no attempt to quarantine ill soldiers. Soldiers were shipping back and forth between Europe and the US on a daily basis, transmitting the virus.

[FearofFutility]

35. He's saying that in the CIVILIAN population it was the same.

And civilians weren't packed in trenches. It was slow to be implemented, but soldiers were in fact quarantined. A second or third draft was canceled.

[SaveElmer]

36. That is the point...

It mutated to attack that age group...once loose everywhere it behaved the same way. The important point is where it gained the mutation that became dominant.

The quarantine was way too little and way too late. We would have trouble quarantining it today with all of the tools at our disposal (although it could be done). Back then it was close to impossible.

[FearofFutility]

41. It did not mutate to attack that age group

The reason that age group had such a high mortality rate was due to the massive immune response the flu triggered which lead to what we now call Acute Respiratory Distress Syndrome (ARDS). The younger and healthier a person was, the stronger the immune response.

[SaveElmer]

44. Flus evolve (mutate) based on the living conditions of its host...

You are accurately describing the effect of the flu on those catching it, but not on how a highly virulent form gained transmissibility. In a condition where the mobility of its host was not a concern, it was possibly for a highly pathogenic virus to spread. Normally, pandemics evolve into less virulent forms because its host population is mobile. In order to find new hosts a mutation that would not kill its host had to become dominant.

And indeed, once the incubator of the western trenches were abandonded, the 1918 virus evolved into a less virulent form.

[FearofFutility]

60. It mutated because that is what they do

not because of the mobility of the host. The civilians were more mobile as compared to the soldiers and 15 times more civilians died than soldiers. Yes, the crowding of the soldiers created an opportune environment, but once it hit the general population, it took off. The population has exploded since 1918, and another deadly virus like the 1918 one would be easily transmitted from person to person.

[SaveElmer]

73. There is no where on earth today...

Even close to the conditions of the WWI trenches...obviously any virus will pass from person to person in a city...I'm not disputing that. The 1918 virus gained its particular virulence in those trenches because of the immobility of the host population.

[Silverhair]

68. And once again, the world has the crowding available.

Look at the crowding in many of the world's cities, especially the poor countries.

Also, you made an error: And indeed, once the incubator of the western trenches were abandonded, the 1918 virus evolved into a less virulent form

It mutated to a less deadly form, because in the deadly form it had already swept around the world, and had to mutate to infect people who had not gotten it in the first two waves. In the third wave, it also mutated to a less deadly form. There are many debates as to why only the 2nd wave was so deadly.

[SaveElmer]

74. I believe there is dispute on your last point...

Dr. Paul Ewald and others contend the Western front acted like a virus pump (my term), constantly introducing ill soldiers with an unusually virulent form of influenza to the general populartion. A strain that deadly would not usually be able to be as virulent except it had an immobile host population within which to spread (the soldiers). Once that was removed the virus already transmitted to the population mutated into a less virulent form.

The debate over this, and the views of Dr. Ewald are included in this link. Dr. Ewald has published in peer reviewed journals his views on this, and they are cited in the blog

http://www.aflupandemic.com/2005/11/1918_disease_fa.html

The important parts:

<snip>

This normal range of virulence and the extraordinarily high virulence of the 1918 pandemic is well explained by the general theory about the evolution of virulence among acute infectious diseases, which I have been developing for the past quarter century. The central gist of this theory is that high virulence evolves when transmission of pathogens does not depend on host mobility. Under such conditions particularly virulent variants of a pathogen can gain the competitive benefits associated with their predator-like exploitation of hosts yet still be transmitted to new hosts; they thus outcompete their more benign competitors.

<snip>

<snip>

After discovering that the transmission from immobilized hosts explained much of the variation in virulence of acute infectious diseases I wondered whether it could explain the high virulence of the 1918 pandemic. Knowing something about conditions at the Western Front in France, I suspected that transmission there would be relatively independent of host mobility. If so the general theory would lead to several predictions: (1) the 1918 pandemic viruses should not have evolved enhanced virulence until they circulated at the Western Front, (2) the 1918 pandemic viruses should have evolved decreased virulence after they were transported away from the Western Front, and (3) an influenza virus as virulent as the viruses that were generated at the Western Front during the fall of 1918 should never again cause pandemic influenza unless conditions that allow transmission from immobile hosts again recurs. I formulated these ideas during the late 1980s and published them in 1991 (in Human Nature vol. 2 pp. 1-30) along with the confirmatory evidence bearing on the first two predictions. So far the last prediction has been confirmed for 15 years and counting. It will continue to be tested year by year as the future becomes the past.

<snip>

Having said all of this, it would obviously not behoove WHO to act in any way other than it has...in my mind they have been doing a very good job working to contain the disease.

[Silverhair]

78. In the same article, others disagreed with him.

Diseases don't necessarily evolve to be mild, rather we evolve resistance to them, by the very harsh process of the non-resistant dying of the disease. When the measles hit Hawaii, it was devastating to them, but to us it is usually a childhood nusiance disease.

I have read in National Geographic, that when an isolated tribe first comes into contact with modern humanity, the diseases carried by the explorers kill about half the tribe. So those diseases have not gotten mild if they still kill 50% of "fresh meat".

However, upon further reflection, I have to agree that a flu that doesn't kill will eventually outcompete the killer version because the host will be contagious for a longer period, unless the killer version is super contagious.

[SaveElmer]

79. Oh yeah...there is definitely disagreement...

No doubt about it...whatever the truth of the matter is...I think WHO is doing the right thing!

Looks like Turkey has gotten a handle on things as well...no outbreaks in several days and no new human cases...

[Silverhair]

81. Yes, I must compliment WHO, and Turkey also. NT

[Silverhair]

80. Further thoughts on the 1918 flu's lethality.

The lethality was only 2%, but the contagion was severe, estimated at 40%. The people who were sickened by it were far sicker than with normal flu, and recovery was prolonged. This could give a greatly increased contagion time, so the evolutionary reward for a flu to be a virulent as the 1918 flu would be greatly increased contagion. That it killed 2%, from the flu's point of view, would be a very minor factor, if it increased the contagion time in the other 98%.

As humans we think in terms of the 2%, but the flu would see the 98%

Note: I am using anthropomorphic language as a shorthand, not as a realistic description. Evolution so closes mimic intelligence that it becomes easy to speak of it as having will and intent. That's OK, as long as we remember that it is a verbal shorthand.

[SaveElmer]

82. Would that be because...

The lethality of the original mutation of the virus was so deadly? So when it spread to the general population it had a longer way to go before it becamse essentially non-lethal. In other words, even though it may have become less deadly, it was still more lethal than the average flu, and took longer top get to that level.

This is looking at it linearly, like it is a steady progression. Probably not the way viruses behave.

[Silverhair]

83. I was suggesting that the lethality was a by-product of a greater...

...contagion time. Just a line of thought. Granted, making linear projections in a non-linear world is rather risky, but still usefull for initial concepts.

My suggestion is that a 2% lethality, from the virus view, is non highly lethal.

[Silverhair]

38. US & Europe is NOT worldwide.

The 1918 flu was global. And the same peak patterns were seen in civilian populations.

[SaveElmer]

39. It was a World War...

Soldiers from all sides were affected...it wasn't limited to Americans.

[Silverhair]

40. It was called a World War, but it wasn't truly.

The Pacific was uneffected by the war, but was effected by the flu.

And you continue to ignore the fact that American civilian populations also had the same mortality profile.

Soldiers were entirely men at the time, and civilian women had the same mortality profile.

[SaveElmer]

42. Forgive me...

I have an answer for your last post...but unfortunately need to get back to work. Will reply later in the day if that's ok!

[Silverhair]

47. I have to get to work too. DU is way too addictive for me. NT

[FearofFutility]

45. And civilian deaths were 15 times that of soldiers. n/t

[unblock]

16. "most people died of a secondary infection". what difference does it make?

does it matter that many people shot during the civil war actually died from infection or lead poisoning rather than the gunshot itself?

heck NO ONE dies of aids. ALL its victims die of a secondary infection.

what matters is how many WOULD HAVE died of that secondary infection WERE IT NOT for the presence of the primary infection.

i haven't read the book, but i would posit that the vast majority who died from a secondary infection probably would have survived it were it not for the primary infection. ergo, the primary infection is still ultimately responsible for the death.

[NNN0LHI]

22. The difference is there was no cure for secondary infection in 1918

There is now.

Don

[Mojorabbit]

77. Well the ones dying now are not dying from 2ndary infections n/t

[FearofFutility]

84. Actually, a lot of those who die from the flu now

are in fact dying from secondary infections i.e. pneumonia.

[Mojorabbit]

89. No that is wrong

They are dying of primary pneumonia from the flu not from bacterial infections. They are also dying of viral damage to the heart, kidneys, and liver, and brain from the flu too.

[FearofFutility]

90. From the WHO website

Secondary bacterial pneumonia (commonly caused by Streptococcus pneumoniae, Haemophilus influenzae or Staphylococcus aureus) is the most frequent complication of influenza and occurs mainly in the elderly and those suffering from certain chronic illnesses. Primary influenza pneumonia is probably an uncommon complication, but has a high fatality rate.

http://www.who.int/vaccines/en/influenza.shtml

[Mojorabbit]

95. That is for regular flu

There was a good article in the journal of medicine which described the cases of this bird flu (for which there are reports available). I will see if I can find it but it should be easily googled. The WHO (I think it was the WHO) also in the past few days put out a statement with the symptoms and the damage the virus does to multiple organs in the body. No mention of secondary infections. The virus itself is the killer.
n edit I found the WHO factsheet released this month. Scroll down to the symptoms and course of the disease
http://usinfo.state.gov/xarchives/display.html?p=washfile-english&y=2006&m=January&x=20060120154859cmretrop0.7842676&t=livefeeds/wf-latest.html
exerpt

Clinical features (1) In many patients, the disease caused by the H5N1 virus follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Like most emerging disease, H5N1 influenza in humans is poorly understood. Clinical data from cases in 1997 and the current outbreak are beginning to provide a picture of the clinical features of disease, but much remains to be learned. Moreover, the current picture could change given the propensity of this virus to mutate rapidly and unpredictably.

snip
Initial symptoms include a high fever, usually with a temperature higher than 38oC, and influenza-like symptoms. Diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients.

Watery diarrhoea without blood appears to be more common in H5N1 avian influenza than in normal seasonal influenza. The spectrum of clinical symptoms may, however, be broader, and not all confirmed patients have presented with respiratory symptoms. In two patients from southern Viet Nam, the clinical diagnosis was acute encephalitis; neither patient had respiratory symptoms at presentation. In another case, from Thailand, the patient presented with fever and diarrhoea, but no respiratory symptoms. All three patients had a recent history of direct exposure to infected poultry.

One feature seen in many patients is the development of manifestations in the lower respiratory tract early in the illness. Many patients have symptoms in the lower respiratory tract when they first seek treatment. On present evidence, difficulty in breathing develops around 5 days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody. Most recently, blood-tinted respiratory secretions have been observed in Turkey. Almost all patients develop pneumonia. During the Hong Kong outbreak,

.....all severely ill patients had primary viral pneumonia, which did not respond to antibiotics......

Limited data on patients in the current outbreak indicate the presence of a primary viral pneumonia in H5N1, usually without microbiological evidence of bacterial supra-infection at presentation. Turkish clinicians have also reported pneumonia as a consistent feature in severe cases; as elsewhere, these patients did not respond to treatment with antibiotics.

[FearofFutility]

97. Thanks for the link

I was referring to the regular flu and the fact that secondary infections continue to be a big problem. I see now that you were only talking about the bird flu. In clinical presentation, it sounds just like the 1918 flu.

[unblock]

18. i agree with the point that sensational killers get the most attention

it's the same thing wherever there is death. airplane crashes are all reported, yet it's the safest mode of transport. far more attention is given to air travel safety than to bus or train or car safety, given the numbers involved.

terrorism which killed 3,000 people in the last 5 years gets an insane amount of attention, when everything from lightning on up is on a par or worse, often far worse, as killers than terrorism.

yet, there isn't a grand political agenda for those in power to be gained from solving the great cholesterol problem....

[Silverhair]

10. The concern is over bird flu's potential, not it's current damage.

Bird flu can be compared to a CAT-5 hurricane that is still out to sea, and whose future path is threatening land, but could stay at sea.

AIDS is a F-5 tornado already on land and going through a city.

Both are disasters. The AIDS tornado is doing huge damage now. The flu-hurricane is potential damage, but IF the flu-hurricane does hit, it will dwarf the tornado damage.

At present, bird flu is not human to human contagious. If it mutates to H-H rapid contagion, it will make AIDS seem very mild.

Further, and I know this will make you very angry, but AIDS is largely completely avoidable - the flu isn't.

[unblock]

17. bird flu isn't even remotely a cat-5 hurricane out to sea

they aren't waiting for it to move to shore, they're waiting for it to mutate into something else.

so i would say it's more like forecasting high and low pressure systems, seeing that they MIGHT collide in just the "right" way as to CREATE a cat-5 hurricane, and THEN slam into a highly populated area.


all this hype NOT when you're waiting for a disease that hasn't shown any particular tendency to deviously mutate to deviously mutate is more than a bit ridiculous, when there are so many more sure killers out there.

[FearofFutility]

21. The analogy that Barry uses

is that it's a ticking time bomb, but we don't know what time it is. If adequate preparations aren't made, the results will be disastrous. It wouldn't make sense to build levees in New Orleans that only protect the city against a category 1 hurricane, would it? And influenza viruses do in fact have a propensity to mutate. It's how they survive. It kills 36,000 Americans every year. And that's just from "mild" flu. And we're not talking about mild flu here.

[unblock]

52. i agree that SOME form of flu eventually will lead to a pandemic.

but there's no particular reason to think that avian flu is going to mutate to a massive human pandemic.

i would guess that it's at least as likely that any other the flu strains that occur normally each year, already in the human population, would become something vastly more lethal, perhaps due to naturally selected resistance to antibiotics.

[FearofFutility]

58. I agree that it probably won't be the avian flu

as I said in an earlier post. After reading John Barry's book, I guess I'm just frustrated that people (and I don't mean you) aren't taking the inevitability of a major, lethal pandemic seriously and are dismissing it out of hand. I guess the fact that I have a child with asthma who ended up with pneumonia after having the common cold, and the fact that I'm a nurse who will be on the front line makes me take it extremely seriously.

[Silverhair]

66. We already have some immunity to the ones that are already...

...in the human population. The next pandemic will be by one that we have no immunity to, which will be a cross-over virus. From time to time, a specific disease mutates to attack a new species. Flu is one of the fastest mutating viruses known, and by the use of vaccines, we are putting evolutionary selective pressure on it to improve it's ability to quickly mutate.

[Silverhair]

29. Yes, it is.

Right now this form of flu is raising hell with bird populations, but not with humans. (It is at sea.) If it makes the minor adaptation that will enable it to move to humans, then it will raise hell with humans. (Minor alteration of course to hit land.)

[unblock]

51. i would not characterize moving from bloodborne to airborne as "minor"

[Silverhair]

63. The RNA change that it needs to make for that is a minor change.

Sometimes minor RNA changes can make great changes in results. It is like a change in one letter of a word that can make a complete change in the meaning.

[Horse with no Name]

20. "AIDS is largely completely avoidable"

Most ignorant statement I have ever read. Anywhere.

[FearofFutility]

23. On the face of it, it does seem like an ignorant statement

How many babies are born with HIV? HIV, however, can't be transmitted by casual contact as I'm sure you know. To get the flu, all you have to do is breathe.

[Horse with no Name]

54. It's a straw man argument

and it is an ignorant statement.

[FearofFutility]

59. I'm fully aware that HIV is a devastating

virus for those that contract it, however, all I'm saying is that the flu is MUCH more easily contracted. Another pandemic like the 1918 one will kill millions in a matter of weeks. It will make the deaths from AIDS pale in comparison. I don't believe it's a straw man argument at all.

[Silverhair]

26. Really. Please state how AIDS spreads. It ain't by breathing.

You are now in a box.

If you try to maintain that AIDS can be spread by casual contact, not only will you be wrong, but you would be promoting the fear of being around an HIV infected person. Various AIDS support groups have gone to much effort to inform the public that they do not need to fear being around and person with AIDS.

Or you admit that AIDS has specific and well known infection routes. Avoid the infection routes, and AIDS becomes extremely rare. Except for infants born to HIV mothers, it is avoidable.

[Horse with no Name]

53. I am not "in a box"

I know EXACTLY how AIDS is spread and the fact that you try to say that AIDS is avoidable shows how ignorant you are.

So you tell me, how does a newborn infant prevent it?
How does a woman who is raped by a man that is HIV+ prevent it?
How does a partner of either sex in a relationship prevent it if they have no idea their partner is straying?
How does a trauma/cancer/hemophiliac patient prevent it if he receives tainted blood?
How does a healthcare worker who is attacked by a patient prevent it?

There are many ways that people are infected through no fault of their own and totally beyond their control.

So please...keep spreading your right wing talking point that people who get AIDS could have avoided it by being chaste and good and that is a disease sent by God to kill the homosexuals.

[Silverhair]

61. All of those are very low order of probability.

Nor did I say you last sentence. You are lying, because you are very angry, but it is still a lie to accuse me of that. If you want to disagree with what I actually say, fine. But to accuse me being RW and saying the last sentence is a flat out lie.

Are the ways you listed the only ways that AIDS is spread? What are the primary routes of transmission?

Are you capable of a non-emotional discussion?

You began by comparing AIDS to flu, so it is completely correct, in this context, to talk about methods of transmission.

[Horse with no Name]

69. You aren't worth my time

You really aren't.
You bring nothing useful here except right wing propaganda.

[guidod]

85. Sorry, Horse with no Name is

right on. You do sound very RW.

[FearofFutility]

86. The only word that Silverhair said that I don't agree with is

completely. Largely avoidable, yes. Completely, no. We now know the transmission routes for HIV, so one can make choices that greatly reduce the chances of contracting it.(IV drug users need to use clean needles etc.) There are of course situations where someone contracts it through no fault of their own. Whatever the case, all with HIV deserve to be treated with dignity and respect. Now, I believe that all he was saying is very little can be done to stop the transmission of influenza. Breathing is all it takes. Why does that sound RW?

[guidod]

87. I'm just having a hard time, might be wrong,

comparing bird-flu with aids. Maybe someday, hopefully not, but not now. Ask someone with Aids if they can compare it to bird-flu.

I feel like somebody is throwing a bunch of "fear" at me like a repuke does. My opinion.

[FearofFutility]

92. Your obviously entitled to your opinion

I can understand on an emotional level that you would have a hard time comparing AIDS with the bird flu that we hear so much about every day, but if what we're talking about should happen, a pandemic caused by a virus against which we have no immunity, it will be beyond devastating. My intent is not to cause fear, but to educate. I'm not running out and stock piling food, water etc, but I am paying attention to the CDC and the WHO so I know what is going on.

[guidod]

96. You're right it is emotional.

My wife and I have lost 2 close friends because of this hideous disease. You're right in your thinking that we should attack this flu at it's infancy so it doesn't get out of hand like aids has. There has been a lot of advances in fighting aids and each day brings us closer to cures. My brother is gay and it angers me when I see the repukes take the wellfare and happiness of people so lightly.

[FearofFutility]

98. I know what you mean about repukes

I've actually heard one say, referring to AIDS in Africa, "If the men stopped fucking goats and the women would just keep their damn legs closed, there wouldn't be a problem." Sickening.

I'm very sorry about your loss. I have cared for people dying of AIDS, and it is heartbreaking. It's unbelievable that after 25 years, this disease still carries so much stigma and unfortunately, we still have a long way to go.

[guidod]

99. You speak of AIDS in Africa, that opens

a new thread and topic that needs to be discussed extensively. Africans have experienced more ethnic cleansing than any other people, Sadam was nothing compared to the brutal events that are occuring there. There's a lot more than AIDS happening there. The Constan Gardner was not just a Hollywood make believe movie, it showed how the huge Pharmicudicals are factually using the Kenyan people as guinea pigs for their drug testing.

Sorry to go off subject the way I did but the events that are happening in Africa really anger me. You're right we should all do what ever we can to make sure the BIRD-FLU does not become a life threatening epidemic.

[Bluebear]

62. What about those who contracted HIV in the 80's

from transfusions, from sexual contact, before the transmission route was even known. Was that completely avoidable?

[Silverhair]

64. If you don't know the transmission route, then you don't know how

to avoid it. But we are talking about now, not then. You can greatly lower you chances of catching many diseases by the choices you make. It is not popular to say that, but it is scientifically true. You can say that about heart disease, diabetes II, lung cancer, and accidents, but the minute you say it about AIDS, everybody gets angry.

Remember that this thread began with a comparison of bird flu to AIDS. You CAN catch flu by being in the same room with an infected person. And a flu victim is contagious BEFORE they show symptoms. You can't catch AIDS that way. Many people in the 80's were afraid to be around a person with AIDS, and some still are.

[Bluebear]

65. But people are alive who contracted it 'then'

To trumpet the 'avoidable' argument does a disservice to them, to begin with.

[Silverhair]

67. No. I said, "is" not "was".

Science has no morality, nor sensitivities. If one is going to compare flu and AIDS, then transmission routes have to also be talked about.

The OP seems to feel that too much attention is being paid to bird flu, and that it should be placed on AIDS instead. But flu has the proved potention to kill hundreds of millions in a few months. IN 1918, on a much smaller human population base, it killed between 50 to 100 million people. With today's population base, greater crowding, and unhealthy city conditions, a deadly form of it could easily kill up to a BILLION. That number comes from the World Health Organization. Admittedly, it is a worse case scenario, but a realistic one based on human experience.

Diseases must be looked at scientifically, if they are to be controlled. That some people choose to respond with anger is unfortunate.

[RiDuvessa]

34. Your discovery date is off.

This particular virus has been kicking around in southeast Asia for a few years now. It's only now getting major media attention because it's starting to spread to many parts of the world. I think they first identified the virus back in 1998.

[NNN0LHI]

49. H5N1 was first identified in Scotland in 1959

http://www.who.int/csr/don/2004_03_02/en/

[Raydawg1234]

57. Maybe they're trying to sell flu medicine

Rumsfeld was chairman of the board of Gilead, the company that developed Tami-flu.

Donald H. Rumsfeld Named Chairman of Gilead Sciences

Foster City, CA, January 3, 1997 - Gilead Sciences Inc. (Nasdaq: GILD) today announced that board member Donald H. Rumsfeld will assume the position of Chairman, effective immediately. Mr. Rumsfeld succeeds Michael L. Riordan, M.D., who founded Gilead in 1987 and has served as Chairman since 1993. Dr. Riordan will continue to serve as a director on the board
{snip}http://www.gilead.com/wt/sec/pr_933190157

The manufacturing is licensed to Roche Pharmaceuticals. Gilead receives royalties from the sale of Tami-flu, which would garner great profits for Rumsfeld.

When you look at these Media Campaigns, you have to ask yourself, Who stands to profit?

[Avalux]

75. A comparison between these two is not relevant.

Two important point to remember here -

1. The avian flu virus that would cause a pandemic does not exist yet. If it does mutate to allow airborne human to human transmission - the infection rate will be great.

2. The disease is not AIDS, it's Human Immunodeficiency Virus. AIDS is a catch-all for what happens once the immune system is destroyed and a patient is susceptible to a host of infections. HIV is transmitted sexually and it's not easy to catch.

I think I know what you're trying to say, but the scientific information you've presented isn't accurate.

[Silverhair]

76. Well said. NT

[unblock]

88. my point wasn't scientific at all, it was political

trying to show the chasm of political response to both health threats.
aids being a real threat that was cynically ignored for criminally immoral AND idiotic reasons, whereas bird flu is massively funded and hyped, again for criminally immoral AND idiotic reasons, when there's no real human threat as of yet.

as to point #2, i would actually say that aids is the disease and hiv is the pathogen. point taken in that i could have been more scientifically accurate, but the inaccuracies are besides the point.

[Avalux]

91. I thought that's what you were getting at.

Seems a lot of folks in this thread are comparing the two scientifically though, so that's what I was trying to clear up a bit. Sadly, the mode of transmission does determine how people and governments react.
HIV was considered a gay disease in the 80's - the govt. saw no urgency. I started working with HIV infected individuals in 1988; a very sad time for me because we were helpless in treating them, not only that - those who could help didn't. I remember many a doctor refusing treatment.

[unblock]

94. yes, and labelling it a "gay" disease was insane and criminal

and just plain STUPID. it was never a gay disease in ANY OTHER COUNTRY. it didn't start in the u.s. it just happened to be that the first victims in this one country were gay. what a ridiculous epidemiological history to call something a "gay" disease.

[LeftCoast]

93. Considering how abysmal the response was to AIDS, I'm surprised

you would set that as the standard. I for one, would prefer a medical community that was much more pro-active and aware than it was in the late '70s early '80s.