Text 7659, 311 rader
Skriven 2005-10-15 22:13:44 av Mike '/m' (1:379/45)
   Kommentar till text 7658 av Mike '/m' (1:379/45)
Ärende: Re: Avian Flu: Is the Government Ready for an Epidemic?
===============================================================
From: Mike '/m' <mike@barkto.com>


Found a URL
http://www.nytimes.com/2005/10/15/health/15tamiflu.html

 /m


On Sat, 15 Oct 2005 21:48:02 -0400, Mike '/m' <mike@barkto.com> wrote:

>
>From today's NYTimes, page A10
>
>"Strains of avian influenza virus that are resistant to the anitflu drug
>Tamiflu have been isolated from a patient in Vietnam, scientists
>reported yesterday...."
>
>The rest of the article suggests that other treatments are still valid
>but...
>
>...(IMHO) this is going from worse to worser.
>
> /m
>
>
>On Sun, 18 Sep 2005 11:57:39 -0400, Mike '/m' <mike@barkto.com> wrote:
>
>>
>>http://abcnews.go.com/Primetime/print?id=1130392
>>
>>===
>> It could kill a billion people worldwide, make ghost towns out of parts
>>of major cities, and there is not enough medicine to fight it. It is
>>called the avian flu.
>>
>>This week, the U.S. government agreed to stockpile $100 million worth of
>>a still-experimental vaccine, while at the United Nations Summit in New
>>York, both the head of the U.N. World Health Organization and President
>>Bush warned of the virus' deadly potential.
>>
>>"We must also remain on the offensive against new threats to public
>>health, such as the Avian influenza," Bush said in his speech to world
>>leaders. "If left unchallenged, the virus could become the first
>>pandemic of the 21st century."
>>
>>According to Dr. Irwin Redlener, director of the National Center for
>>Disaster Preparedness at Columbia University's Mailman School of Public
>>Health, Bush's call to remain on the offensive has come too late.
>>
>>"If we had a significant worldwide epidemic of this particular avian
>>flu, the H5N1 virus, and it hit the United States and the world, because
>>it would be everywhere at once, I think we would see outcomes that would
>>be virtually impossible to imagine," he warns.
>>
>>Already, officials in London are quietly looking for extra morgue space
>>to house the victims of the H5N1 virus, a never-before-seen strain of
>>flu. Scientists say this virus could pose a far greater threat than
>>smallpox, AIDS or anthrax.
>>
>>"Right now in human beings, it kills 55 percent of the people it
>>infects," says Laurie Garrett, a senior fellow on global health policy
>>at the Council on Foreign Relations. "That makes it the most lethal flu
>>we know of that has ever been on planet Earth affecting human beings."
>>
>>No Natural Immunity
>>
>>The Council on Foreign Relations devoted its most recent issue of the
>>prestigious journal, Foreign Affairs, to what it called the coming
>>global epidemic, a pandemic.
>>
>>"Each year different flus come, but your immune system says, 'Ah, I've
>>seen that guy before. No problem. Crank out some antibodies, and I might
>>not feel great for a couple of days, but I'll recover,'" Garrett says.
>>"Now what's scaring us is that this constellation of H number 5 and N
>>number 1, to our knowledge, has never in history been in our species. So
>>absolutely nobody watching this has any natural immunity to this form of
>>flu."
>>
>>Like most flu viruses, this form started in wild birds -- such as geese,
>>ducks and swans -- in Asia.
>>
>>"They die of a pneumonia, just like people," says William Karesh, the
>>lead veterinarian for the Wildlife Conservation Society. "When you open
>>them up, you do a post-mortem exam. Their lungs are just full of fluid
>>and full of blood."
>>
>>Karesh has been tracking this flu strain for the last several years as
>>it has gained strength, spreading from wild birds to chickens to humans.
>>"We start at a market somewhere in Guangdong Province in China,"
>>explains Karesh. "And it's packed with cages, and you'll have chickens,
>>and you'll have ducks. You might have some other animals -- cats, dogs,
>>turtles, snakes -- and they're all stacked in cages, and they're all
>>spreading their germs to each other."
>>
>>In response, Asian governments have killed millions of chickens in
>>futile attempts to stop the flu's spread to humans.
>>
>>"The tipping point, the place where it becomes something of an immediate
>>concern, is where that virus changes, we call it mutates, to something
>>that is able to go from human to human," says Redlener, director of the
>>National Center for Disaster Preparedness.
>>
>>Echoes of the 'Spanish Flu' Epidemic
>>
>>Scientists in Asia and around the world are now working around the clock
>>as they wait for that tipping point.
>>
>>"Unlike the normal human flu, where the virus is predominantly in the
>>upper respiratory tract so you get a runny nose, sore throat, the H5N1
>>virus seems to go directly deep into the lungs so it goes down into the
>>lung tissue and causes severe pneumonia," says Dr. Malik Peiris, the
>>scientist who first discovered the so-called SARS virus, which killed
>>700 people and drew worldwide attention.
>>
>>To date, there have been 57 confirmed human deaths, and another
>>suspected one last week in Indonesia. Scientists say the humans have
>>only been infected by birds. However, they add, every infected person
>>represents one step closer to the tipping point.
>>
>>"Once that virus is capable of not needing the birds to infect humans,
>>then we have the beginnings of what can turn out to be this worldwide
>>epidemic problem that the experts call 'pandemics,'" Redlener says.
>>
>>That is exactly what happened in 1918 when the global epidemic called
>>the Spanish flu struck.
>>
>>"The Spanish flu was killing people in two or three days once they got
>>sick," said Bill Karesh of the Wildlife Conservation Society.
>>
>>"In 1918, my now-quite-elderly uncle was a young boy, living in
>>Baltimore, Maryland," says Garrett of the Council on Foreign Relations.
>>"And the flu came through, and his family insisted that he could not go
>>outside for any reason until the whole epidemic was over. He spent
>>afternoons looking out the window and counting the hearses going up and
>>down the neighborhood and trying to guess which of his schoolmates had
>>died."
>>
>>Disaster Would Require Massive Quarantines
>>
>>Unlike the avian flu, the Spanish flu spread long before the
>>international air travel routes of today. At that time, there were no
>>nonstop flights from flu ground zero to the United States. But not
>>anymore.
>>
>>Karesh believes the avian flu could travel from China to Japan to New
>>York to San Francisco within the first week.
>>
>>"It's on people's hands. You shake hands. You touch a doorknob that
>>somebody recently touched," Garrett says, referring to how the flu is
>>spread.
>>
>>Redlener, who is stationed at Mailman School of Public Health at
>>Columbia University, has been working with New York City officials to
>>get ready for the deadly epidemic.
>>
>>"The city would look like a science fiction movie," according to him.
>>"It's extremely possible we'd have to quarantine hospitals. We'd have to
>>quarantine sections of the city."
>>
>>"I could imagine that you could look at Grand Central Station and not
>>see much of anybody wandering around at all," Garrett agrees. "People
>>would be afraid to take the subways, because who wants to be in an
>>enclosed air space with a whole lot of strangers, never knowing which
>>ones are carrying the flu?"
>>
>>As for the hospitals, there would be scenes like the ones this past
>>month in the stadiums of New Orleans and Houston after Hurricane
>>Katrina.
>>
>>"There wouldn't be equipment and personnel to staff them adequately that
>>you could really call them a hospital," Garrett predicts. "You might
>>more or less call them warehouses for the ailing."
>>
>>And, as happened in New Orleans, there would be no place for the dead.
>>
>>"If you look at the expected number of deaths that could occur in cities
>>across the United States, we are wholly unprepared to process those
>>bodies in a dignified and respectful way," asserts Michael Osterholm,
>>director of the Center for Infectious Disease Research and Policy. "We
>>will run out of caskets literally within days."
>>
>>The prospects have become so bleak that in planning meetings held in New
>>York City, veteran emergency responders have walked away.
>>
>>"They just don't know how we're going to get through," says Osterholm of
>>those responders. "If we have a repeat of the 1918 life experience, I
>>can't imagine anything to be closer to a living hell than that
>>experience of 12 to 24 months of pandemic influenza."
>>
>>If the flu does strike, victims at first would not know if it is the
>>kind of easily treated flu that comes every year or the killer flu,
>>known as H5N1.
>>
>>The man in charge of making sure Americans are prepared in the event of
>>a killer flu epidemic is the secretary of Health and Human Services.
>>
>>"We would do all we could to quarantine," says Secretary Michael
>>Leavitt. "It's not a happy thought. It's something that keeps the
>>president of the United States awake. It keeps me awake."
>>
>>The preparedness plan calls for Leavitt to run operations out of a
>>crisis room in Washington.
>>
>>When pressed as to how ready the country actually is, Leavitt replied,
>>"Not as prepared as we need to be. We're better prepared than we were
>>yesterday; we'll be better prepared tomorrow than we are today."
>>
>>The draft report of the federal government's emergency plan, obtained
>>and examined by ABC News' "Primetime," predicts as many as 200,000
>>Americans will die within a few months. This is considered a
>>conservative estimate.
>>
>>"The first thing is everybody in America's going to say, 'Where's the
>>vaccine?' And they're going to find out that it's really darned hard to
>>make a vaccine. It takes a really long time," said Garrett of the
>>Council on Foreign Relations.
>>
>>In fact, the draft report says it will not be until six months after the
>>first outbreak that any vaccine will be available, and then only in a
>>limited supply.
>>
>>"I imagine that not a lot of poor people will get vaccinated," Garrett
>>says. "If you think about New Orleans, this is a similar situation."
>>
>>'Inadequate' Stockpile of Medicine
>>
>>While there is no vaccine to stop the flu, there is one medicine to
>>treat it. Called Tamiflu, it is made by the Roche pharmaceutical company
>>in Switzerland. Roche has been selling Tamiflu for years.
>>
>>Only recently, however, did scientists learn of its potential to work
>>against the killer flu, H5N1. That has since created a huge demand and a
>>critical shortage.
>>
>>"All of the wealthiest countries in the world are trying to purchase
>>stockpiles of Tamiflu," says Garrett. "Our current stockpile is around
>>2.5 million courses of treatment."
>>
>>According to Leavitt, that is a long way from the country's ideal
>>stockpile. "Our objective is to have 20 million doses of Tamiflu or
>>enough for 20 million people," he says.
>>
>>He later admitted that only 2 million are currently on hand, but
>>asserted that no other country is in a better position.
>>
>>Officials in Australia, however, have 3.5 million courses of treatment,
>>and in Great Britain, officials say they have ordered enough to cover a
>>quarter of their population.
>>
>>"I think at the moment, with 2.5 million doses, you are pretty
>>vulnerable," warns professor John Oxford of the Royal London Hospital.
>>
>>"The lack of advanced planning up until the moment in the United States,
>>in the sense of not having a huge stockpile I think your citizens
>>deserve, has surprised me and has dismayed me," he admits.
>>
>>Faced with worldwide demand, the Roche company, which produces Tamiflu,
>>has organized a first-come, first-served waiting list. The United States
>>is nowhere near the top.
>>
>>"The way we are approaching the discussions with governments is that we
>>are operating on a first-come, first-serve basis," says Dr. David Reddy,
>>head of the pandemic task force at Roche.
>>
>>"Do we wish we had ordered it sooner and more of it? I suspect one could
>>say yes," admits Leavitt. "Are we moving rapidly to assure that we have
>>it? The answer is also yes."
>>
>>When asked why the United States did not place its orders for Tamiflu
>>sooner, Leavitt replied, "I can't answer that. I don't know the answer
>>to that."
>>
>>Even leading Republicans in Congress say the Bush administration has not
>>handled the planning for a possible flu epidemic well.
>>
>>Senate Majority Leader Bill Frist, R-Tenn., says the current Tamiflu
>>stockpile of 2 million could spell disaster.
>>
>>"That's totally inadequate. Totally inadequate today," says Frist, who
>>is also a physician. "The Tamiflu is what people would go after. It's
>>what you're going to ask for, I'm going to ask for, immediately."
>>
>>Leavitt says deciding who gets the 2.5 million doses of Tamiflu
>>currently on hand in the United States is part of the federal
>>government's response plan. However, he also admits that thought has
>>motivated the government to move rapidly in securing more doses of the
>>medicine.
>>
>>"It isn't going to happen tomorrow, but if it happened the day after
>>that, we would not be in as good as a position as we will be in six
>>months," he says.
>>
>>However, in the end, even the country's top health officials concede
>>that a killer flu epidemic this winter would make the scenes of Katrina
>>pale in comparison.
>>
>>"You know, I was down in New Orleans in that crowded airport now a
>>couple weeks ago," Frist says. "And this could be not just equal to
>>that, but many multiple times that. Hundreds of people laid out, all
>>dying, because there was no therapy. And a lot of people don't realize
>>for this avian flu virus, there will be very little effective therapy
>>available early on."
>>===
>>
>>yikes.
>>
>> /m

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