by revere, cross-posted from Effect Measure

The blogosphere (DemFromCT at DailyKos) and the main stream media (Alan Sipress at the Washington Post) brought us the two faces of the current flu pandemic. Like Janus, one took lessons from the present and past, the other looked worriedly to the future.

Dem’s piece on flu at DailyKos (a regular feature of the world’s biggest political blog) is superb. Most everyone who regularly reads about flu in the blogosphere (and it is a huge readership) knows that DemFromCT is the blog handle of an expert who has been writing about pandemic flu for years (as long or longer than we have and we are coming up on our 5th blogiversary), knows the landscape intimately from both the policy and scientific perspective, and is himself a practicing pediatric pulmonologist, so in his daily practice he is in the eye of the storm. With those qualifications you’d expert the best and that’s what you get. His post on Sunday, “Lessons Learned from the Pandemic” hits every nail on the head, and there are a lot of nails. He extracts 7 lessons and you should read his post in its entirety, but I’ll tease you with the first lesson:

[Lesson] 1. Expect the unexpectedNo one saw an H1N1 pandemic coming. Moat of the planning was for a more severe H5N1. This had implications, because a less severe pandemic needed more flexibility in planning. Schools didn’t close, so school buildings could not be used for mass dispensing areas for vaccine and tamiflu or alternate care clinics (and school personnel were busy with their day jobs aqnd not available to help.) HHS and DHS figured out how to get tamiflu to hospitals but not to private pharmacies (how to you give pre-purchased free-to-the-public medicine to retail stores?) While tamiflu shortages didn’t materialize in the fall (spot shortages in children’s preparations were addressed with instructions to pharmacists to compound adult capsules into syrup), they were a problem in the spring. Flexible responses helped to the point where most of these issues were invisible to the public. (DemFromCT in DailyKos)

Everyone says flu is astoundingly unpredictable, but here Dem provides added comment on what that meant in practical terms for this pandemic. The rest is just as good. Read it.

And it’s just that potential for almost anything that forms the nucleus of the Washington Post’s Economics Editor, Alan Sipress. Sipress has been on the trail of pandemic flu since early 2004, following the ups and downs of what many of us thought was going to be the next pandemic, avian influenza (A/H5N1). When I say Sipress has been following it, I don’t mean passively. He has personnally visited the rural and urban incubators of a deadly flu strain (this is one case where the oft misused phrase of the main stream media, “deadly virus” is appropriate), a flu strain that hasn’t gone away (except from the headlines, crowded out by swine flu). It’s still out there bubbling away in a vast human and animal bioreactor that he describes in a WaPo op ed, Playing chicken with a nightmare flu. And now comes swine flu, a virus that seems unusually promiscuous, already transmitting in the wild from humans to animals (and originally from animals to humans). We’re giving it to livestock (pigs), poultry (turkeys) and companion animals (ferrets and cats, so far, but the list will probably extend). And of course we are giving it to each other. It doesn’t have the horrific virulence of bird flu (which kills half or more of its human victims) but it’s much more transmissible. Given the ability of influenza virus to mix and match genetic elements from one strain to the next, Sipress documents the worry of flu scientists that we’ll get the worst of both worlds: an extraorindarily virulent bird flu like virus that transmits as well as swine flu. Given that both viruses can infect the same animals (birds, pigs, humans, ferrets and who knows what else), the potential for co-infection raises the fear of a genetic witches brew:

So far, scientists haven’t found proof that swine and bird flu are about to merge and spawn a deadlier virus. But the prospect is so chilling that health officials have been warning about it since earlier this year. Margaret Chan, director general of the World Health Organization, urged public health experts not to take their eyes off H5N1 bird flu even as H1N1 swine flu was sweeping the globe this spring. “No one can say how this avian virus will behave when pressured by large numbers of people infected with the new H1N1 virus,” she told an assembly of the world’s top health officials in May. Separately, she appealed to Asian health ministers: “Do not drop the ball on monitoring H5N1.” (Alan Sipress, WaPo)

It’s possible this nightmare scenario is impossible. Or it could be likely or even inevitable. Nothing about flu is a certainty at this stage of our knowledge. We don’t know enough about how the genetic elements in the influenza virus have to work together as a team to be able to predict whether this can or can’t happen, or if it can, how likely it is. But it would be foolish for Janus to look neither way. Blinders are not acceptable attire.

Janus is the Roman God of beginnings and endings. Only time will tell how many meanings this has for the swine flu/bird flu story.

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