Tony SNow: Bird Flu in Michigan On Foxnew

I have refrained from posting since the Michigan incident was announced.
The rational behind this was that as the political, economic, and media spin wheels churned, it would be premature to make any observations. It was also the knowledge that when I finally posted my thoughts on this, it might generate a lot of negative posts towards my comments as well as tend to make the hardliners take a very aggresive stance to dismember my comments by declaring me an alarmist. I will be surprised if this does not happen, but I think are those who will follow the logic and sincerity of this post.

Instead of probable, which has been used in many political statements, I will use the term likely. It is likely we have H5N1 in the U.S. Countries are beginning to ban imports of our poultry products as we knew they would if we announced it even might be in the U.S.

The fact that there have been outbreaks in the past is not new news. And the fact that this seems to be quoted "well we have had them in this year and that year and so forth" does not make the current cases any less ominous or a problem for the United States. It is like saying, well we have had Pandemics before in 1918 and several times so this is nothing new. The Bubonic plague is nothing new. Certain virulent diseases have swept the planet since the times of the Egyptians. This has got to be the weakest logic, criteria or statements I have ever heard. We have had this or seen this before. So what? We had the holocaust before. We had World Wars before. We have had many things before? Who writes this stuff for people to say?

I would assume the inferfence is that we have seen it before and we are all still alive (most of us) and there was no Pandemic.  Well, there were Pandemics. And people died. Millions.

On dozens of posts I have presented documentation of this moving from low path to high path, in birds and it can in people. What is basically happeninig is you have the event. H5N1 has been identified and now all the media and release mufflers or on so the public will not panic, the economy won't take a nose dive, and we are being given a flurry of scientific "this is being handled in the top labs with the most advanced methods and so forth."  Can we stop it? Our medical system is not read to handle a Pandemic. We can simply hope, if it happens, to survive it.

The idea is to dilute the incident and calm everyone's nerves and keep all the other countries from banning our poultry.

As the press and government releases dig back through old data, and some of this is old - stuff from May is old - we are in August.  Statements like - well it has been endogenous in the bird population and the sudden emergence of a "North American H5N1" which is not high path raising the yard stick to 80+ percent to make it high path.  This is circle talk. It is politics. It is well designed and translated - birds have been crawling with viruses for hundreds of years and it hasn't jumped to people. Well, look at China okay, and Thailand, and Vietnam. It has. People are dying from it. Wake up and smell the coffee people. Don't panic. Just dig in, grit your teeth, and prepare. If it doesn't happen. Great. I mean it. Great.

This is all semantics and euphemisms. If over half of the birds or people who catch it die, it is high path to me. Its like adjusting warning levels to fit the situation so we are not at a higher alert.  I have worked with facilities that have sequencers and we do not have to incubate a lot of whatever to take a look at the virus and know what the score is.

With a patient and a little common sense, and a 2-4 hour test you can determine if it is pretty likely it's Avian. That test has been around awhile. I have talked to or corresponded with Vietnamese doctors or nurses who cared for  the specific  outbreak cases  of human transmissions. I have seen pics of the X-rays of the lungs, and for several days, simply sat back and observed as the news leaks into the media. 

It does not take two weeks. Considering we had data months ago on certain situations, and weeks ago, the time is up for knowing what it is.
I have talked to scientists who run the tests, what tests they use, and what tests not effective or considered dinosaur in virology and genetics and posted it. They know the score. The swams were tested twice before a word was said about anything.

Understand, it is much safer for me to sit back and be silent and let the media flood the net with official sounding technology which does not reflect the situation.

The pathways are open and the birds will be heading south or will be be soon I believe.

The truth is that humans have had a multiple variety of flu for decades. Flu has got to be the most ridiculous word ever conceived to describe a disease. It is meaningless. The fact the "stomach flu" keeps trying to establish itself as a real word has a reason. And that is because Avian can mutate to a virus, may have mutated to a virus that is intestinal as it is in birds, and therefore gets pushed into "what we see every year."  Do not tell me this. After 40 years in medicine I already know what we see every year.

Never having developed the tough skin of the traditional medical type, when I read things like "well every year flu sweeps through the U.S. and we have periods where GI outbreaks occur and it is just the mutation that happens naturally.

Death is natural. That does not mean it is acceptable for millions of people to die each year. Ebola is natural. That is like saying excrement is organic.
I belong to a group of scientists who don't particularly like death or disease. And honestly, we would like to wipe disease off the face of the planet. That includes Avian.  Not take the approach of the physician after the operation where  the patient expires and says "Well, you know statistically we lose a few. Go tell the family."
 
There is a point here. It is like euphemisms in the funeral industyr. Dearly Departed, the Loved One. A classic psychological tool and manipulation of the American public - telling a patient you "just have the flu" is absurd. Thousands of people die from the flu. The point is, the current medical system in many cases is impotent to treat disease. Instead of just saying,
we don't know what to do, or you are wasting your time if you have the "the flu" when you can go home, take aspirin, and drink plenty of liquids, is just saying, this is beyond our skills or knowledge at the present time.

When Aviian hits, if it does with any force, people will be told  to stay home.

Conclusions : Now let's make this very clear. Other doctors, nurses, health people may find this alarmist. Most of my family are in the hospital right now and I probably should be for a never ending stomach. Every diagnostic test has been done and they still don't know what it is. I have friends in Europe who have "something" which is not classic Avian but is making them very sick.

So, this is my opinion. You can read all that claim to be experts and form your own. I don't claim to be and expert. I think we have a problem. Let's be real here. You don't want to define something as high path so you raise the yardstick where the kill ratio is close to Ebola so our poultry exports won't be banned all over the globe.

Albert, I think the low path has already been here for years, even some in people. I talked to a virologist in Switzerland and they were discussing also, as others here, the definition of disease.

There is no shame in the medical establishment admitting that just as the war on drugs, and other endeavors, we are not doing well on the war on disease. There are chronic established diseases which are endogenous to our population. c. dificil 5% - some reports 50% in children under 18 months. How do we get around this?

Semantics. We call them friendly fauna. So with Avian? We say well, we have always know that the bird species is crawling with viruses  they just live with. Personally, although I know many strains of many things are in us all, I don't want to be crawling with viruses I just live with.

I don't want to spend the next decade of my life with some low path Avian strain which won't kill me, just gives me a tummy ache every day and is not just a part of the "seasonal GI" but has infected our family for two years. And these are sister-in-laws, people with entirely different bodies and not biologically related.

This is opinion. I bought more water yesterday and a lot of Top Ramen. This incuded dog food, cat food, bird food - etc. We like animals.

Nothing will be more convincing than reality. And if there is no serious Pandemic, fine to be called an alarmist and be wrong.

Just keep quoting statistics and raising levels so that we don't ever have to say - it is here - until the numbers are so high and the trip levers are super glued it will be like the guy in Iraq with U.S. tanks rolling up the steps and telling his people (Minister of Information) the Americans are a hundred miles from Baghdad. Not fair to people who need to prepare and be ready. Comforting - but not a true picture at all.

gardener wrote: Medclinicain,   What in the world do you propose that we do about all these low grade infectious agents that according to you plague the human population?  Have you never considered the possibility that the treatment might be worse than the "infection" itself?  Do you want us to go around giving vancomycin to the large percentage of infants who currently live with c.dif?  The world cannot be made sterile, the medical community is already  overextended, so we concentrate on the pathogens causing significant disease.  What would you have us do?   Exactly what kind of medical clinician are you?   gardener

I know you are a highly qualified person Gardener and practice medicine and I certainly respect your opinions and comments. I always have. And I actually appreciate the restraint you have shown here in not really launching into this.

I am retired from the medical clinics, seeing patients, writing scripts. Remember Vietnam was a long time ago, and I was active even then. But I am active in medical research, virology, genetics, and am in the current loop to develop new medical technology. I have been asked frequently in one way or another, this same line of enquiry. The above is all I will ever say. I also still am connected to go out into the field to natural disasters and unnatural disasters.

You are a serious and grounded doctor I believe, and are active and see patients and deal daily probably in an ER or Clinic with them. And you know your stuff. These are positive comments. Everything you have said is right on target, Gardener.

We do have some solutions on the horizon though. Nothing is worse than someone bemoaning the problems with no solutions. That just creates fear with no hope. And that is not the intention here.

First off, antibiotics or anti-virals are not the solution. That is why Tamiflu is not the answer either. We have one clincial trial in Japan where 15-20% developed resistant strains in the first pass. I have posted the actual step by step mechanism and process showing the development at the sequence level and process of the resistance to Tamiflu. So if you gave Vancomycin to all the toddlers, and it's already been done, you will have at least a  20% relapse rate, since c. dificil forms spores.  However the problem is not  c. dificil. It is the damage caused to the natural flora  balance and natural barrier in the wall, the lining of the intestine.

The primary medical rant here is because it is not only my, but other researchers as well, opinion, that it is possible Avian, which is classically an intestinal and almost symbiotic (many birds appear quite healthy and asymptomatic) may mutate to an intestinal pathogen in humans.

If you think our line of defenses are weak against pulmonary diseases- especially ones that require respirators- more armies have died from bowel problems than swords or bullets.

Try to keep this Avian related. Conventional medicine probably will not be effective and even if it is - as in some strains treated by Tamiflu - imagine the resistant strains developed when you give 400,000,000 doses of this to treat a Pandemic. 

Some doctors have enquired or commented on using injected vaccines of antibodies, or pushing more on using Relenza which can be injected rather than inhaled.

http://www.medicalnewstoday.com/medicalnews.php?newsid=49114

This is current. I have spoken to people in the drug company developing Relenza and this is a very promising drug; although studies have show Avian can develop resistance to it as well. The problem, as quoted by Jhetta perhaps, is that the key ingredient is made in China, and there is quite a political and economic struggle going on as to who will make the billions for producing the effective anti-viral or vaccine for Avian.

The magic bullet, which we do not have time to develop, we will need a "vaccine patch kit" which one virologist I spoke to stated they could alter the vaccine in several weaks to changes in the virus. I may have posted links to this this company which I am not connected to.

Make no mistake. Behind the scenes people in CDC and WHO are literally working 24/7 on new technologies which could rejuvinate the immune system so the body can fight this off itself (very simplistic but this is not a medical journal here).

I think most of us want this to stay low path in humans period. The longer the better. The more time we have before it decides to jump clusters on us, like the 6/7 mortality types we have seen in Vietnam, the better weapons we will have to fight it.

This forum is discussion. And realize, sometimes, I do get a bit weary of tip-toeing around the obvious.

You know, if you worked with the Federal government, and I am not an employee of the Federal government, that there are situations where we are not ready and we are attempting to become more ready.

People need the truth. Everytime the government, and there is a new face to our top levels of security and health organizations, releases information, such as the swan in Michigan data to the press, it is like biting the bullet while someone performs surgery on you.

This data must go out there. People need time to digest danger and problems. You would be amazed how resilent the American public is to bad news. Read the headlines.

Thank you for the feedback. No. As I said, doctors I went to over at Oakland Naval Base across the bay from  Stanford in the 50s - some went to school when there were no antibiotics. And one time very ill I got an injection of penicillin that cured whatever I had in hours. Today it would be useless.

What you need in the ER down the road is for a truck to roll up and boxes of vaccine to come in the door - militia to guard the people giving it and the vaccine itself.

The point here is not hopelessness. It is to say we need to focus on reality. We need to be able to give people more than soothing words or try to look professional when we simply don't have the tools we need to help them.

Just an opinion. Something tells me I will never get to quit working on these things or trying to function amidst a pretty complex system already in place. We are on the same team. And I hope we win.

http://www.postgradmed.com/issues/2002/11_02/joyce3.htm

yes, i picked up on that too. Medclinician: i am disappointed because your name implies otherwise. You may be very knowledgeable and I appreciate your comments and sympathize with your difficulties but why imply that you are a clinician?

cli·ni·cian (kl-nshn)

     I'm not seeing anything shocking or alarmist in anything medclinician said.   And I don't believe you have to be a doctor to know that there are many things living dormant in our bodies or at stages of low lying activity that can eventually act up and cause problems that prescriptions alone don't really address.  Anyone familiar with holistic medicine?  Take care of the whole person, not just the 'disease'.  Keep your body in the best conditon possible and allow it to do what it does best.  I wash fruits & veggies before I eat them to remove pesticides and other residue.  Does that make me an alarmist for cutting a risk factor?  I'll save my liver & heart damage for the occasional glass of wine or a good black angus steak, thank you. 

standingfirm wrote: the way things are going we may all end up as clinicians

Isn't that the truth. I'll tell you and everyone an incident. Maybe not exactly lighten things up, but get back on track here a little. It's like being in the field and someone's heart stops and they stop breathing and you have a bunch of people staring.

Was called up to one of the overpasses within an hour of the big quake in California in Oakland and San Francisco. Place was in chaos. We were having aftershocks every few minutes; and I mean big ones. San Francisco is like being on a sea of mud earthquake wise. That's why the big earthquake in the early 20th century almost totaled it.

So, we have this overpass which collapses squishing dozens of cars and people. Encasing them in concrete coffins. And some people near the overpass hit by debri and one older man on the ground and his wife screaming "My husband is dead!"

Well, he looked pretty dead. No pulse, no breathing. But pupils weren't quite gone yet and so I started CPR and yelled "somebody run and get one of the paramedics over here to get this one." I looked around. "Any of you know CPR?" Not a one.

I picked the least shook up woman standing there and I said to her
"Well, your about to learn."

In a few minutes she was breathing him and chest compressing him like a pro. We were switching off and I yelled "Where in the hell is that paramedic?"

Guy came up and said

"Take it easy Mr. We are swamped."

The older man started breathing and we got a pulse. His wife started crying and thanking God and everyone in the general vicinity.  Paramedics got a stretcher and started an IV. The guy survived. His wife asked me for my name and I just told her to thank the one really responsible. She was still crying and I looked back at the overpass and knew I was going to be there a long time.

Point: You would be amazed how much people know about medicine and health. How informed they are. So if and when something like that happens, and you don't have the luxury of all the letters after the names.
Look at your neighbors and friends. There will be your doctors, your nurses, your paramedics. We will teach each other and do the best we can. And its very likely like that woman on that day I could be the man you never met and I will say to you

"Never done CPR? Well, you're about to learn."

My father had bladder cancer. His surgeon had to create a new bladder for him out of intestine. I had to learn how to flush his new system and replace his catheter. Tough to do on your dad but he had had enough and only would let me help him. He died in my arms. We learn and we grow.


But this does not make me a medclinician.

medclinician wrote:   Statements like - well it has been endogenous in the bird population and the sudden emergence of a "North American H5N1" which is not high path raising the yard stick to 80+ percent to make it high path.  This is circle talk. It is politics. It is well designed and translated - birds have been crawling with viruses for hundreds of years and it hasn't jumped to people. Well, look at China okay, and Thailand, and Vietnam. It has. People are dying from it. This is all semantics and euphemisms. If over half of the birds or people who catch it die, it is high path to me. Its like adjusting warning levels to fit the situation so we are not at a higher alert.  I have worked with facilities that have sequencers and we do not have to incubate a lot of whatever to take a look at the virus and know what the score is.

I am curious, what other countries have LPAI "North American" H5NI?

MedClincian,

The bottom line is protecting the economy... chicken is big here.
Go here .....to see how far they go to protect our chickens.
http://www.who.int/vaccine_research/about/gvrf_2004/en/gvrf_2004_palese.pdf

rH5N1 LPAI virus vaccine provides protection in chickens against lethal challenge with a human or chicken H5N1 isolate
........................................................................................................................................

http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=15297071&dopt=Abstract

Vaccination of poultry with inactivated influenza vaccine can be an effective tool in the control of avian influenza (AI). One major concern of using inactivated vaccine is vaccine-induced antibody interference with serologic surveillance and epidemiology.

Sand,

Hope we hear something new on the follow-up tests results on the LPAI North American H5NI situation.