Any thoughts on the verbiage used in This Article?


It talks about there being no evidence of "sustained" human to human transmission and only "limited" ability to transmit H2H.

Sheesh, China has turned into a breeding ground-zero for disease, we need to stop imports from that place, but I guess nobody will consider that mammoth decision until it's too late.

Once they acknowledge it is sustained H2H then they will have to declare a regional pandemic. They want to avoid that because the economic consequences can be severe.


If people are looking for the straw that accelerates the global depression, I believe this may be it.

They keep saying the old paradigm that people are catching it from birds because they report cases that had some potential contact with farmed or market birds, even though it had already been firmly established that most of the farm and market birds do not have this virus, and the ones that do, have the human adopted strain that indicates the birds that do have it have caught it from people.

The CDC, the WHO, and he Chinese govt are using historical paradigms to convey something that is simply not happening, that people are catching this from birds.

There is either another vector that is yet unidetified that they are frantically searching for, or it is H2H.

Since they have tested just about everything, the common link among victims is exposure to other people.

Connecting the dots, I see this as H2H. How sustained it is, is hard to figure because the information being released is many times weeks old and being managed. 2 weeks ago Taiwan had 42 suspected cases from 2 people that had been to China. Now we find that one of those people are confirmed.

I think it is safe to say this has spread past the borders of china and is spreading H2H. It does not appear to be effiently sustained. That is the next buzz word. When they can no longer deny it is sustained, they will say it is not effiently sustained and is spreading only  in localized clusters. That will then be one step before a global pandemic. From that point to global pandemic is nothing more than time.

We are in for a very rough time and it is my opinion the economic consequences will be severe.


ETA, it has been established that this virus is mutating 8 times faster that any regions flu virus. This is what s most disturbing. It has the potential to find sustained  human transmission very quickly, assuming it is not already there.

This is more indication that the virus in the bird markets is coming from people. Historically, the virus is on the farms, the birds go to the markets and people catch it from the market birds.

Migratory birds historically get it from farm birds. Yet no migratory birds have it.

In this situation, the birds on the farms do not have it, so where are the birds in the markets getting it from? Either some unknown vector or from people. The fact that the birds have the human adapted strain, means that the virus the birds have, has adapted to people. Only one way for that to happen. The virus was in people before it was in birds.

3 hospital staff show symptoms after H7N9 contact

http://www.flutrackers.com/forum/showthread.php?t=204534

On the other hand...


China - H7N9 found in chickens says Harbin Veterinary Research Institute: wet markets and farms

Mainland experts yesterday the latest research from the live poultry market surveillance more than 200 poultry and environmental samples, nearly 10% with the H7N9 virus, the virus genes and human viruses of H7N9 avian influenza highly homologous genes, may be the source of human infection with H7N9 viral genes see partial amino acid mutations, increased upper respiratory tract infection and the risk of human-to-human transmission. Mainland yesterday added four new cases, Shandong Province, the first in the move.
Harbin Veterinary Research Institute of Chinese Academy of Agricultural Sciences research team, earlier in Shanghai, Anhui live poultry markets and farms, poultry and environmental samples collected nine hundred and seventy, Anhui and farms samples were found with the H7N9 virus,

http://www.flutrackers.com/forum/showthread.php?t=204497

Well shoot.  It will be interesting to see if there is any further news on this... like if these folks did actually get H7N9 from the guy.

Mach - I enjoy all your posts on this topic.  I'd like to offer another explanation for the birds having the 'human strain' of the virus.  I'm not saying you are wrong, but just because a bird has the 'human' strain, doesn't necessarily mean it contracted the virus directly from an infected person, just that the virus had previously been in humans.  Here is just a potential scenario where the birds are not catching this strain from people directly (this is my understanding, feel free to tell me where I'm wrong, I'm not a biologist :) )

You have a flu strain, originating in whatever animal 10 years ago.  It's not very deadly, it's all about replicating.  Virus adapts (mutates) to transmit more easily from host to host, in order to survive (find more hosts).  It settles in birds as its main host (perhaps trying out other animals in between - pigs, etc), and heavily mutates/adapts to the environment of birds, to the point where we can genetically identify it as an "avian flu".  At some point a human, who works closely and often with birds (say chicken farmer or pigeon breeder), after constant and sustained contact with infected fowl, picks up the virus.  This man fights it off (because the virus has a hard time living in a human host, it is not well adapted), but in the meantime, he is shedding the virus back to his birds.  Now some of his birds have a slightly new strain, as any of the virus that made it out of the human alive had to adapt to do so - they have a slightly human adapted strain.  Wash, rinse, repeat over some period of time (months, years) - and eventually you have a virus that is well adapted to live in both birds and humans.  The virus in the birds has the genetic markers for being "transmissible to humans", and the virus in people is easily identified as "avian flu".  Meanwhile, birds are passing it amongst each other.  People are passing it between each other too; and people and birds are passing it back & forth.  It's the flu triangle of death!  So yes, birds are getting it from people sometimes...but statistically, do birds come into contact with more birds or more people?  Along the same vein, take a person who works in poultry - they are coming into contact with way more birds than people.  I just think it's more likely that the birds are the vector.

That's not to say I don't believe this is already H2H.  I do believe it is.  Maybe not "sustained transmission" (yet).  Just my $0.02 ;)

Lou Dobbs is leading off his program with an update that it has now spread to Tiawan.

that could all be true. some things to consider.

all flu initially starts in the gut of birds.
no person until recently has been known to contract H7N9. it would most likely be known if it had happened because a new virus in a petson should ne deadly to the host because they have no immunity and the virus will replicate unabated.

what you said is certainly plausible but would be unusual.

it could be another vector, typically pigs, and there have been plenty of dead pigs, but this virus has not pig adaptation markers.

so either there is a mysterious vector or the most common one, people.

with report of sick hospital workers, things are about to change

Yes but the way I understand it, not having any immunology to a particular strain is very subjective, in that, had I contracted this flu in it's previous incarnation (literally one gene off), my immune system might have recognized it and targeted it.  Not to say that a human immune system doesn't make mistakes (see all auto-immune disorders).  Interestingly, see people who lived (so far) through this flu, who may or may not have had medical intervention.  Many of the deaths associated will be from immune response (it's the fluid in the lungs, not the virus or bacterial infection, that is "pneumonia").  Fluid in the lungs is a sign of immune response... WBC, cytokines and so forth, gather together and surround an infiltrated cell, causing inflammation.   One dynamic we never can know is the people who "got sick and stayed home and didn't die".  All of that particular data doesn't make it out for years.  Inflammation in itself is an immune response (so encephalitis, pneumonia, stuffy nose etc), is all a result of an immune response.  The people that are scaring the shit out of me are the people that are infected but asymptomatic.  THEY have no immune response, and no detrimental effects from acquiring the virus.  Should they transmit that shit storm to me - who has come into contact with a version of the virus that is CLOSE ENOUGH to generate an immune response  - I die.  So, as I understand it, the danger here is having Just Not Enough immune response (as this is not a H5N1 cytokine storm virus)... not enough to kill, just enough to make you sick enough to die.  If you have zero response, you suffer no side effects.  At least as I'm seeing what's transpiring here.  I know you get what I'm saying because you obviously followed the H5N1 info and other flu pandemics.  :)

Peak N95,N100, Tamiflu, prednisone. The word is out if you have been holding out getting mask and want some just in case, I would be buying now.

There have been I think one asyptomatic patient and one that recovered. Everybody else is still in the hospital or dead.

Generally speaking, all flu death is from immune response. The immune system has no targeted cells and just throws everything it has and that destroys the organs, ussually the lungs first, but not always. It depends on what the virus is adapted too.

I have to admit I do not understand an asyptomatic flu other than had it before or from effective vaccination. If the virus was replicating it would be destroying cells from the inside out. If it is not doing that then how is it in the body but not replicating. I don't understand.

Also an asyptomatic flu host should not spread it casually since there is no coughing and sneezing.

I am no expert, just learned along the way with H5N1 and H1N1.

Has anyone heard either way about Tamiflu being beneficial to combating this virus?

How many masks should one have on hand? We have some (20 or 30) n95s, but not a whole huge stockpile of them. I also have a couple particle respirator (cartridge type) and replacement carts as well.

(Another random thought): Even if this virus somehow didn't make it here, the thought of it going widespread enough to effectively take China offline, that alone would create chaos (given our dependence on them and our just in time inventory).

ETA: I don't just mean economic impacts. I mean real, tangible shortages of critical items.

It is definitely the end of humanity, as we know it.  Thank god.

I've picked up masks, gloves and a shitload of vitamin c. Any other suggestions?

This is pretty much the main focus on my radar screen lately.

http://articles.chicagotribune.com/2013-04-23/business/chi-united-hikes-change-fee-for-us-flights-by-50-20130423_1_united-airlines-flights-fee

I believe the fee is even larger for international flight changes.

Hopefully not related, but they may be trying to get out in front of this.

The MOH in Taiwan has reported that everyone teted negativefor this strain as of April 24

Appears that N7H9 has been confirmed in later tests, at least the subject of this article.

http://www.recombinomics.com/News/04241301/H7N9_Taiwan_Jiangsu.html

The 53-year-old patient of hepatitis B carriers, medical treatment and taking "Tamiflu", 4 days after the onset of, after the condition deteriorated rapidly as pneumonia.

Related physician stressed that patients taking Tamiflu or two days late, but he will be in the hospital receive the best care, according to the patient treatment experience, it normally takes 2-4 weeks of hospitalization.

The doctor said, the influenza virus invade the body, the viral replication peak period for 2-4 weeks, the patient must make it longer than the virus, will win this battle ".

http://www.appledaily.com.tw/realtim...AF%92%E4%B9%85

There may be a probem with the testing. Similiar test results in china show negative test results early on and then positive results later. We have seen ths before with H5N1.

This is most likely due to  the virus being mostly in the lower lungs until well into the disease because it is not fully adapted to the human host temperature wise while the test is testing the upper lungs.

That is my guess from seeing similiar results with H5N1.

But the sputem test have been accurate.

Vitamin D, specifically D3:
http://pandemicchronicle.com/2007/04/vitamin-d-and-pandemic-influenza/
Maybe zinc, may not help but probably won't hurt.
Alcohol hand sanitizer was in short supply during the '09 flu scare.

Then how is it explained that people test negative, then test positive later on?

That's right, the 4 year old boy was asymptomatic. That they know of.  
Recently, there are reports that (I'm searching my alerts, sorry, can't find the exact article) that now some people have left the hospital alive.... we have 104 confirmed cases, 22 deaths, and IIRC there were 14 people who left under their own power.  Still a staggering mortality rate.  

I disagree that an asymptomatic host does not spread the virus casually.  Yeah, they're not sputtering all over the place...but they would still be rubbing their eyes and nose, occasionally coughing like everyone does.  And they will be out and about like they normally would, not staying home on the couch or in bed.  Also, if they have sick family that is sputtering nasties all over the house, asymptomatic person tracks all of that out into the world.

I dunno, frankly, it all scares me.  I don't know what people do in other countries, but here, no one stays home when they are sick and it infuriates me.  I just love being at the store with the clerk all sniveling and drippy, or worse, a waiter or cook.  I guess people use up their sick days at the beach or recovering from a hangover.  

-dupe, stupid internet-

No need to stay home with ObammaCare!

We have nothing to fear but fear itself!

In other countries (China) many stay home....that is the big unknown many time....

China is very different than the States....

Staying at home means loosing my job and same for the wife. Considered essential operations at hospital. Then the EMA/ FD things if are really bad. Kids out of school, etc. Major logistical nightmare for most of US.

It really makes you think about how difficult of a situation this could become.

if one has to continue working during a pandemic, he would have to practice some sort of personal isolation technique in which self-quarantine is done.  This could be guest house/camper/tent/garage etc, setting up living quarters fully isolated from the rest of the family if the kids/spouse are staying home full-time.  though it would be a substantial logistical burden, i think the emotional aspect of isolation would be even more difficult.

A book i read several years ago when i first learned of one of the "hXnX/sars" scares was Expedition Home.  It covered preventative quarantine, which would definately be a lot more difficult in practice than many think.

i used this recent scare as an oportunity to restock on n95 masks.  ive been using them around the house, and added about a 100 more.  and bleach.

still monitoring this thread closely, ive found all of you helpful at providing good sources of info on this threat.  thanks!


loon

You guys that are buying the masks, what are you using for eye protection?



It's all well and good to prevent direct inhalation, however the tear ducts lead to the nasal cavity and you can be dealing with secondary inhalation via that passageway...



Are you wearing safety goggles in addition to the N95 type masks?
Personally, I have half-face respirators and I usually keep a handful of fresh p100 cartridges around for my hobbies (fiberglass sanding & other crap).  If things start going South, my wife & I would be wearing these + safety goggles.



We'd still have to work out a sanitation routine for removal of the PPE.  A major item of concern is our newborn (due in June)...  Travel outside the home for him would be highly restricted as nothing is made for him as far as PPE...  I understand children & infants often wouldn't make it through an outbreak, but you have to try right?

We're a long, long way from masks and eye pro just to go to Walmart or work.

A long, LONG way.

I was referring to those making contingency plans...





 

I'm Sorry, my comment was not meant to make light of the situation many face in terms of days off.

http://focustaiwan.tw/news/asoc/201304250011.aspx

This is the Taiwan case:

http://www.latimes.com/news/science/sciencenow/la-sci-sn-h7n9-china-nejm-report-20130425,0,3468665.story

 

Some other stats from the article (though this article seems to use old numbers, even though it's from today):
21% mortality rate
73% patients are men
46% patients age 65+
84% patients live in urban areas

ETA:  This article explains the LAT numbers - they are from a study done on 82 of the cases, as opposed to all of them.  http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/apr2413epidemiol.html

How scared should we be of H7N9?

The most recent outbreak of avian flu, the strain H7N9, has killed 22 people and infected 108. The cases were thought to be contained within China until Wednesday, when a Taiwanese man was confirmed to be infected with the virus.

As more cases appear, the death toll rises and so does the fear. But are the fears founded?

GlobalPost talked to Dr. Neil Fishman, associate chief medical officer at the University of Pennsylvania Health System, about where to focus efforts to quell the outbreak, how the press is handling the news and just how likely it is that humans will one day transfer the virus to other humans.

GlobalPost: The current flu strain has been found in disparate areas of China. How does the wide spread of cases affect efforts to combat the virus?

Dr. Neil Fishman: There’s two critical things that are promising. One is that the virus has not been isolated in migratory birds. It’s only been found in chickens, ducks and pigeons in live poultry markets, so that makes it potentially easier to manage.

The other piece of promising news is that the closing of poultry markets appears to have led to a slowdown of the spread of disease. The focus needs to be on controlling the live poultry.

Scientists have said H7N9 is more readily transmissible to humans than previous strains. How bad is this outbreak compared to previous ones? Are we at a tipping point?

I wouldn’t call it a tipping point. The prior bird flu outbreak, the H5N1 strain, has been smoldering for well over a decade. This is H7N9 and, on the optimistic side, there haven’t been that many cases.

It does appear to transmit a little more efficiently from animals to humans. But there still hasn’t been any evidence of human-to-human transmission. I don’t think it’s a tipping point yet, but I do think it is a situation that needs to be monitored very closely.

Scientists have acknowledged that human-to-human contact is possible. How likely do you think this is?

It appears unlikely at this time, but it is important to remain vigilant. However, I will not be surprised if we learn about limited human-to-human transmission in the coming months. This is to be expected and does not signal a pandemic. Widespread human-to-human transmission remains unlikely, particularly given the H5N1 experience.

What do you think of the media response to the outbreak?

I actually think it’s been appropriate and well-informed. I always fear too much hype and I haven’t seen that yet. I think if you go back to the early H5N1 days there was overreaction. Initial coverage of this outbreak appears more informed.

I wonder if China has been more transparent about this outbreak [as opposed to the early days of H5N1], so the info is more readily available, and that leads to less circumspection, less hypothesis.

There’s still a lot to learn about this virus. I don’t believe that there is a saturation effect, that people are getting used to these outbreaks. I prefer to think of it as more of an educated response. There have been more outbreaks, the public has learned, the press has learned … we need to gather all of this information to see how an outbreak progresses.

How likely is the international spread of H7N9?

Right now, less likely, because the virus has not been found in migratory birds, and there has not been human-to-human transmission. I will get concerned if the virus mutates and develops the ability for human-to-human transmission. Again, that has never occurred in the 10-plus years of the H5N1 outbreak, but we just need to follow it closely right now.


Article ....

Here are some guidelines.  It's dated 2009.  I'm not sure if there is more current info, but I'll post this for now.  I'll warn you now, the face shields and full face protection is expensive.

 

Good information, thanks.  I went with half face appreciators, P100 filters and goggles for the family.

http://www.businessinsider.com/what-happens-h7n9-bird-flu-infection-2013-4

Here's What Happens When You Get Bird Flu
Jennifer Welsh| Apr. 26, 2013, 4:26 PM

Article covers the following points:
First contact
Incubation
First symptoms appear
Fever worsens
Pneumonia
Respiratory failure
Acidosis
Intubation
Septic shock
Multiple organ dysfunction
Death

Eeek.  I just restocked on jumpsuits, goggles and masks.  

Article

Which is why it is not being transmitted from birds to people, IMO.

US warns of human-to-human H7N9 bird flu

china bird flu 300x190 US warns of human to human H7N9 bird flu

A masked staff member of a poultry market sorts out ducks in Taipei.

WASHINGTON: There is no evidence that the deadly H7N9 bird flu has yet spread between humans in China but health authorities must be ready for the virus to mutate at any time, a top US virologist has warned. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases (NIAID), said officials in China had studied more than 1,000 close contacts of confirmed cases and not found any evidence of human-to-human transmission. “That is powerful evidence because if you had a thousand contacts with someone with the flu you would be pretty sure some of them would have been infected,” Fauci said in an interview with AFP. Nevertheless, Fauci cautioned that authorities needed to be ready for the possibility of the virus mutating and spreading between humans. “It’s unpredictable as are all the influenza.

One of the things we need to be concerned about is this might gain the capability of going humanto- human which up to this point has not happened and is somewhat encouraging news,” Fauci said. “But we still need to be very prepared for the eventuality of that happening.” Researchers are already developing a diagnostic test to identify H7N9, along with a vaccine, with clinical trials due in July or August. “Work is under way on making a diagnostic test to be able to pick it up quickly,” Fauci said. “We have already started on an early development of a vaccine as we did with H5N1 years ago… Hopefully, we will never have to use it.” More than 110 people in mainland China have been confirmed to be infected with H7N9, with 23 deaths, since Beijing announced on March 31 that the virus had been found in humans. Most of the cases have been located in eastern China, although Taiwan has reported one case. Another case has been found in southern China, while Chinese officials confirmed a further outbreak in the central province of Hunan.

Chinese authorities have identified poultry as the source of the virus and have confirmed that patients became sick from contact with infected live fowl. A visiting team from the World Health Organization, which wrapped up a week-long visit to China on Wednesday, said there had been no human-to-human transmission but warned H7N9 was “one of the most lethal” influenza viruses ever seen. Fauci praised Beijing for its handling of the current crisis, contrasting it to the response of the outbreak of severe acute respiratory syndrome in 2002-2003, when China stood accused of covering-up the scale of the crisis. “It was not the case with SARS in 2003 but the transparency has been excellent,” Fauci said. “I am quite satisfied with the Chinese response.”— AFP

4 year boy is infected in China, his father came down with it first.  No direct contact with poultry, only that they "live near to a live poultry market".  

50% of the confirmed cases have had no contact with poultry.

Of the thousands of poultry tested in farms and markets, about 1% of poultry were infected. Somewhere just shy of 7000 poultry tested, about 46 tested positive.

It isn't coming from poultry.

My girl friend in the Phils just reported to me that it's reached Luzon, where Manila is.  (Luckily, she is not on Luzon).  Haven't seen it in the press yet, not up on yahoo.com.ph.  Maybe it's a rumor - another friend that just arrived from Korea told her.  But I wouldn't be all that surprised if it's true.

-April 29, 2013

H7N9: Are we in for the duration?

Mike Coston at Avian Flu Diary has posted Chinese Science Bulletin: Early H7N9 Risk Analysis. I downloaded the PDF, opened it up, and started reading. Get over there and download it for yourself, because you need to. I promise it will be on the final exam.
After a page, I printed out all four pages and started reading again with a highlighter in my hand. Before I was done, I was remembering Sergeant Williams, calling us trainees together on the firing range the morning of November 22, 1963 to tell us the president had been shot.

"Any of you draftees think you're in for your two years and out again—if anything comes out of this, you're in for the duration," he said.

If this paper is accurate, we are all in for the duration. The authors, who appear to be major influenza experts, have drawn on the first 91 cases of H7N9 to project where it might go. Maybe other experts will demolish their conclusions; I certainly hope so.

The paper was submitted to Chinese Science Bulletin on April 11 and accepted on April 23. Less than two months after the first Mr. Li fell ill in Shanghai, the team assessed the cases so far. They offered a formula for judging the severity of outbreaks, and defined the outbreak as Grade III (severe).

Here's what clinched it for me: They predicted that it would become a Grade IV (very severe) outbreak by the end of April, when the case numbers would exceed 100. And so they have.

So I'm prepared to accept their eight-point argument, despite its occasionally incorrect English, that H7N9 "is of enormous risk," and some of those points seem irrefutable: it will be "extremely tough" to eliminate it from China's vast bird and pig populations, so it will spread rapidly. One wild bird with H7N9, found in Jiangsu province, indicates it will spread beyond China.

The eighth argument arrives like a conviction for a capital offence:

Eighthly, the probable long existence of the H7N9 virus in humans will provide the driving force to the virus to adapt to humans through mutations. The virus may thus obtain human-to-human transmission, and may spark a pandemic influenza thereafter. The possible pandemic should likely be very dangerous with the consideration that the virus has showed highly pathogenicity in the first 91 cases.

The paper goes on to call for "forceful scientific measures," ranging from vaccine production to replacement of much of China's food distribution system: Never mind those stupid high-speed trains to Lhasa and Guangzhou, ditch the wet markets!

And while the authors point to the successful suppression of Nipah virus in Malaysia in 1998 and of SARS in 2003, they pin our real hopes on the virus itself: It may be structurally incapable of making itself capable of human-to-human transmission because the mutations that would enable it to do so would also kill it. Failing that, eradicating H7N9 in poultry markets may keep it from getting into poultry farms, and thereby push it toward oblivion.

No doubt more implications of this paper will emerge in coming days, but a few spring to mind at once:

If China really is suppressing some H7N9 news, it has just lost that option. Its own experts have painted it into a corner.

The political and economic consequences will be seismic as 1.4 billion people adjust to a new food-security regime. The same is true of trade and travel.

China will also have to deal with the irony of being a communist country without a real health insurance system. Without such a system, the country can expect that the 2020s will look like the 1920s, when warlords ruled.

I really hope I'm overreacting to this paper, and I will be hugely relieved if other experts can refute it and reassure the world that H7N9 is just another scare, soon to be forgotten. But I'm not holding my breath until they do.

http://crofsblogs.typepad.com/h5n1/2013/04/h7n9-are-we-in-for-the-duration.html

Been sitting back observing all this and did read the article.

What it seems like is, other than presenting cold hard facts, is that the many PROJECTIONS are mostly gross speculation based on THEORIES, that in time may prove to be somewhat correct, wholly correct, or inaccurate.

FluTrackers site is excellent, but there is a tremendous amount of speculation there as well.

The many comments are surely made in/with good faith and intention.

The highly visible person who predicts an H7N9 pandemic that kills many, will no doubt become notorious, the same way a person predicts a stock market crash -and one happens concurrently, he sometimes becomes famous.

While I'm not trivializing this recent H7N9 issue, it's IMHO just too early to be so confident in various extreme projections.

ETA --Want to point out my belief that SPECULATION is a valuable tool that serves to thrash out many possibilities for examination --and more.  

For those of us who are not in the habit of studying pandemics, what reasonable precautions should be taken if this were to make it to CONUS?