And let me assure you I am working on a very long and important series of flublogs. 

But occasionally things happen that just make me so mad, I have to speak out.  And so today, I am calling on the US Navy, the CDC and the WHO to get NAMRU-2 the Hell out of a clearly ungrateful Indonesia and get it to some place that welcomes it.  Like, ironically, Vietnam.  Or Australia, which would probably be easier to get samples to anyway. 

There is little doubt that Indonesia is politically sliding the way of pain-in-the-neck nations such as Iran, North Korea and Venezuela.  Now I know that the United States is a ripe target for ridicule.  We have done things around the world that the average American is not proud of.  But I am sick and tired of America being kicked in the groin by nations that we are trying to help.  From a health perspective, the nation doing most of the kicking these days is Indonesia. 

People have posted replies to my earlier blogs regarding Indonesia, asking me to be patient and to understand that if the US pulls out of any medical support for Indonesia, it will harm the Indonesian people.

Those pleas need to be vectored toward the real source of potential hardship:  The Indonesian government.  They are the ones harming their own people, and the United States cannot and should not be held responsible for what other nations deliberately do to their own people. 

Back to the title of the blog.  It is time to close the doors on NAMRU-2, and to relocate it somewhere else.  It is time to bring closure to this whole sad story.  Put NAMRU where it is appreciated, not condemned by some paranoid schizophrenic regime. 

Speaking of paranoid schizophrenic regimes: Last night, I watched the film The Last King of Scotland, and was mesmerized by the Oscar-winning performance of Forest Whitaker as Idi Amin.  Today, as I write this blog, I am haunted by that film.   How a charismatic person could lead a nation to ruin and mass death is so sad.  And we see several other nations and entire regions of the planet where government madness, fueled by anti-Western sentiment, is destabilizing this planet.  Supari and the Indonesian government overall would be wise to remember that the West wants to help, but its patience is not infinite, nor should it be. 

While I am not ready to call this week's announcements a reversal, it is welcome news and hopefully will eventually be proven to be a reversal of a disastrous policy.

The bad news, of course, was the announced new death toll, and in particular the deaths of two women.  The Health Ministry confirmed what we already suspected was an H5N1-related death -- a 16-year-old girl from South Jakarta  -- who was confirmed dead of H5N1 on May 14.  the second death was a 34-year-old woman from Banten province, who was pronounced dead on June 3.

The virus continues to strike lethally at younger persons, and women continue to be especially hard-hit.

The next story also confirms our deepening concern about the status of things in the archipelago nation of 18,000 islands.  A Reuters story of today validates/vindicates our belief that H5N1 is frequently and dangerously diagnosed as something other than flu.  Thus, we can assume rationally that the actual infection rates from H5N1 are many times higher than what has been reported.  Here's the story:

Bird flu mistaken as dengue and typhoid in Indonesia

Fri Jun 20, 2008 2:11pm IST

By Tan Ee Lyn

KUALA LUMPUR (Reuters) - Some cases of human bird flu in Indonesia have been variously misdiagnosed as dengue fever and typhoid, resulting in the late administration of drugs, a leading doctor in the country said on Friday.

Indonesia has had the highest number of human H5N1 cases in the world and while mortality rates are around 60 percent in other places, the figure is highest, or at 81 percent, in Indonesia.

Sardikin Giriputro, director of the Sulianti Saroso Infectious Disease Hospital in Indonesia, told an infectious disease conference in Kuala Lumpur that misdiagnoses and the late administration of drugs were partially responsible for the high mortality rates.

"It (H5N1) is misdiagnosed initially as dengue, bacterial pneumonia, typhoid and upper respiratory tract infection because of similar clinical features (symptoms)," Giriputro said.

Indonesia has had 135 confirmed human H5N1 cases from late 2003 to May 2008 and 110 resulted in deaths. The country reported two more confirmed cases this week, but these were not reflected in Giriputro's figures.

Oseltamivir, otherwise known by its brand Tamiflu, is considered the drug of choice against bird flu and Giriputro said fatalities mounted the later the drug was administered.

The survival rate was very high when Tamiflu was given less than 2 days after the onset of symptoms, but that plunged the later the drug was given.

"It's best if given less than 24 or 36 hours after the onset of symptoms," he told Reuters later.

While rapid test kits are now used to diagnose the disease in animals, Giriputro said these tools were much less reliable in people.

"It depends on the viral load (in samples taken from patients)," he said, adding that test results could turn out negative even if the person was infected with H5N1, simply because there was not enough virus in samples taken. (bold mine)

In a bid to reduce the death rate, the Indonesian government has begun distributing Tamiflu to health centers in areas where H5N1 cases have occurred.

"When doctors see influenza-like illnesses and where there is evidence of contact with sick poultry, then they give Tamiflu (without waiting for laboratory results)," Giriputro said.

© Thomson Reuters 2008. All rights reserved. Users may download and print extracts of content from this website for their own personal and non-commercial use only.

http://in.reuters.com/article/health/idINKLR31511520080620?pageNumber=2&virtualBrandChannel=0

Dr. Henry Niman and others have warned for years that the hasty administration of Tamiflu without first taking necessary samples causes false negatives and hinders accurate reporting of human H5N1 cases.  This new report from the Boots On The Ground confirms this in a decisive and final way.  It lessens the viral load and allows H5N1 to "fall under the radar" of reporting.  Likewise, Dr. Giriputro has also declared -- on and for the record -- that quick test kits are unreliable for use as the "last word" on whether or not H5N1 is present in someone.

So what can we deduce from all this? 

First, there are many, many, many more unreported cases of human H5N1 than we see in the press.  This may be a "DUH" to us, but it is important to see this in the global media.  And it is equally important that we are vindicated in that venue as well.

Second, we are unable to get some important viral changes mapped, because these people are getting Tamiflu and testing negative.  that may be good in terms of living, which is always nice, but it does mean that any genetic changes in the virus from these people are going undetected. 

Third, Indonesia is a human incubator of H5N1, and we must continue to monitor the situation there 24/7/365, preferably with the full assistance of the Indonesian government.

I am going to tell it like it is, and never look back.

The Indonesian government's self-inflicted death wish has reached intolerable proportions.  The most recent disclosure from Indonesian Health Minister and Court Jester, Siti Fadillah Supari, means Indonesia has reached the Tipping Point between political recklessness and geopolitical suicide.  Or maybe future homicide.

For those unfamiliar with recent developments:  Indonesia has announced it will no longer report bird flu deaths as they happen.  Instead, they will roll up the data and grace the rest of the world with reports every six months or so, or whenever the muse strikes them, or when a goat is slaughtered and the entrails are spread over the government's fax machines and computers.

This means Iran -- Iran! -- is more transparent than Indonesia.  It means China is more transparent.  It means Hell has frozen over.  It also means that for the rest of us, we will not know that an epidemic has started there until it is probably too late to do anything except batten down the hatches and pray.

It has gotten to the point that an ad hoc union of flu bloggers is trying to take more decisive action to bring someone -- anyone -- in the Indonesian government to his or her senses and stop this Supari woman before she dooms not just her nation, but the entire world, to disease and death.  Supari couldn't be jeopardizing the world's health any worse than if she bottled up a few sick people from Tangerang and flew them to Los Angeles.

So here are a few random ideas.  I appeal to my colleagues to use their resources to see if we can accomplish a few things and to add to this list within their own blogsites. 

1. First, let's have somebody ask John McCain and Barack Obama to sign a joint letter to the Indonesian president, expressing their regret and indignation at the government's policies.  If Indonesia knows that both presidential candidates will not stand for this Tomfoolery, and it is a bipartisan effort, it has to count for something. 
2. Second, let's start having some serious travel advisories about any travel to Indonesia.  The US, Britain, Australia (especially Australia, since Bali is to Australia what Disney World is to America) and other nations can all issue joint travel warnings, discouraging people from any travel to Indonesia.
3. Third, let's contact our local Congressman or -woman and Senator, asking them to write the White House and hammer for decisive action.  It is surprising just how few letters it takes to activate a slumbering Congressperson.
4. Fourth, and also within those letters, let's press for UN action against Indonesia.  A nicely-worded UN resolution should do the trick. 
5. Fifth, pull NAMRU the Hell out of Jakarta and put it where it is wanted.  Someplace like Vietnam or Thailand or South Korea would be just great.
6. Sixth, pressure American-led corporations to cancel all Indonesian conferences, including Bali.  Ask everyone to refuse to attend any multinational or multigovernmental conference that is booked in Bali or Jakarta.
7. Seventh, ask the WHO to begin applying the pandemic threat level to individual nations.  I have frequently called upon the WHO to raise the pandemic threat level from Phase Three to Phase Four.  Let's rethink this and take a Homeland Security approach to things.  As DHS applies the terrorism threat level to sectors such as the aviation sector, let's apply a Phase Four warning to Indonesia.
8. Eighth, let's do everything possible to empower doctors, scientists, researchers, reporters and bloggers to get the real story out of there.  Maybe we need a Bloggers Corps to go into Indonesia and teach bloggers how to post their stories and blogs anonymously and without detection by government censors.
9. Ninth, let's hope we have Boots on the Ground, James Bonds armed with Q-Tips and vials, ready to covertly swab the epithelial cells of suspected bird flu patients, and spirit the samples out of Indonesia via submarine.
10. Tenth, pull all US-bought antivirals out of the country.  Today. Save the Tamiflu for our own people.  After all, if the Indonesian government is willing to play Russian Roulette with a loaded gun regarding the health of the entire world's population, they obviously don't care one whit for the safety of their own people.

I am out of ideas.  Let's hear from you!

First, here are some quick excerpts and a link to the whole story.

Heavy Internet Users Targeted
Providers to Test Charges, Delays

By Cecilia Kang
Washington Post Staff Writer
Wednesday, June 4, 2008; D01

 

Cable service operators Comcast and Time Warner Cable said yesterday that they would begin testing new approaches that would slow Internet access for heavy users and charge more to those who want additional speed.

The tests come as the Federal Communications Commission wraps up an investigation on complaints that Comcast blocked certain users from sharing video, music and other files. The complaints fueled a larger debate, with hearings in Congress and by the FCC, on how much control Internet service providers should have over the flow of data.

"The cable companies see a hammer hovering above their heads and are scrambling to find ways to reduce the appearance of wrongdoing," said Ben Scott, head of policy for the public interest group Free Press, which advocates for better oversight of cable operators. He called the plans "Band-Aids" on the bigger problem of network capacity, which he said can be solved only by larger investments in the cable companies' networks.

Comcast said that on Friday it would begin tests in Chambersburg, Pa., and Warrenton, Va., that would delay traffic for the heaviest users of Internet data without targeting specific software applications. Public interest groups complained in November that Comcast targeted users of BitTorrent, a file-sharing application, by blocking or delaying video and other files exchanged with the technology. Free Press said the practice discriminated against certain content and impeded users from having full access to the Web.

Analysts said the test would not differ significantly from Comcast's current network-management practices. The new approach would, however, target a broader range of heavy bandwidth users instead of delaying all traffic using BitTorrent. Roger Entner, a senior vice president at Nielsen IAG, said about 5 to 10 percent of peer-to-peer users -- those who directly exchange files with other users -- gobble up about 50 percent of all Internet bandwidth. (bold mine)

"This is the politically correct version of doing what Comcast had been doing before, though it takes the occasional [peer-to-peer] user off the hook," Entner said.

Time Warner Cable is trying a different approach with a test that will charge customers more for larger volumes of data and faster Internet access. The metered-billing test, which the company compared to cellphone billing structures that charge extra for those who go over their minutes, will begin tomorrow with new customers in Beaumont, Tex. The company said its approach allows customers to choose plans that fit their needs.

"Instead of raising prices across the board, consumers who are excessive users would pay," said Alex Dudley, a spokesman for Time Warner Cable. "It is clearly the fairest way to fund the investment that is going to be required to support that use."

http://www.washingtonpost.com/wp-dyn/content/article/2008/06/03/AR2008060303248_pf.html

Note that five to ten percent of all Internet users consume fifty percent of all Internet bandwidth.  And much of that is peer downloading of crap, usually in the form of illegally pirated music and movies.  That makes it very difficult for the other ninety to ninety-five percent of the rest of us, who only occasionally download crap.

The ISPs all want to move to a "metered" system, similar to how you pay for electricity today.  You pay for what you use.  Personally, I think this is a wonderful idea, and I will expand on this idea over at my blogsite on Computerworld.com.  Paying for what you use could be exported as a fee to university students, where a good deal of this illegal file sharing and downloading goes on.

It is not the only answer, however.  Internet providers must continue to invest in bigger pipes and newer solutions. 

What does this all have to do with a pandemic?  As I have mentioned many times, "telework" or "work at home plans" will not be successful in a severe pandemic.  Why?  think about the bandwidth that will be consumed at home, while Jimmy plays XBox Live and his mom and dad are frantically trying to log into the corporate mainframe and email systems at their jobs.

Cable Internet connectivity is a communal experience.  that means a neighborhood is sharing a single point of access back to the home office.  They may tell you that a five jigabit connection is coming to your home, but it is divided by the number of packets of ones and zeroes that is simultaneously being transmitted and received by every other Internet connection in your community.

DSL claims that it is a "home run" cable pull all the way back to the Central Office of your Telco, but I seriously doubt that.  That is because DSL connectivity is horrifyingly unreliable.  I speak from experience: In my day job, I have over 120 "edge routers" connecting back to my network, and about 73% of those connections are DSL.  Failed DSL connections represent 93% of all my wide area network outages.  In any given week, up to 21% of all DSL connections can fail for extended periods of time.  I have the metrics to prove this.

So the chances are extremely good that if you are a cable subscriber, you will experience extremely slow activity at home during a pandemic.  And if you are a DSL subscriber, count on your DSL failing repeatedly  in a pandemic of any severity.

So your telework will be thrown out the window, along with your computer.  Businesses that depend on such telework will reluctantly call their employees back into work, because nothing will get done otherwise.  This is especially true for government employees, because government overall still moves on paper while business moves digitally.

Will those employees report for work?

Have their bosses bought them masks, gloves and hand sanitizer?  Have they trained their people to know what to do and what to expect in a pandemic?  Have they prepared them for the pain, the PTSD that will inevitably occur, while giving them the resources and the knowledge to think and act for themselves?

Employers, you can answer that question a lot better than I.  Perhaps it's better not to ask at this time.  Much better that your employees ask you these things now, rather than later.

Because the next pandemic might not be H5.  It could be H7.

Soon, I will be resuming my blogs on pandemic readiness.  I have been recharging my batteries and doing some research.  Plus, things have been kinda quiet lately, and I am not one to write if I cannot offer meaningful dialogue (my colleagues all do that much better than do I).

So I will be posting entries again soon.

Scott

The recent disclosure from the Bangladesh government and the CDC that a toddler was positive for H5N1 when originally certified negative opens the door to a multitude of questions.  Read with me the capsule, as digested by Dr. Henry Niman:

The DGHS, as part of its routine surveillance, sent a swab with samples from naso-pharyngeal of the 16-month-old boy to the Centres for Disease Control and Prevention in Atlanta which confirmed the H5N1 infection Wednesday.

"When the child came to us it was diagnosed with strain A positive but the H5 was found negative. However, one and a half months later when we sent the sample to Atlanta, as part of our routine surveillance, it was confirmed after culturing the virus that it was H5 positive,"

The boy, who lives in Kamalapur in Dhaka, was cured without any medicine for Influenza. He was provided with medicines for respiratory infection for 14 days... (bold mine)

http://www.recombinomics.com/News/05220806/H5N1_Dhaka_Mild.html

This one small snippet of the news story is quite revealing.  First, why did it take six weeks to send the virus sample to the WHO and CDC?  Is this routine?  Second, why the false negative for H5?  What test was used that produced the false negative?  Thank the God of your faith that the Bangladesh government did its due diligence and sent a negative sample ahead to the WHO and CDC.

A significant case can be made for the global junking of the test that produced the false negative.  The unanswered question is, How many false negatives have been misdiagnosed across the globe using this and other tests since 2003?

The odds say that this 16-month old should not have survived.  By the way, I do like to play the odds, and got four horses right in the only two Preakness races I participated in last week.  Not bad. 

But I digress.  The odds say this toddler should have died.  Since the child is recovering without the aid of antivirals, this means that we are probably looking at a very mild Qinghai clade 2.2 H5N1.  This implies that if one toddler contracted high-path H5N1, then we need to assume others in the region bordering and including east India (a region the size and shape of the state of Maine) have also contracted H5N1.  Since we have not seen a massive die-off of humans in the region, my suspicion is this mild H5N1 is being misdiagnosed as seasonal flu.  If it is not tipping the scales on influenza tests, it is not evoking concern.  This hypothesis is bolstered by the false negative and subsequent discovery of H5N1 by the CDC six weeks later, in the culturing of the virus.

We have read about cases where Indian cullers have experienced flu-like symptoms.  I hope somebody is following up with those cullers to see if they exhibit antibodies to H5N1.  Certainly mass suggestion could also be a culprit, and I tip my cap to that theory as being entirely possible.  Just as possible now, however, with the Bangladesh disclosure, is the chance we are seeing mild human H5N1 (once again) go completely undiagnosed.  It is not an unfamiliar refrain.

I blogged not too long ago that perhaps Qinghai will not become the pandemic strain of H5N1.  I theorized that Fujian Clade 2.3 would be the trigger.  But I am also reminded of the words given to me by Dr. Richard Webby, protege of the Pope of Influenza, Dr. Robert Webster.  Dr. Webby said to me in 2006 that we would be surprised how little we really know about influenza.

Perhaps this is exactly how influenza becomes pandemic.  We see three or four substrains of a particular virus circumnavigate the globe.  We see the virus move from wild birds to poultry and back again; or we see the virus move from poultry to wild birds and back again.  The sequence really does not matter.  The "Three P's" (poultry, pigs, people) help move the viral goulash along in its evolution and help the virus substrains acquire -- slowly, maybe agonizingly so -- the necessary genetic elements for pandemic activity.

This evolution cannot be stopped, only slowed.  . 

Then, quite suddenly, these subtypes all recombine with each other.  A pandemic "Big Bang," if you will, ensues.  Since influenza A plays King of the Mountain, the strongest (most lethal?) substrain accepts other substrain's acquired genetic characteristics and takes its victory lap around the world a few times.

It is at that point that a pandemic occurs. This theory is not far removed from that of one of my heroes.  The late Dr. R. Edgar Hope-Simpson theorized that asymptomatic carriers of novel influenza were at least partly responsible for pandemics.  He also sprinkled in doses of sunspots and solar radiation -- kind of a Pandemic Theory of Everything. 

What if he was right?  Perhaps those "asymptomatic" carriers were not so asymptomatic, but were actually carrying a milder form of a novel strain that no one picked up on.  That 16-month old toddler could be one such asymptomatic carrier.  So could thousands of Indian, Chinese, Vietnamese, Russian, Thai, Pakistani and Turkish carriers.  This also would explain the sudden appearance of pandemic influenza all over the world simultaneously.  There are too many stories of historic pandemics where the virus' travel was much too quick for any of the conventional transportation mechanisms of the day.  Pandemic influenza outran sailing ships and other ocean-going vessels.  It outran horseback, wagon, carriage and train.  It did so because it was with us already for years, festering, smouldering, waiting for that simultaneous worldwide genetic addition that caused it to spark.

Only antibody testing of tens of thousands of people in bird flu hot spots all over the world will reveal any fact or truth to this hypothesis.  It certainly does underscore the prevailing belief that we won't know that we are in a pandemic until after it starts.  There are simply too many holes in surveillance to guarantee early warning.

But in one remote area of one struggling nation, we may have found a very important clue to solving this riddle.  And we found it courtesy of due diligence and surveillance.

If only other nations (are you listening, Indonesia?) would do as well.

According to ProMED, the toxic 027 strain is the culprit.  Until recently very rare, apparently 027 is becoming not quite commonplace, but not rare anymore, either.  Again, according to ProMED, C.diff 027 killed some 65 Scottish patients at Stoke Mandeville Hospital in Aylesbury, Buckinghamshire, England, between 2003 and 2005.  Stubborn little pest, that C.diff.

Hospitals are pretty dangerous places these days.  In my opinion, that is because there is little functional difference between a hospital and a bus terminal.  We let a virtual stampede of people through our corridors, wings and even rooms.  I have personally visited patients with twelve visitors in a room at one time.  the lax "enforcement" of visitor maximums has to be part of the problem.

So is the laziness of modern healthcare practitioners.  How many surveys have we seen recently that show not even doctors bother to wash their hands between patients?  Here's a 2004 story from WebMD.com:

July 6, 2004 -- Upwards of one-half of doctors don't wash their hands between visits with hospital patients, a new study shows. It's a big infection control concern in hospitals because dirty hands transmit germs to other patients.

Why don't doctors wash their hands -- a seemingly simple procedure? Hospitals routinely promote good hygiene to doctors and other health-care workers, alerting them of the risks of dirty hands after examining different patients or after examining various infected and uninfected sites on a single patient. Yet doctors are frequently observed breaking the rules.

In this study, researchers sought to better understand doctors' attitudes. They secretly tracked 163 doctors to monitor their hand washing during the day. Each doctor also completed a survey about their attitudes on hand hygiene.

They observed just 57% of doctors washing their hands between patients, writes lead researcher Didier Pittet, MD, MS, an infection control expert with the University of Geneva Hospitals. Pittet's report appears in the latest Annals of Internal Medicine.

http://women.webmd.com/news/20040706/study-doctors-dont-wash-hands-enough   

The problem does not rest exclusively with physicians and nurses.  We have become slobs ourselves. 

Restroom Study Finds Hand Washing on the Decline

FRIDAY, Sept. 21 (HealthDay News) -- Americans aren't washing their hands like they used to.

That's the conclusion of a new observational study that found fewer users of public restrooms stopping by the sink on their way out, compared to years past.

The study was released to coincide with National Clean Hands Week by the American Society for Microbiology and The Soap and Detergent Association.

For the study, researchers observed the behavior of almost 6,100 adults at six locations in four cities -- Atlanta, Chicago. New York and San Francisco.

They found that 77 percent of people washed their hands in public restrooms, a 6 percent decline from the 83 percent noted in 2005.

This latest study found that women were still more likely (88 percent) to wash their hands than men (66 percent). In 2005, 90 percent of women and 75 percent of men washed their hands.

In both the 2005 and 2007 studies, researchers observed the hand washing behavior of people at: Turner Field in Atlanta; the Museum of Science and Industry and the Shedd Aquarium in Chicago; Grand Central Station and Penn Station in New York City; and the Ferry Terminal Farmers Market in San Francisco.

In 2007, Chicago had the most conscientious hand washers (81 percent), followed by New York City (79 percent), Atlanta (75 percent) and San Francisco (73 percent).

"According to the Centers for Disease Control and Prevention, the single most important thing we can all do to keep from getting infectious diseases and spreading them to others is to clean our hands," ASM spokesperson Dr. Judy Daly, director of the microbiology laboratories at the Primary Children's Medical Center in Salt Lake City, said in a prepared statement.

"Many cases of colds, flu and foodborne illness are spread by unclean hands, and these diseases are responsible for billions of dollars each year in health-care expenditures and productivity losses in the United States," Daly noted. "Worldwide, infectious diseases remain the leading cause of illness and death."

-- Robert Preidt

SOURCE: American Society for Microbiology, news release, Sept. 17. 2007

http://www.medicinenet.com/script/main/art.asp?articlekey=84055

Two weeks ago, a brother of a very close family friend died.  His autopsy reads, Cause of Death: MRSA.  He had been in hospital for a minor surgical procedure a few weeks prior. Did he contract MRSA from the hospital?  That remains to be seen.  One thing is for sure:  Hospitals are losing the battle against superbugs.  Their own policies regarding visitation, coupled with their inability to enforce common sanitary protocols, may be counteracting any feel-good, window-dressing initiatives their PR departments and legal counsel can conjure up to lull patients into a false sense of security.

Let me close with the last three paragraphs of the ProMED report:

_C. difficile_ is a potentially fatal bug, which mainly affects the elderly, and usually grows in the large intestine. Spores can survive for a long time in the environment, with areas around hospital beds and toilet areas common. Health officials have been concerned that the "hypervirulent" 027 strain could become more common in Scotland as it spreads from England, and a _C. difficile_ "reference laboratory" has been established in Scotland to help identify more virulent strains including 027, which might not be picked up otherwise, and help understand the bug's characteristics.

The 027 strain produces more toxins than other types, has caused large outbreaks of severe disease in hospitals in Canada and the US since the beginning of the decade, and has now been detected in more than 80 hospitals in England and Wales. The 1st Scottish case of 027 was diagnosed in October 2006. Then, in November last year [2007], an unnamed female patient died in the West of Scotland due to a "combination of factors" after being infected with the 027 strain.

Figures show all strains of _C. difficile_ caused 100 deaths in Scotland in 2005 against 57 in 2001. Cases increased by 10 per cent in 3 months.(bold mine)

My Outlook task list is overflowing with blog ideas for these slow periods.  Of course, impatient one, you can also go to the Websites and blogsites that deal with avian flu on a much more dependable, daily basis.  They are all posted on the left frame of this Website, and they are all worthy of your time.

One item that I am looking forward to writing is a critique of the pandemic guide of the American Civil Liberties Union.  I suppose they will sue bird flu to death, yuk yuk.  Seriously, this topic needs to be debated.  That there will be some sort of temporary cessation, or suspension of some subset of civil liberties is all-but-assured.  The scope of that suspension cannot be determined in advance.  It has to be planned for, exercised, and chronicled.  We also need to define, legally, when that cessation of that subset of civil liberties itself ceases.  Is it when cases drop back below the epidemic threshold?  Is it when the Congress says so?  The governors?  The military?  Homeland?

I will also be turning toward the plague of Dengue Fever and DHF that is becoming endemic in the Caribbean, and how we may be only a blow away from Dengue on our own doorstep.  Hurricanes can bring the United States more than just a lot of rain, wind and property damage.  It can bring misery on a scale not seen since the late 1800s. 

I want to comment on something I read in Mike Coston's blog, Avian Flu Diary.  Dr. Mike Osterholm is a genuinely good person and, I am happy to say, a friend of mine.  Mike's stamina as regards pandemic fatigue is remarkable.  I have found that I need to "charge my batteries" from time to time, leaving the topic of bird flu for days to weeks in order to energize.  Mike Coston has the luxury of a Florida beach apartment to lounge in and recharge, curse him.  Me? I have a backyard with a pool that is forming its own ecosystem.  But thank God that Mike Osterholm is the Energizer Bunny of pandemic planning. 

Dr. Mike has given a seminal speech in his native Minnesota, speaking in front of hundreds who were treated to Vintage Osterholm.  the story is at: http://www.postbulletin.com/newsmanager/templates/localnews_story.asp?z=2&a=342839

Osterholm back on the speaking circuit and getting picked up by the media is a good thing: There is no one else in the world today with the gravitas to match Dr. Mike when he speaks about supply chain disruptions, along with the upcoming potential failure of essential services such as municipal fresh water systems and electric utilities.  And Mike consistently gets it right.  He is Cassandra, but so am I.  So are we all.  And we are right and correct in our beliefs. 

I am barely qualified to carry his water when it comes to these topics.  In fact, he is where I draw much of my inspiration from when I blog about IT and the incredible vulnerability our society has if the technology fails.  Yet that is what I am expert in -- IT -- and I mean IT like IT that means the difference between life and death, good and bad, success and failure on an enterprise scale.  So when I see the train wreck that is the failure of multiple essential services like coal mining, petroleum refining and data center failures, I have been there and done that.

One of the countless things I learned while preparing the entire state of Florida for Y2K was that it is not the loss of fresh water that worries me as much as the inability to move waste.  You see, waste flows downhill as they say, and in most areas of Florida (and probably in your area too), that downhill flow has to be power-assisted.  If there are serious disruptions to the electric grid (and you can count on those in a moderate-to-severe pandemic), human waste will back up and become quite a public health problem.  Sure, there are generators that are responsible for doing their thing at transfer stations, but they, too, require energy -- in the form of petroleum products.  When that flow is disrupted, the other flow will be, too.

So add to that cascading series of probable failures, the failure to move human waste from Point A to Point B.  And that means a very real possibility of diseases such as cholera to suddenly appear as a secondary infection during a severe pandemic with accompanying disruptions to the electrical grid.

When I did the Sandy Springs radio show last week, I mentioned that a pandemic is like Y2K where the people fail, not the machines -- at least not in the beginning.  Eventually, however, machines will fail too.  Not all of them at once, but enough of them to make life pretty miserable for an extended period of time.  Machines break.  Computers break, too, because computers are machines at their core. they all require maintenance.  No maintenance, or reduced maintenance, equates to disruptions and failures.

Now factor in Nature.  Nature does not schedule its rage sequentially, in a linear timeline.  Mother Nature likes to "pile on," like some football coach running up the score on Hapless U. to get a few extra poll votes or points in a computer ranking.  So it is that over half of the influenza pandemics of the past 300 years had waves in what is known as Hurricane Season, June 1 to November 30.  Imagine the problems if a major hurricane hit the United States while a flu pandemic raged?  Can we even begin to imagine what happens when the entire veneer of a modern lifestyle is peeled back by a killer virus and then a natural cataclysm?  Anyone who thinks the infrastructure could withstand that is buying illegal substances from Mexican cartels.

Last Sunday, my wife and I were en route to our church when we noticed all the traffic signals were dormant in the mile leading to the church.  We performed the quick calculus and concluded the power would be off in the church and we thanked our God that He gave us the wisdom to dress very Summery.

Sure enough, when we entered the church, it was beginning to get pretty sticky in there.  We became grateful for the incense!  The point is that within about forty-five minutes, the church began to swelter.  That is how long it took for people to become really uncomfortable with the conditions.  Now transpose that to hours or even days.  It is not so unlikely a scenario:  A few months ago, our City of Tallahassee power was off for just shy of eight hours, caused by a mild thunderstorm.  What was maddening was that our power stayed out while the next street over had electricity within three hours.  Why our block was subjected to torture while another was quickly restored is still a mystery.

An increasingly thin veneer separates us from chaos.  That veneer is abraded today by absurdly high gas prices, unemployment, foreclosures and malaise.  It can be stripped bare by natural disasters such as tornadoes, earthquakes or hurricanes.  It can be blown to smithereens by a severe flu pandemic.  Every single thing we can do to ensure the success of the supply chain and the delivery of infrastructure, utilities, food and energy during a pandemic is important, welcomed and is absolutely essential.

My good friend Craig Fugate is the emergency manager for Florida.  He spoke yesterday at the Governor's Hurricane Conference in Ft. Lauderdale ("Ft. Liquordale" to the oldies there).   The topic was hurricane preparedness, but he also spoke indirectly to this culture of victimization and how it is a cancer upon our society.  People are not taking responsibility for their actions.  Read on::

(Florida Governor Charlie) Crist and Craig Fugate, director of the Florida Division of Emergency Management, urged people to stock up on food, water, gasoline and other provisions. Fugate said residents should adopt a proactive approach, instead of relying on government to ride to their rescue.

"You don't have to get ready: Somebody's going to take care of you. Your house got tore up? Blame somebody else," Fugate quipped. "Ice didn't get there today, 12 hours after a hurricane? Blame the government.

"So when did we suddenly decide that we were going to play the role of victim?" he asked.

Myriad newspapers are covering the story today, so I will simply point you toward this story, from the AP and located on  USA Today's Website:

SEOUL (AP) — South Korean officials say they have killed Seoul's entire poultry population to curb the spread of bird flu following a fresh outbreak of the disease in the capital.

Quarantine officials destroyed 15,000 chickens, ducks, pheasants and turkeys raised in farms, restaurants, schools and homes in the city, Kim Yoon-kyu, an official at the Seoul Metropolitan Government, said Monday.

The Seoul government said in a statement that the slaughter was necessary to contain the disease. It said it will now focus on preventing live poultry from being brought into Seoul.

The slaughter began Sunday night, hours after authorities recorded Seoul's second outbreak of bird flu in less than a week.

The slaughter did not affect parrots, parakeets and canaries because they have little chance of spreading the disease, Kim said.

On Monday night, government tests confirmed the latest outbreak in Seoul was caused by the deadly H5N1 virus, said Yoon Young-ku, a spokesman at the Agriculture Ministry.

The tests also confirmed two additional outbreaks of the virus in Busan, brining to 31 the total number of outbreaks in South Korea, he said.

Bird flu began sweeping southern parts of the country last month for the first time in more than a year, forcing the slaughter of about 6.8 million birds.

The virus remains hard for people to catch, but scientists worry it could mutate into a form that spreads more easily between humans, with the potential to kill millions worldwide.

At least 240 people have died from bird flu since 2003, according to the World Health Organization. Most human cases so far have been linked to contact with infected poultry.

http://www.usatoday.com/news/health/2008-05-12-skorea-poultry_N.htm?csp=34

South Korea is currently being ravaged by H5N1 avian influenza.  Perhaps the only other country that can lay claim to the words "currently besieged by bird flu" is India.  No less than 31 separate confirmed outbreaks of high-path H5N1 have been documented in poultry in the past few weeks.

The medicine Seoul is taking to try and halt the spread of H5N1 is drastic, but not unprecedented.  Hong Kong, as we all know, took similar measures in 1997 -- and probably stopped an H5N1 pandemic in its tracks.  It is sad yet comforting to see that another nation is taking the situation as seriously as Hong Kong's government did and decided to act decisively.

Stay tuned for more developments from South Korea. 

Carradine's recurring character the Blind Man talks in Zen riddles during much of the film, so Cooper's frustrated character Cord chimes in with a great line.  Here is the exchange:

“Tie two birds together, and even though they have four wings they cannot fly." – The Blind Man.

"And a horse has no udders and a cow can’t whinny and up is down and sideways is straight ahead." – Cord.

I was drawn to this exchange when I read this article:

Government asks court to block wider testing for mad cow

By SAM HANANEL – 3 hours ago

WASHINGTON (AP) — The Bush administration on Friday urged a federal appeals court to stop meatpackers from testing all their animals for mad cow disease, but a skeptical judge questioned whether the government has that authority. (bold mine)

The government seeks to reverse a lower court ruling that allowed Arkansas City, Kan.-based Creekstone Farms Premium Beef to conduct more comprehensive testing to satisfy demand from overseas customers in Japan and elsewhere. (bold mine)

Less than 1 percent of slaughtered cows are currently tested for the disease under Agriculture Department guidelines. The agency argues that more widespread testing does not guarantee food safety and could result in a false positive that scares consumers.

"They want to create false assurances," Justice Department attorney Eric Flesig-Greene told a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit.

But Creekstone attorney Russell Frye contended the Agriculture Department's regulations covering the treatment of domestic animals contain no prohibition against an individual company testing for mad cow disease, since the test is conducted only after a cow is slaughtered. He said the agency has no authority to prevent companies from using the test to reassure customers.

"This is the government telling the consumers, `You're not entitled to this information,'" Frye said.

Chief Judge David B. Sentelle seemed to agree with Creekstone's contention that the additional testing would not interfere with agency regulations governing the treatment of animals.

"All they want to do is create information," Sentelle said, noting that it's up to consumers to decide how to interpret the information. (bold mine)

Larger meatpackers have opposed Creekstone's push to allow wider testing out of fear that consumer pressure would force them to begin testing all animals too. Increased testing would raise the price of meat by a few cents per pound.

Mad cow disease, or bovine spongiform encephalopathy, can be fatal to humans who eat tainted beef. Three cases of mad cow disease have been discovered in the U.S. since 2003.

The district court's ruling last year in favor of Creekstone was supposed to take effect June 1, 2007, but the Agriculture Department's appeal has delayed the testing so far.

http://ap.google.com/article/ALeqM5gLzqdHsMBuQV9h5k-kVnabJDsj1AD90I89K80

OK, so here we go:  We have a meat company (Creekstone) that wants to do the right thing for both its domestic and international customers.  They want to test all their slaughtered beef for Mad Cow.  Not just a random cow here and there.  ALL OF THEM.

Creekstone would use its own money to test and certify.  What could possibly be wrong with that?

Plenty, if you believe the Department of Agriculture.  Here we have the United States Government going to court to stop this self-imposed practice, because it allegedly gives the meat company an unfair competitive advantage?  Have we all gone MAD, so to speak?

The planet has been knocked off its axis.  Madmen run Washington.  Up is down and sideways is straight ahead.

Perhaps they should be tested for CJD, which may explain their bizarre behavior.