Forget al Qaeda, Kill the Chickens
By Thomas Posted in Foreign Affairs — Comments (27) / Email this page » / Leave a comment »
Attention hysterical libertarians, liberals, paleoconservatives, Bush-haters of all stripes, conspiracy nuts, science illiterates, and pretty much everyone else:
Meet your worst nightmare:
The vicious avian flu that has killed dozens of people in Vietnam, Thailand, and elsewhere in the region "has caused the deaths of hundreds of millions of animals in nearly a dozen Asian countries" in the past two years and could kill millions of people if it becomes capable of spreading efficiently among humans, Michael Specter reports in "Nature's Bioterrorist" (p.50), in the February 28, 2005, issue of The New Yorker.
Forget AIDS. Forget al Qaeda. Forget ebola. (Seriously, forget ebola. That's the dumbest scare we've had in a while.) Forget every other threat we've ever faced, and ask: What happens when the flu hits?
Read on.
I make a simple prediction now: Nothing in the Patriot Act, anything passed in the wake of the Oklahoma City bombing, the Japanese-American internment, Jim Crow -- nothing short of slavery we've ever done to ourselves -- can or will come close to what we face if a superflu hits these shores.
Why? Think the worst stories you've heard of the Black Death. If you know the stories of the Spanish flu, think of that.
Am I overreacting? Well, the folks at the CDC are getting grim. I'll spare you any talk of antigen shifts and genetic recombination. (A quick primer with a minimum of jargon is here.) I'm a lawyer; the rest of the family does the pathogenic microbiology stuff. It's a hobby for me, not a specialty. Suffice it to say, what's right now a danger to birds by the millions might, with just a couple of rearranged proteins, turn into a mass murderer of humans. All it needs is to grab the right proteins to jump from human to human, and voila! You have a flu for which no human groups have any built-in immunity and a buh-zillion transmission vectors, which is to say, you have a plague.
Why do I say we should put the Patriot Act hysteria in perspective? Well, consider some of the measures used to combat the Spanish Flu:
The pandemic affected everyone. With one-quarter of the US and one-fifth of the world infected with the influenza, it was impossible to escape from the illness. Even President Woodrow Wilson suffered from the flu in early 1919 while negotiating the crucial treaty of Versailles to end the World War (Tice). Those who were lucky enough to avoid infection had to deal with the public health ordinances to restrain the spread of the disease. The public health departments distributed gauze masks to be worn in public. Stores could not hold sales, funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines enforced by extra officers (Deseret News). Bodies pilled up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers (Knox). The conditions in 1918 were not so far removed from the Black Death in the era of the bubonic plague of the Middle Ages.
Or this:
The more restrictive methods of infection control issued by public health departments were quarantines and the isolation of the ill. These measures required a sacrifice of individual liberty for the societal good and therefore required a strong public health authority. Both the Illinois and New York State Health Departments ordered that patients must be quarantined until all clinical manifestations of the illness subsided. They held that the danger of the influenza epidemic was so grave that it was imperative to secure isolation for the patient (JAMA, 10/12/1918). The members of the APHA committee agreed in their report, saying that patients with influenza should to be kept in isolation. Because of the strain on facilities, only severe cases were to be hospitalized while mild influenza patients were to remain at home. The APHA also supported institutional quarantines to protect people from the outside world in establishments like asylums and colleges (JAMA, 12/21/1918). The use of institutional quarantines was applied to the many military training camps set up in the United States to prepare soldiers for war. These camps, with masses of men from throughout the country, were prime targets of huge influenza epidemics. The men were kept in strict isolation once ill and entire camps was often quarantined (JAMA, 4/12/1919). These measures were easily implemented in these camps where men were already committed to their country and the authority of the government.
Kinda makes keeping track of library checkouts seem tiny, yes?
If the past few years have been any indication, millions of trees and billions of innocent pixels will be killed to express outrage from the usual suspects at the very minimal efforts needed to simply contain the spread of a superflu. I promise you that someone, somewhere (cough, dKos) will allege that the thing is a plot by the Bush administration to establish a monarchy once and for all.
Putting all that to the side, we face two questions now:
Is it possible to stop this, or some other flu, before it makes the leap to humans? The answer is probably not, but damned if we shouldn't try. I view foreign aid as a tool. It's time to open the toolkit. The $5.5 million we've tossed into the ring for Asian surveillance is a good starting point. But in an age where a flu can take a cross-Pacific flight to Toronto, avail itself of the relentless efficiency of the Canadian health system, and head down to Vermont for a pleasant weekend, we can't afford to think of a superflu as an Asian problem, or a European problem. We have to actively stop this thing from getting out of hand abroad (declare preemptive war, if you will), and if that means making sure a bunch of non-Americans never get it; if that means spending millions or billions redesigning centuries-old farming practices; if that means we need to plow money like mad into new anti-viral agents, then so be it. Because if we don't stop it there, I assure you, it will come here. Every human who shares a plane or a boat or a convention center or a business meeting or a clearance sale or a Christmas Mass is a vector.
What are we prepared to do to stop this once it gets here? It'd be pretty damned stupid to say, If we give up our civil liberties, the virus will have won. It doesn't care. It's a self-replicating genetic sequence locked in a protein case. It'd be even stupider to imagine that life can go on as it did before, at least until the virus is contained and, God willing, burns out. At the very least, there goes Mardi Gras and the Saint Patrick's Day Parades. And the Marathons. And the next time a bunch of Lefties decide to march in opposition to overthrowing a tyrant, they'll need to do so from home.
It goes even deeper than that, at some levels. Since the 1970s, we've sealed up our houses and office buildings and driven air quality to heck. Should we undo this? Free association is one of those rights we held back from Congress, but like all rights in a society, it is subject to circumspection. Can we allow mass meetings -- religious services, conventions, rallies -- when those are basically open invitations to mass infection? Should subways close? Forced wearing of surgical masks?
I don't mean these all as hypothetical questions. And I don't particularly care if you think a couple tens of millions (or maybe only a million or two) dead is worth all the hype. The simple fact of the matter is that the American public will think it's worth the hype. And it will demand measures to stop it.
It behooves us now to ask how we're going to handle this. I'm all in favor of leaving specific quarantine measures to the CDC -- arguably the only Federal agency for which I have any respect -- but we need to work through the political limits and boundaries while we're not dropping dead. We need to start weighing costs and benefits now; we need to discuss how much government power we can allow to combat this; and we very much need to get a grip on the civil liberties hysteria now.
The alternative, frankly, does not bear thinking about.
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Forget al Qaeda, Kill the Chickens 27 Comments (0 topical, 27 editorial, 0 hidden) Post a comment »
Is the kind of thing that gets people like Thomas all freaked out and upset...
...and I loved his thing about "sealing up our houses since the 1970s)...nobody does that except YOU, Thomas...
That's probably why some of you could yet be the biggest bunch of dorks in history.
I guess Thomas' only proper response to the New York Times article on bird flu was to suggest that we go on a worldwide chicken-killing spree. Get your gas masks!! That's why we need nuclear bunker busters!
Now comes the knowing smirk, right? You guys must have had a lot of fun at CPAC.
All I asked for was smarter trolls. Such a small thing to ask for.
Attention, dKos, MyDD, and ObWi readers/commenters: I know most of you are not terribly smart, but in the future, please do not comment here unless you have at least a third grade education. I know that knocks out at least 80% of you, but I'm gonna have to put my foot down on this one.
Thanks in advance.
Speaking as someone who works in public health, it's usually this type of guy who ends up rasping out his last words in a dingy ward somewhere. Manto Tshabalala-Msimang would be proud of that can-do spirit.
In the meantime, though, we can at least hope he discovers girls before the inevitable end.
And, oh yes -- banned.
I also find the history of the Spanish Flu fascinating. PBS did a great documentary about it maybe 7 years ago and there was a new book out ( can't remember the title ) on the subject in the late 90's that covered both the medical side and the social ramifications.
get a grip on the civil liberties hysteria now
I'm not sure the possible pandemic should be politized.
I usually apply a simple test to determine how partsian an issue is.. What would I want or think if the other side was making the choices or did the deed whatever it might be.
The other side is usually the group out of power.
In this case.. how would Republicans feel about a Democratic administration employing extraordinary powers?
Normally, the word "bipartisan" causes me to spit. But this is one of the very few things I think that we should resolve, politically or not, now, with a minimal level of contention. All parties at the table, aware that we're planning for one heck of a crisis, etc. Assuredly, I don't want the long knives out on this one.
I found the PBS documentary I referred to earier, it was on American Experience. PBS has a webpage with information from the program. I found this statistic at the PBS webpage chilling.
851 New Yorkers die of influenza in a single day. In Philadelphia, the city's death rate for one single week is 700 times higher than normal.
I agree with you that we should spend the money now in Southeast Asia.
I assume the CDC has extensive planning in place for this possiblility, but you are right that the public should be made aware of the likely government intervention in advance.
Well sort of.
Price controls on immunizations are a bad idea. As we saw from the flu debacle this past winter, the idea that Uncle Sam can dictate prices to the market may make folks feel better and feel thrifty in the short term, but by closing down the manufacturing process it kills people in the end.
Drug sales to and from Canada are bad. Should the US allow drug makers to export to countries with price controls? or monopoly purchasers or whatever the system is that Canada's health services enforce? Certainly re-importation should be severely penalized. By allowing drugs to flow outside the normal US profit-loss channels you allow the Canadians to limit US research (and liability coverage).
The congress should pass a statute of repose to sheild drug makers from monetary damages in relation to FDA approved drugs and immunizations. (Does the FDA approve vaccines? CDC? Dept of Ag.?)
These types of things would promote even greater profit/incentive for chemically inclined types to research and market anti-viral agents whether immunizations or treatments. Whatever the government may want to be done, the private sector with a little help and few protections can do much faster much better.
With regard to civil liberties.... It has to go one way or the other. The government would either have to restrict the movements of the healthy or of the sick. I know nothing about epidemiology or public health in practical matters, but I can't see protecting the healthy being a solution. Enclaves of un-infected folks would be targetted by bitter, sickly, infectious, kamikaze terrorists who wanted to spread their pain to the 'elite' and 'undeserving' healthy folks. I guess that leaves the restrictions on the sick.
I think the Public Health Service of the US should be empowered to certify some sort of "US Marshalls" or "Justices of the Peace" who could swear out warrents to detain in home, in hospital or in armories or in stadiums or wherever, folks who represent a threat to the public health. Can they already do this or do they need to see a judge? [There should be a provision segregating these detainees from the jail populations. Criminal convicts shouldn't be subjected to infections any more than the innocent should be subjected to incarceration with the guilty.]
Should a judge be able to overturn such an order? Maybe there should be a board of special masters who are medically and legally trained (the 'worst' of both worlds-- doctors who are lawyers or lawyers who are doctors) to review the PHS detentions?
As a practicing physician who's been dealing with a lot of flu lately, I've gotta add a little brake to this runaway train.
In the early 1900's, we didn't know a blessed thing about the flu. We named a bacterium Hemophilus influenzae because we thought it was linked to the flu. We enforced all manner of peculiar quarantine and sanitation methods, few of which were all that effective. We had no antivirals.
Today, we know what the virus looks like. Heck, we've sequenced it. We know how it spreads, and it's not magic. It's secretion-borne, and that means that careful handwashing and good isolation practices can prevent it from spreading between two patients in the same room, let alone in the same city. We have antiviral medications (amantadine and oseltamivir) that can abort the illness if given early and may help prevent it in exposed individuals. We have vaccines, which can't help early but may be helpful to prevent sweeping repeat epidemics among populations fortunate enough to avoid the disease the first time. And with the number of cases of flu each year, we're constantly adding extra items in the arsenal.
None of which means there won't be an epidemic of avian flu, or that it won't be really, really bad. This is why the CDC keeps such careful track of avian flu (how do you think we know about it in the first place?).
I take the flu very seriously. I hate it, because I've seen it kill otherwise healthy kids, and I'm religious about vaccination and hygiene. If avian flu hits, it's going to be serious. But the historical scenes out of the flu pandemics of the early 20th century are just that - history - and pretending that we're going to forego a hundred years of medical and public health practice just to recapture those bygone days is silly.
Thanks for raising this important issue.
As someone who works in healthcare though not specifically in public health, I am sometimes involved in curtailing peoples' civil liberties for their own or others' safety. It's a process which is of course open to abuse by the unscrupulous or the overzealous, but my observation is that when adequate systemic oversight is in place by people who are not colleagues of the initial decision maker it is a generally fair system (I'm thinking specifically of civil commitments for mental health reasons--suicidal/homicidal ideation and psychosis--where the psychiatrist makes the initial decision subject to review by a judge within 3 days in our state). Not that every quarantined person necessarily should have a judicial hearing, but we should be thinking of how public health quarantine and other restrictions can be overseen efficiently and fairly.
Quarantine measures are generally administered by state/local health departments, with the CDC acting as a consultant rather than taking direct responsibility. I think that's as it should be, keeping decisions affecting individuals' liberty in the hands of elected officials rather than scientists, though I share your general trust of the CDC.
As far as what we'll do once the virus gets here, our planning should draw lessons from the recent SARS experience. Hospitals are likely to be where much dissemination happens, and we should build on the preventive measures developed there (requiring those with a cough to wear a mask, changing the healthcare culture to one where it's acceptible to miss a day for being sick yourself, checking the temperatures of workers as they enter in facilities with known infections, etc). Many of these measures may make sense in other high risk venues like daycare, school, and transportation environments.
Of course, vaccination is key, and it would help this cause to counter much of the public misinformation about the risks of vaccinations. For example, there's the infamous autism-MMR debate--a convincing 2001 JAMA article showed at 14-year followup no link-- http://jama.ama-assn.org/cgi/content/abstract/285/9/1183. Nevertheless, sites like this one http://www.casiquest.org/autism_debate.html filled with innuendo and faulty logic continue to propagate the theory. Specifically, the mainstay of the argument is that people observe their children developing autism after the MMR--the problem is that MMR happens to be scheduled to be given at the standard age when children would develop those symptoms anyway if they're going to get autism. My point is not that vaccines are riskless, but that there's a tremendous amount of hype about them which may interfere with mass immunization programs should they be required. The opposite effect of hype is also possible--that people will clamor for vaccines which should properly be restricted to high risk exposures as the smallpox vaccine was. In either case, public education about risks and benefits in advance of the epidemic is the best cure.
I come from a family of microbiologists. Dinner talk is usually consumed with a hemmoragic fever. We're cool that way.
I didn't mean we're looking at the Spanish flu all over again, necessarily. The point wasn't to leave folks gibbering in fear in the streets. The points were:
(1) We need to step it up in foreign aid and coordination to stop this before it starts.
(2) Failing that, we need a frank discussion of how we respond to a virus of fair lethality, that appears resistant to two of our most prominent antiviral agents, with a high transmission rate, in an age of mass travel and a very different set of prevailing internal environmental conditions. 100 years ago, there was no commercial flight. The Northeastern corridor wasn't Amtrak Central. Buildings weren't as tightly sealed, and we were a less urban population.
And while I completely agree that we're light years ahead on this compared to 1918, we're still without herd immunity to this virus. And most of the epidemiologists -- all with Masters degrees or more in relevant microbiology disciplines -- I know get cold sweats at the word "flu." Barely science literate though I am, that's enough to make me shiver.
None of this means that WE'RE DOOMED!! What it means is that we need to seriously consider how we face this sort of thing, without going all Outbreak! on it.
I owe you something of a clarification/apology with respect to the dangers of Neuvo Laredo. In a past debate, I challenged you to produce statistical evidence that Neuvo Laredo had become more dangerous in the period 1990-2004 in order to support your argument in favor of stricter immigration controls. Well, some such evidence has come to my attention: It's very recent data (2002, 2003, and the like), but it does show an increase in crime. The explanation is widely reported as a series of running battles between drug gangs.
(My memory of the need to note the foregoing was jogged by an NPR story on the Neuvo Laredo crime wars of this morning.)
I don't think that any of the foregoing supports further restrictions on immigration, although I continue to agree that more money should be directed to the enforcement of existing laws.
Thomas -
First, I'm not sure I follow the relevance of the USAPA to this issue. What's your point?
On the topic of the flu per se, it seems to me that the responsibility for addressing things like this belongs to the public health system. As I understand it, the CDC budget has been cut. I commented on this elsewhere, streiff replied that in fact the cuts were in the area of discontinued programs and construction.
For my own information, I checked the 04/05 budget comparison for the CDC. If I read this correctly, it appears that, in addition to the buildings and facilities budget mentioned by streiff, the biggest cuts are in the areas of:
o public health improvement
o immunization
The footnote states that the immunization program has been transferred to the DHHS Office of Public Health and Safety. However, per the footnote, only $7M and change went to OPHS, while apparently about $100M came out of the CDC budget for that line item.
It's not clear if the money for public health improvement went anywhere else, or if it's just been cut.
So, without freaking out about it, I share your concern about the possibility of avian, or other, flu strains making a big dent on the collective health of us here. My questions are:
o If this is a real issue, shouldn't it be getting attention in the form of proactive planning and research, rather than just headlines?
o If this is a real issue, is this a good time to be defunding the CDC and related agencies and programs?
Again, if I'm misreading the budget (not unlikely) feel free to clue me in.
Thanks -
Fish oil is an excellent antiviral supplement.
Also, elderberry. A co-worker and I both started to come down with the flu at work at different times. We took elderberry capsules. In both cases the flu left us in less than a half hour. We caught it at the first sign of illness.
No matter how much a virus mutates it remains a virus. It is for this reason that simple things like the two suggestions can be counted on to work.
I think that's as it should be, keeping decisions affecting individuals' liberty in the hands of elected officials rather than scientists...
As far as I can tell my elected officials think science is something to be dismissed when it conflicts with a political agenda.
The sovereign, as the will of the people, decides what to do and when to do it. We already have nine Philosopher kings, thank you. We assuredly don't need any more.
It's the compromised systems I worry about.
(2) Failing that, we need a frank discussion of how we respond to a virus of fair lethality, that appears resistant to two of our most prominent antiviral agents, with a high transmission rate, in an age of mass travel and a very different set of prevailing internal environmental conditions. 100 years ago, there was no commercial flight. The Northeastern corridor wasn't Amtrak Central. Buildings weren't as tightly sealed, and we were a less urban population.
Agreed. Look at SARS for an example. It meets pretty much all of what you're describing, and it caused a fair panic, but it wasn't quite transmissible enough to get free.
The avian flus that have gotten into the human population have also had fairly poor transmissibility in actual practice. Whether this is because of better hygiene or just weaker viruses is hard to say. Most of them have also been type "A" flus and susceptible to amantadine; I'm also not aware of oseltamivir failures in the avians.
We have a LOT of public health issues right now, and I'm not pouring cold water on them. Multidrug resistant TB scares me a lot, and I'm saddened (but not surprised) by the inevitable emergence of antiretroviral resistance in HIV. We're using public health laws that were put in place back during the early 1900s, mostly to ensure antituberculosis compliance. And malaria continues to kill in the hundreds of millions.
If we have a significant avian flu outbreak, we would do well to have thought out the limits on social interaction and travel that might be needed. I just hope that the limitations have more to do with the flu and less to do with politics than might be the case.
Politics is how we resolve these problems, so I take no issue with that; but hyperpartisanship is going to leave us cold when we need to be warm. I don't mind resolving this politically, just so long as we do it soon.
What concerns me with the avian flus to date is that it feels like we've been dodging bullets. All you need is the right protein pairing and things get ugly.
Resistant TIB scares the bejeebers out of me. Folks should be forced to finish their antibiotics at gunpoint.
According to a researcher, the elderberry coats the needles on the virus making it impossible for the virus to puncture the cell wall where replication takes place.
Since both me and my boss were in the throes of the flu, it would appear that our immune system was already compromised.
that it's the responsibility of the "sovereign" to decide what to do in a given situation, but how they decide is extremely relevant. Just because the president was elected by the people does not mean that his decisions are mandated regardless of how he comes to them, and if he or his administration chooses to disregard or manipulate science to gain political advantage, that is as unnacceptable as our philosopher kings ruling from the bench.
The people through their elected representatives make that call. So sorry. If it upsets you that much, there's always the EU. They don't particularly care what their people think, and they love science as faith.
The NYT 2/5/2005. It's archived now, for pay only, but here are a couple of excepts.
The documents show, for example, that Mr. Bush would cut spending for several programs that deal with epidemics, chronic diseases and obesity. His plan would also cut the budget of the Centers for Disease Control and Prevention by 9 percent, to $6.9 billion, the documents show.
Mr. Bush requests money to expand a national stockpile of vaccines and antibiotics. But the public health emergency fund of the centers, which helps state and local agencies prepare for bioterror attacks, would be cut 12.6 percent, to $1 billion.
Not encouraging
You missed this discussion a while back. Been there, been dealt with, got the t-shirt.
Just curious.. what's on the t-shirt??
And the Washington Post, and the CDC website...
Your alarm has now gotten the attention of everyone in the Western world. Thank you.
http://www.theonion.com/news/index.php?issue=4105&n=1