
The Next Pandemic: Not if, but When - tokenadult
http://www.nytimes.com/2013/05/10/opinion/the-next-pandemic-is-closer-than-you-think.html
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tokenadult
I'm surprised that there is so much mention of antibiotics in this thread, as
the author's book excerpt submitted here mentions a viral disease, and thus
far we have very few "antibiotics" that have any effect on viruses. (Usual
usage in English is to use "antibiotic" as a term for a broad-spectrum
antibacterial medicine. Effective antiviral medicines have only existed since
I became an adult, with the treatments for AIDS being the outstanding examples
of antiviral medicines.)

I get a lot of my pandemic prevention information from the Center for
Infectious Disease Research & Policy,

<http://www.cidrap.umn.edu/cidrap/index.html>

which, to be sure, has an institutional reason to raise awareness of risks of
pandemics, but which also links to a lot of current, sound science reporting
on infectious diseases.

Novel strains of the influenza viruses or novel strains of coronaviruses are
scary to thoughtful epidemiologists because they can be spread by the everyday
activity of breathing. If a new coronavirus infection has a high case
mortality rate, high virulence, and long latency period, it could kill many
people before any of us have a chance to practice the isolation that
eventually shut down the spread of SARS back in 2003. Every year, a lot of
people get the flu, and a more virulent and more lethal strain of flu--
especially one for which current seasonal flu vaccines provide no immunity--
could kill a lot of our friends and neighbors.

~~~
Lost_BiomedE
I mentioned this below. A lot of the high death rate from flu is due to
secondary bacterial infection, which antibiotic can treat. Antibiotics would
have reduced the mortality of the 1918 flu, which was novel at the time,
drastically as bacterial infection counted for the majority of deaths.

We are likely to have a decent universal vaccine within the decade. Example,
one test by Inovio used a unmatched vaccine on the 1918 Flu with lethal dose
in mice. All the controls died but none of the vaccinated. This type of
vaccine would reduce the chance greatly that something like a bat flu would
emerge without us being prepared. These universal vaccines are made by
bacteria or other very fast to produce and cheap methods, compared to the
popular egg method today.

The biggest issue which the WHO has been working on is to make sure poorer
countries have the know-how and distribution networks to ensure they can make
and deliver current and next gen vaccines. This is especially important if
access to antibiotics is not common and easy.

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azakai
The problem is that mortality rates are always exaggerated, because the people
that contract the virus and get very sick are the ones that come to medical
attention. If 10x more people contracted the virus and fought it off, and
never went to a hospital or contacted a doctor, no one would be able to factor
them in and reduce the mortality by a factor of 10. That's why mortality rates
tend to decrease in newly-discovered diseases, we start to look harder for
people infected but not killed by them.

Of course this isn't a reason to be complacent.

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knowtheory
The frame of this OpEd is insane.

Anyone who understands what the word "Pandemic" means should also understand
that pandemic disease is an inevitability.

The question is what can we do as a society (or societies) to reduce
transmission, mitigate the severity and treat the afflicted if possible. It's
why Public Health is so important.

(And to be fair to the author, the piece doesn't seem to pick the super weird
frame that the title of the piece does. As Mitt Romney pointed out during the
election regarding his GM bailout piece, the authors don't write the article
titles)

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keyle
It boggles me that nobody find this article disturbing. Also written as some
sort of warning for the future, yet classified in OPINIONS...

Furthermore, click on the author's name and get taken to his personal
website... Where you can admire his book being promoted. And it's about scary
diseases in the world that will kill us all.

Please.

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kaolinite
If you enjoyed this article, I strongly recommend the author's book (mentioned
at the end - Spillover, by David Quammen). I am about half way through and
finding it very interesting.

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f055
Pandemics are overhyped. In the recent years we had 2 "pandemic" strains of
flu, both of which as it turned out, were greatly exaggerated for the benefit
of the pharma companies. The truth is, thousands more people die of know
diseases every year (even from seasonal flu) than from any other unknown
"pandemic" viruses. But this is not "exciting" at all.

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mixmax
No they are not - and a lot of people misunderstand why.

It's true that in any normal year more people die from known diseases, and
that pandemics are a rare occurrence. But _when_ they happen they kill a lot
of people. The 1918 flu pandemic killed 100 million people. 1 out of 20
inhabitants on the planet. And remember that this was back when we didn't fly
around the planet giving a virus the possibility of spreading to the entire
globe within a few days.

That's why pandemics are so scary - when they kill they kill a sizable portion
of the earths population.

~~~
JunkDNA
While I'm in agreement that one can't dismiss them out of hand, I wonder how
likely a 1918 Style pandemic really is. I don't believe we have had a pandemic
on the scale of the 1918 flu in modern times. 1918 was a _long_ time ago. The
outbreak of HIV comes closest. It's easy to forget how much modern practices
cut down on disease: wash hands, don't drink water people (or animals) poop
in, sterilize (or dispose of) medical devices, store your food properly, don't
live in a house also occupied by rodents, etc... That is all a great start,
and we haven't even talked about antibiotics and other modern medical tech.
Granted, access to all of this is far from uniform around the world. However,
the situation has been steadily improving. Epidemiology and monitoring are
also vastly better than years ago. I was working in pharma during the SARS
outbreak and saw firsthand how fast research can move when people perceive
something as an existential threat. Government and corporate red tape that
normally gums things up immediately falls by the wayside (as does the usual
academic quarreling over turf and recognition). Not wanting to see mass death
has a way of focusing the minds of even the most recalcitrant beaurocrats in
any organization.

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brazzy
> It's easy to forget how much modern practices cut down on disease: wash
> hands, don't drink water people (or animals) poop in, sterilize (or dispose
> of) medical devices, store your food properly, don't live in a house also
> occupied by rodents, etc... That is all a great start, and we haven't even
> talked about antibiotics and other modern medical tech.

With the exception of washing hands (which we don't do nearly enough) and the
vague "modern medical tech", none of this would help against a flu pandemic at
all...

~~~
JunkDNA
I disagree. If your immune system is already run down by low grade infection
and you've got a persistent case of diaorreah from poorly sourced drinking
water, it's pretty easy for a flu virus to knock you out. No anibiotics means
there's no way to keep you from getting pneumonia or other secondary lung
infections. The healthier you are to start, the more likely you are to make
it. The one exception to this is the paradoxical case where people's immune
response goes crazy from battling all the virus particles. This can happen in
really healthy young people.

My reference to medical tech is the whole system of diagnostic testing and
patient monitoring. It allows for early identification, quarantine, etc... We
also know a heck of a lot about proper bio safety procedures in medical
centers to lessen the spread of disease through health care workers.

Again, not arguing that a pandemic like 1918 can't happen at all. I'm just
saying that we're not showing up completely clueless and unarmed to a gun
fight. We're bringing a knife this time :)

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rdl
I wonder what the second/third order effects of eradicating bats would be. I
remember the consequences of eradicating mosquitoes being pretty minor, but
presumably no bats would mean more insects, which would raise the incidence of
various insect diseases, but also might increase birds and other insectivores.
I have no great love of bats themselves, particularly due to rabies.

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vxNsr
As always the best offense is a good defense which in this case means keeping
well informed of the spread of these diseases and staying away from
people/places that have higher rates of infection.

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sn0v
I'll just leave this here :D - <http://pandemic3.com/>

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austengary
The Next ______________: Not if, but When

