Prepare for bird flu viral pandemic. H7N9 influenza, MERS-CoV and future virus subtypes are a threat.
The history of the Influenza A virus (Swine and Avian) and its various and evolving sub-types (H?N?) is a complex subject, but worthy of your attention and review. In short, the H1N1 virus was a descendant of the triple reassortant swine flu virus that first appeared in American swine herds in 1998. It was limited to swine herds for a decade before finding the right genetic mutations to bind to human cells - primarily the lungs.
The bird flu virus became dangerous to human with the H9N2 strain. H9N2 has provided the internal genes for the new H10N8 virus, as well as the H7N9 and H5N1 viruses, reports Dr Yuelong Shu from the Chinese Center for Disease Control and Prevention. The H10N8 variant is the latest mutation and has one confirmed death as of Feb, 2014. Most people infected with the H7N9 virus have pre-existing medical problems, thus are at greater risk of getting acute respiratory infections. Its fatality rate reaches 20-30%.
The H9N2 viruses are ubiquitous and have the capacity to change quickly and move rapidly between avian and mammalian hosts. So likely candidates for a future pandemic is the mutated offspring (reassortment) subtype of the H7 or H9 virus. In addition, "The apparent ease with which antiviral resistance emerged in the current H7N9 virus is concerning; it needs to be closely monitored and considered in future pandemic response plans," Dr. Zhenghong Yuang of the Shanghai Public Health Clinical Center and colleagues wrote in a paper published by The Lancet medical journal on Tuesday May 28, 2013.
As the governments fight and prepare responses to these recent viral evolutions, I believe we individuals should take some protective action now, not after a localized epidemic becomes a global pandemic. It will be too late to protect yourself after a public pandemic alert is issued by the government. If unprepared, you could become a statistic during the government's 6-8 month vulnerability response time. In the sections below, I discuss a few simple preps that will be very effective in preventing infection in a viral pandemic event.
Last Update: Feb 5, 2014
Influenza viruses mutate at an astonishing rate! Some Avian Influenza A virus subtypes are able to bind to human cells and thus efficiently infect our bodies. Mutations occur across different traits: binding, viral fusion into the target cell, assume defenses, airborne transmission capabilities, etc. The viruses that are capable of spreading efficiently from human-to-human via airborne transmission could result in a pandemic influenza outbreak.
For example, H7N9 has recently exhibited the ability to mutate in direct response to antiviral medication, and it is transmissible by respiratory droplets. Similarly, it has been reported that H1N1 became Oseltamivir-resistant within 48 hours. While most of these spontaneous mutations are poorly transmissible outside of the patient host, but it may only be a function of time before the mutated trait enters the main virus population. A 2008 report stated human infections with H9N2 viruses may be more common than previously recognized and that the H9N2 virus may be capable of undergoing further adaptation for more efficient transmission among mammals, including humans. A recent study indicated dual infections are a possible source of reassortment between human and avian flu virus strains.
Under current technology, pharmacological treatments for viral infections are a reactive and temporary victory; thus, it would be logical to assume that antiviral or vaccine treatments will be futile in fighting a future viral pandemic (except for smallpox). Especially if we can't identify the host like in the case of MERS-CoV. Rather, limiting your chances of infection will be the best preventative measure taken. See the Contagion section below for ways to limit infection and mitigate exposure with respirator gear.
In short, all three viruses (H5N1, H7N9, and MERS-CoV) are RNA viruses with high rates of mutation. The concern is that any of these could evolve into a virus capable of sustained person-to-person respiratory transmission, and potentially cause a severe global pandemic. The threat is real; see the recent potential threats presentation by the World Health Assembly.
Last Update: July 18, 2013
When the pandemic arrives, washing your hands and minimizing the touching of your face will one key factor in prevention. Make sure that you use the proper hand washing technique because although some claim that soap and water kills 99% of bacteria and viruses, it's probably more true that the agitation of washing/scrubbing your hands with the soap and water is key to removing/killing the virus. Oh, that's why surgeons wash and scrub in prep like that! Wash your hands in warm/hot water and let soap stand on hands for at least 15 seconds before vigorously rinsing.
Even for enveloped viruses, such as influenza A, ethanol-based sanitizers are argued to be effective. However, to be effective you have to use enough so your hands remain damp for 30 seconds as you rub them together. So a suggestion would be to wash with soap and water, and then apply the new stronger Purell formula that is 70% Ethyl alcohol. Note: rub the gel vigorously in your hands until all gel has evaporated and hands rub dry.
Besides washing your hands and not touching your face, another key to prevention is to keep the virus out of your lower lungs. When avian influenza strains infect the lower respiratory tract, a rapidly progressive and severe pneumonia can result. Sequencing of the 1918 Spanish flu reveals it to be avian in origin (Reid et al., 1999, 2000). A recent study shows that aerosol transmission accounts for approximately half of all transmission events in spreading the influenza virus.
So in situations where social distancing is not possible, like shopping for supplies or on public transportation, consider the use of a respirator mask from 3M. Don't waste your money and risk your health with scams. Read about them here. A respirator mask (when worn properly) seals around your face protecting your eyes, nose and mouth, and utilizes filter cartridges that are dense enough to capture viruses. The "nurse" masks won't protect you. Rather, the nurse masks is to keep you from getting others sick.
I won't risk the possibility of these items not being available when I need them most. I store my gear in their original packaging in the home closet. If I don't need them in the future, I guesstimate I could resell them on eBay for ~75% of what I originally paid. I predict the gear will hold its value because without a pandemic we will experience high inflation and the industrial demand of these 3M mask/filters will remain stable or even rise. But if/when a pandemic outbreak/attack occurs, these items will become extremely expensive, and potentially not obtainable to civilians at any price.
Last Update: June 4, 2013
My belief, based on a lot of research and common sense, is that we should all prepare for the worst (a highly lethal, very contagious, drug resistant virus) because recent viral evolution makes it the likely outcome, and the threat of bioterrorism isn't fading. The evolution of today's viruses are pointing towards a pandemic event, so let's prepare for it and minimize its effects on our family and friends.
Ethanol-based sanitizers claim to be effective if you use enough gel to make your hands damp for 30 seconds as you rub them together. But it is more effective to wash with soap and water, and then apply the new stronger Purell formula that is 70% Ethyl alcohol. The ability to shelter-in-place will minimize exposure, but it requires food and water storage.
Social distancing is not an effective solution if you are forced to enter public areas during a pandemic outbreak. In this situation, you should be wearing a 3M respirator mask sold on Amazon. Don't waste your money and risk your health with scams. A respirator mask (when worn properly) seals around your face protecting your eyes, nose and mouth, and utilizes filter cartridges that are small enough to capture viruses.
Modern respirator masks offer civilians a great solution to contagion mitigation. However, I think that while this item is currently abundant and 'on sale', once a pandemic occurs or even rumors of a global outbreak begins, it will become very scarce and expensive. I own them now so I won't be forced to enter public spaces of high congestion (grocery stores, trains, buses, elevators) unprotected.
Honestly, you won't see me wearing this stuff into the grocery store during the next winter seasonal flu. Rather, I'm talking about having this gear on-hand when the government suddenly flips the epidemic alert to Phase 6 and everybody panics. I won't risk these items not being available when I need them most!
If time passes and we get ahead of these viral mutations with some "universal vaccine" and the gear is not needed, I believe it can be easily resold on eBay. Why? Because without a pandemic we'll experience growing inflation and the industrial use of these masks/filters will always be in high demand, and thus retain a stable or even rising price. On the other hand, if/when a pandemic outbreak occurs, these items will become extremely expensive, and possibly not obtainable to civilians at any price.
Last Update: May 30, 2013
The scary truth is that when it comes to viruses, nature is the biggest bio-terrorist threat we have. It never stops evolving and can never be defeated. However, we can not disregard the consequences of human manipulation (either purposeful or accidental) triggering a deadly pandemic. In addition to the current MERS-CoV, H9N7 and future H?N? viruses, there are viral hemorrhagic fever viruses and the smallpox virus that are weaponizable.
If a biological attack occurs, there will be no warning or iterative 'phase' progression as in the case of a virus mutation triggering a Pandemic Alert change from Phase 4 to Phase 6. In a bio-event, many localities could be exposed simultaneously and instantaneously, leaving little time to acquire protective gear. We'll be required to protect ourselves in the days/weeks following an attack while the government's response plan is rolled out. Although food or water contamination are possible attack routes, The National Terror Alert Response Center states that "Experts agree that inhalation of chemical or biological agents is the most likely and effective means. [Then we continue to spread it to each other through the air] Protection of breathing airways is therefore the single most important factor." Again, more fodder for making the preventative investment to get your respirator mask and water storage solution now.
If a bioterrorism attack is a future reality, then it's widely agreed that the smallpox virus is the primary weapon. If that is expected, then maybe we should assume something else? But I digress. The virus can be deployed to population-dense areas with some form of air-dispersion technology, so the U.S. has stockpiled ~300 million vaccines as a countermeasure. Experts estimate that an outbreak started by only 100 initial cases (that could be accomplished at a Friday night high school football game) could necessitate administration of 100 million doses of vaccines before the contagion is contained. So if a smallpox attack occurs in multiple cities, we are going to need every last vaccine in stockpile, and it's going to take some time to administer to the public. I'd like to have a mask that works during this time.
In the panic following an attack, our leaders will be temped to administer the new and untested Arestvyr "pill" antiviral. Remember, it's new and never tested on humans, nor approved as safe and effective by the U.S. Food and Drug Administration. So it could end up being more harmful than helpful. But that is not stopping the U.S. government, controlled by corrupt political lobbyists, from acquiring two million of them. Somebody is getting rich off the unproven, but expensive pill for sale. Let the "sharks" eat each other; I just don't want to die due to their ignorance.
Last Update: June 3, 2013
In 2011, researchers reported the discovery of an antibody effective against all types of the influenza A virus. This is important because currently it's necessary to develop new vaccines for each virus subtype. Development of a "universal" flu vaccine that protects against multiple viral subtypes has long been the goal of immunologists searching for a need for a rapid response to potentially dangerous influenza mutations. So when scientist isolated the antibody called FI6 in 2011, they became hopeful it may eventually lead to a "universal" vaccine. The FI6 antibody has been refined in order to remove any excess, unstable mutations that could negatively affect its neutralising ability, and this new version of the antibody has been termed FI6v3. Clinical trials on humans have not yet begun (as of early 2013) so at best there are five years of testing before it will be available to the general market. So that isn't until around 2019.
However, recent research states that the H7N9 is going to be hard to vaccinate against because of its low "predicted immunogenic potential". That simply means scientist could find it very difficult to make a vaccine that triggers an immune system response in order to shield us. Even if a vaccine formula is obtainable, it will require an estimated 4-6 month lead time for production, according to the WHO's National Pandemic Influenza Preparedness Plans. And the designated special "priority groups" will get it first; that's good because I won't be lining up for their rushed sniff test!
In response to the bioterrorism threat using the smallpox virus, the U.S. is in the process of stockpiling, through its Strategic National Stockpile, the Arestvyr antiviral. However, Arestvyr is an investigational new drug not yet approved or licensed as safe by the U.S. Food and Drug Administration. It's only approved for use in emergencies. I'm assuming it will be 'field tested' on humans if the worst case occurs. In regards to the "live" vaccinia virus vaccine for smallpox, in which we stopped administrating to the public in 1972, we have stockpiled or have immediate access to over 300 million doses. They would be administered in the days and weeks following an outbreak or attack. This vaccine should be beneficial if administered within a few days of exposure. Even in the best case response plans, we're told to expect a 4-6 month exposure window before medicine is available. So at a minimum, you must be prepared to protect yourself from infection during this time period.
Drug-resistant bacteria can emerge and spread much faster than patchy public-health surveillance systems and outdated laboratory-detection methods can pick them up. Today's infection-control practices are yielding to the consequences of years of antibiotic abuse leading to 'superbugs' here and in China. “We have a very serious problem, and we need to sound an alarm,” said Frieden, director of the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Antibiotic-resistant bacteria are here worldwide and spreading from person-to-person is hospitals and long-term critical care facilities. The Superbugs are resistant to the best antibiotics we have and spread in asymptomatic carriers.
Last Update: July 29, 2013
A a drug resistant virus could foretell a virus making the transition from epidemic to global pandemic. On May 28, 2013 it was confirmed in some patients via genetic testing of the H7N9 virus had mutated and obtained resistance to human antiviral drugs such as Tamiflu. Although there had only been 131 confirmed cases and 36 deaths since the virus was reported in early 2013, this mutation sets the stage for a future uncontrollable H?N? virus strain capable of sustained person-to-person respiratory transmission. In addition, social conditions have to be supportive, and now a war-torn Syria has become a perfect breeding ground for epidemics.
As with the 1918 Spanish Influenza, pandemics don't just explode without warning. They progress in distinct phases: moderate public contagion, then a lull in the outbreak, then another third crisis phase after the virus has mutated again. Just prior to and during a pandemic, it will be critical to exercise social distancing and other preventative measures to minimize your chances of infection. See the 'Contagion' and 'Preparation' sections below for ways to limit infection and exposure. I made the decision to get prepared now because it may be hard to acquire protective gear once a Phase 4/5 epidemic becomes a Phase 6 pandemic alert. Or worst case, a bioterrorism attack discussed at the end.
Last Update: June 5, 2013
MERS-CoV is a newcomer that warrants attention because this virus is deadly (killing 77 of 180 confirmed cases as of January 27, 2014), has an incubation period of up to 12 days, and can be asymptomatic (some people unknowingly carry and spread the virus without symptoms). Unlike the various H?N? avian influenza A viruses, MERS-CoV is not an influenza virus. It's rather related to the virus that caused SARS and to the Corona viruses in European and African bats. Its infections are currently limited to only the Europe and the Arabian Peninsula regions, but because of migration due to international travel patters, MERS-CoV is a potential pandemic threat. The current infections and deaths are mostly in males (60%) and those aged greater than 50 years old.
MERS-CoV is proving to be very deadly, with an important difference to SARS; it exhibits a rapid progression to respiratory failure in up to five days. Now it appears to be capable of moving discreetly from person-to-person. Epidemiologist are playing catch up in their study of the virus because the source for SARS was never found and there were no prior laboratory strains available to study. Unlike the flu virus, MERS-CoV remains viable in the air and on surfaces for a longer period of time (48 hours). when you consider a pandemic occurs from efficient transmission, of which virus stability is a component, this is a dangerous and unique trait of the MERS-CoV virus.
Furthermore, another "bat virus", H17N10, exhibits a distinct lineage to the influenza A virus and is reported to possess the potential to re-assort with human influenza viruses. It's getting complicated and mutations crossing animals and humans are accelerating, and they are deadly.
The scary reality is that most of the public thinks that SARS was a 'false alarm' and therefore have become desensitized to recent warnings about viral evolution. The populace in large is dangerously complacent because modern day society has never experienced a pandemic. Some experts believe it's coming and there are accelerating signs of nature progressing towards a viral pandemic - a virus that has the lethal combination of high virulence, high mortality rate, high drug resistance, and efficient airborne human-to-human transmission.
Last Update: January 27, 2014
This section is reserved for a time in the future when the world is experiencing a viral pandemic and exploring various treatment options. Hoping this section never gets used ... but what does hope got to do with it!
Last Update: May 30, 2013
IMPROVING YOUR ODDS THROUGH
KNOWLEDGE AND PREPARATION