Avian Flu & Tamiflu supply

[Torsten]

If you haven't heard of avian flu by now then it's time you crawled out from under that rock. But if you have heard you might not be fully aware of the situation.

A few years ago an avian flu strain started infecting humans. This is bad news. It has killed 50% of all infected. This is good news - because if people get violently ill and possibly die then all cases are easily detected and carriers don't get to spread the virus very far.

Recently the avian flu strain has become less deadly, which is VERY bad news. This in fact makes it MUCH more dangerous as carriers might spread it over a large area before they get seriously ill - if at all.

This was all predicted and so far all predictions have come true in the suggested timeline. If this timeline remains accurate then it is expected that over the next months to years this strain will combine with a more infectious strain which will then race around the world in a matter of days.

Remember how quickly SARS spread?

As usual the world's governments are not very forward thinking. We are much too busy blowing up Iraq rather than spending billions on developing a vaccine.

yesterday the WHO stated that an avain flu pandemic would likely kill between 5 and 150 million people. Obviously these numbers are dependent on many factors, including the virility and infectiousness of the strain and the preparedness of the population.

And that's where we have a problem. If all governments stocked up enough doses of the antiviral Tamiflu for only 25% of the population then it would take Roche over 10 years to manufature them all (at peak production). The product only lasts 8 years, so really by the time they finish they'll have to start again if the disaster hasn't happened by then.

Today it was announced in the news that chemists had run out of stock and that they were making waiting lists for new deliveries. Sounds good in theory, but won't help much in practical terms, because all future stock for the next 5 years production has already been purchased by governments and distributor stocks are diminishing rapidly. Essentially, once the distributors run out there will be no more for 5 years.

Prices are already going through the roof with internet pharmacies charging as much as 4 times the regular (inflated) price. But even that is a small price to pay in the scheme of things.

It makes good sense to stock up on your dose of Tamiflu asap. Not only that, there is a good possibility that the virus will be resistant to tamiflu either by the beginning of the outbreak (if the avian flu combines with a resistant human strain), or by the time it reaches us, if the spread is slow and it develops resistance where it strikes first. It might be a good idea to stock up on Relenza as well.

But let's look at the actual application of these antivirals. You take them either as a preventative which will protect you for as long as you are taking it. or you take it within 48 hours of being infected to reduce the symptoms. Obviously if the pandemic lasts a few weeks or months then the former option is impossible unless you have a few thousand dollars to spend. So we are basically relying on tamiflu to reduce symptoms once infected. So if you can't afford tamiflu or relenza as preventative, what do you do instead? I don't think anyne has thought of that yet. It might be wise to stock up on all those things that help with normal flu, like echinaceae (assume taking 5x recommended dose for several months), high dose vitamin C, respirator masks, alcohol wipes, latex gloves, etc etc depending on where you live, how much contact you have with people, and how desperatly you don't want to catch this thing.

You might also want to start organising where you are going to stay and how you are going to survive financially. if you have friends or family in the country this might be a good time to discuss your options with them. I really can't see how cities will be a viable option during such a crisis.

Let's hope we have another 5 or 10 years before this happens, but as the WHO now states, it is no longer a matter of 'if' it will happen, but 'when'. Being prepared might seem a bit paranoid, but it might be a couple of hundred bucks spent wisely when the time comes.

[AndyAmine.]

I would be very careful buying these medications from O/S online pharmacies/sites, its not uncommon that these drugs are fake especialy something that is in very short supply and or in very high demand.

I notice a lot of these places are in Asia and India and from what I experinaced/read/heard whilst in India, diluted and or fake medications are very common there. I bought Nitrazepam from an Indian chemist that were compleatly fake, nothing but binder. I can only imagine that this problem has gotten a lot worse since then with the boom in online pharmacy's etc.

[oxydiser]

The flu is not a bacterium by the way, but rather a virus

Woops, sorry my bad there... I had a feeling that antivirals were used against viruses

I think it's funny that you say we are overdue for a pandemic and yet you think pointing out the obvious situation is scaremongering

I think the point I was trying to make was that it is impossible, nay, futile to try and prepare for the next pandemic. Strain of 'flu that precipitate pandemics are significantly different from 'normal' subtypes or are subtypes that have never circulated among people or that have not circulated among people for a long time.

I am still waiting for the big '12 monkeys style' pandemic, but my opinion is that bird flu doesn't have the potential of 1918-19 "Spanish flu style"... yet. I welcome the the next influenza pandemic.

Avian flu will be nothing like SARS

Care to elaborate on this? I am aware they are two different viruses, but why will a pandemic H5N1 avain flu be nothing like SARS?

I am surprised that you appear to have more knowledge about these things than some of the most respected scientists in the field, who have been warning about this for several years.

I don't pretend to be an expert in virology, I am just throwing in my educated? $0.02 in the hat

Oxidiser on the other hand will have statistical odds, whatever they might be at the time.

Couldn't have said it better myself Tort, 'cept your statistical odds will only be slightly better than mine

[Torsten]

I think the point I was trying to make was that it is impossible, nay, futile to try and prepare for the next pandemic. Strain of 'flu that precipitate pandemics are significantly different from 'normal' subtypes or are subtypes that have never circulated among people or that have not circulated among people for a long time.

Yes, this is true in most cases. In the case of the avian flu it is in fact the avian flu which is the strain that has never circulated. However, it will likely combine with a flu that has in fact circulated - in fact, one that is probably ciculating right now. The general idea is that avian flu will eventually meet a human host that is infected with a 'normal' flu. The virus' will recombine (ie 'hybridise') to form several options of new strains. The most likely to then spread will be one that is easily carried from human to human (a trait from the 'harmless strain', which will carry the deadly virulence of the avian flu strain, but not quite so virulent as to kill quickly and at such high rate.

This is not guess work. This is already an accepted fact in science. The only thing that could stop this is if we eradicated either birdflu or human flu before then, or if the two virus' never meet in a single host. The likely hood of either of these is VERY slim and hence an avian influenza hybrid is a done deal.

At the moment all but one human flu strain is susceptible to tamiflu. We also know that avian flu is susceptible to tamiflu. This means that unless the resitant human fly strain is one of the hybrid parents, the new hybrid will also be susceptible to tamiflu. At least that's what the story is at the moment. Because of the widespread use of tamiflu I presume that if the hybrid doesn't emerge for another 5 years, tamiflu will probably be useless as most strains will be resitant.

So, if we assume a hybrid within the next 2 or 3 seasons and assume that neither strain has resistance to tamiflu, then tamiflu will indeed be highly effective against the 'new' virus. Hence, starting preparations now will indeed not be futile.

I am still waiting for the big '12 monkeys style' pandemic, but my opinion is that bird flu doesn't have the potential of 1918-19 "Spanish flu style"... yet.

Bird flu itself has no potential at all really. It will only become a real problem if it combines with a human strain. However, when this happens it has a much greater potential than the spanish flu.

I welcome the the next influenza pandemic.

So do i. Not because it will kill many people, but because by doing so it will show people that the current population trends and urban environments are not sustainable. But just because I think that's a good thing doesn't mean I want to die.

Care to elaborate on this? I am aware they are two different viruses, but why will a pandemic H5N1 avain flu be nothing like SARS?

SARS was not very infectious in comparison to human flu. Also, it was quite distinct from the strain of flu that was around at the time, so most cases of flu could be cleared by simply looking at symptoms.

The avian flu hybrid will for all intents and purposes be a human flu and hence there will be no way of telling whether you have a harmless flu or avian hybrid flu.

Education will be the other big issue. Try telling uneducated and poor people that they have to go to hospital as soon as they get a cough or sore throat. This has never worked for any disease and becomes exponentially more difficult with a drop in wealth.

And those who have survived.... no room in hospitals to quarantine them, so they go back on the street infecting other people.

Couldn't have said it better myself Tort, 'cept your statistical odds will only be slightly better than mine

That would be true if tamiflu was likely to be ineffective, which at this point is unlikely in the near future. The fact that tamiflu wasn't the only thing I was advocating also makes a big difference. Do you remember when SARS broke out? Do you remember that face masks sold out in australia in a matter of days (and stayed sold out for almost a month) even though we didn't even have any cases?

The flu virus can live on surfaces for several days, so things like gloves, face masks, goggles and 80% alcohol will become VERY hot trading items. I could guarantee that most of these will sell out within days of the news breaking. It doesn't hurt to stock up on these and it is not a waste of money, but it may save your life and that of other around you (and will provide another person with the materials you would have queued for).

So I fail to see why my odds would be anywhee near as bad as yours.

[oxydiser]

I agree with you Torsten, antiviral drugs such as Tamiflu and Relenza are fairly useless against even the 'normal' influenza strains, they would have to be taken on a long term basis by a large proportion of the population to have any significant effect on the spread of the virus or the number of people killed by it. By nature of the mechanism of action of neuraminidase inhibitors, virulent bacteria are prone to gaining resistance to these drugs which will render them ineffective.

Remember how quickly SARS spread?

SARS did spread very quickly across the globe but was also quickly contained. If it wasn't for the inadequacies of some of the East Asian goverments SARS may have been a non-event.

yesterday the WHO stated that an avain flu pandemic would likely kill between 5 and 150 million people

I think this was irresponsible of the WHO to release a statment like this, regardless if there are any truths or half-truths in it. Saying things like this leads to paranoia and hysteria which only serve to make companies like Roche rich. Heck, if I were Roche now I would subcontract out antiviral production and ride the wave of paranoia and profits.

It makes good sense to stock up on your dose of Tamiflu asap.

You might also want to start organising where you are going to stay and how you are going to survive financially. if you have friends or family in the country this might be a good time to discuss your options with them. I really can't see how cities will be a viable option during such a crisis.

In the same light as the WHO statement, this is scaremongering. Reminds me of how all the yanks went on a gas-mask buying spree after the whole anthrax debacle. I hate to take a leaf out of Jonny Howard's book, but it better to be 'alert, not alarmed'

The bugs were here a long time before the human race and they will be here for a long time after us. In reality, a widespread outbreak of SARS or bird-flu within the next 10 years would be unstoppable. It may sound macabre, but we are well overdue for another pandemic and I think they are one the natural population control mechanisms built into life on this planet.

[Torsten]

I think it's funny that you say we are overdue for a pandemic and yet you think pointing out the obvious situation is scaremongering.

Avian flu will be nothing like SARS. It will likely be indistinguishable from flu in it's early stages. Given how many people get the flu every year, if you apply a 10% fatality rate to that then this alone is several million dead people. Let's not forget that the flu kills hundreds of thousands of people every year aorund the world as it is (and not, not just old and sick people).

The flu is not a bacterium by the way, but rather a virus. And while antivirals are not perfect, they do increase the chance of survival dramatically. remember, we are not comparing this to a normal flu, where the question is whether you can go to work for the 7 days or not, but rather in this case it's a matter of whether you will live or not.

I think the WHO announcement is irresponsible simply because it is so late that there is not much anyone can do abot it now. The pandemic could be as early as next flu season in which case it will be disastrous in all countries.

I am surprised that you appear to have more knowledge about these things than some of the most respected scientists in the field, who have been warning about this for several years.

And yes, the fact that Roche will make shitloads bothers me greatly. However, Roche has already stated that they will allow third party production if an infectious hybrid is found. But even if that doubles or even triples prodution it will still not be enough.

While an outbreak will be unstoppable, many people will survive. Those with the right preparation will increase their chances of survival dramatically. They will still be sick, but will likely not die. Oxidiser on the other hand will have statistical odds, whatever they might be at the time. Anyone comfortable with statistical odds and anyone who trusts the government in making sure they are prepared should not bother with their own preparation.

[ 03. October 2005, 10:21: Message edited by: Torsten ]

[Torsten]

Also, keep in mind that australia usually gets hit first with new flu viruses as they usually develop in asia. So the response time for australia will be a mere few weeks while Europe and the USA have several months to stock up on antivirals and to develop a vaccine.

This is the reason why the australian flu vaccine is often not ready in time or not perfectly matched (and hence poorly effective).

[waterdragon]

good luck getting hold of tamiflu now, don't believe? just try to obtain it. even if your doc writes a script most chemists are well and truly out of stock, and since the media mentioned relenza it is also made of precious 'unobtainium'. i work with birds so i was naturally uneasy about the sitch so i did enquire as to availability. there is a great link to an ongoing discussion of these matters on another oz site if anyone has plenty of time for reading.

[Torsten]

Even though I stocked up a few extra, I am encouraging all friends and family to get their own. Dad tried today and actually had another good reason for tryng to hurry it along as he is going to asia in the next few weeks. 2 chemists didn't even bother taking his order, while the third would take his order if he left his prescription. When pressed for a date the chemist rang the distributor who said 'minimum 6 weeks and no guarantees'.

[Hagakure]

relenza and tamiflu make for really really fascinating science.

different approach to most treatments (for one it isnt really a treatment its a preventative)

basically they got every strain of flu they could find going back in time as far as possible. one of the more fascinating stories is they dug up some antarctic explorers that died of flu and were preserved.

they then looked at the amino acids encoded by the flus DNA. they found regions of the virus that had not changed at all over a hundred or so years. a certain chemical structure fit in there stopping replicated flu viruses from budding off so they stay attatched to the cell they were made in (skipping some details here)

thing was this same chemical fit into a similar enzyme in humans. on inspection they found that there was a big gap near the region in the flu virus that wasnt there in humans. they put a large chemical group on the proposed chemical so it would fit snuggly into the flu virus protein but not in the human equivalent.

the probelm with these drugs is you are meant to take them essentially before you are infected. if you show symptoms then it is too late to use them.

in that way their effectiveness in the general population is yet to be seen - the big thing will be making poultry workers etc take it.

i think the chances of the virus mutating enough to get around it are pretty small at this stage but there are sooo many viruses in so many people they tend to win at the end of the day.

at least there is internet

very quick communication bypassing conventional news sources in own home.

[Torsten]

the probelm with these drugs is you are meant to take them essentially before you are infected. if you show symptoms then it is too late to use them.

Not quite true I believe. There is a long way between initial infection and your body being fully taken over by the virus. The sooner in the replication stage you take these things the more dramatic the result. However, the viral load after 24 hours is still relatively small as compared to at 72 hours (exponential replication and all that...). The idea is to take the pills as soon as possible after first symptoms appear. That way you will get sick, but the actual amount of virus in your body will not cause death. The bonus of this method is that you will also end up immune to the virus, which you probably wouldn't if you were to take tamiflu as a preventative.

in that way their effectiveness in the general population is yet to be seen

Relenza has been around for a while and has become very popular especially with those who are at higher morbidity risk from flu (eg asthmatics, elderly).

i think the chances of the virus mutating enough to get around it are pretty small at this stage but there are sooo many viruses in so many people they tend to win at the end of the day.

I think prevention after an outbreak is probably not such a good idea. It will leave people susceptible when it comes around the following year or three. Prevention would have to be coupled with immunisation soon after. Cutting down the virility of the virus is probably a better option so that we develop natural immunity. Chances are that that is the only option for most people anyway.

at least there is internet

very quick communication bypassing conventional news sources in own home.

This can be a good or a bad thing depending on how good your BS/hype filter is ;)

[Hagakure]

the probelm with these drugs is you are meant to take them essentially before you are infected. if you show symptoms then it is too late to use them.

Not quite true I believe. There is a long way between initial infection and your body being fully taken over by the virus. The sooner in the replication stage you take these things the more dramatic the result. However, the viral load after 24 hours is still relatively small as compared to at 72 hours (exponential replication and all that...). The idea is to take the pills as soon as possible after first symptoms appear. That way you will get sick, but the actual amount of virus in your body will not cause death. The bonus of this method is that you will also end up immune to the virus, which you probably wouldn't if you were to take tamiflu as a preventative.

good point

the tests im thinking of basically allowed those infected to not get any of it, it may still determine life or death for those with symptoms

[oxydiser]

The likely hood of either of these is VERY slim and hence an avian influenza hybrid is a done deal.

At least that's what the story is at the moment. Because of the widespread use of tamiflu I presume that if the hybrid doesn't emerge for another 5 years, tamiflu will probably be useless as most strains will be resitant.

So, if we assume a hybrid within the next 2 or 3 seasons and assume that neither strain has resistance to tamiflu, then tamiflu will indeed be highly effective against the 'new' virus. Hence, starting preparations now will indeed not be futile.

This is a little bit too deterministic for me. Human/avain influenza hybridization is definitely possible, but not a done deal, not in the sense that global warming is a done deal. As you have pointed out Torsten, there are too many assumptions at this point to make any concrete statements.

So do i. Not because it will kill many people, but because by doing so it will show people that the current population trends and urban environments are not sustainable. But just because I think that's a good thing doesn't mean I want to die.

Isn't everyone, including you and I and everyone that doesn't live in a vacuum, a part of the over-population and over-consumption problems of this planet? Don't mind me as I excuse myself from the human race. <_<

i think the chances of the virus mutating enough to get around it are pretty small at this stage but there are sooo many viruses in so many people they tend to win at the end of the day.

when are we going to give up on trying to fight viruses and bacteria with new medications?

[Hagakure]

i think the chances of the virus mutating enough to get around it are pretty small at this stage but there are sooo many viruses in so many people they tend to win at the end of the day.

when are we going to give up on trying to fight viruses and bacteria with new medications?

well hey they work (just not forever)

you can have some homeopathy and i will have some tamiflu and lets see what happens :D (aint a direct attack at you - trying to stir up the homeopathy fans ;))

[Torsten]

Isn't everyone, including you and I and everyone that doesn't live in a vacuum, a part of the over-population and over-consumption problems of this planet? Don't mind me as I excuse myself from the human race. <_>

I am doing my bit by not having any kids. Even if I was to have kids I would not have more than one. What shits me is all these hypocrite hippies and enviromentalists who feel they need to reproduce to pass on their wisdom to 3 or more sprogs

Many people criticise religions for population growth, but at least religious people are honest about their selfish goal (producing as many religious offspring as possible).

[apothecary]

This may sound a bit frivolous, but I reckon the best thing to stockpile in case the world is coming to an end is cigarettes.

They're fucking better than bars of gold as far as barter with desparate individuals is concerned ;)

[Salviador]

I think its the universes way of balancing out the population. Theres too many of us, and because of our environmental encroachment into nature, these diseases are being released from nature. Or because of the squalor that these birds have to live in because of our waste, these diseases are being borne. It's our fault in the first place.

When you stretch a rubber band it snaps back into place, nature always tends towards a balance, simple yin yang stuff.

Still i hope i don't die

[devance]

http://www.curevents.com/vb/showthread.php?t=10876

South Korea's spicy fermented cabbage dish, kimchi, could help to cure bird flu, according to researchers.

Scientists at Seoul National University say they fed an extract of kimchi to 13 infected chickens - and a week later 11 of them had started recovering.

The researchers said the results were far from scientifically proven and if kimchi did have the effects they observed, it was unclear why.

---------------------

Raw garlic will be my first and last resource.

Althought kimchi sounds like a new taste treate.

[Torsten]

LOL, kimchi is quite similar to raw sauerkraut.... I knew there was a reason why germans eat that stuff (other than to expel worms ;))

[Bolwarra]

so has anyone actually paid for/received Tamiflu in Australia yet?

my GP was of the opinion that although he could give me a script, i may have trouble ordering it due to scheduling.

any thoughts?

[Torsten]

so has anyone actually paid for/received Tamiflu in Australia yet?

You mean as in imported from overseas?

No, mine isn't here yet, but I import prescription medicines all the time and as long as you have a valid script and it states EXACTLY the same dosage and quantity that you are importing then there is no problem. Note the provision that it has to be EXACTLY!!

[Bolwarra]

Note the provision that it has to be EXACTLY!!

Canada.

i know quantity was correct...

[Torsten]

the company sending it doesn't need to have a script because they are not supplying it within their borders. However, many companies still go through the prescription thing on line.

If it gets held up in customs in australia then you will be notified by customs. They will then let you have it after you fax them the script. If you don't have a script then the stuff is an illegal import and is destroyed. Customs ALWAYS sends out notification.

If you haven't got your order then chase it up with the supplier. Find out the exact date it was shipped. Once this date is more than 4 weeks old demand to know the shipping method and the amount of shipping paid. This will give you a clue if they accidentally put it into surface mail in which case it will be here in another 2 months.

[2b]

Couldn't a pandemic like this just be natural selection at work ? It seems the world is about due for an adjustment .

[Rev]

Couldn't a pandemic like this just be natural selection at work ? It seems the world is about due for an adjustment .

its a shame people have to die to accomplish it

when all we really needed was the wheels to fall off the machine

still i wouldnt pin hopes on any pandemic

the 1918 did what it did and the population continued to rise with only a blip

likewise the same tyrant in power before the flue were there after

the only value of the flu is in the remote possibility it might uncover some economic achilles heel and bring down the house of cards.

I swear if there is anything that can cause an apolcaypse then i want it to happen ASAP

before the processes of global acculturation and homogenisation are fully achieved and humanitys true diversity and history is fully forgotten

at the very least cant one of our senior govt officials just keel over from a coronary - just to divert them from their warpath

or better still some or all of teh US admin