Staff Memo Concerning A
Possible Pandemic Such As Avian
Influenza H5N1, Generally-Known as Bird Flu
[Note: this memo was prepared
for a for-profit company in the Portland, Oregon
area. The information and recommendations can apply in most circumstances,
RE: POSSIBLE PANDEMIC INFORMATION AND RECOMMENDATIONS
The U.S. Government recommends
that families, businesses and local communities plan for a
This memo is a first step
toward establishing such a plan for XXX Company. Your
comments and suggestions are welcome.
“Avian influenza is
an immediate and real threat to our collective security,” writes Dr. Donald
Burke, professor of International Health and Epidemiology at the Johns Hopkins Bloomberg School
of Public Health. Another expert calls it “the number one sleep-losing problem” we face today.
A recent study by the Congressional
Budget Office assumed a 2.5% mortality rate, and from this
assumption estimated 30% of the population would be infected, that the average employee would
miss 3 weeks of work, and that the cost to the U.S. economy would be $675 billion.
in a variety of industries around the world are bracing for a possible
outbreak ...The brief siege of SARS cost businesses as much as $60 billion ... The World Bank
forecast that economic losses from a bird-flu pandemic could reach $800 billion ... Some
corporations are reticent about discussing their plans for fear of alarming the stock markets or
linking their brands with a possible contagion ... During SARS, companies prepared on the fly ... the
biggest concern is not having a game plan,” writes Marilyn Chase in the 11/17/05 Wall Street
No public government studies
to my knowledge assume higher mortality rates such as 10%, 25%,
40% or more than 50%. It is my guess that there exist classified studies making such assumptions,
studies which might then go on to discuss the extreme measures perhaps considered necessary to
try to maintain social order and control in such circumstances.
In general, flu is one of
the most infectious diseases known. Also, one person can infect another
before symptoms develop. We are not “overdue” for a flu pandemic, because probability doesn’t
work that way. A flu pandemic might happen this year, maybe next year, maybe later, maybe not at
all. Most experts are pretty confident it will happen fairly soon. Historically, flu pandemics occur 2-3
times a century. Health experts are particularly concerned about the flu virus H5N1, popularly
described as bird flu. They believe it is likely to mutate soon so as to spread more easily between
people, and that it may be far more deadly than average. Apparently this mutation can occur when
a person gets bird flu from an animal, and has regular flu at the same time. Then the person
sneezes at everyone else, and the pandemic is off and running.
This is the point at which
competent government emergency response can be effective: isolating
people and groups, preventing travel, destroying disease vectors. Unfortunately, the levels of
competence, honesty, resources, systems and infrastructure vary from place to place. Governments
often deny the existence of a problem, act in ways that are ineffective or worse. And specific individuals
and/or research organizations may not share data as part of the career politics and backstabbing
that can occur in any professional or academic field. My opinion is that the reporting and action
protocols, training and resources, and overall effectiveness have been improving dramatically worldwide.
Such efforts could contain a pandemic. Again maybe not.
Seasonal flu tends to attack
the respiratory system, death sometimes resulting when pneumonia or
secondary bacterial infections take advantage. H5N1 does this, and also causes gastrointestinal
disease, meningitis and devastating infections elsewhere than in lungs. H5N1 shows some
indications, like the flu pandemic of 1917-18, of encouraging an over-reaction from healthier
immune systems. It is this over-reaction that causes organ failure, lungs to fill with fluid and
hemorrhage. Because of this, healthy young people might have a higher death rate.
Often flu viruses of one
year will be enough similar to previous viruses that people have a fair
degree of effective immune response to deal with it. Apparently, H5N1 is different enough from
previous viruses that few humans at present are naturally immune.
With present technology,
vaccine for a particular new version of flu requires at least several months
after the first outbreaks to be developed. Fortunately, organizations such as the World Health
Organization (WHO) and the Centers for Disease Control and Prevention have brought
considerable resources and competence to bear on the problem. New techniques are being
developed to produce vaccine more rapidly for new disease threats. Time will tell if such efforts are
sufficient and in time.
The government admits frankly
that its capacities are not sufficient to respond to a significant
pandemic, and that to a considerable extent families, businesses and communities will have to
respond with their own resources and actions. After the hurricane Katrina, one health expert
described bird flu as a potential New Orleans scale disaster everywhere at once, with no help
coming in from somewhere else.
Further, some experts outside government express concern that some government responses,
particularly federal responses, may be inadequate, wasteful, or even do more harm than good. An
example might be regional military quarantine. Portland in particular faces this risk, I think, if only
because military quarantine of the Portland area would be easier than for most large urban areas,
and thus more tempting to officials under stress. Another example would be system-wide
restrictions on travel and the movement of freight. Such government responses could multiply the
economic effects, tipping an already fragile economic system into decline or even meltdown.
And there’s the political
aspect. Such vaccines and other measures that do work will tend to flow to
the wealthy and influential. Those who are not wealthy and influential are sure to be giving some
thought to how they intend to address this. At present the drug Tamiflu is considered the treatment
of choice. It is proprietary and expensive. Older drugs such as amantadine and rimantadine are
generic now, thus less expensive and more widely available. There have been about 130 different
strains of H5N1 analyzed so far, of which about a quarter are sensitive to these older drugs. At
present the Center For Disease Control in Atlanta recommends against the use of these older
drugs, but this recommendation may change as events develop.
Uncertainties about a possible
flu pandemic include
whether or not it will happen at all
timing of onset and spread
seriousness, particularly in terms of mortality percentage
effectiveness of response, for example whether or not an effective
vaccine can be developed, manufactured, and distributed in time
the degree and seriousness of related social and economic effects
Factors tending to make
a flu pandemic less serious than the most recent serious pandemic of
More knowledge of diseases and best responses
Better health care
More interaction between people around the world, which should have led to more
robust immune systems, on average
Better surveillance for influenza, particularly in regions where H5N1 is prevalent in birds
More rapid and competent incident analysis and response, much like the rapid
response to a brush fire preventing a larger fire (unfortunately, carrying this
analogy further, putting out brush fires tends to increase the severity
of a massive fire when it does happen)
More effective coordination between agencies, specifically across national borders
Factors tending to make
a flu pandemic more serious than that of 1917-18
Faster travel, such as air travel
Possible high virulence of this disease in particular
In the last two years H5N1
is known have infected 160 persons and killed 85 of these, a 53%
mortality rate. And this happened with a level of medical care that will not be available to the
average person if hospitals are overwhelmed. Usually, but not always, the virulence of a disease
declines as it spreads. After all, it does not work from an evolutionary standpoint for a disease to
wipe out its host. H5N1 is at present showing signs of increasing, not reducing, pathogenicity.
However, it is possible there have been unreported milder cases of H5N1 infection, which would
tend to result in a lower actual mortality rate.
Factors affecting mortality
percentage include the percentage of people who are exposed, the
percentage of these who become ill, and the percentage of these who die. No humans are at
present known to be immune to H5N1, but that does not mean 100% of people will become ill. At
one extreme might be the present mortality rate of 51%, “in which case the human race might face
extinction ... [t]his scenario is deemed unlikely,” according to Dr. Burke. At the other end might be a
mortality rate of 1-2%, a tragedy but not a catastrophe.
I do not agree that a 51%
mortality percentage would result in extinction of the human race. Such a
percentage would, however, wreck our present civilization, as did smallpox and other diseases
decimate the well-established civilizations existing on this continent prior to the arrival of Europeans
from 1500 AD onwards. Most people do not know that the population of North and South America
was by some estimates 150,000,000 in 1491 AD. Hi, my name is Columbus, how do you do,
sneeze. Those existing cultures imploded, and the low point in those populations in what is now the
U.S. and Canada, reached about a century ago, was less than 1% of the previous numbers.
The most recent serious
flu pandemic was that of 1917-18. Governments tried to cover up or
minimize the death statistics. Recent research indicates the planetary mortality rate was at least
At 5% of current human population
of 6.4 billion, worldwide deaths would be approx 320,000,000,
and here in the Portland Metro area approx 80,000. The rest of us would carry on, most likely.
Computer models show that
a H5N1 flu pandemic is likely to roar through the human race fairly
quickly, with disease-caused deaths likely to peak within 3 months. If economic and social systems
continue to function reasonably well, people will look back on it as a bad experience, and will move
Unfortunately, the overall
mortality percentage must include the possible synergistic effects of
deaths resulting directly from flu, along with possible related causes of death such as system
breakdown, war, local uncoordinated and/or systematic violence, starvation, other diseases.
For example, if travel and
freight are restricted, the global economy and financial system could
crash. Then many items from distant farms and factories would be unavailable. That apple in the
grocery store might have come from Argentina, passing through the control of many different
businesses. If these all go broke in an afternoon, then suddenly there will be no apple in the grocery
store. Pandemics have been common throughout history, but we have not yet had a pandemic
occurring in the environment of fragile economic and financial systems.
As another example, governments
and other groups might decide circumstances favor a giant
reshuffling of the world order and opportunity to promote their own territorial and other interests,
leading to all sorts of wars all over the place.
As another example, various
military, intelligence and other agencies might want to use H5N1 as a
cover to test out their latest bugs. As another example, there are other naturally-developing bugs of
concern to health professionals such as Marburg, or the possibility of AIDS going airborne, that
could add to the misery. We could see all sorts of strange symptoms and a higher disease death
rate than from H5N1 alone.
It is impossible to predict
the overall mortality percentage, because there are so many factors that
could all combine together. But a high overall mortality percentage is not impossible, and therefore
must be given consideration.
A 40% overall mortality
percentage would compare with the Black Death of the Middle Ages. During
that pandemic, society tended to collapse, adapt, survive in a spotty regional manner. Back then,
however, most people lived closer to the soil. They farmed or followed small-community trades.
Now people depend on complex, fragile systems for food. There are people deeply concerned
about the possibility of a high overall morality percentage from system crash scenarios that do not
even include pandemic. A 40% overall mortality percentage in the Portland Metro area would be
Would civil society would
hold together in something like present fashion at, say, such a 40%
overall mortality rate? Local laws being enforced by local cops and courts, stores staying open?
Enough food being distributed to keep people alive? And most particularly, an enforced currency? If
there’s no enforced currency then quickly there is no nation, no army, just a complex variety of local
and regional responses by you and the people around you. Such response eventually might
coalesce regionally or nationally. Or not. Who can say. The concept of “nation” itself is only a few
centuries old. But as always, people will form local support systems, make do the best they can, kill
local thieves, etc.
My personal opinion is that
if an H5N1 pandemic along with any other diseases kill directly more
than about 15% of humanity in a short time, then a downward spiral in population is likely, with the
low point in population being reached some time later, even years later. Who can say at what point
such a downward spiral would stabilize. I suppose it is not impossible that stability would be
reached only at a level where local agriculture and related activities would support the local
population. If human history is a guide, this would result in a planetary population about 5-10% of
During and following decline
to this population level, current nations such as the United States or
Japan likely would no longer be viable, and people would have to build new forms of social
organization. Such new forms might carry old names, but otherwise have no connection to the
institutions of the past. Those left over are likely to rebuild in ways quite different from much we
take for granted now.
To the extent that complex
resource and financial systems survive, the population could stabilize at
a much higher level, and the nations and other large organizations we take for granted may survive,
perhaps even in forms more or less similar to those of the present.
The best response to approaching
pandemic, like any disaster which has a reasonable but not
certain chance of happening, is to feel some prudent concern, a moderate or appropriate level of
fear, and to do some reasonable preparation that factors in the wide range of possibilities. And
beyond these reasonable efforts not to dwell on it excessively. And not to despair nor panic. Most
people will not respond this way.
The most common response,
as with any possible catastrophe, will be denial and trying to minimize
and ignore, with perhaps some vague ideas about dealing with the crisis when it arrives. This
response actually works quite well in most situations, because most problems work themselves out.
Anybody remember Y2K? Even if catastrophe does happen, there will be many who deny and
ignore approaching catastrophe, but who still get by ok. And some who plan and prepare, still will
suffer and die. Go figure. Tough universe. In this particular case, however, I believe the deny and
ignore response is very definitely not a good idea, and increases the probability of suffering and
early death. That’s my opinion. Each person will have to choose how to respond.
Typical corporate plans
include developing alternate workflow patterns that reduce the likelihood of
spreading disease. Microsoft, for example, is expanding opportunities for telecommuting. “If the
government tells us to stay home, we’ll stay home,” says Bill Gates.
Businesses can develop contingency
plans for dramatic reductions in revenue, alternate means of
transaction payments (buying, selling) in the event of short-term or even long-term failure of the
financial system, and cross-training of employees so that the short-term or even permanent
absence of a skilled employee does not choke work flow.
A business owner can give
some thought to the continued viability of existing business models in
the event of drastic social change. For example, XXX Company has for decades provided YYY, a
pretty solid business model. But what if international commerce pretty much
collapses for several decades, and people no longer ZZZ that much? Perhaps unlikely, but what if?
Perhaps moving to some other sort of [YYY-type of business] more suited to those circumstances.
This would be a concept somewhat related to the existing business, instead of some entirely new
The virus is spread by contact
and droplets in the air. All health experts agree that simple
community public health measures and the simple tasks of personal hygiene we learned as
children can make a huge difference. These include:
closing public places such as schools and public gatherings such as performances
staying home from work, avoiding going out in public if reasonably possible
cleaning commonly-touched areas (doorknobs, kitchen areas, shared items)
washing hands with soap as physicians are trained to do (2 seconds wetting,
10-15 seconds thorough scrubbing, 6 seconds rinsing),
not touching the eyes and face except with clean hands
practicing respiratory etiquette such as using a cloth or inside portion of elbow area
for coughing or sneezing
staying home when obviously sick
Keep it clean! Obtain supplies
necessary for a clean body, clean clothes, clean house. Such
supplies include bleach, denatured alcohol, detergent, soap, antiseptic, hand sanitizers, clean rags,
latex gloves for handling sick or dead animals, birds, people. If possible, shower thoroughly after
dealing with dead animals, or live animals that might be carrying the disease, such as wild birds or
flocks of poultry.
There is debate about the
usefulness of respiratory face masks, but a lot of big companies are
stocking up on these, particularly the 3M N-95. In my opinion, such masks have some preventative
effect, and just as important provide a visual indicator that we are all involved in a health
emergency that must be taken seriously. They can do harm, however, if used improperly. People
with beards need to shave, and masks that become too gooped up are better off discarded. I
expect some businesses, particularly retail, would establish no-mask-no-entry policies, as in Hong
Kong during the SARS scare. Obtain basic first-aid supplies including a fever thermometer.
Families and small groups
are advised not to depend too much on hospitals and the network of
health care and law enforcement professionals. These people are just people. If everyone in a
hospital is dying, would a particular nurse go to work, or focus on family? Who can say.
People might give some thought
to location, where they want to be if things get serious. And who
they want to be with in a life-or-death situation. For example, I might want to be at my rural property
near Lyle, Washington. But then again, most of my family is back in Montana, so I might decide I
want to be there. The ancient concept of “sanctuary” applies here: the safest place one can find to
weather a storm.
Would rural areas show a
lower overall mortality percentage than crowded urban areas? Probably.
There would be less sophisticated medical care in rural areas, but then again less infected air.
Perhaps more chaotic military movements and resource raids by armed people claiming to be
employed by various governments of the past or in formation. But then again less effect from
regional quarantine and curfew. Roaming thieves more likely to be roaming as organized gangs,
relative to urban areas? Possibly, I suppose, but also more easily identified as thieves, and as such
more easily hunted by cooperating neighbors who know the turf. Fewer rioters flopping around in
destructive panic before they starve, certainly in absolute numbers, and also as a percentage of
population, because rural people tend to store more food. I’m going to say yes, the overall mortality
percentage is likely to be lower in rural areas. I choose my rural home over a crowded metro area
such as Portland. No denying that decisions about location are difficult decisions indeed!
One needs also to consider
timing. No point quitting a job, having nothing too serious happen, and
looking pretty dumb. And there’s the matter of travel before and/or during a period in which travel
gets difficult because of closed airports, regional quarantines enforced by the military, local criminal
activity, all those often chaotic and violent things people and governments do in a pandemic.
Those who do have the capacity
to isolate themselves somewhat need to decide how strict they
intend to be about this, which could involve fending off or refusing to help neighbors. People who
do decide to try to avoid the disease entirely must keep in mind that any bird flying by could be
infected. It is perhaps unlikely for a person to avoid the virus entirely. During the pandemic of 1917-
18, virtually the entire human race was exposed, and each person took his/her own roll of the
I suppose it makes sense
to keep incidents of exposure to a minimum, based on the idea that the
body’s defenses can fight off a small number of virus bugs better than a lot of them. But I do not
know the statistics. Personally I would want to be sneezed on as little as possible.
The standard government
line now is to store food, water and basic items “for two to three weeks
longer.” I think it is only common sense to have a year’s food and basic necessities put away, using
or rotating to charity as necessary. Almost everyone at present does not know that most people have
done this in all cultures throughout human history, except for just the past few decades. Failure to do
so, when one could, would have been considered irresponsible. Now, alas, the concept is subject
to derision on Jay Leno. One reason we have forgotten is that history books have tended to be written by
men, while this fundamental homestead chore has tended to be done by women. Also, the convenient
grocery and other retail stores that have come along in the past few decades seem stable and reliable.
Until suddenly they are not, of course. Catastrophes do happen. Any fair student of history will agree.
Unprepared people do tend to die in higher percentages than prepared people, from starvation, disease,
violence. That's the way it is, like it or not. Two to three weeks food and basic items? Better than nothing,
I guess, but not much. If it is foolish not to set aside a significant amount of food and resources for times
of disaster, that means >96% of Americans are foolish. So be it. Over the long haul, Nature tends to
kill off the foolish in greater percentages than the thoughtful.
True, the pandemic of 1917-18
may for some reason have tended to kill young, healthy people. It
still makes sense to do ongoing work on typical health management issues such as eating healthy
food, getting sufficient exercise, reducing drug use, particularly tobacco.
I have read about a tonic
used in Central Asia, equal parts coriander seed, anise seed and ginger,
sweetened with honey or sugar, eaten after meals 3 times/week. Heck, why not. A lot of folk
remedies are useless or worse than useless, but this one seems to have been widely popular for
many centuries. If you do not have access to industrial antibiotics and so forth, what are you going
If you do have access to
industrial antibiotics such as Tamiflu, amantadine, or rimantadine,
(see above for discussion of these three drugs) it might be a good idea to obtain enough courses
of treatment for yourself, family, dependents. A course is a complete recommended treatment plan,
for example so many pills so many times/day over so many days. This commitment requires one
to stay up-to-date concerning recommended drugs and recommended courses of treatment. I expect
some surfing on Google will be sufficient for this.
Some people practicing alternative
medicine believe supplements of vitamin C 1000 mg two or
three times each day, doubled or tripled when symptoms appear, can help prevent or reduce the
severity of flu. They claim that such high doses in a human body might actually help kill flu viruses.
Other people in the field say this should be accompanied by zinc, such as 25-50 mg/day zinc
picolinate. Maybe. I’d put these also in the “what the heck” category, and I would consider such
supplements, even though the National Institute on Aging holds the position that no one should
have more than 2000 mg vitamin C per day.
One can have one’s
typical aging and death-related affairs in order. This includes an up-to-date
will, durable power of attorney, health care directive, all the normal things. The Executor’s Guide
(Randolph, Nolo Press) covers these matters pretty well.
The best stores of value
are working to be the kind of person other people want to be around, and a
lifelong commitment to skills development, particularly in this case the skills related to family
systems and small communities. Those beans, corn and tomatoes in the back yard might look
And as always one can work
on basic life management, interpersonal, and attitude management
skills. After all, the basic reality of life, that we all die and that each of must make the best of this
next hour, that basic reality is unchanged by catastrophe. Tough times tend to favor those who
maintain a realistic but positive outlook, and who work to acquire the on-the-ground skills and
competencies needed in the circumstances. During hard times, people who want to indulge the
expensive luxury of wallowing in a gloomy attitude, and those who wait for other people to save
them, tend to die in greater numbers. That’s just the way it is.
National Public Radio’s
“Weekend Edition Saturday” program 11/19/05 contains a piece on
responses to the Katrina hurricane. In this piece are selected quotes from the U. S. Army Survival
Manual, which the narrator of the piece described as her favorite book at present. I believe these
quotes describe very well the character and behavioral attributes that increase the chances of
making it through a pandemic, or any difficulty. These quotes are as follows:
Having a survival attitude for whatever may occur is extremely important
Knowledge and rehearsal of survival procedures will give you a feeling of
confidence and will prepare you for any emergency, even though you
may be semi-conscious at the time
A person without a positive mental attitude may panic under dire circumstances
The following personal qualities are important to survival
Being able to
make up your mind
live with yourself
adapt to the situation
make a good thing out of a bad thing
to figure out other people and to understand what other people will do
Remaining cool, calm and collected
Hoping for the best but preparing for the worst
Having patience [I would say doing the ongoing work necessary
to develop patience]
Being prepared to meet the worst that can happen
Understanding where your special fears and worries come from
and knowing what to do to control them
You must learn to accept the reality of a new situation or of an emergency, then
take suitable action. This is one of the most important psychological
requirements for survival
Lack of the will to keep trying can also result in a passive outlook. Lethargy,
mental numbness and indifference creep in slowly, but they can
suddenly take over and leave you helpless
Do not sit down and worry. Stay busy
If you are in a friendly area, one of the best ways to gain rapport with the natives
is to show interest in their tools and their ways of procuring water and
food. By studying the people, you will learn to respect them. You can often
make valuable friends and most important, you can learn to adapt to
their environment and increase your chances of survival
In the actual event of catastrophe,
things generally work out so that people find some means of
carrying on, more or less. Those pictures from the Great Depression of 1930s show people lean,
hungry, tired and scarred, but also tough, capable, practical, no-nonsense. Our society is at present
as fat, lazy, self-absorbed and drowning in self-pity as any in history. The luxurious circumstances
favoring that could change fast, within weeks, and the people who refuse to make the necessary
efforts to adapt will tend to die.
I admit that I tend toward the apocalyptic in my view of the future. I’ve been this way for decades,
during which our civilization has continued on without catastrophe. Even so, it is my personal
opinion that we’re headed into a difficult time, perhaps as difficult as any in human history. Those
who survive will rebuild, as we always do. To increase the chances of being one of these people,
one needs to give prudent consideration to basic food and other local needs, as have all sensible
people in all cultures throughout all human history.
An excellent discussion
of the matter can be downloaded from National Public Radio’s “Talk
Nation” program 11/02/05. Books include The Great Influenza by John Barry and The Monster At
Our Door: The Global Threat of Asian Flu by Mike Davis.