Here's a pretty disturbing interview with a University of Minnesota researcher on the potential for an avian flu pandemic:

If this were to go human-to-human—we talk about a worst-case scenario in terms of what happened in 1918, when roughly 2.5 percent of the world's population died. Of those who contracted it, roughly 5 to 6 percent of populations died, varying by age.

The mortality rate so far for this virus is around 55 percent, so this virus would have to attenuate a lot to get down to that level. And we do have good data. There are not a lot of mild, asymptomatic infections out there [with H5N1]. We're now aware of six studies involving over 5,000 close contacts of H5N1-infected people, in Indonesia, Vietnam, and Hong Kong, in which less than one person per thousand contacts had evidence of an H5N1 infection that was missed—that is, a mild infection.

This [virus] is not causing a lot of asymptomatic infections right now. Some people are saying there's a lot of mild [H5N1-related] illness all over out there, but it's just not true. That means we're not artificially inflating the mortality rate by missing a lot of infections. I'm actually pretty confident that the real mortality is almost that high.

So for that number to drop all the way down to a couple percent is a pretty big drop. Which says to me that when people talk about 1918 as a worst-case scenario, well, maybe that isn't the worst-case scenario. That's hard for people to hear, because then they think you're really trying to scare the hell out of people. But you know what? It's just the data.

The quoted numbers are not necessarily alarming, nor do they imply there aren't lots of mild cases. The numbers would be consistent with .1% of the population having experienced a mild case (that these people were contacts of severe cases does not necessarily mean there was human-human transmission.)

If .1% of the population of Indonesia has had a mild case, that's 240,000 cases right there. In that case, the fatality rate would be very low.

That article made me want to order a bunch of Tamiflu. ;-)

The mortality rate numbers they are throwing around are bogus and the article bullshit scaremongering. 18 months ago the mortality rate auoted from all the same idiots was 75%. Just like with the Hong Kong flu, they strut around claiming that they aren't "artificially inflating the mortality rate by missing a lot of infections." In fact, they were doing exactly that with the Hong Kong Flu (which is also an H5 virus) and are doing the same with this.

The mortality rate may, in fact, be higher than the Spanish Flu but quoting absurd numbers like this does nobody any good.

A good article on the subject:

http://www.fumento.com/disease/flu2005.html

Fumento is a hack. That article has transparently false statements. For example: 'All flus, avian or not, Spanish or not, kill primarily through secondary bacterial infections. ' No, the deaths seen from H5N1 bird flu are due to direct viral damage and the immune response.

The article mentioned the deaths of Bengal tigers from eating infected chicken, AND that some cats didn't eat chicken, and caught the bug from another cat.

If robins and sparrows start dropping in the US from the bug, many of the nation's estimated 115 million cats (40 million of which are wild), will no doubt be infected.

So, when you let your tabby out to play, and he finds a live, semi-live or dead bird to play with, he will bring the infection into your house. Does your cat sleep in your bed? Walk around on your food preparation surfaces?

I declare a fatwah on cats!

To say that the mortality rate for avian flu is 50% is to calculate on data that does not exist. We simply do not know how many people have contracted avaian flu, never went to a hospital, and survived easily. Perhaps the mortality rate is 5%.

When you consider the possible number of mutation sites in the avian flu virus DNA, it's much more likely that the virus will mutate into something other than a human infector. It might mutate into a suicide virus, for example.

To say that the mortality rate for avian flu is 50% is to calculate on data that does not exist. We simply do not know how many people have contracted avaian flu, never went to a hospital, and survived easily. Perhaps the mortality rate is 5%.

There's simply too many unknowns here. But the disease does appear considerably more dangerous than the 1918 flu now. Whether it retains that virulence if it crosses over is just something we'll have to see. A 50% mortality rate may be too high to reliably spread the disease through the human population (because the victim weakens and dies too early and doesn't spread the virus around fast enough).

If the same intensity of data monitoring had been available in 1917, I wonder what mortality rate they would have found?

Actually, I thing the Fumento article is a good one.
He raises a number of good points. Particular the business
about the media searching the most inflammatory people
to quote and ignoring any evidence or people out there
that might argue to the contrary.

At the same time, and even though Fumento does raise
a number of valid issues he also makes a number of
mistakes.

For example this quote:

"Avian flu could randomly mutate to be transmissible
between humans. But it would indeed be random, since the
virus is doing just fine in the bird population, thank
you very much. There is no evolutionary pressure for it
to reach out and infect other species."

shows a lack of understanding of how evolution works.
There isn't some agency directing this. Mutations don't
happen because the organism is running out of organisms
to infect. On the contrary the more widely spread an
organism is and the more successful it is the more likely
it is to generate mutations.

And that misunderstanding may have some relevance to the
odds of a pandemic. Fumento talks about H5N1 being discovered
in Scottish chickens in 1959, and I agree that's a very
relevant piece of information. On the other hand reading
between the lines it also apparently quite rare then,
which is to say a somewhat different situation. If H5N1 is
formerly rare and is now becoming common, it's more likely to
mutate into a human pandemic.

Then on the other hand, the counter-argument could be
made that we don't really know how common H5N1 or things
similar have been because really until very recently
we weren't able to track these things at all.

Here's another questionable quote:

"But computer models suggest that quick administration of
antivirals in a localized outbreak just might keep it contained."

Lot's of people have said it that, so it's not really
misinformation. Still to my mind anyone that believes
this is practical has demonstrated poor judgement.

Here's another problematic statement:

"But prophylactic panic-popping of Tamiflu like Chiclets,
as happened with the antibiotic Cipro during the U.S. anthrax
scare, could encourage viral resistance to the drugs."

Sounds like good sense, except Tamiflu's window of
opportunity is when you are just starting to get sick.
If you wait until you actually are sick then it's too
late -- Tamiflu has little effect by that point.
Prophylatic panic-popping every time you think you might
be getting sick is unfortunately exactly the way Tamiflu
should be used.

"Deaths, however, would be vastly lower because we have so
much better access to medicine."

I have serious doubts. If there's really a pandemic
the medical system will break down quickly and we won't
be able to get medical care. Unless he means we are
just in general healthier than people in 1918 which
might be the case. Unfortunately that might mean more
deaths not fewer because the 1918 epidemic preferentially
killed the healthiest people. The stronger your immune
system, the more the body overreacts and the quicker
the person dies.

"The World Health Organization estimate for deaths from
an avian flu pandemic is a reasonable one: "between 2
million and 7.4 million people." "

Why is this more reasonable? I thought his main point
at the beginning of this article was how much we don't
know -- which is certainly true.

"Panicky people forget that in 1918 antibiotics and antibacterial
vaccines that could prevent the deaths caused by secondary
infections were still decades away."

A heck of a lot of people in 1918 epidemic were just
killed straight off by the virus. No secondary infection
was necessary. Also think again of the impact of a
likely breakdown of the medical system. It isn't just
Tamiflu we'll have shortages of; it'll be every vaccine.

Another comment on the secondary infection canard: the death rate from this virus in classified cases is above 50%; does he think that they didn't think to treat secondary infections in these people with antibacterial drugs? Patients are being seen in which the lungs are just gone, replaced by cavernous empty spaces in the chest (of course they die before this goes to 100%, but the damage by the time they do expire is awesome.)

I have stockpiled tamiflu for my entire family, and will obtain Probenecid (which inhibits excretion of the active metabolite of tamiflu, doubling its effectiveness) if human-human transmission takes off.