Elisabeth speaks true. The head of my investment management company's Mergers & Acquisitions Division is seriously concerned about a possible pandemic. His division takes long-term positions, so there's no opportunity for a fast exit if markets start to panic. On the brighter side, being a long-term holder, we can affort to wait-out a panic, but it won't be much fun having to do so. Here, fyi, is some material recently provided to our committee: a set of responses to questions posed by participants of a webcast by The Conference Board:
QUESTIONS TO THE CONFERENCE BOARD WEBCAST
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What are the economic and morbidity implications for a pandemic in the developing world?
No one knows for sure, but it is probable that the developing world is likely to have somewhat higher infection rates due to ignorance and poor sanitation and public health, and substantially higher mortality rates due to a lack of care and intervention capability. Poor urban areas are the most vulnerable everywhere.
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Since the virus currently does not transmit from human to human, is the only real problem with more birds getting it in other continents just means there is greater exposure for it to mutate?
No. As the virus spreads, it causes substantial economic hardship through direct loss of poultry via disease and culling, as well as trade and travel embargo hardships. The virus is also expanding it’s breadth of biological hosts.
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Do we need to be concerned with H5N2 or any of the other strains?
Yes. We need to be concerned with any of the Avian Influenza viruses that have shown pandemic potential – particularly H1N1 (1918 virus), the H5’s, including H5N2 – which recently infected 77 Japanese poultry workers, but is much less virulent than H5N1, the H7’s, and the H9’s.
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For corporate America, is it recommended that a stock of masks and gloves be kept on hand?
I have stocked up for my company and family, so I think it is a good idea.
When to use the supplies depends on circumstance. If you are handling potentially infected birds, you should use them. If you are traveling to an infected area, you should carry them, and be prepared to use them if need be. If you are just in an office somewhere, you probably don’t need to use them until the pandemic virus has arrived in your area, then you may need to use them regularly for an extended period of time.
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Can you expand on the human movement of the virus at the Qinghai Lake area.
There is uncertainty regarding how the virus got to Qinghai lake. The assumption of many is that since it is a known congregation point for migratory birds, it was carried into the area through migratory birds, but another equally plausible possibility is that the virus was carried into the area via tourists or other people. We just don’t know for sure.
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Even if quarantine is not effective can we expect countries to try e.g. border closures
YES. Some countries, like Australia, Canada, and New Zealand have already disclosed their intentions to close borders under some circumstances. The expectation is that border closures will be used, but our hope is that they will not endure for long, or the cure may become more devastating than the disease.
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What is the U.S. government's perspective on the probability of a pandemic in the next 18 months?
No one has a firm answer for that, since the emergence of a pandemic virus is fundamentally uncertain. It is thought that the probability of pandemic in any given year is about 3%., and the spreading H5N1 epidemic would certainly seem to improve those odds substantially over the next two years, but I haven’t seen a quantitative answer to the question that was any good.
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With 50% probability of death, why do you expect the death rate to decrease over time
Evolutionary biologists expect that as the virus adapts to humans, less virulent strains should be selected, since the host that are infected continue to circulate and infect others, while highly virulent forms kill and cut off the chance of the host to infect others.
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Once H5N1 mutates to a human transmissable strain, will it still be spread by birds?
We don’t know for certain, but the sialic acid receptors in the lungs that the hemoglutonin spikes on the virus exploit to enter the cell are different in birds and people, so the better adapted a variant is for humans, the less well adapted to birds.
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What evidence is there that masks really help?
There is good evidence that the widespread use of N95 masks can cut down on small liquid particle transmission of respiratory diseases. There is less good evidence that they will specifically cut down on airborne influenza virus transmission. Nonetheless, it is recommended in general, especially for cutting down on the amount of virus infected people shed into the air when they sneeze.
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Does China have recommended countermeasures for their population to reduce the potential spread of H to H transmission?
Not really – they will try to produce a vaccine, I’m sure, but are capacity constrained. In the end, they will rely primarily on isolation, quarantine, masks, and sanitation.
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Regarding quarantine and border closings, how would this adversely affect countermeasures.
It may interfere with the movement of medical supplies from place to place.
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Do controlled environments (prisons, boarding schools) pose significantly more risk and can they effectively control the risk?
Historically, we know that highly social, confined environments can be especially vulnerable. There are measures that can be taken which will reduce risk of transmission, but while students can be sent home from school, prisoners are pretty much stuck. The cultural behavior and hygiene practices in such institutions will have to change radically.
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There will clearly be a gap between an outbreak and the availability of a vaccine. What are health officals recomended 'best practices' or administrative practices to fill that gap (masks, gloves, other, etc...)?
Yes. Seek, achieve, and maintain social distance to the extent possible, and practice heightened sanitation.
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There will clearly be a gap between an outbreak and the availability of a vaccine. What are health officals recomended 'best practices' or administrative practices to fill that gap (masks, gloves, other, etc...)? Acknowledging your response to CDC Journal article, health officilas do not seem to be endorsing or recommending those practices publically. Why?
The main recommendations are to seek, achieve, and maintain social distance and to practice good hygiene. We would advise N95 masks in public with disposable foot and hand wear, and protective eyewear. I don’t know why federal officials haven’t been more aggressive in recommending basic public health measures.
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Does the cdc article include information on efficacy (% reduction in transmission, forexample) as well as ease of implementation/maintenance. if not on cdc site can speaker recommend other sources...reason for question is to concentrate on high value and easy interventions rather than lower value and logistically difficult.
Yes. To the extend efficacy is known (and it isn’t in many cases), the CDC articles in the Journal of Emerging Infectious Diseases do cite that information.
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Will you please address the question regarding masks and gloves. Are they useful in a workplace setting or not?
See CDC articles mentioned above, and previous answers.
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Are any Corporations stockpiling tamiflu? Are any Corporations advising "don't work if sick"? Are any Corporations providing pneumo vaccine?
Yes. Some corporations have stockpiled tamiflu, but many have decided that the cost benefit anlaysis doesn’t warrant the commitment of such significant resources.
Most corporations are adopting “if sick with any flu symptoms, stay at home” policies, including sending people home who exhibit symptoms at the workplace – in part for the comfort such a policy affords other workers. I don’t understand the last part of the question, but no corporations that I am aware of are trying to provide H5N1 vaccine – which isn’t available yet.
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Key question is when to put these corporate in motion, particularly social distancing. Do companies what to distance until outbreaks are local or take pre-emptive action?
Most global companies will adopt travel policies right away (or early), but will not implement major changes to office protocol (beyond dealing with recent travelers) until after a pandemic influenza arrives in their local area.
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What was name of periodical again released 1/06 giving wide range of methods of personal prevention.
Journal of Emerging Infectious Diseases on the CDC website (http://www.cdc.gov)
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Have you assigned probabilities to your scenarios?
No. We made them equally plausible and fundamentally uncertain on purpose.
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Tamiflu is proported to only limit the duration of the flu and then only if administered at the right time. Please confirm this and if so, will the publicity about the production of Tamiflu mislead the population about its effeciveness and cause people to hoard the medication? Hoarding has already become a problem.
Tamiflu can be used in two ways, therapeutically – meaning after the onset of symptoms where it has very modest effectiveness (typically being cited as reducing the duration of illness by 1.3 days on average, and reducing mortality from common flu infections by about 50%.); or it can be used prophylactically – meaning prior to the onset of illness, where it has been much more effective (reducing likelihood of influenza disease occurring) by about 90%. We don’t know exactly how this works, but one theory is that you still get infected, but the neurimidase inhibiting action of tamiflu disrupts the viruses ability to rapidly spread from cell to cell in your body, and instead of getting sick, you become immune.
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What are the potential complications of Thera flu? I meant the drug he is referencing
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Can you expand on the "herd" behaviors?
By herd behaviour, we mean the phenomena of everyone doing the same thing at the same time… In this case, in the event of a highly virulent, highly transmissible influenza pandemic, many people will be scared and looking to avoid infection. This could lead many to act in the same way at the same time. As with SARS, airline travel may suddenly plummet everywhere. Or everyone may decide to leave an infected city at the same time. Or everyone may buy water or medical supplies at the same time, leading to shortages.
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Will governments give a priotiy to priavte sector critical IT staffs and other essential staff for distribution of countermeasures?
Probably Yes, if they understand and agree with the critical nature of the systems in question.
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Libby from GLP Asked: Are there any recommendedations for measures for disease mitigation on public transit as it is critically interdependent with the function of urban economies and cannot easily be shut down?
Not that I know of, although I would hope against hope that public transit stations will hand out N95 masks upon entry.
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What are 5-10 things that employees (people) can do to boost their immunity in the event of sparse vaccines.
(1) Eat a healthy diet
(2) Get plenty of exercise
(3) Reduce stress
(4) Seek, Achieve and Maintain Social Distance, and practice good hygine (wash your hands a lot, etc.)
(5) Eat lots of Kimchee and/or Saurkraut.
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