Monday, October 10, 2005
Worry about Avian Flu, but don’t panic
LOOKING AHEAD by Wally Dobelis
Three days ago Friday this friend called me to announce that Tamiflu, the anti-viral agent, will not be available in the US until 2007, because all of Roche’s production has been spoken for by Europeans and Asians.
I have these friends who seem to know more about medicine than the professionals, and who make fearless diagnoses. One, a cigar smoker who distrusts doctors, has a compendium of alternate medicines and an elephantine memory, and, when asked a question, will quote a line of recommended remedies, at will. He is an alarmist, and I tend to check his answers with the other two, both of whom have extensive experiences from having cheerfully survived staggering health problems. It is a kind of Delphic problem-solving method, trying to derive solutions from a multitude of unreliable opinions. It eventually leads to a visit with our family doctor, who knows, and also anticipates, and had, last year, flu vaccines when everyone else ran short.
This year, though, the fear of an avian flu pandemic has reached higher levels. Michael Leavitt, the Secretary of Health and Human Services, is traveling in Asia as we speak. Whether the governmental concern is real or prompted by Washington’s panic of another Katrina disaster is moot, and we should not hit the panic button. The facts are simple: the Asian/chicken flu H5N1, first seen in 1998 and revived in 2003, has reached 11 countries in Southeast Asia and now has impacted Romania and Turkey, where police roadblocks have been set to stop the transport of birds to urban markets. It is not transmitted to humans, and not communicated between humans, although there have been 116 cases in Asia blamed on it, with half of the victims dying. The fear is that of a mutation occurring, something that various strains of flu do regularly, this time making the avian flu H5N1 communicable between humans.
On the bright side, pandemics are infrequent, with three in the 20th century, and medicine has progressed. The vaccines stay in step and anticipate strains, and some medicines have capabilities to stop the most frequently encountered viruses, such as Type A and B. Thus Tamiflu, developed by Hoffman-La Roche with Gilead Sciences. Inc in Foster City, was admitted by the FDA in 1999 (there are also older and less potent medicines, such as amantadine, see below), which, when taken within two days of onset, will stop the flu from progressing through the cells. The dose consists of five treatments, fairly pricey.
In February 2005 France ordered a stockpile of 14M doses, covering 20% of its population, as did Canada, with another 8.6M. US had a 3M supply and ordered none. As of end September 2005 Great Britain had ordered 20M, Germany 14M and some 30 other countries had their requests in for 28M. The US, calling for a stockpile of 20M, has meanwhile has been assured of 3M doses and is prompting the maker to open a production facility on this continent. The Roche production unit in Geneva, already doubled twice since the WHO suggested stockpiling Tamiflu in 2004, is totally spoken for, well into the next two years.
Another complication has arisen because Gilead, Roche’s US partner in Foster City, CA., recently requested return of the process, claiming that the giant manufacturer had neglected the product and thus broken the contract. Truly, until 2003 Tamiflu had been hard to sell. We heard about it from our family doctor when asking for amantadine, the flu stopper that had helped us in the past. We used the Tamiflu, seemingly successfully, and tried to put some more of it in the medicine cabinet early in 2004, only to be told by the local pharmacist that “manufacture for the year had ceased, since the flu season was over.” Since then we were able to replenish, not without difficulties.
My review of flu literature is strictly nonprofessional. There are reliable Internet sources that you may want to check. Thus, the Centers for Disease Control and Prevention (CDC) identify the three 20th century pandemics, “Spanish Flu” of 1918-19 (H1N1, 500K deaths), “Asian Flu” of 1958-9 (H2N2, 42K deaths) and “Hong-Kong flu” (H3N2, 34K deaths). This, my chilling recount of fatalities is only to assure us that the progress of medicine has been real, making pandemics less fearsome. The CDC identifies four medicines, amantadine, rimantadine, zanamivir (Relinza) and oseltamivir (Tamiflu), with the H5N1 strain stated to be resistant to the former two. CDC estimates that the costs of the next pandemic will be much more severe than the last two, but studies continue and precautions are made.
What to do? Well, let’s get back to the flu basics. Cover your nose thoroughly when sneezing, and stay away from others so afflicted. Find solitary spots in movies, and in crowded events. No social kissing. Surround your face with a big newspaper in subways (the Paper of Record is best). Try using public transportation in off-hours. Good luck to all of us.
.
Three days ago Friday this friend called me to announce that Tamiflu, the anti-viral agent, will not be available in the US until 2007, because all of Roche’s production has been spoken for by Europeans and Asians.
I have these friends who seem to know more about medicine than the professionals, and who make fearless diagnoses. One, a cigar smoker who distrusts doctors, has a compendium of alternate medicines and an elephantine memory, and, when asked a question, will quote a line of recommended remedies, at will. He is an alarmist, and I tend to check his answers with the other two, both of whom have extensive experiences from having cheerfully survived staggering health problems. It is a kind of Delphic problem-solving method, trying to derive solutions from a multitude of unreliable opinions. It eventually leads to a visit with our family doctor, who knows, and also anticipates, and had, last year, flu vaccines when everyone else ran short.
This year, though, the fear of an avian flu pandemic has reached higher levels. Michael Leavitt, the Secretary of Health and Human Services, is traveling in Asia as we speak. Whether the governmental concern is real or prompted by Washington’s panic of another Katrina disaster is moot, and we should not hit the panic button. The facts are simple: the Asian/chicken flu H5N1, first seen in 1998 and revived in 2003, has reached 11 countries in Southeast Asia and now has impacted Romania and Turkey, where police roadblocks have been set to stop the transport of birds to urban markets. It is not transmitted to humans, and not communicated between humans, although there have been 116 cases in Asia blamed on it, with half of the victims dying. The fear is that of a mutation occurring, something that various strains of flu do regularly, this time making the avian flu H5N1 communicable between humans.
On the bright side, pandemics are infrequent, with three in the 20th century, and medicine has progressed. The vaccines stay in step and anticipate strains, and some medicines have capabilities to stop the most frequently encountered viruses, such as Type A and B. Thus Tamiflu, developed by Hoffman-La Roche with Gilead Sciences. Inc in Foster City, was admitted by the FDA in 1999 (there are also older and less potent medicines, such as amantadine, see below), which, when taken within two days of onset, will stop the flu from progressing through the cells. The dose consists of five treatments, fairly pricey.
In February 2005 France ordered a stockpile of 14M doses, covering 20% of its population, as did Canada, with another 8.6M. US had a 3M supply and ordered none. As of end September 2005 Great Britain had ordered 20M, Germany 14M and some 30 other countries had their requests in for 28M. The US, calling for a stockpile of 20M, has meanwhile has been assured of 3M doses and is prompting the maker to open a production facility on this continent. The Roche production unit in Geneva, already doubled twice since the WHO suggested stockpiling Tamiflu in 2004, is totally spoken for, well into the next two years.
Another complication has arisen because Gilead, Roche’s US partner in Foster City, CA., recently requested return of the process, claiming that the giant manufacturer had neglected the product and thus broken the contract. Truly, until 2003 Tamiflu had been hard to sell. We heard about it from our family doctor when asking for amantadine, the flu stopper that had helped us in the past. We used the Tamiflu, seemingly successfully, and tried to put some more of it in the medicine cabinet early in 2004, only to be told by the local pharmacist that “manufacture for the year had ceased, since the flu season was over.” Since then we were able to replenish, not without difficulties.
My review of flu literature is strictly nonprofessional. There are reliable Internet sources that you may want to check. Thus, the Centers for Disease Control and Prevention (CDC) identify the three 20th century pandemics, “Spanish Flu” of 1918-19 (H1N1, 500K deaths), “Asian Flu” of 1958-9 (H2N2, 42K deaths) and “Hong-Kong flu” (H3N2, 34K deaths). This, my chilling recount of fatalities is only to assure us that the progress of medicine has been real, making pandemics less fearsome. The CDC identifies four medicines, amantadine, rimantadine, zanamivir (Relinza) and oseltamivir (Tamiflu), with the H5N1 strain stated to be resistant to the former two. CDC estimates that the costs of the next pandemic will be much more severe than the last two, but studies continue and precautions are made.
What to do? Well, let’s get back to the flu basics. Cover your nose thoroughly when sneezing, and stay away from others so afflicted. Find solitary spots in movies, and in crowded events. No social kissing. Surround your face with a big newspaper in subways (the Paper of Record is best). Try using public transportation in off-hours. Good luck to all of us.
.
# posted by Wally Dobelis @ 9:07 PM 
