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Lucas: What we can do regarding pandemic flu

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  • ms@auste.elnet.lt
    Lucas Gonzalez Santa Cruz (Ph.D & M.D. !!) alerted us in June 2005 that there is a very real - almost certain - risk that our world will face a pandemic flu
    Message 1 of 4 , Dec 15, 2006
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      Lucas Gonzalez Santa Cruz (Ph.D & M.D. !!) alerted us in June 2005 that there
      is a very real - almost certain - risk that our world will face a pandemic
      flu rather soon. This is because the bird flu that we are now hearing about
      will naturally mutate until it can easily spread from human to human. Flu
      spreads very easily. This flu will be different because it will be new,
      poorly adapted to us, and so it will kill more of us than it might like to.

      What we don't know is whether it will be a "small" pandemic (1 million
      deaths) or a "giant" pandemic (more than 100 million deaths).

      As independent thinkers, this is one more opportunity to "care about
      thinking". In this case, to think ahead. What seems most useful is to deal
      with the worst possibilities, and the most distant possibilities, because
      that's where our thinking can have the most real effect. So, for example, if
      people know some basic information about pandemic flu, it can make a life or
      death difference:
      - most of the sick people survive if they can get enough fluids
      - they will be too weak to take the fluids themselves, and they will need a
      friend to drip the fluids for them into their mouth
      - people should avoid contact with each other during a pandemic, and be
      prepared to scatter in smaller groups

      I imagine that the biggest impact we can have is in Africa, which seems to
      get most neglected. Pamela McLean is leading our MyFoodStory team on
      Poultry, LearningFromEachOther and MultiBandwidthInterfaces. So my feeling
      is that poultry farmers are a group that are naturally interested in having
      the best information regarding bird flu and not be victims of superstition.
      The vast majority of people will NOT get bird flu from birds! They will get
      it from people. So poultry farmers have an interest to spread good
      information.

      Some concrete issues in Africa I imagine might include having sensible ways
      to break up the children in the larger orphanages or schools so they can live
      in into smaller groups . And to make sure that people have essentials for a
      two month period or so. Perhaps there is a way that outsiders could invest
      in such stores?

      Also, as a mathematician I can say that even a small slow of the spread of
      the disease (by taking care to avoid contagion) can cut down dramatically on
      the overall number of people who get sick and also on the shock to our social
      services. So every little bit we do here can make a dramatic difference. We
      could save 1,000 lives.

      Let's think, how can "Learning from each other" be relevant here? Pamela,
      what do you think?

      Andrius

      Andrius Kulikauskas
      Minciu Sodas
      http://www.ms.lt
      ms@...


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

      AndriusKulikauskas: Lucas, great links! What do you think it be useful that
      we do? We have some resources and interest, and some direction - especially
      in Africa. What might you recommend as key? Especially in terms of pilot
      projects that we can try and learn from. Perhaps about emergency preparedness
      in general. Maybe some forms of investment (such as pre-giving) that can be
      released in the event of an emergency? Maybe some kind of viral learning that
      we can spread? Or a network of people who know how to get and spread reliable
      information? The latter seems most relevant to Pamela McLean's MyFoodStory
      team for "poultry" and "learning from each other" and "multi-bandwidth
      interfaces". Peace and greetings from Istanbul, Turkey!


      ----------------------------
      Lucas Gonzalez Santa Cruz:

      What do I think would be useful that some people in or near MSL's network(s)
      do? Please accept that I don't know, really. I'll think out loud in case that
      helps. And please feel free to ask for specifics.

      * I feel a pandemic is inevitable at some point in time. I try and think
      it could be indefinitely averted by humans widely and quickly changing what
      we do, but even if we reduce probabilities I very much doubt we could move
      faster than the virus. It's currently a race among species, and I don't see
      us moving fast enough. That's why I tend to look at it in terms of
      mitigation, not prevention. But I'll try both in my mind and see where that
      takes me.
      * Daydreaming about "averting a pandemic", we humans would have to do a
      number of things. Keep in mind these are not my present "recomendations" (as
      if I could make any!), because I really feel we should devote our energies to
      something else. But anyway, here I go:
      o First, we might want to try diminishing contact between species
      that are able to carry the virus. Feeding chicken waste to pigs is not really
      a wise thing to do. (Prof Chan's ways are so much better from many points of
      view, animal health and human health included.) Handling animals with
      apropriate precautions (I don't know how, exactly; not my field at all) might
      also be wise; children hugging chickens is probably not very wise. All in all,
      we want the virus to stay in other species if at all possible.
      o Second, if humans do get the virus, we want to detect that
      situation as fast as possible, in order to treat the ill and very importantly
      in order to protect human contacts so that the bird-to-human virus doesn't
      have much of a chance to become human-to-human. This may be unavoidable, but
      if we detect it then the World Health Organisation may be able to move
      antivirals and create what they call an "antiviral blanket". It's not likely
      that we'll be able to do this in all places where this is needed. If people
      do the right thing 100% all over Africa but with low "compliance" say in
      Indonesia, then the World would get a pandemic.
      o Other than preventing b2h (my "first" point) and detecting b2h to
      avoid h2h (my "second" point), I currently see no other things we could do to
      minimise the chance of a pandemic emerging. And once it emerges, then we are
      into "mitigation mode".
      * Now, thinking about "mitigation", we're learning about a few things we
      can and should do. I'll summarise them here, but there may be more details
      that either I forget right now or that are being thought openly by experts
      around the world.
      o First, human respiratory networks are what experts call "free
      scale" (I think). This means a relatively small number of people are
      responsible (not morally responsible, but physically they act as springboards
      for the virus) for a disproportionate number of secondary cases. With AIDS,
      this would be people who have many couples. With flu (common flu, and
      assumedly also pandemic flu) this would be children: they get together in
      huge numbers where there are schools, they don't control their manners as
      well as adults, and the shed more virus and for longer. This means that the
      primary mitigation strategy is thought to be closing schools. (What this
      would mean in Kibera is beyond what I can imagine.)
      o Secondly, flu is transmitted by aerosols (large droplets and
      direct contact also play a role, but in my inner summary this role is smaller
      than that of aerosols). This means surgical masks provide almost no
      protection, and sadly the same might be true for simple masks (I've tried to
      explore these, and I'm not certain they would add much). N95 masks will not
      be available outside health-care in rich countries. When the time comes, we
      will use whatever is available. Even if we forget about masks (an open
      question in my opinion) we still have this "cover your cough" strategy, and
      keeping distance regarding each other unless directly needed (asynchronous
      transfer of goods, etc).
      o These strategies are based on what flu scholars call "R-naught",
      which is the "basic reproductive number", or in longer words "the average
      number of secondary cases". If you and I are infected by the same person, and
      then I infect three people and you infect one, on average we've infected two
      people each, so R0 would be 2. On average, the "generation time" for flu is
      about 3 days; for ease of maths we can imagine it's two generations a week,
      or ten generations in 5 weeks. If R0 = 2, then 2 to the power of 10 is 1024
    • minciusodas
      Lucas s letter got chopped off at the end, so I am resending it here. Andrius ... Lucas Gonzalez Santa Cruz: What do I think would be useful that some people
      Message 2 of 4 , Dec 15, 2006
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        Lucas's letter got chopped off at the end, so I am resending it here.
        Andrius
        -----------------

        Lucas Gonzalez Santa Cruz:

        What do I think would be useful that some people in or near MSL's
        network(s) do? Please accept that I don't know, really. I'll think out
        loud in case that helps. And please feel free to ask for specifics.

        * I feel a pandemic is inevitable at some point in time. I try and
        think it could be indefinitely averted by humans widely and quickly
        changing what we do, but even if we reduce probabilities I very much
        doubt we could move faster than the virus. It's currently a race among
        species, and I don't see us moving fast enough. That's why I tend to
        look at it in terms of mitigation, not prevention. But I'll try both
        in my mind and see where that takes me.
        * Daydreaming about "averting a pandemic", we humans would have to
        do a number of things. Keep in mind these are not my present
        "recomendations" (as if I could make any!), because I really feel we
        should devote our energies to something else. But anyway, here I go:
        o First, we might want to try diminishing contact between
        species that are able to carry the virus. Feeding chicken waste to
        pigs is not really a wise thing to do. (Prof Chan's ways are so much
        better from many points of view, animal health and human health
        included.) Handling animals with apropriate precautions (I don't know
        how, exactly; not my field at all) might also be wise; children
        hugging chickens is probably not very wise. All in all, we want the
        virus to stay in other species if at all possible.
        o Second, if humans do get the virus, we want to detect that
        situation as fast as possible, in order to treat the ill and very
        importantly in order to protect human contacts so that the
        bird-to-human virus doesn't have much of a chance to become
        human-to-human. This may be unavoidable, but if we detect it then the
        World Health Organisation may be able to move antivirals and create
        what they call an "antiviral blanket". It's not likely that we'll be
        able to do this in all places where this is needed. If people do the
        right thing 100% all over Africa but with low "compliance" say in
        Indonesia, then the World would get a pandemic.
        o Other than preventing b2h (my "first" point) and detecting
        b2h to avoid h2h (my "second" point), I currently see no other things
        we could do to minimise the chance of a pandemic emerging. And once it
        emerges, then we are into "mitigation mode".
        * Now, thinking about "mitigation", we're learning about a few
        things we can and should do. I'll summarise them here, but there may
        be more details that either I forget right now or that are being
        thought openly by experts around the world.
        o First, human respiratory networks are what experts call
        "free scale" (I think). This means a relatively small number of people
        are responsible (not morally responsible, but physically they act as
        springboards for the virus) for a disproportionate number of secondary
        cases. With AIDS, this would be people who have many couples. With flu
        (common flu, and assumedly also pandemic flu) this would be children:
        they get together in huge numbers where there are schools, they don't
        control their manners as well as adults, and the shed more virus and
        for longer. This means that the primary mitigation strategy is thought
        to be closing schools. (What this would mean in Kibera is beyond what
        I can imagine.)
        o Secondly, flu is transmitted by aerosols (large droplets
        and direct contact also play a role, but in my inner summary this role
        is smaller than that of aerosols). This means surgical masks provide
        almost no protection, and sadly the same might be true for simple
        masks (I've tried to explore these, and I'm not certain they would add
        much). N95 masks will not be available outside health-care in rich
        countries. When the time comes, we will use whatever is available.
        Even if we forget about masks (an open question in my opinion) we
        still have this "cover your cough" strategy, and keeping distance
        regarding each other unless directly needed (asynchronous transfer of
        goods, etc).
        o These strategies are based on what flu scholars call
        "R-naught", which is the "basic reproductive number", or in longer
        words "the average number of secondary cases". If you and I are
        infected by the same person, and then I infect three people and you
        infect one, on average we've infected two people each, so R0 would be
        2. On average, the "generation time" for flu is about 3 days; for ease
        of maths we can imagine it's two generations a week, or ten
        generations in 5 weeks. If R0 = 2, then 2 to the power of 10 is 1024.
        If R0 = 1.9, then 1.9 to the power of 10 is slightly over 600. So what
        each of us does will count, and small things may add up to a possibly
        good "herd immunity". More healthy people taking care, at each
        instant, of less ill people. We need to be able to cut down, on short
        notice, many unnnecesary respiratory contacts. But minimising
        infections will increase disruption, because we do many things near
        each other; so we need to think about minimising secondary effects
        too; in places with schools, this means that closing schools will put
        some parents out of important jobs (higher absentee rates).
        o Then it's home treatment (which I'll tell you about some
        other day, but it needs stocking up and learning a few simple common
        sense things; this could be very important), and the mitigation of
        disruption (stocking up on water containers, food, essential drugs,
        etc; growing food and energy near home; cross-training for essential
        jobs, and networking for mutual aid; and maybe other things we can
        think of).
        * So what could MSL and allies do? I think the scenario is layed
        down so we can see some doable things (among them, the "reliable
        information networks" Andrius writes about). But all of this needs
        further thinking, and I need some sleep.
      • Pamela McLean
        Hi Andrius and all I m lurking rather than contributing at present - pressure of time. Andrius I note you ve moved chickens/poultry to March. This may work
        Message 3 of 4 , Dec 15, 2006
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          Hi Andrius and all

          I'm lurking rather than contributing at present - pressure of time.

          Andrius I note you've moved chickens/poultry to March. This may work
          well as my next trip to Nigeria is planned for late February.

          The main focus of the trip will be two training courses of TT4Trainers
          (a version of Teachers Talking About ICT) but I'll be doing other bits
          and pieces as well. I have been busy preparing the resources and putting
          them up at Cawdnet Campus -so at last you have something to see if you
          go there ;-)

          The notes below were written for some fellow trainers After the notes
          I've started to indulge in some dreams for 2007 - as you requested us to do.

          Ref your question about bird flu and pandemics and prevention - I feel
          that is pulling me towards content about which I know nothing - and I
          can't speak for the emphasis of the people I will be working with. But
          maybe I should consider asking my team to include some people with a
          health background in their research - not just those with a food chain
          (farming or food buying/preparing) interest. .
          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          This is an update about making the Teachers Talking "No-Computer
          Computer Course" resources available online.
          The diagrams are now available plus some explanatory notes at "Cawdnet
          Campus".To go straight to the resources click here
          http://moodle.cawd.net/course/view.php?id=67 and then log on. To see
          them in the context of other work we are doing go to
          http://moodle.cawd.net/ (Cawdnet Campus) as a guest and then visit
          Teachers Talking.

          Thanks are due to:
          # Omo Oaiya, for taking care of the technical side of things.
          # Lorraine Duff for administrative support.
          # Katie Nonyelson for the diagrams.
          # Fantsuam Foundation (FF) for inviting me to design and present the
          programme in the first place, and then sorting out the logistics so the
          courses could happen. (I started to make a "Special thanks are due
          to...." list at this point, but it got ridiculously long. Thanks to
          everyone at FF who helped in any way, large or small.)
          # Everyone who joined the Teachers Talking yahoo group in response to my
          call for help in developing and presenting the initial course at FF.
          # Core members of the TT group whose creative contribution and hard work
          enormously influenced the subsequent shape of the TT programme.
          # Everyone who has participated online to make participants feel part of
          "the connected community" during the Teachers Talking Online parts of
          the programme.
          # Last, but not least, everyone I'm sending this email to - because your
          interest in TT has encouraged me to get it online to share with other
          trainers.

          Pam
          ~~~~~~~~~~~~~~~~~
          Building on the work so far is part of my dreams for next year - I
          hope to write about them soon.

          Regarding Cawdnet Campus I have needed to "struggle without help" - from
          the point of view of the lab- in order to recognise what it was that I
          was trying to do. (Perhaps that makes sense to you.) Now I understand
          better the elements of the communication systems I am working with
          (human and technical) it means that I can communicate about it with
          others in order to move on together. (It's no good trying to "work on
          answers" until the question gets reasonably well defined.)

          It is hard to explain to other people when the work is new - because of
          the way the emphasis keeps shifting between" the content and the conduit".
          You know how it is - getting that balance right between the two - and
          often people want to focus on one or the other - and can get frustrated
          as I shift between the two - with many apparent changes of direction and
          emphasis (though really I am going in the same direction all the time -
          but tacking across the wind...)

          Anyhow - I hope I am beginning to have enough to show (and understand
          for myself) that people who are interested in improving information
          flows will be able to understand better the flows I am trying to
          enable. I also hope that, even the fairly basic, present systems of
          information flow, are becoming clear enough and usable enough to share.
          I hope that people with other content needs relevant to Cawdnet may also
          be able to benefit from using Cawdnet Campus..

          Sorry - not well expressed - more like memory jogging notes to myself.

          On dreaming -
          # I'm also hoping to see the development of schools clubs and teachers
          clubs - less formal expressions of the TT programme. We have already
          started some.
          # And I want to stretch the training delivery systems we have in order
          to cover other professional development for the teachers - not just ICT
          training....
          # And because, in Nigeria, it is said that if you train a teacher you
          train their community - I also want to build our networks stronger and
          more effectively for cascading other community development information.

          There are lots of other special interest groups we want to enable -
          besides just education. I did teachers first because it was easiest for
          me as it reflects my background. Because the groups I work with are
          community groups their concerns tend to include all the concerns that
          all people share - health, education, livelihoods, energy, finance etc.....

          I could go on for ages - I must stop - but it looks like being an
          exciting and productive year because fragments of work (that seemed to
          some people to not fit together) seem to be drawing closer with
          increasingly obvious relationship and potential good fit. I believe
          that when more people see and understand then they will want to join in
          and so - for all of us- as more of us add our contributions together -
          the struggle for sufficient resources may become less burdensome.

          Pam
        • kayiwa fred
          thanks alot for the advise am also advising others that they should always be alet personary am keeping poutry along my education but ihave not seen hapening
          Message 4 of 4 , Dec 17, 2006
          • 0 Attachment
            thanks alot for the advise
            am also advising others that they should always be
            alet
            personary am keeping poutry along my education
            but ihave not seen hapening to my farm but at least in
            northen part of my country it hapened and the
            neibouring country killing thousands of birds
            and now am reading in news papers here always and
            radios all media satations that we should always keep
            alert with this bird flu
            always dont eat died chicken when you have not kiled
            it yourself
            dont eat infected chircken
            use gloves when serving them
            and may prevention you should always inquire
            --- ms@... wrote:

            > Lucas Gonzalez Santa Cruz (Ph.D & M.D. !!) alerted
            > us in June 2005 that there
            > is a very real - almost certain - risk that our
            > world will face a pandemic
            > flu rather soon. This is because the bird flu that
            > we are now hearing about
            > will naturally mutate until it can easily spread
            > from human to human. Flu
            > spreads very easily. This flu will be different
            > because it will be new,
            > poorly adapted to us, and so it will kill more of us
            > than it might like to.
            >
            > What we don't know is whether it will be a "small"
            > pandemic (1 million
            > deaths) or a "giant" pandemic (more than 100 million
            > deaths).
            >
            > As independent thinkers, this is one more
            > opportunity to "care about
            > thinking". In this case, to think ahead. What
            > seems most useful is to deal
            > with the worst possibilities, and the most distant
            > possibilities, because
            > that's where our thinking can have the most real
            > effect. So, for example, if
            > people know some basic information about pandemic
            > flu, it can make a life or
            > death difference:
            > - most of the sick people survive if they can get
            > enough fluids
            > - they will be too weak to take the fluids
            > themselves, and they will need a
            > friend to drip the fluids for them into their mouth
            > - people should avoid contact with each other during
            > a pandemic, and be
            > prepared to scatter in smaller groups
            >
            > I imagine that the biggest impact we can have is in
            > Africa, which seems to
            > get most neglected. Pamela McLean is leading our
            > MyFoodStory team on
            > Poultry, LearningFromEachOther and
            > MultiBandwidthInterfaces. So my feeling
            > is that poultry farmers are a group that are
            > naturally interested in having
            > the best information regarding bird flu and not be
            > victims of superstition.
            > The vast majority of people will NOT get bird flu
            > from birds! They will get
            > it from people. So poultry farmers have an interest
            > to spread good
            > information.
            >
            > Some concrete issues in Africa I imagine might
            > include having sensible ways
            > to break up the children in the larger orphanages or
            > schools so they can live
            > in into smaller groups . And to make sure that
            > people have essentials for a
            > two month period or so. Perhaps there is a way that
            > outsiders could invest
            > in such stores?
            >
            > Also, as a mathematician I can say that even a small
            > slow of the spread of
            > the disease (by taking care to avoid contagion) can
            > cut down dramatically on
            > the overall number of people who get sick and also
            > on the shock to our social
            > services. So every little bit we do here can make a
            > dramatic difference. We
            > could save 1,000 lives.
            >
            > Let's think, how can "Learning from each other" be
            > relevant here? Pamela,
            > what do you think?
            >
            > Andrius
            >
            > Andrius Kulikauskas
            > Minciu Sodas
            > http://www.ms.lt
            > ms@...
            >
            >
            > ----------------------------
            >
            > AndriusKulikauskas: Lucas, great links! What do you
            > think it be useful that
            > we do? We have some resources and interest, and some
            > direction - especially
            > in Africa. What might you recommend as key?
            > Especially in terms of pilot
            > projects that we can try and learn from. Perhaps
            > about emergency preparedness
            > in general. Maybe some forms of investment (such as
            > pre-giving) that can be
            > released in the event of an emergency? Maybe some
            > kind of viral learning that
            > we can spread? Or a network of people who know how
            > to get and spread reliable
            > information? The latter seems most relevant to
            > Pamela McLean's MyFoodStory
            > team for "poultry" and "learning from each other"
            > and "multi-bandwidth
            > interfaces". Peace and greetings from Istanbul,
            > Turkey!
            >
            >
            > ----------------------------
            > Lucas Gonzalez Santa Cruz:
            >
            > What do I think would be useful that some people in
            > or near MSL's network(s)
            > do? Please accept that I don't know, really. I'll
            > think out loud in case that
            > helps. And please feel free to ask for specifics.
            >
            > * I feel a pandemic is inevitable at some point
            > in time. I try and think
            > it could be indefinitely averted by humans widely
            > and quickly changing what
            > we do, but even if we reduce probabilities I very
            > much doubt we could move
            > faster than the virus. It's currently a race among
            > species, and I don't see
            > us moving fast enough. That's why I tend to look at
            > it in terms of
            > mitigation, not prevention. But I'll try both in my
            > mind and see where that
            > takes me.
            > * Daydreaming about "averting a pandemic", we
            > humans would have to do a
            > number of things. Keep in mind these are not my
            > present "recomendations" (as
            > if I could make any!), because I really feel we
            > should devote our energies to
            > something else. But anyway, here I go:
            > o First, we might want to try diminishing
            > contact between species
            > that are able to carry the virus. Feeding chicken
            > waste to pigs is not really
            > a wise thing to do. (Prof Chan's ways are so much
            > better from many points of
            > view, animal health and human health included.)
            > Handling animals with
            > apropriate precautions (I don't know how, exactly;
            > not my field at all) might
            > also be wise; children hugging chickens is probably
            > not very wise. All in all,
            > we want the virus to stay in other species if at all
            > possible.
            > o Second, if humans do get the virus, we
            > want to detect that
            > situation as fast as possible, in order to treat the
            > ill and very importantly
            > in order to protect human contacts so that the
            > bird-to-human virus doesn't
            > have much of a chance to become human-to-human. This
            > may be unavoidable, but
            > if we detect it then the World Health Organisation
            > may be able to move
            > antivirals and create what they call an "antiviral
            > blanket". It's not likely
            > that we'll be able to do this in all places where
            > this is needed. If people
            > do the right thing 100% all over Africa but with low
            > "compliance" say in
            > Indonesia, then the World would get a pandemic.
            > o Other than preventing b2h (my "first"
            > point) and detecting b2h to
            > avoid h2h (my "second" point), I currently see no
            > other things we could do to
            > minimise the chance of a pandemic emerging. And once
            > it emerges, then we are
            > into "mitigation mode".
            > * Now, thinking about "mitigation", we're
            > learning about a few things we
            > can and should do. I'll summarise them here, but
            > there may be more details
            > that either I forget right now or that are being
            > thought openly by experts
            > around the world.
            > o First, human respiratory networks are
            > what experts call "free
            > scale" (I think). This means a relatively small
            > number of people are
            > responsible (not morally responsible, but physically
            > they act as springboards
            > for the virus) for a disproportionate number of
            > secondary cases. With AIDS,
            > this would be people who have many couples. With flu
            > (common flu, and
            > assumedly also pandemic flu) this would be children:
            > they get together in
            > huge numbers where there are schools, they don't
            > control their manners as
            > well as adults, and the shed more virus and for
            > longer. This means that the
            > primary mitigation strategy is thought to be closing
            > schools.
            === message truncated ===


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