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October 23, 2005

“Cytokine Storm” , the W Factor

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Official scenarios of an unfolding Avian Flu pandemic, while harrowing, tend, unfortunately, to over narrowly depict the threat. The projections, as would be expected, all tally up the terrifying number of potential deaths --ranging anywhere from 5 million to 150 million, the percentage of the population stricken as the disease peaks --from 25 to 50%-- and the potential for a breakdown in certain basic related services like the number of available hospital beds and the space in official morgues able to store the surplus of corpses. For anyone who has lived through an extraordinarily disruptive event, and few of us still alive have seen anything like a worldwide pandemic, it's clear that any estimate of the full mayhem has to take into account the massive problems that can easily cascade out of control when basic services and supplies are suddenly cut off or break down.

It's projected that once the H5N1 virus outbreak occurs --that earthshaking moment when the virus recombines in such a way that it can pass easily from person to person-- it will be only a matter of days, even hours, before populations on every corner of the planet are being stricken in wave 1 of several circum-global sweeps.

The first major indications of pending chaos for most populations that have come to rely on their public health systems, will occur when they find that there are enough anti- flu drugs available to cover just a tiny percentage of the population, those designated essential. Most people, those who have not been following particularly closely, will also be shocked to find out that there are not even limited supplies of the vaccine that might have proved effective. It's likely that these shortages alone will set off anger and panicky behavior among people as they begin to realize the vulnerabilities and start to look outside the system for ways to protect themselves and their families.

But where the gravest underestimations in the projections occur, is in limiting the scope of disruptions to events that directly emanate from the health emergency. The various impacts of the spreading disease, will in effect, widen like the rings on still pond. In Washington, back in 2001, a small number of postal workers died and several buildings, including the main postal distribution facility and the Hart Senate Building, were closed as the anthrax mail attack touched homes and businesses from Florida to Connecticut. However, for each real event, the impact snowballed exponentially: buildings all over the country were closed each day, public transportation systems were shut down, people stayed away from work and bills went unpaid as people refused to open their mail for fear of contamination. In relation to the relatively small number of fatalities, the cost in disruptions was totally out of all proportion. Imagine then, if possible, an unprecedented peacetime emergency that hits every segment of society all over the world, simultaneously and in successive waves.

So, move your gaze out to satellite level and view an entire planet in turmoil, a planet  --very different from 1918-20 (the last major pandemic) in the way it relies on a very intricate and complex logistics system that stretches from one end of the globe to the other. Ironically --and their are many twists to this story-- the vulnerabilities around this kind of collapse, may be greatest in the most advanced countries that have systematically built a highly complex system of dependency on the sound functionality of supply chain systems, energy, and communication systems. Advanced countries like the United States no longer manufacture most of their most basic items and the key components of things that are assembled inside the country have finely tuned their just-in-time inventory systems to the point that warehouses and normal stockpiling have become a thing of the past; as a result, today, goods are off-loaded in Los Angeles and sold off the shelves of a Wal-Mart in Sioux City just days later.

Now, imagine how quickly the most ordinary and basic products will disappear off the shelves of drugstores, supermarkets and the big box stores when it becomes clear that factories in Asia have shut down for lack of available workers, that ships are being stopped before they reach US harbors and that there are no domestic manufacturing facilities to take up the slack or railroad workers and truck drivers to move ordinary goods.

In a recent talk, Michael T Osterholm PhD, MPH,Director, Center for Infectious Disease Research and Policy Associate Director, DHS National Center for Food Protection and Defense, noted that there are only two facilities in the world, both in China, that produce the entire globe's supply of surgical quality facemasks. These face masks, in particular, and the common hygiene rules of soap and water may just become the only defense available for most of the world's populations.

Combine this with a world in which the percentage of healthy people will be diminished by those who stay home from work for fear of getting infected, and one where basic services begin to break down as fire and police services turn spotty for lack of personnel. As all human contact becomes potentially fatal, people go to great lengths to avoid contact with strangers. The already overstressed US military, particularly the National Guard under the command of the Governors, will see not only the ongoing strains of the Iraq War but the added burdens of home service even while their soldiers fall into a particularly vulnerable age group because of the way healthy immune systems over-react, something called the "cytokine storm". Because of this phenomenon, for instance, the average life expectancy in the US during the Spanish Flue outbreak dropped from near 60 years to 18 as the disease struck hardest at those who would ordinarily be the most likely to survive. This inversion of the age expectancy chart is called by demographers, perhaps ironically in the present context, the "W factor".

Another irony, is that our modern world, one we imagine more hardened to disease attacks, is actually less able to retard the spread of the plague as air and sea routes act as an efficient dispersion mechanism and as the highly refined supply nodes potentially shut down. Influenza is caused by a virus and thus cannot be impacted by antibiotics --and vaccine capacity and manufacturing methodologies, of the one weapon that could have possibly impeded the attack, have little changed in the last half century. The pharmaceutical companies, as we learned in last year's shortage of common influenza vaccine, have found little profit in building production capacity so there are only 9 countries in the world that produce vaccines.

The greatest irony, of course, is that if an enemy like Osama bin Laden, were to have the potential to unleash such an apocalypse, governments would be readily allocating hundreds of billions of dollars for defense against the pending attack. But the same politicians who have never seen a weapon system, no matter how expensive, they couldn't love would balk at massive expenditures labeled public health.

Compare the $4 billion allocated by Congress so far for Avian Flu, to the near 100 billions spent so far fruitlessly to build an anti-missile weapon, or that new standard, the cost of being bogged down in the Iraq War, $4 billion a month, that isn't even counted as part of the annual $400+ billion military budget.

We've called here on the Dymaxion Web, in a first step, to bring awareness of the pending crisis to a world public. To some degree there has been a major change in the way Bird Flu is being talked about around the world. Here in Italy, where we are writing this piece, there is almost daily television coverage of events in Russia, Rumania, Greece and Turkey.

The next step is for politically aware populations to begin pressing their leaders for the kind of expenditures that take into account the major impacts as we've laid them out, probably underestimating ourselves the full extent of the danger. It is likely too late to do much in terms of medicines and particularly the vaccines, but we can make real and proper plans that ensure the kind of backup systems that will be needed to keep essential supplies and services moving. The H5N1 virus is a kind of neutron bomb, it will leave the physical world intact but its damage to populations will no doubt be enormous. In recent weeks we've had demonstrations of just how unprepared we are to meet commonly recurring terrestrial events like hurricanes and earthquakes. Governments, most particularly the US, need to take another look at how we are spending money to defend ourselves from real threats. Homeland security should be turned around like a great ocean liner by Michael Chertoff and the Administration and given a clear mandate to arm against this pandemic that may miss us this year but, according to those best positioned to know, will happen! It's time to wake up and see this defining challenge for what it is.

 

Posted by dymaxion at 09:20 AM


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