Surviving the Pandemic

March 4, 2005 10:54 AM

Assuming the Avian Flu pandemic become reality within the next year or two, what preparations should a rational first-world citizen undertake?

Let's keep away from debate about whether or not a pandemic can ever occur again, and let's keep away from making fun of those who go all survivalist on us (fallout shelters, tons of ammo, three years' food -- all a little over-the-top for a couple weeks of highly contagious flu).

What precautions can one take when the pandemic is recognized for what it is, what actions can one take should it be identified in one's own city, and what should a person have on hand?

posted by five fresh fish to health & fitness (33 comments total)

So, are you ruling out the most sensible approach to a widespread plague, i.e, removing yourself from densely-populated areas?

It does have a stigma attached to it now, but I don't think you could really beat it, aside from mimicing it without leaving the city by becoming a shut-in (still not as safe an option in my opinion).

I'm confused. That's really the best approach. Move out of populated centers, limit your contact with people, manage your own food production, and wait it out.
posted by odinsdream at 10:59 AM on March 4, 2005

I'd imagine the first step is to do what the Hong Kong folks did: lead the life of a mask-wearer

Once a panic starts, masks will sell out quickly so get yours now. Most projections I've seen are that the flu will pass through quickly so it really is essential to stock up on enough food and water to stay indoors for a week. The other things you need are the kinds of things you find listed for any emergency preparedness and that you can buy in kits.
posted by vacapinta at 11:06 AM on March 4, 2005

Same precautions you take during regular flu season:

-wash your hands frequently and keep them out of your eyes, nose and mouth.

-stay away from infected people.

And additionally, if it looks really dire, take to wearing a surgical mask to avoid inhaling infected droplets. And wear sunglasses if you don't wear prescription specs-- droplet infection can occur through your eyes, too.

For more ideas, see the documentary 28 Days Later.
posted by Mayor Curley at 11:16 AM on March 4, 2005

along with masks, hand-cleaning is very important in minimising exposure to infection. Get hand-cleaning gel in small bottles you can slip in your pocket.
posted by anadem at 11:19 AM on March 4, 2005

Health and Human Services Draft Pandemic Influenza Response and Preparedness Plan.

Also, Preventing the Flu from the CDC.
posted by ..ooOOoo....ooOOoo.. at 11:24 AM on March 4, 2005

i was working in taiwan when the SARS outbreak happened. the masks everyone was wearing were already in wide circulation and commonly used to prevent inhalation of vehicle exhaust. they didn't just appear overnight, as it may have appeared in the news. which means they aren't going to appear overnight if avian flu breaks out. on the other hand, infectious disease doesn't spread as rapidly in more developed areas because we tend to wash our hands more often and have more personal space.
posted by scottreynen at 11:44 AM on March 4, 2005

get with the program !

http://www.ready.gov/index.html
posted by selfsck at 11:45 AM on March 4, 2005

Get your flu shot -- even if the strain isn't covered, you'll have some protection. Keep as healthy as possible (healthy eating, and exercise), so you're in top shape to fight it off. Wash your hands. Stay away from people who are sick. Stay away from other people when you're sick.

Like any other flu.
posted by duck at 12:13 PM on March 4, 2005

odinsdream, I have always thought that the city/state/country borders would be sealed? That once there was an outbreak in a city that people wouldn't be allowed to move around and spread it? I have a New Zealand passport but I always assumed that airports would be closed or something. Woah, I am really alarmist. But then avian flu is not really that big a deal if I understand the rest of you correctly?
posted by scazza at 12:29 PM on March 4, 2005

Ok, I just read the HHS PDF on Strategies to Limit Transmission which says yes, in certain situations, travel would be limited, and people would be screened for the virus, along with other strategies. Sounds reasonable.
posted by scazza at 12:35 PM on March 4, 2005

I suspect travel will be halted as a containment measure.

The thing with this latest avian flu strain is that it has a 75% mortality rate. That is far, far more lethal than the Spanish Flu.

"Keep away from infected people" would be great advice if it could be followed. Unfortunately, this strain incubates without symptom. By the time you find someone is a carrier, they're already past contagious.

Moving out of town is not a practical preparation idea.

Mask-wise, I know that there are various grades of mask. The cheap white ones typically sold in bulk at the hardware store are not going to do any good. I forget the type that does work, unfortunately; they meet a specific criteria, and all masks that qualify would have that marking (ASTM something or other?)

I'm thinking the ol' Mormon preparedness kit would be a good idea. Idahoan dehydrated potatos, yum-yum! Still, it'd be for only a week or two.

I like the hand-cleaner gel idea.

Here's hoping I'm just foolishly paranoid. I'd hate to see three-quarters of my hometown wiped out. It'd kill the real-estate market! (OTOH, it'd certainly improve the traffic situation. Win some, lose some!)
posted by five fresh fish at 12:44 PM on March 4, 2005

Does anyone know any good blogs about the Avian Flu stuff? I remember there was one when I was terrified of SARS/that got me terrified of SARS.
posted by OmieWise at 12:50 PM on March 4, 2005

Is there any research out there on the actual ability of hand washing to help prevent the flu? Not that I doubt it's usefulness, but I wonder to what extent it really helps.
posted by Doug at 1:14 PM on March 4, 2005

I seem to remember something about people wearing masks during the 1918 epidemic but that they were totally ineffective. Are the masks now better, or would they be just as ineffective?
posted by jennyjenny at 1:22 PM on March 4, 2005

A lot of your planning may depend on what kind of virus you are predicting or planning for.

For example, how long will you want to stay isolated or semi-isolated? A virulent disease may take a few weeks to work its way through a community. And since it is likely that a really bad epidemic will start in East or Southeast Asia first, people in the U.S. may have anywhere from a few days to many weeks (even months) of warning. This means some supplies might be obtainable. But it also means a really paranoid person may want to remain isolated for a few months (from early warning until after the worst has passed though your local community).

Another consideration is what mortality rate are you forecasting? In a normal year in the US, influenza has a mortality rate of < .1% (if i am remembering correctly). i seem to recall the 1918 bug had a mortality rate of 2.5% in the us (and it was much, much higher in other places like india). this was enough to create a major disruption to many services. for example, many communities ordered stores to be closed. but it obviously did not put a halt to everything. but since most americans obtained their food from very local sources, it is hard to predict what a 1918 flu might do today. other terrible epidemics (black plague, smallpox, etc) have had even higher mortality rates. so you may obviously make different choices if you are preparing for a life-is-turned-upside-down-for-a-week-epidemic or a life-is-turned-upside-down-for-a-winter-epidemic as opposed to a end-of-life-as-we-know-it-epidemic. br>
Although I am not personally going to be doing any of this, I think one should probably plan for some period of isolation, plan on some disruption in delivery of food stuffs, and maybe plan that if you or someone you know does get sick that the healthcare system might be overwhelmed. Therefore it might be a good idea to have food, live in an area that is closer to sustaining itself with its own local food production, and have some basic medical supplies. How much and which ones will depend on what you want to prepare for.
posted by Tallguy at 1:39 PM on March 4, 2005

how about buying an inhaler for relaxing the bronchial passages? i have a lung infection at the moment and while i understand the inhaler is to treat the symptoms rather than the cause - the plan seems to be simply wait until i recover naturally - it certainly makes breathing easier.

hmmm. maybe i have avian flu. help!

is isolation that good an idea, especially in a first world country? if you do get infected, it might be better to be near a good hospital, rather than in the middle of nowhere.
posted by andrew cooke at 1:41 PM on March 4, 2005

The masks worn in 1918 were far too coarse to stop something as small as a virus. We definitely have better masks now... but not the crap you find at the grocery store or hardware store or whatever.

Also, the mask is only as good as your handwashing habits. It does no good to wear a mask outside if you promptly remove it and touch your face once you get home.
posted by Justinian at 1:42 PM on March 4, 2005

Here's an old article on Slate about the (non)efficacy of masks for stopping SARS.
posted by jennyjenny at 1:52 PM on March 4, 2005

A bad epidemic, especially one with high mortality rates, could also mean looting and rioting as angry, scared people look for a scapegoat or try to take advantage of the situation. If you live in the US, you may want to have the second amendment on your side to protect your loved ones as you hole up for a few weeks. I'm not trying to be all alarmist and crazy-lady here, but honestly noting what has happened in the recent past here in Los Angeles, for example--there are a lot of Korean-American Angelenos at the local range my husband belongs to, and I'll bet the memory of the Rodney King riots has a lot to do with that.

one should probably plan for some period of isolation

This means more than just food. It means things to keep you and your loved ones busy while you're all stuck at home, like books and board games and blogging. But frankly, I'd also assume that the power would go out at some point, so candles and flashlights are a must, so you can actually see the books and board games. And written journal-keeping of the expereince can supplant blogging if the power's out and will be nice for your descendants to read someday, assuming you survive the epidemic. (Otherwise, it would be like the journals of the Donner Party members--morbidly fascinating.)

I pity the parents who will be stuck home with their kids if an epidemic ever hits. Not only will they be super-worried that their kids are at higher risk for the flu, but they'll have to prevent cabin fever among the squalling youngsters for weeks on end, possibly without a TV or other electrical appliances to help them out.
posted by Asparagirl at 2:10 PM on March 4, 2005

Personally, after reading up on the Avian flu/H5N1, I laid in a supply of this stuff large enough to treat my entire family. If the H5N1 flu comes back, the world is facing a disaster. I predict that effective anti-viral agents will become rapidly scarce should a pandemic occur. And the thought of my wife and toddler standing in line at the pharmacy while a bunch of H5N1-infected people cough, sniff, sneeze and keel over isn't appealing to me. So I added the Tamiflu to my paranoid, survivalist stockpile; it's sitting right between the M-16 and the pile of gas masks.
posted by FredFeral at 2:39 PM on March 4, 2005

How exactly did you do that, FredFeral? Is there a place online where you can buy it without a prescription?
posted by jennyjenny at 3:05 PM on March 4, 2005

On a somewhat related note: If Smallpox Strikes Portland, in the March Scientific American. Summary: it doesn't matter exactly what public health officials do, as long as they do it quickly. Upcoming simulations by this team include superflu.
posted by gimonca at 3:08 PM on March 4, 2005

FredFeral: I *really* hope you know what you're doing, or you've consulted a doctor about your plans. Oseltamivir is *not* approved for prophylaxis against the flu (which doesn't mean it won't work, necessarily). And it's not indicated for people under 18, or people with renal disease.

Duck: I don't believe that a flu shot will provide protection; the Influenza H5N1 (Avian) flu strain is new; we haven't been exposed to it, that's why it's so deadly.

If you look at who the Spanish flu predominantly killed, it was young adults, 20-40. This does not go along with the normal trend of virulent bugs killing mostly the very young, the very old, and the immunocompromised. If you look at the Avian flu deaths, they've been mostly teenagers, afaik. These early deaths may predict the population most at risk.

Always been against national health insurance? If you're scared of Avian flu, you should support it. The longer people wait to present to the health care system if they've got any contagious disease, the more people they can infect. Your health affects mine, and vice-versa.

Here's to becoming a first responder in the next year or two.
posted by gramcracker at 3:48 PM on March 4, 2005

gramcracker: The antiviral medication TAMIFLU was prescribed more often than any other during last year’s flu season. It is indicated for the treatment of influenza in patients 1 year and older who have had symptoms for no more than 2 days.

TAMIFLU attacks the influenza virus and stops it from spreading inside your body. TAMIFLU treats flu at its source by attacking the virus that causes the flu, rather than simply masking symptoms.

TAMIFLU is also indicated for the prevention of influenza in adults and adolescents 13 years and older.

It looks like its indicated to prevent flu for those 13+, and treat flu in those 1+..
posted by reverendX at 4:01 PM on March 4, 2005

Happened to be in my workshop and took a boo at the facemasks: NOISH N95 rating. I think that's the level at which they become effective in preventing viral transmission. Or maybe it's just bacterial. Given that it doesn't come with a rubber grommet to seal against one's face, I rather suspect it's of limited efficacy.

The 1918 Spanish Flu killed about 2.5% of those infected in North America. So far the H5N1 flu is killing about 70% of those it infects. In the twenty-four weeks of the 1918 flu, upwards of 75 million people died. The predictions for the H5N1 expected pandemic are for billions of deaths.

H5N1 has been found in chickens, big cats, house cats, pigs, and humans. Exposure to illness in humans takes a few days; hospitalization within a week.

H5N1 as it now stands is not particularly virulent between humans. There is no indication that it has mutated to pandemic form yet.

It may be endemic to the Asian bird population now. The magnitude of the bird flu epidemic across Asia is unprecedented. The virus is now in Asia's porcine population, too. This increases the recombinate odds: the virus can now cross with various pig flus -- some of which are human-infectable -- as well as the various avian flus.

The likelihood of the virus crossing with various human-transmissible flu variants is at sky-high odds: it is no longer a matter of "if", but "when".

When the pandemic strikes, it is going to utterly annihilate the populations living in favelas, shantytowns, and squatter's camps. There are about a billion people living in these places around the world.

If this thing takes off and infects as little as 1/10th the population, a city like New York is going to have a million and a half corpses. Yowsa.
posted by five fresh fish at 4:21 PM on March 4, 2005

You people are really scaring me! However, perhaps there is hope for a vaccine in time...
posted by freebird at 4:44 PM on March 4, 2005

What's got me alarmed is that there's been underground recognition of the risk for a couple years, the media has now picked up on it, and it's being quite circumspect, even rational. It's nothing at all like the bizarro-world alarmism of Y2K. I found the latter so hysterical (cf. hysteria) that it was discountable simply as media silliness as means of selling eyeballs. This time, not quite so.
posted by five fresh fish at 6:06 PM on March 4, 2005

jennyjenny: There's no way to obtain Tamiflu without a prescription (at least as far as I know.) That also holds true for amantadine/rimantadine which are anti-flu drugs that work somehat differently (and are considerably cheaper.) If you want to obtain a supply of these drugs for worst-case-scenario use, I'd suggest the following: do as much research into the issue as you can, and then go talk to your doctor. Tell her "I've done my research, and I'd like to have a supply of these meds on hand in case there is a pandemic . I'll be glad to call you before I start using them. I'll be paying cash for them and not submitting them to my insurance." The last two sentences are particulary important. The first is important so that your doctor has some sense of oversight over your use of the meds. The second is important because your doc isn't going to be able to medically justify (as far as your insurance is concerned) a scrip for meds to just "have on hand."

gramcracker: Thanks for your concern over whether I "know what [I'm] doing" with respect to Tamiflu. Your concern exceeds your understanding of the current indications for oseltamivir, as reverendX has pointed out. I won't belabor that point. I checked out your blog: best of luck in med school and thanks again for your concern.

fivefreshfish: Your last post is a nice, accurate synopsis of the issue that confronts us all regarding H5N1. Thank you.

freebird: Scared? Read this. It'll make you feel all war and toasty inside. I too am encouraged by the early vaccine trials, but there is no way I'm entirely entrusting my family's safety to the vaccine industry.
posted by FredFeral at 6:16 PM on March 4, 2005

There's no way to obtain Tamiflu without a prescription (at least as far as I know.)

*coughs*

Shipped from the EU, in original box and blisterpacks, and legal. Not cheap, though.
posted by Asparagirl at 7:09 PM on March 4, 2005

The Red Cross has a lot of info on preparedness. Lots of common sense.

The effects of a large drop in the population would be dramatic.
posted by theora55 at 12:11 PM on March 5, 2005

Having a supply of masks on hand isn't a bad idea, but you need to find one that fits you properly, and then learn to put it on and take it off properly.

I work in a hospital and they test us yearly to see which masks fit us, and which don't. I am not sure how one would do this, but if you go to a medical supply store, they might be able to help you.
posted by gesamtkunstwerk at 3:09 PM on March 5, 2005

From YaleGlobal last month:

If this avian flu turned lethal to human beings and spread globally the very question of who would have access to vaccines could well become a national security issue, the NIH/WHO meeting concluded, with nations shouting helplessly for immunization while other populations happily survived. Consider the scenario discussed in that Washington meeting: At a maximum production level, with Congress waiving liabilities for the private sector pharmaceutical makers, the US could not make enough vaccine just for its own population without a full year's lead time. That means in a pandemic the US would deny vaccine to its neighbors, Canada and Mexico - neither of which has the capacity to make flu vaccine. This could obviously destabilize relations between the nations, prompt illegal vaccine smuggling and lead to longstanding animosities between the countries.
posted by gimonca at 9:04 PM on March 5, 2005

That means in a pandemic the US would deny vaccine to its neighbors, Canada and Mexico - neither of which has the capacity to make flu vaccine.

Curious, that, given that it's a Canadian biomed company that is developing the avian flu vaccine, and is contracted to the Canuck government to provide vaccine to Canadians...
posted by five fresh fish at 9:48 AM on March 31, 2005