MindSpinner

This commentary at Recombinomics.com notes how W.H.O. is playing the numbers game with the flu pandemic alert level. If you don’t want to change the number, it seems, you just tweak the definitions of the current level as evidence of human-to-human transmission mounts. (Note: Recombinomics was founded by Dr. Henry Niman to further the study of how viruses evolve. Here and elsewhere, Dr. Niman questions W.H.O.’s rendition of the evolutionary state of H5N1, the bird flu.)

The moves to watch may be the ones that don’t make the headlines, such as the U.S.’s deployment of some of its Tamiflu supplies to address the bird flu threat in Asia.

The United States has sent a supply of Tamiflu to Asia to help the region prepare for a human outbreak of avian influenza, U.S. Health and Human Services Secretary Mike Leavitt said on Monday.

“I am not going to specify the amount or the location, but I want to make clear that we are beginning to deploy it,” he said

The deployment of Tamiflu treatment courses to Asia is cause for concern. Tamiflu supplies in the United States are below those of most industrialized countries, so deployment from the US signals a potentially serous situation.

If nobody’s willing to say how much Tamiflu is being shipped and where, there’s got to be a reason for that. The old dependable one, that information could aid our enemies, seems dubious when the enemy is a virus. No doubt widespread alarm causes problems in and of itself, and governments would like to fight containment battles without also having to worry about the disruption fear causes, especially to economies and big business. On the other hand, gradually raising the alert level to reflect actual state of the H5N1 threat would likely generate the waves of preparation that might mitigate the tsunami of chaos that will follow should H5N1 materialize as a pandemic.

For its part, W.H.O. is hardly pooh-poohing the threat, described as “serious.” The W.H.O. bird flu FAQ outlines in broad terms how flu pandemics unfold.

Influenza pandemics are remarkable events that can rapidly infect virtually all countries. Once international spread begins, pandemics are considered unstoppable, caused as they are by a virus that spreads very rapidly by coughing or sneezing. The fact that infected people can shed virus before symptoms appear adds to the risk of international spread via asymptomatic air travellers.

The severity of disease and the number of deaths caused by a pandemic virus vary greatly, and cannot be known prior to the emergence of the virus. During past pandemics, attack rates reached 25-35% of the total population. Under the best circumstances, assuming that the new virus causes mild disease, the world could still experience an estimated 2 million to 7.4 million deaths (projected from data obtained during the 1957 pandemic). Projections for a more virulent virus are much higher. The 1918 pandemic, which was exceptional, killed at least 40 million people. In the USA, the mortality rate during that pandemic was around 2.5%.

Pandemics can cause large surges in the numbers of people requiring or seeking medical or hospital treatment, temporarily overwhelming health services. High rates of worker absenteeism can also interrupt other essential services, such as law enforcement, transportation, and communications. Because populations will be fully susceptible to an H5N1-like virus, rates of illness could peak fairly rapidly within a given community. This means that local social and economic disruptions may be temporary. They may, however, be amplified in today’s closely interrelated and interdependent systems of trade and commerce. Based on past experience, a second wave of global spread should be anticipated within a year.

As all countries are likely to experience emergency conditions during a pandemic, opportunities for inter-country assistance, as seen during natural disasters or localized disease outbreaks, may be curtailed once international spread has begun and governments focus on protecting domestic populations.

Unfortunately, the time to prepare for the possibility of a flu pandemic is before it’s clear to everyone that immediate preparation is necessary. That’s when there’s suddenly not enough of anything. I’ve read enough now to sigh and start making a list of what I’ll buy using this year’s tax refund. I’d rather be caught prepared for a disaster that never comes (insofar as one can prepare) than unprepared for a disaster that does. Beyond that, one has little control.

Growing up, I confronted time and again two possible reactions one can have to those situations over which one finally has little control. Middle-of-the-night tornado warnings offer an example. (Hurricanes offer another; but this post is already long.) My father stayed up as late as necessary on stormy nights to hear the weather reports on the radio. Whenever a tornado warning was announced, he would herd us out of bed and down to the basement to install us in the Olds ‘98. He had a plan. When the whole house fell in on us, we would plow our way out in the big car. We were probably the only peole in the county sitting in our car in our basement during tornado warnings. He spent every moment tightly wound with anxiety, as if vigilance could change the course of a funnel cloud. My mother cooperated with the car plan, which my father thought a stroke of genius, but she had the gall to bring a pillow and fall asleep, if she could, while the storm reverberated all around the house. It wasn’t that she was oblivious; she was just willing to accept that there wasn’t anything more to be done; that what would be would be. I learned from both of them - from my father the importance of strategizing and preparation, from my mother a certain peace that comes when all is done that can be done and matters are out of our hands.

This post is graphic and sad, and you need not read it at all, if you’ve supped full of sadness already. I wasn’t going to write it, wasn’t going to tell it, but the mind wrestles of its own accord and finds words and insists on their arrangement, terrible flowers composed in a vase.

Given that he started bleeding a couple of days before he died and did nothing, sought no medical help; given that he already knew from before there would be death in it; I can only conclude that he decided to let the bleeding bring the end.

The doctors had told him that, should he take up drinking again, the drinking would kill him. He took it up again, and given that he already knew from the doctors that there would be death in it, I can only conclude that he’d already said in his heart, “Let death come.”

His mother, who has aplenty, would have helped him if she could, but he would have none of her help and perhaps could not see that she loved him and worried for him. The angers were old; they began when I was young and we were in school together, when he loved the girl with the feathered, bleached blond hair, the shortest skirts, and breasts to make a boy ache with desire. His mother and father did not approve of his choice and stood between them, stern and judgmental, mindful of his best interests from their own perspective, though the girl loved him and he loved her and this did not really change ever. Cheated of the girl, he pushed his parents away, rebelled. He never ceased to rebel, just as he never ceased to love.

His current partner called his mother in the night to come when he was dying - or perhaps even just dead. When she came, his eyes were already glazed. I believe she must have seen in a single moment the man nearing 50 lying inert in the bed, the baby in her arms, the boy running in the yard. Mothers cannot help but see so.

Then his body convulsed, erupted with blood, blood over everything, and made an end of love and anger at once. There will be no washing the blood from his mother’s dreams.

Why tell such a thing, the life and death of a second cousin? I cannot help but do so. There is a terrible beauty and truth in it. There is no turning away, no regarding in intensity the twirl of petals in an opening rose without also regarding the dead son lying on the bed, the mother grieving, the now heavy set middle-aged woman, my classmate, who remembers the love of her youth.

And for C, my older cousin, I promise to remember not just this tragic end of his story, but his happiest days, the ones that once held bright possibility - his native intelligence, his talent and drive on the basketball court, days we spend out selling yearbook ads, his whizzing by the house on his beloved motorcycle (always a little too fast), his undying love for the girl he would never marry.

I’ve been following the Avian flu now for some months, as have a lot of people, and have thought about what we’ll do should a pandemic erupt and in preparation for that possibility.

The New York Times reports today what people who follow flu sources already know - that human-to-human transmission of the virus is likely already occurring, though not on a grand scale. Consider this case:

Dr. Niman contends that the largest human-to-human cluster so far was not in Indonesia, but in Dogubayazit, Turkey, in January. W.H.O. updates recorded 12 infected in three clusters, and quoted the Turkish Health Ministry blaming chickens and ducks. Dr. Niman counted 30 hospitalized with symptoms and said the three clusters were all cousins with the last names of Kocyigit and Ozcan, and that most fell sick after a big family party on Dec. 24 that was attended by a teenager who fell sick on Dec. 18 and died Jan. 1.

A patriarch, Dr. Niman said, told local papers that the two branches had had dinner together six days after the 14-year-old, Mehmet Ali Kocyigit, had shown mild symptoms. He died on Jan. 1, and several other young members of the two families died shortly after, with other relatives showing symptoms until Jan. 16. No scientific study of that outbreak has been released.

Ironically, there is no move to raise W.H.O.’s alert level from 3 to 4. Here’s the reasoning:

Dr. David Nabarro, chief pandemic flu coordinator for the United Nations, said that even if some unexplained cases were human-to-human, it does not yet mean that the pandemic alert system, now at Level 3, “No or very limited human-human transmission,” should be raised to Level 4, “Increased human-human transmission.”

Level 4 means the virus has mutated until it moves between some people who have been only in brief contact, as a cold does. Right now, Dr. Nabarro said, any human transmission is “very inefficient.”

Let me see now, 30 people got sick after being exposed to the virus by one teenager in the early stages of an illness that would kill him days later. I can’t remember attending any family reunions where 30 people caught a cold from cousin Sammy, who showed up with the sniffles. I’d say that strain of H5N1 moved from human to human nimbly indeed.

As long as numbers are small, maintaining the current alert level may have more to do with forstalling alarm and its consequences than it does with the question of whether the H5N1 virus is capable of moving readily from person to person.

While I’ve been fulfilling my responsibilities at school this week, the new rose (”Lasting Love”) has begun to bloom. Its scent is as intoxicating as its beauty.

Graduation happened at last. (Hugs. Tears. Speeches. No glitches.) I got home about 10:15, took off everything that annoyed and constricted, and fell asleep in the top I’d worn all day, minus the pesky bra.

Now all I have to do is everything else. But not today. Today I do only “gotta do’s” that are also “wanna do’s.” And take naps - oh, even two or three.

Our weather report here suggests that we’ll have a whole series of exquisite days. The cat and I intend to make the best of it today. He’s good company, though he’s is limited in his conversational repertoire. All he says is “Raao,” meaning any of the following, depending on context:

“Please open the mini-blinds so I can see the birdies in the grass and sleep in a patch of sunshine. Why do we need mini-blinds anyway? What if I just paw them down, so you can get them out of the way?”

“Look! There’s a birdie in the grass. I want the birdie in the grass. I’ll pounce on him. I’ll ground him for good. Bat him with my paw. Clamp him in my teeth so that he can’t fly away.”

“I think it’s time to eat. Don’t you think it’s time to eat? I’m flirting madly with you, so, uh, feed me, dammit. Oh good God, do I have to bite the hell out of you to make my point? What do you mean I can’t have breakfast until 6:00?”

“Excuse me, but there has been an oversight. This door has been closed, and I am on the other side of it. Do I look like I can reach the doorknob?”

“This ape-hug has lasted more than long enough. You people are veritable pythons. Put me down.”

Just now, stretched out on the cool floor with his back legs stuck straight out behind him, he’s studying me with one eye open and one closed, as if waiting for me to do something exciting. He’s just listened to me play Leonard Cohen’s “Hallelujah” and “Dance Me to the End of Love,” which, if I could have only two songs on the world (a nonsensical proposition), would be the two I’d likely choose. Of course, I sang along, because I do this, this singing along, when I’m in the car or alone in the house. This morning, singing feels like a good way to start summer.