Day 4: Pandemic Prescription—Generational Conflict

I hate to sound like one of those flu debunkers, but so far most of the cases arising here in New York are false alarms. This is hay fever season, so the prospect that a sneeze could kill has driven thousands to the emergency room. The pictures of corridors and sidewalk tents crammed with anxious people, paper masks askew, are reminiscent of 1918. (Sick people sure dressed better then.)

Many cases are undoubtedly influenza-Like Illness, which accounts for most symptoms in most years. (There are hints that catching the common cold might help fight flu.)

Most of these people are fine. Those who are genuinely ill will get less care because hysterical allergy cases are disrupting the system. That helps H5N1 circulate.

GLOBALLY AEROSOLIZED MICROBES! (David)So do toilets: Flushing infected waste aerosolizes microbes, churning them into a fine mist. Short people and children in particular ought to close toilet lids before they unleash clouds of nasty virions. (Don’t even think about airplane lavatories—those cramped and smelly plastic enclosures, brimming with germs so violently and constantly stirred….)

Stores are emptying. Pharmacies are arming guards. People are bashing pigeons in the streets. (Not the best idea if the birds are sick—peasants in Southeast Asia long ago learned what H5N1 can do to people who slaughter infected chickens and ducks.)

Before we succumb to pointless anxiety—as opposed to the kind that might make us prepare—I’d like to point out that Americans of differing ages face different risk levels.

Influenza is tricky. It works much of its harm indirectly. Even though seasonal flu concentrates on the very old, half of the elderly wind up succumbing to unrelated, opportunistic infections, mainly pneumonia. The flu virus weakens them and pneumonia bacteria swoop in for the kill.

Though seasonal flu can harm the very young, whose immune systems aren’t yet up to speed, it is easily repelled by teenagers and young adults, whose immune systems reject opportunistic infections, too.

Shelter From the Cytokine Storm

Pandemic flu brutalizes youth. It provokes a ferocious immune response that can run out of control—scorching a victim’s lungs beyond repair and flooding them with white gunk. People can turn blue for want of oxygen. Scientists disagree as to whether this is caused by the much-discussed cytokine storm, by which “the violent and uncontrolled immediate response of the immune system … destroys lung tissue by runaway inflammation.” (Sure sounds like what happened to that bus driver; here’s a charming video account of how a Deadwood, S.D., bordello madam saved the narrator’s upright grandparents from a cytokine storm during the Great Pandemic.)

The elderly are not a prime target of pandemic flu. They’ve survived so much that their immune systems are tired—too relaxed to kill them. In 1918, people over 65 accounted for only 1% of excess deaths. The rate at which folks over 75 were killed by influenza and pneumonia fell that year.

Among H5N1 victims, 90% have been under 40. Half were under 18, and most of those were 10 or older. Younger kids tend to survive nearly as well as people from 50 to 70, probably because their immune systems are too immature to put up a suicidal defense. Those aged 10 to 40 have the most to fear.

The elderly face a different peril: They stand to lose things they already rely on to stay alive. Our health system won’t offer much support or medication for such conditions as cancer, diabetes, or heart or lung disorders. A century ago there were numerous extra deaths during the pandemic from tuberculosis, whooping cough, and premature births.

Scientists have added obesity to the list of known flu risk factors that include asthma, pregnancy, and diabetes. That’s progress for you: In Flu: A Social History of Influenza, Tom Quinn quotes a doctor’s observation during the influenza pandemic of 1831 that “stout young men” and pregnant women were likelier to catch pneumonia.

For years, flu debunkers have proclaimed that our advanced civilization—our antiseptic society—could easily withstand an avian flu pandemic. I say sophistication cuts both ways: People didn’t depend on kidney dialysis systems in 1918. There weren’t millions living with cancer. This makes us more vulnerable to disruption, not less.

How will elderly Americans deal with traditionally fatal, chronic illnesses? Who will tend them? With what? In keeping with our just-in-time inventory system, the only stockpiles of medicine and ventilators are maintained by the Feds. I don’t know where the stuff is located, but it can‘t possibly suffice. Heck, I hear fuel is already running out. Coffins and body bags will be scarce. The only products that seem plentiful are bogus flu remedies featured in spam emails, texts, NFC, and calls.

The elderly feel vulnerable and they vote. The young are vulnerable to this flu and they do not. Expect resources to be misdirected.

A final note: I’m receiving a lot of email for a blog that’s only three days old. Some ask why I don’t let readers post responses. Good question.

I don’t want to have to monitor the site for abuse. Nor will I host debates about what politician would make a worse president, or which movie star or pop singer is doing more to fight bird flu, (Listen to the chorus of Smells Like Teen Spirit—lyrics & music about entertaining contagion here.)

I welcome email if you want to talk back. I'll respond to interesting points. Just don't expect me to publish them verbatim.

Day 4 (#2): Boomers Forever?

A study in England has claimed that people born before 1969 seem to bear some immunity to a virus that was never known to affect people until 1997. In 2008 a panel of WHO experts reported in The New England Journal of Medicine that “approximately 15 to 20% of older adults have some baseline neutralizing antibodies to H5N1 virus….”

THE GLORY DAZE GO ON AND ONWhile I like Boomers (who could fail to cherish their childlike egocentricities?), it’s a little creepy to think that nature may be contriving to help them outlast me.

For those few who might wonder how these lucky geezers acquired immunity to H5N1, the authors quietly added: “The mechanisms leading to these antibodies are uncertain.” The deeper I dig, the more I see how little the experts know about influenza.

Day 5: Q&A and Friendly Flublogia

So many questions, readers, though some lack question marks. They read more like indictments of your humble servant. Is it the homebound audience? Feeling edgy? Oh heck, I asked for it.

1. Yeah, I’m sort of young. My most recent milestone was turning 30. Since then, I lost a job, ended a great relationship, and started preparing for epochal pestilence. Do I seem overly sensitive? (Maybe I should add that I’ve since managed to fall in love.)

2. I do indeed fret that my still-youthful immune system will blow me to pieces. I like to think that my darkened corpse would be recognizable to my parents back home, should someone find me in time. More likely I’ll wind up in a lime pit on Staten Island.

IT'S FAR TOO QUIET IN SHANGHAI3. I was born well after 1969, that hallmark year of Manson on the Moon that seems to divide geezers with inexplicable antibodies to H5N1 from the rest of us. I personally fear the cytokine storm and I might well resent that our few solutions are going to the elderly who are less likely to experience one.

 4. On the other hand, I want my parents to have all the help they need. (They wouldn’t listen to me and are unprepared.) My stepmom is in remission from breast cancer and my dad may have something that at least requires further testing. Like most men, he postponed it.

5. Aged Americans will die in great numbers from everything but the flu. Have you seen those idle ports on TV? China makes most of the world’s penicillin, among other indispensables. My stepmom’s meds aren’t even in motion.

6. I never said I was noble. I’m not taking any chances these days. I researched flu, planned to survive it, then invested in the best ways to do so. What’s wrong with that?

7. Sure, I like social networks. I use them. But I stopped haranguing my friends about flu years ago and I maintain strict privacy settings. Readers of this blog might recognize me only by some songs I post.

8. I’m no kind of medical person. I took biology in high school, never in college or grad school. But I love nature and I’m not stupid. I’ve studied bird flu’s history and evolution for years and years.

I learned from books and from Flublogia, as the informal society of flu bloggers is known. Although they cover a compelling array of infectious diseases, influenza is their primary focus. I commend these generous souls, all linked on my Flu Resources Page.

None in any way resembles Alan Krumwiede, the venal, grasping blogger played by Jude Law in Contagion. (Watch the trailer.) Sure, they’re quick-witted, enterprising newshounds who were first to grasp that swine flu was breaking out along the U.S.-Mexican border in 2009. Unlike the villainous Krumwiede, these voluntary reporters and analysts do not profit from their efforts. They won’t accept advertising lest a Tamiflu pitch, for instance, pop up to erode confidence in their musings about antivirals.

For daily insight on anything significant that comes up, I look first to Avian Flu Diary. Blogger Mike Coston is a retired EMT and preparedness stalwart who covers a lot of issues as Fla_Medic. (Peek into his emergency “bug-out bag” and his list of preparedness gifts.) Coston’s site offers one-stop shopping—an exhaustive flow of linked citations and thoughtful commentary, complete with earnest charm and flashes of wit.

Though I follow others, too, my short list of superb bloggers includes retired writing professor and dean of Flublogia Crawford Kilian at H5N1, IT expert (and Computerworld blogger) Scott McPherson at Scott McPherson’s Web Presence, Vincent Racaniello at Virology, and Maryn McKenna’s Superbug at Wired.com. Good, newsy sites also include those of Arkanoid Legent in Malaysia and Flu News Network from Cottontop, an upstate New York mother and longtime flu forum commenter. Many draw on timely reports from Dr. Michael Osterholm’s CIDRAP and on the crowdsourced global disease surveillance that takes place every day at the excellent FluTrackers community board.

9. Finally, patient readers, I would never call the cops on a noisy party. I favor freedom and initiative. I’d yell at them myself if I felt it necessary. Or crash it, if I liked their music.

Day 6: A Harrowing Sneeze & Home Decontamination

I ventured out today in driving rain. I couldn’t get my products picked up and my partner was working his day job, so my backup ‘flu buddy’ insisted on driving me to the UPS shipping center in midtown. I felt like a draftee being hauled off to war by a cackling drill sergeant.

I’ve never seen New York so empty, not even on Christmas. Traffic is scarce. Drivers are courteous.

The mood was radically different at UPS. People were jammed together, nervous, venting at the understaffed desk. I was an alien—safe and distant—wearing what I consider pretty good equipment. As people stared enviously, I started to feel like a celebrity. I should get a t-shirt emblazoned with my URL.

Then a stocky woman sneezed. Flu circulates by annoying our immune systems until we cough or sneeze. Hers was a titanic launch. The room went silent.

VIRUSES TRAVEL IN MANY LANGUAGESAll eyes turned to her, turned on her. She tried to keep her paper mask on, but she needed to blow her nose. In the middle of doing that—as people around her tried to back away without losing their places—she sneezed so hard, her mask blew off.

As she groped on the floor for the soggy piece of bent paper, I wondered how she’d kept her lipstick intact behind a mask. Everyone wanted to kick her. I could feel the rage through my plastic sheathing. I hated her, too. When she opened her mouth to mutter apologies, her lips festooned with slimy, dangling white blood cells, I felt sick.

The sound of a sneeze has become more jarring than chalk scraping a blackboard, scarier than a police siren erupting behind your car. It pumps the heart into overdrive. It’s a loud reminder that invisible viral particles are scratching and clawing inside the others until they can burst forth to fling themselves at us, infesting the very air we gasp when we hear that sick, violent exhalation: Achoooooo….

Or hatschi in Germany, atchim in Brazil, hakushon in Japan, apshkhi in Russia, atchoum in France, and han-chee in China. Here’s a nice Web page about this.

My roommate has been sneezing tonight. It should be cat allergies, though this is denied, probably in deference to the fact that it’s my cat. To throw us off track, the cat sneezed, too.

Bio-Security Starts at the Door

Coming back inside was a pain—and not merely because my roommate has refused to talk for hours. Did I return with a mermaid tattooed on my forehead? The mirror shows nothing but concern.

The process of decontaminating is so bothersome that it’s often easier to stay put. My cleansing area consists of plastic sheeting near the front door of my three-room apartment, which opens into the living room. I keep going-out clothes by the door. I wash in a temporary tub, using a makeshift shower head and a bowl of diluted disinfectant solution to clean parts of me that were exposed and then to soak goggles and gloves.

I worry that my cat will catch H5N1 from something I track in. It’s interesting how caring for a helpless creature makes one more responsible. (Is this what happens to parents?) He is no longer allowed to enter the living room or kitchen. His vocal response to this catastrophic loss of territory has inspired a new nickname: Mrrrowlin Brando.

I like dogs a lot, but I’m glad I didn’t get one. My smarter, dog-owning pals are building indoor litter boxes. Imagine a Doberman lifting his leg in a Manhattan living room. I still see a few people walking canines on the street below, which is risky. They can pick up bird flu, though not quite like cats: Dogs shed it without becoming ill.

I can only imagine how parents feel as they keep their children cooped up. Kids have fingers and voices. They can easily escape, or make you want to.

Day 7: Mail Call! Getting Personal....

I’m proud to be opening a plump digital mailbag after just a week of posting. I’ll never understand why many of you are interested in my personal life. It’s flattering, but I value my privacy. I will limit my responses. Sorry, but TBIMB.

No, I’m not a professional writer. (But thank you.) My degree leans toward the technical side, with some artistry.

I’m glad some people think I’m funny. Feel free to laugh with me—or at me, if you must.

I suppose I look like a white guy from the Midwest. I’m a bit taller than average, but not tall. I’m trim, but not thin. My hair is neither light nor dark; it’s shaggy, but not what you’d call long. I’m clean-shaven. (My dad convulsed unforgettably at my early whiskers; he said I had “a baseball mustache—nine players on each side.”)

MY VILLAGE REALLY HAS EVERYTHINGOkay, I have a wide face and eyes that change with the weather. Mostly I wear dark clothes. I’m a moderate Bohemian, good-looking in a Germanic way.

I live in one of New York City’s infamous neighborhoods, home to generations of immigrants. There’s a nearby Tenement Museum. Closer is a big old-time Jesus Saves cross that advertises an active evangelical mission. There are lots of bars, world food. Sometimes the East Village feels like a small town full of college kids, but I like it.

All kinds of music appeals to me when it’s performed with spirit and taste, but most pop bores me. Here’s a rock song I’ll never tire of—Shotgun, from Earl Greyhound.

I hate Internet jargon, and clichés in general. You’ll have to get your LOLs and ROTFLMAOs elsewhere. I don’t know what most of these things mean, and I don’t care. I’m in no hurry, anyway. Unless I’ve miscalculated, I have loads of time to type.

The real words I won’t use here are curiously known as curse words. Not because I don’t swear when a taxi runs clean over my foot, as once happened (without damage) to me in London. I simply don’t want censorious spider software to bar kids from accessing my thoughts. I welcome anyone who stumbles into my blog. You’ll never leave, hehe.

Mahesh Pops the Big Question: Am I Gay?

Sadly, one question engages a disturbing number of readers—particularly an Indian gentleman named Mahesh. He lives in Mysore (which he kindly explains is near Bangalore) and he demands to know if I am homosexual. (I hope that word doesn’t activate those danged spiders.)

Unlike some Americans who ask the same question, Mahesh didn’t try to coat his query by saying the answer makes no difference to him. Obviously it matters to a lot of people. But Mahesh is desperate. My talk of having a male ‘partner’—as well as a roommate of unspecified gender—has traumatized him. He fears they are one monstrous gay person.

“Please assure me that you are in no way one of these filthy, cursed buggers,” Mahesh pleads so elegantly.

Will he disbelieve my comments about H5N1 if I say I like men? Will Mahesh toss his mask into the rubbish heap?

I’m tempted to stop blogging altogether and join my mysterious roommate in an orgy of strip poker and movie streaming. (Do they have that in Mysore?) Or I could do the politically correct thing and refuse to answer.

But some of you intolerant souls are evidently nice people. Some inquiries even come from people of various genders who seem to be trying to flirt with me. So I’ll bite the bullet by declaring that my roommate is a woman who is indeed my girlfriend and we are vigorously living in sin because of H5N1.

This damsel took refuge in my cramped apartment two months ago. I was predicting a world depression from the effects of bird flu (sure, that looks easy now) and I wanted her safe with me for the duration. She tends to her job at a mega-global bank from this very computer during the day. Her iMac never sleeps.

She is no longer my unofficial editor unless she secretly reads my blog. Let’s see if she complains about tonight’s post. (I’ll test her: Please brush those teeth, honey.)

Did I mention we’re in love? I hope people respect this and stop bugging me about my personal life. I could truthfully add that my best friend is gay, but clichés are abominable.

So Mr. Mahesh, I hope you are not engulfed in aak-chheen or aak-chhoon over in Mysore. I gathered that Hindus have two ways of sneezing. Is one manlier?

I bow to any readers who figured out that TBIMB means too bad it’s my blog.