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  • Welcome, everyone.

  • This is Mike owned.

  • Yes.

  • Yes.

  • My name is Skip Rutherford, and I am dean of the University of Arkansas Clinton School.

  • Public Service.

  • Let me introduce to you who just walked in no stranger to Arkansas founding dean of the Clinton School of Public Service, Senator David Pryor.

  • Stand up on behalf of the students, faculty and staff.

  • Welcome you to this community conversation.

  • It is amazing what a great speaker and a great topic will do for a crowd.

  • So we're honored to have you here.

  • Our students are not here tonight.

  • They are on their international internships.

  • And before you leave, take a look at the map on the back of the room.

  • You see where they are?

  • Certainly of interest to us is the this virus and its impact on the countries where our students are now working.

  • So this topic is both timely and personal, and we're glad to have you here.

  • We will be announcing our new class in early August, and we'll also be announcing our distinguished Mr Public Print programming schedule, which I think you all will like.

  • Enjoy, I hope, like our e mail system where people can respond and come to these events get used to bore because we've got a lot coming this fall.

  • And coordinating that activity is a young man who was a graduate of the University of Nebraska in a pretty fair tennis player in his own right.

  • No, and joined us about a year, year and 1/2 ago at the school and is now the director.

  • A public programming.

  • It is done a fabulous job recruiting an attractive quality.

  • Speakers like the one we have tonight.

  • So the introduce our guest speaker, I want you to be a young man that you're gonna hear a lot about the future.

  • One of the talented young people that we're glad to have on the staff of the Clinton School.

  • Would you welcome a native of South Carolina, a graduate of the University of Nebraska, Patrick Kennedy.

  • Thank you.

  • I, too, would like to thank everyone for coming out tonight and want to welcome you to the Clinton School.

  • Public Service.

  • This is a treat to see all of you here.

  • And I'm excited to have you all here and more in the future.

  • I'd also like to give a special thanks to Dr Thomas Bruce, our associate dean, who has been a strong advocate of holding conversations that global health here at the Clinton School and under his leadership, we will continue to have more of these calm discussing the intersections between global health and public service.

  • I can sure thank you for all your help and guidance in this process.

  • But tonight we're here to discuss an issue that is pretty important issue and is received much publicity lately.

  • And that is the threat of a global pandemic.

  • Uh, much of the conversations that you have seen as of recently has been about the avian influenza virus, also known as the H five n one virus that could potentially trigger a global pandemic and cause massive chaos and disrupt all aspects of life with the United States and around the world.

  • Um, our speaker tonight continually emphasize, is that whether it's the avian influenza or it is an emerging disease that we have yet found and it doesn't even exist yet a global pandemic will, in fact, come the he equates it frequently to the hurricanes.

  • That hurricane will come.

  • We don't know what shape will take, but it will come.

  • In fact, our speaker recently said that if it is, if it is going to happen, it is not.

  • It is not when it is going happen.

  • It is when it is where and it is, how bad.

  • So there really is no better person to talk about this issue tonight about the threat of the global pandemic than our speaker, Dr Michael Foster home.

  • How to tell you a little bit.

  • Just a little bit of doubt about Dr Michael Foster home.

  • Hey is the director of the Center for Infectious Disease Research and Policy.

  • He is the associate director of the Department of Homeland Security's National Center for Food Protection and Defense.

  • He is a professor at the School of Public Health at the University of Minnesota.

  • And in June of 2006 Secretary Michael Leavitt, department Healthy Human Service is appointed Dr Auster, home to the newly established National Science Advisory Board on bio security and in the past month, talking to global health experts throughout the state.

  • Throughout the nation, it said, Doctor Osterholm possesses two qualities, and that is courage and conviction, and that has been evident in the work he's done around the world s so as you can very well tell, we're very privileged.

  • Tohave Dr Rosa home address.

  • Right.

  • And please join me.

  • Michael was Thank you, Patrick, for that very kind introduction.

  • Senator, it's great to be here.

  • Dr.

  • Bruce, I wanna give my acknowledgment of someone who's been a long term fan of work you've done for many years.

  • Dean Rutherford.

  • Thank you.

  • Also, it's a real honor to be here in the throes of Clinton.

  • Here, give it all the president why he was there and I had the fortune to spend some of that time working in some of those programs.

  • And I think it's great and I don't want to diminish that.

  • But I have to tell you the person that I have the fondest in greatest love for of all public policy people probably is Senator Dale Bumpers and Betty Bumpers, who have had a chance to work with in the area of the immunizations for 20 years.

  • And I have to tell you that it is an experience to spend time with Dalen, Betty and work they've done and they truly are real public health hero.

  • So while they're not here tonight, they're here in spirit clearly, uh, and it's great.

  • Well, I'm here tonight to talk about something that no one wants to talk about it everybody wants to talk about.

  • And that's the issue of the concept of an influenza pandemic and what it might do.

  • Let me, at the very beginning, set the record straight as a public health professional and how I will view this issue tonight and go from there.

  • A 9 11 of 2001 year for the 9 11 event, I published a book called Living Terrors.

  • What America Needs to Know To Survive Coming Bio Terrorist Catastrophe.

  • In that book, it was primarily about bioterrorism, including the use of anthrax.

  • Kind of like it waas.

  • But I also talked about the fact that the World Trade Center tower in the Al Qaeda one year before it happened.

  • If you'd asked me in that intervening year between 9 11 2000 and 2001 what the likelihood that that attack would occur?

  • I probably have told you given, you know, my science background of risk, I don't know one and 5001 in 10,000 or something like, Really, I am here to tell you tonight and hopefully provide the support of information.

  • Why the risk of an influenza pandemic is one it is going to happen unless you can somehow eliminate hurricanes blessed Minnesota.

  • You suddenly put a big baggy around our state, eliminate winters you will not ever, ever escape and the next influenza pandemic.

  • So at the outset, let me just just miss any idea.

  • Is this real or is this another Y two k?

  • Whatever this is going to happen, the question, as Patrick framed it, is we just don't know when we don't know what which which virus will cause it, and we don't know how bad it will be.

  • But tonight I'll give you a sense of why we today are as vulnerable to an influenza pandemic as a society is a world, as we may have been in our entire history of humankind.

  • A very strong statement again.

  • But let me share with you why I think that to be the case now.

  • I have about 9000 slides in my repertoire slides.

  • Last count.

  • I had to get rid of all of them to keep one that I think really tells the story where we're at today in the world.

  • This is the slide, and I realize it may be hard for some of you to see, but what you have on the right vertical bar.

  • Here's population in billions in the left, one is days to circumnavigate the globe.

  • And this is the last 150 years in the last 150 years.

  • We haven't really changed a lot for the last 50 years.

  • What it took to get around the world that the 1st 100 years of that time period really made a big change from one year toe, literally.

  • With the advent of the Boeing jet, we're talking now about 42 hours.

  • What has not reflected in this bottom line is what goes around the world today.

  • The global just in time economy is our Achilles heel.

  • While it's our strength, it's our major major vulnerability, and we'll talk about that tonight in the context of inch wins it.

  • Much of what we count on every day originated offshore somewhere, and anything that interrupts international trade and travel will interrupt quickly the global economy.

  • On the other bar, you see the world population.

  • Today, there are 6.5 billion people on the face of the earth, and the number grows quickly back in 1918 upend a time.

  • I'll talk about tonight relative to the previous pandemics, the world population was 1.8 billion today, one out of every nine people's ever lived since the caves is on the earth today.

  • That's a remarkable concept.

  • The point is, that also has real implications for what a pandemic will do Now there's a lot of people who put yeah, wins and avian influenza, Modern world view of pandemic.

  • You can't quite see this business chicken little over in the left bar.

  • This is We're all going to die a bunch of tombstones, and we find ourselves a society typically wanting to fit in either.

  • One couple months ago, I was on Oprah and, needless to say, my email was overrun.

  • After that, I was on there literally thousands of emails and they really divided into two camps.

  • One camp is you know, why in the hell are you scaring us so badly?

  • This is just, you know, you are irresponsible.

  • And the other side of it was saying we're all gonna die and you're not telling us the truth.

  • You know really?

  • You know, why aren't you leveling with us how bad this is gonna be?

  • And I guess this is a natural kind of of relational reaction to any kind of news like this.

  • In fact, ladies and gentlemen, the truth is in the middle, we're not all going to die.

  • We'll get through the next pandemic.

  • Justus.

  • Any civilization has before us, but it's gonna be tough if you believe that it's not gonna happen or you believe we're all gonna die.

  • You can go home, get your bottle right now, go to bed and just write it off because there's nothing you could do.

  • And that's not the case.

  • There's much we can do.

  • What we need to understand is now is the time.

  • And every day we waste to do more and I'll talk about that.

  • Do more later as we go through this.

  • Now, here's an example of why you might very well be quite confused.

  • This is You know, what some would say is one of the prominent papers in United States, The New York Times.

  • This is the same science writer, the same editor for the science writer, the same newspaper on May 14th Sunday publishes a story above the fold that says avian flu wanes and Asian nations that first hit hard.

  • If you read that story, you would come away thinking, you know, this was another Y two k.

  • You know, people kind of really blew this.

  • It wasn't really all that important.

  • Inner same author, Same journalist writes a story.

  • Bird flu deaths Indonesia Raise Concerns Talking about this cluster of cases were just unfolding.

  • An Indonesian said The baby, This is it.

  • Maybe it's coming.

  • Then another's for human flu transfers may exceed reports suggesting a lot more is going on out there.

  • We ever knew about same journalist, same newspaper.

  • What does this mean?

  • Today?

  • We're being with back and forth constantly about what do we really know or not, including our New York.

  • It's not in depth.

  • It doesn't really understand what's happening.

  • And so tonight, what I want to do is I can tell you right now at the outset, and this may be a reason for a number of you to get up and leave.

  • I know less about flew today than I did 10 years ago when I was teaching my graduate students 10 years ago, I thought I knew a lot more about this topic in the more we've learned more, we realized very humbly how little we really know, and I'll try to share that with you tonight.

  • What we really know don't know.

  • And what's a Maybe now the World Health Organization put out a document last October about 10 things you must know about pandemic influenza and let me just say at the outset, at least from the perspective I come from and some of the room may have some additional comments.

  • But the W.

  • H O is really often considered to be one of the most conservative organizations we ever deal with.

  • I mean, they typically are, if you want to have a nice conservative base, where by the conservative meaning, you know, they never shy too far away into the future, etcetera.

  • So take these comments on this light pandemic influences different from avian influenza.

  • 0.1, I'll explain the difference tonight.

  • There's a lot of confusion about avian influenza in what's human pandemic influenza.

  • Second, while influenza pandemics are recurring events like earthquakes, hurricanes and tsunamis, pandemics happen and they will happen again, and that's an important concept in the sense of understanding what we have to prepare for.

  • The world may be on the brink of another pandemic.

  • I gotta tell you, that's pretty strong language for the W H O to say we're on the brink.

  • Another painting as last October.

  • All countries will be effective.

  • Nobody's gonna escape this one.

  • This will be a worldwide event.

  • Unlike a lot of catastrophic events.

  • Wars, natural disasters typically are very regional in their nature and temporary.

  • They tend to be rather short lived at least natural disasters.

  • Widespread illness will occur all comment what widespread illness means.

  • Medical supplies will be inadequate.

  • I will lay out for you right now that our medical care system in this country will be no better during a pandemic in 1918.

  • Now that seems very strong, and a lot of people are negatively react to that.

  • But I will point out why that's the case.

  • Modern medicine as we know it will not take place.

  • A large number of deaths will occur.

  • You'll see what those numbers mean.

  • You know what?

  • How are they related?

  • Economic disruption will be great.

  • W.

  • Joe saying this now every country must be I don't know what that quite means yet, but I will tell you that it's at least in spirit, correct.

  • And finally the w h o alert the world in the pandemic threat increases.

  • I'm not sure I have complete conference a W H O That way.

  • In this recent cluster in Indonesia, only two W H O investigators actually made it to the rural villages Sumatra.

  • In Indonesia, they were, in essence, escorted out pretty quickly for reasons that have to do with some communication skills.

  • It was only because a very persistent Bloomberg News reporter from Hong Kong found at third generation of cases where we would never have known about that.

  • So also don't think we have this elaborate surveillance is melter that's gonna quickly respond to these things because that's not the case.

  • Now I've had it.

  • A couple of additional things you must know about pandemic influenza vaccine and antiviral drugs love minimal impact on the pandemic.

  • It occurs the next several years.

  • Why?

  • Because we won't have vaccines and drugs.

  • I'll explain why that's the case.

  • No quick fixes right now, one of the things that I have the hardest time about doing in Washington with is Everything's about a quick fix just before it happens or after it happens.

  • There aren't any quick second ball.

  • It's going to turn waves.

  • Pandemic influenza is a situation that occurs where once it emerges in world, it has historically swept through the world in waves, meaning that it will go through a community in the spring on a no tire area of the world and then somewhere else throughout the world at the same time in the early summer.

  • And then it comes back.

  • And what's interesting about in 18 90 the pandemic, then the third wave 16 months into the pandemic was by far the worst one that killed the most people in 1918.

  • It was the second wave that occurred in the fall of 1918 even though the first wave it occurred in the spring in 1957 and 60 eight's two pandemics were quite mild.

  • By all of our estimates, there was the first way that was the most severe.

  • We don't have a clue when to blow our wad.

  • When do we take what limited resource is We have and put him out there because we don't know which way is gonna be the worst one.

  • That's a lot of indecision at a time when we need really good decisions.

  • Non pharmaceutical interventions Florentine Infection control Justin Scene will have limited impact.

  • That's in part true, because of the fact with quarantine with influenza.

  • While there has often been stated your infection up to a day before, it's some of that occurs.

  • But the point of it is by the time we realize you have influence, that you'll have likely transmitted to a number of people.

  • That's very different than with SARS, whereby the you're likely transmitting wasn't really that high until about the fourth or fifth day of your illness.

  • You were in the hospital often by then, and then on top of it we were manipulating you terms.

  • Your air source and self worth had made it worse.

  • It's not easy to quarantine.

  • We won't be able to do that Infection control.

  • Come back to today.

  • We will not.

  • We will run out of mask and respirators overnight, and I'll give you the reason why Social Distance e.

  • I don't know what this means.

  • I mean, how do you keep people at arm's length away so that I don't breathe on you.

  • Well, today we worry about that because social distancing works.

  • If it's only the first couple of feet in a story, Senator.

  • But I've nailed you pretty largely already tonight.

  • Here.

  • If I If I realized I have flew on the way home tomorrow morning, I'll give you a call.

  • But in addition, we now know that influence also could be transmitted via the aerosol route.

  • The idea that it can also move distances to the back of the room.

  • And so it's not just only up quotes, and so I'll come back to this.

  • But the idea of what can we do about it is, and we have to be honest with our public about what we know and what we don't know, because as soon as we tell him, do this or do this and it doesn't work.

  • And then we realized we kind of was wishful thinking, not based on data.

  • We will have no credibility, and we have no credibility.

  • That's what leadership is all about in time of crisis, in terms of the other additional things that global, just in time economy prevents unique state of vulnerability to a pandemic.

  • I've had recent discussions lately with people like Tom Friedman in Secretary Bob Rubin, the Treasury secretary under President Clinton, and they would all tell you exactly the same thing.

  • I'll even come back to that in a minute.

  • International governments who have limited resource respond everywhere, everything for 12 18 months.

  • Secretary Michael Evans, secretary of HHS, has been panda bit recently because he's been going out of the community, saying, You gotta do a lot of this yourself.

  • We're not gonna come in here.

  • I give the guy great credit for being just It's not.

  • He's trying to cover his butt up front with a Katrina like event.

  • When you have originally then, like a hurricane or earthquake or tsunami, you can have 47 other states send.

  • Their resource is temporarily to help out that area you can infect.

  • Divert what was in that supply chain for the rest of the world temporarily to that area.

  • When we're all in it together, every Hamlet, every village, every town, every city, every county, every state, every region, every province, every country, we're gonna need it.

  • At the same time, there won't be people coming to assist you, hoping to spare, not strategies.

  • Right now I see a whole lot of it.

  • We hope we despair.

  • In fact, we are.

  • It would be like the issue right now.

  • What if we could have foretold one month before Katrina happened?

  • The levees would give way.

  • This would all happen.

  • We might very well have had hoping to spare.

  • But now we knew after it happened we really responded.

  • We did.

  • But what could we have done if we had known just a little bit before?

  • We've got to do that.

  • Business continuity Planning is not absolutely I mean infections, Epidemiologist by training.

  • What the hell am I doing?

  • Talk about business.

  • I will submit tonight that, as goes the private sector rugal our health because if we don't have food, if we don't have medical supplies, If we don't have a lot of things that we count on every day in our lives, the health impact will be substantially greater.

  • And finally, And this is a message you have toe completely believe, or you might as well go home.

  • Now we will get through it like every other previous catastrophe will get through it.

  • The question is how much collateral damage how much direct damage is gonna occur in the process of what can we do about that now?

  • Now, in terms of wind is a pandemic occurred.

  • Pandemic influenza occurs when a bird virus, which is where the influenza virus, normally resides.

  • And I'm sure that in a moment is finally capable of being transmitted by in to humans.

  • It occurs when it's really adapted genetically.

  • So now that bird viruses readily moved between humans.

  • Second of all way don't have protection in our society, meaning that we haven't seen it before and that it has some increased in Maryland's our ability kill.

  • We've met two of the three, but we are on the cusp of right now with H five n one strain.

  • Asia in some degree in Europe is whether or not that will eventually make it so that it's readily transmitted between humans.

  • And when that happens, as much as we talk about the birds right now, H five and one is about the birds pandemic Human pandemic Influenza in humans is not about birds about humans.

  • The birds will become irrelevant.

  • Pandemics have differed in terms of their population specific mortality and cannot be characterized by a single rose predictive mode.

  • There have been very different kinds of pandemics, and none of us could predict for you whether it be a really severe one or less severe one I would submit today.

  • It doesn't have to be a very severe one to bring you a little kind of SARS.

  • Killed, 8000 affected.

  • 8000 people killed, 800 people.

  • But if you were in Toronto, if you were in Hong Kong, all you're in Singapore, you saw what happened.

  • Your economies.

  • You saw what happened to the psyche of the people for 6 to 12 weeks.

  • And now imagine that even a mile in sires would be considered a mild pandemic if were to occur on a worldwide basis.

  • Now, I mentioned earlier about influenza.

  • Let me just quickly for what I assume to be somewhat away audience.

  • Although I know we have a number of medical professionals here, this is where the reservoir of influence exists.

  • It's a wild aquatic birds for those who are trivia nuts.

  • Years ago, poultry didn't emerge until about 100 million years ago.

  • In that time period, these viruses set up very nicely in these wild aquatic birds Occasionally, these viruses make their way to other bird species, including the domestic birds.

  • Where there's two types of influenza called I enrolled Path I won't go into that.

  • One is a much more severe.

  • That still has not much significance for humans.

  • It's very important to the world's production of poultry, another domestic aquatic birds.

  • We know occasionally this can infect other animal species.

  • For example, we didn't know that cats were really a very good recipient of the H five n one virus until we fed dead H five infected chickens to 46 Bengal tigers at the Bangkok Zoo.

  • And they all died within three days, and four more died with continuum in contact with birds.

  • They just had contact with sick cats.

  • Today, best we know, at least 46 different in a 1,000,000 species are able to be infected by that virus.

  • Now we see what we concern now is it gets closer to humans where we can have what we call the one off transmissions.

  • What's happening right now in Asia will show you that in a moment where basically only rarely does that virus finally infected human and almost never does that virus transmitted on by human to another human not yet sit.

  • We know a concept called reassortment, where it can get into pigs, pigs or a universal recipient, where they could be infected by bird viruses and human viruses.

  • And sometimes they get together.

  • They mix up there and create 1/3 violence, called a re assort that could cause a pandemic or what we're worried about now and what we know about the 1918 viruses.

  • It can also occur when there's just enough changes that same virus, so it essentially is still a bird virus but just has enough changes that finally, it can transmit to humans by humans.

  • And you have a pandemic.

  • This is what we're worried about right now with H five N.

  • One.

  • Now, in terms of understanding pandemics in history, they have been recorded since Hippocrates.

  • The 15 80 pandemic suggest you don't think 1918 is the only severe.

  • One is a classic example of started in Asian spread in Africa, Europe and the Americas in six weeks.

  • Once it got to what is today Turkey from Asia, it wiped through all of Europe.

  • In six weeks, mortality was high.

  • 9000 of 80,000 residents in Rome died in one week during that pandemic.

  • In addition, some Spanish citizen described is nearly entirely depopulated by the disease, so bad influenza pandemics are not unique.

  • We only remember 1918 but they do dear clearly go back for his Now if you look.

  • We've had 10 pandemics last 300 years.

  • Oration.

  • 10 49 years between pandemics.

  • The average about 24.

  • You can do the math last 1968 69.

  • Now I don't think we're due for a pandemic, because this is not what we call normally distributed, meaning.

  • It's not like we expected.

  • This is like having 3 100 year floods in 10 years.

  • It could be another 10 or 15 years for a pandemic.

  • Kids.

  • What's going on?

  • Reason We're so concerned days because of this h five n one evolution virus in Asia.

  • Not understand pandemics a little bit.

  • Let me just explain in 1918 19 we now know this is caused by what's called a Chuan yin one.

  • Hemagglutinin neuraminidase won't go into that.

  • Those are very important parts of virus that proponents of help us identify.

  • It's like Mike Foster home.

  • Paul Peterson, that type of thing.

  • The point being is we only grew this virus out recently because of C S.

  • I like science, actually now extracted genetic material out of tissue from people who died in 1918 found all the genes, went back and re created a virus, which is a whole interesting story in itself.

  • But we know in 1918 20 1,200,000,000 people were infected.

  • 50 to 100 million people died.

  • You often hear a lower number.

  • But there have been several recent efforts really agree to find that one was a group of medical geographers with that country by country and determined clearly probably close to 100 million people died in 1918.

  • It also killed this portion number with healthy young adults.

  • Most influenzas season.

  • The things we see every season, which is the remnants of the previous pandemics, kills the very young, the very old called the U shape.

  • So even when a bad flu season occurs, it kind of like all tides raise all boats.

  • The Kurds just get higher, either In along comes 1918 had a classic W shape where the highest mortality was in healthy 20 to 35 girls, not you.

  • End of life experience.

  • Come back to that in a minute.

  • We had some evidence why that might be occurring with studies that were done involving pregnant women in 1918 13 different studies around the world.

  • Off all the women who are pregnant, 23 to 71% died with meeting about 55%.

  • One pounding in Minnesota, 38 42 women who were pregnant during the pandemic event wins it.

  • This is a hint of us because the way they died was in fact really their own body training themselves.

  • If anyone thinks about the immune system of a healthy person, there really is not much more curious time than that of being pregnant is part of your saying.

  • You know, this shouldn't be a part of me.

  • Is this supposed to be?

  • And there's part of me saying this is most precious cargo over carrot and the immune system really is in a very different state of pregnancy.

  • And when that virus got in the middle of that that created several have come back.

  • One moment, 1957 58 came along H two into a pandemic straight acquired.

  • Now three genes from the avian influenza gene pool of wild ducks re assorted 500.

  • Change the human.

  • This is that re assort.

  • We think it occurred in a pig we don't know, but this is almost the dumbed down version.

  • It's not a new virus in the sense that it's all new, but yet it's got a lot of human, and in this pen and 60 to 70,000 people in us die along comes 1968 69.

  • Home flu H three n two, which is now the remnants, strangely still deal with and whenever, whatever, the next pandemic strangers will likely become our seasonal flu till the next pandemic after that occurs to Gene's McDuck Reservoir 16 from human virus.

  • Approximately 40,000 people died there.

  • Well, let me just take a step back because I think that the current five in one situation should in fact be viewed through the lens of 1980.

  • These two viruses are kissing cousins biologically, we see clinically and explain a bit more about that, and I would urge all of you if you have.

  • If you really want, understand, read this book.

  • Great influenza John Barrier really is a masterpiece of helping to describe what really happened in 1918.

  • Let me just paint a picture for you.

  • This is a letter from Dr Roy Grips was one of the physicians at one of the military training camps outside of Boston.

  • Wrote this to his good friend Bird.

  • In the fall of 1918.

  • It was discovered by Berg's family many years later.

  • Trump in the Attic and Substantive published British Medical Journal 1979.

  • But Dr Bruce wrote, These men start with what appears to be an ordinary tackle, a grip or influenza when brought to hospital.

  • Rapidly developed, most vicious type of pneumonia has ever been seen.

  • A few hours later, you can begin to see cyanosis extending from your ears, spreading over the face until it's hard to distinguish the colored man from the white.

  • It's only a matter of a few hours until death comes.

  • It score.

  • One can stand to see 12 or 20 men died to see those poor devils dropping like flies.

  • We've been averaging about 100 desk per day.

  • Pneumonia means about all cases.

  • We have lost outrageous number of nurses and doctors take special trains to carry away.

  • For several days.

  • There were no coffins and bodies piled up something fierce.

  • It beats any site had ever had in France.

  • After that, an extra long barracks has been vacating for the use of more.

  • We're using more, and it would make any man sit up and take notice to walk down the long lines of God's soldiers, all dressed in laid out number rose Good bio pale with you till we meet again.

  • Several very important points these people didn't night.

  • Typical flu dance, which is what we often think of people getting secondary bacterial pneumonia dying 8 to 10.

  • 12 days later, these people died very quickly from what we believe today is a condition known as storm, leading to a type of of immune over response in the human.

  • In addition, you notice the problems here.

  • If anyone's a historian of World War, you know, the impact was dramatic on the outcome of the war.

  • This is in fact, the same kind of clinical description we see for many of our patients today with H five n.

  • One.

  • This curve, which I'm fortune no, does not project, will both size and let me just point out this is an example.

  • What happened but you have down here.

  • Ages 0 to 9 10 to 1920 29 30 39 40 49 50 to 59 60 to 69 In this Here you have the historic composite desk in September.

  • October November from 1912 1916 and you have 102 103 104 105 105 100,000.

  • Noticed this u shaped her with very high rates.

  • Higher means not hi ng sense we see in a moment in the very young and material along Calm September and October of 1918 This purpose now 1000 2000 3000 4005 10 fold With this one, notice what happens.

  • You still have a tenfold increase from up to 300 to 3000 in young Children.

  • But what's most romantic is almost 6% of the residents of Boston between the ages of 18 30 died in the two months of September October.

  • That's pretty dramatic.

  • Now that didn't play out like that in every city.

  • Hard, but it was many years, but this thing took off like this.

  • The average age of H five n one cases today in in the desk we've had so far is about 25.5 years.

  • The average age of cases died in the United States are best guesstimate in 1918 was 25 years.

  • It's very dramatic similarities in terms of some of the issues were seen.

  • No one looks at the 1918 for the H five n one experience again.

  • I'm sorry you can't see this.

  • It's hard to keep, he slides, even updated.

  • This is 228 W.

  • H A laboratory confirmed cases 130 desk, but you can see this concentration.

  • Here in the purple color is the cases of both human deaths and birds.

  • You see the gentle color, which is actually where the birds now also been showing you have H five one.

  • What's the relationship between cases and humans and what's going on this slide, which depicts the current reported cases in humans?

  • I believe we are getting most cases as much as I made a comment earlier about it took Bloomberg reporter to find, and we're missing something in our studies show.

  • There's not a lot of asymptomatic mild infection out there.

  • We've got blood samples now from over 5000 people.

  • Close contact cases in the same environment.

  • And either you get really sick, you just hardly ever get this infection.

  • The point to make is this is a total cases, but you see, here's the percentage of our live percent died.

  • What you see for January through June 2006 of these case numbers are still coming in.

  • The numbers just keep getting bigger and bigger season.

  • And what I believe that reflects is the amount of virus pressure in the bird population and large domestic birds in age, and will distinguish domestic birds in Asia from those of domestic birds in developing countries in a moment.

  • But the point being is that the more viruses out there and birds, the more chances that humans have actually come in contact with.

  • This is not from sustained transmission.

  • We have evidence of people getting infected easier.

  • Now.

  • It's just there's a lot more virus out.

  • Anytime I see a per where 60% of people are dying from a virus infection to his nephew, me allergies.

  • That's not good now, in terms of what's special for age five.

  • I go into detail, but there are many similarities between the 1918 pandemic strain and H one that thing from making an H H five n one viral Logically, the way it grows.

  • Animals.

  • It's very, very soon.

  • There's been this ongoing opportunity for this thing to what I call the envoy genetic roulette table for which to achieve this human human transmission of words.

  • There are so many birds out there today for this virus to basically have to go through a genetic mutation that, in fact, we believe that this really does lend itself to I'm going risk.

  • It's not gonna burn itself out convicted.

  • And finally I go to medical meetings and I hear the physicians get up.

  • They'll say, Well, you know what's gonna happen.

  • What happened by now, ladies and gentlemen, is part of what we don't understand about influence.

  • In the early 19 sixties, H three and eight, another name for another flu virus, jumped from birds to horses.

  • Anybody who's a horse lover, no horses against influenza virus, we don't know why or how it jumped appeared to be a direct jumped from birds to horses and has been a real problem Suddenly, three years ago, this virus still pretty much a bird virus in horses, jumped dogs.

  • And today we have a major problem with K nine wins out there makes tree and ate.

  • And we don't know why I didn't take 30 years for that virus to jump from horses to dogs.

  • We don't have a clue.

  • The point being h five n 1 may not do it this year, next year, next year, but I wouldn't want to bet that's not gonna do it.

  • Why do I say that?

  • Look at these.

  • You know you're going to hear more about poultry in this country again, I come back said over and over again.

  • Poultry in this country will never be a significant part of the H five n one risk to humans ever.

  • But in Asia, that's different.

  • Where relax, biosecurity, barn production, relax kind of ability to control wild bird domestic bird content and look how the world's changing.

  • Just in China alone in 1968 year bus of intimidating people, the estimated production of hogs and there was about five million be excavated production.

  • Poultry that year is about 12 million.

  • Along comes 2000 or this is really true in many countries of Eastern Asia, population of 1.3 billion pigs are now produced 508 million annual production level.

  • And look at the poultry 15 billion birds produced in 2004 and we see only a very limited change in this at all.

  • Even now, with all the calling, it's occurring.

  • So imagine a forest that burns down once every 100 years because it takes 100 years to accumulate new trees.

  • Imagine a forest every night after a major forest fire suddenly gets 100 years worth of growth way.

  • Have so many new birds being produced every day.

  • Places like China, Indonesia, Vietnam, Thailand that the point of the matter is that whether it's wild birds, domestic bursar has ample opportunity.

  • Keep growing and growing and growing.

  • And that's what we're seeing.

  • And that's where it's gonna mutate Now what will happen?

  • No, no, Can't predict win if or where A 51 virus will shift from an avian string of incidental human infections like it is now medically transmitted.

  • Agent could happen tonight.

  • It could happen three years.

  • We don't know it.

  • We will have a pandemic but it might have been in Asia remains of medical let table for a drive in one mutations.

  • No doubt about that.

  • I convinced that this is where they're such pressure.

  • The first of a pandemic will be third generation cases that are sustained.

  • No Indonesian, we just baby vegetable.

  • We had a recent cluster over there where a woman older adult woman transferred six people in her immediate family.

  • Clear evidence is that because we actually have viruses and show that they continued to mutate and you know when it happened, one of the people who actually became infected was from the first virus license we have in him.

  • Until he died, there's mutations occurred in his and strain.

  • Then, as he was dying, he transmitted that strange to his father, who, by the way, was not biological labels by marriage, and his father got mutated, Strange son, and then before he died of the virus, continued to mutate even more, and then it in.

  • We're lucky.

  • We don't know.

  • Next time.

  • That may not be that false start just don't know.

  • And with all the science training I have, his never genealogist had 47 hours of graduate statistics.

  • You think I could give you better answers to this, but it comes right down to what I know is how would I tell you what the risk is?

  • I wouldn't want to bet my family's life on age five when not become the next pandemic influenza strength.

  • So I could tell you I can't tell you what the risk is.

  • I can't do.

  • It is actually wanna bet against it.

  • This one, I believe, has every possible doing.

  • Now.

  • In terms of the bird issue, there's tremendous confusion about what's going on.

  • Are wild birds is a domestic Curtis?

  • Clearly migratory birds moving this virus Caesar Bird flyways, where you can see you know, birds move seasonally from nesting grounds.

  • Wintering grounds set.

  • There's a lot of overlap.

  • Clearly, some of the movement in Europe occurred because we do know that certain pull three infected poultry were moved.

  • But a lot of it also said the laboratory birds will get to North America.

  • I have some experts in the room.

  • I tell you more about that than I can.

  • But I'll tell you, one thing is, I've been impressed in the past with a relative absence of Asian viruses in migratory birds, Americans.

  • And so we don't know.

  • Is there something here?

  • But it doesn't really matter, in a sense, because when I say it doesn't matter, there will never be the pressure of virus in the Americas because, in fact, way we go.

  • Our modern poultry is basically a very safe product in that it's a bio security.

  • Barnes.

  • It's not exposed to the wild birds Might move.

  • Now.

  • We'll organic chicken to be a possible problem.

  • Your bet.

  • Range chickens, will you?

  • You know the idea of the backyard trip.

  • It's like your problem.

  • You bet, because then they would have contacted birds.

  • Now also, I might add, for those who are bird lovers, you know this already, but birds, Scott flyways or highways.

  • We have examples for for you off actual bird species over summer, a nesting ground up on the northern part of Canada.

  • Then go to Southern South American winner and one Tick Rivers pieces.

  • We have fairly good data four years ago, three years ago in two years ago, when off Rocky Mountain fly away one year because of weather patterns.

  • Pressure systems wins when 180 miles off the Atlantic Coast another year and most recently right down the Mississippi River, fly away in their movements.

  • So even one bird species can move a lot of different locations.

  • Makes it so that, in fact you can't count on a one bird species to tell you what's going on are while words really important with this issue, not probably humans.

  • In a sense of contact, there is likely to be continued that domestic poultry.

  • That's why I think Asia is so unique.

  • But it put it moving.

  • It sure possible we just don't now in terms of what might happen with another pandemic.

  • You know, this is where you get really in trouble because people think you're inflating or you just never know.

  • None of us know.

  • We do assume that if H five n one is the next one, like other pandemics, anywhere from 36% people could become infected, 30 being probably very low.

  • It was the 1968 like pandemic 2 to 7.5 million just worldwide.

  • This very mild.

  • If it's a 1918 like pandemic, it's 180 to 60 million deaths give you a sense of what that means.

  • HIV AIDS in the last 30 years has killed about 28 million people in the world.

  • That's real gnomes.

  • If it's the current age five, when Casey counter from 1.6 billion, does I gotta tell you none of us really believe they would never stay at that high mortality rate because poor to adapt humans would be transmitted.

  • It would reduce the case mortality rate.

  • But, you know, reducing a virus of 60% to 30% of the big drop.

  • Well, 30% My God, 15 times her in 1918.

  • You know, it's a hard place to go.

  • Think about what we don't know.

  • We just don't know that you can't you can't say that wouldn't wouldn't happen.

  • We don't know in terms of what we have to look for in this country.

  • These air The official Numbers department Health Service is planning document looking at a moderate pandemic severe.

  • Why do I think health care will not be that of modern health care?

  • Of the 1918 like healthcare?

  • Well, here's an example.

  • If you look at these numbers, even for a moderate, we're still talking about four or five million people needing help patient care 855,000 hospitalizations.

  • You aware of the Iowa Institute of Medicine report came out two weeks ago showing that we have diverted 500 or 500,000 people last year in this country were diverted from a emergency room at a time, but they needed one, meaning that they have been really were full.

  • That's one every minute in this country are birds so overstretched today?

  • Well, if you look at Isis, you care 1.4 million people need intensive medicine care 742,000 mechanical ventilators.

  • A study that I did when I was serving his invited her secretary Thompson.

  • We went back and looked at all the mechanical ventilators, United States, all hospitals.

  • They were probably 105,000 such mechanical ventilators and anyone given day 80,000 and use your record.

  • Lucy's.

  • We get right up to 100,000.

  • We have no access for passing there whatsoever, but in the global just in time economy and make sure it's mechanical problem.

  • Your average hospital today has no more than two days.

  • This is just in time delivery problem, and that's tight and very quickly the petrochemical industry when they're not operating on any accident, so I'm not sure which is worse.

  • Mechanical ventilators in terms of looking to responding to a pandemic and quickly closed by looking at some prevention patient treatment issues, populations, medical system's response and those nine pharmaceutical interventions that I talked about vaccine, Our current influenza vaccine reflects 19 fifties technology, with one exception.

  • One additional piece of attitude.

  • So the same vaccine made when I was sliding on high school.

  • It's the same vaccine virtually have today on a worldwide basis.

  • We only have the ability to make about 300 million.

  • We call 15 microgram doses.

  • That's the current dosage used right now.

  • Every flu season.

  • Lets get.

  • That's the entire world plumbing.

  • It's all change.

  • That's all the plans we have.

  • We're tryingto buffer that up.

  • We're about to throw 10 million doses from last year's flu season.

  • Companies are disgusting.

  • It's because there's no money besides such old technology who's been invested?

  • Eight track tapes.

  • We all know it's flash.

  • The current research on H five n one has been often misunderstood.

  • We now I'm aware of at least 31 candidate H five n one vaccines are being tested We can take the old spring the strain of six months ago in humans birds and make a vaccine for humans.

  • But we also know you need a new strain.

  • Strain caused the pandemic to really have the best protection, which means you can start making the vaccine really get that strange.

  • Using current technology was really problematic is are we done studies looking?

  • How well the humans respond to be h five n one and all the studies show we need at least 6 to 12 times as much.

  • I mean more than we currently used.

  • And we can't grow this virus with a dime chicken, which is where we grow only 10 to 15 yield off compared to what we currently girl for flu virus vaccine.

  • Bottom line is our best guess.

  • Men in the first year of a pandemic will have enough vaccine.

  • Actually, 20 to 30 million people worldwide and the vast majority of people be outside the United States.

  • That's where the production capacity is.

  • So don't come in vaccine in the first year of a pandemic to do anything for you.

  • Second of all, look at the opposition with also Tammy your treatment of Tamiflu, which again has become separate the flu world H 51 1918 h one n one caused very different disease in a story into the current seasonal flu.

  • This is the site of kind storm secure, aspire toward expressing.

  • And we're doing a lot of work right now to understand.

  • Is this drug really work?

  • We don't know if it works.

  • Thanks, five.

  • We have reason to think it through it and I sure

Welcome, everyone.

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邁克爾-奧斯特霍姆在克林頓學校|2006年 (Michael Osterholm at the Clinton School | 2006)

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