Pandemic UK : Project Death Toll Soars To 650,000

A confidential document from the British government's Home Office reveals plans are falling into place to deal with an estimated bird flu pandemic death more than double the previous 'official' estimates made public.

The British government now rates the likelihood of a bird flu pandemic as "very likely", killing some 650,000 people, with previous governments estimates of fatalities around 320,000.

Plans involve the digging of mass graves and using shipping containers to store stacks of corpses, waiting for burial.

From the UK Telegraph :

The alarming prediction is contained in a confidential Home Office document drawn up to help councils and other organisations deal with a catastrophic outbreak of the deadly H5N1 strain of the virus.

With such a huge death toll, it says cemeteries would be under enormous pressure.

"Inflatable structures" and containerised storage "like those used at ports and freight terminals" could be used as makeshift mortuaries to store bodies before they are buried. The Department of Health advises that refrigerated vehicles and trailers should not be used – but admits that this may not be possible during a pandemic.

Large-scale "common graves" would be needed to accommodate the mountain of bodies, and ensure burials were carried out swiftly.

However the document, called "Planning for a Possible Influenza Pandemic – A Framework for Planners Preparing to Manage Deaths", says the process "would still allow for individual burial plots and marking of graves".

The wishes of families should be considered when planning the graves, the draft guidance says.

They should be "deep enough to allow for additional family burials – but not too deep or densely used to make difficult the removal and re-interment of the remains elsewhere, if this is requested at a later date".

In addition, the choice of coffins and types of funeral services will be limited in an attempt to help manufacturers meet the demand, and chapel services will be "basic and shorter".

Coffins for cremations will have to be re-used if there is a shortage.

The report is being sent out to all organisations that will be involved in preparing for a pandemic, including faith groups.

Other proposals contained in the paper include suspending exhumation powers and coroner's juries and cancelling inquests into deaths from natural causes in prisons.

With such a massive death toll, during a pandemic wave expected to last some six to ten weeks, you would presume few deaths would be investigated. Authorities would be flat out getting the bodies into graves before they started spreading diseases and making town centres unliveable.

The Home Office's report and guidelines are similar to those already distributed to local governments and councils across Australia and the United States.

Some of the most important details of these very similar reports have come from examinations of how various cities in the United States dealt with the high death toll from the last avian influenza pandemic - that of 1918, when hundreds of thousands of Americans died. There is a consensus in many of the reports and guidelines of the need to find a balance between getting the bodies into the ground as soon as possible, but allowing family members time for shortened religious ceremonies as part of those burials.

Mothers Can Pass H5N1 Onto Babies In Utero

More confirmation of H5N1's remarkable ability to infect and destroy major organs, outside of the lungs and respiratory tract.

Chinese experts at Peking University have announced results of a study showing that pregnant women infected with the bird flu virus can pass it on to their unborn babies :

In a study by scientists at Peking University tissue taken from the body of a 24-year-old pregnant woman who died from bird flu, found the virus was also present in the placenta and had infected the fetus.

Gu Jiang, director of the School of Basic Medical Sciences which is affiliated to Peking University...who led the study says the virus was also found in the alimentary canal, brain, blood cells and respiratory tract of both the mother and the fetus and the unborn child's lungs and liver were also affected.

Gu says blood and feces from people infected with the virus must be handled extremely carefully to avoid further spreading of the disease.

The World Health Organization (WHO) also says example of transfer does not prove that the virus can be transmitted from one human to another, as the mother and her unborn child are considered to function as one body.

Indonesia : 4 Year Old Girl Dies From H5N1, Brother Shows Symptoms

Her parents thought she just had the flu, and gave her cold medications and treated her at home for a week before they tried to have her seen doctors at two medical clinics in Tangerang. Both medical clinics refused to admit the child. In total, she ran a fever for ten days. She was finally admitted to a hospital in East Jakarta where the four year old died on Monday.

From the Jakarta Post :

The child's parents were told that Sari Asih military hospital, about 500 meters away, had better facilities and to take her there.

"I took her to Kesdam Hospital but they said they couldn't treat her because there was no doctor on duty. They told us to take her to Sari Asih Hospital," said Zainal, a factory worker.

He said a doctor who examined his daughter at Sari Asih initially said she had dengue fever but later changed his mind, noting acute respiratory problems.

"The Sari Asih doctor sent my daughter to Persahabatan Hospital but she could no longer hang on."

Hani Hariyanto said that people from the village had recently acknowledged that sudden poultry deaths had occurred in the past, long before the girl fell ill, however. He said officials had been sent to carry out health education in the village. "Too bad, the villagers did not inform us earlier."

(Her) brother has flu symptoms and has been given Tamiflu..

The Tangerang regency has recorded six human bird flu deaths since January.

"Dangerous" Human Transmissible Bird Flu Found In North Vietnam

Hundreds of ducks have been found dead in Central Vietnam, as confirmation arrives of a mutated form of the bird flu virus in the north of the country.

From Than Nien Daily :

The virus is transmissible from birds to humans.

Minister of Agriculture and Rural Development Cao Duc Phat asked relevant agencies to strictly control the trading and transportation of poultry and poultry products across borders and in local markets to prevent the spread of this dangerous strain of the H5N1 bird flu virus.

World Health Organisation Confirms Bird Flu Virus Now Spreading From Human To Human

Is this how the pandemic begins? With a small story that barely grabs headlines finally confirming that the H5N1 virus has 'learned' how to spread from one human to another?

We have mentioned before that the WHO was moving towards confirmation that "clusters" of bird flu victims in Indonesia could prove human to human transmission was taking place, but this is the first story we've seen that claims it as a fact :

THE H5N1 strain of bird flu has finally managed to spread from person to person, according to officials of the World Health Organisation (WHO).

Until now, it was spread from birds to humans. They warned that if the bird flu virus mutated to easily spread between humans, it could spark a global pandemic, killing millions.

According to a new study of deaths in Indonesia last year, bird flu could have spread between humans on several occasions. Person to person infection was suspected but could not be confirmed.

In the village of Sumatran, seven family members contracted the H5N1 strain of bird flu, one of the biggest clusters in the world. They died before being tested.

In Thailand, when a mother was hospitalised with avian influenza, her daughter, who lived away from bird-rearing contracted the virus when she came to visit her in hospital.

The Fred Hutchinson Cancer Research Centre in Seattle, US also examined a second family cluster outbreak in Turkey last year, but did not have the evidence to confirm or refute human-to-human transmission.

The researchers have for the first time proved that the virus has spread between a "cluster" of people.

Indonesia, with 84 bird flu deaths, the highest toll in the world, has tried to downplay fears of the spread.

The head of research at the Indonesian health ministry, Triono Soendono, said the findings were "just one" piece of research.

But the WHO assistant director for communicable diseases, David Heymann, said it was likely the Sumatran virus was spread by human-to-human contact.

"We believe there has likely been transmission through intimate or close contact," he said.

Dr. Sam Okware, the commissioner, community health, who is also the chairman of the National Task Force on the disease, said it was sad news.

"But we are also improving capacity and training for surveillance to handle it every day. The laboratory at the Virus Research Institute is ready," he affirmed.

Got your food and water stockpiles ready? You know, just in case.

Bird Flu Pandemic : Are We Hatching Our Own Destruction?

A story from JAMA about the excellent book by Michael Greger, Bird Flu: A Virus Of Our Own Hatching, focuses on one of its more disturbing conclusions about the rapid spread of H5N1 and how our industrialized poultry farming practices are complicit in the repeated outbreaks :

Greger, Director of Public Health and Animal Agriculture at the Humane Society of the United States, discusses how human mistreatment of animals has actually backfired, with factory farming making livestock more susceptible to disease. He explains how modern livestock production facilitates the transmission and evolution of avian influenza and argues convincingly that the right environment for a virus such as H5N1 to thrive now exists.

The message is that pandemics are not born but rather are man-made—and that there is a price to pay for the modern poultry industry, in which fowl are raised in closed, stressful, unhealthy facilities, facilitating mutation and dissemination of the bird flu virus. Greger writes that "[It] may take a pandemic with a virus like H5N1 before the world realizes the true cost of cheap chicken."

There remains room for hope. As Greger states in the Introduction, "[if] changes in human behaviour can cause new plagues, changes in human behaviour may prevent them in the future." A radical change from factory farming to less intensive methods including free-range farming is needed, especially in the poultry industry, in which "humanity must shift toward raising poultry in smaller flocks, under less stressful, less crowded and more hygienic conditions, with outdoor access."

The JAMA story also highlights a few startling facts and estimates from US Centres For Disease Control And Prevention data :

...in a normal flu season some 200 000 individuals in the United States are hospitalized and 38 000 die of influenza, mostly elderly persons, with annual direct medical costs and lost productivity calculated at $12 billion.

However, these figures pale before the catastrophe implied by a severe influenza pandemic. The CDC predicts that a medium-level epidemic would affect a third of the US population, hospitalize 734 000, and kill almost 210 000.

With failure to produce an effective vaccine and with a virus untouched by anti-influenza drugs, an epidemic of the H5N1 avian influenza via person-to-person transmission could wreak havoc. With a probable 80 million disease episodes, a 20% mortality rate would result in 16 million deaths. The human tragedy and economic upheaval would be unprecedented.

Read The Full Story Here

The Final Mutation H5N1 Needs To Become Pandemic Ready

Researcher : The Public "Cannot Do Very Much" To Stop The Pandemic

Some more detail from the research released in early October that claimed to have identified the "key mutation" the H5N1 virus needs to undergo so that it could then "more easily infect and spread among humans".

The key to H5N1 turning into a pandemic ready virus is when it is able to infuse itself into cells in the upper respiratory tract, rather than in just the lungs. The closer the virus can form to the mouth, the more likely it is that it can be passed through close contact amongst people, or become airborne on droplets.

From CIDRAP :

The mutation consists of a single amino acid change...

The change promotes better viral replication at the lower temperatures found in the upper airways of mammals, the press release said. Once the H5N1 virus is established in the upper respiratory tract, infected patients can more easily spread the disease to others through coughing and sneezing, making the infection more contagious.

The authors write that the hemagglutinin protein's specificity for avian- or human-type receptors on airway cells is thought to be a major factor governing the efficient transmission of H5N1 viruses. Yet the disease still doesn't spread easily among humans, though scientists have isolated from humans some H5N1 viruses that had specificity for human receptors.

Kawaoka said in the UW-Madison press release that the H5N1 viruses circulating now are more "mammalian-like" than the ones that circulated in 1997, when the first human infections were identified.

"The viruses that are circulating in Africa and Europe are the ones closest to becoming a human virus," he said.

However, the researchers say in their report that additional genetic changes are probably needed to equip the H5N1 virus with full pandemic potential. "Indeed, multiple amino acid changes have been identified in the so-called Spanish influenza virus, which is thought to be derived from an avian antecedent," they write.

Kawaoka and his team believe it's only a matter of time before the H5N1 virus evolves into a strain that's capable of launching a pandemic, the UW-Madison release says.

"I don't like to scare the public, because they cannot do very much," Kawaoka was quoted as saying in a Reuters news report today. "But at the same time it is important to the scientific community to understand what is happening."

"The billion-dollar question is how many more changes are required and will H5N1 ever achieve this," he said. "We must plan as if it will."

Tamiflu Sales Plunge 60% - Drug Company Misses Profit Projections

Governments, Corporations Stockpiles Full

Roche Holding, as the parent company of Roche Pharmaceuticals, flooded the world with billions of dollars worth of Tamiflu in 2005 and 2006.

So widespread and influential was its marketing campaign for the anti-viral Tamiflu, off the back of very real concerns of a bird flu pandemic, that "government and corporation stockpiling plans (have) largely been completed." Roche now says "no significant new orders had been received."

Sales for Tamiflu fell some 60% for the third quarter.

Sounds like Roche will now have to announce a new kind of anti-viral, or alleged preventative, for dealing with the H5N1 virus in humans.

Another incredible fact gleamed from this story - in just nine months, Roche sold almost $30 billion worth of pharmaceutical products.

The Emergency Stockpile And 'Ready To Go' Kits

The Californian Department of Health Services has a 'bird flu battle plan', which you can view here. Of interest, are the preparedness steps the department is urging the public to take to deal with the outbreak of a bird flu pandemic.

We'll get to the home stockpiling in a moment, but a story on the report estimates some 35% of the US population could fall ill during a pandemic. That's more than 100 million Americans. Based on fatality rates for the infected in Indonesia, that rate of infection would result in more than 70 million dead. Even at a 50% fatality rate, some 50 million Americans would die.

If the Bush administration, and various state legislatures, really believe the pandemic is a coming reality, and it's clear that they do, it is no surprise then to see a huge state like California busily promoting the 'avoidance' measures of dealing with a pandemic. That is, stockpile food and supplies and stay in your home as much as possible until the pandemic passes.

The California Department of Health Services also pushes the prevention-as-cure angle, including :

Frequent, vigorous hand washing, an annual flu vaccine, covering your nose and mouth with coughing and sneezing and avoiding going into the public when you are sick are measures any responsible person should already take to ward off colds and the flu.

More here :

...official orders to stay at home could become a reality, even if you aren't infected. That will mean an emergency preparedness cache of supplies will be crucial.

"Social distancing measures such as wearing masks, staying home if sick, and canceling school and public events," could be necessary, says the CDHS report.

Given the unknown duration of a pandemic, you may need more than the typical three days of food and water and other supplies recommended in a basic emergency preparedness kit, as well as a host of other items.

The American Red Cross and the Federal Emergency Management Agency are now publishing and promoting the stockpiling of 'ready-to-go' kits.

Choose a large camping backpack, duffel back, or even a garbage bin on wheels. Put it somewhere you can easily access it, when you have to get moving fast.

The basics of what to put inside your 'ready-to-go' stockpile kit :

• One gallon of water per person per day.
• A three-day supply of nonperishable, compact, lightweight foods that require no refrigeration, preparation or cooking and little or no water. Pack a can of sterno for foods you must heat. Pack high energy foods, vitamins, food for infants and some comfort and stress foods.
• A first aid kit for your home and one for each car. The kit should at least include: sterile dressing, gauze, germicidal hand wipes or waterless alcohol-based hand sanitizer, medical grade non-latex gloves, adhesive tape, 2" width, anti-bacterial ointment, cold pack, scissors, tweezers, CPR breathing barrier, such as a face shield, non-prescription pain relievers, anti-diarrhea medication, antacid, Syrup of Ipecac, a laxative, activated charcoal.
• Mess kits, or paper cups, plates, and plastic utensils, an emergency preparedness manual, extra batteries for battery-operated devices including a radio, flashlight and other items, cash, travelers checks, change, utility knife with can opener, fire extinguisher, tube tent, hardware tools, water proofed matches, area map, signal flare, paper, pencils, whistle, and other items recommended by FEMA and the Red Cross.
• For sanitation you'll also need toilet paper, towelettes, Soap, liquid detergent, feminine supplies, plastic garbage bags and ties, a plastic bucket with tight lid, disinfectant, household bleach.
• Don't forget special items. A change of clothes, sturdy shoes or work boots, rain gear, sleeping gear, hats, gloves, etc.
• Personal items include baby items, prescription drugs, contact lenses or extra eye glasses, as well as games, books, small portable electronics, important family documents, records, numbers and identification, a household inventory and other items.

Clearly, the stockpile would serve equally well if you were forced to stay in your home for an extended period of time, though clearly you would need to add more water and food.

Indonesia : 12 Year Old Boy Dies From H5N1

88th Official Victim Of Bird Flu In Indonesia

The death rate in Indonesia seems to climbing again :

A 12-year-old Indonesian boy died of bird flu on Saturday, raising the toll in the nation worst affected by avian flu to 88, the health ministry said.

The boy, who tested positive for the H5N1 virus, died in a hospital here at 7:30 am (0030 GMT), said Nirwan, a staffer on duty at the Health Ministry's bird flu information centre.

"Medical doctors at the hospital were meeting to discuss his case, since he showed great improvement in his health condition, with his white-blood cell count rising, but the boy suddenly died at 7:30 this morning," said Nirwan.

Results of two tests on blood and saliva samples taken from the boy on Thursday showed he was infected by the deadly H5N1 strain, making him the country's 109th confirmed human bird flu infection case, of which 88 have died.

The boy, only identified by his initials IR, first showed symptoms of bird flu on September 30 but was only admitted to hospital in Tangerang, just west of here, on October 8.

"The boy had a history of contact with a dead infected chicken near his school," Nirwan said.

Banks, Financial Media Urge Public To Prepare For Pandemic Now

More than 2700 financial institutions, including banks and insurance agencies, are now deep into a three week long simulation exercise to see how well they cope in the event of a pandemic flu outbreak. The key idea being that even if there are hundreds of thousands of Americans dying from bird flu, banks and other financial institutions will have to be able to keep their businesses running.

Off the back of this exercise, influential finance website The Street has published an interesting and informative piece about how the average American can prepare for what most virologists now believe is inevitable. The advice proffered applies to people all over the world, not just in the United States :

You should spend some time considering all the things that you're going to need if a pandemic breaks out. You should stock up on things that you can buy now that will likely become more scarce if a pandemic begins -- such as surgical masks to help keep you from breathing in germs -- while there is a large supply.

You'll also want to make a list of things that you will want to stock up on right away when it appears an outbreak is taking place.

For example, ATMs may quickly run out of cash and with many workers calling in sick, may not be replenished.

Gas will also likely be hard to come by, as the people needed to refine and transport it to gas stations won't be available.

Also consider that you will need to change your habits during this time. You will not want to be in crowded places, meaning that you will want to keep shopping to a minimum.

You will need to make sure to thoroughly wash your hands several times a day -- which is a good habit to get into anyway.

If you have children, you need to come up with a plan on what to do with them. In the event of a pandemic, schools and day care centers are likely to shut down. Alternative day care will likely be difficult to find, meaning that unless you have created alternative plans ahead of time, you will likely find yourself staying home with them. You may want to set up a plan with a couple of friends, where you take turns taking care of the kids. By thinking through and creating a plan ahead of time, you will have a solution to this issue while others are scrambling.

If you have kids that get sick or you get sick yourself, it is likely that you will not be able to go into work for several weeks. You need to make sure that you have enough in your emergency fund if you are forced to stay home during this time.

More Essential Advice From The Street Can Be Read Here

H5N1 Mutates To Become Easier To Spread Human-To-Human

Some more on the new research that claims to have identified a mutation of the H5N1 avian flu virus, which allows it to grow and survive in the upper respiratory tracts of humans. Basically, this is bad news if the virus mutates further and reaches pandemic strength.

The new mutation discovery appears to suggest that the virus could be passed on the breath from human to human, and through saliva droplets from sneezes and coughs.

The Japanese and Vietnamese scientists who identified the new mutation said the potential for the H5N1 virus to effectively gain the ability to transmit human-to-human "is now evident."

The scientists fear the virus is only one mutation away from being able to cause a pandemic :

The group of nine scientific researchers, led by professor Yoshihiro Kawaoka of the University of Tokyo, also found that the virus can spread by coughing and sneezing, signaling a potential for human-to-human transmission.

"We believe another mutation may be necessary (for the virus) to cause a pandemic," Kawaoka said. "As more humans are infected, the greater the chance that the mutation will evolve."

The researchers compared two H5N1-type viruses extracted from the throat and lung of a patient in Vietnam in 2004. They infected a mouse with the virus, and found it tended to grow in the upper respiratory tract, including the throat and nose, where flu viruses usually enter.

Researchers also found that the temperature in these parts is about 33, lower than the average temperature of mammals, which is 37. This indicates that this particular mutation allows H5N1 to live in the human upper respiratory tracts that have cooler temperatures. Normally, bird flu does not grow well in the throat or nasal passages of humans.

Last year, Kawaoka and other scientists found another mutation, which allows the virus to infect people more easily, raising the expectation that these findings could help scientists to predict the emergence of new strains.

The world is not even close to being ready to deal with what may result from further mutations.

'Fast Track Funerals' To Become Norm In UK During Bird Flu Pandemic

Scots To Use Air-Conditioned Mobile 'Inflatable Tents' Instead Of 'Plague Pits' To Store The Dead

Scottish government officials seem to know almost exactly how many people will die in the coming bird flu pandemic. They've settled on a figure : 64,000 dead humans.

The government is also buying up "hundreds of inflatable body storage tents". These are likened to inflatable jumping castles, and will be air-conditioned to slow decomposition. Each 'tent' can store around 50 bodies, and will be 'mobile', meaning that these 'tents' can be dispatched to towns and cities and quickly inflated and made ready to take the dead off the streets and out of homes.

Preparations are also underway to shorten the average funeral service, so as to stop a massive logjam of funerals from building up, and worsening the trauma of friends and relatives of the dead.

In assessing the availability of funeral and mortuary services, Scottish officials found a "shortage of body storage space". The maximum available capacity to deal with the dead today in Scotland allows for only 2513 additional corpses, a shortfall of more than 63,000 'spaces'.

These kinds of stories of localized pandemic preparations, particularly stories about dealing with all the dead, are now regularly appearing in Sunday newspapers across the UK, the EU, Australia, Canada and the United States.

From Scotland On Sunday :

E-mail exchanges and letters reveal officials and police are impressed with a mobile "body storage system" made by Airegroup, for use in disasters. It has been used by the US military and uses a generator to keep bodies at a cool temperature so that they do not decompose.

Police and local authorities across Scotland have now been told to consider purchasing the equipment or consider taking part in trials of new prototypes so that they could purchase the equipment at a cheaper rate. The units cost around £10,000 and can store up to 50 bodies.

Another Scottish Government document states that relatives may have to hold shorter funerals because of the "rapid disposal of the dead".

Fast track funerals will become the norm.

Indonesia : Woman Dies Of Bird Flu

The steady tick over of human bird flu victims in Indonesia continues :

A woman thought to be suffering from bird flu died at the Arifin Achmad Regional General Hospital on Friday, an official said.

"The patient was treated in an isolation ward for bird flu patients at Arifin Achmad Regional General Hospital," Burhanudin Agung of the Riau provincial health office said.

Riau has recorded four bird flu cases since 2005, with three casualties.

The official toll of human bird flu deaths in Indonesia is now 87, though the unofficial toll is suspected to be much higher.

“We’re gonna tear up all these streets one day,” Johnny said, out of the blue. “We’re gonna give the city back to the earth.”

He explained how we could reintroduce mangroves around the edges of the harbour, to draw in fish and bird life, and how four block wide corridors could one day be bulldozed right through the city, “to give the competition some room to breathe.”


Go Here For More

Bird Flu 'One Mutation Away' From Becoming Ultra-Infectious To Humans

American researchers claim that the H5N1 is mutating into a far more dangerous, far more deadly virus. A crucial step in recombination remains before the bird flu virus can spread more easily amongst human populations.

From HealthDayNews :

...researchers led by University of Wisconsin-Madison virologist Yoshihiro Kawaoka have pinpointed a single change in a viral protein that helps H5N1 infect the cells of the upper respiratory system in mammals. The adaptation could enable the virus to infect a wider range of cell types and spread more easily among humans, the scientists said.

Being able to establish itself in the upper respiratory system enables easy transmission of the virus through coughing and sneezing, Kawaoka noted. However, other yet-to-be identified changes would have to occur before the H5N1 virus could potentially trigger a flu pandemic.

"The viruses that are in circulation now are much more mammalian-like than the ones circulating in 1997," Kawoka said in a prepared statement. "The viruses that are circulating in Africa and Europe are the ones closest to becoming a human virus."

H5N1 Has Spread To 60 Countries, Territories In Four Years

30 Countries Reported Infections In Past Year

Since highly pathogenic H5N1 appeared in Asia in 2003, the spread of the avian influenza virus has been far-reaching, and devastating to the poultry industry :

* Since the virus re-emerged in Asia in 2003, outbreaks have been confirmed in around 60 countries and territories, according to data from the World Organisation for Animal Health.

* More than 30 countries have reported outbreaks in the past year, in most cases involving wild birds such as swans.

* The virus has killed at least 201 people since 2003, according to the WHO. Countries with confirmed human deaths are: Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Laos, Nigeria, Thailand, Turkey and Vietnam.

* In total, the virus is known to have infected 329 people since 2003, according to the WHO. Many of the dead are children and young adults.

* The WHO says that Vietnam and Indonesia have the highest number of cases, accounting for 132 of the total deaths.

Widespread Use Of Tamiflu May Help H5N1 Become More Deadly, Infectious

The short version : Tamiflu passes through humans and into sewerage and water systems. Scientists are now concerned that Tamiflu could then leach back into areas where migrating birds sometimes gather and give the H5N1 virus more opportunity to meet its 'front line attacker' and learn how to beat it.

From news.com.au :

Tamiflu - the frontline weapon in any bird-flu pandemic - cannot be broken down by sewage systems and could help the virus mutate dangerously into a drug-resistant strain, Swedish scientists say.

Scientists led by Jerker Fick, a chemist at Umea University, tested the survivability of the Tamiflu molecule in water drawn from three phases in a typical sewage system.

The first was raw sewage water; the second was water that had been filtered and treated with chemicals; the third was water from "activated sludge," in which microbes are used to digest waste material.

Tamiflu's active ingredient survived all three processes, which means that it is released in the waste water leaving the plant.

The finding is important because of the risk that Tamiflu, if overprescribed, could end up in the wild in concentrations high enough to let H5N1 adapt to this key drug, the authors say.

Flu viruses are common among waterfowl, especially dabbling ducks such as mallards which often forage for food near sewage outlets.

"The biggest threat is that resistance will become common among low pathogenic influenza viruses carried by wild ducks," said co-author Bjoern Olsen, professor of infectious diseases at the University of Uppsala and University of Kalmar.

These avian viruses could then recombinate with ordinary human flu viruses, creating new strains that are resistant to Tamiflu, he said.

The story also includes interesting use from Japan about the long-term effects of using Tamiflu to fight the yearly round of influenza outbreaks. During the 2004-2005 influenza 'season' in Japan some 16 million fell ill. Six million were treated with Tamiflu.

The Japanese are now showing some of the highest rates of an "emerging resistance" to Tamiflu anywhere in the world.

Will Pandemic H5N1 Kill Humans In This Way?

1918 : The Horrifically Gruesome Death Of 'Spanish Flu' Victims

An horrifically gruesome, descriptive passage of what happens when a human dies from bird flu, from Michael Greger's extraordinary online book about H5N1, and the likelihood of a re-occurence of the 1918-1919 Spanish Flu pandemic :

What started for millions around the globe as muscle aches and a fever ended days later with many victims bleeding from their nostrils, ears, and eye sockets. Some bled inside their eyes; some bled around them. They vomited blood and coughed it up. Purple blood blisters appeared on their skin.

The Chief of the Medical Services, Major Walter V. Brem, described the horror at the time in the Journal of the American Medical Association. He wrote that “often blood was seen to gush from a patient’s nose and mouth.” In some cases, blood reportedly spurted with such force as to squirt several feet. “When pneumonia appeared,” Major Brem recounted, “the patients often spat quantities of almost pure blood.” They were bleeding into their lungs.

As victims struggled to clear their airways of the bloody froth that poured from their lungs, their bodies started to turn blue from the lack of oxygen, a condition known as violaceous heliotrope cyanosis. “They’re as blue as huckleberries and spitting blood,” one New York City physician told a colleague. U.S. Army medics noted that this was “not the dusky pallid blueness that one is accustomed to in failing pneumonia, but rather [a] deep blueness…an indigo blue color.” The hue was so dark that one physician confessed that “it is hard to distinguish the colored men from the white.” “It is only a matter of a few hours then until death comes,” recalled another physician, “and it is simply a struggle for air until they suffocate.” They drowned in their own bloody secretions.

“It wasn’t always that quick, either,” one historian adds. “And along the way, you had symptoms like fingers and genitals turning black, and people reporting being able to literally smell the body decaying before the patient died.” “When you’re ill like that you don’t care,” recalls one flu survivor, now 100 years old. “You don’t care if you live or die.”

Major Brem described an autopsy: “Frothy, bloody serum poured from the nose and mouth when the body was moved, or the head lowered…. Pus streamed from the trachea when the lungs were removed.” Fellow autopsy surgeons discussed what they called a “pathological nightmare,” with lungs up to six times their normal weight, looking “like melted red currant jelly.” An account published by the National Academies of Science describes the lungs taken from victims as “hideously transformed” from light, buoyant, air-filled structures to dense sacks of bloody fluid.

There was one autopsy finding physicians reported having never seen before. As people choked to death, violently coughing up as much as two pints of yellow-green pus per day, their lungs would sometimes burst internally, forcing air under pressure up underneath their skin. In the Proceedings of the Royal Society of Medicine, a British physician noted “one thing that I have never seen before—namely the occurrence of subcutaneous emphysema”—pockets of air accumulating just beneath the skin—“beginning in the neck and spreading sometimes over the whole body.”

These pockets of air leaking from ruptured lungs made patients crackle when they rolled onto their sides. In an unaired interview filmed for a PBS American Experience documentary on the 1918 pandemic, one Navy nurse compared the sound to a bowl of Rice Krispies. The memory of that sound—the sound of air bubbles moving under people’s skin—remained so vivid that for the rest of her life, she couldn’t be in a room with anyone eating that popping cereal.

There seems to be limited information, online at least, about whether the hundreds of people who have already died of bird flu suffered deaths in any way similar to those detailed above.

Indonesia Clocks Up 86th Human Bird Flu Death

From AFP :

A 21-year-old man from the Indonesian capital Jakarta died from bird flu last week, the health ministry said Monday, bringing the toll in the world's worst-affected nation to 86.

"This confirmed case puts the number now at 107 infected, including 86 dead," Ningrum, a doctor from Indonesia's bird flu information centre, told AFP.

The victim, identified only by the initials "AR", died on Friday at a hospital in West Jakarta, said Ningrum.

He had tested positive for the H5N1 virus in two separate tests, the requirement to be reported as a confirmed case in Indonesia.

The man first suffered flu-like symptoms 10 days earlier but was only admitted to hospital three days before he died, Ningrum said.

It was not known whether he had come into contact with infected poultry, the usual method of transmission, she added.

Has the total fatality rate for H5N1 been reduced in recent months. I thought it was up to about 92. Have to check the records.