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John Barry: The Pandemic Risk

How big a threat is it? How much should we worry?
Monday, July 30, 2018, 5:15 PM

As far as existential threats to the human species go, pandemics rank near the top of the list.

What's the probability of an agressive, highly-fatal outbreak occuring soon? Is it high enough to worry about?

And if one occurs, what can/should we do to protect ourselves and our loved ones?

To address these questions, we interview John M. Barry, author of the award-winning New York Times best-seller The Great Influenza: The Epic Story of the Deadliest Plague in History. John was the only non-scientist to serve on the US government's Infectious Disease Board of Experts and has served on advisory boards for MIT's Center for Engineering System Fundamentals and the Johns Hopkins Bloomberg School of Public Health. He has consulted on influenza preparedness and response to national security entities, the George W. Bush and Obama White Houses, state governments, and the private sector.

His verdict? The risk of a massively fatal world-wide pandemic like the 1918 Spanish flu is remote, but very real -- and is heightened by the hyper-connectedness of our modern society (i.e., the ease and speed with with people can travel). And our readiness for such an outbreak is woefully lacking:

An often-overlooked part of the damage a virulent pandemic can do is its impact on supply chains and the economy.

If you’ve got 20 to 30% of your air traffic controllers sick at the same time, what's that going to do to your economy?

Most of the power plants in the United States are still coal powered. They get their coal, most of them, from Wyoming. You see these enormous trains – that's a highly skilled position, the engineers who move those trains which are a mile and a half long. Suppose they're out. You're not going to have power in many of the power plants.

These are things that we don’t automatically think of as relating to a pandemic. Even a mild one that makes a lot of people sick without killing them will wreak an economic impact.

In terms of the health care system, practically all of the antibiotics are imported. If you interrupt those supply chains then you start getting people dying from diseases that are unrelated to influenza that they would otherwise survive. We had a small example of that with saline solutions bags which were produced in Puerto Rico. Because of the hurricane, Puerto Rico was no longer producing them; so we had tremendous shortages in those bages after the hurricane. Other suppliers worldwide have picked up the slack, so that's not a problem today.

But in a pandemic, you're going to have supply chain issues like that simultaneously all over the world. So you're not going to be able to call on any reserve, anywhere, because everybody's going to be in the same situation whether you talk about hypodermic needles or plastic gloves -- any of that stuff. The supply chain issues in a moderate pandemic are a real problem. If you’ve got a severe pandemic, the hospitals can't cope. There are many fewer hospital beds per capita than there used to be because everything has gotten more efficient. In this past year's bad influenza season, many, many hospitals around the country were so overwhelmed they all but closed their emergency rooms and weren't talking any more patients for any reason.

There's just no slack in the system. What efficiency does is eliminate as much as possible what's considered waste, but that waste is slack. And when you have a surge in something, you need that slack to take care of the surge. If I were grading generously I would give us a D in terms of overall preparedness. If we had a universal influenza vaccine, maybe we'd be relatively okay, but we don’t.

Click the play button below to listen to Chris' interview with John M. Barry (56m:47s).

Transcript: 

Transcript available shortly...

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9 Comments

davefairtex's picture
davefairtex
Status: Diamond Member (Offline)
Joined: Sep 3 2008
Posts: 5461
reducing severity of influenza with NAC

So I posted this a while back, but it might be relevant here.  In terms of "what can I do" to protect vs an influenza pandemic - and this applies especially for older people - there was a double blind placebo-controlled study done on influenza infection severity back in 1997 where half the study group was given 600 mg NAC, the other half, placebo.

Long story short, the NAC group got infected just like the placebo group, but 2/3rds of those infected just didn't notice, and the remaining group had symptoms that were about half as strong as the placebo group.

http://europepmc.org/articles/PMC1884975

NAC treatment was well tolerated and resulted in a significant decrease in the frequency of influenza-like episodes, severity, and length of time confined to bed. Both local and systemic symptoms were sharply and significantly reduced in the NAC group. Frequency of seroconversion towards A/H1N1 Singapore 6/86 influenza virus was similar in the two groups, but only 25% of virus-infected subjects under NAC treatment developed a symptomatic form, versus 79% in the placebo group. Evaluation of cell-mediated immunity showed a progressive, significant shift from anergy to normoergy following NAC treatment. Administration of N-acetylcysteine during the winter, thus, appears to provide a significant attenuation of influenza and influenza-like episodes, especially in elderly high-risk individuals. N-acetylcysteine did not prevent A/H1N1 virus influenza infection but significantly reduced the incidence of clinically apparent disease

 

The mechanism of action: NAC is a precursor required for the body to make glutathione.  When there is a bad outcome in a disease state, low glutathione usually accompanies it.  And as we get older, we make less glutathione.  Taking NAC raises the body's glutathione levels - other studies have shown that if older people take NAC, they can get their glutathione levels back to the 20s-30s age group.

My pandemic plan: use NAC; it won't protect me from infection, but my hope is that it might move me from the "people who died" group into "the survivors" group.  And of course there's the thought that I might actually have agency in such a situation probably helps out as well. 

Now hopefully all the real doctors here can chime in with their thoughts.  :)

sand_puppy's picture
sand_puppy
Status: Diamond Member (Offline)
Joined: Apr 13 2011
Posts: 1926
Flu in the crowded slums

I share DaveF's impression that excellent immune function is a main goal.  And will add that it is GOOD to be infected with the latest strand of communicable disease (but at a low dose).   An excellent immune function allows one to survive immune to that threat.    When a new variation of the virus comes around a few years later, partial immunity will already exist making that next infection milder as well.

In one of Isaac Asimov's space travel novels, the ship physician releases viruses into the ventilation system every Friday evening deliberately infecting the travelers to keep immune systems challenged and strong.

Can you imagine the devastating effects of a virus lose in one of the slums of Manila or Lagos?  Close proximity, inability to clean one's hands and feet, body to body touching, coughing in close spaces, feces and urine running in rivulets down the streets?

These pictures are taken from Pinterest "slums."

richcabot's picture
richcabot
Status: Silver Member (Offline)
Joined: Apr 5 2011
Posts: 193
Food

Having large food stocks reduces one of the main reasons to come in contact with large numbers of other people.  It would also mitigate the issue of reduced truck deliveries.

thatchmo's picture
thatchmo
Status: Gold Member (Offline)
Joined: Dec 14 2008
Posts: 461
Hand sanitizer?

I'm kinda guessin' those folks in the slum photos have some fairly robust immune systems....Aloha, Steve.

Uncletommy's picture
Uncletommy
Status: Platinum Member (Offline)
Joined: May 4 2014
Posts: 586
Globalization's achilles heel?

As for "food for thought", this was a real banquet. Chris, you packed a hell of a lot of stuff to consider in this interview. The speed and the "instanteous" nature of our world was brought home, BIG TIME! Our public epidemiological preparedness has always has always left me a little uneasy, especially, after knowing someone involved with the SARS outbreak some years ago. The world's supply-line dependency only confirms the importance of a resilient preparedness and response. Looking to government during these times is hollow comfort. While this site can be sometimes seen as "Cassandra-esque", it doesn't shy away from discussing real possibilities and the importance of these issues. Again, well done.

Uncletommy's picture
Uncletommy
Status: Platinum Member (Offline)
Joined: May 4 2014
Posts: 586
KugsCheese's picture
KugsCheese
Status: Diamond Member (Offline)
Joined: Jan 2 2010
Posts: 1449
Glutathione and Mold

CoreMed Science makes a Liposomal Glutathione in liquid and gel caps.  Removes biotoxins.   How about a podcast with Surviving Mold founder Dr Shoemaker?  

Humans also need viral substances to combat bacteria.   See this video 

There is so much humans don't know about ecological balance.  Be careful about eliminating influenza as it might be beneficial but we don't see it yet.   Educated guess: keeps innate immune system tuned up and eliminates the weak.   No free lunch.  

nedyne's picture
nedyne
Status: Bronze Member (Offline)
Joined: Jan 14 2012
Posts: 69
Respirator?

What is the best respirator to have in a pandemic? In the podcast they talk about N95 masks, but is that really the best one can aim for? Say if you just have to go out of the house.

I would assume Chris has already done the research, so I would greatly appreciate if he posted a link to the product he chose.

Carl's picture
Carl
Status: Member (Offline)
Joined: Jul 17 2008
Posts: 23
Transcript?

Is the transcript still being prepared?

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