Table of Contents:

Foreword

Introduction

I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken’s Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don’t Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse

Topics

References 1-3,199

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Practicing social distancing techniques not only protects you from the crowds, it protects the crowds from you. If one actually falls ill, the best thing to do from a public health standpoint may be to self-quarantine at home to prevent the spread of the virus.2630 Otherwise, you are visiting a potential death sentence on everyone you meet. The extreme lethality of the current strain of H5N1 may actually work in humanity’s favor—people may be so ill and succumb so quickly that they are unlikely to get out of bed and spread it to others outside their households. Experts expect the virus may ratchet down its lethality in the interest of being more effectively spread. Of course, if we do become infected, it may be a day or two before we know it, so all but essential personnel should consider preparing for a prolonged “snow emergency”-type isolation at home in the event of a pandemic.2631 Instead of a snow “day,” though, Osterholm compares it to preparing for a worldwide “12- to 18-month blizzard,”2632 although each wave may only last a matter of weeks in any particular locale.2633 Everyone should also begin getting into the habit of practicing what infectious control experts refer to as proper “respiratory etiquette.”2634

Most people know to cover their nose and mouth when they cough or sneeze, but most people are not doing it right. One should not cough or sneeze into one’s hand. The current thinking is one should only cough into the crook of the arm.2635 Covering our nose and mouth can somewhat limit the dispersal of contaminated respiratory droplets, but when we cough into our hand, it becomes coated with virus that can then be transferred to everything from elevator buttons and light switches to gas pump and toilet handles.2636 A recent study found that the virus could be recovered from more than 50% of common household and day care center surfaces during flu season.2637 This is not surprising, given that up to five infectious viral doses have been measured in every drop of nasal secretions.2638 Coughing into the inner elbow area of one’s arm or sleeve prevents the contamination of one’s hands.2639 This takes practice, so we should all start rehearsing now. The Mayo Clinic has a slogan: “The 10 worst sources of contagion are our fingers.”2640

Fomite is the technical term for a contaminated physical object, like the archetypal doorknob, that can transmit disease among people. It comes from the Latin fomes, meaning “tinder.”2641 This sparking of an infectious blaze can be prevented through disinfection. At room temperature and humidity, influenza virus can survive intact for up to 48 hours on nonporous surfaces like metal or plastic and up to 12 hours on cloth, paper, or tissues,2642 but can be killed easily with a simple solution of household bleach. One tablespoon of chlorine bleach mixed in a gallon of water is a potent disinfectant. This diluted bleach solution can be sprayed on potentially contaminated common surfaces and left to sit for at least five minutes. Frequently used but infrequently disinfected objects, such as refrigerator handles and phone receivers, should not be missed.2643 The bleach solution can also be used to wash contaminated clothes and bedding, as research has shown that a shaken contaminated blanket can release infectious viral particles into the environment.2644 It must be chlorine bleach, meaning it should contain a chlorine-based compound like sodium hypochlorite. So-called “color-safe” bleaches should not be used as disinfectants.

Wrapped in a stolen fatty coat from our cells, influenza viruses like H5N1 can lie in wait for days under the right conditions, patiently twiddling their thumbs until someone grasps the same doorknob. The virus still needs to bypass the skin barrier and find a way into the body, though. This is why we should get into the habit of avoiding touching our eyes, noses, and mouths whenever possible in public until we can wash or sanitize our hands.2645 The power of this simple intervention is illustrated by a study that showed that children aged four to eight taught to not touch their noses and eyes essentially halved their risk of contracting cold infections.2646 Although viruses like influenza can go airborne, studies of outbreaks at nursing homes suggest that this direct physical contact may play a significant role in its spread.2647