Table of Contents:



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


References 1-3,199

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Views on hand sanitation are evolving rapidly. The 2005 World Health Organization consensus recommendations favor the use of alcohol-based sanitizing rubs or gels over hand washing for routine hand disinfection throughout the day. Products containing between 60% and 80% alcohol were found more effective than soap in every scientific study available for review. Enveloped viruses such as influenza are especially susceptible to topical alcohol sanitizers. Alcohol solutions not only were found to be more effective at eliminating germs, but require less time and cause less irritation than hand washing. Hand washing still has a place when hands are dirty or visibly contaminated with bodily fluids like respiratory secretions or blood, but for routine decontamination, alcohol-based products are the preferred method for hand sanitation.2644

Alcohol gel sanitizers can be found in any drugstore, but given the recommended frequency of use (after every bathroom use, before food preparation, before touching eyes, nose, or mouth in public) these products can get expensive in volume. In the event of a pandemic, all available stock would presumably be sold out almost immediately. Good news: You can make a cheaper, more effective version at home.
Recipe for Alcohol Sanitizer Rub
4 cups 70% rubbing alcohol
4 teaspoons of glycerin

Mix to make approximately one quart (liter).
The glycerin acts as a humectant, or moisturizer.2665 Other moisturizers can be used, but glycerin is nontoxic, cheap, nonallergenic, and widely available. Vegetable glycerin can typically be found in natural food stores or online, and bulk rubbing alcohol can be found in drug stores in convenient 32-ounce (4-cup) bottles. During a pandemic crisis, all forms of alcohol are expected to sell out quickly, but made in advance this recipe could easily yield enough low-cost hand sanitizer solution for a whole neighborhood. Additionally, liquid alcohol sanitizer solutions have been found to be better at disinfecting hands than the alcohol gel products and can be just as conveniently stored in a small squirt bottles.2666

Rubbing alcohol can be acutely toxic if ingested.2667 Instead one can substitute a 140-proof scotch whisky. An additional advantage to using booze is that stockpiled liquor, along with cigarettes, gasoline, water, guns, canned vegetables and, oddly, cosmetics, has historically been among the most highly valued barter items in crisis situations.2668

Although there have been cases of serious alcohol intoxication in patients who drank bottles of alcohol sanitizer gel, only a negligible amount of alcohol is absorbed directly through the skin when properly used topically.2669 Alcohol gels and rubs are flammable, so they need to be kept away from flames and hot surfaces. There is one case in the medical literature of a U.S. health care worker who applied alcohol gel to her hands, immediately stripped off a polyester isolation gown, and touched a metal door before the alcohol had evaporated. The removal of the polyester gown created so much static electricity that an audible static spark was generated that ignited the unevaporated alcohol on her hands. This unlikely series of events can be avoided by rubbing one’s hands together upon application until the alcohol has evaporated completely.2670

In October 2005, a global campaign involving a dozen countries was organized to launch a secret weapon against bird flu: instructions to improve hand hygiene by urging people to wash their hands and carry around a small plastic bottle of alcohol sanitizer.2671 Similar education campaigns need to be spread worldwide, convincing people to increase their standard of hygiene to the highest possible level by practicing safe coughing and sneezing practices, and sanitizing their hands before touching their faces after contact with others or with public surfaces.2672 And if people ever needed another reason to quit smoking or avoid secondhand smoke, now is the time. Keeping the respiratory lining healthy can help prevent the H5N1 virus from taking hold. Everything we need to know to survive a pandemic we learned in kindergarten. “Adhering to simple measures,” said a state deputy health commissioner, “may mean the difference between life and death.”2673