For the epi-geeks in the audience, there's a pretty good discussion on the Effect Measure blog, particularly on the issue of whether closing airports and borders would be dumb or effective at this point. There's also some discussion of whether airplane ventilation systems deserve more regulation to prevent disease transmission.

The most intriguing comment on this blog comes from a Dr. Grattan Woodson, an Atlanta physician who's written a book on how people can prepare for a catastrophic outbreak of avian influenza. Here's his three scenarios:

My current view is that there are three reasonable probabilities of how this outbreak may play out.

#1: The outbreak spreads widely around to globe but self-terminates due to the onset of summer weather in the Northern Hemisphere (although the Southern Hemisphere is now entering fall!). The virus would then re-emerge in the NH fall as occurred in Sep 1918.

#2: The virus defies the usual seasonality seen with ordinary flu and goes pandemic worldwide right away. Non-seasonality was a feature of the Spanish Flu pandemic.

#3: The virus outbreak peaks shortly without spreading very far and simply goes away never causing a pandemic.

Of the three, I think #1 is most likely with #2 beginning possible and #3 being most unlikely.

If the pattern suggested in #1 does occur, what can we expect?

The CDC has the new H1N1 sequence and is currently trying to decide how to develop it into a vaccine. Obviously, if we go the egg route, we will not get any doses before October. This will be too little vaccine available too late to contain the pandemic re-emergence. What would be really a heroic move by the US DHHS would be to go ahead an allow production of vaccine by several of the new methods using cell culture and other innovative techniques currently under development. These early stage methods have the potential to produce vaccine in less than half the time compared with using fertilized chicken eggs and can be scaled up to produce exponentially larger quantities of vaccine. Given the current state of pandemic risk, I sincerely hope they support this approach.

If #2 occurs, then most will be caught flat footed since it will become very difficult to prepare as the panicked public rapidly deplete stocks of commodities useful for pandemic survival as well as regularly needed food and medicine. Most people take for granted that there will always be an abundance of food on the grocery store shelves. Our old nemesis, Just In Time Inventory Management will result in empty store shelves causing more panic even though food is still being produced and in a full pipeline to retailers every day. Panic buying though could keep store shelves relatively empty due to public hoarding. The risk for civil disorder would rise dramatically as a result of the public's concern about both the pandemic as well as their perception of widespread food shortages whether true or false.

Obviously we can all pray for scenario #3 despite its relative improbability. One good result of this is it could serve as a wake up call for our leaders and public but OTOH it might also be seen as another pandemic false alarm that increases complacency even more than has been present over the past two years.

Forbes has a piece on how poorly prepared the US is for pandemics, citing recent investigations by the GAO.

LA Times has a story on what the last great swine flu epidemic was like (in 1976).

Grist.org has a story that raises the question whether the outbreak could be traced to a US agribusiness' pig farm in Mexico.