*Avian Influenza (H5N1) Preparations*
By: Fairplay
25 February 2005

I am not a health care provider. As such I am ignorant of conventional wisdom regarding infectious disease control and cannot recommend any particular practice. I can provide my thoughts as related to preparation for a H5N1 pandemic and supply references that are readily available. I can envision teams forming to assist with care giving to those stricken ill. Even within a family there are things and important knowledge that can help improve survival odds. We may have to become our own doctors and hospitals. I am not suggesting that. Everyone should consult with their physician regarding any illness. I will rely on other members to help review this information and will not be offended at suggestions for revisions.


I have been reading a lot about the H5N1 flu variant and I have realized that if the pandemic becomes full blown that I need to be armed with knowledge and a plan. The information that is currently available is sketchy but I expect that will improve as we learn more about the modes of transmission of H5N1. It apparently is targeting the young at this time. Many of the preparations and supplies for NBC events are overlapping with preparations for a possible H5N1 pandemic.


What will life during a pandemic be like?

It is hard to say. I typically try to imagine worst case scenarios, hope for best case, and remind myself that the reality will probably be somewhere in the middle. What we can expect is a lot of sick people that will die. There will likely be massive disruptions in basic services as more and more people become sick. In earlier pandemics this century, as many as 25% - 30% of the population have fallen ill. Simplified, if you are in a line of people and you look to your left and then look to your right, one of you will likely become ill. Hospitals will not be able to deal with the massive numbers of sick people. I suspect that many people will be sent or will choose to remain home. Depending on the severity of localized epidemics it is possible that whole areas will be quarantined to stop the spread. Schools will be closed. Employers will tell their employees to not report. Store shelves will likely become wanting of goods as transportation and distribution is affected by quarantines and illness. It is likely that the number of dead will force public health officials to make difficult decisions about how to deal with the sheer number of bodies.


How many people will die?

It is impossible to predict because of the many complexities. Let us look at some numbers and history. The 1918 Spanish flu affected 25% - 30% of the population with the number dead estimated at as much as 40 million. This flu strain had a 1% mortality rate! The current H5N1 strain has a mortality rate approaching 70% - 75%! Let us try to apply that information to current populations to grasp the magnitude.


Current world population 6,420,873,910

X 0.25

Sick 1,605,218,478

X 0.70

Perish 1,123,652,934



Current US population 295,540,148

X 0.25

Sick 73,885,037

X 0.70

Perish 51,719,525


Of course these estimates fall short but I think you’ll agree that even a small percentage (best case) would be devastating. The medical care in 1918 was not what it is today. The mortalities in the current H5N1 epidemic have been based on their occurrence in countries with poor medical care as compared to western standards. On the other hand we travel more today which would mean a pandemic will possibly be very sudden seemingly without warning. In the past the second and third waves of a pandemic have been more virulent than the initial wave. Perhaps that will give additional time to create and distribute effective vaccines.


What is the H5N1 incubation period?

The median time between exposure and onset of disease is 3 days (range 2 to 4 days).


How is H5N1 transmitted?

Transmission is by fine droplets and aerosolized particles. Direct and indirect contact transmission is also generally recognized. This means that when caring for a person with H5N1 certain personal protective equipment should be used. The H5N1 virus is endemic in the wild bird population (especially ducks) of some Asian countries. If this were to occur here the feces from wild birds would represent a vector for transmission that would be difficult to avoid. The influenza A is rod shaped with protein strings. Particle size is about 0.1 microns.


How long is someone with H5N1 contagious?

The WHO is currently recommending that infection control practices for adults should remain in place for 7 days after the patient has no fever. For children younger than 12 years old infection control practices should remain in place for 21 days after the onset of the illness.


What kind of infection control practices should be used?

The patient with H5N1 should wear a surgical mask to reduce airborne droplets from exhalation, coughing, and sneezing. The patient should be isolated in a single room away from other family members. Ideally the room should provide access to a bathroom to minimize direct contact with other parts of the house. The care giver should wear a gown, N95 mask (an N100 Mask is preferred, but are more expensive), and eye protection. The door should be kept closed. Air flow should be negative pressurization, perhaps a Safe-Room "Fan In A Can" exhausting outside. Linens and contaminated clothing should be laundered promptly. Surfaces should be regularly disinfected. The care giver should thoroughly wash hands before and after any contact with patient and donning protective equipment.


Do you raise chickens, ducks, geese or other birds?

Currently rural subsistence farmers in Asia are the highest risk group. If the H5N1 pandemic pops it is possible that poultry could be infected here. This means renewed caution when handling raw meat and eggs (yes the virus has been detected in eggs). It is hypothesized that the captive tiger population in Thailand acquired H5N1 from raw poultry the big cats were fed. It appears the greatest risk is to those raising and slaughtering their birds. World Health Organization (WHO) is recommending protective clothing for poultry handlers in countries with H5N1 outbreaks. Cook all meat and eggs to reach 70C internal temperature. Take notice of sick birds and report to local health authorities.


Do you have extra N95 or N100 masks?

Stock up on some extra N95 or N100 masks. There will be shortages. A pandemic will necessitate wearing a mask when in contact with population and when providing care to a stricken family or team members.


Do you have extra surgical masks?

Stock up on some extra surgical masks. Patients with H5N1 virus should wear a surgical mask to reduce transmission of virus. Note that cases should NOT wear a mask with an exhalation valve because exhalations containing virus would not be contained.


Do you have extra isolation gowns, booties, and gloves?

Stock up on some. These will be needed for use by the caregivers and possible workers that have to deal with sick flocks of birds.


Is it the flu or a cold?

Prompt self diagnosis could be critical to appropriate treatment and reduce risk of transmission to others. Table 1 below summarizes some key indicators to help decide if you have the flu or just a cold. That said it is important to note that there have been several documented cases of H5N1 causing mortality in cases experiencing NO respiratory distress. In these cases the cause of death was attributed to organ failure suggesting that N5H1 operates by additional means.






High > 101F 3 or 4 days

Chest discomfort

Mild to moderate


Stuffy nose



Aches and pains


Usual, often severe




Tiredness weakness

Very slight

Can last 2 to 3 weeks




Extreme exhaustion


Early and prominent

Sore throat





Nonproductive can become severe


Can you take an antiviral?

Oseltamivir is being used to treat avian influenza and is being used as a prophylactic if given within 2 days of exposure. Investigate the product for contraindications at http://www.rocheusa.com/products/tamiflu/pi.pdf


Do you carry hand disinfectant and have extra?

Stock up on some extra. Carry a little bottle with you and use frequently when exposed to things that other people are touching. Avoid touching your mouth, eyes, and nose. In the absence of soap and water this can be an effective mean to clean your hands. 70% alcohol will also work.



Avian influenza: assessing the pandemic threat


WHO avian influenza


WHO interim recommendations for the protection of persons involved in the mass slaughter of animals potentially infected with highly pathogenic avian influenza viruses


Influenza A (H5N1) WHO Interim Infection Control Guidelines for Health Care Facilities


WHO Interim guidelines on clinical management of humans infected by influenza A (H5N1)


World population estimate


World population estimate 2


US population estimate


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