Scott McPherson's Web Presence

As veteran readers of this Blogsite know by now, I am decidedly pessimistic about the ability of the Internet to stay viable during a severe influenza pandemic.  Not that I think the Internet will collapse, never to get off the canvas again.  Far from it: Recall that it was the US military that built the ARPANET, as it was called back then, designed to withstand several simultaneous nuclear explosions via its "node" concept. ARPANET became the Internet (sorry, Al), and it still retains its ability to be resilient. 

However, ARPANET did not have petabytes of pedophile photos, Internet porn, eBay auctions, pirate downloads of I Am Legend, illegal gambling, and YouTube videos to contend with like today's Internet does.  So I think the Internet will be resilient, just slow as molasses and not dependable enough to base an economy around without making some pretty serious first-amendment content filtering decisions during a pandemic.  If you search this Blogsite for "telecommuting," you will find my two previous entries on the topic. 

I wanted to offer a history lesson to show how a simple mistake can bring down an entire region's telecommunications grid and impact hundreds of millions in commerce and threaten public safety. Then I will talk about a marvelous article the Dean of Flublogia, Crawford Kilian, found yesterday.

It was June 18, 1996.  A network engineer with Netcom, a San Jose, California-based Internet Service Provider (ISP), was diligently working on configuring a Cisco router.  Cisco is the company whose routers and switches and wireless access points basically run the Internet.  In the course of configuring the aforementioned router, the engineer accidentally hit the ampersand (&) key on his computer -- and all Hell broke loose.  You see, Back in the Day, that little ampersand was to Cisco routers what the end of the tape meant to Mr. Phelps.  The command went downstream, as routers are designed to refresh commands down the line, and soon, the entire Netcom subscriber base of some 400,000 customers -- the entire San Francisco Bay area, basically -- was down for thirteen hours, all because the software that ran the routers became corrupted and incomprehensible.

That was twelve years ago, and many would argue there are multiple safeguards in place to prevent this from happening again.  I would agree that much has been done to block such mistakes in the future, but also look at the adoption of the Web since 1996.  If a similar mistake happened today, it would impact not just 400,000 people getting their email -- it would probably cost hundreds of millions -- if not billions -- of dollars in lost revenue, disrupted commerce, cancelled flights, and other problems.  An old archive of this history lesson can be found at: http://www.merit.edu/mail.archives/nanog/1996-07/msg00074.html.  The piece is written by none other than Bob Metcalfe himself.  Remember Bob whenever you go to your keyboard and assess the Internet; for Bob invented the Ethernet protocol that allows your PC to actually communicate with the rest of the world.

Human error is not confined to telecommunications.  As I mentioned in a blog a few weeks ago, here in sunny Florida, a fire at a Miami substation of Florida Power and Light wound up, via a major lapse in operator judgment, to bring down the Florida Grid for some 4 million customers.  A well-placed government source recently told me the problem was exacerbated when a veteran technician overruled a well-worn protocol and decided not to reroute power in a proven way.  The resulting cascading loss of power stranded hundreds in elevators and threatened public safety and transportation across most of Florida from Orlando south, on both coasts.  FPL does not like errors in judgment, because the Japanese might come along and take back the Deming that FPL won a couple of decades ago. 

So the Ampersand That Ate San Francisco can pop up at any time, anywhere, in varying disguises, because we humans are prone to making mistakes.

Complicating things is this new malady, called Internet Addiction.  Why this is a new malady is beyond me, for I have suffered from it for over fifteen years. As I promised a few paragraphs ago, Crawford Kilian, the Dean of Flublogia, has posted this article:  Add Internet addiction to psychiatric disorders, says doctor.  An excerpt:

Dr Jerald Block, the author of the editorial, points to both China and South Korea as nations that are more cognizant of the problem than the US. South Korea has seen a number of deaths at Internet cafes, and both China and South Korea consider internet addiction one of their more pressing public health concerns; an odd stance considering the much more palpable threats from emerging diseases such as avian flu and SARS. Nevertheless, there are recorded cases of people ignoring basic needs such as sleep or food in favor of lengthy sessions online, sometimes with fatal consequences.

I am aware of a few Asians who have died from lack of sleep/food/bathroom training when attempting some Internet gaming marathon, and that phenomenon is not limited to the Web, but covers all computer/console gaming in general.  Since so many people do their gaming online, however, it merits serious consideration.  My own stepson is constantly online, playing XBox Live with people from God knows where until the wee hours of the morning.  At age 22, he is the perfect example of someone who would spend much of his time online during a pandemic.  He already spends too much of his time online now!

Here's how it will work:  During a pandemic, stuff will break.  Stuff breaks now all the time, because all computer equipment is essentially mechanical in nature.  Bearings in cooling fans in computers, servers and routers seize and the equipment overheats and fails.  hard drives still fail.  So does memory.  During a pandemic, staff will be in short supply and stuff won't get fixed in the time frames that everyone enjoys today.  Service Level Agreements, or SLAs as we call them in the biz, will be thrown out the window. 

Next, the technician who comes to fix the stuff may or may not be a subject matter expert on the failed equipment.  Two days before, that person might be the office receptionist, given coveralls and pressed into service if, for no other reason, to satisfy that four-hour response time promised on the damned SLA.  That person may or may not be qualified to do what happens next:  The initiation of a diagnostic routine to determine what broke and why.  And The Ampersand lurks in the shadows like the monster in The Host, waiting for its next meal.

Now the final piece of the puzzle:  The Just-In-Time Supply Chain.  Computer and network equipment ain't made in Yonkers, folks.  Almost every single piece comes from Asia.  In a pandemic, Asia will be a little preoccupied, and despite the best intentions of the ChiComms and others to keep the containers sailing to America full of marketable goods, the pipeline will be squeezed to a trickle for weeks at a time.  That translates into a longer time frame to fix stuff, because it will take longer to get replacement stuff in.

I have had a personal conversation with none other than Michael Dell on this topic.  Dell's experience with SARS fuels its pandemic plans.  Michael Dell knows that a pandemic is the mortal enemy of his company, and his people are investing a lot of capital -- intellectual and otherwise -- on this topic.  Dell's entire corporate empire was built upon the rock of that JIT supply chain.  Only now, the rock is moving and the temblor is a potential pandemic.  I won't reveal Dell's plans other than to say he has one and he is banking a lot on it being successful.

So now you are home, trying to connect with the corporate mainframe while Junior is online, killing his buddies virtually.  Your connection is slow anyway, because everyone else in the neighborhood is trying to do the same thing.  Oh, I am sorry.  You thought that cable connection was a Home Run (as we call it) right back to Al Gore's Man Room?  Nope.  Think party line and you get the concept that a big pipe gets cut up into little pieces and the more people on The Pipe, the slower the speed.  And come to think of it, The Pipe may be a good metaphor for Internet addiction.

Suddenly, fifty miles away, The Ampersand lunges out and eats a technician's work.  Your connection goes dead and Junior says, "Hey, what's that out the window?"

You respond under your breath, "That's daylight, you dingbat." 

Speaking of The Host:  If you watch the film, look carefully for the bird flu diagram which is prominently displayed during one sequence.  You'll get a kick out of how they use it!

Last night, I got an email from my new blogger friend, Maryn McKenna.  When not working on her forthcoming book exposing MRSA's insidious traversing of the globe, she continues to write for CIDRAP. 

Anyway, Maryn sent Crof, FLA_MEDIC, SophiaZoe and I the same email.  FLA_MEDIC is currently unavailable, on double-secret probation assignment, SophiaZoe is still recovering from a corporate reorganization, and Crof has weighed in on the email's contents.  And now, so shall I.

Here's the skinny:  Last April, an Indonesian teenage girl contracted both H5N1 and H3N2 influenzas, according to Indonesian researchers who just reported the findings at the International Conference on Emerging Infectious Diseases.  The story can be read at: http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/mar1708coinfect.html

The story is being pooh-poohed by the Indonesian government, which would pooh-pooh an alien invasion even while Downtown Jakarta was levitated ten thousand feet into the air.  The (redesigned) Jakarta Post Website features the Indonesian rebuttal, courtesy of the capable journalist Emmy Fitri.  It can be found at: http://www.thejakartapost.com/news/2008/03/18/more-concern-over-bird-flu-virus.html

I was watching the new and incredible HBO miniseries John Adams last night as the superb actor Paul Giamatti (as John Adams) admonishes the jury during the trial of the British soldiers accused of the Boston Massacre deaths thus:  "Facts are stubborn things."

So let us look at the facts and then use some logic to pull them together.

FACT:  From January, 2007 until last month, Indonesia submitted a total of two H5N1 human samples to the WHO.  These samples were from Bali.

FACT:  In a sudden and stunning reversal, the Indonesian government last month decided to resume sending samples once again to the WHO -- even as the Health Minister and Princess of Insanity, Supari, insisted that the Americans were developing a bird flu Weapon of Mass Destruction.

FACT:  A teenage girl in April, 2007 developed a coinfection of H5N1 and H3N2, according to the research paper given at the Conference.  We do not know if a reassortant virus was formed.  And we are not sure which tests were reliable and which were not, as SophiaZoe pointed out to me today.  If coinfection happened, it means that by any statistical yardstick, it has to have happened elsewhere in Indonesia.  We're just not lucky enough (read: Surveillance is not holistic enough) to have found THE coinfection.

FACT:  The lack of virus sample sharing by the Indonesian government meant the world was unable to know precisely what had happened in the island nation, and when.

FACT:  In Rome, the FAO has publicly expressed grave concern about the emergence of new substrains of H5N1 in Indonesia.  The story can be found at: http://en.rian.ru/world/20080318/101628539.html . Please note this came from a Russian news wire service.  American wire services are still too busy attempting to find out which governor slept with whose wife's aide's Great Dane.

Now, if you will, some conclusions. Really, only one big conclusion.  I came to a similar conclusion a few weeks ago in my blog, Indonesia regains its national sanity, shares bird flu samples again.    We must assume that the Indonesians believe that statistically, coinfection has happened multiple times across the nation.  The fact this happened once --almost a year ago -- cannot be chalked up merely to dumb luck.  It probably means they realize that they cannot conduct accurate surveillance over a wide enough area to be effective.  Finally, the Indonesian government's petty footstomping regarding the sharing of virus samples -- aided by Iran and Venezuela, I might add -- means that the Indonesians themselves may be on their way to a viral WMD that will overwhelm the world.

I believe that in the realm of public health, there are no coincidences.  All the events I am about to mention below have happened in the past four weeks. 

1. The Indonesian government starts sending human H5N1 samples to the WHO again, ostensibly after receiving reassurances from the WHO that a vaccine sugar daddy has been found (bada-bing).  
2. The Indonesians reveal the first-ever recorded case of coinfection between H5N1 and H3N2 (bada-boom). 
3. The FAO announces in Rome that H5N1's eventual pandemic genesis may well be on Indonesian soil (bada-bang). 
4. And Bill Gates is set to travel to Indonesia in May, ostensibly to talk software. 

To quote the immortal Stan Lee: " 'Nuff Said!"

Coinfection has a one-year head start on the world's public health people.  If we have gone through coinfection without producing a pandemic strain, that does not mean it will not happen.  Quite possibly, the virus is still trying to reassort in such a way that it can produce virulence in humans.  Influenza is playing a Rubik's Cube game and it will surely (reas)sort itself out in due time.

Don't call me Shirley.  But let's also go the other way:  What if reassortment has already occurred, and what if H5N1 was not the immediate beneficiary?  What if it instead produced an H3N2 that was/is more powerful?  It is just conjecture, but let's follow the timeline.

And timelines here are important.  First, Teenage girl develops coinfection with H5N1 and H3N2 in April, 2007.  Next, Aussies travel to Bali in droves, as Bali is to Australians what Disney World is to people from Illinois.  Next, Australia types a new and more virulent substrain of H3N2, called Brisbane, in Summer, 2007.  Then, that same substrain moves to North America and Europe in 2007 and 2008.

Look at the quote from Emmy's article:

A virologist and microbiologist at Udayana University in Denpasar (Bali), I Gusti Ngurah Mahardhika, said the co-infection involving the girl most likely was not the first such case in Indonesia because researchers used to focus only on H5N1 and did not check for the presence of other H viruses. (bold mine)

"Global fear of a new virus from such a co-infection is well grounded, I think. The product of a reassortment between H5N1 and H3N2 can be still in the form of H5N1 but with traits of H3N2. The new H5N1 is virulent and has the capacity to transmit from human to human like H3N2, our seasonal flu virus," he said.

Only after looking at the genetic makeup of A/H3N2 Brisbane will we know if it acquired any Indonesian H5N1 human polymorphisms.  But in light of this latest peer-reviewed, scientific paper, and considering where and when H3N2 Brisbane came from -- I think it is worth a serious look.  Don't you?

Because facts are stubborn things, indeed. 

The news over the weekend was mixed for Scotland.  The bird flu scare reported just before the weekend has apparently proven negative, and the farm in question is set to re-open.

But as the bird flu scare ebbs, another, even more potentially frightening scare takes its place on the Scottish anxiety meter.  In a BBC story that went online over the weekend, a primary school in Dowanhill has become a potential battleground in the fight against tuberculosis.  A teacher has come down with the disease; a student may also have contracted TB; and some 20 schoolchildren have tested positive in "scratch tests" for TB.  Read the story carefully and note that positive TB results are not uncommon. 

Thanks to Flutrackers.com and poster ironorehopper for the info.

The city fathers in the Greater Orlando area are not happy with the headlines being banged out at this hour.   Seems a hotel in the heart of Tourist Country -- that would be the area along and bordering the nefarious International Drive, or I-Drive for survivors of Disney, Sea World and Universal -- has sickened at least two vacationers with none other than Legionnaires' Disease.   

Legionnaires' Disease was first typed in Philadelphia in 1976.  An American Legion convention drew more than just veterans to a downtown hotel.  It also brought a novel bacteria that sickened hundreds and killed 34 (http://www.mayoclinic.com/health/legionnaires-disease/DS00853 ).  The bacteria was not isolated until several months later.

The significance of the initial outbreak of Legionnaires' is that it came at the exact same time that the Ford Administration was trying to move the H1H1 "Swine Flu" vaccine program through the Congress.  The issue was wrapped around the axle of giving vaccine manufacturers a waiver of liability for the vaccination program.  The bill was stalled until the Philadelphia deaths occurred.  Worried Congressmen and -women, thinking that Swine Flu had inddeed started,  moved with rare and uncharacteristic swiftness to immunize vaccine companies from lawsuits.  The rest, as they say, is history.

Even though Legionnaires' Disease is not that rare any more (another example of the New Normal), the name still conjures up ghastly images.  So when the hotel in question discovered it need to be treated, and guests had to be moved RIGHT NOW, the issue got the attention of the local media.

ORANGE COUNTY, Fla. -- A hotel located in the tourist corridor of Orlando voluntarily closed its doors on Friday after two guests contracted Legionnaires' disease, a respiratory illness that can be fatal.

 

Guests at the Quality Suites, located at 7400 Canada Ave. near International Drive in Orlando, have been relocated because of the incident, although Orange County Health Department spokesman Dane Weister said there are no further reported cases of the disease.

 

The hotel may be closed for about two weeks.

 

No information about the two guests, including names, ages and whether they are related, was released.

 

The health department is conducting an investigation into numerous possible sources to determine the cause of exposure.

 

Legionnaires' disease is caused by the Legionella bacteria that can be found naturally and anywhere in the environment. The bacteria grow best in warm water, like the kind found in hot tubs, cooling towers, hot water tanks, large plumbing systems or parts of the air-conditioning systems of large buildings.

 

Symptoms include headaches, loss of appetite, aches, pains, fever and coughing. The disease is treated with antibiotics. Symptoms can begin between two to 10 days after contracting the bacteria.

Legionnaires' disease causes death in up to 5 to 30 percent of cases, health officials said.

http://www.local6.com/health/15595503/detail.html

Lampung, a province at the southern tip of the Indonesian island of Sumatra, is currently at the center of a lot of intense speculation today.  That is because the intrepid bloggers/posters/lay translators at the various flu sites have identified a growing number of suspected H5N1 human cases that have not, as of yet, been picked up by the local media.  But in the aggregate, these reports taken as one signify yet another possible human bird flu cluster on Sumatra.

I want to note the excellent work veteran poster MomCares has done over at www.Curevents.com to put a timeframe together regarding the Lampung situation.  Here it is:

Timeline – Pangang, Lampung

2/5 – chickens (as many as 45) began dying suddenly in Batu Suluh Village, Kelurahan Way Laga

3/9 – Some villagers start experiencing symptoms, including high fever, breathless, coughs, and bloody nose. Imas and Sanpidi’s symptoms start after eating a sick chicken that had died.

3/11(?) – Santibi {Sanpidi} (43) and his child Imas Supriana (10), go to the Waylaga Panjang Community Health Centre.

3/12 – Santibi and Imas transferred to RSU Abdul Moeloek (RSUAM).

Officials of the Panjang Community Health Centre pick up 8 more suspects from their homes in an ambulence.

They were Imas's (10) two brothers Adi Sutihat {Tihat} (8 ) and Ahmad Dani (8 months); a father and the child, Nurdin (52) and Hariyanto {Ariyanto} (11); afterwards Aminah (20), Febi {Fedi, Fitri} (2), Karniti {Aniti} (42), and Lala {Lola}) (20).

All of them are given Tamiflu at the community health centre -- except Karniti and Lala -- who refused to be taken to the hospital and immediately came home.

The remaining 6 are taken to RSUAM (for a total of 8 suspects in hospital).

3/12 evening -- Sanpidi and Imas bolted from the hospital at around 21,30, apparently because of money concerns, plus they weren’t immediately treated.

3/13 morning – Officials from the Community Health Centre picked up Sanpidi and Imas and returned them to the hospital, assuring them that the cost of care would be borne by the regional government.

3/14 -- Two suspects, Lola (2) and Karnati (52) test positive on VCR.

3/14 -- D {Bayu} (22), a new suspect from Rajabasa Subdistrict, is brought to RSUAM.


SUMMARY of LAMPUNG SUSPECTS, in RSUAM intensive care

1) Sanpidi (43M)
2) Imas (10M), son of Sanpidi
3) Adi Sutihat (8M), son of Sanpidi
4) Dani (8 months), son of Sanpidi

5) Nurdin (52M)
6) Hariyanto (11M), son of Nurdin

7) Aminah (20)
8) Fedi (2)
9) Aniti {Karniti} (42) -- TESTED POSITIVE on VCR
10) Lala {Lola) (20) -- TESTED POSITIVE on VCR

11) D {Bayu} (22)

So to recap, we seem to have some eleven suspected cases, and the local press is reporting that two cases have positive field tests. 

Machine translation, as the dean of flu bloggers Crof points out, is a hit-or-miss proposition.  Inflections are lost when the machines try to talk to each other and convert languages.  The syntax jumbles and one has to look at several sentences together, in order to deconstruct and then reconstruct intent and true meaning.

But there are some cases where the facts shine through the language barriers.  In the Internet age, and specifically in what we IT pros call the Web 2.0 age, collaboration becomes the norm.  So it is that on flu sites such as FluTrackers, CurEvents and Flu Wiki, and/or via email, multiple posters can come together and work collaboratively on a translation, or on research, or just to joke around and stay in contact (Crof and FLA_MEDIC, howdy) and compare notes.

In my own opinion, this collaboration will be how we unearth the Next Pandemic.  It is precisely this kind of cooperation, across the globe, spanning multiple national borders, mountain ranges, and entire oceans, that will help discover Cluster Zero.  Cluster Zero may start in a region of the world that is only covered by regional newspapers printed in Malay, or Arabic, or Hausa, or Chinese.  Or maybe a brave blogger will come up for air and alert the world as to what is happening On The Ground in their province.  But the bloggers and posters will find him or her, or will find the note in the regional press and translate it and tell the world what seems to be going on.

As we all know, the Mainstream Media reads blogs, and our ambassadors are more and more frequently asked to participate in Mainstream Media events regarding bird flu in this country and abroad.  The bloggers and, more importantly, the posters themselves are, in my opinion, just as important to global surveillance on H5N1 as the field WHO and OIE reps who constantly move from village to village, looking for the Next Big Bug.

Twenty-first century flusite posters and translators are to disease what the civilian "skywatcher" program was to World War II   They are the volunteers who constantly and relentlessly watch the global press for any indication that the conditions have changed, the H5N1 virus has mutated, and the countdown has begun.  They are looking for that virus "silhouette" that matches the outline of the enemy.  This time, the silhouette is too small to see.  But it is there.

These posters and bloggers also help ensure transparency of the public health system.  What worries me almost as much as an outbreak of human H5N1 is the certainty that when and how an announcement will be made will become, at its essence, a political decision.  Precious time may be lost while decision-makers debate how to best "spin" the bad news.  We frequently see lapses in H5N1 risk communication big enough to drive a Humvee through.  If something happens somewhere and we are among the first to know, we don't go off half-cocked.  In the military vernacular, we "lean our men forward" and wait.  But we wait prepared and aware of the situation, so as not to be caught off-guard.

So while we look at Lampung and wait for more news, raise a glass to those who take the time to do all this translation, research and grunt work.  Without them, this would be a pretty bland blogsite.  Thanks, gang.