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This is another long blog, so prepare your posterior. I ask you to follow the story and be patient.

CIDRAP News has delivered another bang-up story on Panasonic's shocking decision to remove its foreign dependents and bring them home prior to the end of September.

I don't need to revisit the details: Just follow my blogsite, Crof's, FLA_MEDIC's, Zoe's, FluTrackers and Flu Wiki and about a million others. Here is the CIDRAP article, and then a Time Magazine story that I will interlace with current events. So settle back and enjoy.

Panasonic addresses speculation over employee pandemic order

Lisa Schnirring, Staff Writer

Feb 12, 2009 (CIDRAP News) – A spokesman for Panasonic Corp. said today that the company had no proprietary information about any increased risk of an influenza pandemic in December 2008 when it instructed some of its overseas employees to send their families back to Japan by September.

Jim Reilly, a Panasonic spokesman based in New York City, also denied speculation that the company ordered the families to return to Japan as a cost-saving measure to mitigate the effects of the global economic downturn.

However, he told CIDRAP News that the company realizes its move may seem unusual, given that they are the first major company to enact such a pandemic planning measure. "They realize that there are different perceptions around the world," Reilly said of Panasonic officials.

No change in pandemic risk
Masato Tashiro, MD, PhD, a virologist at Japan's National Institute of Infectious Diseases and a consultant to the World Health Organization (WHO), told CIDRAP News that he hasn't seen any increase in the global pandemic risk. "As far as I understand, the recent situation of poultry outbreaks and human infections in China is within our prediction," he said.

Panasonic said its request to the employees was based on a review of where the H5N1 virus has been detected and an assessment of medical facilities in the areas, according to previous reports.

The regions that were named align with its operational divisions, Reilly said. He reiterated that Japanese employees have been asked to return send their families back from Asia (except Singapore), China, the Middle East, Africa, the Commonwealth of Independent States (the former Soviet republic states), and Latin America. Divisions that aren't subject to the repatriation request include North America, Western Europe, and Oceania (Australia and New Zealand).

He said it was difficult to determine how many people are affected, but he said, for example, that Panasonic has 60 factories and about 100,000 employees in China. The company has 307,000 employees worldwide, including 13,500 in North America.

Panasonic gave the affected employee families several months to make their moving arrangements, because Japanese families aren't typically as mobile as those in other countries, Reilly said. Making new living and school arrangements might be more complicated and take longer, because families don't frequently make such adjustments.

Importance of business preparedness
One element of Japanese culture is that the country is very prepared to address natural disasters, Reilly said. "People from outside of Japan are always impressed when they see lots of information on what to do about earthquakes," he said, alluding to a 1995 earthquake centered in Kobe that killed nearly 6,500 people and one in 1923 that killed 140,000.

"Companies know the importance of continuing business," he said.

Japan's pandemic plan, posted on the health ministry's Web site, contains 14 pages of guidance on business preparedness. It urges employers to consider options for evacuating employees and their families assigned overseas in regions that experience pandemic outbreaks, minimizing travel to outbreak areas, and ensuring that returning employees and families follow quarantine guidelines.

William Raisch, executive director of the New York University International Center for Enterprise Preparedness, told CIDRAP News that Panasonic's action shows that some of the largest corporations still see a pandemic as a continuing and real threat.

"Further, this announcement by Panasonic indicates that they are actively monitoring the prevalence of bird flu and have begun to assess the capability and access to healthcare in key elements of their supply and distribution networks," said Raisch, who is an editorial board member of the CIDRAP Business Source.

Earlier this month, Japan's defense ministry said it had developed a plan to fly Japanese citizens in foreign lands home in government-chartered jets in the event of an influenza pandemic, the Yomiuri Shimbun, an English-language newspaper in Japan, reported on Feb 4.

Strict quarantine, mass cremation
The country's health ministry today announced some new details of its pandemic plan, which includes strict quarantine measures such as shutting down all but four airports and three ports, the Associated Press (AP) reported today. Other plans include closing schools and conducting mass cremation of pandemic flu fatalities.

The ministry said, "It is important to delay as much as possible the virus' entry through measures such as strengthening quarantine to take advantage of the special qualities of our nation as an island nation," according to the AP report.

Some pandemic flu experts have said that closing borders won't stem the spread of a pandemic virus and could hamper the flow of crucial supplies.

Health minister Yosuke Yamaki told the AP that Japan is updating its pandemic plan, based on public feedback collected in recent weeks.

As I mentioned, I see absolutely no coincidence between the Panasonic announcement/admission and the sudden fervor that the Japanese government has shown in upgrading and preparing its population for the management of a flu pandemic.

Now let's shift to Time Magazine, and its story on the sudden resurgence of H5N1 in the country of China:

Is China Making Its Bird Flu Outbreak Worse?

One thing is certain about avian influenza: it's deadly. Of the three people who contracted the H5N1 strain of the virus in China last year, three died. In the first six weeks of 2009, eight people have come down with bird flu and five have died. Another thing is that — while the disease has yet to go pandemic as many doctors fear it could — it remains worryingly persistent. Every year since 2003, about 100 people in Asia, the Middle East and Africa contract the disease. Last year, in a rare exception, the number dropped below 50.

But bird flu, it seems, is back. This year, China has already recorded eight human cases of the disease. Last month five people died in locations as far removed from each other as Beijing in the north, Xinjiang in the west, Guangxi in the south, Hunan in the center and Shandong in the east — and one of the highest tallies of bird flu deaths China has ever recorded in a month. "From a disease-control perspective, the increase in cases in China is notable — as is the wide geographic spread," says Dr. Hans Troedsson, the World Health Organization's representative in China. There is still no evidence that the virus has mutated to spread easily between humans, he says. But while such a nightmare scenario, which could set off a global flu pandemic that could kill millions, has shown no signs of being an immediate threat, serious concerns remain. "The fact that this is the highest number for a single month in China reminds us that the virus is entrenched and circulating in the environment," Troedsson says. See pictures of the resurgence of bird flu.(bold mine)

On Feb. 10, authorities in the far western region of Xinjiang culled more than 13,000 chickens in the city of Hotan after 519 died in a bird flu outbreak. But until this week China had reported no widespread outbreaks of the virus among bird populations, prompting concerns among some public health experts that mainland health and veterinary authorities could be missing — or even concealing — the spread of the disease through mainland poultry and wild birds. Hong Kong, "Hong Kong, where the first human cases of H5N1 infection were found in 1997, reported finding a dozen birds with the deadly strain of the virus earlier this year — a good indication that the virus is very likely present in adjacent Guangdong province. But so far Guangdong has reported no bird cases. Equally unusual is that after such a busy month of infections in China, reports of human cases have gone silent. "It's a surprise for me since in January the human cases, you have so many, but in February it suddenly stops," says Dr. Guan Yi, a virologist from the University of Hong Kong. Read "Is Hong Kong's Bird Flu Vaccine Failing?"

The human deaths in China, plus new outbreaks among poultry in neighboring Vietnam and northeast India indicate the likelihood of a firm presence of the virus on the mainland. Some experts worry that China could be missing the disease's deadly progression. Last week Dr. Lo Wing-Lok, an advisor on communicable diseases to the Hong Kong government, said the mainland had not been forthright about the spread of bird flu in poultry. "There's no doubt of an outbreak of bird flu in China, though the government hasn't admitted it," he told Bloomberg. Yu Kangzhen, the Ministry of Agriculture's chief veterinarian, responded in an interview with the state-run Xinhua news service that human bird flu cases are not necessarily linked with animal cases. Read about living with bird flu in Indonesia.

If mainland investigators are missing the virus, it may be because efforts to block it are inadvertently hiding it. China developed an avian influenza vaccine for poultry in 2005 and inoculates millions of birds annually. But not everyone agrees it's a panacea. In 2005 Dr Robert Webster, a influenza expert at St Jude's Children's Hospital in Memphis, Tennessee, suggested that China may have been using substandard vaccines that stopped symptoms of bird flu in poultry but allowed the virus to continue to spread. Recently, Guangzhou-based expert Zhong Nanshan has also said there is a danger that China's widespread vaccinations could conceal the virus. "Special attention should be paid to such animals, including those that have been vaccinated," Xinhua news service quoted him as saying on Feb. 6. "The existing vaccines can only reduce the amount of virus, rather than totally inactivating it."

Mainland controls may also be lacking another layer of more basic prevention in the way that live chicken markets, prevalent throughout Asia, are inspected. Some worry that Chinese monitors may only be calling for culls once a large number of poultry has become sick, as in the Hotan case this week in which 519 birds died. In contrast, last year Hong Kong culled thousands of birds after a regular inspection found only infected chickens in a wet market. The infected birds, experts say, showed no external signs of disease, and could have been missed if inspectors were only screening birds that were dead or visibly ill.

Ramping up preventative measures may increasingly be a matter of life and death. Since bird flu re-emerged in 2003, 254 people in 15 countries have died from it. Researchers now fear that other crises like global warming and the global recession have crowded the virus out of the news. But the disease survives — in the limelight or out of it. "The point is this virus has not disappeared at all," says Malik Peiris, a virologist at the University of Hong Kong. "It kind of dropped off the radar screen of media attention, but the virus itself has increased its spread. It's not only entrenched in Asia, the Middle East, in Egypt, Africa, parts of India and Bangladesh. It's really a problem."

This is the best digest of news written for the casual reader I have seen since 2006. It also mirrors the concerns I have raised for months and months now. The widespread cases of deaths are somehow reassuring to some, because to them it implies no H2H outbreak center. But to me, it implies the potential confirmation of Hope-Simpson's belief that pandemic influenza appears simultaneously all over the place, not just emanating from an isolated location. Avid readers of this blog know of my affinity toward Hope-Simpson's theories and life's work. And Hope-Simpson's theories may solve the one nagging and inconvenient question regarding previous pandemics -- namely, how did panflu reach out across oceans and mountain ranges simultaneously when it took weeks or even months for people to cross? That little question unravels almost all conventional theories of pandemic flu spread. As Sherlock Holmes said, "Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth."

So as late as the mid-1800s, it was impossible to cross the Atlantic, Pacific or the Eurasian continent and deposit flu virus in as many widespread places as were simultaneously experienced during pandemics. Migrating birds explain part of the story, but not the whole story.  Hope-Simpson believed that a single, simultaneous change in the virus became the tipping point and enabled influenza to cross over genetically to become a human pandemic.  Keep this in mind as you read on. From the English-language Vietnamese newspaper, the Saigon GP-Daily:

Illegal poultry slaughter, sales: HCMC fears bird flu epidemic

Veterinary workers fear Ho Chi Minh City could be hit by a bird flu epidemic since illegal slaughter and sales of poultry are rife in some districts and water fowls bred on small farms have not been vaccinated.

One of the poultry hotspots is Cau market on Quang Trung Street in Districts Go Vap and 11. It is a notorious wet market where poultry has been slaughtered illegally for many years, and it continues to flourish despite the bird flu scare.

Neither district has cleared it. A Go Vap official said sellers in the market flee to the other district when they see inspectors. Besides, he said, since most are migrants from other provinces, it is difficult to catch them.

The situation is similar at Tan Son market which is situated in both Districts 8 and Binh Chanh. The city’s Steering Board for Bird Flu Prevention is unhappy that district authorities have not closed down these illegal markets. The head of the city Department of Animal Health, Phan Xuan Thao, said the city faces the threat of bird flu from the widespread smuggling in of water fowls from neighboring provinces.

Nguyen Trung Tin, vice chairman of the city People’s Committee, expressed worry about a possible human bird flu epidemic. He said inspectors must be posted round the clock at “hot” spots to deal with violations, assisted by police officers. He warned officials in charge of preventing the disease that they would be taken to task if live poultry is found to be sold in their area by inspectors or the media.

The photo here is of confiscated poultry, illegally smuggled into a Ho Chi Minh City market.

I am going to proclaim something here, and for some it may be profound, and for others it may provoke a "DUH!" response.  Here we go:

I believe something has changed.  Not necessarily in the virus itself; it still has not "gone H2H."  But I do believe that the chickens themselves are adapting to the virus.  And once that happens, the virus must also adapt to find new hosts or it will perish.

There is absolutely no reason to believe that H5N1 is going to do anything but adapt.  This virus is amazing, even by influenza standards.  Now factor in the extreme and absolutely sudden number and geographic spread of human cases in China that we know of, and re-read the Time story.  Now also factor in the situation in eastern India, Bangladesh and Nepal.  Look at the new Vietnamese human cases and the continuing situation in Indonesia.

Here's what I think has happened:  H5N1 has won its latest battle with the human race and has completely overrun its defenses.  It has not won the war, but it is clear that it has completely  outmaneuvered every attempt by humans to thwart its advance.  But this latest victory may, eventually, be considered as the turning point in the war. 

Consider the circumstances.  The global economy is in shambles. Surveillance is about to become very lax and unaffordable.  Farmers are risking imprisonment and even execution by bringing in illegal poultry.  Culls cannot keep the virus out of any region. And now the chickens are not doing their duty and dying to warn us -- at least not according to the latest news coming out of China.

Open speculation from leading Chinese scientists regarding this "living chickens" theory leads me to believe that the government itself is stymied and this is how they are asking -- no, begging for outside help to solve the riddle.  This collective shrugging of scientific shoulders from a country that is welling with pride and also within a couple of years of putting a Chinese man on the surface of the Moon is very telling.

So let's review these signs and portents. 

Panasonic is not recanting its earlier plans; in fact, it is restating them and telling anyone who listens not to question their motives nor their methodology.

China has lost the handle on containing H5N1, according to the Time article.  And the widespread geographic location of human cases is not assuring; it is downright troubling (thank you, Time).

Vietnam has also lost the ability to rein in illegal smuggling of poultry, usually from China.

Chickens are not dying in certain areas of China.  But people are.

Human cases are abundant, compared to last year.

Pandemic money is in the US stimulus bill.  Of course there are skateboard parks and a quadrillion condoms, but the presence of panflu monies in both versions was eyebrow-raising.

And the British government recently announced plans to double its antiviral stockpile with Relenza, and not Tamiflu, as the antiviral centerpiece (as I have advocated for two years).

These signs and portents may be the first real indications that the Pandemic Doomsday Clock is ticking. The countdown may have begun, and the cumulative weight of these separate events may have convinced both the Japanese government and Panasonic executives that the countdown has indeed begun; that the clock is no longer stuck at five minutes to midnight; and that the first outbreaks of bona-fide, H2H2H2H avian influenza are just weeks or months away.

It may have also served to convince the Chinese government to lay in additional supplies of their human bird flu vaccine, although to be honest I would rather take my chances with the virus. 

We keep hearing  that the WHO and others are emphatically saying there is no need to raise the pandemic threat level and that there are no outward signs that the virus has mutated.  We don't know if this is true or not; not that we think anyone is lying, but it may take longer than a few days to look at the virus and make that pronouncement. 

But the WHO protocol for changing the threat level ignores the holistic situation and should force us to question if a change in the virus itself is the best/only way to proceed with moving from Phase 3 to Phase 4. 

Everyone needs to be renewed and refreshed and vigilant as heck right now.  And we need to find more signs and portents.  I am uncomfortably sure they are out there and will manifest themselves in due time.