User:LucasG/PanFlu

Severe respiratory pandemic - What to do now (personal notes)[edit | edit source]

A respiratory pandemic is the introduction of a virus into the human population (8 thousand million people in around 200 countries), such that it's as easily transmissible as seasonal "Winter" flu. The new virus can happen via mutation of a flu virus previously adapted to animals, or via the reassortment of that virus with a virus already adapted to humans.

Pandemics have happened in the past, and we need to assume that they will happen in the future. As of now we cannot predict which virus (there are candidates like H5N1 "bird flu", but also others), when, or how lethal. Therefore, for planning and preparedness purposes, we must assume a variety of scenarios. The full range of scenarios must include the "soon and bad" scenario, which is the specific focus of this page.

What do I mean by "Severe"[edit | edit source]

Pandemics vary greatly in severity. Many people may have forgotten the 2009 flu. Covid is harder to forget, though we would all love to.

"Severe" refers to the potential of such a pandemic to cause many deaths, severe disease, and intense self-amplified disruption in societies' vital and important systems. (Some people talk about pandemics being "3D": disease, death, disruption.) Disruption comes from other people’s death and disease: you have a heart attack but your doctor, or her child, are too ill to work - or worse. Disruption also comes from disorganised prevention: "no way I'm going to go to work, catch that and pass it on to my family". It can also be compounded: the surgeon is available but the anesthesist, or the hospital pharmacist, aren't. In complex systems, and the world is one, different effects have the potential to propagate and amplify themselves and each other.

The combined impact is really a function of two factors: the biological severity of the virus in humans (how many people are ill, severely ill, chronically ill and die, per age group and per previous health status) and the societal responses (prevention, treatment, and coping with the direct and indirect consequences of such a pandemic). A terrible virus with a perfect society would do little harm, as we would just stop it. A mediocre virus with an incapable society could do lots of harm. (More than covid? Yes. That's exactly what this page is about.) We can try, and should if we can, stop viruses before they become pandemic (the US is not doing too well at the moment, and that's probably the case in other countries), but it's wise to assume that at some point in the future one of the candidates will get through, and we that's why need to look at our response.

To make the impact more imaginable, in this page we use the following parameters, which again are a scenario, not a prediction:

• Virus, H5N1 capable of human-to-human transmission, as transmissible as common flu.
• 10% of those who catch the disease, including those previously young and healthy, and including children, die within the first few weeks of catching the disease. (You can choose different numbers, and ages most affected, as long as it gives you the hunch that disruption would have the potential to cause as many deaths as the virus, if not more. Resiliencemaps.org/files/fluscim has a spreadsheet for anyone who wishes to "wargame" this.)
• Response, in this scenario, is roughly as globally coordinated and locally effective as we have seen with covid so far (i.e., not much, in general), but the biological impact is an order of magnitude greater, and the potential overall impact is way greater because of the disruption of vital systems, and because of the self-amplification of said disruption.
• We haven't invented any new miraculous technology: we have exactly the resources we have today.
• We have applied existing technology in current small to medium ways.

What do I mean by "Soon"[edit | edit source]

Probability can be thought of in two time frames. In the long term (say a decade or several decades), probability appears high enough to take some action in preparing our species' responses, such that planners refer to it as "when, not if". In the shorter term, point probability, "how likely is it in a given day, week, month, or year", appears to be unknowable but certainly higher than zero.

Thinking it could happen "at some point" may make us believe we may have plenty of time. Thinking it could happen "now" may make us believe we may have no time at all. Both are obviously part of why it's so hard to plan effectively: it feels like getting ready for olympic games... but with no fixed, known, predictable date. It is probably more useful to think of scenarios: what would we do if we knew it were to start in, say, exactly one week, one month, one year or one decade?

This page assumes it starts today or very soon (again as a scenario and not as a prediction), and certainly before we have developed and applied all these amazing technologies that we know exist - and which we have but in small scale. But "soon" could also mean "in 5 or 15 years" if our preparedness doesn't speed up.

What are we doing and not doing about it[edit | edit source]

The full set of cognitive and practical responses that we see playing out around the H5N1 threat happening in 2024 (I write this in the northern Summer) includes several attitudes:

• With regards to probabilities, some say there's no risk at all of a severe pandemic, while some assume it's already happening. Many look at all pandemics, in general, without distinction for severity.
• With regards to what causes pandemics, some say it's obviously intentional or accidental from careless behaviour or risky experiments, while some say they are natural occurrences.
• With regards to who should prepare, most say it's national governments (Member States of the United Nations) and the World Health Organisation, and both WHO and State Members have plans, that may be badly outdated, and preparedness, that it probably very uneven across the world. Some add that people who keep factory farms should just stop doing it. In the USA, we see the dysfunction of individual States having some priorities, the Federal level having others, and important things (for experts) not getting done, or getting done but not fast enough. A few people ("preppers") give up on governments and stock up on medication, food, and "gear" of various kinds.
• With regards to who is it that we should protect, people often think of the vulnerable, healthcare workers, their country, etc.
• With regards to what to do now, people (including experts) tend to look at what they can personally do, and say that it's that what needs more muscle. For example, vaccine people say we need to focus on vaccines, which leaves the rest of us with the gap of "what are we going to do before vaccines are available". Experts in different technologies say we need to increase those technologies. All of this is obviously excellent, but it's also not enough at all.
• Many say we can't do any of that because we're still in a pandemic, because covid hasn't gone away and it's still producing variants and long-covid. This is true (I think), and that truth exists in parallel with everything else.

What do I suggest we do[edit | edit source]

My (not so humble) opinion is that we need to do scenarios including the "bad soon". (Regarding humility, should I give my credentials? Nah. Either these notions make sense to people, or they don't. And in the face of "Soon and Bad" we're all tiny, anyway.)

I see the bad (people are tired and in denial, we have lots of long-covid which would be an extra problem, we don’t trust governance or even public health, etc) but I also see the good (more people know about aerosols, we have the internet, etc). We need to be a bit more optimistic, proactive, effective. I believe it's conceivable that we could tip the balance substantially.

I believe that the origin could be any combination of Nature and Humans (gain of function, mistakes, slow or ineffective response), but the fact is we need to prepare anyway.

I believe that there's room for protecting the whole of humanity, because we depend on each other, because all children are our children (genetically close to 100%, I think), and because for respiratory viruses we're actually one big multicellular organism (they go from cell to cell in one body or, they don't care, the bodies of the whole of humanity)... except that the global immune system is patchy at best.

Finally, I think that there's lots we can do, if we take the minimax approach - what is the minimum practical set of actions, carried out as soon as possible and by the minimum set of people in loose cooperation, that will provide the most respiratory protection and the most resilience protection for most people - all of which buys time to do the other very important jobs (say clean air in all schools, reversing climate change, de-escalating all wars, or whatever else).

So, because I think it's needed and possible, I'm giving it a go - part time, as all of us do.

Anticipating and improving our reactions[edit | edit source]

If the described scenario were to unfold within the next week, what response should we anticipate? What could be improved?

The anticipated response would possibly include intense reactions in everyone, including those directly involved in governance, science and public communication. Those reactions would be primarily emotional (fear, anger) and secondarily cognitive (white noise, denial, racing thoughts, dissociation). Actions would probably be fast, related to individual perceptions of what's going on and of what are the priorities. They would be highly uncoordinated and, ultimately, ineffective in stopping the virus.

What could be improved? We can think of two main directions: ways to stop the virus without stopping societies' vital functions, and coordination. Doing both in real time, in the suggested time frame, can be thought of as an impossible task. This page has the purpose of inviting the reader to temporarily put emotional responses aside, to abandon thinking in terms of point probability ("how likely is is in the short term?"), and, instead, consider minimal actions that could be done now, to help us in that scenario.

For the purposes of this page, the scenario is a biologically capable virus in today's real societies. You're kindly invited to give yourself some time (maybe with friends and colleagues), note some of the details that you'd anticipate, then remind yourselves that "it's just a scenario", and finally get to work.

Stopping the virus without stopping vital activities using mini-max improvements[edit | edit source]

The immediately visible priority is to stop the virus as much as possible, avoiding infections, using what we have now in practical ways, and also whatever we can generate quickly in the moment. Thinking about it with some anticipation (now) is similar to nailing an "EXIT" sign on some of the doors of a theater. We have the same number of doors, but if the need suddenly arises we can use the existing doors in a wiser way.

The specific goals would include: reducing respiratory contacts as much as possible (with minimal impact on vital functions), and protecting the respiratory contacts that we cannot or prefer not to avoid, all of this for as high a percentage of the human population as possible.

Resources would include: present capacity to educate rapidly, present capacity to produce masks, and present computer and communications infrastructure. There are many more resources that become visible when we think of practical steps.

Details:

• It's quite likely that the single most important element in the response is education about several important aspects:
  • Flu is transmitted mainly through aerosols, probably most of the times in short range (badly ventilated rooms).
  • It is transmitted in important proportion from people who have no symptoms, either because the are pre-symptomatic (they will have symptoms, later) or a-symptomatic (they have the infection and they can pass it on, but they themselves have no symptoms or only very mild symptoms that allow them to do normal life and therefore be around others - if you want to use technical terms, "only very mild symptoms" is "pauci-symptomatic" from the Latin word that means "few").
  • Epidemics have "yugulars": there are points of amplification that, if we act on them, the rest of the society can be protected. As an example, if (seasonal) flu was reduced in schools, less grandparents would catch it, or at least they would catch it less often.
  • We all depend on each other, really. This is not viral education but systemic education.
  • Are there more "important education points"? Better phrasing for them?
• Masks work if they are available, if have good surface and good edge/fit, and if enough number of people use them well enough in enough appropriate settings. If these parameters are not just good enough but excellent, then they can work extremely well.
  • For surgical masks, the bare minimum, useful for many, would be to use ways to improve the fit: see Aerosol_pandemic/Adjusters. I don't know of a clear winning design that meets all the requirements for good fit, ease of donning and doffing, ease of manufacture or DIY, etc. There's a case for giving this component of the solution a good push. I don't know if there is a case for making the material available in raw format, so that bigger masks can be manufactured for different adjuster designs. If the material were recyclable, that would be very good.
  • Disposable respirators are better than surgical masks, but the capacity to make them in enough numbers for a sustained period relies on a manufacturing base that would take some time to set up. Probably doable, but not instantaneous. It would also be succeptible to disruption in manufacturing and distribution. Experts in making and testing masks, and people with experience using them, have determined many possible improvements: breathing more easily, understanding speech, lip-reading, recyclability, etc. See Aerosol_pandemic/Facial for more details.
  • One possible element in the big picture is elastomeric respirators. There are designs that can be manufactured rapidly in huge numbers. Manufacturers are located in a limited number of countries, and it's quite possible that raw materials have their own limitations. Design and manufacturing could be improved in ways similar to disposable respirators. Filters could be "generic", say with a few standard sizes (just like batteries can be AA, AAA, etc).
• In a severe pandemic, there's a very strong case for making sure workers of vital jobs are protected first, best and throughout.
  • This is problematic because the definition of what a vital job is is problematic, or at least not directly obvious. The team making sure that the lights are on for a mega-city are obviously important. But so are the people who grow food for them. So finding or working on practical definitions before they are needed could be useful.
  • Also, vital workers can get infected from their families. There's a case for isolating segments of the population, say creating a de facto separate village around energy stations, so that food and other supplies will be given without respiratory contact.
  • Some people will stock up on things like respirators from fear or greed. This calls for ample distribution in ways that aim to guarantee maximum protection. It's likely that there's no perfect solution for this. Knowledge of transmission and zero-materials ways of protecting ourselves (such as ventilation or ways to reduce the number of respiratory contacts) should be explained in ways that are actionable.
• Serious practical creativity from first principles and vital priorities can be very useful. Examples: ruralised schools, mini-tribes - and many ways of reducing the number of respiratory contacts in sustainable ways. See Aerosol pandemic/Needs and Systems (more philosophical) and Aerosol pandemic/PandemicFluGame (more wisdom-of-crowds). These ideas can then be shared for local application.
• Everything else, including waste-water surveillance and apps and modelling the public health effects of having ultraviolet lamps in airport toilets - all those are instrumental in reducing infections while reducing the disruption. Could they help? Yes, of course. As tools, not as the primary goal. (Unless one technology can solve the whole problem, which doesn't seem to be the case.)

Increasing effective coordination: How are we going to do this?[edit | edit source]

The first alarm bells with H5N1 were sounded in 1997, and then in 2005. Some 20 years later, many experts still say we are not prepared. There have been many specific improvements, but governments and populations have shown how we seem to not be ready, and we haven't found ways to cooperate effectively.

So what about looking at cooperation itself? What do we need to learn in order to get better at navigating this global, fast-paced century? See The Future We Deserve/My Ideal Panflu - Lucas Gonzalez.

Some have suggested "global simultaneous enlightenment", which doesn't look likely, particularly in a situation of extreme fear. Some may think of ways to work on emotions: draw on what humanity knows about that, look at what could be done in practice with fear and anger. For cognition, outline the goals, keeping it simple, expanding on thinking modes & "long tables". Collecting good links to Cynefin (Dave Snowden), teams of teams (Yaneer), unconferencing (open space technology), and debono(.com/six-thinking-hats-summary + lateral thinking as a skill that can be practiced) - all of that might help, if turned into practical tools for cooperation that can scale rapidly.

More specifically, there are action plans for businesses. They could be turned into creative commons templates, maybe even for sectors and activities, for "soon and bad".

To coordinate resilience, one possibility is to use OODA & SCIM as "minimal languages" for communicating priorities, needs and haves, in an environment of noise and changing situations, making the best possible use of the layers of coordination: masks are designed at the global level, produced by country or region, and used by individuals in organisations or teams. See Http://Resiliencemaps.org/files/fluscim which has http://Resiliencemaps.org/files/FluSCIM-69p-English.pdf which was written in 2010 and has a useful 2.5-page index. It can be used as a base for conversations, skimmed while keeping in mind what we now know about aerosol transmission, longcovid, societal responses, and communication infrastructure including apps; and keeping in mind also the wider context of conflict, climate change, economy, rapid changes in technology, etc.

What I would like help with, short term[edit | edit source]

In general, I'd need help with this page and the wider effort: what am I missing, who could I contact, what should I read, what flaws are obvious to you, and what would improve the practical actions for the stated scenario. Another possibility is finding valid reasons for not doing any of his, if someone else has something better.

Here are some specific details of what I think might be most useful:

• I would love to widen the conversation: around the scenario as a scenario, and around the set of actionables.
• I think there's room for concerted action around several actionables:
  • Education: defining what's most important, and pointing to materials so that it will all be ready to use it at very short notice. This includes sending, and responding, to very different starting points on this. It's "education" because I believe the scientific knowledge is solid, but it's very likely it's beat started as a conversation. In any case, everything would be very different if and when people have noticeably severe cases frequently. Trust is a problem, and I don't know how it would be built in a rush, so likely there would be network effects. Having models in advance might be important.
  • Improving adjusters, finding better models, learning about ways to manufacture them at scale, etc.
  • Finding out how to improve the situation with elastomerics: learning about manufacturers, finding data or contacts to see what the manufacturing capacity is, per day or week, for different countries, etc. (Note: There's freemask.org.) Preparing an open proposal for countries and manufacturers to consider, in line with the language used by WHO to ask for production of seasonal flu vaccines, but geared towards elastomerics for manufacturing countries and for the rest of the world. Looking at creative ideas if they have any chance of being useful, such as looking at adapting the production capacity for snorkels or asthma masks to make more elastomerics.
  • Designing and testing an accelerated training process for 10 million people to learn the basics of "SCIM * OODA" in say 4 hours (in 5 languages).
  • Looking at apps (translating x.com/yoryobass document into English) in an ecosystem of apps for contact reduction, determining the risk of venues, collecting and delivering local epidemiological information, etc. Again, trust is important, so the apps should be open source etc. There must be work done that can accelerate things if and as needed. Here, prototyping with Aerosol pandemic/PandemicFluGame would be useful.
• Specifically, maybe someone can host the initial conversations and help with editing and publishing videos to get the word out about this project or similar (or better!) ones already underway.

How to let me know:

• Please use private messaging, twitter/x where I'm lucasgonzalez, or the talk page. (The "Discussion" button at the bottom of this page works.)
• Please don't write directly in this page or I will lose track of what I think! Thanks.

What if we all have more time[edit | edit source]

If we have more time, say more than a week or a month or a year or a decade, we can work in three different directions at the same time.

• First, improve the short term reaction (see previous section). How could we better react if we have a bad pandemic but not too soon?
• Second, improve longer term conditions (clean air in all schools of the world, and a long etc). Improving longer term conditions can be done without having a short term plan, and in fact is what many are already doing.
• Last but not least, do enjoy life, and be productive in whatever way you believe is good! All of this is exactly for that goal, right?