There's a lot of talk about the coming threat of Avian H5N1 flu, how it might kill many millions, far beyond the 1918 flu and others, because of how much people travel in the modern world. Others worry about bioterrorism.

Plans are underway to deal with it, but are they truly thinking about some of the tools the modern world has that it didn't have in 1918 which might make up for our added risks? We have the internet, and a lot of dot-coms, both living and dead, created all sorts of interesting tools for living in the world without having to leave your house.

In the event of an outbreak, we'll have limited vaccine available, if there's much at all. Everybody will want it, and society will have to prioritize who gets what. While some choices are obvious -- medical staff and other emergency crews -- there may be other ideas worth considering.

Today, a significant fraction of the population can work from home, with phone, computer and internet. The economy need not shut down just because people must avoid congregating. Plans should be made, even at companies that prefer not to allow telecommuting, to be able to switch to it in an emergency.

Schools might have to close but education need not stop. We can easily devote TV channels in each area to basic curriculum for each grade. Individual schools can modify that for students who have internet access or even just a DVD player or VCR. For example, teachers could teach their class to a camera, and computers can quickly burn DVDs for distribution. Students can watch the DVDs, pause them and phone questions to the teacher. (However, ideally most students are able to make use of the live lectures on TV, and can phone their particular teacher, or chat online, to ask questions.) Parents, stuck at home would also help their children more.

Delivery people (USPS, UPS etc.) would be high in line for vaccination to keep goods flowing to people in their homes. You can of course buy almost anything online already. Systems like Webvan, for efficient grocery ordering and delivery could be brought back up, with extra vaccinated delivery drivers making rounds of every street.

Of course not everybody has a computer, but that need not be a problem. With so many people at home, volunteers would come forward who did have broadband. They would take calls from those who do not have computers and do their computer tasks for them, making sure they got in their orders for food and other supplies. Of course all food handlers would need to be vaccinated and use more sterile procedures.

For this, all we need are expanded call routing systems to create 800 numbers (or similar) that route to these volunteers, ready to help.

Telecom systems could also be made available cheaply for large conference calls and meetings, including free web meetings. Churches could even convene over the phone and internet or spare TV capacity.

Obviously certain manufacturing facilities would need to close down temporarily to avoid being centers of contagion. After we've vaccinated those doing deliveries, food production and other essential services, we can move to those whose jobs depend on public contact to get that part of the economy back to work. Obviously anybody skilled in a needed task (including vaccine production!) would be able to volunteer to help and thus get the coveted vaccine.

Many of these systems are not ready for this sort of scale of operation, or have not been tested. This is where some of the emergency preparedness efforts should go, into making sure systems like these, to run society when people must not congregate, will operate. Plans should be put in place so that the essential conferencing tools and essentials-ordering tools can scale up if simply given more servers. (The servers are out there and would be happily volunteered in time of crisis.)

Plans should be made to adapt them to suppliers not yet ready for the net. For example, the system that lets people order their grocery delivery could end up simply printing out or faxing the result to the local grocery store, where vaccinated workers gather the orders and load them onto vans sorted by address. The store need not have anything more high tech than the fax.

Depending on the incubation period of the disease, and the infectious period, moving to this mode of operation might cut the infection rate tremendously, enough so that the period of shutdown can be tolerably short. Of course, it depends on how quickly vaccine can be produced. While there would be tremendous economic cost to a number of industries, it's nothing like the cost of having millions die.

If vaccine is not available, the problem gets tougher. There may be an effective test for pre-symptomatic, infectious people, which would allow people to be cleared for limited times to work in food distribution and delivery. Training in sterile procedure for such workers should begin in before there is an emergency, of course.

Here's a set of useful resources related to this coming threat prepared by Kathryn:

Nature's set of articles

Good lead editorial:

"But the worst-case scenario is that a pandemic starts within two years. We would have no vaccine and few drugs, and we would be dependent on governments and the WHO to try to extinguish the first outbreaks at source. That's why the first priority must be to prevent a pandemic emerging in the first place, by extinguishing the disease in animals. Unfortunately, the current situation does not bode well for the abilities of governments and international agencies to cope with this challenge. We should be monitoring in almost real time the genetic changes in the avian and human viruses that could herald the emergence of a pandemic strain, for example...

Are we ready?

Short answer: No

The 2005-06 pandemic blog (were we ready?)

Short answer: No

Short article on 1918 with reference to h5n1-- note how 1918 didn't hit the children and elderly so much as it hit the healthy adults.

From ninthday

The US plan - don't need to read it, I'm just noting how Annex 9 barely touches on pre-planning by non-health, non-govt organizations.

Vaccines- just getting started

"But if a pandemic strain is vastly different from the vaccine strains that have already been tested, scientists will have to make a new vaccine from scratch. The St Jude researchers say that they could make a vaccine strain just four weeks after they get their hands on a sample of the pandemic strain8. But there's a problem: reverse genetics has been patented, so companies that make the vaccine would have to pay royalties to the patent holders. Companies are reluctant to do this, but scientists working in the field say that industry is trying to hammer out this issue now.

Even if the intellectual-property issues are resolved, it will be very difficult to step up global vaccine production to make enough to halt a pandemic. Vaccine companies currently make 300 million flu shots a year. But in a pandemic, we could need billions of doses. So why haven't vaccine makers leapt to fill this gap?

The answer is money. Flu vaccines are simply not a lucrative prospect for drug companies, which can make much higher profits on blockbuster drugs. And vaccines are risky: anything injected into a healthy person can end up doing more harm than good, leading to costly lawsuits and bad press. What's more, a flu pandemic might never hit, so business leaders are reluctant to spend money on new factories that might never be used.