John Barry: The Pandemic Risk

As far as existential threats to the human species go, pandemics rank near the top of the list.

What's the probability of an agressive, highly-fatal outbreak occuring soon? Is it high enough to worry about?

And if one occurs, what can/should we do to protect ourselves and our loved ones?

To address these questions, we interview John M. Barry, author of the award-winning New York Times best-seller The Great Influenza: The Epic Story of the Deadliest Plague in History. John was the only non-scientist to serve on the US government's Infectious Disease Board of Experts and has served on advisory boards for MIT's Center for Engineering System Fundamentals and the Johns Hopkins Bloomberg School of Public Health. He has consulted on influenza preparedness and response to national security entities, the George W. Bush and Obama White Houses, state governments, and the private sector.

His verdict? The risk of a massively fatal world-wide pandemic like the 1918 Spanish flu is remote, but very real -- and is heightened by the hyper-connectedness of our modern society (i.e., the ease and speed with with people can travel). And our readiness for such an outbreak is woefully lacking:

An often-overlooked part of the damage a virulent pandemic can do is its impact on supply chains and the economy.

If you’ve got 20 to 30% of your air traffic controllers sick at the same time, what's that going to do to your economy?

Most of the power plants in the United States are still coal powered. They get their coal, most of them, from Wyoming. You see these enormous trains – that's a highly skilled position, the engineers who move those trains which are a mile and a half long. Suppose they're out. You're not going to have power in many of the power plants.

These are things that we don’t automatically think of as relating to a pandemic. Even a mild one that makes a lot of people sick without killing them will wreak an economic impact.

In terms of the health care system, practically all of the antibiotics are imported. If you interrupt those supply chains then you start getting people dying from diseases that are unrelated to influenza that they would otherwise survive. We had a small example of that with saline solutions bags which were produced in Puerto Rico. Because of the hurricane, Puerto Rico was no longer producing them; so we had tremendous shortages in those bages after the hurricane. Other suppliers worldwide have picked up the slack, so that's not a problem today.

But in a pandemic, you're going to have supply chain issues like that simultaneously all over the world. So you're not going to be able to call on any reserve, anywhere, because everybody's going to be in the same situation whether you talk about hypodermic needles or plastic gloves -- any of that stuff. The supply chain issues in a moderate pandemic are a real problem. If you’ve got a severe pandemic, the hospitals can't cope. There are many fewer hospital beds per capita than there used to be because everything has gotten more efficient. In this past year's bad influenza season, many, many hospitals around the country were so overwhelmed they all but closed their emergency rooms and weren't talking any more patients for any reason.

There's just no slack in the system. What efficiency does is eliminate as much as possible what's considered waste, but that waste is slack. And when you have a surge in something, you need that slack to take care of the surge. If I were grading generously I would give us a D in terms of overall preparedness. If we had a universal influenza vaccine, maybe we'd be relatively okay, but we don’t.

Click the play button below to listen to Chris' interview with John M. Barry (56m:47s).

This is a companion discussion topic for the original entry at

So I posted this a while back, but it might be relevant here. In terms of “what can I do” to protect vs an influenza pandemic - and this applies especially for older people - there was a double blind placebo-controlled study done on influenza infection severity back in 1997 where half the study group was given 600 mg NAC, the other half, placebo.
Long story short, the NAC group got infected just like the placebo group, but 2/3rds of those infected just didn’t notice, and the remaining group had symptoms that were about half as strong as the placebo group. NAC treatment was well tolerated and resulted in a significant decrease in the frequency of influenza-like episodes, severity, and length of time confined to bed. Both local and systemic symptoms were sharply and significantly reduced in the NAC group. Frequency of seroconversion towards A/H1N1 Singapore 6/86 influenza virus was similar in the two groups, but only 25% of virus-infected subjects under NAC treatment developed a symptomatic form, versus 79% in the placebo group. Evaluation of cell-mediated immunity showed a progressive, significant shift from anergy to normoergy following NAC treatment. Administration of N-acetylcysteine during the winter, thus, appears to provide a significant attenuation of influenza and influenza-like episodes, especially in elderly high-risk individuals. N-acetylcysteine did not prevent A/H1N1 virus influenza infection but significantly reduced the incidence of clinically apparent disease

The mechanism of action: NAC is a precursor required for the body to make glutathione. When there is a bad outcome in a disease state, low glutathione usually accompanies it. And as we get older, we make less glutathione. Taking NAC raises the body’s glutathione levels - other studies have shown that if older people take NAC, they can get their glutathione levels back to the 20s-30s age group.
My pandemic plan: use NAC; it won’t protect me from infection, but my hope is that it might move me from the “people who died” group into “the survivors” group. And of course there’s the thought that I might actually have agency in such a situation probably helps out as well.
Now hopefully all the real doctors here can chime in with their thoughts. :slight_smile:

I share DaveF’s impression that excellent immune function is a main goal. And will add that it is GOOD to be infected with the latest strand of communicable disease (but at a low dose). An excellent immune function allows one to survive immune to that threat. When a new variation of the virus comes around a few years later, partial immunity will already exist making that next infection milder as well.
In one of Isaac Asimov’s space travel novels, the ship physician releases viruses into the ventilation system every Friday evening deliberately infecting the travelers to keep immune systems challenged and strong.
Can you imagine the devastating effects of a virus lose in one of the slums of Manila or Lagos? Close proximity, inability to clean one’s hands and feet, body to body touching, coughing in close spaces, feces and urine running in rivulets down the streets?
These pictures are taken from Pinterest “slums.”

Having large food stocks reduces one of the main reasons to come in contact with large numbers of other people. It would also mitigate the issue of reduced truck deliveries.

I’m kinda guessin’ those folks in the slum photos have some fairly robust immune systems…Aloha, Steve.

As for “food for thought”, this was a real banquet. Chris, you packed a hell of a lot of stuff to consider in this interview. The speed and the “instanteous” nature of our world was brought home, BIG TIME! Our public epidemiological preparedness has always has always left me a little uneasy, especially, after knowing someone involved with the SARS outbreak some years ago. The world’s supply-line dependency only confirms the importance of a resilient preparedness and response. Looking to government during these times is hollow comfort. While this site can be sometimes seen as “Cassandra-esque”, it doesn’t shy away from discussing real possibilities and the importance of these issues. Again, well done.
Who you gonna trust?

CoreMed Science makes a Liposomal Glutathione in liquid and gel caps. Removes biotoxins. How about a podcast with Surviving Mold founder Dr Shoemaker?
Humans also need viral substances to combat bacteria. See this video

There is so much humans don't know about ecological balance. Be careful about eliminating influenza as it might be beneficial but we don't see it yet. Educated guess: keeps innate immune system tuned up and eliminates the weak. No free lunch.

What is the best respirator to have in a pandemic? In the podcast they talk about N95 masks, but is that really the best one can aim for? Say if you just have to go out of the house.
I would assume Chris has already done the research, so I would greatly appreciate if he posted a link to the product he chose.

Is the transcript still being prepared?

Disclaimer: I don’t have much personal experience with respirators, except to know that wearing surgical and N95 masks is quite uncomfortable for me, personally. They fog my glasses impairing close vision and make me feel hot like I’m suffocating. Most people do OK with them, but not me.
The work of breathing is high in a surgical or N95 mask. The human repiratory musculature is the force that presses air through the filtration membrane that is the the mask itself. The exhaled air exits around the mask edges into the users face. This makes breathing hard work and elicits the “fear of suffocation” type of sensation in me.
There is a respirator design called PAPR (pronounces “PAP-er”) where a small battery, motor and filter are combined into a single casing that clips to the user’s belt. This device filters the air and delivers it to a facemask or head-and-face mask through a tube. The weight of the device is not carried on the head, but on the user’s belt.

Above pictured is a researcher at the CDC working with influenza virus, which is spread when water droplets containing the virus contact nasal and oral mucosa. His headgear is very lightweight. The PAPR device is attached to his belt while a tube delivers air under positive pressure to his head and face.
Powered Air-Purifying Respirators (PAPRs) also come in industrial strength type of rigs with integral helmut / faceplates. These cost about $1,000+.

One of the limitations of the PAPR is that it is ambient air that is drawn in and filtered. So it would not be effective for removing toxic gasses. This rig does not offer nearly the level of protection that a fireman’s PPRBA does. But for respiratory dropplets, a PAPR and light head and face shield would work well.
USAMRIID uses Racal suits to evacuate highly infectious patients.

"A commercial product known as the Racal suit — or Racal space suit — is a portable personal protective equipment consisting of a plastic suit and a PAPR fitted with HEPA filters that supply filtered air to a positive-pressure hood (also known as racal hood). Racal suits were used by the Aeromedical Isolation Team (AIT) to evacuate patients with highly infectious diseases for treatment.[1][2]"
I always thought that if I were to attempt to provide home medical care to others in my town during a big epidemic, I would need a PAPR unit. For most epidemics (influenza, ebola, infectious diarrheas) most of the medical care is simple "support." IV fluids are by far the most important element of support for a person who cannot eat, is vomiting and having profuse diarrhea. A medical provider (paramedic, nurse, doctor) with IV start kits, fluids and tubing, and protective gear, could go house to house starting IVs on the patient's front porch, leaving them at home to be cared for by their family (who are probably already exposed), increasing survival rates during many types of pandemics. This person is wearing a PAPR on her waist. Here is a video by the Minnisota Dept of Health training nurses how to put on a PAPR between the 7:00 and 8:00 minute marks.

I bought the 3M Versaflo PAPR with the soft hood, extra battery & extra filters. So far I’ve only used it once when I was cutting a dry hay field and the dust was getting into my eyes even with safety glasses on. I don’t like to use googles or a full face mask as it tends to fog up. The PAPR does not, but it can get hot if you use it during the summer months. I would recommend getting a white hood (not a black or dark colored hood since it will heat up more). I opted for the soft hood (see Pict above with girl in Yellow Suit) over the face mask since the hood will cover your entire head (dust and debre) can get in your hair and there is more space between the face glass and your face (less claustrophobic & fogging). Its also easier to store since its basically a bag except for the face glass sheild so it can fit into a small space.
The problem is that you cannot carry a PAPR with you everywhere. I don’t like storing batteries in the car (ie too hot or too cold temperatures). I keep a dozen N95 masks in my car and a couple of N95 masks & a pair of safety glasses in my laptop bag that is usually near me at all times. I started carrying the N95 masks after 9/11 when I saw all that dust fall down and cover all the people fleeing.
I also keep a full roll of paper towels in my car or a bag of them in my carry on luggage. When ever I am traveling I use the paper towels when I use the bathroom or wash up. Those hand air driers are ineffective of removing germs. I also like to wash my face when I use the bathroom to also remove any germs. Using this method I have avoided getting sick while travelling. I also use the spent Paper towel to open the bathroom door to avoid getting my hands contaminated.
In my laptop bag (always close by to me) I also keep a small flashlight, Several pairs of Nitrile gloves, NSAID (Advil), Handwarms (during winter months). Ear plugs, Cash & a multitool, a couple of granola bars, and some handwipes. Thus I have some basic supplies to get me out of a jam. All these items is no more than a pound & and I had no trouble going through an airport with these items.

Wow PAPRs are expensive. I have no trouble breathing through an N95 mask, but I was looking for something more protective than an N95 for pandemics, yet more affordable than a PAPR (under $100).