Notebook per
Avian Flu_ What We Need to Know
Citation (APA): Cowen, T. (2014). Avian Flu_ What We Need to Know [Kindle Android version]. Retrieved from Amazon.com
Parte introduttiva
Segnalibro - Posizione 2
Nota - Posizione 2
decentralizzatr gli intrrventi istituire premi rispettare i brevetti prediction market condizionare gli aiuti estrri alle informazioni no alla quarantena
Evidenzia (giallo) - Posizione 2
Avian Flu: What Should Be Done by Tyler Cowen
Evidenzia (giallo) - Posizione 8
The single most important thing we can do for a pandemic— whether avian flu or not— is to have well-prepared local health care systems.
Nota - Posizione 9
x LA COSA PIÙ IMPORTANTE: SANITÀ DECENTRATA
Evidenzia (giallo) - Posizione 10
Prepare social norms and emergency procedures which would limit or delay the spread of a pandemic. Regular hand washing, and other beneficial public customs, may save more lives than a Tamiflu
Nota - Posizione 11
x CONSIGLI ALLA POP
Evidenzia (giallo) - Posizione 11
Decentralize our supplies of anti-virals and treat timely distribution as more important than simply creating a stockpile.
Nota - Posizione 12
x NO ACCUMULI
Evidenzia (giallo) - Posizione 12
Institute prizes for effective vaccines and relax liability laws
Nota - Posizione 12
x PREMI
Evidenzia (giallo) - Posizione 13
Respect intellectual property by buying the relevant drugs and vaccines at fair prices.
Nota - Posizione 14
x BREVETTI DA RISPETTARE
Evidenzia (giallo) - Posizione 16
7. Realize that the federal government will be largely powerless in the worst stages of a pandemic and make appropriate local plans.
Nota - Posizione 17
x DECENTRARE ANCHE POLITICAMENTE
Evidenzia (giallo) - Posizione 17
Encourage the formation of prediction markets in an avian flu pandemic. This will give us a better idea of the probability of widespread
Nota - Posizione 17
x SPECULARE
Evidenzia (giallo) - Posizione 20
We should not do the following:
Evidenzia (giallo) - Posizione 22
We should not rely on quarantines and mass isolations. Both tend to be counterproductive and could spread rather than limit a pandemic.
Nota - Posizione 23
x QUARANTENE
Evidenzia (giallo) - Posizione 23
should not expect the Army
Evidenzia (giallo) - Posizione 24
Once a pandemic has started abroad, we should shut schools and many public places immediately.
Nota - Posizione 24
x CHIUDERE SCUOLE ECC
Segnalibro - Posizione 26
Nota - Posizione 27
t importanza della decentralizzazione
Evidenzia (giallo) - Posizione 27
current outbreak of H5N1 avian flu
Evidenzia (giallo) - Posizione 29
Recent events in Indonesia
Evidenzia (giallo) - Posizione 30
visiting birds in the zoo,
Evidenzia (giallo) - Posizione 31
pulverized feces in the air.
Evidenzia (giallo) - Posizione 34
possibility of a dangerous mutation,
Evidenzia (giallo) - Posizione 36
1918 “Spanish flu” pandemic may have killed fifty to one hundred million individuals.
Evidenzia (giallo) - Posizione 43
We do not currently have a good vaccine against avian flu,
Evidenzia (giallo) - Posizione 46
fatality rate of up to fifty percent,
Evidenzia (giallo) - Posizione 55
Farmers have been killing chicken and duck
Evidenzia (giallo) - Posizione 57
people have backed away from eating chicken, whether rationally or not.
Evidenzia (giallo) - Posizione 71
This study will be divided into parts.
Evidenzia (giallo) - Posizione 75
ineradicably speculative component.
Evidenzia (giallo) - Posizione 76
effective decentralized action.
Evidenzia (giallo) - Posizione 78
A strict top-down approach will not work.
Evidenzia (giallo) - Posizione 79
Local health care institutions
Evidenzia (giallo) - Posizione 80
assumptions about human behavior and human self-interest.
Evidenzia (giallo) - Posizione 81
in a crisis all people will behave like angels
Evidenzia (giallo) - Posizione 82
unintended consequences;
Segnalibro - Posizione 83
Nota - Posizione 83
t
Evidenzia (giallo) - Posizione 84
centralized production and distribution of anti-virals
Evidenzia (giallo) - Posizione 86
The single most important thing we can do for a pandemic— whether avian flu or not— is to have well-prepared local health care systems.
Nota - Posizione 87
x DELOCALIZZARE
Segnalibro - Posizione 87
Nota - Posizione 87
delocalizzazione e conoscenza diffusa deloc.=delegare e moltiplicare la xformance scuola online
Evidenzia (giallo) - Posizione 87
1. Emphasize local preparedness
Nota - Posizione 87
t
Evidenzia (giallo) - Posizione 89
We require greater investments in local, decentralized knowledge about how to handle a crisis.
Nota - Posizione 90
x MAX SPERIMENTAZIONE
Evidenzia (giallo) - Posizione 90
Emergency room
Evidenzia (giallo) - Posizione 96
If a pandemic arrives, public service announcements should tell people that only lifethreatening illnesses should be brought to emergency rooms.
Nota - Posizione 97
x RISERVATEZZA E ANNUNCI
Evidenzia (giallo) - Posizione 99
Testing kits and early warning systems Singapore recently has developed an easy to use testing kit for avian flu.
Nota - Posizione 99
x IL TEST
Evidenzia (giallo) - Posizione 104
know to apply these tests
Evidenzia (giallo) - Posizione 105
c) Upon notice of a global pandemic, shut the schools immediately
Nota - Posizione 105
x CHIUDERE LE SCUOLE
Evidenzia (giallo) - Posizione 111
children are a group especially vulnerable
Evidenzia (giallo) - Posizione 111
the schoolwork could be posted on-line
Evidenzia (giallo) - Posizione 116
The need to care for children will produce high rates of workplace absenteeism.
Evidenzia (giallo) - Posizione 117
offered a tax credit to pay for a babysitter.
Evidenzia (giallo) - Posizione 120
d) Prepare to treat secondary infections During the 1918 pandemic millions of people died, not directly from the flu, but rather from resulting secondary infections and weaknesses. Many of these deaths could have been prevented with antibiotics, oxygen supply, IV fluids, respirators, dialysis, and other now-standard medical technologies.
Nota - Posizione 121
x SECONDARI EFFECT
Evidenzia (giallo) - Posizione 144
Prepare databases of potential volunteers Many doctors, nurses, or retired professionals will be willing to help out in a pandemic. This was the case in 1918. Local authorities should prepare relevant lists of potential volunteers and develop plans for how they might be used.
Nota - Posizione 146
x RISERVA DI VOLONTARI
Evidenzia (giallo) - Posizione 148
f) Preparedness for deaths Lack of mortuaries, coffins, and associated sanitary facilities was a major problem during the pandemic of 1918.
Segnalibro - Posizione 148
Nota - Posizione 149
x SISTEMARE I CADAVERI
Evidenzia (giallo) - Posizione 149
g) Encourage local planning The federal government does not have the resources or the competence to much help if a pandemic breaks out. Decentralized planning at the state, county, city and corporate levels will likely have the greatest positive impact. Many unforeseen local problems will hinder an effective response to a pandemic.
Nota - Posizione 152
x STIMOLARE LE AUT LOCALI
Evidenzia (giallo) - Posizione 157
2. Hand-washing programs Washing your hands regularly is one of the most effective protections against flu, including avian flu. Dr. Peter Sandman, a risk communication expert, writes: “Then there’s hand hygiene— which isn’t really “medical” because you don’t need a doctor to do it right.
Nota - Posizione 160
x LAVARSI LE MANI
Evidenzia (giallo) - Posizione 167
More restrooms should be built so that individuals can wash their hands without having to touch the droplets left by previous individuals.
Nota - Posizione 168
c
Evidenzia (giallo) - Posizione 179
We also should invest more in stockpiling high-quality masks, to protect against the spread of disease.
Nota - Posizione 179
x MASCHERE
Evidenzia (giallo) - Posizione 182
If a pandemic arrives, we should encourage public norms against coughing, sneezing, and shaking hands in public places. During the 1918 pandemic governments passed (and sometimes enforced) laws against coughing and sneezing in the presence of others.
Nota - Posizione 182
x TOSSE
Evidenzia (giallo) - Posizione 184
3. Develop better plans for the distribution of anti-virals
Nota - Posizione 185
t
Evidenzia (giallo) - Posizione 185
We should not equate “having a vaccine” or “having a Tamiflu stockpile” with solving the problem or saving the lives. Yes, we should invest in drugs and vaccines, but this constitutes only part of a good preparation.
Nota - Posizione 187
x DISTRIBUIRE
Evidenzia (giallo) - Posizione 195
Once a given stockpile is produced and distributed, federal involvement (apart from periodic replenishment) should be limited to outlining broad principles for distribution. Regulations should specify an order of priority for drug or vaccine access.
Nota - Posizione 197
c
Evidenzia (giallo) - Posizione 206
Choosing an order of priority
Evidenzia (giallo) - Posizione 215
4. Reform our public policy treatment of vaccines
Nota - Posizione 216
t
Evidenzia (giallo) - Posizione 216
Current American policy toward vaccines brings us the worst of both worlds. Government discourages what it should be encouraging. U.S. firms have been leaving the business in droves, and we are unprotected against many regular flu strains and childhood diseases, much less against a pandemic. If the U.S. needs more flu vaccine in a hurry, it is almost fully dependent on foreign producers.
Nota - Posizione 218
x PRODUZIONE ESTERA E SPIAZZAMENTO
Evidenzia (giallo) - Posizione 224
a) Institute prizes for effective pandemic vaccines
Nota - Posizione 224
t
Evidenzia (giallo) - Posizione 227
Currently only four major American companies make vaccines and two of these four have significantly cut back on their vaccine research programs.
Nota - Posizione 227
x PRODUTTORI DEMOTIVATI
Evidenzia (giallo) - Posizione 232
Paul A. Offit writes: “For the four companies that still make vaccines, gross annual revenues from vaccines are less than 10 percent of total revenues; internationally vaccines account for about 1.5 percent of total revenues. Pharmaceutical companies are businesses, not public health agencies;
Nota - Posizione 233
c
Evidenzia (giallo) - Posizione 235
The federal government could alter these incentives by offering prizes for vaccines that meet the FDA’s “fast track” designation for development.
Nota - Posizione 235
c RISPETTARE I PREZZI
Evidenzia (giallo) - Posizione 246
b) Reform liability law for flu vaccines
Nota - Posizione 246
t
Evidenzia (giallo) - Posizione 247
Liability law is partly to blame for the increasing scarcity of vaccines. A vaccine which is very beneficial on net may still kill or disable some number of victims. These victims or their families can then sue the companies and receive large awards.
Nota - Posizione 248
x ALLEGGERIRE LA RESP
Evidenzia (giallo) - Posizione 255
We need to encourage vaccine production, and we can best do this by limiting liability.
Nota - Posizione 256
c
Evidenzia (giallo) - Posizione 259
We also should reform FDA policies to encourage the production of new vaccines. Currently FDA regulations significantly raise the cost of both vaccine factories and vaccines. On average our regulations are tougher than those of Western Europe.
Nota - Posizione 260
x FDA
Evidenzia (giallo) - Posizione 268
5. Take intellectual property rights seriously
Nota - Posizione 268
x BREVETTI
Evidenzia (giallo) - Posizione 268
Tamiflu is produced by Roche, a Swiss pharmaceutical company. Recently Kofi Annan has questioned whether this property right should be respected. Compulsory licensing of the drug has been raised as one alternative policy. Some countries claim they know how to make Tamiflu, but they wonder how much they should respect current patent rights. India and Taiwan have announced plans to proceed with manufacture of a generic.
Nota - Posizione 270
x ROCHE
Evidenzia (giallo) - Posizione 273
An outright confiscation of drug property rights would set a dangerous precedent.
Nota - Posizione 273
c PRECEDENTI PERICOLOSI
Evidenzia (giallo) - Posizione 290
The best policy on the IP front is probably the following. First, offer Roche the option of licensing production in the United States, but at generous prices relative to the status quo. The U.S. government should subsidize the license price if necessary. Offer Roche favorable regulatory treatment and facility clearances (help with zoning, regulations, etc.) as well. This gives Roche an incentive to spread production, but without confiscating the underlying property right.
Nota - Posizione 293
x ES DI POLITICA POSSIBILE
Evidenzia (giallo) - Posizione 315
Critics of the pharmaceutical companies raise many issues. They point out that much research is funded by the National Institutes of Health (NIH), or is done in universities. Roche did not invent Tamiflu, but rather bought the rights from a smaller company, Gilead. The major drug companies are portrayed as greedy, super-rich, and withholding vital medicines from a global public. Even if we accept this portrait without revision, such criticisms do not address the basic point. Moralizing aside, the future supply of antivirals and other drugs still will depend on expected profits.
Nota - Posizione 319
x I CRITICI DI BIG PHARMA
Evidenzia (giallo) - Posizione 320
6. Make economic preparations
Nota - Posizione 320
t
Evidenzia (giallo) - Posizione 320
It remains an open question how badly a pandemic would damage the global, U.S., and Southeast Asian economies.
Nota - Posizione 321
x EPID ED ECON
Evidenzia (giallo) - Posizione 322
Looking back to 1918 gives us only a partial idea of the economic consequences. After the deaths themselves, the most serious economic problems stemmed from the large number of people who did not show up for work. Some estimates suggest that during the peak of the pandemic up to one-third of the work force was absent.
Nota - Posizione 325
x ASSENTEISMO
Evidenzia (giallo) - Posizione 331
the transportation sector would be hit hard.
Evidenzia (giallo) - Posizione 335
On the optimistic side, it is easier to speak and trade at a distance than before. The telephone and the Internet limit the necessity for direct interpersonal contact.
Nota - Posizione 336
x OGGI IL POSITIVO
Evidenzia (giallo) - Posizione 338
a) Consider possible weak points in our chains of food and water supply.
Nota - Posizione 339
x ACQUA E CIBO
Evidenzia (giallo) - Posizione 344
b) The Federal Reserve should stand prepared to supply the appropriate liquidity
Nota - Posizione 344
x LIQUIDITÀ
Evidenzia (giallo) - Posizione 349
c) Prepare emergency legislation for mortgages.
Nota - Posizione 349
x MUTUI
Evidenzia (giallo) - Posizione 350
d) Prepare for bankruptcy of the airline industry. Air travel would most likely shut down altogether for a while.
Nota - Posizione 351
x FALLIMENTI
Evidenzia (giallo) - Posizione 352
e) Draw up port plans so we can continue to receive shipments of oil and natural gas. Getting those shipments to refineries should be another priority.
Nota - Posizione 353
x PORTI E AEROPORTI
Evidenzia (giallo) - Posizione 356
f) Repeal price-gouging laws, or declare their inapplicability during a pandemic.
Nota - Posizione 356
x PREZZI
Evidenzia (giallo) - Posizione 361
The resulting high prices will be unpopular but in most cases the high price is a better alternative than a shortage.
Nota - Posizione 362
c
Evidenzia (giallo) - Posizione 364
We should not obsess over whether “the rich” or “the poor” are obtaining a greater share of treatment or prevention.
Nota - Posizione 365
c
Evidenzia (giallo) - Posizione 367
g) Holding elections. It is unlikely that a national election could or would be held while a pandemic is raging.
Nota - Posizione 368
x SOSPENDETE ELEZ
Evidenzia (giallo) - Posizione 370
7. Who should be in charge?
Nota - Posizione 370
t
Evidenzia (giallo) - Posizione 370
The ultimate authority for an avian flu crisis should rest in the hands of the Federal government. Protection against a major pandemic is truly a national (and international) public good.
Nota - Posizione 371
x BENE PUBBLICO
Evidenzia (giallo) - Posizione 376
That being said, federal authority should not mean literal federal control over most variables of importance. If a pandemic arrives, the federal government will not have the resources to enforce most, if any, of its emergency mandates.
Nota - Posizione 378
x SCARSA CAPACITÁ DI CONTROLLO
Evidenzia (giallo) - Posizione 383
8. Encourage the formation of “prediction markets” in an avian flu pandemic
Nota - Posizione 384
t
Evidenzia (giallo) - Posizione 384
We do not have a good handle on the probability of an avian flu pandemic. This makes it difficult to know how much to invest, or where we should be investing our resources.
Nota - Posizione 385
x INFO E MERCATO
Evidenzia (giallo) - Posizione 389
Prediction markets are now used on a widespread basis to forecast political and sporting events. A specified contract will pay a dollar, or some other sum, if a specified event (e.g., an election result) comes to pass before a certain date.
Nota - Posizione 390
c
Evidenzia (giallo) - Posizione 398
A wide range of evidence suggests that prediction markets are the best predictors available for a wide class of events. 14 If some better predictor were available, this predictor would itself be used by bettors.
Nota - Posizione 399
c
Evidenzia (giallo) - Posizione 403
To many people it sounds ghoulish to wager on the deaths of other human beings. Yet a prediction market in avian flu could be a critical tool in assessing risk.
Evidenzia (giallo) - Posizione 412
9. Improve international surveillance
Nota - Posizione 412
t
Evidenzia (giallo) - Posizione 415
International surveillance of avian flu is currently in a poor state. Many victims or possible victims do not have their flu strains sequenced and recorded. It is believed that current Indonesian tests, as applied, yield many false negatives. Many Southeast Asian countries, including China, Vietnam, and Indonesia, are secretive about what goes on within their borders.
Nota - Posizione 417
x LÀ DOVE TUTTO COMINCIA
Evidenzia (giallo) - Posizione 427
10. Reform the World Health Organization
Nota - Posizione 427
t
Evidenzia (giallo) - Posizione 427
The World Health Organization
Evidenzia (giallo) - Posizione 428
the organization as a whole tends to be timid. In recent times it has warned about the dangers of avian flu, but earlier it had sought to calm fears. Too often WHO parroted the line of a Southeast Asian government that the problem either was being taken care of, or that the problem did not exist in the first place.
Nota - Posizione 429
x DIFETTO WHO
Evidenzia (giallo) - Posizione 431
The fundamental problem springs from the nature of WHO and its budget. WHO is funded by its member states on a biennial basis.
Nota - Posizione 432
c
Evidenzia (giallo) - Posizione 435
An effective WHO would be more independent. This could involve longer funding cycles and perhaps a partial endowment in the form of a fund.
Nota - Posizione 435
c
Nota - Posizione 436
x CICLO DEI FONDI
Evidenzia (giallo) - Posizione 439
Summary Remarks: The Illusion of Control
Nota - Posizione 439
t
Evidenzia (giallo) - Posizione 455
Part II: What We Should Not Do
Nota - Posizione 455
t
Evidenzia (giallo) - Posizione 458
1. Do not expect vaccines to solve the problem
Nota - Posizione 458
t
Evidenzia (giallo) - Posizione 462
by the time a pandemic comes, it takes a good deal of time to produce enough doses to protect against that strain. It could take over six months to have any doses at all,
Nota - Posizione 463
x TEMPI
Evidenzia (giallo) - Posizione 468
b) Even if we had enough vaccine, adequate and timely distribution would remain an extremely difficult issue.
Nota - Posizione 468
x DISTRIBUIRE
Evidenzia (giallo) - Posizione 473
d) Vaccines expire within a few years’ time. We might stockpile an effective vaccine for an avian flu pandemic.
Nota - Posizione 474
x SCADENZA VACCINI
Evidenzia (giallo) - Posizione 480
vaccines commonly kill some of their recipients, and a design mistake could lead to many deaths.
Nota - Posizione 481
x VACVINI KILLER
Evidenzia (giallo) - Posizione 483
2. Do not rely on quarantines or mass isolations
Evidenzia (giallo) - Posizione 484
New Zealand, are considering quarantines in the case of a pandemic. This would involve closing their airports, preventing visitors from entering the country (or subjecting them to delay), and possibly restricting movement within the country.
Nota - Posizione 485
x QUARANTENA
Evidenzia (giallo) - Posizione 488
Nonetheless quarantine is unlikely to be effective in the United States. We have three hundred million people, porous borders, areas of great population density, and many more transportation nodes connecting a given area.
Nota - Posizione 489
x IMPOSSIB IN CERTI PAESI
Evidenzia (giallo) - Posizione 491
Furthermore the quarantine, even if it could be enforced, would exacerbate food supply problems;
Nota - Posizione 491
c Cibo
Evidenzia (giallo) - Posizione 492
Quarantines involve many other problems. Few people live close to their food supplies and we are highly dependent on transportation.
Nota - Posizione 493
c
Evidenzia (giallo) - Posizione 496
An alternative vision of quarantine— properly called isolation— would round up sick individuals and remove them from broader society.
Nota - Posizione 497
x ISOLAMENTO
Evidenzia (giallo) - Posizione 498
It is difficult to decide which individuals should be handled in this fashion; exactly how sick does a person need to be?
Nota - Posizione 499
x DIFFICOLTÁ NEL DECOIDERE
Evidenzia (giallo) - Posizione 501
Furthermore testing and transporting the individuals might spread infection more than simply leaving them at home.
Nota - Posizione 502
c PERICOLO TRASPORTO
Evidenzia (giallo) - Posizione 502
Grouping sick individuals together could lead to more infection. Keep in mind that the 1918 pandemic had mortality rates of about two percent;
Nota - Posizione 503
x 1918
Evidenzia (giallo) - Posizione 505
A large collection of sick individuals could itself alter the evolution of the virus and encourage a more virulent strain.
Nota - Posizione 506
c MUTAZIONI
Evidenzia (giallo) - Posizione 508
Civil liberties issues arise as well. How should the authorities treat the many individuals who resist evacuation from their homes?
Nota - Posizione 509
x LIBERTÀ CIVILI
Evidenzia (giallo) - Posizione 512
We simply do not have the infrastructure to find, identify, isolate and transport any significant percentage of the flu spreaders.
Nota - Posizione 513
x INFRASTRUTTURE
Evidenzia (giallo) - Posizione 515
Quarantines and isolations also tend to induce panic. When individuals hear that an area will be quarantined, many leave that area preemptively, whether such behavior is rational or not.
Nota - Posizione 516
x PANICO
Evidenzia (giallo) - Posizione 524
3. Do not rely too much on the Army or Armed Forces
Nota - Posizione 525
t
Evidenzia (giallo) - Posizione 529
The U. S. Armed Forces have little or no training in combating a pandemic. Their roles in enforcing a quarantine or isolation would be ill-advised,
Nota - Posizione 530
x MILITARI INESPERTI
Evidenzia (giallo) - Posizione 557
5. Do not rely on blanket targeting in countries of origin
Nota - Posizione 557
t
Evidenzia (giallo) - Posizione 557
Several analysts have suggested that we can attack human-to-human avian flu by an intense targeting of the area of origin. A number of simulations suggest that such a sufficiently aggressive program, if applied within the first few weeks, could stop avian flu from spreading. Sadly, such a program is unlikely to succeed in stopping a pandemic. The simulation models rest upon unrealistic assumptions.
Nota - Posizione 560
x AGGREDIRE ALL ORIGINE? NN CONTIAMOCI
Evidenzia (giallo) - Posizione 561
The most likely countries for an initial outbreak are Vietnam, Thailand, Indonesia, Cambodia, and China. These countries are allergic to scrutiny from the outside world.
Nota - Posizione 562
c
Evidenzia (giallo) - Posizione 565
An attempt to wipe out human-to-human avian flu at the source likely would encounter denial or stonewalling from local officials, lack of transparency with flu samples, and corruption and hold up of Tamiflu (and other) supplies.
Nota - Posizione 567
x PAESI POVERI A SCARSA TRASP
