Posts Tagged ‘pandemic’

As the Senate prepares to take up the issue of health care reform, the Republican Party is gearing up for a fight to the finish, a fight to defeat any attempt at improving our health care system.  It is a desperate struggle the Republicans are waging, desperate because it is about money – lots of money.  It’s also a sad struggle because it shows so clearly how corrupt our government is. Granted, our government has been corrupt for a long time. Slipping a wad of money into a Congressman’s pocket is an old tradition on Capitol Hill. It’s the best way to assure that you can either get the legislation you want or to prevent legislation you don’t want from being passed.  Today, this “passing of bucks” is accomplished by middlemen, called lobbyists. It seems that just about every Congressman and Senator has his price. There are precious few who cannot be bought.

Money is where the health industry comes in. It is, of course where Republicans come in as well.  After all, they are the Party of business, of Capitalism, of profit. That is their constituency.  One is tempted to say, “OK, that’s alright. Let the Republicans represent the sellers of goods and the Democrats represent the buyers of goods.” Of course, it’s not that simple because the Democrats also represent the ordinary workers, while the Republicans represent the employers.  But one would hope at least that there could be an honest debate.  One could hope that there would be a rational discussion of the facts – all in the national interest.  It would be a debate about what is best for the American people – after all, isn’t that ultimately the purpose of Congress – to do what is best for Americans?

Unfortunately, the Republican Party has chosen not to have a debate on the merits of health care reform.  Instead they have launched campaigns of outright lies about reform. They have tried mightily to steer the debate into discussions about Death Panels and Nazi medical experiments and the rationing of health care.  Any reasonable person can tell that these Republican tactics are nothing but lies and because they are lies and not real issues that should be discussed, the Republican Party has done a disservice to America – in brief, they have become un-American in their zeal to protect the profitability of medicine.

There is a danger here in all of this distortion, in all of these attempts to steer the discussion away from the real issues and to focus on trumped-up concerns that have no basis in reality.  The danger is that we will fail to ever discuss the actual dangers that are inherent in our current way of going about the health business.  Here is one excellent example that, as far as I can tell, is being completely ignored: we have a vastly insufficient supply of H1N1 vaccine because we have a for-profit health system.

The simple fact is that not everyone gets a flu shot every year. Most people do not get routine flu shots and because of this our vaccine industry, ever intent on making a profit, has sized itself according to the yearly demand for flu shots.  Our commercial vaccine production industry simply does not have the capability of making enough H1N1 vaccine to protect everyone man, woman, and child in this country. It simply cannot be done.

So, I would ask our imaginative friends in the Republican Party, the ones whose vivid imaginations can conjure up images of Death Panels and Nazi medicine being practiced on Americans, and the limiting of health care to only those who are connected with someone in government, to think about something else. Consider this: suppose the H1N1 flu strain that is making the rounds this year was different. Suppose instead that it was the same H1N1 strain that made the rounds in 1918. How many people would die in America? One hundred million? Two hundred million? How many would die in the entire world? A billion? Two billion? What could be done stop that strain of flu?  Nothing. Nothing could be done in 1918 and nothing could be done now.

The question I would put to the Republican members of Congress is this: is there any way you could think of that we might be able to make enough vaccine for everyone in a case like this?  There is only one answer: the government has to create this capability in advance – it’s not a last-minute sort of thing.  Why? Because it’s a money loser. Big business would hate it – it’s a gigantic capacity that would only be used once in a lifetime.  You can’t make money from that. Which is why there is a natural role for government in health care. The government spends about half of our national budget on defense – i.e. defending us from other people in other countries. How long will it take until we understand that it is also the role of government to defend us from other foreign attackers, things like viruses and bacteria. It might seem strange at first to look at it that way, but think about this: suppose – just suppose – that there really were aliens from Mars attacking us – would it be the role of government to defend us? What if instead of the Martians being little green men they were little green bugs?  What if these little green bugs were actually microscopic invaders? How is that different from deadly Earth-based viruses attacking us?

The simple fact is that the government has a duty to protect its citizens. This duty extends to protecting the citizen’s health. Health care should not be a profit-making business.  It should be more like a utility, available to everyone and dispensed by the government. That doesn’t mean that businesses can’t play. People are certainly free to purchase health related things, but the government has to understand that it has a responsibility for the health of its citizens – a responsibility that cannot be dodged and delegated to the profit-making business community.  We missed a bullet this time with the H1N1 flu; however, it is virtually certain that a time will come in the future when a very deadly viral pandemic will sweep over the Earth.  The steps our Congress takes in the next couple of months may well determine whether America survives that inevitable pandemic; it may well determine whether the population of our country is obliterated or if it survives.  It would be a shame if hundreds of millions of Americans died in the future all because the Republicans wanted to help their friends in the health business make a buck.

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Well, here we are.  The Swine Flu is sweeping over the country like an invisible Tsunami, or maybe like an invisible Katrina.  Several months ago the government – CDC etc  – promised that they were on top of the situation and there would be plenty of flu vaccine available.   “Brownie, you’re doing a heckuva job.” Doesn’t this seem sort of like deja vu all over again? I mean, during Katrina it was – at first anyway – difficult to tell whether the government just didn’t care or if they were just sublimely incompetent.  Now we know.

OK.  Now we have a new government in place. We all knew last spring that the Swine flu was spreading around the world and that it would be coming around here again in the fall. Well, it’s the fall.  Several months ago our government told us that there would be plenty of flu vaccine around, and remember, at the time no one knew whether the H1N1 flu would be morphing into something very deadly, like its cousin the 1918 flu pandemic that killed millions of people worldwide. So, there was a lot of concern and we were assured that there would be a lot of vaccine available.  But there isn’t.

As of today, the H1N1 flu is widespread in just about all the states. Meanwhile there is precious little vaccine available. It appears that the flu might even have peaked in some areas. So, how are things going at the CDC?  It seems they are confused. They thought they were going to have plenty of vaccine – but they don’t. So what happened? Did someone drop the eggs? How can we go from expecting maybe 100 million doses to be available to hoping for 42 million by mid-November? How can we be at the peak of the flu and have only 16 million doses available right now? There are 300 million people in this country.  And if you get a flu shot today, how long does it take before you have built up immunity to the flu? It doesn’t happen overnight.

There are only two conclusions that can be drawn from the H1N1 vaccine debacle – either our government doesn’t care or it is incompetent. There is an amazing similarity between the Katrina catastrophe and this – at least in the way the government has reacted. The primary difference is that the flu is not nearly as deadly as it might have been had it morphed – scant comfort, I suppose, to those whose children have already died from the H1N1.

One would have thought we had learned a lesson from Katrina, but it seems we didn’t – at least the elephantine U.S. government didn’t.  How could they not know there wouldn’t be sufficient supplies of vaccine? Were the manufacturers lying to them? Did anybody actually bother to do a calculation to see how much vaccine would be available on any given day? Have the people who work for the government ever heard of a spreadsheet?  Do they have any idea how to use a computer to project future supply and demand? I don’t think so.

We are simply at the mercy of an incompetent, uncaring assortment of Civil Servants who couldn’t care less if they rescue people from Hurricanes or germs or anything else for that matter. And where is the Presidential anger?  Where is the Presidential outrage at this gross incompetence? Where is my CHANGE? Why isn’t there any foresight, why no vision, why no imagination? Who is responsible for asking, “What if?” What if this had turned out to be a very deadly flu variant, as in 1918? It happened once – it will certainly – CERTAINLY – happen again. Don’t these people get it?

We lucked out this time. There are plenty of embarrassed, red faces in DC, but there should instead be plenty of embarrassed red faces out on the streets of DC.  But that will never happen because when you are a Civil Servant you have a job for life come Hell, High Water, or the Flu.  Nobody takes responsibility or gets blamed for anything – ever.

The problem is this: we have an incompetent government that is unable to protect the people of this country. It was demonstrated in Katrina and it has been demonstrated again with H1N1. Change is needed like never before, but it hasn’t come where it is needed most – inside the halls of government where intelligent, crucial, lifesaving decisions are supposed to be made, but they aren’t.

That is the lesson of the H1N1 vaccine debacle.

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According to the Centers for Disease Control (CDC), the swine flu is now “widespread” in the majority of states in the U.S. In those states where it is not officially “widespread” it is mostly categorized as either “regional” or “local”.  In other words, its pretty much everywhere – right now.  Today, the very first swine flu doses of vaccine are being distributed to health workers. This is only a very small batch of vaccine, the amount of vaccine that could be used to inoculate most of the U.S. population is still far off, and it is unlikely that the huge amounts of the vaccine will be available before the flu is officially “widespread” in just about all parts of the country.  At which point one might wonder if it makes sense to get vaccinated at all.

Here’s something to think about: what if this disease were more deadly? Or, what if it just left lasting effects that didn’t kill quickly but just made your life miserable as long as you lived?  Would we all still be sitting on our couches, still changing the channels to see what else is on TV?  Could it be that this flu pandemic teaching us something that we aren’t learning? You bet it is.  The thing is this, however, the lesson has already been taught to us before – on more than one occasion – but it is one we don’t want to learn.  That’s because it’s about money.

It was almost 100 years ago that the Titanic set sail from its last stop at Cobh harbor in Ireland on its way to New York.   It already had a reputation as being unsinkable, even though this was its maiden voyage, due to its construction, which included a number of water-tight compartments.  Tragically, it turned out that the watertight compartments could not prevent it from sinking.  Even more tragic was the fact that there were not enough lifeboats on the ship.  Perhaps less well known is the fact that a sufficient number of lifeboats had actually been provided for the Titanic, but the ships management company, White Star Line, decided to offload almost half of the lifeboats because they felt the decks of Titanic were too cluttered.  And besides, the existing regulations didn’t require all those lifeboats anyway.  The result, of course, was the most famous maritime disaster of all time.  The lesson was that all ships in the future had to have sufficient lifeboat capacity no matter what anyone says.

There is, however, a further lesson we can learn from both the Titanic and the swine flu – but it is one we are unlikely to learn until it is too late.  The lesson is this: when we entrust our safety to profit-making corporations we have given the option to these corporations of choosing between profits and safety – and they will always choose profits.  The simple fact is that safety doesn’t make money and therefore only an entity that has the safety of the people in mind, and not profit, will make the correct decisions concerning public safety.  That entity is, and can only be, the government.

The simple fact is this: we don’t have enough swine flu vaccine.  We will not have enough swine flu vaccine in time to help prevent that vast majority of cases.  More people will get swine flu that will be protected from it by a vaccine.  The reason for this is simple: we don’t have the capability to make enough a vaccine fast enough.   Of course, when I say “we”, I mean the vaccine industry because there is no government vaccine production capability.  So why is this? Why isn’t there enough commercial vaccine capability to produce a vaccine for everyone in time? It’s because it doesn’t make sense from a profit-making perspective.  How often would these companies use this prodigious capability?  No too often. How would it pay for itself? It wouldn’t.  It would sit idle most of the time.  The Capitalist equation works for the business owner, not the general population.  It is the government (i.e. the people) that has to intervene when the for-profit system fails to provide for the safety of the people.  After the Titanic disaster strict lifeboat regulations were passed – by governments, not by the ocean liner industry.

We are in the process of learning a lesson similar to the Titanic lesson again.  However, it is one I believe we won’t learn well.  That’s because the swine flu is not deadly enough. A lot of us will get sick and a lot of us will die – but not enough, not enough to galvanize the public into demanding action. The result will be that our government won’t create a capability that could immunize all of us at some future time when we are confronted by a truly deadly killer. And then of course, it will be too late.

One can only wonder at a government that designs and builds enough nuclear weapons to kill every man, woman, and child on the planet many times over, all in the name of defense.  Yet, when it comes to defending its own people from disease, our government turns a blind eye to the possibility and its own responsibility, and leaves our lives at the tender mercies of the for-profit medical industry.

Capitalism at its best.

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I’m not talking about some third world country, I’m talking about the United States.  Approximately 50 million Americans have no health insurance and now face the prospect of being turned away from for-profit hospitals if they are in need of treatment for swine flu.  So why is that a concern?  Isn’t that also the way it is for these people if they break a leg or have a heart attack?  Don’t they just wind up at some overcrowded municipal hospital like always?  I suppose so, the only problem is that this time things might be different.

The World Health Organization has announced that there is now a severe form of the Pandemic H1N1 flu that goes straight to the lungs. It causes severe or fatal cases of the flu in young people who had been in good health.  While Americans have been enjoying the summer weather and their days at the beach, the people in the Southern Hemisphere have been battling the Pandemic as it has traveled from country to country and morphed along the way. A second wave if Pandemic H1N1 is about to sweep over the U.S. and the northern countries of the world and we are woefully unprepared.  Unlike Socialist Europe, we have no health care system in place to care for the general population.  We have no system for providing free flu inoculations for the general public. Even more of a concern is that we don’t have the capability to cope with treating the casualties of a severe pandemic, even for our wealthiest citizens.

The World Health Organization has reported that those people who contract the very severe form of Pandemic H1N1 require intensive care in order to survive.  How many of our uninsured poor will be provided intensive care in our for-profit hospitals?  None.  They are going to die.  How many of our uninsured citizens who already suffer respiratory diseases or cardiac disease or diabetes, and thus become very high risks, will be able to be treated in our intensive care units, even if they already pay for the best insurance in the land?  Very few.  The simple fact is that we are unprepared, as a nation, to begin to cope with a serious pandemic. We don’t have the intensive care facilities, we don’t have an emergency plan to deal with need for such mass treatments, and we have no intent on providing it to the general public in any case.

The World Health Organization has issued a worldwide warning about the coming pandemic.  It advises that the disease could have a devastating impact in those parts of the world where adequate health care cannot be obtained.  They are referring to the Third World, where first class medical care is  not available at any price. I guess they forgot about the 50 million – those Americans who also have no access to first class health care because they have no health insurance.

It’s coming soon.  Some of those Socialist European countires are about to begin mass inoculations for the flu.  The United States isn’t ready to do that yet.  Maybe in October.  And it will be done on a priority basis – which may not include you.  Of course, you’ll have to pay for your innoculation, and if you don’t have health insurance maybe you’ll just skip it, like you always do.  Welcome to the land of opportunity.  Welcome to the best health care in the world.  Welcome to North America’s Third World system of “medical care only for the insured and for those who can pay”.

You’re on your own.

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What would Voltaire say?  Here we are facing the prospect of trying to cope with a catastrophic pandemic flu in a few months and we don’t have enough vaccine for everyone.  Meanwhile, our government, through the department of Homeland Security and it’s countless subdivisions, has made plans for the distribution of what vaccine we might have.  Meanwhile, our government is debating the merits of providing medical care via the commercial insurance industry or through some sort of “public” insurance program – the latter funded by taxes, which will not be raised , except on those people on whom they will be raised.  Meanwhile, the government assures us that they have taken the “govern” out of government and they will not dictate what medical care we will receive via the public or private insurance programs.

Meanwhile, the Centers for Disease Control has published its “recommendations” for determining who will be allowed to receive flu shots before the pandemic sweeps over us. First of all, if you are over 64 years old you can forget it.  You aren’t getting a pandemic flu shot.  The good news is that you will get the shot for the “seasonal” flu – that’s the one that was expected to come around anyway. But the pandemic? You’ll have to take your chances because a cousin of this flu was around about fifty or sixty years ago and you probably, or could have been, or might have been exposed then. Therefore you might, perhaps, maybe still have some sort of antibodies to the half-century old cousin of the pandemic flu. So, bottom line: you’re out –  unless, by some miracle there is some vaccine left over, in which case feel free to help yourself.

So, here we are.  Sort of like being on the deck of the Titanic, knowing that our rudder is way too small, and we have nowhere to hide.  Our government, the one that has promised it won’t meddle in our health care choices has already determined the order in which the lifeboats will be filled, regardless of whether you have expensive private insurance or not.  So much for the Republican Party argument that private health insurance will keep us free of our government making our health decisions for us.

Speaking of health insurance, here is the way I look at it: Let’s suppose a bunch of people get together and decide to pool a bunch of money in a big pot – just in case one of them gets sick and they need a doctor.  The money in the pot will be used to pay the medical bills for this unlucky person. Of course someone needs to take care of the pot, so we ask Fred to do that, and Fred says he will – if he can have 25% of the money in the pot. We say OK.  That’s private health insurance.

On the other hand let’s suppose we all put some of our money in the pot and then we elect someone to watch the pot and handle the disbursements.  It turns out we elect Charlie and we tell him that he can’t have any of the money in the pot, but we’ll pay him a salary of $10 a month.  That’s a government insurance plan – where the money in the pot comes from taxes instead of insurance premiums.  So which one is a better way to go? The first way is good old American Capitalism (with a capital C, which rhymes with P which…).  The second is European Socialism. Which do you think is cheaper?  Which has more money in the pot available for your health care? Which one will get you better health care?  Actually, the record speaks for itself.  People live longer in socialist-health-care Europe because they simply have better health care. Same thing with Japan – you can’t beat their welfare state health care. It’s that simple.

We are not going to have that.

Because the Blue Dogs and the Republicans like Tom better than Charlie we’ll be putting our money in Tom’s pot and then getting 3/4 of our money back for our health care needs.  Even so, this private health care system will still be apparently be under the watchful eye and control of our government (as in the aforementioned “recommendation” for the CDC).  So,  even though we’ll have a completely private system (except, of course, for the VA system that is government run and is clearly the best health care system in the U.S.), people who don’t know you at all (like the people who work at Homeland Security or the CDC), or care about you personally will be making your health care decisions for you when it comes to things like pandemics, despite what you thought was going to happen when you bought that expensive private health insurance.

I guess it’s like Candide said: we need to  cultivate our gardens.  Frankly, I thought knee deep would have been enough.

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On June 11, 2009 the World Health Organization declared that the A (H1N1) Swine Flu had become a pandemic.  There is now no question that the disease will spread throughout the world.  It is expected that this influenza virus will revisit the U.S. in the fall, as most influenzas do, and the number of cases will be far higher than what was experienced earlier this year.  There are now a couple of questions that come to mind. 1) Is our government taking any steps to protect the population from the spread of this disease? 2) What will our government do if the virus mutates (as they often do) into a form that is resistant to any vaccines that might have been prepared in advance?

In 1918-1919 a very deadly pandemic influenza spread throughout the world, killing between 30,000,000 and 50,000,000 people worldwide.  More people died from that flu than died in World War I.  An estimated 675,000 Americans died from the flu during that pandemic.  At the time there was nothing that could be done to prevent the spread of the disease. Flu vaccines were unknown.  The coming pandemic may well spread as far and wide as the 1918-1919 pandemic, maybe more since we have a much more densely populated world now.  Right now, the current pandemic flu virus is not as deadly as the 1918 one. But does that mean we are safe?  What if it mutates? What is our government doing about the situation?

According to John O. Brennan, the President’s advisor on Homeland Security, the government is planning to have a flu vaccine available for voluntary vaccinations by mid-October. Which is a little late. The flu season usually starts before then.  He doesn’t say how many doses are being created, nor does he say how much they will cost – but they will be voluntary – if you can get one. Let’s take a moment and compare our American response to the problem with that of a country that has a national health insurance program. Hmmm…I winder what Ireland is doing about the flu? On July 4th the government of Ireland announced that they will provide free flu vaccinations to the entire population of the country this autumn. Aren’t you glad we don’t suffer from a national health program like those poor Europeans?

Oh, there is this one other detail – you know, the one about the virus mutating.  What do we do if the virus mutates into a really deadly virus?  That’s what happened in 1918.  If the mutation is major then the vaccines we are making in the U.S. will probably have no effect – and we also won’t be able to make enough of a new version of the vaccine in time.  That’s because we grow our vaccines in eggs, and that just takes a lot of time and lots of eggs too.  After all, our drug companies can’t make the vaccine in batches of a million eggs at a time.  So, to put it succinctly, we’ll just be out of luck.

On the other hand, there is another way to make a vaccine – synthetically.  Synthetic vaccines using techniques that already exist could build up our supply 100 times or more faster than using eggs. But our government is not pushing this technique. After all – we don’t have a national health system, do we?  It’s up to our private, profit-making, drug companies to develop such a vaccine and, of course, the real issue is this: does it make economic sense? Can they recoup their investment dollars? Who’s going to pay for all the development costs? So, while some companies say they already can make such a vaccine synthetically, as a country, we really don’t have much capability at the moment.  And of course, if the flu suddenly mutates, it’ll be a little late to create the capability won’t it?

So, what is the answer to my question? Can our government save us from the pandemic that the World Health Organization says is certain to come? Sure, if the virus doesn’t mutate and still only produces very mild cases of flu. But do we really need saving from that? And what if the virus turns deadly. That’s when we really will need our government to save us.  So far, however, it doesn’t look good. Right now the profit picture, probabilities of mutation, investment risk, and so forth is sort of keeping our major drug manufacturers on the bench  with regard to the synthetic vaccine thing.  Remember, the key issue here is profit.  Aren’t you glad we don’t have a government health program?

By the way, if you like reading medical thrillers (and you like my blog), you might also like my novel about a pandemic. It’s called The Viral Epiphany and its available on Amazon.  You’ll need a Kindle reader though, because it’s only available for digital downloads for now. You can take a look at it and order it here.

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Yesterday, the World Health Organization (WHO) announced that we are now at threat level 5 for a flu pandemic. A level 5 warning means that a worldwide flu pandemic is imminent. The WHO has never before issued a Level 5 pandemic warning.  It seems logical then to expect that we will soon have a Level 6 warning from WHO indicating that we are immersed in a worldwide pandemic.  While these high level warnings serve to get everyone’s attention, they don’t really do much to protect us, as individuals, from contracting the flu.  While the U.S. and world governments (not to mention the news media) have been quick to warn us of the imminent danger, there doesn’t seem to be much the governments are doing to prevent us from getting the flu.

One might think that the government would quickly order the pharmaceutical companies to ramp up production of a vaccine for the new flu virus. The problem is that even if they did, the companies could not respond quickly enough. That’s because our method of vaccine production, using eggs as incubators, is much too slow. Besides that, the companies just don’t have enough capacity to produce millions or billions of vaccine doses in a few weeks. A timely vaccine is simply out of the question.

OK, so how about distributing anti-viral drugs like Tamiflu or Relenza to the general population today or tomorrow?  Wouldn’t that work?  It probably would. There is, however, only one problem. There isn’t enough of either drug available. There are about 50 million courses of anti-viral medication in the U.S.  That should cover about 15% of the population. Worldwide, there are about 500 million doses available. Currently, there are 6.7 billion people in the world, so we can protect about 7% of the world population.  It doesn’t look promising does it? It appears that the government knows there is a potential for panic and strong public demand for these antiviral medications.  The supplies that we do have are being pre-positioned in all the states – under armed guard.

So, what can the average person do? It’s pretty clear that, no matter how well intentioned the Obama administration is, the government does not have the capability to protect U.S. citizens from this disease.  We are on our own.  A worldwide pandemic is inevitable. The only thing we don’t know is how deadly it will be. So far it doesn’t seem to be as lethal as the 1918 pandemic that killed 50 million people worldwide.  On the other hand, our usual fall and winter seasonal flu kills about 36,000 Americans every year – and we usually have vaccines for those viruses! With this new H1N1 flu, no one in the world will be vaccinated.  It is therefore likely that the death toll will exceed the 36,000 number in the U.S. by quite a bit.  We can only begin to imagine the toll this disease will also take on the worldwide economy as people avoid travel, shopping, public events, and so forth. The economic effect could be significant.

Meanwhile, we are told to wash our hands and avoid crowds.  Both are good advice, but the government will have to do more if the pandemic really takes off. At some point it might be necessary to ban public gatherings, like sports events and concerts.  I haven’t heard anything about quarantine measures, but I wouldn’t be surprised if they are being considered.  Our only defense against the disease is reducing person to person contact and keeping our hands clean until the virus burns itself out.  The flu viruses can survive on surfaces, like door knobs, for many hours, so it is important to not only wash your hands but to keep them away from your face. Just touching a mucous membrane with your hand can help a virus on your hand enter your body.  It probably wouldn’t hurt to buy increased quantities of food and stockpile it at home in order to minimize shopping trips.  It’s also probably a good idea to avoid traveling to places that have major outbreaks of the disease. I don’t know if there is much else we can do…..

On a related note – About a year ago I finally finished my first novel.  My book, The Viral Epiphany, deals with a pandemic situation very much like the one we are now facing (OK, maybe a lot, lot worse).  How’s that for a coincidence?  If you have a Kindle Reader, it is available on Amazon for digital download here. Sorry, it is not currently available in hard copy form.  The Viral Epiphany is, of course a novel, but it might make you think about how we do things, and perhaps it might also provide a few hours of entertainment while you sit in your home and wait for the flu to pass by.  The book is also Part 1 of a planned thriller trilogy.

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