I'm looking for historical / epidemiological / game-theoretic
information that people (including me) can use to decide whether to
stay put or flee, should there be a worldwide H5N1 pandemic.

I've done extensive reading on H5N1, including Google News, the
current CDC info and Recombinomics
http://www.recombinomics.com/whats_new.html. I'm aware of the Tamiflu
shortage and the vaccine development effort, among other details.

Should H5N1 arrive in the US, I can only presume that my family and I,
living in central Chicago (very high population density) will be at
heightened risk. But is this truly the case, and does it have to be
the case? Is there a historical basis (e.g. from Black Plague, 1918
flu, etc,
geographical distributions) to believe that one's chances of survival
are significantly better out in the remote countryside versus a small
town versus the suburbs versus the city?

I don't want to get caught up in a New Orleans / Houston type of panic
escape. And what would be the point, anyway, given the difficulty of
avoiding any non-familial human contact for a period of several years
(after which time ample antiviral stocks and/or vaccine(s) would 
hopefully be available).

It seems to me that the decision to stay put or flee a known pandemic
is a complex one that has several trade-offs, such as:

(1) If one is going to shut oneself inside the house / apartment and
reduce contact with outsiders to the absolute minimum, does it matter
where the dwelling is (i.e., city vs suburbs vs countryside)? I read
the fantasy blog by that woman which spins out a whole start-to-end
scenario of how she and her children would ride out the pandemic in a
small (Canadian?) town. Is the moral of that story just "sit tight,
very tight"?

(2) Given the fact that excursions outside the home will be virtually
inevitable at some point during the pandemic, one has to assume
there's an unavoidable risk of contracting H5N1. There will be fewer
people encountered out in the country, but any one of those people
could still be H5N1+ during a random encounter. Being isolated out in
the remote countryside would seem to be a disadvantage if one needs to
get immediate medical attention or drugs.

(3) Millions of people will certainly be doing the same on-line
research that I'm doing, and thousands of people may end up reading
this thread. Panicky behavior of crowds is well-known to often be at
least as dangerous, if not more so, than the underlying original
threat. A good individual strategy for avoiding H5N1 should therefore
be one that scales well to imitation by others.

This thinking leads me to wonder if there's any reason to believe that
radical behavior modification could reduce a big-city dweller's risk
of infection enough to make it worthwhile to stay put rather than face
all the risks and unknowns of fleeing the city?

For example, I've read (but can't cite at the moment) that surgical
masks are highly effective against passing bacteria and viruses, if
you're already sick, but not against catching them, if you're not
sick. I also read somewhere that Japanese society tolerates /
encourages widespread mask usage during cold / flu season. Is there
any data indicating reduced incidence of sickness to support this
practice? Does it depend on the fineness of the mask (N95, N99, etc)?
OTOH, is there possibly a herd effect to Japanese mask use, which
might not apply in the US given the diversity of individual
lifestyles?

To summarize my question, to the extent that one is able to rationally
prepare for an H5N1 pandemic, and one is currently living in a large
city, are there any established or well-considered strategies that one
should review for adoption before or during pandemic phase 5, with
rapid human-to-human transmission?

---

Clarification of Question by chiresearch-ga on 02 Oct 2005 19:47 PDT

Having following Henry Nimon's helpful links
--http://www.recombinomics.com/in_the_discussion.html

--to various discussions about the H5N1 threat, I've found that
"Canada Health" (Public Health Agency of Canada) has extensive
pandemic preparedness info for health professionals. E.g.

http://www.phac-aspc.gc.ca/cpip-pclcpi/pdf-cpip-03/cpip-preparedness.pdf

It will take me some time to study and digest all this info, so until
then I'm deprecating the value of my Google question.

Brad

Brad,
I hate to see a serious and well thought out question get lost.
And I cannot help you, but please excuse me for two thoughts.

There was a story about a man who with great foresight saw WW II
coming, did a lot of homework and moved his family to Guadalcanal ....

And then there is the Russian proverb:  He, who shall be hanged, won't drown.

"Stay put or flee?"

But don't kill your question because of my fatalistic comment. 
Someone may come along with an answer.

Myoarin

There's an interesting Tamiflu / influenza answer here:
http://answers.google.com/answers/threadview?id=98140
(search for jcg-ga's post)

And there's a "flu preparedness guide" here:
http://fluwikie.com/uploads/Consequences/NewGuideOct5.pdf
Though I would take it with a grain of salt as its obvious opinion in
spots and there are statements unsubstantiated by research (e.g. that
combining acetaminophen and ibuprofen simultaneously is safe).

At the bottom of that guide is a map of the weekly spread of the 1918
Spanish flu. (I can't vouch for its accuracy.) The important thing to
note is that the whole of the United States was affected within a few
weeks -- regardless of location. If you think historical notes from an
age that had not yet cured bacterial pneumonia is a valid predictor of
a future influenza pandemic, then this might be as close an answer as
you will find.

I'm a mild hypochondriac and I've been obsessively reading about
H5N1/influenza since early this year. Reading will not answer your
question and I doubt you will found someone that can satisfactorily
answer it.

The media is obsessing over the issue of late (perhaps this is good to
keep people informed) and everyone is becoming scared. If you're
reading this, you're educated enough to use a computer. Once you are
educated, you are often free to worry about things that have a lower
probability of killing you and your loved ones -- earthquakes,
hurricanes, avian flu -- than everyday events -- car accidents,
homicide, cancer, heart attack.

Our survival instinct demands that we predict the future, as does your
question. After all the reading I've done, I have formed these
opinions about an influenza pandemic:
- Humanity is unprepared.
- Despite advances in technology it *will* occur within our lifetime,
possibly "soon."
- Access to medical care and medication in a developed country/city
will be major survival factors for individuals.
- Public infrastructure will be temporarily crippled, thereby limiting
access to medical care and medication regardless of location.
- A vaccine is unlikely to be produced "in time."
- Humanity as a whole is highly likely to "survive" the next pandemic. 

The predict-the-future questions that we can't answer include:
- Will my loved ones and I survive an influenza pandemic?
- Will I have a higher chance of survival in Chicago or Strasburg, Illinois?
- When will the influenza pandemic occur?

It pains me to see rational minds succumb to fear.

Velshin [Scared in San Francisco]