“The virus has, as far as we know, not spent much time in humans yet. Once it does, it will begin to adapt itself in unpredictable ways. It may become more virulent, or less virulent. It may develop resistance to the antivirals that are currently effective. Antiviral resistance has been a topic of great concern for at least a couple of years. The current virus is already known to be resistant to both amantadine and rimantadine, though oseltamivir is still effective.

[…]

Some aspects of the current outbreak are, to my mind, cause for great concern.

The acting-director of the CDC has already said: “There are things that we see that suggest that containment is not very likely.” That is a remarkably candid statement. I think it’s very clear that the cat is out of the bag. The question is how bad is it going to be. That’s impossible to tell right now, because we do not know what the virus will look like in the future, after it has had time to mutate and adapt inside humans.

[…]

The new virus has been popping up in various places in the US in the last days. I expect it will go global in the next couple of days, maximum. What’s to stop it? The virus has been isolated in several diverse areas and in many cases is genetically identical. The 1918 virus also popped up, in many cases inexplicably, across the US…

There were 3 waves of the 1918/19 pandemic. The first was in summer of 1918 – very unusual, as influenza normally falls to extremely low rates during summer. Note that the current outbreak is also highly unseasonal.

The 1918 pandemic killed with a very unusual age pattern. Instead of peaks in just the very young and the very old, there was a W shape, with a huge number of young and healthy people who would not normally die from influenza. There are various conjectures as to the cause of this. The current virus is also killing young and healthy adults.

The social breakdown in a pandemic is extraordinary. If you read The Great Pandemic by John Barry, you’ll get some sense of it. America’s Forgotten Pandemic also helps give some idea of what it must have been like.

[…]

The influenza people at the CDC and the other international labs are an amazing team of experts. They’ve been at this game for a very long time and they work extremely hard and generally get a bad rap. It’s no wonder flu is such a political issue, the responsibility is high and the tendency towards opaqueness is understandable. Despite all the expertise though, at bottom you have an extremely complex virus – much of whose behavior is unknown, especially in the case of antigenic shift, especially when it is so young, and especially when you don’t know what nearby mutational opportunities may exist for it in antigenic space – spreading in a vastly more complex environment (our bodies), and with us moving and interacting in odd ways in a complex and extremely interconnected world. It’s a wonder we know as much as we do, but in many ways we don’t know much at all.” — Terry Jones via fluidinfo.