World Health Organisation - Preparing For The Second Wave

I still think that the majority of us think that this H1N1 is less scary and not as dangerous as H5N1 (it is but not by much). WHO has recently issued a new warning. Be prepared.

Preparing for the second wave: lessons from current outbreaks
- Pandemic (H1N1) 2009 briefing note 9

28 AUGUST 2009 | GENEVA -- Monitoring of outbreaks from different parts of the world provides sufficient information to make some tentative conclusions about how the influenza pandemic might evolve in the coming months.

WHO is advising countries in the northern hemisphere to prepare for a second wave of pandemic spread. Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases.

Countries in temperate parts of the southern hemisphere should remain vigilant. As experience has shown, localized “hot spots” of increasing transmission can continue to occur even when the pandemic has peaked at the national level.

H1N1 now the dominant virus strain

Evidence from multiple outbreak sites demonstrates that the H1N1 pandemic virus has rapidly established itself and is now the dominant influenza strain in most parts of the world. The pandemic will persist in the coming months as the virus continues to move through susceptible populations.

Close monitoring of viruses by a WHO network of laboratories shows that viruses from all outbreaks remain virtually identical. Studies have detected no signs that the virus has mutated to a more virulent or lethal form.

Likewise, the clinical picture of pandemic influenza is largely consistent across all countries. The overwhelming majority of patients continue to experience mild illness. Although the virus can cause very severe and fatal illness, also in young and healthy people, the number of such cases remains small.

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The Straits Times: The Influenza A (H1N1) virus has been detected in pigs imported into Singapore from Indonesia's Pulau Bulan, Singapore's only source of live pigs. Twelve pigs have been confirmed to have the virus, which causes infections in humans too.

But Singapore's Agri-Food and Veterinary Authority (AVA) has given the assurance that there is no risk of people catching the virus from eating pork as H1N1 is not transmitted from handling meat.

Eight of the pigs are on the farm and have been isolated. The other four were sent to Singapore's only abattoir in Jurong, and slaughtered and sold. It is not yet known how the pigs contracted the virus, though pigs in Australia and Canada have caught it through human handlers.

Ms Tan Poh Hong, AVA's chief executive officer, said the government agency has stepped up monitoring and inspection procedures. Inspections of the farm, which houses about 230,000 pigs at any time, are now done weekly instead of monthly. AVA also tests 60 pre-export samples a week now, instead of 15.

At the abattoir, about 100 samples are extracted from organs and meat every day for testing, up from 30. Workers wear protective gear such as face masks, aprons and gloves.

'We will continue to put measures in place to make sure only healthy pigs are brought into Singapore,' said Ms Tan. 'I would like to emphasise that pork available in Singapore is safe for consumption.' Her assurance comes as pork sellers, told of the news on Thursday, expressed concern that sales would fall.

There is no evidence that eating pork products poses an infection risk, said the World Health Organisation (WHO), a view shared by other experts. Dr Alex Thiermann, special adviser to the director-general of the World Organisation for Animal Health, told The Straits Times that H1N1 is not found in the bloodstream or meat of the pig, but only in respiratory secretions. 'The risk from eating pork is negligible,' he said.

About 1,000 live pigs are shipped from Pulau Bulan, in the Riau Islands, to Singapore daily, then transferred to the abattoir. Live pigs make up 21per cent of pork consumed here. The rest comes chilled or frozen from overseas.

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Large populations susceptible to infection

While these trends are encouraging, large numbers of people in all countries remain susceptible to infection. Even if the current pattern of usually mild illness continues, the impact of the pandemic during the second wave could worsen as larger numbers of people become infected.

Larger numbers of severely ill patients requiring intensive care are likely to be the most urgent burden on health services, creating pressures that could overwhelm intensive care units and possibly disrupt the provision of care for other diseases.

• “…the H1N1 pandemic virus has rapidly established itself and is now the dominant influenza strain in most parts of the world”
• ”Studies have detected no signs that the virus has mutated to a more virulent or lethal form.”
• “[The skew toward younger people being hit worst] is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age or older.”
• “… clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure.”
• “Some cities … report that nearly 15 percent of hospitalized cases have required intensive care.”

Monitoring for drug resistance

At present, only a handful of pandemic viruses resistant to oseltamivir have been detected worldwide, despite the administration of many millions of treatment courses of antiviral drugs. All of these cases have been extensively investigated, and no instances of onward transmission of drug-resistant virus have been documented to date. Intense monitoring continues, also through the WHO network of laboratories.

Not the same as seasonal influenza

Current evidence points to some important differences between patterns of illness reported during the pandemic and those seen during seasonal epidemics of influenza.

The age groups affected by the pandemic are generally younger. This is true for those most frequently infected, and especially so for those experiencing severe or fatal illness.

To date, most severe cases and deaths have occurred in adults under the age of 50 years, with deaths in the elderly comparatively rare. This age distribution is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age or older.

Severe respiratory failure

Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.

During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services. Some cities in these countries report that nearly 15 percent of hospitalized cases have required intensive care.

Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.

Vulnerable groups

An increased risk during pregnancy is now consistently well-documented across countries. This risk takes on added significance for a virus, like this one, that preferentially infects younger people.

Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.

When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people.

Obesity, which is frequently present in severe and fatal cases, is now a global epidemic. WHO estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes.

Moreover, conditions such as asthma and diabetes are not usually considered killer diseases, especially in children and young adults. Young deaths from such conditions, precipitated by infection with the H1N1 virus, can be another dimension of the pandemic’s impact.

Higher risk of hospitalization and death

Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population.

Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension.

Implications for the developing world

Such findings are likely to have growing relevance as the pandemic gains ground in the developing world, where many millions of people live under deprived conditions and have multiple health problems, with little access to basic health care.

As much current data about the pandemic come from wealthy and middle-income countries, the situation in developing countries will need to be very closely watched. The same virus that causes manageable disruption in affluent countries could have a devastating impact in many parts of the developing world.

Co-infection with HIV

The 2009 influenza pandemic is the first to occur since the emergence of HIV/AIDS. Early data from two countries suggest that people co-infected with H1N1 and HIV are not at increased risk of severe or fatal illness, provided these patients are receiving antiretroviral therapy. In most of these patients, illness caused by H1N1 has been mild, with full recovery.

If these preliminary findings are confirmed, this will be reassuring news for countries where infection with HIV is prevalent and treatment coverage with antiretroviral drugs is good.

On current estimates, around 33 million people are living with HIV/AIDS worldwide. Of these, WHO estimates that around 4 million were receiving antiretroviral therapy at the end of 2008.

p/s photo: Aya Nakata

Central Banks & Their Gold Strategy

We all know that the biggest demand for gold comes from central banks. Just how has their buying or selling strategy been over the last 12 months? Is their strategy influenced by the amount of USD being printed into circulation? Are they afraid of the dollar not being able to uphold its long term value? Will they ever regard holding US Treasuries as an option only? Is any of them seriously hinting of reverting back to the gold standard? By holding more gold and less USD does that mean more flexibility to their monetary policy?

• Reduced central bank gold selling and increased investor buying may have been helping to underpin high prices in 2008 at a time of turmoil in financial markets. The renewal of the central bank gold selling agreement with a lower threshold suggests that gold sales by central banks will be lower in the next five years, a move the could support gold prices.
• Gold's share in global foreign exchange reserves is about 10%, the third largest asset by value despite being unevenly distributed across countries. The U.S. and European central banks account for the highest amounts both in absolute terms and as a share of reserve holdings (about 50%). Emerging market central banks have a much smaller share. Gold's share in global reserves declined sharply since the 1950s -1960s.
  

Regulation of Central Bank gold sales


• In August 2009, the central banks party to the central bank gold agreement (CBGA), who collectively have a gold share of just under 60% in their reserves, agreed to renew the treaty but with a lower maximum sales threshold. Analysts suggest that the marginally lower threshold could provide a "mild support" for gold.
• The annual sales by the central banks party to the treaty will be less than 400 tons. The previous agreement had a cap of 500 tons per years. The IMF's planned sales of 403 tons are included in the overall cap of 2000 tons from 2009-2014. With the Swiss National bank suggesting it will not sell, only the European central bank and the Banque de France are likely to take advantage to sell. The Italian and German central banks have been reluctant to sell their gold holdings.
• In H1 2009, estimated net sales by official holders of gold were 39 tonnes, 73% lower than in H1 2008. Net gold official gold sales are expected to be only 140 tons in 2009, the lowest since 1994.
  
• In 2008, European central banks sold the lowest levels of gold in about decade, reversing the practice of recent years whereby official sales helped depress gold prices. Banks bound by the central bank gold agreement (most of the European central banks) sold about 343 tons of gold , the lowest since the first agreement was signed in 1999, and well under the 500 ton annual limit.
• In the fall of 2008, central banks stopped lending out gold to banks as they were afraid they would not get it back. This reluctance contributed to an increase in bullion borrowing costs to 2.649% for one month, the highest since May 2001 and high above recent levels (5yr average 0.12%).
  
• An asset allocation assessment would suggest European central banks still have too much gold. EM central banks have low gold holdings in part because of the rising cost of gold and worries about an inability to sell when forex liquidity is required.
  

Gold holdings of Emerging Market Central banks

• GCC private investors have much higher stocks of gold than its central banks do. However, Qatar increased its gold reserves in 2007.
• China announced early in 2009, that it had increased its total gold holdings by 75%, likely from shifting non-monetary gold to the central bank. Although that increase now makes China one of the top 5 official gold holders, gold makes up less than 2% of China's $2.1 trillion in foreign exchange reserve by value. On the margins, China is likely to keep adding slowly to its holding but it is unlikely to make purchases on the open market given the potential for disrupting prices and reducing the value of USD holdings
• Aside from China with 1054 tons, the emerging market central banks with the largest gold holdings are Russia (540 tons), Taiwan (424 tons), India (358 tons) and Venezuela (356 tons) as of May 2009. Aside from Venezuela and Lebanon, the gold shares of which make up 37.5% and 27.5% respectively of total reserves, most of the other large holders have a gold share of only about 4% of reserves.
  

Gold Sales by the IMF

• The IMF, the third-largest official holder of gold, intends to sell 403 tons (12%) of its 3217 tons of gold, pending approval from 85% of its members which will likely be given in the fall. Any sales are likely be gradual though and may be sold to central banks.
• IMF gold sales are unlikely to be disruptive for the gold market and could be positive if the gold is purchased by other official investors (like central banks).
  
• The IMF is likely to start selling in 2010, selling about 200 tons a year.

p/s photos: Aya Nakata

Commodities Charging On - The Next Bull Phase / KLCI 1,100 Gone Soon

Two pieces of important information which should impact on markets over the near term. First one is oil, which is being pushed higher. The second one is on soyabean prices, which ill drag palm oil higher as well. I think following the inventory work down, funds and genuine buyers are beginning to stockpile. The bookings as reflected in Baltic Dry Index would lend credence to the sustainability of hard and soft commodities run up. Overweight palm oil stocks. The initial run for the last 3 months was more due to recovery in financials. It looks like this run (bear market rally or whatever you want to call it) may have some legs left in it.

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June 10 (Bloomberg) -- Global proved oil reserves fell last year, the first drop since 1998, led by declines in Russia, Norway and China, according to BP Plc. Oil reserves totaled 1.258 trillion barrels at the end of 2008, compared with a revised 1.261 trillion barrels a year earlier, BP said in its annual Statistical Review of World Energy posted on its Web Site today. The world has enough reserves for 42 years at current production rates, BP said.

BP and other oil companies are struggling to replace reserves as access to deposits becomes harder and older fields in places like the U.K. and Mexico are depleted. Russia passed a law last year that limits foreign ownership in some of the country’s biggest energy and metals deposits. Middle East countries, which hold 60 percent of global reserves, restrict access for international companies.

“Our data confirms the world has enough reserves of oil, natural gas and coal to meet the world’s needs for decades to come,” BP Chief Executive Officer Tony Hayward said in his introduction to the report. “The Challenges the world faces in growing supplies to meet future demand are not below ground, they are above ground. They are human, not geological.”

Saudi Arabia’s reserves, the world’s largest, stood at 264.1 billion barrels, little changed from 264.2 billion a year earlier, BP said. The Middle East as a whole holds 754.1 billion barrels, compared with 755 billion barrels last year.

“Declines in Russia, Norway, China and other countries offset increases in Vietnam, India and Egypt,” BP said on its Web site.

Canadian Oil Sands

Including Canadian oil sands deposits of 150.7 billion barrels, total global reserves stood at 1.409 trillion barrels, the review said. BP made an upward revision to 2007’s global oil reserves of 23.1 billion barrels, with the largest increases in OPEC members Venezuela and Angola. None of the biggest international oil companies have replaced output through new discoveries or extending fields in the past six years, Sanford C. Bernstein & Co. said in an April 2 report. Companies such as Royal Dutch Shell Plc, Europe’s largest oil company by market capitalization, are looking at acquisitions to boost reserves, Bernstein said.

BP said the estimates in today’s report are a combination of official sources, OPEC data and other third-party estimates. Oil reserves include gas condensates and natural gas liquids, as well as crude oil.

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Published: June 10 2009 11:38 | Last updated: June 10 2009 20:05

Soyabean prices rose above $12.50 a bushel to a nine-month high after the US government warned on Wednesday that soya stocks in the world’s largest exporter of the commodity will drop to the lowest level in 32 years. The Department of Agriculture said by August 31 stocks of soya would drop to 110m bushels, the lowest since stocks fell to 103m bushels in 1976-77.

Hussein Allidina, head of commodities research at Morgan Stanley, said inventories had reached a “precarious” level. The US exports about 45 per cent of the world’s soya.

CBOT July soyabean rose to an intraday high of $12.55½ a bushel, up 30 per cent so far this year. The new crop contract – CBOT November – rose to $10.81½ a bushel as the USDA also cut its forecast for 2009-10 stocks. CBOT July soyameal jumped to $414.4 per tonne, less than 10 per cent below its all-time high of $456.8 per tonne set last July.

Soyameal is the key feeding commodity for hogs, chicken and turkey; its rise suggests an imminent surge in meat and poultry costs. Corn prices rose as the USDA painted a bullish picture, with 2009-10 corn stocks approaching the key 1bn bushels mark. CBOT July corn rose to $4.49 ¾ a bushel, although it later traded flat at $4.44.

Wheat dropped as a forecast of lower consumption offset a drop in supply in 2009-10. CBOT July wheat fell below $6 a bushel, though the new crop contract of September traded at $6.27 a bushel. Other commodities markets mostly rose, supported by hopes the economy has reached its bottom and a weakening of the US dollar.

Crude oil extended its rally, trading near $72 a barrel at a fresh seven- month high with investor appetite stirred by a larger- than-expected drop in US crude oil inventories. Nymex July West Texas Intermediate, the US benchmark, rose $1.40 in late afternoon trading to $71.41 a barrel. It had hit an intraday high of $71.79 a barrel, the highest level since November. ICE July Brent rose $1.14 to $70.76 a barrel.

Weekly crude inventories data from the US Department of Energy showed that the country’s crude stocks fell by 4.4m barrels last week to 361.6m barrels, a two-month low. The drop came after a sharp fall in oil imports into the US.

Oil prices have doubled in price since the market turmoil of late last year, with WTI gaining 60 per cent since January 1 as speculators have begun to gamble on a rebounding global economy leading to higher crude prices.

The US government data also showed gasoline inventories falling by 1.6m barrels, a figure exceeding forecasts of an 800,000 barrel increase, while distillate stocks, including diesel, dropped by 300,000 barrels against expectations of a 1.4m barrel increase.

Nymex July RBOB gasoline futures rose above $2 a gallon for the first time in eight months following the report on lower stocks.

The broad-based rally lifted copper to an eight-month high of $5,220 per tonne before it fell 0.2 per cent to $5181. Aluminium rose 1.7 per cent to $1,689 per tonne, a six-month high, but later followed copper lower, losing 1 per cent to $1,643. Zinc rose 1.4 per cent to $1,622.5 per tonne.

Gold slipped 0.2 per cent to $951.70 a troy ounce; silver rose 0.5 per cent $1518.5 per troy ounce.

Nymex July West Texas Intermediate, the US benchmark, rose $1.49 to $71.50 a barrel, its highest since early November. Earlier, it hit an intraday high of $71.60 a barrel. Meanwhile, ICE July Brent rose $1.24 to $70.86 a barrel.

The surge came after the American Petroleum Institute, the industry body, reported a larger-than-expected drop in US oil inventories of almost 6m barrels, against Wall Street’s forecast of 400,000 barrels. Although API statistics are less important than the official US Department of Energy figures, to be released later on Wednesday, the market still takes them as a sign of the direction of the official numbers.

Oil has doubled in price since the market turmoil of late last year, with WTI gaining 60 per cent since January 1, as speculators have begun to take bets on a rebounding global economy resulting in higher crude prices.

Production cuts by OPEC, the international oil cartel, of over 4 million barrels per day since September have also contributed to rising oil prices.

The negative correlation between the US dollar and dollar denominated commodities continued, with dollar weakness helping push several base metals to fresh monthly highs. The broad based commodities rally helped copper to an eight-month high of $5220 per tonne, a gain of 0.6 per cent.

Aluminium gained 1.7 per cent to $1689 per tonne – a fresh six month high that took the light metal’s gains to $120 over the past three sessions – and zinc rose 1.2 per cent to $1634.5 per tonne. Aluminium’s continued gains have left many observers puzzled due to the continued stockpiling of the metal by Shanghai traders and London Metals Exchange data showing record levels being held in the LME’s warehouses.

p/s photo: Aya Nakata