Published: September 17, 2006 01:16 pm      

With H5N1 on the rise, are we prepared for a flu pandemic?

Editor’s note: This is part one of a three-part series.



pan·dem·ic (n. and adj.) — Epidemic over a wide geographic area and affecting a large proportion of the population: Pandemic influenza.



A scenario

She had never traveled out of the country, so when Mary Smith was given the opportunity to look into a problem at her company’s factory on the outskirts of Beijing, China, she was thrilled. Halfway through her visit to China, Mary felt a cold coming on. She took some over-the-counter medications and chalked it up to jet lag and a lowered resistance.

When she’d visited the home of the plant’s manager, both of his children seemed to have the sniffles as well. Maybe she’d caught it from them.

On the plane home, she began to feel worse. She felt congested and was having trouble breathing. Her cough was more pronounced. By the time her plane reached its final destination, Mary had to call her husband to come and pick her up.

When he arrived, Jim Smith found his wife apparently sleeping in an airport seat near the baggage carousel. She didn’t look well and when he tried to awaken her, she would not respond. Smith called for help and an ambulance was summoned. A half-hour later, Mary Smith was in the intensive care unit of her hospital and was in quarantine. The virus known by laymen as H5N1 had finally crossed into a human-transmitted disease. By the end of the day, many of the other passengers on Mary’s plane from China were also infected, many of whom had gone onto other planes on connecting flights.



Pandemic

Although the story of Mary Smith is fictional, it is only a matter of time until the fiction becomes fact. Already, there have been isolated cases of the virus having infected human beings. The good part, so far, is that the virus has not yet found a way to pass easily from human to human. Not yet.

Viruses tend to mutate. They take on other forms to adapt to their environments. Today, for example, we find that many bacteria and viruses are unaffected by antibiotics that used to stop them cold. The reason is that they have been able to change in a way that would make them resistant to the antibiotics. Most scientists agree that it isn’t a question of “if” so much as “when” the strain of virus known as H5N1 will mutate into one that is easily transmittable between humans.

Historically, we’ve had many outbreaks of influenza including the outbreak of the so-called Spanish Influenza in 1918. Worldwide, 40 million people died during that outbreak — more than all the fatalities in World War I combined. That outbreak was considered a pandemic because most of the world’s population was affected by it to some extent. An epidemic is not quite as severe. Pandemics of the flu seem to crop up about every 20 years or so. The last influenza pandemic was in 1968 ... in other words, we are long overdue for another.

The odds

“It isn’t if it [avian flu] is going to happen, it is when, where and how bad,” says Michael Osterholm head of the University of Minnesota’s Center for Infectious Disease and Policy in a video broadcast on Sept. 19, 2005.

In 1918, the loss of life worldwide was enormous, but consider this: In 1918, when there were 40 million deaths worldwide, but public air transportation was virtually non-existent then and the population of planet Earth was far smaller. In 2006, with the ready availability of speedy air transportation throughout the world, the opportunity for a disease to spread to pandemic proportions very quickly is a real problem for both governments and health professionals.

“In the modern world, infections diseases travel at jet speed. Pandemic planners tell us we may have up to three months before a pandemic virus hits North America.

SARS (Severely Acute Respiratory Syndrome) was raging in Toronto hospitals before it even had a name, before the World Health Organization (WHO) warned anybody to be on the lookout for the disease,” says Canadian medical journalist Helen Branswell in the aforementioned video conference on the costs and consequences of an influenza outbreak.

As in the fictional case of Mary Smith, the disease can be rapidly spread from Asia to North America in hours rather than in months. This gives organizations like the World Health Control and the Center for Disease Control in Atlanta a microscopic window of opportunity to keep such a disease contained.



Birds do it

Then there is the nature of H5N1’s transmission. H5N1, or as it’s called, avian flu is most commonly transmitted by contact with our feathered friends. Most migratory birds travel great distances in their migratory wanderings. As we approach the end of summer and the coming of colder weather, the built-in calendars of these animals’ brains are instructing them to migrate. Some birds travel thousands of miles and each place they stop along the way is considered a possible point of disease transmission. Already, cats, pigs and members of the weasel family (all of whom include birds in their diets) have been found to be carrying a form of the virus. We know that those who have been stricken have been in contact with either infected birds or parts of birds, which includes feathers, droppings and eggs.

Both avian flu and the Spanish flu are zoonoses — they are carried by one species but can be caught and spread by another. So far, other than in families in which there has been direct contact with an infected bird, the transmission from human to human has not happened to any great extent, but as mentioned earlier, it’s only a matter of time until that happens. Physicians have found that, when the disease in its present state does infect a person, it is quite a nasty bug. Mortality rates have been quite high especially among the young and the elderly. In its present form, the H5N1 virus has been fatal to over 50 percent of its victims.

The danger of this form of flu virus is that it is possible for a person who is already infected with a form of human flu virus to also contract the strain of virus known as H5N1. It is possible for the two forms of virus to then intermingle their genetic materials in a person to become a mutated form that is made of material from each of the two viruses. As most know, human flu viruses are bad enough; the common symptoms of fever, cough, sore throat, aching muscles and conjunctivitis are enough to bring you to your knees. Now imagine a form of the flu that is many times more potent and also far more resistant to medication. Avian flu is capable of producing more severe respiratory problems, pneumonia and, finally, death, than the form of human flu.

In a recent CBS Early Show, Health and Human Services Secretary Mike Leavitt said that avian flu is “the pandemic we’re worried about currently. We’re doing things that I believe are common sense. We’re increasing the amount of surveillance or early warning that we have in other countries.”

The Economy

Pandemics such as 1918’s Spanish flu epidemic can have a severe effect on the U.S. and world economies. There is no reason to doubt that an avian flu outbreak would have anything less than a devastating effect on manufacturing and finance. To date, the primary victims of the virus have worn feathers. One of the most effective ways of isolating the disease is the wholesale destruction of infected flocks. The World Health Organization has estimated that avian flu has cost global agriculture more than $10 billion and has affected the livelihoods of 300 million farmers. In addition, the potential losses to business represented by absentee employees that would occur in the event of a pandemic in our country alone would total in the billions of dollars.

The World Bank has estimated that an avian flu pandemic could result in a loss of $800 billion to the global economy. Economists for the World Bank point out that, in the first quarter of 2003, the spread of SARS in Asia cost Lufthansa airline $477 million. Because the first outbreaks in Asia resulted in mass destruction of poultry flocks, the avian flu has cost the Asian poultry industry roughly $10 billion. Although the impact on local business in the Johnson County area would not result in losses of such a catastrophic nature, the effect on the world’s economy would trickle down sufficiently to affect each of us.



The upside and the downside

There is some good news and some bad news about this potential disaster, though. On the good side, we know it’s coming, so we can prepare. Also, the H5N1 virus appears to respond to medications such as Tamiflu, which is already prescribed for severe cases of the flu. This is good news for those who can get the product and certainly it is good news for Roche, Tamiflu’s manufacturer. Now for the bad news. Even though we have had advance warning, many of our society’s most important sectors will be highly affected by such a pandemic. Imagine, for example, only one person being physically able to show up for duty at the police station. The other bad news? Although Tamiflu does help to subdue the virus, there isn’t nearly enough medication for everyone. It is estimated that, if the Roche company that manufactures Tamiflu was to work for 10 years, stockpiling each pill it made, it would still have only enough doses for 20 percent of the world’s population. Many people will have to tough it out without medication.

“We have been working with the Department of Health Services to prepare for the possible pandemic. We have set up flu vaccination station locations at 16 sites. The doses are ready to go in and are being stored in a secret location. Right now, though, we don’t have enough to handle an outbreak of avian flu. We’re just not making it fast enough, but hopefully we’ll have enough stockpiled when the time comes,” said Gerald Mohr, head of Johnson County’s emergency management director.



About the series

The timing of this series of articles is not a coincidence. It comes at the time of the anniversaries of the attacks on 9/11 and the landfall of Hurricane Katrina. Since then, many Americans have looked quite critically at how our nation handles and learns from a major crisis.

It is not the purpose of this article and the ones that follow to scare you. We are hoping to inform you about what your community is doing and what it needs to do to protect you and your family. In the coming weeks, we will explore how everyday life might be disrupted by a pandemic, what is being done to cope with the disruption of services and what is being done to prepare medical services for the possibly overwhelming task of saving life and preventing disease.



Information for this segment was taken from the following sources:

http://www.cdcfoundation.org/healththreats/avianflu.aspx (the foundation of the Centers for Disease Control)

www.who.int/csr/disease/avian_influenza (the World Health Organization branch of The United Nations)

www.pandemicflu.gov (the U.S. Government’s central website for information about a flu pandemic)



Michael Mager can be reached at 817-645-2441, ext. 2338, or features@trcle.com.