The Coming Pandemic?
The United States is woefully unprepared for the next likely disaster: an avian flu pandemic.
Health officials at the Centers for Disease Control and Prevention, and at the World Health Organization, are urgently warning governments and public health officials that a deadly avian influenza virus may soon spread rapidly across the globe, overwhelming unprepared health systems in rich and poor countries alike. The lethal Type A strain of influenza virus, known as H5N1, first emerged in Hong Kong in 1997 and has since been responsible for the deaths of hundreds of millions of chickens, ducks, and other water fowl, and increasing numbers of mammals. As of July, over 100 people in Southeast Asia have been infected, most from contact with infected birds, and 60 have died.
This is a powerhouse virus. Infectious disease experts are warning that it is only a matter of time before the virus mutates to become more easily transmittable among humans. Once it does, it will spread quickly, and the global death toll will likely be in the tens of millions. Despite these warnings, local, state, national and international preparedness is entirely inadequate to the potential threat. As one health expert said recently, "avian influenza is a viral asteroid on a collision course with humanity".
H5N1 is the most lethal strain of influenza ever seen. Since appearing, it has killed 100 percent of the domesticated chickens it has infected. Over the past 9 months, avian influenza has evolved to become heartier and deadlier, and has jumped the species barrier to kill a wider range of species including mammals such as tigers, horses, pigs, mice, and humans. Most alarming is that since the beginning of the year, several human-to-human cases have occured.
Thus far, the disease has been limited to Southeast Asia, the Korean Peninsula, Indonesia, and China, but Russian health authorities in recent days have confirmed H5N1 as the cause of death in large numbers of migratory birds and poultry in six separate regions east of the Ural Mountains, which are all that now stand between the virus and Europe. Experts are almost certain that the virus will arrive in Europe and the Middle East as early as this fall.
If (and many say when) the virus mutates or acquires just a few new genes, it will travel the world at a deadly velocity. The havoc such a disease could wreak will exceed that of the Spanish flu of 1918-19, which killed at least 50 million people worldwide over a period of 18 months, including 6 percent of the U.S. population. Almost no one will have natural immunity, no matter whether they've received influenza vaccinations previously.
It is also possible that nothing will happen. The virus may not acquire the capability for easy human-to-human transmission. It may lose some or all of its extraordinary virulence. No one can predict with certainty what H5N1 will do. But the risk of danger is profound, and we are quite simply terribly unprepared.
The CDC and WHO predict that an avian influenza epidemic could kill between 2 and 10 million Americans, hospitalize millions more, and sicken one-third to one-half of the U.S. population. The entire world would experience similar levels of carnage, with higher death tolls expected in regions with poorer general health and higher numbers of HIV-infected individuals, such as in Africa. A global death toll in the hundreds of millions is not out of the question.
Unlike the typical yearly influenza virus epidemics, it will be the young and healthy who suffer the most, because it is not so much the virus that kills, rather the overwhelming immune response of the body against it. In what is known as a cytokine storm, the body quite literally destroys itself. Young healthy bodies with healthy immune systems will mount the most overwhelming immune response, and experience the highest mortality.
Aside from the tremendous loss of life, the effect on the global economy would be catastrophic. Profound work stoppages would occur. Borders and airports would be closed for months. Trade and travel would virtually cease. The world's stock markets would undoubtedly crash. Aside from economics, the disease would affect global security, reducing troop strength for all armed forces, UN peacekeeping operations, and civil police worldwide.
Local, state and federal governments are simply unprepared for the massive social disruption and panic that would result from an avian flu pandemic. And the federal government knows this. Outgoing Health and Human Services Secretary Tommy Thompson, when asked what worried him most, stated last December that the threat of a avian flu pandemic was a "really huge bomb that could adversely impact on the healthcare of the world", killing 30 to 70 million people. One would assume that he spoke with the authority of someone with access to the best medical information in the world.
If a pandemic happened in the near future, U.S. hospitals would quickly be overwhelmed. They would also quickly become understaffed, as many medical personnel would be afflicted with the disease. Disruptions in the supply of medications would occur. Hospitals would be overwhelmed with both the sick and the worried well. Many times more people infected with avian influenza would need ventilator care than there exists ventilators in the U.S. How would they deal with the large numbers of patients? How would hospitals make decisions on rationing?
Critical community services would be immobilized, including fire, police, and community government. Workplaces would grind to a halt. Shortages of food and other essentials would occur. Places where people gather - malls, cinemas, theaters, churches, sporting events - would be shut down to limit human spread of the virus. The resulting social breakdown would be unlike anything seen by living Americans.
A vaccine was only very recently developed, and is on the FDA fast-track for approval, however just two million doses are expected to be produced in the U.S. over the next four to six months. The United States would probably only have about a month or less of warning before a pandemic became widespread, therefore there would simply not be enough time to produce a vaccine against H5N1 on a large enough scale to immunize the entire U.S. population. Moreover, unlike the usual single yearly vaccination administered in the fall and winter months against the usual strains of influenza, immunization against avian influenza would require a series of two vaccinations. We simply cannot count on vaccines.
We will also face the dilemma of who to vaccinate. The usual candidates - the very young, the elderly, and the immunocompromised - were actually the ones most likely to survive during the Spanish flu pandemic of 1918-19. As is expected to happen with an avian flu pandemic, it was the young and healthy who suffered the highest mortality during the Spanish flu pandemic. So do we immunize the young and healthy with our limited avian influenza vaccines? Or do we immunize those who society traditionally considers its most vulnerable? Or do we give priority to health care workers, civil servants, and those in the military? How will we decide?
As for treatment, only one antiviral, oseltamivir (Tamiflu), is known to be at least somewhat effective against avian influenza. However, no one knows exactly how effective it will prove in the event of a pandemic.
Only one company, Roche of Switzerland, produces Tamiflu. Its production is slow and difficult, and could not be greatly accelerated in the event of an avian flu pandemic. Countries in the developed world, including Johnny-come-lately the United States, are beginning to stockpile the drug, but if a pandemic were to hit in the next one to two years (and many say it likely will) there simply will not be enough Tamiflu to go around. Great strife would ensue as the limited supplies of this expensive drug were allocated to those in health care and other essential services. Everyone else, and everyone in the underdeveloped world, would simply be out of luck.
The Bush administration since 9/11 has spent billions of dollars on what it terms "biodefense", and has established priorities in inverse relation to actual probabilities. The risk of an avian influenza pandemic, and the potential for massive death and disruption, far exceeds the risks and potentials of outbreaks of anthrax, or smallpox. As one member of the government's advisory panel on vaccinations recently said: "It's too bad that Saddam Hussein's not behind avian influenza. We'd be doing a better job".
What can we do? We can no longer ignore the warnings. Local and state governments, as well as the federal, must move avian influenza pandemic preparedness to the top of their domestic public health priority list. Hospitals and local and state public health officials must do likewise. Citizens must be informed of the brewing threat, and demand immediate attention be given to community preparedness.
While a global pandemic cannot be stopped once it starts, its impact, and its death toll, can be greatly reduced by immediate dedication to preparedness. We might get lucky, and an avian flu pandemic might never materialize, but should we leave it to chance?
add a comment on this article
add a comment on this article