Waiting for a Protein to Shift
This is a Reuters’ story. I note that, over the months I’ve been following this story, the tone has moved from concerned but detached to downright alarmed. By the way, I have yet to see a story on this in the major US dailies. Americans are being kept in the dark about this threat.
Flu Pandemic Inevitable, Plans Needed Urgently -WHO
Fri Nov 26, 7:24 AM ET
By Vissuta Pothong
BANGKOK (Reuters) - Every country in the world must come up urgently with a plan to deal with an inevitable influenza pandemic likely to be triggered by the bird flu virus that hit Asia this year, a top global health expert said on Friday.
“I believe we are closer now to a pandemic than at any time in recent years,” said Shigeru Omi, regional director for the Western Region of the World Health Organization (news - web sites) (WHO).
“No country will be spared once it becomes a pandemic,” he told a news conference.
“History has taught us that influenza pandemics occur on a regular cycle, with one appearing every 20 to 30 years. On this basis, the next one is overdue,” he said at a conference of 13 Asian health ministers trying to figure out how to avoid one.
“We believe a pandemic is highly likely unless intensified international efforts are made to take control of the situation,” he said of the H5N1 avian flu virus, which has defied efforts to eradicate it in several Asian countries, including Thailand.
The Spanish flu pandemic of 1918 and 1919 killed upwards of 20 million people and WHO experts say the next could infect up to 30 percent of the world’s more than 6 billion people and kill up to 7 million of them.
Omi said that to stave that off, the world would have to cooperate closely by sharing information promptly and openly on the virus — such as how it spreads, why it hits children more easily than adults and how quickly it is mutating.
This is very sloppy reporting. First, the Spanish Flu pandemic of 1918 killed 50 million people. The population of the planet was a fraction of what it is now, about 1.8 billion. The lethality (mortality) rate of the 1918 virus was between 2-5%. By contrast, 75% of the people who have contracted this year’s Avian virus (that can be identified, always a sketch business this early) have died. That’s a stunning rate. The 1918 pandemic did it’s lethal business in a mere 8 weeks. Given how much more mobile the world is now, it is chilling to contemplate how much damage this year’s bug could do in next to no time.
What the article doesn’t make clear (among a number of things that it doesn’t make clear) is that the none of these scary scenarios come to pass until the virus has mutated to become transmissable between humans. As far as we know right now, that fatal mutation has not occurred. However, influenza virii are known for their mutability and adaptability. H5N1, this year’s variation, demonstrates that it has this disposition, having been found already in pigs and tigers in addition to waterfowl and chickens. Should the mutation occur, and none of the other characteristics of the disease as it now exists be altered by the mutation, it would be out of control very quickly and impossible to stop.
The Reuters writer, then, took at face value the 7 million deaths from a possible Avian flu pandemic from the “expert” with which he spoke. In 1918, more than half of the world’s population was infected by the flu. Actual numbers of deaths by this Avian flu would be catastrophic. So, the tone of this article, while a little hysterical, actually understates the amount of danger that this potential represents.
In earlier bulletins, WHO was already calling for public health authorities all over the world to begin to prepare for vaccinating their entire populations. If this bug is as bad as it looks, that’s not an outrageous demand. Unfortunately, the earliest estimate for the vaccine to begin to be available is March, and I think that even if we put all of the vaccine makers in the world to the task of manufacturing it, we’ll have a little difficulty cranking out 5 billion doses in time to do a lot of good.
Right now, our defensive strategy is to hope that the mutation doesn’t occur before we are ready for it. I’m not liking those odds.
November 28th, 2004 at 11:01 am
While You Were Worrying About the Budget
While you and I were worrying about the budget — borrow more money to fund the move away from guaranteed social security???? — The American Street has been Waiting for a Protein to Shift. Flu pandemic? If this keeps up I’m expecting a…
November 28th, 2004 at 11:05 am
Yeesh. Melanie, thanks for the grim correction in the percentages. It makes me want to cover myself with Saran Wrap.
Is there a way the death toll can be mitigated? Can scientists prep in advance fast enough to keep it from happening?
November 28th, 2004 at 1:44 pm
Kevin,
Remember that my projection, and it is a projection, not a prediction, is based on what statistical information we have about influenza and its epidemiology. Which is a fair amount.
Here is some context (I’ve been covering this story for so many months that sometimes I forget TAS readers don’t have all the background information that Bump readers do):
–We are overdue for a pandemic. That doesn’t mean that H5N1 will be the pandemic bug. It could be something much milder which makes the jump to human transmissability. There was a pandemic in 1968 but it was only observable from mortality and morbidity statistics and was relatively mild. That said, having this particular strain of the virus emerge this year in the usual host population (all influenzas orginate in birds) means that there is a greater possibility that this will be the emergent strain.
–Not every strain of influenza is equally transmissable. Since this one hasn’t mutated yet, we don’t know if it will be an easy bug to spread or a not particularly easy bug to catch. This has to due the the protein formations on the surface of the virus which make it sticky or not. All flus are relatively easy to catch, but there is a range.
–This flu comes at a time when our worldwide vaccination scheme is in collapse, not that a vaccine could be produced in time to stem this. As the WHO has noted, if this is the emergent strain, the entire planet would need to be vaccinated. That’s impossible. That said, a program of personal hygiene which includes frequent handwashing, avoiding of personal contact (handshaking) with others, keeping one’s hands away from the eyes, nose and mouth, are quite effective at cutting down on the spread of the flu. It’s low-tech and requires personal vigilance, but it works. But it also requires a change of work culture for typically workaholic Americans: anyone who shows up in a place of business with a productive cough or runny nose should be sent home immediately. This particular piece of culture may already be put into place this year for a more ordinary flu season, given the non-existent rates of vaccination. I notice that some Catholic and Episcopal bishops are already telling communicants not to take the common cup at communion until the flu season is over. I know that I shan’t be receiving this way until it is clear we are out of the emergency (I’m high risk and could not get a flu shot.)
–Get a pneumonia vaccine shot. It is not at all clear to me that mortality from H5N1 is due to pneumonia (this sucker kills fast), but for a more ordinary flu season, it is pneumonia which kills people debilitated by the flu which devolves into pneumonias (yes, there is more than one.) You can cut your risk with the pneumonia vaccine.
I wouldn’t be covering this story at all, like the rest of the American media, if I hadn’t become aware a few years back of the epidemiology behind flus and pandemics. Read Laurie Garrett’s The Coming Plague if you want to be radicalized about how poorly all of the world’s public health systems are faring and what we have in front of us from the world of microbes. I hear from a commentor at KOS that the ER docs are already in a panic about this bug, and that’s a hard population to freak.
November 28th, 2004 at 2:32 pm
That troubles me, Melanie, your being a high risker and not being able to get a shot. If you’re close enough to Canada, get it there on a quick trip — puh-lease! I’m also high risk and this year got very, very serious about getting the vaccine, even though it doesn’t guarantee immunity. There are other tips: carry stuff to keep your hands clean. Don’t touch face, etc.
Kevin — didn’t they just do a piece on NPR about the avian flu virus having mutated?
November 28th, 2004 at 2:38 pm
kevin,
Is there a way the death toll can be mitigated? Can scientists prep in advance fast enough to keep it from happening?
i don’t think we can keep it from happening… but we ought to be able to limit the death toll somewhat. WHO seems to be pretty much on top of the monitoring (at least i have no evidence to the contrary).
imo we need to invest in a level of infrastructure (basic science, vaccine development know-how, production facilities, emergency medical people and facilities,…) that looks like over capacity when we are not in the midst of a pandemic. on the up-side, in normal times they could be providing health care to the currently underserved.
*notice of conflict of interest - an nih grant pays my salary.
November 28th, 2004 at 6:28 pm
i have been reading articles on this (mostly outside the US) since this past spring, when i found out that several Asian countries had to destroy something along the lines of 120 million poultry birds to try to control the spread of the disease 8-10 months ago. this thing has been scaring them for almost a year now.
one story from October broke my heart… a tiger preserve in Thailand had to destroy 147 out of the 200 tigers there, because they’d been fed raw chickens… chickens that had been infected with H5N1. the tigers got sick and were dying, so they destroyed all the ones displaying effects of the illness.
i hadn’t heard that it’d crossed into pigs, because that’s the worse-case scenario. i’d read that from pigs it picks up the genes necessary to mutate into an airborne strain that affects humans, rather than just from the direct contact with infected birds as it is now. if it’s already mutated, then it may well be spreading, or about to spread, from human to human contact. weird, i read something a year ago in an astrology forecast about a bug circling the world in January 2005.
100% infectious and 75% lethal is a scary combination, and so far only people who work in high risk areas (ie, poultry farms in SE Asia) have contracted it.
November 28th, 2004 at 6:37 pm
The way I read Garrett and the public health experts, is that the window for gaining a fighting chance against the ever-evolving microbes was roughly between 1980 and 2000. Unfortunately, during that timeframe, the resources that might have been put to beneficial use were squandered on destabilizing communist and socialist governments, and consequently their public health infrastructures. The ultimate irony is that central Asia and Russia might end up being the regions where these unstoppable viruses really take off.
November 28th, 2004 at 9:49 pm
Just how likely is it that this virus could become transmissable in humans..this year, 10 years, 100 years from now, never?
Should we prepare vaccine against a disease which might happen someday? Recently we were developing a vaccine against anthrax in anticipation of a terrorist attack,
(and we will have another terrorist attack someday, right?) while our vaccine program for plain old flu went haywire. We can estimate how many people ordinary flu will kill this year. Why put so much effort into something that might happen, instead of fighting expected, preventable deaths?
November 29th, 2004 at 1:08 am
There was a very interesting Newsweek story on this several weeks ago. I tried to find it on their web site, but they charge for old stories ($2.95). Still, worth reading for background if you’re interested. I’m not connected with Newsweek in any way.
Newsweek archive
November 29th, 2004 at 4:18 am
Well maybe we will learn the real power of prayer!! Because by the time the pwoers that be realise that they have a pandemic on their hands it will be TOO LATE. The Spanish flu was so quick and bad that it ended the first world war. I also read Laurie Garrett’s book, I don’t recommend reading it if you want to sleep soundly at night, or if you want to continue interacting with your fellow man.
Ronin man take a look around you, how often do you catch a cold? How often does the person who works beside you come to work with the sniffles or a cough or a mild temperature? In the Spanish flu epidemic healthy people got on the bus and before their bus stop were dead. People went to bed healthy and were dead before morning. Privates in the training centers were stacking the dead like cordwood, for the only time in our modern history we were burning the dead. Almost every person on earth was exposed to the virus, and this was a time before modern travel. It still to a bit of time to go from here to there. Now International travel is open to anyone with a few bucks in their pocket. I live in Japan, I can tell you the health professionals in this country are terrified and are ready to take draconian measures to prevent the infection of the populace. China is still supressing health information, and Korea just slaughtered almost a million pigs, worry my man worry.
November 29th, 2004 at 8:25 am
<>Comment by selise — November 28, 2004
Selise, yo’re describing the system we had a few years ago. The drug manufacture companies in the US got out of the game because of liability problems. John Edwards made millions by successfully suing a company after some old fart got the flu after receiving his flu shot.
November 29th, 2004 at 12:33 pm
Bogliodemus,
The rumor you are propagating is patently untrue both regarding the reasons for US manufacturers getting out of the vaccine business and bogus anectdote about John Edwards. To quote http://www.snopes.com/politics/business/flushot.asp, “the National Childhood Vaccine Injury Act of 1986 eliminated most of those lawsuits through the creation of the Vaccine Injury Compensation Program (VICP), a no-fault compensation alternative ”
John Edwards was the type of trial lawyer we should all respect and admire. He was not the stereotypical “ambulance chaser”.
In the future, you should be very skeptical of whatever was the source of that information.
November 29th, 2004 at 6:24 pm
I agreed in part and demurred slightly with your excellent post. There is a long post and pull quote from you over at Effect Measure (http://effectmeasure.blogspot.com) which explains my take on this.