Post by Watchman on Feb 27, 2006 14:29:11 GMT -5
Viral Asteroid: Humanity remains dangerously unprepared for the impact of avian flu
By Todd Huffman
For The Register-Guard
Officials at the Centers for Disease Control and Prevention and at the World Health Organization are warning governments and public health officials urgently 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. It has since been responsible for the deaths of hundreds of millions of chickens, ducks and other waterfowl, and increasing numbers of mammals. As of Feb. 20, roughly 200 people in Southeast Asia, China, Turkey, Iraq, and now India have been infected, most from direct contact with infected birds. Ninety-two are known to have died from the virus.
This is a powerhouse virus. Most infectious disease experts are warning that it is only a matter of time before the virus mutates to become more easily transmissible among humans. If it does - and so far it hasn't - 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 address the potential threat. As one health expert famously said, "Avian influenza is a viral asteroid on a collision course with humanity."
H5N1 is the most lethal strain of influenza ever seen. Since its appearance, it has killed 100 percent of the domesticated chickens it has infected. Over the past one to two years, 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.
Until recent months, the disease was limited to Asia. Now, the virus has been detected in birds in Russia, Europe, the Middle East and, most alarmingly, in Africa and India. If (and most experts say when) the virus mutates or acquires just a few new genes, it will travel the human 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.
A global avian flu pandemic is by no means a certainty. It is quite possible that nothing will happen. The virus may never acquire the capability for easy human-to-human transmission. Or it may, but then lose some or all of its extraordinary virulence. No one can predict with confidence what H5N1 will do. But the risk of danger is high, and we are - quite simply - terribly unprepared.
The CDC and WHO predict that an avian influenza pandemic could kill between 2 million 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 likely be the young and healthy who suffer the most, because it is not so much the virus that kills but 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 stout immune systems will mount the most overwhelming immune response, and experience the highest mortality. Most deaths thus far from avian influenza have been in children and young adults.
Aside from the tremendous loss of life, the effect on the global economy would be catastrophic. A pandemic would cause considerable global social and economic disruption. 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 crash. The disease would affect global security, reducing troop strength for all armed forces, U.N. peacekeeping operations and civil police worldwide.
A pandemic quickly would overwhelm U.S. hospitals with both the sick and the worried well. Hospitals soon would become understaffed, because many medical personnel and their families would be afflicted with the disease.
Disruptions in the supply of medications would occur. There would not be enough ventilators. How would hospitals deal with the large numbers of patients? How would they make decisions on rationing?
Critical community services would be immobilized - including fire, police and local government. Workplaces would grind to a halt. There would be shortages of food and other essentials. 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.
The United States probably would have only about a month or less of warning before a pandemic became widespread. While a vaccine against H5N1 has been developed, there would simply not be enough time to produce it on a scale large enough to immunize the entire U.S. population.
Moreover, unlike the usual 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.
Even if vaccines were to become available, there would also be 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.
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? And will the majority of Americans wait patiently as those with first priority status - health care workers, police, firefighters, National Guard members and the military - are vaccinated?
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. Some concerning reports of drug resistance have come out of Southeast Asia.
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 the Johnny-come-lately United States, are beginning to stockpile the drug. But if a pandemic were to hit in the next one to two years, 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.
Until the past nine months, the Bush administration, by spending billions of dollars on what it terms "biodefense" since the Sept. 11, 2001, attacks, established priorities in inverse relation to actual probabilities. Public health officials have been warning for years that the risk of an avian influenza pandemic, and the potential for massive death and disruption, far exceeds the risks and potentials of bioterrorist outbreaks of anthrax or smallpox.
As one member of the government's advisory panel on vaccinations said early last year: "It's too bad that Saddam Hussein's not behind avian influenza. We'd be doing a better job."
But to its credit, the administration, thanks in large part to the serious efforts of new Secretary of Health and Human Services Mike Leavitt, has developed and is continuing to update a national pandemic preparedness plan. Even with this only too recent federal recognition of avian influenza as our greatest public health threat, and the billions in congressionally allocated funds that followed, the federal government is largely limited in what it can do to help local communities in the event of a pandemic. Most communities will simply have to fend for themselves.
So what can the average citizen do? What we don't do is panic. However, we can no longer ignore the warnings. The virus is on the move, and its recent landing in Africa and India has accelerated world health officials' concerns for a global pandemic in the near future.
Local and state governments must be urged to 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 that immediate attention be given to community preparedness.
Likewise, citizens must allow themselves to be educated as to how best to behave in the event of a pandemic. Public panic and the failure to follow the instructions of local and state civil and public health officials will result in far more illness and death.
While a global pandemic will be next to impossible to stop once it starts, its impact, and its death toll, can be greatly reduced by immediate dedication to preparedness.
We might get lucky. An avian flu pandemic might not materialize. But should we leave it to chance?
Copyright © 2006 — The Register-Guard, Eugene, Oregon, USA
By Todd Huffman
For The Register-Guard
Officials at the Centers for Disease Control and Prevention and at the World Health Organization are warning governments and public health officials urgently 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. It has since been responsible for the deaths of hundreds of millions of chickens, ducks and other waterfowl, and increasing numbers of mammals. As of Feb. 20, roughly 200 people in Southeast Asia, China, Turkey, Iraq, and now India have been infected, most from direct contact with infected birds. Ninety-two are known to have died from the virus.
This is a powerhouse virus. Most infectious disease experts are warning that it is only a matter of time before the virus mutates to become more easily transmissible among humans. If it does - and so far it hasn't - 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 address the potential threat. As one health expert famously said, "Avian influenza is a viral asteroid on a collision course with humanity."
H5N1 is the most lethal strain of influenza ever seen. Since its appearance, it has killed 100 percent of the domesticated chickens it has infected. Over the past one to two years, 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.
Until recent months, the disease was limited to Asia. Now, the virus has been detected in birds in Russia, Europe, the Middle East and, most alarmingly, in Africa and India. If (and most experts say when) the virus mutates or acquires just a few new genes, it will travel the human 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.
A global avian flu pandemic is by no means a certainty. It is quite possible that nothing will happen. The virus may never acquire the capability for easy human-to-human transmission. Or it may, but then lose some or all of its extraordinary virulence. No one can predict with confidence what H5N1 will do. But the risk of danger is high, and we are - quite simply - terribly unprepared.
The CDC and WHO predict that an avian influenza pandemic could kill between 2 million 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 likely be the young and healthy who suffer the most, because it is not so much the virus that kills but 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 stout immune systems will mount the most overwhelming immune response, and experience the highest mortality. Most deaths thus far from avian influenza have been in children and young adults.
Aside from the tremendous loss of life, the effect on the global economy would be catastrophic. A pandemic would cause considerable global social and economic disruption. 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 crash. The disease would affect global security, reducing troop strength for all armed forces, U.N. peacekeeping operations and civil police worldwide.
A pandemic quickly would overwhelm U.S. hospitals with both the sick and the worried well. Hospitals soon would become understaffed, because many medical personnel and their families would be afflicted with the disease.
Disruptions in the supply of medications would occur. There would not be enough ventilators. How would hospitals deal with the large numbers of patients? How would they make decisions on rationing?
Critical community services would be immobilized - including fire, police and local government. Workplaces would grind to a halt. There would be shortages of food and other essentials. 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.
The United States probably would have only about a month or less of warning before a pandemic became widespread. While a vaccine against H5N1 has been developed, there would simply not be enough time to produce it on a scale large enough to immunize the entire U.S. population.
Moreover, unlike the usual 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.
Even if vaccines were to become available, there would also be 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.
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? And will the majority of Americans wait patiently as those with first priority status - health care workers, police, firefighters, National Guard members and the military - are vaccinated?
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. Some concerning reports of drug resistance have come out of Southeast Asia.
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 the Johnny-come-lately United States, are beginning to stockpile the drug. But if a pandemic were to hit in the next one to two years, 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.
Until the past nine months, the Bush administration, by spending billions of dollars on what it terms "biodefense" since the Sept. 11, 2001, attacks, established priorities in inverse relation to actual probabilities. Public health officials have been warning for years that the risk of an avian influenza pandemic, and the potential for massive death and disruption, far exceeds the risks and potentials of bioterrorist outbreaks of anthrax or smallpox.
As one member of the government's advisory panel on vaccinations said early last year: "It's too bad that Saddam Hussein's not behind avian influenza. We'd be doing a better job."
But to its credit, the administration, thanks in large part to the serious efforts of new Secretary of Health and Human Services Mike Leavitt, has developed and is continuing to update a national pandemic preparedness plan. Even with this only too recent federal recognition of avian influenza as our greatest public health threat, and the billions in congressionally allocated funds that followed, the federal government is largely limited in what it can do to help local communities in the event of a pandemic. Most communities will simply have to fend for themselves.
So what can the average citizen do? What we don't do is panic. However, we can no longer ignore the warnings. The virus is on the move, and its recent landing in Africa and India has accelerated world health officials' concerns for a global pandemic in the near future.
Local and state governments must be urged to 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 that immediate attention be given to community preparedness.
Likewise, citizens must allow themselves to be educated as to how best to behave in the event of a pandemic. Public panic and the failure to follow the instructions of local and state civil and public health officials will result in far more illness and death.
While a global pandemic will be next to impossible to stop once it starts, its impact, and its death toll, can be greatly reduced by immediate dedication to preparedness.
We might get lucky. An avian flu pandemic might not materialize. But should we leave it to chance?
Copyright © 2006 — The Register-Guard, Eugene, Oregon, USA