Credit: AFP
This article is an extract from Panicology by Simon Briscoe and Hugh Aldersley Williams published by Penguin Australia at $32.95.
Spread of SARS
In the most dramatic illustration of the way disease can spread in the global village, a doctor who had attended some of the first victims in China travelled to Hong Kong for a wedding. There he passed the infection to sixteen other guests. Within a day, those people and others whom they infected in turn distributed the virus to half a dozen countries as far afield as Ireland and Canada, ultimately accounting for 355 cases.
The SARS episode now provides an exemplary case study of how a powerful virus spreads – and may be contained. For although SARS did rapidly kill three times as many people as avian flu has done, it was contained relatively efficiently by isolation and quarantine of those infected.
Preparedness in this case did not mean laying in vast stockpiles of a vaccine since SARS was a completely new virus. Nor would some of the usual government reflex gestures such as closing borders have made any difference in time. The key was openness and rapid reporting, rather than the sort of administrative denial that can give a virus time to spread unchecked.
Another lesson applicable to pandemics of all kinds is the importance of accurate diagnosis and decisively taken preventive measures. In general, even very contagious diseases may be controlled by means of appropriate education as much as by high-tech medicine.
If a flu pandemic is indeed 'inevitable', it is equally inevitable that it will start in Asia. It is the high 'viral load' here that tempts epidemiologists to use the word in the first place. All of the modern global flu outbreaks began in China, where many people live crammed into unsanitary conditions, frequently cohabiting with their ducks, chickens and other livestock. The future issue for the rest of the world may be containment; the issue in rural Asia now is domestic hygiene.
Shock tactics
Despite this reality, western governments and media continue to play to the gallery. "If bird flu grips the nation, doctors will need guns," screamed the Sunday Times.
The viral load is nowhere lower than in the United States, yet this is where some of the most hysterical coverage is seen. The New York Times alarmed its readers with news that the vaccine being stockpiled by the U.S. "protects only about half the people who receive it," making it sound for a moment as if survival would be a lottery even for the inoculated. Only later in the story came the admission: "The disease has not reached the Americas."
In Britain, the Sunday Herald newspaper leaked a government study predicting the breakdown of society: "A minimum of 25 per cent of the population will become ill over each six-to-eight-week period ... Mortality is likely to be high – estimated at one per cent of the total population."
Not that there was much to be done about it. At home, nothing yet needed doing. For anywhere else, the precautions were elementary. The U.K. National Health Service advised people travelling to affected regions to avoid close contact with poultry and to wash their hands.
Washing your hands is never a bad thing, of course, but the clueless advice hardly seems commensurate with the claimed scale of the looming disaster and media talk of stockpiling body bags. It recalls that of the hygiene-obsessed economist Edwin Chadwick, who went to his grave restating his belief in "soap and water as a preventative of epidemics" long after the celebrated John Snow had narrowed down the source of the 1848 London cholera outbreak to a particular street pump.
Dangerous Journalism
This article "Bid Flu: A Dead Duck?" makes several points that lack proper evidence and, as presented as fact, prove dangerous journalism for anyone considering preparation for this disaster scientific experts deem as inevitable.
"The SARS episode now provides an exemplary case study of how a powerful virus spreads – and may be contained. For although SARS did rapidly kill three times as many people as avian flu has done, it was contained relatively efficiently by isolation and quarantine of those infected."
This article fails to note that SARS is not flu. SARS has 10 day incubation period where the victim cannot shed virus. Inversely, influenza only incubates for 3 days before showing symptoms. Worse, the virus can be spread before the end of the incubation period (without any visible symptoms). For this reason, planning for a severe flu pandemic must be vigilant not to rely on overconfidence from past successes.
"There are other reasons to worry less about bird flu. The media has repeatedly said that a pandemic is 'overdue' or even 'long overdue'. This claim is not based on any virological dictum, but simply on the historical pattern of outbreaks – one every 10 to 15 years or so from 1918 to 1977 and then a pregnant pause until now. But in fact the longer H5N1 'tries', the less likely it is to succeed in adapting into a human-transmissible type.
Some scientists now believe H5N1 has had its chance. A virus is not like a volcano, where pressure may build up gradually, leading to an eventual eruption. And a continued non-outbreak doesn't make a future outbreak more likely or more deadly. "
It would be helpful to readers to hear the scientific basis of this argument. Because non of the "experts" referred to earlier in the article as calling a flu pandemic "inevitable" have EVER said that "the longer H5N1 'tries', the less likely it is to succeed in adapting". This shows no understanding of viral mutation and even less respect for the journalistic obligation to inform the public truthfully about pressing current events.
I apologize if this seems harsh, but the duty of journalists to report earnestly on this issue is far too often pushed aside for soothing accusations of scaremongering against the international medical community and others who work to prepare our world for an inevitable public health emergency.
Sincerely,
Justin Kamen
jbk2108@columbia.edu
www.StudentsPrepAmerica.org
H5N1 -prepare for panflu year
This article seems to overlook both the facts that the individual cases, and, human clusters are being fought, (on more than one continent) however sloppily, at great expense, (including animal cull zones, movement restrictions, biohazard Level 3 PPE, and, major donations of Tamiflu - seemingly the only treatment keeping H5N1 from being 100% fatal, and, only if given rapidly at, or, for close contacts, before symptom onset, at higher/longer doses than for seasonal flu, because H5N1 replicates so fast and is so virulent) and, that nations are more and more turning to hiding their cases, in order to not increase those "official" statistics (and to avoid economic or travel consequences of reporting an outbreak)(especially in this Olympic year).
Indonesia, for instance, has been claiming people must test positive three times before being an "officially confirmed" H5N1 case; if they don't get Tamiflu in time, people die - but if they are on Tamiflu for about 3 days, it confuses the test, and people who tested positive on arrival but negative after treatment aren't added to the numbers. (There may also be pressure to report cases/deaths as other diseases with symptoms similar to H5N1.)
Many nations have figured out it is easy to not find anything by not looking for it, or, by doing the wrong test at the wrong time.
(What sorts of things get labelled "state secrets" when they have the "economic and political" consequences an H5N1 confirmation does?)
Remind readers to read the Individual's page under the plans/preparedness sidebar on the US pandemicflu.gov site that's been up since Oct 2005. Search out the "US State Dept H5N1 factsheet" that has said, since July 2006, that travellers should know they risk being stranded (by international or local movement restrictions, put in place by other nations, or, the US itself,) when pandemic breaks out anywhere, and, that the US embassies will not be providing any aid to citizens in the event of pandemic.
"Outsourcing" of essentials has created a huge national security risk, as Dr.Osterholm tried to bring to Congress' attention.
As Dr.Nabarro of the UN said, systems of trade, finance, and workplaces are interconnected, "and will not survive" the impact of pandemic on workforces.
We were all supposed to be making workable local preparations, since 2006, with every community having a Pandemic Preparedness Coordinating Committee, including "all" stakeholders in the process!
H5N1, like HIV, is not going away.
It is on so many continents, in so many bird and mammal species, it will keep mutating, and, swapping with other flu virii.
Each human H5N1 case they only know isn't pandemic start after they apply containment measures and see cases don't continue to appear.
We've already had our months of warning; once you know for sure pandemic has started, preparation time will have ended.
Take care of yourself; the state pandemic flu summits with HHS back in 2006 have not resulted in the feds/state/nor locals making any provision for you during a year or more of infrastructure disruptions, and something deadly and contagious before symptoms.
It is not true, as too many officials have said in private; "we can't tell the public, because there is nothing they can do".
For Community Pandemic Mitigation to be possible we need to be proactive, and use the warning science has given us, and, the time Tamiflu has bought us.
See GetPandemicReady.org and try not to be part of the problem.
We'd finally be better prepared for all other disasters and emergencies (which will still occur during panflu year, with far less aid possible) by trying to be better prepared for pandemic year disruptions.
The people back in 1918 were better prepared at home than the public is today. Let's go back as a society to valuing family preparedness.