Credit: AFP
This article is an extract from Panicology by Simon Briscoe and Hugh Aldersley Williams published by Penguin Australia at $32.95.
What does it take to catch bird flu?
So far, so terrifying. Perhaps it is more instructive to look at what you have to do to catch this disease rather than what to do to prevent it. What does it take to catch flu from a bird? Scientists discovered in 1974 that the avian flu virus thrives in the guts of wild birds, notably waterfowl.
Unlike familiar forms of human-transmissible flu, which is a respiratory infection passed through the air, avian flu is passed on when healthy birds ingest water containing the excreta of infected birds. For a person to become infected, he or she must have intimate exposure to the excreta or intestines of an infected bird. Taking up voodoo and smearing yourself with the raw entrails of an infected chicken in a sacrificial ritual would thus be a good way to contract bird flu.
Another successful method is to eat (carelessly prepared) raw ducks' blood sausage, which is a Vietnamese delicacy and the cause of some cases in that country. Sharing your accommodation with poultry is hazardous because the birds' excreta or remains are likely to contaminate human food. This explains the majority of human cases of bird flu – no cases have been recorded of people catching the disease from live wild birds or from cooked poultry.
In the U.K., it is statistically true to say that you are more likely to die of rabies than bird flu simply because one man – a professional bat handler – died of bat rabies in 2002.
This comparison may seem facetious, but both avian flu and rabies are – along with HIV, ebola and measles – zoonotic diseases, that is to say they are carried by animals but can pass to humans if the virus mutates in the right way. The comparison illustrates the fact that for both these normally animal-borne viruses a human being has to take extraordinary steps to put themselves at such a disadvantage that infection is possible.
Dangerous mutability
Even then, the avian flu virus must be present in a form that is able to attack human cells. There are 144 possible combinations of the 16 H (haemagglutinin) and 9 N (neuraminidase) chemical groups that dot the surface of a flu virus. H5N1 is one particular combination. The previous flu epidemics of the twentieth century were H1N1, H2N2 and H3N2.
Other combinations arise from time to time – for example, in the Netherlands in 2003 an outbreak of H7N7 led to a cull of 11 million chickens. One person died out of 83 infected by this less deadly strain. But scientists do not know what mutations are needed to produce a dangerous type of the virus. They cannot predict when mutations will appear or what they will be. This makes it impossible to prepare specific vaccines or anti-viral treatments before the new type is present in humans.
It is this mutability that makes flu dangerous. The smallpox virus, for example, has a fixed composition, which has made it relatively easy to eradicate. The H and N groups of the flu virus, on the other hand, may 'drift' into a different form if the amino acids within them are altered.
Darwinian natural selection then ensures that the virus reappears each year in a slightly different version, although this change happens sufficiently slowly that the human immune system is generally able to cope with the new invader. But the virus can also 'shift' rapidly into a new type when a new H or N is introduced, for example from birds. When this happens, there is no ready immunity in the general population.
'Mutation' is also a word made for scare stories. It seems to leap straight from the pages of John Wyndham, where some malevolent biological slime manouevres for world domination using processes clearly outside human understanding or control.
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.