Credit: AFP
This article is an extract from Panicology by Simon Briscoe and Hugh Aldersley Williams published by Penguin Australia at $32.95.
Infective and pathogenic
Mutation is an evolutionary process, but it is not directed. The flu virus is not out to get us, it is simply out to survive, which it already does in the bird population. A sequence of mutations is required for H5N1 to be able to thrive not in a bird's gut but in the quite different conditions of the human respiratory tract. These mutations may or may not occur. And if a human-adapted virus does result, it may or may not turn out to be highly pathogenic.
Paradoxically, a virus that is both highly infective (i.e. it spreads efficiently) and highly pathogenic (i.e. it kills a high proportion of those whom it infects) may not be very dangerous on a global level because it quickly kills too many of its host species to be able to continue spreading. The pandemic threat comes from a virus that is only moderately pathogenic but highly infective.
The 1918 flu was such a virus, infecting more than half the world's population but killing only one in twenty of those it infected. The H5N1 virus circulating today is highly pathogenic (it has killed more than half the humans it has infected) but much harder to catch. If it mutates into a highly infective form, that in turn is likely to make it ultimately less lethal worldwide.
Recorded outbreaks have claimed single victims or small groups of people, almost all of whom can be directly linked to birds. All this means that it is extraordinarily unlikely that, for example, Princess Diana's driver was suffering from bird flu on the night of her fatal car crash (a theory reportedly entertained by the U.K.'s Daily Express). Bird flu remains essentially a disease of birds even though it may have taken the New York Times eight paragraphs in its story about the virus "spreading rapidly through Asia, Europe and Africa" to remind its readers of this basic fact.
Has H5N1 missed its chance?
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 seems these truths are at last being acknowledged. In February 2007, H5N1 avian flu rampaged through a Bernard Matthews turkey shed in Suffolk, England, requiring the swift destruction of 160,000 birds. Media talk of an inevitable human pandemic promptly vanished, replaced by a new Dunkirk spirit. When push came to shove, the outbreak was simply something that had to be – and could be – dealt with.
While bird flu has yet to claim a single human victim in Europe or the Americas, and has killed fewer than 300 people worldwide, it is perhaps worth adding that the familiar winter flu that nobody panics about claims at least 30,000 American and 12,000 British lives each year.
Simon Briscoe is a stastistician, a former managing director of research at Nikko Europe and currently statistics editor at The Financial Times. Hugh Aldersey-Williams is an author and journalist and a curator at the Victoria and Albert Museum. This article is an extract from Panicology by these two writers, published by Penguin Australia at $32.95. © 2008 Simon Briscoe and Hugh Aldersley Williams.
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.