Bird Flu Flap

Bird flu duckI’m not entirely convinced that bird flu (avian influenza) is going to be the next big emergent disease that will wipe out thousands, if not millions, of people across the globe. SARS, after all, had nothing to do with avians, nor does HIV, and certainly not malaria, tuberculosis, MRSA, Escherichia coli O157, or any of dozens of virulent strains of disease that have and are killing millions of people.

There are just so many different types of host within which novel microbial organisms and parasites might be lurking, just waiting for humans to impinge on their marginal domains, to chop down that last tree, to hunt their predators to extinction, and to wreak all-round environmental habitat on their ecosystems, that it is actually only a matter of time before something far worse than avian influenza crawls out from under the metaphorical rock.

In the meantime, there is plenty to worry about on the bird flu front, but perhaps nothing for us to get into too much of a flap over, just yet.

According to a report on Australia’s ABC news, researchers have found that the infamous H5N1 strain of bird flu (which is deadly to birds) can mix with the common-or-garden human influenza virus. The news report tells us worryingly that, “A mutated virus combining human flu and bird flu is the nightmare strain which scientists fear could create a worldwide pandemic.”

Of course, the scientists have not discovered this mutant strain in the wild, they have simply demonstrated that it can happen in the proverbial Petri dish.

Meanwhile, bootiful UK turkey company – Bernard Matthews Foods – has called for an early warning system for impending invasions of avian influenza. A feature in Farmers Weekly Interactive says the company is urging the government and poultry industry to work together to establish an early warning system for migratory birds that may carry H5N1 avian flu. “Armed with this knowledge, free range turkey producers would be able to take measures to avoid contact between wild birds and poultry.” That’s all well and good, but what if a mutant strain really does emerge that also happens to be carried by wild (and domesticated birds) or, more scarily by another species altogether? Then, no amount of H5N1 monitoring is going to protect those roaming turkeys.

While all this is going on, the Washington Post reports that the Hong Kong authorities announced Wednesday (June 10) that they are going to cull poultry in the territory’s retail markets because of fears of a dangerous bird flu outbreak. H5N1 virus was detected in chickens being sold from a stall in the Kowloon area and 2700 birds were slaughtered there to prevent its spread. In closely related news, the International Herald Tribune has reported that there has been an outbreak of bird flu in North Korea. “Bird flu has broken out near a North Korean military base in the first reported case of the disease in the country since 2005, a South Korean aid group said Wednesday.” But, note, “since 2005”, which means it happened before, and we didn’t then see the rapid emergence of the killer strain the media scaremongers are almost choking to see.

Finally, the ever-intriguing Arkansas Democrat Gazette reported, with the rather uninspiring headline: Test shows bird flu in hens. Apparently, a sample from a hen flock destroyed near West Fork, Arkansas, tested positive for avian influenza. A little lower down the page we learn that the strain involved is the far less worrisome H7N3. So, avian influenza is yet to crack the US big time. Thankfully.

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17 thoughts on “Bird Flu Flap”

  1. Misinformation

    For some reason information isn’t working it’s way down from the federal and sometimes state level to local planners.

    There are still local planners who are saying that they don’t need to worry about pandemic flu because they don’t have large poultry farms in their areas. (The problem will be infected people not infected birds.)

    There are city health departments saying that we don’t need to worry because people can only get infected by traveling to Asia and having close contact with infected birds. (again untrue.)

    A state health department staff person told me that an influenza pandemic could only start in the fall or early winter – the time during which we see seasonal flu and that it would have to start on the west coast in the U.S. because that it what is closest to Asia. (Influenza pandemics can and have started in the spring and summer.)

    Information

    There are some things that could be done to mitigate the impact of a severe pandemic. Unfortunately, for the most part, that information is not getting to the people who need to hear it.

    The federal government states that closing schools early in a pandemic will be important to attempt to reduce the spread of infection and spread the number of cases over a longer period of time which would produce less stress on the health care system.

    Unfortunately that information isn’t getting to the families who need to know it.

    They are also saying that individuals and families should have the nonperishable food, water, baby food, pet food, medication, over-the-counter medications, cleaning products, etc that they would need during a pandemic.

    That information isn’t getting to families

    Much of the preparation for influenza pandemic is also preparation for any other virus or other disease that would spring up.

    Surge capacity, just-in-time delivery problems, inadequate numbers of health care workers, and spread of infection through international travel are problems that we would see with any pandemic. Individual and family preparedness efforts benefit us if we need to deal with any other disease outbreak in the future as well.

    Even the effort to increase our capacity to produce large amounts of vaccine for H5N1 has expanded the capacity we have to produce large amounts of vaccine against any other disease.

  2. Vaccine

    We don’t have a vaccine and one can’t be produced until the pandemic strain emerges. It will take approx 6 months to have the first vaccine for the pandemic strain. The first batches produced will be given to healthcare workers, first responders, fire fighters, etc. so that they can protect the public.

    Current vaccine production requires fertilized chicken eggs and there may be some trouble producing the vaccine because H5N1 is so lethal for chickens..

    “Prepandemic Vaccines”

    There are “prepandemic vaccines already produced. I don’t have the number of vaccine doses at hand, but I think the U.S. has around 30 million doses.

    Most of the prepandemic vaccine stockpile is based on the H5N1 clade that was in Vietnam in 2004, but that isn’t the clade that is spreading now.

    They are hoping that this vaccine will provide some coverage for a mutated virus, but our experience with seasonal flu vaccine is that a slight mutation is enough to keep the vaccine from being effective.

    Antiviral Medication

    Our antiviral stockpile will cover treatment for only approx 20% of our population. Government plans are based on an attack rate of 30%.

    The stockpile doesn’t include prophylaxis for healthcare workers or first responders, and some health care workers will be reluctant to work without protection from a lethal strain of influenza.

    Some strains of H5N1 have developed resistance to Tamiflu – most of our antiviral stockpile is Tamiflu.

    Home Care for panflu

    Most people who contract pandemic flu will not be admitted to the hospital because there won’t be available beds.

    My community’s trauma center has a plan for an additional 20 beds for pandemic flu – this for an area that has over 500,000 people. Clearly this is enormously inadequate.

    Most patients will be cared for at home by family members just because there will be nowhere to take them.

    In 1918, people were accustomed to caring for a family member who was experiencing a medical problem, but I think that for the most part we have lost the skills needed to nurse someone through a serious illness — in the past two weeks, one of my local ambulance squads was called to transport to emergency rooms people who had: an infected finger, a splinter, an ear infection, and a sore throat. Unfortunately, that’s a common occurrence.

    International Travel

    In 1918 people traveled from one continent to another by boat. Now we’re traveling by air, and many more people travel than did in 1918. A pandemic will spread much more quickly – we could see panflu spread from point of origin in a matter of days or weeks.

  3. Yes, I think it has the potential for a 1918 pandemic impact or much, much worse.

    We have made huge medical advances since 1918, but we won’t be able to provide that technology to the vast majority of our population.

    Surge Capacity

    Our healthcare system doesn’t have the surge capacity necessary to handle a pandemic.

    Many hospitals are full or almost full most of the time. It’s not uncommon for ambulances to be diverted to other emergency rooms because of patient volume. Patients who are to be admitted are sometimes kept in emergency rooms for extended periods of time because there aren’t beds available for them.

    Health Care personnel

    Some panflu needs can be purchased – patient beds, antiviral drugs, ventilators, or the inflatable hospital tents that are becoming popular. But we have only so many health care workers, and their numbers can’t be expanded easily.

    Some health care workers will not be able to work because they will need to be at home taking care of family members who have contracted panflu.

    Medical Supplies

    Many patients will need vents – we have approx 105,000 ventilators in the U.S. We’re using around 90,000 every day – some of the rest are in for maintenance. I believe there are 5,000 in the strategic national stockpile. We could stockpile more vents, but we don’t have more healthcare workers to run them.

    We are not stockpiling respirators, iv sets, infections, control supplies, and other materials needed to care for massive numbers of patients.

    Just-in-Time Delivery System

    Our just-in-time delivery systems will most likely fail when large numbers of people are not working because they are either sick or taking care of family members. So we will probably have problems getting fuel for emergency vehicles, medication that is produced overseas, medical supplies, etc.

    Most hospitals do not have stockpiles of medications or supplies – they have deliveries of medications several times a day. It isn’t likely that they will be receiving deliveries during a pandemic.

  4. To be honest, the original point I was trying to make is that viruses and disease are so unpredictable that expending effort on a single virus may give us a false sense of security. As far as I know no one predicted the emergence of SARS and I strongly suspect a very different virus will emerge from some obscure host pool that will ravage us.

    Meanwhile, do you think that 50 million from 1918 will scale up in proportion to current populations in a global flu epidemic?

  5. Yes, it could become 30 to 40 times less lethal and still be as bad as 1918 when 50 million people died.

    It could also keep it’s current CFR, and we could see patients with multiple organ failure and brain abscesses.

    I’d be thrilled if H5N1 faded away and we never saw another human case, but while it’s in birds in over 60 countries in Asia, Europe, the Middle East and Africa – especially where there is close bird/human interaction – there is serious potential for pandemic.

  6. Some good points Cindy. Things are never clear cut. Yes, of course H5N1 is constantly mutating, as are all “organisms”, those that reproduce most efficiently will be the ones that survive, natural selection in action. A highly virulent and lethal human pathogen will not necessarily persist in a host population, of course, and whether or not a mutant H5N1 is the next big epidemic to which we succumb is certainly open to debate, it could just as easily mutate into a H2H form but be less lethal and so merge into the general strains of influenza to which we are exposed each year, killing thousands as opposed to millions. Meanwhile, some yet unknown pathogen emerges from a different niche and begins infecting people in ways that could not be foreseen (viz HIV), what about an airborne version of a virus with similar effects to HIV, that would certainly cap anything an influenza virus can do…

  7. H5N1 hasn’t mutated into a pandemic strain, but it is mutating.

    We are seeing human deaths from both bird-to-human and from human-to-human transmission. The human-to-human transmission does not appear to be sustained, but that may be because the Indonesians are passing out Tamiflu to every potential case.

    The Indonesians are saying that at least 25% aren’t linked to poultry. That doesn’t necessarily mean human-to-human transmission. We know both cats and dogs have been infected with H5N1 in Indonesia – either could have been the source of human infection as well, but there aren’t reports of large numbers of dogs or cats dying.

    Over the past few months the majority of cases in Indonesia have been in clusters, this is a big change over the past threee years.

    There have been mutations that enable the virus to more easiy latch onto the cells in the human respiratory tract .

    And there have been mutations that make the virus resistant to antiviral drugs – or at least Tamiflu. I don’t know if you can really say that this advances a pandemic because we do not have enough Tamiflu to prevent a pandemic to begin with, but it makes attempts to slow the spread more difficult and has obvious impact during a pandemic.

    Our preparedness is pathetic as well.

  8. Yes, 1918 was originally avian and mutated into a human transmissable form at a time of international conflict and poverty. H5N1 is yet to mutate. Percentages are cruel. Deaths are tragic.

  9. The 1918 influenza pandemic was an avian virus. The fact that SARS, HIV, malaria, tuberculosis, MRSA, etc aren’t avian disease doesn’t influence whether or not H5N1 will cause a pandemic.

    Since H5N1’s current case fatality rate is 60% worldwide (with antiviral meds) and 80% in Indonesia (with antiviral meds) where the virus seems to be most active, I can’t think of much that would be worse.

  10. Ya, I think I would be more afraid of ourselves than I would be of Bird Flu. I’m sure we will wipe eachother out before the next strain for birdflu takes me out. :). Good post, and very informative. Thanks for taking the time to look up all those sources.

  11. If I were a bookmaker I wouldn’t give you good odds that you won’t die from some form of influenza.

  12. Bird flu, West Nile, Lyme disease, SARS, Ebola, Legionnaires disease, Swine flu- all popular at times, but all big disappointments with respect to reducing the surplus population.

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