Stratfor Report: The Bird Flu and You

Special Report: The Bird Flu and You (Stratfor.com)

Stratfor subscribers have been sending us a steady river of requests for our opinion on the bird flu situation. Although we are not medical experts, among our sources are those who are. And here is what we have been able to conclude based on their input and our broader analysis of the bird flu threat:

Calm down.

Now let us qualify that: Since December 2003, the H5N1 bird flu virus -- which has caused all the ruckus -- has been responsible for the documented infection of 121 people, 91 one of whom caught the virus in Vietnam. In all cases where information on the chain of infection has been confirmed, the virus was transmitted either by repeated close contact with fowl or via the ingestion of insufficiently cooked chicken products. In not a single case has human-to-human communicability been confirmed. So long as that remains the case, there is no bird flu threat to the human population of places such as Vietnam at large, much less the United States.

The Politics of Genetics

An uncomfortable but undeniable fact is that there are a great many people and institutions in this world that have a vested interest in feeding the bird flu scare. Much like the "Y2K" bug that commanded public attention in 1999, bird flu is all you hear about. Comparisons to the 1918 Spanish influenza have produced death toll projections in excess of 360 million, evoking images of chaos in the streets.

One does not qualify for funding -- whether for academic research, medical development or contingency studies -- by postulating about best-case scenarios. The strategy is to show up front how bad things could get, and to scare your targeted benefactors into having you study the problem and manufacture solutions.

This hardly means that these people are evil, greedy or irresponsible (although, in the case of Y2K or when a health threat shuts down agricultural trade for years, one really tends to wonder). It simply means that fear is an effective way to spark interest and action.

Current medical technology lacks the ability to cure -- or even reliably vaccinate against -- highly mutable viral infections; the best available medicines can only treat symptoms -- like Roche's Tamiflu, which is becoming as scarce as the oftentimes legendary red mercury -- or slow a virus' reproduction rate. Is more research needed? Certainly. But are we on the brink of a cataclysmic outbreak? Certainly not.

A bird flu pandemic among the human population is broadly in the same category as a meteor strike. Of course it will happen sooner or later -- and when it does, watch out! But there is no -- absolutely no -- particular reason to fear a global flu pandemic this flu season.

This does not mean the laws of nature have changed since 1918; it simply means there is no way to predict when an animal virus will break into the human population in any particular year -- or even if it will at all. Yes, H5N1 does show a propensity to mutate; and, yes, sooner or later another domesticated animal disease will cross over into the human population (most common human diseases have such origins). But there is no scientifically plausible reason to expect such a crossover to be imminent.

But if you are trying to find something to worry about, you should at least worry about the right thing.

A virus can mutate in any host, and pound for pound, the mutations that are of most interest to humanity are obviously those that occur within a human host. That means that each person who catches H5N1 due to a close encounter of the bird kind in effect becomes a sort of laboratory that could foster a mutation and that could have characteristics that would allow H5N1 to be communicable to other humans. Without such a specific mutation, bird flu is a problem for turkeys, but not for the non-turkey farmers among us.

But we are talking about a grand total of 115 people catching the bug over the course of the past three years. That does not exactly produce great odds for a virus -- no matter how genetically mutable -- to evolve successfully into a human-communicable strain. And bear in mind that the first-ever human case of H5N1 was not in 2003 but in 1997. There is not anything fundamentally new in this year's bird flu scare.

A more likely vector, therefore, would be for H5N1 to leap into a species of animal that bears similarities to human immunology yet lives in quarters close enough to encourage viral spread -- and lacks the capacity to complete detailed questionnaires about family health history.

The most likely candidate is the pig. On many farms, birds and pigs regularly intermingle, allowing for cross-infection, and similar pig-human biology means that pigs serving in the role as mutation incubator are statistically more likely than the odd Vietnamese raw-chicken eater to generate a pandemic virus.

And once the virus mutates into a form that is pig-pig transferable, a human pandemic is only one short mutation away. Put another way, a bird flu pandemic among birds is manageable. A bird flu pandemic among pigs is not, and is nearly guaranteed to become a human pandemic.

Pandemics: Past and Future

What precisely is a pandemic? The short version is that it is an epidemic that is everywhere. Epidemics affect large numbers of people in a relatively contained region. Pandemics are in effect the same, but without the geographic limitations. In 1854 a cholera epidemic struck London. The European settling of the Americas brought disease pandemics to the Native Americans that nearly eliminated them as an ethnic classification.

In 1918 the influenza outbreak spread in two waves. The first hit in March, and was only marginally more dangerous than the flu outbreaks of the previous six years. But in the trenches of war-torn France, the virus mutated into a new, more virulent strain that swept back across the world, ultimately killing anywhere from 20 million to 100 million people. Some one in four Americans became infected -- nearly all in one horrid month in October, and some 550,000 -- about 0.5 percent of the total population -- succumbed. Playing that figure forward to today's population, theoretically 1.6 million Americans would die. Suddenly the fear makes a bit more sense, right?

Wrong.

There are four major differences between the 1918 scenario and any new flu pandemic development:

· First -- and this one could actually make the death toll higher -- is the virus itself.

No one knows how lethal H5N1 (or any animal pathogen) would be if it adapted to human hosts. Not knowing that makes it impossible to reliably predict the as-yet-unmutated virus' mortality rate.

At this point, the mortality rate among infected humans is running right at about 50 percent, but that hardly means that is what it would look like if the virus became human-to-human communicable. Remember, the virus needs to mutate before it is a threat to humanity -- there is no reason to expect it to mutate just once. Also, in general, the more communicable a disease becomes the lower its mortality rate tends to be. A virus -- like all life forms -- has a vested interest in not wiping out its host population.

One of the features that made the 1918 panic so unnerving is the "W" nature of the mortality curve. For reasons unknown, the virus proved more effective than most at killing people in the prime of their lives -- those in the 15- to 44-year-old age brackets. While there is no reason to expect the next pandemic virus to not have such a feature, similarly there is no reason to expect the next pandemic virus to share that feature.

· Second, 1918 was not exactly a "typical" year.

World War I, while coming to a close, was still raging. The war was unique in that it was fought largely in trenches, among the least sanitary of human habitats. Soldiers not only faced degrading health from their "quarters" in wartime, but even when they were not fighting at the front they were living in barracks. Such conditions ensured that they were: a) not in the best of health, and b) constantly exposed to whatever airborne diseases afflicted the rest of their unit.

As such, the military circumstances and style of the war ensured that soldiers were not only extraordinarily susceptible to catching the flu, but also extraordinarily susceptible to dying of it. Over half of U.S. war dead in World War I -- some 65,000 men -- were the result not of combat but of the flu pandemic.

And it should be no surprise that in 1918, circulation of military personnel was the leading vector for infecting civilian populations the world over. Nevertheless, while the United States is obviously involved in a war in 2005, it is not involved in anything close to trench warfare, and the total percentage of the U.S. population involved in Iraq and Afghanistan -- 0.005 percent -- is middling compared to the 2.0 percent involvement in World War I.

· Third, health and nutrition levels have radically changed in the past 87 years. Though fears of obesity and insufficient school lunch nutrition are all the rage in the media, no one would seriously postulate that overall American health today is in worse shape than it was in 1918. The healthier a person is going into a sickness, the better his or her chances are of emerging from it. Sometimes it really is just that simple.

Indeed, a huge consideration in any modern-day pandemic is availability of and access to medical care. Poorer people tend to live in closer quarters and are more likely to have occupations (military, services, construction, etc.) in which they regularly encounter large numbers of people. According to a 1931 study of the 1918 flu pandemic by the U.S. Public Health Service, the poor were about 20 percent to 30 percent more likely to contract the flu, and overall mortality rates of the "well-to-do" were less than half that of the "poor" and "very poor."

· But the fourth factor, which will pull some of the strength out of any new pandemic, is even more basic than starting health: antibiotics. The 1918 pandemic virus was similar to the more standard influenza virus in that the majority of those who perished died not from the primary attack of the flu but from secondary infections -- typically bacteria or fungal -- that triggered pneumonia. While antibiotics are hardly a silver bullet and they are useless against viruses, they raise the simple possibility of treatment for bacterial or fungal illnesses. Penicillin -- the first commercialized antibiotic -- was not discovered until 1929, 11 years too late to help when panic gripped the world in 1918.

Send questions or comments on this article to analysis@stratfor.com.

The 'flu pandemic' is just an excuse for the traitors in our government to move forward with the integration (not annexation which would be Constitutional if the procedures were followed) of Mexico and Canada in a "North American Partnership". This "partnership" effects a European Union like entity with all the trappings of a supranational government.

Develop a North American plan for pandemic influenza.*

The threat of an influenza pandemic requires planning and preparation by all three governments working together. Reaction and response to a pandemic requires cooperation and coordination at both a national and an international level to help minimize the health impact and the potential health effects on society, the economy and the health care system within an affected country.

Draft and complete a North American influenza plan by 2006. Explore the feasibility of establishing a coordinated influenza research agenda, including evaluating influenza immunization programs and tracking and updating the global inventory of pandemic influenza vaccine clinical research projects over the
next 12 months.

Developing and assessing strategic approaches to using vaccines and antiviral drugs will help control and/or slow down evolving outbreaks of avian influenza in humans. The harmonization of quarantine and travel medicine approaches will reduce discrepancies between national responses and facilitate both disease control and public
communications. The harmonization of policies on bioterrorism preparedness will minimize any discrepancies in national approaches and ensure common standards across North America.

By being able to react to a smallpox outbreak anywhere in North America, citizens will be protected as part of a global community. Over the next 9 months, use and build upon discussions in other forums (e.g. GHSI, World Health Organization) to improve Canada-U.S. pandemic preparedness (e.g. develop and assess strategic approaches to using
vaccines and antiviral drugs). Continue to conduct pandemic flu tabletop exercises. Share information and develop common plans for quarantine, travel and isolation during a transborder infectious disease outbreak by March 2006.

Plan and test 24/7/365 early warning case reporting infrastructure and implement plans for infectious disease control and containment by June 2006.
Hold key workshops by June 2007 on:
- Plague and Tularemia
- Detection of Bioterrorism Agents in the Environment
- Phase II Smallpox
- Early Warning Infectious Disease Surveillance.
Adopt common positions on guidance with regard to the international transport of diagnostic materials and samples by
March 2006.

Finalize an operational framework for the management and implementation of a global smallpox vaccine reserve (via World Health Organization ad hoc Orthopox Experts Committee) by June 2006.

http://www.fac-aec.gc.ca/spp/spp-en.pdf

From the article, and by the points:

Point One: No one knows how lethal H5N1 (or any animal pathogen) would be if it adapted to human hosts. Not knowing that makes it impossible to reliably predict the as-yet-unmutated virus' mortality rate

True. It could be 100% like HIV, only faster, or it could be like the common cold, or anywhere in between.

Point Two: And it should be no surprise that in 1918, circulation of military personnel was the leading vector for infecting civilian populations the world over. Nevertheless, while the United States is obviously involved in a war in 2005, it is not involved in anything close to trench warfare, and the total percentage of the U.S. population involved in Iraq and Afghanistan -- 0.005 percent -- is middling compared to the 2.0 percent involvement in World War I.

True. But how many people in 1918 went to games packed with 40-50,000 in a stadium? How many people took transcontinental or transoceanic flights with 200+ people from all over the globe packed like sardines breathing some portion of recirculated air? How many children went to school with hundreds of others every day and ate in the same lunchrooms, used the same restrooms and drank from the same fountains? How many ate from fast food restaurants or shopped in malls? (Have you ever caught a cold from a cashier handing you change after wiping her nose? How do you know?)

Point Three: health and nutrition levels have radically changed in the past 87 years. Though fears of obesity and insufficient school lunch nutrition are all the rage in the media, no one would seriously postulate that overall American health today is in worse shape than it was in 1918. The healthier a person is going into a sickness, the better his or her chances are of emerging from it. Sometimes it really is just that simple.

Even in 1918, it was noted that HEALTHY PEOPLE got sick in the morning and died within 24 hours. This is likely due, according to research on the 1918 flu and other viral contagions, to DIC or cytokine storms (in other words, viremia leading to platelet failure--or (and this is important)--cytokine storms, an extreme response of a healthy body to a viral pathogen, which response ends up being more lethal to the host than the pathogen was. Similar in some respects to extreme allergic reaction, although with SARS, corticosteroids didn't help much, if at all. These cytokine storms are particularly likely to occur with people who have STRONG immune systems.

Point Four: fourth factor, which will pull some of the strength out of any new pandemic, is even more basic than starting health: antibiotics. The 1918 pandemic virus was similar to the more standard influenza virus in that the majority of those who perished died not from the primary attack of the flu but from secondary infections -- typically bacteria or fungal -- that triggered pneumonia. While antibiotics are hardly a silver bullet and they are useless against viruses, they raise the simple possibility of treatment for bacterial or fungal illnesses. Penicillin -- the first commercialized antibiotic -- was not discovered until 1929, 11 years too late to help when panic gripped the world in 1918.

I'll just use a personal example here: My nephew, a very healthy, strong, football playing 17 yo Mormon died from today's ordinary garden variety flu. He didn't get pneumonia, he got cardiomyopathy from the flu. It took him a year to die, supported by the finest possible medical care in the country. He was on a waiting list for a donor heart, and didn't get one--he died 5 days before Christmas, 1999. And people made frail by illness die every day in this country from regular old bacteria and fungi which have steadily become more and more treatment resistant.

CONCLUSION: It's my opinion, and my opinion only, that the Avian Flu with mutate in China and go from the avian to the swine population just like thousands of other viruses have done, and infect humans worldwide. I even think it will happen this fall.

DISCLAIMER: I'm a retired nurse. I live in the boonies. I'm willing to be wrong. Your mileage may vary, and I have no argument about that. I've resigned from the debating society, and am just presenting my views here.

Freidman seems to have valid points.

All I know is that my Aunt Roxanne died from the pandemic in 1918... at age 14 months. She, alone of my Father's family, succumbed to the flu. But she was not alone.

1918 Influenza Timeline

March

• At Fort Riley, Kansas, an Army private reports to the camp hospital just before breakfast on March 11 complaining of fever, sore throat, and headache. He was quickly followed by another soldier with similar complaints. By noon, the camp's hospital had dealt with over 100 ill soldiers. By week's end that number jumped to 500.

July

• Public health officials in Philadelphia issue a bulletin about the so-called Spanish influenza.

August

• Around the 27th of the month, sailors stationed on board the Receiving Ship at Commonwealth Pier in Boston begin reporting to sick-bay with the usual symptoms of the grippe. By August 30, over 60 sailors were sick. Soon, Commonwealth Pier was overwhelmed and 50 cases had to be transferred to Chelsea Naval Hospital. Flu sufferers commonly described feeling like they "had been beaten all over with a club."

September

• Dr. Victor Vaughn, acting Surgeon General of the Army, receives urgent orders to proceed to Camp Devens near Boston. Once there, what Vaughn sees changes his life forever: "I saw hundreds of young stalwart men in uniform coming into the wards of the hospital. Every bed was full, yet others crowded in. The faces wore a bluish cast; a cough brought up the blood-stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood." On the day that Vaughn arrived at Camp Devens, 63 men died from influenza.

• The Navy Radio School at Harvard University in Cambridge reports the first cases of influenza among the group of 5000 young men studying radio communications.

• On September 5, the Massachusetts Department of Health alerts area newspapers that an epidemic is underway. Dr. John S. Hitchcock of the state health department warned that "unless precautions are taken the disease in all probability will spread to the civilian population of the city."

• US Surgeon General Rupert Blue of the United States Public Health Service dispatches advice to the press on how to recognize the influenza symptoms. Blue prescribed bed rest, good food, salts of quinine, and aspirin for the sick.

• Lt. Col. Philip Doane, head of the Health and Sanitation Section of the Emergency Fleet Corporation, speaking in Washington, D.C., fuels the rumor and speculation by blaming the Germans for the deadly influenza that was striking Americans. Said Doane: "It would be quite easy for one of these German agents to turn loose Spanish influenza germs in a theater or some other place where large numbers of persons are assembled. The Germans have started epidemics in Europe, and there is no reason why they should be particularly gentle with America."

• Edward Wagner, a Chicagoan newly settled in San Francisco, falls ill with influenza on September 24. San Francisco public health officials had been downplaying the potential dangers posed by the flu. Dr. William Hassler, Chief of San Francisco's Board of Health had gone so far as to predict that the flu would not even reach the city.

• On September 28, 200,000 gather for a 4th Liberty Loan Drive in Philadelphia. Days after the parade, 635 new cases of influenza were reported. Within days, the city will be forced to admit that epidemic conditions exist. Churches, schools, and theaters are ordered closed, along with all other places of "public amusement."

• Royal Copeland, the Health Commissioner of New York City, announces, "The city is in no danger of an epidemic. No need for our people to worry."

October

• Boston registers 202 deaths from influenza on October 2. Shortly thereafter, the city canceled its Liberty Bond parades and sporting events. Churches were closed and the stock market was put on half-days.

• On October 6, Philadelphia posts what would be just the first of several gruesome records for the month: 289 influenza-related deaths in a single day.

• Congress approves a special $1 million fund to enable the U.S. Public Health Service to recruit physicians and nurses to deal with the growing epidemic. US Surgeon General Rupert Blue set out to hire over 1000 doctors and 700 nurses with the new funds. The war effort, however, made Blue's task difficult. With many medical professionals already engaged in lending care to fighting soldiers, Blue was forced to look for some recruits in places like old-age homes and rehabilitation centers.

• 851 New Yorkers die of influenza in a single day. In Philadelphia, the city's death rate for one single week is 700 times higher than normal.

• The crime rate in Chicago drops by 43 percent. Authorities attributed the drop to the toll that influenza was taking on the city's potential lawbreakers.

• On October 19, Dr. C.Y. White announces in Philadelphia that he has developed a vaccine to prevent influenza. Over 10,000 complete series of inoculations were delivered to the Philadelphia Board of Health. Whether or not the so-called vaccine played much of a role in loosening the flu's grip on the city became a matter of great debate.

• October 1918 turns out to be the deadliest month in the nation's history as 195,000 Americans fall victim to influenza.

November

• Celebrating the end of World War I, 30,000 San Franciscans take to the streets to celebrate. There was much dancing and singing. Everybody wore a face mask.

• Sirens wail on November 21, signaling to San Franciscans that it is safe--and legal--to remove their protective face masks. At that point, 2,122 were dead due to influenza.

December

• 5,000 new cases of influenza are reported in San Francisco.

Source: http://www.pbs.org/wgbh/amex/influenza/timeline/

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