Looming pandemic which could kill 10s of millions causing sleepless nights

cnews.canoe.ca ^ | November 20, 2004 | HELEN BRANSWELL

[Ginifer]

TORONTO (CP) - The global community of influenza experts is a small circle. These days, it's an exhausted, alarmed one as well.

Many influenza authorities are suffering sleepless nights, eyes trained on Asia where they fear a viral monster is readying itself to unleash a perfect storm of flu on the world.

Should that happen, what will follow will be a public health disaster that will make SARS seem like child's play, they believe.

Between a quarter and a third of the world's population will fall ill, according to new World Health Organization estimates, and one per cent of the sick will die.

Do the math and the numbers defy credulity; between 16 million and 21 million people would die in a matter of mere months. In Canada, 80,000 to 106,000 people would be expected to succumb.

Armed with that math, think of the consequences. Panic. Crippled health-care systems. Economic disruption on a global scale. Grounded airlines. Distribution networks that will grind to a halt. Social instability.

Or, "three years of a given hell," as a leading U.S. epidemiologist, Michael Osterholm, puts it: "I can't think of any other risk, terrorism or Mother Nature included, that could potentially pose any greater risk to society than this."

Until recently, official guesstimates of the expected death toll of a new pandemic have been modest. Using mathematical models devised by the U.S. Centers for Disease Control, Canada's public health agency estimates between 11,000 to 58,000 here people might die.

The CDC models point to between two million and seven million deaths worldwide.

Many question those figures and say they're far too rosy. And many believe the WHO's new numbers are overly optimistic as well.

Osterholm is one of them. He's done age-adjusted calculations based on the experience of the 1918 Spanish flu, the worst pandemic in known history.

Laying 1918 fatality rates over the world's current population, Osterholm suggests between 36 million and 177 million people would die if a pandemic of similar severity hit again. (The top figure is based on half the world's population becoming infected.)

But public discussion of numbers like those makes many in the flu world nervous, fearing the figures are so impossibly large they take on the mantle of science fiction.

"None of these models can 100 per cent predict what's going to be happening. And it would be wrong in my view to always play the worst case scenario," cautions Dr. Klaus Stohr, head of the WHO's global influenza program.

"Irrespective of what type of model we are talking about, the figures are certainly not comforting," he continues. "None of these estimates would suggest that we should let down our efforts in pandemic preparedness."

But Osterholm and others around the globe are extremely concerned those efforts are moving at a snail's pace. They fear governments and vaccine companies are dismissing the potential disaster as too hypothetical, too apocryphal.

"This to me is akin to living in Iowa . . . and seeing the tornado 35 miles away coming. And it's coming. And it's coming. And it's coming. And it keeps coming," says Osterholm, who is a special adviser to U.S. Health Secretary Tommy Thompson and associate director of Homeland Security's National Center for Food Protection and Defence.

"You just see it. And we're largely ignoring it."

The "it" Osterholm refers to is a nasty strain of influenza A known as H5N1, so named because of the hemagglutinin (H) and neuraminidase (N) proteins on the virus's outer shell. Though flu is notoriously unpredictable, H5N1 is currently considered the leading candidate to spark the next pandemic.

With 500 years of history to guide them, experts say flu pandemics are inevitable.

The highly unstable RNA viruses are constantly recombining (mutating) and reassorting (swapping genes with each other). The result: new forms of flu are always finding ways to slip past the immune system's sentries to pick the lock of the human respiratory tract.

When an entirely new version appears, one to which no one has any immunity, a pandemic occurs. And with 36 years having elapsed since the last pandemic, experts warn another could come at any time.

The thought of an H5N1 pandemic chills the hearts of those who've been following the virus's evolution since it was first known to have infected humans, in Hong Kong in 1997.

Dr. Keiji Fukuda of the CDC's flu branch investigated the Hong Kong outbreak and others since. He sighs softly when asked whether the prospect of an H5N1 pandemic robs him of sleep.

"More nights than I like," admits Fukuda, head of epidemiology for the branch.

Fukuda chooses his words with care. He often describes H5N1 developments as "spooky," the closest he gets to hyperbole.

"When a pandemic will occur and what the agent might be is completely unknowable," he says.

"Nonetheless I think that all of us are definitely working under an increased sense of urgency because of all of the events that have gone on in Asia. . . .

"We know that we're not adequately prepared. And to that extent we are pushing things pretty urgently."

Since the beginning of the year H5N1 has killed millions of chickens and forced the culling of tens of millions more in at least nine Southeast Asian countries.

It has defied longstanding flu dogma by directly infecting and killing mammals previously thought to be immune to an avian virus, house cats, leopards and tigers among them.

It's also killed 32 of the 42 people - mainly children and young adults - known to have caught it in Vietnam and Thailand. There is much suspicion in the flu world that other deaths elsewhere have gone unreported.

Efforts to eradicate the virus from chicken stocks have so far failed. Some believe the virus has become endemic in a region where dense human populations live cheek by jowl with animals that can be a mixing bowl for virus reassortment.

Factor in the inadequacy of the international vaccine system, which under current regulatory rules could only produce enough pandemic vaccine for a fraction of the world's people, add the lack of surge capacity in hospitals the world over and the picture looks bleak, says Osterholm, who is also director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"You keep adding all these things up and you see - we are talking about a perfect storm."

More worrisome still is the fact that H5N1 is currently behaving much like the dreaded Spanish flu, which had the astonishing capacity to swiftly kill people in the prime of life.

Flu generally kills the old and the very young; it weakens their systems, making them prey to secondary infections like pneumonias which they can't fight.

But the Spanish flu was different. It's believed that virus sparked what's called a cytokine storm - a cascading hyper-reaction of the immune system so severe that attacking the invader actually killed the host.

"Everything that we're seeing in the virus-host interaction in Southeast Asia says cytokine storm," Osterholm says.

If H5N1 becomes a pandemic strain and retains that fearsome feature, in addition to the very young and the very old - flu's normal targets - young, healthy people with robust immune systems would be at great risk.

[PoorMuttly]

Just proves the ancient Muttly axiom...birds should be eaten....before they kill us.

...now about those squirrels........

[hgro]

Probably thru Condileeza Rice.

[Yaelle]

Maybe this is a stupid question. If all these weird flus come from animals sharing close quarters with humans, can't we spread the message through Southeast Asia that all homes need to be farther away from the chicken coop? They can surely reorganze their villages a BIT if it means saving the world.

Stopping people's sex habits (as in Africa and AIDS) is of course much harder because of biological desire. But surely we can get some basic "animals over THERE, humans over HERE" facts out there?

[Veto!]

Yes, of course money is always involved. However, viruses can mutate very quickly, while the human immune system adapts to them more slowly. With millions of people traveling to and from potentially "sick" countries every year, just a trip through an international airport like London will expose a lot of people to diseases they never heard of from countries they never heard of either. It is scary, and I'm glad someone is keeping an eye on developments, even if they are Canadians and/or looking for funding. Our CDC is watching too.

But I don't accept the assertion that everyone is at risk. Even during the Spanish Flu, the majority of people did not catch it. And we're smarter now about taking care of our health.

Those in any age group who are in excellent health, take precautions like handwashing and if it comes to it, face masks, and who routinely boost their immune systems with nutritional supplements would probably come through unscathed if a new deadly virus were unleashed.

[Black Powder]

Wonder how it spreads from China to the USA?

Through WalMart.

[Ditter]

Lets make a deal, I won't travel to SE Asia if you won't.

[Ginifer]

How does the disease spread from one country to another?

The disease can spread from country to country through international trade in live poultry. Migratory birds, including wild waterfowl, sea birds, and shore birds, can carry the virus for long distances and have, in the past, been implicated in the international spread of highly pathogenic avian influenza. Migratory waterfowl – most notably wild ducks – are the natural reservoir of bird flu viruses, and these birds are also the most resistant to infection. They can carry the virus over great distances, and excrete it in their droppings, yet develop only mild and short-lived illness.

Domestic ducks, however, are susceptible to lethal infections, as are turkeys, geese, and several other species raised on commercial or backyard farms.

[CTOCS]

I've been to Hong Kong and the mainland. Trust me, some of these homes "are the chicken coop!!!".........

[AEMILIUS PAULUS]

Ok. I'm badly frightened. If we don't fly then it cannot be said:'He flew for the flu!'

[lotusblos]

Trust in Mother Nature. She knows how to take care of earth's ills. We've got way too many people on this planet anyway. But, if you're really worried move to France where they have the best socialized medicine on the planet. Only fifteen thousand of them croaked the last time the temperature exceeded 100F.

[stboz]

>Wonder how it spreads from China to the USA? Airplanes laddie. All those 747s, 777s, and Airbuses full of free traders going back and forth bring home a gift that keeps on giving.

Oh, come now. It's transmitted by and through all the stuff we buy from China. Go to Wallyworld, catch the flu.

[Ditter]

Yeah, we won't be responsible for bringing the flu here. Of course, we can't control all those other people.

[steve86]

I think you have a slightly better chance of being killed by a falling meteor.

You sound like the type who would jump out of an airplane without a parachute, because someone once survived doing that.

[Nick Danger]

No one else seems interested, so I guess it's up to me to start People for the Ethical Treatment of Disease Organisms.

If we can introduce bears into New Jersey, we can certainly find a home for Streptococci. Probably in Boston, where both Kerry and Kennedy have mansions. Why should these, the smallest of God's creatures, have to hang out in lungs and livers and stuff, when all around them, the rich are prospering?

The prejudice against these poor creatures is just astounding. Fully 79% of Americans said that they would "run like Hell" if they learned that a single Ebola virus was in the room with them. What kind of a welcome is that?

Please join me in treating our disease organisms with respect and compassion. It's their Earth, too.

[AEMILIUS PAULUS]

This issue may turn into quite a flap.

[tet68]

"I had a little bird
it's name was Enza.
I opened up the window
and in flew Enza."

Childrens rhyme from time of the Spanish flu.
It's interesting how kids see this kind of thing.

Sort of like "Ring around the rosey,
a pocket full of poseys."

About the bubonic plague, the discolored skin
around the buboe, and a nosegay of poseys to
cover the smell of death.

[Atlas Sneezed]

I CAN FORSEE DISATER IN THE USA IN 2005!!!

OVER A MILLION PEOPLE WILL DIE!!!!

[kitkat]

***......now about those squirrels........***

You don't have to worry about the squirrels, Muttly. They're their own worst enemies, as proven by one of their relatives who stole two grapes off our patio table, and buried them in my garden for later munching. I don't know what he was thinking, but he was survived by a family of seven.

[AEMILIUS PAULUS]

I heard about "Ring a Round the Rosey" The version I heard was that the rhyme reflected the method used to fight the disease; i.e. putting ashes and flower petals in the pocket, joining hands and circling a rose bush etc.

[Feiny]

I will join you. I invite any germ to attempt to survive in my body. I have found that drinking vodka daily keeps germs happy & they don't bother me.