Avian Influenza / Avian Flu / Bird Flu Pandemic
Information and Resources
In an effort to cut through some of the hype and hysteria, I've collected some resources to provide information on what the Avian Flu is and what the world and the U.S. is doing about it.
For questions or comments email Douglas Hackney
Resources
If you want to learn the most, the quickest, read this article (Scientific American - Avian Influenza - Preparing For A Pandemic) and watch this video (Panel on Bird Flu & U.S. Preparedness).
10/25/2005
Summary
The "cut to the chase" version is: Avian Flu is mostly killing birds right now, so don't start digging the bunker yet. While about 70 humans have died out of the known cases, with an approximate 50% death rate, the typical media hype has drown out most of the measured information that could actually help you make smart decisions. The good news is, most importantly, the virus is currently not efficient in moving from human to human. The bad news is, if the virus stays a killer and develops the ability to easily move from human to human like common influenza viruses, millions to hundreds of millions of people could die within months. Now is not the time for breathless reporting and media induced frenzied panic, but it is an excellent time to start learning about this disease and its potential effects.
The Disease
Influenza is an avian (bird) disease. Through mutation and mixing with human specific viruses, it also jumps across to the human species. Every year the world experiences the "flu season." Doctors encourage you to take a flu vaccine shot for this annual influenza every autumn. During the flu season a portion of the human population contracts a relatively mild strain of influenza that has mutated from prior years' versions. When this annual influenza virus arrives, most of us, along with our immune systems, have had previous exposure to a close cousin of the current season's flu virus in previous years, thus limiting the lethality of the annual virus.
If an entirely new form of avian influenza virus makes the jump to humans then our immune systems have no previous experience with any form of it. Thus the virus can be particularly lethal, killing even healthy young adults.
The last time a particularly virulent avian flu unknown to human immune systems jumped from birds to humans was in 1918, when more American soldiers died of the flu than in battle during WWI. The death rate in the general population was about 3% of those infected, with an estimated total of 50-100 million people dying of influenza and subsequent bacterial pneumonia. The 1918 avian influenza pandemic spread worldwide in a handful of months, including isolated Alaskan Eskimo villages reachable only by dog sled.
The reason why everyone is so worried about this particular avian flu currently sweeping the bird populations of the planet is that it is a particularly virulent strain that is completely unknown to human immune systems. 100% of chickens that contract it die, and as previously mentioned, the human death rate among those who have contracted it is about 50%. Fortunately, in its current form the virus is not efficient in human to human transmission. If this particular strain, known by its scientific name of Type A, H5N1, mutates or combines with other viruses to become as efficient in human to human transmission as common influenza viruses spread by sneezing and touch, a global pandemic that could kill a significant portion of people alive today is possible.
The H5N1 influenza virus will continue to mutate and evolve, regardless of what we do at this time. Chances are good that it will make the jump to humans and adapt itself for easy human to human transmission. The key unknown is how lethal it will be after it adapts for easy human to human transmission. The most likely way for the virus to retain its current level of lethality is if it natively mutates, in other words, if it mutates all by itself into a form that can survive in a human host and be transmitted easily from human to human. If the H5N1 virus gets into a human cell and merges with another virus that has already adapted to humans, the H5N1 virus may lose some or most of its lethality.
If the H5N1 virus makes the jump to humans in an easily transmissible form and retains its currents rate of mortality, we, as a species, could face the largest pandemic since the Black Plague killed between 33% to 50% of the population of Europe. Conversely, if it makes the jump to humans and loses some of its lethality in the process of optimizing itself for human to human transmission, the H5N1 virus may turn out to be just another case of annual influenza, albeit more severe.
The Source
Avian influenza typically originates in Southeast Asia, where dense populations of people live in very close contact with birds of various species. Large segments of the societies raise and sell chickens, ducks and geese, often sharing living spaces with the fowl. In addition, local culinary customs include the sale of live poultry and fresh slaughter of poultry in "wet markets." These conditions are all conducive to the transmission of the avian influenza virus to human hosts, where it can mutate or combine with a human adapted virus already thriving there. Once the influenza virus makes the adaptations or merging necessary to become easily transmitted between people by sneezing, coughing, or other physical contact, it quickly spreads throughout the global human population.
Vaccines
The global vaccine production industry is "broken." It has been allowed to decline for a variety of reasons, including the high liability costs in the U.S. market that prevent a viable business model here. In addition, there is little economic incentive for any company to invest in the factories necessary to produce vaccines versus highly profitable patented "blockbuster" drugs. U.S. vaccine manufacturing capacity, in particular, is nearly non-existent compared to the population size. In terms of technology, the current form of creating vaccines still uses live fertilized chicken eggs. The process of developing a valid vaccine takes at least six months from the point the virus is isolated. Consequently, it is likely that most people who are going to die of an easily transmissible virulent avian influenza virus will already be dead by the time meaningful amounts of vaccine can be produced and distributed.
Treatment
There are two classes of anti-viral drugs available, an older class, the amantadines and a newer type, neuraminidase inhibitors (NI). The H5N1 avian influenza tends to be resistant to the older amantadines because these drugs have been administered to poultry flocks in Asia where the viruses commonly originate. The newer NI drugs are available as two products, oseltamivir and zanamivir, currently on the market under the brand names Tamiflu and Relenza. Tamiflu comes in pill form. Relenza is a powder delivered by inhaler, so is much less preferred for wide scale treatment. To be effective against seasonal flu strains, either drug must be taken within 48 hours of symptoms appearing, something difficult to impossible in remote areas.
Currently Tamiflu is produced under license by Hoffman-La Roche, a Swiss pharmaceutical company. Since worldwide demand is far outstripping their internal production capacity, they are currently in discussions to expand production to other companies' facilities around the globe.
Lifeboat
In the U.S., plans call for any available vaccines and drugs to be distributed to key government leaders, medical caregivers, first responders, workers in flu vaccine and drug factories, pregnant women, and those infants, elderly and ill people who are already in the high-priority group for annual flu shots. That top tier includes about 46 million Americans. Considering that current worldwide vaccine annual manufacturing capacity is only 300 million doses, your chances of getting any vaccine (should you still be alive by the time it is produced) or any Tamiflu or other treatment drugs are very slim if you are not a key government leader, doctor or EMT.
Silver Bullets
There are new types of vaccine manufacturing being developed that would eliminate chicken eggs and allow modern mass manufacturing. A third treatment NI drug called peramivir may be approved for intravenous use in hospitalized flu patients. Neither of these will be available in the near to mid term.
Conclusion
Avian Flu is not currently a global killer. The H5N1 influenza virus will need to further mutate or combine with another virus to enable efficient human to human transmission. Viruses specialize in mutation and combining, that's how they survive and spread.
If the worst case scenario comes to pass and the H5N1 influenza virus becomes efficient in human to human transmission, no amount of quarantines, travel bans, school closings or locked doors will contain it. If the virus mutates natively and retains its current level of lethality, governments and health care systems will quickly be overwhelmed and understaffed as they lose their people to the disease and to family responsibilities. Vaccines and treatment drugs will be unavailable or allocated to select government leaders, health care workers and first responders. If this happens, we will all be on our own.
If the best case scenario comes to pass, the H5N1 virus will simply burn through the world's bird populations and leave humans entirely alone. Or if it does make the jump, it may do it by combining with another human virus that could significantly lower its lethality. We may eventually experience the H5N1 influenza virus as simply another annual flu, perhaps a little worse than normal, but one that most people will be able to fight off.
At this time, no one can predict what will happen with any degree of certainty.
Now is not a time for panic, for rumors or hysteria.
Now is a good time to educate yourself and your family about the realities of the situation.
Business Week - Avian Flue Frequently Asked Questions (FAQ)
General questions about the Avian Flu. High level, introductory. PDF file 17KB.
The Economist - Avian Influenza - In a Flap
Global view of the avian flu situation and potential effects. PDF file 71KB.
Scientific American - Avian Influenza - Preparing For A Pandemic
In depth scientific overview of the virus, the situation and potential outcomes.
If you only read one thing about avian flu, this is the one to read. PDF file 229KB.
Panel on Bird Flu & U.S. Preparedness
(Real Media Video file, requires Real Media Player)
Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, Steve Sternberg, Medical Reporter for USA Today, and Ron Hutcheson, White House Correspondent for Knight Ridder Newspapers, talk about the bird flu and U.S. preparedness.
10/21/2005: WASHINGTON, DC: 1 hr.
(Real Media Video file, requires Real Media Player)
Speakers Ujjal Dosanjh, Canadian Health Minister; Dr. Lee Jong-Wook, World Health Organization, Director-General; Dr. Jacques Diouf, Food and Agriculture Organization, Director-General; Dr. Alejandro Thiermann, President, Terrestrial Animal Health Standards Cmsn.; and Dr. Margaret Chan, Assistant Director-General, World Health Organization Communicable Diseases hold a conference on the avian flu.
10/24/2005: OTTAWA, CANADA: 40 min.
U.S. State Dept. Avian Flu News Briefing
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(Real Media Video file, requires Real Media Player)
Secretary of Health and Human Services Michael Leavitt, Under Secretary of State for Democracy and Global Affairs Paula Dobriansky and Agency for International Development Administrator Andrew Natsios hold a press briefing on their respective recent trips to South East Asia and Russia and outline the United States Government's efforts to combat avian influenza from diplomatic, developmental and public health perspectives.
10/21/2005: WASHINGTON, DC: 25 min.
Mike Leavitt, Sec., Health & Human Services
(Real Media Video file, requires Real Media Player)
Mike Leavitt, Secretary of Health and Human Services, discusses the federal response to the avian flu.
10/24/2005: WASHINGTON, DC: 30 min.
Laura Parker & William Prochnau, Vanity Fair
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(Real Media Video file, requires Real Media Player)
Laura Parker, Writer for Vanity Fair, and William Prochnau, Vanity Fair Contributing Editor, discuss the avian flu.
10/11/2005: WASHINGTON, DC: 45 min.
Infectious Diseases Society of America - Avian Flu Information and Resources
Centers for Disease Control (CDC) - Avian Flu Information
World Health Organization - Avian Flu Information
OSHA - Guidance for Protecting Workers Against Avian Flu
Nature Magazine - Avian Flu articles (requires subscription or $)
The Great Influenza: The Epic Story of the Deadliest Plague In History
by John M. Barry
Flu : The Story Of The Great Influenza Pandemic
by Gina Kolata
America's Forgotten Pandemic : The Influenza of 1918
by Alfred W. Crosby
by Pete Davies
Purple Death : The Mysterious Flu of 1918
by David Getz
The Monster at Our Door: The Global Threat of Avian Flu
by Mike Davis
