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Is President Bush Hyping the Avian Flu?
Each day the morning news brings a fresh flurry of sensational headlines about the coming scourge of avian flu.
Many are wondering if this is all hype or truthfully a threat to humankind of Biblical proportions.
Judging from news headlines we're in deep trouble.
"World Health Organization urges governments to act swiftly to control the spread of bird flu, warning that the world is in grave danger of a deadly pandemic," shouts one.
"U.N. advises the deadly strain of avian influenza is likely to be carried over long distances along the flyways of wild water birds to the Middle East, Europe, South Asia and Africa, with the potential to trigger a global human pandemic," blares another.
"A global wave of death and disease may be gathering in Asia, and America's only defense is 2.3 million doses of anti-influenza medication," laments another.
The flu danger even has President Bush in high gear.
On Tuesday he announced a $7.1 billion strategy to prepare for the danger of a pandemic influenza outbreak, saying he wanted to stockpile enough vaccine to protect 20 million Americans and spend $1 billion on more anti-viral drugs.
The president has prodded drug makers to speed up development of a vaccine, and mulled the possibility of using the military to enforce dramatic quarantines and travel restrictions in the event of an outbreak.
And November's Vanity Fair magazine paints a grim picture with its "The Waiting Plague."
The article cites alarmed experts who characterize the bird flu as posing a "greater threat to Asia than [North] Korea's nuclear arms" and making "terrorist threats look like child's play."
The seeming bottom line from the majority of the media's selected experts: It's not a question of if a plague of Biblical proportions is heading our way, but only when.
"This is sort of like watching a train wreck in slow motion," warns Dr. Greg Poland, an infectious disease specialist at the Mayo Clinic.
A New Brand of Watchfulness
Some now watch the skies for flocks of ducks and other migratory birds – as once the most paranoid of the Cold War generation scanned upward for incoming Soviet ICBMs.
But there are calmer, informed and skeptical heads out there. Dr. Leonard G. Horowitz, author of "Emerging Viruses: AIDS & Ebola -Nature, Accident or Intentional?" has not joined the ranks of the near-hysterical, stating pointedly: "If avian flu becomes more than a threatened pandemic, it will have done so by political and economic design."
Start with the most grisly of worst-case scenarios – that around the corner insidiously incubates a new killer plague like the devastating Spanish flu of 1918.
Add in the fact that scientists recently decoded the genome of the 1918 virus and chillingly discovered that it had jumped directly from birds to the human population.
For sure, the Spanish germ, an avian flu, was an unparalleled grim reaper.
Estimates indicate approximately 20 to 40 percent of the worldwide population became ill and over 20 million people died during the Spanish flu outbreak of 1918-19.
Some 500,000 deaths from the flu occurred in the U.S.
Across the Atlantic in the trenches of the Great War in Europe, more American doughboys were felled by the flu than German bullets. Incredibly, of the 57,000 Americans who died in World War I, 43,000 died as a result of Spanish influenza.
The virus also ravaged the German Army. That country's military historians to this day blame the scourge for the loss of the war, as the high command found it impossible to replace their sick and dying soldiers.
During the raging pandemic, some people who seemed well enough in the morning became ill by midday and were dead by nightfall. Those who did not quickly perish from the disease often died later of complications from the flu, such as pneumonia.
These days, however, the avian flu strain currently up in lights is known in medical circles as "avian influenza type A" (H5N1). It is but one of a host of identified bird flu strains - such as H7N7, which began in the Netherlands in February 2003 and caused one death and mild illness in 83 others, and H9N2 that infected two children in Hong Kong in 1999.
The Spanish flu has, of course, come and gone without the benefit of a modern alphanumeric moniker, but modern virologists suggest it was caused by the H1N1 type of flu virus.
H5N1 has thus far failed at super-germ star status, and not everyone sees doomsday on the horizon.
Dr. Marc Siegel, author of "False Alarm: The Truth About the Epidemic of Fear," concedes that it's likely such a pandemic could occur "over the next 50 years and maybe even over the next 10 or 20," but he adds a significant proviso: "It may very well not be this bug."
Respected writer and TV commentator Michael Fumento has made some excellent points regarding the real threat from avian flu.
"There is no evidence that this strain is highly contagious," said Fumento, a Senior Fellow at the Hudson Institute in Washington, D.C. and a specialist on science and health issues.
"Indeed, many of the researchers studying it believe they have yet to see it be transmitted from person to person at all, though in one case a health care worker with extensive contact with a victim later developed antibodies to the virus. Nobody known to have contracted it has passed it to a family member."
Hong Kong, where the avian flu has appeared, "is one of the most crowded places on earth," said Fumento, who quotes Hong Kong's health director as saying, "The efficiency of transmission from human to human should not be high or there should be hundreds of thousands of such cases in the territory by now."
Said Fumento: "Since few Americans come into contact with living Chinese fowl, this is quite good news for us.
"Alas, once again the urge to sensationalize health news has made the media feverish."
On a Scale of One to Six...
Even the World Health Organization (WHO), which has certainly grabbed its share of provocative flu headlines, is not so panicked beneath the surface.
Despite infected birds winging over the Ural Mountains in Europe, the WHO level of pandemic alert remains unchanged at Phase 3. Phase 3 is defined as: A virus new to humans is causing infections, but does not spread easily from one person to another.
There are three more serious phases on the WHO warning scale:
Phase 4. Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.
Phase 5. Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).
Phase 6. Pandemic: increased and sustained transmission
in the general population.
The WHO's current advisory is relatively bland: It recommends that travelers to areas experiencing outbreaks of highly pathogenic H5N1 in poultry should avoid contact with live animal markets and poultry farms, adding:
"Populations in affected countries are advised to avoid contact with dead migratory birds or wild birds showing signs of disease."
For sure, WHO has throttled back on its flu histrionics.
Case in point: David Nabarro, the coordinator for avian and human influenza for the U.N., had journalists' pens flying across their notebooks when he recently tossed out a personal estimate that "150 million" people could perish in an avian flu pandemic.
Nabarro later retracted, saying, "I probably was imprecise."
A chastened WHO currently places its estimate for the death toll of a pandemic at a far less drastic 2 million to 7.4 million.
The director of the Centers for Disease Control and Prevention, Dr. Julie Gerberding, recently returned from a 10-day avian flu fact-finding trip to Asia, and was unwilling to push any panic buttons.
"We're focusing a lot of attention on avian influenza," she announced. "But [human-to-human transmission of the disease] hasn't happened - and it may not happen."
Gerberding does not stand alone. She and other more guarded experts point to the infamous swine flu, which engendered plenty of raw panic in 1976, but never materialized in humans.
"The probability that this strain will cause a pandemic is fairly low," says Neil Ferguson, an epidemiologist at London's Imperial College. Other experts like to quantify that "very low" with a five percent chance.
Even in Australia – which is much closer to Hong Kong than the U.S. – the president of the Australian Medical Association, Mukesh Haikerwal, called for a calming message from a recent Asian-Pacific Economic Cooperation meeting in Brisbane.
"I hope they issue a don't-panic message because it's a message we have to have," he said. "We know at this time there is no pandemic influenza.
"There's been an awful lot of hype and misrepresentation about what's going on with the potential for a pandemic influenza. We need responsible discussion about anti-viral medication and possible immunization."
The most dramatic comment the CDC's Gerberding made was conceding that "we're overdue" for an outbreak.
Following the watershed 1918 event, an outbreak in 1957-58 killed 70,000 worldwide, and the Hong Kong flu outbreak of 1968-69 caused 37,000 deaths.
Why 2005 is Different From 1918
Unlike 1918 when the avian flu became pandemic and killed millions, today national and world health authorities are armed with a modern understanding of epidemiology and some vital tools.
Most influenza experts agree, for instance, that the prompt culling of Hong Kong's entire poultry population in 1997 probably averted a pandemic.
Furthermore, tests for diagnosing all influenza strains in animals and humans are now rapid and reliable. Many laboratories in the WHO global influenza network have the necessary high-security facilities, as well as the reagents and experienced teams for performing these tests.
Rapid bedside tests for the diagnosis of human influenza are also available – allowing for the immediate quarantining of any human victims.
Most significantly, the modern world has modern medicines.
Newsweek recently reported that this past summer two expert virologists developed and ran computer simulations indicating that by simply stockpiling doses of the antiviral medication Tamiflu and maintaining local vigilance, avian flu would be contained in the event of an outbreak.
And modern medicine's approach to pandemics is all about containment - as well as keeping flu survivors from succumbing to so-called secondary infections while in a weakened condition.
Although the numbers are uncertain, many who battled through their siege with the 1918 Spanish flu were subsequently lost to pneumonia and other bacterial infections.
"In 1918 we had no antibiotics [for secondary bacterial infections]; we had no anti-virals, no vaccines; there was a war on, and we didn't even know what viruses were," concluded Ira Longini, a virologist at Emory University in Atlanta. "We keep going back to 1918 and that causes panic and fear, and I don't think we need to do that."
The Nature of the Beast
Curiously, by its very nature the feared H5N1 may prove to be its own worst enemy.
To infect and kill humans, the virus would have to mutate or combine with another virus.
According to experts, by combining with another virus the avian flu would change and become less lethal to humans.
Despite its reputation as a killing machine, the 1918 virus itself killed only one in every 100 persons infected. Compare and contrast H5N1: Of the 120 people who have thus far contracted the disease, 60 perished.
On the surface, H5N1 sounds more dangerous. But that is not the case, according to virologists, who explain that by killing off hosts quickly and in great numbers, the momentum of any H5N1-inspired plague necessarily would falter.
Said John Oxford, a virologist at Queen Mary's
School of Medicine in London: "No virus under the sun would be able
to spread with that kind of mortality."