Flu Pandemic Near, Experts Fear

By Helen Branswell
Canadian Press
TORONTO - 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 1 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.
Dr. 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, Dr. 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 Dr. 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 Dr. 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" Dr. 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 Dr. Fukuda, head of epidemiology for the branch.
Dr. Fukada 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 long-standing 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 Dr. 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," Dr. 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.
Some influenza pandemics of the 20th century:
Spanish Flu - Caused by an H1N1 virus. Emerged in the spring of 1918, subsided by 1920. Estimated to have killed 30,000 to 50,000 Canadians and at least 50 million people around the globe, though a lack of good figures from the developing world means the actual death toll might have been double that.
Asian Flu - Hit in 1957-58. Caused by an H2N2 virus. Estimated to have killed one million to four million in the developed world.
Hong Kong Flu - Caused by an H3N2 virus, it hit in 1968-69. Estimated to have killed from one million to four million people in the developed world.
Glossary of terms related to influenza pandemics:
Influenza - A disease of the respiratory tract caused by a large family of ever-evolving RNA viruses. Influenza viruses live in the guts of wild aquatic birds, causing no illness. But they create disease in a wide variety of mammals, including humans, seals, horses, pigs, and ferrets.
Influenza epidemic - The outbreaks of illness seen regularly, mainly during winter months in the northern hemisphere.
Influenza pandemic - A global influenza outbreak caused by a strain that hasn't circulated before in humans. Pandemics lead to widespread illness around the globe, high numbers of hospitalizations and deaths.
Recombination - One of the two ways a pandemic strain can develop. A novel strain from nature mutates to the point where it can easily infect humans and spread among them.
Reassortment - The second way a pandemic strain can arise. A strain from nature that can't easily infect humans encounters a strain that can, generally in a pig. The two viruses swap genetic material, giving the novel strain the ability to jump easily into humans.
Hemagglutinin - The H in a flu virus's name, a surface protein that allows the virus to attach to and infect cells in the respiratory tract, where the virus multiplies. Hemagglutinin plays a key role in determining whether the strain is mild or severe.
Neuraminidase - The N in a flu virus's name, a surface protein that breaks the new viruses out of an infected cell, allowing disease to spread.
© Copyright 2004 Bell Globemedia Publishing Inc. All Rights Reserved.
From Patricia Doyle, PhD
Hello Jeff -
I think the Helen Branswell article is rooted in fear. The fear is that a "naturally occurring" influenza pandemic will occur. It may very well occur. However, the real risk is that a lab-created genetically altered Influenza virus will appear in the general populace after its escape via infected lab workers returning to their communities and homes after work. This is basically what occurred with SARS on three separate occassions.
Labs are now genetically altering influenza viruses and working with the most deadly influenza strains, inserting lethal genes into them. This is asking for a catastrophe.
The most appalling recent research is the inserting of lethal genes (i.e. genes that gave the 1918 bird flu its lethality, and caused the bird flu to jump species) into contemporary influenza virus. Should this "hybrid" or "chimera virus" escape, we would, indeed, have a major pandemic with millions of casualties. BUT, but...this pandemic could have been prevented.
Should such an event occur, it would probably be compounded with denial of the origin of the pandemic, lying as to the efficacy of vaccine, and then covering up the true numbers of dead.
Furthermore, chaos would erupt in the medical community and public health would be in the same "impotent" mode as was the case when the US learned there was a flu vaccine shortage. Public health was in turmoil. The experts could not figure out how to get existing supplies of vaccine to the public. Actually, the loss of the vaccine was the best news of all for the "health" of the public
regarding the coming flu season. It has been well-noted that people who did not have flu shots in 1918 generally were able to evade the flu while vaccinated soldiers took the highest number of casualties.
I am sure that hospitals and public health would not be able to get medications to those with influenza complications and a health care system in chaos would be the real culprit in loss of life.
It would serve the public far better if public health would stop stirring up fear using the media and concentrate on containing and treating influenza patients. The same public health experts need to be honest with the public and inform the public on the best way to support the immune system which is going to be the first line of defense against any "pandemic" influenza bug. Diet, exercise and reduction of air and body pollutants should be in the front line arsenal for use against the flu bug.
US epidemiologist Michael Osterholm and the CDC need to stop concentrating on, and talking about, the 'MILLIONS OF DEATHS' and start to calculate how best to help people fight the flu without vaccines and how people can better support their immune systems. Constant reports about MILLIONS and MILLIONS of deaths from some POTENTIAL influenza outbreak does not help the situation.
And how about putting a stop to genetic research? Digging up previously eradicated virus samples, genetically altering their lethal genes, and then inserting those death genes into contemporary influenza is the REAL risk of a global pandemic.
Patricia Doyle
Patricia A. Doyle, PhD
Please visit my "Emerging Diseases" message board at:
Zhan le Devlesa tai sastimasa
Go with God and in Good Health



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