- 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
- 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,
- "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
- 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
- "Everything that we're seeing in the virus-host
interaction in Southeast Asia says cytokine storm," Dr. Osterholm
- 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
- 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
- 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
- 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
- © 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
- 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: http://www.clickitnews.com/ubbthreads/postlist.php?
- Zhan le Devlesa tai sastimasa
- Go with God and in Good Health