Darwin Meets His Match – From Stuffy Nose to Pandemic

Media is a fickle business. Today an issue is the prom queen, the captain of the cheerleading squad, and the daughter of an industry scion all rolled into one, a must-read story covered by every media outlet and major print publication.

Tomorrow, like an old thoroughbred, it’s put out to pasture by the media and quickly falls out of the public consciousness.

The avian flu is one such topic. A year ago, I couldn’t turn on the TV or open a newspaper without reading some dramatic headline about this potentially catastrophic pandemic waiting to happen. Not so today. Curious, I wondered if this means that avian flu is no longer a threat, justly trumped by stories of TomKat’s marriage and Britney’s divorce from her greasy backup dancer husband, or whether it is still an important story, but unfortunately, one that has worn out its headline-grabbing lifespan, a fruitfly destined to come…and go…without a trace. The media got their rating boost and are looking for the next quick fix. We are, after all, an ADD society.

My pursuit led me to the outskirts of Philadelphia, where some of the foremost experts on avian flu were congregating for an avian flu symposium. Encorium, the event organizer, was nice enough to let me attend and even film the conference. I also sat down with a few of the speakers and attendees to learn more about the virus that lives, breed, and mutate on a daily basis within the fertile bodies of our fowl friends, the duck and goose.

What I learned freaked me out. The short answer (I like to give the punch line first for those who don’t want to read the entire story), the cliff notes of sorts, is yes, we should still be concerned. After all, when we have Vietnam and China leading the charge on global containment of a potentially contagious and deadly microbe (I’m not a scientist, so I can call a virus a microbe, meaning something small, even though a microbe is a bacteria), we should fear more than fear itself.

Here’s the rub (note, many google searches led to my current elevated knowledge of all things avian). Birds, especially migratory birds, are fertile breeding grounds for influenza viruses of all shapes, forms, and sizes. Often, these viruses pose no threat to the birds, inducing, at most, the bird version of a stuffy nose. However, the one thing virus is good at, more than our friend the pharmacist, is mixing and matching their DNA to change and mutate. What takes mankind thousands of years, say to go from ape hairy to my more moderate Italian version, only takes a virus a day, a week, or a month.

During their winter migration, carriers such as ducks and geese often come into contact with their domestic counterpart, the common KFC or McNugget chicken. As far as I know, there are no wild, migratory chickens. Basically, anywhere there is water and food, migratory birds will land and loiter on their long trip south. This is where a virus that has been incubating patiently in a migratory bird will, in some cases, make its transition to a more plump, inviting host. Sometimes the new host has no adverse reaction to its unwelcome guest, sometimes, the reaction is fatal. It all depends on the strain of the virus and how it interacts with a new host.

Rarely do influenza virus jump species. However, it is possible, and the most recent occurrence happened in Hong Kong in 1997. The people who were infected? Typically farmers lived in close proximity to or among their livestock. Most of the initial occurrences of the avian flu, or the H5N1 influenza virus as it is known in scientific and public health circles, happened in southeast Asia.

Why Southeast Asia?

China had, in the 1960s, a domestic bird population of just over 6 million. That number stands at over 6 billion today. In countries such as China and Vietnam, people who raise birds often work and live among their animals, often in unsanitary conditions. Combine a dense human population with a dense bird population, add some unsanitary conditions and a seasonal migration of carriers, and you have a virus’ wet dream.

So what we witnessed in Hong Kong in 1997 was an instance of a lethal strain of an influenza virus jumping from a bird to a human. However, the virus did not jump from human to human. While lethal (a 60% mortality rate), it was not contagious.

The concern among avian flu experts is over when, not if, the H5N1 strain will finally make the human-to-human jump. At that point, it will not only be lethal but contagious as well. Typically, when a virus makes that transition, it loses some of its lethal nature. A virus can’t always have its cake and eat it too. It will most likely sacrifice some of its lethal nature in order to gain the much-coveted power of contagion. For example, the avian strain (lethal but not contagious) could combine with the common runny nose and sniffles strain (contagious but not very lethal) to create a new strain that has some of the attributes of both parents. But even a virus that has a 3% mortality rate that spreads like the common flu can wipe out millions, and it has.

Some History

Pandemics are nothing new. Every 10-50 years, there is a new influenza pandemic. Imagine (or remember if you are 100 years old and reading this online article) living through World War I, starting to piece your life back together, rebuilding families, towns, cities, and entire countries, only to have a swift kick in the nuts bring you right back down to your knees. That’s exactly what happened when the Spanish Influenza, later discovered to be a strain of the avian flu, struck in the winter of 1918-1919, killing 50+ million people. Yes, 50 million. That wasn’t a typo. Thought war was bad?

But that was 1918. And people didn’t have TiVo then, or cars that could parallel park themselves, or Britney and Puffy bringing music to new heights. Things have changed. There’s a drug for everything.

Our belief that modern science can shield us from another pandemic is a myth. Even for the common flu, we need to develop a different vaccine each season to keep up with its mercurial nature. Now imagine a deadly virus that we have neither natural immunity nor a man-made vaccine to fight. Say hello to the avian flu. While the 1918 avian flu was responsible for the most fatalities in the 20th century, let’s not forget 1957 and 1968, both of which caused over 1 million deaths.

The running tally for today’s variant – by October of 2006, 256 people have caught the bird flu, and 151 have died. The numbers were eerily similar in the years leading up to past outbreaks. In the winter of 1917, there were something like 100 deaths related to Spanish Influenza.

Containment

Typically, when an avian flu outbreak is discovered within a chicken population, the entire population, along with neighboring populations, is wiped out. No birds can argue their innocence before a court of public opinion. If one of you has it, you all have it. Please take one step towards the incinerator.

Vietnam, a favorite target of the avian flu, has received much praise from the global community, and the World Health Organization, for its improved containment efforts, both in terms of educating the population, especially those involved in raising chickens, as well as its responsiveness to outbreaks and sharing of data with global organizations. They have even started to immunize entire poultry populations as a preventative measure.

If Vietnam gets an A for effort, China gets a C. Recently, China has been criticized by the WHO for its lack of transparency and foot-dragging when it comes to reporting recent outbreaks. It is essential for scientists and health experts around the world to share samples to monitor the spread of the virus as well as any new strains that might emerge. The monitoring process becomes much more difficult when one country doesn’t share data.

My best guess is that embarrassment, and economic implications have led the Chinese to drag their feet. After all, who wants to visit or trade with a country with SARS or avian flu outbreaks? Not me!!

Preparedness & Response

An acute catastrophe affecting one city (such as New York) or one region of a country (such as the Gulf of Mexico region) is difficult enough to respond to at a local and national level. Now imagine that every community has its own 9/11 or Katrina to deal with…at the same time. Welcome to the avian flu pandemic, coming to a town near you. The country rallied around New York during 9/11. Millions of people donated money, goods, and services to the victims of Katrina. But who will I reach out and offer help to when I’m dealing with my own local disaster? Will I be competing with other people and other communities for supplies and aid? Will my Darwinian instincts kick in??

Consider the distribution of supplies that will be needed in large quantities during a pandemic outbreak, such as ventilators to help people breathe in case of lung failure. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University School of Public Health, recently wrote a book, Americans At Risk, Why We Are Not Prepared For Megadisasters And What We Can Do Now, that highlights just how unprepared we are for an avian flu outbreak. Dr. Redlener uses simple math to connect the dots:

In the United States, there are about 105,000 ventilators. On any given day, some 80,000 are in use across the nation. During the typical flu season, this number may rise to about 100,000, leaving only about 5,000 in reserve for the whole country….A moderate-sized metropolitan area would use that many in a few weeks of a major pandemic flu season. The actual need for the U.S. stockpile could be 750,000, seven times what we have.

With short supplies, who will be looking out for whom? Can we do anything in advance to prepare, so we’re not all competing for finite resources??

The conclusion of Dr. Redlener’s book is yes, we can. We need to spend some time and money in advance of disasters that may or may not happen, but not much. He offers simple game plans that can, while not averting disasters, at least reduce their impact.

Recently, Frank Peacock, Chairman of Emergency Preparedness at the Cleveland Clinic, ran a hospital-wide pandemic flu drill and came to some startling conclusions about the Cleveland Clinic’s ability to deal with a pandemic flu crisis. For example:

• What happens when you get 10,000 patients a day coming into the emergency room?
• What happens when 1/3 of your staff doesn’t show up for work?
• What happens when hospital food delivery is down by 40% because 1/3 of the truckers didn’t come to work?
• What happens when picketing takes place outside the hospital because of a limited vaccine supply?
• What happens when the hospital runs out of N-95 respiratory protection masks?
• What happens when three members of the upper management of the hospital die?

This is a scenario that was played out in one hospital in one city. Play that scenario out in EVERY town in the country, add every hospital, fire department, police department, school system, news bureau, and public transportation network, and you get the point. Now consider that most people will stay home to avoid catching the virus and to take care of a family who is sick, and we’re looking at over 40% absenteeism rates at work. What kind of crisis management and, more broadly, the economic consequence will that have??

If anything, Katrina taught us, or if not me, certainly the people who live on the Gulf Coast, that there is no safety net to rely on in an emergency situation. The government, even after 9/11 and Katrina, is still a bumbling bureaucracy that will, at best, be the last person showing up to the party, the fashionably late socialite.

When I asked Jason Irvine, who was working at a medical facility in New Orleans when Katrina hit, what single thing the federal government could have done better (among the many things it could have done better), his response was information sharing, letting people within the affected community and outside know what is going on, offering recommendations and advice, and generally acting as an air traffic controller.

Likely, a response to a pandemic will have to be local in nature. Big brother will not be stepping in. Local communities will be the front lines in responding to the thousands of simultaneous local crises.

Given this scenario, it wouldn’t hurt to spend a little time and effort coordinating what to do in such a scenario. As Dr. Redlener shows in his book and the Avian Symposium speakers in the above video, it doesn’t take much, but a little preparedness goes a long way toward minimizing the impact of a disaster.

What can I do?

The first question I asked myself was, is there even anything I can do to lessen the pain of a tidal wave coming in my direction? While NGOs, and federal and local governments are the front lines of defense, there are measures people can take to reduce our risk of catching the bird flu or even the common seasonal flu:

• Stay healthy, exercise, and eat good food
• Avoid crowds
• Stay away from areas where birds are raised, slaughtered, or butchered.
• Stock up on some basics such as canned food, simple face masks, etc.

Not very complicated. But it goes a long way.

My plea to journalists and their editors and producers is simple. Avian flu may not be your passion, or your bag, as Austin Powers likes to say, but can you at least give some airtime to stories that are near and dear to your heart and keep them in the public consciousness? I may not agree with everything Lou Dobbs has to say, but at least he is relentless in keeping issues he finds important on the front burner, regardless of ratings. He does so because America is great at reacting to problems that hit us in the face. We’re not so great at heading problems off before they hit us in the face. Great at triage but not so good at prevention.

A good story to illustrate this point was made by Richard Foreman, a healthcare venture capitalist, when describing the healthcare crisis that is about to hit our country. He said that a frog put on a frying pan would jump off immediately. A frog put in water that is slowly brought to a boil will die. It will never notice the slow change in temperature.