We Must Remain Vigilant On Bird Flu, Say Experts

THE avian flu pandemic is still a real threat to world health and trade and should not be dismissed as a millennium-bug-type phenomenon that will never materialise, according to a United Nations health official.

The H5N1 virus has been laboratory-confirmed in 55 countries and has caused 220 million bird deaths and 143 human deaths, according to the World Bank.

Developed countries have committed $US1.2 billion ($1.6 billion) this year to help fight the spread of the virus.

"There will be another influenza pandemic one day but we don't know when," said David Nabarro, the UN's co-ordinator for avian and human influenza, in Singapore yesterday.

"We cannot predict when it might happen or how, so we would encourage the communities, governments and private entities to get prepared for a pandemic that might start at any time."

For a pandemic to occur, the H5N1 virus will have to mutate to allow easy human-to-human transmission.

New economic modelling by the World Bank suggests a severe pandemic could wipe 3 per cent off the global economy, at a value of $US1 trillion to $US2 trillion.

Despite the recent emergence of the virus in Africa, officials say Asia is still the greatest area of concern, especially China and Indonesia.

China's position has always been that it would not seek assistance or resources from outside. Recently, Chinese authorities refused to share virus samples from a recent outbreak.

"With sharing samples, there are complexities because it is not just used for scientific purposes but also for commercial advantage," Dr Nabarro said.

"I think partnerships are being built based on recognition that it requires world co-operation."

Dr Nabarro said Vietnam, regarded as a hot spot six months ago, had worked hard to bring the outbreaks under control.

Parts of China and Indonesia were still experiencing outbreaks, however: "Indonesia has reported the virus in 260 of its 444 districts," he said.

South-east China is another area that is being closely monitored by health agencies.

"China is a huge country with 60 per cent of the world's poultry population," Dr Nabarro said.

In recent months China and Indonesia have increased efforts to improve surveillance of animal health.

Dr Nabarro said that only by going through a pandemic could humans build up an immunity to the virus.

Report anticipates toll of severe bird flu outbreak

By the Associated Press
September 17, 2006

FAIRFAX, Va. -- A bird flu pandemic would kill nearly 700 people in Fairfax County, forcing hospitals, nursing homes and other makeshift medical centers to set up temporary morgues and stockpile body bags to handle the deaths, according to a new report.

"Life as you see it today will not be the same," Fairfax health director Gloria Addo-Ayensu said in response to a 112-page primer on how the Washington area's largest local government would respond to such an outbreak.

Addo-Ayensu and other emergency management officials say Fairfax is the region's first local government to issue a comprehensive report on pandemic flu preparations.

The report comes amid fears that avian influenza, which is spreading worldwide in poultry and has infected more than 230 people, could mutate into a virulent strain that could spread widely from person to person, killing millions worldwide.

Although the Bush administration has released a federal plan and committed tens of millions of dollars to anticipate a crisis, the details of how to respond are left to state and local governments.

The Fairfax report presents a grim scene. A severe outbreak of bird flu would infect nearly a third of the county's population, sending thousands to local hospitals. As much as 40 percent of the county's work force would be out of commission.

To prepare for such a scenario, the county is giving government officials, infectious disease specialists, emergency planners and first responders explicit instructions on what to do if people get sick.

"We have to look at the scenarios that are the worst-case, and look at how we would deal with them," said C. Douglas Bass, Fairfax County's emergency management director.

The county would track individual infections through reporting by local doctors and hospitals. Sites would be set up to distribute a potential vaccine or medicine, and sick people could be forced into quarantine.

Many county employees would work from home, and hundreds could be diverted from their jobs in libraries, parks and other "nonessential" agencies to help with the emergency response.

Other people would be ordered to stay home, steering clear of trains, buses, malls and other places where they would come into close contact with others.

The county's goal is to minimize the transmission of a highly contagious virus while keeping the county government of 11,000 employees running, albeit with diminished services.

The response could be particularly challenging in a county of more than 1 million people, thousands of whom do not speak English. As many as 51,000 of those infected would be low-income residents without regular access to medical care, the response plan says.

"Trying to do mass vaccinations, for example, would be a huge challenge," county spokeswoman Merni Fitzgerald said. "We are so big that we can't just say, 'Everybody show up at one place."'

No, we must not.

"Bird flu" is not an epidemic. It is an opportunistic infection that, to date, has killed about 200 or so people world-wide. Mostly people who live in third-world sh*tholes where anything resembling decent health care, or even a bottle of Nyquil, is hard to find.

The "threat" of bird flu is not that it is a killer pandemic; it is that people from these third-world sh*tholes where it is prevalent will, when sufficiently panicked, swarm out of thier own disease-ridden slums and seek shelter in the West, swamping OUR health care systems.

The multi-culti view of this is that the WEST must do "something" about bird flu before this nightmare scenario occurs. This is the driving force behind all of the "bird flu will kill us all" rhetoric; since African and Asian countries either cannot or will not confront this little irritation, that we (the West) must, or somehow we (the West)will "be responsible" for the deaths of innocents by our inactivity.

Bird flu will not be the death of western civilization because we are fairly healthy folks, with plenty to eat, access to a wide range of anti-biotics and such, and with a health care network second to none. As a disease, it doesn't even rank as high as the Black Death.

What WILL be the death of western civilization is allowing ourselves to be stampeded into "solving" a problem which is largely an invention; a soilution which will require billions of dollars being poured into Africa and Asia (and subsequently funnelled into Swiss bank acocunts by their corrupt leadership), to the detriment of diseases and afflictions which are serious Westeern health issues, like heart disease, diabetes, AIDS and such.

Charity begins at home.

Killer flu, no matter what variation, has long been and will most likely remain the #1 threat to the United States, short of a major nuclear war.

Each year, common flus kill between 30-50,000 Americans. The last killer flu the US experienced was in 1918, the Spanish flu. It killed anywhere from 200,000 to 2 million Americans, at a time when our national population was about 50 million.

Its mortality was about 26% of those who were infected.

The avian flu has a mortality rate that has unexpectedly remained between 50-60%. On top of which, most survivors have severe lung damage and scarring. There have been NO mild cases of the disease yet discovered.

The ONE element that has prevented widespread Human to Human (H2H) transmission, is that unlike typical flus that concentrate in the sinuses and upper trachea, avian flu is concentrated in the lower trachea. This makes it difficult, but not impossible to spread. However, it also concentrates in and damages several internal organs not normally host to the virus.

Only about 1 dozen cases of H2H have been confirmed. But since only one or two mutations is needed to overcome this obstacle, the odds of it entering the human species is regarded as highly probable.

Other facts about avian flu is the confirmation of the "cytokine swarm", in which the immune system overreacts to the disease. The fight takes place in the lungs, which destroys much lung tissue, and causes the secretion of fluid and blood into the lungs, along with causing systemic oxygen deprivation to internal organs. Young, healthy adults will therefore be far more susceptible to the disease because of their strong immune systems.

Since no immunity exists for avian flu, a much smaller amount of contamination is needed to cause an infection.

The biggest advantage the US has today is that our public awareness of hygiene and our ability to communicate information is far superior to 1918. Medically, however, we are about on the same par now as then.

In 1918, the medical community was far more familiar with epidemic response, and were well versed in antiseptics, though they could not identify the pathogen that caused the Spanish flu.

Today, our medical system is crippled by being a "push" system. Nationally, we have almost no reserve of essential medical supplies that we will need in a major epidemic. For example, our national supply of ventilators is about 102,000, of which 100,000 are needed for a typical flu season.

Once a sample of the final mutation virus is obtained, when it has become H2H, it will take six months for us to produce 30 million vaccinations. For this reason, we have changed our policy as to how vaccinations are to be given. Instead of "the old and infirm and very young children", which is how it is done for a normal flu outbreak, the policy will be "school aged children (the biggest H2H vector), and outbreak areas", trying to contain it before it spreads.

This is how epidemics used to be handled. Quarantines will be common.

Since there is no conceivable way our hospital system can handle all but the most serious cases, State and local authorities will advise people to stay at home. Phone banks will contact households with information and public services. Volunteers will go door-to-door for those who do not answer their phones, providing assistance in summoning emergency medical and funerary services.

The best way to stay healthy are a few important hygiene tips.

#1 is that when in public during an epidemic, to use alcohol hand sanitizer at least six times during the day. It has been determined that coughing and sneezing is far less likely to pass flu and colds than is hand contamination.

#2 it is unnecessary to use expensive anti-virus medical masks when in public. Ordinary ear loop masks keep out the large droplets of moisture that carry the virus. Clear shop glasses work to keep such droplets out of the eyes. Most any type of rubber glove will prevent hand contamination--as long as you remember to assume that used gloves have themselves become contaminated--so must be decontaminated, hopefully before removing them.

#3 Public restrooms and restaurants are often very contaminated. When a toilet is flushed, a fine mist of contamination balloons out of it and covers most surfaces. Processed food in sealed containers will be much safer than fresh foods and vegetables.

#4 Most household cleaners work well as decontaminants, but the technique for cleaning contamination such as vomit or feces should be modified. First add cleaner to the mess before wiping up, then use cleaner again on the cleaned surface.

#5 Ordinary citizens can no longer safely provide help to someone afflicted in public. They can only contact emergency services. Otherwise, it is extremely hazardous to approach a sick person, who can be spraying contamination all around them. An old technique is to set aside a room in the house as a "sick room". This significantly reduces healthy family member exposure.

#6 Not ironically, during an epidemic there will be cases of public panic. People will try to break quarantines, and will horde and loot, usually before there is a serious threat. But also during epidemics, the health department has almost unlimited power, including police power. For this reason it is important to obey their instructions, as they may be at the end of a gun.

The bottom line for all of this is that a killer flu epidemic needs to be treated like any other natural disaster, such as a hurricane or major urban earthquake. Many of the people who will get sick and die will either be unlucky or will stupidly refuse to adapt to the new circumstances and take appropriate precautions. No different than the people who decided to "ride out" hurricane Katrina.

Reports of missed mild bird flu cases raise questions about scope of spread

17:54:50 EDT Sep 17, 2006
Canadian Press: HELEN BRANSWELL

(CP) - Recent reports from South Korea and Indonesia of after-the-fact discovery of a handful of mild human cases of H5N1 avian flu have again raised questions about whether the disease's extraordinarily high death rate is being inflated because mild cases are being missed.

Experts say the evidence to date points away from that notion. But they add that it is important to continue to search for mild cases. Understanding the true number of human infections and the range of symptoms experienced could help scientists better assess the pandemic risk posed by the virus.

As well, tracking mild cases over time could provide an early warning if important changes to H5N1 occur, they suggest. Climbing rates of mild cases might signal the virus was adapting to become a human flu strain, moving closer to triggering a flu pandemic.

"We need to keep monitoring it," Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy, said Sunday.

"Because frankly, one of the indications that there may be a changing epidemiology (disease pattern) with this is in fact if we start seeing larger and larger percentages of individuals who are asymptomatic or only mildly ill that we can clearly confirm as having H5N1 infection."

The World Health Organization announced last week blood tests done on an Indonesian man showed he became infected, likely in May when he helped nurse his sister, a confirmed H5N1 case. The man reported having a cough and abdominal discomfort but his symptoms weren't diagnosed as H5N1-related at the time.

And South Korean officials revealed that testing of blood samples from more than 2,000 workers who culled diseased poultry in late 2003 and early 2004 showed five had developed antibodies to the virus - a sign they had been infected. An earlier round of testing in South Korea turned up four cullers with antibodies.

None of these people had serious illness at the time; none has yet been added to the WHO's official case list.

To the best of the scientific community's knowledge, the H5N1 virus is not adept at infecting people. But when it does, it appears to cause severe disease. Nearly 60 per cent of the 246 confirmed cases have died; many of the survivors battled for their lives.

But there has always been a suspicion in some quarters that a significant number of mild cases are being missed - a theory these new reports may fuel.

Many - though not all - diseases cause a spectrum of illness ranging from undetectable to life-threatening infection. With polio, for instance, it is estimated there are 200 inapparent infections for every person the virus paralyzes. On the other hand, rabies is almost 100 per cent fatal.

If the confirmed H5N1 cases were the proverbial tip of the iceberg, the death rate attributed to the virus would tumble. That in turn might ease worries about the threat posed by H5N1 - though a flu virus that killed even 10 or 20 per cent of its victims would still be a source of serious concern.

Dr. Angus Nicoll, an influenza expert with the European Centre for Disease Control, said these new asymptomatic cases don't change the fact that the bulk of evidence to date suggests such cases are rare.

A number of small studies have been done to test the blood of people who've been in contact with confirmed cases. They have turned up few or no cases that missed earlier detection.

The most recent study - published in the October issue of Emerging Infectious Diseases - looked at blood samples from 351 Cambodians who had been in contact with a man who died from the disease. None developed antibodies to the virus.

"It's still a plausible hypothesis but it's becoming a less likely one," Nicoll said of the notion that there may be a significant number of asymptomatic and mild cases of the disease.

"My bottom line would be: I'm sure we're going to find the occasional mild case. I'm sure we're going to find, eventually, an asymptomatic (case)," he said from Sweden.

"Even if you find just a few asymptomatic and mild cases, that's not going to change the our risk assessment."

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